PAID CLAIMS/EXPENSES SUMMARY                                             
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     250729587807                                           PAGE:               1 of 3            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2025         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/25/2025        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         4 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/29/2025        

               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                           $13.69                    $0.00                 $0.00                  $0.00                   $13.69
  014267-03                                       $14,177.36                    $0.00                 $0.00                  $0.00               $14,177.36
  014267-05                                       $11,033.90                    $0.00                 $0.00                  $0.00               $11,033.90
  014267-06                                          $283.99                    $0.00                 $0.00                  $0.00                  $283.99
  014267-07                                        $1,833.23                    $0.00                 $0.00                  $0.00                $1,833.23
  014267-08                                        $2,461.20                    $0.00                 $0.00                  $0.00                $2,461.20
  014267-12                                          $958.06                    $0.00                 $0.00                  $0.00                  $958.06
  014267-13                                           $96.28                    $0.00                 $0.00                  $0.00                   $96.28
  014267-15                                           $27.14                    $0.00                 $0.00                  $0.00                   $27.14
  014267-26                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-34                                            $6.57                    $0.00                 $0.00                  $0.00                    $6.57
  014267-36                                        $1,390.80                    $0.00                 $0.00                  $0.00                $1,390.80
  014267-37                                          $985.14                    $0.00                 $0.00                  $0.00                  $985.14
014267- Total                                     $33,267.36                    $0.00                 $0.00                  $0.00               $33,267.36
Drug Total                                        $33,267.36                    $0.00                 $0.00                  $0.00               $33,267.36
                                                                                                                                                            
Facility
  053264-01                                          $451.75                    $0.00                 $0.00                  $0.00                  $451.75
053264- Total                                        $451.75                    $0.00                 $0.00                  $0.00                  $451.75
Facility Total                                       $451.75                    $0.00                 $0.00                  $0.00                  $451.75
                                                                                                                                                            
HDHP PPO
  014267-54                                       $44,496.09                    $0.00                 $0.00              $1,178.13               $45,674.22
014267- Total                                     $44,496.09                    $0.00                 $0.00              $1,178.13               $45,674.22
017697-00                                         $29,176.21                    $0.00                 $0.00              $1,423.39               $30,599.60
  017697-01                                        $8,921.86                    $0.00                 $0.00                $206.68                $9,128.54

                                                                                                                                                PAGE:2 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  017697-10                                            $0.00                    $0.00                 $0.00                 $17.44                   $17.44
017697- Total                                     $38,098.07                    $0.00                 $0.00              $1,647.51               $39,745.58
017728-00                                         $10,474.43                    $0.00                 $0.00                $428.65               $10,903.08
017728- Total                                     $10,474.43                    $0.00                 $0.00                $428.65               $10,903.08
104272-02                                         $40,148.29                    $0.00                 $0.00              $2,862.19               $43,010.48
  104272-09                                       $12,529.32                    $0.00                 $0.00                $122.40               $12,651.72
  104272-12                                        $1,943.75                    $0.00                 $0.00                $123.23                $2,066.98
  104272-19                                        $2,203.68                    $0.00                 $0.00                 $65.33                $2,269.01
104272- Total                                     $56,825.04                    $0.00                 $0.00              $3,173.15               $59,998.19
HDHP PPO Total                                   $149,893.63                    $0.00                 $0.00              $6,427.44              $156,321.07
                                                                                                                                                            
Major Medical
  053264-01                                        $1,587.23                    $0.00                 $0.00                  $0.00                $1,587.23
053264- Total                                      $1,587.23                    $0.00                 $0.00                  $0.00                $1,587.23
Major Medical Total                                $1,587.23                    $0.00                 $0.00                  $0.00                $1,587.23
                                                                                                                                                            
PPO
  014267-01                                       $72,440.96                    $0.00                 $0.00                $170.51               $72,611.47
  014267-03                                        $9,276.54                    $0.00                 $0.00              $2,198.32               $11,474.86
  014267-05                                        $9,477.20                    $0.00                 $0.00              $1,592.96               $11,070.16
  014267-06                                        $1,586.65                    $0.00                 $0.00                $316.83                $1,903.48
  014267-07                                       $17,956.96                    $0.00                 $0.00              $1,137.24               $19,094.20
  014267-08                                       $35,195.83                    $0.00                 $0.00                $649.11               $35,844.94
  014267-12                                          $530.98                    $0.00                 $0.00                 $35.88                  $566.86
  014267-13                                          $640.54                    $0.00                 $0.00                $105.15                  $745.69
  014267-15                                          $447.77                    $0.00                 $0.00                 $93.46                  $541.23
  014267-19                                            $0.00                    $0.00                 $0.00                  $7.78                    $7.78
  014267-26                                          $439.78                    $0.00                 $0.00                 $59.40                  $499.18
  014267-34                                            $0.00                    $0.00                 $0.00                 $39.90                   $39.90
  014267-36                                       $11,374.48                    $0.00                 $0.00                $470.77               $11,845.25
  014267-37                                          $102.73                    $0.00                 $0.00                $119.76                  $222.49
014267- Total                                    $159,470.42                    $0.00                 $0.00              $6,997.07              $166,467.49

                                                                                                                                                PAGE:3 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
PPO Total                                        $159,470.42                    $0.00                 $0.00              $6,997.07              $166,467.49
Paid Claims/Expenses Summary Total                                                                                                              $358,094.90