Page 1 of 2 Date: 04/06/2017 ADVICE Reporting System T h i s r e p o r t c o n t a i n s p r o p r i e t a r y a n d / o r c o n f i d e n t i a l i n f o r m a t i o n . D i s c l o s u r e i s s t r i c t l y p r o h i b i t e d e x c e p t t o t h e e x t e n t r e q u i r e d b y l a w . CITY OF CLEVELAND GC MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT April 2016 thru March 2017 FAT : TRADITIONAL RAT : FULLY INSURED NON-PARTICPATING Reported Premium: Billed Premium without fees YTD/MONTH ACCOUNT PRODUCT GROUP IN NETWORK OUT OF NETWORK TOTAL CLAIMS BILLED PREMIUM TOTAL SUBS TOTAL MBRS Apr-16 3329367-CITY OF CLEVELAND DENT $244,615 $64,513 $309,128 $321,218 6,068 15,123 ACCOUNT Total $244,615 $64,513 $309,128 $321,218 6,068 15,123 Apr-2016 Total $244,615 $64,513 $309,128 $321,218 6,068 15,123 May-16 3329367-CITY OF CLEVELAND DENT $236,854 $73,493 $310,347 $317,476 6,020 14,982 ACCOUNT Total $236,854 $73,493 $310,347 $317,476 6,020 14,982 May-2016 Total $236,854 $73,493 $310,347 $317,476 6,020 14,982 Jun-16 3329367-CITY OF CLEVELAND DENT $236,820 $67,462 $304,281 $319,357 6,012 14,960 ACCOUNT Total $236,820 $67,462 $304,281 $319,357 6,012 14,960 Jun-2016 Total $236,820 $67,462 $304,281 $319,357 6,012 14,960 Jul-16 3329367-CITY OF CLEVELAND DENT $211,966 $58,659 $270,625 $315,920 5,945 14,816 ACCOUNT Total $211,966 $58,659 $270,625 $315,920 5,945 14,816 Jul-2016 Total $211,966 $58,659 $270,625 $315,920 5,945 14,816 Aug-16 3329367-CITY OF CLEVELAND DENT $255,597 $71,269 $326,866 $313,591 5,920 14,761 ACCOUNT Total $255,597 $71,269 $326,866 $313,591 5,920 14,761 Aug-2016 Total $255,597 $71,269 $326,866 $313,591 5,920 14,761 Sep-16 3329367-CITY OF CLEVELAND DENT $221,141 $67,712 $288,853 $313,424 5,914 14,707 ACCOUNT Total $221,141 $67,712 $288,853 $313,424 5,914 14,707 Sep-2016 Total $221,141 $67,712 $288,853 $313,424 5,914 14,707 Oct-16 3329367-CITY OF CLEVELAND DENT $204,808 $57,598 $262,406 $314,442 5,939 14,709 ACCOUNT Total $204,808 $57,598 $262,406 $314,442 5,939 14,709 Oct-2016 Total $204,808 $57,598 $262,406 $314,442 5,939 14,709 Nov-16 3329367-CITY OF CLEVELAND DENT $214,716 $63,401 $278,116 $311,303 5,911 14,625 ACCOUNT Total $214,716 $63,401 $278,116 $311,303 5,911 14,625 Nov-2016 Total $214,716 $63,401 $278,116 $311,303 5,911 14,625
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Page 1 of 2Date: 04/06/2017
ADVICE Reporting System
T h i s r e p o r t c o n t a i n s p r o p r i e t a r y a n d / o r c o n f i d e n t i a l i n f o r m a t i o n . D i s c l o s u r e i s s t r i c t l y p r o h i b i t e d e x c e p t t o t h e e x t e n t r e q u i r e d b y l a w .
CITY OF CLEVELANDGC MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
April 2016 thru March 2017FAT : TRADITIONALRAT : FULLY INSURED NON-PARTICPATINGReported Premium: Billed Premium without fees
YTD/MONTH ACCOUNT PRODUCT GROUP IN NETWORK OUT OF NETWORK TOTAL CLAIMS BILLED PREMIUM TOTAL SUBS TOTAL MBRSApr-16 3329367-CITY OF CLEVELAND DENT $244,615 $64,513 $309,128 $321,218 6,068 15,123 ACCOUNT Total $244,615 $64,513 $309,128 $321,218 6,068 15,123
Apr-2016 Total $244,615 $64,513 $309,128 $321,218 6,068 15,123
May-16 3329367-CITY OF CLEVELAND DENT $236,854 $73,493 $310,347 $317,476 6,020 14,982 ACCOUNT Total $236,854 $73,493 $310,347 $317,476 6,020 14,982
May-2016 Total $236,854 $73,493 $310,347 $317,476 6,020 14,982
Jun-16 3329367-CITY OF CLEVELAND DENT $236,820 $67,462 $304,281 $319,357 6,012 14,960 ACCOUNT Total $236,820 $67,462 $304,281 $319,357 6,012 14,960
Jun-2016 Total $236,820 $67,462 $304,281 $319,357 6,012 14,960
Jul-16 3329367-CITY OF CLEVELAND DENT $211,966 $58,659 $270,625 $315,920 5,945 14,816 ACCOUNT Total $211,966 $58,659 $270,625 $315,920 5,945 14,816
Jul-2016 Total $211,966 $58,659 $270,625 $315,920 5,945 14,816
Aug-16 3329367-CITY OF CLEVELAND DENT $255,597 $71,269 $326,866 $313,591 5,920 14,761 ACCOUNT Total $255,597 $71,269 $326,866 $313,591 5,920 14,761
Aug-2016 Total $255,597 $71,269 $326,866 $313,591 5,920 14,761
Sep-16 3329367-CITY OF CLEVELAND DENT $221,141 $67,712 $288,853 $313,424 5,914 14,707 ACCOUNT Total $221,141 $67,712 $288,853 $313,424 5,914 14,707
Sep-2016 Total $221,141 $67,712 $288,853 $313,424 5,914 14,707
Oct-16 3329367-CITY OF CLEVELAND DENT $204,808 $57,598 $262,406 $314,442 5,939 14,709 ACCOUNT Total $204,808 $57,598 $262,406 $314,442 5,939 14,709
Oct-2016 Total $204,808 $57,598 $262,406 $314,442 5,939 14,709
Nov-16 3329367-CITY OF CLEVELAND DENT $214,716 $63,401 $278,116 $311,303 5,911 14,625 ACCOUNT Total $214,716 $63,401 $278,116 $311,303 5,911 14,625
Nov-2016 Total $214,716 $63,401 $278,116 $311,303 5,911 14,625
Page 2 of 2Date: 04/06/2017
ADVICE Reporting System
T h i s r e p o r t c o n t a i n s p r o p r i e t a r y a n d / o r c o n f i d e n t i a l i n f o r m a t i o n . D i s c l o s u r e i s s t r i c t l y p r o h i b i t e d e x c e p t t o t h e e x t e n t r e q u i r e d b y l a w .
CITY OF CLEVELANDGC MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
April 2016 thru March 2017FAT : TRADITIONALRAT : FULLY INSURED NON-PARTICPATINGReported Premium: Billed Premium without fees
YTD/MONTH ACCOUNT PRODUCT GROUP IN NETWORK OUT OF NETWORK TOTAL CLAIMS BILLED PREMIUM TOTAL SUBS TOTAL MBRSDec-16 3329367-CITY OF CLEVELAND DENT $216,770 $58,850 $275,621 $310,248 5,896 14,577 ACCOUNT Total $216,770 $58,850 $275,621 $310,248 5,896 14,577
Dec-2016 Total $216,770 $58,850 $275,621 $310,248 5,896 14,577
Jan-17 3329367-CITY OF CLEVELAND DENT $193,525 $49,964 $243,489 $309,412 5,880 14,536 ACCOUNT Total $193,525 $49,964 $243,489 $309,412 5,880 14,536
Jan-2017 Total $193,525 $49,964 $243,489 $309,412 5,880 14,536
Feb-17 3329367-CITY OF CLEVELAND DENT $181,819 $57,903 $239,723 $310,098 5,900 14,552 ACCOUNT Total $181,819 $57,903 $239,723 $310,098 5,900 14,552
Feb-2017 Total $181,819 $57,903 $239,723 $310,098 5,900 14,552
Mar-17 3329367-CITY OF CLEVELAND DENT $230,101 $71,111 $301,212 $309,306 5,887 14,507 ACCOUNT Total $230,101 $71,111 $301,212 $309,306 5,887 14,507
Mar-2017 Total $230,101 $71,111 $301,212 $309,306 5,887 14,507
Grand Total $2,648,731 $761,935 $3,410,667 $3,765,794 71,292 176,855
Page 1 of 1Date: 10/04/2018
ADVICE Reporting System
T h i s r e p o r t c o n t a i n s p r o p r i e t a r y a n d / o r c o n f i d e n t i a l i n f o r m a t i o n . D i s c l o s u r e i s s t r i c t l y p r o h i b i t e d e x c e p t t o t h e e x t e n t r e q u i r e d b y l a w .
CITY OF CLEVELANDGC MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
April 2018 thru September 2018FAT : TRADITIONALRAT : FULLY INSURED NON-PARTICPATINGReported Premium: Billed Premium without fees
YTD/MONTH ACCOUNT PRODUCT GROUP IN NETWORK OUT OF NETWORK TOTAL CLAIMS BILLED PREMIUM TOTAL SUBS TOTAL MBRSApr-18 3329367-CITY OF CLEVELAND DENT $258,506 $64,075 $322,581 $321,761 6,230 14,949 ACCOUNT Total $258,506 $64,075 $322,581 $321,761 6,230 14,949
Apr-2018 Total $258,506 $64,075 $322,581 $321,761 6,230 14,949
May-18 3329367-CITY OF CLEVELAND DENT $260,360 $84,051 $344,411 $320,871 6,221 14,926 ACCOUNT Total $260,360 $84,051 $344,411 $320,871 6,221 14,926
May-2018 Total $260,360 $84,051 $344,411 $320,871 6,221 14,926
Jun-18 3329367-CITY OF CLEVELAND DENT $251,082 $68,006 $319,088 $320,235 6,215 14,887 ACCOUNT Total $251,082 $68,006 $319,088 $320,235 6,215 14,887
Jun-2018 Total $251,082 $68,006 $319,088 $320,235 6,215 14,887
Jul-18 3329367-CITY OF CLEVELAND DENT $260,787 $59,299 $320,086 $319,063 6,189 14,798 ACCOUNT Total $260,787 $59,299 $320,086 $319,063 6,189 14,798
Jul-2018 Total $260,787 $59,299 $320,086 $319,063 6,189 14,798
Aug-18 3329367-CITY OF CLEVELAND DENT $257,353 $69,396 $326,748 $319,604 6,227 14,811 ACCOUNT Total $257,353 $69,396 $326,748 $319,604 6,227 14,811
Aug-2018 Total $257,353 $69,396 $326,748 $319,604 6,227 14,811
Sep-18 3329367-CITY OF CLEVELAND DENT $200,155 $48,614 $248,769 $318,344 6,213 14,746 ACCOUNT Total $200,155 $48,614 $248,769 $318,344 6,213 14,746
Sep-2018 Total $200,155 $48,614 $248,769 $318,344 6,213 14,746
Grand Total $1,488,241 $393,441 $1,881,682 $1,919,878 37,295 89,117
Loss Ratio Report Combined
Date Executed: 9/12/17Reporting Period: 2016/01 thru 2016/12
Total Adjusted Claims & Percentage $348,703 109.5% 108.8%
Group(s) Used: 9812959;9852161
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premium calculation is based on premium dollars paid as of the report execution date.
LR :1/1
Loss Ratio Report By Group
Date Executed: 9/12/17Reporting Period: 2016/01 thru 2016/12
Total Adjusted Claims & Percentage $347,864 109.4% 108.6%
Group:
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premiums calculation is based on premiums paid as of the report execution date.
LR_Grp:1/2
Loss Ratio Report By Group
Date Executed: 9/12/17Reporting Period: 2016/01 thru 2016/12
Total Adjusted Claims & Percentage $839 351.7% 384.8%
Group:
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premiums calculation is based on premiums paid as of the report execution date.
LR_Grp:2/2
Member Counts by Rate Tier
Date Executed: 9/12/17
City of Cleveland
Group ID Month Rate DescriptionRate perMonth
EmployeeCount
98129591001 201612 Per Subscriber Per Period $5.59 5,278
5,278
98521611001 201612 Per Subscriber Per Period $5.59 4
4
Total 5,282
LR_Mbr :1/1
Loss Ratio Report Combined
Date Executed: 1/26/18Reporting Period: 2017/01 thru 2017/12
Total Adjusted Claims & Percentage $383,217 86.2% 127.6%
Group(s) Used: 9812959;9852161
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premium calculation is based on premium dollars paid as of the report execution date.
LR :1/1
Loss Ratio Report By Group
Date Executed: 1/26/18Reporting Period: 2017/01 thru 2017/12
Total Adjusted Claims & Percentage $382,783 86.2% 127.5%
Group:
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premiums calculation is based on premiums paid as of the report execution date.
LR_Grp:1/2
Loss Ratio Report By Group
Date Executed: 1/26/18Reporting Period: 2017/01 thru 2017/12
Total Adjusted Claims & Percentage $434 160.3% 272.7%
Group:
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premiums calculation is based on premiums paid as of the report execution date.
LR_Grp:2/2
Member Counts by Rate Tier
Date Executed: 1/26/18
City of Cleveland
Group ID MonthRate
Description Rate per Month Employee Count
9812959 1001 201712 PSPM 5.59 5,354
Group ID: 5,354
9852161 1001 201712 PSPM 5.59 3
Group ID: 3
LR_Mbr :1/1
Loss Ratio Report Combined
Date Executed: 10/12/18Reporting Period: 2018/01 thru 2018/09
Total Adjusted Claims & Percentage $340,582 122.9% 136.0%
Group(s) Used: 9812959;9852161
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premium calculation is based on premium dollars paid as of the report execution date.
LR :1/1
Loss Ratio Report By Group
Date Executed: 10/12/18Reporting Period: 2018/01 thru 2018/09
Total Adjusted Claims & Percentage $339,944 122.9% 135.8%
Group:
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premiums calculation is based on premiums paid as of the report execution date.
LR_Grp:1/2
Loss Ratio Report By Group
Date Executed: 10/12/18Reporting Period: 2018/01 thru 2018/09
Total Adjusted Claims & Percentage $638 165.3% 1,044.8%
Group:
Fees on Premium represents the underwriter expense, taxes and other fees & assessments. Maximum Broker Fee during Reporting Period = 0%. Note: IBNR estimate represents accrual for claims incurred by members but not yet paid.
Note: Claims to Net Paid Premiums calculation is based on premiums paid as of the report execution date.
Proc Month Coverage Code Description Sex Employee Age Date Reported Date Incurred Date Paid Claim Amount2016/01 Basic Life M 45 11/30/2015 11/20/2015 01/05/2016 15,000.002016/02 Basic Life M 54 01/08/2016 12/28/2015 02/16/2016 11,746.442016/02 Basic Life M 56 11/12/2014 01/26/2014 02/24/2016 2,500.002016/03 Basic Life M 54 01/08/2016 12/28/2015 03/01/2016 1,626.782016/03 Basic Life M 54 01/08/2016 12/28/2015 03/09/2016 1,626.782016/03 Basic Life M 48 02/09/2016 02/02/2016 03/08/2016 8,460.142016/04 Basic Life M 56 03/18/2016 02/10/2016 04/06/2016 15,000.002016/04 Basic Life F 69 04/07/2016 03/09/2016 04/14/2016 15,000.002016/04 Basic Life M 64 04/14/2016 03/05/2016 04/22/2016 15,000.002016/04 Basic Life M 48 02/09/2016 02/02/2016 04/01/2016 6,539.862016/05 Basic Life M 56 05/03/2016 04/09/2016 05/11/2016 15,000.002016/06 Basic Life M 44 06/10/2016 04/03/2016 06/16/2016 15,000.002016/06 Basic Life M 44 06/20/2016 05/17/2016 06/24/2016 15,000.002016/08 Basic Life M 65 08/02/2016 07/11/2016 08/09/2016 15,000.002016/08 Basic Life M 43 05/03/2016 04/01/2016 08/22/2016 15,000.002016/09 Basic Life F 57 08/11/2016 08/09/2016 09/13/2016 7,500.002016/09 Basic Life F 57 08/11/2016 08/09/2016 09/16/2016 7,500.002016/09 Basic Life M 42 08/22/2016 08/15/2016 09/26/2016 15,000.002016/10 Basic Life M 69 10/13/2016 09/26/2016 10/20/2016 15,000.002016/10 Basic Life M 55 09/26/2016 09/02/2016 10/03/2016 15,000.002016/10 Basic Life M 52 08/29/2016 08/06/2016 10/26/2016 15,000.002016/11 Basic Life M 37 10/27/2016 03/13/2016 11/01/2016 15,000.002016/11 Basic Life M 60 11/16/2016 10/28/2016 11/25/2016 15,000.002017/01 Basic Life F 56 12/27/2016 12/26/2016 01/23/2017 15,000.002017/02 Basic Life M 59 01/30/2017 01/03/2017 02/03/2017 15,000.002017/02 Basic Life F 51 01/25/2017 12/16/2016 02/06/2017 15,000.002017/02 Basic Life M 70 01/30/2017 12/12/2016 02/03/2017 15,000.002017/03 Basic Life M 39 03/08/2017 01/24/2017 03/15/2017 15,000.002017/05 Basic Life M 60 05/10/2017 03/16/2017 05/17/2017 15,000.002017/05 Basic Life M 52 05/09/2017 04/05/2017 05/15/2017 15,000.002017/05 Basic Life M 55 05/22/2017 01/21/2017 05/25/2017 15,000.002017/06 Basic Life F 63 06/13/2017 05/30/2017 06/22/2017 15,000.002017/06 Basic Life M 58 06/05/2017 05/16/2017 06/08/2017 15,000.002017/07 Basic Life M 67 07/14/2017 07/07/2017 07/25/2017 15,000.002017/08 Basic Life M 51 08/14/2017 07/26/2017 08/18/2017 15,000.002017/08 Basic Life M 72 08/25/2017 07/21/2017 08/31/2017 15,000.002017/11 Basic Life F 66 11/07/2017 10/05/2017 11/10/2017 15,000.002017/12 Basic Life M 55 06/26/2017 05/15/2017 12/04/2017 15,000.002017/12 Basic Life M 63 12/12/2017 11/27/2017 12/21/2017 15,000.002018/01 Basic Life F 62 01/08/2018 12/13/2017 01/26/2018 15,000.002018/04 Basic Life M 52 03/30/2018 02/14/2018 04/05/2018 15,000.002018/04 Basic Life F 70 04/20/2018 03/15/2018 04/27/2018 15,000.002018/07 Basic Life M 54 07/05/2018 04/09/2018 07/11/2018 15,000.002018/08 Basic Life M 63 08/07/2018 07/11/2018 08/10/2018 15,000.002018/09 Basic Life M 50 09/20/2018 07/06/2018 09/27/2018 15,000.002018/10 Basic Life F 64 10/22/2018 08/11/2018 10/25/2018 15,000.002018/10 Basic Life M 61 09/25/2018 09/07/2018 10/02/2018 15,000.002016/01 Basic Life Interest M 45 11/30/2015 11/20/2015 01/05/2016 9.452016/02 Basic Life Interest M 54 01/08/2016 12/28/2015 02/16/2016 9.022016/03 Basic Life Interest M 54 01/08/2016 12/28/2015 03/01/2016 1.60
2016/03 Basic Life Interest M 54 01/08/2016 12/28/2015 03/09/2016 1.802016/03 Basic Life Interest M 48 02/09/2016 02/02/2016 03/08/2016 6.572016/04 Basic Life Interest M 56 03/18/2016 02/10/2016 04/06/2016 18.642016/04 Basic Life Interest F 69 04/07/2016 03/09/2016 04/14/2016 9.622016/04 Basic Life Interest M 64 04/14/2016 03/05/2016 04/22/2016 12.822016/04 Basic Life Interest M 48 02/09/2016 02/02/2016 04/01/2016 8.562016/05 Basic Life Interest M 56 05/03/2016 04/09/2016 05/11/2016 9.212016/06 Basic Life Interest M 44 06/10/2016 04/03/2016 06/16/2016 21.292016/06 Basic Life Interest M 44 06/20/2016 05/17/2016 06/24/2016 10.462016/08 Basic Life Interest M 65 08/02/2016 07/11/2016 08/09/2016 8.462016/08 Basic Life Interest M 43 05/03/2016 04/01/2016 08/22/2016 41.422016/09 Basic Life Interest F 57 08/11/2016 08/09/2016 09/13/2016 4.032016/09 Basic Life Interest F 57 08/11/2016 08/09/2016 09/16/2016 4.372016/09 Basic Life Interest M 42 08/22/2016 08/15/2016 09/26/2016 9.672016/10 Basic Life Interest M 69 10/13/2016 09/26/2016 10/20/2016 6.022016/10 Basic Life Interest M 55 09/26/2016 09/02/2016 10/03/2016 7.772016/10 Basic Life Interest M 52 08/29/2016 08/06/2016 10/26/2016 18.642016/11 Basic Life Interest M 37 10/27/2016 03/13/2016 11/01/2016 62.242016/11 Basic Life Interest M 60 11/16/2016 10/28/2016 11/25/2016 7.592017/01 Basic Life Interest F 56 12/27/2016 12/26/2016 01/23/2017 8.512017/02 Basic Life Interest M 59 01/30/2017 01/03/2017 02/03/2017 12.232017/02 Basic Life Interest F 51 01/25/2017 12/16/2016 02/06/2017 15.812017/02 Basic Life Interest M 70 01/30/2017 12/12/2016 02/03/2017 16.122017/03 Basic Life Interest M 39 03/08/2017 01/24/2017 03/15/2017 19.732017/05 Basic Life Interest M 60 05/10/2017 03/16/2017 05/17/2017 25.742017/05 Basic Life Interest M 52 05/09/2017 04/05/2017 05/15/2017 18.242017/05 Basic Life Interest M 55 05/22/2017 01/21/2017 05/25/2017 48.922017/06 Basic Life Interest F 63 06/13/2017 05/30/2017 06/22/2017 10.872017/06 Basic Life Interest M 58 06/05/2017 05/16/2017 06/08/2017 10.872017/07 Basic Life Interest M 67 07/14/2017 07/07/2017 07/25/2017 9.032017/08 Basic Life Interest M 51 08/14/2017 07/26/2017 08/18/2017 11.532017/08 Basic Life Interest M 72 08/25/2017 07/21/2017 08/31/2017 20.562017/11 Basic Life Interest F 66 11/07/2017 10/05/2017 11/10/2017 18.792017/12 Basic Life Interest M 55 06/26/2017 05/15/2017 12/04/2017 95.942017/12 Basic Life Interest M 63 12/12/2017 11/27/2017 12/21/2017 13.612018/01 Basic Life Interest F 62 01/08/2018 12/13/2017 01/26/2018 27.482018/04 Basic Life Interest M 52 03/30/2018 02/14/2018 04/05/2018 37.192018/04 Basic Life Interest F 70 04/20/2018 03/15/2018 04/27/2018 34.642018/07 Basic Life Interest M 54 07/05/2018 04/09/2018 07/11/2018 81.022018/08 Basic Life Interest M 63 08/07/2018 07/11/2018 08/10/2018 29.342018/09 Basic Life Interest M 50 09/20/2018 07/06/2018 09/27/2018 81.182018/10 Basic Life Interest F 64 10/22/2018 08/11/2018 10/25/2018 74.602018/10 Basic Life Interest M 61 09/25/2018 09/07/2018 10/02/2018 25.792016/02 Conversion Basic Life M 64 01/21/2016 01/21/2016 3,300.002017/09 Conversion Basic Life M 60 08/01/2016 08/01/2016 1,100.002017/09 Conversion Basic Life M 66 01/01/2017 01/01/2017 2,300.002017/09 Conversion Basic Life M 59 10/02/2016 10/02/2016 3,150.002018/01 Conversion Basic Life F 58 06/01/2017 06/01/2017 3,150.002018/01 Conversion Basic Life M 65 08/01/2017 08/01/2017 3,450.002018/09 Conversion Basic Life M 56 06/17/2018 06/17/2018 2,100.002018/09 Conversion Basic Life M 55 02/01/2018 02/01/2018 3,150.002018/09 Conversion Basic Life M 65 03/04/2018 03/04/2018 3,450.00
2016/05 Dependent Life F 61 05/11/2016 03/24/2016 05/17/2016 10,000.002017/06 Dependent Life F 44 06/26/2017 11/23/2016 06/30/2017 5,000.002017/06 Dependent Life M 50 05/31/2017 05/19/2016 06/07/2017 5,000.002017/06 Dependent Life M 60 06/13/2017 06/02/2017 06/19/2017 10,000.002018/01 Dependent Life F 62 01/08/2018 12/23/2017 01/11/2018 10,000.002018/01 Dependent Life F 64 01/08/2018 12/19/2017 01/11/2018 10,000.002016/05 Dependent Life Interest F 61 05/11/2016 03/24/2016 05/17/2016 9.622017/06 Dependent Life Interest F 44 06/26/2017 11/23/2016 06/30/2017 20.402017/06 Dependent Life Interest M 50 05/31/2017 05/19/2016 06/07/2017 35.242017/06 Dependent Life Interest M 60 06/13/2017 06/02/2017 06/19/2017 5.362018/01 Dependent Life Interest F 62 01/08/2018 12/23/2017 01/11/2018 7.912018/01 Dependent Life Interest F 64 01/08/2018 12/19/2017 01/11/2018 9.582017/05 OADD M 39 03/08/2017 01/24/2017 05/26/2017 50,000.002017/12 OADD M 72 08/25/2017 07/21/2017 12/01/2017 150,000.002017/05 OADD Interest M 39 03/08/2017 01/24/2017 05/26/2017 160.442017/12 OADD Interest M 72 08/25/2017 07/21/2017 12/01/2017 666.822016/01 Optional Life M 45 11/30/2015 11/20/2015 01/26/2016 300,000.002016/03 Optional Life M 54 01/08/2016 12/28/2015 03/01/2016 10,000.002016/03 Optional Life M 54 01/08/2016 12/28/2015 03/09/2016 10,000.002016/04 Optional Life M 56 03/18/2016 02/10/2016 04/06/2016 50,000.002016/04 Optional Life F 69 04/07/2016 03/09/2016 04/14/2016 50,000.002016/06 Optional Life M 43 05/03/2016 04/01/2016 06/29/2016 100,000.002016/11 Optional Life M 60 11/16/2016 10/28/2016 11/25/2016 100,000.002017/02 Optional Life M 59 01/30/2017 01/03/2017 02/03/2017 50,000.002017/03 Optional Life M 39 03/08/2017 01/24/2017 03/15/2017 50,000.002017/05 Optional Life M 52 05/09/2017 04/05/2017 05/15/2017 50,000.002017/08 Optional Life M 72 08/25/2017 07/21/2017 08/31/2017 150,000.002017/11 Optional Life F 66 11/07/2017 10/05/2017 11/10/2017 40,000.002018/10 Optional Life F 64 10/22/2018 08/11/2018 10/25/2018 30,000.002018/10 Optional Life M 61 09/25/2018 09/07/2018 10/02/2018 20,000.002016/01 Optional Life Interest M 45 11/30/2015 11/20/2015 01/26/2016 275.342016/03 Optional Life Interest M 54 01/08/2016 12/28/2015 03/01/2016 9.822016/03 Optional Life Interest M 54 01/08/2016 12/28/2015 03/09/2016 11.052016/04 Optional Life Interest M 56 03/18/2016 02/10/2016 04/06/2016 62.122016/04 Optional Life Interest F 69 04/07/2016 03/09/2016 04/14/2016 32.052016/06 Optional Life Interest M 43 05/03/2016 04/01/2016 06/29/2016 170.682016/11 Optional Life Interest M 60 11/16/2016 10/28/2016 11/25/2016 50.632017/02 Optional Life Interest M 59 01/30/2017 01/03/2017 02/03/2017 40.772017/03 Optional Life Interest M 39 03/08/2017 01/24/2017 03/15/2017 65.752017/05 Optional Life Interest M 52 05/09/2017 04/05/2017 05/15/2017 60.822017/08 Optional Life Interest M 72 08/25/2017 07/21/2017 08/31/2017 205.562017/11 Optional Life Interest F 66 11/07/2017 10/05/2017 11/10/2017 50.102018/10 Optional Life Interest F 64 10/22/2018 08/11/2018 10/25/2018 149.182018/10 Optional Life Interest M 61 09/25/2018 09/07/2018 10/02/2018 34.382016/03 Portability Optional Life M 60 03/03/2016 03/03/2016 1,600.002016/04 Portability Optional Life M 61 04/01/2016 04/01/2016 4,000.002016/09 Portability Optional Life M 63 09/01/2016 09/01/2016 4,000.002016/12 Portability Optional Life F 65 12/02/2016 12/02/2016 6,000.002016/12 Portability Optional Life F 54 11/01/2016 11/01/2016 1,000.002017/01 Portability Optional Life F 58 01/01/2017 01/01/2017 1,750.002017/01 Portability Optional Life M 54 01/01/2017 01/01/2017 3,000.002017/01 Portability Optional Life F 35 01/17/2017 01/17/2017 1,000.00
2017/06 Portability Optional Life M 56 06/01/2017 06/01/2017 1,750.002017/07 Portability Optional Life M 63 07/02/2017 07/02/2017 4,000.002017/08 Portability Optional Life M 45 08/01/2017 08/01/2017 3,000.002017/08 Portability Optional Life M 63 08/01/2017 08/01/2017 2,400.002017/08 Portability Optional Life M 50 08/01/2017 08/01/2017 1,000.002017/12 Portability Optional Life M 52 12/02/2017 12/02/2017 2,000.002018/02 Portability Optional Life M 43 01/01/2018 01/01/2018 500.002018/03 Portability Optional Life F 53 03/04/2018 03/04/2018 1,000.002018/03 Portability Optional Life M 45 03/04/2018 03/04/2018 1,000.002018/04 Portability Optional Life M 59 04/01/2018 04/01/2018 700.002018/04 Portability Optional Life M 59 04/19/2018 04/19/2018 700.002018/06 Portability Optional Life M 52 05/04/2018 05/04/2018 1,400.002018/07 Portability Optional Life F 51 07/02/2018 07/02/2018 1,000.00