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IGE 4 'A?,-()") :PVENDOF{ NAME CHECK NUNBEF~ CHECK F:EG I STER ACCOUNTS P?l 'f !~BLE PRE - PA I D 1'1OU~mS V I E\.<J INVOICE I NVO I CE NMBF{ DA TE CHECK D{,fjE ACCOUNT NUMBER- 100-4:350-031000 AMT- ACCOUNT NUMBEF:- 1 (H)'-4::::60- 031 000 AI'1T- ACCOUNT NUl'lBEF:- 250....L!.::::51-~O:::~1000 AI'H- ACCOUNT NUr''iBER- 250-4:352-0:31000 AMl- ACCOUNT NUMBER- 250-4354--(r31000 AMT- ACCOUNT NUI'1BER- 270-412(H)31000 AI"lT - ACCOUNT NUl'lBER- 700-4120-0::::1000 AI"lT-' ACCOUNT NUi'1BEP - 700-4121-031000 AI'1T- ACCOUNT NUMBER- 730-'4120-0:31000 f-li"IT - ACCOUNT NUMBER ,- 730-4121-031000 AMT- ACCOUNT NUI'1BER- 770-4121-0::::1000 AI'1T- 54 a 9:::; :31=66 10.02 251101 ::;11.::':7 S' = 0:3 191;98 ':s -:.. J:'t:.: ...}/_In- ...J._: 19.97 36.42 1.05 INVOICE Ai'10UNT DESC~MEDICARE - 5/i2/94 DESC-MEDICARE - 5/12/94 DESC-MEDICARE - 5/12/94 DESC-MEDICARE - 5/12/94 DEse-MEDICARE - 5/12/94 DESC-i'1EDICARE - 5/12/94 DESC-MEDICARE - 5/12/94 DESC-MEDICARE - 5/12/94 DESC-MEDICARE - 5/12n4 DESC-MEDICARE - 5/12/94 DESC-MEDICARE - 5/12/94 VENDOR TOTAL 73::;::72. 7''i1 1970 GROUP HEALTH PLAN, IN* 4::::501 05/10/94 05/10/94 9427.74 ACCOUNT NUMBER- 270-4120~O40000 AMT- 15:3 = 3() DESt-HEALTH INS F'REM - MAY ACCOUNT NUMBER- 100--41.20-040000 AMT- ;::14# B5 t1ESC-,HEAL TH INS PREM - 1'1AY ACCOUNT NUl'lBER - 770-4121-040000 AMT- 7.91 DESC~HEALTH INS PREM - MAY ACCOUNT NUI'1BER-- 100-4150-040000 Al'1T- 620.5;:; DESC-HEALTH INS PREM - MAY ACCOUNT NUl'lBER- 100-41BO-040000 AI"lT- 466.43 DESC-HEALTH INS PREM - MAY ACCOUNT NUI'1BER- 100-4190-040000 AMT- 2::::3.24 DESC-HEALTH INS PREM - MAY ACCOUNT NUMBER- 100-421':,0- 040000 AI"lT- :30~:;. 30 DEse-HEALTH INS PREt"! - t1AY ACCOUNT NUt'lBER- 100-4200-040000 AI'1T- ::::342 . 39 DESC-HEALTH INS PREM - MAY ACCOUNT NUMBER- 100-4270-040000 AI"H- 571.27 DESC-HEALTH INS PREM - MAY .COUNT NUMBEH -- 100-4230-040000 Al'1T- 77 . 50 DESC-HEALTH INS PREM MAY .. CCOUNT - NUMBER- 100-4350-040000 AMT- 611:.,.60 DESt~HEALTH INS PREl''! - MAY ACCOUNT NUl'iBER- 100 - 4:360-~ OLirOOOO At'lT - 308.::::0 DESC-HEAL.TH INS PREM - MAY ACCOUNT NUMBER- 700-4120-040000 At"!T- 41:2.02 DESC-HEALTH INS PF:EM - MAY ACCOUNT NUl'lBER - 700-4121-040000 AMT- 616.60 DESC-HEALTH INS PREM - MAY AceOUNT NUMBER- 7:30-41:20-040000 AMT- 41:2.02 DESC-HEALTH INS PRE!"I - 1'10.... HI ACCOUNT NUt'1BER- 7:30-4121-040000 AMT- 466 . 4:3 DESC-HEALTH INS PREM - MAY VENDoF: TOTAL 9427.74 ~02(l MED I CA AceOUNT NUMBER- ACCOUNT NUl"1BER- ACCOUJ'.H NUI"IBER- ACCOUNT NUt'lBER- ACCOUNT NUMBEF:- ACCOUNT NUMBER- ACCOUNT NUt'1BEF(- Lf3::;02 100-4120-040000 100-41::::0-040000 100-4200-040000 100-4:350-040000 100-4360-040000 700-4120-040000 7:30 - 412(H)40000 ~ooo MEDCENTERS HEALTH PLA* 43503 ACCOUNT NUMBER- 100-4190-040000 ACCOUNT NUi'1BEH-- 100-4200-040000 ACCOUNT NUMBER- 700-4121-040000 ACCOUNT NUMBER- 730-4121-040000 S9~ROUP HEALTH PLAN, IN* 05/l0/94 AMT'- AMT- AI"1T- AMT- AI"1T- At'lT - AMT- 05/1019.4 AMT- AMT- AMT- Ai"lT- 1::;::7.16 168.44 :374. 3:2 187.16 :;:08 11 :~:o 153.30 612=::::1 1 54 . 15 154.15 4:3504 05/10/';:/4 05/10/94 1244.10 t-;.1.:36 DESC-HEALTH DESC-HEALTH DESC-HEALTH DESC-HEALTH DESC-HEALTH DESC-HEALTH DESC-HEALTH VENDOR TOTAL INS PREM - MAY INS PREM - MA Y INS PREM - MAY INS PREM - t1AY INS PREM - MAY INS PREM - MAY INS PREM - MA Y 1244.10 I;}. :3/.:s 05/10/94 1073.91 DESC-HEALTH INS PREM - MAY DESC-HEALTH INS PH EM - MAY DESC-HEALTH INS PREM - MAY DESC-HEALTH INS PREM - MAY VENDOR TOTAL 1073.91 05/10/94 359.92 DISCOUNT AI"10UNT CHErt AMOU!\r 7:3::::72 .7' 9427.7' 94:27.7 1244.1' 1244.1' 1073.9 107:3.9 359.1~