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<br />7
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<br />i~pw~C 1 OM..02
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<br />100,-43::;5-,,0:3].000
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<br />ACC[~UNT !~UMBER'- 1,O(~-'4360-031000 AM-r-
<br />ACCOUNT NUMBER- 100-4362-031000 AMT-
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<br />ACCOUNT NUMBER- 100-4100-035000 AMT-
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<br />36970 GROUP HEALT~1 PLAN7 iN*
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<br />ACCOlJNT NUMBER- 770-412!-040{)OO
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<br />15.61. DESC-MEDICARE
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<br />24.. 9()
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<br />7=90 DESC-MEDICARE
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<br />02/02/'::::~5
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<br />4.26 DESC-HEALTH INS FREM - FEB
<br />149.31 DESC-HEALTH INS PREM - FEB
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<br />124. " '7'::; L1ESC'-HEPiLTH I N~3 PPEi'''1 FEE
<br />165.46 DESC-HEALTH INS PREM - FEB
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