Infinity Resources, Inc.

Tom A. Adams Benefits Summary

Benefit Plan Name Coverage Effective Date Cost per
Pay Period
Medical Blue Care Network HMO Family 04/04/2002 44.03
Dental Dental DMO Plan Family 04/04/2002 12.98
Vision Vision Service Plan Family 04/04/2002 11.45
Disability Short Term Disability $10,000 (base)
$10,000 		04/04/2002 2.00
Disability Long Term Disability 1 x Salary (Base)
$10.000 		04/04/2002 2.00
Life Basic Life Plan 2 x Salary + $2,000
$10,000.00 		04/04/2002 2.00
Life Basic AD&D Plan 5 x Salary + $1,000 (Base) + $1,000
$5,000.00 		04/04/2002 2.00
FSA Dependent Care Reimbursement FSA $2,500.00 04/04/2002 2.00
FSA Health Care Reimbursement FSA $5,000.00 04/04/2002 2.00
Dollar Amount Spent Per Pay Period $120.14

Dependent Information:
Below is a summary of information for your dependents that are enrolled in at least one benefit plan. If any information is incorrect or missing, please make changes below.

Name SSN Relationship Sex DOB
Jane C. Adams
 255-44-4111
 Spouse F 11/05/1954
Jill A. Adams
 323-33-3333 Child F 01/21/1971
Ralph A. Adams
 333-33-3333 Child M 02/24/1978
Penelope Adams
 776-66-7676 Child F 10/19/1975

Beneficiary Information:
Below is a summary of information for your beneficiary information currently on record. If any information is incorrect or missing, please make changes below.

Basic Life Plan
Name Relationship Primary Contingent
Jane C. Adams Spouse 20% 20%
Jill A. Adams Child 20% 20%
Jean L. Picard Stepson 20% 20%
Ralph A. Adams Child 20% 20%
Penelope Adams Child 20% 20%

Voluntary Life Plan
Name Relationship Primary Contingent
Jane C. Adams Spouse 20% 20%
Jill A. Adams Child 20% 20%
Jean L. Picard Stepson 20% 20%
Ralph A. Adams Child 20% 20%
Penelope Adams Child 20% 20%


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