Infinity Resources, Inc.

Carrier Name - List Bill 04/2002 Location(s): All Division(s): All Subtotaled by: Location

Montreal HMO Policy Number 89343 Name SSN Division Effective Date Coverage Volume Premium Edwards, Andrew 123-456-789 Sales 04/12/2002 Family   $475.59 Gallagher, Susan 987-456-123 Marketing 04/12/2002 Employee   $182.03 Jackson, Melissa 234-567-890 Marketing 04/12/2002 Family   $490.90 HMO Total   $1,150.00 PPO Policy Number 349343 Name SSN Division Effective Date Coverage Volume Premium Edwards, Andrew 123-456-789 Sales 04/12/2002 Family   $475.59 Gallagher, Susan 987-456-123 Marketing 04/12/2002 Employee   $182.03 Jackson, Melissa 234-567-890 Marketing 04/12/2002 Family   $490.90 PPO Total   $1,150.00 Montreal Total   $1,150.00   Quebec HMO Policy Number 89343 Name SSN Division Effective Date Coverage Volume Premium Edwards, Andrew 123-456-789 Sales 04/12/2002 Family   $475.59 Gallagher, Susan 987-456-123 Marketing 04/12/2002 Employee   $182.03 Jackson, Melissa 234-567-890 Marketing 04/12/2002 Family   $490.90 HMO Total   $1,150.00 PPO Policy Number 349343 Name SSN Division Effective Date Coverage Volume Premium Edwards, Andrew 123-456-789 Sales 04/12/2002 Family   $475.59 Gallagher, Susan 987-456-123 Marketing 04/12/2002 Employee   $182.03 Jackson, Melissa 234-567-890 Marketing 04/12/2002 Family   $490.90 PPO Total $1,150.00 Quebec Total   $1,150.00

Total Premium            $1,150.00

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