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Termination History






Request ID: 2144 Status: COMPLETE
Request Date: 2019-02-12 Status Date: 2019-02-12
Member Name: PAUL RICHARDS Member ID: 09571258101
Employer ID: DATAPG Termination Date: 2016-04-11
Contract Record ID: 27963261701 Term Reason: null
Comments:





Request ID: 2144 Status: COMPLETE
Request Date: 2019-02-12 Status Date: 2019-02-12
Member Name: PAUL RICHARDS Member ID: 09571258101
Employer ID: DATAPG Termination Date: 2016-04-11
Contract Record ID: 27963261701 Term Reason: null
Comments:





Request ID: 2281 Status: COMPLETE
Request Date: 2019-02-13 Status Date: 2019-02-13
Member Name: SHARI SELL Member ID: 51742258601
Employer ID: DATAPG Termination Date: 2012-06-06
Contract Record ID: 81744104701 Term Reason: null
Comments:





Request ID: 2281 Status: COMPLETE
Request Date: 2019-02-13 Status Date: 2019-02-13
Member Name: SHARI SELL Member ID: 51742258601
Employer ID: DATAPG Termination Date: 2012-06-06
Contract Record ID: 81744104701 Term Reason: null
Comments:





Request ID: 2381 Status: COMPLETE
Request Date: 2019-02-15 Status Date: 2019-02-15
Member Name: ANNIE FURMAN SAWYERS Member ID: 23181678601
Employer ID: CNT Termination Date: 2016-07-31
Contract Record ID: 88908168001 Term Reason: null
Comments: Gayle was promoted to full time management and is no longer eligible for the MEC plan as of 8/1/16 as she is eligible for the regular health insurance.





Request ID: 2381 Status: COMPLETE
Request Date: 2019-02-15 Status Date: 2019-02-15
Member Name: ANNIE FURMAN SAWYERS Member ID: 23181678601
Employer ID: CNT Termination Date: 2016-07-31
Contract Record ID: 88908168001 Term Reason: null
Comments:





Request ID: 2591 Status: COMPLETE
Request Date: 2019-02-22 Status Date: 2019-02-22
Member Name: SAMANTHA WADE Member ID: 26839843201
Employer ID: CNT Termination Date: 2016-07-01
Contract Record ID: 67578545101 Term Reason: TERMINATION
Comments:





Request ID: 2591 Status: COMPLETE
Request Date: 2019-02-22 Status Date: 2019-02-22
Member Name: SAMANTHA WADE Member ID: 26839843201
Employer ID: CNT Termination Date: 2016-07-01
Contract Record ID: 67578545101 Term Reason: TERMINATION
Comments:





Request ID: 2862 Status: COMPLETE
Request Date: 2019-03-01 Status Date: 2019-03-01
Member Name: JOHN ALLEN Member ID: 02852098601
Employer ID: DATAPG Termination Date: 2016-08-01
Contract Record ID: 24280374001 Term Reason: TERMINATION
Comments: please term eff. 8-1-16





Request ID: 2862 Status: COMPLETE
Request Date: 2019-03-01 Status Date: 2019-03-01
Member Name: JOHN ALLEN Member ID: 02852098601
Employer ID: DATAPG Termination Date: 2016-08-01
Contract Record ID: 24280374001 Term Reason: TERMINATION
Comments:





Request ID: 3102 Status: COMPLETE
Request Date: 2016-08-09 Status Date: 2016-08-09
Member Name: RAUL C CAMPUZANO Member ID: 88286020701
Employer ID: ENF Termination Date: 2016-06-01
Contract Record ID: 88286020701 Term Reason: TERMINATION
Comments:





Request ID: 3102 Status: COMPLETE
Request Date: 2016-08-09 Status Date: 2016-08-09
Member Name: RAUL C CAMPUZANO Member ID: 88286020701
Employer ID: ENF Termination Date: 2016-06-01
Contract Record ID: 88286020701 Term Reason: TERMINATION
Comments:





Request ID: 3522 Status: COMPLETE
Request Date: 2019-03-20 Status Date: 2019-03-20
Member Name: ANTHONY LAZZARO Member ID: 68494959901
Employer ID: DATAPG Termination Date: 2016-09-30
Contract Record ID: 27285855201 Term Reason: TERMINATION
Comments:





Request ID: 3522 Status: COMPLETE
Request Date: 2019-03-20 Status Date: 2019-03-20
Member Name: ANTHONY LAZZARO Member ID: 68494959901
Employer ID: DATAPG Termination Date: 2016-09-30
Contract Record ID: 27285855201 Term Reason: TERMINATION
Comments:





Request ID: 3651 Status: COMPLETE
Request Date: 2016-09-27 Status Date: 2016-09-27
Member Name: ARTURO MARTINEZ-CORTES Member ID: 83257843801
Employer ID: ENF Termination Date: 2016-07-01
Contract Record ID: 83257843801 Term Reason: TERMINATION
Comments:





Request ID: 3866 Status: COMPLETE
Request Date: 2019-03-25 Status Date: 2019-03-25
Member Name: BONNIE RAMOS Member ID: 51105861901
Employer ID: DATAPG Termination Date: 2016-05-23
Contract Record ID: 72769504601 Term Reason: TERMINATION
Comments:





Request ID: 3866 Status: COMPLETE
Request Date: 2019-03-25 Status Date: 2019-03-25
Member Name: BONNIE RAMOS Member ID: 51105861901
Employer ID: DATAPG Termination Date: 2016-05-23
Contract Record ID: 72769504601 Term Reason: TERMINATION
Comments:





Request ID: 3868 Status: COMPLETE
Request Date: 2019-03-25 Status Date: 2019-03-25
Member Name: SOFIA ELLIS Member ID: 14340503901
Employer ID: DATAPG Termination Date: 2016-07-22
Contract Record ID: 54299179001 Term Reason: TERMINATION
Comments:





Request ID: 3868 Status: COMPLETE
Request Date: 2019-03-25 Status Date: 2019-03-25
Member Name: SOFIA ELLIS Member ID: 14340503901
Employer ID: DATAPG Termination Date: 2016-07-22
Contract Record ID: 54299179001 Term Reason: TERMINATION
Comments:





Request ID: 5122 Status: COMPLETE
Request Date: 2016-12-06 Status Date: 2016-12-06
Member Name: CRISTINA A GUZMAN ESTEVEZ Member ID: 25407183801
Employer ID: ENF Termination Date: 2016-11-22
Contract Record ID: 25407183801 Term Reason: TERMINATION
Comments: Member needs MES HP3 ID cards





Request ID: 5122 Status: COMPLETE
Request Date: 2016-12-06 Status Date: 2016-12-06
Member Name: CRISTINA A GUZMAN ESTEVEZ Member ID: 25407183801
Employer ID: ENF Termination Date: 2016-11-22
Contract Record ID: 25407183801 Term Reason: TERMINATION
Comments:





Request ID: 5142 Status: COMPLETE
Request Date: 2016-12-06 Status Date: 2016-12-06
Member Name: EMELIA LOPEZ SIXTO Member ID: 00333062801
Employer ID: ENF Termination Date: 2016-07-23
Contract Record ID: 00333062801 Term Reason: TERMINATION
Comments:





Request ID: 5142 Status: COMPLETE
Request Date: 2016-12-06 Status Date: 2016-12-06
Member Name: EMELIA LOPEZ SIXTO Member ID: 00333062801
Employer ID: ENF Termination Date: 2016-07-23
Contract Record ID: 00333062801 Term Reason: TERMINATION
Comments:





Request ID: 5203 Status: COMPLETE
Request Date: 2016-12-07 Status Date: 2016-12-07
Member Name: TAUVE A BEGAYE Member ID: 19264264701
Employer ID: NNEBP Termination Date: 2019-03-30
Contract Record ID: 91385072301 Term Reason: VOLUNTARY
Comments:





Request ID: 5203 Status: COMPLETE
Request Date: 2016-12-07 Status Date: 2016-12-07
Member Name: TAUVE A BEGAYE Member ID: 19264264701
Employer ID: NNEBP Termination Date: 2019-03-30
Contract Record ID: 91385072301 Term Reason: VOLUNTARY
Comments: member lost id card about 2 months ago





Request ID: 5362 Status: COMPLETE
Request Date: 2019-04-10 Status Date: 2019-04-10
Member Name: MICHAEL BRESSLER Member ID: 09546164101
Employer ID: DATAPG Termination Date: 2017-01-31
Contract Record ID: 03591556601 Term Reason: TERMINATION
Comments:





Request ID: 5362 Status: COMPLETE
Request Date: 2019-04-10 Status Date: 2019-04-10
Member Name: MICHAEL BRESSLER Member ID: 09546164101
Employer ID: DATAPG Termination Date: 2017-01-31
Contract Record ID: 03591556601 Term Reason: TERMINATION
Comments: Member needs HSP3 ID card





Request ID: 6303 Status: COMPLETE
Request Date: 2019-04-23 Status Date: 2019-04-23
Member Name: KEVIN BARCELON Member ID: 28074794301
Employer ID: DATAPG Termination Date: 2016-09-23
Contract Record ID: 13303416601 Term Reason: VOLUNTARY
Comments:





Request ID: 6303 Status: COMPLETE
Request Date: 2019-04-23 Status Date: 2019-04-23
Member Name: KEVIN BARCELON Member ID: 28074794301
Employer ID: DATAPG Termination Date: 2016-09-23
Contract Record ID: 13303416601 Term Reason: VOLUNTARY
Comments: Member needs HSP3 ID card





Request ID: 6321 Status: COMPLETE
Request Date: 2019-04-23 Status Date: 2019-04-23
Member Name: CYNTHIA TRUSZAK Member ID: 19083316801
Employer ID: DATAPG Termination Date: 2016-08-22
Contract Record ID: 06747901901 Term Reason: VOLUNTARY
Comments:





Request ID: 6321 Status: COMPLETE
Request Date: 2019-04-23 Status Date: 2019-04-23
Member Name: CYNTHIA TRUSZAK Member ID: 19083316801
Employer ID: DATAPG Termination Date: 2016-08-22
Contract Record ID: 06747901901 Term Reason: VOLUNTARY
Comments: PLEASE RESEND ID CARDS





Request ID: 6850 Status: COMPLETE
Request Date: 2019-04-30 Status Date: 2019-04-30
Member Name: ALEXANDER BLANCO Member ID: 93427823001
Employer ID: DATAPG Termination Date: 2017-03-31
Contract Record ID: 33967390901 Term Reason: TERMINATION
Comments:





Request ID: 6850 Status: COMPLETE
Request Date: 2019-04-30 Status Date: 2019-04-30
Member Name: ALEXANDER BLANCO Member ID: 93427823001
Employer ID: DATAPG Termination Date: 2017-03-31
Contract Record ID: 33967390901 Term Reason: TERMINATION
Comments:





Request ID: 7663 Status: COMPLETE
Request Date: 2019-05-14 Status Date: 2019-05-14
Member Name: EDEN ELYSE BITSOI Member ID: 47981739803
Employer ID: NNEBP Termination Date: 2017-03-27
Contract Record ID: 70499453001 Term Reason: TERMINATION
Comments:





Request ID: 7668 Status: COMPLETE
Request Date: 2019-05-14 Status Date: 2019-05-14
Member Name: EDEN ELYSE BITSOI Member ID: 47981739803
Employer ID: NNEBP Termination Date: 2017-06-02
Contract Record ID: 57307360801 Term Reason: TERMINATION
Comments:





Request ID: 7669 Status: COMPLETE
Request Date: 2019-05-14 Status Date: 2019-05-14
Member Name: JOSE REYES Member ID: 23911464301
Employer ID: JAZXP Termination Date: 2017-02-11
Contract Record ID: 98978703501 Term Reason: TERMINATION
Comments: Please send ID Card to address on file. Thank you.





Request ID: 7669 Status: COMPLETE
Request Date: 2019-05-14 Status Date: 2019-05-14
Member Name: JOSE REYES Member ID: 23911464301
Employer ID: JAZXP Termination Date: 2017-02-11
Contract Record ID: 98978703501 Term Reason: TERMINATION
Comments:





Request ID: 7691 Status: COMPLETE
Request Date: 2019-05-15 Status Date: 2019-05-15
Member Name: SYLVIA E NEZ Member ID: 55296996901
Employer ID: NNEBP Termination Date: 2016-11-21
Contract Record ID: 68315652701 Term Reason: TERMINATION
Comments:





Request ID: 7691 Status: COMPLETE
Request Date: 2019-05-15 Status Date: 2019-05-15
Member Name: SYLVIA E NEZ Member ID: 55296996901
Employer ID: NNEBP Termination Date: 2016-11-21
Contract Record ID: 68315652701 Term Reason: TERMINATION
Comments:





Request ID: 7692 Status: COMPLETE
Request Date: 2019-05-15 Status Date: 2019-05-15
Member Name: SYLVIA E NEZ Member ID: 55296996901
Employer ID: NNEBP Termination Date: 2017-05-20
Contract Record ID: 50458991501 Term Reason: TERMINATION
Comments:





Request ID: 7692 Status: COMPLETE
Request Date: 2019-05-15 Status Date: 2019-05-15
Member Name: SYLVIA E NEZ Member ID: 55296996901
Employer ID: NNEBP Termination Date: 2017-05-20
Contract Record ID: 50458991501 Term Reason: TERMINATION
Comments:





Request ID: 7696 Status: COMPLETE
Request Date: 2019-05-15 Status Date: 2019-05-15
Member Name: JAMES GRIGAITIS Member ID: 86412025101
Employer ID: DATAPG Termination Date: 2017-03-14
Contract Record ID: 24124293101 Term Reason: TERMINATION
Comments:





Request ID: 7696 Status: COMPLETE
Request Date: 2019-05-15 Status Date: 2019-05-15
Member Name: JAMES GRIGAITIS Member ID: 86412025101
Employer ID: DATAPG Termination Date: 2017-03-14
Contract Record ID: 24124293101 Term Reason: TERMINATION
Comments: Membre needs HSP3 ID cards





Request ID: 15321 Status: COMPLETE
Request Date: 2019-07-01 Status Date: 2019-07-01
Member Name: FRANK B HELSLEY Member ID: 10445932701
Employer ID: FOGLE Termination Date: 2017-12-13
Contract Record ID: 79745927601 Term Reason: TERMINATION
Comments: last effective date 12/31/17





Request ID: 22001 Status: COMPLETE
Request Date: 2019-07-16 Status Date: 2019-07-16
Member Name: ROBERTO G PEREZ Member ID: 66374580501
Employer ID: NORTHAM Termination Date: 2018-09-18
Contract Record ID: 01754546801 Term Reason: VOLUNTARY
Comments:





Request ID: 23722 Status: COMPLETE
Request Date: 2019-07-18 Status Date: 2019-07-18
Member Name: DELANA A STEVENS Member ID: 66990072501
Employer ID: CNT Termination Date: 2019-07-31
Contract Record ID: 66990072501 Term Reason: TERMINATION
Comments:





Request ID: 54201 Status: COMPLETE
Request Date: 2019-11-27 Status Date: 2019-11-27
Member Name: TAMEKA L RIGGINS Member ID: 56845024401
Employer ID: BRANDY Termination Date: 2019-10-01
Contract Record ID: 56845024401 Term Reason: VOLUNTARY
Comments:





Request ID: 54989 Status: COMPLETE
Request Date: 2019-12-05 Status Date: 2019-12-05
Member Name: KERRY L NADEAU Member ID: 29705901801
Employer ID: BRANDY Termination Date: 2019-12-01
Contract Record ID: 29705901801 Term Reason: TERMINATION
Comments: Last day worked 11/22/2019





Request ID: 55020 Status: COMPLETE
Request Date: 2019-12-06 Status Date: 2019-12-06
Member Name: KERRY L NADEAU Member ID: 29705901801
Employer ID: BRANDY Termination Date: 2020-10-31
Contract Record ID: 29705901801 Term Reason: TERMINATION
Comments:





Request ID: 58729 Status: COMPLETE
Request Date: 2020-01-17 Status Date: 2020-01-17
Member Name: MARC J LAPOINTE Member ID: 31516616501
Employer ID: BRECK Termination Date: 2020-01-03
Contract Record ID: 31516616501 Term Reason: TERMINATION
Comments: Benefits termination 12/31/2020





Request ID: 58730 Status: COMPLETE
Request Date: 2020-01-17 Status Date: 2020-01-17
Member Name: MELYNDA BARQUIN Member ID: 96545805701
Employer ID: BRECK Termination Date: 2020-01-01
Contract Record ID: 96545805701 Term Reason: VOLUNTARY
Comments: Waived Coverage





Request ID: 58732 Status: COMPLETE
Request Date: 2020-01-17 Status Date: 2020-01-17
Member Name: MARC J LAPOINTE Member ID: 31516616501
Employer ID: BRECK Termination Date: 2020-01-01
Contract Record ID: 31516616501 Term Reason: VOLUNTARY
Comments: Waived Coverage





Request ID: 60749 Status: COMPLETE
Request Date: 2020-02-04 Status Date: 2020-02-04
Member Name: JODI WHITE Member ID: 74843812101
Employer ID: CARBON Termination Date: 2020-02-01
Contract Record ID: 74843812101 Term Reason: VOLUNTARY
Comments: left for new employment





Request ID: 63781 Status: COMPLETE
Request Date: 2020-02-13 Status Date: 2020-02-13
Member Name: JORDAN LOVE Member ID: 93261687601
Employer ID: VTCORP Termination Date: 2020-02-14
Contract Record ID: 93261687601 Term Reason: VOLUNTARY
Comments:





Request ID: 75223 Status: COMPLETE
Request Date: 2020-04-07 Status Date: 2020-04-07
Member Name: JERI L TILLMAN Member ID: 88408431601
Employer ID: CNT Termination Date: 2020-04-30
Contract Record ID: 88408431601 Term Reason: TERMINATION
Comments:





Request ID: 75264 Status: COMPLETE
Request Date: 2020-04-09 Status Date: 2020-04-09
Member Name: JOSEPH OKOLOWITCZ Member ID: 91237690801
Employer ID: PELTZ Termination Date: 2020-04-30
Contract Record ID: 91237690801 Term Reason: TERMINATION
Comments:





Request ID: 77291 Status: COMPLETE
Request Date: 2020-05-12 Status Date: 2020-05-12
Member Name: JERI L TILLMAN Member ID: 88408431601
Employer ID: CNT Termination Date: 2020-04-30
Contract Record ID: 88408431601 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 80678 Status: COMPLETE
Request Date: 2020-06-15 Status Date: 2020-06-15
Member Name: FELICIA LEE Member ID: 51254982101
Employer ID: CARBON Termination Date: 2020-06-15
Contract Record ID: 51254982101 Term Reason: VOLUNTARY
Comments: now on husbands coverage





Request ID: 81807 Status: COMPLETE
Request Date: 2020-07-02 Status Date: 2020-07-02
Member Name: CEPHAS MUJURUKI Member ID: 66456365201
Employer ID: CNT Termination Date: 2020-06-30
Contract Record ID: 66456365201 Term Reason: TERMINATION
Comments:





Request ID: 85661 Status: COMPLETE
Request Date: 2020-08-13 Status Date: 2020-08-13
Member Name: CASSIE STEVENS Member ID: 09183817601
Employer ID: HPIGRP Termination Date: 2020-07-31
Contract Record ID: 09183817601 Term Reason: VOLUNTARY
Comments:





Request ID: 91382 Status: COMPLETE
Request Date: 2020-09-18 Status Date: 2020-09-18
Member Name: KASEY ELDER Member ID: 98370551801
Employer ID: BRECK Termination Date: 2020-09-30
Contract Record ID: 98370551801 Term Reason: TERMINATION
Comments: Please send COBRA letter.





Request ID: 91383 Status: COMPLETE
Request Date: 2020-09-18 Status Date: 2020-09-18
Member Name: KASEY ELDER Member ID: 98370551801
Employer ID: BRECK Termination Date: 2020-09-30
Contract Record ID: 98370551801 Term Reason: TERMINATION
Comments: Please send COBRA letter.





Request ID: 95541 Status: COMPLETE
Request Date: 2020-10-14 Status Date: 2020-10-14
Member Name: EDUARD A MENDOZA Member ID: 13156613901
Employer ID: LEHMAN Termination Date: 2020-07-31
Contract Record ID: 13156613901 Term Reason: VOLUNTARY
Comments:





Request ID: 98621 Status: COMPLETE
Request Date: 2020-11-06 Status Date: 2020-11-06
Member Name: ARIANA HINOJOSA Member ID: 35334592101
Employer ID: CNT Termination Date: 2020-11-30
Contract Record ID: 35334592101 Term Reason: TERMINATION
Comments:





Request ID: 98853 Status: COMPLETE
Request Date: 2020-11-13 Status Date: 2020-11-13
Member Name: GILFREDO SARDINAS Member ID: 08414822901
Employer ID: LEHMAN Termination Date: 2020-11-30
Contract Record ID: 08414822901 Term Reason: TERMINATION
Comments:





Request ID: 98856 Status: COMPLETE
Request Date: 2020-11-13 Status Date: 2020-11-13
Member Name: OSCAR M TORRES CASTILLO Member ID: 44560452901
Employer ID: LEHMAN Termination Date: 2020-10-31
Contract Record ID: 44560452901 Term Reason: TERMINATION
Comments:





Request ID: 102421 Status: COMPLETE
Request Date: 2020-12-01 Status Date: 2020-12-01
Member Name: JEANNIE L LAFOLLETTE Member ID: 26442082601
Employer ID: LNB Termination Date: 2020-11-01
Contract Record ID: 26442082601 Term Reason: VOLUNTARY
Comments: This employee wants to terminate health coverage only. All other insurance coverage remains the same.





Request ID: 102441 Status: COMPLETE
Request Date: 2020-12-01 Status Date: 2020-12-01
Member Name: LORETTA L ROUTT Member ID: 51328884001
Employer ID: LNB Termination Date: 2020-11-01
Contract Record ID: 51328884001 Term Reason: VOLUNTARY
Comments: This employee wants to terminate health coverage only. All other insurance coverage remains the same.





Request ID: 103021 Status: COMPLETE
Request Date: 2020-12-07 Status Date: 2020-12-07
Member Name: MEGAN L UNDERWOOD Member ID: 08255778201
Employer ID: LNB Termination Date: 2020-11-01
Contract Record ID: 08255778201 Term Reason: VOLUNTARY
Comments: Employee requested to cancel health insurance only. All other policies are still in effect.





Request ID: 105601 Status: COMPLETE
Request Date: 2020-12-18 Status Date: 2020-12-18
Member Name: DEBBIE BURLISON Member ID: 98834913601
Employer ID: CNT Termination Date: 2020-12-31
Contract Record ID: 98834913601 Term Reason: TERMINATION
Comments:





Request ID: 108021 Status: COMPLETE
Request Date: 2020-12-30 Status Date: 2020-12-30
Member Name: TINNA GARCELL Member ID: 29154780901
Employer ID: LEHMAN Termination Date: 2020-11-30
Contract Record ID: 29154780901 Term Reason: TERMINATION
Comments:





Request ID: 109281 Status: COMPLETE
Request Date: 2021-01-05 Status Date: 2021-01-05
Member Name: VERNON L KESSINGER Member ID: 71491885801
Employer ID: LNB Termination Date: 2020-12-31
Contract Record ID: 71491885801 Term Reason: VOLUNTARY
Comments: Employee is only terminating health coverage - will still have dental. Please update Cobra also.





Request ID: 109301 Status: COMPLETE
Request Date: 2021-01-05 Status Date: 2021-01-05
Member Name: JOAN KESSINGER Member ID: 71491885802
Employer ID: LNB Termination Date: 2020-12-31
Contract Record ID: 71491885801 Term Reason: VOLUNTARY
Comments: Husband is terminating medical coverage only - will still have dental. Please update Cobra.





Request ID: 109401 Status: COMPLETE
Request Date: 2021-01-05 Status Date: 2021-01-05
Member Name: RANDALL D MURRAY Member ID: 78311892801
Employer ID: LNB Termination Date: 2020-12-31
Contract Record ID: 78311892801 Term Reason: VOLUNTARY
Comments: Employee is canceling health coverage only - still has dental. Please update Cobra.





Request ID: 109403 Status: COMPLETE
Request Date: 2021-01-05 Status Date: 2021-01-05
Member Name: STACY S WOLF Member ID: 05058743801
Employer ID: LNB Termination Date: 2020-12-31
Contract Record ID: 05058743801 Term Reason: VOLUNTARY
Comments: Employee is terminating health coverage only - still has dental. Please update Cobra.





Request ID: 109841 Status: COMPLETE
Request Date: 2021-01-06 Status Date: 2021-01-06
Member Name: MARC PELTZ Member ID: 14281794401
Employer ID: PELTZ Termination Date: 2021-01-31
Contract Record ID: 14281794401 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 111171 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: ALI SAIID A AL AMMAL Member ID: 97381116501
Employer ID: VICTSEN Termination Date: 2020-12-31
Contract Record ID: 97381116501 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 111172 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: AMELIA BATTEN Member ID: 88522437001
Employer ID: THERALT Termination Date: 2020-12-31
Contract Record ID: 88522437001 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 111174 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: HILDA BERNAL Member ID: 39734280801
Employer ID: VICTSEN Termination Date: 2020-12-31
Contract Record ID: 39734280801 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 111175 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: TAMIKCO L BETHEA Member ID: 83196203201
Employer ID: THERALT Termination Date: 2020-12-31
Contract Record ID: 83196203201 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 111176 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: JOE B BILLINGS JR Member ID: 63140812901
Employer ID: THERALT Termination Date: 2020-12-31
Contract Record ID: 63140812901 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 111179 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: MARY BOYD Member ID: 78911707301
Employer ID: VICTSEN Termination Date: 2020-12-31
Contract Record ID: 78911707301 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 111180 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: SHAWNDA B MOREE Member ID: 50896309001
Employer ID: THERALT Termination Date: 2020-12-31
Contract Record ID: 50896309001 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 111181 Status: COMPLETE
Request Date: 2021-01-12 Status Date: 2021-01-12
Member Name: RENARTA P BROWN Member ID: 02809202201
Employer ID: THERALT Termination Date: 2020-12-31
Contract Record ID: 02809202201 Term Reason: VOLUNTARY
Comments: EMPLOYEE DROPPED AT OE





Request ID: 112662 Status: COMPLETE
Request Date: 2021-01-21 Status Date: 2021-01-21
Member Name: CRYSTAL L NELSON Member ID: 24599147801
Employer ID: LNB Termination Date: 2021-01-01
Contract Record ID: 24599147801 Term Reason: VOLUNTARY
Comments: Employee never enrolled in medical - signed waiver. Only enrolled in dental. Please update.





Request ID: 114222 Status: COMPLETE
Request Date: 2021-01-27 Status Date: 2021-01-27
Member Name: BILLIE PHILLIPS Member ID: 13275533201
Employer ID: CNT Termination Date: 2021-01-31
Contract Record ID: 13275533201 Term Reason: TERMINATION
Comments:





Request ID: 117806 Status: COMPLETE
Request Date: 2021-02-04 Status Date: 2021-02-04
Member Name: ALICE HOLLOWAY Member ID: 55666499301
Employer ID: KAUBRY Termination Date: 2021-01-31
Contract Record ID: 55666499301 Term Reason: VOLUNTARY
Comments:





Request ID: 124461 Status: COMPLETE
Request Date: 2021-02-25 Status Date: 2021-02-25
Member Name: SHERI FIRST Member ID: 64438481201
Employer ID: PELTZ Termination Date: 2021-03-01
Contract Record ID: 64438481201 Term Reason: VOLUNTARY
Comments:





Request ID: 131361 Status: COMPLETE
Request Date: 2021-03-17 Status Date: 2021-03-17
Member Name: TARIQ SIDDIQUI Member ID: 13394135601
Employer ID: LEHMAN Termination Date: 2021-02-28
Contract Record ID: 13394135601 Term Reason: VOLUNTARY
Comments:





Request ID: 137181 Status: COMPLETE
Request Date: 2021-04-02 Status Date: 2021-04-02
Member Name: LOGAN ROBERTSON Member ID: 74233370701
Employer ID: DAVIS Termination Date: 2021-03-31
Contract Record ID: 74233370701 Term Reason: VOLUNTARY
Comments: Found other coverage





Request ID: 140484 Status: COMPLETE
Request Date: 2021-04-19 Status Date: 2021-04-19
Member Name: DIONNA THIGPEN Member ID: 50569306201
Employer ID: PELTZ Termination Date: 2021-05-01
Contract Record ID: 50569306201 Term Reason: VOLUNTARY
Comments: Gained other coverage through Spouse





Request ID: 144203 Status: COMPLETE
Request Date: 2021-05-06 Status Date: 2021-05-06
Member Name: JUDY C WELLS Member ID: 78791098201
Employer ID: LNB Termination Date: 2021-04-30
Contract Record ID: 78791098201 Term Reason: TERMINATION
Comments:





Request ID: 145032 Status: COMPLETE
Request Date: 2021-05-10 Status Date: 2021-05-10
Member Name: MICHAEL BOANE Member ID: 57626054301
Employer ID: TPCH Termination Date: 2021-04-07
Contract Record ID: 57626054301 Term Reason: TERMINATION
Comments:





Request ID: 145268 Status: COMPLETE
Request Date: 2021-05-17 Status Date: 2021-05-17
Member Name: CRYSTAL NEWCOMB Member ID: 53268112801
Employer ID: DAVIS Termination Date: 2021-05-27
Contract Record ID: 53268112801 Term Reason: VOLUNTARY
Comments:





Request ID: 145501 Status: COMPLETE
Request Date: 2021-05-25 Status Date: 2021-05-25
Member Name: STACY S WOLF Member ID: 05058743801
Employer ID: LNB Termination Date: 2021-05-31
Contract Record ID: 05058743801 Term Reason: VOLUNTARY
Comments: Husband has coverage with new job now.





Request ID: 147901 Status: COMPLETE
Request Date: 2021-06-09 Status Date: 2021-06-09
Member Name: MICHAEL PATRICK Member ID: 54247092801
Employer ID: TBX Termination Date: 2021-06-30
Contract Record ID: 54247092801 Term Reason: TERMINATION
Comments:





Request ID: 153341 Status: COMPLETE
Request Date: 2021-06-29 Status Date: 2021-06-29
Member Name: LINDA ALBERT Member ID: 58385456501
Employer ID: CARBON Termination Date: 2020-07-01
Contract Record ID: 58385456501 Term Reason: VOLUNTARY
Comments:





Request ID: 154142 Status: COMPLETE
Request Date: 2021-07-02 Status Date: 2021-07-02
Member Name: PAUL HEFFERNAN Member ID: 48948741001
Employer ID: WCE Termination Date: 2021-06-24
Contract Record ID: 48948741001 Term Reason: VOLUNTARY
Comments:





Request ID: 155222 Status: COMPLETE
Request Date: 2021-07-12 Status Date: 2021-07-12
Member Name: BOK YEON LEE Member ID: 58847070501
Employer ID: HANUL Termination Date: 2021-06-30
Contract Record ID: 58847070501 Term Reason: VOLUNTARY
Comments:





Request ID: 155223 Status: COMPLETE
Request Date: 2021-07-12 Status Date: 2021-07-12
Member Name: BOK YEON LEE Member ID: 58847070501
Employer ID: HANUL Termination Date: 2021-06-30
Contract Record ID: 58847070501 Term Reason: VOLUNTARY
Comments:





Request ID: 155224 Status: COMPLETE
Request Date: 2021-07-12 Status Date: 2021-07-12
Member Name: JIN LEE Member ID: 29981488901
Employer ID: HANUL Termination Date: 2021-06-30
Contract Record ID: 29981488901 Term Reason: VOLUNTARY
Comments:





Request ID: 155225 Status: COMPLETE
Request Date: 2021-07-12 Status Date: 2021-07-12
Member Name: JONG LEE Member ID: 29981488902
Employer ID: HANUL Termination Date: 2021-06-30
Contract Record ID: 29981488901 Term Reason: VOLUNTARY
Comments:





Request ID: 155742 Status: COMPLETE
Request Date: 2021-07-19 Status Date: 2021-07-19
Member Name: MARISSA DANIELLE CAMPOS Member ID: 25468710001
Employer ID: EASYLVNG Termination Date: 2021-07-19
Contract Record ID: 25468710001 Term Reason: VOLUNTARY
Comments: Marissa put in her formal resignation effective 7/16/21, but I believe coverage goes through end of month.





Request ID: 158401 Status: COMPLETE
Request Date: 2021-08-02 Status Date: 2021-08-02
Member Name: HILLARY A LOGSDON Member ID: 75600136601
Employer ID: LNB Termination Date: 2021-07-31
Contract Record ID: 75600136601 Term Reason: VOLUNTARY
Comments: Employee is dropping medical coverage only.





Request ID: 158981 Status: COMPLETE
Request Date: 2021-08-04 Status Date: 2021-08-04
Member Name: ERIC HOUGH Member ID: 53232445001
Employer ID: NEC Termination Date: 2021-07-22
Contract Record ID: 53232445001 Term Reason: VOLUNTARY
Comments: Please term 7/22/21 prior to coverage starting





Request ID: 165581 Status: COMPLETE
Request Date: 2021-09-03 Status Date: 2021-09-03
Member Name: ALEXANDRA LEYDON Member ID: 03151400201
Employer ID: PELTZ Termination Date: 2021-08-31
Contract Record ID: 03151400201 Term Reason: VOLUNTARY
Comments:





Request ID: 169501 Status: COMPLETE
Request Date: 2021-09-29 Status Date: 2021-09-29
Member Name: DAVID WYDEMON Member ID: 81196851701
Employer ID: NEC Termination Date: 2021-09-24
Contract Record ID: 81196851701 Term Reason: VOLUNTARY
Comments:





Request ID: 177421 Status: COMPLETE
Request Date: 2021-10-15 Status Date: 2021-10-15
Member Name: DAVID GARY JOHNSON Member ID: 79063121101
Employer ID: BRECK Termination Date: 2021-10-31
Contract Record ID: 79063121101 Term Reason: TERMINATION
Comments: email COBRA letter





Request ID: 177602 Status: COMPLETE
Request Date: 2021-10-18 Status Date: 2021-10-18
Member Name: CHRISTOPHER LAGOS Member ID: 35787670601
Employer ID: NEC Termination Date: 2021-10-12
Contract Record ID: 35787670601 Term Reason: VOLUNTARY
Comments:





Request ID: 183261 Status: COMPLETE
Request Date: 2021-11-05 Status Date: 2021-11-05
Member Name: CHANDLER HELMS Member ID: 53521291501
Employer ID: CNT Termination Date: 2021-11-30
Contract Record ID: 53521291501 Term Reason: TERMINATION
Comments:





Request ID: 184041 Status: COMPLETE
Request Date: 2021-11-10 Status Date: 2021-11-10
Member Name: ASHER JOSEPH Member ID: 45847593201
Employer ID: CNT Termination Date: 2021-10-31
Contract Record ID: 45847593201 Term Reason: TERMINATION
Comments:





Request ID: 185967 Status: COMPLETE
Request Date: 2021-11-15 Status Date: 2021-11-15
Member Name: MATTHEW TRAPP Member ID: 28900064701
Employer ID: NEC Termination Date: 2021-11-12
Contract Record ID: 28900064701 Term Reason: VOLUNTARY
Comments:





Request ID: 187701 Status: COMPLETE
Request Date: 2021-11-23 Status Date: 2021-11-23
Member Name: SAMUEL FERNANDEZ Member ID: 06545339001
Employer ID: WCE Termination Date: 2021-10-29
Contract Record ID: 06545339001 Term Reason: TERMINATION
Comments:





Request ID: 187901 Status: COMPLETE
Request Date: 2021-11-23 Status Date: 2021-11-23
Member Name: ANDREA BERMAN Member ID: 79761083801
Employer ID: PELTZ Termination Date: 2021-12-01
Contract Record ID: 79761083801 Term Reason: VOLUNTARY
Comments: department 990





Request ID: 188001 Status: COMPLETE
Request Date: 2021-11-23 Status Date: 2021-11-23
Member Name: CARLISIA SINGLETON Member ID: 16620952701
Employer ID: PELTZ Termination Date: 2021-12-01
Contract Record ID: 16620952701 Term Reason: VOLUNTARY
Comments: department 990





Request ID: 189481 Status: COMPLETE
Request Date: 2021-12-01 Status Date: 2021-12-01
Member Name: LEE KEMP Member ID: 69212951801
Employer ID: NEC Termination Date: 2021-11-30
Contract Record ID: 69212951801 Term Reason: VOLUNTARY
Comments:





Request ID: 189521 Status: COMPLETE
Request Date: 2021-12-01 Status Date: 2021-12-01
Member Name: TERRY ARCHIBALD Member ID: 15004588001
Employer ID: NEC Termination Date: 2021-11-30
Contract Record ID: 15004588001 Term Reason: VOLUNTARY
Comments:





Request ID: 189981 Status: COMPLETE
Request Date: 2021-12-02 Status Date: 2021-12-02
Member Name: SIDNEY DAVIES Member ID: 57988492601
Employer ID: MESH Termination Date: 2021-12-31
Contract Record ID: 57988492601 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 192341 Status: COMPLETE
Request Date: 2021-12-16 Status Date: 2021-12-16
Member Name: BELINDA G TATE Member ID: 10226312401
Employer ID: LNB Termination Date: 2021-12-31
Contract Record ID: 10226312401 Term Reason: TERMINATION
Comments:





Request ID: 192342 Status: COMPLETE
Request Date: 2021-12-16 Status Date: 2021-12-16
Member Name: WILLIAM F TATE Member ID: 10226312402
Employer ID: LNB Termination Date: 2021-12-31
Contract Record ID: 10226312401 Term Reason: TERMINATION
Comments:





Request ID: 192421 Status: COMPLETE
Request Date: 2021-12-16 Status Date: 2021-12-16
Member Name: ANDREA BERMAN Member ID: 79761083801
Employer ID: PELTZ Termination Date: 2021-12-01
Contract Record ID: 79761083801 Term Reason: VOLUNTARY
Comments:





Request ID: 192461 Status: COMPLETE
Request Date: 2021-12-16 Status Date: 2021-12-16
Member Name: CARLISIA SINGLETON Member ID: 16620952701
Employer ID: PELTZ Termination Date: 2021-12-01
Contract Record ID: 16620952701 Term Reason: VOLUNTARY
Comments:





Request ID: 192481 Status: COMPLETE
Request Date: 2021-12-16 Status Date: 2021-12-16
Member Name: CARLISIA SINGLETON Member ID: 16620952701
Employer ID: PELTZ Termination Date: 2021-12-01
Contract Record ID: 16620952701 Term Reason: VOLUNTARY
Comments:





Request ID: 193181 Status: COMPLETE
Request Date: 2021-12-21 Status Date: 2021-12-21
Member Name: JAMES ELY SR Member ID: 61402517601
Employer ID: MESH Termination Date: 2021-12-31
Contract Record ID: 61402517601 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 193302 Status: COMPLETE
Request Date: 2021-12-21 Status Date: 2021-12-21
Member Name: JAMES T LENZ Member ID: 81268807501
Employer ID: MESH Termination Date: 2021-12-31
Contract Record ID: 81268807501 Term Reason: VOLUNTARY
Comments:





Request ID: 193304 Status: COMPLETE
Request Date: 2021-12-21 Status Date: 2021-12-21
Member Name: JAMES ELY SR Member ID: 61402517601
Employer ID: MESH Termination Date: 2021-12-31
Contract Record ID: 61402517601 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 193641 Status: COMPLETE
Request Date: 2021-12-22 Status Date: 2021-12-22
Member Name: DAVID WELLS Member ID: 57272823301
Employer ID: RCI Termination Date: 2021-09-01
Contract Record ID: 57272823301 Term Reason: TERMINATION
Comments: DOES NOT HAVE VISION





Request ID: 193661 Status: COMPLETE
Request Date: 2021-12-22 Status Date: 2021-12-22
Member Name: ZABRINA SMITH-WELLS Member ID: 57272823302
Employer ID: RCI Termination Date: 2021-09-01
Contract Record ID: 57272823301 Term Reason: TERMINATION
Comments: DOES NOT HAVE VISION





Request ID: 193701 Status: COMPLETE
Request Date: 2021-12-22 Status Date: 2021-12-22
Member Name: DAVID WELLS Member ID: 57272823301
Employer ID: RCI Termination Date: 2021-09-01
Contract Record ID: 57272823301 Term Reason: TERMINATION
Comments: DOES NOT HAVE DENTAL





Request ID: 193721 Status: COMPLETE
Request Date: 2021-12-22 Status Date: 2021-12-22
Member Name: ZABRINA SMITH-WELLS Member ID: 57272823302
Employer ID: RCI Termination Date: 2021-09-01
Contract Record ID: 57272823301 Term Reason: TERMINATION
Comments: DOES NOT HAVE DENTAL





Request ID: 195341 Status: COMPLETE
Request Date: 2021-12-31 Status Date: 2021-12-31
Member Name: MIA L YATES Member ID: 47558740701
Employer ID: LNB Termination Date: 2022-01-01
Contract Record ID: 47558740701 Term Reason: VOLUNTARY
Comments: Employee was never enrolled - entered into your system incorrectly.





Request ID: 195461 Status: COMPLETE
Request Date: 2022-01-01 Status Date: 2022-01-01
Member Name: SHAWN OSBORNE Member ID: 53161352101
Employer ID: TBX Termination Date: 2021-12-31
Contract Record ID: 53161352101 Term Reason: TERMINATION
Comments:





Request ID: 195481 Status: COMPLETE
Request Date: 2022-01-01 Status Date: 2022-01-01
Member Name: CHARLES A RAY Member ID: 88833724701
Employer ID: TBX Termination Date: 2021-12-31
Contract Record ID: 88833724701 Term Reason: TERMINATION
Comments:





Request ID: 195501 Status: COMPLETE
Request Date: 2022-01-01 Status Date: 2022-01-01
Member Name: KYLE SHESTACK Member ID: 14410199401
Employer ID: TBX Termination Date: 2021-12-31
Contract Record ID: 14410199401 Term Reason: TERMINATION
Comments:





Request ID: 196002 Status: COMPLETE
Request Date: 2022-01-04 Status Date: 2022-01-04
Member Name: NEVA THORN Member ID: 61697971301
Employer ID: CNT Termination Date: 2021-12-31
Contract Record ID: 61697971301 Term Reason: TERMINATION
Comments:





Request ID: 197043 Status: COMPLETE
Request Date: 2022-01-10 Status Date: 2022-01-10
Member Name: ERIC HOUGH Member ID: 53232445001
Employer ID: NEC Termination Date: 2021-12-31
Contract Record ID: 53232445001 Term Reason: VOLUNTARY
Comments:





Request ID: 197381 Status: COMPLETE
Request Date: 2022-01-10 Status Date: 2022-01-10
Member Name: MICHAEL SING Member ID: 85239410301
Employer ID: NEC Termination Date: 2022-01-03
Contract Record ID: 85239410301 Term Reason: VOLUNTARY
Comments:





Request ID: 199685 Status: COMPLETE
Request Date: 2022-01-25 Status Date: 2022-01-25
Member Name: ULRIC K BRADLEY Member ID: 09992393601
Employer ID: RCI Termination Date: 2021-12-23
Contract Record ID: 09992393601 Term Reason: VOLUNTARY
Comments:





Request ID: 200182 Status: COMPLETE
Request Date: 2022-01-27 Status Date: 2022-01-27
Member Name: NATALIE BAILEY Member ID: 86789665901
Employer ID: NEC Termination Date: 2022-01-20
Contract Record ID: 86789665901 Term Reason: VOLUNTARY
Comments:





Request ID: 200241 Status: COMPLETE
Request Date: 2022-01-27 Status Date: 2022-01-27
Member Name: ROBERT J MILLER Member ID: 64985384101
Employer ID: WCE Termination Date: 2022-01-10
Contract Record ID: 64985384101 Term Reason: TERMINATION
Comments:





Request ID: 201962 Status: COMPLETE
Request Date: 2022-02-02 Status Date: 2022-02-02
Member Name: ROBERT J MILLER Member ID: 64985384101
Employer ID: WCE Termination Date: 2022-01-10
Contract Record ID: 64985384101 Term Reason: VOLUNTARY
Comments:





Request ID: 202921 Status: COMPLETE
Request Date: 2022-02-07 Status Date: 2022-02-07
Member Name: WILLIAM D COPP Member ID: 68542907601
Employer ID: MESH Termination Date: 2022-02-05
Contract Record ID: 68542907601 Term Reason: TERMINATION
Comments:





Request ID: 203001 Status: COMPLETE
Request Date: 2022-02-07 Status Date: 2022-02-07
Member Name: MICHAEL SING Member ID: 85239410301
Employer ID: NEC Termination Date: 2022-01-31
Contract Record ID: 85239410301 Term Reason: INVOLUNTARY
Comments:





Request ID: 203601 Status: COMPLETE
Request Date: 2022-02-09 Status Date: 2022-02-09
Member Name: MARK ARNOLD Member ID: 90705643201
Employer ID: NEC Termination Date: 2022-01-30
Contract Record ID: 90705643201 Term Reason: VOLUNTARY
Comments:





Request ID: 203621 Status: COMPLETE
Request Date: 2022-02-09 Status Date: 2022-02-09
Member Name: BRITTEN SNOW Member ID: 23796979601
Employer ID: NEC Termination Date: 2022-01-30
Contract Record ID: 23796979601 Term Reason: VOLUNTARY
Comments:





Request ID: 203641 Status: COMPLETE
Request Date: 2022-02-09 Status Date: 2022-02-09
Member Name: KEVIN R BAILEY Member ID: 50762884301
Employer ID: NEC Termination Date: 2022-01-30
Contract Record ID: 50762884301 Term Reason: VOLUNTARY
Comments:





Request ID: 203661 Status: COMPLETE
Request Date: 2022-02-09 Status Date: 2022-02-09
Member Name: AMON L MAHON Member ID: 91746877601
Employer ID: NEC Termination Date: 2022-02-01
Contract Record ID: 91746877601 Term Reason: VOLUNTARY
Comments:





Request ID: 204201 Status: COMPLETE
Request Date: 2022-02-11 Status Date: 2022-02-11
Member Name: KIERRE SULLIVAN Member ID: 96817274001
Employer ID: DNA Termination Date: 2022-02-28
Contract Record ID: 96817274001 Term Reason: VOLUNTARY
Comments:





Request ID: 204281 Status: COMPLETE
Request Date: 2022-02-14 Status Date: 2022-02-14
Member Name: LEESA B HAILE Member ID: 23156818801
Employer ID: CNT Termination Date: 2022-02-28
Contract Record ID: 23156818801 Term Reason: TERMINATION
Comments: Resigned





Request ID: 204701 Status: COMPLETE
Request Date: 2022-02-15 Status Date: 2022-02-15
Member Name: TIMOTHY BARWICK Member ID: 52944434501
Employer ID: NEC Termination Date: 2022-02-12
Contract Record ID: 52944434501 Term Reason: VOLUNTARY
Comments:





Request ID: 204821 Status: COMPLETE
Request Date: 2022-02-16 Status Date: 2022-02-16
Member Name: MYRON LAMONT LOGAN Member ID: 70940182101
Employer ID: BRECK Termination Date: 2022-02-28
Contract Record ID: 70940182101 Term Reason: INVOLUNTARY
Comments: please mail COBRA





Request ID: 204822 Status: COMPLETE
Request Date: 2022-02-16 Status Date: 2022-02-16
Member Name: MYRON LAMONT LOGAN Member ID: 70940182101
Employer ID: BRECK Termination Date: 2022-02-28
Contract Record ID: 70940182101 Term Reason: INVOLUNTARY
Comments: please mail COBRA





Request ID: 204921 Status: COMPLETE
Request Date: 2022-02-16 Status Date: 2022-02-16
Member Name: ALEX HADAWAY Member ID: 76095497501
Employer ID: AP Termination Date: 2022-02-03
Contract Record ID: 76095497501 Term Reason: TERMINATION
Comments: Employee resigned effective 02-03-2022.





Request ID: 205021 Status: COMPLETE
Request Date: 2022-02-16 Status Date: 2022-02-16
Member Name: PEDRO ARRIAZA Member ID: 10086998201
Employer ID: YHP00158 Termination Date: 2022-02-04
Contract Record ID: 10086998201 Term Reason: TERMINATION
Comments:





Request ID: 205101 Status: COMPLETE
Request Date: 2022-02-17 Status Date: 2022-02-17
Member Name: JARED RAPIER Member ID: 55430298301
Employer ID: SFM Termination Date: 2022-02-28
Contract Record ID: 55430298301 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 205102 Status: COMPLETE
Request Date: 2022-02-17 Status Date: 2022-02-17
Member Name: JOANNE ELAINE GRAHAM Member ID: 03950642001
Employer ID: SFM Termination Date: 2022-02-28
Contract Record ID: 03950642001 Term Reason: TERMINATION
Comments:





Request ID: 205103 Status: COMPLETE
Request Date: 2022-02-17 Status Date: 2022-02-17
Member Name: AUBREY KING Member ID: 52131767201
Employer ID: SFM Termination Date: 2022-02-28
Contract Record ID: 52131767201 Term Reason: TERMINATION
Comments:





Request ID: 205381 Status: COMPLETE
Request Date: 2022-02-18 Status Date: 2022-02-18
Member Name: JOSEPHINE HERNANDEZ Member ID: 01054187901
Employer ID: BRANDY Termination Date: 2022-02-04
Contract Record ID: 01054187901 Term Reason: DECEASED
Comments:





Request ID: 205841 Status: COMPLETE
Request Date: 2022-02-22 Status Date: 2022-02-22
Member Name: RICKY NOLAN PICKENS Member ID: 03919206801
Employer ID: BROSOL Termination Date: 2022-02-28
Contract Record ID: 03919206801 Term Reason: TERMINATION
Comments:





Request ID: 206161 Status: COMPLETE
Request Date: 2022-02-23 Status Date: 2022-02-23
Member Name: SHAUN WOODY Member ID: 69087315601
Employer ID: NEC Termination Date: 2022-02-16
Contract Record ID: 69087315601 Term Reason: INVOLUNTARY
Comments:





Request ID: 206441 Status: COMPLETE
Request Date: 2022-02-24 Status Date: 2022-02-24
Member Name: ALICIA LINGER Member ID: 02451455101
Employer ID: TPCH Termination Date: 2022-02-09
Contract Record ID: 02451455101 Term Reason: VOLUNTARY
Comments:





Request ID: 206485 Status: COMPLETE
Request Date: 2022-02-25 Status Date: 2022-02-25
Member Name: KIMBERLY ALDRIDGE Member ID: 33045660601
Employer ID: COS Termination Date: 2022-02-11
Contract Record ID: 33045660601 Term Reason: TERMINATION
Comments:





Request ID: 206641 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: STERLING NAMAN RAMOS Member ID: 87944116801
Employer ID: WCE Termination Date: 2022-02-25
Contract Record ID: 87944116801 Term Reason: VOLUNTARY
Comments:





Request ID: 206681 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: TERRY ANDERSON III Member ID: 18135383801
Employer ID: MESH Termination Date: 2022-02-14
Contract Record ID: 18135383801 Term Reason: TERMINATION
Comments:





Request ID: 206761 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: CRYSTAL LOUISE SPANNKNEBEL Member ID: 92384542901
Employer ID: LNB Termination Date: 2022-02-28
Contract Record ID: 92384542901 Term Reason: TERMINATION
Comments: Employee ended employment on 2/19/22





Request ID: 206801 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: CHARLES B SPANNKNEBEL Member ID: 92384542902
Employer ID: LNB Termination Date: 2022-02-28
Contract Record ID: 92384542901 Term Reason: TERMINATION
Comments: Wife terminated employment on 2/19/22.





Request ID: 207022 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: ROBERT J MILLER Member ID: 64985384101
Employer ID: WCE Termination Date: 2022-01-10
Contract Record ID: 64985384101 Term Reason: TERMINATION
Comments:





Request ID: 207023 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: MAURO ARREDONDO JR Member ID: 74374016301
Employer ID: APRES Termination Date: 2022-02-28
Contract Record ID: 74374016301 Term Reason: INVOLUNTARY
Comments:





Request ID: 207024 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: DANIEL PEREZ Member ID: 42399027601
Employer ID: APRES Termination Date: 2022-02-28
Contract Record ID: 42399027601 Term Reason: INVOLUNTARY
Comments:





Request ID: 207025 Status: COMPLETE
Request Date: 2022-02-28 Status Date: 2022-02-28
Member Name: LAURA HEROD Member ID: 62179721501
Employer ID: APRES Termination Date: 2022-03-01
Contract Record ID: 62179721501 Term Reason: VOLUNTARY
Comments:





Request ID: 207061 Status: COMPLETE
Request Date: 2022-03-01 Status Date: 2022-03-01
Member Name: NOEL DIGGINS Member ID: 12324321201
Employer ID: PELTZ Termination Date: 2021-02-28
Contract Record ID: 12324321201 Term Reason: VOLUNTARY
Comments:





Request ID: 207163 Status: COMPLETE
Request Date: 2022-03-01 Status Date: 2022-03-01
Member Name: JADA PLYLER Member ID: 74700370801
Employer ID: YHP00015 Termination Date: 2022-02-28
Contract Record ID: 74700370801 Term Reason: TERMINATION
Comments:





Request ID: 207201 Status: COMPLETE
Request Date: 2022-03-01 Status Date: 2022-03-01
Member Name: STERLING NAMAN RAMOS Member ID: 87944116801
Employer ID: WCE Termination Date: 2022-02-25
Contract Record ID: 87944116801 Term Reason: TERMINATION
Comments:





Request ID: 207223 Status: COMPLETE
Request Date: 2022-03-01 Status Date: 2022-03-01
Member Name: ROBERT MOORE Member ID: 97638053201
Employer ID: NEC Termination Date: 2022-02-28
Contract Record ID: 97638053201 Term Reason: TERMINATION
Comments:





Request ID: 207224 Status: COMPLETE
Request Date: 2022-03-01 Status Date: 2022-03-01
Member Name: TIMOTHY BARWICK Member ID: 52944434501
Employer ID: NEC Termination Date: 2022-02-28
Contract Record ID: 52944434501 Term Reason: VOLUNTARY
Comments:





Request ID: 207561 Status: COMPLETE
Request Date: 2022-03-02 Status Date: 2022-03-02
Member Name: JOHN BARBALAS Member ID: 22884545001
Employer ID: BROSOL Termination Date: 2022-03-01
Contract Record ID: 22884545001 Term Reason: VOLUNTARY
Comments: Retired and now enrolled in Medicaid.





Request ID: 207688 Status: COMPLETE
Request Date: 2022-03-02 Status Date: 2022-03-02
Member Name: CARMEL WOLFE Member ID: 34329466301
Employer ID: YHP00158 Termination Date: 2022-03-01
Contract Record ID: 34329466301 Term Reason: TERMINATION
Comments:





Request ID: 207713 Status: COMPLETE
Request Date: 2022-03-03 Status Date: 2022-03-03
Member Name: FELECIA MOSQUEDA Member ID: 69147782401
Employer ID: BRECK Termination Date: 2022-03-31
Contract Record ID: 69147782401 Term Reason: TERMINATION
Comments: please mail COBRA





Request ID: 207824 Status: COMPLETE
Request Date: 2022-03-04 Status Date: 2022-03-04
Member Name: ALISHA M ORNELAS Member ID: 42954806501
Employer ID: SFM Termination Date: 2022-02-28
Contract Record ID: 42954806501 Term Reason: TERMINATION
Comments:





Request ID: 207825 Status: COMPLETE
Request Date: 2022-03-04 Status Date: 2022-03-04
Member Name: DEANNA MEHLHOFF Member ID: 13608037401
Employer ID: SFM Termination Date: 2022-02-28
Contract Record ID: 13608037401 Term Reason: TERMINATION
Comments:





Request ID: 207871 Status: COMPLETE
Request Date: 2022-03-07 Status Date: 2022-03-07
Member Name: LISA SUMMERS Member ID: 83674350001
Employer ID: YHP00332 Termination Date: 2022-03-07
Contract Record ID: 83674350001 Term Reason: TERMINATION
Comments:





Request ID: 207905 Status: COMPLETE
Request Date: 2022-03-08 Status Date: 2022-03-08
Member Name: HOLLIS WOOD Member ID: 80850545801
Employer ID: COS Termination Date: 2022-03-03
Contract Record ID: 80850545801 Term Reason: TERMINATION
Comments: Employee last day of work was on 3/3/2022





Request ID: 207906 Status: COMPLETE
Request Date: 2022-03-08 Status Date: 2022-03-08
Member Name: SCOTT CHRISTOPHER MARTIN Member ID: 18741773701
Employer ID: COS Termination Date: 2022-03-04
Contract Record ID: 18741773701 Term Reason: TERMINATION
Comments: Employee last day worked was on 03/04/2022





Request ID: 207907 Status: COMPLETE
Request Date: 2022-03-08 Status Date: 2022-03-08
Member Name: NICOLE FLOYD Member ID: 46029237401
Employer ID: COS Termination Date: 2022-03-11
Contract Record ID: 46029237401 Term Reason: TERMINATION
Comments: Employee final day is on 03/11/2022





Request ID: 207909 Status: COMPLETE
Request Date: 2022-03-08 Status Date: 2022-03-08
Member Name: JACHEIN STEWART Member ID: 06578706001
Employer ID: DAVIS Termination Date: 2022-03-31
Contract Record ID: 06578706001 Term Reason: VOLUNTARY
Comments: Resigned 3/11





Request ID: 207915 Status: COMPLETE
Request Date: 2022-03-08 Status Date: 2022-03-08
Member Name: KRISTINA MARQUEZ Member ID: 45091425401
Employer ID: BRECK Termination Date: 2022-03-31
Contract Record ID: 45091425401 Term Reason: TERMINATION
Comments: please send COBRA





Request ID: 207945 Status: COMPLETE
Request Date: 2022-03-09 Status Date: 2022-03-09
Member Name: STEPHANIE CELAYA Member ID: 93103807301
Employer ID: AZOPT Termination Date: 2022-02-28
Contract Record ID: 93103807301 Term Reason: VOLUNTARY
Comments:





Request ID: 207948 Status: COMPLETE
Request Date: 2022-03-09 Status Date: 2022-03-09
Member Name: DANIEL MARTIN Member ID: 28310647301
Employer ID: DNA Termination Date: 2022-03-31
Contract Record ID: 28310647301 Term Reason: VOLUNTARY
Comments:





Request ID: 207995 Status: COMPLETE
Request Date: 2022-03-11 Status Date: 2022-03-11
Member Name: JAMES E GEE Member ID: 76826292601
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 76826292601 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 208004 Status: COMPLETE
Request Date: 2022-03-12 Status Date: 2022-03-12
Member Name: MICHELLE PADDOCK Member ID: 17384075701
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 17384075701 Term Reason: VOLUNTARY
Comments:





Request ID: 208005 Status: COMPLETE
Request Date: 2022-03-12 Status Date: 2022-03-12
Member Name: IMEE MARIE N SUPERALES Member ID: 17418053901
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 17418053901 Term Reason: VOLUNTARY
Comments:





Request ID: 208039 Status: COMPLETE
Request Date: 2022-03-14 Status Date: 2022-03-14
Member Name: VERONICA SUSAN SULLIVAN Member ID: 78051691901
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 78051691901 Term Reason: VOLUNTARY
Comments:





Request ID: 208062 Status: COMPLETE
Request Date: 2022-03-15 Status Date: 2022-03-15
Member Name: KEVIN JOHNSON Member ID: 28079776701
Employer ID: PELTZ Termination Date: 2022-03-31
Contract Record ID: 28079776701 Term Reason: TERMINATION
Comments:





Request ID: 208074 Status: COMPLETE
Request Date: 2022-03-15 Status Date: 2022-03-15
Member Name: BRIAN CHRISTOPHER MOSS Member ID: 35482742301
Employer ID: YHP00015 Termination Date: 2022-02-07
Contract Record ID: 35482742301 Term Reason: TERMINATION
Comments:





Request ID: 208121 Status: COMPLETE
Request Date: 2022-03-15 Status Date: 2022-03-15
Member Name: ALEXIS MICHELLE MUSICK Member ID: 56583019701
Employer ID: YHP00331 Termination Date: 2022-03-15
Contract Record ID: 56583019701 Term Reason: TERMINATION
Comments:





Request ID: 208241 Status: COMPLETE
Request Date: 2022-03-15 Status Date: 2022-03-15
Member Name: LUIS OVALLE Member ID: 53936469301
Employer ID: APRES Termination Date: 2022-03-11
Contract Record ID: 53936469301 Term Reason: INVOLUNTARY
Comments:





Request ID: 208341 Status: COMPLETE
Request Date: 2022-03-16 Status Date: 2022-03-16
Member Name: JACOB MCGOUGH Member ID: 99624537401
Employer ID: NEC Termination Date: 2022-03-31
Contract Record ID: 99624537401 Term Reason: VOLUNTARY
Comments:





Request ID: 208361 Status: COMPLETE
Request Date: 2022-03-16 Status Date: 2022-03-16
Member Name: TERRY ARCHIBALD Member ID: 15004588001
Employer ID: NEC Termination Date: 2022-02-28
Contract Record ID: 15004588001 Term Reason: VOLUNTARY
Comments:





Request ID: 208381 Status: COMPLETE
Request Date: 2022-03-16 Status Date: 2022-03-16
Member Name: BRADLEY MILLER Member ID: 67048347901
Employer ID: NEC Termination Date: 2022-03-31
Contract Record ID: 67048347901 Term Reason: VOLUNTARY
Comments:





Request ID: 209144 Status: COMPLETE
Request Date: 2022-03-17 Status Date: 2022-03-17
Member Name: LORI EDWARDS Member ID: 00895060101
Employer ID: YHP00158 Termination Date: 2022-03-31
Contract Record ID: 00895060101 Term Reason: TERMINATION
Comments: Employee left the company.





Request ID: 209182 Status: COMPLETE
Request Date: 2022-03-17 Status Date: 2022-03-17
Member Name: DANEA THOMAS GORHAM Member ID: 55657334201
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 55657334201 Term Reason: TERMINATION
Comments:





Request ID: 209241 Status: COMPLETE
Request Date: 2022-03-18 Status Date: 2022-03-18
Member Name: DAMIEN COLLINGS Member ID: 67088454001
Employer ID: BRANDY Termination Date: 2022-03-31
Contract Record ID: 67088454001 Term Reason: TERMINATION
Comments:





Request ID: 209501 Status: COMPLETE
Request Date: 2022-03-21 Status Date: 2022-03-21
Member Name: JESSICA ANDERSON Member ID: 24466049501
Employer ID: YHP00116 Termination Date: 2022-02-22
Contract Record ID: 24466049501 Term Reason: VOLUNTARY
Comments:





Request ID: 209721 Status: COMPLETE
Request Date: 2022-03-22 Status Date: 2022-03-22
Member Name: KASSI FUGETT Member ID: 88549820001
Employer ID: CNT Termination Date: 2022-03-31
Contract Record ID: 88549820001 Term Reason: TERMINATION
Comments:





Request ID: 209741 Status: COMPLETE
Request Date: 2022-03-22 Status Date: 2022-03-22
Member Name: CRYSTAL FASHAUER Member ID: 65014089301
Employer ID: CARBON Termination Date: 2022-02-12
Contract Record ID: 65014089301 Term Reason: VOLUNTARY
Comments: employee resigned full time status





Request ID: 209761 Status: COMPLETE
Request Date: 2022-03-22 Status Date: 2022-03-22
Member Name: MALLORY J GRIMES Member ID: 89963583201
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 89963583201 Term Reason: TERMINATION
Comments:





Request ID: 210143 Status: COMPLETE
Request Date: 2022-03-23 Status Date: 2022-03-23
Member Name: JOSHUA PENAS Member ID: 26472846401
Employer ID: DNA Termination Date: 2022-03-11
Contract Record ID: 26472846401 Term Reason: VOLUNTARY
Comments: Please terminate medical plan effective 3/31/2022. Thank you.





Request ID: 210241 Status: COMPLETE
Request Date: 2022-03-23 Status Date: 2022-03-23
Member Name: TRA W WALTERS Member ID: 14692182601
Employer ID: BROSOL Termination Date: 2022-03-31
Contract Record ID: 14692182601 Term Reason: VOLUNTARY
Comments:





Request ID: 210261 Status: COMPLETE
Request Date: 2022-03-23 Status Date: 2022-03-23
Member Name: MARQUIZ D STEVENSON Member ID: 91823289201
Employer ID: BROSOL Termination Date: 2022-03-31
Contract Record ID: 91823289201 Term Reason: VOLUNTARY
Comments:





Request ID: 210301 Status: COMPLETE
Request Date: 2022-03-23 Status Date: 2022-03-23
Member Name: AUTEMN PAINTER Member ID: 25080060001
Employer ID: WCE Termination Date: 2022-03-22
Contract Record ID: 25080060001 Term Reason: TERMINATION
Comments:





Request ID: 210521 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: RICKETA BLACKMAN Member ID: 13463628401
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 13463628401 Term Reason: TERMINATION
Comments:





Request ID: 210522 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: ROSE J FANNING Member ID: 27687898601
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 27687898601 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 210523 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: JOHN BUTERA Member ID: 06944744301
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 06944744301 Term Reason: TERMINATION
Comments:





Request ID: 210524 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: REBECCA JISUNG YU Member ID: 43733897401
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 43733897401 Term Reason: TERMINATION
Comments:





Request ID: 210525 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: VALERIE ROSE MARPLE Member ID: 45721206001
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 45721206001 Term Reason: TERMINATION
Comments:





Request ID: 210901 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: FLORITA C CARIASO Member ID: 85928743301
Employer ID: TPCH Termination Date: 2022-02-28
Contract Record ID: 85928743301 Term Reason: VOLUNTARY
Comments:





Request ID: 210903 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: DRENDA R WILLIAMS Member ID: 63361688401
Employer ID: TPCH Termination Date: 2022-03-03
Contract Record ID: 63361688401 Term Reason: VOLUNTARY
Comments:





Request ID: 210904 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: KASSI FUGETT Member ID: 88549820001
Employer ID: CNT Termination Date: 2022-03-31
Contract Record ID: 88549820001 Term Reason: TERMINATION
Comments:





Request ID: 210906 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: JASMINE DECOTEAU Member ID: 07300352901
Employer ID: TPCH Termination Date: 2022-03-17
Contract Record ID: 07300352901 Term Reason: VOLUNTARY
Comments: TERMINATION





Request ID: 210907 Status: COMPLETE
Request Date: 2022-03-24 Status Date: 2022-03-24
Member Name: SIERRA STRANDBERG Member ID: 74866956101
Employer ID: TPCH Termination Date: 2022-03-20
Contract Record ID: 74866956101 Term Reason: VOLUNTARY
Comments: TERMINATION





Request ID: 211061 Status: COMPLETE
Request Date: 2022-03-25 Status Date: 2022-03-25
Member Name: EDWARD KEE Member ID: 09704884701
Employer ID: NEC Termination Date: 2022-03-13
Contract Record ID: 09704884701 Term Reason: VOLUNTARY
Comments:





Request ID: 211081 Status: COMPLETE
Request Date: 2022-03-25 Status Date: 2022-03-25
Member Name: JEREMY SIDEBOTOM Member ID: 07596892801
Employer ID: NEC Termination Date: 2022-03-04
Contract Record ID: 07596892801 Term Reason: VOLUNTARY
Comments:





Request ID: 211101 Status: COMPLETE
Request Date: 2022-03-25 Status Date: 2022-03-25
Member Name: CHRISTOPHER A WORKMAN Member ID: 41239255201
Employer ID: NEC Termination Date: 2022-03-07
Contract Record ID: 41239255201 Term Reason: VOLUNTARY
Comments:





Request ID: 211141 Status: COMPLETE
Request Date: 2022-03-25 Status Date: 2022-03-25
Member Name: JOSEPH YOUNG Member ID: 91790943001
Employer ID: NEC Termination Date: 2022-03-07
Contract Record ID: 91790943001 Term Reason: VOLUNTARY
Comments:





Request ID: 211381 Status: COMPLETE
Request Date: 2022-03-28 Status Date: 2022-03-28
Member Name: EDWARD SHAEFFER Member ID: 42302865101
Employer ID: YHP00126 Termination Date: 2022-03-27
Contract Record ID: 42302865101 Term Reason: VOLUNTARY
Comments: Quit without notice





Request ID: 211387 Status: COMPLETE
Request Date: 2022-03-28 Status Date: 2022-03-28
Member Name: GREGORY WITTHOFT Member ID: 93030266601
Employer ID: DNA Termination Date: 2022-03-25
Contract Record ID: 93030266601 Term Reason: VOLUNTARY
Comments: Please terminate coverage eff last day of month - 3/31/2022. Thank you.





Request ID: 211390 Status: COMPLETE
Request Date: 2022-03-28 Status Date: 2022-03-28
Member Name: JENETTE TORRES Member ID: 50671597201
Employer ID: ADVRX Termination Date: 2022-03-11
Contract Record ID: 50671597201 Term Reason: TERMINATION
Comments:





Request ID: 211401 Status: COMPLETE
Request Date: 2022-03-29 Status Date: 2022-03-29
Member Name: CHEYANNE WOLPERT Member ID: 65679132601
Employer ID: EASYLVNG Termination Date: 2022-03-25
Contract Record ID: 65679132601 Term Reason: VOLUNTARY
Comments:





Request ID: 211414 Status: COMPLETE
Request Date: 2022-03-29 Status Date: 2022-03-29
Member Name: KOELTON FENTON Member ID: 67831857201
Employer ID: EASYLVNG Termination Date: 2022-03-31
Contract Record ID: 67831857201 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 211420 Status: COMPLETE
Request Date: 2022-03-29 Status Date: 2022-03-29
Member Name: PAUL HEFFERNAN Member ID: 48948741001
Employer ID: WCE Termination Date: 2022-03-30
Contract Record ID: 48948741001 Term Reason: TERMINATION
Comments:





Request ID: 211422 Status: COMPLETE
Request Date: 2022-03-30 Status Date: 2022-03-30
Member Name: MARY VIOLA HAWKINS Member ID: 51789175901
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 51789175901 Term Reason: VOLUNTARY
Comments:





Request ID: 211423 Status: COMPLETE
Request Date: 2022-03-30 Status Date: 2022-03-30
Member Name: MARY VIOLA HAWKINS Member ID: 51789175901
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 51789175901 Term Reason: TERMINATION
Comments: Employee retired on 3/15/22





Request ID: 211424 Status: COMPLETE
Request Date: 2022-03-30 Status Date: 2022-03-30
Member Name: DEBRA H MUDD Member ID: 95765093901
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 95765093901 Term Reason: TERMINATION
Comments: Employee retired 3/25/22





Request ID: 211427 Status: COMPLETE
Request Date: 2022-03-30 Status Date: 2022-03-30
Member Name: JOHN M VELDHUIS Member ID: 40704690301
Employer ID: BRECKS Termination Date: 2022-03-31
Contract Record ID: 40704690301 Term Reason: TERMINATION
Comments: Please send COBRA





Request ID: 211438 Status: COMPLETE
Request Date: 2022-03-30 Status Date: 2022-03-30
Member Name: CHARLES BELANGER Member ID: 29451833901
Employer ID: TPCH Termination Date: 2022-03-31
Contract Record ID: 29451833901 Term Reason: INVOLUNTARY
Comments:





Request ID: 211439 Status: COMPLETE
Request Date: 2022-03-30 Status Date: 2022-03-30
Member Name: CHRISTINE BELANGER Member ID: 29451833902
Employer ID: TPCH Termination Date: 2022-03-31
Contract Record ID: 29451833901 Term Reason: VOLUNTARY
Comments:





Request ID: 211461 Status: COMPLETE
Request Date: 2022-03-31 Status Date: 2022-03-31
Member Name: PAUL HEFFERNAN Member ID: 48948741001
Employer ID: WCE Termination Date: 2022-03-30
Contract Record ID: 48948741001 Term Reason: VOLUNTARY
Comments:





Request ID: 211801 Status: COMPLETE
Request Date: 2022-04-01 Status Date: 2022-04-01
Member Name: MICHELLE PADDOCK Member ID: 17384075701
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 17384075701 Term Reason: TERMINATION
Comments:





Request ID: 211821 Status: COMPLETE
Request Date: 2022-04-01 Status Date: 2022-04-01
Member Name: LEHUA MCMILLAN Member ID: 45253576401
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 45253576401 Term Reason: TERMINATION
Comments:





Request ID: 211822 Status: COMPLETE
Request Date: 2022-04-01 Status Date: 2022-04-01
Member Name: NANCY MARIE PALMER Member ID: 49634325101
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 49634325101 Term Reason: TERMINATION
Comments:





Request ID: 211901 Status: COMPLETE
Request Date: 2022-04-02 Status Date: 2022-04-02
Member Name: TIMOTHY MUDD Member ID: 95765093902
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 95765093901 Term Reason: TERMINATION
Comments: Debbie Mudd retired and he lost dental coverage as a spouse. Cobra should be notified.





Request ID: 211921 Status: COMPLETE
Request Date: 2022-04-02 Status Date: 2022-04-02
Member Name: BARBARA R LYON Member ID: 41108845301
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 41108845301 Term Reason: TERMINATION
Comments: Retired 3/31/22





Request ID: 211941 Status: COMPLETE
Request Date: 2022-04-02 Status Date: 2022-04-02
Member Name: BARBARA R LYON Member ID: 41108845301
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 41108845301 Term Reason: TERMINATION
Comments: Retired 3/31/22





Request ID: 211961 Status: COMPLETE
Request Date: 2022-04-02 Status Date: 2022-04-02
Member Name: WILLIAM H LYON Member ID: 41108845302
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 41108845301 Term Reason: TERMINATION
Comments: Wife Barbara retired 3/31/22





Request ID: 211981 Status: COMPLETE
Request Date: 2022-04-02 Status Date: 2022-04-02
Member Name: CASSIDY L BUTLER Member ID: 26579758001
Employer ID: LNB Termination Date: 2022-03-31
Contract Record ID: 26579758001 Term Reason: TERMINATION
Comments: Quit 3/30/22





Request ID: 212121 Status: COMPLETE
Request Date: 2022-04-04 Status Date: 2022-04-04
Member Name: MARCUS REEVES Member ID: 43697459001
Employer ID: YHP00134 Termination Date: 2022-03-25
Contract Record ID: 43697459001 Term Reason: TERMINATION
Comments: EMPLOYEE RESIGNED





Request ID: 212141 Status: COMPLETE
Request Date: 2022-04-04 Status Date: 2022-04-04
Member Name: ALYSSA MICHELLE PENA Member ID: 04289466001
Employer ID: YHP00134 Termination Date: 2022-03-27
Contract Record ID: 04289466001 Term Reason: TERMINATION
Comments: EMPLOYEE QUIT





Request ID: 212861 Status: COMPLETE
Request Date: 2022-04-05 Status Date: 2022-04-05
Member Name: DANIEL B FORCE Member ID: 94688011001
Employer ID: MESH Termination Date: 2022-03-31
Contract Record ID: 94688011001 Term Reason: VOLUNTARY
Comments:





Request ID: 213021 Status: COMPLETE
Request Date: 2022-04-05 Status Date: 2022-04-05
Member Name: JOSHUA REINA Member ID: 77269562702
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 77269562701 Term Reason: VOLUNTARY
Comments: Has other coverage





Request ID: 213161 Status: COMPLETE
Request Date: 2022-04-06 Status Date: 2022-04-06
Member Name: MICHELLE BARCLAY Member ID: 22671512701
Employer ID: DNA Termination Date: 2022-04-01
Contract Record ID: 22671512701 Term Reason: VOLUNTARY
Comments:





Request ID: 213181 Status: COMPLETE
Request Date: 2022-04-06 Status Date: 2022-04-06
Member Name: MICHELLE BARCLAY Member ID: 22671512701
Employer ID: DNA Termination Date: 2022-04-01
Contract Record ID: 22671512701 Term Reason: VOLUNTARY
Comments: CLARIFICATION: Employment term date is 4/1/2022; Coverage end date is 4/30/2022; first day of no coverage is 5/1/2022.





Request ID: 213261 Status: COMPLETE
Request Date: 2022-04-06 Status Date: 2022-04-06
Member Name: CRYSTAL MCFARLAND Member ID: 30646401601
Employer ID: YHP00116 Termination Date: 2022-03-29
Contract Record ID: 30646401601 Term Reason: VOLUNTARY
Comments:





Request ID: 213381 Status: COMPLETE
Request Date: 2022-04-07 Status Date: 2022-04-07
Member Name: CLAYTON DEAN CAMPBELL Member ID: 28490377201
Employer ID: YHP00134 Termination Date: 2022-03-31
Contract Record ID: 28490377201 Term Reason: TERMINATION
Comments: EMPLOYMENT TERMINATED





Request ID: 213561 Status: COMPLETE
Request Date: 2022-04-07 Status Date: 2022-04-07
Member Name: DANIEL ESCOBAR Member ID: 95615679501
Employer ID: DNA Termination Date: 2022-05-01
Contract Record ID: 95615679501 Term Reason: VOLUNTARY
Comments: Employment termination is 4/6/2022. Last day of coverage is 4/30/2022. First Day of no coverage is 5/1/2022.





Request ID: 213641 Status: COMPLETE
Request Date: 2022-04-07 Status Date: 2022-04-07
Member Name: GEORGETTE SHAWNA WRIGHT Member ID: 05003504101
Employer ID: YHP00015 Termination Date: 2022-03-05
Contract Record ID: 05003504101 Term Reason: TERMINATION
Comments:





Request ID: 213661 Status: COMPLETE
Request Date: 2022-04-07 Status Date: 2022-04-07
Member Name: MEDHAT H SANAD Member ID: 13561816401
Employer ID: TPCH Termination Date: 2022-04-30
Contract Record ID: 13561816401 Term Reason: TERMINATION
Comments:





Request ID: 213821 Status: COMPLETE
Request Date: 2022-04-08 Status Date: 2022-04-08
Member Name: DANIEL S BEROLO Member ID: 00536420001
Employer ID: WCE Termination Date: 2022-04-30
Contract Record ID: 00536420001 Term Reason: VOLUNTARY
Comments:





Request ID: 214001 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: JAMES B HOWE Member ID: 89947871501
Employer ID: MESH Termination Date: 2022-04-04
Contract Record ID: 89947871501 Term Reason: TERMINATION
Comments:





Request ID: 214061 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: NANCY LEES Member ID: 43092070301
Employer ID: NEC Termination Date: 2022-03-27
Contract Record ID: 43092070301 Term Reason: VOLUNTARY
Comments:





Request ID: 214062 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: CHRISTOPHER LAGOS Member ID: 35787670601
Employer ID: NEC Termination Date: 2022-03-21
Contract Record ID: 35787670601 Term Reason: VOLUNTARY
Comments:





Request ID: 214063 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: BRANDON BLAIZE Member ID: 92555590401
Employer ID: NEC Termination Date: 2022-03-31
Contract Record ID: 92555590401 Term Reason: VOLUNTARY
Comments:





Request ID: 214064 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: JOSEPH D PATRICK Member ID: 54702929301
Employer ID: NEC Termination Date: 2022-03-25
Contract Record ID: 54702929301 Term Reason: VOLUNTARY
Comments:





Request ID: 214065 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: VICTOR DURAN Member ID: 80052430701
Employer ID: NEC Termination Date: 2022-03-26
Contract Record ID: 80052430701 Term Reason: VOLUNTARY
Comments:





Request ID: 214066 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: MATTHEW TRAPP Member ID: 28900064701
Employer ID: NEC Termination Date: 2022-03-30
Contract Record ID: 28900064701 Term Reason: VOLUNTARY
Comments:





Request ID: 214067 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: TROY DAFFRON Member ID: 80691812301
Employer ID: NEC Termination Date: 2022-03-25
Contract Record ID: 80691812301 Term Reason: VOLUNTARY
Comments:





Request ID: 214068 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: BRANDON DECOURSEY Member ID: 01582930201
Employer ID: NEC Termination Date: 2022-03-19
Contract Record ID: 01582930201 Term Reason: INVOLUNTARY
Comments:





Request ID: 214181 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: ANGELA ALEXANDER Member ID: 46083400501
Employer ID: BRANDY Termination Date: 2022-03-31
Contract Record ID: 46083400501 Term Reason: TERMINATION
Comments:





Request ID: 214221 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: LLOYD WIX Member ID: 78146507201
Employer ID: NEC Termination Date: 2022-04-04
Contract Record ID: 78146507201 Term Reason: VOLUNTARY
Comments:





Request ID: 214222 Status: COMPLETE
Request Date: 2022-04-11 Status Date: 2022-04-11
Member Name: AMON L MAHON Member ID: 91746877601
Employer ID: NEC Termination Date: 2022-04-01
Contract Record ID: 91746877601 Term Reason: VOLUNTARY
Comments:





Request ID: 214421 Status: COMPLETE
Request Date: 2022-04-12 Status Date: 2022-04-12
Member Name: HADEN BRISTOL Member ID: 23042703601
Employer ID: NVMECH Termination Date: 2022-04-01
Contract Record ID: 23042703601 Term Reason: TERMINATION
Comments:





Request ID: 214461 Status: COMPLETE
Request Date: 2022-04-12 Status Date: 2022-04-12
Member Name: RANDAL CROWDER Member ID: 01163478301
Employer ID: NVMECH Termination Date: 2022-05-01
Contract Record ID: 01163478301 Term Reason: VOLUNTARY
Comments:





Request ID: 214541 Status: COMPLETE
Request Date: 2022-04-12 Status Date: 2022-04-12
Member Name: KYLE SHESTACK Member ID: 14410199401
Employer ID: TBX Termination Date: 2022-02-28
Contract Record ID: 14410199401 Term Reason: NON PAYMENT OF PREMIUMS
Comments: Employee Termed from COBRA coverage effective 02.28.22 per Ameriflex





Request ID: 214701 Status: COMPLETE
Request Date: 2022-04-12 Status Date: 2022-04-12
Member Name: IAN M LARSON Member ID: 82708286001
Employer ID: AZOPT Termination Date: 2022-04-30
Contract Record ID: 82708286001 Term Reason: VOLUNTARY
Comments:





Request ID: 214702 Status: COMPLETE
Request Date: 2022-04-12 Status Date: 2022-04-12
Member Name: IAN M LARSON Member ID: 82708286001
Employer ID: AZOPT Termination Date: 2022-04-30
Contract Record ID: 82708286001 Term Reason: VOLUNTARY
Comments:





Request ID: 214961 Status: COMPLETE
Request Date: 2022-04-13 Status Date: 2022-04-13
Member Name: AIDAN PETERSON Member ID: 59990384301
Employer ID: NEC Termination Date: 2022-03-31
Contract Record ID: 59990384301 Term Reason: VOLUNTARY
Comments:





Request ID: 215041 Status: COMPLETE
Request Date: 2022-04-13 Status Date: 2022-04-13
Member Name: LESLIE RONNET GUMBS Member ID: 48233127101
Employer ID: DNA Termination Date: 2022-04-13
Contract Record ID: 48233127101 Term Reason: VOLUNTARY
Comments: This employee has voluntarily terminated employment on 4/13/2022 - prior to benefit effective date of 5/1/2022. Please terminate benefits 4/30/2022. If you have any questions, please contact me. Thank you. Kind regards, Dawn Broderick Eligibility Specialist - Employee Benefits Presidio 55 Shuman Blvd. Suite 900 Naperville, IL 60563 D 630.524.6122 F 630.524.6123 E dbroderick@presidiogrp.com www.Presidiogrp.com





Request ID: 215521 Status: COMPLETE
Request Date: 2022-04-14 Status Date: 2022-04-14
Member Name: RICKETA BLACKMAN Member ID: 13463628401
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 13463628401 Term Reason: TERMINATION
Comments:





Request ID: 215581 Status: COMPLETE
Request Date: 2022-04-15 Status Date: 2022-04-15
Member Name: JOEL M BAYLE Member ID: 03493883501
Employer ID: MESH Termination Date: 2022-04-15
Contract Record ID: 03493883501 Term Reason: TERMINATION
Comments: employee quit for another job.





Request ID: 215901 Status: COMPLETE
Request Date: 2022-04-18 Status Date: 2022-04-18
Member Name: TIAWANNA HARRISON Member ID: 43111667101
Employer ID: COS Termination Date: 2022-04-15
Contract Record ID: 43111667101 Term Reason: VOLUNTARY
Comments: Employee resigned as of 4/15/22





Request ID: 216280 Status: COMPLETE
Request Date: 2022-04-20 Status Date: 2022-04-20
Member Name: MAICO SOTTO-CURBELO Member ID: 76346506201
Employer ID: APRES Termination Date: 2022-04-29
Contract Record ID: 76346506201 Term Reason: VOLUNTARY
Comments:





Request ID: 216281 Status: COMPLETE
Request Date: 2022-04-20 Status Date: 2022-04-20
Member Name: MELANIE WALTMON Member ID: 61223160301
Employer ID: APRES Termination Date: 2022-04-20
Contract Record ID: 61223160301 Term Reason: INVOLUNTARY
Comments:





Request ID: 216282 Status: COMPLETE
Request Date: 2022-04-20 Status Date: 2022-04-20
Member Name: CAROLINA ROCHA Member ID: 07579901501
Employer ID: APRES Termination Date: 2022-04-29
Contract Record ID: 07579901501 Term Reason: VOLUNTARY
Comments:





Request ID: 216319 Status: COMPLETE
Request Date: 2022-04-21 Status Date: 2022-04-21
Member Name: JESSICA YADLEY CANTAVE Member ID: 44029217801
Employer ID: SFM Termination Date: 2022-04-30
Contract Record ID: 44029217801 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 216320 Status: COMPLETE
Request Date: 2022-04-21 Status Date: 2022-04-21
Member Name: TANGI VERNETTA HENLEY Member ID: 22441004501
Employer ID: SFM Termination Date: 2022-04-30
Contract Record ID: 22441004501 Term Reason: TERMINATION
Comments:





Request ID: 216321 Status: COMPLETE
Request Date: 2022-04-21 Status Date: 2022-04-21
Member Name: JOYCE MARIE DONOHUE Member ID: 51551755401
Employer ID: SFM Termination Date: 2022-04-30
Contract Record ID: 51551755401 Term Reason: TERMINATION
Comments:





Request ID: 216347 Status: COMPLETE
Request Date: 2022-04-22 Status Date: 2022-04-22
Member Name: JOSEPH BACA Member ID: 25019702001
Employer ID: NEC Termination Date: 2022-04-13
Contract Record ID: 25019702001 Term Reason: INVOLUNTARY
Comments:





Request ID: 216381 Status: COMPLETE
Request Date: 2022-04-25 Status Date: 2022-04-25
Member Name: RANDALL E SHAFFER Member ID: 56671395101
Employer ID: WCE Termination Date: 2022-05-31
Contract Record ID: 56671395101 Term Reason: VOLUNTARY
Comments:





Request ID: 216382 Status: COMPLETE
Request Date: 2022-04-25 Status Date: 2022-04-25
Member Name: ALICE DANILOVICS Member ID: 47385897901
Employer ID: PELTZ Termination Date: 2022-04-30
Contract Record ID: 47385897901 Term Reason: TERMINATION
Comments:





Request ID: 216402 Status: COMPLETE
Request Date: 2022-04-25 Status Date: 2022-04-25
Member Name: BREANNA MARTINEZ Member ID: 92081837701
Employer ID: CNT Termination Date: 2022-01-31
Contract Record ID: 92081837701 Term Reason: TERMINATION
Comments:





Request ID: 216408 Status: COMPLETE
Request Date: 2022-04-25 Status Date: 2022-04-25
Member Name: CARA N HAMILTON Member ID: 14068330701
Employer ID: LNB Termination Date: 2022-04-30
Contract Record ID: 14068330701 Term Reason: TERMINATION
Comments: last day of employment 4/22/22





Request ID: 216411 Status: COMPLETE
Request Date: 2022-04-25 Status Date: 2022-04-25
Member Name: RANDALL E SHAFFER Member ID: 56671395101
Employer ID: WCE Termination Date: 2022-05-31
Contract Record ID: 56671395101 Term Reason: VOLUNTARY
Comments:





Request ID: 216426 Status: COMPLETE
Request Date: 2022-04-26 Status Date: 2022-04-26
Member Name: EDWARD EICK Member ID: 07283743701
Employer ID: DAVIS Termination Date: 2022-04-30
Contract Record ID: 07283743701 Term Reason: VOLUNTARY
Comments: Resigned





Request ID: 216456 Status: COMPLETE
Request Date: 2022-04-27 Status Date: 2022-04-27
Member Name: NATHAN RAMSEY Member ID: 36201351501
Employer ID: BROSOL Termination Date: 2022-04-27
Contract Record ID: 36201351501 Term Reason: TERMINATION
Comments:





Request ID: 216464 Status: COMPLETE
Request Date: 2022-04-28 Status Date: 2022-04-28
Member Name: DARLINGTON NGASSA Member ID: 97568354901
Employer ID: DNA Termination Date: 2022-04-30
Contract Record ID: 97568354901 Term Reason: TERMINATION
Comments:





Request ID: 216478 Status: COMPLETE
Request Date: 2022-04-28 Status Date: 2022-04-28
Member Name: JUAN JACOBO Member ID: 97543425501
Employer ID: WCE Termination Date: 2022-04-28
Contract Record ID: 97543425501 Term Reason: TERMINATION
Comments:





Request ID: 216601 Status: COMPLETE
Request Date: 2022-04-29 Status Date: 2022-04-29
Member Name: CHRISTINA GRANT Member ID: 02213155501
Employer ID: BRANDY Termination Date: 2022-03-31
Contract Record ID: 02213155501 Term Reason: TERMINATION
Comments:





Request ID: 216621 Status: COMPLETE
Request Date: 2022-04-29 Status Date: 2022-04-29
Member Name: ANGELA ROBINSON Member ID: 01756396101
Employer ID: BRANDY Termination Date: 2022-03-31
Contract Record ID: 01756396101 Term Reason: TERMINATION
Comments:





Request ID: 216641 Status: COMPLETE
Request Date: 2022-04-29 Status Date: 2022-04-29
Member Name: JUAN JACOBO Member ID: 97543425501
Employer ID: WCE Termination Date: 2022-04-28
Contract Record ID: 97543425501 Term Reason: TERMINATION
Comments:





Request ID: 216661 Status: COMPLETE
Request Date: 2022-04-29 Status Date: 2022-04-29
Member Name: AMSY GERMOSEN Member ID: 88796843801
Employer ID: BRANDY Termination Date: 2022-04-30
Contract Record ID: 88796843801 Term Reason: TERMINATION
Comments:





Request ID: 216741 Status: COMPLETE
Request Date: 2022-04-29 Status Date: 2022-04-29
Member Name: SHERRI TAYLOR Member ID: 51329528701
Employer ID: COS Termination Date: 2022-04-29
Contract Record ID: 51329528701 Term Reason: TERMINATION
Comments: Last Day Worked 04/29/2022





Request ID: 216821 Status: COMPLETE
Request Date: 2022-04-30 Status Date: 2022-04-30
Member Name: JEREMY A SPENCER Member ID: 57955510201
Employer ID: MESH Termination Date: 2022-04-29
Contract Record ID: 57955510201 Term Reason: VOLUNTARY
Comments:





Request ID: 216901 Status: COMPLETE
Request Date: 2022-05-02 Status Date: 2022-05-02
Member Name: DEBRA SMITH Member ID: 63746033001
Employer ID: YHP00123 Termination Date: 2022-04-21
Contract Record ID: 63746033001 Term Reason: TERMINATION
Comments:





Request ID: 217002 Status: COMPLETE
Request Date: 2022-05-02 Status Date: 2022-05-02
Member Name: DAVID BOWDEN Member ID: 33660987802
Employer ID: APRES Termination Date: 2022-04-30
Contract Record ID: 33660987801 Term Reason: VOLUNTARY
Comments: Coverage from new job eff 5/1/2022





Request ID: 217161 Status: COMPLETE
Request Date: 2022-05-03 Status Date: 2022-05-03
Member Name: JEREMY BELL Member ID: 14587246501
Employer ID: CNT Termination Date: 2022-05-31
Contract Record ID: 14587246501 Term Reason: TERMINATION
Comments:





Request ID: 217221 Status: COMPLETE
Request Date: 2022-05-03 Status Date: 2022-05-03
Member Name: JAMES MORRIS Member ID: 24120957601
Employer ID: NEC Termination Date: 2022-05-01
Contract Record ID: 24120957601 Term Reason: VOLUNTARY
Comments:





Request ID: 217222 Status: COMPLETE
Request Date: 2022-05-03 Status Date: 2022-05-03
Member Name: DAVID MILLER Member ID: 32374186001
Employer ID: NEC Termination Date: 2022-04-29
Contract Record ID: 32374186001 Term Reason: VOLUNTARY
Comments:





Request ID: 217223 Status: COMPLETE
Request Date: 2022-05-03 Status Date: 2022-05-03
Member Name: SHANE BACA Member ID: 35883436001
Employer ID: NEC Termination Date: 2022-04-28
Contract Record ID: 35883436001 Term Reason: VOLUNTARY
Comments:





Request ID: 217343 Status: COMPLETE
Request Date: 2022-05-03 Status Date: 2022-05-03
Member Name: CHILENA ROSE ALVAREZ Member ID: 20807388101
Employer ID: CNT Termination Date: 2022-04-30
Contract Record ID: 20807388101 Term Reason: TERMINATION
Comments:





Request ID: 217524 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: ANN PROKOP Member ID: 21004024301
Employer ID: PELTZ Termination Date: 2022-05-31
Contract Record ID: 21004024301 Term Reason: TERMINATION
Comments:





Request ID: 217541 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: PAIGE TOWNSEND Member ID: 52023945001
Employer ID: PELTZ Termination Date: 2022-05-31
Contract Record ID: 52023945001 Term Reason:
Comments:





Request ID: 217601 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: JEREMY BELL Member ID: 14587246501
Employer ID: CNT Termination Date: 2022-05-31
Contract Record ID: 14587246501 Term Reason: TERMINATION
Comments:





Request ID: 217602 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: JOSHUA R BLAYLOCK Member ID: 38123926901
Employer ID: CNT Termination Date: 2022-04-30
Contract Record ID: 38123926901 Term Reason: TERMINATION
Comments:





Request ID: 217603 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: DEBORAH GREEN Member ID: 00014426901
Employer ID: CNT Termination Date: 2022-04-30
Contract Record ID: 00014426901 Term Reason: TERMINATION
Comments:





Request ID: 217604 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: CHILENA ROSE ALVAREZ Member ID: 20807388101
Employer ID: CNT Termination Date: 2022-04-30
Contract Record ID: 20807388101 Term Reason: TERMINATION
Comments:





Request ID: 217606 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: MICHAEL DAVID BATES Member ID: 36611703101
Employer ID: YHP00134 Termination Date: 2022-04-30
Contract Record ID: 36611703101 Term Reason: VOLUNTARY
Comments:





Request ID: 217607 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: TAYLER ERIN LYONS Member ID: 77657030001
Employer ID: YHP00134 Termination Date: 2022-04-30
Contract Record ID: 77657030001 Term Reason: VOLUNTARY
Comments: QUIT, NO NOTICE





Request ID: 217608 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: NATHAN W WICKER Member ID: 80246341901
Employer ID: TRILAT Termination Date: 2022-05-03
Contract Record ID: 80246341901 Term Reason: TERMINATION
Comments:





Request ID: 217721 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: MARILYN A BASSETT Member ID: 68613154901
Employer ID: BRANDY Termination Date: 2022-03-31
Contract Record ID: 68613154901 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 217741 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: HILDA GAITAN Member ID: 13537697601
Employer ID: BRANDY Termination Date: 2022-04-28
Contract Record ID: 13537697601 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 217761 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: NADINE SANKAR Member ID: 48968995401
Employer ID: BRANDY Termination Date: 2022-04-06
Contract Record ID: 48968995401 Term Reason: TERMINATION
Comments:





Request ID: 217781 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: MARLON STEWART Member ID: 08513422201
Employer ID: BRANDY Termination Date: 2022-03-18
Contract Record ID: 08513422201 Term Reason: TERMINATION
Comments:





Request ID: 217801 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: MARLON STEWART Member ID: 08513422201
Employer ID: BRANDY Termination Date: 2022-03-18
Contract Record ID: 08513422201 Term Reason: TERMINATION
Comments:





Request ID: 217821 Status: COMPLETE
Request Date: 2022-05-04 Status Date: 2022-05-04
Member Name: LUZ E VALLE Member ID: 51165674301
Employer ID: BRANDY Termination Date: 2022-03-24
Contract Record ID: 51165674301 Term Reason: TERMINATION
Comments:





Request ID: 218081 Status: COMPLETE
Request Date: 2022-05-06 Status Date: 2022-05-06
Member Name: DAVID J PRZYBYL Member ID: 02679791201
Employer ID: WCE Termination Date: 2022-05-03
Contract Record ID: 02679791201 Term Reason: VOLUNTARY
Comments:





Request ID: 218181 Status: COMPLETE
Request Date: 2022-05-06 Status Date: 2022-05-06
Member Name: WHITNEY LIGGETT Member ID: 13039087301
Employer ID: SFM Termination Date: 2022-04-30
Contract Record ID: 13039087301 Term Reason: TERMINATION
Comments:





Request ID: 218203 Status: COMPLETE
Request Date: 2022-05-06 Status Date: 2022-05-06
Member Name: TERESA MAE SHEPARD Member ID: 97026184201
Employer ID: SFM Termination Date: 2022-04-30
Contract Record ID: 97026184201 Term Reason: TERMINATION
Comments:





Request ID: 218221 Status: COMPLETE
Request Date: 2022-05-06 Status Date: 2022-05-06
Member Name: GABRIELA MORENO Member ID: 21290789101
Employer ID: SFM Termination Date: 2022-04-30
Contract Record ID: 21290789101 Term Reason: VOLUNTARY
Comments: Has other coverage





Request ID: 218241 Status: COMPLETE
Request Date: 2022-05-06 Status Date: 2022-05-06
Member Name: BERNICE AMATO Member ID: 00034296701
Employer ID: SFM Termination Date: 2022-04-30
Contract Record ID: 00034296701 Term Reason: TERMINATION
Comments:





Request ID: 218401 Status: COMPLETE
Request Date: 2022-05-08 Status Date: 2022-05-08
Member Name: ARTURO GARZA Member ID: 34425629101
Employer ID: APRES Termination Date: 2022-02-28
Contract Record ID: 34425629101 Term Reason: VOLUNTARY
Comments:





Request ID: 218621 Status: COMPLETE
Request Date: 2022-05-09 Status Date: 2022-05-09
Member Name: SAVANNAH BEST Member ID: 68682963101
Employer ID: DNA Termination Date: 2022-06-01
Contract Record ID: 68682963101 Term Reason: VOLUNTARY
Comments:





Request ID: 218641 Status: COMPLETE
Request Date: 2022-05-09 Status Date: 2022-05-09
Member Name: SAVANNAH BEST Member ID: 68682963101
Employer ID: DNA Termination Date: 2022-06-01
Contract Record ID: 68682963101 Term Reason: VOLUNTARY
Comments:





Request ID: 218721 Status: COMPLETE
Request Date: 2022-05-09 Status Date: 2022-05-09
Member Name: CODY BURGIN Member ID: 50084849601
Employer ID: APRES Termination Date: 2022-05-31
Contract Record ID: 50084849601 Term Reason: VOLUNTARY
Comments:





Request ID: 218861 Status: COMPLETE
Request Date: 2022-05-10 Status Date: 2022-05-10
Member Name: EVAN D GARRENTON Member ID: 45977155401
Employer ID: BROSOL Termination Date: 2022-04-28
Contract Record ID: 45977155401 Term Reason: VOLUNTARY
Comments: Evan resigned.





Request ID: 219081 Status: COMPLETE
Request Date: 2022-05-11 Status Date: 2022-05-11
Member Name: GLORIA VILLEGAS Member ID: 55340804101
Employer ID: ADVRX Termination Date: 2022-05-31
Contract Record ID: 55340804101 Term Reason: INVOLUNTARY
Comments:





Request ID: 219301 Status: COMPLETE
Request Date: 2022-05-11 Status Date: 2022-05-11
Member Name: VANESSA MARSTERS Member ID: 38222409502
Employer ID: APRES Termination Date: 2022-05-11
Contract Record ID: 38222409501 Term Reason: DIVORCE FROM EMPLOYEE
Comments:





Request ID: 219604 Status: COMPLETE
Request Date: 2022-05-12 Status Date: 2022-05-12
Member Name: MARK KELLOGG Member ID: 28857923601
Employer ID: YHP00158 Termination Date: 2022-05-06
Contract Record ID: 28857923601 Term Reason: TERMINATION
Comments:





Request ID: 219607 Status: COMPLETE
Request Date: 2022-05-12 Status Date: 2022-05-12
Member Name: CHRISTIAN FURMAN Member ID: 69214745301
Employer ID: YHP00015 Termination Date: 2022-04-18
Contract Record ID: 69214745301 Term Reason: TERMINATION
Comments:





Request ID: 219922 Status: COMPLETE
Request Date: 2022-05-16 Status Date: 2022-05-16
Member Name: ANTHONY KNIPPEL Member ID: 34743202801
Employer ID: WCE Termination Date: 2022-05-20
Contract Record ID: 34743202801 Term Reason: VOLUNTARY
Comments:





Request ID: 220081 Status: COMPLETE
Request Date: 2022-05-17 Status Date: 2022-05-17
Member Name: ANTHONY KNIPPEL Member ID: 34743202801
Employer ID: WCE Termination Date: 2022-05-20
Contract Record ID: 34743202801 Term Reason: VOLUNTARY
Comments:





Request ID: 220141 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: ANTHONY PORFIDIO Member ID: 72093386701
Employer ID: ASSI Termination Date: 2022-05-06
Contract Record ID: 72093386701 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220142 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: ARLENE D ROGERS Member ID: 55846952501
Employer ID: ASSI Termination Date: 2022-05-06
Contract Record ID: 55846952501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220143 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: CARLOS A COLON Member ID: 21865211401
Employer ID: ASSI Termination Date: 2022-05-04
Contract Record ID: 21865211401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220144 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: DANIEL J MULVEY Member ID: 44972097801
Employer ID: ASSI Termination Date: 2022-05-09
Contract Record ID: 44972097801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220145 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: DAWN M POGANIK Member ID: 82023255801
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 82023255801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220146 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: DENNIS MARTINEZ Member ID: 41043080401
Employer ID: ASSI Termination Date: 2022-05-07
Contract Record ID: 41043080401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220147 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: EDWIN RIVAS Member ID: 50770721301
Employer ID: ASSI Termination Date: 2022-05-09
Contract Record ID: 50770721301 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220148 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: GARY WHITAKER Member ID: 15886516501
Employer ID: ASSI Termination Date: 2022-05-09
Contract Record ID: 15886516501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220149 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: GEORGE P TRIANTIS Member ID: 60719628701
Employer ID: ASSI Termination Date: 2022-05-09
Contract Record ID: 60719628701 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220150 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: GREGORY WHITTINGTON Member ID: 38973097901
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 38973097901 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220151 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: HECTOR L CARABALLO Member ID: 81517929401
Employer ID: ASSI Termination Date: 2022-05-05
Contract Record ID: 81517929401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220152 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: HECTOR L CARABALLO Member ID: 81517929401
Employer ID: ASSI Termination Date: 2022-05-05
Contract Record ID: 81517929401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220153 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: HERMINIO APONTE Member ID: 24440486401
Employer ID: ASSI Termination Date: 2022-05-04
Contract Record ID: 24440486401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220154 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JANET M PELOSI Member ID: 93106098501
Employer ID: ASSI Termination Date: 2022-05-07
Contract Record ID: 93106098501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220155 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JOHN J SADLER Member ID: 43418774401
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 43418774401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220156 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JOHN J SADLER Member ID: 43418774401
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 43418774401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220157 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JORGE L CHICO Member ID: 72387498001
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 72387498001 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220158 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JOSEPH SERRANO Member ID: 23278166501
Employer ID: ASSI Termination Date: 2022-05-10
Contract Record ID: 23278166501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220159 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JOSEPH SERRANO Member ID: 23278166501
Employer ID: ASSI Termination Date: 2022-05-10
Contract Record ID: 23278166501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220160 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JUAN REYES Member ID: 41957743301
Employer ID: ASSI Termination Date: 2022-05-08
Contract Record ID: 41957743301 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220161 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: LAWRENCE J ARATO Member ID: 30276617801
Employer ID: ASSI Termination Date: 2022-03-25
Contract Record ID: 30276617801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220162 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: MILDRED PALMER Member ID: 62951057401
Employer ID: ASSI Termination Date: 2022-05-05
Contract Record ID: 62951057401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220163 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: NANCY Y MALDONADO Member ID: 59289012801
Employer ID: ASSI Termination Date: 2022-05-05
Contract Record ID: 59289012801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220165 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: NINO A LAMA Member ID: 77063426801
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 77063426801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220166 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: NINO A LAMA Member ID: 77063426801
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 77063426801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220167 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: PHILIP J SIMONIS Member ID: 66045501301
Employer ID: ASSI Termination Date: 2022-05-10
Contract Record ID: 66045501301 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220168 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: RICHARD FRESHKO Member ID: 74096399101
Employer ID: ASSI Termination Date: 2022-05-10
Contract Record ID: 74096399101 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220169 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: SCOTT W MACKAY Member ID: 35577235101
Employer ID: ASSI Termination Date: 2022-05-06
Contract Record ID: 35577235101 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220170 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: THOMAS C MAY Member ID: 85758825401
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 85758825401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220171 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: TROY OVERTON Member ID: 54849352401
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 54849352401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220173 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: ADRIAN S REILLY Member ID: 28574177401
Employer ID: ASSI Termination Date: 2022-05-12
Contract Record ID: 28574177401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220174 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JOHN V AUGERI Member ID: 30781602801
Employer ID: ASSI Termination Date: 2022-05-13
Contract Record ID: 30781602801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220175 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: WILLIAM WILSON Member ID: 51756760701
Employer ID: ASSI Termination Date: 2022-05-13
Contract Record ID: 51756760701 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220176 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: ARTHUR R PALMER Member ID: 82403117701
Employer ID: ASSI Termination Date: 2022-05-09
Contract Record ID: 82403117701 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220182 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JAMES L SCHERER Member ID: 15744442801
Employer ID: ASSI Termination Date: 2022-05-16
Contract Record ID: 15744442801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220183 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: DANIEL K MEJIAS Member ID: 15467057101
Employer ID: ASSI Termination Date: 2022-05-16
Contract Record ID: 15467057101 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220184 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: DANIEL K MEJIAS Member ID: 15467057101
Employer ID: ASSI Termination Date: 2022-05-16
Contract Record ID: 15467057101 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220185 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: EDWARD A THOMAS Member ID: 64976126501
Employer ID: ASSI Termination Date: 2022-05-18
Contract Record ID: 64976126501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220186 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: ORLANDO PEREZ Member ID: 23928384501
Employer ID: ASSI Termination Date: 2022-05-18
Contract Record ID: 23928384501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220187 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: ANTHONY J BONANNO Member ID: 88938808901
Employer ID: ASSI Termination Date: 2022-05-16
Contract Record ID: 88938808901 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220188 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JERRY R THOMAS Member ID: 00505315801
Employer ID: ASSI Termination Date: 2022-05-12
Contract Record ID: 00505315801 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220189 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: JACOB A HERNANDEZ Member ID: 37880135001
Employer ID: ASSI Termination Date: 2022-05-16
Contract Record ID: 37880135001 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220190 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: BASIL M KOMONDOREA Member ID: 59511054001
Employer ID: ASSI Termination Date: 2022-05-09
Contract Record ID: 59511054001 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220191 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: BASIL M KOMONDOREA Member ID: 59511054001
Employer ID: ASSI Termination Date: 2022-05-09
Contract Record ID: 59511054001 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220201 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: MANUEL CRUZ Member ID: 73554282301
Employer ID: ASSI Termination Date: 2022-05-14
Contract Record ID: 73554282301 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220221 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: MANUEL CRUZ Member ID: 73554282301
Employer ID: ASSI Termination Date: 2022-05-14
Contract Record ID: 73554282301 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 220241 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: TONI R DEMEO Member ID: 03213988701
Employer ID: ASSI Termination Date: 2022-05-12
Contract Record ID: 03213988701 Term Reason: VOLUNTARY
Comments: WAIVER





Request ID: 220321 Status: COMPLETE
Request Date: 2022-05-18 Status Date: 2022-05-18
Member Name: WHISPER JEAN COULSON Member ID: 59035252501
Employer ID: YHP00263 Termination Date: 2022-05-31
Contract Record ID: 59035252501 Term Reason: TERMINATION
Comments:





Request ID: 220541 Status: COMPLETE
Request Date: 2022-05-19 Status Date: 2022-05-19
Member Name: LISA MARIE GAIL Member ID: 66696377501
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 66696377501 Term Reason: TERMINATION
Comments:





Request ID: 220621 Status: COMPLETE
Request Date: 2022-05-19 Status Date: 2022-05-19
Member Name: LYNANN CAROL STEPHENS Member ID: 86953310601
Employer ID: LNB Termination Date: 2022-05-31
Contract Record ID: 86953310601 Term Reason: TERMINATION
Comments:





Request ID: 220641 Status: COMPLETE
Request Date: 2022-05-19 Status Date: 2022-05-19
Member Name: KIMBERLY MEREDITH Member ID: 39105179602
Employer ID: LNB Termination Date: 2022-05-31
Contract Record ID: 39105179601 Term Reason: DIVORCE FROM EMPLOYEE
Comments: Please file with Cobra





Request ID: 220661 Status: COMPLETE
Request Date: 2022-05-19 Status Date: 2022-05-19
Member Name: AMY J ROTEN Member ID: 48592062201
Employer ID: LNB Termination Date: 2022-05-31
Contract Record ID: 48592062201 Term Reason: TERMINATION
Comments:





Request ID: 220681 Status: COMPLETE
Request Date: 2022-05-19 Status Date: 2022-05-19
Member Name: MAKAYLA L MCCRADY Member ID: 94545638101
Employer ID: LNB Termination Date: 2022-05-31
Contract Record ID: 94545638101 Term Reason: TERMINATION
Comments:





Request ID: 220941 Status: COMPLETE
Request Date: 2022-05-20 Status Date: 2022-05-20
Member Name: JASON B DAVIS Member ID: 16363643701
Employer ID: DAVIS Termination Date: 2022-05-31
Contract Record ID: 16363643701 Term Reason: VOLUNTARY
Comments: Termed employment





Request ID: 221201 Status: COMPLETE
Request Date: 2022-05-23 Status Date: 2022-05-23
Member Name: RUTH THOMAS Member ID: 45463588701
Employer ID: BRANDY Termination Date: 2022-03-31
Contract Record ID: 45463588701 Term Reason: TERMINATION
Comments:





Request ID: 221202 Status: COMPLETE
Request Date: 2022-05-23 Status Date: 2022-05-23
Member Name: VALGARION L MOSLEY Member ID: 22384206201
Employer ID: BRANDY Termination Date: 2022-03-31
Contract Record ID: 22384206201 Term Reason: TERMINATION
Comments:





Request ID: 221761 Status: COMPLETE
Request Date: 2022-05-24 Status Date: 2022-05-24
Member Name: OKTAY BAYRAMI Member ID: 58167868304
Employer ID: TPCH Termination Date: 2022-04-30
Contract Record ID: 58167868301 Term Reason: LOSS OF DEPENDANT STATUS
Comments:





Request ID: 221762 Status: COMPLETE
Request Date: 2022-05-24 Status Date: 2022-05-24
Member Name: MELAKH BAYRAMI Member ID: 58167868303
Employer ID: TPCH Termination Date: 2022-04-30
Contract Record ID: 58167868301 Term Reason: LOSS OF DEPENDANT STATUS
Comments:





Request ID: 221921 Status: COMPLETE
Request Date: 2022-05-25 Status Date: 2022-05-25
Member Name: EDDIE THOMAS BECK Member ID: 95220788301
Employer ID: DNA Termination Date: 2022-05-04
Contract Record ID: 95220788301 Term Reason: VOLUNTARY
Comments: Employment term on 5/4/2022. Coverage ends on 5/31/2022. First Day of no coverage is 6/1/2022. Please process this cancellation accordingly. Thank you. Dawn Broderick Eligibility Specialist - Employee Benefits Presidio 55 Shuman Blvd. Suite 900 Naperville, IL 60563 D 630.524.6122 F 630.524.6123 E dbroderick@presidiogrp.com www.Presidiogrp.com Acrisure Agency Partner





Request ID: 222043 Status: COMPLETE
Request Date: 2022-05-25 Status Date: 2022-05-25
Member Name: CAROL A MARTIN Member ID: 87655979901
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 87655979901 Term Reason: TERMINATION
Comments:





Request ID: 222044 Status: COMPLETE
Request Date: 2022-05-25 Status Date: 2022-05-25
Member Name: JOSEPH MALLOQUE Member ID: 34844861401
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 34844861401 Term Reason: TERMINATION
Comments:





Request ID: 222045 Status: COMPLETE
Request Date: 2022-05-25 Status Date: 2022-05-25
Member Name: KIANA L JENSEN Member ID: 95079707601
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 95079707601 Term Reason: TERMINATION
Comments:





Request ID: 222046 Status: COMPLETE
Request Date: 2022-05-25 Status Date: 2022-05-25
Member Name: MELAYNA TOWNSEND FALCK Member ID: 60381427901
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 60381427901 Term Reason: TERMINATION
Comments:





Request ID: 222102 Status: COMPLETE
Request Date: 2022-05-25 Status Date: 2022-05-25
Member Name: CAMERON EZEFF Member ID: 43768889501
Employer ID: COS Termination Date: 2022-05-04
Contract Record ID: 43768889501 Term Reason: TERMINATION
Comments:





Request ID: 222141 Status: COMPLETE
Request Date: 2022-05-25 Status Date: 2022-05-25
Member Name: DENICE BELL Member ID: 95516091802
Employer ID: COS Termination Date: 2022-05-01
Contract Record ID: 95516091801 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 222361 Status: COMPLETE
Request Date: 2022-05-26 Status Date: 2022-05-26
Member Name: WILLIAM HERNANDEZ Member ID: 50741491801
Employer ID: DNA Termination Date: 2022-05-31
Contract Record ID: 50741491801 Term Reason: VOLUNTARY
Comments: Employee class changed from Manager to All Others on 5/16/2022, resulting in a significant increase in employee cost for the medical coverage. The EE elected to drop the coverage based on this class change.





Request ID: 222561 Status: COMPLETE
Request Date: 2022-05-27 Status Date: 2022-05-27
Member Name: DOROTHY A MELLONE Member ID: 61746671901
Employer ID: ASSI Termination Date: 2022-05-19
Contract Record ID: 61746671901 Term Reason: VOLUNTARY
Comments: submit waiver





Request ID: 222581 Status: COMPLETE
Request Date: 2022-05-27 Status Date: 2022-05-27
Member Name: JOHNNY L MOTZ Member ID: 22809654401
Employer ID: ASSI Termination Date: 2022-05-20
Contract Record ID: 22809654401 Term Reason: TERMINATION
Comments: waiver





Request ID: 222601 Status: COMPLETE
Request Date: 2022-05-27 Status Date: 2022-05-27
Member Name: MARK J MAZZELLA Member ID: 07083177601
Employer ID: ASSI Termination Date: 2022-05-19
Contract Record ID: 07083177601 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 222721 Status: COMPLETE
Request Date: 2022-05-27 Status Date: 2022-05-27
Member Name: WILLIAM F KUNTZ Member ID: 16581703501
Employer ID: ASSI Termination Date: 2022-02-25
Contract Record ID: 16581703501 Term Reason: TERMINATION
Comments: awol





Request ID: 222861 Status: COMPLETE
Request Date: 2022-05-27 Status Date: 2022-05-27
Member Name: ANTHONY ADAMS Member ID: 98406865201
Employer ID: TPCH Termination Date: 2022-05-06
Contract Record ID: 98406865201 Term Reason: VOLUNTARY
Comments:





Request ID: 222881 Status: COMPLETE
Request Date: 2022-05-27 Status Date: 2022-05-27
Member Name: MARIE BELLIS Member ID: 05135902901
Employer ID: TPCH Termination Date: 2022-05-02
Contract Record ID: 05135902901 Term Reason: VOLUNTARY
Comments:





Request ID: 223041 Status: COMPLETE
Request Date: 2022-05-31 Status Date: 2022-05-31
Member Name: JESSICA SHORT Member ID: 42844210701
Employer ID: CNT Termination Date: 2022-05-31
Contract Record ID: 42844210701 Term Reason: TERMINATION
Comments:





Request ID: 223461 Status: COMPLETE
Request Date: 2022-06-01 Status Date: 2022-06-01
Member Name: TOMMI SUE JOHNSON Member ID: 05713976501
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 05713976501 Term Reason: TERMINATION
Comments:





Request ID: 223481 Status: COMPLETE
Request Date: 2022-06-01 Status Date: 2022-06-01
Member Name: JESSI TURNER Member ID: 77502456801
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 77502456801 Term Reason: TERMINATION
Comments:





Request ID: 223501 Status: COMPLETE
Request Date: 2022-06-01 Status Date: 2022-06-01
Member Name: KIMBERLY A MITCHELL Member ID: 54821434901
Employer ID: SFM Termination Date: 2022-05-31
Contract Record ID: 54821434901 Term Reason: TERMINATION
Comments:





Request ID: 224322 Status: COMPLETE
Request Date: 2022-06-03 Status Date: 2022-06-03
Member Name: DESTINEY BEAL Member ID: 49945138401
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 49945138401 Term Reason: TERMINATION
Comments:





Request ID: 224642 Status: COMPLETE
Request Date: 2022-06-06 Status Date: 2022-06-06
Member Name: AURELIO DIAZ RAMOS Member ID: 17475269301
Employer ID: MESH Termination Date: 2022-05-28
Contract Record ID: 17475269301 Term Reason: VOLUNTARY
Comments:





Request ID: 224643 Status: COMPLETE
Request Date: 2022-06-06 Status Date: 2022-06-06
Member Name: CALI ADAMSON Member ID: 67291416601
Employer ID: BRULE Termination Date: 2022-07-31
Contract Record ID: 67291416601 Term Reason: TERMINATION
Comments:





Request ID: 224721 Status: COMPLETE
Request Date: 2022-06-07 Status Date: 2022-06-07
Member Name: ROBERT BONAVITA Member ID: 70126383801
Employer ID: MESH Termination Date: 2022-06-03
Contract Record ID: 70126383801 Term Reason: VOLUNTARY
Comments:





Request ID: 224801 Status: COMPLETE
Request Date: 2022-06-07 Status Date: 2022-06-07
Member Name: DAWN M PURSER Member ID: 36136799501
Employer ID: TPCH Termination Date: 2022-04-30
Contract Record ID: 36136799501 Term Reason: TERMINATION
Comments: Need credit for May, June





Request ID: 224861 Status: COMPLETE
Request Date: 2022-06-07 Status Date: 2022-06-07
Member Name: CECELIA IRIZARRY Member ID: 50532378001
Employer ID: PELTZ Termination Date: 2022-05-31
Contract Record ID: 50532378001 Term Reason: VOLUNTARY
Comments:





Request ID: 225101 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: DUANE LITZAU Member ID: 25428519801
Employer ID: YHP00015 Termination Date: 2022-05-19
Contract Record ID: 25428519801 Term Reason: TERMINATION
Comments:





Request ID: 225201 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: DOROTHY A MELLONE Member ID: 61746671901
Employer ID: ASSI Termination Date: 2022-05-19
Contract Record ID: 61746671901 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 225221 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: MARC J CATHCART Member ID: 89803026901
Employer ID: ASSI Termination Date: 2022-05-18
Contract Record ID: 89803026901 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 225241 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: JOHNNY L MOTZ Member ID: 22809654401
Employer ID: ASSI Termination Date: 2022-05-20
Contract Record ID: 22809654401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 225261 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: MARK J MAZZELLA Member ID: 07083177601
Employer ID: ASSI Termination Date: 2022-05-19
Contract Record ID: 07083177601 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 225281 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: DOROTHY A MELLONE Member ID: 61746671901
Employer ID: ASSI Termination Date: 2022-05-19
Contract Record ID: 61746671901 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 225301 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: MATT VOEGTLI Member ID: 42508605101
Employer ID: WCE Termination Date: 2022-06-24
Contract Record ID: 42508605101 Term Reason: TERMINATION
Comments:





Request ID: 225321 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: JAIME GUERRERO Member ID: 65213895101
Employer ID: WCE Termination Date: 2022-06-24
Contract Record ID: 65213895101 Term Reason: TERMINATION
Comments:





Request ID: 225441 Status: COMPLETE
Request Date: 2022-06-08 Status Date: 2022-06-08
Member Name: JENNIFER L SHELTON Member ID: 41854646501
Employer ID: TPCH Termination Date: 2022-05-31
Contract Record ID: 41854646501 Term Reason: VOLUNTARY
Comments:





Request ID: 225461 Status: COMPLETE
Request Date: 2022-06-09 Status Date: 2022-06-09
Member Name: JOSEPH R ALEXANDER Member ID: 06726411501
Employer ID: BRANDY Termination Date: 2022-05-31
Contract Record ID: 06726411501 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 225841 Status: COMPLETE
Request Date: 2022-06-10 Status Date: 2022-06-10
Member Name: SUSAN CRAIG Member ID: 55960063901
Employer ID: DNA Termination Date: 2022-07-01
Contract Record ID: 55960063901 Term Reason: VOLUNTARY
Comments: Last day of coverage is 6/30/2022. Please terminate policy accordingly. Thank you.





Request ID: 225861 Status: COMPLETE
Request Date: 2022-06-10 Status Date: 2022-06-10
Member Name: THUY-TRANG T HAHN Member ID: 44113011101
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 44113011101 Term Reason: TERMINATION
Comments:





Request ID: 225862 Status: COMPLETE
Request Date: 2022-06-10 Status Date: 2022-06-10
Member Name: RHEA DE RAMA-PARAYNO Member ID: 00194269101
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 00194269101 Term Reason: TERMINATION
Comments:





Request ID: 225863 Status: COMPLETE
Request Date: 2022-06-10 Status Date: 2022-06-10
Member Name: BILLIE JUDD Member ID: 36721358101
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 36721358101 Term Reason: TERMINATION
Comments:





Request ID: 225921 Status: COMPLETE
Request Date: 2022-06-13 Status Date: 2022-06-13
Member Name: MATT VOEGTLI Member ID: 42508605101
Employer ID: WCE Termination Date: 2022-06-27
Contract Record ID: 42508605101 Term Reason: VOLUNTARY
Comments:





Request ID: 225961 Status: COMPLETE
Request Date: 2022-06-13 Status Date: 2022-06-13
Member Name: PATRICIA SUROVIC Member ID: 51778781001
Employer ID: APRES Termination Date: 2022-06-30
Contract Record ID: 51778781001 Term Reason: VOLUNTARY
Comments: Cancelling COBRA coverage, has other coverage now





Request ID: 226021 Status: COMPLETE
Request Date: 2022-06-13 Status Date: 2022-06-13
Member Name: APRIL HOFF Member ID: 69067198401
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 69067198401 Term Reason: TERMINATION
Comments:





Request ID: 226561 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: JASON B DAVIS Member ID: 16363643701
Employer ID: DAVIS Termination Date: 2022-06-01
Contract Record ID: 16363643701 Term Reason: VOLUNTARY
Comments: this is a test





Request ID: 226601 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: ASHLEY OSINSKI Member ID: 93930812301
Employer ID: CCRAFT Termination Date: 2022-02-01
Contract Record ID: 93930812301 Term Reason: VOLUNTARY
Comments: Ashley left the company back in February.





Request ID: 226621 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: ANTHONY ADAMS Member ID: 98406865201
Employer ID: TPCH Termination Date: 2022-05-05
Contract Record ID: 98406865201 Term Reason: TERMINATION
Comments:





Request ID: 226641 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: MALISSA M AITON Member ID: 71878344301
Employer ID: TPCH Termination Date: 2022-04-30
Contract Record ID: 71878344301 Term Reason: TERMINATION
Comments:





Request ID: 226661 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: AUDREY ANGELBECK Member ID: 13648131201
Employer ID: TPCH Termination Date: 2022-05-27
Contract Record ID: 13648131201 Term Reason: TERMINATION
Comments:





Request ID: 226701 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: JACK FREDERICKS Member ID: 63772596201
Employer ID: TPCH Termination Date: 2022-04-30
Contract Record ID: 63772596201 Term Reason: TERMINATION
Comments:





Request ID: 226721 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: LORA A JOHNSON Member ID: 42406124601
Employer ID: TPCH Termination Date: 2022-03-27
Contract Record ID: 42406124601 Term Reason: TERMINATION
Comments:





Request ID: 226741 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: ALISSA N LANGWORTHY Member ID: 33263184301
Employer ID: TPCH Termination Date: 2022-05-31
Contract Record ID: 33263184301 Term Reason: TERMINATION
Comments:





Request ID: 226761 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: CHARLES LESLIE Member ID: 36275525501
Employer ID: TPCH Termination Date: 2022-06-08
Contract Record ID: 36275525501 Term Reason: TERMINATION
Comments:





Request ID: 226841 Status: COMPLETE
Request Date: 2022-06-15 Status Date: 2022-06-15
Member Name: LOREN ANNE RAMSEY Member ID: 99395401301
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 99395401301 Term Reason: TERMINATION
Comments:





Request ID: 227121 Status: COMPLETE
Request Date: 2022-06-16 Status Date: 2022-06-16
Member Name: MEDHAT H SANAD Member ID: 13561816401
Employer ID: TPCH Termination Date: 2022-04-01
Contract Record ID: 13561816401 Term Reason: TERMINATION
Comments:





Request ID: 227161 Status: COMPLETE
Request Date: 2022-06-16 Status Date: 2022-06-16
Member Name: AMY HALL Member ID: 66996420401
Employer ID: VAUGHAN Termination Date: 2022-05-12
Contract Record ID: 66996420401 Term Reason: INVOLUNTARY
Comments:





Request ID: 227341 Status: COMPLETE
Request Date: 2022-06-17 Status Date: 2022-06-17
Member Name: JEFFREY LESTER Member ID: 03737813201
Employer ID: MESH Termination Date: 2022-06-12
Contract Record ID: 03737813201 Term Reason: VOLUNTARY
Comments:





Request ID: 227422 Status: COMPLETE
Request Date: 2022-06-17 Status Date: 2022-06-17
Member Name: HAILEY DAWN DIESSNER Member ID: 61865419201
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 61865419201 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 227461 Status: COMPLETE
Request Date: 2022-06-17 Status Date: 2022-06-17
Member Name: MICHELE REINA Member ID: 77269562701
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 77269562701 Term Reason: TERMINATION
Comments:





Request ID: 227481 Status: COMPLETE
Request Date: 2022-06-17 Status Date: 2022-06-17
Member Name: ADELAIDA SABLAON Member ID: 79540708701
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 79540708701 Term Reason: TERMINATION
Comments:





Request ID: 227501 Status: COMPLETE
Request Date: 2022-06-17 Status Date: 2022-06-17
Member Name: EVAN SPURGEON Member ID: 57534560901
Employer ID: BROSOL Termination Date: 2022-05-31
Contract Record ID: 57534560901 Term Reason: VOLUNTARY
Comments: Evan resigned. His last day was 5/26/2022





Request ID: 227941 Status: COMPLETE
Request Date: 2022-06-21 Status Date: 2022-06-21
Member Name: EVAN HAGANMAN Member ID: 55475437901
Employer ID: PELTZ Termination Date: 2022-05-13
Contract Record ID: 55475437901 Term Reason: TERMINATION
Comments: Please note this employees coverage never went into effect for 7.1.2022, as they terminated 5.13.2022





Request ID: 228381 Status: COMPLETE
Request Date: 2022-06-22 Status Date: 2022-06-22
Member Name: MCKENZIE MOBERG Member ID: 38879180901
Employer ID: VAUGHAN Termination Date: 2022-06-20
Contract Record ID: 38879180901 Term Reason: VOLUNTARY
Comments:





Request ID: 228901 Status: COMPLETE
Request Date: 2022-06-24 Status Date: 2022-06-24
Member Name: STEPHANNEE SCHWINGER Member ID: 70641715101
Employer ID: YHP00116 Termination Date: 2022-05-31
Contract Record ID: 70641715101 Term Reason: VOLUNTARY
Comments:





Request ID: 228941 Status: COMPLETE
Request Date: 2022-06-24 Status Date: 2022-06-24
Member Name: TRISTON HUNTER BARRETT Member ID: 55728432801
Employer ID: YHP00134 Termination Date: 2022-06-06
Contract Record ID: 55728432801 Term Reason: VOLUNTARY
Comments: PROMOTED TO ASSISTANT RGM. OFFERED/ACCEPTED OTHER COVERAGE





Request ID: 229161 Status: COMPLETE
Request Date: 2022-06-26 Status Date: 2022-06-26
Member Name: ROBERT J MILLER Member ID: 64985384101
Employer ID: WCE Termination Date: 2022-06-21
Contract Record ID: 64985384101 Term Reason: VOLUNTARY
Comments:





Request ID: 229201 Status: COMPLETE
Request Date: 2022-06-26 Status Date: 2022-06-26
Member Name: MEGAN L UNDERWOOD Member ID: 08255778201
Employer ID: LNB Termination Date: 2022-06-30
Contract Record ID: 08255778201 Term Reason: TERMINATION
Comments: Address is actually 9635 New Jackson Hwy, employees last day is 6/29/22





Request ID: 229382 Status: COMPLETE
Request Date: 2022-06-27 Status Date: 2022-06-27
Member Name: COLLTON BECK Member ID: 73499476801
Employer ID: BRULE Termination Date: 2022-07-31
Contract Record ID: 73499476801 Term Reason: TERMINATION
Comments:





Request ID: 229383 Status: COMPLETE
Request Date: 2022-06-27 Status Date: 2022-06-27
Member Name: TORY ENGEL Member ID: 65397972401
Employer ID: BRULE Termination Date: 2022-08-31
Contract Record ID: 65397972401 Term Reason: VOLUNTARY
Comments:





Request ID: 229621 Status: COMPLETE
Request Date: 2022-06-28 Status Date: 2022-06-28
Member Name: ANDY ROMERO Member ID: 56380140401
Employer ID: BRECK Termination Date: 2022-05-31
Contract Record ID: 56380140401 Term Reason: VOLUNTARY
Comments: Other employment





Request ID: 229641 Status: COMPLETE
Request Date: 2022-06-28 Status Date: 2022-06-28
Member Name: CARTER GRAVES Member ID: 71573053101
Employer ID: BRECKS Termination Date: 2022-03-31
Contract Record ID: 71573053101 Term Reason: TERMINATION
Comments: other employment





Request ID: 229661 Status: COMPLETE
Request Date: 2022-06-28 Status Date: 2022-06-28
Member Name: MATTHEW HRYNIEWICZ Member ID: 45440772601
Employer ID: BRECK Termination Date: 2022-06-30
Contract Record ID: 45440772601 Term Reason: VOLUNTARY
Comments: other employment





Request ID: 229921 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: KAILYN HAMMERLING Member ID: 75301484101
Employer ID: YHP00116 Termination Date: 2022-06-29
Contract Record ID: 75301484101 Term Reason: VOLUNTARY
Comments:





Request ID: 230041 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: KIMBERLY ANN THOMPSON Member ID: 25434900001
Employer ID: FIRSTCUP Termination Date: 2022-03-19
Contract Record ID: 25434900001 Term Reason: TERMINATION
Comments:





Request ID: 230042 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: JESSIE LE CALL Member ID: 37373389301
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 37373389301 Term Reason: TERMINATION
Comments:





Request ID: 230043 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: BRIGETTE LANGKILDE Member ID: 89136382001
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 89136382001 Term Reason: TERMINATION
Comments:





Request ID: 230044 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: CASSIE HANSON Member ID: 23887390401
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 23887390401 Term Reason: TERMINATION
Comments:





Request ID: 230045 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: SERAH MUTHONI NGANGA Member ID: 13834141101
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 13834141101 Term Reason: TERMINATION
Comments:





Request ID: 230046 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: KEVIN HAMLET Member ID: 82722432701
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 82722432701 Term Reason: TERMINATION
Comments:





Request ID: 230047 Status: COMPLETE
Request Date: 2022-06-29 Status Date: 2022-06-29
Member Name: HUNTER STUTZ Member ID: 78902732601
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 78902732601 Term Reason: TERMINATION
Comments:





Request ID: 230161 Status: COMPLETE
Request Date: 2022-06-30 Status Date: 2022-06-30
Member Name: DYLAN M COMPTON Member ID: 83289943301
Employer ID: BROSOL Termination Date: 2022-06-30
Contract Record ID: 83289943301 Term Reason: TERMINATION
Comments:





Request ID: 230162 Status: COMPLETE
Request Date: 2022-06-30 Status Date: 2022-06-30
Member Name: AMANDA MOORE Member ID: 49137842601
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 49137842601 Term Reason: TERMINATION
Comments:





Request ID: 230163 Status: COMPLETE
Request Date: 2022-06-30 Status Date: 2022-06-30
Member Name: LINDA COLLINS Member ID: 60437492101
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 60437492101 Term Reason: TERMINATION
Comments:





Request ID: 230261 Status: COMPLETE
Request Date: 2022-06-30 Status Date: 2022-06-30
Member Name: MICHAEL CALVENTE Member ID: 44394046201
Employer ID: ASSI Termination Date: 2022-06-14
Contract Record ID: 44394046201 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 230281 Status: COMPLETE
Request Date: 2022-06-30 Status Date: 2022-06-30
Member Name: KIMBERLY ARLLYN CERVANTES Member ID: 79094657001
Employer ID: FIRSTCUP Termination Date: 2022-02-28
Contract Record ID: 79094657001 Term Reason: TERMINATION
Comments:





Request ID: 230301 Status: COMPLETE
Request Date: 2022-06-30 Status Date: 2022-06-30
Member Name: KIMBERLY ANN THOMPSON Member ID: 25434900001
Employer ID: FIRSTCUP Termination Date: 2022-03-19
Contract Record ID: 25434900001 Term Reason: TERMINATION
Comments:





Request ID: 230421 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: CODY BURGIN Member ID: 50084849601
Employer ID: APRES Termination Date: 2022-06-30
Contract Record ID: 50084849601 Term Reason: VOLUNTARY
Comments: Drop coverage - other coverage





Request ID: 230441 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: TYLER FIELDS Member ID: 50084849603
Employer ID: APRES Termination Date: 2022-06-30
Contract Record ID: 50084849601 Term Reason: VOLUNTARY
Comments:





Request ID: 230461 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: CAYLEB BURGIN Member ID: 50084849604
Employer ID: APRES Termination Date: 2022-06-30
Contract Record ID: 50084849601 Term Reason: VOLUNTARY
Comments:





Request ID: 230481 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: FAYTH BURGIN Member ID: 50084849602
Employer ID: APRES Termination Date: 2022-06-30
Contract Record ID: 50084849601 Term Reason: VOLUNTARY
Comments:





Request ID: 230621 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: JULIE A LARGE Member ID: 63968768801
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 63968768801 Term Reason: TERMINATION
Comments:





Request ID: 230701 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: NICOLE HINDS Member ID: 72883556001
Employer ID: PELTZ Termination Date: 2022-07-31
Contract Record ID: 72883556001 Term Reason: TERMINATION
Comments:





Request ID: 230722 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: JEFFREY HOLCOMB Member ID: 03395155501
Employer ID: YHP00049 Termination Date: 2022-06-23
Contract Record ID: 03395155501 Term Reason: VOLUNTARY
Comments: Resigned for better job





Request ID: 230723 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: NICOLE HINDS Member ID: 72883556001
Employer ID: PELTZ Termination Date: 2022-07-31
Contract Record ID: 72883556001 Term Reason: TERMINATION
Comments:





Request ID: 230724 Status: COMPLETE
Request Date: 2022-07-01 Status Date: 2022-07-01
Member Name: LISA THOMPSON Member ID: 45256727201
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 45256727201 Term Reason: TERMINATION
Comments:





Request ID: 230781 Status: COMPLETE
Request Date: 2022-07-02 Status Date: 2022-07-02
Member Name: ANGELA REED-BECKER Member ID: 84600695001
Employer ID: DNA Termination Date: 2022-07-31
Contract Record ID: 84600695001 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 231063 Status: COMPLETE
Request Date: 2022-07-05 Status Date: 2022-07-05
Member Name: SHAUN JOHNSON Member ID: 77646109501
Employer ID: BRECK Termination Date: 2022-06-30
Contract Record ID: 77646109501 Term Reason: VOLUNTARY
Comments: Please send COBRA lettter





Request ID: 231202 Status: COMPLETE
Request Date: 2022-07-05 Status Date: 2022-07-05
Member Name: TORY ENGEL Member ID: 65397972401
Employer ID: BRULE Termination Date: 2022-08-31
Contract Record ID: 65397972401 Term Reason: VOLUNTARY
Comments:





Request ID: 231504 Status: COMPLETE
Request Date: 2022-07-06 Status Date: 2022-07-06
Member Name: AARON GUZMAN Member ID: 28364176101
Employer ID: CLEAR Termination Date: 2022-06-30
Contract Record ID: 28364176101 Term Reason: TERMINATION
Comments:





Request ID: 231722 Status: COMPLETE
Request Date: 2022-07-07 Status Date: 2022-07-07
Member Name: KORI DUNNING Member ID: 79254071701
Employer ID: CLEAR Termination Date: 2022-06-01
Contract Record ID: 79254071701 Term Reason: TERMINATION
Comments:





Request ID: 232021 Status: COMPLETE
Request Date: 2022-07-08 Status Date: 2022-07-08
Member Name: CHRISTOPHER RITCHIE Member ID: 89622529001
Employer ID: ACW Termination Date: 2022-04-30
Contract Record ID: 89622529001 Term Reason: TERMINATION
Comments:





Request ID: 232022 Status: COMPLETE
Request Date: 2022-07-08 Status Date: 2022-07-08
Member Name: FRANCELI REBOLLARD Member ID: 06400119701
Employer ID: ACW Termination Date: 2022-03-31
Contract Record ID: 06400119701 Term Reason: TERMINATION
Comments:





Request ID: 232023 Status: COMPLETE
Request Date: 2022-07-08 Status Date: 2022-07-08
Member Name: CASANDRA GARZA Member ID: 20149563801
Employer ID: APRES Termination Date: 2022-07-08
Contract Record ID: 20149563801 Term Reason: TERMINATION
Comments:





Request ID: 232041 Status: COMPLETE
Request Date: 2022-07-08 Status Date: 2022-07-08
Member Name: MADELINE MARTINEZ Member ID: 91723579101
Employer ID: BRECKS Termination Date: 2022-07-31
Contract Record ID: 91723579101 Term Reason: VOLUNTARY
Comments: Please email COBRA





Request ID: 232101 Status: COMPLETE
Request Date: 2022-07-10 Status Date: 2022-07-10
Member Name: CHARLES RAY Member ID: 88833724703
Employer ID: TBX Termination Date: 2022-06-30
Contract Record ID: 88833724701 Term Reason: TERMINATION
Comments:





Request ID: 232121 Status: COMPLETE
Request Date: 2022-07-10 Status Date: 2022-07-10
Member Name: CHRIS DELLA SALA Member ID: 26379287501
Employer ID: TBX Termination Date: 2022-06-30
Contract Record ID: 26379287501 Term Reason: TERMINATION
Comments:





Request ID: 232161 Status: COMPLETE
Request Date: 2022-07-11 Status Date: 2022-07-11
Member Name: MORGAN TAYLOR Member ID: 50051524601
Employer ID: COS Termination Date: 2022-07-08
Contract Record ID: 50051524601 Term Reason: TERMINATION
Comments: Termination of employment





Request ID: 232781 Status: COMPLETE
Request Date: 2022-07-12 Status Date: 2022-07-12
Member Name: CINTHYA MONTEVERDE Member ID: 96166821201
Employer ID: AZOPT Termination Date: 2022-07-27
Contract Record ID: 96166821201 Term Reason: TERMINATION
Comments: left before benefits became active





Request ID: 233121 Status: COMPLETE
Request Date: 2022-07-13 Status Date: 2022-07-13
Member Name: MACY TURNER Member ID: 63271110601
Employer ID: YHP00158 Termination Date: 2022-06-27
Contract Record ID: 63271110601 Term Reason: TERMINATION
Comments:





Request ID: 233261 Status: COMPLETE
Request Date: 2022-07-14 Status Date: 2022-07-14
Member Name: THOMAS ONDRIAS Member ID: 21783199801
Employer ID: APRES Termination Date: 2022-07-29
Contract Record ID: 21783199801 Term Reason: TERMINATION
Comments:





Request ID: 234041 Status: COMPLETE
Request Date: 2022-07-18 Status Date: 2022-07-18
Member Name: HOA NGUYEN Member ID: 75270400502
Employer ID: APRES Termination Date: 2022-07-31
Contract Record ID: 75270400501 Term Reason: VOLUNTARY
Comments:





Request ID: 234561 Status: COMPLETE
Request Date: 2022-07-19 Status Date: 2022-07-19
Member Name: JOHN C ROGERS Member ID: 82192819001
Employer ID: ASSI Termination Date: 2022-07-19
Contract Record ID: 82192819001 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 235061 Status: COMPLETE
Request Date: 2022-07-21 Status Date: 2022-07-21
Member Name: JOYCE LYNN DAVID Member ID: 40268201501
Employer ID: ADVRX Termination Date: 2022-07-31
Contract Record ID: 40268201501 Term Reason: TERMINATION
Comments: Moved to a 1099 employee





Request ID: 235081 Status: COMPLETE
Request Date: 2022-07-21 Status Date: 2022-07-21
Member Name: MICHAELA WARNER Member ID: 95955835901
Employer ID: ADVRX Termination Date: 2022-07-31
Contract Record ID: 95955835901 Term Reason: TERMINATION
Comments: Terminated Employment -- COBRA Eligible.





Request ID: 235261 Status: COMPLETE
Request Date: 2022-07-21 Status Date: 2022-07-21
Member Name: DAVID MARTINEZ Member ID: 86254495001
Employer ID: FIRSTCUP Termination Date: 2022-04-16
Contract Record ID: 86254495001 Term Reason: TERMINATION
Comments:





Request ID: 235681 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: RICHARD OSBORNE Member ID: 42096429701
Employer ID: WCE Termination Date: 2022-06-22
Contract Record ID: 42096429701 Term Reason: TERMINATION
Comments:





Request ID: 235721 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: PAMELA PETRAK Member ID: 92950846701
Employer ID: BRULE Termination Date: 2022-07-22
Contract Record ID: 92950846701 Term Reason: EMPLOYEES DEATH
Comments: this is a test, do not term member





Request ID: 235761 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: PAMELA PETRAK Member ID: 92950846701
Employer ID: BRULE Termination Date: 2022-07-22
Contract Record ID: 92950846701 Term Reason:
Comments: this is a test, do not term member





Request ID: 235801 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: PAMELA PETRAK Member ID: 92950846701
Employer ID: BRULE Termination Date: 2022-07-01
Contract Record ID: 92950846701 Term Reason:
Comments: this is a test, do not term member





Request ID: 235861 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: SHELBY P SCHROEDER Member ID: 20690592703
Employer ID: CNT Termination Date: 2022-07-31
Contract Record ID: 20690592701 Term Reason: VOLUNTARY
Comments:





Request ID: 235923 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: KELLY BORG Member ID: 04617722501
Employer ID: SFM Termination Date: 2022-07-31
Contract Record ID: 04617722501 Term Reason: TERMINATION
Comments:





Request ID: 235924 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: HALEY GURR Member ID: 98509909301
Employer ID: SFM Termination Date: 2022-07-31
Contract Record ID: 98509909301 Term Reason: TERMINATION
Comments:





Request ID: 235925 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: ANNA HEBERT Member ID: 33267284201
Employer ID: SFM Termination Date: 2022-07-31
Contract Record ID: 33267284201 Term Reason: TERMINATION
Comments:





Request ID: 235926 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: CHRISTINA ANN KIST Member ID: 86933732801
Employer ID: SFM Termination Date: 2022-07-31
Contract Record ID: 86933732801 Term Reason: TERMINATION
Comments:





Request ID: 235927 Status: COMPLETE
Request Date: 2022-07-22 Status Date: 2022-07-22
Member Name: PHILLIP R STREETER Member ID: 00523606101
Employer ID: SFM Termination Date: 2022-07-31
Contract Record ID: 00523606101 Term Reason: TERMINATION
Comments:





Request ID: 236323 Status: COMPLETE
Request Date: 2022-07-25 Status Date: 2022-07-25
Member Name: JOHN C ROGERS Member ID: 82192819001
Employer ID: ASSI Termination Date: 2022-07-18
Contract Record ID: 82192819001 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 236324 Status: COMPLETE
Request Date: 2022-07-25 Status Date: 2022-07-25
Member Name: VINCENT BROOKS Member ID: 38664013501
Employer ID: ASSI Termination Date: 2022-06-21
Contract Record ID: 38664013501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 236326 Status: COMPLETE
Request Date: 2022-07-25 Status Date: 2022-07-25
Member Name: JAMES GROGAN Member ID: 19534326701
Employer ID: ASSI Termination Date: 2022-06-07
Contract Record ID: 19534326701 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 236327 Status: COMPLETE
Request Date: 2022-07-25 Status Date: 2022-07-25
Member Name: GREGORY C BYRNE Member ID: 42224829701
Employer ID: ASSI Termination Date: 2022-06-04
Contract Record ID: 42224829701 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 236341 Status: COMPLETE
Request Date: 2022-07-25 Status Date: 2022-07-25
Member Name: RUTESE DICKERSON Member ID: 97323951601
Employer ID: DNA Termination Date: 2022-07-31
Contract Record ID: 97323951601 Term Reason: VOLUNTARY
Comments:





Request ID: 236901 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: RILEY BELGARDE Member ID: 32587595201
Employer ID: TPCH Termination Date: 2022-07-15
Contract Record ID: 32587595201 Term Reason: VOLUNTARY
Comments:





Request ID: 236902 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: SIERRA K DECOTEAU Member ID: 29542795501
Employer ID: TPCH Termination Date: 2022-07-01
Contract Record ID: 29542795501 Term Reason: VOLUNTARY
Comments:





Request ID: 236903 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: BRAD IVES Member ID: 79635734101
Employer ID: TPCH Termination Date: 2022-06-30
Contract Record ID: 79635734101 Term Reason: VOLUNTARY
Comments:





Request ID: 236904 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: TYLER L IVES Member ID: 83939548801
Employer ID: TPCH Termination Date: 2022-06-20
Contract Record ID: 83939548801 Term Reason: VOLUNTARY
Comments:





Request ID: 236905 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: TANNER E IVES Member ID: 15447296801
Employer ID: TPCH Termination Date: 2022-06-20
Contract Record ID: 15447296801 Term Reason: VOLUNTARY
Comments:





Request ID: 236906 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: TATYANA JACOBS Member ID: 80911311801
Employer ID: TPCH Termination Date: 2022-07-18
Contract Record ID: 80911311801 Term Reason: VOLUNTARY
Comments:





Request ID: 236907 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: KELLI MCDONALD Member ID: 52768228001
Employer ID: TPCH Termination Date: 2022-07-04
Contract Record ID: 52768228001 Term Reason: VOLUNTARY
Comments:





Request ID: 236908 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: HILLARY PURSER Member ID: 75159406801
Employer ID: TPCH Termination Date: 2022-07-26
Contract Record ID: 75159406801 Term Reason: VOLUNTARY
Comments:





Request ID: 236909 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: NOELLE C ROOT Member ID: 43660467901
Employer ID: TPCH Termination Date: 2022-07-04
Contract Record ID: 43660467901 Term Reason: VOLUNTARY
Comments:





Request ID: 236910 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: GREGORY SPENCER Member ID: 54200447601
Employer ID: TPCH Termination Date: 2022-07-03
Contract Record ID: 54200447601 Term Reason: VOLUNTARY
Comments:





Request ID: 236911 Status: COMPLETE
Request Date: 2022-07-26 Status Date: 2022-07-26
Member Name: LORI ZINK Member ID: 24335404801
Employer ID: TPCH Termination Date: 2022-07-11
Contract Record ID: 24335404801 Term Reason: VOLUNTARY
Comments:





Request ID: 237161 Status: COMPLETE
Request Date: 2022-07-27 Status Date: 2022-07-27
Member Name: CLAUDIA RODRIGUEZ Member ID: 25430957401
Employer ID: DNA Termination Date: 2022-07-31
Contract Record ID: 25430957401 Term Reason: VOLUNTARY
Comments:





Request ID: 237421 Status: COMPLETE
Request Date: 2022-07-28 Status Date: 2022-07-28
Member Name: LAFAYETTE LEWIS Member ID: 89417676801
Employer ID: PELTZ Termination Date: 2022-07-31
Contract Record ID: 89417676801 Term Reason: VOLUNTARY
Comments:





Request ID: 237422 Status: COMPLETE
Request Date: 2022-07-28 Status Date: 2022-07-28
Member Name: LAFAYETTE LEWIS Member ID: 89417676801
Employer ID: PELTZ Termination Date: 2022-07-31
Contract Record ID: 89417676801 Term Reason: VOLUNTARY
Comments:





Request ID: 237642 Status: COMPLETE
Request Date: 2022-07-28 Status Date: 2022-07-28
Member Name: CASSIE HANSON Member ID: 23887390401
Employer ID: SFM Termination Date: 2022-06-30
Contract Record ID: 23887390401 Term Reason: TERMINATION
Comments:





Request ID: 237681 Status: COMPLETE
Request Date: 2022-07-28 Status Date: 2022-07-28
Member Name: LIEZL HODGES Member ID: 46942961401
Employer ID: SFM Termination Date: 2022-03-31
Contract Record ID: 46942961401 Term Reason: TERMINATION
Comments:





Request ID: 237921 Status: COMPLETE
Request Date: 2022-07-29 Status Date: 2022-07-29
Member Name: SHEILA C BLOYD Member ID: 42906283801
Employer ID: LNB Termination Date: 2022-07-31
Contract Record ID: 42906283801 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments: Employee is keeping DENTAL so term only the medical





Request ID: 238001 Status: COMPLETE
Request Date: 2022-07-29 Status Date: 2022-07-29
Member Name: TIFFANIE HENSON Member ID: 22634953201
Employer ID: CNT Termination Date: 2022-07-31
Contract Record ID: 22634953201 Term Reason: TERMINATION
Comments:





Request ID: 238002 Status: COMPLETE
Request Date: 2022-07-29 Status Date: 2022-07-29
Member Name: CHELSEA JANE BAIRD Member ID: 46273179801
Employer ID: CNT Termination Date: 2022-07-31
Contract Record ID: 46273179801 Term Reason: TERMINATION
Comments:





Request ID: 238363 Status: COMPLETE
Request Date: 2022-08-01 Status Date: 2022-08-01
Member Name: LLOYD GARCIA Member ID: 19103253801
Employer ID: PELTZ Termination Date: 2022-07-31
Contract Record ID: 19103253801 Term Reason: TERMINATION
Comments:





Request ID: 238364 Status: COMPLETE
Request Date: 2022-08-01 Status Date: 2022-08-01
Member Name: ALEXANDRA LEYDON Member ID: 03151400201
Employer ID: PELTZ Termination Date: 2022-07-31
Contract Record ID: 03151400201 Term Reason: TERMINATION
Comments:





Request ID: 238385 Status: COMPLETE
Request Date: 2022-08-01 Status Date: 2022-08-01
Member Name: RACHEL ALLEN Member ID: 63130640301
Employer ID: PELTZ Termination Date: 2022-07-31
Contract Record ID: 63130640301 Term Reason: TERMINATION
Comments:





Request ID: 238481 Status: COMPLETE
Request Date: 2022-08-02 Status Date: 2022-08-02
Member Name: DYLAN MCKEE Member ID: 20545135601
Employer ID: BROSOL Termination Date: 2022-07-31
Contract Record ID: 20545135601 Term Reason: REDUCTION OF HOURS
Comments: Employee voluntarily chose to go part-time





Request ID: 238482 Status: COMPLETE
Request Date: 2022-08-02 Status Date: 2022-08-02
Member Name: JAMES R MCKEE Member ID: 37972946601
Employer ID: BROSOL Termination Date: 2022-07-31
Contract Record ID: 37972946601 Term Reason: VOLUNTARY
Comments:





Request ID: 238561 Status: COMPLETE
Request Date: 2022-08-02 Status Date: 2022-08-02
Member Name: STEPHANIE LYNN JOHNSON Member ID: 64226073601
Employer ID: DNA Termination Date: 2022-07-31
Contract Record ID: 64226073601 Term Reason: TERMINATION
Comments:





Request ID: 238581 Status: COMPLETE
Request Date: 2022-08-02 Status Date: 2022-08-02
Member Name: STEPHANIE LYNN JOHNSON Member ID: 64226073601
Employer ID: DNA Termination Date: 2022-07-31
Contract Record ID: 64226073601 Term Reason: TERMINATION
Comments:





Request ID: 238645 Status: COMPLETE
Request Date: 2022-08-02 Status Date: 2022-08-02
Member Name: JENNIFER FAYE COFFMAN Member ID: 28792159101
Employer ID: SFM Termination Date: 2022-07-31
Contract Record ID: 28792159101 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 239121 Status: COMPLETE
Request Date: 2022-08-03 Status Date: 2022-08-03
Member Name: MARGARET BENITEZ Member ID: 67969235601
Employer ID: YHP00158 Termination Date: 2022-07-25
Contract Record ID: 67969235601 Term Reason: TERMINATION
Comments:





Request ID: 239141 Status: COMPLETE
Request Date: 2022-08-03 Status Date: 2022-08-03
Member Name: LAUREN JOHNSON Member ID: 97901483601
Employer ID: YHP00158 Termination Date: 2022-07-22
Contract Record ID: 97901483601 Term Reason: TERMINATION
Comments:





Request ID: 239481 Status: COMPLETE
Request Date: 2022-08-04 Status Date: 2022-08-04
Member Name: ALICIA WELTON Member ID: 85634199301
Employer ID: TPCH Termination Date: 2022-05-20
Contract Record ID: 85634199301 Term Reason: TERMINATION
Comments:





Request ID: 239601 Status: COMPLETE
Request Date: 2022-08-05 Status Date: 2022-08-05
Member Name: ROSCHOD PRINCE Member ID: 47509156701
Employer ID: CLEAR Termination Date: 2022-07-31
Contract Record ID: 47509156701 Term Reason: TERMINATION
Comments:





Request ID: 239662 Status: COMPLETE
Request Date: 2022-08-05 Status Date: 2022-08-05
Member Name: JOSEPH COLLINS Member ID: 75145186901
Employer ID: VAUGHAN Termination Date: 2022-08-01
Contract Record ID: 75145186901 Term Reason: INVOLUNTARY
Comments:





Request ID: 239663 Status: COMPLETE
Request Date: 2022-08-05 Status Date: 2022-08-05
Member Name: BRYAN DIERICK Member ID: 15470654301
Employer ID: VAUGHAN Termination Date: 2022-07-29
Contract Record ID: 15470654301 Term Reason: VOLUNTARY
Comments: Retired





Request ID: 239701 Status: COMPLETE
Request Date: 2022-08-08 Status Date: 2022-08-08
Member Name: JANAY CONNOR Member ID: 43528097601
Employer ID: ADVRX Termination Date: 2022-07-31
Contract Record ID: 43528097601 Term Reason: TERMINATION
Comments: Employment Status Change (7/20/2022) Employee went to part time





Request ID: 240181 Status: COMPLETE
Request Date: 2022-08-09 Status Date: 2022-08-09
Member Name: SHAWN OSBORNE Member ID: 53161352101
Employer ID: TBX Termination Date: 2022-06-30
Contract Record ID: 53161352101 Term Reason: NON PAYMENT OF PREMIUMS
Comments: Cancel EE+FAM HMA 3000 medical coverage COBRA





Request ID: 240461 Status: COMPLETE
Request Date: 2022-08-10 Status Date: 2022-08-10
Member Name: STEPHANIE R MOSELEY Member ID: 48789535401
Employer ID: BRANDY Termination Date: 2022-06-30
Contract Record ID: 48789535401 Term Reason: TERMINATION
Comments:





Request ID: 240462 Status: COMPLETE
Request Date: 2022-08-10 Status Date: 2022-08-10
Member Name: TAMEKA VAUGHAN-TAYLOR Member ID: 29160857601
Employer ID: BRANDY Termination Date: 2022-06-30
Contract Record ID: 29160857601 Term Reason: TERMINATION
Comments:





Request ID: 240463 Status: COMPLETE
Request Date: 2022-08-10 Status Date: 2022-08-10
Member Name: RHONDA WALTON Member ID: 66284414901
Employer ID: BRANDY Termination Date: 2022-06-30
Contract Record ID: 66284414901 Term Reason: TERMINATION
Comments:





Request ID: 240761 Status: COMPLETE
Request Date: 2022-08-10 Status Date: 2022-08-10
Member Name: BRADLEY J GUENTHNER Member ID: 54514578301
Employer ID: TPCH Termination Date: 2022-05-22
Contract Record ID: 54514578301 Term Reason: TERMINATION
Comments:





Request ID: 240781 Status: COMPLETE
Request Date: 2022-08-10 Status Date: 2022-08-10
Member Name: DEAN FULTON Member ID: 62351309501
Employer ID: TPCH Termination Date: 2022-06-14
Contract Record ID: 62351309501 Term Reason: TERMINATION
Comments:





Request ID: 240821 Status: COMPLETE
Request Date: 2022-08-11 Status Date: 2022-08-11
Member Name: BREANNA MARTINEZ Member ID: 92081837701
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 92081837701 Term Reason: TERMINATION
Comments:





Request ID: 241141 Status: COMPLETE
Request Date: 2022-08-12 Status Date: 2022-08-12
Member Name: LISA NIELS Member ID: 59383859901
Employer ID: VAUGHAN Termination Date: 2022-08-16
Contract Record ID: 59383859901 Term Reason: VOLUNTARY
Comments:





Request ID: 241181 Status: COMPLETE
Request Date: 2022-08-12 Status Date: 2022-08-12
Member Name: TENLEY NIELS Member ID: 59383859903
Employer ID: VAUGHAN Termination Date: 2022-08-31
Contract Record ID: 59383859901 Term Reason: VOLUNTARY
Comments:





Request ID: 241401 Status: COMPLETE
Request Date: 2022-08-15 Status Date: 2022-08-15
Member Name: WILLIAM DOWNS Member ID: 17042427802
Employer ID: LNB Termination Date: 2022-07-31
Contract Record ID: 17042427801 Term Reason: VOLUNTARY
Comments: Employees Spouse gained new employment/new eligibility and signed on there.





Request ID: 241821 Status: COMPLETE
Request Date: 2022-08-17 Status Date: 2022-08-17
Member Name: DORENA HIRSCHMAN Member ID: 34062369202
Employer ID: VAUGHAN Termination Date: 2022-07-31
Contract Record ID: 34062369201 Term Reason: DIVORCE FROM EMPLOYEE
Comments:





Request ID: 241933 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: STEPHANIE MURGUIA Member ID: 52362885201
Employer ID: SFM Termination Date: 2022-08-31
Contract Record ID: 52362885201 Term Reason: TERMINATION
Comments:





Request ID: 241934 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: ROBERTA LYNN COLQUHOUN Member ID: 70989417401
Employer ID: SFM Termination Date: 2022-08-31
Contract Record ID: 70989417401 Term Reason: TERMINATION
Comments:





Request ID: 241935 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: KITANNA WILCOX Member ID: 06888491901
Employer ID: SFM Termination Date: 2022-08-31
Contract Record ID: 06888491901 Term Reason: TERMINATION
Comments:





Request ID: 241936 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: HOWNAZ FARIS OMAR Member ID: 17090537901
Employer ID: SFM Termination Date: 2022-08-31
Contract Record ID: 17090537901 Term Reason: TERMINATION
Comments:





Request ID: 241937 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: CHARLY MARSH Member ID: 21554125901
Employer ID: SFM Termination Date: 2022-08-31
Contract Record ID: 21554125901 Term Reason: TERMINATION
Comments:





Request ID: 241942 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: VANESSA EVANGELINE STARESINIC Member ID: 83111254601
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 83111254601 Term Reason: TERMINATION
Comments:





Request ID: 241953 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: DEVIN DAVIS-LUCAS Member ID: 81884848501
Employer ID: SFM Termination Date: 2022-08-31
Contract Record ID: 81884848501 Term Reason: VOLUNTARY
Comments:





Request ID: 241954 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: COLETTE BECKMAN Member ID: 36969182903
Employer ID: SERVHIGH Termination Date: 2022-06-17
Contract Record ID: 36969182901 Term Reason: TERMINATION
Comments:





Request ID: 241955 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: JOSHUA BECKMAN Member ID: 36969182901
Employer ID: SERVHIGH Termination Date: 2022-06-17
Contract Record ID: 36969182901 Term Reason: TERMINATION
Comments:





Request ID: 241957 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: JOHN IV D MACWILLIE Member ID: 36669033601
Employer ID: SERVHIGH Termination Date: 2022-07-15
Contract Record ID: 36669033601 Term Reason: TERMINATION
Comments:





Request ID: 241958 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: CARLIE EMMA MACWILLIE Member ID: 36669033602
Employer ID: SERVHIGH Termination Date: 2022-07-15
Contract Record ID: 36669033601 Term Reason: TERMINATION
Comments:





Request ID: 241959 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: SAMUEL GOODING Member ID: 06986635301
Employer ID: SERVHIGH Termination Date: 2022-07-21
Contract Record ID: 06986635301 Term Reason: TERMINATION
Comments:





Request ID: 241960 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: JOSHUA II CHRISTOPHER BECKMAN Member ID: 36969182904
Employer ID: SERVHIGH Termination Date: 2022-06-17
Contract Record ID: 36969182901 Term Reason: TERMINATION
Comments:





Request ID: 241961 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: MARYANN BECKMAN Member ID: 36969182902
Employer ID: SERVHIGH Termination Date: 2022-06-17
Contract Record ID: 36969182901 Term Reason: TERMINATION
Comments:





Request ID: 241962 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: JOHN G A MORRIS Member ID: 80205354101
Employer ID: SERVHIGH Termination Date: 2022-06-30
Contract Record ID: 80205354101 Term Reason: TERMINATION
Comments:





Request ID: 241963 Status: COMPLETE
Request Date: 2022-08-19 Status Date: 2022-08-19
Member Name: CASEY MORRIS Member ID: 80205354102
Employer ID: SERVHIGH Termination Date: 2022-06-30
Contract Record ID: 80205354101 Term Reason: TERMINATION
Comments:





Request ID: 241991 Status: COMPLETE
Request Date: 2022-08-22 Status Date: 2022-08-22
Member Name: JUAN LOPEZ TORRES Member ID: 72525751401
Employer ID: USEGG Termination Date: 2022-08-01
Contract Record ID: 72525751401 Term Reason: TERMINATION
Comments:





Request ID: 242009 Status: COMPLETE
Request Date: 2022-08-23 Status Date: 2022-08-23
Member Name: JONATHAN DURHAM Member ID: 85081427701
Employer ID: BROSOL Termination Date: 2022-08-01
Contract Record ID: 85081427701 Term Reason: VOLUNTARY
Comments: Voluntarily quit.





Request ID: 242010 Status: COMPLETE
Request Date: 2022-08-23 Status Date: 2022-08-23
Member Name: QUITTEN PEDIGO Member ID: 18854978801
Employer ID: BROSOL Termination Date: 2022-09-01
Contract Record ID: 18854978801 Term Reason: VOLUNTARY
Comments: Employee voluntarily quit onn 8/8/2022





Request ID: 242012 Status: COMPLETE
Request Date: 2022-08-23 Status Date: 2022-08-23
Member Name: WILLIAM A MEANS Member ID: 09417518403
Employer ID: BROSOL Termination Date: 2022-08-01
Contract Record ID: 09417518401 Term Reason: VOLUNTARY
Comments: William voluntarily terminated on 7/18/2022





Request ID: 242020 Status: COMPLETE
Request Date: 2022-08-23 Status Date: 2022-08-23
Member Name: APRIL MONTGOMERY Member ID: 31089540901
Employer ID: PELTZ Termination Date: 2022-08-18
Contract Record ID: 31089540901 Term Reason: TERMINATION
Comments:





Request ID: 242022 Status: COMPLETE
Request Date: 2022-08-23 Status Date: 2022-08-23
Member Name: JOE ESTRADA Member ID: 54825526601
Employer ID: BRECKS Termination Date: 2022-07-31
Contract Record ID: 54825526601 Term Reason: TERMINATION
Comments:





Request ID: 242023 Status: COMPLETE
Request Date: 2022-08-23 Status Date: 2022-08-23
Member Name: MARTHA JUAREZ Member ID: 05947083901
Employer ID: BRECKS Termination Date: 2022-08-31
Contract Record ID: 05947083901 Term Reason: TERMINATION
Comments:





Request ID: 242083 Status: COMPLETE
Request Date: 2022-08-25 Status Date: 2022-08-25
Member Name: DENNIS JAMES HOHENBRINK Member ID: 50659967801
Employer ID: EASYLVNG Termination Date: 2022-08-31
Contract Record ID: 50659967801 Term Reason: TERMINATION
Comments:





Request ID: 242085 Status: COMPLETE
Request Date: 2022-08-25 Status Date: 2022-08-25
Member Name: JORDAN GRIMALDO Member ID: 17657205901
Employer ID: YHP00134 Termination Date: 2022-07-30
Contract Record ID: 17657205901 Term Reason: VOLUNTARY
Comments: VOLUNTARY, OTHER EMPLOYMENT





Request ID: 242095 Status: COMPLETE
Request Date: 2022-08-25 Status Date: 2022-08-25
Member Name: ANDREW DICRISI Member ID: 83483742303
Employer ID: SERVHIGH Termination Date: 2022-08-05
Contract Record ID: 83483742301 Term Reason: TERMINATION
Comments:





Request ID: 242096 Status: COMPLETE
Request Date: 2022-08-25 Status Date: 2022-08-25
Member Name: COLLEEN POYAR Member ID: 76986911901
Employer ID: SERVHIGH Termination Date: 2022-08-01
Contract Record ID: 76986911901 Term Reason: TERMINATION
Comments:





Request ID: 242097 Status: COMPLETE
Request Date: 2022-08-25 Status Date: 2022-08-25
Member Name: COLLEEN POYAR Member ID: 76986911901
Employer ID: SERVHIGH Termination Date: 2022-08-01
Contract Record ID: 76986911901 Term Reason: TERMINATION
Comments:





Request ID: 242098 Status: COMPLETE
Request Date: 2022-08-25 Status Date: 2022-08-25
Member Name: IVONNE DUCHARME Member ID: 96645915601
Employer ID: SERVHIGH Termination Date: 2022-07-07
Contract Record ID: 96645915601 Term Reason: TERMINATION
Comments:





Request ID: 242127 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: JOSHUA LEE Member ID: 22217423101
Employer ID: BROSOL Termination Date: 2022-08-31
Contract Record ID: 22217423101 Term Reason: TERMINATION
Comments: Last day of employment 8/26/2022





Request ID: 242128 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: JOSHUA LEE Member ID: 22217423101
Employer ID: BROSOL Termination Date: 2022-08-31
Contract Record ID: 22217423101 Term Reason: TERMINATION
Comments: Last day of employment 8/26/2022





Request ID: 242130 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: AUSTIN H VALENTINE Member ID: 57659517401
Employer ID: BROSOL Termination Date: 2022-08-31
Contract Record ID: 57659517401 Term Reason: TERMINATION
Comments: Last day of employment 8/27/2022





Request ID: 242161 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: JESSICA BEDNARZ Member ID: 92944917901
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 92944917901 Term Reason: TERMINATION
Comments:





Request ID: 242163 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: JESSICA BEDNARZ Member ID: 92944917901
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 92944917901 Term Reason: TERMINATION
Comments:





Request ID: 242164 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: AUTUMN JOHNSON Member ID: 12351545301
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 12351545301 Term Reason: TERMINATION
Comments:





Request ID: 242181 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: AUTUMN JOHNSON Member ID: 12351545301
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 12351545301 Term Reason: TERMINATION
Comments:





Request ID: 242201 Status: COMPLETE
Request Date: 2022-08-26 Status Date: 2022-08-26
Member Name: DINA HERFORTH Member ID: 97577795801
Employer ID: SFM Termination Date: 2022-08-31
Contract Record ID: 97577795801 Term Reason: TERMINATION
Comments:





Request ID: 242342 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: MARIA C MERKEL Member ID: 07149521801
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 07149521801 Term Reason: TERMINATION
Comments:





Request ID: 242423 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: EVETTE BLEVINS Member ID: 61728976601
Employer ID: HOSPAUTH Termination Date: 2022-08-16
Contract Record ID: 61728976601 Term Reason: TERMINATION
Comments:





Request ID: 242424 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: TERRY CRAWFORD III Member ID: 09658775201
Employer ID: HOSPAUTH Termination Date: 2022-08-02
Contract Record ID: 09658775201 Term Reason: TERMINATION
Comments:





Request ID: 242425 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: LARRY EIDE Member ID: 39543817801
Employer ID: HOSPAUTH Termination Date: 2022-07-18
Contract Record ID: 39543817801 Term Reason: TERMINATION
Comments:





Request ID: 242426 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: LEAH GIBBONS Member ID: 23429558801
Employer ID: HOSPAUTH Termination Date: 2022-06-16
Contract Record ID: 23429558801 Term Reason: VOLUNTARY
Comments:





Request ID: 242427 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: YOLONDA HARLEY Member ID: 92294188801
Employer ID: HOSPAUTH Termination Date: 2022-04-21
Contract Record ID: 92294188801 Term Reason: TERMINATION
Comments:





Request ID: 242428 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: JAMES HOLMES Member ID: 61560460601
Employer ID: HOSPAUTH Termination Date: 2022-04-18
Contract Record ID: 61560460601 Term Reason: TERMINATION
Comments:





Request ID: 242441 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: AMANDA MORGAN Member ID: 11184678001
Employer ID: HOSPAUTH Termination Date: 2021-11-28
Contract Record ID: 11184678001 Term Reason: TERMINATION
Comments:





Request ID: 242461 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: TALISHA C PAIGE Member ID: 81130214801
Employer ID: HOSPAUTH Termination Date: 2022-04-26
Contract Record ID: 81130214801 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 242462 Status: COMPLETE
Request Date: 2022-08-29 Status Date: 2022-08-29
Member Name: KYANDRA SMITH Member ID: 61775987901
Employer ID: HOSPAUTH Termination Date: 2022-04-06
Contract Record ID: 61775987901 Term Reason: TERMINATION
Comments:





Request ID: 242741 Status: COMPLETE
Request Date: 2022-08-30 Status Date: 2022-08-30
Member Name: MENNO YODER Member ID: 04240817001
Employer ID: MESH Termination Date: 2022-08-24
Contract Record ID: 04240817001 Term Reason: VOLUNTARY
Comments:





Request ID: 242781 Status: COMPLETE
Request Date: 2022-08-30 Status Date: 2022-08-30
Member Name: MOHAMAD ALSADI Member ID: 29328408401
Employer ID: BRECK Termination Date: 2022-08-31
Contract Record ID: 29328408401 Term Reason: VOLUNTARY
Comments: please mail the COBRA documents





Request ID: 243221 Status: COMPLETE
Request Date: 2022-08-31 Status Date: 2022-08-31
Member Name: SPENCER ORSCHELN Member ID: 53345840801
Employer ID: TRILAT Termination Date: 2022-08-31
Contract Record ID: 53345840801 Term Reason: VOLUNTARY
Comments: Gained coverage through his spouse, United Healthcare





Request ID: 243761 Status: COMPLETE
Request Date: 2022-09-06 Status Date: 2022-09-06
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments:





Request ID: 243763 Status: COMPLETE
Request Date: 2022-09-06 Status Date: 2022-09-06
Member Name: HOLLIE ROSE Member ID: 24441573101
Employer ID: CNT Termination Date: 2022-09-30
Contract Record ID: 24441573101 Term Reason: TERMINATION
Comments:





Request ID: 243881 Status: COMPLETE
Request Date: 2022-09-06 Status Date: 2022-09-06
Member Name: SHAUN CRUMBLE Member ID: 02733278201
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 02733278201 Term Reason: VOLUNTARY
Comments:





Request ID: 244341 Status: COMPLETE
Request Date: 2022-09-07 Status Date: 2022-09-07
Member Name: SHAUN CRUMBLE Member ID: 02733278201
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 02733278201 Term Reason: VOLUNTARY
Comments:





Request ID: 244430 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: MIGUEL ANTONIO ZUNIGA ZAMORA Member ID: 56593666101
Employer ID: YHP00134 Termination Date: 2022-08-28
Contract Record ID: 56593666101 Term Reason: VOLUNTARY
Comments: QUIT, OTHER EMPLOYMENT





Request ID: 244436 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-09-08
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments: this is a test, please disregard





Request ID: 244437 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-09-08
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments: this is a test, please disregard





Request ID: 244438 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-09-08
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments: this is a test, please disregard





Request ID: 244440 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-09-08
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments: this is a test please disregard





Request ID: 244443 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-09-08
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments: this is a test, please disregard





Request ID: 244444 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-09-08
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments: this is a test, please disregard





Request ID: 244445 Status: COMPLETE
Request Date: 2022-09-08 Status Date: 2022-09-08
Member Name: KAREN ASHLEY DAY Member ID: 54305682901
Employer ID: CNT Termination Date: 2022-09-08
Contract Record ID: 54305682901 Term Reason: TERMINATION
Comments: this is a test, please disregard





Request ID: 244470 Status: COMPLETE
Request Date: 2022-09-09 Status Date: 2022-09-09
Member Name: AMANDA ZAMBRANO Member ID: 83918923601
Employer ID: CNT Termination Date: 2022-09-30
Contract Record ID: 83918923601 Term Reason: TERMINATION
Comments:





Request ID: 244485 Status: COMPLETE
Request Date: 2022-09-12 Status Date: 2022-09-12
Member Name: DOUGLAS K SICKLER Member ID: 12818760101
Employer ID: MESH Termination Date: 2022-08-26
Contract Record ID: 12818760101 Term Reason: TERMINATION
Comments:





Request ID: 244486 Status: COMPLETE
Request Date: 2022-09-12 Status Date: 2022-09-12
Member Name: TONY CARROLL Member ID: 37892417201
Employer ID: WCE Termination Date: 2022-09-23
Contract Record ID: 37892417201 Term Reason: VOLUNTARY
Comments:





Request ID: 244547 Status: COMPLETE
Request Date: 2022-09-14 Status Date: 2022-09-14
Member Name: CAMERON HESS Member ID: 53306012001
Employer ID: YHP00397 Termination Date: 2022-09-01
Contract Record ID: 53306012001 Term Reason: TERMINATION
Comments:





Request ID: 244550 Status: COMPLETE
Request Date: 2022-09-14 Status Date: 2022-09-14
Member Name: RENA FRAZIER Member ID: 85510035301
Employer ID: YHP00397 Termination Date: 2022-09-13
Contract Record ID: 85510035301 Term Reason: VOLUNTARY
Comments: Employee is eligible for insurance through other employer.





Request ID: 244581 Status: COMPLETE
Request Date: 2022-09-15 Status Date: 2022-09-15
Member Name: KENDREA K WARD Member ID: 19067797101
Employer ID: LNB Termination Date: 2022-09-30
Contract Record ID: 19067797101 Term Reason: TERMINATION
Comments: last day 9/15/22 - policy thru 9/30/22





Request ID: 244626 Status: COMPLETE
Request Date: 2022-09-16 Status Date: 2022-09-16
Member Name: RONALD A THIBODEAUX Member ID: 56400707901
Employer ID: BRANDY Termination Date: 2022-08-31
Contract Record ID: 56400707901 Term Reason: TERMINATION
Comments:





Request ID: 244627 Status: COMPLETE
Request Date: 2022-09-16 Status Date: 2022-09-16
Member Name: ADAM MATLON Member ID: 74951796101
Employer ID: TRILAT Termination Date: 2022-09-15
Contract Record ID: 74951796101 Term Reason: VOLUNTARY
Comments:





Request ID: 244629 Status: COMPLETE
Request Date: 2022-09-16 Status Date: 2022-09-16
Member Name: JOSEPH COLLINS Member ID: 75145186901
Employer ID: VAUGHAN Termination Date: 2022-08-01
Contract Record ID: 75145186901 Term Reason: TERMINATION
Comments:





Request ID: 244630 Status: COMPLETE
Request Date: 2022-09-16 Status Date: 2022-09-16
Member Name: MA SOPHIA Y RIVO Member ID: 71341473201
Employer ID: SFM Termination Date: 2022-09-30
Contract Record ID: 71341473201 Term Reason: TERMINATION
Comments:





Request ID: 244671 Status: COMPLETE
Request Date: 2022-09-19 Status Date: 2022-09-19
Member Name: JOSEPH GAGLIARDO Member ID: 02213123401
Employer ID: ASSI Termination Date: 2022-09-07
Contract Record ID: 02213123401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 244702 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: COLLIER MCKENZIE Member ID: 22673916301
Employer ID: APRES Termination Date: 2022-10-03
Contract Record ID: 22673916301 Term Reason: TERMINATION
Comments:





Request ID: 244703 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: DAVID CHOVANEC Member ID: 44168881701
Employer ID: WCE Termination Date: 2022-09-26
Contract Record ID: 44168881701 Term Reason: TERMINATION
Comments:





Request ID: 244704 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: CHARLES W W BEVAN Member ID: 71616685301
Employer ID: MESH Termination Date: 2022-09-10
Contract Record ID: 71616685301 Term Reason: VOLUNTARY
Comments:





Request ID: 244712 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: JAMES CAWEIN Member ID: 05742825601
Employer ID: ASSI Termination Date: 2022-09-20
Contract Record ID: 05742825601 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 244713 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: ROSS P FISHETTI Member ID: 18359142501
Employer ID: ASSI Termination Date: 2022-09-20
Contract Record ID: 18359142501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 244714 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: JOSEPH GAGLIARDO Member ID: 02213123401
Employer ID: ASSI Termination Date: 2022-09-07
Contract Record ID: 02213123401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 244717 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: DENNIS MARTINEZ Member ID: 41043080401
Employer ID: ASSI Termination Date: 2022-05-07
Contract Record ID: 41043080401 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 244719 Status: COMPLETE
Request Date: 2022-09-20 Status Date: 2022-09-20
Member Name: JOHN VENTURA Member ID: 06775309701
Employer ID: ASSI Termination Date: 2022-09-20
Contract Record ID: 06775309701 Term Reason: TERMINATION
Comments:





Request ID: 244748 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: STEVEN LIVINGSTON Member ID: 12580312501
Employer ID: ASSI Termination Date: 2022-09-21
Contract Record ID: 12580312501 Term Reason: VOLUNTARY
Comments:





Request ID: 244749 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: SCOTT A BURTON Member ID: 02478255301
Employer ID: ASSI Termination Date: 2022-09-21
Contract Record ID: 02478255301 Term Reason: TERMINATION
Comments:





Request ID: 244751 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: STEVEN LIVINGSTON Member ID: 12580312501
Employer ID: ASSI Termination Date: 2022-09-21
Contract Record ID: 12580312501 Term Reason: VOLUNTARY
Comments:





Request ID: 244752 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: JAMES M RICH Member ID: 86952122001
Employer ID: ASSI Termination Date: 2022-09-21
Contract Record ID: 86952122001 Term Reason: TERMINATION
Comments:





Request ID: 244764 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: EVETTE BLEVINS Member ID: 61728976601
Employer ID: HOSPAUTH Termination Date: 2022-08-16
Contract Record ID: 61728976601 Term Reason: VOLUNTARY
Comments:





Request ID: 244766 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: JUSTIN A ALBERTSON Member ID: 66912052501
Employer ID: BROSOL Termination Date: 2022-09-30
Contract Record ID: 66912052501 Term Reason: VOLUNTARY
Comments: Dediced to drop medical coverage during open enrollment.





Request ID: 244768 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: JAMES HOLMES Member ID: 61560460601
Employer ID: HOSPAUTH Termination Date: 2022-04-18
Contract Record ID: 61560460601 Term Reason: VOLUNTARY
Comments:





Request ID: 244770 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: MALENA BRISSETT Member ID: 54369408901
Employer ID: HOSPAUTH Termination Date: 2022-05-02
Contract Record ID: 54369408901 Term Reason: VOLUNTARY
Comments:





Request ID: 244771 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: RODNEY CORWIN Member ID: 02336613201
Employer ID: HOSPAUTH Termination Date: 2022-06-30
Contract Record ID: 02336613201 Term Reason: TERMINATION
Comments:





Request ID: 244772 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: TERRY CRAWFORD III Member ID: 09658775201
Employer ID: HOSPAUTH Termination Date: 2022-08-02
Contract Record ID: 09658775201 Term Reason: TERMINATION
Comments:





Request ID: 244773 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: LASHONDREA CRUZ Member ID: 58416474401
Employer ID: HOSPAUTH Termination Date: 2022-04-14
Contract Record ID: 58416474401 Term Reason: VOLUNTARY
Comments:





Request ID: 244774 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: MARKCUS DAY Member ID: 67915948401
Employer ID: HOSPAUTH Termination Date: 2022-08-24
Contract Record ID: 67915948401 Term Reason: VOLUNTARY
Comments:





Request ID: 244775 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: LARRY EIDE Member ID: 39543817801
Employer ID: HOSPAUTH Termination Date: 2022-07-18
Contract Record ID: 39543817801 Term Reason: VOLUNTARY
Comments:





Request ID: 244776 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: MARTINIQUE EVANS Member ID: 11830943501
Employer ID: HOSPAUTH Termination Date: 2022-06-27
Contract Record ID: 11830943501 Term Reason: VOLUNTARY
Comments:





Request ID: 244777 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: LEAH GIBBONS Member ID: 23429558801
Employer ID: HOSPAUTH Termination Date: 2022-06-16
Contract Record ID: 23429558801 Term Reason: VOLUNTARY
Comments:





Request ID: 244778 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: SANDRA JESTER Member ID: 21613327301
Employer ID: HOSPAUTH Termination Date: 2022-03-22
Contract Record ID: 21613327301 Term Reason: VOLUNTARY
Comments:





Request ID: 244779 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: RACHEL JETHROE Member ID: 90103276101
Employer ID: HOSPAUTH Termination Date: 2022-02-09
Contract Record ID: 90103276101 Term Reason: VOLUNTARY
Comments:





Request ID: 244780 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: FRANCES KERCE Member ID: 67021542501
Employer ID: HOSPAUTH Termination Date: 2022-08-01
Contract Record ID: 67021542501 Term Reason: TERMINATION
Comments:





Request ID: 244782 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: GWENDOLYN MCGHEE Member ID: 91184740201
Employer ID: HOSPAUTH Termination Date: 2022-04-04
Contract Record ID: 91184740201 Term Reason: VOLUNTARY
Comments:





Request ID: 244783 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: AMANDA MORGAN Member ID: 11184678001
Employer ID: HOSPAUTH Termination Date: 2021-11-28
Contract Record ID: 11184678001 Term Reason: VOLUNTARY
Comments:





Request ID: 244784 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: FRANK ODELL Member ID: 90856922901
Employer ID: HOSPAUTH Termination Date: 2022-05-03
Contract Record ID: 90856922901 Term Reason: VOLUNTARY
Comments:





Request ID: 244785 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: TALISHA C PAIGE Member ID: 81130214801
Employer ID: HOSPAUTH Termination Date: 2022-04-26
Contract Record ID: 81130214801 Term Reason: VOLUNTARY
Comments:





Request ID: 244786 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: BARBARA RATLIFF Member ID: 90559310501
Employer ID: HOSPAUTH Termination Date: 2022-03-31
Contract Record ID: 90559310501 Term Reason: VOLUNTARY
Comments:





Request ID: 244787 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: DOVEY ROBERSON Member ID: 47547578401
Employer ID: HOSPAUTH Termination Date: 2022-08-22
Contract Record ID: 47547578401 Term Reason: VOLUNTARY
Comments:





Request ID: 244788 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: LAURENCE WHARTON Member ID: 12721370203
Employer ID: HOSPAUTH Termination Date: 2022-05-25
Contract Record ID: 12721370201 Term Reason: LOSS OF DEPENDANT STATUS
Comments:





Request ID: 244789 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: MARTA CENICEROS Member ID: 61987399301
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 61987399301 Term Reason: TERMINATION
Comments:





Request ID: 244792 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: DAVID CHOVANEC Member ID: 44168881701
Employer ID: WCE Termination Date: 2022-09-26
Contract Record ID: 44168881701 Term Reason: TERMINATION
Comments:





Request ID: 244796 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: SARA LYNNE BONSON Member ID: 72946785201
Employer ID: SFM Termination Date: 2022-09-30
Contract Record ID: 72946785201 Term Reason: TERMINATION
Comments:





Request ID: 244797 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: LAURA DAVIS Member ID: 25388211601
Employer ID: SFM Termination Date: 2022-09-30
Contract Record ID: 25388211601 Term Reason: TERMINATION
Comments:





Request ID: 244798 Status: COMPLETE
Request Date: 2022-09-21 Status Date: 2022-09-21
Member Name: CAREY MORRILL Member ID: 54144615301
Employer ID: SFM Termination Date: 2022-09-30
Contract Record ID: 54144615301 Term Reason: TERMINATION
Comments:





Request ID: 244804 Status: COMPLETE
Request Date: 2022-09-22 Status Date: 2022-09-22
Member Name: SCOTT R FAUX Member ID: 36304647101
Employer ID: MESH Termination Date: 2022-09-06
Contract Record ID: 36304647101 Term Reason: VOLUNTARY
Comments:





Request ID: 244820 Status: COMPLETE
Request Date: 2022-09-22 Status Date: 2022-09-22
Member Name: ALEXIS ROSE AUSTAD Member ID: 30422683201
Employer ID: YHP00134 Termination Date: 2022-08-29
Contract Record ID: 30422683201 Term Reason: VOLUNTARY
Comments: OTHER EMPLOYMENT





Request ID: 244863 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: JULIA HOLZHAUSEN Member ID: 23317922801
Employer ID: PELTZ Termination Date: 2022-10-31
Contract Record ID: 23317922801 Term Reason: TERMINATION
Comments:





Request ID: 244865 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: MARTHA JUAREZ Member ID: 05947083901
Employer ID: BRECKS Termination Date: 2022-08-31
Contract Record ID: 05947083901 Term Reason: TERMINATION
Comments:





Request ID: 244879 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: KELLIE CORPUZ Member ID: 30253007501
Employer ID: SFM Termination Date: 2022-09-30
Contract Record ID: 30253007501 Term Reason: TERMINATION
Comments:





Request ID: 244883 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: ELAINE FULTON Member ID: 56023383301
Employer ID: TPCH Termination Date: 2022-09-02
Contract Record ID: 56023383301 Term Reason:
Comments:





Request ID: 244885 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: MISTY WHITE Member ID: 29830095101
Employer ID: TPCH Termination Date: 2022-08-25
Contract Record ID: 29830095101 Term Reason: TERMINATION
Comments:





Request ID: 244886 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: DAYLON M MARTIN Member ID: 04131981201
Employer ID: TPCH Termination Date: 2022-09-18
Contract Record ID: 49161398001 Term Reason: TERMINATION
Comments:





Request ID: 244887 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: JUSTIN SMITH Member ID: 31912610601
Employer ID: TPCH Termination Date: 2022-09-18
Contract Record ID: 31912610601 Term Reason: TERMINATION
Comments:





Request ID: 244888 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: JUSTIN L SYMES Member ID: 79092266501
Employer ID: TPCH Termination Date: 2022-08-26
Contract Record ID: 79092266501 Term Reason: TERMINATION
Comments:





Request ID: 244890 Status: COMPLETE
Request Date: 2022-09-26 Status Date: 2022-09-26
Member Name: GEORGE SPARKS Member ID: 05209812101
Employer ID: TPCH Termination Date: 2022-08-26
Contract Record ID: 05209812101 Term Reason: TERMINATION
Comments:





Request ID: 245362 Status: COMPLETE
Request Date: 2022-09-28 Status Date: 2022-09-28
Member Name: CAITLIN SPAANSTRA Member ID: 03515126301
Employer ID: YHP00435 Termination Date: 2022-10-02
Contract Record ID: 03515126301 Term Reason: TERMINATION
Comments: Caitlin Spaanstra resigned from EAVS effective 10/02/2022.





Request ID: 245363 Status: COMPLETE
Request Date: 2022-09-28 Status Date: 2022-09-28
Member Name: CAITLIN SPAANSTRA Member ID: 03515126301
Employer ID: YHP00435 Termination Date: 2022-10-02
Contract Record ID: 03515126301 Term Reason: TERMINATION
Comments: Caitlin Spaanstra resigned from EAVS effective 10/02/2022.





Request ID: 245401 Status: COMPLETE
Request Date: 2022-09-28 Status Date: 2022-09-28
Member Name: BARU MUELA Member ID: 66460769001
Employer ID: WCE Termination Date: 2022-09-28
Contract Record ID: 66460769001 Term Reason: VOLUNTARY
Comments:





Request ID: 245521 Status: COMPLETE
Request Date: 2022-09-29 Status Date: 2022-09-29
Member Name: KELSEY WOODARD Member ID: 35765619901
Employer ID: YHP00158 Termination Date: 2022-09-01
Contract Record ID: 35765619901 Term Reason: TERMINATION
Comments:





Request ID: 245661 Status: COMPLETE
Request Date: 2022-09-29 Status Date: 2022-09-29
Member Name: KATRINA WATERS Member ID: 33764536201
Employer ID: HOSPAUTH Termination Date: 2022-09-19
Contract Record ID: 33764536201 Term Reason: VOLUNTARY
Comments:





Request ID: 245861 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: AMBER DAWN BELCHER Member ID: 68553651701
Employer ID: YHP00227 Termination Date: 2022-07-30
Contract Record ID: 68553651701 Term Reason: VOLUNTARY
Comments:





Request ID: 245881 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: ROBERT J ROBERTSON Member ID: 65861123101
Employer ID: SERVHIGH Termination Date: 2022-09-30
Contract Record ID: 65861123101 Term Reason: TERMINATION
Comments:





Request ID: 245901 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: JACKIE MICHELLE SNIDER Member ID: 78979253201
Employer ID: YHP00227 Termination Date: 2022-05-27
Contract Record ID: 78979253201 Term Reason: VOLUNTARY
Comments:





Request ID: 245944 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: FELIPE CARBO Member ID: 03423805201
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 03423805201 Term Reason: VOLUNTARY
Comments: Open Enrollment waive of coverage





Request ID: 245945 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: ASHANTI CARTER Member ID: 15759541201
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 15759541201 Term Reason: VOLUNTARY
Comments: Open Enrollment waived coverage





Request ID: 245950 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: TINA OKOJEVOH Member ID: 55029867201
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 55029867201 Term Reason: VOLUNTARY
Comments: Open Enrollment waived coverage





Request ID: 245951 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: TYLER HARTLEY Member ID: 19297544503
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 19297544501 Term Reason: VOLUNTARY
Comments: Open Enrollment drop child coverage





Request ID: 245952 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: JULIE SIMMONS Member ID: 43994300702
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 43994300701 Term Reason: VOLUNTARY
Comments: Open Enrollment drop spouse coverage





Request ID: 245953 Status: COMPLETE
Request Date: 2022-09-30 Status Date: 2022-09-30
Member Name: CHERYL SOBIERAJ Member ID: 80130160501
Employer ID: DNA Termination Date: 2022-09-30
Contract Record ID: 80130160501 Term Reason: VOLUNTARY
Comments: Open Enrollment waived coverage





Request ID: 245964 Status: COMPLETE
Request Date: 2022-10-03 Status Date: 2022-10-03
Member Name: BRITTANY SMITH Member ID: 63201007301
Employer ID: HOSPAUTH Termination Date: 2022-08-31
Contract Record ID: 63201007301 Term Reason: TERMINATION
Comments:





Request ID: 245971 Status: COMPLETE
Request Date: 2022-10-03 Status Date: 2022-10-03
Member Name: PAULA Z DUNCAN Member ID: 26691432301
Employer ID: BRANDY Termination Date: 2022-09-30
Contract Record ID: 26691432301 Term Reason: TERMINATION
Comments:





Request ID: 245983 Status: COMPLETE
Request Date: 2022-10-03 Status Date: 2022-10-03
Member Name: JASON MATTISON Member ID: 06758445903
Employer ID: YHP00123 Termination Date: 2022-09-30
Contract Record ID: 06758445901 Term Reason: LOSS OF DEPENDANT STATUS
Comments: Please remove the child Jason Mattison DOB 9/15/1996 due to him turning 26 years old





Request ID: 245994 Status: COMPLETE
Request Date: 2022-10-03 Status Date: 2022-10-03
Member Name: SUSAN BLAYLCOK Member ID: 14317759701
Employer ID: YHP00134 Termination Date: 2022-09-22
Contract Record ID: 14317759701 Term Reason: VOLUNTARY
Comments: QUIT





Request ID: 246027 Status: COMPLETE
Request Date: 2022-10-04 Status Date: 2022-10-04
Member Name: DESTINEY BEAL Member ID: 49945138401
Employer ID: CNT Termination Date: 2022-06-30
Contract Record ID: 49945138401 Term Reason: TERMINATION
Comments:





Request ID: 246041 Status: COMPLETE
Request Date: 2022-10-05 Status Date: 2022-10-05
Member Name: DOMYNIQUE ARCHAMBAULT Member ID: 19748309601
Employer ID: TPCH Termination Date: 2022-08-16
Contract Record ID: 19748309601 Term Reason: TERMINATION
Comments:





Request ID: 246042 Status: COMPLETE
Request Date: 2022-10-05 Status Date: 2022-10-05
Member Name: ANTONIO REYES RAMIREZ Member ID: 17669091201
Employer ID: TPCH Termination Date: 2022-08-18
Contract Record ID: 17669091201 Term Reason: TERMINATION
Comments:





Request ID: 246043 Status: COMPLETE
Request Date: 2022-10-05 Status Date: 2022-10-05
Member Name: LACEY M BUGG Member ID: 57744579301
Employer ID: TPCH Termination Date: 2022-08-29
Contract Record ID: 57744579301 Term Reason: TERMINATION
Comments:





Request ID: 246044 Status: COMPLETE
Request Date: 2022-10-05 Status Date: 2022-10-05
Member Name: JENNIFER TUCKER Member ID: 32982601001
Employer ID: TPCH Termination Date: 2022-09-14
Contract Record ID: 32982601001 Term Reason: TERMINATION
Comments:





Request ID: 246061 Status: COMPLETE
Request Date: 2022-10-05 Status Date: 2022-10-05
Member Name: CAITLYN M CUNNINGHAM Member ID: 62884961201
Employer ID: PELTZ Termination Date: 2022-10-31
Contract Record ID: 62884961201 Term Reason: TERMINATION
Comments:





Request ID: 246081 Status: COMPLETE
Request Date: 2022-10-05 Status Date: 2022-10-05
Member Name: JACK MABRY Member ID: 63354792901
Employer ID: BRANDY Termination Date: 2022-09-30
Contract Record ID: 63354792901 Term Reason: TERMINATION
Comments:





Request ID: 246461 Status: COMPLETE
Request Date: 2022-10-06 Status Date: 2022-10-06
Member Name: LESLIE CODY Member ID: 84111085301
Employer ID: YHP00134 Termination Date: 2022-09-30
Contract Record ID: 84111085301 Term Reason: VOLUNTARY
Comments: QUIT





Request ID: 246481 Status: COMPLETE
Request Date: 2022-10-06 Status Date: 2022-10-06
Member Name: JULIE BEREND Member ID: 40274105301
Employer ID: CNT Termination Date: 2022-09-30
Contract Record ID: 40274105301 Term Reason: TERMINATION
Comments:





Request ID: 246501 Status: COMPLETE
Request Date: 2022-10-06 Status Date: 2022-10-06
Member Name: LESLEY DIAZ Member ID: 05324515301
Employer ID: CNT Termination Date: 2022-08-31
Contract Record ID: 05324515301 Term Reason: TERMINATION
Comments:





Request ID: 246661 Status: COMPLETE
Request Date: 2022-10-06 Status Date: 2022-10-06
Member Name: DANIEL YOFFRIEN Member ID: 48369615401
Employer ID: DNA Termination Date: 2022-10-03
Contract Record ID: 48369615401 Term Reason: TERMINATION
Comments:





Request ID: 246761 Status: COMPLETE
Request Date: 2022-10-07 Status Date: 2022-10-07
Member Name: ALESIA CAROL LACHER Member ID: 69303412601
Employer ID: PELTZ Termination Date: 2022-09-30
Contract Record ID: 69303412601 Term Reason: TERMINATION
Comments:





Request ID: 248061 Status: COMPLETE
Request Date: 2022-10-12 Status Date: 2022-10-12
Member Name: ANTHONY STAGNER Member ID: 48072224302
Employer ID: CNT Termination Date: 2022-09-30
Contract Record ID: 48072224301 Term Reason: VOLUNTARY
Comments:





Request ID: 248205 Status: COMPLETE
Request Date: 2022-10-13 Status Date: 2022-10-13
Member Name: EDWARD G YOUNICA Member ID: 77092655501
Employer ID: MESH Termination Date: 2022-10-31
Contract Record ID: 77092655501 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 248224 Status: COMPLETE
Request Date: 2022-10-13 Status Date: 2022-10-13
Member Name: TALITHA LEAH SEELYE Member ID: 34482236501
Employer ID: YHP00227 Termination Date: 2022-10-12
Contract Record ID: 34482236501 Term Reason: VOLUNTARY
Comments:





Request ID: 248226 Status: COMPLETE
Request Date: 2022-10-13 Status Date: 2022-10-13
Member Name: ROOSEVELT DANIEL Member ID: 41278922001
Employer ID: HOSPAUTH Termination Date: 2022-09-30
Contract Record ID: 41278922001 Term Reason: VOLUNTARY
Comments:





Request ID: 248256 Status: COMPLETE
Request Date: 2022-10-14 Status Date: 2022-10-14
Member Name: ADDIE JO BUSH Member ID: 58066360701
Employer ID: SFM Termination Date: 2022-10-31
Contract Record ID: 58066360701 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 248257 Status: COMPLETE
Request Date: 2022-10-14 Status Date: 2022-10-14
Member Name: CHERYL A HALL Member ID: 75537154501
Employer ID: SFM Termination Date: 2022-10-31
Contract Record ID: 75537154501 Term Reason: TERMINATION
Comments:





Request ID: 248266 Status: COMPLETE
Request Date: 2022-10-17 Status Date: 2022-10-17
Member Name: COLLIER MCKENZIE Member ID: 22673916301
Employer ID: APRES Termination Date: 2022-10-03
Contract Record ID: 22673916301 Term Reason: VOLUNTARY
Comments:





Request ID: 248267 Status: COMPLETE
Request Date: 2022-10-17 Status Date: 2022-10-17
Member Name: NIVIDA AGURCIA Member ID: 63376089301
Employer ID: APRES Termination Date: 2022-10-21
Contract Record ID: 63376089301 Term Reason: INVOLUNTARY
Comments:





Request ID: 248274 Status: COMPLETE
Request Date: 2022-10-17 Status Date: 2022-10-17
Member Name: NANCY WINDISCH Member ID: 62025987201
Employer ID: SERVHIGH Termination Date: 2022-09-30
Contract Record ID: 62025987201 Term Reason: VOLUNTARY
Comments:





Request ID: 248372 Status: COMPLETE
Request Date: 2022-10-19 Status Date: 2022-10-19
Member Name: TIMOTHY J MANGRUM Member ID: 06962021301
Employer ID: YHP00134 Termination Date: 2022-10-03
Contract Record ID: 06962021301 Term Reason: TERMINATION
Comments: QUIT





Request ID: 248374 Status: COMPLETE
Request Date: 2022-10-19 Status Date: 2022-10-19
Member Name: BREANNA FORTNER Member ID: 39983134201
Employer ID: SFM Termination Date: 2022-09-30
Contract Record ID: 39983134201 Term Reason: TERMINATION
Comments:





Request ID: 248377 Status: COMPLETE
Request Date: 2022-10-19 Status Date: 2022-10-19
Member Name: MICHAEL REYES Member ID: 77767135601
Employer ID: DNA Termination Date: 2022-10-31
Contract Record ID: 77767135601 Term Reason: VOLUNTARY
Comments:





Request ID: 248485 Status: COMPLETE
Request Date: 2022-10-24 Status Date: 2022-10-24
Member Name: KEVIN E PURVIS Member ID: 57869085701
Employer ID: BROSOL Termination Date: 2022-10-14
Contract Record ID: 57869085701 Term Reason: TERMINATION
Comments: Coverage termed on 10/31/2022





Request ID: 248487 Status: COMPLETE
Request Date: 2022-10-24 Status Date: 2022-10-24
Member Name: AMY NEWELL Member ID: 24381686801
Employer ID: YHP00123 Termination Date: 2022-09-30
Contract Record ID: 24381686801 Term Reason: TERMINATION
Comments: Please terminate all coverage effective 9/30/2022 as she is no longer employed.





Request ID: 248489 Status: COMPLETE
Request Date: 2022-10-24 Status Date: 2022-10-24
Member Name: KARINA COLLINS Member ID: 34337553401
Employer ID: YHP00123 Termination Date: 2022-08-31
Contract Record ID: 34337553401 Term Reason: TERMINATION
Comments: Please remove all coverage effective 08/31/2022.





Request ID: 248490 Status: COMPLETE
Request Date: 2022-10-24 Status Date: 2022-10-24
Member Name: JOSEPH DOHERTY Member ID: 77997713402
Employer ID: DATAPG Termination Date: 2021-07-27
Contract Record ID: 77997713401 Term Reason: DIVORCE FROM EMPLOYEE
Comments: Please remove Joseph Doherty as a dependent. This individual would have been removed from the coverage due to a plan change to Member+Children in July 2021.





Request ID: 248499 Status: COMPLETE
Request Date: 2022-10-24 Status Date: 2022-10-24
Member Name: MADYLISSA ROSARIO Member ID: 95304942201
Employer ID: DNA Termination Date: 2022-11-01
Contract Record ID: 95304942201 Term Reason: VOLUNTARY
Comments: Employee voluntarily terminated employment on 10/21/2022 and is covered through 10/31/2022. First day of no coverage is 11/1/2022. Please terminate coverage on 11/1/2022. Thank you.





Request ID: 248554 Status: COMPLETE
Request Date: 2022-10-25 Status Date: 2022-10-25
Member Name: JOSHUA L WHITE Member ID: 78753005201
Employer ID: BROSOL Termination Date: 2022-08-15
Contract Record ID: 78753005201 Term Reason: TERMINATION
Comments: Coverage should end 9/1/2022





Request ID: 248555 Status: COMPLETE
Request Date: 2022-10-25 Status Date: 2022-10-25
Member Name: DAMON D MILLER Member ID: 54842751901
Employer ID: BROSOL Termination Date: 2022-10-31
Contract Record ID: 54842751901 Term Reason: VOLUNTARY
Comments: Subscriber request to terminate coverage on 11/1/2022





Request ID: 248556 Status: COMPLETE
Request Date: 2022-10-25 Status Date: 2022-10-25
Member Name: KEVIN E PURVIS Member ID: 57869085701
Employer ID: BROSOL Termination Date: 2022-10-14
Contract Record ID: 57869085701 Term Reason: TERMINATION
Comments: Coverage should end 11/1/2022





Request ID: 248558 Status: COMPLETE
Request Date: 2022-10-25 Status Date: 2022-10-25
Member Name: KEVIN E PURVIS Member ID: 57869085701
Employer ID: BROSOL Termination Date: 2022-10-14
Contract Record ID: 57869085701 Term Reason: TERMINATION
Comments:





Request ID: 248598 Status: COMPLETE
Request Date: 2022-10-26 Status Date: 2022-10-26
Member Name: PATIENCE MATHIS Member ID: 19904300603
Employer ID: SFM Termination Date: 2022-11-01
Contract Record ID: 19904300601 Term Reason: VOLUNTARY
Comments:





Request ID: 248599 Status: COMPLETE
Request Date: 2022-10-26 Status Date: 2022-10-26
Member Name: PATIENCE MATHIS Member ID: 19904300603
Employer ID: SFM Termination Date: 2022-11-01
Contract Record ID: 19904300601 Term Reason: VOLUNTARY
Comments: Opting out of dependent coverage





Request ID: 248600 Status: COMPLETE
Request Date: 2022-10-26 Status Date: 2022-10-26
Member Name: SKYLER MATHIS Member ID: 19904300604
Employer ID: SFM Termination Date: 2022-11-01
Contract Record ID: 19904300601 Term Reason: VOLUNTARY
Comments: Opting out of dependent coverage





Request ID: 248601 Status: COMPLETE
Request Date: 2022-10-26 Status Date: 2022-10-26
Member Name: MICHAEL ALTLAND Member ID: 21762202901
Employer ID: YHP00126 Termination Date: 2022-09-30
Contract Record ID: 21762202901 Term Reason: TERMINATION
Comments: Can we please cancel his insurance for the months of October & November. Please advise





Request ID: 248625 Status: COMPLETE
Request Date: 2022-10-27 Status Date: 2022-10-27
Member Name: MARCIA WILSON Member ID: 56191708501
Employer ID: HOSPAUTH Termination Date: 2022-10-20
Contract Record ID: 56191708501 Term Reason: TERMINATION
Comments:





Request ID: 248634 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: RAMON ISAIAH BENAVIDEZ Member ID: 65357513501
Employer ID: FIRSTCUP Termination Date: 2022-10-24
Contract Record ID: 65357513501 Term Reason: TERMINATION
Comments: vol





Request ID: 248635 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: TERRANCE DENSMORE Member ID: 25097611901
Employer ID: FIRSTCUP Termination Date: 2022-10-24
Contract Record ID: 25097611901 Term Reason: TERMINATION
Comments: Vol





Request ID: 248636 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: BRANDI NICOLE MACASINAG-PETERSON Member ID: 26850030801
Employer ID: FIRSTCUP Termination Date: 2022-10-24
Contract Record ID: 26850030801 Term Reason: TERMINATION
Comments: vol





Request ID: 248637 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: SUE ANDREA MARQUEZ Member ID: 74729357401
Employer ID: FIRSTCUP Termination Date: 2022-10-24
Contract Record ID: 74729357401 Term Reason: TERMINATION
Comments: vol





Request ID: 248638 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: CECILIA MORENO Member ID: 23474812201
Employer ID: FIRSTCUP Termination Date: 2022-10-24
Contract Record ID: 23474812201 Term Reason: TERMINATION
Comments: vol





Request ID: 248639 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: ERIC SEMUHUNGU Member ID: 60203835601
Employer ID: FIRSTCUP Termination Date: 2022-10-24
Contract Record ID: 60203835601 Term Reason: TERMINATION
Comments: voluntary





Request ID: 248640 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: JADEN MICHAEL WEED Member ID: 79782231701
Employer ID: FIRSTCUP Termination Date: 2022-10-24
Contract Record ID: 79782231701 Term Reason: TERMINATION
Comments: vol





Request ID: 248667 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: TRACY ENGLE Member ID: 93102188401
Employer ID: BRECK Termination Date: 2022-10-31
Contract Record ID: 93102188401 Term Reason: TERMINATION
Comments: please send COBRA documents





Request ID: 248668 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: DAVID ALLAN VROMAN Member ID: 40763550701
Employer ID: BRECKS Termination Date: 2022-10-31
Contract Record ID: 40763550701 Term Reason: TERMINATION
Comments:





Request ID: 248669 Status: COMPLETE
Request Date: 2022-10-28 Status Date: 2022-10-28
Member Name: SARA MICHEL MINOR Member ID: 17460000401
Employer ID: BRECKS Termination Date: 2022-10-31
Contract Record ID: 17460000401 Term Reason: TERMINATION
Comments:





Request ID: 248681 Status: COMPLETE
Request Date: 2022-10-29 Status Date: 2022-10-29
Member Name: ALEXANDER SORIA Member ID: 22335021601
Employer ID: APRES Termination Date: 2022-10-29
Contract Record ID: 22335021601 Term Reason: TERMINATION
Comments:





Request ID: 248942 Status: COMPLETE
Request Date: 2022-11-01 Status Date: 2022-11-01
Member Name: CHANDRA CRAWFORD Member ID: 85838736501
Employer ID: HOSPAUTH Termination Date: 2022-10-22
Contract Record ID: 85838736501 Term Reason: VOLUNTARY
Comments:





Request ID: 248961 Status: COMPLETE
Request Date: 2022-11-01 Status Date: 2022-11-01
Member Name: JAHDAREINE WILLIAMS Member ID: 64236658901
Employer ID: HOSPAUTH Termination Date: 2022-09-27
Contract Record ID: 64236658901 Term Reason: VOLUNTARY
Comments:





Request ID: 248962 Status: COMPLETE
Request Date: 2022-11-01 Status Date: 2022-11-01
Member Name: LAKESHIA THORNTON Member ID: 04816704601
Employer ID: HOSPAUTH Termination Date: 2022-10-04
Contract Record ID: 04816704601 Term Reason: VOLUNTARY
Comments:





Request ID: 248981 Status: COMPLETE
Request Date: 2022-11-01 Status Date: 2022-11-01
Member Name: CARI WILSON Member ID: 04404698301
Employer ID: SFM Termination Date: 2022-10-31
Contract Record ID: 04404698301 Term Reason: TERMINATION
Comments:





Request ID: 249141 Status: COMPLETE
Request Date: 2022-11-02 Status Date: 2022-11-02
Member Name: JOSE PINEDA Member ID: 28745336601
Employer ID: MESH Termination Date: 2022-10-31
Contract Record ID: 28745336601 Term Reason: VOLUNTARY
Comments:





Request ID: 249461 Status: COMPLETE
Request Date: 2022-11-03 Status Date: 2022-11-03
Member Name: SANDRA AKOSA Member ID: 31142641601
Employer ID: DNA Termination Date: 2022-11-30
Contract Record ID: 31142641601 Term Reason: VOLUNTARY
Comments:





Request ID: 249802 Status: COMPLETE
Request Date: 2022-11-04 Status Date: 2022-11-04
Member Name: DEBORAH L LINCOLN Member ID: 62050274401
Employer ID: TPCH Termination Date: 2022-10-14
Contract Record ID: 62050274401 Term Reason: TERMINATION
Comments:





Request ID: 249881 Status: COMPLETE
Request Date: 2022-11-04 Status Date: 2022-11-04
Member Name: MARIA LOBINO Member ID: 70587916401
Employer ID: HOSPAUTH Termination Date: 2022-10-01
Contract Record ID: 70587916401 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments: Medicare effective date 10/01/2022





Request ID: 249981 Status: COMPLETE
Request Date: 2022-11-04 Status Date: 2022-11-04
Member Name: ELSIE ALLEN Member ID: 42498317201
Employer ID: TPCH Termination Date: 2022-08-21
Contract Record ID: 42498317201 Term Reason: TERMINATION
Comments:





Request ID: 250021 Status: COMPLETE
Request Date: 2022-11-04 Status Date: 2022-11-04
Member Name: KRIS LUCHMUN Member ID: 44541784902
Employer ID: VAUGHAN Termination Date: 2022-11-30
Contract Record ID: 44541784901 Term Reason: VOLUNTARY
Comments: Eligible for other coverage





Request ID: 250881 Status: COMPLETE
Request Date: 2022-11-09 Status Date: 2022-11-09
Member Name: EDMUND GUTKOWSKI Member ID: 60384635401
Employer ID: MESH Termination Date: 2022-10-18
Contract Record ID: 60384635401 Term Reason: VOLUNTARY
Comments:





Request ID: 250882 Status: COMPLETE
Request Date: 2022-11-09 Status Date: 2022-11-09
Member Name: LAVERNE SELDON Member ID: 54561762201
Employer ID: HOSPAUTH Termination Date: 2022-11-30
Contract Record ID: 54561762201 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 250901 Status: COMPLETE
Request Date: 2022-11-09 Status Date: 2022-11-09
Member Name: DEANGELA J CRAWFORD Member ID: 07784357501
Employer ID: YHP00158 Termination Date: 2022-11-04
Contract Record ID: 07784357501 Term Reason: TERMINATION
Comments:





Request ID: 251041 Status: COMPLETE
Request Date: 2022-11-10 Status Date: 2022-11-10
Member Name: STEPHANIE RAE BLAND Member ID: 23227415901
Employer ID: LNB Termination Date: 2022-11-30
Contract Record ID: 23227415901 Term Reason: TERMINATION
Comments: Employees last day was 11/4/22 but allowed on our policies thru 11/30/22





Request ID: 251149 Status: COMPLETE
Request Date: 2022-11-10 Status Date: 2022-11-10
Member Name: SARAH WELLMAN Member ID: 95712157201
Employer ID: TRILAT Termination Date: 2022-11-04
Contract Record ID: 95712157201 Term Reason: TERMINATION
Comments:





Request ID: 251184 Status: COMPLETE
Request Date: 2022-11-11 Status Date: 2022-11-11
Member Name: HARRY R MADER Member ID: 85103729301
Employer ID: MESH Termination Date: 2022-11-09
Contract Record ID: 85103729301 Term Reason: VOLUNTARY
Comments:





Request ID: 251219 Status: COMPLETE
Request Date: 2022-11-14 Status Date: 2022-11-14
Member Name: GREGORY RALLS Member ID: 44120467801
Employer ID: WCE Termination Date: 2022-11-11
Contract Record ID: 44120467801 Term Reason: VOLUNTARY
Comments:





Request ID: 251227 Status: COMPLETE
Request Date: 2022-11-14 Status Date: 2022-11-14
Member Name: SARA ATKINSON Member ID: 97270045501
Employer ID: CNT Termination Date: 2022-11-30
Contract Record ID: 97270045501 Term Reason: TERMINATION
Comments:





Request ID: 251242 Status: COMPLETE
Request Date: 2022-11-15 Status Date: 2022-11-15
Member Name: WALTER MARK Member ID: 65140857801
Employer ID: DNA Termination Date: 2022-12-01
Contract Record ID: 65140857801 Term Reason: VOLUNTARY
Comments: Last day of coverage is 11/30/2022.





Request ID: 251262 Status: COMPLETE
Request Date: 2022-11-15 Status Date: 2022-11-15
Member Name: BRAD CARSON Member ID: 20266564001
Employer ID: BRULE Termination Date: 2022-12-31
Contract Record ID: 20266564001 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 251263 Status: COMPLETE
Request Date: 2022-11-15 Status Date: 2022-11-15
Member Name: JEAN CARSON Member ID: 20266564002
Employer ID: BRULE Termination Date: 2022-12-31
Contract Record ID: 20266564001 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 251461 Status: COMPLETE
Request Date: 2022-11-16 Status Date: 2022-11-16
Member Name: CATHERINE TRUSSELL Member ID: 87669953801
Employer ID: TPCH Termination Date: 2022-11-10
Contract Record ID: 87669953801 Term Reason: TERMINATION
Comments:





Request ID: 251541 Status: COMPLETE
Request Date: 2022-11-17 Status Date: 2022-11-17
Member Name: DIAMOND KIANNA BOLDEN Member ID: 29817444901
Employer ID: ADVRX Termination Date: 2022-10-31
Contract Record ID: 29817444901 Term Reason: TERMINATION
Comments: Did not elect a coverage decision





Request ID: 251641 Status: COMPLETE
Request Date: 2022-11-17 Status Date: 2022-11-17
Member Name: WANDA HILLARD Member ID: 39841860201
Employer ID: LNB Termination Date: 2022-11-30
Contract Record ID: 39841860201 Term Reason: REDUCTION OF HOURS
Comments: Employee voluntarily went to part-time. Still employed. No longer eligible for coverage though.





Request ID: 251661 Status: COMPLETE
Request Date: 2022-11-17 Status Date: 2022-11-17
Member Name: MEGAN CLARK Member ID: 28700347901
Employer ID: LNB Termination Date: 2022-11-30
Contract Record ID: 28700347901 Term Reason: TERMINATION
Comments:





Request ID: 252141 Status: COMPLETE
Request Date: 2022-11-18 Status Date: 2022-11-18
Member Name: ALYSSA J KING Member ID: 57855577201
Employer ID: BRULE Termination Date: 2022-12-31
Contract Record ID: 57855577201 Term Reason: VOLUNTARY
Comments: Found insurance elsewher





Request ID: 253363 Status: COMPLETE
Request Date: 2022-11-21 Status Date: 2022-11-21
Member Name: KAYLA MARIE CASTRO TOVES Member ID: 78085241201
Employer ID: SFM Termination Date: 2022-11-30
Contract Record ID: 78085241201 Term Reason: TERMINATION
Comments:





Request ID: 253381 Status: COMPLETE
Request Date: 2022-11-21 Status Date: 2022-11-21
Member Name: CRYSTAL STURTEVANT Member ID: 33997883201
Employer ID: SFM Termination Date: 2022-11-30
Contract Record ID: 33997883201 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 254041 Status: COMPLETE
Request Date: 2022-11-22 Status Date: 2022-11-22
Member Name: MARC J LAPOINTE Member ID: 31516616501
Employer ID: BRECK Termination Date: 2022-12-31
Contract Record ID: 31516616501 Term Reason: VOLUNTARY
Comments: Retirement. Please email COBRA as son as possible





Request ID: 254101 Status: COMPLETE
Request Date: 2022-11-22 Status Date: 2022-11-22
Member Name: JOANNE ROLLINS Member ID: 04316924101
Employer ID: YHP00158 Termination Date: 2022-11-04
Contract Record ID: 04316924101 Term Reason: TERMINATION
Comments:





Request ID: 255021 Status: COMPLETE
Request Date: 2022-11-23 Status Date: 2022-11-23
Member Name: BRIAN EATON Member ID: 85733600101
Employer ID: BROSOL Termination Date: 2022-09-30
Contract Record ID: 85733600101 Term Reason: TERMINATION
Comments:





Request ID: 255041 Status: COMPLETE
Request Date: 2022-11-23 Status Date: 2022-11-23
Member Name: JARED W WESTBROOK Member ID: 80025483401
Employer ID: BROSOL Termination Date: 2022-11-30
Contract Record ID: 80025483401 Term Reason: TERMINATION
Comments:





Request ID: 255201 Status: COMPLETE
Request Date: 2022-11-23 Status Date: 2022-11-23
Member Name: CRYSTAL STURTEVANT Member ID: 33997883201
Employer ID: SFM Termination Date: 2022-11-30
Contract Record ID: 33997883201 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 255221 Status: COMPLETE
Request Date: 2022-11-23 Status Date: 2022-11-23
Member Name: KAYLA MARIE CASTRO TOVES Member ID: 78085241201
Employer ID: SFM Termination Date: 2022-11-30
Contract Record ID: 78085241201 Term Reason: TERMINATION
Comments:





Request ID: 255661 Status: COMPLETE
Request Date: 2022-11-28 Status Date: 2022-11-28
Member Name: CACHE JACKSON SIMMS Member ID: 38188450301
Employer ID: YHP00134 Termination Date: 2022-11-07
Contract Record ID: 38188450301 Term Reason: TERMINATION
Comments: VOLUNTARY , QUIT





Request ID: 255721 Status: COMPLETE
Request Date: 2022-11-28 Status Date: 2022-11-28
Member Name: MORGAN BYNUM Member ID: 57600276201
Employer ID: CNT Termination Date: 2022-11-30
Contract Record ID: 57600276201 Term Reason: TERMINATION
Comments:





Request ID: 255741 Status: COMPLETE
Request Date: 2022-11-28 Status Date: 2022-11-28
Member Name: RANDI WRIGHT Member ID: 12999016701
Employer ID: CNT Termination Date: 2022-11-30
Contract Record ID: 12999016701 Term Reason: TERMINATION
Comments:





Request ID: 256605 Status: COMPLETE
Request Date: 2022-11-30 Status Date: 2022-11-30
Member Name: TROY THOMAS Member ID: 28402726401
Employer ID: SERVHIGH Termination Date: 2022-11-11
Contract Record ID: 28402726401 Term Reason: TERMINATION
Comments:





Request ID: 256607 Status: COMPLETE
Request Date: 2022-11-30 Status Date: 2022-11-30
Member Name: ARIANA HINOJOSA Member ID: 35334592101
Employer ID: CNT Termination Date: 2022-11-30
Contract Record ID: 35334592101 Term Reason: TERMINATION
Comments:





Request ID: 256761 Status: COMPLETE
Request Date: 2022-12-01 Status Date: 2022-12-01
Member Name: ADALINN M AVELLANEDA Member ID: 58219701801
Employer ID: YHP00134 Termination Date: 2022-11-16
Contract Record ID: 58219701801 Term Reason: TERMINATION
Comments: INVOLUNTARY





Request ID: 256891 Status: COMPLETE
Request Date: 2022-12-02 Status Date: 2022-12-02
Member Name: JORDAN KASZA Member ID: 36232092901
Employer ID: CNT Termination Date: 2022-12-31
Contract Record ID: 36232092901 Term Reason: TERMINATION
Comments:





Request ID: 256892 Status: COMPLETE
Request Date: 2022-12-02 Status Date: 2022-12-02
Member Name: ALLISON MATHEWS Member ID: 50648579501
Employer ID: CNT Termination Date: 2022-11-30
Contract Record ID: 50648579501 Term Reason: TERMINATION
Comments:





Request ID: 257021 Status: COMPLETE
Request Date: 2022-12-05 Status Date: 2022-12-05
Member Name: MARIO MAGANA Member ID: 94395382601
Employer ID: APRES Termination Date: 2022-12-30
Contract Record ID: 94395382601 Term Reason: INVOLUNTARY
Comments:





Request ID: 257181 Status: COMPLETE
Request Date: 2022-12-06 Status Date: 2022-12-06
Member Name: HARRY R MADER Member ID: 85103729301
Employer ID: MESH Termination Date: 2022-11-30
Contract Record ID: 85103729301 Term Reason: TERMINATION
Comments:





Request ID: 257261 Status: COMPLETE
Request Date: 2022-12-06 Status Date: 2022-12-06
Member Name: DACIA GARBIG Member ID: 82014753001
Employer ID: TRILAT Termination Date: 2022-12-14
Contract Record ID: 82014753001 Term Reason: TERMINATION
Comments: Voluntary termination





Request ID: 257542 Status: COMPLETE
Request Date: 2022-12-08 Status Date: 2022-12-08
Member Name: BRIAN WATERS Member ID: 48886677501
Employer ID: HOSPAUTH Termination Date: 2022-11-23
Contract Record ID: 48886677501 Term Reason: TERMINATION
Comments:





Request ID: 257801 Status: COMPLETE
Request Date: 2022-12-09 Status Date: 2022-12-09
Member Name: FREDDIE ARTUZ Member ID: 64172799701
Employer ID: DNA Termination Date: 2022-12-05
Contract Record ID: 64172799701 Term Reason: TERMINATION
Comments:





Request ID: 257848 Status: COMPLETE
Request Date: 2022-12-09 Status Date: 2022-12-09
Member Name: PETER HART Member ID: 31433771701
Employer ID: MESH Termination Date: 2022-12-31
Contract Record ID: 31433771701 Term Reason: VOLUNTARY
Comments:





Request ID: 258161 Status: COMPLETE
Request Date: 2022-12-12 Status Date: 2022-12-12
Member Name: BRANDON KELLY Member ID: 96069822403
Employer ID: VAUGHAN Termination Date: 2022-12-31
Contract Record ID: 96069822401 Term Reason: VOLUNTARY
Comments:





Request ID: 258242 Status: COMPLETE
Request Date: 2022-12-12 Status Date: 2022-12-12
Member Name: SHEILA PELLEGRINO Member ID: 33726825202
Employer ID: VAUGHAN Termination Date: 2022-12-31
Contract Record ID: 33726825201 Term Reason: VOLUNTARY
Comments:





Request ID: 258243 Status: COMPLETE
Request Date: 2022-12-12 Status Date: 2022-12-12
Member Name: COLE SWENSON Member ID: 59677174003
Employer ID: VAUGHAN Termination Date: 2022-12-31
Contract Record ID: 59677174001 Term Reason: TERMINATION
Comments:





Request ID: 258244 Status: COMPLETE
Request Date: 2022-12-12 Status Date: 2022-12-12
Member Name: BLAKE SWENSON Member ID: 59677174004
Employer ID: VAUGHAN Termination Date: 2022-12-31
Contract Record ID: 59677174001 Term Reason: VOLUNTARY
Comments:





Request ID: 258281 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: SCOTT R FAUX Member ID: 36304647101
Employer ID: MESH Termination Date: 2022-11-29
Contract Record ID: 36304647101 Term Reason: VOLUNTARY
Comments:





Request ID: 258301 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: CARMEN PEREZ Member ID: 64710087101
Employer ID: PELTZ Termination Date: 2022-12-31
Contract Record ID: 64710087101 Term Reason: TERMINATION
Comments:





Request ID: 258363 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: KADENCE BEAVERS Member ID: 66520011603
Employer ID: GPR Termination Date: 2022-12-06
Contract Record ID: 66520011601 Term Reason: TERMINATION
Comments:





Request ID: 258364 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: CAROLINE VASON Member ID: 34073374501
Employer ID: GPR Termination Date: 2022-12-11
Contract Record ID: 34073374501 Term Reason: TERMINATION
Comments:





Request ID: 258481 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: ADELA ARELLANO Member ID: 47288648501
Employer ID: ACW Termination Date: 2022-07-24
Contract Record ID: 47288648501 Term Reason: TERMINATION
Comments: Sold business





Request ID: 258482 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: MICHELLE L CAMP Member ID: 74298180901
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 74298180901 Term Reason: TERMINATION
Comments: Sold Buiness





Request ID: 258483 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: PAUL CAMPBELL Member ID: 80265296801
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 80265296801 Term Reason: TERMINATION
Comments:





Request ID: 258484 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: GREGORIO CASIANO Member ID: 00445775301
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 00445775301 Term Reason: TERMINATION
Comments:





Request ID: 258485 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: ARMANDO CASTRO Member ID: 30743180101
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 30743180101 Term Reason: TERMINATION
Comments:





Request ID: 258487 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: DACIOUS HUNTER Member ID: 28215844201
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 28215844201 Term Reason: TERMINATION
Comments:





Request ID: 258488 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: LILIANA LOPEZ Member ID: 51255988801
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 51255988801 Term Reason: TERMINATION
Comments:





Request ID: 258489 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: HUGO MARTINEZ Member ID: 43115620901
Employer ID: ACW Termination Date: 2022-07-24
Contract Record ID: 43115620901 Term Reason: TERMINATION
Comments:





Request ID: 258490 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: JOSE MARIA PICHARDO AVILES Member ID: 23031691801
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 23031691801 Term Reason: TERMINATION
Comments:





Request ID: 258491 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: WILFRIDO RODRIGUEZ Member ID: 90584698401
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 90584698401 Term Reason: TERMINATION
Comments:





Request ID: 258492 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: LEON MARCELINO ROMERO FLORES Member ID: 18201500501
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 18201500501 Term Reason: TERMINATION
Comments:





Request ID: 258493 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: ANTONIO S SALGADO Member ID: 26041398201
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 26041398201 Term Reason: TERMINATION
Comments:





Request ID: 258494 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: ISMAEL M SALGADO Member ID: 11324111301
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 11324111301 Term Reason: TERMINATION
Comments:





Request ID: 258495 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: VINCENTE SALINAS Member ID: 33346426801
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 33346426801 Term Reason: TERMINATION
Comments:





Request ID: 258496 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: JORGE C SANTIAGO Member ID: 66591786701
Employer ID: ACW Termination Date: 2022-06-24
Contract Record ID: 66591786701 Term Reason: TERMINATION
Comments:





Request ID: 258497 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: JOSE U SAUCEDO Member ID: 57892967701
Employer ID: ACW Termination Date: 2022-07-24
Contract Record ID: 57892967701 Term Reason: TERMINATION
Comments:





Request ID: 258498 Status: COMPLETE
Request Date: 2022-12-13 Status Date: 2022-12-13
Member Name: DAVID J SCHAETZLE Member ID: 94371452701
Employer ID: ACW Termination Date: 2022-07-24
Contract Record ID: 94371452701 Term Reason: TERMINATION
Comments:





Request ID: 258861 Status: COMPLETE
Request Date: 2022-12-14 Status Date: 2022-12-14
Member Name: ZACHARY LONG Member ID: 53423136001
Employer ID: PELTZ Termination Date: 2022-11-30
Contract Record ID: 53423136001 Term Reason: TERMINATION
Comments:





Request ID: 259484 Status: COMPLETE
Request Date: 2022-12-15 Status Date: 2022-12-15
Member Name: BRICHELLE ROSE OLSEN Member ID: 17796900101
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 17796900101 Term Reason: REDUCTION OF HOURS
Comments:





Request ID: 259485 Status: COMPLETE
Request Date: 2022-12-15 Status Date: 2022-12-15
Member Name: KELLY NICHOLE JONES Member ID: 19615894201
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 19615894201 Term Reason: TERMINATION
Comments:





Request ID: 259486 Status: COMPLETE
Request Date: 2022-12-15 Status Date: 2022-12-15
Member Name: KATHRYNE M SCHERER Member ID: 00904191301
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 00904191301 Term Reason: TERMINATION
Comments:





Request ID: 259841 Status: COMPLETE
Request Date: 2022-12-19 Status Date: 2022-12-19
Member Name: CHRISTOPHER DAVID JONES Member ID: 62676029201
Employer ID: BRECKS Termination Date: 2022-12-31
Contract Record ID: 62676029201 Term Reason: TERMINATION
Comments: Please mail and email COBRA documents





Request ID: 259881 Status: COMPLETE
Request Date: 2022-12-19 Status Date: 2022-12-19
Member Name: BENJAMIN M DEFENDER Member ID: 05642410101
Employer ID: BRULE Termination Date: 2022-11-28
Contract Record ID: 05642410101 Term Reason: TERMINATION
Comments:





Request ID: 260162 Status: COMPLETE
Request Date: 2022-12-20 Status Date: 2022-12-20
Member Name: CAWANA BURTON Member ID: 86569901401
Employer ID: HOSPAUTH Termination Date: 2022-12-08
Contract Record ID: 86569901401 Term Reason: TERMINATION
Comments:





Request ID: 260423 Status: COMPLETE
Request Date: 2022-12-22 Status Date: 2022-12-22
Member Name: SHUMMIEYUM KIMBEL Member ID: 85466461501
Employer ID: CNT Termination Date: 2022-12-31
Contract Record ID: 85466461501 Term Reason: TERMINATION
Comments:





Request ID: 260424 Status: COMPLETE
Request Date: 2022-12-22 Status Date: 2022-12-22
Member Name: BEVERLY L BYAS Member ID: 32847072801
Employer ID: CNT Termination Date: 2022-12-31
Contract Record ID: 32847072801 Term Reason: TERMINATION
Comments:





Request ID: 260682 Status: COMPLETE
Request Date: 2022-12-23 Status Date: 2022-12-23
Member Name: JUSTIN DOTSON Member ID: 94724207801
Employer ID: VAUGHAN Termination Date: 2022-12-31
Contract Record ID: 94724207801 Term Reason: VOLUNTARY
Comments:





Request ID: 260701 Status: COMPLETE
Request Date: 2022-12-27 Status Date: 2022-12-27
Member Name: JEREMY HANCOCK Member ID: 77424200501
Employer ID: PELTZ Termination Date: 2022-12-31
Contract Record ID: 77424200501 Term Reason: TERMINATION
Comments:





Request ID: 260802 Status: COMPLETE
Request Date: 2022-12-27 Status Date: 2022-12-27
Member Name: CYNTHIA HOWERY Member ID: 48095579201
Employer ID: CNT Termination Date: 2022-12-31
Contract Record ID: 48095579201 Term Reason: TERMINATION
Comments:





Request ID: 261162 Status: COMPLETE
Request Date: 2022-12-28 Status Date: 2022-12-28
Member Name: ASHLEY BALDYGA Member ID: 47361302401
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 47361302401 Term Reason: TERMINATION
Comments:





Request ID: 261163 Status: COMPLETE
Request Date: 2022-12-28 Status Date: 2022-12-28
Member Name: JEREMY WADE VAN GIESON Member ID: 72611277101
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 72611277101 Term Reason: TERMINATION
Comments:





Request ID: 261203 Status: COMPLETE
Request Date: 2022-12-29 Status Date: 2022-12-29
Member Name: JESSE J WEAVER Member ID: 70575245801
Employer ID: MESH Termination Date: 2022-12-30
Contract Record ID: 70575245801 Term Reason: VOLUNTARY
Comments:





Request ID: 261782 Status: COMPLETE
Request Date: 2022-12-30 Status Date: 2022-12-30
Member Name: MYRNA ANDRES Member ID: 39934594001
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 39934594001 Term Reason: TERMINATION
Comments:





Request ID: 261881 Status: COMPLETE
Request Date: 2022-12-30 Status Date: 2022-12-30
Member Name: ZACHARY SZAFRYK Member ID: 62812718003
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 62812718001 Term Reason: LOSS OF DEPENDANT STATUS
Comments:





Request ID: 262021 Status: COMPLETE
Request Date: 2023-01-03 Status Date: 2023-01-03
Member Name: MAKENZIE MOHON Member ID: 95300455001
Employer ID: BROSOL Termination Date: 2022-12-31
Contract Record ID: 95300455001 Term Reason: VOLUNTARY
Comments:





Request ID: 262204 Status: COMPLETE
Request Date: 2023-01-03 Status Date: 2023-01-03
Member Name: KATHERINE GAINES Member ID: 74247200101
Employer ID: CNT Termination Date: 2022-12-31
Contract Record ID: 74247200101 Term Reason: TERMINATION
Comments:





Request ID: 262601 Status: COMPLETE
Request Date: 2023-01-05 Status Date: 2023-01-05
Member Name: ZACKARY D MARTINSON Member ID: 92863291001
Employer ID: SERVHIGH Termination Date: 2022-12-15
Contract Record ID: 92863291001 Term Reason: TERMINATION
Comments:





Request ID: 262621 Status: COMPLETE
Request Date: 2023-01-05 Status Date: 2023-01-05
Member Name: ROXANNE BARRERA Member ID: 19797229001
Employer ID: SERVHIGH Termination Date: 2022-12-31
Contract Record ID: 19797229001 Term Reason: EMPLOYEES MEDICARE ENROLLMENT
Comments:





Request ID: 262961 Status: COMPLETE
Request Date: 2023-01-06 Status Date: 2023-01-06
Member Name: MARY D GEARON Member ID: 65248876004
Employer ID: LNB Termination Date: 2023-01-01
Contract Record ID: 65248876001 Term Reason: VOLUNTARY
Comments: Gained other insurance coverage due to new job. Please leave her on Dental - she is only canceling the health - Please notate.....





Request ID: 263161 Status: COMPLETE
Request Date: 2023-01-06 Status Date: 2023-01-06
Member Name: LAUREEN AKPOMUDJE Member ID: 69813937401
Employer ID: SFM Termination Date: 2022-12-31
Contract Record ID: 69813937401 Term Reason: VOLUNTARY
Comments:





Request ID: 263381 Status: COMPLETE
Request Date: 2023-01-09 Status Date: 2023-01-09
Member Name: MICHAEL BONILLA Member ID: 45323565701
Employer ID: WCE Termination Date: 2023-01-03
Contract Record ID: 45323565701 Term Reason: TERMINATION
Comments:





Request ID: 263521 Status: COMPLETE
Request Date: 2023-01-09 Status Date: 2023-01-09
Member Name: JILLIAN J CHAMBERLAIN Member ID: 85687479302
Employer ID: APRES Termination Date: 2022-12-31
Contract Record ID: 85687479301 Term Reason: VOLUNTARY
Comments: Open Enrollment dropping coverage only for spouse, Jillian





Request ID: 263641 Status: COMPLETE
Request Date: 2023-01-09 Status Date: 2023-01-09
Member Name: JUSTIN DOTSON Member ID: 94724207801
Employer ID: VAUGHAN Termination Date: 2022-12-30
Contract Record ID: 94724207801 Term Reason: VOLUNTARY
Comments: This is the 2nd attempt to term coverage for this member. Original request was made on 12/23/22 with request ID # 260682





Request ID: 263661 Status: COMPLETE
Request Date: 2023-01-09 Status Date: 2023-01-09
Member Name: JASPER G DAVIS Member ID: 00444484801
Employer ID: TRILAT Termination Date: 2023-01-06
Contract Record ID: 00444484801 Term Reason: TERMINATION
Comments:





Request ID: 264321 Status: COMPLETE
Request Date: 2023-01-10 Status Date: 2023-01-10
Member Name: MATTHEW T BOYD Member ID: 81884286501
Employer ID: BROSOL Termination Date: 2022-12-31
Contract Record ID: 81884286501 Term Reason: VOLUNTARY
Comments:





Request ID: 264384 Status: COMPLETE
Request Date: 2023-01-10 Status Date: 2023-01-10
Member Name: WILLIAM A MEANS Member ID: 09417518401
Employer ID: BROSOL Termination Date: 2022-07-18
Contract Record ID: 09417518401 Term Reason: TERMINATION
Comments:





Request ID: 264501 Status: COMPLETE
Request Date: 2023-01-11 Status Date: 2023-01-11
Member Name: JESSIE OWENS Member ID: 18875106401
Employer ID: HOSPAUTH Termination Date: 2022-12-29
Contract Record ID: 18875106401 Term Reason: TERMINATION
Comments:





Request ID: 265181 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: MARIO MAGANA Member ID: 94395382601
Employer ID: APRES Termination Date: 2022-12-09
Contract Record ID: 94395382601 Term Reason: TERMINATION
Comments:





Request ID: 265361 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: LARIAH MUASAU Member ID: 40709549501
Employer ID: SFM Termination Date: 2023-01-31
Contract Record ID: 40709549501 Term Reason: TERMINATION
Comments:





Request ID: 265381 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: DESTINY MARINA LUPESINA KEALOHA Member ID: 44827467901
Employer ID: SFM Termination Date: 2023-01-31
Contract Record ID: 44827467901 Term Reason: TERMINATION
Comments:





Request ID: 265401 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: VIRGINIA MORCOMBE Member ID: 52262695001
Employer ID: SFM Termination Date: 2023-01-05
Contract Record ID: 52262695001 Term Reason: TERMINATION
Comments:





Request ID: 265441 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: DIANNE FORD Member ID: 65172949701
Employer ID: HOSPAUTH Termination Date: 2023-01-12
Contract Record ID: 65172949701 Term Reason: VOLUNTARY
Comments:





Request ID: 265461 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: GARY WHITAKER Member ID: 15886516501
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 15886516501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 265481 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: GARY WHITAKER Member ID: 15886516501
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 15886516501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 265501 Status: COMPLETE
Request Date: 2023-01-13 Status Date: 2023-01-13
Member Name: GARY WHITAKER Member ID: 15886516501
Employer ID: ASSI Termination Date: 2022-05-11
Contract Record ID: 15886516501 Term Reason: VOLUNTARY
Comments: waiver





Request ID: 265961 Status: COMPLETE
Request Date: 2023-01-16 Status Date: 2023-01-16
Member Name: CHELSI BEECH Member ID: 85666624501
Employer ID: CCRAFT Termination Date: 2023-01-01
Contract Record ID: 85666624501 Term Reason: VOLUNTARY
Comments: Employee voluntary wants to cancel the coverage effective 01/01/2023.





Request ID: 266041 Status: COMPLETE
Request Date: 2023-01-16 Status Date: 2023-01-16
Member Name: ROSA GONZALEZ Member ID: 34253861802
Employer ID: APRES Termination Date: 2022-12-31
Contract Record ID: 34253861801 Term Reason: VOLUNTARY
Comments: Enrolled in error eff. 1/1/23, please delete





Request ID: 269461 Status: COMPLETE
Request Date: 2023-01-25 Status Date: 2023-01-25
Member Name: PETER ZIMMER Member ID: 28602516701
Employer ID: PELTZ Termination Date: 2023-01-24
Contract Record ID: 28602516701 Term Reason: TERMINATION
Comments:





Request ID: 269667 Status: COMPLETE
Request Date: 2023-01-25 Status Date: 2023-01-25
Member Name: JENELL OUTERSON Member ID: 55336731801
Employer ID: SFM Termination Date: 2023-01-31
Contract Record ID: 55336731801 Term Reason: TERMINATION
Comments:





Request ID: 270261 Status: COMPLETE
Request Date: 2023-01-26 Status Date: 2023-01-26
Member Name: BLANCA ZUNIGA Member ID: 48343505401
Employer ID: SFM Termination Date: 2023-01-31
Contract Record ID: 48343505401 Term Reason: VOLUNTARY
Comments: Other coverage





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