Termination History
| Request ID: 328 | Status: COMPLETE |
| Request Date: 2018-12-17 | Status Date: 2018-12-17 |
| Member Name: NEIL RYAN | Member ID: 76152286801 |
| Employer ID: ASSI | Termination Date: 2018-11-30 |
| Contract Record ID: 76152286801 | Term Reason: VOLUNTARY |
| 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: 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: 2301 | Status: COMPLETE |
| Request Date: 2019-02-14 | Status Date: 2019-02-14 |
| Member Name: TIM P HOLGATE | Member ID: 86054498701 |
| Employer ID: CALHOUN | Termination Date: 2016-06-02 |
| Contract Record ID: 13672284901 | Term Reason: null |
| Comments: |
|
| Request ID: 2301 | Status: COMPLETE |
| Request Date: 2019-02-14 | Status Date: 2019-02-14 |
| Member Name: TIM P HOLGATE | Member ID: 86054498701 |
| Employer ID: CALHOUN | Termination Date: 2016-06-02 |
| Contract Record ID: 13672284901 | 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: 2461 | Status: COMPLETE |
| Request Date: 2019-02-19 | Status Date: 2019-02-19 |
| Member Name: FERNANDO LUIS CAPOTE JR | Member ID: 69584086401 |
| Employer ID: UBGP | Termination Date: 2016-06-30 |
| Contract Record ID: 07982754501 | Term Reason: null |
| Comments: Employee quit 06/12/2016 |
|
| Request ID: 2461 | Status: COMPLETE |
| Request Date: 2019-02-19 | Status Date: 2019-02-19 |
| Member Name: FERNANDO LUIS CAPOTE JR | Member ID: 69584086401 |
| Employer ID: UBGP | Termination Date: 2016-06-30 |
| Contract Record ID: 07982754501 | 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: 2786 | Status: COMPLETE |
| Request Date: 2019-02-26 | Status Date: 2019-02-26 |
| Member Name: PAUL MILLER | Member ID: 38198518701 |
| Employer ID: DATAPG | Termination Date: 2016-06-30 |
| Contract Record ID: 91898848001 | Term Reason: TERMINATION |
| Comments: Employee failed to call or appear for work - Voluntary quit. |
|
| Request ID: 2786 | Status: COMPLETE |
| Request Date: 2019-02-26 | Status Date: 2019-02-26 |
| Member Name: PAUL MILLER | Member ID: 38198518701 |
| Employer ID: DATAPG | Termination Date: 2016-06-30 |
| Contract Record ID: 91898848001 | 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: 2982 | Status: COMPLETE |
| Request Date: 2019-03-04 | Status Date: 2019-03-04 |
| Member Name: PHILIP GOMEZ | Member ID: 89082398001 |
| Employer ID: DATAPG | Termination Date: 2016-05-01 |
| Contract Record ID: 97648723301 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 2982 | Status: COMPLETE |
| Request Date: 2019-03-04 | Status Date: 2019-03-04 |
| Member Name: PHILIP GOMEZ | Member ID: 89082398001 |
| Employer ID: DATAPG | Termination Date: 2016-05-01 |
| Contract Record ID: 97648723301 | Term Reason: REDUCTION OF HOURS |
| Comments: PLEASE RESEND ID CARDS |
|
| 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: 3228 | Status: COMPLETE |
| Request Date: 2019-03-13 | Status Date: 2019-03-13 |
| Member Name: JOHNNY L WALKER | Member ID: 37957022801 |
| Employer ID: CALHOUN | Termination Date: 2019-03-31 |
| Contract Record ID: 37957022801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 3229 | Status: COMPLETE |
| Request Date: 2019-03-13 | Status Date: 2019-03-13 |
| Member Name: JOHNNY L WALKER | Member ID: 37957022801 |
| Employer ID: CALHOUN | Termination Date: 2019-03-31 |
| Contract Record ID: 37957022801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 3288 | Status: COMPLETE |
| Request Date: 2019-03-19 | Status Date: 2019-03-19 |
| Member Name: PATRICK J SHERMAN | Member ID: 39532168301 |
| Employer ID: CALHOUN | Termination Date: 2019-02-28 |
| Contract Record ID: 39532168301 | 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: 6304 | Status: COMPLETE |
| Request Date: 2019-04-23 | Status Date: 2019-04-23 |
| Member Name: MORRIS GREER IV | Member ID: 09389606601 |
| Employer ID: DATAPG | Termination Date: 2016-07-11 |
| Contract Record ID: 15025144201 | Term Reason: VOLUNTARY |
| Comments: member needs HSP3 ID card |
|
| Request ID: 6304 | Status: COMPLETE |
| Request Date: 2019-04-23 | Status Date: 2019-04-23 |
| Member Name: MORRIS GREER IV | Member ID: 09389606601 |
| Employer ID: DATAPG | Termination Date: 2016-07-11 |
| Contract Record ID: 15025144201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 6305 | Status: COMPLETE |
| Request Date: 2019-04-23 | Status Date: 2019-04-23 |
| Member Name: MORRIS GREER IV | Member ID: 09389606601 |
| Employer ID: DATAPG | Termination Date: 2016-02-14 |
| Contract Record ID: 17223679101 | Term Reason: VOLUNTARY |
| Comments: Please update Zip Code |
|
| Request ID: 6305 | Status: COMPLETE |
| Request Date: 2019-04-23 | Status Date: 2019-04-23 |
| Member Name: MORRIS GREER IV | Member ID: 09389606601 |
| Employer ID: DATAPG | Termination Date: 2016-02-14 |
| Contract Record ID: 17223679101 | 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: |
|
| 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: 7722 | Status: COMPLETE |
| Request Date: 2019-05-16 | Status Date: 2019-05-16 |
| Member Name: JACOB FERGUSON | Member ID: 94079886804 |
| Employer ID: CALHOUN | Termination Date: 2106-02-08 |
| Contract Record ID: 24749554601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 7722 | Status: COMPLETE |
| Request Date: 2019-05-16 | Status Date: 2019-05-16 |
| Member Name: JACOB FERGUSON | Member ID: 94079886804 |
| Employer ID: CALHOUN | Termination Date: 2019-04-30 |
| Contract Record ID: 94079886801 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 7722 | Status: COMPLETE |
| Request Date: 2019-05-16 | Status Date: 2019-05-16 |
| Member Name: JACOB FERGUSON | Member ID: 94079886804 |
| Employer ID: CALHOUN | Termination Date: 2019-04-30 |
| Contract Record ID: 94079886801 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 7722 | Status: COMPLETE |
| Request Date: 2019-05-16 | Status Date: 2019-05-16 |
| Member Name: JACOB FERGUSON | Member ID: 94079886804 |
| Employer ID: CALHOUN | Termination Date: 2106-02-08 |
| Contract Record ID: 24749554601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 7849 | Status: COMPLETE |
| Request Date: 2019-05-20 | Status Date: 2019-05-20 |
| Member Name: GREG G TRIPPE | Member ID: 87417649601 |
| Employer ID: CALHOUN | Termination Date: 2019-05-31 |
| Contract Record ID: 87417649601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 7854 | Status: COMPLETE |
| Request Date: 2019-05-20 | Status Date: 2019-05-20 |
| Member Name: LAQUITA HUSTON | Member ID: 79452249001 |
| Employer ID: CALHOUN | Termination Date: 2019-04-30 |
| Contract Record ID: 79452249001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 7882 | Status: COMPLETE |
| Request Date: 2019-05-20 | Status Date: 2019-05-20 |
| Member Name: MATTHEW UPSHALL | Member ID: 17652018801 |
| Employer ID: DATAPG | Termination Date: 2016-03-09 |
| Contract Record ID: 14769129601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 7882 | Status: COMPLETE |
| Request Date: 2019-05-20 | Status Date: 2019-05-20 |
| Member Name: MATTHEW UPSHALL | Member ID: 17652018801 |
| Employer ID: DATAPG | Termination Date: 2016-03-09 |
| Contract Record ID: 14769129601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 11101 | Status: COMPLETE |
| Request Date: 2019-06-17 | Status Date: 2019-06-17 |
| Member Name: SHADAB MALAK | Member ID: 69246210401 |
| Employer ID: CALHOUN | Termination Date: 2019-06-30 |
| Contract Record ID: 69246210401 | Term Reason: VOLUNTARY |
| Comments: Quit |
|
| 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: 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: 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: 67661 | Status: COMPLETE |
| Request Date: 2020-02-24 | Status Date: 2020-02-24 |
| Member Name: AMIA M TOWNS | Member ID: 53077029801 |
| Employer ID: CALHOUN | Termination Date: 2020-02-01 |
| Contract Record ID: 53077029801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 68832 | Status: COMPLETE |
| Request Date: 2020-02-28 | Status Date: 2020-02-28 |
| Member Name: JONUS J GOUDEAU | Member ID: 51333604703 |
| Employer ID: COUSH | Termination Date: 2020-02-24 |
| Contract Record ID: 51333604701 | Term Reason: TERMINATION |
| Comments: Employment Termination 2/24/2020 |
|
| Request ID: 71821 | Status: COMPLETE |
| Request Date: 2020-03-10 | Status Date: 2020-03-10 |
| Member Name: SHARON D SIMEON | Member ID: 52248375501 |
| Employer ID: COUSH | Termination Date: 2020-01-02 |
| Contract Record ID: 52248375501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 72381 | Status: COMPLETE |
| Request Date: 2020-03-11 | Status Date: 2020-03-11 |
| Member Name: CHRISTIAN POTTS | Member ID: 17918635103 |
| Employer ID: COUSH | Termination Date: 2020-01-09 |
| Contract Record ID: 17918635101 | Term Reason: TERMINATION |
| Comments: Termination of employment |
|
| Request ID: 74989 | Status: COMPLETE |
| Request Date: 2020-03-25 | Status Date: 2020-03-25 |
| Member Name: ANGELICA FLORES-VALDEZ | Member ID: 58005172501 |
| Employer ID: BRECK | Termination Date: 2020-03-31 |
| Contract Record ID: 58005172501 | Term Reason: INVOLUNTARY |
| 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: 75250 | Status: COMPLETE |
| Request Date: 2020-04-08 | Status Date: 2020-04-08 |
| Member Name: THU NGUYEN | Member ID: 82505834301 |
| Employer ID: PELTZ | Termination Date: 2020-04-30 |
| Contract Record ID: 82505834301 | 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: 77245 | Status: COMPLETE |
| Request Date: 2020-05-12 | Status Date: 2020-05-12 |
| Member Name: HOBY THERIOT | Member ID: 10737914701 |
| Employer ID: NSS | Termination Date: 2019-12-27 |
| Contract Record ID: 10737914701 | Term Reason: TERMINATION |
| Comments: He should have NEVER had HMA coverage as he was terminated prior to the 01/01/2020 effective date |
|
| Request ID: 77248 | Status: COMPLETE |
| Request Date: 2020-05-12 | Status Date: 2020-05-12 |
| Member Name: FORREST KOERNER-FOX | Member ID: 10125227301 |
| Employer ID: NSS | Termination Date: 2020-04-15 |
| Contract Record ID: 10125227301 | Term Reason: TERMINATION |
| Comments: Termination of benefits as of 04.15.2020 |
|
| 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: 81818 | Status: COMPLETE |
| Request Date: 2020-07-02 | Status Date: 2020-07-02 |
| Member Name: ADAM GRUNDT | Member ID: 41216204403 |
| Employer ID: CARBON | Termination Date: 2020-07-01 |
| Contract Record ID: 41216204401 | Term Reason: REDUCTION OF HOURS |
| Comments: left position |
|
| Request ID: 82841 | Status: COMPLETE |
| Request Date: 2020-07-20 | Status Date: 2020-07-20 |
| Member Name: CHRISTOPHER R HUDSON | Member ID: 30134707301 |
| Employer ID: NSS | Termination Date: 2020-07-17 |
| Contract Record ID: 30134707301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 82921 | Status: COMPLETE |
| Request Date: 2020-07-20 | Status Date: 2020-07-20 |
| Member Name: VALERIE A LEE | Member ID: 89092813401 |
| Employer ID: NSS | Termination Date: 2020-07-17 |
| Contract Record ID: 89092813401 | Term Reason: VOLUNTARY |
| Comments: Other health insurance coverage |
|
| Request ID: 83441 | Status: COMPLETE |
| Request Date: 2020-07-22 | Status Date: 2020-07-22 |
| Member Name: AMY GRUNDT | Member ID: 41216204401 |
| Employer ID: CARBON | Termination Date: 2020-06-30 |
| Contract Record ID: 41216204401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 84605 | Status: COMPLETE |
| Request Date: 2020-08-03 | Status Date: 2020-08-03 |
| Member Name: FELIPE TELLEZ | Member ID: 49007729003 |
| Employer ID: NSS | Termination Date: 2020-07-27 |
| Contract Record ID: 49007729001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 84606 | Status: COMPLETE |
| Request Date: 2020-08-03 | Status Date: 2020-08-03 |
| Member Name: FELIPE TELLEZ | Member ID: 49007729003 |
| Employer ID: NSS | Termination Date: 2020-07-27 |
| Contract Record ID: 49007729001 | 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: 88401 | Status: COMPLETE |
| Request Date: 2020-09-01 | Status Date: 2020-09-01 |
| Member Name: ALICIA A RINKER | Member ID: 28556879301 |
| Employer ID: CARBON | Termination Date: 2020-08-31 |
| Contract Record ID: 28556879301 | Term Reason: VOLUNTARY |
| Comments: change in status to casual |
|
| 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: 93901 | Status: COMPLETE |
| Request Date: 2020-10-06 | Status Date: 2020-10-06 |
| Member Name: ERICA MORIN | Member ID: 81991162701 |
| Employer ID: THEMA | Termination Date: 2020-07-31 |
| Contract Record ID: 81991162701 | Term Reason: TERMINATION |
| Comments: |
|
| 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: 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: 99721 | Status: COMPLETE |
| Request Date: 2020-11-18 | Status Date: 2020-11-18 |
| Member Name: DESIREE VOINCHE | Member ID: 74214274201 |
| Employer ID: COUSH | Termination Date: 2020-10-20 |
| Contract Record ID: 74214274201 | 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: 102601 | Status: COMPLETE |
| Request Date: 2020-12-02 | Status Date: 2020-12-02 |
| Member Name: CODY FIELDGROVE | Member ID: 58508484401 |
| Employer ID: CENTRAL | Termination Date: 2020-11-30 |
| Contract Record ID: 58508484401 | Term Reason: TERMINATION |
| Comments: Last day worked was 11/24/2020 |
|
| 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: 106921 | Status: COMPLETE |
| Request Date: 2020-12-24 | Status Date: 2020-12-24 |
| Member Name: THOMAS MOORE | Member ID: 42212496401 |
| Employer ID: TIMESPEC | Termination Date: 2020-12-31 |
| Contract Record ID: 42212496401 | Term Reason: VOLUNTARY |
| Comments: Waived coverage for 1/1/2021 open enrollment |
|
| 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 JR | 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: 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: 111173 | Status: COMPLETE |
| Request Date: 2021-01-12 | Status Date: 2021-01-12 |
| Member Name: JEFFREY L BATTEN | Member ID: 97979196601 |
| Employer ID: THERALT | Termination Date: 2020-12-31 |
| Contract Record ID: 97979196601 | 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 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: 112081 | Status: COMPLETE |
| Request Date: 2021-01-20 | Status Date: 2021-01-20 |
| Member Name: APRIL HAMMONDS | Member ID: 72920026901 |
| Employer ID: KAUBRY | Termination Date: 2020-12-31 |
| Contract Record ID: 72920026901 | Term Reason: VOLUNTARY |
| Comments: DROPPED DURING OPEN ENROLLMENT |
|
| 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: 119309 | Status: COMPLETE |
| Request Date: 2021-02-09 | Status Date: 2021-02-09 |
| Member Name: ALICIA A RINKER | Member ID: 28556879301 |
| Employer ID: CARBON | Termination Date: 2021-02-09 |
| Contract Record ID: 28556879301 | Term Reason: TERMINATION |
| 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: 139781 | Status: COMPLETE |
| Request Date: 2021-04-08 | Status Date: 2021-04-08 |
| Member Name: EDDIE LINDSEY | Member ID: 87293355101 |
| Employer ID: LAIRWAYS | Termination Date: 2021-04-02 |
| Contract Record ID: 87293355101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 140383 | Status: COMPLETE |
| Request Date: 2021-04-14 | Status Date: 2021-04-14 |
| Member Name: DAVID LEECH | Member ID: 84162308801 |
| Employer ID: ZAT | Termination Date: 2021-04-07 |
| Contract Record ID: 84162308801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 140402 | Status: COMPLETE |
| Request Date: 2021-04-15 | Status Date: 2021-04-15 |
| Member Name: RUSSELL EAVES | Member ID: 30337070901 |
| Employer ID: LEHMAN | Termination Date: 2021-04-09 |
| Contract Record ID: 30337070901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 141544 | Status: COMPLETE |
| Request Date: 2021-04-27 | Status Date: 2021-04-27 |
| Member Name: ASHLEY S LYKINS | Member ID: 98709048501 |
| Employer ID: GOLDENYR | Termination Date: 2021-04-30 |
| Contract Record ID: 98709048501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 142661 | Status: COMPLETE |
| Request Date: 2021-04-29 | Status Date: 2021-04-29 |
| Member Name: AMBER VALENTINE | Member ID: 11710975401 |
| Employer ID: SFM | Termination Date: 2021-04-30 |
| Contract Record ID: 11710975401 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| 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: 144401 | Status: COMPLETE |
| Request Date: 2021-05-07 | Status Date: 2021-05-07 |
| Member Name: LOGAN ROLMAN | Member ID: 97096346301 |
| Employer ID: ZAT | Termination Date: 2021-05-07 |
| Contract Record ID: 97096346301 | Term Reason: VOLUNTARY |
| 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: 145202 | Status: COMPLETE |
| Request Date: 2021-05-14 | Status Date: 2021-05-14 |
| Member Name: DAVID MCCLERREN | Member ID: 71149194601 |
| Employer ID: ZUS | Termination Date: 2021-05-13 |
| Contract Record ID: 71149194601 | Term Reason: REDUCTION OF HOURS |
| 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: 146901 | Status: COMPLETE |
| Request Date: 2021-06-04 | Status Date: 2021-06-04 |
| Member Name: CINDY L BLUE | Member ID: 11124622501 |
| Employer ID: NASCO | Termination Date: 2021-06-21 |
| Contract Record ID: 11124622501 | Term Reason: INVOLUNTARY |
| Comments: |
|
| 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: 150961 | Status: COMPLETE |
| Request Date: 2021-06-22 | Status Date: 2021-06-22 |
| Member Name: DOUGLAS RICHTER | Member ID: 19441565701 |
| Employer ID: NASCO | Termination Date: 2021-06-30 |
| Contract Record ID: 19441565701 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 151161 | Status: COMPLETE |
| Request Date: 2021-06-22 | Status Date: 2021-06-22 |
| Member Name: ROGER SEVIGNY | Member ID: 29992035201 |
| Employer ID: DAVIS | Termination Date: 2021-06-30 |
| Contract Record ID: 29992035201 | Term Reason: VOLUNTARY |
| Comments: Resigned |
|
| 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: 155605 | Status: COMPLETE |
| Request Date: 2021-07-13 | Status Date: 2021-07-13 |
| Member Name: SHONQUELLA C LEDAY | Member ID: 04649549901 |
| Employer ID: COUSH | Termination Date: 2021-04-26 |
| Contract Record ID: 04649549901 | Term Reason: NON PAYMENT OF PREMIUMS |
| Comments: |
|
| Request ID: 155606 | Status: COMPLETE |
| Request Date: 2021-07-13 | Status Date: 2021-07-13 |
| Member Name: SHONQUELLA C LEDAY | Member ID: 04649549901 |
| Employer ID: COUSH | Termination Date: 2021-05-24 |
| Contract Record ID: 04649549901 | Term Reason: NON PAYMENT OF PREMIUMS |
| Comments: Please change Loss of coverage to 5/24/21 not 4/26/21. I put the wrong date. Thanks. |
|
| Request ID: 155708 | Status: COMPLETE |
| Request Date: 2021-07-16 | Status Date: 2021-07-16 |
| Member Name: NANCY HOWELL | Member ID: 10956314201 |
| Employer ID: CNT | Termination Date: 2021-07-31 |
| Contract Record ID: 10956314201 | Term Reason: TERMINATION |
| 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: 157691 | Status: COMPLETE |
| Request Date: 2021-07-29 | Status Date: 2021-07-29 |
| Member Name: GRADY MARTIN | Member ID: 01773153601 |
| Employer ID: ZAT | Termination Date: 2021-07-28 |
| Contract Record ID: 01773153601 | Term Reason: INVOLUNTARY |
| Comments: Employee Terminating with Effective 07/28/2021 |
|
| Request ID: 157721 | Status: COMPLETE |
| Request Date: 2021-07-30 | Status Date: 2021-07-30 |
| Member Name: GRADY MARTIN | Member ID: 01773153601 |
| Employer ID: ZAT | Termination Date: 2021-07-28 |
| Contract Record ID: 01773153601 | Term Reason: INVOLUNTARY |
| Comments: Employee Terminated with Effective 07/28/2021 |
|
| 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: 161641 | Status: COMPLETE |
| Request Date: 2021-08-18 | Status Date: 2021-08-18 |
| Member Name: BROCK L DENNY | Member ID: 72447764501 |
| Employer ID: NEC | Termination Date: 2021-08-13 |
| Contract Record ID: 72447764501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 163144 | Status: COMPLETE |
| Request Date: 2021-08-24 | Status Date: 2021-08-24 |
| Member Name: TIMOTHY FARRIS | Member ID: 03092772501 |
| Employer ID: NEC | Termination Date: 2021-08-24 |
| Contract Record ID: 03092772501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 163145 | Status: COMPLETE |
| Request Date: 2021-08-24 | Status Date: 2021-08-24 |
| Member Name: BRANDON EPPERSON | Member ID: 26017831701 |
| Employer ID: NEC | Termination Date: 2021-08-24 |
| Contract Record ID: 26017831701 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 165181 | Status: COMPLETE |
| Request Date: 2021-09-02 | Status Date: 2021-09-02 |
| Member Name: KAREN L JESKE | Member ID: 70329189901 |
| Employer ID: NASCO | Termination Date: 2021-09-01 |
| Contract Record ID: 70329189901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 165182 | Status: COMPLETE |
| Request Date: 2021-09-02 | Status Date: 2021-09-02 |
| Member Name: DENISE M HOEYE | Member ID: 44773211001 |
| Employer ID: NASCO | Termination Date: 2021-09-01 |
| Contract Record ID: 44773211001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 165401 | Status: COMPLETE |
| Request Date: 2021-09-02 | Status Date: 2021-09-02 |
| Member Name: TRACY L KLINE | Member ID: 47331608001 |
| Employer ID: EASYLVNG | Termination Date: 2021-09-30 |
| Contract Record ID: 47331608001 | Term Reason: VOLUNTARY |
| Comments: She resigned effective 9/1/2021, but coverage should go through the end of the month. |
|
| 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: 166202 | Status: COMPLETE |
| Request Date: 2021-09-07 | Status Date: 2021-09-07 |
| Member Name: JONTEL JOSEPH | Member ID: 33804618301 |
| Employer ID: CNT | Termination Date: 2021-09-30 |
| Contract Record ID: 33804618301 | Term Reason: TERMINATION |
| Comments: Employee resigned. |
|
| Request ID: 166541 | Status: COMPLETE |
| Request Date: 2021-09-09 | Status Date: 2021-09-09 |
| Member Name: RICKY DEEL | Member ID: 66611244901 |
| Employer ID: NEC | Termination Date: 2021-09-26 |
| Contract Record ID: 66611244901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 166781 | Status: COMPLETE |
| Request Date: 2021-09-09 | Status Date: 2021-09-09 |
| Member Name: CARLOS FLORES ARELLANO | Member ID: 54714564101 |
| Employer ID: CLEAR | Termination Date: 2021-09-30 |
| Contract Record ID: 54714564101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 166942 | Status: COMPLETE |
| Request Date: 2021-09-10 | Status Date: 2021-09-10 |
| Member Name: MELISSA HORTON | Member ID: 30061683902 |
| Employer ID: DAVIS | Termination Date: 2021-09-30 |
| Contract Record ID: 30061683901 | Term Reason: VOLUNTARY |
| Comments: Obtained Employment with Own Coverage |
|
| Request ID: 167481 | Status: COMPLETE |
| Request Date: 2021-09-17 | Status Date: 2021-09-17 |
| Member Name: SHANNON WIRTH | Member ID: 20743821701 |
| Employer ID: SFM | Termination Date: 2021-09-30 |
| Contract Record ID: 20743821701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 167501 | Status: COMPLETE |
| Request Date: 2021-09-17 | Status Date: 2021-09-17 |
| Member Name: JENNIFER OWSLEY | Member ID: 08637220301 |
| Employer ID: SFM | Termination Date: 2021-09-30 |
| Contract Record ID: 08637220301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 168582 | Status: COMPLETE |
| Request Date: 2021-09-22 | Status Date: 2021-09-22 |
| Member Name: SUZY BROOKS | Member ID: 02952242301 |
| Employer ID: TRILAT | Termination Date: 2021-09-20 |
| Contract Record ID: 02952242301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 168641 | Status: COMPLETE |
| Request Date: 2021-09-22 | Status Date: 2021-09-22 |
| Member Name: MICHAEL BLAZEK | Member ID: 41935655801 |
| Employer ID: BRECK | Termination Date: 2021-09-30 |
| Contract Record ID: 41935655801 | Term Reason: TERMINATION |
| Comments: please send Cobra |
|
| Request ID: 168681 | Status: COMPLETE |
| Request Date: 2021-09-23 | Status Date: 2021-09-23 |
| Member Name: MICHAEL J STANLEY | Member ID: 62643484801 |
| Employer ID: NEC | Termination Date: 2021-09-13 |
| Contract Record ID: 62643484801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 168701 | Status: COMPLETE |
| Request Date: 2021-09-23 | Status Date: 2021-09-23 |
| Member Name: AARON R BELCHER | Member ID: 49315818201 |
| Employer ID: NEC | Termination Date: 2021-09-09 |
| Contract Record ID: 49315818201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 168721 | Status: COMPLETE |
| Request Date: 2021-09-23 | Status Date: 2021-09-23 |
| Member Name: CODY J STUCHELL | Member ID: 72537536101 |
| Employer ID: NEC | Termination Date: 2021-09-15 |
| Contract Record ID: 72537536101 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 168921 | Status: COMPLETE |
| Request Date: 2021-09-24 | Status Date: 2021-09-24 |
| Member Name: EVAN DONNELL | Member ID: 11710694001 |
| Employer ID: CNT | Termination Date: 2021-09-30 |
| Contract Record ID: 11710694001 | Term Reason: TERMINATION |
| Comments: Voluntarily terminated. |
|
| Request ID: 169061 | Status: COMPLETE |
| Request Date: 2021-09-27 | Status Date: 2021-09-27 |
| Member Name: MATTHEW A BAKKEN | Member ID: 03437174402 |
| Employer ID: NASCO | Termination Date: 2021-09-12 |
| Contract Record ID: 03437174401 | Term Reason: DECEASED |
| Comments: PLEASE DO NOT SEND A COBRA NOTICE. |
|
| Request ID: 169161 | Status: COMPLETE |
| Request Date: 2021-09-27 | Status Date: 2021-09-27 |
| Member Name: LAURA N LYSTEDT | Member ID: 88769548601 |
| Employer ID: SFM | Termination Date: 2021-09-30 |
| Contract Record ID: 88769548601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 169181 | Status: COMPLETE |
| Request Date: 2021-09-27 | Status Date: 2021-09-27 |
| Member Name: LISA C BRITZ | Member ID: 47087400401 |
| Employer ID: SFM | Termination Date: 2021-09-30 |
| Contract Record ID: 47087400401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 169461 | Status: COMPLETE |
| Request Date: 2021-09-29 | Status Date: 2021-09-29 |
| Member Name: JEFFERY CHESTER | Member ID: 80001858901 |
| Employer ID: NEC | Termination Date: 2021-09-27 |
| Contract Record ID: 80001858901 | Term Reason: INVOLUNTARY |
| Comments: Employee termed before coverge started. |
|
| Request ID: 169481 | Status: COMPLETE |
| Request Date: 2021-09-29 | Status Date: 2021-09-29 |
| Member Name: BRENDAN BROWN | Member ID: 12996367601 |
| Employer ID: NEC | Termination Date: 2021-09-23 |
| Contract Record ID: 12996367601 | 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: 169781 | Status: COMPLETE |
| Request Date: 2021-09-30 | Status Date: 2021-09-30 |
| Member Name: SHELBY T BREWER | Member ID: 01923678101 |
| Employer ID: CLEAR | Termination Date: 2021-09-30 |
| Contract Record ID: 01923678101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 169862 | Status: COMPLETE |
| Request Date: 2021-09-30 | Status Date: 2021-09-30 |
| Member Name: GARY COOPER | Member ID: 87933675901 |
| Employer ID: AP | Termination Date: 2021-09-30 |
| Contract Record ID: 87933675901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 169865 | Status: COMPLETE |
| Request Date: 2021-09-30 | Status Date: 2021-09-30 |
| Member Name: LIZBETH LEYVA | Member ID: 92041529201 |
| Employer ID: SFM | Termination Date: 2021-09-30 |
| Contract Record ID: 92041529201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 169866 | Status: COMPLETE |
| Request Date: 2021-09-30 | Status Date: 2021-09-30 |
| Member Name: PATRICIA FACKLER | Member ID: 67350354101 |
| Employer ID: VISTA | Termination Date: 2021-09-11 |
| Contract Record ID: 67350354101 | Term Reason: TERMINATION |
| Comments: COBRA Plans-
Medical: 2000 Plan EE Only - Ending 9/11/2021
Dental: High Plan EE + SP - Ending 9/30/2021
Vision: Vision Plan EE + SP - Ending 9/30/2021 |
|
| Request ID: 169867 | Status: COMPLETE |
| Request Date: 2021-09-30 | Status Date: 2021-09-30 |
| Member Name: CATHERINE PARKER | Member ID: 87930589001 |
| Employer ID: VISTA | Termination Date: 2021-09-01 |
| Contract Record ID: 87930589001 | Term Reason: TERMINATION |
| Comments: COBRA Plans-
Medical: 2000 Plan EE-Only - Ending 9/1/2021
Dental: High Plan EE-Only - Ending 9/30/2021
Vision: Vision Plan EE-Only - Ending 9/30/2021 |
|
| Request ID: 170181 | Status: COMPLETE |
| Request Date: 2021-10-01 | Status Date: 2021-10-01 |
| Member Name: LYNDSIE STECKELBERG | Member ID: 33299041801 |
| Employer ID: BRULE | Termination Date: 2021-11-30 |
| Contract Record ID: 33299041801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 170361 | Status: COMPLETE |
| Request Date: 2021-10-04 | Status Date: 2021-10-04 |
| Member Name: PETE HARDY | Member ID: 30210100001 |
| Employer ID: LAIRWAYS | Termination Date: 2021-10-01 |
| Contract Record ID: 30210100001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 170501 | Status: COMPLETE |
| Request Date: 2021-10-04 | Status Date: 2021-10-04 |
| Member Name: ALLEN C YATES | Member ID: 03604269601 |
| Employer ID: CNT | Termination Date: 2021-10-31 |
| Contract Record ID: 03604269601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 170761 | Status: COMPLETE |
| Request Date: 2021-10-04 | Status Date: 2021-10-04 |
| Member Name: ALLEN C YATES | Member ID: 03604269601 |
| Employer ID: CNT | Termination Date: 2021-10-31 |
| Contract Record ID: 03604269601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 171021 | Status: COMPLETE |
| Request Date: 2021-10-04 | Status Date: 2021-10-04 |
| Member Name: KEVIN A HAUKOM | Member ID: 20890443101 |
| Employer ID: NASCO | Termination Date: 2021-09-24 |
| Contract Record ID: 20890443101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 171221 | Status: COMPLETE |
| Request Date: 2021-10-04 | Status Date: 2021-10-04 |
| Member Name: KRISTEN SHANE | Member ID: 73260580601 |
| Employer ID: CNT | Termination Date: 2021-09-30 |
| Contract Record ID: 73260580601 | Term Reason: TERMINATION |
| Comments: Resigned |
|
| Request ID: 171441 | Status: COMPLETE |
| Request Date: 2021-10-05 | Status Date: 2021-10-05 |
| Member Name: RICHARD COURNOYER | Member ID: 17962378801 |
| Employer ID: ZAT | Termination Date: 2021-10-01 |
| Contract Record ID: 17962378801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 171821 | Status: COMPLETE |
| Request Date: 2021-10-05 | Status Date: 2021-10-05 |
| Member Name: ERNEST KASUSE | Member ID: 58192188001 |
| Employer ID: SUNRISE | Termination Date: 2021-09-03 |
| Contract Record ID: 58192188001 | Term Reason: TERMINATION |
| Comments: ERNEST WAS LET GO FROM EMPLOYEEMENT WITH SUNRISE CHEVROLET |
|
| Request ID: 173161 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: STEVEN AHART | Member ID: 97989786703 |
| Employer ID: LAIRWAYS | Termination Date: 2021-10-01 |
| Contract Record ID: 97989786701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 173181 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: STEVEN J AHART | Member ID: 97989786701 |
| Employer ID: LAIRWAYS | Termination Date: 2021-10-01 |
| Contract Record ID: 97989786701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 173641 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: DENISE J KINCAID | Member ID: 39962096201 |
| Employer ID: NASCO | Termination Date: 2021-09-29 |
| Contract Record ID: 39962096201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 173661 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: DENISE A JOHNSON | Member ID: 71305540201 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 71305540201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 173681 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: NORMAN L LAUER | Member ID: 01908017501 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 01908017501 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173701 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: DENISE A WAGI | Member ID: 32747046101 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 32747046101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 173721 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: NORMAN L LAUER | Member ID: 01908017501 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 01908017501 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173741 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: ALEXANDER E NORDEEN | Member ID: 63133793701 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 63133793701 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173761 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: TARI J NIEMUTH | Member ID: 04839821001 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 04839821001 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173781 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: NANCY L SMITH | Member ID: 37227256001 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 37227256001 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173801 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: TRACY A FIEGE | Member ID: 78870774201 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 78870774201 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173821 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: EILEEN A SCHWENN | Member ID: 86735681301 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 86735681301 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173841 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: DANIEL SCHWENN | Member ID: 43408697001 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 43408697001 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173861 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: SARAH L ANTCZAK | Member ID: 58666291201 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 58666291201 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173881 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: ESTRELLA M LEAL RODRIGUEZ | Member ID: 68078562101 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 68078562101 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173901 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: ANDREW J LOMBARDO | Member ID: 49577703201 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 49577703201 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173921 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: THOMAS BOES | Member ID: 39406051301 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 39406051301 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173941 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: LEANN M CLAAHSEN | Member ID: 27431536401 |
| Employer ID: NASCO | Termination Date: 2021-09-27 |
| Contract Record ID: 27431536401 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173961 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: CHRISTOPHER L MCLEAN | Member ID: 20144380301 |
| Employer ID: NASCO | Termination Date: 2021-10-01 |
| Contract Record ID: 20144380301 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 173981 | Status: COMPLETE |
| Request Date: 2021-10-07 | Status Date: 2021-10-07 |
| Member Name: KEVIN A HAUKOM | Member ID: 20890443101 |
| Employer ID: NASCO | Termination Date: 2021-09-24 |
| Contract Record ID: 20890443101 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 174401 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: CORETTA LOGAN | Member ID: 44136060601 |
| Employer ID: VISTA | Termination Date: 2021-09-30 |
| Contract Record ID: 44136060601 | Term Reason: VOLUNTARY |
| Comments: COBRA PLANS:
Dental PPO- EE + Spouse
Vision- EE + Spouse |
|
| Request ID: 174441 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: MICHAEL MOSHIER | Member ID: 37707884801 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 37707884801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 174461 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: FAZILA SALIM | Member ID: 57219401301 |
| Employer ID: VISTA | Termination Date: 2021-09-30 |
| Contract Record ID: 57219401301 | Term Reason: TERMINATION |
| Comments: COBRA PLANS:
PPO Dental- EE+Family
Vision- EE+Family |
|
| Request ID: 174481 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: JOSEPH ROMERO | Member ID: 54573676801 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 54573676801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 174521 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: ROBERT CONKLIN | Member ID: 64578129501 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 64578129501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 174541 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: WILLIAM CHEEK | Member ID: 43409639002 |
| Employer ID: NASCO | Termination Date: 2021-10-31 |
| Contract Record ID: 43409639001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 174561 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: DUDLEY VANNOSTRAND | Member ID: 66381587401 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 66381587401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 174581 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: JASON KING | Member ID: 98818714901 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 98818714901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 174582 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: JASON KING | Member ID: 98818714901 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 98818714901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 174621 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: CHARLES PALMER | Member ID: 76713631901 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 76713631901 | Term Reason: DECEASED |
| Comments: |
|
| Request ID: 174641 | Status: COMPLETE |
| Request Date: 2021-10-08 | Status Date: 2021-10-08 |
| Member Name: THOMAS NORTHEY | Member ID: 36899822701 |
| Employer ID: NASCO | Termination Date: 2021-10-08 |
| Contract Record ID: 36899822701 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 175121 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: GERALD THOMPSON | Member ID: 18953412201 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 18953412201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 175141 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: GERALD THOMPSON | Member ID: 18953412201 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 18953412201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 175161 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: SYDNEY SCHWARTZ | Member ID: 21145336001 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 21145336001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 175181 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: MICHAEL MOSHIER | Member ID: 37707884801 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 37707884801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 175201 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: JOSEPH ROMERO | Member ID: 54573676801 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 54573676801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 175221 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: ROBERT CONKLIN | Member ID: 64578129501 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 64578129501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 175241 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: DUDLEY VANNOSTRAND | Member ID: 66381587401 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 66381587401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 175261 | Status: COMPLETE |
| Request Date: 2021-10-11 | Status Date: 2021-10-11 |
| Member Name: JASON KING | Member ID: 98818714901 |
| Employer ID: ASSI | Termination Date: 2021-10-08 |
| Contract Record ID: 98818714901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 175701 | Status: COMPLETE |
| Request Date: 2021-10-12 | Status Date: 2021-10-12 |
| Member Name: JAMES NICHOLAS CURRY | Member ID: 56513553501 |
| Employer ID: RCI | Termination Date: 2020-10-02 |
| Contract Record ID: 56513553501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 175721 | Status: COMPLETE |
| Request Date: 2021-10-12 | Status Date: 2021-10-12 |
| Member Name: CORY DOERR | Member ID: 16846293201 |
| Employer ID: RCI | Termination Date: 2021-09-16 |
| Contract Record ID: 16846293201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 175761 | Status: COMPLETE |
| Request Date: 2021-10-12 | Status Date: 2021-10-12 |
| Member Name: REBECCA MICHELLE GREMILLION | Member ID: 54071131101 |
| Employer ID: RCI | Termination Date: 2021-09-22 |
| Contract Record ID: 54071131101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 176001 | Status: COMPLETE |
| Request Date: 2021-10-12 | Status Date: 2021-10-12 |
| Member Name: NICOLE SIMER | Member ID: 65818594301 |
| Employer ID: RCI | Termination Date: 2021-09-03 |
| Contract Record ID: 65818594301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 176061 | Status: COMPLETE |
| Request Date: 2021-10-12 | Status Date: 2021-10-12 |
| Member Name: B TRAVIS HARPER | Member ID: 33071885301 |
| Employer ID: BRECK | Termination Date: 2021-10-31 |
| Contract Record ID: 33071885301 | Term Reason: TERMINATION |
| Comments: Please send COBRA letter |
|
| Request ID: 176221 | Status: COMPLETE |
| Request Date: 2021-10-13 | Status Date: 2021-10-13 |
| Member Name: KEVIN LOZEN | Member ID: 64952873801 |
| Employer ID: ZAT | Termination Date: 2021-10-12 |
| Contract Record ID: 64952873801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 176281 | Status: COMPLETE |
| Request Date: 2021-10-13 | Status Date: 2021-10-13 |
| Member Name: KAY INNES | Member ID: 40674177501 |
| Employer ID: PELTZ | Termination Date: 2021-10-31 |
| Contract Record ID: 40674177501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 176681 | Status: COMPLETE |
| Request Date: 2021-10-13 | Status Date: 2021-10-13 |
| Member Name: NEVIN HENDERSON | Member ID: 86059200301 |
| Employer ID: CLEAR | Termination Date: 2021-09-30 |
| Contract Record ID: 86059200301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 177101 | Status: COMPLETE |
| Request Date: 2021-10-14 | Status Date: 2021-10-14 |
| Member Name: NICOLAS ARMSTRONG | Member ID: 52188236301 |
| Employer ID: PELTZ | Termination Date: 2021-10-31 |
| Contract Record ID: 52188236301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 177121 | Status: COMPLETE |
| Request Date: 2021-10-14 | Status Date: 2021-10-14 |
| Member Name: CARL BEATTY | Member ID: 44061012701 |
| Employer ID: PELTZ | Termination Date: 2021-10-31 |
| Contract Record ID: 44061012701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 177401 | Status: COMPLETE |
| Request Date: 2021-10-15 | Status Date: 2021-10-15 |
| Member Name: CODY M WELLS | Member ID: 58382255901 |
| Employer ID: SUNRISE | Termination Date: 2021-10-31 |
| Contract Record ID: 58382255901 | Term Reason: VOLUNTARY |
| Comments: Changed his mind on having insurance |
|
| 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: 177641 | Status: COMPLETE |
| Request Date: 2021-10-18 | Status Date: 2021-10-18 |
| Member Name: SOPHIA COLE | Member ID: 72248687901 |
| Employer ID: CNT | Termination Date: 2021-10-31 |
| Contract Record ID: 72248687901 | Term Reason: TERMINATION |
| Comments: Resigned, moving out of state |
|
| Request ID: 177681 | Status: COMPLETE |
| Request Date: 2021-10-18 | Status Date: 2021-10-18 |
| Member Name: KIMBERLY CLUTTERBUCK | Member ID: 03212065201 |
| Employer ID: DAVIS | Termination Date: 2021-11-30 |
| Contract Record ID: 03212065201 | Term Reason: VOLUNTARY |
| Comments: Moved out of the area :( |
|
| Request ID: 178241 | Status: COMPLETE |
| Request Date: 2021-10-19 | Status Date: 2021-10-19 |
| Member Name: GARY WEBB | Member ID: 35409195401 |
| Employer ID: ZAT | Termination Date: 2021-10-12 |
| Contract Record ID: 35409195401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 178381 | Status: COMPLETE |
| Request Date: 2021-10-19 | Status Date: 2021-10-19 |
| Member Name: DON JOHNSON | Member ID: 24565960101 |
| Employer ID: SHS | Termination Date: 2021-09-23 |
| Contract Record ID: 24565960101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 178641 | Status: COMPLETE |
| Request Date: 2021-10-20 | Status Date: 2021-10-20 |
| Member Name: KELSEY M NYE | Member ID: 45465824101 |
| Employer ID: EASYLVNG | Termination Date: 2021-09-30 |
| Contract Record ID: 45465824101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 178881 | Status: COMPLETE |
| Request Date: 2021-10-20 | Status Date: 2021-10-20 |
| Member Name: CORY DOERR | Member ID: 16846293201 |
| Employer ID: RCI | Termination Date: 2021-09-16 |
| Contract Record ID: 16846293201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 178981 | Status: COMPLETE |
| Request Date: 2021-10-20 | Status Date: 2021-10-20 |
| Member Name: LULA WOOTEN | Member ID: 37491263501 |
| Employer ID: ZUS | Termination Date: 2021-10-11 |
| Contract Record ID: 37491263501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 179061 | Status: COMPLETE |
| Request Date: 2021-10-20 | Status Date: 2021-10-20 |
| Member Name: DAVID R FINNEY | Member ID: 71060206501 |
| Employer ID: BROSOL | Termination Date: 2021-09-30 |
| Contract Record ID: 71060206501 | Term Reason: VOLUNTARY |
| Comments: Employee resigned; last day was 9/17/2021, last day of coverage was 9/30/2021. This was on the census. |
|
| Request ID: 179081 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: JON KESSLER | Member ID: 65711441101 |
| Employer ID: BROSOL | Termination Date: 2021-09-01 |
| Contract Record ID: 65711441101 | Term Reason: VOLUNTARY |
| Comments: Employee resigned and last day of coverage was 9/1/2021; this was submitted on the census. |
|
| Request ID: 179101 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: JON KESSLER | Member ID: 65711441101 |
| Employer ID: BROSOL | Termination Date: 2021-09-01 |
| Contract Record ID: 65711441101 | Term Reason: VOLUNTARY |
| Comments: Employee resigned and last day of coverage was 9/1/2021; this was submitted on the census. |
|
| Request ID: 179121 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: BILLY RICHARDSON | Member ID: 85234196901 |
| Employer ID: BROSOL | Termination Date: 2021-10-01 |
| Contract Record ID: 85234196901 | Term Reason: VOLUNTARY |
| Comments: Employee resigned and last day of coverage was 10/1/2021. |
|
| Request ID: 179221 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: CORY DOERR | Member ID: 16846293201 |
| Employer ID: RCI | Termination Date: 2021-09-16 |
| Contract Record ID: 16846293201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 179241 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: CARLOS ALBERTO GOMEZ CORREA | Member ID: 12832945201 |
| Employer ID: RCI | Termination Date: 2021-09-23 |
| Contract Record ID: 12832945201 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 179261 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: TRAVIS GORDON | Member ID: 11681108601 |
| Employer ID: RCI | Termination Date: 2021-10-14 |
| Contract Record ID: 11681108601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 179321 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: SAVANNAH HUCKS | Member ID: 23389429601 |
| Employer ID: YHP00015 | Termination Date: 2021-09-25 |
| Contract Record ID: 23389429601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 179341 | Status: COMPLETE |
| Request Date: 2021-10-21 | Status Date: 2021-10-21 |
| Member Name: DEENA DURANT-BARTHOLOW | Member ID: 14290717301 |
| Employer ID: YHP00015 | Termination Date: 2021-09-30 |
| Contract Record ID: 14290717301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 179661 | Status: COMPLETE |
| Request Date: 2021-10-22 | Status Date: 2021-10-22 |
| Member Name: KELSEY M NYE | Member ID: 45465824101 |
| Employer ID: EASYLVNG | Termination Date: 2021-09-30 |
| Contract Record ID: 45465824101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 179881 | Status: COMPLETE |
| Request Date: 2021-10-22 | Status Date: 2021-10-22 |
| Member Name: WILSON CHARLES | Member ID: 39073499801 |
| Employer ID: WCE | Termination Date: 2021-10-05 |
| Contract Record ID: 39073499801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 180141 | Status: COMPLETE |
| Request Date: 2021-10-25 | Status Date: 2021-10-25 |
| Member Name: CALDEN H LANGE | Member ID: 19939417601 |
| Employer ID: SNELL | Termination Date: 2021-10-14 |
| Contract Record ID: 19939417601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 180261 | Status: COMPLETE |
| Request Date: 2021-10-25 | Status Date: 2021-10-25 |
| Member Name: NATHALIE AVILES | Member ID: 06519028101 |
| Employer ID: DNA | Termination Date: 2021-10-31 |
| Contract Record ID: 06519028101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 180361 | Status: COMPLETE |
| Request Date: 2021-10-25 | Status Date: 2021-10-25 |
| Member Name: STEPHEN GLENN | Member ID: 84181173401 |
| Employer ID: ZAT | Termination Date: 2021-10-22 |
| Contract Record ID: 84181173401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 180721 | Status: COMPLETE |
| Request Date: 2021-10-26 | Status Date: 2021-10-26 |
| Member Name: CARLOS ALBERTO GOMEZ CORREA | Member ID: 12832945201 |
| Employer ID: RCI | Termination Date: 2021-09-23 |
| Contract Record ID: 12832945201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 181561 | Status: COMPLETE |
| Request Date: 2021-10-29 | Status Date: 2021-10-29 |
| Member Name: TAKOTA FAHEY | Member ID: 21260086101 |
| Employer ID: NEC | Termination Date: 2021-10-21 |
| Contract Record ID: 21260086101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 181642 | Status: COMPLETE |
| Request Date: 2021-10-29 | Status Date: 2021-10-29 |
| Member Name: DOMINIQUE MAYO | Member ID: 66198112901 |
| Employer ID: ZAT | Termination Date: 2021-10-14 |
| Contract Record ID: 66198112901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 181881 | Status: COMPLETE |
| Request Date: 2021-10-30 | Status Date: 2021-10-30 |
| Member Name: KATELYN KITTS | Member ID: 55392510101 |
| Employer ID: TBX | Termination Date: 2021-10-01 |
| Contract Record ID: 55392510101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 181901 | Status: COMPLETE |
| Request Date: 2021-10-30 | Status Date: 2021-10-30 |
| Member Name: BRITTANY L GRIFFITH | Member ID: 50784779501 |
| Employer ID: TBX | Termination Date: 2021-10-29 |
| Contract Record ID: 50784779501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 181981 | Status: COMPLETE |
| Request Date: 2021-11-01 | Status Date: 2021-11-01 |
| Member Name: AKEEM HINDS | Member ID: 72883556002 |
| Employer ID: PELTZ | Termination Date: 2021-11-01 |
| Contract Record ID: 72883556001 | Term Reason: DIVORCE FROM EMPLOYEE |
| Comments: |
|
| Request ID: 182062 | Status: COMPLETE |
| Request Date: 2021-11-01 | Status Date: 2021-11-01 |
| Member Name: GARRETT W YOUNT | Member ID: 06620166101 |
| Employer ID: LAIRWAYS | Termination Date: 2021-11-02 |
| Contract Record ID: 06620166101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 182121 | Status: COMPLETE |
| Request Date: 2021-11-01 | Status Date: 2021-11-01 |
| Member Name: WILLIAM P EXINER | Member ID: 56873084501 |
| Employer ID: ASSI | Termination Date: 2021-10-31 |
| Contract Record ID: 56873084501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 182122 | Status: COMPLETE |
| Request Date: 2021-11-01 | Status Date: 2021-11-01 |
| Member Name: WILLIAM P EXINER | Member ID: 56873084501 |
| Employer ID: ASSI | Termination Date: 2021-10-31 |
| Contract Record ID: 56873084501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 182123 | Status: COMPLETE |
| Request Date: 2021-11-01 | Status Date: 2021-11-01 |
| Member Name: THOMAS NAPOLITANO | Member ID: 25464160201 |
| Employer ID: ASSI | Termination Date: 2021-10-31 |
| Contract Record ID: 25464160201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 182124 | Status: COMPLETE |
| Request Date: 2021-11-01 | Status Date: 2021-11-01 |
| Member Name: LETITIA WHITEHEAD | Member ID: 97980259701 |
| Employer ID: PELTZ | Termination Date: 2021-11-01 |
| Contract Record ID: 97980259701 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 182401 | Status: COMPLETE |
| Request Date: 2021-11-02 | Status Date: 2021-11-02 |
| Member Name: ERIC ORR | Member ID: 99855009901 |
| Employer ID: VISTA | Termination Date: 2021-09-30 |
| Contract Record ID: 99855009901 | Term Reason: TERMINATION |
| Comments: COBRA Plans:
NO MEDICAL
High Dental EE-Only Ending 9/30/2021
NO VISION |
|
| Request ID: 182402 | Status: COMPLETE |
| Request Date: 2021-11-02 | Status Date: 2021-11-02 |
| Member Name: LIYYAHKAAT ZAFARALI | Member ID: 25385087401 |
| Employer ID: VISTA | Termination Date: 2021-09-30 |
| Contract Record ID: 25385087401 | Term Reason: REDUCTION OF HOURS |
| Comments: COBRA Plans:
NO MEDICAL
High Dental EE-only ending 9/30/2021
Vision EE-only ending 9/30/2021 |
|
| Request ID: 182403 | Status: COMPLETE |
| Request Date: 2021-11-02 | Status Date: 2021-11-02 |
| Member Name: NICKI MARTIN | Member ID: 67761775701 |
| Employer ID: VISTA | Termination Date: 2021-10-29 |
| Contract Record ID: 67761775701 | Term Reason: TERMINATION |
| Comments: COBRA PLANS:
Medical 2000 EE-only ending 10/29/2021
High Dental EE-only ending 10/31/2021
Vision EE-only ending 10/31/2021 |
|
| Request ID: 182404 | Status: COMPLETE |
| Request Date: 2021-11-02 | Status Date: 2021-11-02 |
| Member Name: TABITHA WILSON | Member ID: 38599785101 |
| Employer ID: VISTA | Termination Date: 2021-10-20 |
| Contract Record ID: 38599785101 | Term Reason: TERMINATION |
| Comments: COBRA PLANS:
Medical 2000 EE-only ending 10/20/2021
High Dental EE-only ending 10/31/2021
Vision EE-only ending 10/31/2021 |
|
| Request ID: 182421 | Status: COMPLETE |
| Request Date: 2021-11-02 | Status Date: 2021-11-02 |
| Member Name: JANICE HUFFMAN | Member ID: 74719653901 |
| Employer ID: VISTA | Termination Date: 2021-10-31 |
| Contract Record ID: 74719653901 | Term Reason: TERMINATION |
| Comments: COBRA PLANS:
NO MEDICAL
Low Dental EE+Family ending 10/31/2021
Vision EE+Family ending 10/31/2021 |
|
| Request ID: 182541 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: MICHAEL J GOETHEL | Member ID: 38899945001 |
| Employer ID: NASCO | Termination Date: 2021-11-01 |
| Contract Record ID: 38899945001 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 182561 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: EMILY FAULKNER | Member ID: 29602363101 |
| Employer ID: NASCO | Termination Date: 2021-10-29 |
| Contract Record ID: 29602363101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 182701 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: ANA KAREN PEREZ GUZMAN | Member ID: 19012540401 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 19012540401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 182721 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: ANA KAREN PEREZ GUZMAN | Member ID: 19012540401 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 19012540401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 182761 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: MARK CHAPMAN | Member ID: 83252798001 |
| Employer ID: TUBEFORM | Termination Date: 2021-10-31 |
| Contract Record ID: 83252798001 | Term Reason: DECEASED |
| Comments: |
|
| Request ID: 182841 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: MARCQUISHA VALARY | Member ID: 78317584501 |
| Employer ID: DNA | Termination Date: 2021-10-31 |
| Contract Record ID: 78317584501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 182861 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: MARCQUISHA VALARY | Member ID: 78317584501 |
| Employer ID: DNA | Termination Date: 2021-10-31 |
| Contract Record ID: 78317584501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 182881 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: DAVID SWANBERG | Member ID: 95662146801 |
| Employer ID: SUNRISE | Termination Date: 2021-10-30 |
| Contract Record ID: 95662146801 | Term Reason: VOLUNTARY |
| Comments: EMPLOYEE REQUESTED |
|
| Request ID: 182901 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: SHALLA SANDERSON | Member ID: 52512396301 |
| Employer ID: DNA | Termination Date: 2021-10-31 |
| Contract Record ID: 52512396301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 182981 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: ANA KAREN PEREZ GUZMAN | Member ID: 19012540401 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 19012540401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 183001 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: JENNIFER HOPE KENT | Member ID: 16241605301 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 16241605301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 183021 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: NICHOLE M RODARTE | Member ID: 76099637901 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 76099637901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 183022 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: SUMMER POLLEY | Member ID: 21482770901 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 21482770901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 183023 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: JESSICA R HOOVER | Member ID: 82202807801 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 82202807801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 183024 | Status: COMPLETE |
| Request Date: 2021-11-03 | Status Date: 2021-11-03 |
| Member Name: KATY LYN PALMER | Member ID: 70761274401 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 70761274401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 183182 | Status: COMPLETE |
| Request Date: 2021-11-04 | Status Date: 2021-11-04 |
| Member Name: CARSON NEELY | Member ID: 33099037403 |
| Employer ID: DNA | Termination Date: 2021-10-31 |
| Contract Record ID: 33099037401 | Term Reason: LOSS OF DEPENDANT STATUS |
| Comments: Turned 26 on 10/10/2021 |
|
| 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: 183381 | Status: COMPLETE |
| Request Date: 2021-11-05 | Status Date: 2021-11-05 |
| Member Name: DYLAN FORD | Member ID: 28512184401 |
| Employer ID: NEC | Termination Date: 2021-10-29 |
| Contract Record ID: 28512184401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 183382 | Status: COMPLETE |
| Request Date: 2021-11-05 | Status Date: 2021-11-05 |
| Member Name: JEFFREY FORD | Member ID: 79029215003 |
| Employer ID: NEC | Termination Date: 2021-10-29 |
| Contract Record ID: 79029215001 | Term Reason: TERMINATION |
| Comments: Termed before coverage started not Cobra eligible |
|
| Request ID: 183383 | Status: COMPLETE |
| Request Date: 2021-11-05 | Status Date: 2021-11-05 |
| Member Name: DYLAN MARTIN | Member ID: 43281790401 |
| Employer ID: NEC | Termination Date: 2021-10-26 |
| Contract Record ID: 43281790401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 183385 | Status: COMPLETE |
| Request Date: 2021-11-05 | Status Date: 2021-11-05 |
| Member Name: BRADLEY WHITT | Member ID: 91227178101 |
| Employer ID: NEC | Termination Date: 2021-10-18 |
| Contract Record ID: 91227178101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 183386 | Status: COMPLETE |
| Request Date: 2021-11-05 | Status Date: 2021-11-05 |
| Member Name: TIMOTHY GROFF | Member ID: 75737877001 |
| Employer ID: NEC | Termination Date: 2021-10-18 |
| Contract Record ID: 75737877001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 183387 | Status: COMPLETE |
| Request Date: 2021-11-05 | Status Date: 2021-11-05 |
| Member Name: ROBERT MARTINEZ | Member ID: 14588756601 |
| Employer ID: NEC | Termination Date: 2021-11-03 |
| Contract Record ID: 14588756601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 183701 | Status: COMPLETE |
| Request Date: 2021-11-08 | Status Date: 2021-11-08 |
| Member Name: NEAL MCPHATTER | Member ID: 65225780001 |
| Employer ID: TIMESPEC | Termination Date: 2021-10-21 |
| Contract Record ID: 65225780001 | Term Reason: INVOLUNTARY |
| Comments: Per Ease update |
|
| Request ID: 183721 | Status: COMPLETE |
| Request Date: 2021-11-08 | Status Date: 2021-11-08 |
| Member Name: JENNIFER LINDSEY | Member ID: 45661868001 |
| Employer ID: TBX | Termination Date: 2021-11-30 |
| Contract Record ID: 45661868001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 183861 | Status: COMPLETE |
| Request Date: 2021-11-09 | Status Date: 2021-11-09 |
| Member Name: BROCK L FREDERICK | Member ID: 05583517901 |
| Employer ID: BRULE | Termination Date: 2021-12-31 |
| Contract Record ID: 05583517901 | Term Reason: VOLUNTARY |
| Comments: Insurance coverage until end of December as premiums paid in November. |
|
| 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: 184121 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: KENNETH WEST | Member ID: 02926681901 |
| Employer ID: PELTZ | Termination Date: 2021-10-31 |
| Contract Record ID: 02926681901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 184141 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: KENNETH WEST | Member ID: 02926681901 |
| Employer ID: PELTZ | Termination Date: 2021-10-31 |
| Contract Record ID: 02926681901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 184161 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: HEATHER PETTY | Member ID: 85137360201 |
| Employer ID: PELTZ | Termination Date: 2021-11-30 |
| Contract Record ID: 85137360201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 184204 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: TRAVIS GORDON | Member ID: 11681108601 |
| Employer ID: RCI | Termination Date: 2021-10-14 |
| Contract Record ID: 11681108601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 184205 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: CHASE HILLIARD | Member ID: 90657660301 |
| Employer ID: RCI | Termination Date: 2021-10-15 |
| Contract Record ID: 90657660301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 184206 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: ROBERT WILLIAM POLK | Member ID: 37052365201 |
| Employer ID: RCI | Termination Date: 2021-10-22 |
| Contract Record ID: 37052365201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 184207 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: NICOLE SIMER | Member ID: 65818594301 |
| Employer ID: RCI | Termination Date: 2021-09-03 |
| Contract Record ID: 65818594301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 184214 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: REBECCA MICHELLE GREMILLION | Member ID: 54071131101 |
| Employer ID: RCI | Termination Date: 2021-09-22 |
| Contract Record ID: 54071131101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 184215 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: CARLOS ALBERTO GOMEZ CORREA | Member ID: 12832945201 |
| Employer ID: RCI | Termination Date: 2021-09-23 |
| Contract Record ID: 12832945201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 184216 | Status: COMPLETE |
| Request Date: 2021-11-10 | Status Date: 2021-11-10 |
| Member Name: CORY DOERR | Member ID: 16846293201 |
| Employer ID: RCI | Termination Date: 2021-09-16 |
| Contract Record ID: 16846293201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 184981 | Status: COMPLETE |
| Request Date: 2021-11-11 | Status Date: 2021-11-11 |
| Member Name: KENNAN JACKSON | Member ID: 35701036201 |
| Employer ID: COASTRAN | Termination Date: 2021-11-08 |
| Contract Record ID: 35701036201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 185021 | Status: COMPLETE |
| Request Date: 2021-11-11 | Status Date: 2021-11-11 |
| Member Name: SHAWN REBECCA TUBBS | Member ID: 85161704801 |
| Employer ID: RCI | Termination Date: 2021-09-01 |
| Contract Record ID: 85161704801 | Term Reason: VOLUNTARY |
| Comments: waived benefits in open enrollment |
|
| Request ID: 185221 | Status: COMPLETE |
| Request Date: 2021-11-11 | Status Date: 2021-11-11 |
| Member Name: JAMIE J FLANARY | Member ID: 35378384201 |
| Employer ID: NASCO | Termination Date: 2021-09-09 |
| Contract Record ID: 35378384201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 185241 | Status: COMPLETE |
| Request Date: 2021-11-11 | Status Date: 2021-11-11 |
| Member Name: RICHARD THOMAS SELLIER | Member ID: 16627033401 |
| Employer ID: LAIRWAYS | Termination Date: 2021-11-12 |
| Contract Record ID: 16627033401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 185441 | Status: COMPLETE |
| Request Date: 2021-11-12 | Status Date: 2021-11-12 |
| Member Name: BALBINA CASTILLO | Member ID: 68710701201 |
| Employer ID: VISTA | Termination Date: 2021-11-12 |
| Contract Record ID: 68710701201 | Term Reason: TERMINATION |
| Comments: COBRA Plans:
Medical 5000 ending 11/12/2021
NO DENTAL
NO VISION |
|
| Request ID: 185581 | Status: COMPLETE |
| Request Date: 2021-11-12 | Status Date: 2021-11-12 |
| Member Name: WILBERT VAUGHAN | Member ID: 36614307301 |
| Employer ID: DNA | Termination Date: 2021-11-30 |
| Contract Record ID: 36614307301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 185755 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: THEODORE REGO LOCOCO | Member ID: 84120279701 |
| Employer ID: LAIRWAYS | Termination Date: 2021-11-15 |
| Contract Record ID: 84120279701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 185757 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: NICHOLAS DILLAN LOCOCO | Member ID: 84120279703 |
| Employer ID: LAIRWAYS | Termination Date: 2021-11-15 |
| Contract Record ID: 84120279701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 185758 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: CECILIA NICOLE LOCOCO | Member ID: 84120279704 |
| Employer ID: LAIRWAYS | Termination Date: 2021-11-15 |
| Contract Record ID: 84120279701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 185760 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: LINDA J OUTLAW | Member ID: 68910257401 |
| Employer ID: CNT | Termination Date: 2021-11-30 |
| Contract Record ID: 68910257401 | Term Reason: TERMINATION |
| Comments: Resigned for personal reasons. |
|
| Request ID: 185881 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: STEFANIE HOLLOWAY | Member ID: 86496984901 |
| Employer ID: NASCO | Termination Date: 2021-11-06 |
| Contract Record ID: 86496984901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 185965 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: MICHAEL ARMSTRONG | Member ID: 70128618501 |
| Employer ID: NEC | Termination Date: 2021-11-05 |
| Contract Record ID: 70128618501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 185966 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: JEREMY TOLER | Member ID: 78044133101 |
| Employer ID: NEC | Termination Date: 2021-11-03 |
| Contract Record ID: 78044133101 | 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: 185968 | Status: COMPLETE |
| Request Date: 2021-11-15 | Status Date: 2021-11-15 |
| Member Name: SEAN MICHAEL O HAYRE | Member ID: 08385297801 |
| Employer ID: NEC | Termination Date: 2021-11-12 |
| Contract Record ID: 08385297801 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 186061 | Status: COMPLETE |
| Request Date: 2021-11-16 | Status Date: 2021-11-16 |
| Member Name: JONATHAN HARRELL | Member ID: 28022405301 |
| Employer ID: ZAT | Termination Date: 2021-11-12 |
| Contract Record ID: 28022405301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 186081 | Status: COMPLETE |
| Request Date: 2021-11-16 | Status Date: 2021-11-16 |
| Member Name: JONATHAN HARRELL | Member ID: 28022405301 |
| Employer ID: ZAT | Termination Date: 2021-11-12 |
| Contract Record ID: 28022405301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 186241 | Status: COMPLETE |
| Request Date: 2021-11-16 | Status Date: 2021-11-16 |
| Member Name: KAREN LATIMER | Member ID: 62386106201 |
| Employer ID: DNA | Termination Date: 2021-11-30 |
| Contract Record ID: 62386106201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 186242 | Status: COMPLETE |
| Request Date: 2021-11-16 | Status Date: 2021-11-16 |
| Member Name: KAREN LATIMER | Member ID: 62386106201 |
| Employer ID: DNA | Termination Date: 2021-11-30 |
| Contract Record ID: 62386106201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 186341 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: ETHAN MALE CAMPO | Member ID: 46467722801 |
| Employer ID: RCI | Termination Date: 2021-11-01 |
| Contract Record ID: 46467722801 | Term Reason: VOLUNTARY |
| Comments: decided within 30 days grace period |
|
| Request ID: 186361 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: ETHAN MALE CAMPO | Member ID: 46467722801 |
| Employer ID: RCI | Termination Date: 2021-11-01 |
| Contract Record ID: 46467722801 | Term Reason: VOLUNTARY |
| Comments: decided within 30 days grace period |
|
| Request ID: 186381 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: ETHAN MALE CAMPO | Member ID: 97995766903 |
| Employer ID: RCI | Termination Date: 2021-11-01 |
| Contract Record ID: 97995766901 | Term Reason: VOLUNTARY |
| Comments: decided within 30 days grace period |
|
| Request ID: 186401 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: JULIE SCHAEFER | Member ID: 76421098201 |
| Employer ID: DAVIS | Termination Date: 2021-11-30 |
| Contract Record ID: 76421098201 | Term Reason: VOLUNTARY |
| Comments: Resigned |
|
| Request ID: 186421 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: JORDAN BOZE | Member ID: 09168221501 |
| Employer ID: DAVIS | Termination Date: 2021-12-31 |
| Contract Record ID: 09168221501 | Term Reason: TERMINATION |
| Comments: Resigned |
|
| Request ID: 186441 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: JENNIFER WETZEL | Member ID: 48584697401 |
| Employer ID: DAVIS | Termination Date: 2021-11-30 |
| Contract Record ID: 48584697401 | Term Reason: VOLUNTARY |
| Comments: Quit |
|
| Request ID: 186462 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: MEGAN WOLZ | Member ID: 06468823901 |
| Employer ID: DAVIS | Termination Date: 2021-11-30 |
| Contract Record ID: 06468823901 | Term Reason: VOLUNTARY |
| Comments: Resigned |
|
| Request ID: 186481 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: KYRA ROOKARD | Member ID: 26097383501 |
| Employer ID: DAVIS | Termination Date: 2021-11-30 |
| Contract Record ID: 26097383501 | Term Reason: VOLUNTARY |
| Comments: Quit |
|
| Request ID: 186501 | Status: COMPLETE |
| Request Date: 2021-11-17 | Status Date: 2021-11-17 |
| Member Name: JORDAN BOZE | Member ID: 09168221501 |
| Employer ID: DAVIS | Termination Date: 2021-12-31 |
| Contract Record ID: 09168221501 | Term Reason: VOLUNTARY |
| Comments: Quit |
|
| Request ID: 186801 | Status: COMPLETE |
| Request Date: 2021-11-18 | Status Date: 2021-11-18 |
| Member Name: JASON WOOD | Member ID: 96260166001 |
| Employer ID: NEC | Termination Date: 2021-10-29 |
| Contract Record ID: 96260166001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 186821 | Status: COMPLETE |
| Request Date: 2021-11-18 | Status Date: 2021-11-18 |
| Member Name: DAVID BRENDEL | Member ID: 48459297101 |
| Employer ID: MESH | Termination Date: 2021-11-17 |
| Contract Record ID: 48459297101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 186861 | Status: COMPLETE |
| Request Date: 2021-11-18 | Status Date: 2021-11-18 |
| Member Name: ZACHARY SCHRAM | Member ID: 86562787901 |
| Employer ID: NASCO | Termination Date: 2021-11-12 |
| Contract Record ID: 86562787901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 186941 | Status: COMPLETE |
| Request Date: 2021-11-18 | Status Date: 2021-11-18 |
| Member Name: TYLER VAUGHAN | Member ID: 94652237601 |
| Employer ID: ZUS | Termination Date: 2021-11-12 |
| Contract Record ID: 94652237601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 186961 | Status: COMPLETE |
| Request Date: 2021-11-18 | Status Date: 2021-11-18 |
| Member Name: MARK COPELAND | Member ID: 09078940901 |
| Employer ID: ZAT | Termination Date: 2021-11-17 |
| Contract Record ID: 09078940901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 187201 | Status: COMPLETE |
| Request Date: 2021-11-19 | Status Date: 2021-11-19 |
| Member Name: ALYSSA PHANSISAY | Member ID: 69314722201 |
| Employer ID: VAUGHAN | Termination Date: 2021-11-16 |
| Contract Record ID: 69314722201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 187321 | Status: COMPLETE |
| Request Date: 2021-11-22 | Status Date: 2021-11-22 |
| Member Name: THU NGUYEN | Member ID: 82505834301 |
| Employer ID: PELTZ | Termination Date: 2021-11-30 |
| Contract Record ID: 82505834301 | Term Reason: TERMINATION |
| 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: 187721 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: EVA CALDERONE | Member ID: 04157373001 |
| Employer ID: COS | Termination Date: 2021-10-08 |
| Contract Record ID: 04157373001 | Term Reason: TERMINATION |
| Comments: Employee Quit |
|
| Request ID: 187722 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: EVA CALDERONE | Member ID: 04157373001 |
| Employer ID: COS | Termination Date: 2021-10-08 |
| Contract Record ID: 04157373001 | Term Reason: TERMINATION |
| Comments: Employee Quit |
|
| Request ID: 187742 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: WYATT VANN | Member ID: 36205721902 |
| Employer ID: SFM | Termination Date: 2021-11-30 |
| Contract Record ID: 36205721901 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| Comments: |
|
| Request ID: 187861 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: BELMARY APONTE | Member ID: 77292292901 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 77292292901 | Term Reason: VOLUNTARY |
| Comments: department 010 |
|
| Request ID: 187881 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: LAUREN BELL | Member ID: 32008976001 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 32008976001 | Term Reason: VOLUNTARY |
| Comments: department 001 |
|
| 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: 187921 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: DAVID BONILLA | Member ID: 61924574001 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 61924574001 | Term Reason: VOLUNTARY |
| Comments: department 777 |
|
| Request ID: 187941 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: REBECCA HELSEL | Member ID: 59334124901 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 59334124901 | Term Reason: VOLUNTARY |
| Comments: 002 |
|
| Request ID: 187981 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: HEATHER MCCALLON | Member ID: 34749822601 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 34749822601 | Term Reason: VOLUNTARY |
| Comments: department 800 |
|
| 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: 188021 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: BRODY WILSON | Member ID: 77977532201 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 77977532201 | Term Reason: VOLUNTARY |
| Comments: department 990 |
|
| Request ID: 188121 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: KAREN FORCE | Member ID: 14254609201 |
| Employer ID: MESH | Termination Date: 2021-11-30 |
| Contract Record ID: 14254609201 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| Comments: |
|
| Request ID: 188181 | Status: COMPLETE |
| Request Date: 2021-11-23 | Status Date: 2021-11-23 |
| Member Name: NANCY HESS | Member ID: 02275253801 |
| Employer ID: GRACE | Termination Date: 2021-12-31 |
| Contract Record ID: 02275253801 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| Comments: |
|
| Request ID: 188401 | Status: COMPLETE |
| Request Date: 2021-11-24 | Status Date: 2021-11-24 |
| Member Name: JEFFREY A ARNOLD | Member ID: 84291312501 |
| Employer ID: SNELL | Termination Date: 2021-11-20 |
| Contract Record ID: 84291312501 | Term Reason: DECEASED |
| Comments: Member passed away 11/19/2021 |
|
| Request ID: 188461 | Status: COMPLETE |
| Request Date: 2021-11-24 | Status Date: 2021-11-24 |
| Member Name: MICHELLE ALLEN | Member ID: 94695230701 |
| Employer ID: CNT | Termination Date: 2021-11-30 |
| Contract Record ID: 94695230701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 188521 | Status: COMPLETE |
| Request Date: 2021-11-26 | Status Date: 2021-11-26 |
| Member Name: HANNAH R TORO | Member ID: 71747005301 |
| Employer ID: LNB | Termination Date: 2021-11-23 |
| Contract Record ID: 71747005301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 188561 | Status: COMPLETE |
| Request Date: 2021-11-27 | Status Date: 2021-11-27 |
| Member Name: MARY E MELENDEZ-KIMBERL | Member ID: 81389696901 |
| Employer ID: GOLDENYR | Termination Date: 2021-11-30 |
| Contract Record ID: 81389696901 | Term Reason: VOLUNTARY |
| Comments: EE waiving coverage during OE |
|
| Request ID: 188621 | Status: COMPLETE |
| Request Date: 2021-11-27 | Status Date: 2021-11-27 |
| Member Name: ASHLEY S LYKINS | Member ID: 98709048501 |
| Employer ID: GOLDENYR | Termination Date: 2021-10-31 |
| Contract Record ID: 98709048501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 188641 | Status: COMPLETE |
| Request Date: 2021-11-29 | Status Date: 2021-11-29 |
| Member Name: JESSICA K HILLMAN | Member ID: 06325875401 |
| Employer ID: EASYLVNG | Termination Date: 2021-11-30 |
| Contract Record ID: 06325875401 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 189103 | Status: COMPLETE |
| Request Date: 2021-11-30 | Status Date: 2021-11-30 |
| Member Name: ASHLEY S LYKINS | Member ID: 98709048501 |
| Employer ID: GOLDENYR | Termination Date: 2021-10-31 |
| Contract Record ID: 98709048501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 189183 | Status: COMPLETE |
| Request Date: 2021-11-30 | Status Date: 2021-11-30 |
| Member Name: KERRY R HORNBACK | Member ID: 98198811901 |
| Employer ID: LNB | Termination Date: 2021-11-10 |
| Contract Record ID: 98198811901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 189201 | Status: COMPLETE |
| Request Date: 2021-11-30 | Status Date: 2021-11-30 |
| Member Name: JACOB C HORNBACK | Member ID: 98198811903 |
| Employer ID: LNB | Termination Date: 2021-11-30 |
| Contract Record ID: 98198811901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 189221 | Status: COMPLETE |
| Request Date: 2021-11-30 | Status Date: 2021-11-30 |
| Member Name: RICHARD C HORNBACK | Member ID: 98198811902 |
| Employer ID: LNB | Termination Date: 2021-11-30 |
| Contract Record ID: 98198811901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 189261 | Status: COMPLETE |
| Request Date: 2021-11-30 | Status Date: 2021-11-30 |
| Member Name: DALLAS TUCK | Member ID: 79641245301 |
| Employer ID: VISTA | Termination Date: 2021-11-06 |
| Contract Record ID: 79641245301 | Term Reason: TERMINATION |
| Comments: COBRA Plans
Medical 2000 EE Only- starting 11/7/2021
High Dental PPO EE Only- starting 12/1/2021
Vision EE Only- starting 12/1/2021 |
|
| Request ID: 189281 | Status: COMPLETE |
| Request Date: 2021-11-30 | Status Date: 2021-11-30 |
| Member Name: LAURA LUFKIN | Member ID: 15737364201 |
| Employer ID: SFM | Termination Date: 2021-11-30 |
| Contract Record ID: 15737364201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 189301 | Status: COMPLETE |
| Request Date: 2021-11-30 | Status Date: 2021-11-30 |
| Member Name: ROZALYN KAHEALAUNANI MABINI | Member ID: 73271467401 |
| Employer ID: SFM | Termination Date: 2021-11-30 |
| Contract Record ID: 73271467401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 189321 | Status: COMPLETE |
| Request Date: 2021-12-01 | Status Date: 2021-12-01 |
| Member Name: MIYA DELETTE COOPER | Member ID: 39543210701 |
| Employer ID: BRECK | Termination Date: 2021-11-30 |
| Contract Record ID: 39543210701 | Term Reason: TERMINATION |
| Comments: Resignation. Please send COBRA letter |
|
| Request ID: 189341 | Status: COMPLETE |
| Request Date: 2021-12-01 | Status Date: 2021-12-01 |
| Member Name: MIYA DELETTE COOPER | Member ID: 39543210701 |
| Employer ID: BRECK | Termination Date: 2021-11-30 |
| Contract Record ID: 39543210701 | Term Reason: TERMINATION |
| Comments: Resignation. Please send COBRA letter |
|
| Request ID: 189461 | Status: COMPLETE |
| Request Date: 2021-12-01 | Status Date: 2021-12-01 |
| Member Name: MICHELLE REECE | Member ID: 01244956602 |
| Employer ID: DAVIS | Termination Date: 2021-11-30 |
| Contract Record ID: 01244956601 | Term Reason: VOLUNTARY |
| Comments: Eligible for Coverage under employer |
|
| 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: 189501 | Status: COMPLETE |
| Request Date: 2021-12-01 | Status Date: 2021-12-01 |
| Member Name: DILAN VILLA TERRAZAS | Member ID: 08146651401 |
| Employer ID: NEC | Termination Date: 2021-11-30 |
| Contract Record ID: 08146651401 | 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: 189522 | Status: COMPLETE |
| Request Date: 2021-12-01 | Status Date: 2021-12-01 |
| Member Name: BRIAN RINKER | Member ID: 71839070401 |
| Employer ID: NEC | Termination Date: 2021-11-30 |
| Contract Record ID: 71839070401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 189821 | Status: COMPLETE |
| Request Date: 2021-12-02 | Status Date: 2021-12-02 |
| Member Name: DESTINY CORKLE | Member ID: 80762399001 |
| Employer ID: TIMESPEC | Termination Date: 2021-10-28 |
| Contract Record ID: 80762399001 | Term Reason: TERMINATION |
| Comments: per Susan D |
|
| Request ID: 189963 | Status: COMPLETE |
| Request Date: 2021-12-02 | Status Date: 2021-12-02 |
| Member Name: JERRY WELLS | Member ID: 62976329001 |
| Employer ID: MESH | Termination Date: 2021-12-31 |
| Contract Record ID: 62976329001 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| 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: 190061 | Status: COMPLETE |
| Request Date: 2021-12-03 | Status Date: 2021-12-03 |
| Member Name: ALLANA L HODGES | Member ID: 31479095401 |
| Employer ID: BROSOL | Termination Date: 2021-11-30 |
| Contract Record ID: 31479095401 | Term Reason: VOLUNTARY |
| Comments: Allana resigned. |
|
| Request ID: 190081 | Status: COMPLETE |
| Request Date: 2021-12-03 | Status Date: 2021-12-03 |
| Member Name: TRAVIS GORDON | Member ID: 11681108601 |
| Employer ID: RCI | Termination Date: 2021-10-14 |
| Contract Record ID: 11681108601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 190082 | Status: COMPLETE |
| Request Date: 2021-12-03 | Status Date: 2021-12-03 |
| Member Name: CHASE HILLIARD | Member ID: 90657660301 |
| Employer ID: RCI | Termination Date: 2021-10-15 |
| Contract Record ID: 90657660301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 190083 | Status: COMPLETE |
| Request Date: 2021-12-03 | Status Date: 2021-12-03 |
| Member Name: ROBERT WILLIAM POLK | Member ID: 37052365201 |
| Employer ID: RCI | Termination Date: 2021-10-22 |
| Contract Record ID: 37052365201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 190084 | Status: COMPLETE |
| Request Date: 2021-12-03 | Status Date: 2021-12-03 |
| Member Name: BRADLEY JAMES ARABIE | Member ID: 68018304201 |
| Employer ID: RCI | Termination Date: 2021-11-05 |
| Contract Record ID: 68018304201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 190161 | Status: COMPLETE |
| Request Date: 2021-12-03 | Status Date: 2021-12-03 |
| Member Name: CIERRA SAULS | Member ID: 63318499001 |
| Employer ID: CNT | Termination Date: 2021-11-30 |
| Contract Record ID: 63318499001 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 190301 | Status: COMPLETE |
| Request Date: 2021-12-03 | Status Date: 2021-12-03 |
| Member Name: MAXIME EXALUS | Member ID: 62665158801 |
| Employer ID: CNT | Termination Date: 2021-12-31 |
| Contract Record ID: 62665158801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 190421 | Status: COMPLETE |
| Request Date: 2021-12-06 | Status Date: 2021-12-06 |
| Member Name: DAVID DOLIN | Member ID: 76147717901 |
| Employer ID: NEC | Termination Date: 2021-12-31 |
| Contract Record ID: 76147717901 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 190564 | Status: COMPLETE |
| Request Date: 2021-12-06 | Status Date: 2021-12-06 |
| Member Name: ABRIA SEALS | Member ID: 66399040001 |
| Employer ID: DNA | Termination Date: 2021-12-01 |
| Contract Record ID: 66399040001 | Term Reason: TERMINATION |
| Comments: Medical HDHP 5000 2021/22 |
|
| Request ID: 190921 | Status: COMPLETE |
| Request Date: 2021-12-08 | Status Date: 2021-12-08 |
| Member Name: PAUL D SCAGLIONE | Member ID: 24933126201 |
| Employer ID: BROSOL | Termination Date: 2021-12-01 |
| Contract Record ID: 24933126201 | Term Reason: VOLUNTARY |
| Comments: Employee resigned on 11/17/2021 |
|
| Request ID: 191021 | Status: COMPLETE |
| Request Date: 2021-12-08 | Status Date: 2021-12-08 |
| Member Name: ANAIS C CAMPBELL | Member ID: 01930779801 |
| Employer ID: THEMA | Termination Date: 2021-11-30 |
| Contract Record ID: 01930779801 | Term Reason: VOLUNTARY |
| Comments: Employee gained coverage through spouse effective 12/01/2021 |
|
| Request ID: 191102 | Status: COMPLETE |
| Request Date: 2021-12-08 | Status Date: 2021-12-08 |
| Member Name: JOHN LINTH | Member ID: 89443068302 |
| Employer ID: VAUGHAN | Termination Date: 2022-01-01 |
| Contract Record ID: 89443068301 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 191961 | Status: COMPLETE |
| Request Date: 2021-12-14 | Status Date: 2021-12-14 |
| Member Name: GARY P OZIER | Member ID: 15170730201 |
| Employer ID: CNT | Termination Date: 2021-12-31 |
| Contract Record ID: 15170730201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 191981 | Status: COMPLETE |
| Request Date: 2021-12-14 | Status Date: 2021-12-14 |
| Member Name: MONTREL ROSS | Member ID: 38555868001 |
| Employer ID: RCI | Termination Date: 2021-12-03 |
| Contract Record ID: 38555868001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 192061 | Status: COMPLETE |
| Request Date: 2021-12-14 | Status Date: 2021-12-14 |
| Member Name: BROCK L DENNY | Member ID: 72447764501 |
| Employer ID: NEC | Termination Date: 2021-12-31 |
| Contract Record ID: 72447764501 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 192241 | Status: COMPLETE |
| Request Date: 2021-12-15 | Status Date: 2021-12-15 |
| Member Name: KANADA R ISAAC | Member ID: 46586576201 |
| Employer ID: COUSH | Termination Date: 2021-12-05 |
| Contract Record ID: 46586576201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 192243 | Status: COMPLETE |
| Request Date: 2021-12-15 | Status Date: 2021-12-15 |
| Member Name: JOSHUA B CERNEK | Member ID: 75516259901 |
| Employer ID: COUSH | Termination Date: 2021-11-05 |
| Contract Record ID: 75516259901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 192247 | Status: COMPLETE |
| Request Date: 2021-12-15 | Status Date: 2021-12-15 |
| Member Name: BETTY E REEVES | Member ID: 61740606501 |
| Employer ID: COUSH | Termination Date: 2021-11-12 |
| Contract Record ID: 61740606501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 192248 | Status: COMPLETE |
| Request Date: 2021-12-15 | Status Date: 2021-12-15 |
| Member Name: BETTY E REEVES | Member ID: 61740606501 |
| Employer ID: COUSH | Termination Date: 2021-11-12 |
| Contract Record ID: 61740606501 | Term Reason: TERMINATION |
| 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: 192344 | Status: COMPLETE |
| Request Date: 2021-12-16 | Status Date: 2021-12-16 |
| Member Name: DAVID BONILLA | Member ID: 61924574001 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 61924574001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 192361 | Status: COMPLETE |
| Request Date: 2021-12-16 | Status Date: 2021-12-16 |
| Member Name: REBECCA HELSEL | Member ID: 59334124901 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 59334124901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 192381 | Status: COMPLETE |
| Request Date: 2021-12-16 | Status Date: 2021-12-16 |
| Member Name: BELMARY APONTE | Member ID: 77292292901 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 77292292901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 192401 | Status: COMPLETE |
| Request Date: 2021-12-16 | Status Date: 2021-12-16 |
| Member Name: LAUREN BELL | Member ID: 32008976001 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 32008976001 | Term Reason: VOLUNTARY |
| 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: 192441 | Status: COMPLETE |
| Request Date: 2021-12-16 | Status Date: 2021-12-16 |
| Member Name: HEATHER MCCALLON | Member ID: 34749822601 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 34749822601 | 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: 192501 | Status: COMPLETE |
| Request Date: 2021-12-16 | Status Date: 2021-12-16 |
| Member Name: BRODY WILSON | Member ID: 77977532201 |
| Employer ID: PELTZ | Termination Date: 2021-12-01 |
| Contract Record ID: 77977532201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 192541 | Status: COMPLETE |
| Request Date: 2021-12-16 | Status Date: 2021-12-16 |
| Member Name: DARLA E PAXTON | Member ID: 70846160101 |
| Employer ID: EASYLVNG | Termination Date: 2021-12-31 |
| Contract Record ID: 70846160101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 192741 | Status: COMPLETE |
| Request Date: 2021-12-17 | Status Date: 2021-12-17 |
| Member Name: ALLISA ELJARIEH | Member ID: 07124697101 |
| Employer ID: YHP00015 | Termination Date: 2021-12-04 |
| Contract Record ID: 07124697101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 192821 | Status: COMPLETE |
| Request Date: 2021-12-17 | Status Date: 2021-12-17 |
| Member Name: MICHELLE TUMA | Member ID: 17366982601 |
| Employer ID: TIMESPEC | Termination Date: 2021-11-30 |
| Contract Record ID: 17366982601 | Term Reason: VOLUNTARY |
| Comments: eligible for spouse plan |
|
| Request ID: 192982 | Status: COMPLETE |
| Request Date: 2021-12-20 | Status Date: 2021-12-20 |
| Member Name: KRYSTLE TUA | Member ID: 09368445201 |
| Employer ID: SFM | Termination Date: 2021-12-31 |
| Contract Record ID: 09368445201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 192983 | Status: COMPLETE |
| Request Date: 2021-12-20 | Status Date: 2021-12-20 |
| Member Name: NICOLE RACHELLE KLOBUCHAR | Member ID: 80823973001 |
| Employer ID: SFM | Termination Date: 2021-12-31 |
| Contract Record ID: 80823973001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 192984 | Status: COMPLETE |
| Request Date: 2021-12-20 | Status Date: 2021-12-20 |
| Member Name: ASHLEE MARIE FLOYD | Member ID: 74210546301 |
| Employer ID: SFM | Termination Date: 2021-12-31 |
| Contract Record ID: 74210546301 | Term Reason: TERMINATION |
| 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: 193303 | Status: COMPLETE |
| Request Date: 2021-12-21 | Status Date: 2021-12-21 |
| Member Name: DAVID SNYDER | Member ID: 11258445602 |
| Employer ID: MESH | Termination Date: 2021-12-31 |
| Contract Record ID: 11258445601 | 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: 193341 | Status: COMPLETE |
| Request Date: 2021-12-21 | Status Date: 2021-12-21 |
| Member Name: CHELSEA SMITH | Member ID: 41444573001 |
| Employer ID: SFM | Termination Date: 2021-10-31 |
| Contract Record ID: 41444573001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 193381 | Status: COMPLETE |
| Request Date: 2021-12-21 | Status Date: 2021-12-21 |
| Member Name: WALTER HAWKINS | Member ID: 51789175902 |
| Employer ID: LNB | Termination Date: 2022-01-01 |
| Contract Record ID: 51789175901 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| Comments: Term Walter 1/1/2022 due to HIS medicare enrollment |
|
| Request ID: 193481 | Status: COMPLETE |
| Request Date: 2021-12-22 | Status Date: 2021-12-22 |
| Member Name: WILLIAM A SAYRE | Member ID: 14902585801 |
| Employer ID: MESH | Termination Date: 2021-12-23 |
| Contract Record ID: 14902585801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 193501 | Status: COMPLETE |
| Request Date: 2021-12-22 | Status Date: 2021-12-22 |
| Member Name: ANNA DALLAS | Member ID: 53872815101 |
| Employer ID: CNT | Termination Date: 2021-12-31 |
| Contract Record ID: 53872815101 | Term Reason: TERMINATION |
| Comments: Resigned |
|
| Request ID: 193601 | Status: COMPLETE |
| Request Date: 2021-12-22 | Status Date: 2021-12-22 |
| Member Name: JIM GENTRY | Member ID: 47982689601 |
| Employer ID: RCI | Termination Date: 2021-12-14 |
| Contract Record ID: 47982689601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 193621 | Status: COMPLETE |
| Request Date: 2021-12-22 | Status Date: 2021-12-22 |
| Member Name: RONI F LUPARELLO | Member ID: 93672096001 |
| Employer ID: RCI | Termination Date: 2021-09-01 |
| Contract Record ID: 93672096001 | Term Reason: TERMINATION |
| Comments: DOES NOT HAVE VISION |
|
| Request ID: 193681 | Status: COMPLETE |
| Request Date: 2021-12-22 | Status Date: 2021-12-22 |
| Member Name: AVERY LAMAR PAIGE | Member ID: 64232554701 |
| Employer ID: RCI | Termination Date: 2021-09-01 |
| Contract Record ID: 64232554701 | Term Reason: TERMINATION |
| Comments: DOES NOT HAVE DENTAL |
|
| Request ID: 193741 | Status: COMPLETE |
| Request Date: 2021-12-22 | Status Date: 2021-12-22 |
| Member Name: RONI F LUPARELLO | Member ID: 93672096001 |
| Employer ID: RCI | Termination Date: 2021-09-01 |
| Contract Record ID: 93672096001 | Term Reason: TERMINATION |
| Comments: DOES NOT HAVE DENTAL |
|
| Request ID: 193922 | Status: COMPLETE |
| Request Date: 2021-12-23 | Status Date: 2021-12-23 |
| Member Name: JENNIFER KINNEY | Member ID: 36290580401 |
| Employer ID: MESH | Termination Date: 2021-12-31 |
| Contract Record ID: 36290580401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 194141 | Status: COMPLETE |
| Request Date: 2021-12-27 | Status Date: 2021-12-27 |
| Member Name: BENJAMIN SCHLODER | Member ID: 58831367901 |
| Employer ID: MESH | Termination Date: 2021-12-31 |
| Contract Record ID: 58831367901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 194602 | Status: COMPLETE |
| Request Date: 2021-12-28 | Status Date: 2021-12-28 |
| Member Name: SHERRIE A SIGLINSKY | Member ID: 07011718601 |
| Employer ID: NASCO | Termination Date: 2002-11-30 |
| Contract Record ID: 07011718601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 194681 | Status: COMPLETE |
| Request Date: 2021-12-29 | Status Date: 2021-12-29 |
| Member Name: NILA WAGAMAN | Member ID: 72672410601 |
| Employer ID: BRULE | Termination Date: 2021-12-31 |
| Contract Record ID: 72672410601 | Term Reason: VOLUNTARY |
| Comments: |
|
| 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: 195361 | Status: COMPLETE |
| Request Date: 2021-12-31 | Status Date: 2021-12-31 |
| Member Name: MICHELE ROBERTSON | Member ID: 73106948301 |
| Employer ID: BRECK | Termination Date: 2021-12-31 |
| Contract Record ID: 73106948301 | Term Reason: RETIREE FILED CHAPTER 11 |
| Comments: Retirement |
|
| Request ID: 195381 | Status: COMPLETE |
| Request Date: 2021-12-31 | Status Date: 2021-12-31 |
| Member Name: LIAM DONALDSON | Member ID: 78859601001 |
| Employer ID: BRECK | Termination Date: 2021-12-31 |
| Contract Record ID: 78859601001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 195401 | Status: COMPLETE |
| Request Date: 2021-12-31 | Status Date: 2021-12-31 |
| Member Name: VORALAK ARROYO | Member ID: 05756025601 |
| Employer ID: BRECK | Termination Date: 2021-11-30 |
| Contract Record ID: 05756025601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 195421 | Status: COMPLETE |
| Request Date: 2021-12-31 | Status Date: 2021-12-31 |
| Member Name: KEVIN TAIT | Member ID: 01578082101 |
| Employer ID: BRECK | Termination Date: 2021-12-31 |
| Contract Record ID: 01578082101 | Term Reason: VOLUNTARY |
| Comments: mOved to another plan |
|
| Request ID: 195441 | Status: COMPLETE |
| Request Date: 2022-01-01 | Status Date: 2022-01-01 |
| Member Name: THOMAS P GEORGIA | Member ID: 65115160301 |
| Employer ID: TBX | Termination Date: 2021-12-31 |
| Contract Record ID: 65115160301 | Term Reason: TERMINATION |
| Comments: |
|
| 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: 195642 | Status: COMPLETE |
| Request Date: 2022-01-03 | Status Date: 2022-01-03 |
| Member Name: EDDIE LINDSEY | Member ID: 87293355101 |
| Employer ID: LAIRWAYS | Termination Date: 2022-01-03 |
| Contract Record ID: 87293355101 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| Comments: |
|
| Request ID: 195643 | Status: COMPLETE |
| Request Date: 2022-01-03 | Status Date: 2022-01-03 |
| Member Name: THOMASENA LINDSEY | Member ID: 87293355102 |
| Employer ID: LAIRWAYS | Termination Date: 2022-01-03 |
| Contract Record ID: 87293355101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 195841 | Status: COMPLETE |
| Request Date: 2022-01-03 | Status Date: 2022-01-03 |
| Member Name: HUNTER G STEIN | Member ID: 76229382801 |
| Employer ID: RCI | Termination Date: 2021-12-01 |
| Contract Record ID: 76229382801 | Term Reason: VOLUNTARY |
| Comments: Did not enroll |
|
| Request ID: 195941 | Status: COMPLETE |
| Request Date: 2022-01-04 | Status Date: 2022-01-04 |
| Member Name: JAMES LYONS MASSENGALE | Member ID: 48005444201 |
| Employer ID: RCI | Termination Date: 2021-12-24 |
| Contract Record ID: 48005444201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 195942 | Status: COMPLETE |
| Request Date: 2022-01-04 | Status Date: 2022-01-04 |
| Member Name: SARAH KATHERINE MASSENGALE | Member ID: 48005444202 |
| Employer ID: RCI | Termination Date: 2021-12-24 |
| Contract Record ID: 48005444201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 195943 | Status: COMPLETE |
| Request Date: 2022-01-04 | Status Date: 2022-01-04 |
| Member Name: COLE CHIZ MASSENGALE | Member ID: 48005444203 |
| Employer ID: RCI | Termination Date: 2021-12-21 |
| Contract Record ID: 48005444201 | Term Reason: VOLUNTARY |
| 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: 196003 | Status: COMPLETE |
| Request Date: 2022-01-04 | Status Date: 2022-01-04 |
| Member Name: DEBORAH YEATTS | Member ID: 34032842001 |
| Employer ID: CNT | Termination Date: 2021-12-31 |
| Contract Record ID: 34032842001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 196221 | Status: COMPLETE |
| Request Date: 2022-01-05 | Status Date: 2022-01-05 |
| Member Name: ANDREA MILLER | Member ID: 39574321501 |
| Employer ID: YHP00015 | Termination Date: 2021-12-06 |
| Contract Record ID: 39574321501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 196261 | Status: COMPLETE |
| Request Date: 2022-01-05 | Status Date: 2022-01-05 |
| Member Name: WALTER SIMS | Member ID: 74336327101 |
| Employer ID: YHP00015 | Termination Date: 2021-12-10 |
| Contract Record ID: 74336327101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 196361 | Status: COMPLETE |
| Request Date: 2022-01-06 | Status Date: 2022-01-06 |
| Member Name: PATRICK J GEORGIA | Member ID: 02479811101 |
| Employer ID: TBX | Termination Date: 2021-12-31 |
| Contract Record ID: 02479811101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 196382 | Status: COMPLETE |
| Request Date: 2022-01-06 | Status Date: 2022-01-06 |
| Member Name: DAVID BONILLA | Member ID: 61924574001 |
| Employer ID: PELTZ | Termination Date: 2021-11-30 |
| Contract Record ID: 61924574001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 196721 | Status: COMPLETE |
| Request Date: 2022-01-07 | Status Date: 2022-01-07 |
| Member Name: MALYSSA SMITH | Member ID: 74569452001 |
| Employer ID: SFM | Termination Date: 2021-12-31 |
| Contract Record ID: 74569452001 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 197042 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: ASHLEE KINTZLER | Member ID: 13727327801 |
| Employer ID: NEC | Termination Date: 2021-12-31 |
| Contract Record ID: 13727327801 | Term Reason: VOLUNTARY |
| 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: 197061 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: JAMES WOODSMALL | Member ID: 27334042601 |
| Employer ID: NEC | Termination Date: 2021-12-31 |
| Contract Record ID: 27334042601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 197081 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: JOHN ORMSBEE | Member ID: 48239141601 |
| Employer ID: NEC | Termination Date: 2021-12-31 |
| Contract Record ID: 48239141601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 197241 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: TREVOR WRIGHT | Member ID: 39974793001 |
| Employer ID: NEC | Termination Date: 2021-12-23 |
| Contract Record ID: 39974793001 | Term Reason: DECEASED |
| Comments: |
|
| Request ID: 197342 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: CAITLYN SAWYER | Member ID: 75178816202 |
| Employer ID: YHP00038 | Termination Date: 2022-01-01 |
| Contract Record ID: 75178816201 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 197361 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: JOHN A MOWRY | Member ID: 40586966601 |
| Employer ID: MESH | Termination Date: 2021-12-31 |
| Contract Record ID: 40586966601 | Term Reason: REDUCTION OF HOURS |
| 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: 197403 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: JIM GENTRY | Member ID: 47982689601 |
| Employer ID: RCI | Termination Date: 2021-12-14 |
| Contract Record ID: 47982689601 | Term Reason: |
| Comments: |
|
| Request ID: 197421 | Status: COMPLETE |
| Request Date: 2022-01-10 | Status Date: 2022-01-10 |
| Member Name: AMANDA MCDONALD | Member ID: 60740956401 |
| Employer ID: CNT | Termination Date: 2021-12-31 |
| Contract Record ID: 60740956401 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 197661 | Status: COMPLETE |
| Request Date: 2022-01-11 | Status Date: 2022-01-11 |
| Member Name: PAULINE MUNOZ | Member ID: 32363574501 |
| Employer ID: AZOPT | Termination Date: 2022-12-31 |
| Contract Record ID: 32363574501 | Term Reason: |
| Comments: |
|
| Request ID: 197662 | Status: COMPLETE |
| Request Date: 2022-01-11 | Status Date: 2022-01-11 |
| Member Name: PAULINE MUNOZ | Member ID: 32363574501 |
| Employer ID: AZOPT | Termination Date: 2021-12-31 |
| Contract Record ID: 32363574501 | Term Reason: VOLUNTARY |
| Comments: Was supposed to be terminated during open enrollment |
|
| Request ID: 197801 | Status: COMPLETE |
| Request Date: 2022-01-11 | Status Date: 2022-01-11 |
| Member Name: MATTHEW DANIEL HOWELL | Member ID: 39279755701 |
| Employer ID: YHP00038 | Termination Date: 2022-01-10 |
| Contract Record ID: 39279755701 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 197861 | Status: COMPLETE |
| Request Date: 2022-01-12 | Status Date: 2022-01-12 |
| Member Name: HILLARY EHAS | Member ID: 07227184401 |
| Employer ID: ADVRX | Termination Date: 2021-12-31 |
| Contract Record ID: 07227184401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 197881 | Status: COMPLETE |
| Request Date: 2022-01-12 | Status Date: 2022-01-12 |
| Member Name: MARIANNA KOROLEVA | Member ID: 67202930901 |
| Employer ID: ADVRX | Termination Date: 2021-12-31 |
| Contract Record ID: 67202930901 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 198082 | Status: COMPLETE |
| Request Date: 2022-01-12 | Status Date: 2022-01-12 |
| Member Name: KIMBERLY JONES | Member ID: 31844316601 |
| Employer ID: DNA | Termination Date: 2022-01-31 |
| Contract Record ID: 31844316601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198161 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: CARLOS RAMOS | Member ID: 18135720901 |
| Employer ID: DNA | Termination Date: 2022-01-31 |
| Contract Record ID: 18135720901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198201 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: DUSTYN BURDETTE | Member ID: 59084481701 |
| Employer ID: COS | Termination Date: 2021-12-06 |
| Contract Record ID: 59084481701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198202 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: JACQUELINE BUTLER | Member ID: 02920938201 |
| Employer ID: COS | Termination Date: 2021-12-06 |
| Contract Record ID: 02920938201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198203 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: JESSIE COOPER | Member ID: 31689290101 |
| Employer ID: COS | Termination Date: 2021-12-06 |
| Contract Record ID: 31689290101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198204 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: LATONYA HAYNES | Member ID: 70234587601 |
| Employer ID: COS | Termination Date: 2021-12-06 |
| Contract Record ID: 70234587601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198205 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: REGINALD JACKSON | Member ID: 73745048001 |
| Employer ID: COS | Termination Date: 2021-12-31 |
| Contract Record ID: 73745048001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 198206 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: MARK KEITH | Member ID: 82077668101 |
| Employer ID: COS | Termination Date: 2021-12-31 |
| Contract Record ID: 82077668101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 198207 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: RUTHIE MAY | Member ID: 78070420201 |
| Employer ID: COS | Termination Date: 2021-12-06 |
| Contract Record ID: 78070420201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198208 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: LORA MORRISON | Member ID: 82609442301 |
| Employer ID: COS | Termination Date: 2021-12-06 |
| Contract Record ID: 82609442301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198209 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: GEORGETTE RABB | Member ID: 78259992501 |
| Employer ID: COS | Termination Date: 2021-12-06 |
| Contract Record ID: 78259992501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198210 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: JANET TARTT | Member ID: 85691311001 |
| Employer ID: COS | Termination Date: 2021-11-30 |
| Contract Record ID: 85691311001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198211 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: JORDAN WILLIAMS | Member ID: 82188624001 |
| Employer ID: COS | Termination Date: 2021-12-31 |
| Contract Record ID: 82188624001 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 198212 | Status: COMPLETE |
| Request Date: 2022-01-13 | Status Date: 2022-01-13 |
| Member Name: CONSTANCE WILLIS | Member ID: 22841013501 |
| Employer ID: COS | Termination Date: 2021-12-31 |
| Contract Record ID: 22841013501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198404 | Status: COMPLETE |
| Request Date: 2022-01-17 | Status Date: 2022-01-17 |
| Member Name: TIFANIE KELLY | Member ID: 96069822402 |
| Employer ID: VAUGHAN | Termination Date: 2022-01-01 |
| Contract Record ID: 96069822401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 198410 | Status: COMPLETE |
| Request Date: 2022-01-17 | Status Date: 2022-01-17 |
| Member Name: MOLLY KATHERINE GLEASON | Member ID: 27424633001 |
| Employer ID: SFM | Termination Date: 2022-01-31 |
| Contract Record ID: 27424633001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198411 | Status: COMPLETE |
| Request Date: 2022-01-17 | Status Date: 2022-01-17 |
| Member Name: PATRICIA A SOLOMOS | Member ID: 87228806401 |
| Employer ID: SFM | Termination Date: 2022-01-31 |
| Contract Record ID: 87228806401 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 198683 | Status: COMPLETE |
| Request Date: 2022-01-19 | Status Date: 2022-01-19 |
| Member Name: MELISSA HORN | Member ID: 88575604801 |
| Employer ID: CNT | Termination Date: 2022-01-31 |
| Contract Record ID: 88575604801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198702 | Status: COMPLETE |
| Request Date: 2022-01-19 | Status Date: 2022-01-19 |
| Member Name: FELISA ACOSTA | Member ID: 27251914801 |
| Employer ID: ADVRX | Termination Date: 2022-01-07 |
| Contract Record ID: 27251914801 | Term Reason: VOLUNTARY |
| Comments: End coverage 1/31/22 |
|
| Request ID: 198703 | Status: COMPLETE |
| Request Date: 2022-01-19 | Status Date: 2022-01-19 |
| Member Name: JOHN SNOWDEN | Member ID: 46400327001 |
| Employer ID: ADVRX | Termination Date: 2021-12-31 |
| Contract Record ID: 46400327001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 198742 | Status: COMPLETE |
| Request Date: 2022-01-19 | Status Date: 2022-01-19 |
| Member Name: DANIEL J HAHN | Member ID: 36402476601 |
| Employer ID: SFM | Termination Date: 2022-01-31 |
| Contract Record ID: 36402476601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 199181 | Status: COMPLETE |
| Request Date: 2022-01-21 | Status Date: 2022-01-21 |
| Member Name: WENDY SALMON | Member ID: 72312148801 |
| Employer ID: CNT | Termination Date: 2022-01-01 |
| Contract Record ID: 72312148801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 199302 | Status: COMPLETE |
| Request Date: 2022-01-21 | Status Date: 2022-01-21 |
| Member Name: TIFANIE KELLY | Member ID: 96069822402 |
| Employer ID: VAUGHAN | Termination Date: 2022-01-01 |
| Contract Record ID: 96069822401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 199303 | Status: COMPLETE |
| Request Date: 2022-01-21 | Status Date: 2022-01-21 |
| Member Name: CINDY DONNELLY | Member ID: 12747993102 |
| Employer ID: VAUGHAN | Termination Date: 2022-01-01 |
| Contract Record ID: 12747993101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 199341 | Status: COMPLETE |
| Request Date: 2022-01-21 | Status Date: 2022-01-21 |
| Member Name: JAMES BEALS | Member ID: 34664355701 |
| Employer ID: WCE | Termination Date: 2022-01-19 |
| Contract Record ID: 34664355701 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 199602 | Status: COMPLETE |
| Request Date: 2022-01-24 | Status Date: 2022-01-24 |
| Member Name: CINDY DONNELLY | Member ID: 12747993102 |
| Employer ID: VAUGHAN | Termination Date: 2021-12-31 |
| Contract Record ID: 12747993101 | 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: 199721 | Status: COMPLETE |
| Request Date: 2022-01-25 | Status Date: 2022-01-25 |
| Member Name: NEIL RYAN | Member ID: 76152286801 |
| Employer ID: ASSI | Termination Date: 2019-12-01 |
| Contract Record ID: 76152286801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 200081 | Status: COMPLETE |
| Request Date: 2022-01-26 | Status Date: 2022-01-26 |
| Member Name: WILLIAM P EXINER | Member ID: 56873084501 |
| Employer ID: ASSI | Termination Date: 2019-12-31 |
| Contract Record ID: 56873084501 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 200121 | Status: COMPLETE |
| Request Date: 2022-01-26 | Status Date: 2022-01-26 |
| Member Name: DARCIE CRANE | Member ID: 88295795502 |
| Employer ID: CNT | Termination Date: 2021-12-31 |
| Contract Record ID: 88295795501 | Term Reason: DIVORCE FROM EMPLOYEE |
| 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: 200223 | Status: COMPLETE |
| Request Date: 2022-01-27 | Status Date: 2022-01-27 |
| Member Name: ROBERT SILVAIN | Member ID: 82357613601 |
| Employer ID: WCE | Termination Date: 2022-01-12 |
| Contract Record ID: 82357613601 | Term Reason: TERMINATION |
| 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: 200261 | Status: COMPLETE |
| Request Date: 2022-01-27 | Status Date: 2022-01-27 |
| Member Name: JOSE R AGUILAR | Member ID: 66049822701 |
| Employer ID: WCE | Termination Date: 2022-01-10 |
| Contract Record ID: 66049822701 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 200481 | Status: COMPLETE |
| Request Date: 2022-01-28 | Status Date: 2022-01-28 |
| Member Name: GARTH DENNY | Member ID: 10112545801 |
| Employer ID: NEC | Termination Date: 2022-01-01 |
| Contract Record ID: 10112545801 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 200482 | Status: COMPLETE |
| Request Date: 2022-01-28 | Status Date: 2022-01-28 |
| Member Name: CODY J STUCHELL | Member ID: 72537536101 |
| Employer ID: NEC | Termination Date: 2022-01-01 |
| Contract Record ID: 72537536101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 200483 | Status: COMPLETE |
| Request Date: 2022-01-28 | Status Date: 2022-01-28 |
| Member Name: BRENT RUNYON | Member ID: 13414544601 |
| Employer ID: NEC | Termination Date: 2022-01-01 |
| Contract Record ID: 13414544601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 200521 | Status: COMPLETE |
| Request Date: 2022-01-28 | Status Date: 2022-01-28 |
| Member Name: ROSIE ROWE | Member ID: 47210241801 |
| Employer ID: BRANDY | Termination Date: 2021-12-31 |
| Contract Record ID: 47210241801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 200561 | Status: COMPLETE |
| Request Date: 2022-01-28 | Status Date: 2022-01-28 |
| Member Name: VANESSA VASQUEZ | Member ID: 39976693401 |
| Employer ID: BRANDY | Termination Date: 2021-11-30 |
| Contract Record ID: 39976693401 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 200961 | Status: COMPLETE |
| Request Date: 2022-01-31 | Status Date: 2022-01-31 |
| Member Name: VIVIANA DIAZ AVENDANO | Member ID: 94529520101 |
| Employer ID: MESH | Termination Date: 2022-01-14 |
| Contract Record ID: 94529520101 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 201081 | Status: COMPLETE |
| Request Date: 2022-02-01 | Status Date: 2022-02-01 |
| Member Name: RENA CHAPPELL | Member ID: 74597768901 |
| Employer ID: CNT | Termination Date: 2022-01-31 |
| Contract Record ID: 74597768901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 201301 | Status: COMPLETE |
| Request Date: 2022-02-01 | Status Date: 2022-02-01 |
| Member Name: TAUNA SMITH | Member ID: 65323772101 |
| Employer ID: SFM | Termination Date: 2022-01-31 |
| Contract Record ID: 65323772101 | Term Reason: VOLUNTARY |
| Comments: Other Coverage |
|
| Request ID: 201321 | Status: COMPLETE |
| Request Date: 2022-02-01 | Status Date: 2022-02-01 |
| Member Name: ALMA CORNEJO | Member ID: 83653520001 |
| Employer ID: SFM | Termination Date: 2022-01-31 |
| Contract Record ID: 83653520001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 201961 | Status: COMPLETE |
| Request Date: 2022-02-02 | Status Date: 2022-02-02 |
| Member Name: JOSE R AGUILAR | Member ID: 66049822701 |
| Employer ID: WCE | Termination Date: 2022-01-10 |
| Contract Record ID: 66049822701 | Term Reason: VOLUNTARY |
| 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: 202261 | Status: COMPLETE |
| Request Date: 2022-02-03 | Status Date: 2022-02-03 |
| Member Name: SHERRON CRAWFORD | Member ID: 72294784301 |
| Employer ID: YHP00158 | Termination Date: 2022-02-01 |
| Contract Record ID: 72294784301 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 202401 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: JESSICA KINCL | Member ID: 29317822401 |
| Employer ID: TPCH | Termination Date: 2021-12-31 |
| Contract Record ID: 29317822401 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 202541 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: CODY HEIM | Member ID: 12309674401 |
| Employer ID: TPCH | Termination Date: 2022-01-01 |
| Contract Record ID: 12309674401 | Term Reason: VOLUNTARY |
| Comments: he never enroll. |
|
| Request ID: 202561 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: STELLA WELLMAN | Member ID: 87730194801 |
| Employer ID: TPCH | Termination Date: 2022-01-18 |
| Contract Record ID: 87730194801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 202601 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: SHAINA GIBBS JUDD | Member ID: 58936703301 |
| Employer ID: TPCH | Termination Date: 2021-11-30 |
| Contract Record ID: 58936703301 | Term Reason: TERMINATION |
| Comments: send email before, still on the invoice |
|
| Request ID: 202621 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: NYDIA ENOS | Member ID: 04548530601 |
| Employer ID: TPCH | Termination Date: 2022-01-05 |
| Contract Record ID: 04548530601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 202641 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: MATTHEW LITZEL | Member ID: 67710729601 |
| Employer ID: TPCH | Termination Date: 2021-10-24 |
| Contract Record ID: 67710729601 | Term Reason: TERMINATION |
| Comments: send message in November |
|
| Request ID: 202661 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: CHRISTINA FERNANDEZ | Member ID: 76757337301 |
| Employer ID: TPCH | Termination Date: 2021-11-30 |
| Contract Record ID: 76757337301 | Term Reason: TERMINATION |
| Comments: On Spouse (Ervin Bayrami) insurance effective 01/01/2022 |
|
| Request ID: 202662 | Status: COMPLETE |
| Request Date: 2022-02-04 | Status Date: 2022-02-04 |
| Member Name: KRISTINA BRYSZ | Member ID: 34676484201 |
| Employer ID: TPCH | Termination Date: 2022-01-18 |
| Contract Record ID: 34676484201 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 202681 | Status: COMPLETE |
| Request Date: 2022-02-05 | Status Date: 2022-02-05 |
| Member Name: TINA M LUDWIG | Member ID: 10842187401 |
| Employer ID: TPCH | Termination Date: 2021-12-31 |
| Contract Record ID: 10842187401 | Term Reason: VOLUNTARY |
| Comments: Decline medical for 2022 |
|
| Request ID: 202682 | Status: COMPLETE |
| Request Date: 2022-02-05 | Status Date: 2022-02-05 |
| Member Name: HEATHER A LUTHY | Member ID: 04164815101 |
| Employer ID: TPCH | Termination Date: 2021-12-29 |
| Contract Record ID: 04164815101 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 202683 | Status: COMPLETE |
| Request Date: 2022-02-05 | Status Date: 2022-02-05 |
| Member Name: AUSTIN MAKEY | Member ID: 16238316701 |
| Employer ID: TPCH | Termination Date: 2022-01-01 |
| Contract Record ID: 16238316701 | Term Reason: VOLUNTARY |
| Comments: decline medical,
Covered by parent |
|
| 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: 202981 | Status: COMPLETE |
| Request Date: 2022-02-07 | Status Date: 2022-02-07 |
| Member Name: BEVERLY ALDRIDGE | Member ID: 98418512201 |
| Employer ID: HOSPAUTH | Termination Date: 2022-01-31 |
| Contract Record ID: 98418512201 | 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: 203241 | Status: COMPLETE |
| Request Date: 2022-02-08 | Status Date: 2022-02-08 |
| Member Name: COLTEN B HOLMAN | Member ID: 71871121001 |
| Employer ID: BROSOL | Termination Date: 2021-12-29 |
| Contract Record ID: 71871121001 | Term Reason: TERMINATION |
| Comments: Colten is no longer employed as of 12/29/2021. |
|
| Request ID: 203261 | Status: COMPLETE |
| Request Date: 2022-02-08 | Status Date: 2022-02-08 |
| Member Name: EVAN R NALLEY | Member ID: 60753982301 |
| Employer ID: BROSOL | Termination Date: 2022-02-01 |
| Contract Record ID: 60753982301 | Term Reason: TERMINATION |
| Comments: Evan is no longer employed as of 1/27/2022. |
|
| 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: 203721 | Status: COMPLETE |
| Request Date: 2022-02-10 | Status Date: 2022-02-10 |
| Member Name: ERIC SALAZAR | Member ID: 01617741001 |
| Employer ID: TBX | Termination Date: 2022-01-31 |
| Contract Record ID: 01617741001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 203861 | Status: COMPLETE |
| Request Date: 2022-02-10 | Status Date: 2022-02-10 |
| Member Name: MARCO BUDIJA | Member ID: 21223036001 |
| Employer ID: CLEAR | Termination Date: 2022-01-31 |
| Contract Record ID: 21223036001 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 203882 | Status: COMPLETE |
| Request Date: 2022-02-10 | Status Date: 2022-02-10 |
| Member Name: ANGEL ESTRADA | Member ID: 10937164601 |
| Employer ID: CLEAR | Termination Date: 2022-01-31 |
| Contract Record ID: 10937164601 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 203883 | Status: COMPLETE |
| Request Date: 2022-02-10 | Status Date: 2022-02-10 |
| Member Name: LARRY FRAYRE | Member ID: 06627124001 |
| Employer ID: CLEAR | Termination Date: 2022-01-31 |
| Contract Record ID: 06627124001 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| Request ID: 203884 | Status: COMPLETE |
| Request Date: 2022-02-10 | Status Date: 2022-02-10 |
| Member Name: MICHAEL MILLER | Member ID: 29999899801 |
| Employer ID: CLEAR | Termination Date: 2022-01-31 |
| Contract Record ID: 29999899801 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 203981 | Status: COMPLETE |
| Request Date: 2022-02-10 | Status Date: 2022-02-10 |
| Member Name: JUDY M BERSHOK | Member ID: 11888297602 |
| Employer ID: WCE | Termination Date: 2021-12-31 |
| Contract Record ID: 11888297601 | Term Reason: VOLUNTARY |
| Comments: Did not elect coverage during open enrollment for spouse. EMployee Only |
|
| 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: 204981 | Status: COMPLETE |
| Request Date: 2022-02-16 | Status Date: 2022-02-16 |
| Member Name: SHAWN HICKMAN | Member ID: 93200714601 |
| Employer ID: PSSI | Termination Date: 2022-02-01 |
| Contract Record ID: 93200714601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 204982 | Status: COMPLETE |
| Request Date: 2022-02-16 | Status Date: 2022-02-16 |
| Member Name: EMILY D HICKMAN | Member ID: 93200714602 |
| Employer ID: PSSI | Termination Date: 2022-02-01 |
| Contract Record ID: 93200714601 | Term Reason: VOLUNTARY |
| Comments: |
|
| Request ID: 204983 | Status: COMPLETE |
| Request Date: 2022-02-16 | Status Date: 2022-02-16 |
| Member Name: ZANDER M HICKMAN | Member ID: 93200714603 |
| Employer ID: PSSI | Termination Date: 2022-02-01 |
| Contract Record ID: 93200714601 | Term Reason: VOLUNTARY |
| Comments: |
|
| 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: 205541 | Status: COMPLETE |
| Request Date: 2022-02-18 | Status Date: 2022-02-18 |
| Member Name: GARY DOZARK | Member ID: 20273957101 |
| Employer ID: BRULE | Termination Date: 2022-01-31 |
| Contract Record ID: 20273957101 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| 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: 206482 | Status: COMPLETE |
| Request Date: 2022-02-25 | Status Date: 2022-02-25 |
| Member Name: EDWARD CHENIER | Member ID: 82163082001 |
| Employer ID: COS | Termination Date: 2022-12-22 |
| Contract Record ID: 82163082001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 206483 | Status: COMPLETE |
| Request Date: 2022-02-25 | Status Date: 2022-02-25 |
| Member Name: EDWARD CHENIER | Member ID: 82163082001 |
| Employer ID: COS | Termination Date: 2022-12-22 |
| Contract Record ID: 82163082001 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 206484 | Status: COMPLETE |
| Request Date: 2022-02-25 | Status Date: 2022-02-25 |
| Member Name: JORDAN WILLIAMS | Member ID: 82188624001 |
| Employer ID: COS | Termination Date: 2022-02-24 |
| Contract Record ID: 82188624001 | Term Reason: TERMINATION |
| 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: 207041 | Status: COMPLETE |
| Request Date: 2022-02-28 | Status Date: 2022-02-28 |
| Member Name: JOSE R AGUILAR | Member ID: 66049822701 |
| Employer ID: WCE | Termination Date: 2022-01-10 |
| Contract Record ID: 66049822701 | Term Reason: TERMINATION |
| 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: 207082 | Status: COMPLETE |
| Request Date: 2022-03-01 | Status Date: 2022-03-01 |
| Member Name: ANN LANDRY | Member ID: 11179621601 |
| Employer ID: BRANDY | Termination Date: 2022-01-31 |
| Contract Record ID: 11179621601 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 207161 | Status: COMPLETE |
| Request Date: 2022-03-01 | Status Date: 2022-03-01 |
| Member Name: VIJAYA DWARAMPUDI | Member ID: 28262804901 |
| Employer ID: YHP00015 | Termination Date: 2022-01-31 |
| Contract Record ID: 28262804901 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 207162 | Status: COMPLETE |
| Request Date: 2022-03-01 | Status Date: 2022-03-01 |
| Member Name: ELIZABETH B ROTHWELL | Member ID: 47027959401 |
| Employer ID: YHP00015 | Termination Date: 2022-01-31 |
| Contract Record ID: 47027959401 | Term Reason: TERMINATION |
| 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: 207522 | Status: COMPLETE |
| Request Date: 2022-03-02 | Status Date: 2022-03-02 |
| Member Name: JAMES BEALS | Member ID: 34664355701 |
| Employer ID: WCE | Termination Date: 2022-01-18 |
| Contract Record ID: 34664355701 | Term Reason: INVOLUNTARY |
| Comments: |
|
| Request ID: 207523 | Status: COMPLETE |
| Request Date: 2022-03-02 | Status Date: 2022-03-02 |
| Member Name: ROBERT SILVAIN | Member ID: 82357613601 |
| Employer ID: WCE | Termination Date: 2022-01-12 |
| Contract Record ID: 82357613601 | Term Reason: INVOLUNTARY |
| 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: 207914 | Status: COMPLETE |
| Request Date: 2022-03-08 | Status Date: 2022-03-08 |
| Member Name: WENDY YOUNG | Member ID: 92969466801 |
| Employer ID: BRANDY | Termination Date: 2022-01-12 |
| Contract Record ID: 92969466801 | Term Reason: TERMINATION |
| Comments: |
|
| 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: 207917 | Status: COMPLETE |
| Request Date: 2022-03-08 | Status Date: 2022-03-08 |
| Member Name: CHLOE ELLISON | Member ID: 43530744203 |
| Employer ID: CNT | Termination Date: 2022-01-31 |
| Contract Record ID: 43530744201 | Term Reason: VOLUNTARY |
| Comments: |
|
| 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: 207946 | Status: COMPLETE |
| Request Date: 2022-03-09 | Status Date: 2022-03-09 |
| Member Name: YANA LAGUERRE | Member ID: 11608028501 |
| Employer ID: BRANDY | Termination Date: 2022-01-27 |
| Contract Record ID: 11608028501 | Term Reason: TERMINATION |
| Comments: |
|
| Request ID: 207947 | Status: COMPLETE |
| Request Date: 2022-03-09 | Status Date: 2022-03-09 |
| Member Name: NYDIA ENOS | Member ID: 04548530601 |
| Employer ID: TPCH | Termination Date: 2022-01-31 |
| Contract Record ID: 04548530601 | Term Reason: TERMINATION |
| 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: 207970 | Status: COMPLETE |
| Request Date: 2022-03-10 | Status Date: 2022-03-10 |
| Member Name: RHONDA J RICHARDSON | Member ID: 31257460001 |
| Employer ID: BRANDY | Termination Date: 2021-12-31 |
| Contract Record ID: 31257460001 | Term Reason: VOLUNTARY |
| Comments: other coverage |
|
| Request ID: 207983 | Status: COMPLETE |
| Request Date: 2022-03-11 | Status Date: 2022-03-11 |
| Member Name: ASHLEY ROSE SALTER | Member ID: 64008770001 |
| Employer ID: YHP00331 | Termination Date: 2022-01-21 |
| Contract Record ID: 64008770001 | Term Reason: TERMINATION |
| 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: 210221 | Status: COMPLETE |
| Request Date: 2022-03-23 | Status Date: 2022-03-23 |
| Member Name: ROGER MASON | Member ID: 14993476201 |
| Employer ID: BROSOL | Termination Date: 2022-01-31 |
| Contract Record ID: 14993476201 | Term Reason: TERMINATION |
| Comments: |
|
| 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: 211389 | Status: COMPLETE |
| Request Date: 2022-03-28 | Status Date: 2022-03-28 |
| Member Name: CHANDRA EDWARDS | Member ID: 29670867001 |
| Employer ID: ADVRX | Termination Date: 2021-10-26 |
| Contract Record ID: 29670867001 | Term Reason: TERMINATION |
| Comments: Voluntary |
|
| 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: 211407 | Status: COMPLETE |
| Request Date: 2022-03-29 | Status Date: 2022-03-29 |
| Member Name: LARRY HEAIR | Member ID: 84365401601 |
| Employer ID: YHP00356 | Termination Date: 2022-01-01 |
| Contract Record ID: 84365401601 | Term Reason: EMPLOYEES MEDICARE ENROLLMENT |
| 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: 211435 | Status: COMPLETE |
| Request Date: 2022-03-30 | Status Date: 2022-03-30 |
| Member Name: DEVLIN C COMBES | Member ID: 35179459101 |
| Employer ID: TPCH | Termination Date: 2022-02-28 |
| Contract Record ID: 35179459101 | Term Reason: TERMINATION |
| Comments: |
|
| 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: 220164 | Status: COMPLETE |
| Request Date: 2022-05-18 | Status Date: 2022-05-18 |
| Member Name: NEIL RYAN | Member ID: 76152286801 |
| Employer ID: ASSI | Termination Date: 2022-05-10 |
| Contract Record ID: 76152286801 | 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: 220172 | Status: COMPLETE |
| Request Date: 2022-05-18 | Status Date: 2022-05-18 |
| Member Name: WILLIAM P EXINER | Member ID: 56873084501 |
| Employer ID: ASSI | Termination Date: 2022-05-09 |
| Contract Record ID: 56873084501 | 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: 222764 | Status: COMPLETE |
| Request Date: 2022-05-27 | Status Date: 2022-05-27 |
| Member Name: KRYSTAL SIMS | Member ID: 70910441001 |
| Employer ID: CNT | Termination Date: 2022-02-01 |
| Contract Record ID: 70910441001 | Term Reason: TERMINATION |
| Comments: |
|
| 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: 223681 | Status: COMPLETE |
| Request Date: 2022-06-01 | Status Date: 2022-06-01 |
| Member Name: CHRISTOPHER LUKE | Member ID: 45876625801 |
| Employer ID: BRECK | Termination Date: 2022-06-30 |
| Contract Record ID: 45876625801 | Term Reason: TERMINATION |
| Comments: Please send COBRA documents |
|
| Request ID: 223701 | Status: COMPLETE |
| Request Date: 2022-06-01 | Status Date: 2022-06-01 |
| Member Name: CHRISTOPHER LUKE | Member ID: 45876625801 |
| Employer ID: BRECK | Termination Date: 2022-06-30 |
| Contract Record ID: 45876625801 | Term Reason: TERMINATION |
| Comments: Please send COBRA documents |
|
| Request ID: 223702 | Status: COMPLETE |
| Request Date: 2022-06-01 | Status Date: 2022-06-01 |
| Member Name: CHRISTOPHER LUKE | Member ID: 45876625801 |
| Employer ID: BRECK | Termination Date: 2022-06-30 |
| Contract Record ID: 45876625801 | Term Reason: TERMINATION |
| Comments: Please send COBRA documents |
|
| 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: 229401 | Status: COMPLETE |
| Request Date: 2022-06-27 | Status Date: 2022-06-27 |
| Member Name: GLENN H SOKOLOFF | Member ID: 11031062801 |
| Employer ID: ASSI | Termination Date: 2022-01-01 |
| Contract Record ID: 11031062801 | Term Reason: VOLUNTARY |
| Comments: waiver |
|
| 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: 233001 | Status: COMPLETE |
| Request Date: 2022-07-13 | Status Date: 2022-07-13 |
| Member Name: AMANDA MCDONALD | Member ID: 60740956401 |
| Employer ID: CNT | Termination Date: 2021-12-31 |
| Contract Record ID: 60740956401 | Term Reason: REDUCTION OF HOURS |
| Comments: |
|
| 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: 236325 | Status: COMPLETE |
| Request Date: 2022-07-25 | Status Date: 2022-07-25 |
| Member Name: THOMAS NAPOLITANO | Member ID: 25464160201 |
| Employer ID: ASSI | Termination Date: 2022-05-05 |
| Contract Record ID: 25464160201 | 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 |