SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 02/20/19 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 22:22:41 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 2950 MONTHLY ALPHA LIST FOR BILLING PERIOD 03/01/2019 - 03/31/2019 (201903) LOCAL/ACTIVE/MONTHLY 0897-00 - PHILLIPSBURG TOWN HEALTH---------- RX-------------- DENTAL---------- -HEALTH- ---RX--- -DENTAL- --NAME---------------------- ---SSN--- --DOB--- SRV L EFF DATE SRV L EFF DATE SRV L EFF DATE --COST-- --COST-- --COST-- AMEY MATTHEW M *****6600 19810611 150 P 20150301 201 P 20150301 1440.56 290.07 0.00 ANDERSON THOMAS A *****8347 19600902 150 S 20110401 201 S 20110401 804.78 162.05 0.00 ANTHES KRISTI L *****7635 19821227 050 F 20190101 201 F 20160101 2357.88 452.12 0.00 ANTHES LAWRENCE E *****7578 19820820 ( SPOUSE INFO ) ANTHONY MICHAEL J *****8635 19790714 150 P 20170301 201 P 20170301 1440.56 290.07 0.00 BELCASTRO DOMINIC D *****2737 19820617 150 F 20121201 201 F 20121201 2245.34 452.12 0.00 BELCASTRO KRISTEN M *****2681 19820525 ( SPOUSE INFO ) BERRIGAN BRIAN N *****4259 19620213 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 BERRIGAN DINA *****7986 19630528 ( SPOUSE INFO ) BESS MICHAEL D *****5160 19761102 050 F 20140402 201 F 20140402 2357.88 452.12 0.00 TAMPIER DANIELLE T *****5801 19820608 ( SPOUSE INFO ) BITTENMASTER CHRIS *****8226 19741115 150 F 20111008 201 F 20111008 2245.34 452.12 0.00 BITTENMASTER TANYA M *****5107 19720318 ( SPOUSE INFO ) BROTONS CRAIG R *****4528 19650821 150 F 20111101 201 F 20111101 2245.34 452.12 0.00 BROTONS LAURIE A *****8653 19661104 ( SPOUSE INFO ) BRUNETTI MAUREEN L *****6658 19500814 150 M 20140101 201 M 20140101 1609.56 324.10 0.00 BRUNETTI BRUCE W *****0360 19530518 ( SPOUSE INFO ) BURGER TIMOTHY L *****8845 19870505 050 F 20171028 201 F 20171028 2357.88 452.12 0.00 BURGER DANA *****6609 19920212 ( SPOUSE INFO ) CALLERY SANDRA A *****1806 19560916 150 M 20110401 201 M 20110401 1609.56 324.10 0.00 CALLERY JOHN F *****5751 19550319 ( SPOUSE INFO ) CAMPBELL JAMES *****3152 19850703 150 S 20181027 201 S 20181027 804.78 162.05 0.00 CONNAUGHTON MICHAEL S *****8635 19810324 150 F 20121201 201 F 20121201 2245.34 452.12 0.00 CONNAUGHTON KELLI M *****8365 19850304 ( SPOUSE INFO ) CONNORS COREY M *****1681 19920804 150 P 20140225 201 P 20140225 1440.56 290.07 0.00 COURTER THOMAS J *****0023 19950802 050 S 20181001 201 S 20181001 845.12 162.05 0.00 CRANDALL CHRISTINA *****2443 19830224 050 M 20171125 201 M 20171125 1690.24 324.10 0.00 CRANDALL AARON *****4435 19830810 ( SPOUSE INFO ) CROUSE LORI M *****5809 19661210 150 P 20150301 201 P 20150301 1440.56 290.07 0.00 CUPON DAVID G *****3536 19740310 150 S 20181208 201 S 20181208 804.78 162.05 0.00 DAVIS STEVEN A *****2207 19670826 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 DAVIS ANNMARIE *****8902 19690808 ( SPOUSE INFO ) DUCKWORTH KRISTOPHER R *****0599 19900317 150 S 20130817 201 S 20130817 804.78 162.05 0.00 DUDDY KEVIN R *****4369 19531130 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 DUDDY MARYELIZ *****1726 19580130 ( SPOUSE INFO ) DUGEY THOMAS *****9085 19550728 150 M 20110401 201 M 20110401 1609.56 324.10 0.00 DUGEY SHIRLEY *****1416 19590726 ( SPOUSE INFO ) FEY GINA I *****2193 19710716 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 FEY BERNARD F *****9252 19690103 ( SPOUSE INFO ) GAL SANDOR *****6413 19800612 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 CURTISS-GAL SHARON E *****0338 19750615 ( SPOUSE INFO ) HAY DEBORAH *****7120 19610313 150 S 20181124 201 S 20181124 804.78 162.05 0.00 HOADLEY ANGELA M *****3996 19700826 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 HOADLEY JOHN *****6483 19640604 ( SPOUSE INFO ) HOYD ROBERT D *****3157 19760417 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 HOYD BRANDY L *****4086 19800801 ( SPOUSE INFO ) HULL BRANDON E *****9193 19931029 150 S 20170825 201 S 20170825 804.78 162.05 0.00 SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 02/20/19 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 22:22:41 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 2951 MONTHLY ALPHA LIST FOR BILLING PERIOD 03/01/2019 - 03/31/2019 (201903) LOCAL/ACTIVE/MONTHLY 0897-00 - PHILLIPSBURG TOWN HEALTH---------- RX-------------- DENTAL---------- -HEALTH- ---RX--- -DENTAL- --NAME---------------------- ---SSN--- --DOB--- SRV L EFF DATE SRV L EFF DATE SRV L EFF DATE --COST-- --COST-- --COST-- HULSE KEVIN I *****0469 19761004 150 S 20150101 201 S 20110401 804.78 162.05 0.00 HUXTA PATRICIA M *****3229 19720504 150 M 20160101 201 M 20160101 1609.56 324.10 0.00 HUXTA CHRISTOPHE H *****2776 19710913 ( SPOUSE INFO ) JOHNSON KEVIN R *****6251 19780125 150 F 20161104 201 F 20161104 2245.34 452.12 0.00 JOHNSON STACIE L *****9723 19780325 ( SPOUSE INFO ) KAYS PATRICK *****2090 19800921 018 F 20180325 201 F 20180325 2357.88 452.12 0.00 GAY JANNA *****4004 19820821 ( SPOUSE INFO ) KISSELBACH BRAD M *****0215 19810926 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 KISSELBACH JACQUELINE L *****9267 19780814 ( SPOUSE INFO ) KOELLER JUSTIN M *****1325 19850731 150 P 20170401 201 P 20170401 1440.56 290.07 0.00 LACEY BRADLEY S *****2088 19830426 150 F 20141108 201 F 20141108 2245.34 452.12 0.00 LACEY RACHAEL L *****7662 19831005 ( SPOUSE INFO ) LANCE WILLIAM J *****2293 19710131 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 LANCE ANNMAR *****8989 19771005 ( SPOUSE INFO ) MACZKO JOHN M *****3882 19710205 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 MACZKO STEPHANIE A *****1925 19721002 ( SPOUSE INFO ) MARINO BRETT M *****2967 19780131 150 F 20150327 201 F 20150327 2245.34 452.12 0.00 MARINO KARYSSA J *****3166 19830121 ( SPOUSE INFO ) MARINO LARRY L *****2819 19761007 150 P 20110401 201 P 20110401 1440.56 290.07 0.00 MARINO ROBERT A *****4617 19740430 150 S 20171101 201 S 20171101 804.78 162.05 0.00 MCDONALD JAMES *****9917 19801128 150 F 20160101 201 F 20160101 2245.34 452.12 0.00 MCDONALD KRISTEN L *****7404 19830516 ( SPOUSE INFO ) MCGINLEY CHAD *****3271 19640601 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 MCGINLEY STEPHANIE *****3669 19640529 ( SPOUSE INFO ) MECCA CHRISTOPHE A *****9196 19810924 150 S 20140201 201 S 20140201 804.78 162.05 0.00 MECCA MARC A *****1205 19850307 150 F 20180131 201 F 20180131 2245.34 452.12 0.00 MECCA KRISTI *****6871 19860414 ( SPOUSE INFO ) MERLO ROBERT J *****2639 19640615 150 M 20110401 201 M 20110401 1609.56 324.10 0.00 MERLO PATRICIA M *****8555 19600612 ( SPOUSE INFO ) MESSLING DEBBIE L *****6060 19551010 150 M 20110401 201 M 20110401 1609.56 324.10 0.00 HERTZ RONALD W *****9419 19520315 ( SPOUSE INFO ) MONTILONE DEREK *****4761 19900207 150 P 20140825 201 P 20140825 1440.56 290.07 0.00 MOORE TIMOTHY *****8006 19780726 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 MOORE LAUREN A *****6398 19811209 ( SPOUSE INFO ) PAPOVICH BRENDA J *****0486 19690712 150 S 20110401 201 S 20110401 804.78 162.05 0.00 PARRY DAWN *****3086 19690725 150 F 20180918 201 F 20180918 2245.34 452.12 0.00 PARRY JOSHUA *****6763 19760306 ( SPOUSE INFO ) PETERS WILLIAMS G *****3207 19680628 150 P 20110401 201 P 20110401 1440.56 290.07 0.00 PFLUGH ERICH J *****6531 19900417 050 S 20170722 201 S 20170722 845.12 162.05 0.00 QUICK SHANNON *****6605 19830729 150 S 20170724 201 S 20170724 804.78 162.05 0.00 RATH-TICKLE STEPHANIE *****2207 19821130 051 F 20160311 205 F 20160311 2178.04 410.07 0.00 TICKLE GLEN P *****0602 19830427 ( SPOUSE INFO ) REED CHRISTOPHE H *****0713 19640404 150 M 20110401 201 M 20110401 1609.56 324.10 0.00 REED CYNDEE S *****6770 19610324 ( SPOUSE INFO ) REPPERT RALPH A *****1327 19670227 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 REPPERT JANICE L *****1892 19720310 ( SPOUSE INFO ) RICKER GARY A *****2215 19800101 050 S 20170101 201 S 20170101 845.12 162.05 0.00 SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 02/20/19 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 22:22:41 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 2952 MONTHLY ALPHA LIST FOR BILLING PERIOD 03/01/2019 - 03/31/2019 (201903) LOCAL/ACTIVE/MONTHLY 0897-00 - PHILLIPSBURG TOWN HEALTH---------- RX-------------- DENTAL---------- -HEALTH- ---RX--- -DENTAL- --NAME---------------------- ---SSN--- --DOB--- SRV L EFF DATE SRV L EFF DATE SRV L EFF DATE --COST-- --COST-- --COST-- SERRANO THEODORE K *****9737 19660617 150 F 20181019 201 F 20181019 2245.34 452.12 0.00 SERRAMO CHAREE *****7343 19711022 ( SPOUSE INFO ) SLATON BARBARA J *****0861 19560215 150 M 20110401 201 M 20110401 1609.56 324.10 0.00 SLATON JON C *****4488 19560725 ( SPOUSE INFO ) SLIFER JOSHUA M *****0733 19740907 150 P 20140823 201 P 20140823 1440.56 290.07 0.00 SMITH PAUL R *****2903 19530623 150 M 20150101 201 M 20150101 1609.56 324.10 0.00 SMITH PHYLLIS A *****3997 19530209 ( SPOUSE INFO ) SNYDER MARTIN *****9036 19900313 011 F 20170701 201 F 20170701 2180.75 452.12 0.00 SNYDER NATASHA L *****0976 19910515 ( SPOUSE INFO ) SOSNOVIK MATTHEW *****7482 19811121 150 S 20111101 201 S 20111101 804.78 162.05 0.00 STETTNER JAMES P *****1237 19770422 050 F 20140708 201 F 20140708 2357.88 452.12 0.00 VACCARO BETTINA C *****2684 19800819 ( SPOUSE INFO ) STIRES MICHAEL F *****2117 19820811 150 P 20190101 201 P 20190101 169.00- 34.03- 0.00 SUTTON BRIAN S *****3423 19641214 150 M 20110401 201 M 20110401 1609.56 324.10 0.00 SUTTON LISA B *****2736 19650129 ( SPOUSE INFO ) THOMPSON RASHEEDAH M *****0962 19891203 150 F 20180101 201 F 20180101 2245.34 452.12 0.00 THOMPSON PRINCE A *****9059 19881218 ( SPOUSE INFO ) VAUGHN DONALD J *****4866 19580809 150 M 20160101 201 M 20160101 1609.56 324.10 0.00 VAUGHN LAURA *****7463 19620623 ( SPOUSE INFO ) VINE WILLIAM R *****6357 19681015 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 VINE STEPHANIE A *****2460 19711109 ( SPOUSE INFO ) WARGO JEANNINE R *****5910 19760107 050 F 20110401 201 F 20110401 2357.88 452.12 0.00 WARGO ROBERT J *****1030 19750710 ( SPOUSE INFO ) WEIGAND KYLE M *****9730 19891015 150 M 20170902 201 M 20170902 1609.56 324.10 0.00 WEIGAND LINDSAY S *****3082 19910731 ( SPOUSE INFO ) WIDEMOND MARVIN *****3774 19810221 150 F 20160101 201 F 20160101 2245.34 452.12 0.00 PAUL SAMARIA *****1072 19810621 ( SPOUSE INFO ) ZECHMAN TRAVIS J *****7936 19770218 150 F 20110401 201 F 20110401 2245.34 452.12 0.00 ZECHMAN SHERRI A *****1061 19770317 ( SPOUSE INFO ) TOTAL EMPLOYEES - 74 TOTAL BILL - 152,824.23 TOTAL HEALTH ENROLLED - 74 TOTAL HEALTH COST - 127,369.31 TOTAL RX ENROLLED - 74 TOTAL RX COST - 25,454.92 SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 02/20/19 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 22:22:41 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 2953 MONTHLY ALPHA LIST FOR BILLING PERIOD 03/01/2019 - 03/31/2019 (201903) LOCAL/ACTIVE/MONTHLY 0897-00 - PHILLIPSBURG TOWN HEALTH SERVICES SRV **S** *M/S* *M/P* *F/S* *F/P* **P** *TOT* *TOT AMT** --- ----- ----- ----- ----- ----- ----- ----- ---------- 011 0 0 0 1 0 0 1 2180.75 018 0 0 0 1 0 0 1 2357.88 050 3 1 0 5 0 0 9 16015.00 051 0 0 0 1 0 0 1 2178.04 150 12 12 0 28 0 10 62 104637.64 RX SERVICES SRV **S** *M/S* *M/P* *F/S* *F/P* **P** *TOT* *TOT AMT** --- ----- ----- ----- ----- ----- ----- ----- ---------- 201 15 13 0 35 0 10 73 25044.85 205 0 0 0 1 0 0 1 410.07 SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 02/20/19 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 22:22:41 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 2954 MONTHLY ALPHA LIST FOR BILLING PERIOD 03/01/2019 - 03/31/2019 (201903) LOCAL/ACTIVE/MONTHLY 0897-00 - PHILLIPSBURG TOWN HEALTH SERVICES LOG ------------------- 011 - HORIZON HMO 018 - AETNA FREEDOM10 050 - NJ DIRECT10 051 - NJ DIRECT1525 150 - NJ DIRECT15 RX SERVICES LOG --------------- 201 - EMPLOYEE RX (LOCAL & EDUC-ACVP 205 - STATE 1525 PRESCRIPTION PLAN HEALTH CONTRACT LEVEL LOG ------------------------- **S** SINGLE *M/S* MARRIED/SPOUSE *M/P* MARRIED/DOM PARTNER/CIVIL UNION PARTNER *F/S* FAMILY/SPOUSE *F/P* FAMILY/DOM PARTNER/CIVIL UNION PARTNER **P** PARENT/CHILD