SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 06/22/17 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 21:54:25 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3389 MONTHLY ALPHA LIST FOR BILLING PERIOD 07/01/2017 - 07/31/2017 (201707) 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 1350.06 351.55 0.00 ANDERSON THOMAS A *****8347 19600902 150 S 20110401 201 S 20110401 754.23 196.39 0.00 ANTHES KRISTI L *****7635 19821227 019 F 20160101 201 F 20160101 2064.43 547.94 0.00 ANTHES LAWRENCE E *****7578 19820820 ( SPOUSE INFO ) ANTHONY MICHAEL J *****8635 19790714 150 P 20170301 201 P 20170301 1350.06 351.55 0.00 BELCASTRO DOMINIC D *****2737 19820617 150 F 20121201 201 F 20121201 2104.28 547.94 0.00 BELCASTRO KRISTEN M *****2681 19820525 ( SPOUSE INFO ) BERRIGAN BRIAN N *****4259 19620213 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 BERRIGAN DINA *****7986 19630528 ( SPOUSE INFO ) BESS MICHAEL D *****5160 19761102 050 F 20140402 201 F 20140402 2209.79 547.94 0.00 TAMPIER DANIELLE T *****5801 19820608 ( SPOUSE INFO ) BITTENMASTER CHRIS *****8226 19741115 150 F 20111008 201 F 20111008 2104.28 547.94 0.00 BITTENMASTER TANYA M *****5107 19720318 ( SPOUSE INFO ) BROTONS CRAIG R *****4528 19650821 150 F 20111101 201 F 20111101 2104.28 547.94 0.00 BROTONS LAURIE A *****8653 19661104 ( SPOUSE INFO ) BRUNETTI MAUREEN L *****6658 19500814 150 M 20140101 201 M 20140101 1508.45 392.79 0.00 BRUNETTI BRUCE W *****0360 19530518 ( SPOUSE INFO ) BURGER TIMOTHY L *****8845 19870505 050 P 20160101 201 P 20160101 1417.75 351.55 0.00 CALLERY SANDRA A *****1806 19560916 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 CALLERY JOHN F *****5751 19550319 ( SPOUSE INFO ) CONNAUGHTON MICHAEL S *****8635 19810324 150 F 20121201 201 F 20121201 2104.28 547.94 0.00 CONNAUGHTON KELLI M *****8365 19850304 ( SPOUSE INFO ) CONNORS COREY M *****1681 19920804 150 P 20140225 201 P 20140225 1350.06 351.55 0.00 CROUSE LORI M *****5809 19661210 150 P 20150301 201 P 20150301 1350.06 351.55 0.00 DAVIS STEVEN A *****2207 19670826 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 DAVIS ANNMARIE *****8902 19690808 ( SPOUSE INFO ) DEILY LOUISE H *****4279 19510604 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 DEILY CHARLES R *****7433 19511108 ( SPOUSE INFO ) DUCKWORTH KRISTOPHER R *****0599 19900317 150 S 20130817 201 S 20130817 754.23 196.39 0.00 DUDDY KEVIN R *****4369 19531130 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 DUDDY MARYELIZ *****1726 19580130 ( SPOUSE INFO ) DUGEY THOMAS *****9085 19550728 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 DUGEY SHIRLEY *****1416 19590726 ( SPOUSE INFO ) FEY GINA I *****2193 19710716 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 FEY BERNARD F *****9252 19690103 ( SPOUSE INFO ) GAL SANDOR *****6413 19800612 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 CURTISS-GAL SHARON E *****0338 19750615 ( SPOUSE INFO ) HOADLEY ANGELA M *****3996 19700826 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 HOADLEY JOHN *****6483 19640604 ( SPOUSE INFO ) HOYD ROBERT D *****3157 19760417 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 HOYD BRANDY L *****4086 19800801 ( SPOUSE INFO ) HULSE KEVIN I *****0469 19761004 150 S 20150101 201 S 20110401 754.23 196.39 0.00 HUXTA PATRICIA M *****3229 19720504 150 M 20160101 201 M 20160101 1508.45 392.79 0.00 HUXTA CHRISTOPHE H *****2776 19710913 ( SPOUSE INFO ) JOHNSON DONNA L *****0049 19501008 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 JOHNSON DONALD V *****8061 19490316 ( SPOUSE INFO ) JOHNSON KEVIN R *****6251 19780125 150 F 20161104 201 F 20161104 2104.28 547.94 0.00 SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 06/22/17 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 21:54:25 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3390 MONTHLY ALPHA LIST FOR BILLING PERIOD 07/01/2017 - 07/31/2017 (201707) 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-- JOHNSON STACIE L *****9723 19780325 ( SPOUSE INFO ) KISSELBACH BRAD M *****0215 19810926 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 KISSELBACH JACQUELINE L *****9267 19780814 ( SPOUSE INFO ) KOELLER JUSTIN M *****1325 19850731 150 P 20170401 201 P 20170401 1350.06 351.55 0.00 LACEY BRADLEY S *****2088 19830426 150 F 20141108 201 F 20141108 2104.28 547.94 0.00 LACEY RACHAEL L *****7662 19831005 ( SPOUSE INFO ) LANCE WILLIAM J *****2293 19710131 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 LANCE ANNMAR *****8989 19771005 ( SPOUSE INFO ) MACZKO JOHN M *****3882 19710205 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 MACZKO STEPHANIE A *****1925 19721002 ( SPOUSE INFO ) MARINO BRETT M *****2967 19780131 150 F 20150327 201 F 20150327 2104.28 547.94 0.00 MARINO KARYSSA J *****3166 19830121 ( SPOUSE INFO ) MARINO LARRY L *****2819 19761007 150 P 20110401 201 P 20110401 1350.06 351.55 0.00 MARINO ROBERT A *****4617 19740430 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 MARINO KIMBERLY *****1287 19811125 ( SPOUSE INFO ) MCDONALD JAMES *****9917 19801128 150 F 20160101 201 F 20160101 2104.28 547.94 0.00 MCDONALD KRISTEN L *****7404 19830516 ( SPOUSE INFO ) MCGINLEY CHAD *****3271 19640601 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 MCGINLEY STEPHANIE *****3669 19640529 ( SPOUSE INFO ) MECCA CHRISTOPHE A *****9196 19810924 150 S 20140201 201 S 20140201 754.23 196.39 0.00 MECCA MARC A *****1205 19850307 150 S 20141101 201 S 20141101 754.23 196.39 0.00 MERLO ROBERT J *****2639 19640615 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 MERLO PATRICIA M *****8555 19600612 ( SPOUSE INFO ) MESSLING DEBBIE L *****6060 19551010 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 HERTZ RONALD W *****9419 19520315 ( SPOUSE INFO ) MONTILONE DEREK *****4761 19900207 150 P 20140825 201 P 20140825 1350.06 351.55 0.00 MOORE TIMOTHY *****8006 19780726 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 MOORE LAUREN A *****6398 19811209 ( SPOUSE INFO ) OLOUGHLIN SANDRA J *****0735 19590810 150 P 20110401 201 P 20110401 1350.06 351.55 0.00 PAPOVICH BRENDA J *****0486 19690712 150 S 20110401 201 S 20110401 754.23 196.39 0.00 PATTI VALERIE *****3749 19530505 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 PATTI BENJAMIN J *****8661 19471213 ( SPOUSE INFO ) PETERS WILLIAMS G *****3207 19680628 150 P 20110401 201 P 20110401 1350.06 351.55 0.00 PURSELL PAUL E *****6960 19531103 150 M 20160101 201 M 20160101 1508.45 392.79 0.00 PURSELL BRENDA M *****5498 19621130 ( SPOUSE INFO ) QUICK SHANNO *****6605 19830729 150 S 20170724 201 S 20170724 194.59 50.66 0.00 RATH-TICKLE STEPHANIE *****2207 19821130 051 F 20160311 205 F 20160311 2041.24 496.96 0.00 TICKLE GLEN P *****0602 19830427 ( SPOUSE INFO ) REED CHRISTOPHE H *****0713 19640404 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 REED CYNDEE S *****6770 19610324 ( SPOUSE INFO ) REPPERT RALPH A *****1327 19670227 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 REPPERT JANICE L *****1892 19720310 ( SPOUSE INFO ) RICKER GARY A *****2215 19800101 050 S 20170101 201 S 20170101 792.04 196.39 0.00 SERRANO THEODORE K *****9737 19660617 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 SERRANO CYNTHIA A *****7711 19700105 ( SPOUSE INFO ) SLATON BARBARA J *****0861 19560215 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 SLATON JON C *****4488 19560725 ( SPOUSE INFO ) SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 06/22/17 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 21:54:25 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3391 MONTHLY ALPHA LIST FOR BILLING PERIOD 07/01/2017 - 07/31/2017 (201707) 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-- SLIFER JOSHUA M *****0733 19740907 150 P 20140823 201 P 20140823 1350.06 351.55 0.00 SMITH PAUL R *****2903 19530623 150 M 20150101 201 M 20150101 1508.45 392.79 0.00 SMITH PHYLLIS A *****3997 19530209 ( SPOUSE INFO ) SNYDER MARTIN *****9036 19900313 011 P 20170701 201 P 20170701 2043.78 547.94 0.00 SOSNOVIK MATTHEW *****7482 19811121 150 S 20111101 201 S 20111101 754.23 196.39 0.00 STETTNER JAMES P *****1237 19770422 050 F 20140708 201 F 20140708 2209.79 547.94 0.00 VACCARO BETTINA C *****2684 19800819 ( SPOUSE INFO ) STIRES MICHAEL F *****2117 19820811 150 F 20150101 201 F 20150101 2104.28 547.94 0.00 STIRES TRICIA M *****2758 19780516 ( SPOUSE INFO ) SUTTON BRIAN S *****3423 19641214 150 M 20110401 201 M 20110401 1508.45 392.79 0.00 SUTTON LISA B *****2736 19650129 ( SPOUSE INFO ) VAUGHN DONALD J *****4866 19580809 150 M 20160101 201 M 20160101 1508.45 392.79 0.00 VAUGHN LAURA *****7463 19620623 ( SPOUSE INFO ) VINE WILLIAM R *****6357 19681015 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 VINE STEPHANIE A *****2460 19711109 ( SPOUSE INFO ) WARGO JEANNINE R *****5910 19760107 050 F 20110401 201 F 20110401 2209.79 547.94 0.00 WARGO ROBERT J *****1030 19750710 ( SPOUSE INFO ) WEIGAND KYLE M *****9730 19891015 150 S 20130202 201 S 20130202 754.23 196.39 0.00 WIDEMOND MARVIN *****3774 19810221 150 F 20160101 201 F 20160101 2104.28 547.94 0.00 PAUL SAMARIA *****1072 19810621 ( SPOUSE INFO ) ZECHMAN TRAVIS J *****7936 19770218 150 F 20110401 201 F 20110401 2104.28 547.94 0.00 ZECHMAN SHERRI A *****1061 19770317 ( SPOUSE INFO ) TOTAL EMPLOYEES - 69 TOTAL BILL - 143,768.06 TOTAL HEALTH ENROLLED - 69 TOTAL HEALTH COST - 114,159.95 TOTAL RX ENROLLED - 69 TOTAL RX COST - 29,608.11 SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 06/22/17 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 21:54:25 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3392 MONTHLY ALPHA LIST FOR BILLING PERIOD 07/01/2017 - 07/31/2017 (201707) 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 0 0 1 1 2043.78 019 0 0 0 1 0 0 1 2064.43 050 1 0 0 3 0 1 5 8839.16 051 0 0 0 1 0 0 1 2041.24 150 9 15 0 27 0 10 61 99171.34 RX SERVICES SRV **S** *M/S* *M/P* *F/S* *F/P* **P** *TOT* *TOT AMT** --- ----- ----- ----- ----- ----- ----- ----- ---------- 201 10 15 0 31 0 12 68 29111.15 205 0 0 0 1 0 0 1 496.96 SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 06/22/17 PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 21:54:25 FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1 STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3393 MONTHLY ALPHA LIST FOR BILLING PERIOD 07/01/2017 - 07/31/2017 (201707) LOCAL/ACTIVE/MONTHLY 0897-00 - PHILLIPSBURG TOWN HEALTH SERVICES LOG ------------------- 011 - HORIZON HMO 019 - AETNA HMO 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