EXPENSE CATEGORY MEDICAL CLAIMS

FISCAL YEAR FISCAL PERIOD DEPARTMENT DEPARTMENT DESCRIPTION FUND FUND DESCRIPTION PROGRAM PROGRAM DESCRIPTION ACTIVITY ACTIVITY DESCRIPTION CATEGORY CATEGORY DESCRIPTION EXPENSE CATEGORY EXPENSE CATEGORY DESCRIPTION VENDOR VENDOR TYPE INDICATOR PAYMENT REQUEST COMMODITY CODE COMMODITY DESCRIPTION CHECK ISSUED DATE CHECK STATUS PURCHASE REQUEST LINE NUMBER PURCHASE ORDER NUMBER ACCOUNTING LINE DESCRIPTION CALENDAR YEAR CALENDAR MONTH AMOUNT
2010 5 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims SCHATTENTBERG, CARL Vendor GAX 5800 10020108795 02/03/2010 Paid 101 MEDICAL CLAIMS 2010 February $75.00
2010 5 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims WOJTASCZYK, DAVID Vendor GAX 5800 10012708422 02/02/2010 Paid 101 MEDICAL CLAIMS 2010 February $28.00
2010 5 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims VINEYARD, TIMOTHY J. Vendor GAX 5800 10012808497 02/02/2010 Paid 101 MEDICAL CLAIMS 2010 February $49.98
2010 2 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims RODRIGUEZ, PAUL Vendor GAX 5800 09111803675 11/24/2009 Paid 101 MEDICAL CLAIMS 2009 November $30.00
2010 2 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EHM Employee HMO 152 Contractuals 6342 Medical Claims SCOTT, LORI H Vendor GAX 5800 09110402599 11/10/2009 Paid 101 MEDICAL CLAIMS 2009 November $25.00
2010 2 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims JOSEPH, RAVINDER Vendor GAX 5800 09110402603 11/10/2009 Paid 101 MEDICAL CLAIMS 2009 November $50.00
2010 2 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims DECUIR, RAYMOND S. Vendor GAX 5800 09110402608 11/10/2009 Paid 101 MEDICAL CLAIMS 2009 November $25.00
2010 2 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EHM Employee HMO 152 Contractuals 6342 Medical Claims GONZALES, LUIS Vendor GAX 5800 09110402597 11/10/2009 Paid 101 MEDICAL CLAIMS 2009 November $24.00
2010 2 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims MARSH, PETER Vendor GAX 5800 09110402656 11/10/2009 Paid 101 MEDICAL CLAIMS 2009 November $50.00
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims JONES, JOHN Vendor GAX 5800 09102301889 10/27/2009 Paid 101 MEDICAL CLAIMS 2009 October $26.00
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EHM Employee HMO 152 Contractuals 6342 Medical Claims BONEE, LUCY Vendor GAX 5800 09102201855 10/27/2009 Paid 101 MEDICAL CLAIMS 2009 October $48.00
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims MORENO, ANNETTE Vendor GAX 5800 09102301890 10/27/2009 Paid 101 MEDICAL CLAIMS 2009 October $30.00
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EHM Employee HMO 152 Contractuals 6342 Medical Claims RAMIREZ, PATRICIA Vendor GAX 5800 09102101614 10/23/2009 Paid 101 MEDICAL CLAIMS 2009 October $24.00
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims WASHINGTON, MARK Vendor GAX 5800 09102101610 10/23/2009 Paid 101 MEDICAL CLAIMS 2009 October $24.99
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims GUERIN, NOEL Vendor GAX 5800 09102101605 10/23/2009 Paid 101 MEDICAL CLAIMS 2009 October $24.00
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims ZARATE, JUAN Vendor GAX 5800 09102101611 10/23/2009 Paid 101 MEDICAL CLAIMS 2009 October $24.00
2010 1 58 Human Resources 7140 Health Insurance Fund 7EMD Employee Medical 7EPO Employee PPO 152 Contractuals 6342 Medical Claims ROBLEDO, JESSICA Vendor GAX 5800 09101200786 10/23/2009 Paid 101 MEDICAL CLAIMS 2009 October $27.00

TOTAL AMOUNT: $584.97