RFP%2031786-00193%20Appendix%207.18%20Detail%20Claims%20Listing%20_Basic%20Term%20Life%20Basic%20ADandD.xlsx

XLSX spreadsheet 736 KB Posted Aug 20, 2026

Attached to: Life and Accidental Death and Dismemberment Insurance - UPDATED
Solicitation number: RFP 31786-00193
Issued by: Davidson County, Tennessee

About this file

Written by GovTribe AI · Aug 21, 2026

This document is a detailed claims listing appendix for RFP 31786-00193 regarding Basic Term Life and Accidental Death & Dismemberment (AD&D) insurance coverage for Tennessee under Policy Number 34294. The file presents comprehensive death and dismemberment claims experience data spanning 2018 through 2020, organized by coverage type including Participating Basic Life, Participating Spouse & Child Life, Participating Child Life, and Participating Basic AD&D (Employee and Dependent). The claims data includes individual claim numbers, ages at death, dates of death and notice received, dates paid, insurance amounts paid, interest paid, and total incurred claims. The document serves as a historical record of claims experience to support the state's evaluation of life and AD&D insurance carriers and their pricing proposals.

The claims data demonstrates significant claims activity across the three-year period, with Participating Basic Life claims totaling approximately $5.6 million in 2018, $4.5 million in 2019, and $6.3 million in 2020, while Spouse & Child Life, Child Life, and AD&D claims represent substantially smaller portions of the overall claims experience. Each claim entry includes interest paid calculations and incurred claims totals, with the document also noting 2018 and 2019 Incurred But Not Reported (IBNR) reserves for rate development purposes. The data indicates consistent claims processing with notice periods typically ranging from several weeks to several months following death, and payment periods generally following within one to three months of notice. This comprehensive claims experience record enables analysis of mortality patterns, processing efficiency, and cost trends to inform renewal rate negotiations and carrier performance evaluation.

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File	Type	Posted
RFP_31786-00193_Appendix_7.28.pdf	PDF	Oct 14, 2026
RFP_31786-00193_Appendix_7.30.xlsx	XLSX spreadsheet	Oct 14, 2026
RFP_31786-00193_Life_and_ADD_RFP_Release_2.docx	DOCX document	Oct 14, 2026
RFP_31786-00193_Appendix_7.27.pdf	PDF	Oct 14, 2026
RFP_31786-00193_Appendix_7.15.xlsx	XLSX spreadsheet	Oct 14, 2026
RFP_31786-00193_Appendix_7.26.xlsx	XLSX spreadsheet	Oct 14, 2026
RFP_31786-00193_Appendix_7.29.pdf	PDF	Oct 14, 2026
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RFP_31786-00193_Appendix_7.4.xlsx	XLSX spreadsheet	Oct 14, 2026
RFP_31786-00193_Appendix_7.25.xlsx	XLSX spreadsheet	Oct 14, 2026
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RFP_31786-00193_Amendment_One_Schedule_Update.docx	DOCX document	Oct 2, 2026
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RFP%2031786-00193%20Appendix%207.14%20Voluntary%20Term%20Life%20Enrollment%20History%202018%20-%20June%202026.pdf	PDF	Aug 20, 2026
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31786-00193_Digital_Submission_Instructions.docx	DOCX document	Aug 20, 2026
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2018 Basic Life & ADD

RFP 31786-00193 Appendix 7.18 Detail Claims Listing – Basic Term Life Basic AD&D

Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1255806	62	04/14/2017	02/09/2018	02/26/2018	$ 50,000.00	$ 435.62	$ 50,435.62
1265798	53	05/18/2017	01/31/2018	02/13/2018	50,000.00	371.23	50,371.23
1286267	85	07/31/2017	10/12/2017	05/04/2018	14,250.00	108.14	14,358.14
1287700	57	10/06/2017	10/20/2017	03/20/2018	47,500.00	214.73	47,714.73
1288776	22	08/04/2017	10/26/2017	01/03/2018	20,000.00	83.29	20,083.29
1290503	54	07/22/2017	02/07/2018	02/08/2018	50,000.00	275.34	50,275.34
1291035	65	10/07/2017	11/06/2017	01/29/2018	16,250.00	50.75	16,300.75
1293668	49	11/04/2017	12/14/2017	06/20/2018	50,000.00	270.20	50,270.20
1293804	48	10/25/2017	11/21/2017	01/30/2018	33,500.00	89.02	33,589.02
1298546	59	11/24/2017	12/18/2017	01/19/2018	40,500.00	62.14	40,562.14
1298703	48	11/23/2017	12/20/2017	02/14/2018	20,000.00	45.48	20,045.48
1299251	55	12/18/2017	01/03/2018	01/05/2018	40,500.00	19.97	40,519.97
1299481	58	10/13/2017	12/22/2017	04/03/2018	20,000.00	565.48	20,565.48
1299697	61	11/26/2017	12/19/2017	01/17/2018	50,000.00	71.24	50,071.24
1299868	68	11/02/2017	12/28/2017	01/15/2018	24,050.00	48.76	24,098.76
1300925	76	12/03/2017	01/17/2018	01/25/2018	15,000.00	21.78	15,021.78
1301346	44	12/18/2017	01/04/2018	02/21/2018	44,000.00	78.36	44,078.36
1301461	38	12/08/2017	01/05/2018	01/09/2018	47,500.00	41.64	47,541.64
1301462	59	11/07/2017	01/04/2018	03/01/2018	50,000.00	125.11	50,125.11
1301493	63	11/29/2017	01/04/2018	01/18/2018	50,000.00	68.49	50,068.49
1301955	22	11/26/2017	01/04/2018	02/01/2018	33,500.00	61.49	33,561.49
1301975	62	01/02/2018	02/16/2018	02/20/2018	50,000.00	67.12	50,067.12
1302871	72	12/18/2017	01/16/2018	01/18/2018	22,500.00	19.11	22,519.11
1302918	54	12/01/2017	01/10/2018	01/19/2018	50,000.00	67.12	50,067.12
1303049	22	12/09/2017	01/11/2018	01/16/2018	20,000.00	20.82	20,020.82
1303834	56	11/04/2017	01/17/2018	01/25/2018	50,000.00	112.33	50,112.33
1304188	62	07/10/2017	01/17/2018	01/19/2018	50,000.00	264.38	50,264.38
1304871	69	12/25/2017	01/19/2018	01/25/2018	28,600.00	24.29	28,624.29
1305465	64	01/01/2018	02/13/2018	02/16/2018	47,500.00	59.88	47,559.88
1305585	63	01/13/2018	01/23/2018	01/25/2018	50,000.00	16.44	50,016.44
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1305608	65	12/02/2017	01/23/2018	01/25/2018	$ 13,000.00	$ 19.23	$ 13,019.23
1306714	56	12/28/2017	02/14/2018	03/13/2018	50,000.00	102.74	50,102.74
1306865	47	12/21/2017	01/30/2018	02/19/2018	47,500.00	74.18	47,574.18
1307741	63	10/26/2017	02/09/2018	03/08/2018	50,000.00	182.19	50,182.19
1307991	59	12/30/2017	02/16/2018	11/14/2018	50,000.00	436.99	50,436.99
1308725	56	12/09/2017	03/23/2018	04/02/2018	47,500.00	148.36	47,648.36
1309230	63	01/29/2018	02/07/2018	02/19/2018	50,000.00	28.77	50,028.77
1309437	38	09/02/2017	02/08/2018	02/16/2018	25,000.00	114.38	25,114.38
1309778	55	01/28/2018	02/09/2018	06/11/2018	50,000.00	183.56	50,183.56
1310876	35	11/07/2017	02/13/2018	02/22/2018	47,500.00	139.25	47,639.25
1311091	57	01/27/2018	04/20/2018	04/30/2018	50,000.00	127.40	50,127.40
1311302	37	10/22/2017	02/16/2018	02/21/2018	20,000.00	66.85	20,066.85
1311399	32	11/16/2017	02/16/2018	03/19/2018	50,000.00	168.49	50,168.49
1311452	63	01/18/2018	02/16/2018	03/12/2018	30,000.00	43.56	30,043.56
1312111	52	01/05/2018	02/21/2018	02/27/2018	50,000.00	72.60	50,072.60
1312170	42	10/27/2017	02/21/2018	02/26/2018	44,000.00	147.07	44,147.07
1312472	33	01/04/2018	02/22/2018	04/30/2018	20,000.00	63.56	20,063.56
1312554	73	02/13/2018	02/26/2018	03/05/2018	22,500.00	12.33	22,512.33
1313070	60	02/03/2018	04/09/2018	04/11/2018	50,000.00	91.78	50,091.78
1313409	52	02/05/2018	02/27/2018	05/18/2018	50,000.00	95.89	50,095.89
1313492	67	01/13/2018	02/27/2018	03/07/2018	30,875.00	44.84	30,919.84
1313497	37	11/30/2017	03/01/2018	05/21/2018	50,000.00	203.07	50,203.07
1313996	64	02/09/2018	03/01/2018	03/12/2018	25,000.00	21.23	25,021.23
1314102	49	11/01/2017	03/01/2018	05/03/2018	50,000.00	250.68	50,250.68
1314255	37	02/16/2018	03/02/2018	03/28/2018	50,000.00	222.22	50,222.22
1315376	55	02/24/2018	03/12/2018	03/16/2018	50,000.00	27.40	50,027.40
1315728	64	10/23/2017	03/08/2018	03/13/2018	50,000.00	193.15	50,193.15
1316773	60	03/06/2018	03/14/2018	05/02/2018	50,000.00	78.08	50,078.08
1317541	55	03/10/2018	07/09/2018	07/13/2018	40,500.00	138.70	40,638.70
1317623	61	03/08/2018	05/08/2018	05/16/2018	50,000.00	94.52	50,094.52
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1317715	65	02/22/2018	03/20/2018	03/23/2018	$ 50,000.00	$ 39.73	$ 50,039.73
1318560	40	02/27/2018	03/22/2018	06/12/2018	50,000.00	143.84	50,143.84
1318626	44	03/19/2018	04/25/2018	05/07/2018	50,000.00	67.12	50,067.12
1319672	70	02/21/2018	03/27/2018	04/05/2018	22,500.00	26.50	22,526.50
1321357	54	03/25/2018	05/04/2018	05/09/2018	50,000.00	61.64	50,061.64
1321759	66	03/24/2018	05/11/2018	05/14/2018	32,500.00	45.41	32,545.41
1322021	53	02/03/2018	04/09/2018	04/12/2018	20,000.00	37.26	20,037.26
1324621	39	04/01/2018	04/20/2018	05/24/2018	50,000.00	7.95	50,007.95
1325015	52	03/31/2018	04/24/2018	05/25/2018	50,000.00	75.34	50,075.34
1326196	64	03/30/2018	04/30/2018	05/07/2018	50,000.00	52.05	50,052.05
1326473	51	03/31/2018	04/30/2018	06/04/2018	44,000.00	78.36	44,078.36
1328734	72	02/26/2018	05/09/2018	05/16/2018	22,500.00	48.70	22,548.70
1329057	69	03/27/2018	05/14/2018	05/17/2018	32,500.00	45.42	32,545.42
1330156	57	05/04/2018	06/08/2018	06/22/2018	50,000.00	67.12	50,067.12
1330548	69	04/22/2018	05/25/2018	05/31/2018	26,800.00	28.64	26,828.64
1330777	61	05/08/2018	05/23/2018	05/31/2018	50,000.00	31.51	50,031.51
1331261	41	04/10/2018	05/24/2018	05/31/2018	33,500.00	46.81	33,546.81
1333423	61	06/01/2018	07/10/2018	07/11/2018	50,000.00	54.79	50,054.79
1334211	36	05/03/2018	06/06/2018	06/15/2018	50,000.00	58.90	50,058.90
1334480	59	04/30/2018	06/07/2018	07/11/2018	40,500.00	319.49	40,819.49
1335017	61	06/03/2018	06/12/2018	06/19/2018	50,000.00	21.92	50,021.92
1335804	52	06/02/2018	06/18/2018	06/21/2018	44,000.00	22.90	44,022.90
1337827	47	05/06/2018	06/26/2018	07/02/2018	20,000.00	31.23	20,031.23
1338690	34	06/01/2018	07/25/2018	09/07/2018	50,000.00	134.25	50,134.25
1338949	66	06/21/2018	07/10/2018	07/17/2018	32,500.00	23.15	32,523.15
1339959	62	06/23/2018	07/10/2018	07/18/2018	50,000.00	34.25	50,034.25
1340014	69	07/03/2018	11/19/2018	11/20/2018	32,500.00	124.66	32,624.66
1341896	60	05/18/2018	07/19/2018	07/30/2018	50,000.00	93.15	50,093.15
1342060	45	07/09/2018	07/31/2018	08/02/2018	44,000.00	28.93	44,028.93
1343040	63	06/27/2018	07/25/2018	07/30/2018	50,000.00	45.21	50,045.21
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1343245	63	07/13/2018	07/26/2018	08/02/2018	$ 47,500.00	$ 26.03	$ 47,526.03
1343416	69	07/05/2018	07/26/2018	08/01/2018	21,775.00	16.11	21,791.11
1343649	60	06/11/2018	07/30/2018	09/05/2018	44,000.00	103.67	44,103.67
1343747	71	06/19/2018	07/30/2018	08/01/2018	16,650.00	19.62	16,669.62
1344424	63	07/23/2018	08/20/2018	08/22/2018	50,000.00	41.10	50,041.10
1344810	46	07/14/2018	08/22/2018	08/27/2018	50,000.00	60.27	50,060.27
1345539	63	06/28/2018	08/07/2018	08/28/2018	50,000.00	83.56	50,083.56
1345697	62	07/27/2018	08/08/2018	09/05/2018	50,000.00	54.79	50,054.79
1347641	31	07/31/2018	08/17/2018	08/23/2018	50,000.00	31.51	50,031.51
1347679	49	02/10/2018	08/20/2018	08/22/2018	50,000.00	264.38	50,264.38
1347883	51	08/09/2018	08/20/2018	08/23/2018	47,500.00	18.22	47,518.22
1348775	61	07/22/2018	08/24/2018	09/14/2018	50,000.00	73.97	50,073.97
1348939	63	07/21/2018	08/24/2018	08/30/2018	50,000.00	54.79	50,054.79
1349416	69	04/07/2018	08/28/2018	09/05/2018	13,000.00	53.78	13,053.78
1349454	56	06/04/2018	08/28/2018	11/05/2018	50,000.00	210.96	50,210.96
1349701	71	08/06/2018	08/29/2018	09/12/2018	9,000.00	9.12	9,009.12
1349869	44	08/16/2018	08/30/2018	09/05/2018	50,000.00	27.40	50,027.40
1349924	57	11/23/2017	08/29/2018	11/06/2018	50,000.00	476.71	50,476.71
1350339	72	08/17/2018	09/10/2018	09/18/2018	15,075.00	13.22	15,088.22
1352566	52	09/12/2018	09/25/2018	11/02/2018	33,500.00	189.83	33,689.83
1353940	59	09/11/2018	09/27/2018	09/28/2018	44,000.00	20.49	44,020.49
1354564	35	07/13/2018	09/26/2018	09/28/2018	50,000.00	105.48	50,105.48
1355265	49	09/23/2018	10/01/2018	10/29/2018	33,500.00	33.04	33,533.04
1356406	54	09/19/2018	10/04/2018	10/09/2018	50,000.00	27.40	50,027.40
1356408	73	08/20/2018	10/04/2018	10/09/2018	22,500.00	30.82	22,530.82
1356412	37	08/25/2018	10/05/2018	10/09/2018	50,000.00	61.64	50,061.64
1357613	43	10/07/2018	10/15/2018	11/14/2018	44,000.00	45.81	44,045.81
1358205	50	10/06/2018	10/18/2018	11/16/2018	50,000.00	140.41	50,140.41
1359188	73	10/12/2018	10/19/2018	12/06/2018	22,500.00	33.90	22,533.90
1359854	59	09/22/2018	10/24/2018	12/05/2018	44,000.00	89.21	44,089.21
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1359974	58	10/08/2018	10/24/2018	10/26/2018	$ 50,000.00	$ 24.66	$ 50,024.66
1359994	50	10/08/2018	10/25/2018	10/29/2018	50,000.00	28.77	50,028.77
1360858	47	09/29/2018	10/29/2018	10/31/2018	50,000.00	43.84	50,043.84
1360879	51	10/14/2018	10/30/2018	11/13/2018	50,000.00	23.28	50,023.28
1361430	62	10/04/2018	11/01/2018	11/02/2018	50,000.00	39.73	50,039.73
1361719	61	10/28/2018	11/26/2018	11/26/2018	20,000.00	15.89	20,015.89
1362348	31	10/07/2018	11/07/2018	11/09/2018	20,000.00	18.08	20,018.08
1363074	67	10/27/2018	11/28/2018	12/19/2018	32,500.00	47.19	32,547.19
1363233	75	11/09/2018	11/29/2018	12/03/2018	15,000.00	9.86	15,009.86
1363984	42	10/26/2018	11/15/2018	11/23/2018	50,000.00	38.36	50,038.36
1365877	73	11/13/2018	11/27/2018	12/05/2018	15,075.00	9.09	15,084.09
1366105	67	11/17/2018	12/11/2018	12/31/2018	32,500.00	39.18	32,539.18
1367012	62	11/13/2018	12/04/2018	12/19/2018	50,000.00	49.32	50,049.32
1367058	65	11/12/2018	12/03/2018	12/19/2018	30,875.00	31.30	30,906.30
1367241	49	11/26/2018	12/04/2018	12/18/2018	47,500.00	28.63	47,528.63
D089028	58	11/29/2017	11/29/2017	01/02/2018	40,500.00	0.00	40,500.00	(A)
D089808	53	01/09/2018	01/09/2018	02/27/2018	47,500.00	0.00	47,500.00	(A)
D090696	54	02/16/2018	02/16/2018	03/21/2018	50,000.00	0.00	50,000.00	(A)
D095116	64	08/29/2018	08/29/2018	10/11/2018	40,500.00	0.00	40,500.00	(A)
					$ 5,596,775.00	$ 12,113.47	$ 5,608,888.47
						2018 IBNR	$ 895,500
						2017 IBNR	($ 888,175)
			139	Total Claims			$ 5,616,213.47
(A) Accelerated Death Claim

Participating Spouse & Child Life Claims Experience Policy Number: 34294 For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1258388	81	05/13/2017	05/11/2018	05/14/2018	$ 3,000.00	$ 30.08	$ 3,030.08
1259850	60	05/19/2017	01/25/2018	02/02/2018	3,000.00	21.29	3,021.29
1268441	50	07/09/2017	07/31/2017	06/04/2018	3,000.00	27.12	3,027.12
1278609	56	08/24/2017	08/30/2017	03/01/2018	3,000.00	62.99	3,062.99
1285375	64	10/08/2017	11/21/2017	02/15/2018	3,000.00	10.68	3,010.68
1289063	68	10/19/2017	05/03/2018	05/08/2018	3,000.00	16.52	3,016.52
1291272	67	10/15/2017	11/13/2017	01/09/2018	3,000.00	7.07	3,007.07
1292365	20	11/07/2017	12/13/2017	03/09/2018	3,000.00	10.03	3,010.03
1295362	67	11/29/2017	01/03/2018	01/04/2018	3,000.00	2.96	3,002.96
1296510	68	11/09/2017	12/06/2017	02/16/2018	3,000.00	3.21	3,003.21
1298631	58	12/09/2017	01/08/2018	02/20/2018	3,000.00	6.00	3,006.00
1298740	60	12/17/2017	01/29/2018	02/02/2018	3,000.00	3.86	3,003.86
1299179	66	10/24/2017	12/20/2017	01/29/2018	3,000.00	7.97	3,007.97
1299499	63	11/02/2017	12/22/2017	01/05/2018	3,000.00	5.26	3,005.26
1301317	58	12/06/2017	01/03/2018	01/10/2018	3,000.00	2.88	3,002.88
1301902	17	12/06/2017	01/05/2018	01/11/2018	3,000.00	2.96	3,002.96
1301982	16	07/18/2016	02/14/2018	07/03/2018	3,000.00	58.77	3,058.77
1302025	68	10/04/2017	01/19/2018	01/24/2018	3,000.00	9.21	3,009.21
1302721	75	01/04/2018	02/16/2018	02/19/2018	3,000.00	3.78	3,003.78
1302900	65	12/08/2017	01/10/2018	01/30/2018	3,000.00	4.36	3,004.36
1302904	67	12/26/2017	01/10/2018	01/17/2018	3,000.00	1.81	3,001.81
1303662	58	12/03/2017	01/16/2018	01/25/2018	3,000.00	4.36	3,004.36
1304203	69	12/04/2017	01/17/2018	01/25/2018	3,000.00	4.27	3,004.27
1305557	67	01/16/2018	02/13/2018	02/23/2018	3,000.00	3.12	3,003.12
1306624	54	01/13/2018	01/26/2018	02/01/2018	3,000.00	1.56	3,001.56
1306904	49	12/19/2017	01/26/2018	02/06/2018	3,000.00	4.03	3,004.03
1307087	71	11/29/2017	01/26/2018	02/01/2018	3,000.00	5.26	3,005.26
1308718	59	01/22/2018	02/06/2018	02/19/2018	3,000.00	2.30	3,002.30
Participating Spouse & Child Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1308755	30	09/04/2017	02/06/2018	08/21/2018	$ 3,000.00	$ 28.85	$ 3,028.85
1309225	63	12/13/2017	02/07/2018	02/28/2018	3,000.00	6.33	3,006.33
1309278	61	01/18/2018	02/07/2018	02/16/2018	3,000.00	2.38	3,002.38
1309606	60	01/14/2018	02/07/2018	02/13/2018	3,000.00	2.47	3,002.47
1310659	50	12/21/2017	03/20/2018	03/21/2018	3,000.00	7.40	3,007.40
1311303	70	02/05/2018	02/16/2018	02/22/2018	3,000.00	1.40	3,001.40
1312172	53	02/07/2018	02/21/2018	02/26/2018	3,000.00	1.56	3,001.56
1313461	0	06/03/2017	02/27/2018	03/08/2018	3,000.00	22.85	3,022.85
1313772	64	12/30/2017	02/28/2018	03/09/2018	3,000.00	5.67	3,005.67
1313776	64	01/18/2018	02/28/2018	03/09/2018	3,000.00	4.11	3,004.11
1314302	46	02/09/2018	03/02/2018	03/06/2018	3,000.00	2.05	3,002.05
1315648	53	02/21/2018	03/08/2018	03/13/2018	3,000.00	1.64	3,001.64
1317516	35	03/13/2018	04/11/2018	04/20/2018	3,000.00	3.12	3,003.12
1317765	70	03/16/2018	04/25/2018	06/06/2018	3,000.00	6.74	3,006.74
1319307	44	01/18/2018	03/26/2018	04/03/2018	3,000.00	6.16	3,006.16
1319346	72	03/25/2018	05/03/2018	05/07/2018	3,000.00	3.53	3,003.53
1322461	70	04/01/2018	04/16/2018	04/27/2018	3,000.00	2.14	3,002.14
1323432	79	03/24/2018	04/16/2018	05/11/2018	3,000.00	3.95	3,003.95
1323714	59	04/07/2018	05/01/2018	05/10/2018	3,000.00	2.71	3,002.71
1324013	72	04/07/2018	04/18/2018	04/20/2018	3,000.00	1.07	3,001.07
1325832	66	04/06/2018	04/26/2018	04/30/2018	3,000.00	1.97	3,001.97
1326324	65	04/06/2018	04/27/2018	05/07/2018	3,000.00	2.55	3,002.55
1327799	74	04/15/2018	05/07/2018	05/10/2018	3,000.00	2.05	3,002.05
1328091	56	04/13/2018	05/08/2018	05/11/2018	3,000.00	2.30	3,002.30
1328203	56	01/24/2018	05/09/2018	05/10/2018	3,000.00	8.71	3,008.71
1328825	69	04/21/2018	05/11/2018	05/17/2018	3,000.00	2.14	3,002.14
1330959	47	03/18/2018	05/22/2018	05/25/2018	3,000.00	5.59	3,005.59
1331436	54	03/19/2018	05/23/2018	05/31/2018	3,000.00	6.00	3,006.00
Participating Spouse & Child Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1332063	65	04/23/2018	05/29/2018	07/10/2018	$ 3,000.00	$ 3.53	$ 3,003.53
1332597	68	05/03/2018	05/31/2018	06/04/2018	3,000.00	2.63	3,002.63
1333461	53	05/25/2018	06/04/2018	06/07/2018	3,000.00	1.07	3,001.07
1334890	67	06/01/2018	06/12/2018	06/15/2018	3,000.00	2.88	3,002.88
1336138	60	05/21/2018	06/19/2018	07/02/2018	3,000.00	3.45	3,003.45
1338638	54	06/08/2018	06/29/2018	07/17/2018	3,000.00	3.21	3,003.21
1339173	68	06/22/2018	07/24/2018	07/25/2018	3,000.00	2.71	3,002.71
1339938	53	05/13/2018	07/09/2018	07/19/2018	3,000.00	5.51	3,005.51
1339944	63	06/20/2018	07/09/2018	08/03/2018	3,000.00	3.62	3,003.62
1341024	40	05/21/2018	07/16/2018	07/18/2018	3,000.00	4.77	3,004.77
1341156	58	07/03/2018	07/13/2018	07/23/2018	3,000.00	1.64	3,001.64
1341159	55	06/26/2018	07/13/2018	07/23/2018	3,000.00	2.22	3,002.22
1342204	50	06/11/2018	07/20/2018	07/30/2018	3,000.00	4.03	3,004.03
1342773	44	07/05/2018	07/24/2018	09/10/2018	3,000.00	5.51	3,005.51
1343324	69	07/05/2018	07/27/2018	08/10/2018	3,000.00	2.96	3,002.96
1343524	46	07/14/2018	07/30/2018	07/31/2018	3,000.00	1.40	3,001.40
1343665	60	07/09/2018	07/30/2018	10/09/2018	3,000.00	7.56	3,007.56
1343740	55	05/11/2018	07/30/2018	08/03/2018	3,000.00	6.90	3,006.90
1344805	44	07/31/2018	09/12/2018	09/13/2018	3,000.00	3.62	3,003.62
1345400	67	07/22/2018	08/06/2018	08/09/2018	3,000.00	1.48	3,001.48
1345656	65	06/23/2018	08/08/2018	08/10/2018	3,000.00	3.95	3,003.95
1345692	57	08/02/2018	09/12/2018	09/20/2018	3,000.00	4.03	3,004.03
1346046	12	07/11/2018	08/09/2018	08/20/2018	3,000.00	3.29	3,003.29
1346961	71	07/10/2018	08/15/2018	09/12/2018	3,000.00	5.26	3,005.26
1347786	60	06/27/2018	08/20/2018	08/22/2018	3,000.00	4.60	3,004.60
1347881	57	07/29/2018	08/20/2018	08/28/2018	3,000.00	2.47	3,002.47
1348117	55	08/03/2018	08/27/2018	09/05/2018	3,000.00	2.71	3,002.71
1348162	57	07/03/2018	08/22/2018	08/23/2018	3,000.00	4.19	3,004.19
Participating Spouse & Child Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1348935	68	08/09/2018	08/24/2018	08/29/2018	$ 3,000.00	$ 1.64	$ 3,001.64
1349366	58	08/03/2018	08/28/2018	08/30/2018	3,000.00	2.22	3,002.22
1349821	66	08/20/2018	09/04/2018	09/05/2018	3,000.00	1.32	3,001.32
1350811	63	08/14/2018	09/05/2018	09/10/2018	3,000.00	2.22	3,002.22
1351094	75	08/19/2018	09/06/2018	09/10/2018	3,000.00	1.81	3,001.81
1351123	68	08/29/2018	09/07/2018	09/10/2018	3,000.00	0.99	3,000.99
1351841	57	09/06/2018	09/20/2018	09/21/2018	3,000.00	1.23	3,001.23
1351950	56	06/23/2018	09/11/2018	09/13/2018	3,000.00	6.74	3,006.74
1353496	59	09/11/2018	09/19/2018	09/25/2018	3,000.00	1.15	3,001.15
1353508	60	08/25/2018	09/21/2018	09/25/2018	3,000.00	2.55	3,002.55
1353695	53	08/21/2018	09/20/2018	09/24/2018	3,000.00	2.79	3,002.79
1353977	55	09/10/2018	09/26/2018	09/27/2018	3,000.00	1.40	3,001.40
1355044	58	07/16/2018	09/28/2018	10/01/2018	3,000.00	6.33	3,006.33
1356114	54	08/25/2018	10/03/2018	10/17/2018	3,000.00	4.36	3,004.36
1356402	62	09/18/2018	10/04/2018	10/09/2018	3,000.00	1.73	3,001.73
1356603	52	10/02/2018	10/25/2018	11/08/2018	3,000.00	3.04	3,003.04
1357655	73	05/05/2018	10/11/2018	10/29/2018	3,000.00	13.97	3,013.97
1360467	39	10/12/2018	10/29/2018	11/26/2018	3,000.00	1.64	3,001.64
1361620	51	07/24/2018	11/02/2018	11/26/2018	3,000.00	8.55	3,008.55
1361863	63	02/25/2018	11/05/2018	11/26/2018	3,000.00	20.96	3,020.96
1362336	70	05/31/2018	11/06/2018	11/13/2018	3,000.00	13.64	3,013.64
1363622	60	10/22/2018	11/14/2018	11/26/2018	3,000.00	2.30	3,002.30
1364612	69	09/29/2018	11/19/2018	11/26/2018	3,000.00	4.77	3,004.77
1364706	74	10/24/2018	11/19/2018	11/26/2018	3,000.00	2.71	3,002.71
1365841	50	11/02/2018	11/27/2018	11/30/2018	3,000.00	2.22	3,002.22
1366370	61	11/01/2018	11/28/2018	12/05/2018	3,000.00	2.79	3,002.79
1368965	63	12/03/2018	12/24/2018	12/17/2018	3,000.00	1.15	3,001.15
1369730	37	10/26/2018	12/17/2018		0.00	0.00	0.00
Participating Spouse & Child Life Claims Experience Policy Number: 34294

For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1370566	47	12/07/2018	12/19/2018	12/31/2018	$ 0.00	$ 0.00	$ 0.00
1371634	60	12/04/2018	12/27/2018	12/31/2018	3,000.00	2.22	3,002.22
					$ 336,000.00	$ 690.79	$ 336,690.79
						2018 IBNR	$ 42,206
						2017 IBNR	($ 41,955)
			114	Total Claims			$ 336,941.79

Participating Child Life Claims Experience Policy Number: 34294 For the Period January 1, 2018 through December 31, 2018

	Death Claims
	Claim Number		Age at
Death				Date of
Death		Date Notice
Received				Date
Paid							Insurance
Amount Paid						Interest
Paid					Incurred

Claims

1288995	22	10/09/2017	10/25/2017	03/23/2018	$ 3,000.00	$ 13.56	$ 3,013.56
1316766	13	02/21/2018	03/14/2018	03/27/2018	3,000.00	2.79	3,002.79
1317478	0	01/17/2018	03/21/2018	03/22/2018	3,000.00	5.26	3,005.26
1317857	25	03/02/2018	03/20/2018	05/02/2018	3,000.00	5.01	3,005.01
1320734	38	03/14/2018	04/03/2018	04/06/2018	3,000.00	1.89	3,001.89
1321370	0	02/20/2018	04/05/2018	04/06/2018	3,000.00	3.70	3,003.70
1323783	25	08/09/2017	05/18/2018	05/22/2018	3,000.00	23.51	3,023.51
1323784	21	03/30/2018	07/17/2018	08/15/2018	3,000.00	11.34	3,011.34
1341409	18	04/26/2018	07/13/2018	07/19/2018	3,000.00	6.90	3,006.90
1351963	18	08/29/2018	09/11/2018	09/14/2018	3,000.00	1.32	3,001.32
1360881	0	08/11/2018	10/30/2018	10/31/2018	3,000.00	6.66	3,006.66
					$ 33,000.00	$ 81.94	$ 33,081.94
						2018 IBNR	$ 4,831
						2017 IBNR	($ 4,816)
			11	Total Claims			$ 33,096.94

Participating Basic AD&D - Employee Claims Experience Policy Number: 34294 For the Period January 1, 2018 through December 31, 2018

	Accidental Death & Dismemberment Claims
	Claim Number			Age at
Claim		Date of
Claim		Date Notice
Received			Date
Paid						Insurance
Amount Paid					Interest
Paid				Incurred

Claims

1293804	48	10/25/2017	11/21/2017	01/30/2018	$ 67,000.00	$ 178.06	$ 67,178.06
1303049	22	12/09/2017	01/11/2018	01/16/2018	88,000.00	91.62	88,091.62
1326473	51	03/31/2018	04/30/2018	06/04/2018	88,000.00	156.71	88,156.71
1335804	52	06/02/2018	06/18/2018	07/27/2018	88,000.00	132.60	88,132.60
1338690	34	06/01/2018	07/25/2018	09/07/2018	125,000.00	268.49	125,268.49	*
1349416	69	04/07/2018	08/28/2018	09/05/2018	51,000.00	210.98	51,210.98	*
D091523	64	10/28/2016	03/22/2018	03/29/2018	50,000.00	716.67	50,716.67	(D)
D092302	58	04/09/2018	06/11/2018	08/02/2018	50,000.00	159.72	50,159.72	(D)
					$ 607,000.00	$ 1,914.85	$ 608,914.85
						2018 IBNR	$ 176,188
						2017 IBNR	($ 174,747)
			8	Total Claims			$ 610,355.85
* Includes Seatbelt Benefit
(D) Dismemberment Benefit

Participating Basic AD&D - Dependent Claims Experience Policy Number: 34294 For the Period January 1, 2018 through December 31, 2018

	Accidental Death & Dismemberment Claims
	Claim Number			Age at
Claim		Date of
Claim		Date Notice
Received			Date
Paid						Insurance
Amount Paid					Interest
Paid				Incurred

Claims

1234209	23	12/26/2016	01/18/2017	08/10/2018	$ 500.00	$ 0.00	$ 500.00
1297374	55	10/11/2017	12/13/2017	03/13/2018	32,000.00	134.14	32,134.14
1330959	47	03/18/2018	05/22/2018	06/05/2018	40,000.00	86.58	40,086.58
1336138	60	05/21/2018	06/19/2018	07/02/2018	38,000.00	43.73	38,043.73
1345656	65	06/23/2018	08/08/2018	10/08/2018	51,000.00	149.51	51,149.51 *
1353508	60	08/25/2018	09/21/2018	09/25/2018	60,000.00	50.96	60,050.96
D092793	16	07/17/2015	05/29/2018	08/20/2018	4,500.00	137.75	4,637.75 (D)
					$ 226,000.00	$ 602.67	$ 226,602.67
						2018 IBNR	$ 33,136
						2017 IBNR	($ 32,790)
			7	Total Claims			$ 226,948.67
* Includes Seatbelt Benefit
(D) Dismemberment Claim

2019 Basic Life & ADD Participating Basic Life Claims Experience Policy Number: 34294 For the Period January 1, 2019 through December 31, 2019

	Death Claims
	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1374254	49	01/08/2019	01/25/2019	01/28/2019	$ 50,000.00	$ 27.40	$ 50,027.40
1375933	79	01/06/2019	01/17/2019	01/22/2019	6,000.00	2.63	6,002.63
1377321	62	01/08/2019	03/11/2019	04/03/2019	50,000.00	112.37	50,112.37
1378818	64	01/07/2019	01/31/2019	02/04/2019	40,500.00	31.07	40,531.07
1378900	56	01/18/2019	01/31/2019	02/06/2019	50,000.00	26.03	50,026.03
1378920	42	01/29/2019	03/05/2019	03/14/2019	47,500.00	57.26	47,557.26
1379322	60	02/01/2019	02/15/2019	02/22/2019	50,000.00	28.77	50,028.77
1380787	55	01/29/2019	02/08/2019	02/12/2019	25,000.00	9.59	25,009.59
1381626	64	02/10/2019	03/11/2019	03/12/2019	47,500.00	39.04	47,539.04
1381639	51	01/23/2019	02/13/2019	02/26/2019	47,500.00	44.25	47,544.25
1381903	57	01/09/2019	02/14/2019	02/22/2019	37,000.00	44.60	37,044.60
1381908	48	01/25/2019	02/14/2019	02/22/2019	50,000.00	38.36	50,038.36
1383425	33	02/07/2019	02/21/2019	03/08/2019	47,500.00	37.74	47,537.74
1383764	60	01/25/2019	02/22/2019	02/28/2019	50,000.00	46.58	50,046.58
1383969	60	02/09/2019	02/27/2019	04/18/2019	50,000.00	93.15	50,093.15
1384002	74	02/15/2019	02/25/2019	02/28/2019	9,000.00	3.21	9,003.21
1384820	58	01/31/2019	02/27/2019	03/06/2019	40,500.00	37.73	40,537.73
1384901	48	02/12/2019	03/04/2019	04/16/2019	20,000.00	32.69	20,032.69
1384949	46	02/12/2019	02/28/2019	04/09/2019	44,000.00	51.24	44,051.24
1385157	74	02/04/2019	03/01/2019	03/06/2019	22,500.00	18.49	22,518.49
1385174	26	01/14/2019	03/01/2019	04/10/2019	44,000.00	103.67	44,103.67
1385787	62	02/16/2019	03/04/2019	03/07/2019	47,500.00	24.73	47,524.73
1386358	52	02/26/2019	03/06/2019	03/11/2019	50,000.00	17.81	50,017.81
1386404	57	02/23/2019	03/26/2019	04/04/2019	50,000.00	54.79	50,054.79
1388990	61	03/10/2019	03/22/2019	03/27/2019	50,000.00	23.28	50,023.28
1390231	59	03/14/2019	03/29/2019	05/06/2019	50,000.00	72.60	50,072.60
1390524	60	02/04/2019	03/25/2019	05/31/2019	50,000.00	158.90	50,158.90
1390710	65	03/15/2019	04/26/2019	04/30/2019	50,000.00	63.01	50,063.01
1390906	48	01/07/2019	03/26/2019	05/16/2019	47,500.00	167.88	47,667.88
1390987	70	02/02/2019	03/26/2019	04/02/2019	22,500.00	36.37	22,536.37
1393503	47	03/25/2019	04/08/2019	04/29/2019	50,000.00	47.95	50,047.95
1394625	65	03/21/2019	04/10/2019	04/17/2019	13,000.00	9.62	13,009.62
1394908	66	03/27/2019	04/15/2019	04/17/2019	32,500.00	18.70	32,518.70
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2019 through December 31, 2019

	Death Claims
	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1395143	50	03/30/2019	04/16/2019	04/18/2019	$ 50,000.00	$ 26.03	$ 50,026.03
1395730	39	02/05/2019	04/17/2019	09/17/2019	22,000.00	88.60	22,088.60
1396082	63	03/13/2019	04/22/2019	04/24/2019	47,500.00	54.66	47,554.66
1396388	54	04/15/2019	04/23/2019	04/26/2019	50,000.00	15.07	50,015.07
1397178	64	04/10/2019	04/25/2019	05/01/2019	40,500.00	23.30	40,523.30
1397746	37	03/04/2019	04/29/2019	05/07/2019	50,000.00	87.67	50,087.67
1397966	41	04/21/2019	05/03/2019	05/07/2019	50,000.00	21.92	50,021.92
1399598	67	04/28/2019	05/09/2019	05/14/2019	30,875.00	13.53	30,888.53
1400116	55	04/28/2019	05/15/2019	06/05/2019	50,000.00	52.05	50,052.05
1401537	62	04/12/2019	07/12/2019	07/15/2019	20,000.00	51.51	20,051.51
1401589	58	04/15/2019	05/17/2019	05/23/2019	50,000.00	52.05	50,052.05
1402363	56	05/19/2019	06/27/2019	07/01/2019	15,000.00	17.67	15,017.67
1402991	43	05/21/2019	06/17/2019	06/18/2019	50,000.00	38.36	50,038.36
1403910	72	05/05/2019	06/05/2019	06/05/2019	9,000.00	7.64	9,007.64
1405651	60	04/22/2019	06/10/2019	07/03/2019	50,000.00	98.63	50,098.63
1406651	69	04/06/2019	06/13/2019	06/17/2019	32,500.00	64.10	32,564.10
1406752	36	04/04/2019	06/19/2019	06/25/2019	50,000.00	112.33	50,112.33
1406902	71	05/25/2019	06/18/2019	07/19/2019	22,500.00	33.90	22,533.90
1408089	62	06/20/2019	09/03/2019	09/11/2019	50,000.00	113.68	50,113.68
1408487	65	06/01/2019	06/24/2019	06/28/2019	50,000.00	36.99	50,036.99
1408992	54	06/11/2019	06/28/2019	06/28/2019	50,000.00	23.29	50,023.29
1409494	65	06/10/2019	06/27/2019	07/01/2019	50,000.00	28.77	50,028.77
1410093	59	05/30/2019	07/01/2019	07/03/2019	50,000.00	46.58	50,046.58
1410801	65	07/02/2019	08/19/2019	08/27/2019	50,000.00	311.11	50,311.11
1410863	55	06/14/2019	07/08/2019	07/11/2019	50,000.00	36.99	50,036.99
1411321	42	06/13/2019	07/10/2019	07/16/2019	50,000.00	45.21	50,045.21
1411367	56	06/21/2019	07/09/2019	07/16/2019	47,500.00	32.53	47,532.53
1411374	54	07/02/2019	07/29/2019	08/14/2019	47,500.00	55.96	47,555.96
1411698	58	05/23/2019	07/11/2019	11/06/2019	47,500.00	217.33	47,717.33
1411894	67	06/23/2019	07/11/2019	07/31/2019	32,500.00	33.84	32,533.84
1412052	58	06/13/2019	07/12/2019	07/17/2019	40,500.00	37.73	40,537.73
1413525	62	06/16/2019	07/22/2019	07/23/2019	47,500.00	48.15	47,548.15
1413813	55	07/20/2019	08/12/2019	08/15/2019	50,000.00	35.62	50,035.62
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2019 through December 31, 2019

	Death Claims
	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1414054	62	06/15/2019	07/23/2019	07/29/2019	$ 50,000.00	$ 150.68	$ 50,150.68
1414735	56	05/24/2019	08/01/2019	08/15/2019	50,000.00	113.70	50,113.70
1414737	56	06/12/2019	07/26/2019	07/31/2019	50,000.00	67.12	50,067.12
1415257	70	07/17/2019	08/02/2019	08/19/2019	32,500.00	29.38	32,529.38
1415276	62	07/18/2019	08/13/2019	08/27/2019	50,000.00	54.79	50,054.79
1415277	24	05/06/2019	08/30/2019	09/24/2019	50,000.00	193.15	50,193.15
1416608	59	06/23/2019	08/09/2019	08/14/2019	50,000.00	71.23	50,071.23
1416940	72	08/01/2019	08/19/2019	08/20/2019	22,500.00	11.71	22,511.71
1417621	62	07/16/2019	08/08/2019	09/20/2019	50,000.00	90.41	50,090.41
1417832	55	02/09/2019	08/12/2019	08/19/2019	50,000.00	261.64	50,261.64
1417994	64	08/08/2019	10/17/2019	10/29/2019	50,000.00	112.33	50,112.33
1418386	54	08/11/2019	08/29/2019	09/06/2019	50,000.00	35.62	50,035.62
1419538	63	07/23/2019	08/23/2019	08/27/2019	50,000.00	47.94	50,047.94
1421081	61	08/18/2019	09/06/2019	09/06/2019	50,000.00	26.03	50,026.03
1424752	72	08/07/2019	09/16/2019	09/23/2019	9,000.00	11.58	9,011.58
1426097	61	09/11/2019	09/27/2019	10/01/2019	50,000.00	27.40	50,027.40
1426656	32	09/05/2019	09/25/2019	10/01/2019	40,500.00	28.85	40,528.85
1427011	62	09/13/2019	09/30/2019	10/04/2019	33,500.00	19.27	33,519.27
1427033	56	09/12/2019	09/27/2019	10/01/2019	50,000.00	26.03	50,026.03
1427056	74	09/17/2019	10/14/2019	10/14/2019	21,375.00	15.82	21,390.82
1427209	57	09/14/2019	09/30/2019	10/02/2019	50,000.00	24.66	50,024.66
1427589	67	09/21/2019	10/01/2019	10/10/2019	13,000.00	6.77	13,006.77
1427625	42	09/24/2019	10/16/2019	11/13/2019	33,500.00	33.31	33,533.31
1428047	64	09/20/2019	10/09/2019	10/22/2019	50,000.00	43.84	50,043.84
1428481	61	09/13/2019	10/07/2019	10/10/2019	50,000.00	36.99	50,036.99
1429680	72	08/17/2019	10/14/2019	10/18/2019	22,500.00	38.22	22,538.22
1429852	47	08/24/2019	10/21/2019	10/21/2019	50,000.00	79.45	50,079.45
1429908	48	09/07/2019	10/15/2019	10/18/2019	50,000.00	56.16	50,056.16
1431073	59	10/19/2019	10/25/2019	10/30/2019	50,000.00	15.07	50,015.07
1432285	44	10/23/2019	10/31/2019	11/01/2019	50,000.00	12.33	50,012.33
1432460	68	04/09/2019	10/31/2019	10/31/2019	32,500.00	182.53	32,682.53
1433966	73	10/20/2019	11/05/2019	11/20/2019	22,500.00	15.41	22,515.41
1434118	51	10/25/2019	11/04/2019	11/11/2019	50,000.00	23.29	50,023.29
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2019 through December 31, 2019

	Death Claims
	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1434245	48	09/24/2019	11/06/2019	11/12/2019	$ 50,000.00	$ 67.12	$ 50,067.12
1434290	26	10/07/2019	11/06/2019	11/12/2019	50,000.00	49.32	50,049.32
1434747	61	11/04/2019	11/14/2019	12/26/2019	50,000.00	71.23	50,071.23
1435315	43	11/08/2019	12/02/2019	12/04/2019	20,000.00	14.25	20,014.25
1436315	43	11/03/2019	12/16/2019	12/18/2019	50,000.00	61.64	50,061.64
1438313	47	11/06/2019	11/26/2019	12/03/2019	20,000.00	14.79	20,014.79
1439637	56	11/14/2019	12/04/2019	12/10/2019	47,500.00	33.84	47,533.84
1440979	60	11/30/2019	12/10/2019	12/18/2019	50,000.00	24.66	50,024.66
1442037	67	11/29/2019	12/16/2019	12/20/2019	28,600.00	16.45	28,616.45
					$ 4,493,850.00	$ 5,860.32	$ 4,499,710.32
						2019 IBNR	$ 275,818
			108	Total Claims			$ 4,775,528.32

Participating Spouse & Child Life Claims Experience Policy Number: 34294 For the Period January 1, 2019 through December 31, 2019

	Death Claims
	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1379181	37	01/18/2019	02/01/2019	02/11/2019	$ 3,000.00	$ 1.97	$ 3,001.97
1390104	64	03/08/2019	03/22/2019	03/28/2019	3,000.00	1.64	3,001.64
1390267	79	02/26/2019	03/22/2019	03/28/2019	3,000.00	2.47	3,002.47
1395381	50	04/13/2019	05/07/2019	05/08/2019	3,000.00	2.05	3,002.05
1397149	67	04/14/2019	04/30/2019	05/01/2019	3,000.00	1.40	3,001.40
1403731	20	05/10/2019	06/03/2019	06/05/2019	3,000.00	2.14	3,002.14
1403772	68	03/02/2019	05/30/2019	06/05/2019	3,000.00	7.81	3,007.81
1405617	0	05/26/2019	06/11/2019	06/12/2019	3,000.00	1.40	3,001.40
1406577	79	05/26/2019	06/17/2019	06/17/2019	3,000.00	1.81	3,001.81
1406775	77	06/09/2019	07/16/2019	07/25/2019	3,000.00	3.78	3,003.78
1406847	22	05/26/2019	06/17/2019	06/19/2019	3,000.00	1.97	3,001.97
1406874	54	05/10/2019	06/19/2019	06/19/2019	3,000.00	3.29	3,003.29
1408323	53	05/31/2019	06/21/2019	06/26/2019	3,000.00	2.14	3,002.14
1408975	63	06/03/2019	06/27/2019	08/23/2019	3,000.00	6.66	3,006.66
1410009	61	05/29/2019	07/01/2019	07/03/2019	3,000.00	2.88	3,002.88
1412075	64	06/24/2019	07/16/2019	08/05/2019	3,000.00	3.45	3,003.45
1414409	61	07/24/2019	08/14/2019	08/14/2019	3,000.00	1.73	3,001.73
1417719	58	07/17/2019	08/12/2019	08/19/2019	3,000.00	2.71	3,002.71
1417720	62	07/12/2019	08/12/2019	08/15/2019	3,000.00	2.79	3,002.79
1420761	56	08/05/2019	08/28/2019	09/03/2019	3,000.00	2.38	3,002.38
1421194	61	07/26/2019	09/03/2019	09/03/2019	3,000.00	3.21	3,003.21
1428461	0	01/24/2019	10/23/2019	10/24/2019	3,000.00	22.44	3,022.44
1429854	77	09/28/2019	10/15/2019	10/21/2019	3,000.00	1.89	3,001.89
1433523	48	09/22/2019	11/06/2019	11/07/2019	3,000.00	3.78	3,003.78
1435301	49	10/24/2019	11/20/2019	11/21/2019	3,000.00	2.30	3,002.30
1436874	57	10/23/2019	12/04/2019	12/04/2019	3,000.00	2.47	3,002.47
1437238	79	10/27/2019	11/26/2019	11/27/2019	3,000.00	2.55	3,002.55
1439922	60	11/19/2019	12/09/2019	12/09/2019	3,000.00	1.64	3,001.64
1441371	68	12/03/2019	12/11/2019	12/18/2019	3,000.00	1.23	3,001.23
1442332	23	11/22/2019	12/17/2019	12/27/2019	3,000.00	2.88	3,002.88
Participating Spouse & Child Life Claims Experience Policy Number: 34294

For the Period January 1, 2019 through December 31, 2019

	Death Claims
	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1442335	23	11/27/2019	12/17/2019	12/23/2019	$ 3,000.00	$ 2.14	$ 3,002.14
1442639	41	12/04/2019	12/18/2019	12/23/2019	3,000.00	1.56	3,001.56
					$ 96,000.00	$ 104.56	$ 96,104.56
						2019 IBNR	$ 7,981
			32	Total Claims			$ 104,085.56

Participating Spouse Life Claims Experience Policy Number: 34294 For the Period January 1, 2019 through December 31, 2019 Death Claims

	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1376208	60	01/01/2019	01/18/2019	01/28/2019	$ 3,000.00	$ 2.22	$ 3,002.22
1376270	65	01/07/2019	01/18/2019	01/24/2019	3,000.00	1.40	3,001.40
1377189	66	01/02/2019	01/23/2019	01/28/2019	3,000.00	2.14	3,002.14
1378036	54	01/13/2019	01/29/2019	02/01/2019	3,000.00	1.56	3,001.56
1378073	65	01/09/2019	01/28/2019	01/30/2019	3,000.00	1.73	3,001.73
1378822	47	01/21/2019	01/31/2019	02/04/2019	3,000.00	1.15	3,001.15
1380050	66	01/20/2019	02/08/2019	02/14/2019	3,000.00	2.05	3,002.05
1380616	61	01/15/2019	02/08/2019	02/13/2019	3,000.00	2.38	3,002.38
1382951	62	02/12/2019	04/03/2019	05/10/2019	3,000.00	7.15	3,007.15
1384511	67	02/01/2019	02/27/2019	03/06/2019	3,000.00	2.71	3,002.71
1386427	70	02/15/2019	03/07/2019	03/15/2019	3,000.00	2.30	3,002.30
1388270	60	02/26/2019	03/15/2019	03/21/2019	3,000.00	1.89	3,001.89
1388945	33	02/26/2019	03/22/2019	06/04/2019	3,000.00	8.05	3,008.05
1391627	45	03/10/2019	03/28/2019	04/10/2019	3,000.00	2.55	3,002.55
1393727	48	04/02/2019	04/25/2019	04/25/2019	3,000.00	1.89	3,001.89
1394341	79	03/29/2019	04/11/2019	04/16/2019	3,000.00	1.48	3,001.48
1395270	63	03/29/2019	04/22/2019	04/22/2019	3,000.00	1.97	3,001.97
1395276	64	03/19/2019	04/17/2019	04/22/2019	3,000.00	2.79	3,002.79
1395403	61	03/20/2019	04/16/2019	04/23/2019	3,000.00	2.79	3,002.79
1395430	68	04/15/2019	05/01/2019	05/02/2019	3,000.00	1.40	3,001.40
1397148	64	02/07/2019	04/25/2019	05/21/2019	3,000.00	8.47	3,008.47
1398834	63	04/28/2019	05/06/2019	05/07/2019	3,000.00	0.74	3,000.74
1400827	67	04/19/2019	05/14/2019	05/17/2019	3,000.00	2.30	3,002.30
1401149	56	04/06/2019	05/15/2019	05/17/2019	3,000.00	3.37	3,003.37
1401532	52	04/14/2019	05/17/2019	05/21/2019	3,000.00	18.25	3,018.25
1403231	54	05/10/2019	05/29/2019	05/30/2019	3,000.00	1.64	3,001.64
1406766	68	05/18/2019	06/14/2019	06/19/2019	3,000.00	2.63	3,002.63
1409817	67	05/13/2019	06/28/2019	07/02/2019	3,000.00	4.11	3,004.11
1410360	72	06/16/2019	07/03/2019	08/01/2019	3,000.00	3.78	3,003.78
1414689	53	05/30/2019	07/29/2019	07/30/2019	3,000.00	5.01	3,005.01
1414920	55	07/12/2019	07/29/2019	08/06/2019	3,000.00	2.05	3,002.05
1420246	55	08/17/2019	08/26/2019	08/29/2019	3,000.00	0.99	3,000.99
1422105	63	07/19/2019	10/14/2019	10/22/2019	3,000.00	7.81	3,007.81
Participating Spouse Life Claims Experience Policy Number: 34294

For the Period January 1, 2019 through December 31, 2019 Death Claims

	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1423587	61	09/01/2019	09/17/2019	09/20/2019	$ 3,000.00	$ 1.56	$ 3,001.56
1423884	48	09/10/2019	10/02/2019	10/04/2019	3,000.00	1.97	3,001.97
1427047	64	09/18/2019	09/27/2019	10/01/2019	3,000.00	1.07	3,001.07
1427468	73	09/05/2019	09/30/2019	12/17/2019	3,000.00	8.47	3,008.47
1429205	69	09/09/2019	10/09/2019	10/17/2019	3,000.00	3.12	3,003.12
1432853	61	09/23/2019	10/29/2019	10/31/2019	3,000.00	3.12	3,003.12
1432924	94	09/24/2019	10/29/2019	11/01/2019	3,000.00	3.12	3,003.12
1434263	59	10/06/2019	11/05/2019	11/11/2019	3,000.00	2.96	3,002.96
1435861	54	11/09/2019	11/25/2019	12/02/2019	3,000.00	1.89	3,001.89
1436954	69	11/08/2019	11/19/2019	11/25/2019	3,000.00	1.40	3,001.40
1439654	52	11/29/2019	12/13/2019	12/17/2019	3,000.00	1.48	3,001.48
1439928	85	11/21/2019	12/05/2019	12/09/2019	3,000.00	1.48	3,001.48
1441322	74	11/23/2019	12/12/2019	12/16/2019	3,000.00	1.89	3,001.89
1441577	62	11/22/2019	12/13/2019	12/16/2019	3,000.00	1.97	3,001.97
1442137	57	11/16/2019	12/18/2019	12/19/2019	3,000.00	2.71	3,002.71
					$ 144,000.00	$ 150.96	$ 144,150.96
						2019 IBNR	$ 3,652
			48	Total Claims			$ 147,802.96

Participating Child Life Claims Experience Policy Number: 34294 For the Period January 1, 2019 through December 31, 2019

	Death Claims
	Claim Number				Age at
Death			Date of
Death			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1379176	26	01/19/2019	02/01/2019	02/26/2019	$ 3,000.00	$ 3.12	$ 3,003.12
1389015	0	01/29/2019	03/19/2019	04/18/2019	3,000.00	6.49	3,006.49
1395313	20	04/14/2019	05/10/2019	05/14/2019	3,000.00	2.47	3,002.47
1399864	21	04/16/2019	05/09/2019	05/16/2019	3,000.00	2.47	3,002.47
1406926	23	06/09/2019	06/24/2019	07/01/2019	3,000.00	1.81	3,001.81
1410798	18	04/28/2019	07/05/2019	07/09/2019	3,000.00	5.92	3,005.92
1418775	25	06/15/2019	09/11/2019	09/12/2019	3,000.00	7.32	3,007.32
1420036	17	07/05/2019	08/21/2019	08/23/2019	3,000.00	4.03	3,004.03
1420591	18	01/01/2019	10/09/2019	12/23/2019	3,000.00	29.26	3,029.26
1424589	17	07/23/2019	09/20/2019	09/24/2019	3,000.00	5.18	3,005.18
					$ 30,000.00	$ 68.07	$ 30,068.07
						2019 IBNR	$ 1,526
			10	Total Claims			$ 31,594.07

Participating Basic AD&D - Employee Claims Experience Policy Number: 34294 For the Period January 1, 2019 through December 31, 2019 Accidental Death & Dismemberment Claims

	Claim Number				Age at
Claim			Date of
Claim			Date Notice
Received				Date
Paid			Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1381903	57	01/09/2019	02/14/2019	02/22/2019	$ 74,000.00	$ 89.21	$ 74,089.21
1381908	48	01/25/2019	02/14/2019	02/22/2019	100,000.00	76.71	100,076.71
1410863	55	06/14/2019	07/08/2019	07/11/2019	100,000.00	73.97	100,073.97
1415277	24	05/06/2019	08/30/2019	09/30/2019	100,000.00	402.74	100,402.74
1417994	64	08/08/2019	10/17/2019	12/10/2019	105,000.00	358.49	105,358.49	*
1418386	54	08/11/2019	08/29/2019	09/06/2019	100,000.00	71.23	100,071.23
					$ 579,000.00	$ 1,072.35	$ 580,072.35
						2019 IBNR	$ 65,507
			6	Total Claims			$ 645,579.35
*Includes Additional AD&D Benefit

Participating Basic AD&D - Dependent Claims Experience Policy Number: 34294 For the Period January 1, 2019 through December 31, 2019 Accidental Death & Dismemberment Claims

	Claim Number				Age at
Claim			Date of
Claim				Date Notice
Received				Date
Paid		Insurance
Amount Paid			Interest
Paid		Incurred

Claims

1395381	50	04/13/2019	05/07/2019	05/31/2019	$ 57,000.00	$ 74.96	$ 57,074.96
1410009	61	05/29/2019	07/01/2019	08/21/2019	60,000.00	57.53	60,057.53
1414409	61	07/24/2019	08/14/2019	08/27/2019	40,000.00	37.26	40,037.26
1403731	20	05/10/2019	06/03/2019	06/05/2019	10,000.00	7.12	10,007.12
1406847	22	05/26/2019	06/17/2019	07/10/2019	20,000.00	24.66	20,024.66	*
1420036	17	07/05/2019	08/21/2019	10/07/2019	9,000.00	23.18	9,023.18
					$ 196,000.00	$ 224.71	$ 196,224.71
						2019 IBNR	$ 12,424
			6	Total Claims			$ 208,648.71
*Includes Additional AD&D Benefit

2020 Basic Life & ADD Participating Basic Life Claims Experience Policy Number: 34294 For the Period January 1, 2020 through December 31, 2020

	Death Claims
	Claim Number					Age at
Death			Date of
Death					Date Notice
Received				Date
Paid			Insurance
Amount Paid					Interest
Paid		Incurred

Claims

1402363	56	05/19/2019	06/27/2019	10/14/2020	$ 35,000.00	$ 0.00	$ 35,000.00
1415299	44	06/24/2019	11/12/2020	11/19/2020	50,000.00	705.54	50,705.54
1427625	42	09/24/2019	10/16/2019	01/06/2020	16,500.00	47.01	16,547.01
1428431	48	09/19/2019	10/04/2019	01/08/2020	47,500.00	144.46	47,644.46
1431602	63	10/10/2019	11/14/2019	03/06/2020	50,000.00	202.74	50,202.74
1436178	45	07/29/2019	11/14/2019	10/27/2020	20,000.00	250.17	20,250.17
1439795	70	11/27/2019	12/30/2019	01/07/2020	32,500.00	36.51	32,536.51
1444000	55	11/06/2019	01/13/2020	01/14/2020	44,000.00	83.18	44,083.18
1446333	63	12/07/2019	01/13/2020	01/15/2020	50,000.00	53.42	50,053.42
1446460	67	12/09/2019	01/08/2020	01/13/2020	32,500.00	31.16	32,531.16
1446654	42	12/18/2019	01/09/2020	01/14/2020	50,000.00	36.99	50,036.99
1446656	49	12/16/2019	01/09/2020	01/14/2020	20,000.00	15.89	20,015.89
1446727	60	11/08/2019	01/09/2020	01/15/2020	40,500.00	75.45	40,575.45
1446973	72	12/18/2019	01/27/2020	02/04/2020	22,500.00	29.59	22,529.59
1447201	62	12/03/2019	01/13/2020	02/05/2020	50,000.00	87.67	50,087.67
1447205	59	10/26/2019	01/13/2020	02/27/2020	50,000.00	169.86	50,169.86
1447334	56	12/18/2019	01/14/2020	01/16/2020	25,000.00	19.86	25,019.86
1448340	49	10/07/2019	01/21/2020	07/23/2020	50,000.00	397.26	50,397.26
1448811	69	12/18/2019	02/18/2020	02/20/2020	32,500.00	56.99	32,556.99
1448814	62	01/03/2020	01/30/2020	01/31/2020	50,000.00	38.36	50,038.36
1449342	66	01/02/2020	01/23/2020	01/28/2020	32,500.00	23.15	32,523.15
1449468	59	12/14/2019	01/24/2020	01/29/2020	50,000.00	63.01	50,063.01
1449667	59	01/21/2020	02/07/2020	02/10/2020	40,500.00	22.20	40,522.20
1452594	27	01/22/2020	03/02/2020	03/03/2020	44,000.00	49.42	44,049.42
1453296	41	01/10/2020	02/13/2020	02/14/2020	50,000.00	47.95	50,047.95
1453675	59	02/05/2020	03/19/2020	03/19/2020	47,500.00	55.96	47,555.96
1453749	49	01/30/2020	02/13/2020	02/19/2020	47,500.00	26.03	47,526.03
1453915	39	01/04/2020	02/13/2020	02/17/2020	20,000.00	24.11	20,024.11
1454495	60	02/10/2020	02/24/2020	02/25/2020	50,000.00	20.55	50,020.55
1454805	49	01/31/2020	02/18/2020	02/24/2020	50,000.00	32.88	50,032.88
1455468	55	02/10/2020	03/10/2020	04/17/2020	50,000.00	91.78	50,091.78
1455595	63	02/19/2020	03/05/2020	03/10/2020	50,000.00	27.40	50,027.40
1456705	44	12/03/2019	02/27/2020	03/04/2020	47,500.00	119.73	47,619.73
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2020 through December 31, 2020

	Death Claims
	Claim Number					Age at
Death			Date of
Death					Date Notice
Received				Date
Paid			Insurance
Amount Paid					Interest
Paid		Incurred

Claims

1457976	57	01/18/2020	03/04/2020	03/17/2020	$ 50,000.00	$ 80.82	$ 50,080.82
1458080	71	03/02/2020	08/24/2020	10/14/2020	9,000.00	55.73	9,055.73
1458863	48	03/04/2020	03/31/2020	04/01/2020	30,000.00	23.02	30,023.02
1459221	42	01/27/2020	03/17/2020	04/17/2020	50,000.00	110.96	50,110.96
1459430	69	02/07/2020	05/04/2020	05/29/2020	13,000.00	34.44	13,034.44
1459544	64	11/12/2019	03/12/2020	03/18/2020	50,000.00	173.97	50,173.97
1459893	76	02/27/2020	03/13/2020	03/20/2020	15,000.00	9.04	15,009.04
1460430	57	02/17/2020	03/18/2020	03/23/2020	50,000.00	47.95	50,047.95
1460487	63	11/18/2019	03/18/2020	03/25/2020	44,000.00	154.30	44,154.30
1460783	51	11/16/2019	03/19/2020	03/23/2020	47,500.00	166.58	47,666.58
1460945	30	03/08/2020	03/20/2020	03/26/2020	50,000.00	24.66	50,024.66
1461684	71	03/01/2020	03/24/2020	03/31/2020	22,500.00	18.49	22,518.49
1462692	41	03/21/2020	03/30/2020	04/14/2020	47,500.00	31.23	47,531.23
1463007	73	03/28/2020	04/30/2020	05/04/2020	22,500.00	22.81	22,522.81
1463032	60	08/10/2019	03/31/2020	04/08/2020	50,000.00	331.51	50,331.51
1463329	25	03/15/2020	03/31/2020	04/08/2020	50,000.00	32.88	50,032.88
1464441	67	03/19/2020	04/14/2020	12/28/2020	32,500.00	252.88	32,752.88
1465145	64	03/26/2020	04/29/2020	05/04/2020	50,000.00	53.42	50,053.42
1465283	72	03/19/2020	04/27/2020	05/01/2020	21,375.00	25.18	21,400.18
1465982	64	03/02/2020	04/14/2020	07/07/2020	50,000.00	173.96	50,173.96
1466338	59	04/02/2020	04/15/2020	04/22/2020	40,500.00	22.19	40,522.19
1466892	65	04/15/2020	05/08/2020	05/12/2020	13,000.00	9.61	13,009.61
1467177	46	04/09/2020	04/20/2020	04/23/2020	20,000.00	7.67	20,007.67
1467477	59	04/13/2020	04/24/2020	04/27/2020	50,000.00	19.18	50,019.18
1467548	48	04/13/2020	05/12/2020	05/12/2020	50,000.00	39.73	50,039.73
1468012	60	04/10/2020	04/22/2020	04/29/2020	50,000.00	26.03	50,026.03
1468358	85	03/29/2020	04/24/2020	05/01/2020	15,000.00	13.56	15,013.56
1470084	65	04/16/2020	05/04/2020	05/08/2020	32,500.00	19.59	32,519.59
1470613	55	03/19/2020	05/15/2020	05/18/2020	50,000.00	82.19	50,082.19
1471154	64	04/27/2020	05/11/2020	05/28/2020	44,000.00	37.37	44,037.37
1472028	54	04/13/2020	06/19/2020	06/24/2020	50,000.00	98.63	50,098.63
1473130	47	04/26/2020	05/18/2020	05/21/2020	50,000.00	34.25	50,034.25
1473560	69	03/21/2020	05/19/2020	05/26/2020	13,000.00	23.51	13,023.51
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2020 through December 31, 2020

	Death Claims
	Claim Number					Age at
Death			Date of
Death					Date Notice
Received				Date
Paid			Insurance
Amount Paid					Interest
Paid		Incurred

Claims

1473582	72	12/25/2019	07/09/2020	07/14/2020	$ 22,500.00	$ 124.52	$ 22,624.52
1473840	50	05/15/2020	06/10/2020	06/16/2020	50,000.00	43.84	50,043.84
1473932	69	05/04/2020	05/21/2020	05/26/2020	32,500.00	19.59	32,519.59
1475246	47	03/29/2020	05/28/2020	06/19/2020	44,000.00	98.85	44,098.85
1475247	47	01/27/2020	05/28/2020	06/04/2020	50,000.00	176.72	50,176.72
1475551	64	05/18/2020	06/01/2020	06/10/2020	50,000.00	31.51	50,031.51
1476522	54	06/02/2020	06/24/2020	10/16/2020	50,000.00	186.30	50,186.30
1477157	56	05/12/2020	06/08/2020	09/22/2020	50,000.00	182.19	50,182.19
1477410	71	05/20/2020	06/09/2020	06/15/2020	21,735.00	15.48	21,750.48
1477671	38	05/11/2020	06/24/2020	06/29/2020	50,000.00	67.12	50,067.12
1477827	49	04/26/2020	06/10/2020	06/18/2020	44,000.00	63.89	44,063.89
1479213	29	02/29/2020	06/17/2020	07/01/2020	50,000.00	168.49	50,168.49
1479934	63	06/16/2020	07/10/2020	07/16/2020	50,000.00	41.09	50,041.09
1480968	47	06/13/2020	06/26/2020	09/04/2020	50,000.00	113.70	50,113.70
1481928	64	06/12/2020	06/30/2020	07/07/2020	20,000.00	13.70	20,013.70
1482401	68	06/25/2020	07/09/2020	07/13/2020	21,775.00	10.74	21,785.74
1482535	51	05/22/2020	07/02/2020	07/09/2020	50,000.00	65.75	50,065.75
1483100	62	06/12/2020	07/07/2020	07/10/2020	47,500.00	36.44	47,536.44
1483492	45	07/01/2020	07/08/2020	07/13/2020	40,500.00	13.32	40,513.32
1485423	62	06/16/2020	08/07/2020	08/18/2020	50,000.00	80.88	50,080.88
1486614	56	06/11/2020	07/23/2020	07/28/2020	47,500.00	61.16	47,561.16
1487646	29	07/09/2020	10/14/2020	10/14/2020	50,000.00	132.88	50,132.88
1488248	54	07/10/2020	07/31/2020	11/18/2020	50,000.00	179.45	50,179.45
1488753	59	07/08/2020	08/24/2020	08/26/2020	50,000.00	67.12	50,067.12
1488838	58	07/31/2020	08/20/2020	08/24/2020	50,000.00	32.88	50,032.88
1488935	50	07/14/2020	08/04/2020	08/11/2020	33,500.00	25.70	33,525.70
1489173	58	06/26/2020	08/05/2020	09/15/2020	37,000.00	64.87	37,064.87
1489411	63	07/27/2020	08/19/2020	09/21/2020	50,000.00	76.71	50,076.71
1490562	60	07/28/2020	08/12/2020	08/19/2020	50,000.00	30.14	50,030.14
1490720	64	07/28/2020	08/20/2020	10/30/2020	50,000.00	76.71	50,076.71
1491602	50	08/07/2020	08/26/2020	09/23/2020	47,500.00	61.16	47,561.16
1491653	30	07/12/2020	08/17/2020	10/14/2020	37,000.00	95.29	37,095.29
1491905	47	08/07/2020	08/18/2020	08/26/2020	50,000.00	26.03	50,026.03
Participating Basic Life Claims Experience Policy Number: 34294

For the Period January 1, 2020 through December 31, 2020

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File details come from the government source that posted it. Updated Aug 21, 2026.