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IFT394_TO_IA_CAD_201709041.xlsx

KennedyNouHW - Sheet1

EffectiveDate Status EmployeeID ClientID MemberFirstName MemberMiddleName MemberLastName MemberSSN DOB Month DOB_Day DOB_Year Address1 Address2 City State ZipCode Area_Code Home_Phone Email DeductionMethod CustomerDefined Relationship Primary Family_ID UniqueID Plan_Type PID
3/1/99 Add 123123123 176456 Taylor Justin Jeffries 320-22-3145 4 23 1990 123 E Test Drive Milwaukee WI 53005 262 1231230 [email protected] Employer Payroll Deduction P Y 998754 667 Individual PA
1/1/00 Drop 324543210 441234 Chad Wilson Smith 344-11-5413 5 22 1980 540 E Mainest St San Diego CA 92001 000 6464310000 [email protected] Employer Payroll Deduction P Y F777 665 Family PAP
12/31/99 Change 300778890 908765 Alex Arturo Coleson 432-33-3434 2 13 1971 5111 W Arboles Drive Los Angeles CA 92221 949 9110911 [email protected] Employer Sponsored D N F777 654 Family PA
1/2/03 Drop 543098432 784332 Alexandra Marie Samson 655-32-0999 1 6 1963 6800 Main St Santa Barbara CA 92018 000 +19494110114 [email protected] Employer Sponsored D Y F778 332 Family PA
11/11/11 Drop 321543654 301001 Kyle Robert Walker 765-12-5656 3 5 1967 77123 W Faraway Drive Newport Beach CA 92312 858 7896756 [email protected] Employer Payroll Deduction P Y F778 333 Family PA
11/11/17 Add 1 111111 Thomas Edward Brady 123-45-6789 10 10 1977 1 Patriots Place Foxboro MA 2035 619 6191234567 [email protected] Employer Payroll Deduction P Y 1 1 Individual
11/11/17 Add 2 222222 Kennedy S Nou 213-53-8976 12 15 1994 2007 Fruit Tree Ln. Queen Crek AZ 85142 623 6232340458 [email protected] Employer Payroll Deduction S N 665462 665462 Individual
1/1/16 Add P123 123456 Austin Bradley Mork 123456789 2 1 1994 505 W BASELINE RD 2003 Tempe AZ 85283 000 +16024325110 [email protected] Employer Payroll Deduction P Y 198721 198721 Individual PAP
2/1/16 Drop P124 111111 John Wayne Doe 987654321 7 24 1980 1234 FAKE LANE RD Phoenix AZ 85254 602 4023214 [email protected] Employer Sponsored P Y 987111 987111 Individual PA
3/1/16 Add P125 222222 Alice Ann Girl 456789123 9 12 1990 6732 LAKESIDE RD Tucson AZ 85641 000 +14809807632 [email protected] Employer Payroll Deduction P Y 222321 222321 Individual PA
4/3/17 Add P126 333333 Bob Chris Guy 321789654 1 30 1974 1095 MOUNTAIN RD Tempe AZ 85283 602 7915402 [email protected] Employer Payroll Deduction P Y F123 L111 Family PAP
4/3/17 Change P127 444444 Amber Blah Guy 693582471 12 5 1978 1095 MOUNTAIN RD Tempe AZ 85283 602 4715897 [email protected] Employer Sponsored S N F123 L112 Family PAP
11/11/17 Change 3 333333 Luke Skywalker 978-65-4321 11 31 1951 456 Tatooine Place Tatooine AK 2121 234 2349876540 [email protected] Employer Payroll Deduction C Y 3 3 Family
11/11/17 Drop 4 444444 Peter Parker 798-56-2143 10 14 1980 221 Baker St New York City NY 45678 978 9783216547 [email protected] Employer sponsored D N 4 4 Family
11/11/17 Drop 5 555555 Bartholomey Henry Allen 456-12-9783 12 12 1975 1255 Random St. Central City KA 91023 455 4557863542 [email protected] Employer sponsored P Y 5 5 Family