| 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 |