Oscar ID Agent Subscriber First Name Subscriber Last Name State On or Off Exchange Tier Plan Lives Effective Date Producer Commission Commission Month Renewal Status County Commission

OSC79900239-01 Rafaela Alejandro Alvarez FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC02486744-01 Rafaela Alexis Exposito FL On HIX Individual Oscar Silver Connect CSR 150 1 2021-01-01 $ 20.00 Jan Renewal 12086 $ 10.00

OSC03087392-01 Rafaela Amy Rodriguez Rosario FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 20.00 Jan Renewal 12127 $ 10.00

OSC79887355-01 Rafaela Ana Rodriguez FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12057 $ 10.00

OSC79897724-01 Rafaela Antonio Rodriguez FL On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79897723-01 Rafaela Ariel Rodriguez FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79827913-01 Rafaela Arnulfo Matute TX On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 22.00 Jan New 48439 $ 10.00

OSC79897655-01 Rafaela Carlos Gottardi FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79866019-01 Rafaela Christofer Montalvo FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12117 $ 10.00

OSC79857699-01 Rafaela Daniel Pinto FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12011 $ 10.00

OSC79866561-01 Rafaela Delia Alvarenga FL On HIX Ind+Spouse Oscar Silver Saver CSR 150 2 2021-01-01 $ 50.00 Jan New 12095 $ 20.00

OSC79797103-01 Rafaela Deyaneira Hernandez Sanchez FL On HIX Ind+Spouse Oscar Silver Saver CSR 150 2 2021-01-01 $ 50.00 Jan New 12117 $ 20.00

OSC79792567-01 Rafaela Diego Perez Lopez FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 25.00 Jan New 12115 $ 10.00

OSC79774757-01 Rafaela Edgardo Quintana FL On HIX Ind+Spouse Oscar Bronze Classic Next 2 2 2021-01-01 $ 50.00 Jan New 12095 $ 20.00

OSC79857024-01 Rafaela Enrique Flores TX On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 22.00 Jan New 48201 $ 10.00

OSC79802145-01 Rafaela Esteban Baltazar FL On HIX Individual Oscar Silver Classic Next CSR 150 1 2021-01-01 $ 25.00 Jan New 12085 $ 10.00

OSC79752205-01 Rafaela Florentino Gutierrez TX On HIX Ind+Child(ren) Oscar Silver Saver 2 CSR 150 6 2021-01-01 $ 110.00 Jan New 48251 $ 60.00

OSC79918163-01 Rafaela Gabriel Jimenez FL On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79900744-01 Rafaela Ivan Gonzalez FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 20.00 Jan Renewal 12127 $ 10.00

OSC79799978-01 Rafaela Jairo Velasquez FL On HIX Individual Oscar Silver Saver CSR 150 1 2021-01-01 $ 25.00 Jan New 12057 $ 10.00

OSC79852473-01 Rafaela Joe Quinones FL On HIX Individual Oscar Silver Saver CSR 150 1 2021-01-01 $ 25.00 Jan New 12081 $ 10.00

OSC79929713-01 Rafaela Jorge Gonzalez Milian FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79759977-01 Rafaela Jose Garcia Tobar TX On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 22.00 Jan New 48157 $ 10.00

OSC79897837-01 Rafaela Jovanny Marrero FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12097 $ 10.00

OSC79758283-01 Rafaela Juan De Dios Garcia Puertas TX On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 22.00 Jan New 48029 $ 10.00

OSC79887179-01 Rafaela Julio Cruz FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12095 $ 10.00

OSC79922063-01 Rafaela Liliana Fierro FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79891133-01 Rafaela Livan Sanchez Vega FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12057 $ 10.00

OSC79828312-01 Rafaela Maria Pacheco TX On HIX Ind+Spouse Oscar Bronze Classic Next 2 2 2021-01-01 $ 44.00 Jan New 48113 $ 20.00

OSC79923266-01 Rafaela Maria Sariol FL On HIX Individual Oscar Silver Classic Copay CSR 150 1 2021-01-01 $ 25.00 Jan New 12069 $ 10.00

OSC79819888-01 Rafaela Maria Martinez FL On HIX Individual Oscar Silver Connect CSR 150 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79923257-01 Rafaela Maria Montiel FL On HIX Individual Oscar Bronze Classic 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79782362-01 Rafaela Mariana Hernandez Perez FL On HIX Ind+Child(ren) Oscar Bronze Classic Next 3 2021-01-01 $ 75.00 Jan New 12099 $ 30.00

OSC02601946-01 Rafaela Maribel Acosta FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 20.00 Jan Renewal 12086 $ 10.00

OSC79897287-01 Rafaela Mario Garcia FL On HIX Individual Oscar Silver Connect CSR 200 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79819230-01 Rafaela Maritza Reategui FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 25.00 Jan New 12099 $ 10.00

OSC79863175-01 Rafaela Melida Calloway FL On HIX Individual Oscar Bronze Classic Next 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79936381-01 Rafaela Mireya Blanco FL On HIX Individual Oscar Silver Classic Next CSR 150 1 2021-01-01 $ 25.00 Jan New 12097 $ 10.00

OSC79862776-01 Rafaela Nancy Medina Urbina FL On HIX Ind+Child(ren) Oscar Silver Classic Next CSR 150 3 2021-01-01 $ 75.00 Jan New 12095 $ 30.00

OSC79865534-01 Rafaela Omayra Sanchez FL On HIX Individual Oscar Bronze Classic Next 2 1 2021-01-01 $ 25.00 Jan New 12083 $ 10.00

OSC79926938-01 Rafaela Osnel Alvarez Molina FL On HIX Ind+Child(ren) Oscar Bronze Classic Next 2 2021-01-01 $ 50.00 Jan New 12086 $ 20.00

OSC79760479-01 Rafaela Pedro Avalos Salazar TX On HIX Family Oscar Bronze Classic PCP Copay 3 2021-01-01 $ 66.00 Jan New 48113 $ 30.00

OSC79755670-01 Rafaela Roberth Jimenez FL On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 25.00 Jan New 12097 $ 10.00

OSC79889187-01 Rafaela Rosa Sierra FL On HIX Individual Oscar Silver Connect CSR 150 1 2021-01-01 $ 25.00 Jan New 12086 $ 10.00

OSC79774380-01 Rafaela Rosa Esquivel Martinez TX On HIX Ind+Child(ren) Oscar Bronze Classic Next 2 2 2021-01-01 $ 44.00 Jan New 48091 $ 20.00

OSC79865992-01 Rafaela Rosy Lozada Ledezma FL On HIX Ind+Spouse Oscar Bronze Classic 2 2021-01-01 $ 50.00 Jan New 12081 $ 20.00

OSC79828344-01 Rafaela Roy De Hoyos TX On HIX Individual Oscar Bronze Classic PCP Copay 1 2021-01-01 $ 22.00 Jan New 48029 $ 10.00

OSC79796590-01 Rafaela Suheily Vega Casanova FL On HIX Ind+Child(ren) Oscar Bronze Classic Next 2 2021-01-01 $ 50.00 Jan New 12111 $ 20.00

$ 670.00

Adv $ (1,560.00)

$ (890.00)

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 1 of 13
state commission members is_renewal oscar_id Start Date - Jan mem_fname mem_lname is_on_exchange plan_name Total

FL $ 10 1 FALSE OSC79900239-01 1/1/21 Alejandro Alvarez TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 10 1 TRUE OSC02486744-01 1/1/21 Alexis Exposito TRUE Oscar Silver Connect CSR 150 Rafaela

FL $ 20 2 FALSE OSC79896193-01 2/1/21 Alina Rodriguez Cabezas TRUE Oscar Bronze Classic Next Rafaela

FL $ 10 1 TRUE OSC03087392-01 1/1/21 Amy Rodriguez Rosario TRUE Oscar Bronze Classic Next Rafaela

FL $ 10 1 FALSE OSC79887355-01 1/1/21 Ana Rodriguez TRUE Oscar Bronze Classic Next Rafaela

FL $ 10 1 FALSE OSC79897724-01 1/1/21 Antonio Rodriguez TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79897723-01 1/1/21 Ariel Rodriguez TRUE Oscar Bronze Classic Next Rafaela

FL $ 30 3 FALSE OSC79740915-01 2/1/21 Arizaida Montejo TRUE Oscar Bronze Classic Next Rafaela

TX $ 10 1 FALSE OSC79827913-01 1/1/21 Arnulfo Matute TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79738435-01 3/1/21 Carlos Gottardi TRUE Oscar Bronze Classic Next 2 Rafaela

TX $ 10 1 FALSE OSC79754392-01 1/1/21 Carmen Salazar- TRUE Oscar Bronze HDHP Rafaela

FL $ 10 1 FALSE OSC79857699-01 1/1/21 Daniel Pinto TRUE Oscar Bronze Classic Next Rafaela

FL $ 20 2 FALSE OSC79866561-01 1/1/21 Delia Alvarenga TRUE Oscar Silver Saver CSR 150 Rafaela

FL $ 10 1 TRUE OSC02602522-01 1/1/21 Delic Aviles TRUE Oscar Silver Saver CSR 150 Rafaela

FL $ 20 2 FALSE OSC79797103-01 1/1/21 Deyaneira Hernandez Sanchez TRUE Oscar Silver Saver CSR 150 Rafaela

FL $ 10 1 FALSE OSC79792567-01 1/1/21 Diego Perez Lopez TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 20 2 FALSE OSC79774757-01 1/1/21 Edgardo Quintana TRUE Oscar Bronze Classic Next 2 Rafaela

TX $ 10 1 FALSE OSC79857024-01 1/1/21 Enrique Flores TRUE Oscar Bronze Classic PCP Copay Rafaela

TX $ 60 6 FALSE OSC79752205-01 1/1/21 Florentino Gutierrez TRUE Oscar Silver Saver 2 CSR 150 Rafaela

FL $ 10 1 TRUE OSC79900744-01 1/1/21 Ivan Gonzalez TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 10 1 FALSE OSC79799978-01 1/1/21 Jairo Velasquez TRUE Oscar Silver Saver CSR 150 Rafaela

FL $ 10 1 FALSE OSC79929713-01 1/1/21 Jorge Gonzalez Milian TRUE Oscar Bronze Classic Next Rafaela

TX $ 10 1 FALSE OSC79759977-01 1/1/21 Jose Garcia Tobar TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79897837-01 1/1/21 Jovanny Marrero TRUE Oscar Bronze Classic Next Rafaela

TX $ 10 1 FALSE OSC79758283-01 1/1/21 Juan De Dios Garcia Puertas TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79887179-01 1/1/21 Julio Cruz TRUE Oscar Bronze Classic Next Rafaela

FL $ 10 1 FALSE OSC79867928-01 2/1/21 Lazara Dominguez TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 10 1 FALSE OSC79922063-01 1/1/21 Liliana Fierro TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 10 1 FALSE OSC79891133-01 1/1/21 Livan Sanchez Vega TRUE Oscar Bronze Classic Next Rafaela

FL $ 10 1 FALSE OSC79720216-01 1/1/21 Lucia Rodriguez Otero TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 20 2 FALSE OSC79867968-01 2/1/21 Mara Franquiz TRUE Oscar Bronze HDHP Rafaela

TX $ 20 2 FALSE OSC79828312-01 1/1/21 Maria Pacheco TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 10 1 FALSE OSC79923266-01 1/1/21 Maria Sariol TRUE Oscar Silver Classic Copay CSR 150 Rafaela

FL $ 10 1 FALSE OSC79819888-01 1/1/21 Maria Martinez TRUE Oscar Silver Connect CSR 150 Rafaela

FL $ 30 3 FALSE OSC79782362-01 1/1/21 Mariana Hernandez Perez TRUE Oscar Bronze Classic Next Rafaela

FL $ 10 1 TRUE OSC02601946-01 1/1/21 Maribel Acosta TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 10 1 FALSE OSC79897287-01 1/1/21 Mario Garcia TRUE Oscar Silver Connect CSR 200 Rafaela

FL $ 10 1 FALSE OSC79819230-01 1/1/21 Maritza Reategui TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 10 1 FALSE OSC79863175-01 1/1/21 Melida Calloway TRUE Oscar Bronze Classic Next Rafaela

FL $ 10 1 TRUE OSC79936381-01 1/1/21 Mireya Blanco TRUE Oscar Bronze Classic Next Rafaela

TX $ - 0 FALSE OSC79708696-01 1/8/21 Olivia Garcia TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79865534-01 1/1/21 Omayra Sanchez TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 20 2 FALSE OSC79926938-01 1/1/21 Osnel Alvarez Molina TRUE Oscar Bronze Classic Next Rafaela

TX $ 30 3 FALSE OSC79760479-01 1/1/21 Pedro Avalos Salazar TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79755670-01 1/1/21 Roberth Jimenez TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79889187-01 1/1/21 Rosa Sierra TRUE Oscar Silver Connect CSR 150 Rafaela

TX $ 20 2 FALSE OSC79774380-01 1/1/21 Rosa Esquivel Martinez TRUE Oscar Bronze Classic Next 2 Rafaela

TX $ 10 1 FALSE OSC79752207-01 1/1/21 Rosa Palamantes TRUE Oscar Silver Classic Copay CSR 150 Rafaela

FL $ 20 2 FALSE OSC79865992-01 1/1/21 Rosy Lozada Ledezma TRUE Oscar Bronze Classic Rafaela

TX $ 10 1 FALSE OSC79828344-01 1/1/21 Roy De Hoyos TRUE Oscar Bronze Classic PCP Copay Rafaela

FL $ 10 1 FALSE OSC79838617-01 1/1/21 Sasha Martinez TRUE Oscar Silver Saver CSR 150 Rafaela

FL $ 10 1 FALSE OSC79762270-01 2/1/21 Sonia Romero TRUE Oscar Bronze Classic Next 2 Rafaela

FL $ 20 2 FALSE OSC79796590-01 1/1/21 Suheily Vega Casanova TRUE Oscar Bronze Classic Next Rafaela

TX $ 10 1 FALSE OSC79795223-01 1/1/21 Yamilet Lopez TRUE Oscar Bronze Classic PCP Copay Rafaela

$ 740

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 2 of 13
Subscriber ID Agent Month Subscriber Plan Member Count Effective Date Term Date Premium Paid CommissionPayment Policy Class Original Eff. Date

FL-0010594347 Rafaela January-2021 CABRERA MONTES DE OCA, ALEJANDRO Core Care Bronze 4 1 01/01/2021 $ 339.78 $ 10.00 OEP 01/01/2021

FL-0010966720 Rafaela January-2021 PASSO BARROS, BEDOUTH Core Care Bronze 4 1 01/01/2021 $ 493.01 $ 10.00 OEP 01/01/2021

FL-0011048964 Rafaela January-2021 SOTO VAZQUEZ, MIGUEL ANGEL Core Care Bronze 4 1 01/01/2021 $ 434.86 $ 10.00 OEP 01/01/2021

FL-0011344519 Rafaela January-2021 PAREDES, ESMIEL Core Care Bronze 4 1 01/01/2021 $ 302.70 $ 10.00 OEP 01/01/2021

FL-0011439680 Rafaela January-2021 VELASQUEZ, JOSE Core Care Bronze 5 1 01/01/2021 $ 388.73 $ 10.00 OEP 01/01/2021

TX-0003884009 Rafaela January-2021 PALOMARES, MARIA Constant Care Silver 2 100 1 01/01/2021 $ 956.42 $ 10.00 OEP 01/01/2021

TX-0006999224 Rafaela January-2021 RAMOS, ROSA Constant Care Silver 4 100 1 01/01/2021 $ 931.40 $ 10.00 OEP 01/01/2021

TX-0007037927 Rafaela January-2021 RODRIGUEZ, DAVID Constant Care Silver 4 100 1 01/01/2021 $ 390.61 $ 10.00 OEP 01/01/2021

TX-0008032138 Rafaela January-2021 ROJAS, JUAN MANUEL Core Care Bronze 4 1 01/01/2021 $ 716.58 $ 10.00 OEP 01/01/2021

TX-0008177803 Rafaela January-2021 FLORES, CELIA Core Care Bronze 4 1 01/01/2021 $ 557.26 $ 10.00 OEP 01/01/2021

TX-0008213884 Rafaela January-2021 JUSTINIANI, RAFAEL Constant Care Silver 4 100 1 01/01/2021 $ 906.47 $ 10.00 OEP 01/01/2021

TX-0008395747 Rafaela January-2021 MEJIA, JOSE Constant Care Silver 1 100 + Vision 3 01/01/2021 $ 1,891.38 $ 30.00 OEP 01/01/2021

TX-0008543275 Rafaela January-2021 INFANTE, PERLA Core Care Bronze 4 2 01/01/2021 $ 629.42 $ 20.00 OEP 01/01/2021

TX-0008565819 Rafaela January-2021 CONTRERAS, AGUSTIN Constant Care Silver 1 100 1 01/01/2021 $ 326.76 $ 10.00 OEP 01/01/2021

TX-0008737619 Rafaela January-2021 GOMEZ, LIXANDER Core Care Bronze 4 1 01/01/2021 $ 282.57 $ 10.00 OEP 01/01/2021

TX-0008757597 Rafaela January-2021 LOPEZ, CESARIO Constant Care Silver 4 100 1 01/01/2021 $ 1,640.40 $ 10.00 OEP 01/01/2021

TX-0008840795 Rafaela January-2021 SANCHEZ DAVILA, JORGE Constant Care Silver 2 100 2 01/01/2021 $ 1,666.40 $ 20.00 OEP 01/01/2021

TX-0008868997 Rafaela January-2021 FIERRO, YADIRA Constant Care Silver 4 100 3 01/01/2021 $ 1,753.59 $ 30.00 OEP 01/01/2021

TX-0008879940 Rafaela January-2021 OLIVEROS, ROBERTO Constant Care Silver 4 100 1 01/01/2021 $ 960.81 $ 10.00 OEP 01/01/2021

TX-0008922413 Rafaela January-2021 GARZA, ALEJANDRO Core Care Bronze 4 2 01/01/2021 $ 547.34 $ 20.00 OEP 01/01/2021

TX-0009014717 Rafaela January-2021 PANTOJA, MARIA Constant Care Silver 4 100 1 01/01/2021 $ 847.22 $ 10.00 OEP 01/01/2021

TX-0009040603 Rafaela January-2021 GAITAN, EDGAR Core Care Bronze 4 2 01/01/2021 $ 883.56 $ 20.00 OEP 01/01/2021

TX-0009047658 Rafaela January-2021 CACHO, IRZA Core Care Bronze 4 4 01/01/2021 $ 913.41 $ 40.00 OEP 01/01/2021

TX-0009174069 Rafaela January-2021 GALINDO, MIGUEL A Core Care Bronze 4 3 01/01/2021 $ 1,318.02 $ 30.00 OEP 01/01/2021

TX-0009180373 Rafaela January-2021 HERNANDEZ, CARLOS Core Care Bronze 4 1 01/01/2021 $ 310.86 $ 10.00 OEP 01/01/2021

TX-0009230459 Rafaela January-2021 REQUENES, CAROLINA Constant Care Silver 4 100 1 01/01/2021 $ 243.91 $ 10.00 OEP 01/01/2021

TX-0009308589 Rafaela January-2021 COVARRUBIA, BLANCA E Constant Care Silver 4 100 1 01/01/2021 $ 537.58 $ 10.00 OEP 01/01/2021

TX-0009365929 Rafaela January-2021 QUEZADA, MIGUEL Core Care Bronze 4 3 01/01/2021 $ 1,292.72 $ 30.00 OEP 01/01/2021

TX-0009374884 Rafaela January-2021 PUENTES, PORFIRIO Constant Care Silver 4 100 2 01/01/2021 $ 1,088.18 $ 20.00 OEP 01/01/2021

$ 450.00

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 3 of 13
Agent Month Subscriber Plan Subscriber ID Member Count Effective Date Term Date Policy Class Eff. Date Commission

Rafaela Feb-21 ALONSO, JOAQUIN Core Care Bronze 4 FL-0011179963 1 1/1/21 OEP 1/1/21 $ 10.00

Rafaela Jan-21 ALONSO, JOAQUIN Core Care Bronze 4 FL-0011179963 1 1/1/21 OEP 1/1/21 $ 10.00

Rafaela Jan-21 ASCENCIO BIBIAN, MA GUADALUPE Constant Care Silver 1 100 + Vision TX-0008397276 1 1/1/21 1/31/21 OEP 1/1/21 $ 10.00

Rafaela Feb-21 CASTRO, ENRIQUE Constant Care Silver 2 100 TX-0009211218 5 1/1/21 OEP 1/1/21 $ 50.00

Rafaela Jan-21 CASTRO, ENRIQUE Constant Care Silver 2 100 TX-0009211218 5 1/1/21 OEP 1/1/21 $ 50.00

Rafaela Feb-21 GALVAN, PAULA Constant Care Silver 4 100 TX-0009112819 1 1/1/21 OEP 1/1/21 $ 10.00

Rafaela Feb-21 GARCIA, EVELYN Core Care Bronze 4 TX-0008875261 2 2/1/21 SEP 1/1/21 $ 20.00

Rafaela Feb-21 GONZALEZ, NIDIA Core Care Bronze 4 TX-0003147020 2 2/1/21 SEP 2/1/21 $ 20.00

Rafaela Feb-21 MENDEZ, JOSE ANGEL Core Care Bronze 2 TX-0007499217 2 2/1/21 RENEWAL 1/1/18 $ 20.00

Rafaela Feb-21 RAMIREZ, RUBEN Constant Care Silver 1 100 TX-0006798336 2 1/1/21 OEP 1/1/21 $ 20.00

Rafaela Jan-21 RAMIREZ, RUBEN Constant Care Silver 1 100 TX-0006798336 2 1/1/21 OEP 1/1/21 $ 20.00

Rafaela Jan-21 RODRIGUEZ, CRISTIAN Constant Care Silver 4 100 TX-0007978545 1 1/1/21 OEP 1/1/21 $ 10.00

Rafaela Feb-21 SANCHEZ, SANDRA Core Care Bronze 4 TX-0009240281 1 2/1/21 SEP 2/1/21 $ 10.00

Rafaela February-2021 SOTO VAZQUEZ, MIGUEL ANGEL Core Care Bronze 4 FL-0011048964 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 GALINDO, MIGUEL A Core Care Bronze 4 TX-0009174069 3 01/01/2021 OEP 01/01/2021 $ 30.00

Rafaela February-2021 GAITAN, EDGAR Core Care Bronze 4 TX-0009040603 2 01/01/2021 OEP 01/01/2021 $ 20.00

Rafaela February-2021 FIERRO, YADIRA Constant Care Silver 4 100 TX-0008868997 5 01/01/2021 OEP 01/01/2021 $ 50.00

Rafaela February-2021 CABRERA MONTES DE OCA, ALEJANDRO Core Care Bronze 4 FL-0010594347 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 VELASQUEZ, JOSE Core Care Bronze 5 FL-0011439680 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 QUEZADA, MIGUEL Core Care Bronze 4 TX-0009365929 3 01/01/2021 OEP 01/01/2021 $ 30.00

Rafaela February-2021 RAMOS, ROSA Constant Care Silver 4 100 TX-0006999224 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 PAREDES, ESMIEL Core Care Bronze 4 FL-0011344519 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 PASSO BARROS, BEDOUTH Core Care Bronze 4 FL-0010966720 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 PANTOJA, MARIA Constant Care Silver 4 100 TX-0009014717 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 CONTRERAS, AGUSTIN Constant Care Silver 1 100 TX-0008565819 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 PALOMARES, MARIA Constant Care Silver 2 100 TX-0003884009 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 SANCHEZ DAVILA, JORGE Constant Care Silver 2 100 TX-0008840795 3 01/01/2021 OEP 01/01/2021 $ 30.00

Rafaela February-2021 HERNANDEZ, CARLOS Core Care Bronze 4 TX-0009180373 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 ROJAS, JUAN MANUEL Core Care Bronze 4 TX-0008032138 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 INFANTE, PERLA Core Care Bronze 4 TX-0008543275 2 01/01/2021 OEP 01/01/2021 $ 20.00

Rafaela February-2021 FLORES, CELIA Core Care Bronze 4 TX-0008177803 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 GOMEZ, LIXANDER Core Care Bronze 4 TX-0008737619 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela January-2021 FIERRO, YADIRA Constant Care Silver 4 100 TX-0008868997 2 01/01/2021 OEP 01/01/2021 $ 20.00

Rafaela February-2021 MEJIA, JOSE Constant Care Silver 1 100 + Vision TX-0008395747 2 01/01/2021 OEP 01/01/2021 $ 20.00

Rafaela January-2021 SANCHEZ DAVILA, JORGE Constant Care Silver 2 100 TX-0008840795 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 COVARRUBIA, BLANCA E Constant Care Silver 4 100 TX-0009308589 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 OLIVEROS, ROBERTO Constant Care Silver 4 100 TX-0008879940 1 01/01/2021 OEP 01/01/2021 $ 10.00

Rafaela February-2021 CACHO, IRZA Core Care Bronze 4 TX-0009047658 4 01/01/2021 OEP 01/01/2021 $ 40.00

Rafaela February-2021 GARZA, ALEJANDRO Core Care Bronze 4 TX-0008922413 2 01/01/2021 OEP 01/01/2021 $ 20.00

Rafaela February-2021 JUSTINIANI, RAFAEL ANTONIO Constant Care Silver 4 100 TX-0008213884 1 01/01/2021 OEP 01/01/2021 $ 10.00

$ 710.00

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 4 of 13
Policy ID Member First Name Member Last Name Product Effective Date Term Date Rep ID Amount Agent

200048684-01 ABEL RODRIGUEZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200035710-01 ADRIANA MONROY TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200067630-01 Alfredo Rashor TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200049143-01 AMADO SANCHEZ-MORENO TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200053186-01 ANTONIO FERNIZA TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200044174-01 ARTURO VELAZQUEZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200052399-01 BERTHA MARTINEZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200059800-01 BLANCA SAUCEDO TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200058302-01 Cesar Macias TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200067619-01 DAVID SALOMON TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200066916-01 Diana Minota TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200048669-01 Eusebio Gonzalez Castillo TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200048683-01 GREGORIA DIMAS CARRETO TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200073664-01 HILDA CORDERO AREVALO TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200074596-01 ISAEL MARTINEZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200038769-01 JESUS RAMOS TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200063307-01 JFrancisco Chavez TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200049239-01 Jose Torrez Olguin TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200037758-01 JUAN FUENTES TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200037758-04 juan fuente jr TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200049031-01 Karina Erazo Perez TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200047664-01 KARLA FLOREZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200048679-01 LETICIA ESTRADA TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200073879-01 LETICIA SOSA TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200054306-01 MARGARITA JUAREZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200076751-01 MARIA RODRIGUEZ TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200062398-01 MARIA CAMPOS TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200067553-01 Maria Guzman TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200073441-01 MARIA GARCIA TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200074374-01 Maria Sanchez TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200044799-01 MARTIS GARCIA LOPEZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200074376-01 NATIVIDAD VASQUEZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 5 of 13
200047589-01 Nestavy Perez Ibarra TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200075124-01 Noemi Torres TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200075080-01 RODOLFO RODRIGUEZ TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200070894-01 Ruth Moreno TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200049520-01 VIRGILIA JAVALERA BOJORQUEZ TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200074596-03 Diego Hernandez TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200067619-03 ELQUIS JAVIER PAVON TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200073664-02 IRAM NINO TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200073664-03 IRASEMA NINO TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200035710-03 JACKELIN MONROY TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200035710-06 JIMENA MONROY TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200053185-01 JOSE FERNIZA TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200059800-02 Jose Saucedo TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200049031-03 Joshua Castillo Erazo TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200037758-02 maria fuentes TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200049237-01 Maria Velazquez TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200063307-02 Marta Garcia TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200035710-04 NAYELY MONROY TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200075124-03 Octavio Lara TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200070894-02 Pedro Moreno TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200075124-04 Rafael Lara TX IND 1/1/21 12/31/21 18956521 $10.00 Rafaela

200067630-03 Rigoberto Rashor TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200035710-02 RUBEN MONTOY TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200044174-02 Teresa Velazquez TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200037758-03 yohana fuentes TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

200035710-05 YUREM MONROY TX IND 1/1/21 12/31/21 19339124 $10.00 Rafaela

$580.00

Advance ($890.00)

($310.00)

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 6 of 13
Policy ID Member First Name Member Last Name Product Effective Date Term Date Amount Agent

200035710-01 ADRIANA MONROY TX IND 1/1/21 12/31/21 $ 10 Rafaela

200035710-02 RUBEN MONTOY TX IND 1/1/21 12/31/21 $ 10 Rafaela

200035710-03 JACKELIN MONROY TX IND 1/1/21 12/31/21 $ 10 Rafaela

200035710-04 NAYELY MONROY TX IND 1/1/21 12/31/21 $ 10 Rafaela

200035710-05 YUREM MONROY TX IND 1/1/21 12/31/21 $ 10 Rafaela

200035710-06 JIMENA MONROY TX IND 1/1/21 12/31/21 $ 10 Rafaela

200037758-01 JUAN FUENTES TX IND 1/1/21 2/28/21 $ 10 Rafaela

200037758-02 maria fuentes TX IND 1/1/21 2/28/21 $ 10 Rafaela

200037758-03 yohana fuentes TX IND 1/1/21 2/28/21 $ 10 Rafaela

200037758-04 juan fuente jr TX IND 1/1/21 2/28/21 $ 10 Rafaela

200038769-01 JESUS RAMOS TX IND 1/1/21 12/31/21 $ 10 Rafaela

200044174-01 ARTURO VELAZQUEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200044174-02 Teresa Velazquez TX IND 1/1/21 12/31/21 $ 10 Rafaela

200044799-01 MARTIS GARCIA LOPEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200047589-01 Nestavy Perez Ibarra TX IND 1/1/21 12/31/21 $ 10 Rafaela

200047664-01 KARLA FLOREZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200048669-01 Eusebio Gonzalez Castillo TX IND 1/1/21 12/31/21 $ 10 Rafaela

200048679-01 LETICIA ESTRADA TX IND 1/1/21 12/31/21 $ 10 Rafaela

200048683-01 GREGORIA DIMAS CARRETO TX IND 1/1/21 12/31/21 $ 10 Rafaela

200048684-01 ABEL RODRIGUEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200049031-01 Karina Erazo Perez TX IND 1/1/21 12/31/21 $ 10 Rafaela

200049031-03 Joshua Castillo Erazo TX IND 1/1/21 12/31/21 $ 10 Rafaela

200049143-01 AMADO SANCHEZ-MORENO TX IND 1/1/21 12/31/21 $ 10 Rafaela

200049237-01 Maria Velazquez TX IND 1/1/21 12/31/21 $ 10 Rafaela

200049239-01 Jose Torrez Olguin TX IND 1/1/21 12/31/21 $ 10 Rafaela

200049520-01 VIRGILIA JAVALERA BOJORQUEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200052399-01 BERTHA MARTINEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200053185-01 JOSE FERNIZA TX IND 1/1/21 12/31/21 $ 10 Rafaela

200053186-01 ANTONIO FERNIZA TX IND 1/1/21 12/31/21 $ 10 Rafaela

200054306-01 MARGARITA JUAREZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200058302-01 Cesar Macias TX IND 1/1/21 12/31/21 $ 10 Rafaela

200059800-01 BLANCA SAUCEDO TX IND 1/1/21 12/31/21 $ 10 Rafaela

200059800-02 Jose Saucedo TX IND 1/1/21 12/31/21 $ 10 Rafaela

200062398-01 MARIA CAMPOS TX IND 1/1/21 12/31/21 $ 10 Rafaela

200063307-01 JFrancisco Chavez TX IND 1/1/21 12/31/21 $ 10 Rafaela

200063307-02 Marta Garcia TX IND 1/1/21 12/31/21 $ 10 Rafaela

200066916-01 Diana Minota TX IND 1/1/21 12/31/21 $ 10 Rafaela

200067552-01 Alix Navarro Baysa TX IND 1/1/21 12/31/21 $ 10 Rafaela

200067553-01 Maria Guzman TX IND 1/1/21 12/31/21 $ 10 Rafaela

200067619-01 DAVID SALOMON TX IND 1/1/21 12/31/21 $ 10 Rafaela

200067619-03 ELQUIS JAVIER PAVON TX IND 1/1/21 12/31/21 $ 10 Rafaela

200067630-01 Alfredo Rashor TX IND 1/1/21 12/31/21 $ 10 Rafaela

200067630-03 Rigoberto Rashor TX IND 1/1/21 12/31/21 $ 10 Rafaela

200070894-01 Ruth Moreno TX IND 1/1/21 12/31/21 $ 10 Rafaela

200070894-02 Pedro Moreno TX IND 1/1/21 12/31/21 $ 10 Rafaela

200072823-01 Jose Vallecillo TX IND 2/1/21 12/31/21 $ 10 Rafaela

200073441-01 MARIA GARCIA TX IND 1/1/21 12/31/21 $ 10 Rafaela

200073664-01 HILDA CORDERO AREVALO TX IND 1/1/21 12/31/21 $ 10 Rafaela

200073664-02 IRAM NINO TX IND 1/1/21 12/31/21 $ 10 Rafaela

200073664-03 IRASEMA NINO TX IND 1/1/21 12/31/21 $ 10 Rafaela

200073879-01 LETICIA SOSA TX IND 1/1/21 12/31/21 $ 10 Rafaela

200074374-01 Maria Sanchez TX IND 1/1/21 12/31/21 $ 10 Rafaela

200074376-01 NATIVIDAD VASQUEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200074596-01 ISAEL MARTINEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200074596-03 Diego Hernandez TX IND 1/1/21 12/31/21 $ 10 Rafaela

200075080-01 RODOLFO RODRIGUEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200075124-01 Noemi Torres TX IND 1/1/21 12/31/21 $ 10 Rafaela

200075124-03 Octavio Lara TX IND 1/1/21 12/31/21 $ 10 Rafaela

200075124-04 Rafael Lara TX IND 1/1/21 12/31/21 $ 10 Rafaela

200076751-01 MARIA RODRIGUEZ TX IND 1/1/21 12/31/21 $ 10 Rafaela

200081526-01 EUNICE RAMIREZ TX IND 1/1/21 12/31/21 $ 20 Rafaela

200081526-03 ALEXA CASTILLO RAMIREZ TX IND 1/1/21 12/31/21 $ 20 Rafaela

$ 640

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 7 of 13
Subscriber ID Customer Name Product Comm Basis State/ Region Policy Period Premium Code Member Count Commission Agent

2K307H CHARLES, MERCEDES Medical, HMO1 PMPM NC 01/2021 $ - X, CP 1 $ 10.00 Rafaela

2K307H CHARLES, MERCEDES Medical, HMO1 PMPM NC 01/2021 $ 35.76 X, CP 2 $ 20.00 Rafaela

3K77Y5 RAMOS BONACHEA, YAIMA Medical, HOAPIN PMPM FL-N 01/2021 $ 39.82 X, CP 1 $ 10.00 Rafaela

5J693V BERNALDEZ, VERONICA Medical, HOAPIN PMPM FL-N 02/2021 $ 25.38 X, CP 1 $ 10.00 Rafaela

8K778M TORRES, MAITE Medical, HOAPIN PMPM FL-S 01/2021 $ - X, CP 1 $ 10.00 Rafaela

8K778M TORRES, MAITE Medical, HOAPIN PMPM FL-S 01/2021 $ 43.67 X, CP 2 $ 20.00 Rafaela

$ 80.00

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 8 of 13
Subscriber ID Customer Name Product Comm Basis State/ Region Policy Period Premium Member Count Commission Agent

2K307H CHARLES, MERCEDES Medical, HMO1 PMPM NC Feb-21 $ - 1 $ 10.00 Rafaela

2K307H CHARLES, MERCEDES Medical, HMO1 PMPM NC Feb-21 $35.76 2 $ 20.00 Rafaela

3J705J GARCIA, LUIS Medical, HOAPIN PMPM FL-N Jan-21 $ - 2 $ 20.00 Rafaela

3J705J GARCIA, LUIS Medical, HOAPIN PMPM FL-N Jan-21 $975.48 1 $ 10.00 Rafaela

9KC624 PEREZ, GLENDY Medical, HOAPIN PMPM FL-N Feb-21 $26.51 1 $ 10.00 Rafaela

8K7N12 ROLOM CARABALLO, ANGELA Medical, HMO1 PMPM NC Jan-21 $316.85 1 $ 10.00 Rafaela

8K778M TORRES, MAITE Medical, HOAPIN PMPM FL-S Feb-21 $ - 1 $ 10.00 Rafaela

8K778M TORRES, MAITE Medical, HOAPIN PMPM FL-S Feb-21 $43.67 2 $ 20.00 Rafaela

Feb $ 110.00

Jan $ 80.00

Subtotal $ 190.00

Adv $ (310.00)

Total $ (120.00)

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 9 of 13
Premium Month Effective Date Name Contract Number Product Commission Amount Original Effective Date Termination Date Termination Reason Premium Agent

1 1/1/21 Ada M Ruiz Morales 100499985-20210101-867587 94% AV Level Silver Plan $10.00 1/1/21 12/31/21 Benefit End Date $439.30 Rafaela

1 1/1/21 Albanys Boggeano 100629707-20210101-1049677 94% AV Level Silver Plan $10.00 1/1/21 12/31/21 Benefit End Date $1,050.84 Rafaela

1 1/1/21 Alejandra Aviles 100322921-20210101-642118 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $269.87 Rafaela

1 1/1/21 Alexander De Jesus 100397183-20210101-732897 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $437.65 Rafaela

1 1/1/21 Angela E Javier Domiguez 100383566-20210101-716417 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $305.35 Rafaela

1 1/1/21 Darinka Mederos 100382784-20210101-715079 94% AV Level Silver Plan $10.00 1/1/21 12/31/21 Benefit End Date $1,165.46 Rafaela

1 1/1/21 David Leon Otero 100294093-20210101-607344 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $312.53 Rafaela

1 1/1/21 Eduardo Cenen 100459331-20210101-808551 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $596.92 Rafaela

1 1/1/21 Eric Natal 100677015-20210101-1110476 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $310.58 Rafaela

1 1/1/21 Fernando Lopez 100314082-20210101-632070 Standard Bronze On Exchange Plan $10.00 1/1/21 1/31/21 Terminated $331.91 Rafaela

1 1/1/21 Jose Rodriguez 100367790-20210101-697480 Standard Bronze On Exchange Plan $10.00 1/1/21 2/28/21 Benefit End Date $926.61 Rafaela

1 1/1/21 Julio R Paredes 100591650-20210101-1003254 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $621.17 Rafaela

1 1/1/21 Lidia Margarita Diaz 100676000-20210101-1106893 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $603.00 Rafaela

1 1/1/21 Mauricio Acosta 100319822-20210101-638641 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $1,219.89 Rafaela

1 1/1/21 Michelle Olivencia 100313921-20210101-631881 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $396.04 Rafaela

1 1/1/21 Milady Rosario 100562804-20210101-968198 94% AV Level Silver Plan $10.00 1/1/21 12/31/21 Benefit End Date $992.67 Rafaela

1 1/1/21 Norma Caceres 100520042-20210101-896359 94% AV Level Silver Plan $10.00 1/1/21 12/31/21 Benefit End Date $861.31 Rafaela

1 1/1/21 Oscar A Granados 100670498-20210101-1098613 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $777.75 Rafaela

1 1/1/21 Rafaela Valiente 100367851-20210101-697547 94% AV Level Silver Plan $10.00 1/1/21 12/31/21 Benefit End Date $726.19 Rafaela

1 1/1/21 Raul Perez Menendez 100559191-20210101-963736 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $715.87 Rafaela

1 1/1/21 Rene Hernandez Castellanos 100673611-20210101-1102406 Standard Bronze On Exchange Plan $10.00 1/1/21 1/13/21 Terminated $312.68 Rafaela

1 1/1/21 Teresita Farres 100485866-20210101-850659 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $699.42 Rafaela

1 1/1/21 Wilberto Suarez Rosario 100293904-20210101-607023 Standard Bronze On Exchange Plan $10.00 1/1/21 12/31/21 Benefit End Date $713.36 Rafaela

1 1/1/21 Zulima Gonzalez 100354002-20210101-680404 94% AV Level Silver Plan $10.00 1/1/21 12/31/21 Benefit End Date $407.00 Rafaela

$240.00

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 10 of

13
Members Subscriber Group Subname Paid To Date Effective Date Month Policy Product Commission Rate Total Commission Agent

4 925489480 AVILA, MARIBEL 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ 40.00 Rafaela

1 925454164 BRICENO ALTUNA, PEDRO 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ 10.00 Rafaela

1 925448921 DURAN DE LUNA, ALEJANDRO 20210301 20210101 2 BLUEADVANTAGE^ $ 10.00 $ 10.00 Rafaela

2 923928964 FLORES, ISAI 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ 20.00 Rafaela

2 925428611 GARCIA, JOSE 20210301 20201101 4 BLUEADVANTAGE^ $ 10.00 $ 20.00 Rafaela

2 925498399 LOPEZ, MAXIMA 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ 20.00 Rafaela

2 925498399 LOPEZ, MAXIMA 20210201 20210101 1 MYBLUEHEALTH^ $ 10.00 $ 20.00 Rafaela

5 925446268 LUNA, BALTAZAR 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ 50.00 Rafaela

1 924067787 RINCON, BLAS 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ 10.00 Rafaela

-1 924067787 RINCON, BLAS 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ (10.00) Rafaela

5 925448075 TABARES ACOSTA, NABOR 20210301 20210101 2 BLUEADVANTAGE^ $ 10.00 $ 50.00 Rafaela

1 925447975 TAPIA, RAUL 20210301 20210101 2 MYBLUEHEALTH^ $ 10.00 $ 10.00 Rafaela

4 925454799 VASQUEZ, MARGARITA 20210301 20210101 2 BLUEADVANTAGE^ $ 10.00 $ 40.00 Rafaela

1 925450229 VILLANUEVA, HUMBERTO 20210301 20210101 2 BLUEADVANTAGE^ $ 10.00 $ 10.00 Rafaela

$ 300.00

Adv $ (120.00)

$ 180.00

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 11 of

13
STATE TYPE POLICY NUMBERPRODUCT TYPECO NAME / GROUP NAME Agent COMM EFF DATETIER LEVEL AOR CHANGE COMM TYPE OI SPLIT % AMT DUE DATE NO MOS MBR CNT INT PRM ADV BAL PREMIUM RECEIVED STL-TO-DT PREMIUM STL-TO-DT-COMMISSION CURRENT COMMISSION COMMENTS

GA INDIVIDUAL 679W07668 MED C5 ALEXIS FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 332.02 0 0 10 NEW

GA INDIVIDUAL 619W07882 MED C5 ALEXIS FERNANDEZ Rafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 332.02 0 0 10

GA INDIVIDUAL 679W07668 MED C5 ALEXIS FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 0 0 0 0 CX-0221

GA INDIVIDUAL 679W07668 MED C5 ALEXIS FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1- 1 0 0 -4.88 0 0 -10 CX-0221

GA INDIVIDUAL 619W07882 MED C5 ALEXIS FERNANDEZ Rafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 332.02 0 0 10

GA INDIVIDUAL 679W07668 MED C5 ALEXIS FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0121

GA INDIVIDUAL 221W07772 MED C5 AMPARO LOBATON Rafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 320.54 0 0 10

GA INDIVIDUAL 221W07772 MED C5 AMPARO LOBATON Rafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 320.54 0 0 10

GA INDIVIDUAL 802W07619 MED C5 ASHIS FERRERA CARR Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 261.85 0 0 10 NEW

GA INDIVIDUAL 802W07619 MED C5 ASHIS FERRERA CARR Rafaela 1/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 261.85 0 0 10

GA INDIVIDUAL 802W07619 MED C5 ASHIS FERRERA CARR Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0421

GA INDIVIDUAL 768W07736 MED C5 CANDIDA VASQUEZ Rafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 480.81 0 0 10

GA INDIVIDUAL 768W07736 MED C5 CANDIDA VASQUEZ Rafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 480.81 0 0 10

GA INDIVIDUAL 679W07668 MED C5 CARLA FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 261.85 0 0 10 NEW

GA INDIVIDUAL 679W07668 MED C5 CARLA FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 0 0 0 0 CX-0221

GA INDIVIDUAL 679W07668 MED C5 CARLA FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1- 1 0 0 -3.84 0 0 -10 CX-0221

GA INDIVIDUAL 679W07668 MED C5 CARLA FERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0121

GA INDIVIDUAL 740W06753 MED C5 DELFINA CASTILLO Rafaela 1/1/21 YES PMGA17 N 100 2/1/21 1 1 0 0 983.4 0 0 10

GA INDIVIDUAL 231W08191 MED C5 DELFINA CASTILLO Rafaela 4/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 NEW

GA INDIVIDUAL 740W06753 MED C5 DELFINA CASTILLO Rafaela 1/1/21 YES PMGA17 N 100 3/1/21 1 1 0 0 983.4 0 0 10

GA INDIVIDUAL 407W07834 MED C5 ENRIQUE ELORZARafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 481.59 0 0 10

GA INDIVIDUAL 407W07834 MED C5 ENRIQUE ELORZARafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 481.59 0 0 10

GA INDIVIDUAL 679W07668 MED C5 ERMELIN HERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 513.44 0 0 10 NEW

GA INDIVIDUAL 679W07668 MED C5 ERMELIN HERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 0 0 0 0 CX-0221

GA INDIVIDUAL 679W07668 MED C5 ERMELIN HERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1- 1 0 0 -7.59 0 0 -10 CX-0221

GA INDIVIDUAL 679W07668 MED C5 ERMELIN HERNANDEZ Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0121

GA INDIVIDUAL 657W07709 MED C5 ESTER HERNANDEZ Rafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 714.8 0 0 10

GA INDIVIDUAL 657W07709 MED C5 ESTER HERNANDEZ Rafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 714.8 0 0 10

GA INDIVIDUAL 740W06753 MED C5 HECTOR ERAZORafaela 1/1/21 YES PMGA17 N 100 2/1/21 1 1 0 0 983.4 0 0 10

GA INDIVIDUAL 740W06753 MED C5 HECTOR ERAZORafaela 1/1/21 YES PMGA17 N 100 3/1/21 1 1 0 0 983.4 0 0 10

GA INDIVIDUAL 221W07772 MED C5 HIPOLIT LOBATON Rafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 920.91 0 0 10

GA INDIVIDUAL 221W07772 MED C5 HIPOLIT LOBATON Rafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 920.91 0 0 10

GA INDIVIDUAL 184W07452 MED C5 JAIME HERNANDEZ PA Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0

GA INDIVIDUAL 184W07452 MED C5 JAIME HERNANDEZ PA Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0121

GA INDIVIDUAL 184W07452 MED C5 JAIME HERNANDEZ PA Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0121

GA INDIVIDUAL 085W07476 MED C5 JAVIER MEJIA Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 320.54 0 0 10

GA INDIVIDUAL 085W07476 MED C5 JAVIER MEJIA Rafaela 1/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 320.54 0 0 10

GA INDIVIDUAL 085W07476 MED C5 JAVIER MEJIA Rafaela 1/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 320.54 0 0 10

GA INDIVIDUAL 802W07619 MED C5 JUAN FERRERA NOVA Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 261.85 0 0 10 NEW

GA INDIVIDUAL 802W07619 MED C5 JUAN FERRERA NOVA Rafaela 1/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 261.85 0 0 10

GA INDIVIDUAL 802W07619 MED C5 JUAN FERRERA NOVA Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0421

GA INDIVIDUAL 802W07619 MED C5 LUIS FERRERA Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 494.27 0 0 10 NEW

GA INDIVIDUAL 802W07619 MED C5 LUIS FERRERA Rafaela 1/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 494.27 0 0 10

GA INDIVIDUAL 802W07619 MED C5 LUIS FERRERA Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0421

GA INDIVIDUAL 221W07772 MED C5 MARIA SILVA Rafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 834.37 0 0 10

GA INDIVIDUAL 221W07772 MED C5 MARIA SILVA Rafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 834.37 0 0 10

GA INDIVIDUAL 507W07620 MED C5 RAYMI FERRERASRafaela 1/1/21 NO PMGA17 N 100 1/1/21 1- 1 0 0 -16.29 0 0 -10 NEW

GA INDIVIDUAL 507W07620 MED C5 RAYMI FERRERASRafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 342.29 0 0 10 NEW

GA INDIVIDUAL 507W07620 MED C5 RAYMI FERRERASRafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0121

GA INDIVIDUAL 507W07620 MED C5 RAYMI FERRERASRafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0121

GA INDIVIDUAL 802W07619 MED C5 SANDRA FERRERA NOVA Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 285.13 0 0 10 NEW

GA INDIVIDUAL 802W07619 MED C5 SANDRA FERRERA NOVA Rafaela 1/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 285.13 0 0 10

GA INDIVIDUAL 802W07619 MED C5 SANDRA FERRERA NOVA Rafaela 1/1/21 NO PMGA17 N 100 1 0 0 0 0 0 0 CX-0421

GA INDIVIDUAL 768W07736 MED C5 SERGIO LIZARRAGA Rafaela 2/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 961.62 0 0 10

GA INDIVIDUAL 768W07736 MED C5 SERGIO LIZARRAGA Rafaela 2/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 961.62 0 0 10

GA INDIVIDUAL 297W06753 MED C5 SOIBRO PEREZ Rafaela 1/1/21 YES PMGA17 N 100 3/1/21 1 1 0 0 304.76 0 0 10 REINSTATE

GA INDIVIDUAL 015W07625 MED C5 WILSON CRUZ Rafaela 1/1/21 NO PMGA17 N 100 1/1/21 1 1 0 0 684.35 0 0 10 NEW

GA INDIVIDUAL 015W07625 MED C5 WILSON CRUZ Rafaela 1/1/21 NO PMGA17 N 100 2/1/21 1 1 0 0 684.35 0 0 10

GA INDIVIDUAL 015W07625 MED C5 WILSON CRUZ Rafaela 1/1/21 NO PMGA17 N 100 3/1/21 1 1 0 0 684.35 0 0 10

350

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 12 of

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First Name Last Name State Members Effective Date Commission Date Statement Date Policy Number Commission Agent

Antonio Gonzalez FL 2 1/1/21 1/1/21 1/31/21 U94136072 $ 20.00 Rafaela

Ramiro Martinez TX 1 1/1/20 1/1/21 1/31/21 U93177394 $ 10.00 Rafaela

Yordansy Hernandez FL 1 12/1/20 12/1/20 1/31/21 U94308271 $ 10.00 Rafaela 

Elena Apodaca TX 1 9/1/16 1/1/21 1/31/21 U90749218 $ 10.00 Rafaela 

Juana Villanueva TX 2 3/1/17 1/1/21 1/31/21 U90846791 $ 20.00 Rafaela 

Juana Noriega FL 1 1/1/17 1/1/21 1/31/21 U91094981 $ 10.00 Rafaela 

Herminia Palomares TX 1 1/1/18 1/1/21 1/31/21 U92127686 $ 10.00 Rafaela 

Dora Creado TX 1 1/1/19 1/1/21 1/31/21 U92435387 $ 10.00 Rafaela 

Silvia Gonzalez FL 1 1/1/21 1/1/21 1/31/21 U92497596 $ 10.00 Rafaela 

Luz Castellon TX 1 1/1/19 1/1/21 1/31/21 U92623075 $ 10.00 Rafaela 

Telma Cruz GA 1 1/1/19 1/1/21 1/31/21 U92750499 $ 10.00 Rafaela 

Elian Guerra TX 1 3/1/19 1/1/21 1/31/21 U92944382 $ 10.00 Rafaela 

Rene Villarreal TX 1 1/1/20 1/1/21 1/31/21 U93172855 $ 10.00 Rafaela 

Yuleysis Diaz Medina FL 1 1/1/20 1/1/21 1/31/21 U93481625 $ 10.00 Rafaela 

Jesus Oliva Lagos TX 2 1/1/20 1/1/21 1/31/21 U93522897 $ 20.00 Rafaela 

Damaris Mora FL 1 1/1/20 1/1/21 1/31/21 U93583639 $ 10.00 Rafaela 

Ricardo Ramos TX 1 2/1/20 1/1/21 1/31/21 U93630704 $ 10.00 Rafaela 

Jose Diaz Quintero FL 1 4/1/20 1/1/21 1/31/21 U93720169 $ 10.00 Rafaela 

Alexander Morales GA 1 6/1/20 1/1/21 1/31/21 U93798390 $ 10.00 Rafaela 

Ducila Ortega FL 1 7/1/20 1/1/21 1/31/21 U93812051 $ 10.00 Rafaela 

Carlos Molinero FL 1 1/1/21 1/1/21 1/31/21 U94136809 $ 10.00 Rafaela 

Jose Palacios TX 2 1/1/21 1/1/21 1/31/21 U94139793 $ 20.00 Rafaela 

Juan Perez FL 1 1/1/21 1/1/21 1/31/21 U94171328 $ 10.00 Rafaela 

Itzel Garcia FL 1 1/1/21 1/1/21 1/31/21 U94179063 $ 10.00 Rafaela 

Alexander Alvarez FL 1 1/1/21 1/1/21 1/31/21 U94179529 $ 10.00 Rafaela 

Vladimir Santana FL 2 1/1/21 1/1/21 1/31/21 U94221119 $ 20.00 Rafaela 

Viviana Vargas Vasquez GA 1 1/1/21 1/1/21 1/31/21 U94274040 $ 10.00 Rafaela 

Jorge Aguilar Duarte FL 4 1/1/21 1/1/21 1/31/21 U94298252 $ 40.00 Rafaela 

Luz Rodriguez TX 2 1/1/21 1/1/21 1/31/21 U94340950 $ 20.00 Rafaela 

Adrianna Garza TX 1 1/1/21 1/1/21 1/31/21 U94352523 $ 10.00 Rafaela 

Felicitas De Velasquez FL 2 1/1/21 1/1/21 1/31/21 U94362333 $ 20.00 Rafaela 

Dora Limon TX 1 1/1/21 1/1/21 1/31/21 U94376643 $ 10.00 Rafaela 

Paula Alcantar Torres TX 3 1/1/21 1/1/21 1/31/21 U94376712 $ 30.00 Rafaela 

Vidal Lopez Mendez TX 1 1/1/21 1/1/21 1/31/21 U94426772 $ 10.00 Rafaela 

Juan Alvarado GA 1 1/1/21 1/1/21 1/31/21 U94486475 $ 10.00 Rafaela 

Ray Daly Martinez FL 1 1/1/21 1/1/21 1/31/21 U94533626 $ 10.00 Rafaela 

Roelina Sanchez De Herrera FL 1 8/1/19 1/1/21 1/31/21 U93047098 $ 10.00 Rafaela 

$ 490.00

Case 1:22-cv-22671-CMA Document 117-3 Entered on FLSD Docket 08/15/2023 Page 13 of

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