Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldme Page 10 of 18
Description Client Caset GRGt oty Rate Amount
Verification Fee ~ Leonard, Lewis 166972 2.00 50,00 100.00
Medicare First Obligation Fee ~ 166972 1.00 350,00 350.00
Leonard, Lewis
Verification Fee ~ Lewis,Artis 97744 2.00 50.00 100.00
Verification Fee ~ Lewis, hadyvan 167059 2.00 50.00 100.00
Medicare First Obligation Fee - 167059 1.00 350.00 350.00
Lewis, Ladyvan
Medicaid Additional Obligation Fee - 167059 1.00 150.00 150.00
Lewis, Ladyvan
Verification Fee - Lindsey, Sylvia 97676 2,00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 97676 4.00 350.00 350.00
Lindsey, Sylvia
Verification Fee - Long,Harry 167042 2.00 50.00 100.00
Medicare First Obligation Fee - Long,Harry 167042 1.00 350.00 350.00
Verification Fee ~ Lord, Sharon 89877 2.00 50.00 100.00
Medicare First Obligation Fee - 89877 1.00 350.00 350.00
Lord, Sharon
Verification Fee - Lyons,Delores 97736 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee — 97736 1.00 350.00 350.00
Lyons, Delores
verification Fee ~ Machesney, Lois 167087 2.00 50.00 100,00
Medicare First Obligation Fee - 167087 1,00 350,00 350.00
Machesney, Lois
Verification Fee ~ Manville, Janice 97463 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 97463 1.00 350.00 350.00
Manville, Janice
Verification Fee - Mathews, Patricia 167003 2.00 50.00 100.00
Medicare First Obligation Fee - 167003 1.00 350.00 350.00
Mathews, Patricia
Verification Fee - Mcclurg,Bethany 64499 2.00 50.00 100.00
Verification Fee - Mecorritstin,Kelly 166994 2.00 50.00 100.00
Verification Fee ~ Mcelroy,Kenneth 97451 2.00 50,00 100.00
Medicare First Obligation Fee ~ 97451 2.00 350.00 350.00
Mcelroy, Kenneth
Verification Fee - Mckee, Lyman 89999 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 89899 1.00 350.00 350.00
Mckee, Lyman
Verification Fee - Mckinney, Ruth 167076 2.00 50.00 100.00
Medicare First Obligation Fee - 167076 1.00 350.00 350.00
Mckinney, Ruth
Medicaid Additional Obligation Fee - 167076 1.00 150.00 150.00
Mckinney, Ruth
Verification Fee ~ Mcneil, Angela 97485 2.00 50.00 100.00



Invoice Number

628651

Project: BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 13 of 71
Description Client Cased GRGE Qty Rate Amount
Verification Fee - Cravey Melvin 97678 2.00 50.00 100.00
Medicaid First Obligation Fee - Cravey 97678 1.00 350.00 350.00
Melvin
Medicare Additional Obligation Fee - 97678 1.00 150.00 150.00
Cravey Melvin
Verification Fee - Crawford Austin 167046 2.00 50.00 100.00
Medicaid First Obligation Fee - Crawford 167046 1,00 350,00 350.00
Austin
Medicaid Additional Obligation Fee - 167046 1.00 150.00 150.00
Crawford Austin
Verification Fee - Crawford Hollis 90024 2.00 50.00 100.00
Medicare First Obligation Fee - Crawford 90024 1.00 380.00 350.00
Hollis
Verification Fee - Creech Terri 167068 2.00 50.00 100.00
Verification Fee - Crissinger Ronald 97546 2.00 50.00 100.00
Verification Fee - Crissman Gina 97384 2.00 50.00 100.00
Verification Fee - Cronan Isabelle 99764 2.00 50.00 100.00
Medicare First Obligation Fee - Cronan 89764 1.00 350.00 350.00
Tsabelle
Medicaid Additional Obligation Fee - 89764 1.00 150.00 150.00
Cronan Isabelle
Verification Fee - Cross Terry 81466 2.00 50.00 100.00
Medicare First Obligation Fee - Cross 81466 1.00 350.00 350.00
Terry
Verification Fee - Culverhouse Grover 81455, 2.00 50,00 100.00
Medicare First Obligation Fee - 81455 1,00 350.00 350.00
Culverhouse Grover
Verification Fee - Cumming Richard 296242 2.00 50.00 100.00
Verification Fee - Dale Linda 166958 2.00 50.00 100.00
Medicare First Obligation Fee - Dale Linda 166958 1,00 350.00 350.00
Verification Fee - Daniel Marjorie 296243 2.00 50.00 100.00
Medicare First Obligation Fee - Daniel 296243 1.00 350.00 350.00
Marjorie
Verification Fee - Daniell Kevin 97719 2.00 50.00 100.00
Verification Fee - Daniels Ora 89840 2.00 50.00 100.00
Medicaid First Obligation Fee ~ Daniels 89840 1,00 350.00 350.00
ora
Medicare Additional Obligation Fee - 89840 1.00 150.00 150.00
Daniels Ora
Verification Fee - Dantzler John 167065 2,00 50.00 100.00
Medicare First Obligation Fee - Dantzler 167065 1.00 350.00 350.00
John
Verification Fee - Darah William 64474 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 9 of 71
Description Client Case# GRG# ary Rate Amount
Verification Fee ~ Butler Wayne 91371 2.00 50,00 100.00
Verification Fee - Butters Barbara 282786 2.00 50,00 100.00
Medicare First Obligation Fee - Butters 282786 1,00 350.00 350.00
Barbara
Medicaid Additional Obligation Fee - 282786 1,00 150.00 150.00
Butters Barbara
Verification Fee - Buzzell Patricia 1511 2.00 50.00 100.00
Medicare First Obligation Fee - Buzzell 81511 1,00 350.00 350.00
Patricia
Verification Fee - Cain Linda 292405 2.00 50.00 100.00
Verification Fee - Callahan Richard 99929 2.00 50.00 100.00
Medicare First Obligation Fee - Callahan 89929 1,00 350.00 350.00
Richard
Verification Fee ~ Calvert Lorna 81459 2.00 50.00 100.00
Medicare First Obligation Fee - Calvert 81459 1.00 350.00 350.00
Lorna
Verification Fee - Campbell Robert 271253 2.00 50.00 100,00
Medicaid First Obligation Fee - Campbell 271253 1.00 350.00 350.00
Robert
Medicare Additional Obligation Fee ~ 271253 1.00 150.00 150.00
Campbell Robert
Verification Fee - Cansler Pamela 81458 2.00 50.00 100.00
Verification Fee - Cappel James 104350 2.00 50.00 100.00
Medicare First Obligation Fee - Cappel 104350 1.00 350.00 350.00
James
Verification Fee - Cardone Candace 97453 2.00 50.00 100.00
Medicare First Obligation Fee - Cardone 97453 1.00 350.00 350.00
Candace
Verification Fee - Carlson Reba 104347 2.00 50.00 100,00
Verification Fee ~ Carnard Annette 104562 2.00 50.00 100.00
Medicare First Obligation Fee - Carnard 104562 1.00 350.00 350.00
Annette
Verification Fee - Carr Corwin 97664 2.00 50.00 100.00
Verification Fee - Carreon Cesar 296239 2.00 50.00 100.00
Medicare First Obligation Fee - Carreon 296239 1.00 350.00 350.00
Cesar
Verification Fee - Carter Vernon 167067 2.00 50.00 100.00
Medicare First Obligation Fee - Carter 167067 1,00 350.00 350.00
Vernon
Verification Fee - Carter Richard 104411 2,00 50.00 100.00
Medicare First Obligation Fee - Carter 104412 1.00 350.00 350.00
Richard

104411 1.00 150.00 150.00

Medicaid Additional Obligation Fee -
Carter Richard



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 64 of 72
Description Client Case# GRGH aty Rate Amount
Verification Fee - Turner Sharon 296273 2.00 50.00 100.00
Verification Fee - Turner Clifford 99935 2.00 50.00 100.00
Medicare First Obligation Fee - Turner 89935 1.00 350.00 350.00
Clifford
Verification Fee - Tyler Deborah 271106 2.00 50,00 100.00
Verification Fee ~ Tyrrell Neil 89916 2.00 50.00 100.00
Verification Fee - Uzzell Steven 97467 2.00 50,00 100.00
Medicare First Obligation Fee - Uzzell 97467 1.00 350.00 350.00
Steven
Verification Fee - Valdez Linda 285812 2.00 50.00 100.00
Medicare First Obligation Fee - Valdez 285812 1.00 350.00 350.00
Linda
Medicaid Additional Obligation Fee - 285812 1.00 150.00 150.00
Valdez Linda
Verification Fee - Van Buren Sylvia 97718 2,00 50.00 100.00
Verification Fee - Van Koll Dallas 166991 2.00 50.00 100.00
Medicare First Obligation Pee - Van Koll 166991 1.00 350.00 350.00
Dallas
Verification Fee - Vander Vorste Karen 89979 2.00 50.00 100.00
Medicare First Obligation Fee - Vander 89979 1.00 350.00 350.00
Vorste Karen
Verification Fee - Vango Marva 104325 2,00 50.00 100.00
Medicare First Obligation Fee - Vango 104325 1.00 350.00 350.00
Marva
Verification Fee - Varieur James 64466 2.00 50.00 100.00
Medicare First Obligation Fee ~ Varieur 64466 1.00 350.00 350,00
James
Medicaid Additional Obligation Fee ~ 64466 1.00 150.00 150.00
Varieur James
Verification Fee - Varnes Dennis 167082 2.00 50.00 100.00
Medicare First Obligation Fee - Varnes 167082 1,00 350.00 350.00
Dennis
Medicaid Additional Obligation Fee - 167082 1.00 150.00 150.00
Varnes Dennis
Verification Fee - Vickers Allen 292396 2.00 50.00 100.00
Medicare First Obligation Fee - Vickers 292396 1.00 350,00 350.00
Allen
Verification Fee - Villamonte Liliosa 89966 2.00 50.00 100.00
Verification Fee - Vincent Leon 166962 2.00 50.00 100.00
Medicare First Obligation Fee - Vincent 166962 1,00 350.00 350.00
Leon
Medicaid Additional Obligation Fee - 166962 1,00 150.00 150.00
Vincent Leon
Verification Fee - Vincent Pamela 81403 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 18 of 71
Description Client Cased GRG# aty Rate Amount
Medicare First Obligation Fee - Fant 81470 1,00 350,00 350,00
Luther
Verification Fee - Farney Karen 166969 2.00 50.00 100.00
Medicare First Obligation Fee - Farney 166969 1.00 350.00 350,00
Karen
Verification Fee - Farrell Michael 166997 2.00 50.00 100.00
Medicare First Obligation Fee - Farrell 166997 1.00 350.00 350.00
Michael
Verification Fee - Fatzinger Derrick 97403 2.00 50.00 100.00
Verification Fee - Faulconer Gerald 104340 2.00 50,00 100.00
Medicare First Obligation Fee - Faulconer 104340 1.00 350.00 350.00
Gerald
Verification Fee - Feeney Bonnie 90009 2.00 50.00 100.00
Medicare First Obligation Fee - Feeney 90009 1,00 350.00 350.00
Bonnie
Verification Fee - Feldman Nancy 89901 2.00 50.00 100.00
Medicare First Obligation Fee - Feldman 89901 1.00 350.00 350.00
Nancy
Verification Fee - Fenderson Sadie 97504 2.00 50.00 100.00
Medicare First Obligation Fee - Fenderson 97504 1.00 350.00 350.00
Sadie
Medicaid Additional Obligation Fee ~ 97504 1.00 450.00 150.00
Fenderson Sadie
Verification Fee - Fenn Delbert 97523 2.00 50.00 100.00
Verification Fee - Ferguson Daniel 91514 2.00 50.00 100.00
Medicare First Obligation Fee - Ferguson 81514 1.00 350.00 350.00
Daniel
Verification Fee - Ferguson Patrice 174614 2.00 50.00 100.00
Verification Fee - Fernandez Cindy 97616 2.00 50.00 100.00
Medicaid First Obligation Fee - Fernandez 97616 1.00 350.00 350.00
Cady ee Oe ~
Medicaid Additional Obligation Fee - Ferry 104345 1.00 450.00 150.00
Leonard
Verification Fee - Fezer Dale 308057 2,00 50.00 100.00
Verification Fee - Fields Nicholas 166998 2.00 50.00 100.00
Medicaid First Obligation Fee - Fields 166998 1.00 380.00 350.00
Nicholas
Verification Fee - Findley Edward 97630 2.00 50.00 100.00
Medicaid First Obligation Fee - Findley 97630 1,00 350.00 350.00
Edward
Medicare Additional Obligation Fee ~ 97630 1,00 150,00 150.00
Findley Edward
Medicaid Additional Obligation Fee - 97630 1.00 150.00 150.00

Findley Edward



Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldmé Page 4 of 18
Description Client Caset GRGt Ooty Rate Amount
Verification Fee ~ Davis,Galen 104587 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 104587 1.00 350.00 350.00
Davis,Galen
Verification Fee - Davis,Keith 104512 2.00 50.00 100.00
Verification Fee ~ Deacon, Carolyne 174456 2.00 50.00 100.00
Medicaxe First Obligation Fee - 174456 1.00 350,00 350.00
Deacon, Carolyne
verification Fee ~ Debolt, Susan age6L 2.00 50.00 100.00
Medicare First Obligation Fee ~ 69861 1.00 350.00 350.00
Debolt, Susan .
Verification Fee ~ Delph,Amy 104542 2,00 50.00 100.00
Verification Fee - Demarcus, Jan 174477 2.00 50.00 100.00
Verification Fee ~ Deuley, Jeanne 81516 2.00 50.00 100.00
Medicaid First Obligation Fee - 81516 1.00 350.00 350.00
Deuley, Jeanne
Medicaid Additional Obligation Fee - 81516 1.00 150.00 150.00
Deuley, Jeanne
Verification Fee - Dixon, Susan 174587 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 174587 1,00 350.00 350.00
Dixon, Susan
Verification Fee - Dowd, Josephine 270324 2.00 50.00 100,00
Verification Fee - Dowling, Dean 167092 2.00 50.00 100.00
Verification Fee ~ Dryden,Cheryl 89990 2.00 50.00 100,00
Verification Fee - Dullberg, Spencer 97563 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 97563 1.00 350.00 350.00
Dullberg, Spencer
Verification Fee - Dunford, Robert 97425 2.00 50.00 100.00
Verification Fee - Dupee, Jolene 89898 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 89898 1,00 350.00 350.00
Dupee, Jolene
Verification Fee ~ Ebnex, George 97371 2,00 50.00 100.00
Medicare First Obligation Fee ~ 97371 1.00 350.00 350.00
Ebner, George
Verification Fee - Edmonds, Bonnie 174506 2.00 50.00 100.00
Medicare First Obligation Fee ~ 174506 1.00 350.00 350.00
Edmonds, Bonnie
Verification Fee - Edwards, Madeline 167073 2.00 50.00 100.00
Medicare First Obligation Fee - 467073 1,00 350.00 350.00
Edwards, Madeline
Medicaid Additional Obligation Fee - 167073 1.00 150.00 150.00
Edwards, Madeline
Verification Fee ~ Eldridge, Edwin 264616 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 46 of 71

Description Client Case# GRGH oty Rate Amount
Verification Fee - Newberry Robert 292400 2.00 50.00 100.00
Medicare First Obligation Fee - Newberry 292400 1.00 350.00 350,00
Robert

Verification Fee - Newman Arthur Ann 292397 2.00 50.00 100.00
Medicare First Obligation Fee - Newman 292397 1.00 350.00 350.00
Arthur Ann

Medicaid Additional Obligation Fee - 292397 1.00 150.00 150.00
Newman Arthur Ann

Verification Fee - Newman Bonnie 9911 2.00 50.00 100.00
Medicare First Obligation Fee - Newman 89911 1,00 350.00 350.00
Bonnie

Verification Fee - Nick Joy 264430 2.00 50.00 100.00
Verification Fee - Nickerson Deborah 167077 2.00 50.00 100.00
Medicaid First Obligation Fee ~ Nickerson 167077 1,00 350.00 350.00
Deborah

Verification Fee - Nicotera Anthony 89981 2.00 50.00 100.00
Verification Fee - Nixon Geraldine 271093 2.00 50.00 100.00
Medicaid First Obligation Fee - Nixon 271093 1,00 350.00 350.00
Geraldine

Medicare Additional Obligation Fee ~ Nixon 271093 1.00 150.00 150.00
Geraldine

Verification Fee - Nock Margaret 104355 2.00 50.00 100.00
Medicare First Obligation Fee - Nock 104355 1.00 350.00 350.00
Margaret.

Verification Fee - Nohner Gary 90031 2.00 50.00 100.00
Medicare First Obligation Fee ~ Nohner 90031 1.00 350.00 350.00
Gary

Verification Fee - Nolte Linda 292391 2.00 50.00 100,00
Medicare First Obligation Fee - Nolte 292391 1,00 350,00 350,00
Linda

“Verification Fee - Norryce Carol a 296258 2.00 50.00 100.00
Medicare First Obligation Fee - Norryce 296258 1.00 350.00 350.00
Carol

Verification Fee - Nottingham Evelyn 81476 2.00 50.00 100.00
Medicare First Obligation Fee - Nottingham 81476 1.00 350.00 350.00
Evelyn

Verification Fee - Novak Ellen 167054 2.00 50.00 100.00
Medicare First Obligation Fee - Novak 167054 1.00 350.00 350.00
Ellen

Verification fee - Nugent Marie 104620 2.00 50.00 100.00
Medicare First Obligation Fee - Nugent 104620 1.00 350.00 350.00
Marie

Verification Fee - Ocheltree Debra 99887 2.00 50.00 100.00



Invoice Number 628651
Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 28 of 71

Description Client Cased GRG# Qty Rate Amount

Medicare First Obligation Fee - Holland 104419 1.00 350.00 350.00

Laura

Verification Fee - Holley Robert 271385 2.00 50.00 100.00

Medicare First Obligation Fee - Holley 271385 1.00 350.00 350.00

Robert

Medicaid Additional Obligation Fee - 271385 1,00 150.00 150.00

Holley Robert.

Verification Fee - Holmes George 97634 2,00 50.00 100.00

Medicare First Obligation Fee - Holmes 97634 1.00 350.00 350.00

George

Verification Fee - Holston Ann 99847 2.00 50,00 100.00

Medicare First Obligation Fee - Holston 89847 1.00 350.00 350.00

Ann

Verification Fee - Holt Nancy 271283 2.00 50.00 100.00

Medicare First Obligation Fee - Holt Nancy 271283 1,00 350.00 350.00

Verification Fee ~ Holy Exma 90016 2,00 50.00 100.00

Medicare First Obligation Fee - Holy Erma 90016 1.00 350.00 350.00

Verification Fee - Hoover Michael 104549 2.00 50.00 100.00

Verification Fee - Hoover Neill 270362 2.00 50.00 100.00

Medicare First Obligation Fee - Hoppe Jane 89882 1.00 350.00 350.00

Verification Fee - Horn Richard 90013, 2.00 50,00 100.00

Medicare First Obligation Fee - Horn 90013 1.00 350.00 350.00

Richard

Verification Fee - Hornezes David 89888 2.00 50.00 100.00

Verification Fee - Horsley Barbara 97698 2.00 50.00 100.00

Verification Fee - Hovey Karen 97492 2.00 50.00 100.00

Verification Fee - Howard Linda 89962 2.00 50.00 100.00
Medicare First Obigat ion Fee ="Howard—~— —- ~~ 89962 _ 1.00. _ 350,00 350.00.

Linda

Verification Fee - Howard Gregory 285808 2.00 50.00 100.00

Verification Fee - Howe Elizabeth 271146 2.00 50.00 100.00

Medicare First Obligation Fee - Howe 271146 1.00 350.00 350.00

Elizabeth

Verification Fee - Howe Stanley 271078 2.00 50.00 100.00

Medicare First Obligation Fee - Howe 271078 1.00 350.00 350.00

Stanley

Verification Fee - Howland Jon 97477 2.00 50.00 100.00

Medicare First Obligation Fee - Howland 97477 1.00 350.00 350.00

Jon

Verification Fee - Hroch Janet 282764 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 26 of 71
Description Client Case# GRG# ty Rate Amount
Verification Fee - Harvey Deanna 99830 2.00 50.00 100.00
Verification Fee - Haskins Linda 89832 2.00 50.00 100.00
Medicare First Obligation Fee - Haskins 89832 1.00 350.00 350.00
Linda
Verification Fee - Hasner Judy 89802 2.00 50.00 100.00
Medicare First Obligation Fee - Hasner e802 1.00 350.00 350.00
Judy
Verification Fee - Hatak Tom 9781 2.00 50.00 100.00
Medicare First Obligation Fee - Hatak Tom 89781 1.00 350.00 350.00
Verification Fee - Hauzer Karen 286011 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hauzer 286011 1.00 350.00 350,00
Karen
Verification Fee - Hawkins Ann 97575 2.00 50.00 100,00
Medicaid First Obligation Fee - Hawkins 97875, 1.00 350.00 350.00
Ann
Verification Fee - Hawkins Odessa 97609 2.00 50.00 100.00
Medicaid First Obligation Fee - Hawkins 97609 1.00 350.00 350.00
Odessa .
Medicare Additional Obligation Fee - 97609 1,00 150.00 150,00
Hawkins Odessa
Verification Fee - Hawks James 97479 2.00 50.00 100.00
Medicare First Obligation Fee - Hawks 97479 1,00 350.00 350.00
James
Verification Fee - Haynes Carroll 167057 2.00 50.00 100.00
Medicaid First Obligation Fee - Haynes 167057 1.00 350.00 350.00
Carroll
Verification Fee - Haynes Marionett 97602 2.00 50.00 100.00
Medicaid First Obligation Fee - Haynes 97602 1.00 350.00 350.00
Marionett
Verification Fee - Hazlett Lee 167000 2.00 50.00 100.00
Verification Fee - Hegler Janice 104380 2,00 80.00 100.00
Medicare First Obligation Fee ~ Hegler 104380 1.00 350.00 350.00
Janice
Verification Fee - Helstrom Carla 81447 2.00 50.00 100.00
Verification Fee - Henderson Mary 97522 2.00 50.00 100.00
Medicare First Obligation Fee - Henderson 97522 1.00 350.00 350.00
Mary
Medicaid Additional Obligation Fee - 97522 1.00 150.00 150.00
Henderson Mary
Verification Fee - Henderson Donna 271073 2.00 50.00 100.00
Medicare First Obligation Fee - Henderson 271073 1,00 350,00 350.00
Donna
Verification Fee - Henley Patricia 270401 2.00 50.00 100.00



Invoice Number 628651
Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 32 of 71
Description Client Caset# GRG# oty Rate Amount
Medicare Additional Obligation Fee - Jones 104490 1.00 150,00 150,00
Glenda
Verification Fee - Jones Sylvia 104462 2.00 50.00 100.00
Medicaid First Obligation Fee - Jones 104462 1.00 350.00 350,00
sylvia
Medicare Additional Obligation Fee - Jones 104462 1.00 150.00 150.00
Sylvia
Verification Fee - Jones Oscar 97483, 2.00 50.00 100.00
Medicare First Obligation Fee - Jones 97483 1.00 350.00 350.00
Oscar
Verification Fee - Jones Getheyn 174484 2.00 50.00 100.00
Verification Fee - Jones Lucille 308240 2.00 50.00 100.00
Medicaid First Obligation Fee - Jones 308240 1.00 350.00 350.00
Lucille
Verification Fee - Jones Elaine 296249 2.00 50.00 100.00
Medicare First Obligation Fee -~ Jones 296249 1.00 350.00 350.00
Elaine
Medicaid Additional Obligation Fee - Jones 296249 1,00 150.00 150.00
Elaine
Verification Fee - Jones Scott 296250 2.00 50.00 100.00
Verification Fee - Jones-Geis Virginia 271147 2.00 50.00 100.00
Medicare First Obligation Fee - Jones-Geis 271147 1.00 350.00 350.00
Virginia
Verification Fee - Judge Barbara 104600 2.00 50.00 100.00
Medicare First Obligation Fee - Judge 104600 1.00 350.00 350.00
Barbara
Verification Fee - Kamrath Thomas 285805 2.00 50,00 100.00
Medicare First Obligation Fee - Kamrath 285805 1,00 350.00 350.00
Thomas
Verification Fee - Kanieski Edward 104395 2.00 50.00 100.00
Medicare First Obligation Fee ~ Kanieski _ _ _ _ 104398 1,00 350.00 350.00
Edward - —
Verification Fee - Kapella Caroline 293711 2.00 50.00 100.00
Verification Fee - Karris Linda 89961 2.00 50.00 100.00
Medicare First Obligation Fee - Karris 89961 1.00 350.00 350.00
Linda
Verification Fee - Kasim Doris 310017 2.00 50.00 100.00
Verification Fee - Kasprzak Cheryl 270001 2.00 50.00 100.00
Verification Fee - Kauffman Paul 308440 2.00 50.00 100.00
Medicare First Obligation Fee - Kauffman 308440 1,00 350.00 350.00
Paul
Verification Fee - Kaufman Sandra 89823, 2.00 50.00 100.00

89823, 2.00 350.00 350.00

Medicare First Obligation Fee - Kaufman
Sandra



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 36 of 71
Description Client Case# GRGE oty Rate Amount
Medicaid Additional Obligation Fee - 271085 1.00 150.00 150.00
Larsen John
Verification Fee - Latimer Laura 264355 2.00 50.00 100.00
Verification Fee - Lattanzio Lawrence 104335 2.00 50.00 100.00
Medicare First Obligation Fee - Lattanzio 104335 1.00 350,00 350.00
Lawrence
Verification Fee - Laurel Emily 89953 2.00 50.00 100.00
Medicare First Obligation Fee ~ Laurel 89953 1.00 350.00 350.00
Emily
Verification Fee - Law Delmer 97628 2.00 50.00 100.00
Verification Fee - Law Patsy 1311 2.00 50.00 100.00
Medicare First Obligation Fee - Law Patsy 1311 1,00 350.00 350.00
Verification Fee - Leatherman David 309970 2.00 50.00 100.00
Verification Fee - Lee Barbara 104489 2.00 50.00 100.00
Medicare First Obligation Fee - Lee 104489 1,00 350.00 350.00
Barbara
Medicaid Additional Obligation Fee - Lee 174486 1,00 150.00 150.00
Kay
Verification Fee - Lee Gladys 89778 2.00 50.00 100.00
Medicare First Obligation Fee - Lee Gladys 89778 1.00 350.00 350.00
Medicaid Additional Obligation Fee - Lee 89778 1,00 150.00 150.00
Gladys
Verification Fee - Lees Ronald 90025 2.00 50.00 100.00
Medicaid First Obligation Fee - Lees 90025 1.00 350.00 350.00
Ronald
Verification Fee - Lehman Thomas 97474 2.00 50.00 100.00
Medicare First Obligation Fee - Lehman 97474 1,00 350.00 350.00
Thomas
Verification Fee - Lehr Robert 286007 2.00 50.00 100.00
“verification Fee - Leming Cynthia _ SS 34 100.00
Verification Fee ~ Leonard Sheryl 97567 2.00 50,00 100.00
Medicare First Obligation Fee - Leonard 97567 1.00 350.00 350.00
Sheryl
Verification Fee - Leverett Rose 308079 2.00 50.00 100.00
Medicare First Obligation Fee - Leverett 308079 1.00 350.00 350.00
Rose
Medicaid Additional Obligation Fee ~ 308079 1.00 150,00 150.00
Leverett Rose
Verification Fee - Lewis Simmone 99942 2.00 50.00 100.00
Medicare First Obligation Fee - Lewis 89942 1.00 350,00 350.00
Simmone
Verification Fee - Lewis Aveta 264617 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 24 of 71
Description Client Case GRG# Qty Rate Amount:
Verification Fee -.Groves Barbara 97430 2.00 50.00 100.00
Medicare First Obligation Fee - Groves 97430 1,00 350.00 350.00
Barbara
Verification Fee - Grys Evelyn 89960 2.00 50.00 100.00
Medicaid First Obligation Fee - Grys 89960 1,00 350.00 350.00
Evelyn
Verification Fee - Guerra Michael 264422 2.00 50.00 100.00
Medicare First Obligation Fee - Guerra 264422 1.00 350.00 350.00
Michael
Verification Fee - Gugino Beverly 174628 2.00 50.00 100.00
Medicaid First Obligation Fee - Gugino 174628 1.00 350.00 350.00
Beverly
Medicaid Additional Obligation Fee - 174628 1,00 150.00 150.00
Gugino Beverly
Verification Fee - Gumbert James 282412 2.00 50.00 100.00
Medicare First Obligation Fee - Gumbert 282412 1,00 350.00 350.00
James
Verification Fee - Gunther Peggy 104418 2.00 50.00 100.00
Medicare First Obligation Fee - Gunther 104418 1.00 350.00 350.00
Peggy
Verification Fee - Gwinn Roselia 174519 2,00 50.00 100.00
Medicare First Obligation Fee - Gwinn 174519 1.00 350.00 350.00
Roselia
Verification Fee - Hada Lawrence 99919 2.00 50.00 100.00
Medicare First Obligation Fee - Hada 89919 1.00 350.00 350.00
Lawrence
Medicaid Additional Obligation Fee - Hada 69919 1.00 150.00 150.00
Lawrence
Verification Fee - Hadley Donna 264368 2.00 50.00 100.00
Medicare First Obligation Fee - Hadley 264368 1.00 350.00 350.00
Donna
Verification Fee - Hales Ricky 167100 _ 50.00 100.00
Medicaid First Obligation Fee - Hall 167033 350.00 350.00
Anthony
Verification Fee - Hall David 174627 2.00 50.00 100.00
Verification Fee - Hallquist Patricia 270361 2.00 50.00 100.00
Medicare First Obligation Fee - Hallquist 270361 1,00 350.00 350.00
Patricia
Verification Fee - Hambright Catherine 104376 2.00 50.00 100.00
Medicare First Obligation Fee - Hambright 104376 1,00 350.00 350.00
Catherine
Medicaid Additional Obligation Fee - 104376 1.00 150.00 150.00
Hambright Catherine
Verification Fee - Hammons Lanita 274815 2.00 50.00 100.00



Invoice Number 621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldm Page 14 of 18
Description Client Caset GRGt Qty Rate Amount
Medicare Zero Interest Obligation Fee - 174444 1.00 350.00 350.00
Sager, John
verification Fee - Sanchez,Hermelinda 1475 2.00 50.00 100.00
Verification Fee - Sanchez,Mary Lou 90043 2.00 50.00 100.00
Verification Fee - Sanders, George a9ao1 2.00 50,00 100.00
Verification Fae - Sanford,Robert 89970 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 89970 1.00 350.00 350,00
Sanford, Robert
Verification Fee - Sansom,Carmen 89820 2.00 50.00 100.00
Verification Fee - Sasseen, Susan 104450 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 104450 1.00 350.00 350,00
Sasseen, Susan
Verification Fee - Schermann, Hubert 97605 2.00 50.00 100.00
Medicare First Obligation Fee - 97605 1.00 350.00 350.00
Schermann, Hubert
Verification Fee - Schoening, Robext 174619 2.00 50.00 100.00
Medicare First Obligation Fee - 174619 1.00 350.00 350.00
Schoening, Robert
Verification Fee - Scofield, Tina 167075 2.00 50.00 100.00
Medicare First Obligation Fee - 167075 1.00 350.00 350.00
Scofield, Tina
Medicaid Additional Obligation Fee - 167075 1.00 150.00 150.00
Scofield, Tina
Verification Fee ~ scott,Markham 270324 2.00 50.00 100.00
Verification Fee ~ Scurlock, Daniel 89754 2.00 50.00 100.00
Verification Fee ~ Seale,Kathleen 64460 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 64460 1.00 350.00 350.00
Seale, Kathleen
Verification Fee - Secor, Barbara 166968 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 166968 1.00 350.00 350.00
Secor, Barbara
Verification Fee - Seevers,Darlene 264472 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 264472 1.00 350.00 350.00
Seevers, Darlene
Verification Fee - Shivers, Tracey 97581 2.00 50.00 100.00
Verification Fee ~ Shoched,Shirley 97545 2.00 50.00 100.00
Verification Fee ~ Sinmons,Michael 166948 2.00 50.00 100.00
Verification Fee ~ Sirna, Anthony 174536 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 174536 1.00 350.00 350.00
Sirna, Anthony
Verification Fee - Sloffer,Karen 142976 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 14 of 71

Description Client Casef GRG# Qty Rate Amount

Verification Fee - Darter Vickie 90075 2.00 50.00 100.00

Verification Fee - Daugherty David 320006 2.00 50.00 100.00

Verification Fee - Davidson Robert 104539 2.00 50.00 100.00

Verification Fee - Davino Karen 271062 2.00 50,00 100.00

Verification Fee - Davis Thomas 97695, 2.00 50.00 100.00

Verification Fee - Davis Sandra 296244 2.00 50.00 100.00

Medicare First Obligation Fee - Davis 296244 1.00 350.00 350.00

Sandra

Verification Fee - Davis Lori 167021 2.00 50.00 100.00

Verification Fee ~ Davis Frances 89969 2.00 50,00 100.00

Medicaid First Obligation Fee - Davis 89969 1.00 350.00 350.00

Frances

Verification Fee - Davis Carole 97512 2.00 50.00 100.00

Medicare First Obligation Fee - Davis 97512 1,00 350.00 350.00

Carole

Verification Fee - Davis Barbara 97577 2.00 50.00 100.00

Medicare First Obligation Fee - Davis 97577 1.00 350.00 350.00

Barbara

Verification Fee - Davis John 91493 2.00 50.00 100.00

Medicare First Obligation Fee - Davis 104512 1.00 350.00 350.00

Keith

Verification Fee - Dawson Luann 271142 2.00 50.00 100.00

Medicaid First Obligation Fee ~ Dawson 271142 1.00 350.00 350.00

Luann

Verification Fee - Dawson Larry 97435, 2.00 50.00 100.00

Medicare First Obligation Fee - Dawson 97435 1.00 350.00 350.00

Larry

Medicaid Additional Obligation Fee - 174456 1.00 150.00 150.00

Deacon Carolyne

Verification Fee - Deaton Aleene 97741 2,00 50.00 100,00

Medicare First Obligation Fee - Deaton 97741 1.00 350.00 350,00

Aleene

Verification Fee - Dell Kathleen a9e12 2.00 50.00 100.00

Medicare First Obligation Fee -~ Dell 89812 1,00 350.00 350.00

Kathleen

Verification Fee - Demontel Rita 64477 2.00 50.00 100.00

Verification Fee - Demott Danny 282771 2.00 50.00 100.00

Medicare First Obligation Fee - Demott 282771 1.00 350.00 350.00

Danny

Verification Fee - Demougin Nancy 271063 2.00 50.00 100.00
271063 1,00 350.00 350.00

Medicare First Obligation Fee - Demougin
Nancy



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 45 of 71
Description Client Case# GRG# ty Rate Amount
Medicare First Obligation Fee - Mullis 271390 1.00 350.00 350.00
sylvia
Verification Fee - Murchie Ida 104307 2.00 50.00 100.00
Medicare First Obligation Fee - Murchie 104307 1.00 350.00 350.00
Ida
Verification Fee - Murdock Alfred 90036 2.00 50.00 100.00
Medicare First Obligation Fee ~ Murdock 90036 1,00 350.00 350.00
Alfred
Verification Fee - Murphree Vester 296255 2.00 50.00 100.00
Medicare First Obligation Fee - Murphree 296255 1,00 350.00 350.00
Vester
Medicaid Additional Obligation Fee ~ 296255 1.00 150.00 150.00
Murphree Vester
Verification Fee - Mutter Naomi 296256 2.00 50.00 100.00
Medicare First Obligation Fee - Mutter 296256 1.00 350.00 350.00
Naomi
Verification Fee - Myers Mary 264427 2.00 50.00 100.00
Medicare First Obligation Fee - Myers Mary 264427 1.00 350.00 350.00
Verification Fee - Myers John 104346 2.00 50.00 100.00
Medicaid First Obligation Fee - Myers John 104346 1.00 350.00 350.00
Medicare Additional Obligation Fee - Myers 104346 1,00 150,00 150.00
John
Verification Fee - Nace Kay 64456 2.00 50.00 100.00
Medicare First Obligation Fee - Nace Kay 64456 1.00 350.00 350.00
Verification Fee ~ Nance Rita 308241 2.00 50,00 100.00
Medicare First Obligation Fee - Nance Rita 308241 1.00 350.00 350.00
Verification Fee - Nardelli Mario 97596 2.00 50.00 100.00
Verification Fee - Navarro Patricia 310011 2.00 50.00 100.00
Verification Fee - Nawaz Rahil ~ ggg 2500-80000 —— 100500
Verification Fee - Necessary-Corrigan 97551 2.00 50.00 100,00
Sherry
Medicare First Obligation Fee - 97551 1.00 350.00 350.00
Necessary-Corrigan Sherry
Verification Fee - Negrinelli Gail 296257 2.00 50.00 100.00
Medicare First Obligation Fee - Negrinelli 296257 1,00 350.00 350.00
Gail
Verification Fee - Neill Angela 97683 2.00 50.00 100.00
Medicare First Obligation Fee - Neill 97683 1,00 350.00 350.00
Angela
Verification Fee - Nelson Vicki 90034 2.00 50,00 100.00
Medicare First Obligation Fee - Nelson 90034 1,00 350.00 350.00

Vicki



Invoice Number 615437
Invoice Date October 31, 2014
PO Number
Contract
Project BIOMT-00050-00
2115 Rexford Road, 4th Floor | Charlotte, NC 28211
Texms 30
Page 1of 5
Anapol Schwartz Weiss Cohan Feldman et
1710 Spruce Street
Philadelphia, PA 19103
United States
Description Client Caset Ret aty Rate Amount.
Verification Fee - Bermes,Kathleen 167055 2.00 50.00 100,00
Verification Fee - Bicket, William 174433 2.00 50.00 100.00
Medicare First Obligation Fee - 174433 1.00 350.00 350.00
Bicket, William
Verification Fee - Birmingham, Larry 174461 2.00 50.00 100.00
Medicare First Obligation Fee - 174461 1.00 350.00 350.00
Birmingham, Larry
Verification Fee - Bogart, Pamela 174453 2.00 50.00 100.00
Verification Fee - Bridges, Linda 174508 2.00 50.00 100.00
Medicare First Obligation Fee - 174508 1,00 350.00 350.00
Bridges, Linda
Verification Fee ~ Burr, Jeffrey 174603 2.00 50.00 100.00
Medicare First Obligation Fee - 174603 1.00 350.00 350.00
Burr, Jeffrey
Medicaid Additional Obligation Fee - 174603 1.00 150.00 150.00
Burr, Jeffrey
Verification Fee ~ Camp,Margaret 174584 2.00 50.00 100.00
Verification Fee - Connors, Penny 73444 2.00 50.00 100.00
Medicare First Obligation Fee - 73444 1.00 350.00 350.00
Connors, Penny
Medicare Additional Obligation Fee - 264463 1.00 150.00 150.00
Connoxs, Penny
Verification Fee ~ Crespo, Jessica 166963 2.00 50,00 100.00
Medicaid First Obligation Fee - 166963 1,00 350.00 350.00
Crespo, Jessica
Verification Fee ~ Curry, Dharla 174596 2.00 50.00 200.00
Verification Fee ~ Derr, Wanda 73438 2,00 50.00 100.00
Medicare First Obligation Fee - Derr,Wanda 73438 1,00 350.00 350.00
Medicare Additional Obligation Fee - 264457 1,00 150.00 150.00
Derr, Wanda
Verification Fee - Dunson, Trena 167048 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 48 of 71

Description Client Caset# GRG# Qty Rate Amount
Verification Fee - Pairan Rodger 308441 2.00 50.00 100.00
Medicare First Obligation Fee - Pairan 308441 1,00 350.00 350.00
Rodger

Verification Fee - Pappas Anne 166961 2.00 50.00 100.00
Medicare First Obligation Fee - Pappas 166961 1.00 350.00 350.00
Anne

Verification Fee - Parker Timothy 104488 2.00 50.00 100.00
Medicare First Obligation Fee - Parker 104488 1,00 350.00 350.00
Timothy

Verification Fee - Parker David 89926 2.00 50.00 100.00
Verification Fee - Parshall Steven 97713 2.00 50.00 100.00
Verification Fee - Pasquale Anthony 285815 2.00 50.00 100.00
Verification Fee - Pates Kathy 271096 2.00 50.00 100.00
Medicare First Obligation Fee - Pates 271096 1.00 350.00 350.00
Kathy

Medicaid Additional Obligation Fee - Pates 271096 1.00 150.00 150.00
Kathy

Verification Fee ~ Patterson Obie 91314 2.00 50.00 100.00
Medicaid First Obligation Fee ~ Patterson 81314 1.00 350.00 350.00
Obie

Medicare Additional Obligation Fee -~ 81314 1.00 150.00 150.00
Patterson Obie

Verification Fee - Paul Lisa 97391 2.00 50.00 100.00
Medicare First Obligation Fee - Paul Lisa 97391 1.00 350.00 350.00
Medicaid Additional Obligation Fee - Paul 97391 1.00 150.00 150.00
Lisa

Verification Fee - Pavic Douglas 90067 2.00 50.00 100.00
Verification Fee - Pearce David 90072 2.00 50.00 100.00
Medicaid First Obligation Fee - Pearce 90072 1.00 350.00 350.00
David — — — a
Verification Fee - Pearsall Mary 97568 2.00 50.00 100.00
Medicare First Obligation Fee - Pearsall 97568 1.00 350.00 350.00
Mary

Medicaid Additional Obligation Fee - 97568 1,00 150.00 150.00
Pearsall Mary

Verification Fee - Pearson Tonya 174416 2.00 50.00 100.00
Medicare First Obligation Fee - Pearson 174416 1.00 350.00 350.00
Tonya

Verification Fee - Peluso Felicia 64457 2.00 50.00 100.00
Verification Fee - Pemberton Sandra 90026 2.00 50.00 100,00
Verification Fee - Pendlebury Sean 174631 2.00 50.00 100.00
Medicare First Obligation Fee - Pendlebury 174631 1.00 350.00 350.00

Sean



Invoice Number 628651

Project BIOMT=00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 47 of 71
Description Client Case# GRG# Qty Rate Amount
Medicare First Obligation Fee - Ocheltree 89887 1,00 350.00 350.00
Debra
Medicaid Additional Obligation Fee - 99887 1,00 150.00 150,00
Ocheltree Debra
Verification Fee - O'Connor Paul 282779 2.00 50.00 100.00
Medicare First Obligation Fee - O'Connor 282779 1.00 350.00 350.00
Paul
Verification Fee - O'Dwyer Claire 89976 2.00 50.00 100.00
Verification Fee - Oest Florence 174568 2,00 50.00 100.00
Medicare First Obligation Fee - Oest 174568 1.00 350.00 350.00
Florence
Verification Fee - Oliver Kristina 81508 2.00 50.00 100.00
Medicare First Obligation Fee - Oliver 81508 1.00 350.00 350.00
Kristina
Verification Fee - Ondayko Michael 97421 2.00 50.00 100.00
Medicaid First Obligation Fee - Ondayko 97421 1.00 350.00 350.00
Michael
Verification Fee - O'Neal Nancy 97481 2.00 50.00 100.00
Medicare First Obligation Fee - O'Neal 97481 1.00 350.00 350.00
Nancy
Verification Fee - O'Reilly Shirlene 271386 2.00 50,00 100.00
Medicare First Obligation Fee - O'Reilly 271386 1,00 350.00 350.00
Shirlene
Medicaid Additional Obligation Fee - 271386 1.00 150.00 150.00
O'Reilly Shirlene
Verification Fee - Osborn Jerry 282773 2.00 50.00 100.00
Medicare First Obligation Fee - Osborn 282773 1.00 350.00 350.00
Jerry
Verification Fee - Osterberg Mary 97380 2.00 50.00 100.00
Verification Fee - Owens Antionette 64442 2.00 50.00 100.00

___Verification Fee - Packard William 104613 2.00 50.00 100.00
Medicare First Obligation Fee - Packard 104613 1.00 350.00 350.00
William
Verification Fee - Packer William 104593 2.00 50.00 100.00
Medicare First Obligation Fee - Packer 104593 1,00 350.00 350.00
william
Medicaid Additional Obligation Fee - 104593 1.00 150,00 150.00
Packer William
Verification Fee - Padilla-Figueroa 104420 2.00 50.00 100.00
orlando
Medicaid First Obligation Fee - 104420 1.00 350.00 350,00
Padilla-Figueroa Orlando
Verification Fee - Pahls Robert 296259 2.00 50.00 100.00
Medicare First Obligation Fee ~ Pahls 296259 1.00 350.00 350.00

Robert



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 50 of 71
Description Client Case# GRGH Qty Rate Amount
Verification Fee - Pitchford Tyrone 333889 2,00 50,00 100.00
Verification Fee - Plank Loreli 292394 2.00 50.00 100.00
Verification Fee - Plumlee Cary 264438 2.00 50,00 100.00
Medicaid First Obligation Fee - Plumlee 264438 1.00 350.00 350.00
cary
Verification Fee - Poer Barry 104298 2.00 50.00 100.00
Medicare First Obligation Fee - Poer Barry 104298 1.00 350.00 350.00
Verification Fee - Pogue Jimmy 282776 2.00 50.00 100.00
Medicare First Obligation Fee - Pogue 282776 1,00 350.00 350,00
Jimmy
Verification Fee - Polhemus John 89996 2.00 50.00 100.00
Medicare First Obligation Fee - Polhemus 89996 1,00 350.00 350.00
John
Verification Fee - Poole Leon 99769 2.00 50.00 100.00
Medicare First Obligation Fee - Poole Leon 89769 1.00 350.00 350.00
Verification Fee - Pope Linda 81416 2.00 50.00 100.00
Medicaid First Obligation Fee - Pope Linda 81416 1,00 350.00 350.00
Medicare Additional Obligation Fee - Pope 81416 1.00 150,00 150.00
Linda
Verification Fee - Popick Marilyn 174605 2.00 50.00 100.00
Medicare First Obligation Fee - Popick 174605 1,00 350.00 350.00
Marilyn
Verification Fee - Postma Carol 97686 2.00 50.00 100.00
Medicaid First Obligation Fee - Postma 97686 1,00 350.00 350,00
Carol
Medicaid Additional Obligation Fee - 97686 1,00 150.00 150.00
Postma Carol
Verification Fee ~ Potter Sandra 296262 2.00 50.00 100.00
Verification Fee - Pratt Ruby =~=~=~=~=~C~s=“‘“‘—sS*C<“‘;COS”*”*”*S:SSTTCS! 889A BLO $0500 100007
Verification Fee - Preece Aimee 174574 2.00 50.00 100.00
Medicare First Obligation Fee - Preece 174574 1,00 350,00 350.00
Aimee
Medicaid Additional Obligation Fee - 174574 1,00 150.00 150.00
Preece Aimee
Verification Fee - Prentiss Mack 99827 2.00 50.00 100.00
Medicare First Obligation Fee - Prentiss 89827 1,00 350,00 350.00
Mack
Verification Fee - Price Carl 237014 2.00 50.00 100.00
Medicare First Obligation Fee - Price Carl 237014 1.00 350.00 350.00
Verification Fee - Probst Karl 308055 2,00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page of 11
Description Client Case# GRG# oty Rate Amount
Medicaid Additional Obligation Fee ~ 64445 1.00 150.00 150.00
Bracey Sonja
Verification Fee - Branch Tommy 89745 2.00 50.00 100.00
Verification Fee - Branch Janis 89974 2.00 50.00 100.00
Verification Fee - Brand Cody 308053 2.00 50.00 100.00
Medicaid First Obligation Fee - Brand Cody 308053 1.00 350.00 350.00
Verification Fee - Bransford Kenneth 90047 2.00 50.00 100.00
Verification Fee - Brice Bruce 97446 2.00 50.00 100.00
Medicare First Obligation Fee - Brice 97446 1.00 350.00 350.00
Bruce
Verification Fee - Brickhouse Albert 27.112 2.00 50.00 100.00
Medicare First Obligation Fee - Brickhouse 27112 1,00 350.00 350.00
Albert
Medicaid Additional Obligation Fee - 271112 1.00 150.00 150.00
Brickhouse Albert
Verification Fee - Broadnax Latonya 274812 2.00 50.00 100.00
Medicare First Obligation Fee - Broadnax 274812 1.00 350.00 350.00
Latonya
Medicaid Additional Obligation Fee ~ 274812 1.00 150,00 150.00
Broadnax Latonya
Medicaid Additional Obligation Fee - 274812 1.00 150.00 150.00
Broadnax Latonya
Medicaid Additional Obligation Fee - 274812 1.00 150,00 150.00
Broadnax Latonya
Verification Fee - Broughton Lloyd 271299 2.00 50.00 100.00
Medicare First Obligation Fee - Broughton 271299 1,00 350.00 350.00
Lloyd
Verification Fee - Brown Joan 97660 2.00 50.00 100.00
Medicare First Obligation Fee - Brown Joan 97660 1.00 350.00 350,00
Medicaid Additional Obligation Fee - Brown 97660 1,00 150.00 150.00
Joan
Verification Fee - Brown Sarah 296237 2.00 50.00 100.00
Medicare First Obligation Fee - Brown 296237 1.00 350.00 350.00
Sarah
Medicaid Additional Obligation Fee - Brown 296237 1,00 150.00 150.00
Sarah
Verification Fee - Brown Lon 282762 2.00 50.00 100.00
Medicare First Obligation Fee - Brown Lon 282762 1.00 350.00 350.00
Medicaid Additional Obligation Fee ~ Brown 282762 1.00 150,00 150.00
Lon
Verification Fee ~ Brown Jill 104423 2.00 50.00 100.00
Verification Fee - Brown Leslie 285813 2.00 50.00 100.00

285813 1.00 350.00 350.00

Medicaid First Obligation Fee - Brown
Leslie



Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldme Page 41 of 18
Description Client Caset GRGt Qty Rate Amount
Medicaid First Obligation Fee - 97485 1.00 350.00 350.00
Moneil,Angela
Verification Fee - Merrell, Shannon 174561 2.00 50.00 100.00
Medicare First Obligation Fee - 174561 1.00 350.00 350.00
Merzel1, Shannon .
Verification Fee - Metzger, Jerome 89858 2.00 50.00 100.00
Medicaxe Zero Interest Obligation Fee ~ 89858 1.00 350.00 350.00
Metzger, Jerome
Verification Fee ~ Meyer,William 97376 2.00 50.00 100.00
Medicare First Obligation Fee - 97376 1.00 350.00 350.00
Meyer, William
Verification Fee - Miele,Louise 166974 2.00 50.00 100,00
Medicare Zero Interest Obligation Fee ~ 166974 1.00 350.00 350.00
Miele, Louise
Verification Fee - Miller,Glenn 49992 2.00 50.00 100.00
Verification Fee - Miller,Kathryn 104564 2.00 50.00 100.00
Verification Fee - Millman, Rochelle 174429 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee — 174429 1.00 350.00 350.00
Millman, Rochelle
Verification Fee - Minney, Arthur 167091 2.00 50.00 100.00
Medicare First Obligation Fee - 167091 1.00 350.00 350.00
Minney, Arthur
Verification Fee - Minni,Victoxia 167028 2.00 50.00 100.00
Medicare First Obligation Fee - 167028 1.00 350.00 350.00
Minni, Victoria
Verification Fee ~ Mitton, Carol 97701 2.00 50.00 100,00
Medicare First Obligation Fee ~ 97701 1.00 350.00 350.00
Mitton,Carol
Verification Fee ~ Mlynarski, Suzan 174434 2.00 50.00 100.00
Verification Fee ~ Montes,Mauro 89993 2.00 50.00 100.00
Verification Fee ~ Moreland, Carol 90023 2.00 50.00 100.00
Verification Fee ~ Morrolf,Michael 142971 2.00 50.00 100.00
Verification Fee ~ Mudron, Christine 81523 2.00 50.00 100.00
Medicare First Obligation Fee - 81523 1.00 350.00 350.00
Mudron, Christine
Verification Fee - Mueller, Douglas 104486 2.00 50,00 100.00
Medicare Zero Interest Obligation Fee - 104486 1.00 350.00 350.00
Mueller, Douglas
Verification Fee - Mullen,Mary 64507 2.00 50.00 100.00
Verification Fee - Mulvey,Marilyn 97703 2.00 50.00 100.00

97703 1.00 350.00 350.00

Medicare First Obligation Fee -
Mulvey, Marilyn



Invoice Number

621297

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldme Page 17 of 18

Description Client Case# GRG# Qty Rate Amount

Medicare Additional Obligation Fee - 97444 1,00 350.00 350.00

Webb, Susie

Verification Fee - Weber,Dan 97658 2.00 50.00 100.00

Verification Fee ~ Wehrli, Lisette 166934 2.00 50,00 100.00

Medicare First Obligation Fee - 166934 1.00 350.00 350.00

Wehrli,Lisette

Verification Fee ~ Welder, Duard 104476 2.00 50.00 100.00

Verification Fee - Whaley,Marc 174428 2.00 50.00 100.00

Verification Fee - White,Angela 167070 2.00 50.00 100.00

Medicare First Obligation Fee ~ 167070 1,00 350.00 350.00

White, Angela

Verification Fee - white, Barbara 97589 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee ~ 97589 1,00 350.00 350.00

White, Barbara

Verification Fee ~ White,Bonnie 99989 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee-- 89989 1.00 350.00 350.00

White, Bonnie

Verification Fee ~ White,Heather 89991 2.00 50.00 100,00

Verification Fee - Wilcome,Michael 174462 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee ~ 174462 1.00 350.00 350.00

Wilcome, Michael

Medicaid Additional Obligation Fee ~ 174462 1.00 150.00 + 150.00

Wilcome, Michael

Verification Fee - Williams,Darlene 174582 2.00 50.00 100.00

Medicare First Obligation Fee ~ 174582 1.00 350.00 350.00

Williams, Darlene

Verification Fee - Williams, James 97673 2.00 50.00 100.00

Verification Fee ~ Williams,Thomas 270323 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 270323 1,00 350,00 350.00

Williams, Thomas

Verification Fee - Wills,Maxine 104459 2.00 50.00 100.00

Verification Fee ~ Wilson, Far] 174624 2.00 50.00 100.00

Medicaid First Obligation Fee ~ 174624 1.00 350.00 350.00

Wilson, Bar)

Verification Fee ~ Wilson, Russell 174499 2,00 50.00 100.00

Medicare Zero Interest Obligation Fee — 174499 1,00 350.00 350.00

Wilson, Russe1L

Verification Fee - Wollins,Allen 89885 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 89885 1,00 350.00 350.00

Wollins, Allen

Verification Fee ~ Woodcock, Ronald 104541 2.00 50.00 100.00
104541 1.00 350.00 350.00

Medicare First Obligation Fee ~
Woodcock, Ronald



Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldme Page 13 of 18
Deseription Client CaseP GRGt aty Rate Amount
Verification Fee ~ Pulver, Diane 81536 2.00 50.00 100.00
Verification Fee - Quarles, Kimberly 81480 2.00 50.00 100.00
Verification Fee - Quintero, Donnita 269999 2.00 50.00 100.00
Vexification Fee ~ Ranoff, Sondra 89850 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 89850 1.00 350.00 350.00
Ranof£, Sonda
Verification Fee - Redmond, Janice 174564 2.00 50.00 100.00
Medicare First Obligation Fee - 174564 1.00 350.00 350.00
Redmond, Janice
Verification Fee ~ Reichard,Kathleen 97610 2.00 50.00 100.00
Medicare First Obligation Fee ~ 97610 1.00 350.00 350.00
Reichard, Kathleen
Verification Fee - Rementer, Todd 142973 2.00 50.00 100.00
Medicare First Obligation Fee ~ 142973 1.00 350.00 350.00
Rementer, Todd
Verification Fee - Richards, Darryl 167024 2.00 50.00 100.00
Medicare First Obligation Fee - 167024 1.00 350.00 350.00
Richards, Darryl)
Verification Fee - Ridings,Lori 167006 2.00 50.00 100.00
Medicaid First Obligation Fee - 167006 1.00 350.00 350.00
Ridings, Lori
Verification Fee - Rios,Carlos ei44t 2.00 50.00 100.00
Verification Fee - Roberts, Linda 81437 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - $1437 2.00 350.00 350.00
Roberts, Linda
Verification Fee - Rochelle,Kathy 97599 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 97599 1.00 350.00 350.00
Rochelle, Kathy
Verification Fee ~ Rockowitz,Ira 81504 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 81504 2.00 350.00 350.00
Rockowitz, Ira
Verification Fee ~ Rodriguez, Arthur 174594 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 174594 1.00 350.00 350.00
Rodriguez, Arthur
Verification Fee - Rodriguez,Rodney 73439 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 73439 1.00 350.00 350.00
Rodriguez, Rodney
Verification Fee - Rommel, Robert 174620 2.00 50.00 100,00
Verification Fee - Runnalls, Stephen 270316 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 270316 1.00 350.00 350.00
Runnalls, Stephen
Verification Fee - Sager, John 174444 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 8 of 71

Description Client Caset GRGH Qty Rate Amount
Verification Fee - Brown Marliese 97422 2,00 50.00 100.00
Verification Fee - Brown Angela 104594 2,00 50.00 100.00
Medicare First Obligation Fee - Brown 104594 1.00 350.00 350.00
Angela

Medicaid Additional Obligation Fee - Brown 104594 1.00 150,00 150.00
Angela

Verification Fee - Bruck Joseph 89946 2.00 50.00 100.00
Medicare First Obligation Fee ~ Bruck 89946 1.00 350.00 350,00
Joseph

Verification Fee - Brucker Kathryn 167095 2.00 50,00 100.00
Medicare First Obligation Fee - Brucker 167095 1.00 350.00 350.00
Kathryn,

Verification Fee - Brunker Robert 174575 2,00 50.00 100.00
Medicare First Obligation Fee - Brunker 174875 1.00 350.00 350.00
Robert

Verification Fee ~ Bryan Tracy 97547 2.00 50.00 100.00
Medicare First Obligation Fee - Bryan 97547 1.00 350.00 350.00
Tracy

Verification Fee - Bryant Crystal 81336 2.00 50.00 100.00
Medicaid First Obligation Fee - Bryant 81336 1.00 350.00 350.00
crystal

Verification Fee - Buchmueller Barrett 104322 2,00 50.00 100.00
Medicare First Obligation Fee - 104322 1,00 350.00 350.00
Buchmueller Barrett

Verification Fee - Bucket Frank 97614 2.00 50.00 100.00
Medicare First Obligation Fee - Bucket 97614 2.00 350.00 350.00
Prank

Verification Fee - Buckner Sandra 296238 2.00 50.00 100,00
Medicare First Obligation Fee - Buckner 296238 1.00 350.00 350.00
Sandra

Verification Fee - Bugg Joyce 174534 2.00 50.00 100.00
Medicare First Obligation Fee - Bugg Joyce 174534 1.00 350.00 350.00
Verification Fee - Bulluck William 274811 2.00 50.00 100.00
Verification Fee - Burcham John 81492 2.00 50.00 100,00
Medicare First Obligation Fee - Burcham 81492 1.00 350.00 350.00
John

Verification Fee - Burgess Yusef 89954 2.00 50.00 100.00
Verification Fee - Bush Janice 81390 2.00 50.00 100.00
Medicare First Obligation Fee - Bush 81390 1,00 350.00 350.00
Janice

Medicaid Additional Obligation Fee - Bush 81390 1.00 150.00 150.00
Janice

Verification Fee - Bushey Grant 97745 2.00 50.00 100.00



Invoice Number

621297

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldmz Page 8 of 18

Description Client Caset GRGt aty Rate Amount

Verification Fee ~ Hyett,Marlene 174411 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 174411 1.00 350,00 350.00

Hyett,Marlene

Verification Fee - Inman, Jeremy 174617 2.00 50.00 100.00

Verification Fee - Isaac,Diane 97404 2.00 50.00 100.00

Medicare First Obligation Fee - 97404 1.00 350.00 350.00

Isaac, Diane

Verification Fee ~ Jackson, Barbara 97416 2,00 50.00 100.00

Medicare First Obligation Fee ~ 97416 1.00 350.00 350.00

Jackson, Barbara

Verification Fee - Jenkins,Mary 167058 2.00 50.00 100.00

Medicare First Obligation Fee - 167058 1,00 350.00 350,00

Jenkins, Mary

Verification Fee - Johnston,Mary 166927 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 166927 1.00 350.00 350,00

Johnston, Mary

Verification Fee ~ Jolliffe,Charis 104859 2.00 50.00 100.00

Verification Fee - Jordan, Debra 142975 2.00 50.00 100.00

Verification Fee ~ Kalbaugh, Zed 104319 2.00 50.00 100.00

Verification Fee - Kemerer,Maureen 167002 2.00 50,00 100.00

Verification Fee - Keyes, Todd 104598 2.00 50.00 100,00

Verification Fee - King,Gerald 89826 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee ~ 89826 1.00 350.00 350.00

King, Gerald

Verification Fee - King, John 174616 2.00 50.00 100.00

Medicare First Obligation Fee - King, Jobn 174616 1.00 350.00 350.00

Verification Fee ~ Klimas, Patricia 99860 2.00 50.00 100.00

Verification Fee - Kloppenburg,Robert 81505 2.00 50.00 100.00

Medicare First Obligation Fee - 81505 1.00 350.00 350.00

Kloppenburg, Robert: ‘

Medicaid Additional Obligation Fee - 81505 1.00 150.00 150.00

Kloppenburg, Robert

Verification Fee - Knight, Sandra 64463 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 64463 1.00 350.00 350.00

Knight, Sandra

Verification Fee ~ Krenzer, Shirley 166971 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 4166971 1.00 350,00 350.00

Kxenzer, Shirley

Verification Fee - Krouse,Michael 174591 2.00 50.00 100.00
174591 1.00 350.00 350.00

Medicaid Zero Interest Obligation Fee ~
Krouse, Michael



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 62 of 71
Description Client Cased GRG# ty Rate Amount
Verification Fee - Taylor Julie 104394 2.00 50.00 100.00
Verification Fee - Taylor Mark 89837 2.00 50.00 100.00
Medicare First Obligation Fee - Taylor 89837 1,00 350.00 350.00
Mark
Medicaid Additional Obligation Fee - 89837 1,00 150.00 150.00
Taylor Mark
Verification Fee - Taylor Stephanie 174621 2.00 50.00 100.00
Medicaid First Obligation Fee - Taylor 174621 1.00 350.00 350.00
Stephanie
Medicare First Obligation Fee - Tempesta 89818 1.00 350,00 350.00
Esther
Verification Fee - Terry Leon 167032 2.00 50.00 100.00
Medicare First Obligation Fee - Terry Leon 167032 1,00 350.00 350.00
Verification Fee - Tessnear Rodney 167052 2.00 50.00 100.00
Medicare First Obligation Fee - Tessnear 167052 1,00 350.00 350.00
Rodney
Medicaid Additional Obligation Fee - 167052 1,00 150.00 150.00
Tessnear Rodney
Verification Fee - Theis Kelleen 97458 2.00 50.00 100.00
Medicaid First Obligation Fee - Theis 97458 1,00 350.00 350.00
Kelleen
Verification Fee - Theobald Rodney 90063 2.00 50.00 100.00
Medicare First Obligation Fee - Theobald 90063 1.00 350.00 350.00
Rodney
Verification Fee - Thiessen Diana 104385 2.00 50.00 100.00
Medicaid First Obligation Fee - Thiessen 104385 1,00 350.00 350.00
Diana
Verification Fee - Thomas Hattie 97636 2.00 50.00 100.00
Medicare First Obligation Fee - Thomas 97636 1.00 350.00 350.00
Hattie
Medicaid Additional Obligation Fee - _ 97636 00,150.00 150.00
Thomas Hattie —_ oO
Verification Fee - Thome Richard 166936 2.00 50.00 100.00
Medicare First Obligation Fee - Thome 166936 1,00 350.00 350.00
Richard
Verification Fee - Thompson Jean 89956 2.00 50.00 100.00
Medicare First Obligation Fee - Thompson 89956 1.00 350.00 350.00
Jean
Medicaid Additional Obligation Fee - 89956 1.00 150.00 150.00
Thompson Jean
Verification Fee - Thompson Anthony 104602 2.00 50.00 100.00
Verification Fee - Thompson Donald 89871 2.00 50.00 100.00
Medicaid First Obligation Fee - Thompson 89871 1.00 350,00 350.00

Donald



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 49 of 71

Description Client Case# GRGH Qty Rate Amount
Verification Fee - Penneman Dean 174571 2.00 50.00 100.00
Verification Fee - Perrera Roxanne 81460 2.00 50.00 100.00
Medicare First Obligation Fee - Perrera 81460 1.00 350.00 350.00
Roxanne

Medicaid Additional Obligation Fee - 81460 1.00 150.00 150.00
Perrera Roxanne

Verification Fee - Perry Mary 90074 2.00 50.00 100.00
Medicare First Obligation Fee - Perry Mary 90074 1,00 350.00 350.00
Verification Fee ~ Perry Sandra 174482 2.00 50.00 100.00
Medicare First Obligation Fee - Perry 174482 1.00 350.00 350.00
Sandra

Verification Fee - Peters Ardella 296260 2.00 50.00 100.00
Verification Fee - Peterson Heather 166930 2.00 50.00 100.00
Medicaid First Obligation Fee - Peterson 166930 1,00 350.00 350.00
Heather

Verification Fee - Peterson David 282754 2.00 50.00 100.00
Medicare First Obligation Fee - Peterson 282754 1.00 350.00 350.00
David

Verification Fee - Peterson Robert 174613 2.00 50.00 100.00
Medicaid First Obligation Fee ~ Peterson 174613 1.00 350.00 350.00
Robert

Verification Fee - Pettigrew Demaches 9912 2.00 50.00 100.00
Medicare First Obligation Fee - Pettigrew 89912 1,00 350,00 350.00
Demaches

Medicaid Additional Obligation Fee ~ 89912 1.00 150.00 150.00
Pettigrew Demaches

Verification Fee - Pettway Freddie 296261 2.00 50.00 100.00
Medicaid First Obligation Fee - Pettway 296261 1,00 350.00 350.00
Freddie

Verification Fee - Phelps Anthony 282755 2.00 50.00 100.00
Medicaid First Obligation Fee - Phelps 282755 1,00 350.00 350.00
Anthony

Verification Fee - Picano Christopher 97714 2.00 50.00 100.00
Medicare First Obligation Fee - Picano 97714 1.00 350,00 350.00
Christopher

Medicaid Additional Obligation Fee - 97744 1.00 150.00 150.00
Picano Christopher

Verification Fee - Pieri Anthony 121200 2.00 50.00 100.00
Verification Fee - Pikula Sandra 174611 2.00 50.00 100.00
Verification Fee - Pilcher Teresa 271131 2.00 50.00 100.00
Medicare First Obligation Fee - Pilcher 271131 1.00 350.00 350.00
Teresa

Verification Fee - Pinkston Rodney 90054 2.00 50.00 100.00



James

Invoice Number 628651
Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 34 of 71
Description Client Case# GRGH Qty Rate Amount
Medicaid Additional Obligation Fee - Kisel 89938 1.00 150.00 150.00
John
Verification Fee - Kiska Matthew 64453 2.00 50.00 100.00
Medicare First Obligation Fee - Kiska 64453 1.00 350,00 350.00
Matthew
Medicaid Additional Obligation Fee - Kiska 64453 1,00 150.00 150.00
Matthew
Verification Fee - Klein Tom 310012 2.00 50.00 100.00
Verification Fee - Klingberg Betsy 81453 2.00 50.00 100.00
Medicare First Obligation Fee - Klingberg 81453 1,00 350.00 350.00
Betsy
Verification Fee - Kneiss Judith 308928 2.00 50.00 100.00
Medicare First Obligation Fee - Kneiss 308928 1.00 350.00 350,00
Judith
Medicaid Additional Obligation Fee - 308928 1.00 150.00 150.00
Kneiss Judith
Verification Fee - Knott Richard 167036 2.00 50.00 100.00
Medicare First Obligation Fee - Knott 167036 1,00 350.00 350.00
Richard
Medicaid Additional Obligation Fee ~ Knott 167036 1.00 150.00 150.00
Richard
Verification Fee - Kobza Marilyn 104500 2.00 50.00 100.00
Verification Fee - Koch Sharon 104581 2.00 50.00 100.00
Medicare First Obligation Fee - Koch 104581 1.00 350.00 350.00
Sharon
Verification Fee - Koehn Linda 64446 2.00 50.00 100.00
Medicare First Obligation Fee - Koehn 64446 1.00 350.00 350.00
Linda
Medicaid Additional Obligation Fee - Koehn 64446 1.00 150.00 150.00
Linda
Verification Fee - Kopac Peter 97517 2.00 50.00 100.00

--_Medicare—First—Obligation—Fee--—Kepae——- ——-__ —___________ _ _ _ 97517 ____1.00__ 350.00
Peter
Verification Fee ~ Kotzian Merrilee 97705 2.00 50.00 100.00
Medicare First Obligation Fee - Kotzian 97708 1.00 350.00 350.00
Merrilee
Verification Fee - Kubic Kenneth 97399 2.00 50.00 100.00
Medicare First Obligation Fee - Kubic 97399 1.00 350.00 350,00
Kenneth
Verification Fee - Kubitz Ned 97417 2,00 50.00 100.00
Medicare First Obligation Fee - Kubitz Ned 97417 1.00 350.00 350.00
Verification Fee - Kunstler James 271275 2.00 50,00 100.00
Medicare First Obligation Fee - Kunstler 271275 1.00 350.00 350.00



Invoice Number
Invoice Date

616403
November 24, 2014

PO Number
Contract
Project BIOMT~00050-00
2115 Rexford Road, 4th Floor | Charlotte, NC 28211
Terns 30
Thomas Anapol, Esquire Page Lof1
Anapol, Schwartz, Weiss, Cohan, Feldme
1710 Spruce Street
Philadelphia, PA 19103-6795
Biomet MDL~Pund Administration Services
Deseription Client. Caset cRct ory Rate Amount
Fund Administration Fee 1.00 300,000.00 300,000.00

Subtotal

Invoice Total

300,000.00

300,000.00



Invoice Number

628651

Project: BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 5 of 71
Description Client Cased GRG# Qty Rate Amount
Medicare First Obligation Fee - Belill 81474 1.00 350.00 350.00
Joseph
Verification Fee - Bell Valarie 104505 2.00 50.00 100.00
Medicare First Obligation Fee - Bell 104505 1,00 350.00 350.00
Valarie
Verification Fee - Bell Barbara 104487 2.00 50.00 100.00
Medicare First Obligation Fee - Bell 104487 1,00 350.00 350.00
Barbara
Verification Fee - Bendell Linda 89880 2.00 50.00 100.00
Verification Fee - Benge Sherman 89997 2.00 50.00 100.00
Verification Fee - Bennett Rodney 81448 2.00 50.00 100.00
Medicaid First Obligation Fee - Bennett 81448 1.00 350.00 350.00
Rodney
Medicare Additional Obligation Fee - 91448 1.00 150.00 150.00
Bennett Rodney
Verification Fee - Bergin Kaitlyn 73435 2.00 50,00 100.00
Verification Fee - Bergman Michele 282765 2.00 50,00 100.00
Medicare First Obligation Fee - Bergman 282765 1.00 350,00 350.00
Michele
Verification Fee - Bernstein Leslie 81501 2,00 50.00 100.00
Medicare First Obligation Fee - Bernstein 81501 1,00 350.00 350.00
Leslie
Verification Fee - Berry Ruby 308072 2.00 50.00 100.00
Medicaid First Obligation Fee - Berry Ruby 308072 1.00 350.00 350.00
Medicaid Additional Obligation Fee - Berry 308072 1.00 150.00 150.00
Ruby
Verification Fee - Beymer Jutta 296234 2.00 50.00 100.00
Medicare First Obligation Fee - Beymer 296234 1.00 350.00 350.00
Jutta
Verification Fee - Biles Yvonne 174472 2.00 50.00 100.00
Medicare First Obligation Fee - Biles 174472 1.00 350.00 350,00
Yvonne
Verification Fee - Birchfield Joy 97623 2.00 50.00 100.00
Verification Fee - Birchmeier George 97478 2.00 50.00 100.00
Verification Fee - Black Doris 97502 2.00 50.00 100.00
Medicare First Obligation Fee - Black 97502 1.00 350,00 350.00
Doris
Medicaid Additional Obligation Fee - Black 97502 1,00 150,00 150,00
Doris
Verification Fee - Blake Vickie 97526 2.00 50.00 100,00
Verification Fee - Blank Andrea 174544 2.00 50.00 100.00

174544 1.00 350.00 350.00

Medicare First Obligation Fee - Blank
Andrea



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 41 of 71

Description Client Cased GRGH aty Rate Amount
Medicare First Obligation Fee - Mcelroy 81380 1.00 350.00 350.00
Edward

Verification Fee - Mcfarlane Jeremy 90069 2.00 50,00 100.00
Verification Fee - Megarity Lynne 308081 2.00 50.00 100.00
Medicare First Obligation Fee - Mcgarity 308081 1.00 350.00 350.00
Lynne

Verification Fee - Mcguire Elyce 282794 2,00 50.00 100.00
Medicare First Obligation Fee - Mcguire 282794 1.00 350.00 350.00
Elyce

Verification Fee - Mckinnon Everett 308875 2.00 50,00 100.00
Medicare First Obligation Fee - Mckinnon 308875 1,00 350.00 350.00
Everett

Verification Fee - Mclamore Roosevelt 292404 2.00 50,00 100.00
Medicare First Obligation Fee - Mclamore 292404 1.00 350.00 350.00
Roosevelt

Medicaid Additional Obligation Fee ~ 292404 1.00 150.00 150.00
Mclamore Roosevelt

Verification Fee - Mclaughlin Michael 104290 2.00 50,00 100.00
Medicare First Obligation Fee - Mclaughlin 104290 1.00 350.00 350.00
Michael

Medicaid Additional Obligation Fee ~ 104290 1.00 150.00 150.00
Mclaughlin Michael

Verification Fee - Mclaughlin Mary 81477 2.00 50.00 100.00
Medicare First Obligation Fee - Mclaughlin 81477 1.00 350.00 350.00
Mary

Verification Fee - Mcnaught David 104364 2.00 50.00 100.00
Medicare First Obligation Fee - Mcnaught 104364 1.00 350.00 350.00
David

Verification Fee - Mcqueen Mary 64502 2.00 50.00 100.00
Medicare First Obligation Fee - Mcqueen 64502 1.00 350.00 350.00
Mary

Verification Fee - Mcquiston William 292403 200 50,00 100.00
Medicare First Obligation Fee - Mcquiston 292403 1,00 350.00 350,00
William

Verification Fee - Mcveigh Jan 167053 2,00 50.00 100.00
Verification Fee - Mead Richard 81532 2.00 50.00 100.00
Medicare First Obligation Fee - Mead 61532 1,00 350.00 350.00
Richard

Verification Fee - Meares Lisa 39821 2.00 50.00 100.00
Verification Fee - Medlock Wanda 81467 2.00 50.00 100.00
Verification Fee - Meehan Dottie 282795 2.00 50.00 100.00
Medicare First Obligation Fee - Meehan 282795 1.00 350.00 350.00
Dottie

Verification Fee - Meierer Linda 64454 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 43 of 71
Description Client Case# GRG# Qty Rate Amount
Medicaid First Obligation Fee - Milam 271300 1,00 350.00 350.00
Deborah
Verification Fee - Milbrand Robert 64455 2.00 50,00 100.00
Medicare First Obligation Fee - Milbrand 64455 1.00 350.00 350,00
Robert
Medicaid Additional Obligation Fee - 64455 1.00 150.00 150.00
Milbrand Robert
Verification Fee - Miller Carl 271301 2.00 50.00 100.00
Medicare First Obligation Fee ~ Miller 271301 1.00 350.00 350.00
carl
Verification Fee - Miller Pamela 81454 2.00 50.00 100.00
Medicare First Obligation Fee - Miller 81454 1,00 350.00 350,00
Pamela
Medicaid Additional Obligation Fee ~ 81454 1,00 150.00 150.00
Miller Pamela
Verification Fee - Miller Richard 24540 2.00 50,00 100.00
Verification Fee - Mills Ron 97382 2.00 50.00 100.00
Medicare First Obligation Fee - Mills Ron 97382 1.00 350.00 350.00
Verification Fee - Miln Matthew 97661 2.00 50.00 100.00
Medicaid First Obligation Fee - Miln 97661 1.00 350.00 350.00
Matthew
Verification Fee - Misner Betty 167080 2.00 50,00 100.00
Medicare First Obligation Fee - Misner 167080 1,00 350.00 350.00
Betty
Verification Fee - Mitchell Angelo 73430 2.00 50.00 100.00
Verification Fee - Mitchell Rosalind 271091 2.00 50.00 100.00
Medicare First Obligation Fee - Mitchell 271091 1.00 350.00 350.00
Rosalind
Medicaid Additional Obligation Fee - 271091 1.00 150,00 150.00
Mitchell Rosalind
Verification Fee - Mitchell Amber 9921 100.00
Medicaid First Obligation Fee - Mitchell 99921 1.00 350.00 350.00
Amber
Medicaid Additional Obligation Fee - 89921 1.00 150.00 150.00
Mitchell Amber
Verification Fee - Mohrhaus Diana 274810 2.00 50.00 100.00
Medicaid First Obligation Fee - Mohrhaus 274810 1.00 350.00 350.00
Diana
Medicaid Additional Obligation Fee - 274810 2.00 150.00 150.00
Mohrhaus Diana
Verification Fee - Monroe Anthony 308056 2.00 50,00 100,00
Verification Fee ~ Montmorency Michelle 271380 2.00 50.00 100.00

271380 1,00 350.00 350.00

Medicare First Obligation Fee -
Montmorency Michelle



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 44 of 71

Description Client Case# GRGH Qty Rate Amount
Verification Fee - Montoya Gloria 296254 2.00 50.00 100.00
Medicare First Obligation Fee - Montoya 296254 2,00 350.00 350.00
Gloria

Verification Fee - Moore Rafeal 97452 2,00 50.00 100.00
Medicaid First Obligation Fee - Moore 97452 1.00 350.00 350.00
Rafeal

Verification Fee - Moore Jeffrey 97437 2.00 50.00 100.00
Medicaid Pirst Obligation Fee - Moore 97437 1.00 350.00 350.00
Jeffrey

Verification Fee - Moorehead Randolph 264460 2.00 50.00 100.00
Medicare First Obligation Fee - Moorehead 264460 1.00 350.00 350.00
Randolph

Verification Fee - Moran Donald 292421 2.00 50.00 100.00
Medicare First Obligation Fee - Moran 282421 1.00 350.00 350.00
Donald

Verification Fee - Mordica Nina 264397 2.00 50.00 100.00
Medicare First Obligation Fee - Mordica 264397 1,00 350.00 350.00
Nina

Verification Fee - Morgan James 90058 2.00 50.00 100.00
Verification Fee - Morrison Ruby 104334 2.00 50.00 100.00
Medicare First Obligation Fee - Morrison 104334 1.00 350.00 350.00
Ruby

Verification Fee - Morrison Heary 174615 2.00 50.00 100.00
Medicare First Obligation Fee ~ Morrison 174615 1.00 350.00 350.00
Henry

Medicaid Additional Obligation Fee - 174615 1.00 150,00 150,00
Morrison Henry

Verification Fee - Moses Janice 97700 2.00 50.00 100.00
Medicaid First Obligation Fee - Moses 97700 1.00 350.00 350.00
Janice

Medicare Additional Obligation Fee - Moses _ Le _ 97700 1.00 150.00 150.00
Janice —_ —- oo —
Verification Fee - Moshos Freya 271092 2.00 50.00 100.00
Medicare First Obligation Fee - Moshos 271092 1.00 350.00 350.00
Freya

Verification Fee - Mosley Faye 97693 2.00 50,00 100.00
Medicaid First Obligation Fee - Mosley 97693 1.00 350.00 350.00
Faye

Verification Fee - Muhammad Duane 282778 2.00 50.00 100.00
Verification Fee - Muhammad Mini 270347 2.00 50.00 100.00
Medicaid First Obligation Fee - Muhammad 270347 1.00 350,00 350.00
Mink

Verification Fee - Mullis Sylvia 271390 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 2 of 71
Description Client Case# GRGH Qty Rate Amount
Verification Fee - Allgeier Wayne 104339 2.00 50.00 100,00
Medicare First Obligation Fee - Allgeier 104339 1,00 350.00 350.00
Wayne
Verification Fee - Allison William (274820 2.00 50.00 100,00
Medicare First Obligation Fee - Allison 274820 1.00 350.00 350.00
William
Verification Fee - Altman John 97423 2.00 50.00 100,00
Verification Fee - Alvey Scott 296230 2.00 50.00 100.00
Verification Fee - Amaral Diane age14 2.00 50,00 100.00
Medicare First Obligation Fee - Amaral 89814 1.00 350.00 350.00
Diane
Verification Fee - Ames William 282782 2.00 50,00 100.00
Verification Fee - Ames Deretha 89950 2.00 50.00 100.00
Verification Fee - Anderson Sylvia 97432 2.00 50.00 100.00
Medicaid First Obligation Fee - Anderson 97432 2.00 350,00 350.00
sylvia
Verification Fee - Anderson William 296229 2.00 50,00 100.00
Medicare First Obligation Fee - Anderson 296229 1,00 350.00 350.00
William
Verification Fee - Anderson Vivian 104465 2.00 50.00 100.00
Medicare First Obligation Fee - Anderson 104465 1,00 350.00 350.00
Vivian
Verification Fee - Anderton Darrin 104410 2.00 50.00 100.00
Medicare First Obligation Fee - Anderton 104410 1.00 350.00 350.00
Darrin
Medicaid Additional Obligation Fee - 104410 1.00 150.00 150.00
Anderton Darrin
Verification Fee - Andrews William 97593 2.00 50.00 100,00
Medicare First Obligation Fee - Andrews 97593 1.00 350.00 350.00
William
Verification Fee - Andrews Bradley 282402 2.00 50.00 100.00
Verification Fee - Andrews Wanda 97393 2.00 50,00 100.00
Medicare First Obligation Fee - Andrews 97393 1,00 350.00 350,00
Wanda
Verification Fee - Angell Pamela 286875 2.00 50.00 100.00
Verification Fee - Antler Steven 97650 2.00 50.00 100.00
Medicare First Obligation Fee - Antler 97650 1.00 350,00 350.00
Steven
Verification Fee - Archie Deborah 296231 2.00 50.00 100.00
Verification Fee - Ardoin John 64413 2.00 50.00 100.00
Verification Fee - Arroyo Nilda 166945 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 54 of 71

Description Client Case# GRG# aty Rate Amount
Verification Fee - Rountree Leonard 89755 2.00 50.00 100.00
Verification Fee - Rowland Claude 174487 2.00 50.00 100.00
Medicare First Obligation Fee - Rowland 174487 1,00 350.00 350.00
Claude

Medicaid Additional Obligation Fee - 174487 1,00 150.00 150.00
Rowland Claude

Verification Fee - Rudner Barbara 97727 2.00 50.00 100.00
Medicare First Obligation Fee - Rudner 97727 1.00 350.00 350.00
Barbara

Verification Fee - Ruffner Don 271098 2.00 50.00 100.00
Medicare First Obligation Fee - Ruffner 271098 1,00 350.00 350.00
Don

Verification Fee ~ Rushing Peggy 104316 2.00 50.00 100.00
Medicare First Obligation Fee - Rushing 104316 1.00 350.00 350.00
Peggy

Verification Fee - Sabados Charles 174563 2.00 50.00 100.00
Medicare First Obligation Fee - Sabados 174563 1,00 350.00 350.00
Charles

Medicaid Additional Obligation Fee - 174563 4.00 150.00 150.00
Sabados Charles

Verification Fee - Sadler Carmen 104351 2.00 50.00 100.00
Verification Fee - Sage Gregory 174507 2.00 50.00 100.00
Medicare First Obligation Fee - Sage 174507 1,00 350.00 350.00
Gregory

Verification Fee - Salinas Ricky 97725 2.00 50.00 100.00
Medicare First Obligation Fee - Salinas 97725 1,00 350.00 350.00
Ricky

Medicaid Additional Obligation Fee - 97725 1.00 150.00 150.00
Salinas Ricky

Medicaid Additional Obligation Fee - 97725 1.00 150.00 150.00
Salinas Ricky

Verification Fee - Salsbury Linda _100,00
Medicare First Obligation Fee - Salsbury 350.00
Linda

Verification Fee - Sample Gerald 296267 2.00 50.00 100.00
Medicare First Obligation Fee - Sample 296267 1.00 350.00 350.00
Gerald

Verification Fee - Sanborn Peggy 271113 2.00 50.00 100.00
Medicare First Obligation Fee - Sanborn 271113 1,00 350.00 350.00
Peggy

Medicare First Obligation Fee - Sanchez 81475 1.00 350.00 350.00
Hermelinda

Medicaid Additional Obligation Fee - 81475 1,00 150.00 150.00
Sanchez Hermelinda

Verification Fee ~ Sanders Patricia 190507 2.00 50,00 100.00



Invoice Number

615437

Project BIOMT-00050~00
Anapol Schwartz Weiss Cohan Feldman et Page 3 0f5
Description Client Caset ret oty Rate Amount
Medicaid Additional Obligation Fee - 73443 1.00 150.00 150.00
Rooker, Joe
Verification Fee - Howard, Kathleen 167022 2.00 50,00 100.00
Verification Fee - Johnson,Maria 174440 2.00 50.00 100.00
Medicaid First Obligation Fee ~ 174440 1.00 350.00 350.00
Johnson, Maria
Verification Fee - Kelleher,Marcia 64481 2.00 50.00 100.00
Verification Fee - Konowal,William 166965 2.00 50.00 100.00
Medicare First Obligation Fee ~ 166965 1.00 350.00 350.00
Konowal, William
Verification Fee ~ Kresse, Joseph 174491. 2.00 50.00 100.00
Medicare First Obligation Fee ~ 174493 1.00 350.00 350.00
Kresse, Joseph
Verification Fee - Krom,Celia 174623 2.00 50.00 100.00
Medicare First Obligation Fee ~ Krom,Celia 174623 1.00 350.00 350.00
Verification Fee - Kuhimann,Debara 64482 2.00 50.00 100.00
Verification Fee - Lee,Kay 174486 2.00 50.00 100.00
Medicare First Obligation Fee ~ Lee,Kay 174486 1.00 350.00 350.00
Verification Fee - Lillard,Robin 174598 2.00 50.00 100.00
Verification Fee ~ Lynch,Micaela 174458 2.00 50.00 100.00
Medicare First Obligation Fee - 174458 1.00 350.00 350.00
Lynch, Micaela
Verification Fee - Maroney, Deborah 174497 2.00 50.00 100.00
Verification Fee - Martel,Lawrence 166928 2.00 50.00 100.00
Verification Fee - Mattern, Gregg 167009 2.00 50.00 100.00
Verification Fee - Mcelvain,Brenda 174537 2.00 50.00 100.00
Medicaid First Obligation Fee - 174537 1.00 350,00 350.00
Mcelvain, Brenda
Verification Fee - Miller, Brett 64484 2,00 50.00 100,00
Verification Fee - Mudiraj,Mary 166993 2.00 50.00 100.00
Verification Fee ~ 0'Brien,Michelle 166995 2.00 50.00 100.00
Verification Fee - Pearson,Reta 167037 2.00 50.00 100.00
Medicare First Obligation Fee ~ 167037 1.00 350.00 350.00
Pearson,Reta
Verification Fee - Pernitz,Constance 64485, 2.00 50.00 100.00
Verification Fee - Peters, Suzanne 64500 2.00 50.00 100.00
Verification Fee - Pierson, Teresa 174421 2.00 50.00 100.00
Verification Fee - Ponicsan, David 64502 2.00 50.00 100.00



Invoice Number

615437

Project BIOMT-00050-00
Anapol Schwartz Weiss Cohan Feldman et Page 2 of 5
Description Client Caset GRGE ty Rate Amount,
Medicare First Obligation Fee - 167048 1,00 350.00 350.00
Dunson, Trena
Medicaid Additional Obligation Fee ~ 167048 1,00 150.00 150.00
Dunson, Trena
Verification Fee - Edelen, Gwendolyn 174469 2.00 50.00 100.00
Verification Fee - Evers,Angela 64479 2.00 50.00 100.00
Medicare First Obligation Fee - 64479 1.00 350.00 350.00
Evers, Angela
Verification Fee ~ Felinski,Julee 174457 2.00 50.00 100.00
Verification Fee - Finz,Robert 166976 2.00 50.00 100.00
Medicare First Obligation Fee — 166976 1.00 350.00 350.00
Finz, Robert.
Verification Fee - Frank, Jana 174474 2.00 50.00 100.00
Verification Fee - Geist,Brenda 64472 2.00 50.00 100.00
Medicare First Obligation Fee - 64472 1.00 350.00 350.00
Geist, Brenda
Verification Fee - Gray,Diane 73429 2.00 50.00 100.00
Medicare First Obligation Fee - Gray, Diane 73429 1.00 350.00 350.00
Medicare Additional Obligation Fee - 264358 1,00 150.00 150.00
Gray, Diane
verification Fee ~ Hales, Patrick 64493 2.00 50.00 100.00
Medicare First Obligation Fee ~ 64493 1.00 350.00 350.00
Hales, Patrick
Medicaid Additional Obligation Fee - 64493 1.00 150.00 150.00
Hales, Patrick
Medicare Additional Obligation Fee - 264402 1.00 150.00 150.00
Hales, Patxick
Medicaid Additional Obligation Fee - 264402 1,00 150.00 150.00
Hales, Patrick
Verification Fee + Hammond,Margo 64439 2.00 50.00 100.00
Medicare First Obligation Fee - 64439 1.00 350.00 350.00
Hammond, Margo
Verification Fee - Hansbery, Kristine 64480 2.00 50.00 100.00
verification Fee - Henson, Sterling 174579 2.00 50.00 200.00
Verification Fee - Hodge,Wallace 167017 2.00 50.00 100.00
Medicare First Obligation Fee - 167017 1.00 350.00 350.00
Hodge, Wallace
Medicaid Additional Obligation Fee ~ 167017 1.00 150.00 150.00
Hodge, Wallace
Verification Fee - Hoff, Joann 174514 2.00 50.00 100.00
Medicare First Obligation Fee - Hoff, Joann 174514 1.00 350.00 350.00
Verification Fee - Hooker, Joe 73443 2.00 50.00 100.00
Medicaid First Obligation Fee - Hooker, Joe 73443 1.00 350,00 350.00



Invoice Number

621297

Project. BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldmz Page 9 of 18
Description Client Caset GRG¥ Qty Rate Amount
Verification Fee - Krueger,Mark 97441 2.00 50.00 100.00
Verification Fee ~ Kuhns,Ralla 167010 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 167010 1.00 350.00 350.00
Kuhne,Ralla
Verification Fee - Kvasnicka,Rick 81440 2.00 50,00 100.00
Medicare Zero Interest Obligation Fee - 81440 1.00 350.00 350.00
Kvasnicka, Rick
Medicaid Additional Obligation Fee - 81440 1.00 150.00 150.00
Kvasnicka, Rick
Verification Fee ~ La Course, Catherine 97419 2.00 50.00 100.00
Medicare First Obligation Fee ~ La 97419 1.00 350,00 350.00
Course, Catherine
Medicaid Additional Obligation Fee - La 97419 1.00 150.00 150.00
Course, Catherine
Verification Fee ~ Laging, Shirley 174546 2.00 50.00 100.00
verification Fee - Landreth, Barbara 97583 2.00 50.00 100.00
Medicare First Obligation Fee - 97583 1.00 350.00 350.00
Landreth, Barbara
Verification Fee - Lane,Cornelia 166990 2,00 50.00 100.00
Verification Fee - Lane,Norma 174538 2.00 50.00 100.00
Medicare First Obligation Fee - Lane,Noxma 174538 1.00 350.00 350.00
Verification Fee ~ Lanier,Walter 97457 2.00 50,00 100.00
Verification Fee - Laporte, Zlizabeth 97580 2,00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 97580 1.00 350.00 350.00
Laporte, Elizabeth
Verification Fee ~ Lara,Jesse 64498 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 64498 1.00 350.00 350.00
Lara, Jesse
Verification Fee - Larocco,Antonette 166992 2.00 50.00 100.00
Verification Fee - Laudenslager, Gail 97586 2.00 50.00 100.00
Medicare First Obligation Fee - 97586 1.00 350.00 350.00
Laudenslager, Gail
Verification Fee - Leaders Ferrebee, Sherry 89995 2.00 50.00 100.00
Verification Fee - Leaf, Barbara 64475 2.00 50.00 100.00
Medicare Zexo Interest Obligation Fee - 64475 1.00 350.00 350.00
Leaf, Barbara
Verification Fee - Leary, Kathi 81439 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 81439 1.00 350.00 350.00
Leary, Kathi
Verification Fee - Leclaixe, Priscilla 89890 2.00 50.00 100.00

89890 1.00 350.00 350.00

Medicare First Obligation Fee -
Leclaire, Priscilla



Invoice Number 615437

Project BIOMT-00050-00

Anapol Schwartz Weiss Cohan Feldman et Page 5 of 5
Description Client Case# GRGH Qty Rate Amount:
Medicare First Obligation Fee - 64487 1.00 350.00 350.00
Winz, Richard
Verification Fee - Ziegler,Mary 174553 2.00 50.00 100.00
Verification Fee - Baker, Regina 174450 2.00 50,00 100.00

Subtotal 21,200.00

Invoice Total 21,200.00



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 71 of 71
Description Client Case# GRGH aty Rate Amount
Medicaid First Obligation Fee ~ Young 97396 1.00 350.00 350.00
Donald
Medicaid Additional Obligation Fee - Young 97396 1.00 150.00 150.00
Donald
Verification Fee - Young Brenda 308439 2,00 50.00 100,00
Medicare First Obligation Fee - Young 308439 1.00 350.00 350.00
Brenda
Verification Fee - Young Lisa 308438 2.00 50.00 100.00
Medicaid First Obligation Fee - Young Lisa 308438 1.00 350.00 350.00
Verification Fee - Young Michael 97565 2.00 50.00 100.00
Medicare First Obligation Fee - Young 97565 1.00 350.00 350.00
Michael
Verification Fee - Zablonski Richard 89763 2.00 50.00 100.00
Verification Fee - Zambrano Mireya 104580 2.00 50.00 100.00
Medicare First Obligation Fee - Zambrano 104580 1.00 350.00 350.00
Mireya
Verification Fee - Zamora Deborah 97465 2.00 50.00 100.00
Medicare First Obligation Fee - Zamora 97465 1.00 350.00 350.00
Deborah
Verification Fee - Zdarko Dawn 104408 2.00 50.00 100.00
Verification Fee - Zepeda Miguel 97436 2.00 50.00 100,00
Medicaid First Obligation Fee - Zepeda 97436 1.00 350.00 350.00
Miguel
Verification Fee - Zimmerman Joel 296278 2.00 50,00 100.00
Verification Fee ~ Zlutka Zenon 17444 2.00 50.00 100.00

subtotal 414,800.00

Invoice Total 414,800.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 63 of 71
Description Client Case# GRG# Qty Rate Amount
Medicare Additional Obligation Fee - 99871 1.00 150,00 150.00
Thompson Donald
Verification Fee - Thompson Johnny 270398 2.00 50.00 100.00
Verification Fee - Tice John 271119 2.00 50.00 100.00
Medicare First Obligation Fee - Tice John 271119 1,00 350.00 350,00
Verification Fee - Tindle Patricia 264347 2,00 50.00 100.00
Medicare First Obligation Fee - Tindle 264347 1.00 350.00 350.00
Patricia
Medicaid Additional Obligation Fee ~ 264347 1.00 150.00 150.00
Tindle Patricia
Verification Fee - Tobias Daniel 81386 2.00 50.00 100.00
Verification Fee - Toliver Joseph 167030 2.00 50,00 100.00
Medicare First Obligation Fee - Toliver 167030 1,00 350.00 350.00
Joseph
Verification Fee - Tomaino Peter 166981 2.00 50.00 100.00
Medicare First Obligation Fee - Tomaino 166981 1.00 350.00 350.00
Peter
Medicaid First Obligation Fee - Toomey 61424 1,00 350.00 350.00
David
Verification Fee - Torres-Hernandez Lisa 97652 2.00 50.00 100.00
Medicaid First Obligation Fee - 97652 1,00 350.00 350.00
Torres-Hernandez Lisa
Medicaid Additional Obligation Fee ~ 104599 1.00 150.00 150,00
Towery Nadine
Verification Fee - Tran Tony goged 2.00 50,00 100.00
Medicare First Obligation Fee - Tran Tony 89884 1.00 350.00 350.00
Verification Fee - Trapp Rita 97389 2.00 50.00 100.00
Medicaid First Obligation Fee - Trapp Rita 97389 1.00 350.00 350.00
Medicaid Additional Obligation Fee - Trapp 97389 1.00 150.00 150.00
" ee
Verification Fee - Tribbitt Frankie 29834 2.00 50,00 100.00
Medicare First Obligation Fee - Tribbitt 89834 1.00 350.00 350.00
Frankie
Medicaid Additional Obligation Fee - 89834 1.00 150.00 150.00
Tribbitt Frankie
Verification Fee - Trost Timothy 97643 2.00 50,00 100.00
Medicare First Obligation Fee - Trost 97643 1.00 350.00 350.00
Timothy
Verification Fee - Tucker Paul 167045 2.00 50.00 100.00
Medicare First Obligation Fee - Tucker 167045 1.00 350.00 350.00
Paul
Verification Fee - Turner Samuel 167039 2.00 50.00 100.00
Medicare First Obligation Fee - Turner 167039 1.00 350.00 350.00

Samuel



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 56 of 71

Description Client Case# GRG# aty Rate Amount
Medicare First Obligation Fee - Seeley 64443 1.00 350.00 350.00
Irving

Verification Fee - Selma Dorothy 271132 2.00 50.00 100.00
Medicare First Obligation Fee - Selma 271132 1.00 350.00 350.00
Dorothy

Verification Fee - Selman Linda 174492 2,00 50.00 100.00
Medicare First Obligation Fee - Selman 174492 1.00 350.00 350.00
Linda

Medicaid Additional Obligation Fee - 174492 1.00 150.00 150.00
Selman Linda

Verification Fee - Seybt Loriann 166954 2.00 50.00 100.00
Verification Fee - Seymour Michael 104611 2.00 50.00 100.00
Medicare First Obligation Fee - Seymour 104611 1.00 350,00 350.00
Michael

Verification Fee - Shaffer Doris 90053 2.00 50.00 100.00
Medicare First Obligation Fee - Shaffer 90053 1.00 350.00 350.00
Doris

Verification Fee ~ Shanks Traci 90000 2.00 50.00 100.00
Medicare First Obligation Fee - Shanks 90000 1,00 350.00 350,00
Traci

Medicaid Additional Obligation Fee - 90000 1.00 150.00 150.00
Shanks Traci

Verification Fee - Sharp John 89977 2.00 50.00 100.00
Medicare First Obligation Fee - Sharp John 89977 1.00 350.00 350.00
Verification Fee - Shaw Clifton 89947 2.00 50.00 100.00
Verification Fee - Shear Carolyn 296268 2.00 50.00 100.00
Medicare First Obligation Fee - Shear 296268 1.00 350.00 350.00
Carolyn

Verification Fee - Shelton William 296270 2.00

Medicaid First Obligation Fee - Shelton 296270 1.00

William Se

Medicare Additional Obligation Fee - 296270 1,00

Shelton William

Verification Fee - Sheridan Paul 296269 2.00 50.00 100.00
Medicaid First Obligation Fee - Sheridan 296269 1,00 350.00 350.00
Paul

Verification Fee - Shiff Michael 308434 2.00 50,00 100.00
Medicare First Obligation Fee - Shift 308434 1.00 350.00 350,00
Michael

Medicaid Additional Obligation Fee - Shiff 308434 1.00 150,00 150.00
Michael

Verification Fee - Shirley Verlan 444d 2.00 50.00 100.00
Medicaid First Obligation Fee - Shirley 64444 1.00 350.00 350.00

Verlan



Invoice Number 628651
Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 59 of 71
Description Client Case# GRG# Qty Rate Amount
Verification Fee - Smith Tonya 104397 2.00 50.00 100.00
Medicaid First Obligation Fee - Smith 104397 1.00 350.00 350.00
Tonya
Verification Fee - Smith Colleen 270360 2.00 50.00 100.00
Medicare First Obligation Fee - Smith 270360 1,00 350,00 350,00
Colleen
Verification Fee - Smith Laura 97669 2.00 50.00 100.00
Medicare First Obligation Fee - Smith 97669 1.00 350.00 350.00
Laura
Verification Fee - Smithey Dave 270317 2.00 50.00 100.00
Medicaid First Obligation Fee - Smithey 270317 1,00 350.00 350.00
Dave
Medicare Additional Obligation Fee - 270317 1.00 150.00 150.00
Smithey Dave
Verification Fee - Smithson Douglas 104473 2.00 50.00 100.00
Medicare First Obligation Fee - Smithson 104473 1.00 350.00 350.00
Douglas
Verification Fee - Smugeresky Joseph 104295 2.00 50,00 100.00
Medicare First Obligation Fee - Smugeresky 104295 1,00 350.00 350.00
Joseph
Medicare Additional Obligation Fee ~ 61481 1.00 150.00 150.00
Soares Mary
Verification Fee - Soll Rachel 308436 2.00 50.00 100.00
Verification Fee - Soltermann Connie 308960 2.00 50.00 100.00
Verification Fee - Sperling Phillip 97682 2.00 50.00 100.00
Verification Fee - Spiewak Joseph 273644 2.00 50.00 100.00
Medicaid First Obligation Fee - Spiewak 273644 1,00 350.00 350.00
Joseph
Medicaid Additional Obligation Fee - 273644 1.00 150.00 150.00
Spiewak Joseph
Medicaid Additional Obligation Fee - _ 273644 1.00 150.00 150.00
Spiewak Joseph TN _
Medicaid Additional Obligation Fee - 273644 1.00 150.00 150.00
Spiewak Joseph
Verification Fee - Spillane Teresa 270351 2.00 50.00 100.00
Verification Fee - Spirek Mary 97559 2.00 50.00 100.00
Medicare First Obligation Fee - Spirek 97559 1.00 350.00 350.00
Mary
Verification Fee - Spitler Sheila 89867 2.00 50.00 100.00
Medicare First Obligation Fee ~ Spitler 89867 1.00 350.00 350.00
Sheila
Verification Fee - Spivey Dana 97735 2.00 50.00 100.00

97735 1,00 350.00 350.00

Medicare First Obligation Fee - Spivey
Dana



Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldm: Page 15 of 18
Description Client Caset GRGt ty Rate Amount
Verification Fee - Smith, Suzanne 89748 2.00 50.00 100.00
Verification Fee - Smith, Thomas 166952 2.00 50.00 ° 100.00
Medicare First Obligation Fee - 166952 1.00 350.00 350.00
smith, Thomas
Medicaid Additional Obligation Fee ~ 166952 1.00 150.00 150.00
Smith, Thomas
Verification Fee ~ Soares,Mary 1481 2.00 50,00 100.00
Medioare Zero Interest Obligation Fee ~ 614e1 1,00 350,00 350.00
Soares Mary
verification Fee - Southern,Marolyn 97651 2.00 50,00 100.00
Medicare Firet Obligation Fee - 97651 1.00 350.00 350.00
Southern, Marolyn
Medicaid Additional Obligation Fee - 97651 1.00 150.00 150.00
Southern, Marolyn
Verification Fee - Sparks,Donald 89815 2.00 50,00 100.00
Medicare First Obligation Fee - 89815 1.00 350.00 350.00
Sparks, Donald
Verification Fee - Sperandeo, Giuliana 166980 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 166980 1.00 350.00 350.00
Sperandeo, Giuliana
Verification Fee - Stegall, Edward 167069 2.00 50,00 100.00
Medicare First Obligation Fee - 167069 1.00 350.00 350.00
Stegall, Edward
Verification Fee - Steiner, Vickie 121206 2.00 50.00 100.00
Verification Fee ~ Stillwell, Jerry 89780 2.00 50.00 100.00
verification Fee - Stott,Kristiane 90004 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 90004 1.00 350.00 350.00
Stott, Kristiane
Verification Fee ~ Sullivan, Brenda 104609 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 104609 1.00 350.00 350.00
Sullivan, Brenda
Verification Fee ~ Swanson, Scott 174554 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 174554 1.00 350,00 350.00
Swanson, Scott
Verification Fee - Taylor,Gary 166956 2.00 50.00 100,00
Medicare Zero Interest Obligation Fee — 166956 1.00 350.00 350.00
Taylor, Gary
Medicaid Additional Obligation Fee - 166956 1.00 150.00 150.00
Taylor,Gary
Verification Fee - Taylor,Jennie 174630 2,00 50.00 100.00
Verification Fee - Tempesta,Esther 89818 2.00 50.00 100.00
Verification Fee - Thompson,Rebecca 142978 2.00 50.00 100.00
Verification Fee - Tibbs, Estella 174413 2.00 50.00 100.00



Exhibit G



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 60 of 71

Description Client Case# GRG# Qty Rate Amount
Verification Fee - Spoon Ethel 97496 2.00 50.00 100.00
Verification Fee - Sporer Kenneth 97707 2.00 50.00 100.00
Medicaid First Obligation Fee - Sporer 97707 1.00 350,00 350.00
Kenneth

Medicare Additional Obligation Fee - 97707 1.00 150.00 150.00
Sporer Kenneth

Verification Fee - Spradlin Kitty 296272 2.00 50.00 100.00
Verification Fee - Sprietzer Lawrence 286005 2.00 50.00 100.00
Verification Fee - Spurlock Jerry 308083 2.00 50.00 100.00
Medicare First Obligation Fee - Spurlock 308083 1.00 350.00 350.00
Jerry

Verification Fee - Stallings Terri 264436 2.00 50.00 100.00
Verification Fee - Stedham John 174590 2.00 50.00 100.00
Medicare First Obligation Fee ~ Stedham 174590 1.00 350.00 350.00
John

Verification Fee - Stefanini Alice 89967 2.00 50.00 100.00
Verification Fee - Stephens Terry 271118 2.00 50.00 100.00
Medicare First Obligation Fee - Stephens 271118 1.00 350.00 350.00
Terry

Verification Fee - Stephenson Diana 104363 2.00 50,00 100.00
Medicare First Obligation Fee - Stephenson 104363 1.00 350.00 350.00
Diana

Verification Fee - Stevens Rhonda 264365 2.00 50.00 100.00
Verification Fee - Stewart Gerald 166989 2.00 50.00 100.00
Medicare First Obligation Fee - Stewart 166989 1.00 350.00 350.00
Gerald

Medicaid Additional Obligation Fee - 166989 1,00 150.00 150.00
Stewart Gerald

Verification Fee - Stewart Melba 270296 2.00 50.00 100.00
Medicare First Obligation Fee - Stewart 270296 = 1.00 350.00 © 350,00 0
Melba

Verification Fee - Stockton Doris 174517 2.00 50.00 100.00
Verification Fee - Stone Margaret 174503 2.00 50.00 100.00
Medicare First Obligation Fee - Stone 174503 1.00 350.00 350.00
Margaret

Medicaid Additional Obligation Fee - stone 174503 1,00 150.00 150.00
Margaret

Verification Fee - Strakosch Katherine 97709 2.00 50.00 100.00
Medicare First Obligation Fee - Strakosch 97709 1,00 350.00 350.00
Katherine

Verification Fee - Strohm Jocelyn 308049 2.00 50.00 100.00
Verification Fee - Strong Ronald 99915 2.00 50.00 100.00



Invoice Number 628651
Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman page 20 of 71

Description Client Case# GRGH Ooty Rate Amount
Verification Fee - Foresta Theresa 97524 2.00 50.00 100.00
Medicare First Obligation Fee - Foresta 97524 1.00 350.00 350.00
Theresa

Verification Fee ~ Foster Richard 97516 2.00 50.00 100.00
Verification Fee - Foster George 264435, 2.00 50.00 100.00
Medicare First Obligation Fee - Foster 264435 1.00 350.00 350,00
George

Verification Fee - Francis Kimala 97624 2.00 50.00 100.00
Medicaid First Obligation Fee - Francis 97624 1.00 350.00 350.00
Kimala

Verification Fee - Freedman Richard 97657 2.00 50.00 100.00
Verification fee - Freeman Matthew 307657 2.00 50.00 100.00
verification Fee - Freisthler George 269995 2.00 50,00 100.00
Verification Fee - Friedrich Carol 104309 2,00 50.00 100.00
Verification Fee - Fritz Diana 90083 2.00 50.00 100.00
Medicare First Obligation Fee ~ Fritz 90083 1.00 380.00 350.00
Diana

Medicaid Additional Obligation Fee - Fritz 90083 1.00 150.00 150.00
Diana

Verification Fee - Frohm Michael 195844 2.00 50.00 100.00
Verification Fee - Furlow Dennis 271065 2.00 50.00 100.00
Medicare First Obligation Fee - Furlow 271065 1.00 350.00 350.00
Dennis

Medicaid Additional Obligation Fee ~ 271065 1.00 150.00 150.00
Furlow Dennis

Medicaid Additional Obligation Fee - 271065 1,00 150.00 150.00
Furlow Dennis

Verification Fee - Gaffney James 166960 2,00 50.00 100.00
Verification Fee - Gage Donna 174424 2.00 50.00 100.00
“Medicare First Obligation Fee - Gage Donna sssts—S 114424 ~~ 1.00- 350,00
Verification Fee - Gaines-Reese Joyce 285816 2.00 50.00 100.00
Medicare First Obligation Fee - 285816 1,00 350.00 350.00
Gaines-Reese Joyce

Verification Fee - Gallagher John 121190 2.00 50.00 100.00
Medicare First Obligation Fee - Gallagher 121190 1.00 350.00 350.00
John

Medicare First Obligation Fee - Gamble 271145 1.00 350.00 350.00
Cecilia

Medicaid Additional Obligation Fee - 271145 1.00 150.00 150.00
Gamble Cecilia

Verification Fee - Gammill Carroll 90081 2.00 50.00 100.00

90081 1,00 350.00 350.00

Medicare First Obligation Fee - Gammill
Carroll



Invoice Number

621297

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldme Page 2 of 18

Description Client Caset GRGt Qty Rate Amount

Medicare First Obligation Fee - 89795 1.00 350.00 350,00

Bean, Glenda

Verification Fee - Beaver,Anita 104563 2.00 50.00 100.00

Medicare First Obligation Fee - 104563 1.00 350.00 350.00

Beaver, Anita

Verification Fee ~ Benson,Donna 174586 2.00 50,00 100.00

Medicare Zero Interest Obligation Fee - 174586 1.00 350.00 350.00

Benson, Donna

Verification Fee - Benton, Jeffrey 270325 2.00 50,00 200,00

Verification Fee - Birdsell,Rebecca 90038 2.00 50,00 100.00

Verification Fee - Birtig,Leslie 89873 2.00 50.00 100,00

Medicare Zero Interest Obligation Fee - 89873 1.00 350.00 350.00

Birtig, Leslie .

Verification Fee - Bishop, Tony 64431 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 64432 1.00 350.00 350.00

Bishop, Tony

Verification Fee ~ Bland, Henry 97454 2.00 50.00 100.00

Medicare First Obligation Fee - 97454 1.00 350.00 350.00

Bland, Henry

Verification Fee - Blette,Kathryn 64509 2.00 50.00 100,00

Verification Fee - Boehme, Peggy 104494 2.00 50.00 100.00

Medicare First Obligation Fee ~ 104494 1.00 350.00 350.00

Boehme, Peggy

Verification Fee - Boetcher, Julie 81465, 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 81465 1.00 350.00 350.00

Boetcher, Julie

verification Fee - Bou-Hamdan, Daoud 104482 2.00 50,00 100.00

Medicare Zero Interest Obligation Fee - 104482 1.00 350.00 350.00

Bou-Hamdan, Daoud

Verification Fee - Brickell, Bradley 64438 2.00 50.00 100.00

Verification Fee - Brooks, Dennis 166982 2.00 50.00 100.00

Verification Fee ~ Brown,Rodney 97426 2.00 50.00 100.00

Medicare First Obligation Fee - 97426 1.00 350.00 350.00

Brown, Rodney

verification Fee ~ Calvert, Barbara 174485 2.00 50.00 100.00

Medicare First Obligation Fee - 174485 1,00 350.00 350.00

Calvert,Barbara

Verification Fee ~ Campbell, Elizabeth 97688 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee ~ 97688 1.00 350.00 350,00

Campbell, Blizabeth

Verification Fee - Campbell, Loyd 270318 2.00 50.00 100.00
270318 1.00 350.00 350.00

Medicare Zero Interest Obligation Fee ~
Campbell, Loyd



Invoice Number
Invoice Date

RRE ‘Sc PO Nunbex

ROUR Contract

a a a Project

621297

February 11, 2015

BIOMT-00050-00

Msp cet
2115 Rexford Road, 4th Floor | Charlotte, NC 28211
. Terms 30

Thomas Anapol, Esquire Page 1 of 18

Anapol, Schwartz, Weiss, Cohan, Feldme

1710 Spruce Street

Philadelphia, PA 19103-6795
Description Client Caset GRGE oty Rate Amount.
Verification Fee - Angeluski, Steven 90007 2.00 50.00 100.00
Medicare First Obligation Fee - 90007 1.00 350.00 350.00
Angeluski, Steven
Medicaid Additional Obligation Fee - 90007 1.00 150.00 150.00
Angeluski, Steven
Verification Fee - Anker, Peter 174562 2.00 50.00 100,00
Medicare Pirst Obligation Fee - 174562 1.00 350.00 350,00
Anker, Peter
Verification Fee - Armstrong, Barbara 174518 2.00 50.00 100.00
Medicare First Obligation Fee - 174518 1.00 350.00 350.00
Armstrong, Barbara
Verification Fee ~ Asbille,Billie 174501 2.00 50,00 100.00
Medicare First Obligation Fee ~ 174501 1.00 350.00 350.00
Asbille,Billie
Verification Fee ~ Atilla, Victoria 166950 2.00 50.00 100.00
Verification Fee - Atkinson,Marilyn 97702 2.00 50.00 100.00
Verification Fee - Bailey, Katherine 166985 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 166985 1,00 350.00 350.00
Bailey, Katherine
Verification Fee - Baldwin, Rhonda 89855, 2.00 50.00 100.00
Verification Fee - Banning-Michiels, Teresa 104480 2.00 50.00 100.00
Verification Fee - Bannister, James 167018 2.00 50.00 100.00
Medicare First Obligation Fee - 167018 1.00 350.00 350.00
Bannister, James
Medicaid Additional Obligation Fee - 167018 1.00 150.00 150.00
Bannister, James
Medicaid Additional Obligation Fee ~ 167018 1.00 150.00 150.00
Bannister, James
Verification Fee - Barrett,Eileen 89943 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 99943 1.00 350.00 350.00
Barrett,Eileen
Verification Fee - Bean,Glenda 89795 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman page 33 of 71
Description Client Case# GRGH Qty Rate Amount
Verification Fee - Kave Staci 104610 2.00 50.00 100.00
Medicaid First Obligation Fee - Kave Staci 104610 1.00 350.00 350.00
Medicaid Additional Obligation Fee - Kave 104610 1,00 150.00 150.00
Staci
Verification Fee - Keating Kathryn 97489 2,00 50.00 100.00
Medicare First Obligation Fee - Keating 97489 1.00 350,00 350.00
Kathryn
Medicaid Additional Obligation Fee - 97489 1.00 150,00 150.00
Keating Kathryn
Verification Fee - Keen Joan 166996 2.00 50.00 100.00
Medicare First Obligation Fee - Keen Joan 166996 1.00 350.00 350.00
Verification Fee ~ Keller Kathleen 81409 2.00 50.00 100.00
Verification Fee - Keller Brent 292390 2.00 50.00 100.00
Verification Fee - Kelly Michael 90071 2.00 50.00 100.00
Medicare First Obligation Fee - Kelly 90071 1.00 350.00 350.00
Michael
Verification Fee - Kenfield Vernon 174607 2.00 50.00 100.00
Medicare First Obligation Fee - Kenfield 174607 1.00 350.00 350.00
Vernon
Verification Fee - Kenny Francis 292407 2.00 50.00 100.00
Verification Fee ~ Kestner Melvin 271082 2.00 50.00 100.00
Medicare First Obligation Fee - Kestner 271082 1.00 350.00 350.00
Melvin
Medicaid Additional Obligation Fee - 271082 1,00 150.00 150.00
Kestner Melvin
Verification Fee - Kimmel Edward 97471, 2.00 50.00 100.00
Verification Fee - King Scott 166975 2.00 50.00 100.00
Medicare First Obligation Fee - King Scott 166975 1.00 350.00 350,00
Verification Fée - King Shirley - - mo 89777 ~~ 2,00" ~~ -50.00- ~~~ -100.00~
Verification Fee - King Lynetta 121196 2.00 50.00 100.00
Medicare First Obligation Fee - King 121196 1.00 350.00 350.00
Lynetta
Verification Fee - King Dinean 174464 2.00 50.00 100.00
Verification Fee - Kinney Barbara 167007 2.00 50.00 100.00
Medicare First Obligation Fee - Kinney 167007 1,00 350.00 350.00
Barbara
Verification Fee - Kirby Marcia 174480 2.00 50.00 100.00
Verification Fee - Kisel John 89938 2.00 50.00 100.00

Medicare First Obligation Fee - Kisel John 99938 1,00 350.00 350.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 16 of 71
Description Client Case# GRGE Qty Rate Amount
Verification Fee - Dubbink Belva 286013 2.00 50,00 100.00
Verification Fee - Dubose Larry 97556 2,00 50.00 100.00
Medicare First Obligation Fee - Dubose 97556 1,00 350.00 350.00
Larry
Verification Fee ~ Dunn Gloria 308073 2.00 50.00 100.00
Medicare First Obligation Fee - Dunn 308073 1,00 350.00 350.00
Gloria
Medicaid Additional Obligation Fee - Dupee 89898 1.00 150.00 150.00
Jolene
Verification Fee - Duran Mark 104495 2.00 50.00 100.00
Medicaid First Obligation Fee - Duran Mark 104495 1.00 350,00 350.00
Medicare Additional Obligation Fee - Duran 104495 1.00 150.00 150.00
Mark
Verification Fee - Dyer Steven 285810 2.00 50.00 100.00
Medicare First Obligation Fee - Dyer 285810 1,00 350,00 350.00
Steven
Verification Fee - Early Helen 296245 2.00 50.00 100.00
Medicare First Obligation Fee ~ Early 296245 1,00 350.00 350.00
Helen
Medicaid Additional Obligation Fee - Early 296245 1.00 150.00 150.00
Helen
Verification Fee - Eastman Donald 97681 2.00 50.00 100.00
Medicaid First Obligation Fee - Eastman 97681 1.00 350.00 350.00
Donald
Verification Fee - Eberle Stephanie 292402 2.00 50.00 100.00
Verification Fee - Ebron Sylvester agoa4 2.00 50,00 100.00
Medicare First Obligation Fee ~ Ebron 89944 1.00 350.00 350.00
sylvester
Verification Fee - Eby Francis 89894 2.00 50.00 100.00
Verification Fee - Edelen Gary 282772 2.00 50,00 100.00
Medicare First Obligation Fee - Edelen 292772 1,00 350.00 350.00
Gary
Medicaid Additional Obligation Fee ~ 282772 1.00 150.00 150.00
Edelen Gary
Verification Fee - Edgington Christopher 104360 2.00 50.00 100.00
Medicaid First Obligation Fee - Edgington 104360 1.00 350.00 350.00
Christopher
Verification Fee - Edwards Ruth 267791 2.00 50.00 100.00
Medicare First Obligation Fee - Edwards 267791 1.00 350.00 350.00
Ruth
Verification Fee - Edwards Amanda 104391 2.00 50.00 100.00
Medicare First Obligation Fee - Edwards 104391 1.00 350,00 350.00
Amanda
Verification Fee - Edwards Donna 97440 2.00 50.00 100.00



Invoice Number

628651

Medicare First Obligation Fee - Slade
Debra

Project: BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 57 of 71
Description Client Case# GRGH ty Rate Amount
Medicaid Additional Obligation Fee - e44a4 1.00 150.00 150.00
Shirley Verlan
Medicaid Additional Obligation Fee - 64444 1.00 150.00 150.00
Shirley Verlan
Verification Fee - Shiver Jacqueline 167063 2.00 50.00 100.00
Medicare First Obligation Fee - Shiver 167063 1.00 350.00 350.00
Jacqueline
Medicaid First Obligation Fee - Shivers 97581 1.00 350.00 350,00
Tracey
Verification Fee - Shobe Melinda 64448 2.00 50.00 100.00
Medicare First Obligation Fee - Shobe 64448 1.00 350.00 350.00
Melinda
Medicare First Obligation Fee - Shoched 97545 1,00 350.00 350.00
Shirley
Verification Fee - Short Norma 97721 2,00 50.00 100.00
Verification Fee - Shreve Jeanie 97656 2.00 50.00 100.00
Verification Fee - Sibborn Margarete 81513 2.00 50.00 100.00
Medicare First Obligation Fee - Sibborn 81513 1.00 350.00 350.00
Margarete
Verification Fee - Sieren Daniel 296271 2.00 50.00 100.00
Verification Fee - Simmons Roosevelt 282767 2.00 50.00 100.00
Medicaid First Obligation Fee - Simmons 282767 1.00 350.00 350.00
Roosevelt
Verification Fee - Simmons Patricia 97611 2.00 50.00 100.00
Medicaid First Obligation Fee - Simmons 97611 1.00 350.00 350.00
Patricia
Verification Fee ~ Simon Robert 308243 2.00 50,00 100.00
Medicaid First Obligation Fee ~ Simon 308243 1.00 350.00 350.00
Robert
Medicare Additional Obligation Fee - Simon 308243 1.00 150,00 150.00
Robert

___Varification Fee - Sims Arvin a a 89913 2. 50,00 ______ 100.00
Medicare First Obligation Fee - Sims Arvin 89913 1.00 350.00 350.00
Verification Fee - Sisnroy Fred 264381 2.00 50.00 100.00
Verification Fee - Sissenstein Birdie 270396 2.00 50.00 100.00
Medicare First Obligation Fee - 270396 1.00 350.00 350.00
Sissenstein Birdie
Verification Fee - Sitek Gregory 97663, 2.00 50.00 100.00
Medicare First Obligation Fee - Sitek 97663 1.00 350,00 350.00
Gregory
Verification Fee ~ Skapley John 89918 2.00 50,00 100,00
Verification Fee - Slade Debra 308435 2.00 50.00 100.00

308435 1,00 350.00 350.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 4 of 71

Description Client Case# GRGH Ooty Rate Amount
Medicaid Pirst Obligation Fee - Ballinger 89949 1.00 350.00 350.00
Lee

Verification Fee - Bamford Diana 89774 2.00 50.00 100.00
Medicare First Obligation Fee - Bamford 89774 1,00 350.00 350.00
Diana

Medicaid Additional Obligation Fee - 89774 1.00 150.00 150.00
Bamford Diana

Verification Fee - Barber Valerie 167020 2.00 50.00 100.00
Verification Fee - Barber Gerald 104596 2.00 50,00 100.00
Medicare First Obligation Fee - Barber 104596 1.00 350.00 350.00
Gerald

Verification Fee - Barker Carey 264452 2.00 50.00 100.00
Verification Fee - Barlow Zona 29801 2.00 50.00 100.00
Medicare First Obligation Fee - Barlow 29801 1.00 350.00 350.00
Zona

Medicaid Additional Obligation Fee ~ 89801 1.00 150,00 150.00
Barlow Zona

Verification Fee - Barnett James 64504 2.00 50.00 100.00
Medicaid First Obligation Fee - Barnett 64504 1.00 350.00 350.00
James

Medicare Additional Obligation Fee ~ 64504 1.00 150.00 150.00
Barnett James

Medicaid Additional Obligation Fee - 64504 1.00 150.00 150.00
Barnett James

Medicaid Additional Obligation Fee - 64504 1.00 150.00 150.00
Barnett James

Medicaid Additional Obligation Fee - 64504 1,00 150.00 150.00
Barnett James

Verification Fee - Barnette Pamela 97644 2.00 50.00 100.00
Verification Fee - Barrero Alan 166973 2.00 50.00 100.00
Verification Fee - Barrett Betty 296233 2.00 50.00 100.00
Medicare First Obligation Fee - Barrett 296233 1.00 350.00 350.00
Betty

Medicaid Additional Obligation Fee - 296233 1.00 150.00 150.00
Barrett Betty

Verification Fee - Barrington Leslie 310013 2.00 50.00 100.00
Verification Fee - Batey Lynn 282783 2.00 50.00 100.00
Medicare First Obligation Fee - Batey Lynn 282783 1.00 350.00 350.00
Verification Fee - Bayham Yvonne 81507 2.00 50.00 100,00
Verification Fee ~ Belcher Larry 270338 2.00 50.00 100.00
Medicare First Obligation Fee - Belcher 270338 1.00 350.00 350.00
Larry

Verification Fee - Belill Joseph 81474 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 21 of 71
Description Client Case# GRG# Qty Rate Amount
Verification Fee - Gant Bobby 271066 2.00 50.00 100.00
Medicare First Obligation Fee - Gant Bobby 271066 1.00 350.00 350.00
Verification Fee - Garafola Greg 308074 2.00 50,00 100.00
Verification Fee - Garey Barbara 274809 2.00 50,00 100.00
Medicare First Obligation Fee - Garey 274809 1.00 350.00 350.00
Barbara
Medicaid Additional Obligation Fee - Garey 274809 1.00 150.00 150.00
Barbara
Verification Fee - Garner Lynne 104595 2.00 50.00 100.00
Medicare First Obligation Fee - Garner 104595 1,00 350.00 350.00
Lynne
Verification Fee - Garver Christine 174455 2.00 50.00 100.00
Verification Fee - Garvin Michael 174543 2.00 50.00 100.00
Verification Fee - Gassner Jamie 308075 2.00 50,00 100.00
Medicaid First Obligation Fee - Gassner 308075 1.00 350.00 350.00
Jamie
Verification Fee - Gay Karen 167088 2.00 50.00 100.00
Verification Fee - Gayle Kenneth 89907 2.00 50.00 100.00
Medicare First Obligation Fee - Gayle 89907 1,00 350.00 350.00
Kenneth
Medicaid Additional Obligation Fee ~ Gayle 89907 1.00 150.00 150.00
Kenneth
Verification Fee - Genovese Cheryl 104591 2.00 50.00 100.00
Verification Fee - George Ernest 104424 2.00 50,00 100.00
Medicare First Obligation Fee - George 104424 1.00 350.00 350.00
Ernest
Verification Fee - Gerry Richard 104276 2.00 50.00 100.00
Medicare First Obligation Fee - Gerry 104276 2.00 350,00 350.00
— Richard a
Verification Fee - Gibbs Michael 90046 50,00 > ~~ 100. 00"
Medicare First Obligation Fee - Gibbs 90046 1,00 350.00 350.00
Michael
Verification Fee - Gibson Jack 310010 2.00 50.00 100.00
Verification Fee - Gibson Daniel 90056 2.00 50.00 100.00
Medicare First Obligation Fee - Gibson 90056 1,00 350.00 350.00
Daniel
Verification Fee - Gibson James 97597 2.00 50.00 100.00
Medicare First Obligation Fee - Gibson 97597 1.00 350.00 350.00
James
Medicaid Additional Obligation Fee ~ 174436 1.00 150.00 150.00

Gibson Mary
Verification Fee - Gill David 90077 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 3 of 71
Description Client Case# GRG# Qty Rate Amount
Medicaid First Obligation Fee - Arroyo 166945 1,00 350.00 350.00
Nilda
Verification Fee - Artis Daniel 97418 2.00 50.00 100.00
Medicaid First Obligation Fee - Artis 97418 1.00 350.00 350.00
Daniel
Verification Fee - Ash Richard 104315, 2.00 50,00 100.00
Medicaid First Obligation Fee ~ Ash 104315 1.00 350.00 350.00
Richard
Medicaid Additional Obligation Fee - Ash 104315 1.00 150.00 150.00
Richard
Verification Fee - Ashby Robert 282403 2.00 50.00 100,00
Medicare First Obligation Fee ~ Ashby 282403 1.00 350.00 350,00
Robert
Medicaid Additional Obligation Fee - Ashby 282403 1.00 150,00 150.00
Robert
Verification Fee - Ashley Patricia 90064 2.00 50.00 100.00
Medicare First Obligation Fee - Ashley 90064 1,00 350.00 350.00
Patricia
Medicaid First Obligation Fee - Atilla 166950 1.00 350.00 350.00
Victoria
Verification Fee - Atkin Kathleen 81500 2.00 50.00 100.00
Medicare First Obligation Fee - Atkinson 97702 1,00 350.00 350.00
Marilyn
Verification Fee ~ August John 99828 2.00 50.00 100.00
Verification Fee - Averill Pamela 97687 2.00 50.00 100.00
Verification Fee - Awad Sally 81473 2.00 50.00 100.00
Medicare First Obligation Fee - Awad Sally 81473 1,00 350.00 350.00
Verification Fee - Ayers Anthony 97742 2.00 50.00 100.00
Medicare First Obligation Fee - Ayers 97742 1.00 350.00 350.00
Anthony
Verification Fee - Aziz Sami 271110 2.00 50.00 100,00
Verification Fee - Babb Martha 286876 2.00 50.00 100.00
Medicare First Obligation Fee - Babb 286876 1.00 350.00 350.00
Martha
Medicaid Additional Obligation Fee - Babb 286876 1.00 150.00 150.00
Martha
Verification Fee - Baker Melba 296232 2.00 50.00 100.00
Medicaid First Obligation Fee - Baker 296232 1,00 350.00 350.00
Melba
Verification Fee - Ballaro William 285795 2.00 50.00 100.00
Medicare First Obligation Fee - Ballaro 285795 1.00 350.00 350.00
William
Verification Fee - Ballinger Lee 99949 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 40 of 72
Description Client Case# GRGH ty Rate Amount
Medicare First Obligation Fee - Martinez 274821 1.00 350.00 350.00
Cecilia
Medicaid Additional Obligation Fee - 274821 1.00 150.00 150.00
Martinez Cecilia
Verification Fee -~ Mason Dave 264361 2.00 50.00 100.00
Verification Fee - Mattingly Joyce 296253 2.00 50.00 100.00
Medicare First Obligation Fee - Mattingly 296253 1,00 350.00 350.00
Joyce
Verification Fee - Mauceri James 104513 2.00 50.00 100.00
Medicare First Obligation Fee - Mauceri 104513 1.00 350.00 350.00
James
Verification Fee - Mauch David 271148 2.00 50.00 100.00
Medicare First Obligation Fee - Mauch 271148 1,00 350,00 350.00
David
Verification Fee - Mcadams Joan 271104 2.00 50.00 100,00
Medicare First Obligation Fee - Mcadams 272104 1.00 350.00 350.00
Joan
Verification Fee - Mcbride William 97668 2.00 50.00 100.00
Verification Fee ~ Mccarroll Eric 167099 2.00 50.00 100.00
Medicaid First Obligation Fee - Mccarroll 167099 1,00 350.00 350.00
Eric
Verification Fee - Mcclellan Linda 97613 2.00 50.00 100,00
Medicare First Obligation Fee - Mcclellan 97613 1.00 350.00 350.00
Linda
Verification Fee - Mccomas Sherrie 104417 2.00 50.00 100.00
Verification Fee - Mccormick Walter 97472 2.00 50.00 100.00
Medicare First Obligation Fee - Mccormick 97472 1.00 350.00 350.00
Walter
Verification Fee - Mccraw Bobby 271089 2,00 50.00 100.00
Medicare First Obligation Fee - Mccraw 271089 1.00 350.00 350.00
‘Bobby _ I rs
Verification Fee - Mcdevitt Peter 174604 2.00 50.00 100.00
Verification Fee - Mcdonald Peggy 97708 2.00 50.00 100.00
Medicare First Obligation Fee - Mcdonald 97708 1.00 350.00 350.00
Peggy
Verification Fee - Mcdonald David 270346 2.00 50.00 100.00
Medicare First Obligation Fee - Mcdonald 270346 1.00 350.00 350.00
David
Medicaid Additional Obligation Fee - 270346 1.00 150.00 150.00
Mcdonald David
Verification Fee - Mcdonald Charlotte 269996 2.00 50.00 100.00
Verification Fee - Mcdowell Joseph 104431 2,00 50.00 100.00
Verification Fee - Mcelroy Edward 81380 2.00 50.00 100.00



Invoice Number

615437

Project. BIOMT-00050-00
Anapol Schwartz Weiss Cohan Feldman et Page 40f 5
Description Client Caset GRGt oty Rate Amount:
Verification Fee ~‘Pratt,Margaret 174578 2.00 $0.00 100.00
Medicare First Obligation Fee - 174578 1,00 350.00 350.00
Pratt,Margaret
Verification Fee - Rodriguez, Julio 174526 2.00 50,00 100.00
Verification Fee - Rose,Marlene 64497 2.00 50.00 100.00
Medicare First Obligation Fee ~ 64497 1.00 350.00 350,00
Rose, Marlene
Medicare Additional Obligation Fee - 264405 1,00 150.00 150.00
Rose, Marlene
Verification Fee ~ Rosmarin, Irwin 174441 2.00 50.00 100,00
Medicare Pirst Obligation Fee - 174441 1.00 350,00 350.00
Rosmarin, Irwin
Verification Fee - Samson,Wilma 166942 2.00 50.00 100.00
Medicare Firet Obligation Fee ~ 166942 1.00 350.00 350.00
Samson, Wilma
Verification Fee ~ Seabolt, Gregory 174417 2.00 50.00 100.00
Verification Fee - St. Cyz,Carol 166929 2.00 50.00 100.00
Medicare First Obligation Fee ~ St. 166929 1.00 350.00 350.00
Cyr, Carol
Verification Fee ~ Stapp,Martha 174610 2.00 50.00 100.00
Verification Fee ~ Stempin,Allen 167008 2.00 50.00 100.00
Medicare First Obligation Fee - 167008 1.00 350.00 350.00
Stempin, Allen
Verification Fee ~ Struchen, Ronald 174531. 2.00 50.00 100.00
Medicare First Obligation Fee ~ 174531 1.00 350.00 350.00
Struchen, Ronald
Medicaid Additional Obligation Fee ~ 174531 1,00 150.00 150.00
Struchen, Ronald
Verification Fee - Thiner,Roger 174529 2.00 50.00 100.00
Medicare First Obligation Fee ~ 174529 1.00 350.00 350.00
Thiner, Roger
Verification Fee ~ Thompson, Suzan 174419 2.00 50.00 100.00
Verification Fee ~ Tibbetts, Peter 166931 2.00 50.00 100.00
Verification Fee ~ Verstoppen, Dean 64486 2.00 50,00 100.00
Verification Fee - Villa,Shireen 174606 2.00 50.00 100.00
Medicare First Obligation Fee - , 174606 1.00 350.00 350.00
Villa, Shireen
Verification Fee - Williams, Bertha 167029 2.00 50.00 100.00
Medicare First Obligation Fee - 167029 1.00 350.00 350.00
Williams, Bertha
Verification Fee - Wilmington,Dori 174422 2.00 50.00 100.00
Verification Fee - Winz, Richard 64487 2.00 50.00 100.00



Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldme Page 12 of 18
Deseription Client Caset GRGE oty Rate Amount
Verification Fee - Murphy, Rodney 174532 2.00 50.00 100.00
Medicare First Obligation Fee - 174532 1.00 350.00 350.00
Murphy, Rodney
Verification Fee - Ney, Peter 89951 2.00 50,00 100.00
Verification Fee - O'Rourke, Txacy 174431 2.00 50,00 100.00
verification Fee - Oteo,Rae 174559 2.00 50.00 100.00
Medicare First Obligation Fee - Oteo,Rae 174559 1.00 350,00 350.00
Verification Fee - Palmreuter,Martha 89994 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 89994 1.00 350,00 350.00
Palmreuter, Martha
Verification Fee - Patterson,Lillian 104332 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 104332 1.00 350.00 350.00
Patterson, Lillian
Verification Fee - Patterson, Rodney 97697 2.00 50.00 100.00
Medicare First Obligation Fee - 97697 1.00 350.00 350.00
Patterson, Rodney
Verification Fee - Paxton, Sara 142970 2.00 50,00 100.00
Medicare Zero Interest Obligation Fee - 142970 1.00 350.00 350.00
Paxton, Sara
Verification Fee - Pearce, Karen 99810 2,00 50.00 100.00
Verification Fee - Peick,William 97738 2.00 50.00 100.00
Verification Fee - Pelrine,Robert 90062 2.00 50.00 100.00
Medicare First Obligation Fee - 90062 1,00 350.00 350.00
Pelrine,Robert
Verification Fee - Phillips, Isabella 97415 2.00 50.00 100.00
Medicare First Obligation Fee ~ 97415 1.00 350.00 350.00
Phillips, Isabella
Verification Fee - Phillips, John 174577 2.00 50.00 100,00
Verification Fee - Pierson,Michael 89999 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 89999 1.00 350.00 350.00
Pierson, Michael
Verification Fee - Pisani, Alfred 166966 2.00 50.00 100.00
Verification Fee - Pitts, Treva 97639 2.00 50.00 100.00
Verification Fee - Pohar,Ronald 174442 2.00 50.00 100.00
Verification Fee - Portnow,Marilyn 97604 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 97604 1,00 350.00 380.00
Portnow,Marilyn
Verification Fee - Provencal, Bonnie 89843 2.00 50.00 100.00

89843 1.00 450.00 350.00

Medicare First Obligation Fee -
Provencal, Bonnie



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 58 of 71
Description Client Case# GRGH ty Rate Amount.
Medicaid Additional Obligation Fee - Slade 308435 1.00 180.00 150.00
Debra
Medicaid Additional Obligation Fee - Slade 308435 1.00 150,00 150,00
Debra
Verification Fee - Smalley Janet 90008 2.00 50.00 100.00
Medicare First Obligation Fee - Smalley 90008 1,00 350.00 350.00
Janet
Verification Fee ~ Smith Jeannie 271116 2.00 50.00 100.00
Medicare First Obligation Fee - Smith 271116 1,00 350.00 350.00
Jeannie
Medicaid Additional Obligation Fee - Smith 271116 1,00 150.00 150.00
Jeannie
Verification Fee - Smith Comedia 308235 2.00 50.00 100.00
Verification Fee - Smith Joyce 97594 2.00 50.00 100.00
Medicare First Obligation Fee ~ Smith 97594 1.00 350.00 350.00
Joyce
Verification Fee - Smith Thelma 264379 2.00 50.00 100.00
Medicare First Obligation Fee - Smith 264379 1,00 350.00 350.00
Thelma
Verification Fee - Smith Joetta 167043 2.00 50.00 100.00
Medicare First Obligation Fee - Smith 167043 1.00 350.00 350.00
Joetta
Verification Fee - Smith William 264433 2.00 50,00 100.00
Medicare First Obligation Fee - Smith 264433 1,00 350.00 350.00
William
Verification Fee - Smith Shadrach 90073 2.00 50.00 100.00
Medicaid First Obligation Fee - Smith 90073 1,00 350.00 350.00
Shadrach
Verification Fee - Smith Linda 282770 2.00 50.00 100.00
Medicare First Obligation Fee - Smith 282770 1.00 350,00 350.00
Linda

______Verification Fee - Smith Ronald a _ 97428200 50,00 100.00
Medicare First Obligation Fee - Smith 97428 1,00 350.00 350.00
Ronald
Verification Fee - Smith Gregory 104429 2.00 50.00 100.00
Medicaid First Obligation Fee - Smith 104429 1.00 350.00 350.00
Gregory
Verification Fee - Smith Mary 270350 2.00 50.00 100.00
Verification Fee - Smith Eddie 271117 2.00 50.00 100.00
Medicaid First Obligation Fee - Smith 274117 1.00 350.00 350.00
Eddie
Verification Fee - Smith Janice 174540 2.00 50.00 100.00

174540 1,00 350.00 350.00

Medicare First Obligation Fee - Smith
Janice



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 31 of 71

Description Client Case# GRG# Ooty Rate Amount

Medicare First Obligation Fee - Joftus 97497 1.00 350.00 350.00

Mary

Verification Fee - Johnson Jc 166984 2,00 50.00 100.00

Medicare First Obligation Fee - Johnson Jc 166984 1.00 350.00 350.00

Medicaid Additional Obligation Fee - 166984 1,00 150,00 150,00

Johnson Jc

Verification Fee - Johnson William 274819 2.00 50.00 100.00

Medicaid First Obligation Fee - Johnson 274819 1,00 350,00 350.00

William

Verification Fee - Johnson Vonzella 97619 2.00 50.00 100.00

Medicaid First Obligation Fee - Johnson 97619 1,00 350,00 350.00

Vonzella

Medicare Additional Obligation Fee - 97619 1,00 150.00 150.00

Johnson Vonzella

Medicaid Additional Obligation Fee - 97619 1.00 150.00 150.00

Johnson Vonzella

Medicaid Additional Obligation Fee ~ 97619 1.00 150.00 150.00

Johnson Vonzella

Verification Fee ~ Johnson Joe 89756 2.00 50.00 100.00

Medicare First Obligation Fee - Johnson 89756 1,00 350.00 350.00

Joe

Verification Fee - Johnson Timothy 89796 2.00 50.00 100.00

Verification Fee - Johnson Iris 104365 2.00 50.00 100.00

Medicare First Obligation Fee - Johnson 104365 1,00 350.00 350.00

Iris

Verification Fee - Johnson Pamela 99831 2,00 50.00 100.00

Medicare First Obligation Fee - Johnson 89831 1.00 350.00 350.00

Pamela

Medicaid Additional Obligation Fee - $9831 1.00 150.00 150.00

Johnson Pamela

Verification Fee - Johnson Ramona 308239 2.00 50.00 100.00

Medicaid First. Obligation Fee - Johnson _ _ _ 308239 1,00 350,00 350.00

Ramona

Medicare Additional Obligation Fee - 308239 1.00 150.00 150.00

Johnson Ramona

Verification Fee - Jones Thelma 166959 2.00 50.00 100.00

Medicaid First Obligation Fee - Jones 166959 1.00 350.00 350.00

Thelma

Verification Fee - Jones William 91517 2.00 50.00 100.00

Medicaid First Obligation Fee - Jones 81517 1,00 350.00 350.00

william

Verification Fee - Jones Audrey 97672 2.00 50.00 100.00

Verification Fee - Jones Glenda 104490 2.00 50.00 100.00
104490 1.00 350.00 350.00

Medicaid First Obligation Fee ~ Jones
Glenda



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 85 of 71
Description Client Cased GRGH ty Rate Amount
Verification Fee - Sanders Kenneth 81527 2.00 50.00 100.00
Medicare First Obligation Fee - Sanders 81527 1.00 350.00 350.00
Kenneth
Verification Fee - Sanders Willie 97641 2.00 50.00 100.00
Medicare First Obligation Fee - Sanders 97641 1.00 350.00 350.00
Willie
Verification Fee - Sanford Tammy 308876 2.00 50.00 100.00
Medicare First Obligation Fee - Sanford 308876 1.00 350,00 350.00
Tammy
Medicaid Additional Obligation Fee - 308876 1.00 150.00 150.00
Sanford Tammy
Medicaid Additional Obligation Fee - 104450 1.00 150,00 150.00
Sasseen Susan
Verification Fee - Sauer Michael Ann 270294 2.00 50.00 100.00
Medicare First Obligation Fee - Sauer 270294 1.00 350.00 350.00
Michael Ann
Verification Fee - Saunders Sonja 104467 2.00 50.00 100.00
Verification Fee - Sawyer Edward 293344 2.00 50.00 100.00
Verification Fee - Saylor Cory 89939 2.00 50.00 100.00
Medicaid First Obligation Fee - Saylor 89939 1.00 350,00 350.00
cory
Verification Fee - Scarcella Robert 90006 2.00 50.00 100.00
Verification Fee - Scarfia Shirley 90060 2.00 50.00 100.00
Verification Fee - Schmidt Ronald 264445, 2.00 50.00 100.00
Verification Fee - Schmidt Carol 174549 2.00 50.00 100.00
Verification Fee - Schuda Rebecca 174533 2.00 50.00 100.00
Medicaid First Obligation Fee - Schuda 174533 1.00 350.00 350.00
Rebecca
Medicaid First Obligation Fee - Scott 270324 1,00 350.00 350.00
Markham ——— oe
Verification Fee - Scott Gloria 121205 2.00 50.00 100.00
Medicare First Obligation Fee - Scott 121205 1.00 350.00 350.00
Gloria
Verification Fee - Seabury Terence 292406 2.00 50,00 100.00
Verification Fee - Seamon James 104491 2.00 50.00 100.00
Medicare First Obligation Fee - Seamon 104491 1.00 350.00 350.00
James
Medicaid Additional Obligation Fee - 104491 1.00 150.00 150.00
Seamon James
Verification Fee - Sebastian Sandra 269998 2.00 50.00 100.00
Medicare First Obligation Fee - Sebastian 269998 1.00 350.00 350.00
Sandra
Verification Fee - Seeley Irving 64443 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 10 of 71

Description Client Casef# GRG# Qty Rate Amount
Verification Fee - Woods Robert 174479 2.00 50.00 100.00
Medicare First Obligation Fee - Woods 174479 1.00 350,00 350.00
Robert

Verification Fee - Woods Preston 286879 2.00 50.00 100.00
Verification Fee - Worthy Reginald 104422 2.00 50.00 100.00
Medicare First Obligation Fee - Worthy 104422 1.00 350.00 350.00
Reginald

Verification Fee - Wright Deidre 104606 2.00 50.00 100.00
Medicaid First Obligation Fee - Wright 104606 1.00 350.00 350.00
Deidre

Verification Fee - Wright Amanda 296276 2.00 50.00 100.00
Verification Fee - Wright Michael 296277 2.00 50.00 100.00
Medicare First Obligation Fee - Wright 296277 1,00 350,00 350.00
Michael

Medicaid Additional Obligation Fee - 296277 1.00 150.00 150,00
Wright Michael

Verification Fee - Wright Larry 81324 2.00 50.00 100.00
Medicaid First Obligation Fee - Wright 81324 1.00 350.00 350.00
Larry

Medicare Additional Obligation Fee - 81324 1.00 150.00 150.00
Wright Larry

Verification Fee - Wright Randy 270402 2.00 50.00 100.00
Medicare First Obligation Fee - Wright 270402 1.00 350.00 350.00
Randy

Verification Fee - Wry Brenda 271389 2.00 50.00 100.00
Verification Fee - Wyse Jerlyn 104621 2.00 50.00 100.00
Verification Fee - Yates Janet 174550 2.00 50.00 100.00
Medicare First Obligation Fee ~ Yates 174550 1.00 350.00 350.00
Janet

Verification Fee - Yaws Patricia 271125 2.00 50.00 100.00
Medicare First Obligation Fee ~ Yaws 271125 1.00 350.00 350.00
Patricia

Medicaid Additional Obligation Fee - Yaws 271125 1.00 150.00 150.00
Patricia

Medicaid Additional Obligation Fee - Yaws 271125 1.00 150.00 150.00
Patricia

Medicare First Obligation Fee - 270320 1.00 350.00 350.00
Yeager-Sier Kathe

Verification Fee ~ Yocklin Glenn 97509 2.00 50.00 100.00
Verification Fee - Young Robert 1442 2.00 50,00 100.00
Medicare First Obligation Fee - Young 81442 1,00 350.00 350.00
Robert

Verification Fee - Young Donald 97396 2.00 50,00 100.00



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 61 of 71

Description Client Case# GRG# ty Rate Amount

Medicare First Obligation Fee - Strong 89915 1.00 350.00 350.00

Ronald

Verification Fee - Suddath Donald 104493 2.00 50,00 100.00

Medicaid First Obligation Fee - Suddath 104493 1,00 350.00 350.00

Donald

Verification Fee - Sullivan Kim 89908 2,00 50.00 100.00

Verification Fee - Sullivan Robert 167025 2.00 50.00 100.00

Medicare First Obligation Fee - Sullivan 167025 1.00 350.00 350.00

Robert

Verification Fee - Sumter Anita 264425 2.00 50.00 100.00

Medicare First Obligation Fee ~ Sumter 264425 1.00 350.00 350.00

Anita

Verification Fee - Sutherland Krischina 174504 2.00 50,00 100.00

Verification Fee - Swanigan Gloria 264428 2.00 50.00 100.00

Medicare First Obligation Fee - Swanigan 264428 1,00 350.00 350.00

Gloria

Verification Fee - Swanson Virgil 97710 2.00 50.00 100.00

Medicare First Obligation Fee - Swanson 97710 1.00 350.00 350.00

Virgil

Verification Fee - Szabo Joan 64423, 2.00 50.00 100.00

Medicare First Obligation Fee - Szabo Joan 64423 1.00 350.00 350.00

Verification Fee - Szostak John 104601 2.00 50.00 100.00

Medicare First Obligation Fee - Szostak 104601 1.00 350.00 350.00

John

Medicaid Additional Obligation Fee - 104601 1,00 150.00 150.00

Szostak John

Verification Fee - Tallon Lorna 90021 2.00 50,00 100.00

Medicare First Obligation Fee - Tallon 90021 1,00 350.00 350.00

Lorna

Medicaid Additional Obligation Fee ~ 90021 1,00 150.00 150.00

Tallon Lorna — a

Verification Fee - Tanner Carlton 97375 2,00 50.00 100.00

Medicare First Obligation Fee - Tanner 97375 1.00 350.00 350.00

Carlton

Verification Fee - Tawney Ronald 99968 2.00 50.00 100.00

Verification Fee - Taylor Gregory 271388 2.00 50,00 100.00

Medicare First Obligation Fee - Taylor 271388 1.00 350.00 350.00

Gregory

Verification Fee - Taylor Charlie 104552 2.00 50,00 100.00

Medicare First Obligation Fee - Taylor 104552 1.00 350.00 350.00

Charlie

Verification Fee - Taylor Rhonda 97449 2,00 50.00 100.00
97449 1.00 350.00 350.00

Medicaid First Obligation Fee - Taylor
Rhonda



Invoice Number

628651

Medicare Additional Obligation Fee -
Wilson Steven

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 68 of 71
Description Client Caset GRGH aty Rate Amount
Medicare First Obligation Fee - Williams 271108 1.00 350.00 350.00
Eugene
Medicaid Additional Obligation Fee - 271108 1.00 150.00 150.00
Williams Eugene
Verification Fee - Williams Danny 104556 2.00 50.00 100.00
Medicare First Obligation Fee - Williams 104556 1,00 350.00 350.00
Danny
Verification Fee - Williams Thomas 97528 2.00 50.00 100.00
Verification Fee - Williams Mildred 89842 2.00 50.00 100.00
Medicare First Obligation Fee - Williams 89842 1,00 350,00 350.00
Mildred
Medicaid Additional Obligation Fee - 270323 1.00 150,00 150.00
Williams Thomas
Verification Fee - Williams Lorna 167064 2.00 50.00 100.00
Medicaid First Obligation Fee - Williams 167064 1.00 350.00 350.00
Lorna
Verification Fee - Williams Edith 89940 2.00 50.00 100.00
Medicaid First Obligation Fee - Williams 99940 1,00 350.00 350.00
Edith
Medicare Additional Obligation Fee - 89940 1,00 150.00 150.00
Williams Edith
Verification Fee - Williams Lawrence 81335 2.00 50.00 100.00
Medicaid First Obligation Fee ~ Williams 81335 1.00 350,00 350.00
Lawrence
Verification Fee - Williams Arthur 167079 2.00 50.00 100.00
Medicare First Obligation Fee - Williams 167079 1.00 350,00 350.00
Arthur
Medicaid Additional Obligation Fee - 167079 1.00 150.00 150.00
Williams Arthur
Verification Fee - Williams Gladys 97600 2,00 50.00 100.00
Medicare First Obligation Fee ~ Williams 97600 1,00 350.00 350.00
Gladys

______Verification-_Fee-- Williams Angela — 282218. 00 50.00 100.00
Verification Fee - Williams Milton 104516 2.00 50.00 100.00
Medicare First Obligation Fee - Williams 104516 1,00 350.00 350,00
Milton
Verification Fee - Williams Pat 174626 2.00 50.00 100.00
Medicare First Obligation Fee - Williams 174626 1,00 350.00 350.00
Pat
Medicaid First Obligation Fee - Wills 104459 1.00 350,00 350.00
Maxine
Verification Fee - Wilson Steven 271134 2.00 50,00 100.00
Medicaid First Obligation Fee - Wilson 271134 1.00 350,00 350.00
Steven

271134 1,00 150.00 150.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 38 of 71

Description Client Cased GRGE oty Rate Amount

Medicare First Obligation Fee - Lorenzen 97494 1.00 350.00 350.00

Joan

Verification Fee - Lotenero Joseph 195846 2.00 50.00 100.00

Medicare First Obligation Fee ~ Lotenero 195846 1,00 350,00 350.00

Joseph

Verification Fee - Loubey Frank 296252 2.00 50.00 100.00

Medicaid First Obligation Fee - Loubey 296252 1.00 350,00 350.00

Frank

Verification Fee - Loud Richard 97427 2.00 50,00 100.00

Verification Fee - Love Andrew 308080 2.00 50.00 100.00

Medicaid First Obligation Fee - Love 308080 1,00 350.00 350.00

Andrew

Medicare Additional Obligation Fee - Love 308080 1.00 150.00 150.00

Andrew

Verification Fee - Lovely Cathy 270314 2.00 50.00 100.00

Medicare First Obligation Fee ~ Lovely 270314 1,00 350.00 350.00

Cathy

Medicaid Additional Obligation Fee - 270314 1.00 150.00 150.00

Lovely Cathy

Verification Fee - Luna Faye 97637 2.00 50.00 100.00

Medicare First Obligation Fee - Luna Faye 97637 1.00 350.00 350.00

Medicaid Additional Obligation Fee - Luna 97637 1,00 150.00 150.00

Faye

Verification Fee - Lund Robb 286008 2.00 50.00 100.00

Medicaid First Obligation Fee - Lund Robb 286008 1.00 350.00 350.00

Medicare Additional Obligation Fee - Lund 286008 1.00 150.00 150,00

Robb

Medicaid Additional Obligation Fee - Lund 286008 1.00 150.00 150.00

Robb

Medicaid Additional Obligation Fee - Lund 286008 1.00 150.00 150.00

Robb

____Verification Fee = Macdonald Colin. os 288d —— 80-00 100,00

Medicare First Obligation Fee - Macdonald 262414 1.00 350.00 350.00

Colin

Verification Fee ~ Macklin Ola 210345 2.00 50,00 100.00

Medicare First Obligation Fee - Macklin 270345 1,00 350.00 350.00

Ola

Verification Fee - Madea Kathryn 166947 2.00 50.00 100.00

Medicare First Obligation Fee - Madea 166947 1.00 350.00 350.00

Kathryn

Verification Fee - Major Maria 282766 2.00 50.00 100.00

Verification Fee - Malone Johnny 174496 2,00 50.00 100.00
174496 1.00 350.00 350.00

Medicare First Obligation Fee - Malon|
Johnny

e



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 11 of 71

Description Client Case# GRGH Qty Rate Amount
Medicare First Obligation Fee - Cherry 97480 1,00 350.00 350.00
Asia

Verification Fee - Childers Marlene 97558 2.00 50,00 100.00
Medicare First Obligation Fee - Childers 97558 1.00 350,00 350,00
Marlene

Verification Fee ~ Childress Thomas 64450 2.00 50,00 100.00
Medicare First Obligation Fee - Childress 64450 1.00 350.00 350,00
Thomas

Verification Fee - Christophe Carolyn 274816 2.00 50.00 100.00
Medicare First Obligation Fee - Christophe 274816 1,00 350.00 350.00
Carolyn

Verification Fee ~ Christopher Ricky 282405 2.00 50.00 100.00
Medicare First Obligation Fee - 282405 1,00 350.00 350.00
Christopher Ricky

Medicaid Additional Obligation Fee - 282405 1,00 150.00 150,00
Christopher Ricky

Verification Fee - Chuffo Frank 81408 2.00 50.00 100.00
Medicare First Obligation Fee - Chuffo 81408 1,00 350,00 350,00
Frank

Verification Fee - Clark Lenora 2805814 2.00 50.00 100.00
Medicare First Obligation Fee ~ Clark 265814 1.00 350.00 350.00
Lenora

Verification Fee - Clark Barbara 89746 2.00 50.00 100.00
Medicare First Obligation Fee - Clark 89746 1.00 350.00 350.00
Barbara

Verification Fee ~ Clark Delores 64429 2.00 50.00 100.00
Medicare First Obligation Fee ~ Clark 64429 1.00 350.00 350.00
Delores

Verification Fee - Clark Ronald 89927 2.00 50.00 100.00
Medicare First Obligation Fee - Clark 89927 1,00 350.00 350.00
Ronald

Verification Fee - Clark Stephanie 296240 2,00 50.00 100.00
Verification Fee - Clubb Melinda 104323 2.00 50.00 100.00
Medicare First Obligation Fee - Clubb 104323 1.00 350.00 350.00
Melinda

Verification Fee - Cobb Jo Ann 89879 2.00 50.00 100.00
Medicare First Obligation Fee - Cobb Jo 89879 1.00 350,00 350.00
Ann

Verification Fee - Cochran Julia 104607 2.00 50.00 100.00
Medicare First Obligation Fee - Cochran 104607 1,00 350.00 350.00
Julia

Verification Fee - Codman Donna 97412 2.00 50.00 100.00
Verification Fee - Coffman Alfred 81337 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 51 of 71
Description Client Case# GRG# Ooty Rate Amount
Verification Fee - Pruitt Lori 104576 2.00 50.00 100,00
Medicaid First Obligation Fee - Pruitt 104576 1.00 350.00 350.00
Lori
Medicaid Additional Obligation Fee - 104576 1,00 150.00 150.00
Pruitt Lori
Verification Fee - Pryor Patricia 81400 2.00 50.00 100.00
Medicare First Obligation Fee - Pryor 81400 1.00 350.00 350.00
Patricia
Medicaid Additional Obligation Fee - Pryor 81400 1.00 150,00 150.00
Patricia
Verification Fee - Pugh Florence 104472 2.00 50.00 100.00
Medicare First Obligation Fee - Pugh 104472 1.00 350.00 350.00
Florence
Medicaid Additional Obligation Fee - Pugh 104472 1.00 150.00 150.00
Florence
Verification Fee - Pulsford Ellen 64470 2.00 50.00 100.00
Medicare First Obligation Fee - Pulver 81536 1.00 350.00 350.00
Diane
Verification Fee - Puskarich Gary 89955, 2.00 50.00 100.00
Medicare First Obligation Fee - Puskarich 89955 1,00 350.00 350.00
Gary
Verification Fee ~ Pynn Steven 91443 2.00 50.00 100.00
Verification Fee ~ Querin Camille 296263 2.00 50.00 100.00
Verification Fee - Quinones Elizabeth 97520 2.00 50.00 100.00
Medicare First Obligation Fee - Quintero 269999 1.00 350.00 350.00
Donnita
Verification Fee - Quirk Maureen 97377 2,00 50.00 100.00
Verification Fee - Rabinowitz Sylvia 97385 2.00 50.00 100.00
Medicare First Obligation Fee - Rabinowitz 97385 1.00 350.00 350.00
Sylvia
Verification Fee - Rader Larry __ 90059 2.00 50.00 100.00
Medicare First Obligation Fee - Rader 90059 1,00 350.00 350.00
Larry
Verification Fee ~ Rael Lilly 89762 2.00 50.00 100.00
Medicare First Obligation Fee - Rael Lilly 89762 1.00 350.00 350.00
Verification Fee - Raines Sheliah 64506 2.00 50.00 100.00
Medicaid First Obligation Fee - Raines 64506 1.00 350.00 350.00
Sheliah
Verification Fee - Rao Lois 89792 2.00 50.00 100.00
Medicare First Obligation Fee - Rao Lois 89792 1,00 350.00 350.00
Verification Fee - Rapp Kenneth 81495 2.00 50,00 100.00
Verification Fee - Rathbone Leonard 296264 2.00 50.00 100.00



Invoice Number

628651

Project: BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 12 of 71
Description Client Case¢ GRGH aty Rate Amount
Medicare First Obligation Fee - Coffman 81337 1,00 350.00 350.00
Alfred
Verification Fee - Colaizzi Nancy 174566 2.00 50.00 100.00
Medicare First Obligation Fee - Colaizzi 174566 1,00 350.00 350.00
Nancy
Verification Fee - Colbert Damion 90010 2.00 50.00 100.00
Medicaid First Obligation Fee ~ Colbert 90010 1,00 350.00 350.00
Damion
Verification Fee - Cole Rocky 296241 2.00 50.00 100.00
Medicare First Obligation Fee - Cole Rocky 296241 1.00 350.00 350.00
Verification Fee - Conaway Wendy 97490 2.00 50.00 100.00
Verification Fee ~ Conley Katherine 104342 2.00 50.00 100.00
Medicare First Obligation Fee - Conley 104342 1.00 350.00 350.00
Katherine
Verification Fee - Cook Beverly 285807 2.00 50.00 100.00
Verification Fee - Cook Lorissa 174587 2.00 50.00 100,00
Medicare First Obligation Fee - Cook 174557 1.00 350.00 350.00
Lorissa
Verification Fee - Cook Joanna 104614 2,00 50.00 100,00
Verification Fee - Cooksey Rachel 167074 2.00 50.00 100,00
Medicare First Obligation Fee ~ Cooksey 167074 1.00 350.00 350.00
Rachel
Verification Fee ~ Coop Wilma 282787 2,00 50.00 100.00
Medicare First Obligation Fee - Coop Wilma 282787 1,00 350.00 350.00
Verification Fee - Cooper Richard 97690 2.00 50.00 100.00
Verification Fee - Corcoran Christina 90052 2.00 50.00 100.00
Medicare First Obligation Fee - Corcoran 90052 1.00 350.00 350.00
Christina
Verification Fee - Costa-Rosa Ana 270356 2.00 50.00 100.00
Medicare First Obligation Fee - Costa-Rosa 270386 1.00 350.00 350.00
Ana
Verification Fee - Cotton Jacqueline 81528 2.00 50.00 100.00
Verification Fee - Coveart Mark 104471 2.00 50,00 100.00
Verification Fee - Cox William 73428 2,00 50.00 100.00
Verification Fee - Cox Carl 27141 2.00 50.00 100.00
Medicare First Obligation Fee - Cox Carl 27114 1.00 350.00 350.00
Verification Fee - Craigo Marie 97578 2.00 50.00 100.00

97578 1.00 350.00 350.00

Medicare First Obligation Fee - Craigo
Marie



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 27 of 71

Description Client Case# GRGE aty Rate Amount
Medicare First Obligation Fee ~ Henley 270401 1,00 350.00 350.00
Patricia

Verification Fee - Henry Dale 166933 2.00 50.00 100.00
Medicaid First Obligation Fee - Henry Dale 166933 1,00 350.00 350.00
Verification Fee - Hicks Michael 104435 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hicks 104435 1,00 350,00 350.00
Michael

Verification Fee - Hiett Virginia 89829 2.00 50.00 100.00
Medicare First Obligation Fee - Hiett 89829 1,00 350.00 350.00
Virginia

Verification Fee - Higgins Regina 174494 2.00 50.00 100.00
Verification Fee - Hikes Katherine 1451 2,00 50.00 100.00
Medicare First Obligation Fee - Hikes 81451 1.00 350.00 350.00
Katherine

Verification Fee - Hill Sheila 89998 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hill 89998 1,00 350.00 350.00
Sheila

Verification Fee - Hilliard Hattie 308054 2.00 50.00 100.00
Medicare First Obligation Fee - Hilliard 308054 1.00 350.00 350.00
Hattie

Medicaid Additional Obligation Fee - 308054 1.00 150.00 150.00
Hilliard Hattie

Verification Fee - Hilton Steve 296248 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hilton 296248 1.00 350.00 350.00
Steve

Verification Fee - Hinch-Dorn Lynn 97717 2.00 50.00 100.00
Medicare First Obligation Fee - Hinch-Dorn 97717 1,00 350.00 350.00
Lynn

Verification Fee - Hinojosa Verna 271074 2.00 50,00 100.00
Verification Fee - Hodge Sandra 104577 2.00 50.00 100.00
Medicare First Obligation Fee - Hodge 104577 1.00 350.00 350.00
Sandra

Verification Fee - Hodges William 104409 2.00 50,00 100,00
Medicaid First Obligation Fee - Hoey 97438 1.00 350.00 350.00
Debora

Verification Fee - Holder Grace 167081 2.00 50.00 100.00
Medicare First Obligation Fee - Holder 167081 1,00 350.00 350.00
Grace

Medicaid Additional Obligation Fee - 167081 1.00 150.00 150.00
Holder Grace

Verification Fee ~ Holladay John 104461 2.00 50.00 100.00
Medicare First Obligation Fee - Holladay 104461 1.00 350.00 350.00
John

Verification Fee - Holland Laura 104419 2.00 50.00 100.00



Invoice Number 621297

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldme Page 18 of 18
Description Client Case# GRGH Oty Rate Amount
Verification Fee - Woods,Barlina 167013 2.00 50.00 100.00
Medicare First Obligation Fee ~ 167013 1.00 350.00 350.00
Woods, Earlina
Medicaid Additional Obligation Fee ~ 167013 1,00 150.00 150.00
Woods, Earlina
Verification Fee ~ Wurzel,Lester 174473 2,00 50.00 100.00
Verification Fee - Yeager-Sier,Kathe 270320 2.00 50.00 100.00
Verification Fee ~ Zager,Daniel 174847 2.00 50.00 100.00
Medicaid Zero Interest Obligation Fee - 174547 1.00 350,00 350.00
Zager, Daniel
Verification Fee ~ Zakashefski, Gloria g1498 2,00 50.00 100.00
Verification Fee - Zeller,Donald 174589 2.00 50.00 100.00
Medicare First Obligation Fee - 174589 1.00 350.00 350.00
Zeller, Donald
Verification Fee - 2upetz,Charles 174528 2.00 50.00 100.00
Medicare First Obligation Fee - 174528 1.00 350.00 350.00
Zupetz,Charles

Subtotal 99,700.00

|

Invoice Total 99,700.00

|



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 30 of 71
Description Client Case# GRGH oty Rate Amount
Verification Fee - Jackson Mabel 308077 2.00 50.00 100.00
Medicare First Obligation Fee - Jackson 308077 1,00 350.00 350.00
Mabel
Verification Fee - Jackson Linda 121195 2.00 50.00 100.00
Medicare First Obligation Fee ~ Jackson 121195 1.00 350.00 350.00
Linda
Verification Fee - Jackson Robert 99845 2.00 50.00 100.00
Verification Fee - Jackson Gladys 64469 2.00 50.00 100.00
Medicare First Obligation Fee - Jackson 64469 1,00 350.00 350.00
Gladys
Medicaid Additional Obligation Fee ~ 64469 1.00 150.00 150.00
Jackson Gladys
Verification Fee - Jackson Donna 328626 2,00 50.00 100.00
Medicare First Obligation Fee - Jackson 328626 1,00 350.00 350.00
Donna
Medicaid Additional Obligation Fee - 328626 1.00 150.00 150.00
Jackson Donna
Medicaid Additional Obligation Fee ~ 328626 1.00 150.00 150.00
Jackson Donna
Verification Fee - Jackson Mary 90020 2.00 50.00 100.00
Medicare First Obligation Fee - Jackson 90020 1.00 350.00 350,00
Mary
Medicaid Additional Obligation Fee - 90020 1,00 150.00 150.00
Jackson Mary
Verification Fee - Jackson Mary 270342 2.00 50.00 100.00
Medicare First Obligation Fee - Jackson 270342 1,00 350.00 350.00
Mary
Medicaid Additional Obligation Fee - 270342 1.00 150.00 150,00
Jackson Mary
Verification Fee ~ Jackson Wanda 174524 2.00 50.00 100.00
Medicare First Obligation Fee - Jackson 174524 1,00 350.00 350.00
Wanda

—-Verification-Fee--—-James-Peter———_ —_ —§ | 8463... 2.00 50.00... 100,00
Verification Fee - Jenkins Pamela 104446 2.00 50.00 100.00
Medicare First Obligation Fee ~ Jenkins 104446 1.00 350.00 350.00
Pamela
Verification Fee - Jennings Freddie 104477 2.00 50.00 100.00
Medicaid First Obligation Fee - Jennings 104477 1.00 350.00 350.00
Freddie
Medicare Additional Obligation Fee - 104477 1,00 150.00 150.00
Jennings Freddie
Verification Fee - Jennings-Shaud Jenifer 262547 2.00 50.00 100.00
Medicare First Obligation Fee - 262547 1,00 350.00 350.00

Jennings-Shaud Jenifer
Verification Fee - Joftus Mary 97497 2,00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 39 of 71

Description Client Case# GRGH oty Rate Amount
Medicaid Additional Obligation Fee - 174496 1.00 150.00 150.00
Malone Johnny

Verification Fee - Maltorell Theresa 89900 2.00 50.00 100.00
Verification Fee - Mansell Mary Jo 308405 2.00 50.00 100.00
Verification Fee - Marchese Emilia 64430 2.00 50.00 100.00
Medicare First Obligation Fee ~ Marchese 64430 1,00 350.00 350.00
Emilia

Verification Fee - Marett Evelyn 97720 2.00 50,00 100.00
Medicare First Obligation Fee - Marett 97720 1,00 350,00 350.00
Evelyn

Verification Fee ~ Marino Susan 308433 2.00 50.00 100.00
Medicare First Obligation Fee - Marino 308433 1.00 350.00 350.00
Susan

Verification Fee - Marion Rex 264446 2.00 50.00 100.00
Medicare First Obligation: Fee - Marion Rex 264446 1.00 350.00 350.00
Verification Fee - Markowski Mary 281614 2.00 50.00 100.00
Verification Fee - Markusen Nancy 174541 2.00 50,00 100.00
Medicare First Obligation Fee - Markusen 174541 1.00 350.00 350.00
Nancy

Verification Fee ~ Marrs Cathy 90057 2.00 50.00 100.00
Medicare First Obligation Fee - Marrs 90057 1,00 350.00 350.00
cathy

Verification Fee - Mars Shannon 97640 2.00 50.00 100.00
Medicare First Obligation Fee - Mars 97640 1.00 350.00 350.00
Shannon

Verification Fee - Marshall Cynthia 89757 2.00 50.00 100.00
Medicare First Obligation Fee - Marshall 89757 1,00 350.00 350.00
Cynthia

Medicaid Additional Obligation Fee - 89757 1.00 150.00 150.00
Marshali-Cynthia——— i a —
Verification Fee - Marshall Charlie 210397 2.00 50.00 100.00
Verification Fee - Marshall Billie 174505 2.00 50.00 100.00
Medicaid First Obligation Fee - Marshall 174505 1.00 350.00 350.00
Billie

Medicaid Additional Obligation Fee ~ 174505 1,00 150.00 150.00
Marshall Billie

Verification Fee - Martin Karen 292401 2.00 50.00 100.00
Medicare First Obligation Fee - Martin 292401 1.00 350.00 350.00
Karen

Medicaid Additional Obligation Fee - 292401 1.00 150.00 150.00
Martin Karen

Verification Fee - Martinez Christopher 308959, 2.00 50.00 100.00
Verification Fee - Martinez Cecilia 274821 2.00 50,00 100.00



Invoice Number 616513

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldme Page 3 of 3
Description Client Caset Ret ty Rate Amount.
Medicaid Additional Obligation Fee ~ 64496 1.00 150,00 150.00
Selby, Samuel.
Verification Fee - Shirley, Polly 174511 2.00 50.00 100.00
Verification Fee - Stice,Barbaxa 174459 2.00 50.00 100.00
Medicare First Obligation Fee - 174459 1.00 350.00 350.00
Stice, Barbara
Verification Fee - Strine,Sandra 167001 2.00 50.00 100.00
Verification Fee - Thomas, Linda 167093 2.00 50.00 100.00
Medicare First Obligation Fee - 167093 1.00 350.00 350.00
Thomas, Linda
Verification Fee ~ Walton,F D 64462 2.00 50.00 100.00
Medicare First Obligation Fee - Walton,F D 64462 1.00 350.00 350.00
Verification Fee - Walton,Gail 167019 2.00 50.00 100.00
Medicare First Obligation Fee - 167019 1,00 350.00 350.00
Walton, Gail
Verification Fee - Willson, Patricia 174516 2.00 50.00 100.00
Medicare First Obligation Fee - 174516 1.00 350.00 350.00
Willson, Patricia
Verification Fee - Winningham, Diane 174542 2.00 50.00 100.00
Medicare First Obligation Fee - 174542 1.00 350.00 350.00
Winningham, Diane
Verification Fee ~ Woody, James 167044 2.00 50,00 100.00
Medicare First Obligation Fee ~ 167044 1.00 350.00 350.00
Woody, James

Subtotal 13,550.00

|

Invoice Total 13,550.00

|



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 19 of 71
Description Client Case# GRGH Qty Rate Amount
Verification Fee - Fish Donna 271137 2.00 50,00 100.00
Medicare First Obligation Fee - Fish Donna 271137 1.00 350.00 350.00
Verification Fee - Fitzpatrick Janet 81464 2.00 50.00 100.00
Medicaid First Obligation Fee - 81464 1.00 350,00 350.00
Pitzpatrick Janet
Medicare Additional Obligation Fee - 81464 1.00 150,00 150.00
Fitzpatrick Janet
Verification Fee - Flach Yuba 174523 2.00 50.00 100.00
Medicare First Obligation Fee - Flach Yuba 174523 1.00 350.00 350.00
Verification Fee - Flaherty John 167005 2.00 50.00 100.00
Medicare First Obligation Fee ~ Flaherty 167005 1,00 350.00 350.00
John
Medicaid Additional Obligation Fee - 167005 1.00 150.00 150.00
Flaherty John
Verification Fee - Flake Melvin 97712 2.00 50.00 100.00
Medicare First Obligation Fee - Flake 97712 1.00 350,00 350.00
Melvin
Verification Fee - Fleming Jarvis 166964 2.00 50.00 100.00
Medicare First Obligation Fee - Fleming 166964 1.00 350.00 350.00
Jarvis
Medicaid Additional Obligation Fee - 166964 1.00 150.00 150.00
Fleming Jarvis
Verification Fee - Fleming Charles 104626 2.00 50.00 100.00
Medicare First Obligation Fee - Fleming 104626 2.00 350.00 350.00
Charles
Verification Fee - Fletcher Johnnie 90051 2.00 50.00 100.00
Verification Fee - Fleury James 167083 2,00 50.00 100.00
Verification Fee - Flyer James 89917 2.00 50.00 100.00
Medicare First Obligation Fee - Flyer 89917 1.00 350.00 350.00
Medicaid Additional Obligation Fee - Flyer 89917 1,00 150.00 150.00
James
Verification Fee ~ Flynn Brian 308958 2.00 50.00 100.00
Verification Fee - Foltz Barry 89903, 2.00 50.00 100.00
Verification Fee - Foos Scott 97402 2.00 50.00 100.00
Verification Fee - Ford Kathleen 89987 2.00 50.00 100.00
Medicare First Obligation Fee - Ford 89987 1,00 350.00 350.00
Kathleen
verification Fee - Ford Jeanette 104294 2.00 50.00 100.00
Medicare First Obligation Fee - Ford 104294 1.00 350.00 350.00
Jeanette
Medicaid Additional Obligation Fee - Ford 104294 1.00 150.00 150.00

Jeanette



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page inof 71

Description Client Case# GRGH aty Rate Amount
Medicare First Obligation Fee ~ Edwards 97440 1.00 350.00 350.00
Donna

Verification Fee - Elliott Judith 73424 2.00 50,00 100.00
Medicare First Obligation Fee ~ Elliott 73424 1.00 350.00 350.00
Judith

Verification Fee - Ellison Harold 293714 2.00 50,00 100.00
Medicare First Obligation Fee - Ellison 293714 1.00 350.00 350.00
Harold

Medicaid Additional Obligation Fee - 293714 1.00 150.00 150.00
Ellison Harold

Verification Fee - Elsea Roy 293342 2.00 50,00 100.00
Medicare First Obligation Fee - Elsea Roy 293342 1.00 350.00 350.00
Medicaid Additional Obligation Fee - Blsea 293342 1.00 150.00 150.00
Roy

Verification Fee - Emma Mary 89930 2.00 50.00 100.00
Verification Fee - Emmons Christina 97383 2.00 50.00 100.00
Medicare First Obligation Fee - Emmons 97383 1.00 350.00 350.00
Christina

Medicaid Additional Obligation Fee - 97383 1.00 150.00 150.00
Emmons Christina

Medicare First Obligation Fee - Engstrom 271144 1.00 350,00 350.00
Gloria

Verification Fee - Erickson Carol 308237 2.00 50.00 100.00
Medicare First Obligation Fee - Erickson 308237 1.00 350.00 350.00
Carol

Verification Fee - Eskew Teresa 104338 2.00 50.00 100.00
Verification Fee - Espinosa Jose 97675 2.00 50.00 100.00
Medicare First Obligation Fee - Espinosa 97675 1,00 350,00 350.00
Jose

Verification Fee ~ Evans Kimberly 174425 2.00 50.00 100.00
“Medicare First Obligation Fee - Evans oo 174425 1,00 350,00 350.00
Kimberly a Te ee ae
Medicaid Additional Obligation Fee - Evans 174425 1.00 150.00 150,00
Kimberly

Medicaid Additional Obligation Fee - 64468 1.00 150.00 150.00
Excell Kristeen

Verification Fee - Fann Alphonso 81461 2.00 50.00 100.00
Medicaid First Obligation Fee - Fann 81461 1.00 350.00 350.00
Alphonso

Medicare Additional Obligation Fee ~ Fann 81461 1.00 150.00 150.00
Alphonso

Verification Fee - Fannon Buford 97443 2.00 50.00 100.00
Medicare First Obligation Fee - Fannon 97443, 21.00 350.00 350.00
Buford

Verification Fee - Fant Luther 81470 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 42 of 71
Description Client Case# GRGH aty Rate Amount
Medicare First Obligation Fee ~ Meierer 64454 1,00 350.00 350.00
Linda
Verification Fee - Meischker Nicole 104377 2.00 50.00 100.00
Medicaid First Obligation Fee - Meischker 104377 1,00 350.00 350.00
Nicole
Verification Fee - Melroy Susan 104370 2.00 50.00 100.00
Verification Fee - Melsness Timothy 104403 2.00 50.00 100.00
Medicaid First Obligation Fee - Melsness 104403 1,00 350.00 350,00
Timothy
Medicaid Additional Obligation Fee - 104403 1,00 150.00 150.00
Melsness Timothy
Verification Fee - Menderis Lilija 104466 2.00 50.00 100.00
Medicare First Obligation Fee - Menderis 104466 1,00 350.00 350.00
Lilija
Verification Fee - Mendez Bobby 73425 2.00 50.00 100.00
Medicare First Obligation Fee - Mendez 73425 1.00 350.00 350,00
Bobby
Medicaid Additional Obligation Fee - 73425 1,00 150.00 150.00
Mendez Bobby
Verification Fee - Mercer Donna 271271 2.00 50.00 100.00
Medicare First Obligation Fee - Mercer 271271 1,00 350.00 350.00
Donna
Verification Fee - Meredith Gary 121197 2,00 50.00 100.00
Verification Fee - Merrifield Anne 121198 2.00 50.00 100.00
Verification Fee - Mersinger Gail 104333 2.00 50.00 100.00
Medicaid First Obligation Fee - Mersinger 104333 1,00 350.00 350.00
Gail
Verification Fee - Messer Paulina 282777 2.00 50.00 100.00
Medicare First Obligation Fee - Messer 282777 1,00 350.00 350.00
Paulina
Verification Fee - Meyer Elizabeth 271090 2.00 50.00 100.00
Medicare First Obligation Fee - Meyer 271090 1.00 350.00 350,00
Elizabeth
Verification Fee - Meyers Candace goo1a 2.00 50.00 100.00
Medicare First Obligation Fee -~ Meyers 90014 1.00 350.00 350.00
Candace
Verification Fee - Middleton Melody 97448 2.00 50.00 100.00
Medicare First Obligation Fee ~ Middleton 97448 1.00 350.00 350.00
Melody
Medicaid Additional Obligation Fee - 97448 1,00 150.00 150.00
Middleton Melody
Medicare Additional Obligation Fee ~ Miele 166974 1.00 150.00 150.00
Louise
Verification Fee - Milam Deborah 271300 2.00 50.00 100.00



Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldme Page 5 of 18
Description Client Casef GRGE ty Rate Amount
Medicare First Obligation Fee ~ 264616 2.00 350.00 350.00
Eldridge, Edwin
Verification Fee - Ellington, Susan 264471 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 264471 1.00 350.00 350.00
Ellington, Susan
Verification Fee ~ Engstrom,Gloria 271144 2.00 50.00 100.00
Verification Fee ~ Btchison,Wendolyn 97606 2.00 50.00 100.00
Verification Fee - Excell,Kristeen 64468 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 64468 1.00 350.00 350.00
Excell, Kristeen
Verification Tee ~ Fay,Tina 90045 2.00 50.00 100.00
Medicaid Zero Interest Obligation Fee - 90045 1.00 350,00 350.00
Fay, Tina
Verification Fee ~ Felix, Shari 195849 2.00 50.00 100,00
Medicaid Zero Interest Obligation Fee - 195849 1,00 350.00 350.00
Felix, Shari
Verification Fee - Ferry, Leonard 104345 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 104345 1.00 350.00 350.00
Ferry, Leonard
verification Fee - Fouts, Thomas 64476 2.00 50.00 100.00
Medicaid Zero Interest Obligation Fee - 64476 1,00 350.00 350.00
Fouts, Thomas
Verification Fee - Fritchman, Ellis 174569 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 174569 1.00 350.00 350.00
Fritchman, Ellis
Verification Fee ~ Fudger, Pat 166937 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 166937 1.00 350.00 350.00
Fudger, Pat
verification Fee - Gallagher, Michael 174426 2.00 50.00 100.00
Medicare First Obligation Fee - 174426 1.00 350.00 350.00
Gallagher, Michael
Medicaid Additional Obligation Fee ~ 174426 1.00 150.00 150.00
Gallagher, Michael
Verification Fee - Gamble,Cecilia 271145 2.00 50.00 100.00
Verification Fee - Gardberg, Francine 174446 2.00 50,00 100.00
Medicare First Obligation Fee - 174446 1,00 350,00 350.00
Gardberg, Francine
Verification Fee - Getman, Pamela 174488 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 174468 1.00 350.00 350.00
Getman, Pamela
Verification Fee - Gibson, Mary 174436 2.00 50.00 100.00
Medicare First Obligation Fee - 174436 1.00 350.00 350.00
Gibson, Mary
verification Fee ~ Giordano, Nancy 167078 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 29 of 71

Description Client Case# GRGH ty Rate Amount,
Medicare First Obligation Fee - Hroch 282764 1,00 350.00 350.00
Janet

Verification Fee - Hudgins Robert 104456 2,00 50.00 100.00
Medicaid First Obligation Fee - Hudgins 104456 1.00 350.00 350.00
Robert

Medicare Additional Obligation Fee ~ 104456 1.00 150.00 150.00
Hudgins Robert

Verification Fee - Hudson Robert 167062 2.00 50,00 100.00
Medicare First Obligation Fee - Hudson 167062 1.00 350.00 350.00
Robert

Verification Fee - Hudson Harry 282413 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hudson 282413 1,00 350.00 350.00
Harry

Verification Fee - Hudson Jimny 281852 2,00 50.00 100.00
Verification Fee - Huff Sylvester 264356 2.00 50.00 100.00
Medicare First Obligation Fee - Huff 264356 1.00 350.00 350.00
sylvester

Medicaid Additional Obligation Fee - Huff 264356 1,00 150.00 150.00
Sylvester

Verification Fee - Hughes Elaine 89932 2,00 50.00 100.00
Medicare First Obligation Fee - Hughes 89932 1,00 350.00 350.00
Elaine

Verification Fee - Hunt Maxie 1421 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hunt Maxie 91421 1,00 350.00 350.00
Medicaid Additional Obligation Fee - Hunt 61421 1,00 150.00 150.00
Maxie

Verification Fee - Hunt Wanda 271079 2,00 50.00 100.00
Medicare First Obligation Fee - Hunt Wanda 271079 1,00 350.00 350.00
Verification Fee - Hunter Jo Ann 174476 2.00 50,00 100.00
Medicare First Obligation Fee - Hunter Jo 174476 1.00 350.00 350.00
ann — nee

Verification Fee - Inman Becky 271081 2.00 50.00 100.00
Verification Fee - Ipson Roger 97381 2.00 50.00 100.00
Verification Fee - Isaacs Lenzille 174470 2.00 50.00 100,00
Medicare First Obligation Fee - Isaacs 174470 1.00 350.00 350.00
Lenzille

Verification Fee - Isella Denise 270355 2.00 50.00 100.00
Verification Fee - Iwan Justin 89808 2.00 50.00 100.00
Medicare First Obligation Fee - Iwan 89808 1.00 350.00 350.00
Justin

Medicaid Additional Obligation Fee - Iwan 89808 1.00 150.00 150.00
Justin

Verification Fee - Jackiewicz Edward 97518 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 35 of 71

Description Client Case# GRG# oty Rate Amount.
Verification Fee - Kuykendall Anna 97689 2.00 50,00 100.00
Medicare First Obligation Fee - Kuykendall 97689 1.00 350.00 350.00
Anna

Verification Fee - Lachance Larry 104453 2.00 50.00 100.00
Medicare First Obligation Fee - Lachance 104453 1,00 350.00 350.00
Larry

Verification Fee - Lanclos Chadwick 308078 2.00 50.00 100.00
Medicare First Obligation Fee ~ Lanclos 308078 1.00 350,00 350.00
Chadwick

Verification Fee - Landecker Donald 90019 2.00 50.00 100.00
Verification Fee ~ Lang Donald 296251 2.00 50,00 100.00
Medicare First Obligation Fee - Lang 296251 1.00 350.00 350,00
Donald

Medicaid Additional Obligation Fee - Lang 296251 1,00 150.00 150.00
Donald

Verification Fee - Lang Dennis 91486 2.00 50.00 100.00
Medicaid First Obligation Fee - Lang 81486 1.00 350,00 350.00
Dennis

Medicare Additional Obligation Fee - Lang 81486 1,00 150.00 180.00
Dennis

Verification Fee - Langford Carolyn 271084 2.00 50,00 100.00
Medicare First Obligation Fee - Langford 271084 1.00 350.00 350.00
Carolyn

Medicaid Additional Obligation Fee - 271084 1,00 150.00 150.00
Langford Carolyn

Verification Fee - Langford-Johnson Debra 97521 2.00 50.00 100.00
Medicaid First Obligation Fee - 97521 1.00 350.00 350.00
Langford-Johnson Debra

Medicare Additional Obligation Fee - 97521 1.00 150.00 150.00
Langford-Johnson Debra

Verification Fee - Langley Margaret 104506 2,00 50.00 100.00
Medicare First_Obligation_Fee-- Langley == 204806 200 35000 350,00
Margaret

Medicaid Additional Obligation Fee - 104506 1.00 150.00 150.00
Langley Margaret

Verification Fee - Langowski Janet 89809 2.00 50.00 100.00
Medicare First Obligation Fee - Langowski 89809 1.00 350.00 350.00
Janet

Verification Fee - Lapointe Doris 90018 2.00 50.00 100.00
Medicare First Obligation Fee - Lapointe 90018 1.00 350.00 350.00
Doris

Verification Fee - Larsen Joseph 271086 2.00 50.00 100.00
Verification Fee - Larsen John 271085 2.00 50,00 100.00
Medicare First Obligation Fee - Larsen 271085 1.00 350.00 350.00

John



Invoice Number

621297

Project BIOMT-00050-00

Anapol, Schwaxtz, Weiss, Cohan, Feldmz Page 1 of 18
Description Client Case# Ret aty Rate Amount
Verification Fee - Haynes,Gregory 89856 2.00 50.00 100.00
Verification Fee - Heath,Beverly 166940 2.00 50.00 100.00
Medicare First Obligation Fee - 166940 1.00 350.00 350.00
Heath, Beverly
Verification Fee - Heffner, David 97501 2.00 50,00 100.00
Medicaid Zero Interest Obligation Fee - 97501 2.00 350.00 350.00
Heffner, David
Verification Fee - Helzing,Nancy 104412 2.00 50.00 100.00
Medicare First Obligation Fee - 104412 1.00 350.00 350.00
Helzing, Nancy
Verification Fee - Herbst,Kathleen 174449 2.00 50,00 100.00
Verification Fee ~ Hett,Shirley 99933 2.00 50.00 100.00
Medicare First Obligation Fee - 89933 1,00 350.00 350.00
Hett, Shirley
Verification Fee ~ Heyburn, Sandra 167004 2.00 50.00 100.00
Verification Fee - Highnote, Ava 174629 2.00 50.00 100.00
Medicare First Obligation Fee + 174629 1,00 350.00 350.00
Highnote, Ava
Verification Fee - Hodge, Ernest 167094 2,00 50.00 100.00
Medicare First Obligation Fee ~ 167094 1,00 350.00 350.00
Hodge, Ernest
Verification Fee - Hoey, Debora 97438 2.00 50.00 100.00
Verification Fee - Holgate, Dorothy 166999 2.00 50.00 100.00
Medicare First Obligation Fee - 166999 1.00 350.00 350.00
Holgate, Dorothy
Verification Fee - Hope,Kathy 167051 2.00 50.00 100.00
Medicare First Obligation Fee - Hope, Kathy 167051 1.00 350.00 350.00
Verification Fee - Hoppe, Jane 89882 2.00 50.00 100.00
Verification Fee - Hunt,Rickie 174451 2.00 50.00 100.00
Verification Fee ~ Hunziker,Marietta 174583 2.00 50.00 100.00
Medicare First Obligation Fee - 174583 1.00 350.00 350.00
Hunziker, Marietta
Verification Fee - Hurley, Kay 142972 2.00 50.00 100.00
Verification Fee - Hurt, David 174415 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hurt, David 174415 1.00 350.00 350.00
Verification Fee - Hyde,Mariam 73433 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 73433 1.00 350.00 350.00
Hyde, Mariam

73433 1,00 150.00 150.00

Medicaid Additional Obligation Fee ~
Hyde,Mariam



Invoice Number

616513

Project BIOM?-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldme Page 2 of 3

Description Client Case# GRGH aty Rate Amount

Verification Fee - Standridge, Judy 64434 2.00 50.00 100.00

Medicare First Obligation Fee -~ 64434 1.00 350.00 350.00

Standridge, Judy -

Verification Fee - Wedekind, Kelly 167011 2.00 50.00 100,00

Verification Fee - Bird, Barbara 166979 2.00 50.00 100.00

Medicare First Obligation Fee - 166979 1.00 350.00 350.00

Bird, Barbara

Verification Fee - Bradford, David 167097 2.00 50.00 100.00

Verification Fee - Brood, Lucinda 174560 2.00 50.00 100.00

Verification Fee - Ferguson,Mary 64488 2.00 50.00 100.00

Medicare First Obligation Fee - 64488 1.00 350.00 350.00

Ferguson, Mary

Verification Fee - Gallman,Wayne 167060 2.00 50.00 100.00

Medicare First Obligation Fee ~ 167060 1.00 350.00 350.00

Gallman, Wayne

verification Fee - Grable,Richard 64472 2.00 50.00 100.00

Medicare First Obligation Fee - 64471 1.00 350,00 350.00

Grable, Richard

Verification Fee - Hausladen, Sharon 174527 2.00 50,00 100.00

Medicare First Obligation Fee - 174527 1.00 350.00 350.00

Hausladen, Sharon

Verification Fee - Krewson,David 166970 2.00 50,00 100.00

Verification Fee - Lemons,Richard 167086 2.00 50.00 100.00

Medicare First Obligation Fee ~ 167086 1.00 350.00 350.00

Lemons, Richard

Verification Fee - Lippman,Marilyn 166953 2.00 50.00 100.00

Medicare First Obligation Fee ~ 166953 1.00 350.00 350.00

iippman, Marilyn

Verification Fee ~ Mathiason, Peggy 174555 2.00 50,00 100.00

Verification Fee - Miller, Steve 174481 2.00 50.00 100.00

Medicare First Obligation Fee - 174481 1.00 350.00 350.00

Miller, Steve

Verification Fee - Modrey, Ronald 167012 2.00 50.00 100.00

Medicare First Obligation Fee - 167012 1.00 350,00 350.00

Modrey, Ronald

Verification Fee ~ Nikiforou,Candace 167027 2.00 50.00 100.00

Verification Fee - Schweitzer, Paul 174500 2.00 50.00 100.00

Medicare First Obligation Fee ~ 174500 2.00 350.00 350.00

Schweitzer, Paul

Verification Fee - Selby, Same) 64496 2.00 50.00 100.00
64496 1.00 350.00 350.00

Medicare First Obligation Fee -
Selby, Samuel



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 10 of 71
Description Client Case# GRGH aty Rate Amount
Verification Fee - Casler Chris 271060 2.00 50.00 100.00
Medicare First Obligation Fee - Casler 271060 1,00 350,00 350.00
Chris
Verification Fee ~ Cassady Perry 308426 2.00 50.00 100.00
Verification Fee - Cassetta Anthony 97627 2,00 50.00 100.00
Medicare First Obligation Fee ~ Cassetta 97627 1.00 350.00 350.00
Anthony
Medicaid Additional Obligation Fee - 97627 1.00 150.00 150.00
Cassetta Anthony
Verification Fee - Casteel Pamela 271135 2.00 50.00 100.00
Medicare First Obligation Fee - Casteel 271135 1,00 350.00 350.00
Pamela
Medicaid Additional Obligation Fee - 271135 1.00 150.00 150.00
Casteel Pamela
Medicaid Additional Obligation Fee - 271135 1.00 150.00 150.00
Casteel Pamela
Verification Fee - Caudill Michelle 274814 2.00 50,00 100.00
Verification Fee - Cavanaugh Hazel Ann 271061 2.00 50.00 100.00
Medicare First Obligation Fee - Cavanaugh 271061 1,00 350.00 350.00
Hazel Ann
Verification Fee - Cavnar Jewell 174509 2,00 50.00 100.00
Medicare First Obligation Fee - Cavnar 174509 1.00 350.00 350.00
Jewell
Verification Fee - Cebula Betty 104469 2.00 50.00 100.00
Medicare First Obligation Fee - Cebula 104469 1.00 350.00 350.00
Betty
Verification Fee - Cedillo Mary 104317 2.00 50.00 100.00
Medicare First Obligation Fee - Cedillo 104317 1.00 350.00 350.00
Mary
Verification Fee - Cellucci Catherine 64441, 2.00 50.00 100.00
Medicare First Obligation Fee - Cellucci 64441 1.00 350.00 350.00
Catherine
Verification Fee - Chacon Angelina 274817 2.00 50.00 100.00
Verification Fee - Chambers Jonathan 274813 2.00 50.00 100.00
Verification Fee - Champion Patricia 104352 2.00 50.00 100.00
Verification Fee ~ Chandler John 1292 2,00 50.00 100.00
Medicare First Obligation Fee - Chandler 81292 1.00 350.00 350.00
John
Medicaid Additional Obligation Fee - 81292 1,00 150.00 150.00
Chandler John
Verification Fee - Chernish Holly 81410 2.00 50.00 100.00
Medicare First Obligation Fee - Chernish 81410 1.00 350.00 350.00
Holly
Verification Fee - Cherry Asia 97480 2.00 50.00 100.00



Invoice Number 628651
Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 52 of 71
Description Client Case# GRGH Qty Rate Amount
Medicare First Obligation Fee - Rathbone 296264 1,00 350.00 350.00
Leonard
Verification Fee - Register Barbara 167066 2.00 50.00 100.00
Verification Fee - Reynolds Patricia 174471 2.00 50.00 100.00
Medicare First Obligation Fee - Reynolds 1744721 1.00 350.00 350.00
Patricia
Verification Fee - Rhoden Jimmie 271136 2.00 50.00 100.00
Medicare First Obligation Fee - Rhoden 271136 1.00 350.00 350.00
Jimmie
Medicaid Additional Obligation Fee - 271136 1.00 150.00 150.00
Rhoden Jimmie
Verification Fee - Rhodes Sabrina 104358 2.00 50.00 100.00
Verification Fee - Rhodes Sherita 264398 2.00 50.00 100.00
Medicare First Obligation Fee - Rhodes 264398 1,00 350.00 350.00
Sherita
Medicaid Additional Obligation Fee ~ 264398 1,00 150,00 150.00
Rhodes Sherita
Verification Fee - Richards Sue 104421 2.00 50.00 100.00
Medicare First Obligation Fee - Richards 104421 1,00 350.00 350.00
sue
Verification Fee - Richardson Jack 174567 2.00 50.00 100.00
Verification Fee - Richmond Lovetta 99866 2.00 50.00 100.00
Verification Fee - Richmond Frances 104451 2.00 50.00 100.00
Medicare First Obligation Fee - Richmond 104451 1,00 350.00 350.00
Frances
Verification Fee - Ridens John 97649 2.00 50.00 100.00
Medicare First Obligation Fee - Ridens 97649 1,00 350.00 350.00
John
Medicaid First Obligation Fee - Rios 91441 1.00 350.00 350.00
Carlos

_____ Medicaid Additional Obligation Fee - Rios 1,00 150.00 150.00
Carlos NE ~~
Verification Fee - Rios Raymond 332559 2.00 50.00 100.00
Verification Fee - Ritter Linda Sue 270359 2.00 50.00 100.00
Medicare First Obligation Fee - Ritter 270359 1,00 350,00 350.00
Linda Sue
Verification Fee - Rivers Carolyn 97654 2.00 50.00 100.00
Medicare First Obligation Fee - Rivers 97654 1.00 350.00 350.00
Carolyn
Verification Fee - Roberts Mary 296265 2.00 50,00 100.00
Medicare First Obligation Fee - Roberts 296265 1,00 350.00 350.00
Mary
Verification Fee - Roberts Brenda 174525 2.00 50,00 100.00



Invoice Number

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldmz Page 16 of 18
Description Client Caset GRGH aty Rate Amount
Verification Fee - Tidwell,Bryan 174489 2.00 50.00 100.00
Medicare First Obligation Fee - 174489 1.00 350.00 350,00
Tidwell, Bryan
Verification Fee - Tillman, Jean 174463 2.00 50.00 100.00
Medicare First Obligation Fee - 174463 1,00 350.00 350.00
‘Tillman, Jean
Verification Fee - Tobacco, Pearl 174552 2.00 50.00 100.00
Medicaid First Obligation Fee - 174582 1.00 150.00 150.00
Tobacco, Pearl
Medicare Additional Obligation Fee - 174552 1.00 350.00 350,00
Tobacco, Pear)
Verification Fae - Toomey, David 1424 2.00 50.00 100.00
Verification Fee - Towery, Nadine 104599 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 104599 1,00 350.00 350.00
Towery, Nadine
Verification Fee ~ Twenhafel, Cathy 167034 2.00 50,00 100.00
Verification Fee ~ Urciouli,Donato 64427 2.00 50.00 100.00
Verification Fee - Van Hout, Jean 166939 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 166939 1.00 350,00 350.00
Van Hout, Jean
Verification Fee - Vanover,Margaret 89892 2,00 50.00 100.00
Verification Fee - Vasquez, Jeanette 174573 2,00 50.00 100.00
Verification Fee - Vidak, Charles 264618 2.00 50.00 100.00
Medicare First Obligation Fee - 264618 1.00 350.00 350.00
Vidak, Charles
Verification Fee - Wade,Gary 167035 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 167035 1.00 350.00 350.00
Wade, Gary
Verification Fee - Walker,Myrtle 270352 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 270352 1.00 350.00 350.00
Walker, Myrtle
Verification Fee - Waller, Catherine 167090 2,00 50.00 100.00
Verification Fee - Ward,Hazel 97587 2.00 50.00 100.00
Verification Fee - Washington, Steven 174493 2.00 50.00 100.00
Medicare First Obligation Fee ~ 174493 1,00 350.00 350.00
Washington, Steven
Medioaid Additional Obligation Fee - 174493 1.00 150.00 150.00
Washington, Steven
Verification Fee - Watkins Roosevelt 174437 2.00 50.00 100.00
Verification Fee - Webb, Susie 97441 2.00 50.00 100.00
Medicaid First Obligation Fee ~ Webb, Susie 97441 1.00 150.00 150.00



Invoice Number
Invoice Date

616513

November 25, 2014

PO Number
Contract
Project BIOMT-00050-00
2115 Rexford Road, 4th Floor | Charlotte, NC 28211
Terms 30
Thomas Anapol, Esquire Page 1 of 3
Anapol, Schwartz, Weiss, Cohan, Feldme
1710 Spruce Street
Philadelphia, PA 19103-6795
Description Client Caset GRGt aty Rate Amount
Verification Fee - Bignault, Francis 64437 2.00 50.00 100.00
Medicare First Obligation Fee ~ 64437 1.00 350.00 350.00
Bignault, Francis
Verification Fee - Borris,Jeane 73434 2.00 50.00 100.00
Verification Fee ~ Colby, Linda 166925 2.00 50.00 100.00
Medicare First Obligation Fee - 166925 1.00 350.00 350.00
Colby, Linda
Verification Fee - Faber,Nan 64415 2,00 50.00 100.00
Verification Fee - Ferree, Louise 64416 2.00 50.00 100.00
Medicaxe First Obligation Fee ~ 64416 1.00 350.00 350.00
Ferree, Louise
Verification Fee - Gill,Patricia 166938 2.00 50.00 100,00
Verification Fee - Grother, Carol 166946 2.00 50.00 100.00
Medicare First Obligation Fee ~ 166946 1,00 350.00 350.00
Grother, Carol
Verification Fee - Keeler,William 167040 2.00 50.00 100.00
Verification Fee ~ Myers, Stuart 167031 2.00 50.00 100.00
Nedicare First Obligation Fee ~ 167031 1.00 350.00 350.00
Myers, Stuart
Verification Fee - Newby,Catherine 167089 2.00 50.00 100.00
Medicare First Obligation Fee - 167089 1.00 350.00 350.00
Newby, Catherine
Medicaid Additional Obligation Fee - 167083 1.00 150.00 150.00
Newby, Catherine
Verification Fee - Odum, Izyna 167015 2.00 50.00 100.00
Verification Fee - Peterschick,Melinda 64458 2.00 50.00 100.00
Medicare First Obligation Fee ~ 64458 1,00 350.00 350.00
Peterschick, Melinda
Medicaid Additional Obligation Fee - 64458 1.00 150.00 150.00
Peterschick, Melinda
Verification Fee - Rehbein, Patricia 64465, 2.00 50,00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 67 of 71

Description Client Case# GRG# Qty Rate Amount
Verification Fee - White James 89775 2.00 50.00 100,00
Medicare First Obligation Fee - White 89775 1.00 350.00 350.00
James

Verification Fee - White Francis 333890 2,00 50.00 100,00
Verification Fee - White-Jones Christina 174515 2.00 50,00 100.00
Medicare First Obligation Fee - 174515 1,00 350,00 350.00
White-Jones Christina

Verification Fee - Whitman John 308247 2.00 50.00 100,00
Medicare First Obligation Fee ~ Whitman 308247 1.00 350.00 350.00
John

Medicaid Additional Obligation Fee - 308247 1.00 150.00 150.00
Whitman John

Verification Fee - Whitney Bruce 104561 2.00 50.00 100.00
Medicare First Obligation Fee - Whitney 104561 1.00 350.00 350.00
Bruce

Medicaid Additional Obligation Fee - 104561 1,00 150,00 150.00
whitney Bruce

Verification Fee - Whitten Patrick 97680 2,00 50.00 100.00
Medicare First Obligation Fee - Whitten 97680 1,00 350.00 350.00
Patrick

Verification Fee - Wierleski Gary 292395 2.00 50,00 100.00
Verification Fee - Wiggins Diann 97617 2.00 50.00 100.00
Medicare First Obligation Fee - Wiggins 97617 1.00 350,00 350.00
Diann

Verification Fee - Wiggins Debra 89806 2.00 50.00 100.00
Medicare First Obligation Fee ~ Wiggins 89806 1.00 350.00 350.00
Debra

Medicaid Additional Obligation Fee - 89806 1,00 150.00 150.00
Wiggins Debra

Medicaid Additional Obligation Fee - 89806 1.00 150.00 150.00
Wiggins Debra

Verification Fee - Wigley Kenneth 97533 2,00 50.00 100.00
Medicare First Obligation Fee - Wigley 97533 1.00 350.00 350.00
Kenneth

Verification Fee - Wilder Michael 282768 2.00 50.00 100.00
Medicare First Obligation Fee - Wilder 282768 1.00 350.00 350.00
Michael

Medicaid Additional Obligation Fee - 282768 1.00 150.00 150.00
Wilder Michael

Verification Fee - Wilkins William 281613 2.00 50.00 100.00
Medicare First Obligation Fee - Wilkins 281613 1.00 350.00 350.00
William

Verification Fee - Williams Valerie 90065 2.00 50.00 100.00
Verification Fee - Williams Eugene 271108 2.00 50.00 100.00



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 22 of 71
Description Client Case# GRG# Qty Rate Amount
Verification Fee - Giofu Robert 104390 2.00 50.00 100.00
Medicaid First Obligation Fee - Giofu 104390 1.00 350.00 350.00
Robert
Medicare Additional Obligation Fee - Giofu 104390 1.00 150.00 150.00
Robert
Verification Fee - Goetz Susan 97410 2.00 50.00 100.00
Verification Fee - Golds Susan 97390 2.00 50.00 100.00
Medicare First Obligation Fee - Golds 97390 1.00 350.00 350.00
susan
Verification Fee - Gomez Richard 97620 2.00 50,00 100.00
Medicare First Obligation Fee - Gomez 97620 1.00 350.00 350.00
Richard
Verification Fee - Gonzalez Jorge 166986 2.00 50.00 100.00
Medicare First Obligation Fee - Gonzalez 166986 1.00 350.00 350.00
Jorge
Medicaid Additional Obligation Fee - 166986 1.00 150.00 150.00
Gonzalez Jorge
Verification Fee - Goodlett Yvette 97615 2.00 50,00 100.00
Verification Fee - Goodwin Martha 89805 2.00 50.00 100.00
Medicare First Obligation Fee - Goodwin 89805 1.00 350.00 350.00
Martha
Verification Fee - Goodyear Carole 104507 2.00 50.00 100.00
Medicare First Obligation Fee - Goodyear 104507 1.00 350,00 350.00
Carole
Verification Fee - Gordon Bruce 89779 2.00 50.00 100.00
Verification Fee - Gordon Priscilla 286877 2.00 50.00 100.00
Medicare First Obligation Fee - Gordon 286877 1.00 350.00 350.00
Priscilla
verification Fee - Gordovez Alfonso 121191 2.00 50.00 100.00
Verification Fee - Goss Richard 121192 2.00 50.00 100,00
Medicare First Obligation Fee - Goss 121192 1,00 350.00 350.00
Richard
Verification Fee - Gragg Diann 81347 2.00 50.00 100.00
Verification Fee - Graham Joan 64494 2.00 50.00 100.00
Medicaid First Obligation Fee - Graham 73437 1.00 350.00 350.00
Michael
Verification Fee - Graham Joann 104550 2.00 50,00 100.00
Medicaid First Obligation Fee - Graham 104550 1.00 350.00 350.00
Joann
Medicare Additional Obligation Fee ~ 104550 1.00 150.00 150.00
Graham Joann
Verification Fee - Grant Barbara 64492 2.00 50.00 100.00
Medicare First Obligation Fee - Grant 64492 1.00 350,00 350.00

Barbara



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 6 of 11

Description Client Case# GRGH ty Rate Amount

Verification Fee - Blanton Zappaneka 104478 2.00 50,00 100.00

Medicaid First Obligation Fee - Blanton 104478 1.00 350.00 350.00

Zappaneka

Verification Fee - Bloch Laurie 97486 2.00 50.00 100.00

Medicare First Obligation Fee - Bloch 97486 1.00 350.00 350.00

Laurie

Verification Fee - Blunt Roosevelt 174423 2.00 50.00 100.00

Verification Fee - Blyler George 271379 2.00 50.00 100.00

Medicare First Obligation Fee - Blyler 271379 1.00 350.00 350.00

George

Verification Fee - Bogans Gwendolyn 274... 2.00 50.00 100.00

Medicare First Obligation Fee - Bogans 2711i1 1.00 350.00 350.00

Gwendolyn

Medicaid Additional Obligation Fee - 27ui1a 1.00 150,00 150.00

Bogans Gwendolyn

Verification Fee - Boitnott Earl 174432 2.00 50.00 100.00

Verification Fee - Bolton Richard 97555 2.00 50.00 100.00

Medicaid First Obligation Fee - Bolton 97555 1.00 350.00 350.00

Richard

Verification Fee - Bonavolonta Saverio 97622 2.00 50.00 100.00

Medicare First Obligation Fee - 97622 1.00 350.00 350.00

Bonavolonta Saverio

Verification Fee - Bonnell Jack 292399 2.00 50.00 100.00

Medicare First Obligation Fee - Bonnell 292399 1.00 350.00 350.00

Jack

Verification Fee - Borlace Kara 89875, 2.00 50.00 100.00

Medicaid Additional Obligation Fee - 104482 1.00 150.00 150.00

Bou-Hamdan Daoud

Verification Fee - Bowens Ben 296236 2.00 50.00 100.00

Medicaid First Obligation Fee - Bowens Ben 296236 1.00 350.00 350.00

Medicare Additional Obligation Fee - 296236 1.00 150.00 150.00

Bowens Ben

Verification Fee - Boyd Gloria 174502 2.00 50.00 100.00

Medicare First Obligation Fee - Boyd 174502 1.00 350.00 350.00

Gloria

Verification Fee - Boykin Ixma 81438 2.00 50.00 100.00

Medicare First Obligation Fee - Boykin 81438 1.00 350.00 350.00

Irma

Verification Fee - Bozard Judith 90068 2.00 50.00 100.00

Medicare First Obligation Fee - Bozard 90068 1.00 350.00 350.00

Judith

Verification Fee - Bracey Sonja 64445 2.00 50.00 100.00
64445 1.00 350.00 350.00

Medicare First Obligation Fee - Bracey
Sonja



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 15 of 71

Description Client Case# GRG# Qty Rate Amount

Verification Fee - Derck Kathy 81502 2.00 50.00 100.00

Verification Fee - Desjardins George 104551 2,00 50,00 100.00

Medicare First Obligation Fee - Desjardins 104551 1.00 350.00 350.00

George

Verification Fee - Dill James 282788 2.00 50.00 100.00

Verification Fee - Dilley Gracelyn 97645, 2.00 50,00 100.00

Medicare First Obligation Fee - Dilley 97645 1,00 350.00 350.00

Gracelyn

Medicaid Additional Obligation Fee - 97645 1,00 150.00 150.00

Dilley Gracelyn

Verification Fee - Dinsmore Ralph 104619 2.00 50.00 100.00

Verification Fee - Divine Colette 282789 2.00 50.00 100.00

Medicare First Obligation Fee - Divine 282789 1.00 350.00 350.00

Colette

Verification Fee - Dobbs Danny 64435 2.00 50,00 100.00

Medicare First Obligation Fee ~ Dobbs 64435 1.00 350.00 350.00

Danny

Verification Fee - Dodgen William 89838 2.00 50.00 100.00

Medicare First Obligation Fee - Dodgen 89638 1.00 350.00 350.00

William

Verification Fee - Dortch Jewell 104402 2.00 50.00 100.00

Medicare First Obligation Fee ~ Dowd 270321 1.00 350.00 350.00

Josephine

Verification Fee ~ Down William 292389 2.00 50.00 100.00

Verification Fee - Downs Colleen 89905 2.00 50.00 100.00

Medicare First Obligation Fee - Downs 89905 1.00 350,00 350.00

Colleen

Medicaid Additional Obligation Fee - Downs 89905 1.00 150.00 150.00

Colleen

Verification Fee - Doyle Patrick 264466 2.00 50.00 100.00

Verification Fee - Drake Annie 97532 2.00 50.00 100.00

Medicare First Obligation Fee - Drake 97532 1.00 350.00 350.00

Annie

Verification Fee - Draper Doug 90070 2.00 50.00 100.00

Medicare First Obligation Fee - Draper 90070 1,00 350.00 350.00

Doug

Verification Fee - Drinkard Joann 174467 2.00 50.00 100.00

Medicare First Obligation Fee - Drinkard 174467 1.00 350.00 350.00

Joann

Medicaid Additional Obligation Fee - 174467 1.00 150.00 150.00

Drinkard Joann

Verification Fee - Dryden Linda 271143 2.00 50.00 100.00
271143 1,00 350,00 350.00

Medicare First Obligation Fee - Dryden
Linda



Invoice Number 628651

Project BIOM?-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 65 of 71
Description Client Case# GRGH Qty Rate Amount
Verification Fee - Vincent John 167085 2.00 50.00 100.00
Medicaid First Obligation Fee - Vincent 167085 1,00 350.00 350.00
John
Verification Fee - Vivian Charmaine 104604 2.00 50.00 100.00
Medicare First Obligation Fee - Vivian 104604 1.00 350.00 350.00
Charmaine
Medicaid Additional Obligation Fee - 104604 1.00 150.00 150.00
Vivian Charmaine
Verification Fee - Vogler Terry 121201 2.00 50.00 100.00
Verification Fee ~ Vokey Vicki 81426 2.00 50.00 100.00
Verification Fee - Volenec Georgette 286006 2.00 50.00 100.00
Medicare First Obligation Fee - Volenec 286006 1.00 350,00 350.00
Georgette
Verification Fee - Wagener Karen 81491 2.00 50,00 100.00
Verification Fee - Wagner William 293712 2.00 50.00 100.00
Verification Fee - Waits Kathleen 308874 2.00 50.00 100.00
Medicare First Obligation Fee - Waits 308874 1.00 350,00 350.00
Kathleen
Verification Fee - Waldron Craig 90080 2.00 50,00 100.00
Medicare First Obligation Fee - Waldron 90080 1.00 350.00 350.00
Craig
Medicare Additional Obligation Fee - 270352 1,00 150.00 150.00
Walker Myrtle
Verification Fee - Walker Sandra 308050 2.00 50.00 100.00
Medicaid First Obligation Fee - Walker 308050 1.00 350.00 350.00
Sandra
Verification Fee - Wallace Sandra 97582 2.00 50.00 100.00
Medicare First Obligation Fee - Wallace 97582 1,00 350.00 350.00
Sandra
Verification Fee - Walls Douglas 328625 2.00 50.00 100.00
Verification Fee ~ Wampole Leonard 282781 2.00 50.00 100.00
Medicaid First Obligation Fee - Wampole 282781 1.00 350.00 350.00
Leonard
Medicare First Obligation Fee - Ward Hazel 97587 1,00 350.00 350.00
Verification Fee - Ward-Davis Denise 166949 2.00 50,00 100.00
Verification Fee - Warden Nancy 104508 2.00 50.00 100.00
Verification Fee - Watkins David 271120 2.00 50.00 100.00
Verification Fee - Watson Jane 104337 2.00 50.00 100.00
Verification Fee - Watson Virginia 282769 2.00 50.00 100.00
282769 1.00 350.00 350.00

Medicare First Obligation Fee - Watson
Virginia



Invoice Number

Invoice Date

628651
June 29, 2015

PO Number
Contract
Project BIOMT-00050-00
2115 Rexford Road, 4th Floor | Charlotte, NC 28211
Terms 30
Thomas Anapol, Esquire Page 1 of 71
Anapol, Schwartz, Weiss, Cohan, Feldman
1710 Spruce Street
Philadelphia, PA 19103-6795
Description Client Case# GRGH Qty Rate Amount
Verification Fee - Abdelhak Heather 174608 2.00 50.00 100.00
Medicaid First Obligation Fee - Abdelhak 174608 1.00 350.00 350.00
Heather
Verification Fee - Abourjilie Denise 167038 2.00 50.00 100.00
Verification Fee - Adams Rubye 281608 2.00 50.00 100.00
Medicare First Obligation Fee - Adams 281608 1.00 350,00 350.00
Rubye
Medicaid Additional Obligation Fee - Adams 281608 1.00 150.00 150.00
Rubye
Verification Fee - Adewunmi Julius 104628 2.00 50.00 100.00
Verification Fee - Alcon Thomas 89865 2.00 50.00 100,00
Medicare First Obligation Fee - Alcon 89865 1.00 350.00 350.00
Thomas
Verification Fee - Allen Donna 286010 2.00 50.00 100.00
Medicare First Obligation Fee - Allen 286010 1.00 350.00 350.00
Donna
Medicaid Additional Obligation Fee ~ Allen 286010 1.00 150.00 150.00
Donna
Medicaid Additional Obligation Fee ~ Allen 286010 1.00 150,00 150.00
Donna
Verification Fee - Allen Roy 89771 2.00 50.00 100.00
Medicare First Obligation Fee - Allen Roy 89771 1,00 350.00 350.00
Medicaid Additional Obligation Fee - Allen 89771 1,00 150.00 150.00
Roy
Medicaid Additional Obligation Fee - Allen 89771 1,00 150.00 150.00
Roy
Verification Fee - Allen Jerry 264350 2.00 50.00 100.00
Medicare First Obligation Fee - Allen 264350 1.00 350.00 350.00
Jerry
Medicaid Additional Obligation Fee ~ Allen 264350 1.00 150.00 150.00
Jerry
Verification Fee - Allen Robert 104448 2.00 50.00 100.00
Medicare First Obligation Fee - Allen 104448 1.00 350.00 350.00

Robert



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 66 of 71
Description Client Case# GRGH Qty Rate Amount
Verification Fee - Way Michael 174454 2.00 50.00 100.00
Medicare First Obligation Fee - Way 174454 1.00 350.00 350.00
Michael
Medicaid Additional Obligation Fee - Way 174454 1,00 150,00 150.00
Michael
Verification Fee - Weathers Marlene 174468 2.00 50.00 100.00
Verification Fee - Webster Stanley 174478 2.00 50.00 100.00
Medicaid Pirst Obligation Fee - Webster 174478 1.00 350,00 350.00
Stanley
Medicare First Obligation Fee - Welder 104476 1.00 350.00 350,00
Duard
Verification Fee - Welsh James 271272 2.00 50.00 100.00
Medicare First Obligation Fee - Welsh 271272 1.00 350.00 350.00
James
Verification Fee - Wenger Sherrie 296274 2.00 50.00 100.00
Medicare First Obligation Fee - Wenger 296274 1,00 350.00 350.00
Sherrie
Verification Fee - Wenzel Lauren 104618 2.00 50.00 100.00
Medicare First Obligation Fee - Wenzel 104618 1.00 350.00 350.00
Lauren
Verification Fee - West Greg 167047 2.00 50,00 100.00
Medicare First Obligation Fee - West Greg 167047 1.00 350.00 350.00
Verification Fee - Westmoreland David 89752 2.00 50.00 100.00
Medicare First Obligation Fee - 89752 1.00 350.00 350.00
Westmoreland David
Medicaid Additional Obligation Fee - 89752 1.00 150.00 150.00
Westmoreland David
Verification Fee - Wetter Carol 296275 2.00 50.00 100.00
Medicare First Obligation Fee - Wetter 2962715 1,00 350.00 350.00
Carol
Verification Fee - Whalen John 271122 2.00 50.00 100.00
Medicare First Obligation Fee - Whalen 271122 1.00 350.00 350.00
John
Medicaid Additional Obligation Fee ~ 271122 1.00 150.00 150.00
Whalen John
Verification Fee - Wheeler Rebecca 104401 2.00 50,00 100.00
Verification Fee - Wheeler Virginia 332560 2.00 50.00 100.00
Verification Fee - White Nancy 271133 2,00 50.00 100.00
Medicaid First Obligation Fee - White 271133 1.00 350.00 350.00
Nancy
Verification Fee - White Victoria 97534 2,00 50.00 100.00
Medicare First Obligation Fee - White 97534 1,00 350.00 350.00
Victoria
Verification Fee - White Freddie 104573 2.00 50.00 100.00



Invoice Number

621297

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldme Page 3 of 18

Description Client Caset GRGE aty Rate Amount.

Verification Fee ~ Caporrino, Jean 89988 2,00 50.00 100.00

Verification Fee - Carlson,Ruth 270319 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee — 270319 1,00 350.00 350.00

Carlson, Ruth

Verification Fee ~ Carpenter, Sharon 64433 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 64433 1,00 350.00 350,00

Caxpenter, Sharon

Verification Fee ~ Carpenter, Susan 174893 2.00 50,00 100.00

Verification Fee - Casto,Michael 167096 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 167096 1.00 350.00 350.00

Casto, Michael

Verification Fee - Cherry,William 64467 2.00 50.00 100.00

Medicaid First Obligation Fee - 64467 1.00 150.00 150.00

Cherry, William

Medicare Additional Obligation Fee ~ 64467 1.00 350.00 350.00

Cherry, William

Verification Fee - Clinton,Denice 174510 2.00 50.00 100.00

verification Fee - Cochran, Barbara 89782 2.00 50.00 100.00

Verification Fee ~ Coffey,lynda 174588 2.00 50.00 100.00

Medicare Firat Obligation Fee ~ 174588 1.00 350.00 350.00

Coffey, Lynda

Medicaid Additional Obligation Fee - 174588 1,00 150.00 150.00

Coffey, Lynda

Verification Fee - Collins, Stanley 64491 2.00 50.00 100,00

Medicare First Obligation Fee - 64491 1.00 350.00 350,00

Collins, Stanley

Medicaid Additional Obligation Fee - 64491 1.00 150.00 150.00

Collins, Stanley

Verification Fee - Cortes, Sharlon 174602 2.00 50.00 100.00

Medicaid First Obligation Fee - 174602 1.00 350.00 350.00

Cortes,Sharlon

Verification Fee - Cox,Margaret 174581 2.00 50,00 100.00

Medicare First Obligation Fee - 174581 1.00 350.00 350.00

Cox, Margazet

Verification Fee - Crane,Lutshia 89975 2,00 50.00 100.00

Medicare Zero Interest Obligation Fee - 89975 1.00 350.00 350.00

Crane, Lutshia

Verification Fee - Crawford,Dennis 90048 2.00 50.00 100.00

Medicare Zero Interest Obligation Fee - 90048 1.00 350.00 350.00

Crawford, Dennis

Verification Fee - Crisafulli,Frances 167014 2.00 50,00 100.00

Verification Fee - Dalton, Daniel 99833 2.00 $0.00 100.00
89833 1.00 350.00 350.00

Medicare Zero Interest Obligation Fee -
Dalton, Daniel



Invoice Number

628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 37 of 71
Description Client Case# GRG# Ooty Rate Amount
Medicare First Obligation Fee - Lewis 264617 1,00 350.00 350.00
Aveta
Medicaid Additional Obligation Fee - Lewis 264617 1.00 150,00 150.00
Aveta
Verification Fee - Libby Laurel 270364 2.00 50.00 100.00
Medicare First Obligation Fee - Libby 270364 1.00 350,00 350,00
Laurel
Verification Fee - Light Jack 97392 2.00 50.00 100.00
Medicare First Obligation Fee - Light Jack 97392 1,00 350.00 350.00
Medicaid Additional Obligation Fee - Light 97392 1.00 150.00 150,00
Jack
Verification Fee - Lineaweaver Teresa 174625 2,00 50,00 100.00
Medicaid First Obligation Fee - 174625 1.00 350.00 350.00
Lineaweaver Teresa
Verification Fee - Lipp Brenda 104592 2.00 50.00 100.00
Verification Fee - Lise Nancy 271087 2.00 50,00 100.00
Medicaid First Obligation Fee - Lise Nancy 271087 1.00 350.00 350.00
Medicare Additional Obligation Fee - Lise 271087 1,00 150.00 150.00
Nancy
Medicaid Additional Obligation Fee - Lise 271087 1.00 150,00 150.00
Nancy
Verification Fee - Lissauer Gail 292392 2.00 50,00 100.00
Medicare First Obligation Fee - Lissauer 292392 1,00 350,00 350.00
Gail
Verification Fee - Little Thomas 1471 2.00 50.00 100.00
Medicare First Obligation Fee - Little 81471 1.00 350.00 350.00
Thomas
Verification Fee - Littleton William 89923, 2.00 50,00 100.00
Medicare First Obligation Fee - Littleton 89923 1.00 350.00 350.00
William
Verification Fee - Lohnas Eva 90076 2.00 50.00 100.00
Medicaid First Obligation Fee - Lohnas Eva 90076 1.00 350.00 350,00
Verification Fee - Long Kimberly 292408 2.00 50.00 100.00
Verification Fee - Long Charles 81479 2.00 50.00 100.00
Verification Fee - Longenecker Julie 104496 2.00 50.00 100.00
Verification Fee - Longus Dorothy 99948 2.00 50.00 100.00
Medicare First Obligation Fee - Longus 89948 1,00 350,00 350.00
Dorothy
Verification Fee - Lopez Cleofas 104301 2.00 50.00 100.00
Medicare First Obligation Fee - Lopez 104301 1.00 350.00 350.00
Cleofas
Verification Fee - Lorenzen Joan 97494 2.00 50.00 100.00



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 53 of 71
Description Client Case# GRGH aty Rate Amount:
Medicare First Obligation Fee - Roberts 174525 1.00 350.00 350.00
Brenda
Verification Fee - Roberts Craig 89848 2.00 50.00 100.00
Verification Fee - Robinson Toya 104623 2.00 50.00 100.00
Medicare First Obligation Fee - Robinson 104623 1.00 350.00 350.00
Toya
Medicaid Additional Obligation Fee - 104623 1.00 150.00 150.00
Robinson Toya
Verification Fee - Robinson James 97631 2.00 50.00 100.00
Verification Fee - Rodgers Dennis 264447 2.00 50.00 100.00
Medicare First Obligation Fee - Rodgers 264447 1.00 350.00 350,00
Dennis
Medicaid Additional Obligation Fee - 174594 1.00 150.00 150.00
Rodriguez Arthur
Verification Fee - Rogalski Michael 282758 2.00 50.00 100.00
Medicare First Obligation Fee - Rogalski 282758 1.00 350.00 350.00
Michael
Verification Fee - Rohlf Gary 282763 2.00 50.00 100.00
Medicare First Obligation Fee - Rohlf Gary 282763 1,00 350.00 350.00
Medicaid Additional Obligation Fee ~ Rohlf 282763 1.00 150.00 150,00
Gary
Verification Fee - Rohlfing Kathy 190506 2.00 50.00 100.00
Verification Fee - Romania Michele 104445 2.00 50.00 100.00
Verification Fee - Romine James 292398 2.00 50.00 100.00
Medicare First Obligation Fee - Romine 292398 1,00 350.00 350.00
James
Medicaid Additional Obligation Fee - 292398 1.00 150.00 150.00
Romine James
Verification Fee - Rosa Brian 97588 2.00 50.00 100.00
Verification Fee - Rosales Samuel 104492 2.00 50.00 100.00
Medicaid First Obligation Fee - Rosales 104492 1.00 350.00
Samuel
Verification Fee - Rose Matthew 293713 2.00 50.00 100.00
Medicare First Obligation Fee - Rose 293713 1.00 350.00 350.00
Matthew
Medicaid Additional Obligation Fee ~ Rose 293713 1.00 150.00 150.00
Matthew
Verification Fee - Rosenberg Sharon 174599 2.00 50.00 100.00
Medicare First Obligation Fee - Rosenberg 174599 1.00 350.00 350.00
Sharon
Verification Fee - Rosin Abbe 89874 2.00 50.00 100.00
Verification Fee -~ Ross Timothy 99816 2.00 50.00 100.00

89816 1,00 350.00 350.00

Medicare First Obligation Fee - Ross
Timothy



Invoice Number 628651

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldman Page 23 of 71
Description Client Cased GRGH ty Rate Amount
Medicaid Additional Obligation Fee - Grant 64492 1.00 150.00 150.00
Barbara
Medicare Additional Obligation Fee - Grant 97608 1.00 150.00 150.00
Mary
Verification Fee - Grau Mary 97696 2.00 50.00 100.00
Verification Fee - Graves Phillip 97414 2.00 50.00 100.00
Medicare First Obligation Fee ~ Graves 97414 2.00 350.00 350.00
Phillip
Verification Fee - Gray Drema 81520 2.00 50.00 100.00
Medicaid First Obligation Fee - Gray Drema 81520 1,00 350.00 350.00
Verification Fee - Green Diane 271068 2.00 50.00 100.00
Medicare First Obligation Fee ~ Green 271068 1.00 350.00 350.00
Diane
Medicaid Additional Obligation Fee ~ Green 271068 1.00 150.00 150.00
Diane
Verification Fee - Green Myrtle 270358 2.00 50.00 100.00
Medicare First Obligation Fee - Green 270358 1.00 350.00 350.00
Myrtle
Verification Fee ~ Green John 104608 2.00 50.00 100.00
Medicare First Obligation Fee - Green John 104608 1,00 350,00 350.00
Verification Fee - Green Larry 89910 2.00 50,00 100.00
Medicare First Obligation Fee - Green 89910 1.00 350.00 350.00
Larry
Verification Fee - Greene Debra 296246 2,00 50.00 100.00
Medicare First Obligation Fee - Greene 296246 1.00 350.00 350.00
Debra
Verification Fee - Greene Theresa 97592 2.00 50.00 100.00
Medicare First Obligation Fee - Greene 97592 1.00 350.00 350.00
Theresa
Verification Fee - Greer Carolyn 271069 2.00 50.00 100.00
Medicare First Obligation Fee - Greer 271069 1.00 350.00 350.00
Carolyn
Medicaid Additional Obligation Fee - Greer 271069 1,00 150.00 150.00
Carolyn
Verification Fee - Gregory Frances 271070 2.00 50.00 100.00
Verification Fee - Grindrod Mary 81503, 2.00 50.00 100.00
Medicare First Obligation Fee - Grindrod 81503 1.00 350.00 350.00
Mary
Verification Fee - Gritz Blayne 310015 2,00 50.00 100.00
Verification Fee - Grover Jon 81435, 2.00 50.00 100.00
Medicare First Obligation Fee - Grover Jon 81435 1.00 350.00 350.00
Medicaid Additional Obligation Fee - 81435 1,00 150.00 150.00

Grover Jon



Invoice Number 628651
Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 25 of 71

Description Client Case# GRGE ty Rate Amount

Verification Fee - Hampton-Wilcox Eric 90082 2,00 50.00 100.00

Verification Fee - Hamrick Thomas 271102 2.00 50.00 100.00

Medicare First Obligation Fee - Hamrick 271102 1.00 350.00 350.00

Thomas

Verification Fee - Hancock Frank 89813 2.00 50.00 100.00

Medicare First Obligation Fee ~ Hancock 89813 1,00 350.00 350.00

Prank

Medicaid Additional Obligation Fee - 89813 1.00 150.00 150.00

Hancock Frank

Verification Fee - Hansen Walter 282791 2.00 50.00 100.00

Medicare First Obligation Fee - Hansen 282791 1,00 350.00 350.00

Walter

Medicaid Additional Obligation Fee - 282791 1.00 150.00 150.00

Hansen Walter

Verification Fee - Hardacker Jeanne 271274 2.00 50.00 100.00

Medicare First Obligation Fee - Hardacker 271274 1.00 350,00 350.00

Jeanne

Medicaid Additional Obligation Fee - 271274 1.00 150.00 150.00

Hardacker Jeanne

Medicaid First Obligation Fee - Harden 97590 1.00 350.00 350.00

Robert

Verification Fee - Hardrick Travis 104586 2.00 50.00 100.00

Medicare First Obligation Fee ~ Hardrick 104586 1.00 350.00 350.00

Travis

Medicaid Additional Obligation Fee - 104586 1.00 150.00 150.00

Hardrick Travis

Verification Fee - Hargis Lorraine 104348 2.00 50.00 100.00

Verification Fee - Harper Jack 81420 2.00 50.00 100.00

Medicare First Obligation Fee - Harper 81420 1.00 350.00 350.00

Jack

Verification Fee - Harris Robert 89952 2.00 50.00 100.00
__.. Medicare First obligation Fee= Harris 89982 200350, 00 350-00

Robert

Verification Fee - Harris Candiesas 296247 2.00 50.00 100.00

Medicare First Obligation Fee - Harris 296247 1.00 350.00 350.00

Candiesas

Medicaid Additional Obligation Fee - 296247 1.00 150.00 150.00

Harris Candiesas

Verification Fee - Harris Renardi 167072 2.00 50.00 100.00

Medicare First Obligation Fee - Harris 167072 1,00 350.00 350.00

Renardi

Medicaid Additional Obligation Fee ~ 167072 1.00 150.00 150.00

Harris Renardi

Verification Fee - Hartzell John 308432 2.00 50.00 100.00

308432 1.00 350.00 350.00

Medicare First Obligation Fee - Hartzell
John



Invoice Number

628651

Project BIOMT-00050-00

Anapol, Schwartz, Weiss, Cohan, Feldman Page 69 of 71

Description Client Case# GRGH Qty Rate Amount:
Verification Fee - Wilson Lichala 97677 2.00 50.00 100.00
Medicaid First Obligation Fee - Wilson 97677 1,00 350.00 350.00
Lichala

Medicaid Additional Obligation Fee - 97677 1,00 150,00 150.00
Wilson Lichala

Verification Fee - Wilson Zinia 89819 2.00 50.00 100.00
Medicaid First Obligation Fee - Wilson 89819 1.00 350.00 350.00
Zinia

Verification Fee - Wilson Terri 174558 2.00 50.00 100.00
Verification Fee - Wilson Cynthia 308063 2.00 50.00 100,00
Medicare First Obligation Fee ~ Wilson 308063 1.00 350,00 350.00
Cynthia

Medicaid Additional Obligation Fee - 308063 1.00 150.00 150,00
Wilson Cynthia

Verification Fee - Wilson Claude 308084 2.00 50.00 100.00
Medicare First Obligation Fee - Wilson 308084 1.00 350.00 350.00
Claude

Medicaid Additional Obligation Fee - 308084 1.00 150.00 150,00
Wilson Claude

Verification Fee - Winfield Shaun 64419 2.00 50.00 100.00
Medicare First Obligation Fee - Winfield 64419 1.00 350.00 350.00
shaun

Verification Fee - Winger Karen 89870 2.00 50.00 100.00
Medicare First Obligation Fee ~ Winger 89870 1.00 350.00 350.00
Karen

Verification Fee - Witten Gregory 90001 2.00 50.00 100.00
Medicaid First Obligation Fee - Witten 90001 1.00 350,00 350.00
Gregory

Verification Fee - Wittum Sharon 81452 2.00 50.00 100.00
Medicare First Obligation Fee - Wittum 81452 1,00 350.00 350.00
Sharon

Verification Fee - Wohlgenant Michael 89868 2.00 50.00 100.00
Medicare First Obligation Fee - Wohlgenant 89868 1.00 350.00 350.00
Michael

Verification Fee - Wolfe Kathy 167084 2.00 50.00 100.00
Medicare First Obligation Fee - Wolfe 167084 1,00 350.00 350.00
Kathy

Medicaid Additional Obligation Fee - Wolfe 167084 1.00 150.00 150,00
Kathy

Verification Fee - Wolgast Sandra 104302 2.00 50.00 100.00
Medicare First Obligation Fee - Wolgast 104302 1.00 350.00 350.00
Sandra

Verification Fee - Wommack William 270353 2.00 50.00 100.00
Medicare First Obligation Fee - Wommack 270353 1,00 350.00 350.00

William



Invoice Numbex

621297

Project BIOMT-00050-00
Anapol, Schwartz, Weiss, Cohan, Feldme Page 6 of 18
Description Client Caset GRGt aty Rate Amount
Verification Fee - Goggins, James 97505 2,00 50.00 100.00
Medicare First Obligation Fea ~ 97505 1.00 350.00 350.00
Goggins, James
Verification Fee - Golden, Charles 90027 2.00 50.00 100.00
Medicare First Obligation Fee - 90027 1.00 350.00 380.00
Golden, Charles
Verification Fee - Good, Christie 89859 2.00 50.00 100.00
Verification Fee - Graham,Michael 73437 2.00 50.00 100.00
Verification Fee - Grant,Mary 97608 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee - 97608 1.00 350.00 350.00
Grant,Mary
Verification Fee - Green,David 174512 2.00 50.00 100.00
Medicare First Obligation Fee - 174512 1,00 350.00 350.00
Green, David
Medicaid Additional Obligation Fee - 174512 1.00 180.00 150.00
Green, David
Medicaid Additional Obligation Fee - 174512 1.00 180.00 150.00
Green, David
Verification Fee - Griffin, Allison 174475 2.00 50.00 100.00
Verification Fee - Gruver, Philomena 97576 2.00 50.00 100.00
Medicaxe First Obligation Fee - 97576 1,00 350.00 350.00
Gruver, Philomena
Verification Fee - Gull,Kathryn 97642 2.00 50.00 100.00
Verification Fee - Haley, Judy 174556 2.00 50.00 100.00
Medicare First Obligation Fee -~ Haley,Judy 174556 1.00 350.00 350.00
Verification Fee - Hall, Anthony 167033 2.00 50.00 100.00
Verification Fee - Hallagan,Maureen 166951 2.00 50.00 100.00
Verification Fee - Hamm,Michael 64452 2.00 50.00 100.00
Verification Fee - Handley,Angela 142974 2.00 50.00 100.00
Medicare Zero Interest Obligation Fee ~ 142974 1.00 350.00 350.00
Handley, Angela
Verification Fee - Hansen, Justin 166955 2.00 50,00 100,00
Medicaid First Obligation Fee - 166955 1.00 350.00 350.00
Hansen, Justin
Verification Fee - Hanson, Lisa 167016 2.00 50.00 100.00
Verification Fee - Harden, Robert 97590 2.00 50.00 100.00
Verification Fee - Hart, Janet 166932 2.00 50.00 100.00
Medicare First Obligation Fee ~ Hart,Janet. 166932 1.00 350.00 350.00
Verification Fee - Hartsook, Dixie 97500 2.00 50.00 100.00