JONES, KATHERINE A Date Printed: 10/26/2020

SHP-State Retirement
Confirmation Statement System
KATHERINE A JONES Employing Unit Assigned 855595
ID
109 EAST WHISPERWOOD CIRCLE
Date of Hire: 09/01/2020
HENDERSONVILLE, NC, USA 28791
Gender: Female
Home Phone: 8283292647
Work Email: kathy.jones0110@gmail.com

Open Enrollment Elections Monthly Subscriber Costs: $50.00

KATHERINE JONES
Relationship: Subscriber | Date of Birth: 01/10/1962

80/20 PPO Plan Effective: 01/01/2021

Employee Only Monthly Cost $50.00 *

* Costs have been reduced by $60.00 of benefit program allocations

Current Elections Monthly Subscriber Costs: $50.00

KATHERINE JONES
Relationship: Subscriber | Date of Birth: 01/10/1962

80/20 PPO Plan Effective: 10/01/2020

Employee Only Monthly Cost $50.00 *

* Costs have been reduced by $60.00 of benefit program allocations

Key
Person is covered by the benefit
The benefit coverage will be ending
Person is no longer covered by the benefit