Principal Life Insurance Company © Principal’ =voresissoss2 Important payment notice 001600 ATTN: BRANDI FISHER KEMAH PALMS RECOVERY, LLC 1013 DELSANDRI LN KEMAH TX 77565 payment has alcaady been made, please disregard thisnatice. eee ‘Account number: 1110780-10001 Last billed amount: Payments since last bill Balance forward: Adjustments since last bill: Current premium: Total amount due: Contact us Due date: 01/01/2023 $616.79 $616.79 "30.00 $0.00 $581.77 $581.77 Billing statement For period: 01/01/2023 to 01/31/2023 Bill produced: 12/17/2022 Important information Important Notice for vision groups: ‘As the group policyholder, under Texas law, you must pay premiums for any member who has terminated until the end of the -month when Principal receives notification of the termination. This requirement does not apply if you do not contribute to the payment of any insured's premium, If you use BillPay, please update your bank system to reflect the new address on the coupon below. Group Benefits, call 800.843.1371 Monday-Friday 7:00 a.m. -6:00 p.m. CT|| principal.com Please make your check payable to Principal Life Insurance Company. Send your check with the stub to the address below. © Principal’ ATTN: BRANDI FISHER KEMAH PALMS RECOVERY, LLC 1013 DELSANDRI LN KEMAH TX 77565 Due date: ‘Account number: Total amount due: ? 0000058177 122078020001 oooooo0ILSs2e44bs 4 01/01/2023 1110780-10001 $581.77 Principal Life Insurance Company PO BOX 77202 MINNEAPOLIS MN 55480-7200 ‘00 onouo ooeecoanoonrasestoessze0 obo0z8 01082Bill totals © Principal Current billed lives ieee Account number: 1110780-10001 Melb For period: 01/01/2023 to 01/31/2023 il produced: 12/17/2022 Current premium totals $581.77 Vetta tie iy Dea ‘en pia eee aes teas/ vt —78a6| oen-ce tues ie Word ——“Zanoe vie ee ms soa $022 Wis - Dep $1758Billing statement © Principal’ Account number: 1110780-10001 Adjustments since last bill "[ranacton Herbert© | Member name Total Current premium For period: 01/01/2023 to 01/31/2023 Bill produced: 12/17/2022 This is your copy. Please keep for your records, Total Dentaly | MemberID | Membername Voluntary Life Disability Vision ‘Transaction | premium STOTT vsTo—-5655| VDEN-EF. 2564 | MGERATE sia “aera VSO SEE | WORN -EE et TOES s Ws. 899 | ‘eINTOTTE | CHAPHAN, TONY ~ seaseorod | FELOT LINDA T VOEN- EE | | WORN -SP 2aor | | ws 839 a | | an ‘SORBET — [OREN ICE aT 35530 cra eas ae eee Z “em| o ‘SETaGSSIE | ROSE, FONE 2568 a ‘BRRTOEISE | UPOEGRATE DA Be a | dani wis-ee 223 aE aH | _|was's. an __ | 9581.77 Insurance products and/or plan administrative ser -es are provided by Principal Life Insurance Company ‘member of the Principal Financial Group®, (Principal®), Des Moines, JA 50392 (© 2017 Principal Financial Serle, ne Billing statement | For period 01/01/2023 to 01/31/2023 | Account number: 1110780-10001 | principal.com oasess