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Health Maintenance/Wellness View Below are your annual benefits, amount(s) used, and balance(s) remaining for the Annual Physical Exam and Wellness Programs.

Employee ID: 11111	Name: Doe,Jane	Suffix:	Date: 03/28/2004
Plan Year*:    2003-2004 2002-2003 2001-2002

Available Benefit     Amount Used     Balance   Remaining   Annual Physical Exam Program $175.00   $50.00   $125.00 Wellness Program $50.00   $15.00   $35.00     Blood Bank Membership:   No

* A plan year is defined as the twelve-month period between July 1 and June 30.

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