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Record TypeRcp AccountLast Name/CompanyMiddle InitialFirst NameSuffixRcp TINAddress Deliv/StreetAddress Apt/SuiteCityStateZipAddress TypeCountryRcp EmailPlan Start MonthAll Months CoverageJan Offer CoverageFeb Offer coverageMar Offer CoverageApr Offer CoverageMay Offer CoverageJun Offer CoverageJul Offer CoverageAug Offer CoverageSep Offer CoverageOct Offer CoverageNov Offer CoverageDec Offer CoverageAll Months PremiumJan Emp Cost ShareFeb Emp Cost ShareMar Emp Cost ShareApr Emp Cost ShareMay Emp Cost ShareJun Emp Cost ShareJul Emp Cost ShareAug Emp Cost ShareSep Emp Cost ShareOct Emp Cost ShareNov Emp Cost ShareDec Emp Cost ShareAll Months Safe HbrJan Safe Harbor CodeFeb Safe Harbor CodeMar Safe Harbor CodeApr Safe Harbor CodeMay Safe Harbor CodeJun Safe Harbor CodeJul Safe Harbor CodeAug Safe Harbor CodeSep Safe Harbor CodeOct Safe Harbor CodeNov Safe Harbor CodeDec Safe Harbor CodeEmp Self Insured ChkRCP Date of BirthInd All Coverage ChkInd Jan Coverage ChkInd Feb Coverage ChkInd Mar Coverage ChkInd Apr Coverage ChkInd May Coverage ChkInd Jun Coverage ChkInd Jul Coverage ChkInd Aug Coverage ChkInd Sep Coverage ChkInd Oct Coverage ChkInd Nov Coverage ChkInd Dec Coverage ChkForm SourceForm CategoryBatch IDAlt Rcp AccountPrint Code 1
E1RecipientLast1E.RecipientFirst1JR100-01-00012993 Spruce LaneFort CollinsCO80522someone@gmail.com11E1E1E1E1E1E1E1E1E1E1E1E1002003004005006007008009001000110012002C2C2C2C2C2C2C2C2C2C2C2Cx1/1/2000xsourcecategorybatchid
C1RecipientLast1E.RecipientFirst1100-01-0001x1/2/20001
E2RecipientLast2B.RecipientFirst2100-01-00025991 Sycamore Lane#532SandyUT8409411E1234.560000000000002Cx1/3/20001
C2RecipientLast2B.RecipientFirst4100-01-0002x1/4/20001
E3RecipientLast3R.RecipientFirst5100-01-0003847 Walnut AvenueRoyNM8774331H1H1E1E1E1E1E1E1E1E1E1E003004005006007008009001000110012002C2C2C2C2C2C2C2C2C2Cx1/5/20001
C3RecipientLast3R.RecipientFirst6100-01-0003x1/6/20001
E4RecipientLast4E.RecipientFirst7100-01-00042994 Spruce LaneFort CollinsCO8052211E1234.560000000000002Cx1/7/20001
C4RecipientLast4E.RecipientFirst8100-01-0004x1/8/20001
E5RecipientLast5B.RecipientFirst9100-01-00055992 Sycamore Lane#533SandyUT8409411E1234.560000000000002Cx1/9/20001
C5RecipientLast5B.RecipientFirst10100-01-0005x1/10/20001
E6RecipientLast6R.RecipientFirst11100-01-0006848 Walnut AvenueRoyNM8774331H1H1E1E1E1E1E1E1E1E1E1E0003456.783456.783456.783456.783456.783456.783456.783456.783456.783456.782Cx1/11/20001
C6RecipientLast6R.RecipientFirst12100-01-0006x1/12/20001
E7RecipientLast7E.RecipientFirst13100-01-00072995 Spruce LaneFort CollinsCO8052211E1234.560000000000002Cx1/13/20001
C7RecipientLast7E.RecipientFirst14100-01-0007x1/14/2000xxxxxxxxxxxx
E8RecipientLast8B.RecipientFirst15100-01-00085993 Sycamore Lane#534SandyUT8409411E1E1E1E1E1E1E1E1E1E1E1E1002003004005006007008009001000110012002Cx1/15/20001
C8RecipientLast8B.RecipientFirst16100-01-0008x1/16/20001
E9RecipientLast9R.RecipientFirst17100-01-0009849 Walnut AvenueVancouverBCa1a 2a2C31H1H1E1E1E1E1E1E1E1E1E1E003456.783456.783456.783456.783456.783456.783456.783456.783456.783456.782Cx1/17/20001
C9RecipientLast9R.RecipientFirst18100-01-0009x1/18/20001
E10RecipientLast10E.RecipientFirst19100-01-00102996 Spruce LaneForeign CityProvincePostalOAJ11F1F1F1F1F1F1F1F1F1F1F1F1234.560000000000002Cx1/19/20001
C10RecipientLast11E.RecipientFirst20100-01-0010x1/20/20001