Co Code EE SSN SSN Relationship First Name Last Name Gender Birth Date Employee Status Address 1 Address 2 City State Zip Class1 Class2 Class3 Class4 Change Reason Status Change Date Benefit Description Benefit Tier Benefit Eligibility Date Benefit Enrollment Date Coverage End Date Karma 384620665 384620665 Employee Andre Beduschi Male 02/27/1966 Terminated 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 Karma Exempt - benefit eligible Indirect TERMINATION 01/12/2018 Anthem PPO 500 Employee Spouse + 2+ Children 01/01/2018 01/01/2018 01/31/2018 Karma 384620665 384620665 Employee Andre Beduschi Male 02/27/1966 Terminated 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 Karma Exempt - benefit eligible Indirect TERMINATION 01/12/2018 Anthem Dental Employee Spouse + 2+ Children 12/01/2016 12/01/2016 01/31/2018 Karma 384620665 384620665 Employee Andre Beduschi Male 02/27/1966 Terminated 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 Karma Exempt - benefit eligible Indirect TERMINATION 01/12/2018 EyeMed Vision Employee Spouse + 2+ Children 01/01/2017 01/01/2017 01/31/2018 Karma 384620665 383154625 Spouse Maria Cristina Beduschi Female 01/10/1967 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 Anthem PPO 500 Employee Spouse + 2+ Children 01/01/2018 01/31/2018 Karma 384620665 383154625 Spouse Maria Cristina Beduschi Female 01/10/1967 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 Anthem Dental Employee Spouse + 2+ Children 12/01/2016 01/31/2018 Karma 384620665 383154625 Spouse Maria Cristina Beduschi Female 01/10/1967 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 EyeMed Vision Employee Spouse + 2+ Children 01/01/2017 01/31/2018 Karma 384620665 380236853 Natural child Juliana Beduschi Female 03/25/1999 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 Anthem PPO 500 Employee Spouse + 2+ Children 01/01/2018 01/31/2018 Karma 384620665 384311409 Natural child Andre Beduschi Male 09/02/2005 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 Anthem PPO 500 Employee Spouse + 2+ Children 01/01/2018 01/31/2018 Karma 384620665 380236853 Natural child Juliana Beduschi Female 03/25/1999 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 Anthem Dental Employee Spouse + 2+ Children 12/01/2016 01/31/2018 Karma 384620665 384311409 Natural child Andre Beduschi Male 09/02/2005 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 Anthem Dental Employee Spouse + 2+ Children 12/01/2016 01/31/2018 Karma 384620665 380236853 Natural child Juliana Beduschi Female 03/25/1999 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 EyeMed Vision Employee Spouse + 2+ Children 01/01/2017 01/31/2018 Karma 384620665 384311409 Natural child Andre Beduschi Male 09/02/2005 108 LA MIRAGE CIRCLE Aliso Viejo CA 92656 01/12/2018 EyeMed Vision Employee Spouse + 2+ Children 01/01/2017 01/31/2018 Karma 547693538 547693538 Employee Javad Hashtroudian Male 01/15/1947 Terminated 15365 Los Altos Dr. Hacienda Heights CA 91745 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem Dental Employee + Spouse 01/01/2016 01/01/2016 01/31/2018 Karma 547693538 547693538 Employee Javad Hashtroudian Male 01/15/1947 Terminated 15365 Los Altos Dr. Hacienda Heights CA 91745 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 EyeMed Vision Employee + Spouse 01/01/2017 01/01/2017 01/31/2018 Karma 547693538 573642384 Spouse Elaine Kindle Female 10/05/1945 15365 Los Altos Dr. Hacienda Heights CA 91745 01/26/2018 Anthem Dental Employee + Spouse 01/01/2016 01/31/2018 Karma 547693538 573642384 Spouse Elaine Kindle Female 10/05/1945 15365 Los Altos Dr. Hacienda Heights CA 91745 01/26/2018 EyeMed Vision Employee + Spouse 01/01/2017 01/31/2018 Karma 440028147 440028147 Employee Jina Kim Female 12/27/1988 Terminated 3395 Michelson Dr. 4541 Irvine CA 92612 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem Dental Employee 04/01/2016 04/01/2016 01/31/2018 Karma 440028147 440028147 Employee Jina Kim Female 12/27/1988 Terminated 3395 Michelson Dr. 4541 Irvine CA 92612 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 EyeMed Vision Employee 01/01/2017 01/01/2017 01/31/2018 Karma 440028147 440028147 Employee Jina Kim Female 12/27/1988 Terminated 3395 Michelson Dr. 4541 Irvine CA 92612 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem HMO 35 Employee 01/01/2018 01/01/2018 01/31/2018 Karma 567991002 567991002 Employee Elizabeth Figueroa Female 11/01/1977 Terminated 2726 N. Fernside St. Orange CA 92865 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 01/24/2017 01/24/2017 01/31/2018 Karma 567991002 567991002 Employee Elizabeth Figueroa Female 11/01/1977 Terminated 2726 N. Fernside St. Orange CA 92865 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 01/24/2017 01/24/2017 01/31/2018 Karma 567991002 567991002 Employee Elizabeth Figueroa Female 11/01/1977 Terminated 2726 N. Fernside St. Orange CA 92865 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 01/01/2018 01/01/2018 01/31/2018 Karma 567991002 551517027 Spouse Jesus Berber Male 11/04/1977 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 551517027 Spouse Jesus Berber Male 11/04/1977 2726 N. Fernside St. Orange CA 92865 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 551517027 Spouse Jesus Berber Male 11/04/1977 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 01/01/2018 01/31/2018 Karma 567991002 612494914 Natural child Jesus Berber Male 01/13/2005 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 607790468 Natural child Ava Berber Female 10/24/2009 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 380696342 Natural child Nicholas Berber Male 01/24/2017 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 612494914 Natural child Jesus Berber Male 01/13/2005 2726 N. Fernside St. Orange CA 92865 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 607790468 Natural child Ava Berber Female 10/24/2009 2726 N. Fernside St. Orange CA 92865 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 380696342 Natural child Nicholas Berber Male 01/24/2017 2726 N. Fernside St. Orange CA 92865 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 01/24/2017 01/31/2018 Karma 567991002 612494914 Natural child Jesus Berber Male 01/13/2005 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 01/01/2018 01/31/2018 Karma 567991002 607790468 Natural child Ava Berber Female 10/24/2009 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 01/01/2018 01/31/2018 Karma 567991002 380696342 Natural child Nicholas Berber Male 01/24/2017 2726 N. Fernside St. Orange CA 92865 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 01/01/2018 01/31/2018 Karma 612855433 612855433 Employee Jaewon Choi Male 05/07/1992 Terminated 23478 Ridgeway Mission Viejo CA 92692 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem HMO 35 Employee 04/01/2017 04/01/2017 01/31/2018 Karma 550719285 550719285 Employee Hoai Vu Male 08/11/1964 Terminated 10882 Allen Dr. Garden Grove CA 92840 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 09/01/2017 09/01/2017 01/31/2018 Karma 550719285 550719285 Employee Hoai Vu Male 08/11/1964 Terminated 10882 Allen Dr. Garden Grove CA 92840 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 09/01/2017 09/01/2017 01/31/2018 Karma 550719285 550719285 Employee Hoai Vu Male 08/11/1964 Terminated 10882 Allen Dr. Garden Grove CA 92840 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 09/01/2017 09/01/2017 01/31/2018 Karma 550719285 586424448 Spouse Christine Bui Female 09/12/1966 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 586424448 Spouse Christine Bui Female 09/12/1966 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 586424448 Spouse Christine Bui Female 09/12/1966 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 623746252 Natural child Brandon Vu Male 07/22/1994 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 614020108 Natural child Randy Vu Male 10/27/1997 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 Anthem Dental Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 623746252 Natural child Brandon Vu Male 07/22/1994 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 614020108 Natural child Randy Vu Male 10/27/1997 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 EyeMed Vision Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 623746252 Natural child Brandon Vu Male 07/22/1994 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 550719285 614020108 Natural child Randy Vu Male 10/27/1997 10882 Allen Dr. Garden Grove CA 92840 01/26/2018 Anthem HMO 35 Employee Spouse + 2+ Children 09/01/2017 01/31/2018 Karma 334540131 334540131 Employee Donald Anderson Male 05/16/1958 Terminated 1974 Vista Caudal Newport Beach CA 92660 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem HMO 10 Employee 01/01/2018 01/01/2018 01/31/2018 Karma 334540131 334540131 Employee Donald Anderson Male 05/16/1958 Terminated 1974 Vista Caudal Newport Beach CA 92660 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 Anthem Dental Employee 01/01/2018 01/01/2018 01/31/2018 Karma 334540131 334540131 Employee Donald Anderson Male 05/16/1958 Terminated 1974 Vista Caudal Newport Beach CA 92660 Karma Exempt - benefit eligible Indirect TERMINATION 01/26/2018 EyeMed Vision Employee 01/01/2018 01/01/2018 01/31/2018 Karma 326086158 326086158 Employee Haydar Mahmoud Male 05/25/1982 Terminated 13207 Telmo Irvine CA 92618 Karma Exempt - benefit eligible Indirect TERMINATION 03/02/2018 Anthem Dental Employee 06/01/2016 06/01/2016 03/31/2018 Karma 326086158 326086158 Employee Haydar Mahmoud Male 05/25/1982 Terminated 13207 Telmo Irvine CA 92618 Karma Exempt - benefit eligible Indirect TERMINATION 03/02/2018 EyeMed Vision Employee 01/01/2017 01/01/2017 03/31/2018 Karma 326086158 326086158 Employee Haydar Mahmoud Male 05/25/1982 Terminated 13207 Telmo Irvine CA 92618 Karma Exempt - benefit eligible Indirect TERMINATION 03/02/2018 Anthem HMO 35 Employee 01/01/2018 01/01/2018 03/31/2018 Karma 545938705 545938705 Employee Jessica Noland Female 12/15/1986 Terminated 18 Bella Caserta Lake Elsinore CA 92532 Moreno Valley Exempt - benefit eligible Indirect TERMINATION 03/22/2018 Anthem HMO 10 Employee + 2+ Children 09/01/2017 09/01/2017 03/31/2018 Karma 545938705 545938705 Employee Jessica Noland Female 12/15/1986 Terminated 18 Bella Caserta Lake Elsinore CA 92532 Moreno Valley Exempt - benefit eligible Indirect TERMINATION 03/22/2018 Anthem Dental Employee + 2+ Children 09/01/2017 09/01/2017 03/31/2018 Karma 545938705 545938705 Employee Jessica Noland Female 12/15/1986 Terminated 18 Bella Caserta Lake Elsinore CA 92532 Moreno Valley Exempt - benefit eligible Indirect TERMINATION 03/22/2018 EyeMed Vision Employee + 2+ Children 09/01/2017 09/01/2017 03/31/2018 Karma 545938705 672364540 Natural child Taylor noland Female 01/05/2008 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 Anthem HMO 10 Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 672364537 Natural child Cameron noland Male 01/05/2008 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 Anthem HMO 10 Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 159498706 Natural child dean Martinez Male 05/06/2015 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 Anthem HMO 10 Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 672364540 Natural child Taylor noland Female 01/05/2008 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 Anthem Dental Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 672364537 Natural child Cameron noland Male 01/05/2008 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 Anthem Dental Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 159498706 Natural child dean Martinez Male 05/06/2015 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 Anthem Dental Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 672364540 Natural child Taylor noland Female 01/05/2008 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 EyeMed Vision Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 672364537 Natural child Cameron noland Male 01/05/2008 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 EyeMed Vision Employee + 2+ Children 09/01/2017 03/31/2018 Karma 545938705 159498706 Natural child dean Martinez Male 05/06/2015 18 Bella Caserta Lake Elsinore CA 92532 03/22/2018 EyeMed Vision Employee + 2+ Children 09/01/2017 03/31/2018