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EE#	EE Name	M/F	Age/DOB	Enrollment Status	Zip	#COBRA'S
1				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
2				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
3				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
4				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
5				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
6				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
7				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
8				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
9				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
10				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
11				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
12				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
13				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
14				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
15				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
16				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
17				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
18				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
19				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
20				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
21				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
22				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
23				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
24				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
25				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
26				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
27				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
28				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
29				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
30				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
31				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
32				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
33				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
34				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
35				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
36				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
37				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
38				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
39				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
40				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
41				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
42				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
43				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
44				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
45				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
46				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
47				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
48				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
49				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No
50				Select Employee Only Employee & Spouse Employee & Child(ren) Employee, Spouse & Child(ren)		Yes No