EFTA01582667.pdf

Posting Date: 2012-08-06 Account Number: Amount: $15,131.38 Bank Number: 802 Capture Source: PV Check/Serial #: 000000025295 DB/CR: Debit Routing Transit Number: 02100002 Sequence Number: 6370589004 Trancode: 000000 UDK: 802120806006370589004 Missing Image: 5 Application Code: 1 Item Type: Paper Item IRD: PE Indicator: P Entry Number: 0000004829 BOFD: 000000000 Cost Center: Teller Number: Teller Sequence Processing Date: 2012-08-06 Number: NES, LLC JPMORGAN PRIVATE BANK NEWARK, DE 25295 9 EAST 71ST STREET NEW YORK, NY 10021 t,- 1-2/210 7/31/2012 PAY TO THE ORDER OF United- HealthCare $ .*15,131.38 -Fifteen-Thousand One Hundred-Thirty-One and 381100 DOLLARS United HealthCare Insurance Company Dept. CH 10151 Palatine, IL 60055-0151 MEMO: AUTHORIZED SIGNATURE • Account # II*0 2 29 S II' I:0 2 L0000 2 LI: x Z 0 0, DO NOT WRITE I SIGN I STAMP BELOW THIS LINE rn 000d0 0010151 00293 0015 M3IA aL 37ONV NV it , C1-1OH 08-06-202 " BNYMELLON 23 O o CRED TO PAYEE ABS END GUAR rO co Z) ti 2 -n rn a) cf) 4- Confidential Treatment Requested by JPMorgan Chase JPM-SDNY-00062225 EFTA01582667