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nsurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL or visit the Connector website (www.mahealthconnector.orq). This plan Is not intended to provide comprehensive health care coverag

0102 Passenger Name: Document Type: SUPPORTED REFUND 08/05/12 AMERICAN EXPRESS TVLPHOENIX AZ AMERICAN MRUNES INC From: To: Carrier: Class: SAN FRANCISCO INTL N.Y. J F KENNEDY I AA WA YY 00 WA YY 00 WA YY 00 Ticket Number 00171230129722 Date of Departure: 08/07 Passenger Name: Document Type:

nsurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL or visit the Connector website (www.mahealthconnector.orq). This plan is not intended to provide comprehensive health care coverag

sengerName: Document Type: SUPPORTED REFUND 08/05/12 AMERICAN EXPRESS 1VLPHOENIX AZ -$679.80 AMERICAN MRUNES INC From: To: Carrier: Class: SAN FRANCISCO INTL N.Y. J F KENNEDY I AA WA YY 00 WA YY 00 WA YY 00 Ticket Number: 00171230129722 Date of Departure:08/07 Passenger Name: Document Type:

nsurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more Information call the Connector at 1-871-MA-ENROLL or visit the Connector webslte (ynvw.mahealthconnector.org). This plan rs not intended to provide comprehensive health care covera

/18/12 NY 52.900.00 Description 06/19/12 ORBITZ MANKATO MN UNITED AIRLINES From: To: Carrier Class: ALBUQUERQUE LOS ANGELES INTERN UA SAN FRANCISCO INTL AS N/A YY 00 N/A YY 00 Ticket Number: Date of Departure: 06/21 Passenger Name: Document Type: PASSENGER TICKET 06/19/12 ORBITZ MANKATO