EFTA00299013.pdf

Enrollee Detail Report Print Date 09/08/2015 Policy Information Last Update Date 04/21/2014 Policy Number 0272605 Policy Name SOUTHERN TRUST COMPANY Policy Status ACTIVE Policy Anniversary 11/01 Enrollee Information - JEFFREY EPSTEIN Original Eff Date 11/01/2002 Status ACTIVE Termination Date Termination Reason Relationship Employee Gender MALE Date of Birth 01/20/1953 Address 1 6100 RED HOOK QUARTER B-3 Address 2 City, State, Zip ST THOMAS, VI, 00802 Home Phone (340) 774-1611 Employee Information - JEFFREY EPSTEIN Social Security # ***-**-3348 Date of Hire Alternate ID 854905597 Retirement Date 01/01/2000 Coverage Information Type Description Begin Date End Date MEDICAL CHOICE-P/INS 05/01/2014 DENTAL Dental Indemnity-I0016 05/01/2014 LIFE Flat Life 05/01/2014 COBRA / State Benefit Continuation Information Effective Date Enrollee Type EFTA00299013