January 15, 2008

The Empire Plan

Customer Service Department
PO Box 1600
Kingston, NY 12402

RE: Request for Information

Subscriber # 890350518

Dear Customer Service Department:

I am writing to request information on all co-payments and/or out of pocket expenses for
January 1, 2007 to December 31, 2007 for the following individuals.

• Sheelagh Roache DOB: 10/25/1977

• Windsor J. Kinney DOB: 04/21/1966
• Rigel Kinney DOB: 09/19/06
• Gavin Kinney DOB: 09/19/06

Please send me the information I have requested as soon as possible. Thank you for your
prompt attention to this matter.

Sincerely,

Sheelagh Roache

Windsor J. Kinney
January 15, 2008

Value Options
Customer Service Department
PO Box 778
Troy, NY 12181

RE: Request for Information

Subscriber # 890350518

Dear Customer Service Department:

I am writing to request information on all co-payments and/or out of pocket expenses for
January 1, 2007 to December 31, 2007 for the following individuals.

• Sheelagh Roache DOB: 10/25/1977

• Windsor J. Kinney DOB: 04/21/1966
• Rigel Kinney DOB: 09/19/06
• Gavin Kinney DOB: 09/19/06

Please send me the information I have requested as soon as possible. Thank you for your
prompt attention to this matter.

Sincerely,

Sheelagh Roache

Windsor J. Kinney
January 15, 2008

BlueCross BlueShield
Customer Service Department
One Liberty Plaza
New York, NY 10006

RE: Request for Information

Subscriber # 890350518
Blue Gross Plan 303
Blue Gross Prefix: YLS

Dear Customer Service Department:

I am writing to request information on all co-payments and/or out of pocket expenses for
January 1, 2007 to December 31, 2007 for the following individuals.

• Sheelagh Roache DOB: 10/25/1977

• Windsor J. Kinney DOB: 04/21/1966
• Rigel Kinney DOB: 09/19/06
• Gavin Kinney DOB: 09/19/06

Please send me the information I have requested as soon as possible. Thank you for your
prompt attention to this matter.

Sincerely,

Sheelagh Roache

Windsor J. Kinney
January 10, 2008

[Medical Group or Health Plan]

Customer Service Department
[address]

RE: Request for Information

Subscriber #[your number]

Dear Customer Service Department:

I am writing to request information on all co-payments and/or out of pocket expenses for
January 1, 2007 to December 31, 2007 for the following individuals.

• Sheelagh Roache DOB: 10/25/1977

• Windsor J. Kinney DOB: 04/21/1966
• Rigel Kinney DOB: 09/19/06
• Gavin Kinney DOB: 09/19/06

Please send me the information I have requested as soon as possible. Thank you for your
prompt attention to this matter.

Sincerely,

Sheelagh Roache

Windsor J. Kinney