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<br />TABULATION <br /> <br />SlicE. , <br /> <br />ITEM GROIlP HO~PT'I'Ar.T '7,)\.'T'TON DATE --M"y 1? 1 q 77 <br />MEDICAL, & LIFE INSURANCE <br /> <br />2:00 p.m. <br /> <br /> Connecticut General Blue Cross Blue Shi Id I <br /> Life Insurance Co. of Texas <br />Ilrrpnr ~- I <br /> Jerry L. Dave Porte field <br /> Moore <br />Specifications <br />Met? Yes No - <br />A. Life Insur I <br /> I <br /> ance <br />R",,; ~_1\1~" r'~"+-_-_ <br />butorv .44 4<; <br /> - <br />contributory .44 .45 <br />B. A.D.&.D <br />~ ,,- <br />bu torv 0(; nq <br /> ,+-~ 1. <br />Contributory .06 .09 <br />.- I <br />r' M=rH~~1 c. <br /> -- <br />Hospitalization <br />Non-Contributor <br />"'m~ 1 ~"aa ~"'" ~~ nn 25 '14 <br /> - <br /> F ami 1 y (1 or <br /> more dependen t ) 53.04 34.60 <br /> I. -. <br />----- -----.-- ._--_...- .-- '-----. -_. --. . _._L-._ _____ <br />