| STANDARD INSURANCE COMPANY RD ABC COMPANY 00 159159 0001
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| PO BOX 5676 ATTN SCOTT GIBSON
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| PORTLAND OR 97228-5676 P O BOX S
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| RIDGWAY PA 15853
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| JAN. 01, 2009 JAN. 31, 2009
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| **** HELP US PROCESS YOUR PAYMENT ACCURATELY ****
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| PLEASE MAKE YOUR CHECK PAYABLE TO THE STANDARD AND RETURN TO US WITH
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| THE COUPON ADDRESS DISPLAYED IN THE ENCLOSED RETURN ENVELOPE.
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| LINE MEMBER ID NAME BILL EFFECTIVE LTD LTD PREMIUM
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| CAT DATE PREM VOL DUE
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| 1 *****9999 ANDERSON, JAY W 0100 02/16/98 49.84 7,330 49.84
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| 2 *****9999 ARMANINI, JAMES P 0100 10/25/04 22.66 3,333 22.66
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| 3 *****9999 ARNOLD, WILLIAM R 0100 10/15/03 23.34 3,433 23.34
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| 4 *****9999 BISH, LORRAINE C 0100 08/28/00 17.80 2,618 17.80
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| 5 *****9999 BRADY, LORI L 0100 07/22/02 17.56 2,583 17.56
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| 6 *****9999 BURDICK, THOMAS J 0100 03/22/05 27.20 4,000 27.20
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| 7 *****9999 CHIESA, DAVID R 0100 03/17/97 41.03 6,034 41.03
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| 8 *****9999 CHITTESTER, JAMES 0100 04/25/05 15.86 2,333 15.86
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| 9 *****9999 DAVIDSON, DONALD 0100 02/02/98 21.06 3,097 21.06
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| 10 *****9999 DEFRAIN, SCOTT T 0100 05/04/98 23.41 3,442 23.41
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| 11 *****9999 DIIULIO, DANIEL J 0100 06/16/97 48.56 7,141 48.56
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| 12 *****9999 ELLIS, GUY 0100 12/01/95 13.26 1,950 13.26
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| 13 *****9999 FEDORKO, THOMAS A 0100 11/10/97 30.50 4,485 30.50
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| 14 *****9999 FERONTI, JOEL E 0100 09/17/01 39.81 5,854 39.81
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| 15 *****9999 GIBSON, SCOTT 0100 12/01/95 43.74 6,433 43.74
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| 16 *****9999 GILMORE, THOMAS B 0100 09/30/02 26.27 3,863 26.27
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| 17 *****9999 HAUPRICHT, GINA M 0100 09/08/98 17.78 2,614 17.78
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| 18 *****9999 HERZING, MICHAEL 0100 12/01/95 31.25 4,596 31.25
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| 19 *****9999 HOFFMAN, MARK 0100 12/01/95 29.42 4,326 29.42
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| 20 *****9999 KENNEDY, JAMES 0100 12/01/95 28.40 4,177 28.40
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| 21 *****9999 KIELBOWICK, DEBRA 0100 12/01/95 32.10 4,721 32.10
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| 22 *****9999 KNARR, NANCY J 0100 08/30/04 11.78 1,733 11.78
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| 23 *****9999 MALONE, ROGER 0100 12/01/95 25.68 3,777 25.68
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| 24 *****9999 MARCHIORI, CHARLES 0100 03/20/05 25.50 3,750 25.50
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| 25 *****9999 MARZELLA, BENJAMIN 0100 12/01/95 61.20 9,000 61.20
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| 26 *****9999 MILLIRON, JILL A 0100 09/30/96 16.73 2,460 16.73
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| 27 *****9999 MITCHELL-YOUNG, SH 0100 06/02/97 18.94 2,785 18.94
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| 28 *****9999 MITCHELTREE, NICHO 0100 11/11/02 16.34 2,403 16.34
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| 29 *****9999 MITCHELTREE, SHELL 0100 04/21/97 22.68 3,335 22.68
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| 30 *****9999 MOORE, SHAWN K 0100 09/29/97 25.74 3,785 25.74
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| 31 *****9999 NEDZINSKI, MICHAEL 0100 10/28/96 51.16 7,524 51.16
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| 32 *****9999 OLSON, ANN M 0100 01/27/97 11.71 1,722 11.71
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| 33 *****9999 PARKS, PHILIP T 0100 08/04/03 33.27 4,893 33.27
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| 34 *****9999 PELGRIN, JOLENE M 0100 02/23/98 25.38 3,733 25.38
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| 35 *****9999 PETERSON, DANIEL A 0100 04/28/97 24.51 3,605 24.51
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| 36 *****9999 PETERSON, GEORGE 0100 12/01/95 25.13 3,695 25.13
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| 37 *****9999 PETERSON, HOWARD 0100 12/01/95 61.20 9,000 61.20
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| 38 *****9999 PETERSON, JEFFREY 0100 12/01/95 29.42 4,326 29.42
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| 39 *****9999 RAPP, MICHAEL D 0100 08/16/04 22.66 3,333 22.66
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| STANDARD INSURANCE COMPANY RD (CONT) ABC COMPANY 00 159159 0001
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| PO BOX 5676 ATTN SCOTT GIBSON
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| PORTLAND OR 97228-5676 P O BOX S
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| RIDGWAY PA 15853
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| JAN. 01, 2009 JAN. 31, 2009
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| LINE MEMBER ID NAME BILL EFFECTIVE LTD LTD PREMIUM
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| CAT DATE PREM VOL DUE
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| 40 *****9999 REDMOND, ROBERT JR 0100 12/01/95 40.40 5,941 40.40
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| 41 *****9999 SALBERG, MARGARET 0100 02/02/98 20.43 3,005 20.43
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| 42 *****9999 SHUEY, JOHN S 0100 03/16/98 20.19 2,969 20.19
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| 43 *****9999 TUTTON, KENNETH G 0100 12/01/95 21.35 3,139 21.35
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| 44 *****9999 VARGA, M CORINE 0100 09/20/99 14.05 2,066 14.05
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| 45 *****9999 WITTMAN, MARK G 0100 04/01/96 27.55 4,052 27.55
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| 46 *****9999 ZIMMERMAN, MISTY M 0100 05/26/98 25.74 3,785 25.74
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| 47 SUBTOTAL FOR BILLING CATEGORY 0100 1340.79
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| *** MEMBER ADJUSTMENTS ***
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| 48 *****9999 HOWARD, ROBERT 0100 08/01/05 61.20- 61.20-
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| 49 SUBTOTAL FOR BILLING CATEGORY 0100 61.20-
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| 50 LTD 46 188179 1218.39 0 .00 TOTAL PREMIUMS 1340.79
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| 51 TOTAL MEMBER ADJUSTMENTS 61.20-
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| -----------
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| 52 TOTAL THIS BILL 1279.59
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| 53 OUTSTANDING BAL AS OF 12/01/08 1279.59
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| -----------
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| 54 PLEASE PAY THIS AMOUNT 2559.18
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