Terril Jones

Wellness professional with strong focus on team collaboration and achieving results. Skilled in program development, health education, and client engagement. Adaptable to changing needs and trusted for reliability. Passionate about fostering positive and healthy environment.

Experienced with wellness program development and implementation. Utilizes health promotion strategies to enhance employee well-being and organizational performance. Track record of effective team leadership and fostering culture of health and wellness.

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.

• Benefit Elections
• Benefit Plan Election Coverage Effective Date Price Per Pay Period
• Total Before Tax Cost: $271.91
• Total After Tax Cost: $34.70
• Total Cost: $306.61
• Options denoted by an asterisk(
• ) indicate that some or all of the cost of your benefits will be taken as a post tax deduction (i.e., deducted from your paycheck after taxes are withheld)
• Dependent Information
• Name Relationship Date of Birth Gender Disabled Full Time Student
• Jason D. Jones Spouse 1981-08-18 Man/Male No No
• Samantha N. Jones Child 2006-12-07 Woman/Female No Yes
• Beneficiary Information
• Name Relationship Critical Illness Group Term Life Insurance with AD&D Voluntary Employee Life with AD&D
• Pri/Con Percent Pri/Con Percent Pri/Con Percent
• Jason D Spouse Pri 100% Pri 100% Pri 100%
• Samantha Child Pri null% Pri null% Pri null%
• T Jones Child Pri null% Pri null% Pri null%
• Page 2 of 2
• 2026-01-14

• Benefit Deductions Summary
• These amounts are deducted from your pay for benefits.
• Estimated Total per Paycheck: $309.73
• View all Benefits
• Estimated per Paycheck: $309.73
• Plan Name Medical Section 125 Effective Date 2025-12-21 Per Paycheck $252.37
• Plan Name DENTAL SECTION 125 Effective Date 2025-12-21 Per Paycheck $11.16
• Plan Name VISION SECTION 125 Effective Date 2025-12-21 Per Paycheck $8.38
• Plan Name VOL LIFE POST TAX EMPLOYEE Effective Date 2025-12-21 Per Paycheck $4.52
• Https://secure.lyric.adp.com/view/2a285365f93e4b0cb3ca52fc69fb7d75?activeTab=3&benefits_selected_tab=tabAssociateView¶mTileName=tab...

• STATE OF OHIO
• OFFICE OF VITAL STATISTICS
• CERTIFICATION OF BIRTH
• STATE FILE NUMBER 1981124848
• DATE RECORD FILED 1981-10-01
• NAME JASON DUWAYNE JONES
• DATE OF BIRTH 1981-08-18
• SEX Male
• BIRTHPLACE OHIO
• MOTHER'S NAME MARY LOUISE JONES
• FATHER'S NAME
• MAIDEN NAME JONES
• MOTHER'S BIRTHPLACE KENTUCKY
• FATHER'S BIRTHPLACE
• Note:
• This is a true certification of the name and birth facts as recorded in the Office of Vital Statistics, Columbus, Ohio. Witness my signature and seal of the Department of Health this 20 day of September, 2011
• Judith B. Neay
• State Registrar of Vital Statistics
• HEALTH INFORMATION SYSTEMS CINCINNATI HEALTH DEPT
• VOID WITHOUT WATERMARK OR IF ALTERED OR ERASED

• Letter of Eligibility
• Dear SAMANTHA N JONES
• We are writing about your membership record:
• Our records show that the following person(s) is listed on your contract:
• SAMANTHA JONES
• Coverage Effective Date
• 2026-01-14
• We value your membership and look forward to assisting you in the future. If you have any questions, please call Customer Service at the number on the back of your Blue Cross Blue Shield of Michigan ID card. Our representatives will make every effort to assist you.
• Sincerely
• Key and Large Group Servicing
• Blue Cross Blue Shield of Michigan
• Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association.

• COMMONWEALTH OF KENTUCKY
• REGISTRAR OF VITAL STATISTICS
• CERTIFIED RECORD OF BIRTH
• FILE NO. 116 2006 54863 DATE FILED BY REGISTRAR: 2006-12-14
• CHILD'S NAME: SAMANTHA NICOLE JONES
• CHILD'S DATE OF BIRTH: 2006-12-07
• SEX: Female
• TIME OF BIRTH: 1341
• FACILITY NAME: SAINT ELIZABETH MEDICAL CENTER SOUTH
• COUNTY OF BIRTH: KENTON
• CITY OF BIRTH: EDGEWOOD
• MOTHER'S MAIDEN NAME: TERRI LYNN HAMMOND
• MOTHER'S DATE OF BIRTH: 1979-12-16
• MOTHER'S AGE: 26
• MOTHER'S BIRTHPLACE: KENTUCKY
• MOTHER'S ADDRESS: 500 DANA LANE
• CITY: SPARTA
• STATE: KENTUCKY
• ZIP: 41086
• COUNTY: GALLATIN
• FATHER'S CURRENT LEGAL NAME: JASON DWAYNE JONES
• FATHER'S DATE OF BIRTH: 1981-08-18
• FATHER'S AGE: 25
• FATHER'S BIRTHPLACE: OHIO
• CERTIFIER'S NAME: SCHULTE JUDY
• DATE CERTIFIED: 2006-12-11
• This record certifies that the above birth occurred on the date and place shown. The original certificate of birth is registered at the Kentucky Office of Vital Statistics under the file number shown.
• DATE ISSUED 2026-02-16
• Jeffrey E. Lapsley Jr.
• State Registrar
• FOR QUESTIONS REGARDING THE INFORMATION PROVIDED ON THE KENTUCKY CERTIFIED RECORD OF BIRTH, PLEASE CONTACT THE KENTUCKY OFFICE OF VITAL STATISTICS AT (502) 564-4212. OFFICE HOURS ARE 8:00 A.M. TO 4:30 P.M. EST, MONDAY THROUGH FRIDAY. THE KENTUCKY OFFICE OF VITAL STATISTICS IS LOCATED AT 275 EAST MAIN STREET 1-E-A, FRANKFORT, KY 40621. MULTIPLE ORDERS MAY BE MAILED SEPARATELY.
• COPIES: 1
• CERTIFICATE HOLDER: SAMANTHA NICOLE JONES
• SAMANTHA JONES
• 1232 PARK RIDGE ROAD
• SANDERS KY 41083

• Required Documentation
• Important! Please black out Social Security numbers and any financial information if included on your documentation.
• Child
• Please submit one item from List A. If your Child is a stepchild, please provide your Marriage Certificate with Spouse listed in addition to one of the items listed below.
• List A
• Adoption Certificate
• Adoption Placement Agreement
• Birth Certificate with Parent’s Name Listed
• Documentation of Legal Custody
• Documentation of Legal Guardianship
• Hospital Birth Record (within 90 Days of Birth)
• Qualified Medical Child Support Order
• Spouse
• Please submit the item from List A.
• Marriage Certificate

• ACTION REQUIRED – PLEASE READ
• 1440 Service Co LLC
• Attn: Human Resources Team
• 7927 Nemco Way Suite 200
• Brighton, MI 48116
• 2026-02-09
• Terri L Jones
• 1232 PARK RIDGE ROAD
• SANDERS, KY 41083
• Dear Terri:
• As part of 1440 Service Co LLC's continued effort to provide our employees with a competitive benefits program, we are verifying each of your dependent's eligibility for coverage. Your participation in this dependent verification process will help ensure that only eligible dependents are enrolled in coverage.
• All you need to do is complete these three simple steps:
• 1. Review the enclosed Cover Sheet and confirm that each dependent is eligible for coverage.
• 2. Obtain the required documentation for each dependent listed on the Cover Sheet. For information regarding where to obtain the necessary documentation, log onto http://www.cdc.gov/nchs/w2w.htm or https://www.usa.gov/replace-vital-documents.
• 3. Upload, fax or mail the completed Cover Sheet, along with the required documentation, by 2026-03-26.
• SECURE UPLOAD: https://secure.lyric.adp.com
• Note: To upload scanned images of your documentation, please log onto https://secure.lyric.adp.com, navigate to your profile by selecting your initials/picture in the top right corner, then choose Your Profile. From the left menu select Benefits, then ADP Benefits Dashboard, then click on View Status in the View Verification Status tile.
• The website allows you to view the required documents, view a copy of this letter, submit documents and check your verification status.
• SECURE FAX: ADP Dependent Verification Services
• 866-400-1686
• MAIL: ADP Dependent Verification Services
• ADP-DVS
• PO Box 2338
• Alpharetta, GA 30023-2338
• Note: Do not mail original documents; they will not be returned.
• We are committed to protecting employee privacy and can assure you that all documentation will be treated confidentially. You will receive a confirmation letter after your documentation has been processed.
• If you do not complete the process and provide acceptable proof of dependent eligibility, your dependent coverage may be terminated or rescinded.
• If you have questions or need additional information regarding the necessary documentation, call:
• Dependent Verification Services Center
• 1-800-553-3823
• Representatives are available 8:00 AM - 8:00 PM ET Monday - Friday (except holidays).
• Sincerely
• Human Resources Team
• Enclosure(s)

• 1440 Service Co LLC
• From: TERRI L JONES
• 1232 PARK RIDGE ROAD
• SANDERS, KY 41083
• To verify the eligibility of each of your dependents, complete the following three simple steps by 2026-03-26.
• Step 1: Review the Dependent Information table below. If your dependent is not eligible for coverage, please check 'Not Eligible.'
• No. Name Birth Date Dependent Type Not Eligible
• 1 JASON JONES 1981-08-18 Spouse
• 2 SAMANTHA JONES 2006-12-07 Child
• Step 2: Obtain the Required Documentation for each eligible dependent listed.
• Refer to the previous page for a list of documents that must be submitted for dependent verification. Also, print 1440 Service Co LLC on each of the proof items if sending by fax or mail.
• If you have questions concerning your audit, please call 1-800-553-3823.
• Step 3: Upload, fax or mail this completed Cover Sheet, along with the required documentation, by 2026-03-26.
• Note: This completed Cover Sheet is required for your documentation to be processed!
• SECURE UPLOAD: https://secure.lyric.adp.com
• Note: To upload scanned images of your documentation, please log onto https://secure.lyric.adp.com, navigate to your profile by selecting your initials/picture in the top right corner, then choose Your Profile. From the left menu select Benefits, then ADP Benefits Dashboard, then click on View Status in the View Verification Status tile.
• The website allows you to view the required documents, view a copy of this letter, submit documents and check your verification status.
• SECURE FAX: ADP Dependent Verification Services
• 866-400-1686
• MAIL: ADP Dependent Verification Services
• ADP-DVS
• PO Box 2338
• Alpharetta, GA 30023-2338
• Note: Do not mail original documents; they will not be returned.
• Your Signature
• Terri Jones
• Date 2026-03-15
• Do not write below this line
• VERIFICATION DEADLINE
• 2026-03-26
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