OBPP Invoice listing

Customer Name

ABC COMPANY

Customer Number

123456

Invoice Overview

Customer Name	ABC COMPANY
Invoice Number	116563665684
Invoice Date	03/07/2022
Customer Number	123456
Bill Group Number	88210
Coverage Period	04/01/2022 - 04/30/2022
Due Date	04/01/2022

Total Invoice Amount: $605.38

Account Summary

Previous Balance	$605.38
Payments(-)	-$605.38
Account Adjustments(+/-)	$0.00
Current Charges(+)	$605.38
Current Adjustments(+/-)	$0.00
Other Fees/Credits	$0.00

Total Balance Due: $605.38

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Current Charges
Description	Invoice Period	Employee Count	Total Volume (000's)	Rate	Net Amount
242078 - ABC COMPANY
NJ 2500/70 DIRECT HSA
EMPLOYEE		1		$0.00	$605.38
Subtotal, NJ 2500/70 DIRECT HSA		1			$605.38
Subtotal, 242078 - ABC COMPANY		1			$605.38
Fees/Credits
Subtotal, Fees/Credits					$0.00
Adjustment Charges
Account Adjustments					$0.00
Current Adjustments					$0.00
Subtotal, Adjustment					$0.00
Total		1			$605.38