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Medical, Pharmacy & Dental Incurred But Not Paid (IBNP) Report

CONFIDENTIAL

ABC Company

The information provided herein is the confidential and proprietary work product of CBIZ and cannot be disclosed, copied or distributed to outside third

parties without the prior written consent of CBIZ. This information can be expressly used only for the intended purpose and recipient.

For December 31, 2015

CBIZ, Inc.

625 Maryville Centre Dr, Suite 200

St. Louis, MO 63141

Telephone: (314) 692-2249

Completed January 22, 2016