id Cornell 3 Service Date(s) From / Through 01/14/15 2 Account Number Statement Date Pa se 02/18/15 6 This is the current insurance information on file 9 '1'1'1'11144 Please review and make corrections on the back of this form Insurance Name 7 CHECK/M.O. ACCT. BALANCE $ V05.22 $ AMT. ENCLOSED NEVVYORK-PRESBYTERIAN HOSPITAL PO BOX 9305 NEW YORK, NY 10087-9305 I 1111111111111111111 653585A (PC EFTA01195207