Quarterly Adjustment Invoice

This invoice is an adjustment to the regular quarterly invoice. It must be requested by an employer.

invoice 2 page 001
1  -  Statement number ending in "QA" indicates this is a "Quarterly Adjustment Bill"
2  -  Any changes in health, dental, LIDI, compensation, termination or deferral rate triggers creation of the "QA" bill type.
3  -  This is the total adjusted amount due for this listed member "John Smith" .