ISA*00*          *00*          *ZZ*123456789012345*ZZ*123456789012346*180231*1047*^*00501*100000001*0*T*:~
GS*HC*9876543210*1234567890*180231*1047*10001*X*005010X222A1~
ST*837*1001*005010X222A1~
BHT*0019*00*12345*20181231*1047*RP~
NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23~
PER*IC*RALPH*TE*3135552222*EX*1021~
NM1*40*2*AHLIC*****46*66783JJT~
HL*1**22*0~
SBR*P*18*******12~
NM1*IL*1*Cunningham*Bob~
N3*1974 Hamilton Drive~
N4*Laurel*MD*20707*US~
CLM*388496213*140.55***11:B:1*Y*A*Y*I~
DTP*431*D8*19981003~
REF*D9*17312345600006351~
HI*BK:0340*BF:V7389~
NM1*77*2*KILDARE ASSOCIATES*****XX*5812345679~
N3*2345 OCEAN BLVD~
N4*MIAMI*FL*33111~
LX*1~
SV1*HC:99213*140.55*UN*1***1~
DTP*472*D8*20061003~
HL*2**22*0~
SBR*P*18*******12~
NM1*IL*1*Nunez*Francis~
N3*4149 Ashmor Drive~
N4*Bronson*KS*66716*US~
CLM*103084986*6452.24***11:B:1*Y*A*Y*I~
DTP*431*D8*19981003~
REF*D9*17312345600006351~
HI*BK:0340*BF:V7389~
NM1*77*2*KILDARE ASSOCIATES*****XX*5812345679~
N3*2345 OCEAN BLVD~
N4*MIAMI*FL*33111~
LX*1~
SV1*HC:99213*6452.24*UN*1***1~
DTP*472*D8*20061003~
HL*3**22*0~
SBR*P*18*******12~
NM1*IL*1*Berge*Frank~
N3*3548 Boggess Street~
N4*Ankeny*IA*50023*US~
CLM*94989621*321.0***11:B:1*Y*A*Y*I~
DTP*431*D8*19981003~
REF*D9*17312345600006351~
HI*BK:0340*BF:V7389~
NM1*77*2*KILDARE ASSOCIATES*****XX*5812345679~
N3*2345 OCEAN BLVD~
N4*MIAMI*FL*33111~
LX*1~
SV1*HC:99213*321.0*UN*1***1~
DTP*472*D8*20061003~
HL*4**22*0~
SBR*P*18*******12~
NM1*IL*1*Cablish*Susan~
N3*3563 Friendship Lane~
N4*Lincolnville*ME*4849*US~
CLM*146757606*1532.0***11:B:1*Y*A*Y*I~
DTP*431*D8*19981003~
REF*D9*17312345600006351~
HI*BK:0340*BF:V7389~
NM1*77*2*KILDARE ASSOCIATES*****XX*5812345679~
N3*2345 OCEAN BLVD~
N4*MIAMI*FL*33111~
LX*1~
SV1*HC:99213*1532.0*UN*1***1~
DTP*472*D8*20061003~
SE*66*1001~
GE*1*10001~
IEA*1*100000001~