2004 COVERED LIVES/ASSESSMENTS/SURCHARGES

REGION COUNTIES 2004 INDIVIDUAL COVERED LIVES ANNUAL ASSESSMENT 2004 FAMILY COVERED LIVES ANNUAL ASSESSMENT 2004 ALTERNATIVE PER UNIT OF PYMT SURCHARGE ∗
New York City Bronx
Kings
New York
Queens
Richmond
$116.23 $383.56 26.98%
Long Island Nassau
Suffolk
$ 38.24 $126.20 13.73%
Northern Metro Columbia
Delaware
Dutchess
Orange
Putnam
Rockland
Sullivan
Ulster
Westchester
$ 21.32 $ 70.36 9.21%
Northeastern Albany
Clinton
Essex
Fulton
Greene
Montgomery
Rensselaer
Saratoga
Schenectady
Schoharie
Warren
Washington
$ 23.75 $ 78.39 8.33%
Utica/Watertown Chenango
Franklin
Hamilton
Herkimer
Jefferson
Lewis Madison
Oneida
Oswego
Otsego
St. Lawrence
$ 5.54 $ 18.27 2.22%
Central Broome
Cayuga
Chemung
Cortland
Onondaga
Schuyler
Steuben
Tioga
Tompkins
$ 30.68 $101.23 9.46%
Rochester Livingston
Monroe
Ontario
Seneca
Wayne
Yates
$ 60.05 $198.16 18.41%
Western Allegany
Cattaraugus
Chautauqua
Erie
Genesee
Niagara
Orleans
Wyoming
$ 20.10 $ 66.32 6.70%

∗ This would be in addition to the surcharges reflected in Attachment 4.