Exhibit C-3 — Casey David Crowther (Dkt. 162.12)

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Case 2:20-cr-00114-JES-M_M Document 16

390

Target Roofing & Sheet Metal, Inc. Schedule 3
Forgivable Expense Payments: Group Insurance
April 14, 2020 to September 28, 2020 (Covered Period)

Banking Activity Summary- Exhibits 70-88
CLEAR DATE ACCT CHECK DESCRIPTION AMOUNT
4/14/2020 x1791 Colonial Life Ins. Prem $ (1,015.67)
4/16/2020 x1791 5164 Florida Combined Life - Group (241.55)
4/21/2020 x1791 Colonial Life Ins. Prem (1,032.43)
4/28/2020 x1791 Colonial Life Ins. Prem (1,032.43)
4/29/2020 x1791 5213 Florida Blue (19,486.68)
5/1/2020 x1791 5239 Florida Blue Group Ancillary (1,107.13)
5/5/2020 x1791 Colonial Life Ins. Prem (1,032.43)
5/6/2020 x1791 5278 Florida Combined Life - Group (222.22)
5/12/2020 x1791 Colonial Life Ins. Prem (1,032.43)
5/19/2020 x1791 Colonial Life Ins. Prem (1,618.02)
5/29/2020 x1791 5370 Florida Blue (16,812.83)
6/2/2020 x1791 Colonial Life Ins. Prem (809.01)
6/2/2020 x1791 5401 Florida Combined Life - Group (277.00)
6/4/2020 x1791 5400 Florida Blue Group Ancillary (1,120.05)
6/9/2020 x1791 Colonial Life Ins. Prem (809.01)
6/16/2020 x1791 Colonial Life Ins. Prem (809.01)
6/23/2020 x1791 Colonial Life Ins. Prem (872.25)
6/30/2020 x1791 Colonial Life Ins. Prem (872.25)
6/30/2020 x1791 5492 Florida Blue (15,920.04)
7/1/2020 x1791 5493 Florida Blue Group Ancillary (833.57)
7/8/2020 x1791 Colonial Life Ins. Prem (872.25)
7/14/2020 x1791 Colonial Life Ins. Prem (861.36)
7/21/2020 x1791 Colonial Life Ins. Prem (871.33)
7/28/2020 x1791 Colonial Life Ins. Prem (1,543.00)
7/30/2020 x1791 5611 Florida Blue Group Ancillary (1,258.38)
8/3/2020 x1791 5610 Florida Blue (6,520.82)
8/7/2020 x1791 5628 Florida Blue (10,923.49)
8/11/2020 x1791 Colonial Life Ins. Prem (771.50)
8/12/2020 x1791 5630 Florida Combined Life - Group (74.18)
8/18/2020 x1791 Colonial Life Ins. Prem (740.29)
8/25/2020 x1791 Colonial Life Ins. Prem (740.29)
9/1/2020 x1791 Colonial Life Ins. Prem (740.29)
9/9/2020 x1791 Colonial Life Ins. Prem (740.29)
9/15/2020 x1791 Colonial Life Ins. Prem (730.27)
9/16/2020 x1791 Sun Life Canada Payment (2,056.33)
9/22/2020 x1791 Colonial Life Ins. Prem (1,155.48)
TOTAL GROUP HEALTH PAYMENTS (NOTE 1) $ (97,555.56)

NOTE 1: The payments to the group health plans include both the amount contributed by Target, as well
as the amounts withheld from the employees' gross wages. See Exhibit C-4 Invoices. The PEO reports
submitted into evidence did not indicate the amounts contributed by employee and, accordingly, we

cannot calculate the employer portion eligible for forgiveness.

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