26-000867.pdf
Nobel H Atto Petitioner V City Of Warren Respondent · 26-000867-TT
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. 1 GVer” —Fo bios /t al (on Cera MTT Docker He “- ia A 0o0€el ATT O Lo Elha P ease Loam vide. 4, or all my 2 pen ree —A ew Cut ouv medicd, an Ae (ud ow” 0CT 07 2026 MICHIGAN TAX TRIBUNA Ie) wr saVing plan.fhal AO3es + 203.00 Fram suv SoU Searvidy . [Vebel 4c ald $]534..- Quit. eve “hom Yet ¥ SP 00 SVN oth Fp. re 3 JR. 0 Grn owt. hea Irs uence Yo! ZLham Mie 5 [2824 eVeluy mewt ly supp/e med” eta M int T MY Rusbon J Nobel ohlY he Have he BHT e Prescrigioe- £5 Copayd (DY Fo EERE aa 2.6.0 For mo Fecth Pav £% ~)e ere Mo 8 t Nn Sena. A Jenin
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Social Security Administration Great Lakes Program Service Center 6% West Medien as Social Security Administration 16280, ; Retirement, Survivors, and Disability Insurance Important Information Inf dicker ’ Deter, September 24,220 D&E p00) En LLL AUR REE TH TI LAT 0000304 00024723 1 AB 0.672 0917MIT2R4PN T95 8 ia ELHAM T ATTO 30131 GRUENBURG DR WARREN MI 48092-3362 We are writing to you about your Social Security benefits. What You Should Know The State of Michigan will no longer pay your Medicare Part B (Medical Insurance) premiums after August 5026. You must pay the premiums starting September 2026. If you disagree or have questions about the State’s determination to stop paying the premiums, please call the State Medicaid office. If you recently received a notice from the State Medicaid office telling you that you lost benefits, follow the instructidns in the notice about the best way to contact them. What We Will Pay And When We pay Social Security benefits for a Given month in the next month. For example, Social Security benefits for March are paid in April. e You will receive $310.10 for September 2026 around October 2, 2026. e After that you will receiye-$513.00 oy or about the third of each + 158200ANTEF1020. 0000000000 $0E0000
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Insurance Important Information +696200MSTE Date: September 21, 2026 BNC#: 26VI420K34879-A | I AAaLl doer o ~0bofl 7 0000900 00023264 1 AB 0.672 0914M1T2R4PN T81 PR KG Borat GRUENBURG 0. 1 WARREN MI 48092-3362 “Th ots Lhe on! n J hh Com 0000000000 0060000 We are writing to you about your Social Security benefits. _ What You Should Know . meen The State of Michigan will no longer pay your Medicare Part B (Medical Insurance) premiums after August 2026. You must pay the premiums starting September 2026. If you disagree or have questions about the State's determination to stop paying the premiums, please call the State Medicaid office. If you recently received a notice from the State Medicaid office telling you that you lost benefits, follow the instructions in the notice about the best way to contact 2 them. , ] What We Will Pay And When We pay Social Security benefits for a given month in the next month. "For example, Social Security benefits for March are paid in April. e You will receive $1,336.10 for September 2026 around October 2,;2026. s After that you will receivg $1,539.00.6n or about the third of each month. Information About Medicare We deduct Medicare medical insurance (Part B) premiums 1 month in advance.
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IVER ASIVILS AWS DT IW YY LD A 13041 E 10 MILE RD WARREN MI 48089 | Specialist /1D: M. Connection / mdhhs-macomb-warren Jn Do @ el H Phone: (844) 464-3447 Fax: 517) 346-9888 oe Beneficiary ID) DE- 600847 a if you do not understand this, call an MDHHS office in your area. STATE OF MICHIGAN MDHHS employees are prohibited by law from providing legal advice. : Si usted no entiende esto, llame a una oficina de MDHHS en su area. Department of Health and Human Services La ley prohibe a los empleados de MDHHS proporcionar asesorla legal, dlihle d 3 gn galt MDHHS ia oath call) 138 gh (8 pane cagad 5 12) A gH Lagat ole] MDHHS dk se Jo 05880 p05 Date: 09/10/2026 MDHHS Office: MACOMB CO DHS WARREN DISTRICT NOBEL HATTO 30131 GRUENBURG DR WARREN MI 48092 HEALTH CARE COVERAGE DETERMINATION NOTICE If you have previously received a determination notice regarding health care coverage for individuals not listed on this notice, their coverage has not changed. - Denial / Closure Information Below are the reason(s) for the intended action. 09/01/2026 - Ongoing- Nobel H Atto, Etham Atto are not Eligible (Medicare Savings Program) -Income exceeds the limit for this program. Case not eligible. ~~ Manual Item(s): BEM 544, 42 CFR 435.200 Internal use only code: EL3029 The income below was used in determining the Health Care Coverage for Nobel H Atto Annual Income: $ 20,892.00 The income below was used in determining the Health Care Coverage for Elham Atto Annual Income: $ 8,592.00 saving Preavam jo part B pier dd
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MICHIGAN FARM BUREAU HEALTH PLANS + Doe | in ul PO BOX 1424 COLUMBIA TN 38402-1424 INVOICE D4 pp0 827 SUBGROUP ID: MGM 000001 0000000 SUBSCRIBER ID: hn el E+ DUEDATE: 05/01/2026 HC. oe Wont BILLING FROM: 05/01/2026 he WARREN MI 48092-3362 BILLING THRU: 05/31/2026 ee STATEMENT NO: 26126000332 BALANCE PRIOR TO CURRENT BILLING PERIOD $0.00 PAYMENTS $0.00 CURRENT BILLING PERIOD PLAN ID FAMILY INDICATOR FROM THRU AMOUNT Individual 05/01/2026 05/31/2026 $128.39 CURRENT PERIOD TOTAL $128.39 TOTAL AMOUNT DUE $128.39 Supplement For #, FlLhpm ATT Q6f [28:39 QVerq mitch: heed Via Srl - ++ Your first payment must be made via check or online with a one-fime credit card or ACH payment. Visit mfbhealthplans.com for the ontine payment link,*** Future payments will be drafted from the bank account provided. This billing statement must be paid for continuous coverage. If you have any questions concerning this statement, please call Michigan Farm Bureau Health Plans @ 1-833-282-6975 If paying by check fold and tear here - return coupon below. IB FARM BUREAU En, HEALTH PLANS [Evi cen GaA NE Billing From: 05/01/2026 Insured ly: Members Healtls Insurance Company : Billing Thru: 05/31/2026 wo | Pisaso Refurm wily Your os2t2028 | Payment On Or Before Check Group Subgroup Subscriber ID: Amount Due here - of 400050 vie i | $128.39 address - see back DO NOT SEND CASH . Please make payments payable to Michigan Farm Bureau Health Plans and mail to the address below ELHAM TATTO
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MICHIGAN FARM BUREAU HEALTH PLANS PO BOX 1424 COLUMBIA TN 38402-1424 INVOICE SUBGROUP iD: MI6M 000001 D0DODDDO SUBSCRIBER ID: — Tet fe ep [ DUE DATE: i SHITE ro on ODE: est on ¥ BILLING FROM: 05/01/2026 fos WARREN MI 48092-3362 BILUNG THRU: 05/31/2026 i STATEMENT NO: 26126000332 BALANCE PRIOR TO CURRENT BILLING PERIOD $0.00 ] PAYMENTS B $0.00 CURRENT BILLING 5 PERIOD PLAN ID FAMILY INDICATOR FROM THRU AMOUNT Individual 05/01/2026 05/31/2026 $128.38 CURRENT PERIOD TOTAL $128.39 TOTAL AMOUNT DUE $128.39 Supplement For ®. Flhpm ATT 6[. [38.3 Veg murach. +=» Your first payment must be made via check or onfine with a one-time credit card or AGH payment. Visit mfbhealthplans.com for the online payment link.*** Future payments will be drafted from the bank account provided. This billing statement must be paid for continuous coverage. If you have any questions concerning this statement, please call Michigan Farm Bureau Health Plans @ 1-833-282-5975 if paying by check fold and tear here - return coupon below. Billing From: 05/01/2026 Billing Thru: 05/31/2026 INVOICE: 26126000332 - Ph Return With Ye Payment On OF Before 05/21/2028 Check “Group Subgroup Subscriber ID Amount Due a of 400050 wisv | [EE $128.39 address - DO NOT SEND CASH Please make payments payable to Michigan Farm Bureau Health Plans and mail to the address below
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Zp Fud amp Period Status "Amount Household Member(s) 09/01/2026 - 08/31/2028 APPROVED $ 179.00/mo. Nobel H Atto Efham Atto A+ Jockey Xr / ovo 247 If approved for cash assistance, your benefits may go down or stop. Your monthly income is based on your total income and expenses. Your expenses do not reduce your income dollar for dollar. The following amounts were used to determine your benefits: Monthly Income (after deductions) $1222.00 BUDGET SUMMARY Earned Income 0.00 Self Employment Income 0.00 Unearned Income 2457.00 Standard Deduction 209.00 Homeless Shelter Deduction 0.00 Internet Deduction 0.00 Medical Expenses 165.00 Dependent Care 0.00 Child Support Payments 0.00 Housing Costs 1219.69 Heat/Utility Standard (including phone) 682.00 Non-Heat Electric Standard 0.00 Water/Sewer Standard 0.00 Telephone Standard 0.00 Cooking Fuel Standard 0.00 Trash Standard 0.00 Benefits Withheld to Repay an Overissuance 0.00 HEARING RIGHTS You have the right to request a hearing if you do not agree with any action or decision the department makes (including failure to act with reasonable promptness). You can ask for a hearing for FAP by phone. Hearings for all other programs must be requested in writing. At the hearing you can explain why you disagree with the action or decision and present evidence. The request should include your name, address and case number. Attach a copy of this notice if possible. Go fo http:/fwww.michigan.gov/-/media/Project/Websites/mdhhs/Forms/DHS-18.dotx to download a form to use or contact local MDHHS office shown on the first page of this notice to request a form. - Keep a copy of the request and any other document you attach for yourself.
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Iuesday, June UY, 2026 10:56:19 Patient Name Elham Atto Type SALE Account VISA Card Number Order ID Reference Number 1798546759 App Preferred Name VISA CREDIT EMV AID A0000000031010 TC C2A733CCB837E997 Entry Contactlce Response Code 00/Approved Approval Number 23681D 11g 05818 Neighborhood Fam 1y Dent is4vy A7753 Dequndre gf Ma) sen RHeignt #847] AMOUNT $375.00 APPROVED - THANK YOU Signature IMPORTANT - retain this copy for your records *** Cardholder Copy *** <u \ 2 J h y / / ) y a 7 fo [Cf / £: £/ od / / rd i rd y rd \ 4 @» 3 A / 4 Far - / J P=
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CastFil Rx # Drug Name r= eg] Qy TP Price RPh . fe _ 600-86 Physician Name Prescriber ID mt Doc ket é-4 7 08/12/2026 622200469185 Latanoprost 0.005% Eye Solution 7.5 DHMS $0.00 HP Rolain, Mark 1366481855 08/25/2026 422200037529 LORazepam 0.5 MG TAB TEVA 60 DHMS $0.00 RIS GHAFFARLOO, MOHAMMAD G 1275631764 08/31/2026 622200441729 Losartan Potassium 50 MG TAB SOLC 180 DHMS $0.00 ~BG | PENUMALEE, SREELATHA 1396753372 08/31/2026 622200448230 Omeprazole DR 20 MG CAP DR.R 90 DHMC $0.00 NIS GHAFFARLOO, MOHAMMAD G 1275631764 09/04/2026 822200048468 OneTouch Ultra TES LIFE 100 ERX $3.33 ABS Ghaffarloo, Mohammad 1275631764 09/08/2026 622200487417 valACYclovir HCI 1 GM TAB NORT 21 DHMC $0.00 RIS Sampat, Radha 1801190913 09/08/2026 622200487418 Betamethasone Dipropionate 0.05% OIN PADA 15 $0.00 HP SAMPAT, RADHA K 1801190913 09/08/2026 622200487418 Betamethasone Dipropionate 0.05% OIN PADA 30 DHMC $0.00 HP SAMPAT, RADHA K 1801190013 09/08/2026 622200444516 VITAMIN D 50,000 UNIT CAP BION 12 SNGL $11.90 KIL GHAFFARLOO, MOHAMMAD G 1275631764 09/08/2026 622200448124 Xareito 20 MG TAB JANS 90 MFP $0.00 ~BG AL-ZAGOUM, MAJID M 1053318170 Report Date: 09/12/2026 Attested By: $109.11 Registered Pharmacist Vebel Ale Ss /Jo9N This Will for eo PON For” ped [ cakion.
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INTEREST CHARGES. PLEASE SEE THE PROMOTIONAL PURCHASE SUMMARY SECTION ON THIS STATEMENT
S) EXPIRING ON 01/10/27.Page 12
Faust vais Type Account Card Number Order ID teference Number o Preferred Name’ EMV AID Entry Response Code Approval Number EE can hd Yay [SECT ate ~ , SALE ot Baa Ey 9 ket 52” ceo 84 VISA CREDIT A0000000031010 2 5 ARQC D48E66D4DD2F5D78 7 Ns Contactlesslce 53 De uit ndev RL Q0/Approved 389810 Den +isdvy mag) soin Helent . ) Te 80) AMOUNT $75.00 F383 voy, o APPROVED - THANK YOU ignature IMPORTANT - retain this copy for your records “+ Cardholder Copy ***
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Expiration NotificationPage 14
Page 1 Patient: Atto,ElhamT Cdse Pharmacy: MEIJER #222 RespPty: = Address: 1005 THIRTEEN MILE RD Address: 30131 Gruenburg Drive MADISON HEIGHTS, MI 48071 RPh: Saadalla Mh Rafi | Docket #2 Warren, Ml 48092 NCPOPH: NEE 4-004 £47 Birth : I Prescriptions: Dates: 01/01/2026 TO 09/12/2026 LastFill Rx # Drug Name Qty T/P Price RPh Physician Name Prescriber ID 01/19/2026 622200378484 ~Chlorthalidone 25 MG TAB AJAN 90 DHMS $160 AIK ALZAGOUM, MAJID 1053318170 01/29/2026 622200418297 Eliquis 5 MG TAB B-MS 180 MFP $490 ~BG AL-ZAGOUM, MAJID M 1053318170 01/29/2026 622200440370 Potassium Chloride Crys ER 20 MEQ TABUPSH 180 DHMS $160 ABS STEPHAN, ELENA M 1609926138 02/01/2026 622200422758 Synthroid 125 MCG TAB ABBY 90 DHMS $160 ~BG Ghaffarloo, Mohammad 1arsaatres 02/07/2026 622200422760 metFORMIN HCI ER 24HR 500 MG ~~ TAB 270 DHMS $0.00 ~BG UNIC Ghaffarloo, Mohammad 1275631764 02/07/2026 622200422761 Allopurinol 100 MG TAB AVET 90 DHMS $160 ~BG Ghaffarloo, Mohammad 1275631764 02/07/2026 622200422771 Jardiance 25 MG TAB BOEH 90 MFP $490 ~BG GHAFFARLOO, MOHAMMAD G 1275631764 02/18/2026 622200444815 Valsartan 160 MG TAB CAMB 90 DHMS $160 ABS AL-ZAGOUM, MAJID M 1053318170 02/18/2026 622200444816 Metoprolol Succinate ER 24HR 50 MG TAB EPIC 180 ~~ DHMS $1.60 NB AL-ZAGOUM, MAJID M 1053318170 02/23/2026 622200445824 Nitrofurantoin Monohyd Macro 100 MG CAP LIFE 14 DHMS $120 ABS RUFFOLO, KATHLEEN A 9084142620 02/26/2026 622200446747 VITAMIN D 50,000 UNIT CAP BION 12 SNGL $6.36 PAS STEPHAN, ELENA M 1609926138 03/01/2026 622200440331 Mirtazapine 15 MG TAB AURO El) DHMS $160 ABS STEPHAN, NAMIR Y 1053461590
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‘ - Prover SPREE ren HFT ROYAL OAK, MI 48067 va IT Noe ke od Date/Time: 06/10/2026 05:17 PM ET ) €-000847 Account Number: wo [ Cardholder Name: ELHAM ATTO Promo Code: 106: 6 Month Deferred/No Interest if Paid in Full Total: $1,680.00 Authorization Code: 010992 Reconciliation Number: 202606109026733308 Patient/Client ID: Promotion Terms: No Interest Charges will be assessed if the promotional purchase balance is paid in full within the promotion period, which is in 6 months. If the promotional purchase balance is not paid in full by the end of this promo period, interest will be imposed from the date of purchase at the Annual Percentage Rate of 32.89%. If the word "variable" appears in the previous sentence, that APR will vary with the market based on the prime rate. This means to avoid paying interest on the promotional purchase, you must pay the entire amount of the promotional purchase balance before the end of the promo period. Minimum monthly payments are required. Making only the minimum payments required by your monthly statement may or may not pay off the promotional purchase within the promo period. If you would like to estimate a monthly payment amount that would pay off the full amount of the promotional purchase within the promo period, divide your promotional purchase amount by the number of months in the promo period or visit http://www.carecredit.com/payment_calculator. This estimated monthly payment amount assumes the promotional purchase is the only balance on your account during the entire promo period and you make each payment when due. Regular account terms apply to non- promotional purchases and, after promotion ends, to the promotional balance.
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Provider: ENDODONTIC CENTER 26154 WOODWARD AVE SUITE A ROYAL OAK, Mi 48067 [I — Date/Time: 06/10/2026 05:17 PM ET Account Number: Rida | Cardholder Name: ELHAM ATTO #romo Code: 106: 6 Month Deferred/No interest if Paid in Full Total: $1,680.00 Authorization Code: 010992 Reconciliation Number: 202606109026733308 patient/Client 1D: Promotion Terms: No Interest Charges will be assessed if the promotional purchase balance is paid in full within the promotion period, which is in 6 months. if the promotional purchase balance is not paid in full by the end of this promo period, interest will be imposed from the date of purchase at the Annual Percentage Rate of 32.99%. If the word "wariable" appears in the previous sentence, that APR will vary with the market based on the prime rate. This means to avoid paying interest on the promotional purchase, you must pay the entire amount of the promotional purchase balance before the end of the promo period. Minimum monthly payments are required. Making only the minimum payments required by your monthly statement may or may not pay off the promotional purchase within the promo period. If you would like to estimate a monthly payment amount that would pay off the full amount of the promotional purchase within the promo period, divide your promotional purchase amount by the number of months in the promo period or visit hitp:/www.carecredit.com/payment_calculator. This estimated monthly payment amount assumes the promotional purchase is the only balance on your account during the entire promo period and you make each payment when due. Regular account terms apply to non- promotional purchases and, after promotion ends, to the promotional balance. CdSe
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ii PTT TONE IE TFT OUE FUTUR TN 1 41 TN 8 1 . a ep este preg tail US. POSTAGE PAID or — yr 7 4 LI ———c FF MADISON HEIGHTS, Ba OCT 02, 2026 3 1) [3 GY genous 48909 $2.27 (Jarrer A) Joh a 2 RDC 99 §2324K505376-07 Mich igan TAK Teibuna po got 50a 25° Jansing mr #591 mT Do chet H=— De 0060 £67