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Home My WebLink About20020421 RESOLUTION RE: CANCELLATION OF OUTSTANDING ACCOUNTS RECEIVABLE FOR THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, a list of Weld County Department of Public Health and Environment accounts has been submitted to the Accounting Department of Weld County, Colorado, and WHEREAS, said accounts have been deemed uncollectible in accordance with guidelines adopted by the County of Weld, a copy of said list being attached hereto and incorporated herein by reference, and WHEREAS, the Accounting Department has recommended the cancellation of said list of uncollectible debts due and owing the Weld County Department of Public Health and Environment in the amount of $14,516.00. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the aforementioned list of uncollectible accounts in the amount of $14,516.00 be, and hereby is, approved for cancellation. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 20th day of February, A.D., 2002. BOARD OF COUNTY COMMISSIONERS WEL COUNTY, COLORADO ATTEST: g CC f � I Vaad, Chairman Weld County Clerk to thetBoac E ,CV '� u tz David E. Lon ro em ti, BY: Deputy Clerk to the Board ,i`! di((/ M. J. G ile APPROVED ST : • � v lia H. rke o ,. yAtto ey Robert D. Masden Date of signature: v ° 2002-0421 et .fit) Ace! HL0019 02/12/2002 Weld County Health Department Page 1 oft Write-Off Balance Report (Write-Off Date 06/30/2001) Service Program 'Amount Year 1999 FPP (14 service records) $168.00 IM (2 service records) $16.00 1999 SubTotal (16 detail records) $184.00 2000 COP _ (16 service records) $128.00 FPP (2 service records) $35.00 IM (13 service records) $50.00 2000 SubTotal (31 detail records) $213.00 2001 CDP (11 service records) $65.00 CHP (9 service records) $121.00 COP (30 service records) $403.00 FPP (109 service records) $1,582.00 IM (651 service records) $9,437.00 PE (4 service records) $240.00 PNP (6 service records) $1,938.00 STD (23 service records) $322.00 WAP (1 service record) $11.00 2001 SubTotal (844 detail records) $14,119.00 Grand Total $14,516.00 2002-0421 02/12/2002 Weld County Health Department Page 1 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000001771 04/13/2001 00300 $35.00 04/24/2001 ENC FPP Client Subtotal $35.00 000002019 03/12/2001 88142 $30.00 03/12/2001 ENC FPP Client Subtotal $30.00 000002196 01/03/2001 90744 $15.00 01/03/2001 ENC IM 000002196 01/03/2001 X0718 $15.00 01/03/2001 ENC IM Client Subtotal $30.00 000002349 11/24/1999 00047 $14.00 02/15/2001 TRNF FPP . . Client Subtotal $14.00 000002924 04/30/2001 90745 $15.00 04/30/2001 ENC IM 000002924 04/30/2001 X0730 $15.00 04/30/2001 ENC IM . Client Subtotal $30.00 • 000003799 05/11/2001 99214 $30.00 05/11/2001 SFD FPP 000003799 05/11/2001 00043 $104.00 05/11/2001 SFD FPP Client Subtotal $134.00 000004026 04/19/2001 90745 $15.00 04/25/2001 ENC COP Client Subtotal $15.00 000004287 07/26/1999 00059 $20.00 02/15/2001 TRNF FPP Client Subtotal $20.00 000004606 04/30/2001 88142 $30.00 04/30/2001 ENC FPP 000004606 04/30/2001 00037 $21.00 04/30/2001 SFD FPP 000004606 04/30/2001 99212 $8.00 04/30/2001 SFD FPP Client Subtotal $59.00 000004968 01/15/2001 85018 $1.00 02/08/2001 SFD FPP 000004968 01/15/2001 00300 $35.00 02/08/2001 TRNF FPP Client Subtotal $36.00 000005591 05/23/2001 99214 $30.00 05/23/2001 SFD FPP 000005591 05/23/2001 87110 $10.00 05/23/2001 ENC FPP 000005591 05/23/2001 00136 $24.00 05/23/2001 SFD FPP Client Subtotal $64.00 000006491 02/21/2001 90745 $15.00 02/21/2001 ENC IM 000006491 02/21/2001 X0718 $15.00 02/21/2001 ENC IM Client Subtotal $30.00 000008140 08/20/1999 00059 $5.00 05/03/2001 PYMT FPP Client Subtotal $5.00 000008382 04/06/2001 00269 $25.00 04/06/2001 ENC STD Client Subtotal $25.00 000009838 09/03/1999 00047 $7.00 02/15/2001 TRNF FPP Client Subtotal $7.00 000009868 02/12/2001 90745 $15.00 02/12/2001 ENC IM 000009868 02/12/2001 90707 $15.00 02/12/2001 ENC IM • 02/12/2002 Weld County Health Department Page 2 of 32 Write-Off Detail Report (Write-Off-Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000009868 02/12/2001 X0718 $15.00 02/12/2001 ENC IM Client Subtotal $45.00 000009869 02/05/2001 X0730 $10.00 02/12/2001 PYMT IM Client Subtotal $10.00 000010685 02/28/2001 90745 $10.00 02/28/2001 PYMT IM Client Subtotal $10.00 000011643 05/09/2001 90745 $15.00 05/09/2001 ENC IM Client Subtotal $15.00 000011855 05/04/2001 85018 $1.00 05/04/2001 SFD FPP Client Subtotal $1.00 000012220 04/16/2001 90707 $15.00 04/16/2001 ENC IM _ 000012220 04/1612001 90745 $15.00 04/16/2001 ENC IM Client Subtotal $30.00 000012359 04/19/2001 90744 $15.00 04/26/2001 ENC COP Client Subtotal $15.00 000013571 05/02/2001 90745 $10.00 05/02/2001 PYMT IM Client Subtotal $10.00 000014670 05/21/2001 90745 $9.00 05/21/2001 PYMT IM 000014670 05/21/2001 X0730 $15.00 05/21/2001 ENC IM Client Subtotal $24.00 000014808 04/23/2001 90745 $5.00 04/23/2001 PYMT IM Client Subtotal $5.00 000016495 06/04/2001 99214 $10.00 06/04/2001 PYMT STD 000016495 06/04/2001 87110 $10.00 06/04/2001 ENC STD Client Subtotal $20.00 000016596 02/21/2001 90745 $15.00 02/21/2001 ENC IM Client Subtotal $15.00 000016820 01/10/2001 X5578 $60.00 01/10/2001 ENC PE Client Subtotal $60.00 000017038 03/23/2001 66720 $10.00 03/23/2001 ENC STD Client Subtotal $10.00 000017273 02/26/2001 90745 $15.00 02/26/2001 ENC IM 000017273 02/26/2001 X0730 $15.00 02/26/2001 ENC IM 000017273 02/26/2001 X0718 $15.00 02/26/2001 ENC IM 000017273 02/26/2001 90707 $15.00 02/26/2001 ENC IM 000017273 03/26/2001 90745 $15.00 03/26/2001 ENC IM Client Subtotal $75.00 000017482 05/14/2001 X0730 $15.00 05/18/2001 ENC IM Client Subtotal $15.00 000018095 03/12/2001 90745 $15.00 03/12/2001 ENC IM 000018095 03/29/2001 90745 $15.00 04/05/2001 ENC COP 02/12/2002 Weld County Health Department Page 3 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $30.00 000020586 01/25/2001 90745 $15.00 01/30/2001 ENC COP 000020586 01/25/2001 90707 $15.00 01/30/2001 ENC COP Client Subtotal $30.00 000024049 01/15/2001 90724 $5.00 01/15/2001 PYMT CDP Client Subtotal $5.00 000024155 02/23/2001 85018 $1.00 02/23/2001 SFD FPP Client Subtotal $1.00 _ _ 000024564 02/21/2001 90745 $15.00 02/21/2001 ENC IM Client Subtotal $15.00 000024728 0.4/26/1999 00059 $20.00 02/15/2001 TRNF FPP - Client Subtotal $20.00 000024885 03/26/2001 00014 $5.00 03/26/2001 ENC CDP 000024885 03/26/2001 00014 $5.00 03/26/2001 ENC CDP Client Subtotal $10.00 000024983 06/27/2001 85018 $1.00 06/27/2001 SFD FPP Client Subtotal $1.00 000025049 12/06/1999 X5560 $7.00 04/02/2001 PYMT FPP Client Subtotal $7.00 000025447 04/02/2001 X0730 $5.00 05/18/2001 PYMT IM Client Subtotal $5.00 000025619 04/20/2001 00300 $25.00 06/22/2001 PYMT FPP 000025619 06/22/2001 00009 $5.00 06/22/2001 ENC FPP Client Subtotal $30.00 000026184 01/17/2001 90745 $15.00 01/17/2001 ENC IM Client Subtotal $15.00 000026879 05/11/2001 99213 $13.00 05/11/2001 SFD FPP 000026879 05/11/2001 87110 $10.00 05/11/2001 ENC FPP 000026879 05/11/2001 00040 $21.00 05/11/2001 SFD FPP Client Subtotal $44.00 000027223 02/20/2001 90745 $3.00 05/14/2001 PYMT COP 000027223 02/20/2001 90707 $2.00 05/14/2001 PYMT COP 000027223 05/02/2001 90745 $15.00 05/10/2001 ENC COP Client Subtotal $20.00 000027422 06/06/2001 90716 $15.00 06/06/2001 ENC IM 000027422 06/06/2001 90745 $15.00 06/06/2001 ENC IM Client Subtotal $30.00 000028290 06/08/2001 85018 $1.00 06/08/2001 SFD FPP Client Subtotal $1.00 000028445 01/17/2001 90745 $15.00 01/17/2001 ENC IM 000028445 03/19/2001 90745 $15.00 03/19/2001 ENC IM 02/12/2002 Weld County Health Department Page 4 of 32 Write-Off Detail Report (Write-OffDate 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $30.00 000029400 01/03/2001 90745 $15.00 01/03/2001 ENC IM 000029400 01/03/2001 90707 $15.00 01/03/2001 ENC IM Client Subtotal $30.00 000029779 01/19/2001 X5571 $255.00 03/26/2001 ENC PNP Client Subtotal $255.00 000029786 04/09/2001 00016 $2.00 06/08/2001 PYMT STD 000029786 04/16/2001 00016 $10.00 04/16/2001 ENC EPP _ _ 000029786 05/07/2001 66720 $10.00 05/08/2001 ENC STD 000029786 05/08/2001 00016 $10.00 05/08/2001 ENC FPP 000029786 05/21/2001 00016 $10.00 05/21/2001 ENC FPP _ 000029786 06/0172001 66720 $10.00 06/01/2001 ENC STD Client Subtotal $52.00 000029922 02/05/2001 90745 $15.00 02/05/2001 ENC IM Client Subtotal $15.00 000030249 08/02/2000 90745 $3.00 03/26/2001 PYMT IM 000030249 03/26/2001 90745 $15.00 03/26/2001 ENC IM Client Subtotal $18.00 000030516 03/30/2001 00051 $1.00 03/30/2001 SFD FPP 000030516 03/30/2001 99214 $15.00 03/30/2001 SFD FPP 000030516 04/04/2001 00120 $11.00 04/04/2001 ENC WAP Client Subtotal $27.00 000032897 05/23/2001 00014 $10.00 05/23/2001 ENC CDP Client Subtotal $10.00 000032929 03/14/2001 X0730 $10.00 03/14/2001 PYMT IM Client Subtotal $10.00 000034394 04/19/2001 80062 $7.00 05/02/2001 PYMT COP Client Subtotal $7.00 000034873 05/11/2001 X0730 $15.00 05/11/2001 ENC IM 000034873 05/11/2001 90745 $15.00 05/11/2001 ENC IM 000034873 05/11/2001 90707 $15.00 05/11/2001 ENC IM Client Subtotal $45.00 000034874 05/11/2001 90745 $15.00 05/11/2001 ENC IM 000034874 05/11/2001 90707 $15.00 05/11/2001 ENC IM 000034874 05/11/2001 X0730 $15.00 05/11/2001 ENC IM Client Subtotal $45.00 000038174 04/26/1999 00047 $7.00 02/15/2001 SFD FPP 000038174 04/26/1999 00045 $15.00 02/14/2001 SFD FPP Client Subtotal $22.00 000038482 03/12/2001 00030 $5.00 03/12/2001 SFD EPP 000038482 03/12/2001 X5560 $22.00 03/12/2001 SFD FPP 02/12/2002 Weld County Health Department Page5 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $27.00 000038533 03/12/2001 X0718 $10.00 03/12/2001 PYMT IM Client Subtotal $10.00 000038641 04/30/2001 X0730 $15.00 04/30/2001 ENC IM 000038641 04/30/2001 90713 $15.00 04/30/2001 ENC IM Client Subtotal $30.00 000039139 02/23/2001 90745 $15.00 02/23/2001 ENC IM Client Subtotal $15.00 _ 000039228 04/02/2001 90744 $5.00 05/18/2001 PYMT IM 000039228 04/02/2001 X0730 $15.00 04/02/2001 ENC IM Client Subtotal $20.00 _ 000040819 04/13/2001 00030 $5.00 04/13/2001 SFD FPP Client Subtotal $5.00 000041458 04/12/2000 00035 $3.00 02/14/2001 SFD FPP Client Subtotal $3.00 000041849 12/22/1999 00136 $29.00 01/15/2001 PYMT FPP 000041849 01/15/2001 00051 $21.00 01/15/2001 SFD FPP 000041849 01/15/2001 00033 $3.00 01/15/2001 SFD FPP 000041849 01/15/2001 99214 $15.00 01/15/2001 SFD FPP 000041849 01/15/2001 87110 $10.00 01/15/2001 ENC FPP 000041849 01/15/2001 00035 $3.00 01/15/2001 SFD FPP Client Subtotal $81.00 000042234 06/01/2001 00118 $10.00 06/01/2001 ENC CDP Client Subtotal $10.00 000042690 04/16/2001 X0730 $15.00 04/16/2001 ENC IM 000042690 04/16/2001 90745 $15.00 04/16/2001 ENC IM Client Subtotal $30.00 000043186 02/02/2001 00020 $20.00 02/02/2001 ENC STD Client Subtotal $20.00 000043927 04/24/2001 58300 $11.00 05/08/2001 SFD FPP Client Subtotal $11.00 000044269 04/23/2001 90745 $15.00 04/23/2001 ENC IM Client Subtotal $15.00 000044629 02/28/2001 90716 $15.00 02/28/2001 ENC IM 000044629 02/28/2001 X0718 $15.00 02/28/2001 ENC IM 000044629 02/28/2001 90745 $15.00 02/28/2001 ENC IM Client Subtotal $45.00 000044753 05/18/2001 00269 $20.00 05/18/2001 PYMT FPP Client Subtotal $20.00 000044783 08/16/1999 00047 $14.00 02/15/2001 TRNF FPP Client Subtotal $14.00 02/12/2002 Weld County Health Department Page 6 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000044852 04/06/2001 88142 $30.00 04/06/2001 ENC FPP Client Subtotal $30.00 000045202 06/29/2001 90744 $15.00 06/29/2001 ENC IM Client Subtotal $15.00 000045752 06/06/2001 99204 $13.00 06/06/2001 PYMT FPP 000045752 06/06/2001 87110 $10.00 06/06/2001 ENC FPP 000045752 06/06/2001 00040 $24.00 06/06/2001 SFD FPP 000045752 06/06/2001 85018 $4.00 06/06/2001 SFD FPP _ .. Client Subtotal $51.00 000045851 03/07/2001 90707 $15.00 03/07/2001 ENC IM 000045851 03/07/2001 X0730 $15.00 03/07/2001 ENC IM _ Client Subtotal $30.00 000046070 01/02/2001 90713 $15.00 01/02/2001 ENC CHP 000046070 01/02/2001 90707 $15.00 01/02/2001 ENC CHP 000046070 01/02/2001 00400 $15.00 01/02/2001 ENC CHP 000046070 01/02/2001 81002 $1.00 01/02/2001 SFD CHP Client Subtotal $46.00 000047201 04/04/2001 90716 $6.00 04/04/2001 PYMT IM Client Subtotal $6.00 000048018 05/23/2001 99212 $4.00 05/23/2001 PYMT FPP Client Subtotal $4.00 000048289 05/10/2001 X0730 $15.00 05/18/2001 ENC COP Client Subtotal $15.00 000048860 03/07/2001 85018 $1.00 03/20/2001 SFD FPP Client Subtotal $1.00 000049615 05/21/2001 00269 $25.00 05/21/2001 ENC STD 000049615 05/21/2001 87110 $10.00 05/21/2001 ENC STD 000049615 05/21/2001 99214 $30.00 05/21/2001 SFD STD Client Subtotal $65.00 000049630 02/23/2001 X0730 $15.00 02/23/2001 ENC IM 000049630 02/23/2001 90713 $15.00 02/23/2001 ENC IM Client Subtotal $30.00 000050043 02/16/2001 00013 $7.00 02/16/2001 PYMT FPP Client Subtotal $7.00 000050438 02/02/2001 90707 $15.00 • 02/02/2001 ENC IM 000050438 02/02/2001 00400 $15.00 02/02/2001 ENC IM 000050438 02/02/2001 90716 $15.00 02/02/2001 ENC IM 000050438 02/02/2001 90713 $15.00 02/02/2001 ENC IM Client Subtotal $60.00 000051371 01/22/2001 X0730 $15.00 01/22/2001 ENC IM Client Subtotal $15.00 02/12/2002 Weld County Health Department Page 7 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000051459 03/23/2001 X0718 $15.00 03/23/2001 ENC IM 000051459 03/23/2001 90745 $15.00 03/23/2001 ENC IM Client Subtotal $30.00 000052106 01/17/2001 90707 $15.00 01/17/2001 ENC IM 000052106 01/17/2001 00400 $15.00 01/17/2001 ENC IM 000052106 01/17/2001 90744 $15.00 01/17/2001 ENC IM 000052106 01/17/2001 90716 $15.00 01/17/2001 ENC IM 000052106 01/17/2001 90713 $15.00 01/17/2001 ENC IM _ ._ Client Subtotal $75.00 000052185 01/26/2001 00043 $2.00 02/02/2001 PYMT FPP --- Client Subtotal $2.00 000052246 03/2672001 X5571 $255.00 03/28/2001 ENC PNP Client Subtotal $255.00 000052355 02/12/2001 00037 $40.00 02/12/2001 PYMT FPP Client Subtotal $40.00 000052358 02/23/2001 90669 $15.00 02/23/2001 ENC IM 000052358 02/23/2001 X0730 $15.00 02/23/2001 ENC IM 000052358 02/23/2001 90707 $15.00 02/23/2001 ENC IM Client Subtotal $45.00 000052409 02/26/2001 X0730 $2.00 04/16/2001 MDD IM Client Subtotal $2.00 000052418 01/29/2001 00051 $9.00 01/29/2001 PYMT FPP 000052418 03/21/2001 85018 $1.00 03/21/2001 SFD FPP Client Subtotal $10.00 000052435 01/19/2001 90713 $15.00 01/19/2001 ENC IM 000052435 01/19/2001 00400 $4.00 01/19/2001 PYMT IM 000052435 01/19/2001 90707 $15.00 01/19/2001 ENC IM Client Subtotal $34.00 000052558 01/19/2001 00045 $13.00 04/13/2001 PYMT FPP 000052558 04/13/2001 00045 $49.00 04/13/2001 SFD FPP Client Subtotal $62.00 000052663 06/01/2001 00040 $1.00 06/01/2001 PYMT FPP Client Subtotal $1.00 000053355 05/18/2001 90707 $15.00 05/18/2001 ENC IM Client Subtotal • $15.00 • 000053619 03/30/2001 X5571 $255.00 04/02/2001 ENC PNP Client Subtotal $255.00 000053918 02/23/2001 90716 $15.00 02/23/2001 ENC IM 000053918 02/23/2001 90713 $15.00 02/23/2001 ENC IM 000053918 02/23/2001 00400 $15.00 02/23/2001 ENC IM Client Subtotal $45.00 02/12/2002 Weld County Health Department Page 8 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000053925 01/22/2001 90745 $15.00 01/22/2001 ENC IM 000053925 01/22/2001 X0730 $15.00 01/22/2001 ENC IM Client Subtotal $30.00 000053934 01/10/2001 00300 $35.00 01/10/2001 ENC FPP Client Subtotal $35.00 000054312 06/20/2001 90716 $15.00 06/20/2001 ENC IM 000054312 06/20/2001 90707 $15.00 06/20/2001 ENC IM 000054312 06/20/2001 90713 $15.00 06/20/2001 ENC IM _ -. Client Subtotal $45.00 000054355 01/24/2001 00004 $5.00 01/24/2001 ENC FPP 000054355 01/24/2001 81002 $1.00 01/24/2001 SFD FPP _ Client Subtotal $6.00 000054805 01/17/2001 90745 $15.00 01/17/2001 ENC IM Client Subtotal $15.00 000054830 01/22/2001 00014 $5.00 01/22/2001 ENC CDP Client Subtotal $5.00 000055001 01/19/2001 90745 $15.00 01/19/2001 ENC IM Client Subtotal $15.00 000055408 06/11/2001 87110 $10.00 06/11/2001 ENC STD 000055408 06/11/2001 99214 $5.00 06/11/2001 PYMT STD Client Subtotal $15.00 000055435 06/25/1999 00037 $10.00 02/14/2001 TRNF FPP 000055435 06/25/1999 00045 $10.00 02/14/2001 TRNF FPP Client Subtotal $20.00 000055796 03/27/2001 00016 $8.00 04/24/2001 PYMT FPP 000055796 06/05/2001 00009 $5.00 06/05/2001 ENC FPP Client Subtotal $13.00 000055881 05/11/2001 X0730 $15.00 05/11/2001 ENC IM Client Subtotal $15.00 000055968 01/04/2001 X5578 $60.00 01/08/2001 ENC PE Client Subtotal $60.00 000056084 05/21/2001 X0730 $15.00 05/21/2001 ENC IM 000056084 05/21/2001 90707 $15.00 05/21/2001 ENC IM Client Subtotal $30.00 000056335 04/16/2001 X5560 $22.00 04/16/2001 SFD FPP 000056335 04/16/2001 00030 $5.00 04/16/2001 SFD FPP Client Subtotal $27.00 000056653 02/28/2001 90713 $15.00 02/28/2001 ENC IM 000056653 02/28/2001 90716 $15.00 02/28/2001 ENC IM Client Subtotal $30.00 000056781 05/04/2001 X5560 $10.00 05/04/2001 PYMT FPP 02/12/2002 Weld County Health Department Page 9 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $10.00 000056842 01/10/2001 90745 $15.00 01/10/2001 ENC IM Client Subtotal $15.00 000057578 06/15/2001 00030 $5.00 06/15/2001 SFD FPP Client Subtotal $5.00 000057699 01/22/2001 X0730 $15.00 01/22/2001 ENC IM Client Subtotal $15.00 000057856 05/14/1999 00047 $7.00 02/15/2001 TRNF FPP _ __ Client Subtotal $7.00 000057937 06/13/2001 85018 $1.00 06/13/2001 SFD FPP Client Subtotal $1.00 000058119 06/29/2001 00030 $5.00 06/29/2001 SFD FPP 000058119 06/29/2001 00045 $70.00 06/29/2001 SFD FPP Client Subtotal $75.00 000058175 03/02/2001 00040 $84.00 03/02/2001 SFD FPP 000058175 03/02/2001 99214 $15.00 03/02/2001 SFD FPP Client Subtotal $99.00 000058558 02/23/2001 90707 $15.00 02/23/2001 ENC IM 000058558 02/23/2001 00400 $15.00 02/23/2001 ENC IM 000058558 02/23/2001 90716 $15.00 02/23/2001 ENC IM Client Subtotal $45.00 000059616 04/25/2001 85018 $1.00 05/03/2001 SFD FPP Client Subtotal $1.00 000059634 07/30/1999 00009 $3.00 02/14/2001 SFD FPP Client Subtotal $3.00 000059838 01/26/2001 90745 $15.00 01/26/2001 ENC IM Client Subtotal $15.00 000059914 04/05/1999 00133 $8.00 02/13/2001 TRNF IM Client Subtotal $8.00 000060094 02/26/2001 90716 $15.00 02/26/2001 ENC im 000060094 02/26/2001 X0730 $15.00 02/26/2001 ENC im 000060094 02/26/2001 90713 $15.00 02/26/2001 ENC im 000060094 02/26/2001 90707 $15.00 02/26/2001 ENC im 000060094 02/26/2001 90669 $15.00 02/26/2001 ENC im 000060094 02/26/2001 00133 $15.00 02/26/2001 ENC im 000060094 02/26/2001 00400 $15.00 02/26/2001 ENC im Client Subtotal $105.00 000060095 06/22/2001 00133 $5.00 06/22/2001 PYMT IM 000060095 06/22/2001 90713 $15.00 06/22/2001 ENC IM 000060095 06/22/2001 90669 $15.00 06/22/2001 ENC IM 000060095 06/22/2001 00400 $15.00 06/22/2001 ENC IM 02/12/2002 Weld County Health Department Page 10 of 32 Write-Off Detail Report (Write-OJfDate 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $50.00 000060102 03/09/2001 90669 $15.00 03/09/2001 ENC IM 000060102 03/09/2001 X0730 $15.00 03/09/2001 ENC IM Client Subtotal $30.00 000060113 03/05/2001 X0730 $15.00 03/05/2001 ENC IM Client Subtotal $15.00 000060349 06/25/1999 00133 $8.00 02/13/2001 TRNF IM Client Subtotal $8.00 000061361 01/08/2001 00013 $15.00 01/08/2001 ENC FPP Client Subtotal $15.00 000061545 0.1/05/2001 00113 $10.00 01/04/2001 PYMT IM _ Client Subtotal $10.00 000061590 06/18/2001 99213 $12.00 06/18/2001 PYMT FPP 000061590 06/18/2001 00033 $3.00 06/18/2001 SFr) FPP Client Subtotal $15.00 000061917 11/06/2000 90732 $5.00 01/24/2001 PYMT IM 000061917 01/24/2001 00127 $25.00 01/24/2001 ENC IM Client Subtotal $30.00 000061954 04/30/2001 90713 $15.00 04/30/2001 ENC IM 000061954 04/30/2001 90716 $15.00 04/30/2001 ENC IM 000061954 04/30/2001 90707 $15.00 04/30/2001 ENC IM 000061954 04/30/2001 90669 $15.00 04/30/2001 ENC IM Client Subtotal $60.00 000062277 12/21/2000 90713 $8.00 01/03/2001 ENC COP Client Subtotal $8.00 000062318 04/20/2001 90745 $15.00 04/20/2001 ENC IM Client Subtotal $15.00 000062448 05/11/2001 90745 $10.00 05/11/2001 PYMT IM Client Subtotal $10.00 000062743 05/04/2001 00400 $15.00 05/04/2001 ENC IM 000062743 05/04/2001 90669 $15.00 05/04/2001 ENC IM 000062743 05/04/2001 90713 $15.00 05/04/2001 ENC IM 000062743 05/04/2001 00133 $15.00 05/04/2001 ENC IM 000062743 05/04/2001 90707 $15.00 05/04/2001 ENC IM 000062743 05/04/2001 90716 $15.00 05/04/2001 ENC IM Client Subtotal $90.00 000062965 01/05/2001 00300 $30.00 01/05/2001 PYMT FPP Client Subtotal $30.00 000063335 02/26/2001 90669 $15.00 02/26/2001 ENC IM 000063335 02/26/2001 00400 $15.00 02/26/2001 ENC IM Client Subtotal $30.00 02/12/2002 Weld County Health Department Page 11 of 32 Write-Off Detail Report (Write-Of Date 06/30/2001) - Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000063960 03/26/2001 00014 $5.00 03/26/2001 ENC CDP 000063960 03/26/2001 00014 $5.00 03/26/2001 ENC CDP Client Subtotal $10.00 000064242 01/15/2001 00133 $15.00 01/15/2001 ENC IM 000064242 01/15/2001 90707 $15.00 01/15/2001 ENC IM 000064242 01/15/2001 90716 $15.00 01/15/2001 ENC IM 000064242 01/15/2001 90669 $15.00 01/15/2001 ENC IM Client Subtotal $60.00 - - 000064247 11/16/2000 X0718 $8.00 01/15/2001 BCK COP 000064247 11/16/2000 90707 $8.00 01/15/2001 BCK COP 000064247 1-1/16/2000 90745 $8.00 01/15/2001 BCK COP Client Subtotal $24.00 000064288 01/19/2001 X5560 $22.00 01/19/2001 SFD FPP 000064288 01/19/2001 00030 $5.00 01/19/2001 SFD FPP Client Subtotal $27.00 000064436 02/26/2001 90716 $15.00 02/26/2001 ENC IM 000064436 02/26/2001 90707 $15.00 02/26/2001 ENC IM 000064436 02/26/2001 90669 $15.00 02/26/2001 ENC IM 000064436 02/26/2001 00400 $15.00 02/26/2001 ENC IM 000064436 02/26/2001 00133 $15.00 02/26/2001 ENC IM Client Subtotal $75.00 000064442 02/26/2001 00400 $8.00 02/26/2001 PYMT IM 000064442 02/26/2001 90707 $15.00 02/26/2001 ENC IM Client Subtotal $23.00 000064611 05/11/2001 00040 $8.00 06/13/2001 PYMT FPP Client Subtotal $8.00 000064745 04/13/2001 00400 $15.00 04/13/2001 ENC IM Client Subtotal $15.00 000065101 01/26/2001 90745 $15.00 01/26/2001 ENC IM Client Subtotal $15.00 000065103 01/26/2001 90745 $15.00 01/26/2001 ENC IM Client Subtotal $15.00 000065171 02/23/2001 X5571 $255.00 03/26/2001 ENC PNP Client Subtotal $255.00 000065252 03/28/2001 90716 $15.00 03/28/2001 ENC IM 000065252 03/28/2001 90707 $15.00 03/28/2001 ENC IM 000065252 03/28/2001 90669 $15.00 03/28/2001 ENC IM 000065252 03/28/2001 00400 $15.00 03/28/2001 ENC IM 000065252 03/28/2001 00133 $15.00 03/28/2001 ENC IM Client Subtotal $75.00 000065408 03/05/2001 00133 $15.00 03/05/2001 ENC IM 02/12/2002 Weld County Health Department Page 12 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $15.00 000065587 04/16/2001 90707 $5.00 04/16/2001 PYMT IM 000065587 04/16/2001 X0730 $15.00 04/16/2001 ENC IM Client Subtotal $20.00 000065677 04/04/2001 00113 $10.00 04/04/2001 PYMT IM 000065677 04/04/2001 X0707 $35.00 04/04/2001 ENC IM Client Subtotal $45.00 000065686 01/15/2001 85018 - $1.00 01/15/2001 SFD FPP - -- Client Subtotal $1.00 000065739 09/18/2000 90716 $6.00 06/04/2001 PYMT IM 000065739 06/04/2001 90745 $15.00 06/04/2001 ENC IM - Client Subtotal $21.00 000065854 03/28/2001 X5572 $459.00 03/28/2001 ENC PNP Client Subtotal $459.00 000065879 08/28/2000 907/3 $4.00 02/12/2001 PYMT IM 000065879 02/12/2001 90669 $15.00 02/12/2001 ENC IM 000065879 02/12/2001 90713 $15.00 02/12/2001 ENC IM 000065879 02/12/2001 00400 $15.00 02/12/2001 ENC IM Client Subtotal $49.00 000066067 01/26/2001 90669 $4.00 01/26/2001 PYMT IM 000066067 01/26/2001 907/3 $15.00 01/26/2001 ENC IM 000066067 03/21/2001 90669 $15.00 03/21/2001 ENC IM Client Subtotal $34.00 000066146 04/25/2001 X0730 $15.00 04/25/2001 ENC IM 000066146 04/25/2001 90669 $15.00 04/25/2001 ENC IM Client Subtotal $30.00 000066147 04/25/2001 90669 $15.00 04/25/2001 ENC IM 000066147 04/25/2001 90707 $15.00 04/25/2001 ENC TM 000066147 04/25/2001 90716 $15.00 04/25/2001 ENC IM Client Subtotal $45.00 000066160 03/30/2001 X5572 $459.00 04/02/2001 ENC PNP Client Subtotal $459.00 000066179 06/08/2001 00033 $3.00 06/08/2001 SFD FPP 000066179 06/08/2001 85018 $3.00 06/08/2001 SFD FPP 000066179 06/08/2001 00035 $3.00 06/08/2001 SFD FPP 000066179 06/08/2001 00040 $21.00 06/08/2001 SFD FPP Client Subtotal $30.00 000066218 04/19/2001 90745 $15.00 04/26/2001 ENC COP Client Subtotal $15.00 000066410 04/20/2001 90669 $15.00 04/20/2001 ENC IM 000066410 04/20/2001 00400 $15.00 04/20/2001 ENC IM 02/12/2002 Weld County Health Department Page 13 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Mr Amount Date Code Code Client Subtotal $30.00 000066450 10/06/2000 00300 $32.00 01/15/2001 PYMT FPP Client Subtotal $32.00 000066516 06/20/2001 X0730 $15.00 06/20/2001 ENC IM Client Subtotal $15.00 000066518 06/20/2001 X0730 $15.00 06/20/2001 ENC IM 000066518 06/20/2001 90713 $15.00 06/20/2001 ENC IM 000066518 06/20/2001 90744 $15.00 06/20/2001 ENC IM _ _- Client Subtotal $45.00 000066681 05/23/2001 90716 $15.00 05/23/2001 ENC IM ___ Client Subtotal $15.00 000066702 05/07/2001 99203 $10.00 05/07/2001 SFD FPP Client Subtotal $10.00 000066707 10/30/2000 90744 $7.00 02/14/2001 PYMT IM 000066707 02/14/2001 X0730 $15.00 02/14/2001 ENC IM 000066707 02/14/2001 90744 $15.00 02/14/2001 ENC IM Client Subtotal $37.00 000066725 01/15/2001 90745 $15.00 01/15/2001 ENC IM Client Subtotal $15.00 000066726 01/15/2001 90745 $15.00 01/15/2001 ENC IM Client Subtotal $15.00 000066766 02/23/2001 99212 $40.00 06/24/2001 RWO FPP Client Subtotal $40.00 000066804 01/22/2001 90745 $15.00 01/22/2001 ENC IM Client Subtotal $15.00 000066816 06/27/2001 90707 $15.00 06/27/2001 ENC IM Client Subtotal $15.00 000066850 01/10/2001 90707 $15.00 01/10/2001 ENC IM Client Subtotal $15.00 000066866 01/10/2001 90707 $15.00 01/10/2001 ENC IM 000066866 01/10/2001 90745 $15.00 01/10/2001 ENC IM Client Subtotal $30.00 000066867 01/31/2001 90745 $15.00 01/31/2001 ENC IM Client Subtotal $15.00 000066868 01/31/2001 90745 $9.00 01/31/2001 PYMT IM Client Subtotal $9.00 000066869 01/10/2001 90744 $15.00 01/10/2001 ENC IM Client Subtotal $15.00 000066917 02/23/2001 90744 $15.00 02/23/2001 ENC IM Client Subtotal $15.00 000066920 08/26/2000 90744 $4.00 03/28/2001 PYMT IM 02/12/2002 Weld County Health Department Page 14 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000066920 03/28/2001 90744 $15.00 03/28/2001 ENC IM Client Subtotal $19.00 000066954 01/17/2001 90745 $15.00 01/17/2001 ENC IM Client Subtotal $15.00 000066955 09/06/2000 90707 $3.00 03/26/2001 PYMT IM 000066955 03/28/2001 X0730 $15.00 03/28/2001 ENC IM 000066955 03/28/2001 90745 $15.00 03/28/2001 ENC IM Client Subtotal $33.00 - -- 000066956 09/06/2000 90707 $1.00 03/26/2001 PYMT IM Client Subtotal $1.00 000067019 05/09/2001 00400 $15.00 05/09/2001 ENC IM _ 000067019 05/0972001 90713 $15.00 05/09/2001 ENC IM 000067019 05/09/2001 90744 $15.00 05/09/2001 ENC IM Client Subtotal $45.00 000067027 05/07/2001 90713 $15.00 05/07/2001 ENC IM 000067027 05/07/2001 X0718 $15.00 05/07/2001 ENC IM 000067027 05/07/2001 90744 $15.00 05/07/2001 ENC IM Client Subtotal $45.00 000067028 01/29/2001 90745 $15.00 01/29/2001 ENC IM Client Subtotal $15.00 000067031 04/02/2001 90744 $15.00 04/02/2001 ENC IM 000067031 04/02/2001 X0730 $15.00 04/02/2001 ENC IM Client Subtotal $30.00 000067032 04/02/2001 90745 $15.00 04/02/2001 ENC IM 000067032 04/02/2001 X0730 $15.00 04/02/2001 ENC IM Client Subtotal $30.00 000067035 04/16/2001 X0730 $15.00 04/16/2001 ENC IM 000067035 04/16/2001 90745 $15.00 04/16/2001 ENC IM Client Subtotal $30.00 000067047 02/07/2001 90745 $7.00 02/07/2001 PYMT IM Client Subtotal $7.00 000067099 01/15/2001 90713 $15.00 01/15/2001 ENC IM 000067099 01/15/2001 X0730 $15.00 01/15/2001 ENC IM 000067099 01/15/2001 00400 $15.00 01/15/2001 ENC IM Client Subtotal $45.00 000067100 01/17/2001 90745 $15.00 01/17/2001 ENC IM Client Subtotal $15.00 000067122 09/06/2000 X0718 $4.00 05/09/2001 PYMT IM 000067122 05/09/2001 90745 $15.00 05/09/2001 ENC IM Client Subtotal $19.00 000067138 04/18/2001 90745 $15.00 04/18/2001 ENC IM 02/12/2002 Weld County Health Department Page 15 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $15.00 000067139 01/29/2001 90745 $15.00 01/29/2001 ENC IM Client Subtotal $15.00 000067191 01/17/2001 90745 $15.00 01/17/2001 ENC IM Client Subtotal $15.00 000067329 02/07/2001 90744 $15.00 02/07/2001 ENC IM 000067329 02/07/2001 90713 $15.00 02/07/2001 ENC IM 000067329 02/07/2001 00400 $15.00 02/07/2001 ENC IM . -- Client Subtotal $45.00 000067333 04/04/2001 90745 $15.00 04/04/2001 ENC IM Client Subtotal $15.00 000067339 01/2412001 90745 $15.00 01/24/2001 ENC IM Client Subtotal $15.00 000067349 01/19/2001 90744 $5.00 01/19/2001 PYMT IM Client Subtotal $5.00 000067358 04/30/2001 90745 $15.00 04/30/2001 ENC IM Client Subtotal $15.00 000067373 09/20/2000 X0718 $1.00 04/16/2001 PYMT IM 000067373 04/16/2001 90745 $15.00 04/16/2001 ENC IM Client Subtotal $16.00 000067428 01/05/2001 85018 $1.00 01/05/2001 SFD FPP Client Subtotal $1.00 000067447 04/02/2001 90669 $15.00 04/02/2001 ENC IM 000067447 04/02/2001 90707 $15.00 04/02/2001 ENC IM 000067447 04/02/2001 90716 $15.00 04/02/2001 ENC IM 000067447 04/02/2001 90713 $15.00 04/02/2001 ENC IM Client Subtotal $60.00 000067536 04/02/2001 X0730 $15.00 04/02/2001 ENC IM 000067536 04/02/2001 90745 $15.00 04/02/2001 ENC IM Client Subtotal $30.00 000067541 02/28/2001 90707 $15.00 02/28/2001 ENC IM 000067541 02/28/2001 90744 $15.00 02/28/2001 ENC IM Client Subtotal $30.00 000067569 02/14/2001 90713 $15.00 02/14/2001 ENC IM 000067569 02/14/2001 90669 $15.00 02/14/2001 ENC IM 000067569 02/14/2001 00133 $15.00 02/14/2001 ENC IM 000067569 02/14/2001 00400 $15.00 02/14/2001 ENC IM 000067569 03/28/2001 90669 $15.00 03/28/2001 ENC IM 000067569 03/28/2001 00400 $15.00 03/28/2001 ENC IM 000067569 03/28/2001 90713 $15.00 03/28/2001 ENC IM Client Subtotal $105.00 02/12/2002 Weld County Health Department Page 16 of 32 Write-Off Detail Report (Write-Off Date06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000067571 02/14/2001 90669 $15.00 02/14/2001 ENC IM 000067571 02/14/2001 90707 $15.00 02/14/2001 ENC IM Client Subtotal $30.00 000067607 02/26/2001 00400 $15.00 02/26/2001 ENC IM 000067607 02/26/2001 90707 $15.00 02/26/2001 ENC IM 000067607 02/26/2001 00133 $15.00 02/26/2001 ENC IM 000067607 02/26/2001 90669 $15.00 02/26/2001 ENC IM 000067607 06/04/2001 00400 $15.00 06/04/2001 ENC 000067607 06/04/2001 90669 $15.00 06/04/2001 ENC IM 000067607 06/04/2001 90713 $15.00 06/04/2001 ENC IM --. Client Subtotal $105.00 000067663 03/07/2001 X0730 $15.00 03/07/2001 ENC IM - 000067663 03/07/2001 90745 $15.00 03/07/2001 ENC IM 000067663 03/07/2001 90707 $15.00 03/07/2001 ENC IM Client Subtotal $45.00 000067716 01/17/2001 90745 $10.00 01/17/2001 PYMT IM Client Subtotal $10.00 000067721 02/07/2001 00133 $15.00 02/07/2001 ENC IM 000067721 02/07/2001 00400 $15.00 02/07/2001 ENC IM 000067721 02/07/2001 90713 $15.00 02/07/2001 ENC IM Client Subtotal $45.00 000067752 02/28/2001 90707 $15.00 03/06/2001 ENC IM Client Subtotal $15.00 000067795 12/27/2000 00400 $5.00 04/18/2001 PYMT IM 000067795 04/18/2001 90713 $15.00 04/18/2001 ENC IM 000067795 04/18/2001 90669 $15.00 04/18/2001 ENC IM 000067795 04/18/2001 00400 $15.00 04/18/2001 ENC IM Client Subtotal $50.00 000067845 01/10/2001 90744 $4.00 01/10/2001 PYMT IM Client Subtotal $4.00 000067846 01/10/2001 90707 $15.00 01/10/2001 ENC IM 000067846 01/10/2001 90744 $15.00 01/10/2001 ENC IM Client Subtotal $30.00 000067847 01/10/2001 90707 $15.00 01/10/2001 ENC IM 000067847 01/10/2001 90744 $15.00 01/10/2001 ENC IM Client Subtotal $30.00 000067848 01/10/2001 90744 $4.00 01/10/2001 PYMT IM Client Subtotal $4.00 000067876 01/10/2001 90745 $15.00 01/10/2001 ENC IM Client Subtotal $15.00 000067923 01/02/2001 90669 $15.00 01/02/2001 ENC CHP 02/12/2002 Weld County Health Department Page 17 of 32 Write-Off Detail Report . (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000067923 01/02/2001 00133 $15.00 01/02/2001 ENC CHP 000067923 01/02/2001 00400 $15.00 01/02/2001 ENC CHP 000067923 01/02/2001 90713 $15.00 01/02/2001 ENC CHP Client Subtotal $60.00 000067940 04/18/2001 90745 $15.00 04/18/2001 ENC IM 000067940 04/18/2001 X0730 $15.00 04/18/2001 ENC IM Client Subtotal $30.00 000067992 02/23/2001 X0730 $15.00 02/23/2001 ENC IM - __ 000067992 02/23/2001 X0718 $5.00 02/23/2001 PYMT IM Client Subtotal $20.00 000068029 01/24/2001 90744 $15.00 01/25/2001 ENC IM Client Subtotal $15.00 000068040 03/30/2001 X0718 $15.00 03/30/2001 ENC IM Client Subtotal $15.00 000068051 04/25/2001 87210 $10.00 04/25/2001 ENC FPP 000068051 04/25/2001 85018 $3.00 04/25/2001 SFD FPP 000068051 04/25/2001 87110 $8.00 04/25/2001 PYMT FPP 000068051 04/25/2001 00046 $21.00 04/25/2001 SFD FPP Client Subtotal $42.00 000068131 11/22/2000 90744 $4.00 03/12/2001 PYMT IM 000068131 03/12/2001 00400 $15.00 03/12/2001 ENC IM 000068131 03/12/2001 90669 $15.00 03/12/2001 ENC IM 000068131 03/12/2001 X0737 $15.00 03/12/2001 ENC IM 000068131 05/21/2001 90669 $15.00 05/21/2001 ENC 1M Client Subtotal $64.00 000068132 11/22/2000 00400 $3.00 03/23/2001 PYMT IM 000068132 01/22/2001 90713 $15.00 01/22/2001 ENC IM 000068132 01/22/2001 X0737 $15.00 01/22/2001 ENC IM 000068132 01/22/2001 00400 $15.00 01/22/2001 ENC IM 000068132 03/23/2001 00400 $15.00 03/23/2001 ENC IM 000068132 03/23/2001 X0737 $15.00 03/23/2001 ENC IM 000068132 03/23/2001 90713 $15.00 03/23/2001 ENC IM 000068132 06/04/2001 90669 $15.00 06/04/2001 ENC IM Client Subtotal $108.00 000068163 04/11/2001 X0730 $15.00 04/11/2001 ENC IM Client Subtotal $15.00 000068228 01/18/2001 90745 $15.00 01/24/2001 ENC COP 000068228 04/19/2001 90745 $15.00 04/26/2001 ENC COP Client Subtotal $30.00 000068246 03/23/2001 90713 $15.00 03/23/2001 ENC IM 000068246 03/23/2001 90669 $9.00 03/23/2001 PYMT IM 02/12/2002 Weld County Health Department Page 18 of 32 Write-Off Detail Report (Write-Of Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $24.00 000068259 02/14/2001 00400 $15.00 02/14/2001 ENC IM 000068259 02/14/2001 00133 $15.00 02/14/2001 ENC IM 000068259 02/14/2001 90669 $15.00 02/14/2001 ENC IM 000068259 02/14/2001 90713 $15.00 02/14/2001 ENC 1M Client Subtotal $60.00 000068316 01/09/2001 00133 $15.00 02/13/2001 TRNF CHP Client Subtotal $15.00 000068379 01/22/2001 00133 $15.00 02/13/2001 TRNF IM Client Subtotal $15.00 000068548 01105/2001 90724 $10.00 01/05/2001 ENC IM Client Subtotal $10.00 000068559 12/21/2000 X0718 $8.00 01/03/2001 ENC COP 000068559 12/21/2000 90745 $8.00 01/03/2001 ENC COP 000068559 12/21/2000 90707 $8.00 01/03/2001 ENC COP 000068559 05/02/2001 90745 $15.00 05/10/2001 ENC COP Client Subtotal $39.00 000068560 05/02/2001 90745 $15.00 05/10/2001 ENC COP Client Subtotal $15.00 000068566 12/21/2000 90707 $8.00 01/03/2001 ENC COP 000068566 12/21/2000 00400 $8.00 01/03/2001 ENC COP 000068566 12/21/2000 90713 $8.00 01/03/2001 ENC COP Client Subtotal $24.00 000068567 12/21/2000 90745 $8.00 01/03/2001 ENC COP Client Subtotal $8.00 000068571 12/21/2000 X0718 $8.00 01/03/2001 ENC COP 000068571 12/21/2000 90707 $8.00 01/03/2001 ENC COP Client Subtotal $16.00 000068572 12/21/2000 90707 $8.00 01/03/2001 ENC COP 000068572 12/21/2000 90745 $8.00 01/03/2001 ENC COP 000068572 12/21/2000 X0718 $8.00 01/03/2001 ENC COP Client Subtotal $24.00 000068579 05/02/2001 90745 $15.00 05/10/2001 ENC COP Client Subtotal $15.00 000068600 02/20/2001 90745 $15.00 02/27/2001 ENC COP Client Subtotal $15.00 000068604 05/02/2001 90745 $15.00 05/10/2001 ENC COP Client Subtotal $15.00 000068622 04/09/2001 00051 $32.00 04/09/2001 PYMT FPP Client Subtotal $32.00 000068629 01/03/2001 90713 $15.00 01/03/2001 ENC IM 02/12/2002 Weld County Health Department Page 19 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000068629 01/03/2001 90707 $5.00 01/03/2001 PYMT IM 000068629 01/03/2001 90716 $15.00 01/03/2001 ENC IM 000068629 01/03/2001 90744 $15.00 01/03/2001 ENC IM Client Subtotal $50.00 000068642 02/21/2001 85018 $1.00 02/21/2001 SFD FPP Client Subtotal $1.00 000068647 01/15/2001 90744 $5.00 01/15/2001 PYMT IM Client Subtotal $5.00 000068651 03/02/2001 90707 $15.00 03/20/2001 TRNF IM 000068651 03/02/2001 90744 $15.00 03/20/2001 TRNF IM -- Client Subtotal $30.00 000068652 01/10/2001 90707 $15.00 01/10/2001 ENC IM 000068652 01/10/2001 90713 $15.00 01/10/2001 ENC IM 000068652 04/13/2001 90716 $15.00 04/13/2001 ENC IM 000068652 04/13/2001 90707 $15.00 04/13/2001 ENC IM Client Subtotal $60.00 000068654 01/10/2001 X0718 $10.00 04/13/2001 PYMT IM 000068654 04/13/2001 90707 $15.00 04/13/2001 ENC IM 000068654 04/13/2001 90716 $15.00 04/13/2001 ENC IM Client Subtotal $40.00 000068710 01/08/2001 90707 $10.00 01/08/2001 PYMT IM 000068710 01/08/2001 90744 $15.00 01/08/2001 ENC IM Client Subtotal $25.00 000068723 01/22/2001 X0730 $15.00 01/22/2001 ENC IM 000068723 01/22/2001 90716 $5.00 01/22/2001 PYMT IM Client Subtotal $20.00 000068724 01/22/2001 90716 $15.00 01/22/2001 ENC IM 000068724 01/22/2001 90669 $15.00 01/22/2001 ENC IM Client Subtotal $30.00 000068726 01/24/2001 X0730 $15.00 01/25/2001 ENC IM 000068726 01/24/2001 90716 $15.00 01/25/2001 ENC IM 000068726 01/24/2001 90707 $15.00 01/25/2001 ENC IM 000068726 03/16/2001 90713 $15.00 03/16/2001 ENC IM 000068726 03/16/2001 00400 $15.00 03/16/2001 ENC IM Client Subtotal $75.00 000068745 01/17/2001 90707 $15.00 01/17/2001 ENC IM 000068745 01/17/2001 90716 $15.00 01/17/2001 ENC IM 000068745 01/17/2001 90713 $15.00 01/17/2001 ENC IM Client Subtotal $45.00 000068759 03/29/2001 90745 $15.00 04/05/2001 ENC COP Client Subtotal $15.00 02/12/2002 Weld County Health Department Page 20 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000068784 01/17/2001 00400 $15.00 01/17/2001 ENC IM 000068784 01/17/2001 90713 $15.00 01/17/2001 ENC IM Client Subtotal $30.00 000068799 01/17/2001 00400 $15.00 01/17/2001 ENC IM 000068799 01/17/2001 90669 $15.00 01/17/2001 ENC IM 000068799 01/17/2001 90713 $15.00 01/17/2001 ENC IM 000068799 01/17/2001 00133 $15.00 01/17/2001 ENC IM Client Subtotal $60.00 000068803 01/17/2001 00133 $15.00 01/17/2001 ENC IM 000068803 01/17/2001 00400 $15.00 01/17/2001 ENC IM 000068803 01/17/2.001 90707 $15.00 01/17/2001 ENC IM - Client Subtotal $45.00 000068804 01/17/2001 90716 $15.00 01/17/2001 ENC IM 000068804 01/17/2001 00400 $15.00 01/17/2001 ENC IM Client Subtotal $30.00 000068805 05/30/2001 90707 $15.00 05/30/2001 ENC IM 000068805 05/30/2001 X0730 $15.00 05/30/2001 ENC IM Client Subtotal $30.00 000068816 01/22/2001 00133 $15.00 02/13/2001 TRNF IM Client Subtotal $15.00 000068825 01/22/2001 00400 $12.00 01/22/2001 PYMT IM 000068825 01/22/2001 90713 $15.00 01/22/2001 ENC IM 000068825 01/22/2001 90669 $15.00 01/22/2001 ENC IM Client Subtotal $42.00 000068832 01/22/2001 00014 $5.00 01/22/2001 ENC CDP Client Subtotal $5.00 000068846 01/22/2001 00133 $15.00 01/22/2001 ENC IM 000068846 01/22/2001 90713 $15.00 01/22/2001 ENC IM 000068846 01/22/2001 00400 $15.00 01/22/2001 ENC IM Client Subtotal $45.00 000068867 05/23/2001 90744 $15.00 05/23/2001 ENC IM Client Subtotal $15.00 000068873 01/24/2001 90716 $15.00 01/25/2001 ENC IM 000068873 01/24/2001 90713 $15.00 01/25/2001 ENC IM 000068873 01/24/2001 90707 $15.00 01/25/2001 ENC IM 000068873 01/24/2001 00400 $15.00 01/25/2001 ENC IM 000068873 01/24/2001 90744 $15.00 01/25/2001 ENC IM 000068873 03/26/2001 90744 $15.00 03/26/2001 ENC IM 000068873 03/26/2001 X0730 $15.00 03/26/2001 ENC IM 000068873 03/26/2001 90713 $15.00 03/26/2001 ENC IM 000068873 03/26/2001 00400 $15.00 03/26/2001 ENC IM 02/12/2002 Weld County Health Department Page 21 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $135.00 000068880 01/22/2001 00133 $15.00 01/22/2001 ENC IM 000068880 01/22/2001 00400 $15.00 01/22/2001 ENC IM 000068880 01/22/2001 90713 $15.00 01/22/2001 ENC IM 000068880 02/12/2001 90669 $15.00 02/12/2001 ENC IM 000068880 04/02/2001 00400 $15.00 04/03/2001 ENC IM 000068880 04/02/2001 00133 $15.00 04/03/2001 ENC IM 000068880 04/02/2001 90669 $15.00 04/03/2001 ENC IM 000068880 04/02/2001 90713 $15.00 04/03/2001 ENC IM Client Subtotal $120.00 000068884 01/22/2001 90724 $10.00 01/22/2001 ENC IM Client Subtotal $10.00 000068893 02/09/2001 X0730 $15.00 02/09/2001 ENC IM 000068893 02/09/2001 90745 $15.00 02/09/2001 ENC IM Client Subtotal $30.00 000068905 01/29/2001 90669 $15.00 01/29/2001 ENC IM 000068905 01/29/2001 90707 $15.00 01/29/2001 ENC IM 000068905 01/29/2001 90716 $15.00 01/29/2001 ENC IM 000068905 01/29/2001 00400 $15.00 01/29/2001 ENC IM Client Subtotal $60.00 000068908 04/19/2001 90745 $15.00 04/26/2001 ENC COP Client Subtotal $15.00 000068910 01/18/2001 90745 $15.00 01/24/2001 ENC COP Client Subtotal $15.00 000068912 04/19/2001 90744 $15.00 04/26/2001 ENC COP Client Subtotal $15.00 000068913 02/02/2001 90669 $10.00 02/02/2001 PYMT IM Client Subtotal $10.00 000068920 01/24/2001 90744 $15.00 01/24/2001 ENC IM . 000068920 02/21/2001 90744 $15.00 02/21/2001 ENC IM 000068920 05/30/2001 90745 $15.00 05/30/2001 ENC IM Client Subtotal $45.00 000068921 01/24/2001 90744 $15.00 01/24/2001 ENC IM 000068921 02/21/2001 90744 $15.00 02/21/2001 ENC IM 000068921 05/30/2001 90744 $15.00 05/30/2001 ENC IM Client Subtotal $45.00 000068922 01/24/2001 90744 $15.00 01/24/2001 ENC IM 000068922 02/21/2001 90744 $15.00 02/21/2001 ENC IM 000068922 05/30/2001 90744 $15.00 05/30/2001 ENC IM Client Subtotal $45.00 000068949 03/28/2001 85018 $1.00 03/28/2001 SFD FPP 02/12/2002 Weld County Health Department Page 22 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000068949 04/11/2001 00300 $35.00 04/11/2001 ENC FPP Client Subtotal $36.00 000068981 02/05/2001 90744 $15.00 02/05/2001 ENC IM 000068981 02/05/2001 90716 $15.00 02/05/2001 ENC IM Client Subtotal $30.00 000068989 01/31/2001 00400 $15.00 01/31/2001 ENC IM Client Subtotal $15.00 000068990 01/31/2001 X0730 $15.00 01/31/2001 ENC IM 000068990 01/31/2001 90716 $15.00 01/31/2001 ENC IM Client Subtotal $30.00 000068993 04/19/2001 90745 $15.00 04/26/2001 ENC COP - 000068993 04/19/2001 90707 $15.00 04/26/2001 ENC COP Client Subtotal $30.00 000069014 04/25/2001 X0730 $15.00 04/25/2001 ENC IM 000069014 04/25/2001 90669 $15.00 04/25/2001 ENC IM 000069014 04/25/2001 90716 $15.00 04/25/2001 ENC IM 000069014 04/25/2001 90707 $15.00 04/25/2001 ENC IM 000069014 04/25/2001 X0737 $15.00 04/25/2001 ENC IM Client Subtotal $75.00 000069020 02/02/2001 00400 $15.00 02/02/2001 ENC IM 000069020 02/02/2001 90707 $15.00 02/02/2001 ENC IM 000069020 02/02/2001 X0737 $15.00 02/02/2001 ENC IM Client Subtotal $45.00 000069023 01/31/2001 90716 $10.00 01/31/2001 PYMT IM 000069023 01/31/2001 X0730 $15.00 01/31/2001 ENC IM Client Subtotal $25.00 000069029 02/28/2001 90716 $15.00 02/28/2001 ENC IM 000069029 02/28/2001 00400 $15.00 02/28/2001 ENC IM 000069029 02/28/2001 90707 $15.00 02/28/2001 ENC IM Client Subtotal $45.00 000069032 02/02/2001 90707 $15.00 02/02/2001 ENC IM 000069032 02/02/2001 90713 $15.00 02/02/2001 ENC IM 000069032 02/02/2001 90716 $15.00 02/02/2001 ENC IM 000069032 02/02/2001 00400 $15.00 02/02/2001 ENC IM Client Subtotal $60.00 000069035 04/23/2001 90707 $15.00 04/23/2001 ENC IM 000069035 04/23/2001 90744 $15.00 04/23/2001 ENC IM Client Subtotal $30.00 000069046 02/05/2001 90669 $15.00 02/05/2001 ENC IM 000069046 02/05/2001 00400 $15.00 02/05/2001 ENC IM 000069046 02/05/2001 00133 $15.00 02/05/2001 ENC IM 02/12/2002 Weld County Health Department Page 23 of 32 Write-Off Detail Report (Write-O)7Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000069046 02/05/2001 90713 $15.00 02/05/2001 ENC IM Client Subtotal $60.00 000069074 06/27/2001 85018 $1.00 06/27/2001 SFD FPP Client Subtotal $1.00 000069085 02/07/2001 X0730 $15.00 02/07/2001 ENC IM Client Subtotal $15.00 000069086 04/23/2001 90745 $15.00 04/23/2001 ENC IM Client Subtotal $15.00 - -- 000069088 02/09/2001 90669 $15.00 02/09/2001 ENC IM 000069088 02/09/2001 90713 $15.00 02/09/2001 ENC IM --- Client Subtotal $30.00 000069089 02/07/2001 X0718 $15.00 02/07/2001 ENC IM 000069089 02/07/2001 X0730 $15.00 02/07/2001 ENC IM 000069089 02/07/2001 90744 $15.00 02/07/2001 ENC IM 000069089 02/07/2001 90707 $15.00 02/07/2001 ENC IM 000069089 02/07/2001 90713 $15.00 02/07/2001 ENC IM Client Subtotal $75.00 000069099 02/07/2001 00136 $11.00 02/07/2001 PYMT FPP 000069099 05/02/2001 99204 $22.00 05/02/2001 SFD FPP 000069099 05/02/2001 85018 $3.00 05/02/2001 SFD FPP 000069099 05/02/2001 00136 $21.00 05/02/2001 SFD FPP Client Subtotal $57.00 000069120 02/09/2001 90744 $15.00 02/09/2001 ENC IM 000069120 02/09/2001 90713 $15.00 02/09/2001 ENC IM 000069120 02/09/2001 90716 $15.00 02/09/2001 ENC IM 000069120 02/09/2001 90707 $15.00 02/09/2001 ENC IM 000069120 04/09/2001 X0730 $15.00 04/09/2001 ENC IM 000069120 04/09/2001 90744 $15.00 04/09/2001 ENC IM Client Subtotal $90.00 000069141 03/09/2001 00013 $15.00 03/12/2001 ENC FPP 000069141 03/09/2001 85018 $1.00 03/12/2001 SFD FPP Client Subtotal $16.00 000069143 02/16/2001 90713 $15.00 02/16/2001 ENC IM 000069143 02/16/2001 00400 $15.00 02/16/2001 ENC IM Client Subtotal $30.00 000069144 03/02/2001 90707 $9.00 05/04/2001 PYMT IM 000069144 03/02/2001 90716 $15.00 03/02/2001 ENC IM 000069144 05/04/2001 90669 $15.00 05/04/2001 ENC IM Client Subtotal $39.00 000069147 02/26/2001 90713 $15.00 02/26/2001 ENC IM 000069147 02/26/2001 00400 $15.00 02/26/2001 ENC IM 02/12/2002 Weld County Health Department Page 24 of 32 Write-Off Detail Report (Write-OJfDate 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000069147 02/26/2001 00133 $15.00 02/26/2001 ENC IM Client Subtotal $45.00 000069202 02/20/2001 90745 $15.00 02/27/2001 ENC COP Client Subtotal $15.00 000069206 05/02/2001 90745 $15.00 05/10/2001 ENC COP Client Subtotal $15.00 000069207 02/21/2001 X0718 $15.00 02/21/2001 ENC IM 000069207 02/21/2001 90707 $15.00 02/21/2001 ENC IM - - 000069207 02/21/2001 90745 $15.00 02/21/2001 ENC IM Client Subtotal $45.00 000069209 02123/2001 X0737 $15.00 02/23/2001 ENC IM 000069209 02/23/2001 X0730 $15.00 02/23/2001 ENC IM 000069209 02/23/2001 90707 $15.00 02/23/2001 ENC IM 000069209 02/23/2001 90669 $15.00 02/23/2001 ENC IM 000069209 02/23/2001 90716 $15.00 02/23/2001 ENC IM Client Subtotal $75.00 000069222 02/26/2001 90713 $15.00 02/26/2001 ENC IM 000069222 02/26/2001 90669 $15.00 02/26/2001 ENC IM 000069222 02/26/2001 00400 $15.00 02/26/2001 ENC IM Client Subtotal $45.00 000069277 03/02/2001 00020 $20.00 03/02/2001 ENC STD Client Subtotal $20.00 000069283 03/28/2001 90707 $15.00 03/28/2001 ENC IM 000069283 03/28/2001 90716 $15.00 03/28/2001 ENC IM 000069283 03/28/2001 90744 $15.00 03/28/2001 ENC IM Client Subtotal $45.00 000069287 02/28/2001 X0730 $15.00 02/28/2001 ENC IM 000069287 02/28/2001 90716 $15.00 02/28/2001 ENC IM 000069287 02/28/2001 90707 $15.00 02/28/2001 ENC IM Client Subtotal $45.00 000069289 02/28/2001 90716 $10.00 02/28/2001 PYMT IM Client Subtotal $10.00 000069317 03/19/2001 90744 $15.00 03/19/2001 ENC IM 000069317 03/19/2001 90707 $15.00 03/19/2001 ENC IM Client Subtotal $30.00 000069351 05/07/2001 90744 $15.00 05/07/2001 ENC IM 000069351 06/20/2001 00014 $5.00 06/20/2001 ENC CDP Client Subtotal $20.00 000069353 04/06/2001 85018 $1.00 04/06/2001 SFD FPP Client Subtotal $1.00 000069365 03/12/2001 90744 $15.00 03/12/2001 ENC IM 02/12/2002 Weld County Health Department Page 25 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $15.00 000069385 03/09/2001 X0718 $15.00 03/09/2001 ENC IM 000069385 03/09/2001 90745 $15.00 03/09/2001 ENC IM 000069385 04/16/2001 90707 $15.00 04/17/2001 ENC IM 000069385 04/16/2001 90744 $15.00 04/17/2001 ENC IM Client Subtotal $60.00 000069386 03/09/2001 90745 $15.00 04/09/2001 ENC IM 000069386 04/16/2001 00400 $15.00 04/17/2001 ENC IM 000069386 04/16/2001 90707 $15.00 04/17/2001 ENC IM 000069386 04/16/2001 90744 $15.00 04/17/2001 ENC IM 000069386 0416/.2001 90713 $15.00 04/17/2001 ENC IM Client Subtotal $75.00 000069387 03/09/2001 90745 $15.00 03/09/2001 ENC IM 000069387 04/16/2001 90707 $15.00 04/17/2001 ENC IM 000069387 04/16/2001 90745 $15.00 04/17/2001 ENC IM Client Subtotal $45.00 000069404 03/12/2001 90669 $15.00 03/12/2001 ENC IM 000069404 03/12/2001 90744 $15.00 03/12/2001 ENC 1M 000069404 03/12/2001 90713 $15.00 03/12/2001 ENC IM 000069404 03/12/2001 00400 $15.00 03/12/2001 ENC IM Client Subtotal $60.00 000069419 03/30/2001 87110 $10.00 03/30/2001 ENC STD 000069419 03/30/2001 99202 $10.00 03/30/2001 SFD STD Client Subtotal $20.00 000069425 03/16/2001 90707 $5.00 03/16/2001 PYMT IM 000069425 03/16/2001 90744 $15.00 03/16/2001 ENC IM 000069425 03/16/2001 X0718 $15.00 03/16/2001 ENC IM 000069425 03/16/2001 90716 $15.00 03/16/2001 ENC IM Client Subtotal $50.00 000069432 03/21/2001 00400 $15.00 03/21/2001 ENC IM 000069432 03/21/2001 00133 $15.00 03/21/2001 ENC IM 000069432 03/21/2001 90713 $15.00 03/21/2001 ENC IM Client Subtotal $45.00 000069433 03/14/2001 90669 $15.00 03/14/2001 ENC IM 000069433 03/14/2001 00400 $15.00 03/14/2001 ENC IM 000069433 03/14/2001 90707 $15.00 03/14/2001 ENC IM 000069433 03/14/2001 90716 $15.00 03/14/2001 ENC IM 000069433 03/14/2001 X0737 $15.00 03/14/2001 ENC 1M Client Subtotal $75.00 000069434 03/14/2001 00400 $15.00 03/14/2001 ENC IM 000069434 03/14/2001 X0730 $15.00 03/14/2001 ENC IM 02/12/2002 Weld County Health Department Page 26 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000069434 03/14/2001 90707 $15.00 03/14/2001 ENC 1M Client Subtotal $45.00 000069447 03/23/2001 X5578 $60.00 03/23/2001 ENC PE Client Subtotal $60.00 000069449 04/06/2001 90744 $15.00 04/06/2001 ENC IM 000069449 04/06/2001 90713 $15.00 04/06/2001 ENC IM 000069449 04/06/2001 90707 $15.00 04/06/2001 ENC IM 000069449 04/06/2001 90716 $10.00 04/06/2001 PYMT IM 000069449 04/06/2001 00400 $15.00 04/06/2001 ENC IM Client Subtotal $70.00 000069456 03/26/2.001 90745 $15.00 03/26/2001 ENC IM Client Subtotal $15.00 000069457 03/26/2001 90745 $15.00 03/26/2001 ENC IM Client Subtotal $15.00 000069491 03/21/2001 90713 $15.00 03/21/2001 ENC IM 000069491 03/21/2001 00400 $15.00 03/21/2001 ENC IM 000069491 03/21/2001 90669 $15.00 03/21/2001 ENC IM 000069491 03/21/2001 00133 $15.00 03/21/2001 ENC 1M Client Subtotal $60.00 000069509 03/28/2001 00010 $5.00 03/28/2001 ENC STD 000069509 03/28/2001 00269 $25.00 03/28/2001 ENC STD 000069509 06/15/2001 00269 $25.00 06/15/2001 ENC STD Client Subtotal $55.00 000069517 04/02/2001 90669 $15.00 04/02/2001 ENC IM 000069517 04/02/2001 00400 $15.00 04/02/2001 ENC IM 000069517 04/02/2001 90707 $15.00 04/02/2001 ENC IM 000069517 04/02/2001 90713 $15.00 04/02/2001 ENC IM 000069517 04/02/2001 00133 $15.00 04/02/2001 ENC 1M Client Subtotal $75.00 000069559 03/26/2001 X0718 $15.00 03/26/2001 ENC IM 000069559 03/26/2001 X0730 $15.00 03/26/2001 ENC IM Client Subtotal $30.00 000069560 03/26/2001 00400 $15.00 03/26/2001 ENC IM 000069560 03/26/2001 X0730 $15.00 03/26/2001 ENC IM 000069560 03/26/2001 90744 $15.00 03/26/2001 ENC IM 000069560 03/26/2001 90713 $15.00 03/26/2001 ENC IM 000069560 03/26/2001 90707 $15.00 03/26/2001 ENC 1M Client Subtotal $75.00 000069564 03/30/2001 90707 $15.00 03/30/2001 ENC IM 000069564 03/30/2001 X0718 $15.00 03/30/2001 ENC IM 000069564 03/30/2001 90716 $15.00 03/30/2001 ENC IM 02/12/2002 Weld County Health Department Page 27 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000069564 03/30/2001 90713 $15.00 03/30/2001 ENC IM 000069564 03/30/2001 90744 $15.00 03/30/2001 ENC IM Client Subtotal $75.00 000069568 03/30/2001 00133 $15.00 03/30/2001 ENC IM 000069568 03/30/2001 00400 $15.00 03/30/2001 ENC IM 000069568 03/30/2001 90669 $15.00 03/30/2001 ENC IM 000069568 03/30/2001 90713 $15.00 03/30/2001 ENC IM Client Subtotal $60.00 000069571 04/02/2001 90713 $15.00 04/02/2001 ENC IM 000069571 04/02/2001 90744 $15.00 04/02/2001 ENC IM --- Client Subtotal $30.00 000069574 03/26/2001 90713 $15.00 03/26/2001 ENC IM 000069574 03/26/2001 00400 $15.00 03/26/2001 ENC IM 000069574 03/26/2001 00133 $15.00 03/26/2001 ENC IM Client Subtotal $45.00 000069578 04/02/2001 X0718 $15.00 04/03/2001 ENC IM Client Subtotal $15.00 000069579 04/02/2001 90707 $15.00 04/03/2001 ENC IM 000069579 04/02/2001 90745 $15.00 04/03/2001 ENC IM Client Subtotal $30.00 000069581 04/02/2001 90744 $15.00 04/03/2001 ENC IM Client Subtotal $15.00 000069584 04/04/2001 90669 $15.00 04/04/2001 ENC IM 000069584 04/04/2001 00400 $15.00 04/04/2001 ENC IM 000069584 04/04/2001 00133 $15.00 04/04/2001 ENC IM 000069584 04/04/2001 90713 $15.00 04/04/2001 ENC IM Client Subtotal $60.00 000069587 03/30/2001 90744 $15.00 03/30/2001 ENC IM 000069587 03/30/2001 X0718 $15.00 03/30/2001 ENC IM Client Subtotal $30.00 000069588 03/30/2001 90669 $15.00 03/30/2001 ENC IM 000069588 03/30/2001 00400 $15.00 03/30/2001 ENC IM 000069588 03/30/2001 00133 $15.00 03/30/2001 ENC IM 000069588 03/30/2001 90713 $15.00 03/30/2001 ENC IM Client Subtotal $60.00 000069594 04/02/2001 90669 $15.00 04/02/2001 ENC IM 000069594 04/02/2001 90713 $15.00 04/02/2001 ENC IM 000069594 05/18/2001 90669 $15.00 05/18/2001 ENC IM 000069594 05/18/2001 90713 $15.00 05/18/2001 ENC IM 000069594 05/18/2001 X0737 $15.00 05/18/2001 ENC IM 000069594 05/18/2001 00400 $15.00 05/18/2001 ENC IM 02/12/2002 Weld County Health Department Page 28 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $90.00 000069601 04/11/2001 X5578 $60.00 04/13/2001 ENC PE Client Subtotal $60.00 000069637 04/09/2001 90745 $15.00 04/09/2001 ENC IM Client Subtotal $15.00 000069665 04/04/2001 90745 $15.00 04/04/2001 ENC IM Client Subtotal $15.00 000069666 04/04/2001 90745 $15.00 04/04/2001 ENC IM - - 000069666 04/04/2001 90713 $15.00 04/04/2001 ENC IM Client Subtotal $30.00 000069674 04/18/2001 00120 $6.00 04/18/2001 PYMT FPP Client Subtotal $6.00 000069686 04/18/2001 90707 $15.00 04/18/2001 ENC COP Client Subtotal $15.00 000069689 04/27/2001 90669 $15.00 04/27/2001 ENC IM 000069689 04/27/2001 90713 $15.00 04/27/2001 ENC IM 000069689 04/27/2001 00133 $15.00 04/27/2001 ENC IM 000069689 04/27/2001 00400 $15.00 04/27/2001 ENC IM Client Subtotal $60.00 000069690 03/29/2001 90745 $15.00 04/05/2001 ENC COP Client Subtotal $15.00 000069694 04/06/2001 90745 $15.00 04/06/2001 ENC IM 000069694 04/16/2001 X0730 $15.00 04/16/2001 ENC IM Client Subtotal $30.00 000069717 04/11/2001 X0718 $15.00 04/11/2001 ENC IM 000069717 04/11/2001 90744 $15.00 04/11/2001 ENC IM Client Subtotal $30.00 000069725 04/11/2001 00133 $15.00 04/11/2001 ENC IM 000069725 04/11/2001 90707 $5.00 04/11/2001 PYMT IM 000069725 04/11/2001 00400 $15.00 04/11/2001 ENC IM Client Subtotal $35.00 000069730 05/14/2001 87110 $10.00 05/14/2001 ENC FPP 000069730 05/14/2001 99204 $22.00 05/14/2001 SFD FPP 000069730 05/14/2001 00046 $10.00 05/14/2001 PYMT FPP Client Subtotal $42.00 000069736 05/07/2001 00133 $15.00 05/07/2001 ENC IM 000069736 05/07/2001 90713 $15.00 05/07/2001 ENC IM 000069736 05/07/2001 90669 $15.00 05/07/2001 ENC IM 000069736 05/07/2001 00400 $15.00 05/07/2001 ENC IM Client Subtotal $60.00 000069777 04/16/2001 90713 $15.00 04/16/2001 ENC IM 02/12/2002 Weld County Health Department Page 29 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000069777 04/16/2001 00133 $15.00 04/16/2001 ENC IM 000069777 04/16/2001 00400 $15.00 04/16/2001 ENC IM 000069777 04/16/2001 90669 $15.00 04/16/2001 ENC IM Client Subtotal $60.00 000069808 04/18/2001 00133 $10.00 04/18/2001 PYMT IM 000069808 04/18/2001 00400 $15.00 04/18/2001 ENC IM 000069808 04/18/2001 90669 $15.00 04/18/2001 ENC IM - — Client Subtotal $40.00 000069815 04/23/2001 90713 $15.00 04/23/2001 ENC IM 000069815 04/23/2001 00133 $15.00 04/23/2001 ENC IM -- Client Subtotal $30.00 000069843 04/19/2001 90744 $15.00 04/26/2001 ENC COP Client Subtotal $15.00 000069851 04/30/2001 90716 $15.00 04/30/2001 ENC IM 000069851 04/30/2001 00133 $10.00 04/30/2001 PYMT IM 000069851 04/30/2001 X0730 $15.00 04/30/2001 ENC IM Client Subtotal $40.00 000069862 04/19/2001 00120 $1.00 05/01/2001 PYMT COP Client Subtotal $1.00 000069870 04/30/2001 00045 $24.00 04/30/2001 SFD FPP 000069870 04/30/2001 85018 $4.00 04/30/2001 SFD FPP 000069870 04/30/2001 00033 $6.00 04/30/2001 SFD FPP 000069870 04/30/2001 87110 $10.00 04/30/2001 ENC FPP 000069870 04/30/2001 99214 $30.00 04/30/2001 SFD FPP 000069870 04/30/2001 00035 $5.00 04/30/2001 SFD FPP Client Subtotal $79.00 000069872 06/04/2001 90745 $15.00 06/04/2001 ENC IM Client Subtotal $15.00 000069873 04/25/2001 90707 $15.00 04/25/2001 ENC IM 000069873 04/25/2001 90669 $10.00 04/25/2001 PYMT IM Client Subtotal $25.00 000069905 05/11/2001 X0730 $15.00 05/11/2001 ENC IM 000069905 05/11/2001 90744 $15.00 05/11/2001 ENC IM 000069905 05/11/2001 90713 $15.00 05/11/2001 ENC IM Client Subtotal $45.00 000069906 04/27/2001 90707 $15.00 04/27/2001 ENC IM 000069906 04/27/2001 90744 $15.00 04/27/2001 ENC IM Client Subtotal $30.00 000069909 05/04/2001 X0737 $15.00 05/04/2001 ENC IM Client Subtotal $15.00 000069921 05/02/2001 00133 $15.00 05/02/2001 ENC IM 02/12/22 Weld County Health Department l'age 30 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code 000069921 05/02/2001 00400 $15.00 05/02/2001 ENC IM 000069921 05/02/2001 90669 $15.00 05/02/2001 ENC IM 000069921 05/02/2001 90707 $15.00 05/02/2001 ENC IM 000069921 05/02/2001 90713 $15.00 05/02/2001 ENC IM 000069921 05/02/2001 90716 $15.00 05/02/2001 ENC IM Client Subtotal $90.00 000069924 04/30/2001 90716 $10.00 04/30/2001 PYMT IM 000069924 04/30/2001 90744 $15.00 04/30/2001 ENC IM _ 000069924 04/30/2001 X0730 $15.00 04/30/2001 ENC IM Client Subtotal $40.00 000069938 06/11/2001 X0730 $15.00 06/11/2001 ENC IM Client Subtotal $15.00 000069949 05/04/2001 00269 $25.00 05/04/2001 ENC STD Client Subtotal $25.00 000069965 05/07/2001 90713 $15.00 05/07/2001 ENC IM 000069965 05/07/2001 90669 $15.00 05/07/2001 ENC IM 000069965 05/07/2001 00400 $15.00 05/07/2001 ENC IM Client Subtotal $45.00 000069967 06/11/2001 66720 $10.00 06/11/2001 ENC STD 000069967 06/11/2001 00016 $10.00 06/11/2001 ENC ST1D Client Subtotal $20.00 000070003 05/11/2001 90713 $15.00 05/11/2001 ENC IM 000070003 05/11/2001 90669 $15.00 05/11/2001 ENC IM 000070003 05/11/2001 00400 $15.00 05/11/2001 ENC IM 000070003 05/11/2001 00133 $15.00 05/11/2001 ENC IM Client Subtotal $60.00 000070038 05/11/2001 X0718 $15.00 05/11/2001 ENC IM 000070038 05/11/2001 90745 $15.00 05/11/2001 ENC IM 000070038 05/11/2001 90707 $15.00 05/11/2001 ENC IM 000070038 05/11/2001 90713 $15.00 05/11/2001 ENC IM Client Subtotal $60.00 000070039 05/11/2001 90745 $5.00 05/11/2001 PYMT IM Client Subtotal $5.00 000070040 05/21/2001 90707 $15.00 05/21/2001 ENC IM 000070040 05/21/2001 90716 $15.00 05/21/2001 ENC 1M 000070040 05/21/2001 90669 $15.00 05/21/2001 ENC IM 000070040 05/21/2001 00133 $15.00 05/21/2001 ENC IM Client Subtotal $60.00 000070069 05/18/2001 90707 $15.00 05/18/2001 ENC IM 000070069 05/18/2001 X0730 $15.00 05/18/2001 ENC IM 000070069 05/18/2001 90713 $15.00 05/18/2001 ENC IM 02/12/2002 Weld County Health Department Page 31 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $45.00 000070078 05/21/2001 90744 $15.00 05/21/2001 ENC IM 000070078 05/21/2001 90716 $15.00 05/21/2001 ENC IM 000070078 05/21/2001 90713 $15.00 05/21/2001 ENC IM 000070078 05/21/2001 90707 $15.00 05/21/2001 ENC IM 000070078 05/21/2001 90669 $15.00 05/21/2001 ENC IM 000070078 05/21/2001 00400 $15.00 05/21/2001 ENC IM 000070078 05/21/2001 X0737 $15.00 05/21/2001 ENC IM 000070078 06/22/2001 00400 $15.00 06/22/2001 ENC IM 000070078 06/22/2001 90669 $15.00 06/22/2001 ENC IM 000070078 06722/2001 X0730 $15.00 06/22/2001 ENC IM 000070078 06/22/2001 90713 $15.00 06/22/2001 ENC IM Client Subtotal $165.00 000070080 05/21/2001 X0730 $15.00 05/21/2001 ENC IM 000070080 05/21/2001 90716 $15.00 05/21/2001 ENC IM 000070080 05/21/2001 90707 $15.00 05/21/2001 ENC IM Client Subtotal $45.00 000070084 05/16/2001 90669 $15.00 05/16/2001 ENC IM 000070084 05/16/2001 90707 $15.00 05/16/2001 ENC IM Client Subtotal $30.00 000070100 05/18/2001 90713 $15.00 05/18/2001 ENC N 000070100 05/18/2001 00400 $15.00 05/18/2001 ENC IM 000070100 05/18/2001 90707 $15.00 05/18/2001 ENC IM 000070100 05/18/2001 00133 $15.00 05/18/2001 ENC IM Client Subtotal $60.00 000070101 05/18/2001 90707 $15.00 05/18/2001 ENC IM 000070101 05/18/2001 90745 $15.00 05/18/2001 ENC IM Client Subtotal $30.00 000070115 05/21/2001 90744 $15.00 05/21/2001 ENC IM Client Subtotal $15.00 000070152 06/04/2001 85018 $5.00 06/04/2001 SFD FPP 000070152 06/04/2001 87110 $10.00 06/04/2001 ENC FPP 000070152 06/11/2001 99211 $5.00 06/11/2001 SFD STD Client Subtotal $20.00 000070216 06/08/2001 90716 $15.00 06/08/2001 ENC IM 000070216 06/08/2001 90744 $15.00 06/08/2001 ENC IM Client Subtotal $30.00 000070219 06/01/2001 90713 $15.00 06/01/2001 ENC IM 000070219 06/01/2001 90707 $15.00 06/01/2001 ENC IM 000070219 06/01/2001 X0741 $5.00 06/01/2001 SFD IM 000070219 06/01/2001 90745 $15.00 06/01/2001 ENC IM 02/12/2002 Weld County Health Department Page 32 of 32 Write-Off Detail Report (Write-Off Date 06/30/2001) Last Last Transaction Transaction Program Client ID Service Date Service Nbr Amount Date Code Code Client Subtotal $50.00 000070294 06/11/2001 90713 $15.00 06/11/2001 ENC IM Client Subtotal $15.00 000070296 06/11/2001 90745 $15.00 06/11/2001 ENC IM 000070296 06/11/2001 X0730 $15.00 06/11/2001 ENC IM 000070296 06/11/2001 90713 $10.00 06/11/2001 PYMT IM Client Subtotal $40.00 000070303 06/13/2001 00400 $15.00 06/13/2001 ENC IM - — - 000070303 06/13/2001 00133 $15.00 06/13/2001 ENC IM 000070303 06/13/2001 90713 $15.00 06/13/2001 ENC IM -- Client Subtotal $45.00 000070313 06/13/2001 90713 $15.00 06/13/2001 ENC IM 000070313 06/13/2001 90669 $15.00 06/13/2001 ENC IM 000070313 06/13/2001 00400 $15.00 06/13/2001 ENC IM 000070313 06/13/2001 00133 $15.00 06/13/2001 ENC IM Client Subtotal $60.00 000070363 06/20/2001 00014 $5.00 06/20/2001 ENC CDP Client Subtotal $5.00 000070371 06/20/2001 00133 $15.00 06/20/2001 ENC IM 000070371 06/20/2001 90713 $15.00 06/20/2001 ENC IM 000070371 06/20/2001 90707 $15.00 06/20/2001 ENC IM 000070371 06/20/2001 90744 $15.00 06/20/2001 ENC IM 000070371 06/20/2001 90669 $15.00 06/20/2001 ENC IM Client Subtotal $75.00 000070416 06/27/2001 90707 $15.00 06/27/2001 ENC TM 000070416 06/27/2001 90716 $15.00 06/27/2001 ENC IM Client Subtotal $30.00 Grand Total $14,516.00 Hello