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Home My WebLink About20023194.tiff RESOLUTION RE: CANCELLATION OF OUTSTANDING ACCOUNTS RECEIVABLE FOR THE WELD COUNTY PARAMEDIC SERVICES 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 Paramedic Services 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 City of Greeley and 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 Paramedic Services in the amount of $1,379,624.18. 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 $1,379,624.18 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 16th day of December, A.D., 2002. BOARD OF COUNTY COMMISSIONERS � WELD COUNTY, OLO DO ` A i1 ATTEST: 4 �f •. l- /J • .aa r at �" ,�';;; tile_ G Vaad, ChaJ'� Weld County Clerk to th ( "�� cA'(� i '�Y. — c (' W f ,a, Si ,4 David E. Lo , Pro-Tem� BY: ni'44 p. i"i•Pi�`/ ✓ �2 Deputy Clerk to the Boar. ' I /7 " 414 M J. eile APPROVED AS TO FORM: 1.? EXCUSED DATE OF SIGNING (AYE) _7 iillliam� H. Jerke nA ....- G_L.-�� -''Countt (V y Attorney \.��c Bert D. Masden Date of signature: �/9 2002-3194 AM0001 ciC : 1 ?. lCCt ' MEMORANDUM TO: Claud Hanes, Accounting DATE:December 12, 2002 FROM: Kathy Baxley, Ambulance Service lID SUBJECT: Accounts Written Off in 2002 c . COLORADO Attached are the lists of accounts written off in 2002 . Listed below are the amounts each month for a total of $$1 , 379, 624 . 18 . All journal entries have been made except for the one for December, which will be after the end of the month. Let me know if you have any questions . January $180, 580 . 98 February $78 , 932 . 02 March $77, 246 . 90 April $85, 652 . 25 May $118 , 085 . 61 June $70 , 640 . 78 July $122 , 718 . 21 August $92 , 759 . 53 September $51, 013 . 19 October $125, 546 . 29 November $288 , 349 . 93 December $88 , 098 . 49 Total $1 , 379, 624 . 18 2002-3194 Date:01/25/2002 Weld County Paramedic Services Page: 1 Tithe:09:00:35 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/23/2002 Thru 01/23/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/23/2002 715.00 4 83C 000907365A 09/24/2000 KATO, NANCY 01/23/2002 231.85 4 83C 001008354A 10/29/2000 KEIHL, ARON 01/23/2002 310.00 4 83C 001209443B 12/09/2000 VALDEZ, GENOVEVA 01/23/2002 382 .80 4 83C 010100134A 01/05/2001 HOFFMANN, ARIANA A 01/23/2002 468.16 4 83C 010301899A 03/09/2001 VILLALVA, MARIA ROSA 01/23/2002 629.00 4 83C 010301915A 03/10/2001 DONEHOO, FRANCES 01/23/2002 806.00 4 83C 010301941A 03/11/2001 DIETERLE, MARVIN 01/23/2002 812 .00 4 83C 010302089A 03/16/2001 GARCIA, AMANDA 01/23/2002 775.08 4 83C 010302262A 03/23/2001 TAYLOR, MARGARET R 01/23/2002 368.94 4 83C 010402696A 04/07/2001 SANDERS, KATHLEEN J 01/23/2002 769.00 4 83C 010402704B 04/08/2001 RAMIREZ, GABRIEL 01/23/2002 25.00 4 83C 010402741A 04/09/2001 CONTRERAS, SERGIO 01/23/2002 451.50 4 83C 010402823A 04/11/2001 SANDERS, KATHLEEN J 01/23/2002 126.48 4 83C 010402894A 04/13/2001 SANDERS, KATHLEEN J 01/23/2002 212 .15 4 83C 010402967A 04/16/2001 SOTO, MIGUEL 01/23/2002 628.42 4 83C 010403054A 04/19/2001 SANDOVAL, JOSIE 01/23/2002 925.00 4 83C 010403084A 04/19/2001 MARSHALL, GAY 01/23/2002 787.00 4 83C 010403130A 04/21/2001 DAVIS, LARRY 01/23/2002 20.00 4 83C 010403161A 04/21/2001 DUCHENE, CLAUDIA 01/23/2002 769.00 4 83C 010403317A 04/26/2001 CRESPIN, SAMUEL 01/23/2002 100.00 4 83C 010403344A 04/27/2001 YOUNG, TODD MICHAEL 01/23/2002 534 .00 4 83C 010403364A 04/28/2001 BREKKE, KODY D 01/23/2002 544.32 4 83C 010403390A 04/29/2001 BROWN, PATRICIA 01/23/2002 629.00 4 83C 010403398A 04/29/2001 GUTIERREZ, NICOLE T 01/23/2002 781.00 4 83C 010501406A 05/25/2001 SIEM, DARREN 01/23/2002 769.00 4 83C 010503468A 05/01/2001 LISED, NORMA 01/23/2002 732 .00 4 83C 010503526B 05/03/2001 CADENA, SANDRA 01/23/2002 563 .00 4 83C 010503540A 05/04/2001 VILLALOBOS, BENITO A 01/23/2002 72 .48 4 83C 010503540B 05/04/2001 VASQUEZ, ROLAND 01/23/2002 631.00 4 83C 010503644A 05/07/2001 CHAVEZ, HERIBERTO 01/23/2002 765.00 4 83C 010503677A 05/09/2001 KING, DONALD 01/23/2002 163 .40 4 83C 010503694A 05/10/2001 VAN HOESEN, JESSICA 01/23/2002 50.00 4 83C 010503696A 05/10/2001 GEARHART, DAVID 01/23/2002 806.00 4 83C 010503724A 05/11/2001 DIETERLE, MARVIN 01/23/2002 654.00 4 83C 010503792A 05/13/2001 FLANAGAN, MICHAEL C 01/23/2002 769.00 4 83C 010503801A 05/13/2001 REZA, JESSE 01/23/2002 999.00 4 83C 010503833A 05/14/2001 BUCHANAN, BRETTA 01/23/2002 629.00 4 83C 010503935A 05/18/2001 DIETERLE, MARVIN 01/23/2002 100.00 4 83C 010503946A 05/18/2001 WEBER, JOHN 01/23/2002 858.00 4 83C 010503955A 05/18/2001 RODRIGUEZ, LUIS 01/23/2002 50.00 4 83C 010503975A 05/19/2001 SCHAFER, JULIA M 01/23/2002 901.00 4 83C 010503981A 05/19/2001 TERRAZAS, LOUIS 01/23/2002 901.00 4 83C 010503981B 05/19/2001 RAMIREZ, JUAN CARLOS 01/23/2002 399.00 4 83C 010503982A 05/19/2001 ZELINGER, ELIZABETH 01/23/2002 25.00 4 83C 010504008A 05/21/20O1 MILLER, DIANA 01/23/2002 25.00 4 83C 010504008B 05/21/2001 MILLER, JOHN R 01/23/2002 25.00 4 83C 010504008C 05/21/2001 MILLER, ERIC 01/23/2002 25.00 4 83C 010504014A 05/21/2001 CONTRERAS, SERGIO 01/23/2002 25.00 4 83C 010504015A 05/21/2001 RANSOM, CODY A Date:01/25/2002 Weld County Paramedic Services Page: 2 Time:09:00:36 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/23/2002 Thru 01/23/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/23/2002 629.00 4 83C 010504024A 05/22/2001 DIETERLE, MARVIN 01/23/2002 690 .00 4 83C 010504034A 05/22/2001 VANATTA, PAM 01/23/2002 25.00 4 83C 010504054A 05/23/2001 CONTRERAS, SERGIO 01/23/2002 819.00 4 83C 010504062A 05/23/2001 ROMERO, DEBBIE 01/23/2002 819.00 4 83C 010504063A 05/23/2001 LANCKRIET, GREGORY 01/23/2002 809.00 4 83C 010504105A 05/25/2001 MATA, ALFREDO 01/23/2002 823.08 4 83C 010504124A 05/25/2001 GARCIA, JESUS 01/23/2002 711.00 4 83C 010504170A 05/27/2001 TELLEZ, ALICE 01/23/2002 813.00 4 83C 010504177A 05/28/2001 SANDOVAL, LAURA 01/23/2002 50.00 4 83C 010504179A 05/28/2001 GUTIERREZ, CLEMENTE 01/23/2002 841.00 4 83C 010504183A 05/28/2001 TAYLOR, ADOLFO 01/23/2002 961.00 4 83C 010504184A 05/28/2001 RAINWATER, LYNN 01/23/2002 159.60 4 83C 010504230A 05/30/2001 PETERSON, PHYLLIS AM 01/23/2002 629.00 4 83C 010504273A 05/31/2001 DONEHOO, FRANCES 01/23/2002 25.00 4 83C 010504276A 05/31/2001 WALKER, REID E 01/23/2002 769.00 4 83C 010603477A 06/04/2001 GARZA, IRENE 01/23/2002 900.00 4 83C 010604305A 06/01/2001 SUGGS, SADIE 01/23/2002 807.08 4 83C 010604322A 06/02/2001 TAVENNER, ROSALIE 01/23/2002 54.83 4 83C 010604348A 06/03/2001 HARTLEY, LEILA 01/23/2002 399.00 4 83C 010604354A 06/03/2001 JACKSON, DAVID R 01/23/2002 1242.00 4 83C 010604367B 06/04/2001 FIGUERA MONTES, FRAN 01/23/2002 510.97 4 83C 010604386A 06/05/2001 KARROL, RICHARD 01/23/2002 100.00 4 83C 010604407A 06/06/2001 TALAMANTES, TOMAS 01/23/2002 766.00 4 83C 010604441A 06/07/2001 TORREZ, HALLE ALEXAN 01/23/2002 769.00 4 83C 010604519A 06/10/2001 HUARACA-MARTIN, APAR 01/23/2002 654.00 4 83C 010604554A 06/11/2001 SUTTON, GARY D 01/23/2002 399.00 4 83C 010604555A 06/12/2001 SUTTON, GARY D 01/23/2002 823 .00 4 83C 010604620B 06/14/2001 JOHNSON, TROY 01/23/2002 176.28 4 83C 010604628A 06/14/2001 LONGAKER, BRENDAN G 01/23/2002 399.00 4 83C 010604766A 06/19/2001 HENDERSON, CURTIS L 01/23/2002 715.00 4 83C 010604802A 06/21/2001 HARRIS, VIRGINIA 01/23/2002 100.00 4 83C 010604826A 06/21/2001 ROBINSON, SCOTT 01/23/2002 841.00 4 83C 010604851A 06/22/2001 GASCA-HERNANDEZ, OLE 01/23/2002 817.00 4 83C 010604916A 06/24/2001 ANDERSON, JOHNNA 01/23/2002 767.00 4 83C 010604916B 06/24/2001 PABEN, JERICA 01/23/2002 100.00 4 83C 010604945A- 06/25/2001 EGERTON, CARLA 01/23/2002 839.00 4 83C 010604964A 06/26/2001 MAES, RUDY V • 01/23/2002 706.00 4 83C 010605006A 06/27/2001 SHREEVES, AMBER 01/23/2002 939.00 4 83C 010605046A 06/28/2001 GRIFFIN, KATHERINE 01/23/2002 209.00 4 83C 010705110A 07/01/2001 TALMADGE, RAY 01/23/2002 719.00 4 83C 010705127A 07/01/2001 GUTIERREZ, MARIE 01/23/2002 904.00 4 83C 010705137A 07/01/2001 GALVEZ, AMBROSIO G 01/23/2002 728.00 4 83C 010705159A 07/02/2001 MIRELES, MARIBEL 01/23/2002 819.00 4 83C 010705193A 07/03/2001 LOPEZ, CRISTIN 01/23/2002 754.00 4 83C 010705240A 07/05/2001 PARKER, GLENN 01/23/2002 690.00 4 83C 010705242A 07/05/2001 MARTINEZ JR, MICHEAL 01/23/2002 100.00 4 83C 010705253A 07/05/2001 PARKOS, JEFF 01/23/2002 911.00 4 83C 010705322A 07/07/2001 MARES, RAMON 01/23/2002 860.00 4 83C 010705336A 07/08/2001 LUJAN-JIMINEZ, SERGI Date:01/25/2002 Weld County Paramedic Services Page: 3 Tithe:09:00:36 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/23/2002 Thru 01/23/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/23/2002 889.00 4 83C 010705472A 07/13/2001 KAUFFMAN, KARYN 01/23/2002 755.00 4 83C 010705478A 07/13/2001 BOWMAN, DAKOTA 01/23/2002 781.00 4 83C 010705523A 07/14/2001 PORTER, JOHN 01/23/2002 719.00 4 83C 010705529A 07/14/2001 GORE, DELBERT 01/23/2002 1280.00 4 83C 010705549A 07/15/2001 GARCIA, ALBERTO 01/23/2002 834 .00 4 83C 010705555A 07/15/2001 NOBLETT, DON 01/23/2002 915.00 4 83C 010705605A 07/17/2001 SCHAFER, CHAD LAN 01/23/2002 846.00 4 83C 010705605C 07/17/2001 WHITE, PHILLIP 01/23/2002 897.00 4 83C 010705609A 07/17/2001 VELASQUEZ, FELIX PET 01/23/2002 803 .00 4 83C 010705647A 07/18/2001 FARMER, RONNY L 01/23/2002 666.00 4 83C 010705648A 07/18/2001 GONZALEZ, JUAN 01/23/2002 447.00 4 83C 010705654A 07/19/2001 BRITO MONTES, GABRIE 01/23/2002 704 .00 4 83C 010705674A 07/20/2001 PARKER, GLENN 01/23/2002 654.00 4 83C 010705675A 07/20/2001 HEIL, DOUGLAS L 01/23/2002 652 .45 4 83C 010705677A 07/20/2001 KARROL, RICHARD 01/23/2002 100.00 4 83C 010705678A 07/20/2001 DE SELMS, EDWIN 01/23/2002 731.00 4 83C 010705682A 07/20/2001 LANCKRIET, GREGORY 01/23/2002 100.00 4 83C 010705697A 07/20/2001 ORTEGA, EMMA 01/23/2002 829.00 4 83C 010705724A 07/21/2001 ARRIGO, TIMOTHY G 01/23/2002 875.00 4 83C 010705726A 07/21/2001 MESE, VICTORIA 01/23/2002 690.00 4 83C 010705746A 07/22/2001 ALBERTS, TIMMOTHY 01/23/2002 666.00 4 83C 010705748A 07/22/2001 VELASQUEZ, JOSE M 01/23/2002 666.00 4 83C 010705748B 07/22/2001 CALDERA, CONNIE L 01/23/2002 666.00 4 83C 010705748C 07/22/2001 SIRIO, JAMES 01/23/2002 1033 .00 4 83C 010705758A 07/22/2001 GLOVER, KARRIE 01/23/2002 793 .00 4 83C 010705795A 07/24/2001 BALDERRAMA, OCTAVIO 01/23/2002 704.00 4 83C 010705813A 07/24/2001 MILLER, KYLE D 01/23/2002 704.00 4 83C 010705814A 07/24/2001 GALLEGOS, LINDA M 01/23/2002 100.00 4 83C 010705845A 07/25/2001 MENDOZA, JESSE 01/23/2002 831.00 4 83C 010705846A 07/25/2001 STROH, CURTIS 01/23/2002 769.00 4 83C 010705877A 07/27/2001 CHALI, ERIC 01/23/2002 74.31 4 83C 010705900A 07/27/2001 KELM, JACK 01/23/2002 901.00 4 83C 010705907A 07/27/2001 STERKEL, JULIE 01/23/2002 130.80 4 83C 010705910A 07/28/2001 FAUDOA, DEBRA S 01/23/2002 496.25 4 83C 010705914A 07/28/2001 STOW, KEITH W 01/23/2002 654.00 4 83C 010705956A 07/29/2001 REVOLORIO, ABEL E 01/23/2002 781.00 4 83C 010705975A 07/29/2001 WATSON, SHANE 01/23/2002 896.00 4 83C 010705981A 07/29/2001 LUNDSFORD, JAMES 01/23/2002 935.00 4 83C 010705982A 07/29/2001 CASTILLO, SERGIO 01/23/2002 951.00 4 83C 010705984A 07/30/2001 RODRIGUEZ, ROSA 01/23/2002 819.00 4 83C 010705985A 07/30/2001 REMIGIO, OLGA L 01/23/2002 716.00 4 83C 010706005A 07/30/2001 MERCADO-GARCIA, ROSA 01/23/2002 654.00 4 83C 010706008A 07/30/2001 MARTINEZ, ROSA R 01/23/2002 839.00 4 83C 010706009A 07/30/2001 SALINAS, SABRINA 01/23/2002 399.00 4 83C 010706019A 07/30/2001 MARTINEZ, ROSA R 01/23/2002 825.00 4 83C 010706042A 07/31/2001 RAGER, RANDY 01/23/2002 961.00 4 83C 010706043A 07/31/2001 ANDRADE, VIVIANA 01/23/2002 951.00 4 83C 010806058A 08/01/2001 JOHNSON, BRADLEY 01/23/2002 769.00 4 83C 010806068A 08/01/2001 ALONSO, JOANN Date:01/25/2002 Weld County Paramedic Services Page: 4 Tithe:09:00:37 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/23/2002 Thru 01/23/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/23/2002 399.00 4 83C 010806088A 08/02/2001 JOHNSON, BRADLEY 01/23/2002 40.76 4 83C 010806166A 08/04/2001 MCNEAR, DESIREE 01/23/2002 975.00 4 83C 010806169A 08/04/2001 CASA, MIGUEL 01/23/2002 920 .00 4 83C 010806176A 08/04/2001 GARCIA, JESUS 01/23/2002 853 .00 4 83C 010806205A 08/05/2001 GUERRA, GABRIEL 01/23/2002 759.00 4 83C 010806211A 08/06/2001 KENTON, ROBERT 01/23/2002 654.00 4 83C 010806224C 08/06/2001 BENCOMO TORRES, CELE 01/23/2002 769.00 4 83C 010806231A 08/06/2001 KENTON, ROBERT 01/23/2002 654 .00 4 83C 010806236A 08/06/2001 FLORES, RUTH 01/23/2002 654 .00 4 83C 010806258A 08/07/2001 HUDSPETH, ANDREW 01/23/2002 740.00 4 83C 010806271A 08/07/2001 HAYES, ALYSSA 01/23/2002 719.00 4 83C 010806280A 08/08/2001 ARCHULETA, MICHAEL 01/23/2002 769.00 4 83C 010806311A 08/09/2001 AMAN, STEVE 01/23/2002 1057.00 4 83C 010806353A 08/10/2001 GALLEGOS, RAMONA 01/23/2002 25.00 4 83C 010806364A 08/11/2001 HORNE, MELISSA D 01/23/2002 1236.00 4 83C 010806375A 08/11/2001 INGMIRE, CHRIS 01/23/2002 789.00 4 83C 010806397A 08/12/2001 MCCORD, HEATHER 01/23/2002 899.00 4 83C 010806404A 08/12/2001 BOTELLO, PRIMITIVO 01/23/2002 399.00 4 83C 010806421A 08/12/2001 MCCORD, HEATHER 01/23/2002 399.00 4 83C 010806432A 08/13/2001 GORE, DELBERT 01/23/2002 25.00 4 83C 010806470A 08/14/2001 CONTRERAS, SERGIO 01/23/2002 25.00 4 83C 010806513A 08/16/2001 CONTRERAS, SERGIO 01/23/2002 15.76 4 81 010806522A 08/16/2001 BARNES, MAE 01/23/2002 819.00 4 83C 010806544A 08/17/2001 LANCKRIET, GREGORY 01/23/2002 789.00 4 83C 010906973A 09/01/2001 KENTON, ROBERT 01/23/2002 47.86 4 81 011008585A 10/26/2001 WHATLEY, BELVIA 01/23/2002 18.58 4 81 011008585A 10/26/2001 WHATLEY, BELVIA I 01/23/2002 20.00 4 81 011008659A 10/28/2001 HURT, NORA 01/23/2002 48.24 4 81 011008743A 10/31/2001 STEMBRIDGE, MARY C 01/23/2002 25.00 4 83C 011109167A 11/15/2001 CONTRERAS, SERGIO 01/23/2002 12 .59 4 81 011210065A 12/20/2001 JACOBSON, MARY ANNE 01/23/2002 480.13 4 81 011210081A 12/20/2001 ALLMER, DONALD 01/23/2002 403 .28 4 81 011210083A 12/20/2001 SILVA, CINTIA B 01/23/2002 391.42 4 81 011210105A 12/21/2001 MATA, NELLIE MANUELA 01/23/2002 407.09 4 81 011210108A 12/21/2001 MONCRIEF, OPHA O 01/23/2002 456.01 4 81 011210117A 12/21/2001 JOBES, ANITA 01/23/2002 480.55 4 81 011210125A 12/21/2001 DOMINGUEZ, THERESA • 01/23/2002 618.61 4 81 011210126A 12/21/2001 SPEAKER, MARY 01/23/2002 414.77 4 81 011210143A 12/22/2001 ESCOBAR, TERESA 01/23/2002 494.60 4 81 011210152A 12/22/2001 MASTERS, ALVIE 01/23/2002 19.02 4 81 011210170A 12/22/2001 GIESICK, HARVEY 01/23/2002 - 464.24 4 81 011210181A 12/23/2001 LUNA, MANUELA 01/23/2002 585.13 4 81 011210182A 12/23/2001 APPLE, DARLINE 01/23/2002 471.80 4 81 011210192A 12/23/2001 RODRIGUEZ, PAULINE 01/23/2002 404.07 4 81 011210203A 12/24/2001 ALLEE, LUCILLE R 01/23/2002 390.63 4 81 011210211A 12/24/2001 BLEVINS, ELDORA F 01/23/2002 38.04 4 81 011210229A 12/25/2001 BRAVO, IDA 01/23/2002 470.69 4 81 011210230A 12/25/2001 KOSKA, STEPHEN 01/23/2002 391.42 4 81 011210237A 12/25/2001 SILVA, JESSIE Date:01/25/2002 Weld County Paramedic Services Page: 5 Tithe:09:00:37 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/23/2002 Thru 01/23/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/23/2002 38.04 4 81 011210251A 12/26/2001 DRESSEL, JOHANN 01/23/2002 390.63 4 81 011210255A 12/26/2001 TIDQUIST, CHARLOTTE 01/23/2002 504.23 4 81 011210260A 12/26/2001 TIDQUIST, CHARLOTTE 01/23/2002 199.23 4 81 011210262A 12/26/2001 GAMBRELL, DARIN 01/23/2002 50.36 4 81 011210268A 12/27/2001 LUHMAN, LOUISE A 01/23/2002 18.04 4 81 011210282A 12/28/2001 JOHNS, ELIZABETH G 01/23/2002 453 .69 4 81 011210285A 12/28/2001 MORALES, ISABEL 01/23/2002 491.61 4 81 011210298A 12/28/2001 MIRICK, J. D. 01/23/2002 37.56 4 81 011210306A 12/29/2001 SHOOK, PATRICIA 01/23/2002 454.23 4 81 011210312A 12/29/2001 SCHWINDT, SHIRLEY 01/23/2002 19.02 4 81 011210315A 12/29/2001 MILLER, RICHARD 01/23/2002 199.23 4 81 011210323A 12/29/2001 SCHWINDT, SHIRLEY 01/23/2002 520.57 4 81 011210332A 12/29/2001 RAMIREZ, MARY ELLEN 01/23/2002 422.30 4 81 011210336A 12/29/2001 SCHWINDT, SHIRLEY 01/23/2002 347.99 4 81 011210338A 12/29/2001 RAMIREZ, MARY ELLEN 01/23/2002 546.54 4 81 011210348A 12/30/2001 GARZA, GENARO 01/23/2002 404.07 4 81 011210351A 12/30/2001 DILLARD, VERA FERN 01/23/2002 382.36 4 81 011210354A 12/30/2001 SCHLESINGER, KENNETH 01/23/2002 391.42 4 81 011210359A 12/30/2001 FORD, TAO Y 01/23/2002 475.15 4 81 011210365A 12/31/2001 MCINTIRE, INA 01/23/2002 423.09 4 81 011210372A 12/31/2001 FARMER, TOMMIE J 01/23/2002 483.38 4 81 011210375A 12/31/2001 ACHENBACH, EVA M 01/23/2002 620 .00 4 83C 980704991A 07/31/1998 VARNER, CHRIS Total of 219 WriteOff Entries Totaling 119490.26 Dollars Average WriteOff: 545.62 Dollars Average Time:187 Days Date:01/25/2002 Weld County Paramedic Services Page: 6 Time:09:00 :38 Receipt, Write-off, Adjustment Batch Report MRR300. WriteOffBatch From 01/23/2002 Thru 01/23/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 173 104692.99 605.16 226 .46 81 MEDICARE WRITEOFF 46 14797.27 321.68 36.28 Date:01/25/2002 Weld County Paramedic Services Page: 1 Time:09:02 :19 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/24/2002 Thru 01/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/24/2002 287.43 4 83C 001209376A 12/07/2000 PEIF, JOYE 01/24/2002 10.15 4 83C 001210019A 12/31/2000 DITTMAN, MELODY L 01/24/2002 250 .20 4 83C 010301842A 03/07/2001 PONCE, MICHAEL 01/24/2002 351.00 4 83C 010302198A 03/20/2001 LUJAN, CARMELIA 01/24/2002 737.00 4 83C 010402619A 04/05/2001 LOOK, ALBERT 01/24/2002 159.80 4 83C 010402925A 04/14/2001 PARDY, JEFFREY 01/24/2002 129.90 4 83C 010604714A 06/17/2001 PRESTON, JEFFREY 01/24/2002 831.00 4 83C 010702242A 07/06/2001 KEEKORA, DEREK M 01/24/2002 819.00 4 83C 010705165A 07/03/2001 CARDOZA, JOHNNY C 01/24/2002 913 .00 4 83C 010705168A 07/03/2001 BRADBURY, FRANCIS C 01/24/2002 715.00 4 83C 010705175A 07/03/2001 YODER, DOUG 01/24/2602 787.53 4 83C 010705176A 07/03/2001 WILSON, RICHARD W 01/24/2002 285.40 4 83C 010705181A 07/03/2001 ASTORGA, NATHAN J 01/24/2002 654 .00 4 83C 010705184A 07/03/2001 DELGADO, ROSITA P 01/24/2002 819.00 4 83C 010705197A 07/03/2001 KNUDSON, CHUCK 01/24/2002 268.40 4 83C 010705200A 07/03/2001 HARNEY, COURTNEY M 01/24/2002 819.00 4 83C 010705271A 07/06/2001 COLE, MICHELLE 01/24/2002 731.00 4 83C 010705285A 07/06/2001 KINDSFATHER, JOSHUA 01/24/2002 100.00 4 83C 010705310A 07/07/2001 DODGE, KERRIE 01/24/2002 855.00 4 83C 010705323A 07/08/2001 BAROS, VICTORIA 01/24/2002 704 .00 4 83C 010705324A 07/08/2001 TORO-PUENTE, ISRAEL 01/24/2002 769.00 4 83C 010705327A 07/08/2001 VANDERLOO, CORY 01/24/2002 807.08 4 83C 010705350A 07/09/2001 PALMER, MARGUERITE 01/24/2002 949.00 4 83C 010705351A 07/09/2001 GOMEZ, RITA 01/24/2002 995.00 4 83C 010705370A 07/10/2001 BARRON, JOSE 01/24/2002 967.00 4 83C 010705371A 07/10/2001 WINTERS, EVAGENE MAR 01/24/2002 841.00 4 83C 010705401A 07/10/2001 COURTNEY, DANKE 01/24/2002 100.00 4 83C 010705402A 07/10/2001 SIFUENTEZ, BETTY 01/24/2002 769.00 4 83C 010705409A 07/11/2001 JACKSON, ELLIE E 01/24/2002 100.00 4 83C 010705410A 07/11/2001 ROKER, THEO 01/24/2002 684.00 4 83C 010705452A 07/12/2001 BROWN, GEORGE E 01/24/2002 1297.00 4 83C 010705454A 07/12/2001 JONES, FRANK J 01/24/2002 769.00 4 83C 010705457A 07/12/2001 GALLARDO, DANIEL 01/24/2002 25.00 4 83C 010705904A 07/27/2001 PBR BULL RIDING, 01/24/2002 654 .00 4 83C 010705950A 07/29/2001 DODGE, KERRIE L 01/24/2002 399.00 4 83C 010706029A 07/31/2001 DODGE, KERRIE L 01/24/2002 719.00 4 83C 010800690A 08/29/2001 HASLEY, GARY L 01/24/2002 819.00 4 83C 010806129A 08/03/2001 DODGE, KERRIE L 01/24/2002 14 .00 4 83 010806173A 08/04/2001 MONCIVAIS, BENJAMIN 01/24/2002 704 .00 4 83C 010806399A 08/12/2001 DODGE, KERRIE L 01/24/2002 399.00 4 83C 010806437A 08/13/2001 DODGE, KERRIE L 01/24/2002 743 .00 4 83C 010806482A 08/14/2001 ALTAVILLA, PIERRE 01/24/2002 891.00 4 83C 010806519A 08/16/2001 DUENEZ, NANCY 01/24/2002 859.00 4 83C 010806532A 08/16/2001 MAYORGA, MARIA G 01/24/2002 100.00 4 83C 010806534A 08/16/2001 PEREA, ASHTON 01/24/2002 1143 .00 4 83C 010806537A 08/16/2001 TOVAR, JESUS ALBERT 01/24/2002 100.00 4 83C 010806574A 08/17/2001 BELL, ROYCE 01/24/2002 859.00 4 83C 010806579A 08/17/2001 BYERS, TODD 01/24/2002 399.00 4 83C 010806591A 08/18/2001 STRONG, KIP Date:01/25/2002 Weld County Paramedic Services Page: 2 Time:09:02 :20 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/24/2002 Thru 01/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/24/2002 839.00 4 83C 010806616A 08/19/2001 WILLIAMS, KAMI 01/24/2002 399.00 4 83C 010806625A 08/19/2001 ALISEA, LISA D 01/24/2002 853 .00 4 83C 010806627A 08/19/2001 JOHNS, SHIRLEY 01/24/2002 743 .00 4 83C 010806631A 08/20/2001 MARTINEZ III, MAX 01/24/2002 901.00 4 83C 010806652A 08/20/2001 ASHMORE, VALARIE A 01/24/2002 100.00 4 83C 010806663A 08/21/2001 MATA, TRACI 01/24/2002 999.00 4 83C 010806685A 08/21/2001 CONNALLY, THOMAS M 01/24/2002 769.00 4 83C 010806698A 08/22/2001 HERNANDEZ, RUDY 01/24/2002 769.00 4 83C 010806721A 08/23/2001 WHITE, ROBIN 01/24/2002 775.08 4 83C 010806752A 08/24/2001 INGRAM, RUBY H 01/24/2002 1107.00 4 83C 010806763A 08/24/2001 KELSEY, JOYCE 01/24/2002 860.00 4 83C 010806797A 08/25/2001 HANEY, JAMES 01/24/2002 100.00 4 83C 010806818A 08/26/2001 OSBORNE, DARELL 01/24/2002 654.00 4 83C 010806847A 08/27/2001 RANGEL, BEATRIZ 01/24/2002 769.00 4 83C 010806892A 08/28/2001 DODGE, KERRIE L 01/24/2002 399.00 4 83C 010806897A 08/28/2001 DODGE, KERRIE L 01/24/2002 100.00 4 83C 010806945A 08/30/2001 CONN, ROBERT 01/24/2002 851.00 4 83C 010906989A 09/01/2001 GONZALES, MIGUEL 01/24/2002 654 .00 4 83C 010907009A 09/02/2001 LYONS, HEATHER 01/24/2002 399.00 4 83C 010907010A 09/02/2001 LYONS, HEATHER 01/24/2002 775.18 4 83C 010907078A 09/05/2001 DESANTIAGO, STELLA 01/24/2002 1241.00 4 83C 010907268A 09/10/2001 MOSQUEDA, RAMON 01/24/2002 654 .00 4 83C 010907297B 09/11/2001 RODRIGUEZ, JUAN 01/24/2002 775.08 4 83C 010907418A 09/15/2001 DIVORNE, RAMONA A 01/24/2002 449.00 4 83C 010907423A 09/15/2001 DIVORNE, RAMONA A 01/24/2002 963 .00 4 83C 010907445A 09/16/2001 ALTHAUSER, TIM 01/24/2002 839.00 4 83C 010907532A 09/19/2001 MARKHAM, STEVEN CLAY 01/24/2002 831.00 4 83C 010907555A 09/20/2001 MARKHAM, STEVEN CLAY 01/24/2002 925.00 4 83C 010907631A 09/22/2001 HERNANDEZ, LEON 01/24/2002 769.00 4 83C 010907679A 09/24/2001 WHITE, ROBIN 01/24/2002 834.00 4 83C 010907685A 09/24/2001 PULOS, DANIEL 01/24/2002 855.00 4 83C 010907693B 09/25/2001 ANDRADE MORAN, CATAL 01/24/2002 769.00 4 83C 010907721A 09/26/2001 ROYCE, MICHELLE 01/24/2002 819.00 4 83C 010907787A 09/28/2001 STRONG, KIP 01/24/2002 769.00 4 83C 010907790A 09/28/2001 MARTINEZ, ELIZABETH 01/24/2002 399.00 4 83C 010907822A 09/29/2001 STRONG, KIP 01/24/2002 654.00 4 83C 010907832A 09/29/2001 CRAMER, KEN 01/24/2002 100.00 4 83C 010907836A 09/30/2001 SOSA, ALFREDO 01/24/2002 819.00 4 83C 010907865A 09/30/2001 GURNEY, BRANDI 01/24/2002 399.00 4 83C 011007868A 10/01/2001 GURNEY, BRANDI 01/24/2002 62.68 4 83C 011007881A 10/01/2001 NEHRING, LINDA 01/24/2002 769.00 4 83C 011007956A 10/04/2001 WHITE, ROBIN 01/24/2002 781.00 4 83C 011007958A 10/04/2001 ELLINGFORD, TODD 01/24/2002 704.00 4 83C 011008008A 10/06/2001 HERNANDEZ-VASQUEZ, V 01/24/2002 100.00 4 83C 011008025A 10/07/2001 AGUILAR, LEOBARDO 01/24/2002 839.00 4 83C 011008056A 10/08/2001 GONZALEZ, LUIS G 01/24/2002 951.00 4 83C 011008070A 10/08/2001 LONEBEAR, ALLEN 01/24/2002 654.00 4 83C 011008073A 10/08/2001 RAY, MELISSA 01/24/2002 781.00 4 83C 011008110A 10/09/2001 MARKHAM, STEVEN CLAY Date:01/25/2002 Weld County Paramedic Services Page: 3 Time:09:02:20 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/24/2002 Thru 01/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/24/2002 843 .00 4 83C 011008131A 10/10/2001 FOUNTAIN, GREG J 01/24/2002 716.00 4 83C 011008164A 10/11/2001 MARKHAM, STEVEN CLAY 01/24/2002 - 781.00 4 83C 011008164B 10/11/2001 VALDEZ, TERRY 01/24/2002 399.00 4 83C 011008166A 10/11/2001 VALDEZ, TERRY 01/24/2002 100.00 4 83C 011008236A 10/14/2001 RUCOBOS, MERCY 01/24/2002 775.08 4 83C 011008293A 10/16/2001 DIVORNE, RAMONA A 01/24/2002 819.00 4 83C 011008320A 10/17/2001 GARZA, MICHELLE 01/24/2002 100.00 4 83C 011008327A 10/17/2001 SANCHEZ, MAYOLO 01/24/2002 399.00 4 83C 011008352A 10/18/2001 WELLS, KATHERINE 01/24/2002 100.00 4 83C 011008474A 10/22/2001 BROWN, GEORGE E 01/24/2002 1107.00 4 83C 011008529A 10/24/2001 MARSHALL, SHANNON 01/24/2002 654.00 4 83C 011008532A 10/24/2001 SAINZ, ALBINO 01/24/2002 819.00 4 83C 011008534A 10/24/2001 STRONG, KIP 01/24/2002 399.00 4 83C 011008575A 10/25/2001 STRONG, KIP 01/24/2002 100.00 4 83C 011008685A 10/29/2001 EANES, CHARLES 01/24/2002 754.00 4 83C 011108784A 11/02/2001 BARNARD, RICHARD E 01/24/2002 819.00 4 83C 011108800A 11/02/2001 STRONG, KIP 01/24/2002 819.00 4 83C 011108846A 11/04/2001 BELTRAN, LEANDRO 01/24/2002 20.00 4 81 011108903A 11/06/2001 NELSON, EARL 01/24/2002 20.00 4 81 011109227A 11/17/2001 GARCIA, MIGUEL 01/24/2002 851.00 4 83C 011109347A 11/22/2001 MORENO, JORGE 01/24/2002 704 .00 4 83C 011109352A 11/22/2001 SHERWOOD, CHRISTOPHE 01/24/2002 654 .00 4 83C 011209817A 12/10/2001 TROTCHIE, JACK 01/24/2002 38.04 4 81 011209999A 12/17/2001 HAZLETT, ELSE S 01/24/2002 19.02 4 81 011210021A 12/18/2001 KARICH, CLARA 01/24/2002 769.00 4 83C 011210051A 12/19/2001 RODRIGUEZ, ANA C 01/24/2002 19.02 4 81 011210058A 12/19/2001 MARTINEZ, CRESCENCIO Total of 125 WriteOff Entries Totaling 76018.07 Dollars Average WriteOff: 608.14 Dollars Average Time:150 Days Date:01/25/2002 Weld County Paramedic Services Page: 4 Time:09:02:21 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/24/2002 Thru 01/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ . Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 119 75887.99 637.71 154.34 83 WRITEOFF 1 14 .00 14 .00 173 .00 81 MEDICARE WRITEOFF 5 116.08 23 .22 51.60 i Date:02/21/2002 Weld County Paramedic Services Page: 1 Time:09:17:10 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/20/2002 Thru 02/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/20/2002 754.00 4 83C 010402662A 04/07/2001 MARTINEZ-MORALES, PA 02/20/2002 198.88 4 83C 010402923A 04/14/2001 HELTON, LINDA 02/20/2002 399.00 4 83C 010403072A 04/19/2001 GROSSMAN, CHRISTOPHE 02/20/2002 769.00 4 83C 010403144A 04/21/2001 MARTINEZ, BRIAN K 02/20/2002 20.00 4 83C 010503980B 05/19/2001 ALEJANDRO, SHAWN 02/20/2002 642.00 4 83C 010504180A 05/28/2001 MARTINEZ-MORALES, PA 02/20/2002 654.00 4 83C 010504212A 05/29/2001 WALDEN, JENNIFER 02/20/2002 769.00 4 83C 010604539A 06/11/2001 HILL, JOHN C 02/20/2002 877.00 4 83C 010604566A 06/12/2001 FULTON, KACI 02/20/2002 1068.00 4 83C 010604579A 06/13/2001 SHORTINO, JOSEPH P 02/20/2002 769.00 4 83C 010604720A 06/17/2001 PLANTE, NICHOLE K 02/20/2002 179.59 4 83C 010605058A 06/29/2001 RAMIREZ, SONEY 02/20/2002 1394 .00 4 83C 010705191A 07/03/2001 RISOLI, ANDY 02/20/2002 754.00 4 83C 010705392A 07/10/2001 SWANSON, MICHAEL 02/20/2002 50.00 4 83C 010705400A 07/10/2001 EILERS, ULINDA 02/20/2002 48.00 4 83C 010705613A 07/17/2001 ARNOLD, PAUL D 02/20/2002 693 .56 4 83C 010705691A 07/20/2001 SHIELDS, PRUDENCE 02/20/2002 25.00 4 83C 010705977A 07/29/2001 TELLEZ, GINA 02/20/2002 719.00 4 83C 010806077A 08/01/2001 CATLEGOS, OLIVER RUB 02/20/2002 100 .00 4 83C 010806106B 08/02/2001 DEINES, FELICIA 02/20/2002 769.00 4 83C 010806109A 08/02/2001 VILLEGAS, ASHLEY 02/20/2002 704 .00 4 83C 010806111A 08/03/2001 SPILLMAN, ARCHIE T 02/20/2002 461.53 4 83C 010806114A 08/03/2001 ARNOLD, PAUL D 02/20/2002 399.00 4 83C 010806127A 08/03/2001 YBARRA, RAMON 02/20/2002 771.96 4 83C 010806160A 08/04/2001 JONES, HELEN 02/20/2002 769.00 4 83C 010806172A 08/04/2001 RAMOS-SOTO, RAUL 02/20/2002 654.00 4 83C 010806181A 08/05/2001 MALDONADO, JOSE 02/20/2002 1122.08 4 83C 010806194A 08/05/2001 MCFARLAND, LARRY 02/20/2002 654.00 4 83C 010806207A 08/05/2001 MONDRAGON, JUSTIN L 02/20/2002 719.00 4 83C 010806247A 08/06/2001 STRONG, MARILYN 02/20/2002 793 .00 4 83C 010806354A 08/10/2001 BRANDLY, JOHN ***SEE 02/20/2002 916.00 4 83C 010806358A 08/11/2001 VILIATOBOS, GUADALUP 02/20/2002 25.00 4 83C 010806359A 08/11/2001 SALAZAR, JONI 02/20/2002 704.00 4 83C 010806371A 08/11/2001 SANCHEZ, LONNIE 02/20/2002 852.00 4 83C 010806381A 08/11/2001 SALAZAR, NICHOLAS G 02/20/2002 131.18 4 83C 010806390A 08/11/2001 RIVERA, RICHARD 02/20/2002 819.00 4 83C 010806435A 08/13/2001 CARTER, ELIZABETH A 02/20/2002 911.00 4 83C 010806447A 08/13/2001 LOPEZ, DANIEL L 02/20/2002 915.00 4 83C 010806464A 08/14/2001 WAMBOLT, DEBRA A 02/20/2002 819.00 4 83C 010806508A 08/15/2001 TOVAR, ADRIANO 02/20/2002 839.00 4 83C 010806525A 08/16/2001 WEBER, INA M 02/20/2002 716.00 4 83C 010806539A 08/17/2001 QUINTANA, NORMA 02/20/2002 180.60 4 83C 010806581A 08/18/2001 MARTINEZ, JUAN 02/20/2002 1221.00 4 83C 010806582A 08/18/2001 SILVAS, OSCAR 02/20/2002 915.00 4 83C 010806587A 08/18/2001 VILLARREAL, ARNOLDO 02/20/2002 789.00 4 83C 010806592A 08/18/2001 ESCOBEDO, SARA M 02/20/2002 979.00 4 83C 010806594A 08/18/2001 VELASQUEZ, IRMA O 02/20/2002 769.00 4 83C 010806692A 08/21/2001 CID-ROMER, FRANCISCA 02/20/2002 719.00 4 83C 010806719A 08/22/2001 MENDEZ, ALONZO PEDRO Date:02/21/2002 Weld County Paramedic Services Page: 2 Time:09:17:11 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/20/2002 Thru 02/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/20/2002 716.00 4 83C 010806731A 08/23/2001 TRAYNOR, VICKI LEE 02/20/2002 399.00 4 83C 010806745A 08/23/2001 JOHNSON, SANDRA 02/20/2002 100.00 4 83C 010806746A 08/24/2001 LOPEZ, JORGE ALBERTO 02/20/2002 1342 .00 4 83C 010806757A 08/24/2001 MONTEZ, JOE 0 02/20/2002 754 .00 4 83C 010806760A 08/24/2001 SHOPE, CLARENCE E 02/20/2002 793.00 4 83C 010806783A 08/24/2001 TAYLOR, JAMES ANDREW 02/20/2002 839.00 4 83C 010806805A 08/25/2001 BROWN, ARTHUR T 02/20/2002 847.08 4 83C 010806856A 08/27/2001 REID, ROBERTA 02/20/2002 100.00 4 83C 010806888A 08/28/2001 SPEAKER, HERBERT 02/20/2002 865.00 4 83C 010806902A 08/28/2001 RICHARDS, MELISSA 02/20/2002 949.00 4 83C 010806911A 08/29/2001 SKELTON, MEGAN 02/20/2002 793.00 4 83C 010806942A 08/30/2001 YBARRA, RAMON 02/20/2002 399.00 4 83C 010806956A 08/31/2001 YBARRA, RAMON 02/20/2002 775.00 4 83C 010906974C 09/01/2001 PEREZ, ARACELY 02/20/2002 775.00 4 83C 010906974D 09/01/2001 BENCOMO, JAVIER 02/20/2002 855.00 4 83C 010906974E 09/01/2001 PEREZ-IBANEZ, CLAUDI 02/20/2002 819.00 4 83C 010907041B 09/03/2001 LOPEZ, FERRETIZ 02/20/2002 100.00 4 83C 010907092A 09/05/2001 MOSCO, LISA 02/20/2002 654.00 4 83C 010907147A 09/07/2001 PECK, ROBERT K 02/20/2002 769.00 4 83C 010907159A 09/07/2001 CASTILLO, WILLIE 02/20/2002 839.00 4 83C 010907167A 09/07/2001 PEREZ-IBANEZ, CLAUDI 02/20/2002 100 .00 4 83C 010907196A 09/08/2001 DILKA, ROBERT 02/20/2002 100.00 4 83C 010907217A 09/09/2001 ANCHONDO, MONIQUE 02/20/2002 100.00 4 83C 010907217C 09/09/2001 MAESTAS, LEROY 02/20/2002 827.00 4 83C 010907266A 09/10/2001 CORDOVA, LENA 02/20/2002 789.00 4 83C 010907278A 09/11/2001 CRAVEN, MAX 02/20/2002 903 .00 4 83C 010907308A 09/11/2001 FERNANDEZ, DIEGO 02/20/2002 969.00 4 83C 010907545A 09/20/2001 HIGH, ARLAN 02/20/2002 769.00 4 83C 011007911A 10/02/2001 GALLEGOS, OLIVER RUB 02/20/2002 402 .29 4 81 011007982A 10/05/2001 RUDD, PHIL 02/20/2002 879.00 4 83C 011007984A 10/05/2001 CLIFTON, SHELLY 02/20/2002 834.00 4 83C 011008194A 10/12/2001 MESA, ANGEL A 02/20/2002 839.00 4 83C 011008483A 10/22/2001 YORK, RONALD 02/20/2002 896.56 4 83C 011008623A 10/27/2001 DOYLE, SHIRLEY 02/20/2002 10.00 4 83C 011008726A 10/31/2001 LEBLANC, RICHARD 02/20/2002 774.00 4 83C 011008731A 10/31/2001 CASTILLO, JANET ' 02/20/2002 769.00 4 63C 011008744A 10/31/2001 CABRERA, LUIS 02/20/2002 704.00 4 83C 011008744B 10/31/2001 OROZCO, ALEJANDRO 02/20/2002 1366.00 4 83C 011108778A 11/01/2001 CASTILLO, JANET 02/20/2002 884.00 4 83C 011108804A 11/02/2001 DELEON, ESIQUIEL JR 02/20/2002 931.00 4 83C 011108820A 11/03/2001 BLAKELY, DARREN 02/20/2002 935.00 4 83C 011108847A 11/04/2001 ROMERO, BARBARA 02/20/2002 819.00 4 83C 011108865A 11/05/2001 CARROLL, CHRISTOPHER 02/20/2002 719.00 4 83C 011108929A 11/06/2001 MCCRACKEN, DEELYNN 02/20/2002 731.00 4 83C 011109006A 11/09/2001 WILLIAMS, AARON S 02/20/2002 769.00 4 83C 011109036A 11/10/2001 TALBOTT, GREGORY 02/20/2002 860.00 4 83C 011109071A 11/12/2001 CHAVEZ, DOUG 02/20/2002 719.00 4 83C 011109176A 11/16/2001 WHITEHEAD, STEPHANIE 02/20/2002 654.00 4 83C 011109236A 11/17/2001 MARROW, TANYA M Date:02/21/2002 Weld County Paramedic Services Page: 3 Time:09:17:11 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/20/2002 Thru 02/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/20/2002 831.00 4 83C 011109250A 11/18/2001 NICHOLS, KEITH 02/20/2002 819.00 4 83C 011109282A 11/19/2001 LABELLE, PATRICK 02/20/2002 939.00 4 83C 011109345A 11/22/2001 SHIELDS, PRUDENCE 02/20/2002 851.00 4 83C 011109517A 11/28/2001 YORK, RONALD 02/20/2002 399.00 4 83C 011109524A 11/28/2001 YORK, RONALD 02/20/2002 1030 .00 4 83C 011209750A 12/08/2001 AVILES, EUFIMIO 02/20/2002 789.00 4 83C 011209757A 12/08/2001 GOODYEAR, WILLIAM G 02/20/2002 851.00 4 83C 011209863A 12/12/2001 MILLER, RAYMOND M 02/20/2002 100 .00 4 83C 011209893A 12/13/2001 CASTILLO, EVA 02/20/2002 715.00 4 83C 011209899A 12/14/2001 MORENO, LORENZO 02/20/2002 769.00 4 83C 011209975A 12/16/2001 BLANCO, FABIAN 02/20/2002 399.00 4 83C 011210092A 12/20/2001 CARTER, ELIZABETH A 02/20/2002 100.00 4 83C 011210131A 12/21/2001 JARAMILLO, JACOB 02/20/2002 901.00 4 83C 011210221A 12/25/2001 RICO, CHRIS 02/20/2002 754.00 4 83C 011210296A 12/28/2001 RANGEL, MARIA DE LA 02/20/2002 20.00 4 81 011210355A 12/30/2001 LIGHTSEY, MARGARET V 02/20/2002 934.00 4 83C 020100014A 01/01/2002 CHAVEZ, JOSE CARLOS 02/20/2002 936.00 4 83C 020100147A 01/05/2002 O'BRIEN, DALLAS 02/20/2002 764 .00 .4 83C 020100162A 01/05/2002 RADER, TRACY Total of 117 WriteOff Entries Totaling 79354.31 Dollars Average WriteOff: 678.24 Dollars Average Time:163 Days Date:02/21/2002 Weld County Paramedic Services Page: 4 Time:09:17:12 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/20/2002 Thru 02/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 115 78932 .02 686.37 164.30 81 MEDICARE WRITEOFF 2 422 .29 211.15 95.00 Date:04/01/2002 Weld County Paramedic Services Page: 1 Time:10 :01:26 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/29/2002 Thru 03/29/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/29/2002 62.00 4 70CE 000100069A 01/04/2000 PINEDA, MARK 03/29/2002 40.00 4 70CE 000100304A 01/13/2000 ROMAYOR, MARIE 03/29/2002 50.00 4 70CE 000100501A 01/21/2000 MEEKS, KATHY 03/29/2002 16.66 4 70CE 000100624A 01/26/2000 VELEZ, ALEIDA 03/29/2002 37.50 4 70CE 000100694A 01/29/2000 EREBIA, ANNE 03/29/2002 55.07 4 70CE 000201340A 02/24/2000 WINTERS, CHRISTOPHER 03/29/2002 13 .33 4 70CE 000201447A 02/29/2000 ESPARZA, APRIL M 03/29/2002 19.99 4 70CE 000301639A 03/07/2000 ARANDA, ISIDRA 03/29/2002 21.80 4 70CE 000301793A 03/13/2000 PROSPERO, DEJARENAY 03/29/2002 13 .33 4 70CE 000301833A 03/14/2000 ESPARZA, APRIL 03/29/2002 261.66 4 70PF 000301883A 03/16/2000 TRAYNOR, CONNIE 03/29/2002 29.05 4 70CE 000301910C 03/17/2000 REYES, MAGDA 03/29/2002 25.00 4 70CE 000301981A 03/20/2000 GALLEGOS, CARLOS 03/29/2002 57.07 4 70CE 000302291A 03/31/2000 PADILLA, MAX 03/29/2002 55 .00 4 70CE 000402350A 04/02/2000 GAUKEL, DAVID 03/29/2002 38.33 4 70CE 000402894A 04/22/2000 REYES, JOHN C 03/29/2002 27.06 4 70CE 000403003A 04/26/2000 BUSH, ASHLEY 03/29/2002 2.50 4 70PF 000403026A 04/26/2000 HARRIS, ROBERT JOSEP 03/29/2002 10.54 4 70CE 000503621A 05/19/2000 ZAMORA, BLANCA 03/29/2002 15.84 4 70CE 000503931A 05/30/2000 ROMERO, REGINA 03/29/2002 16.54 4 70CE 000604192A 06/08/2000 BROWN, ZOE 03/29/2002 16.66 4 70CE 000604206A 06/08/2000 HEIDENREICH, CLINT 03/29/2002 63 .66 4 70CE 000604382A 06/14/2000 PIEDALUE, MARIE 03/29/2002 33 .33 4 70CE 000604459A 06/17/2000 BROOKS, JEANETTE D 03/29/2002 172 .50 4 70CE 000604489A 06/18/2000 SMALL, CHRISTY 03/29/2002 27.50 4 70CE 000705018A 07/05/2000 BEVINS, BARBARA 03/29/2002 6 .66 4 70CE 000705456A 07/19/2000 GATES, LASHAUNTA 03/29/2002 56 .43 4 70CE 000705551A 07/22/2000 LUNA, GLORIA 03/29/2002 100 .00 4 83 000705744A 07/30/2000 DUNN, JEFFREY 03/29/2002 116.57 4 70CE 000806425A 08/22/2000 TORRES, SILVERIO 03/29/2002 135.77 4 70CE 000606583A 08/28/2000 MOCK, ALYSSA 1 03/29/2002 137.41 4 70PF 000806633A 08/30/2000 HOVANIC, DAVID 1 03/29/2002 146.97 4 70PF 000906921A 09/08/2000 HOVANIC, DAVID 03/29/2002 75.00 4 70CE 000907044A 09/12/2000 REITZ, CHRISTOPHER 03/29/2002 12 .08 4 70CE 000907083A 09/14/2000 SIMER, CHARITY D 03/29/2002 8.33 4 70CE 000907166A 09/17/2000 VELO-BRAVO, TEODOSIO 03/29/2002 150 .54 4 70PF 000907172A 09/17/2000 HOVANIC, DAVID 03/29/2002 48 .66 4 70CE 001007587A 10/01/2000 ZIPPERER, DANIELLE 03/29/2002 16.66 4 70CE 001007967A 10/15/2000 EATON, MICHELLE 03/29/2002 41.66 4 70CE 001007999A 10/16/2000 KIRKER, KELLY 03/29/2002 66.66 4 70CE 001108917A 11/18/2000 ENCINIA, VICTORIA 03/29/2002 100.00 4 70CE 001109004A 11/22/2000 GUTHRIE, TRACI 03/29/2002 83 .33 4 70CE 001109154A 11/30/2000 BRACKEN, ERICKA 03/29/2002 50.00 4 70CE 001209456A 12/09/2000 URBACH, JEFFREY L 03/29/2002 50.00 4 70CE 001209514A 12/11/2000 SANCHEZ, AMADOR 03/29/2002 3 .38 4 70CE 001210019A 12/31/2000 DITTMAN, MELODY L 03/29/2002 39.85 4 70CE 010100400A 01/15/2001 SWEIGARD, RICHARD 03/29/2002 8 .33 4 70CE 010100712A 01/26/2001 WALKER, JACKSON 03/29/2002 93 .10 4 70CE 010100883A 01/31/2001 HARPER, TYLER Date:04/01/2002 Weld County Paramedic Services Page: 2 Time:10 :01:28 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/29/2002 Thru 03/29/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/29/2002 50.00 4 70CE 010201087A 02/07/2001 ENDSLEY, PAM 03/29/2002 73 .00 4 70CE 010201174A 02/10/2001 POLLMILLER, JEFF 03/29/2002 71.84 4 70CE 010201205A 02/11/2001 MORALES, JULIAN 03/29/2002 37.10 4 70CE 010201213A 02/12/2001 GIROUARD, JANET M 03/29/2002 33 .33 4 70CE 010201494A 02/22/2001 RAMOS, MARIA 03/29/2002 70.00 4 70CE 010302077A 03/16/2001 LOPEZ, VICTORIA 03/29/2002 011340 AMB 15.07 4 70CE 010302137A 03/18/2001 HERRICK, TAWONNA J 03/29/2002 6.66 4 70CE 010302232A 03/22/2001 GUTIERREZ, SAUL 03/29/2002 58.48 4 70CE 010402557A 04/02/2001 HOOD, DOUGLAS M 03/29/2002 737.00 4 83C 010402619A 04/05/2001 LOOK, ALBERT 03/29/2002 283 .00 4 70CE 010402653A 04/06/2001 ADAMS, JOSHUA DAVID 03/29/2002 5.07 4 70CE 010402697A 04/07/2001 RODNEY, STEPHANIE 03/29/2002 8 .33 4 70CE 010402741A 04/09/2001 CONTRERAS, SERGIO 03/29/2002 96.56 4 70PF 010402913A 04/14/2001 ANALCO, CIRILO A 03/29/2002 765.00 4 83C 010403299A 04/26/2001 RODGERS, BRENDA M 03/29/2002 264.33 4 70PF 010503642A 05/07/2001 CREECH, KELLI 03/29/2002 8.33 4 70CE 010504014A 05/21/2001 CONTRERAS, SERGIO 03/29/2002 8.33 4 70CE 010504054A 05/23/2001 CONTRERAS, SERGIO 03/29/2002 765.00 4 83C 010504178A 05/28/2001 RODGERS, BRENDA M 03/29/2002 678 .00 4 83C 010604351A 06/03/2001 WINSLOW, BRADLEY A 03/29/2002 399.00 4 83C 010604353A 06/03/2001 WINSLOW, BRADLEY A 03/29/2002 319.00 4 83C 010604424A 06/06/2001 BALDWIN, DAVID A 03/29/2002 192 .25 4 83C 010604544A 06/11/2001 ROGERS, KAREN 03/29/2002 25.00 4 83C 010604767A 06/19/2001 GARZA, DAWN 03/29/2002 632 .00 4 83C 010604990A 06/26/2001 BARC, WALTER 03/29/2002 293 .00 4 83C 010605095A 06/30/2001 ARREOLA, MARIA 03/29/2002 54 .64 4 70PF 010705138A 07/01/2001 FISHER, NAOMI JO 03/29/2002 296.60 4 83C 010705172A 07/03/2001 LANG, COLIN T 03/29/2002 8.33 4 70PF 010705181A 07/03/2001 ASTORGA, NATHAN J 03/29/2002 654 .00 4 83C 010705205A 07/04/2001 BENAVIDES, SONDRA 03/29/2002 328.45 4 83C 010705376A 07/10/2001 BARC, WALTER 03/29/2002 50 .00 4 70CE 010705387A 07/10/2001 ROBERTS, JASON L 03/29/2002 1059.00 4 83C 010705422A 07/11/2001 TURNER, JAY 03/29/2002 399.00 4 83C 010705434A 07/11/2001 TURNER, JAY 03/29/2002 788.00 4 83C 010705546A 07/15/2001 PEARSON, BRYCE 03/29/2002 819.00 4 83C 010705559A 07/15/2001 TURNER, JAY 03/29/2002 399.00 4 83C 010705568A 07/15/2001 TURNER, JAY 03/29/2002 839.00 4 83C 010705581A 07/16/2001 TURNER, JAY 03/29/2002 400.26 4 83C 010705662A 07/19/2001 PATTERSON, RJ**SEE N 03/29/2002 33.33 4 70CE 010705678A 07/20/2001 DE SELMS, EDWIN 03/29/2002 1119.00 4 83C 010705737A 07/22/2001 RODRIGUEZ, ELOY 03/29/2002 333 .00 4 70PF 010705741A 07/22/2001 BARBER, BETTY J 03/29/2002 399.00 4 83C 010705745A 07/22/2001 PULVER, KATHY ***SEE 03/29/2002 1040 .00 4 83C 010705912A 07/28/2001 HOGARTH, JOHN H 03/29/2002 100.00 4 83C 010705947A 07/28/2001 JACKSON, GRIFFON 03/29/2002 399.00 4 83C 010806052A 08/01/2001 JARAMILLO, LAURA M 03/29/2002 776.00 4 83C 010806137A 08/03/2001 MELENDEZ, LLUVIA 03/29/2002 399.00 4 83C 010806199A 08/05/2001 ROBERTS, CHRISTINE 03/29/2002 100.00 4 83C 010806204A 08/05/2001 KELTNER, LEE . Date04/01/2002 Weld County Paramedic Services Page: 3 Time:10:01:29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/29/2002 Thru 03/29/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/29/2002 754 .00 4 83C 010806254A 08/07/2001 THIEL, ROXANNE 03/29/2002 769.00 4 83C 010806267A 08/07/2001 GIRON, KATHY 03/29/2002 9.72 4 70PF 010806280A 08/08/2001 ARCHULETA, MICHAEL 03/29/2002 75 .00 4 83C 010806347A 08/10/2001 VENTURA, MARIA 03/29/2002 8.33 4 70CE 010806470A 08/14/2001 CONTRERAS, SERGIO 03/29/2002 769.00 4 83C 010806472A 08/14/2001 HOLGUIN, DARLENE 03/29/2002 8.33 4 70CE 010806513A 08/16/2001 CONTRERAS, SERGIO 03/29/2002 885.00 4 83C 010806526A 08/16/2001 MAREZ, EDWARD 03/29/2002 885.00 4 83C 010806526B 08/16/2001 SMITH, LISA L 03/29/2002 1048.00 4 83C 010806542A 08/17/2001 URDIALES, ELEANOR 03/29/2002 716.00 4 83C 010806595A 08/18/2001 LOPEZ, JASON S 03/29/2002 100 .00 4 83C 010806609A 08/18/2001 GARCIA, TORRIE 03/29/2002 809.00 4 83C 010806688A 08/21/2001 MALKASIAN, MITCHELL 03/29/2002 891.00 4 83C 010806790A 08/25/2001 JULIO, BETTY 03/29/2002 769.00 4 83C 010806816A 08/25/2001 PINO, LORRAINE 03/29/2002 715.00 4 83C 010806867A 08/27/2001 BROADHEAD, CAROLINE 03/29/2002 911.00 4 83C 010806916A 08/29/2001 GUZMAN, HECTOR D 03/29/2002 23 .33 4 70CE 010806945A 08/30/2001 CONN, ROBERT 03/29/2002 654 .00 4 83C 010906981A 09/01/2001 HERNANDEZ, REYNALDO 03/29/2002 399.00 4 83C 010906983A 09/01/2001 HERNANDEZ, REYNALDO 03/29/2002 871.00 4 83C 010907063A 09/04/2001 GONZALEZ, BEATRICE 03/29/2002 743 .00 4 83C 010907067A 09/04/2001 GRUBBS, PEGGY 03/29/2002 207.40 4 83C 010907161A 09/07/2001 LOPEZ, LEOLA 03/29/2002 769.00 4 83C 010907170A 09/07/2001 PONTIUS, ROBBIE 03/29/2002 399.00 4 83C 010907175A 09/08/2001 MANCHA, ANNA D 03/29/2002 839.00 4 83C 010907249A 09/10/2001 GONZALEZ, BEATRICE 03/29/2002 399.00 4 83C 010907254A 09/10/2001 STINNETT, MICHELLE 03/29/2002 399.00 4 83C 010907294A 09/11/2001 HALLER, RICHARD 03/29/2002 654.00 4 83C 010907300A 09/11/2001 ARIAS, JOSE O 03/29/2002 100.00 4 83C 010907304A 09/11/2001 GARCIA, ASHLY 03/29/2002 100.00 4 83C 010907312A 09/12/2001 MENDOZA, CHRISTINE 03/29/2002 434 .54 4 83C 010907315A 09/12/2001 CARNAHAN, CINDY 03/29/2002 BANKRUPTCY 740 .00 4 83 010907354A 09/13/2001 ISHAM, JASMYN MERCED 03/29/2002 399.00 4 83C 010907369A 09/14/2001 MALONEY, LEA ANNE 03/29/2002 100.00 4 83C 010907377A 09/14/2001 BANUELOS, ROSA 03/29/2002 719.00 4 83C 010907390A 09/14/2001 CHAVEZ, PEDRO 03/29/2002 100.00 4 83C 010907394A 09/14/2001 ECKARDT, SUSAN 03/29/2002 983 .00 4 83C 010907416A 09/15/2001 HOPWOOD, DEE R 03/29/2002 765.00 4 83C 010907455A 09/17/2001 RODGERS, BRENDA M 03/29/2002 100 .00 4 83C 010907457A 09/17/2001 GRAHAM, COURTNEY 03/29/2002 333 .47 4 83C 010907468B 09/17/2001 BARC, WALTER 03/29/2002 814 .00 4 83C 010907472A 09/17/2001 BROOKEY, JUSTINE 03/29/2002 871.00 4 83C 010907548A 09/20/2001 HIGH, JUDIE 03/29/2002 704.00 4 83C 010907554A 09/20/2001 GARCIA, JOSE 03/29/2002 654.00 4 83C 010907566A 09/20/2001 BARRERA, MARTIN 03/29/2002 100.00 4 83C 010907576A 09/21/2001 BLASHOCK, PRICILLA 03/29/2002 399.00 4 83C 010907577A 09/21/2001 MANG, KEN 03/29/2002 728.00 4 83C 010907581B 09/21/2001 ANDRADE, JENNESSA 03/29/2002 1415 .00 4 83C 010907609A 09/22/2001 FONTES, GEORGE • Date:04/01/2002 Weld County Paramedic Services Page: 4 Time:10:01:29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/29/2002 Thru 03/29/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/29/2002 399.00 4 83C 010907648A 09/23/2001 CANTU, MATTHEW 03/29/2002 855.00 4 83C 010907670A 09/24/2001 BURT, JAMES 03/29/2002 204.00 4 83C 010907697A 09/25/2001 ROGERS, KAREN 03/29/2002 769.00 4 83C 010907703A 09/25/2001 ARELLANO, GEORGE 03/29/2002 99.75 4 83C 010907707A 09/25/2001 ROGERS, KAREN 03/29/2002 399.00 4 83C 010907712A 09/25/2001 BURT, JAMES 03/29/2002 925.00 4 83C 010907716A 09/25/2001 MCBRIDE, DAVID 03/29/2002 781.00 4 83C 010907743A 09/26/2001 KELLOGG, IRENE 03/29/2002 776.00 4 83C 010907806A 09/29/2001 JULIO, BELIA 03/29/2002 715.00 4 83C 010907825A 09/29/2001 PEREZ, ANTONIO 03/29/2002 100.00 4 83C 010907838A 09/30/2001 GUTIERREZ, JAMES 03/29/2002 754.00 4 83C 010907861A 09/30/2001 IBARRA, JAZMIN YAZEL 03/29/2002 704.00 4 83C 011007935A 10/03/2001 BURBACK, DONA SUE 03/29/2002 654.00 4 83C 011008013A 10/06/2001 FLOT, EUGENE 03/29/2002 40.00 4 70CE 011008056A 10/08/2001 GONZALEZ, LUIS G 03/29/2002 948.08 4 83C 011008157A 10/11/2001 GOMEZ, JUAN 03/29/2002 839.00 4 83C 011008241A 10/14/2001 CASTOR, JOSEPH 03/29/2002 666.00 4 83C 011008348A 10/18/2001 WINTER, MIKE 03/29/2002 1225.00 4 83C 011008504A 10/23/2001 WATSON, NATHAN 03/29/2002 1196.00 4 83C 011008616A 10/27/2001 DIAZ, VICTOR 03/29/2002 937.00 4 83C 011008669A 10/28/2001 MEZA, ARTURO 03/29/2002 754.00 4 83C 011008715A 10/30/2001 GARZA, DEANGELO 03/29/2002 50.30 4 83C 011008747A 10/31/2001 DAVIS, LARRY 03/29/2002 764.00 4 83C 011108768A 11/01/2001 SANCHEZ, REBEKAH 03/29/2002 769.00 4 83C 011108827A 11/03/2001 RODRIGUEZ, MICHAEL 03/29/2002 843 .00 4 83C 011108906A 11/06/2001 PINEDA, PETER D 03/29/2002 769.00 4 83C 011108924A 11/06/2001 KIRSCH, ALLAN W 03/29/2002 819.00 4 83C 011109052A 11/11/2001 ROGERS, KAREN 03/29/2002 754.00 4 83C 011109052B 11/11/2001 MARKHAM, STEVEN CLAY 03/29/2002 100.00 4 83C 011109143A 11/14/2001 SANSONE, TAMMIE 03/29/2002 8.33 4 70CE 011109167A 11/15/2001 CONTRERAS, SERGIO 03/29/2002 769.00 4 83C 011109245A 11/18/2001 NIRA, CARPIO I 03/29/2002 819.00 4 83C 011109256A 11/18/2001 BARNARD, RICHARD E 03/29/2002 853 .00 4 83C 011109280A 11/19/2001 ROCHA, TRAVIS 03/29/2002 819.00 4 83C 011109295A 11/20/2001 VILLALOBOS, LETICIA 03/29/2002 781.00 4 83C 011109309A 11/20/2001 DOMINGUEZ, JOSE 03/29/2002 399.00 4 83C 011209603A 12/02/2001 HEIDEN, MATTHEW 03/29/2002 924.00 4 83C 011209979A 12/16/2001 HERNANDEZ, PABLO 03/29/2002 789.00 4 83C 011210134A 12/21/2001 ROGERS, KAREN 03/29/2002 399.00 4 83C 011210141A 12/22/2001 ROGERS, KAREN 03/29/2002 62 .68 4 82 011210255A 12/26/2001 TIDQUIST, CHARLOTTE 03/29/2002 39.96 4 82 011210260A 12/26/2001 TIDQUIST, CHARLOTTE 03/29/2002 793 .00 4 83C 011210358A 12/30/2001 STOLTZ, ROSELLA 03/29/2002 724 .00 4 83C 020100011A 01/01/2002 BENAVIDES, SONDRA 03/29/2002 814 .00 4 83C 020100090B 01/03/2002 OLIVAS, ALONZO 03/29/2002 958 .00 4 83C 020100199A 01/07/2002 ROCHA, TRAVIS 03/29/2002 90.80 4 83C 020100207A 01/07/2002 NEW, MICHAEL 03/29/2002 812 .00 4 83C 020100310F 01/10/2002 HERNANDEZ, ROBERTO 03/29/2002 374.00 4 83C 020100535A 01/17/2002 HAGEMEIER, MICHAEL Date:04/01/2002 Weld County Paramedic Services Page: 5 Time:10 :01:30 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/29/2002 Thru 03/29/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/29/2002 768.54 4 82 020100647A 01/21/2002 PEREA-TORREZ, DANIEL 03/29/2002 740 .89 4 82 020100711A 01/23/2002 CAMPBELL, DONNA 03/29/2002 786 .00 4 83C 020100754A 01/25/2002 MARTINEZ, CHRISTOPHE 03/29/2002 636.24 4 82 020100769A 01/25/2002 MASSER, LINDA 03/29/2002 676.18 4 82 020100839A 01/28/2002 MULLANEY, BARBARA 03/29/2002 1478.00 4 83C 020100847A 01/28/2002 RODRIGUEZ, ALFREDO 03/29/2002 774.00 4 83C 020100895A 01/30/2002 BRUNETTI, THERESA 03/29/2002 724 .00 4 83C 020100916A 01/31/2002 BOYCE, LILLIE 03/29/2002 686.97 4 82 020100920A 01/31/2002 TRUJILLO, STEPHANIE 03/29/2002 374 .00 4 83C 020100921A 01/31/2002 BOYCE, LILLIE 03/29/2002 626.18 4 82 020100935A 01/31/2002 MORALES, GABRIELA 03/29/2002 945.08 4 82 020201087A 02/06/2002 RUNNELLS, WILLIAM R 03/29/2002 894.00 4 83C 020201184A 02/09/2002 WHITE, ROBIN 03/29/2002 19.14 4 81 020201411A 02/17/2002 HOLLIS, FRIEDA 03/29/2002 512 .57 4 81 020201708A 02/27/2002 ESSARY, MARY 03/29/2002 3 .33 4 70CE 860528008A 05/28/1986 WOOLDRIDGE, JUDY 03/29/2002 8.33 4 70CE 900918057A 09/18/1990 HERNANDEZ, DELORES 03/29/2002 3.33 4 70CE 910707026A 07/07/1991 GOMEZ, FELIX 03/29/2002 138.00 4 70CE 921110023A 11/10/1992 FERGUSON, LEON 03/29/2002 50.00 4 70CE 931013040A 10/14/1993 RENNER, VALENTINE 03/29/2002 23 .99 4 70CE 940200791B 02/09/1994 GUTIERREZ, MARIA 03/29/2002 4 .82 4 70CE 941206896A 12/02/1994 SHAW, TAMARA 03/29/2002 25.00 4 70CE 950603727A 06/20/1995 HOUSER, SHELLY 03/29/2002 120 .00 4 70CE 950703984A 07/01/1995 RODRIGUEZ, LUIS 03/29/2002 50.00 4 70CE 950905772B 09/13/1995 ORTIZ, LINDA 03/29/2002 25.65 4 70CE 951107050L 11/02/1995 CAUDILLO, MARIA 03/29/2002 50.00 4 70CE 960603464A 06/09/1996 MOORE, DEBRA 03/29/2002 5.00 4 70CE 960603647A 06/16/1996 DUDICK, JAMES 03/29/2002 50 .00 4 70CE 960704563A 07/27/1996 GAYTON, RUDY 03/29/2002 100 .00 4 70CE 960704660A 07/30/1996 BERNAL, NICHOLAS 03/29/2002 1.66 4 70CE 970201045A 02/17/1997 KELLNER, THEODORE 03/29/2002 2 .54 4 70CE 970704280A 07/04/1997 CAMPBELL, KAY 03/29/2002 25.00 4 70CE 970805118A 08/07/1997 DEVRIES, MARIE L 03/29/2002 16.66 4 70CE 970805308A 08/15/1997 MONTOYA, JACOB 03/29/2002 74 .56 4 70CE 971006810A 10/14/1997 KIBLER, LAURA 03/29/2002 12.50 4 70CE 971107321A 11/04/1997 KENNEDY, LARRY 03/29/2002 17 .50 4 70CE 971107332A 11/04/1997 SERNA, JUAN FRANCISC 03/29/2002 16.66 4 70CE 971107777A 11/23/1997 HERNANDEZ-GOMEZ, MEL 03/29/2002 12 .50 4 70CE 971107878A 11/27/1997 GUTIERREZ, BRENDA 03/29/2002 256.82 4 70CE 980100701A 01/31/1998 MCKEE, TIM 03/29/2002 50 .62 4 70CE 980503182A 05/18/1998 HERNANDEZ, CESAR 03/29/2002 17 .93 4 70CE 980503505A 05/31/1998 ALLEN, MARIAN 03/29/2002 50.00 4 70CE 980603649A 06/07/1998 MACIAS, DIANA 03/29/2002 46.45 4 70CE 980604083A 06/24/1998 TURECEK, ROBERT 03/29/2002 2 .50 4 70PF 980702099A 04/03/1998 HARRIS, ROBERT JOSEP 03/29/2002 50.00 4 70CE 980704978A 07/30/1998 SERRANO, LETICIA 03/29/2002 66.66 4 70CE 980805386A 08/14/1998 NOPENS, WILLIAM 03/29/2002 50 .00 4 70CE 980805714A 08/26/1998 HATFIELD, MARK ANDRE 03/29/2002 32.69 4 70CE 980805823A 08/31/1998 VAUGHAN, THOMAS • Date:04/01/2002 Weld County Paramedic Services Page: 6 Time:10:01:31 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/29/2002 Thru 03/29/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/29/2002 1.66 4 70PF 980906568A 09/29/1998 RAU, MARY E 03/29/2002 33.24 4 70CE 981007270A 10/28/1998 CHAVEZ, ROSALINDA 03/29/2002 101.60 4 70CE 981107947A 11/26/1998 CERVANTES, JESSIE 03/29/2002 44.98 4 70CE 981107966A 11/26/1998 RODRIGUEZ, MARTHA 03/29/2002 25.00 4 70CE 990100051A 01/02/1999 DELAP, AUTUMN 03/29/2002 6.66 4 70CE 990100367A 01/14/1999 CORDES, CONNIE 03/29/2002 011340 AMB 14 .99 4 70CE 990100660A 01/24/1999 BELL, KENDRA 03/29/2002 8.33 4 70CE 990100687A 01/25/1999 DURAN, CONSUELO 03/29/2002 8.80 4 70CE 990100794A 01/30/1999 BATTEN, DIEDRE 03/29/2002 14.50 4 70CE 990200950A 02/05/1999 TURLEY, HEATHER 03/29/2002 8.33 4 70CE 990302138A 03/22/1999 PROVENCHER, JESSIAH 03/29/2002 6.66 4 70CE 990402666A 04/11/1999 HEALEY, JAMES 03/29/2002 62 .50 4 70CE 990402943A 04/20/1999 BAIRD, WENDY ',. 03/29/2002 25.50 4 70CE 990503449A 05/10/1999 SICKLER, JULIA A 03/29/2002 75.00 4 70CE 990503656A 05/19/1999 GUREVICH, DAVID 03/29/2002 2 .62 4 70CE 990503686A 05/20/1999 HARNESS, MELEA 03/29/2002 28.64 4 70CE 990604072B 06/05/1999 BARKER, DEBORAH 03/29/2002 26.66 4 70CE 990604536A 06/22/1999 HERMASILLO, MARTA HI 03/29/2002 7.33 4 70CE 990705235A 07/17/1999 DUKE, JACQUELIN 03/29/2002 33.33 4 70CE 990805897A 08/09/1999 FITHIAN, BETTY M 03/29/2002 10.00 4 70CE 990806025A 08/14/1999 SCHRAM, DAVID 03/29/2002 163 .00 4 83C 990806323A 08/26/1999 RODRIGUEZ, DANIEL R 03/29/2002 25.33 4 70CE 990906588A 09/05/1999 ARELLANES, JORGE 03/29/2002 27.90 4 70CE 990907147A 09/27/1999 GONZALEZ, DANIEL 03/29/2002 25.00 4 70CE 991007467B 10/09/1999 SAENZ, REYNA 03/29/2002 33.33 4 70CE 991007478A 10/10/1999 ROLON, LORENA 03/29/2002 9.49 4 70CE 991108047A 11/01/1999 MILLER, MICHELLE 03/29/2002 25.33 4 70CE 991108073A 11/02/1999 THOMAS, BILL 03/29/2002 6.66 4 70CE 991108153A 11/04/1999 ROYBAL, FRANCES 03/29/2002 131.66 4 70CE 991108516A 11/17/1999 JENKINS, AUSTIN 03/29/2002 280.00 4 70CE 991108553A 11/19/1999 BURCH, HEATHER 03/29/2002 58.94 4 70CE 991208943A 12/04/1999 RODRIGUEZ, JEANETTE 03/29/2002 3 .09 4 70PF 991209407A 12/22/1999 HUNT, CAROL V 03/29/2002 31.70 4 70CE AR00030148 05/11/1994 GUTIERREZ, MARIA Lat Total of 279 WriteOff Entries Totaling 90762 .87 Dollars Average WriteOff: 325.31 Dollars Average Time:621 Days • Date 04/01/2002 Weld County Paramedic Services Page: 7 Time:10:01:32 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/29/2002 Thru 03/29/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 70CE COLLECTION EXPENSE 128 5488 .63 42 .88 1086.80 70PF PROFESSIONAL FINANCE COLL 14 1472.91 105.21 600.36 83 WRITEOFF 2 840.00 420 .00 402 .00 83C WRITEOFF TO COLLECTION AG 124 77246.90 622 .96 196.10 82 MEDICAID WRITEOFF 9 5182 .72 575 .86 67.33 81 MEDICARE WRITEOFF 2 531.71 265.86 35 .00 I • Date:04/30/2002 Weld County Paramedic Services Page: 1 Time:16 :01:48 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/24/2002 Thru 04/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/24/2002 14 .00 4 REV 02035 03/08/2002 BRADEN MORTENSEN 04/24/2002 467 .50 4 83C 001209970A 12/29/2000 HALL, AMY 04/24/2002 107.50 4 83C 001209976A 12/29/2000 HALL, AMY 04/24/2002 219.70 4 83C 010100835A 01/30/2001 BARKER, WALTER R 04/24/2002 299.60 4 83C 010403386A 04/29/2001 COAN, ALAN 04/24/2002 769.00 4 83C 010604373A 06/04/2001 MAGADAN, JOHN P 04/24/2002 1050.00 4 83C 010604780A 06/19/2001 SHIVELY, MICHELLE 04/24/2002 100.00 4 83C 010705146A 07/02/2001 MAGADAN, JOHN P 04/24/2002 951.00 4 83C 010705416A 07/11/2001 DEVORA, ANTHONY 04/24/2002 704.00 4 83C 010705497A 07/13/2001 BLEA, ANITA L 04/24/2002 681.00 4 83C 010705583A 07/16/2001 LARSON, MICK 04/24/2002 646.70 4 83C 010705670A 07/20/2001 DAILY, CECIL 04/24/2002 59.10 4 83C 010705800A 07/24/2001 MJOEN, ESTHER K 04/24/2002 337.70 4 83C 010806337A 08/10/2001 VARANO, MEGAN 04/24/2002 100.00 4 83C 010806379A 08/11/2001 OLIVAS, CESAR 04/24/2002 19.00 4 83C 010806393A 08/12/2001 RODRIGUEZ, GUADALUPE 04/24/2002 966.00 4 83C 010806541A 08/17/2001 MIRELES, NANCY G 04/24/2002 846.00 4 83C 010806624A 08/19/2001 RUIZ, ARMANDO 04/24/2002 50.00 4 83C 010806636A 08/20/2001 NAB, DAVID P 04/24/2002 646.00 4 83C 010806666A 08/21/2001 BARROSO, JORGE 04/24/2002 769.00 4 83C 010806694A 08/21/2001 PACHECO, HECTOR 04/24/2002 704.72 4 83C 010806732A 08/23/2001 SEPULVEDA, AGRIPINA 04/24/2002 743.00 4 83C 010806821A 08/26/2001 PHILLIPS, DOUG 04/24/2002 819.00 4 83C 010806843A 08/27/2001 CIDDIO, RUTH 04/24/2002 719.00 4 83C 010906993A 09/01/2001 SALAZAR, CHARLES R 04/24/2002 859.00 4 83C 010907057A 09/04/2001 FISHER, MARGIE A 04/24/2002 143.80 4 83C 010907109A 09/06/2001 SAUER, JACOB 04/24/2002 913 .00 4 83C 010907113A 09/06/2001 RUIZ, MARTIN 04/24/2002 824.00 4 83C 010907121A 09/06/2001 SCOTT, MICHAEL 04/24/2002 991.00 4 83C 010907202A 09/08/2001 AREVALO, MARIA 04/24/2002 908.00 4 83C 010907227A 09/09/2001 DAVIS, CALEB 04/24/2002 100 .00 4 83C 010907301B 09/11/2001 DE LOS SANTOS, RAMON 04/24/2002 755.00 4 83C 010907357A 09/13/2001 SYLVESTER, DUANE C 04/24/2002 879.00 4 83C 010907363A 09/13/2001 VAN WINKLE, CURTIS 04/24/2002 769.00 4 83C 010907365A 09/14/2001 THOMPSON, LANCE A i 04/24/2002 745.00 4 83C 010907404A 09/15/2001 SHIFFER, TOD 04/24/2002 901.00 4 83C 010907414A 09/15/2001 GARMAN, CHAD M 04/24/2002 654 .00 4 83C 010907417A 09/15/2001 CHILCOTT, WILLIAM 04/24/2002 769.00 4 83C 010907430A 09/16/2001 SIRIO, JAMES 04/24/2002 100 .00 4 83C 010907471B 09/17/2001 TROSTLE, AMANDA 04/24/2002 1071.00 4 83C 010907489A 09/18/2001 ARRIAGA-GONZALEZ, MA 04/24/2002 100.00 4 83C 010907520A 09/19/2001 BROWN, VIOLET 04/24/2002 879.00 4 83C 010907599A 09/22/2001 COLLEY, TRAVIS 04/24/2002 25.00 4 83C 010907646A 09/23/2001 REED, MARK 04/24/2002 100.00 4 83C 010907647A 09/23/2001 STERLING, RYAN 04/24/2002 25 .00 4 83C 010907652A 09/23/2001 REED, MARK 04/24/2002 654 .00 4 83C 010907667A 09/23/2001 ROWE, BRANDI 04/24/2002 949.00 4 83C 010907682A 09/24/2001 WASIKOWSKI, ROSALIE 04/24/2002 1423 .00 4 83C 010907683A 09/24/2001 TRAVIS, STEPHEN KENT Date:04/30/2002 Weld County Paramedic Services Page: 2 Time:16 :01:49 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/24/2002 Thru 04/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/24/2002 177.80 4 83C 010907684A 09/24/2001 KISSLER, ANDREW J 04/24/2002 913 .00 4 83C 010907687A 09/25/2001 NALLY, KRISTY J 04/24/2002 407.50 4 83C 010907704A 09/25/2001 SHIFFER, TOD 04/24/2002 728.00 4 83C 010907746A 09/27/2001 MALLOY, JESSICA 04/24/2002 704.00 4 83C 010907749A 09/27/2001 CORPUS-PEREZ, GUSTAV 04/24/2002 371.61 4 83C 010907750A 09/27/2001 BARRANCO, BELINDA 04/24/2002 399.00 4 83C 010907754A 09/27/2001 CORPUS-PEREZ, GUSTAV 04/24/2002 654.00 4 83C 010907765A 09/27/2001 CORPUS-PEREZ, GUSTAV 04/24/2002 752 .00 4 83C 010907766A 09/27/2001 WULLSCHLEGER, CHERYL 04/24/2002 399.00 4 83C 010907768A 09/28/2001 WULLSCHLEGER, CHERYL 04/24/2002 526.26 4 83C 010907771A 09/28/2001 BOSKY, KENNETH H 04/24/2002 50 .00 4 83C 010907782A 09/28/2001 FURISTER, ELAINE 04/24/2002 678.00 4 83C 010907812A 09/29/2001 UNGER, JAYDEN 04/24/2002 100.00 4 83C 010907837A 09/30/2001 RIVERA, JUAN BLAS 04/24/2002 819.00 4 83C 010907847A 09/30/2001 SOLIZ, FRED 04/24/2002 819.00 4 83C 011007877A 10/01/2001 O'MALLEY, MICHAEL 04/24/2002 776.00 4 83C 011007897A 10/02/2001 MOODY, TYLER 04/24/2002 769.00 4 83C 011007903A 10/02/2001 CRISWELL, ROBERT C 04/24/2002 879.00 4 83C 011007910A 10/02/2001 GONZALES, ANITA K 04/24/2002 654.00 4 83C 011007916A 10/03/2001 SANCHEZ, RICHARD 04/24/2002 841.00 4 83C 011007936A 10/03/2001 SANCHEZ, ANGELA 04/24/2002 769.00 4 83C 011007987A 10/05/2001 KENITZER, LANCE 04/24/2002 399.00 4 83C 011007991A 10/06/2001 KENITZER, LANCE 04/24/2002 839.00 4 83C 011008000A 10/06/2001 RANGEL, FRANK S 04/24/2002 654 .00 4 83C 011008002A 10/06/2001 WATSON, BRITTANY 04/24/2002 518 .28 4 83C 011008024A 10/07/2001 CALL, FRANK 04/24/2002 50.00 4 83C 011008026A 10/07/2001 MORALES, JOSIE 04/24/2002 164.74 4 83C 011008048A 10/07/2001 HERNANDEZ, CAROLINA 04/24/2002 719.00 4 83C 011008053A 10/07/2001 SANCHEZ, MARIA T 04/24/2002 719.00 4 83C 011008081A 10/08/2001 BLEA, ANITA L 04/24/2002 399.00 4 83C 011008066A 10/08/2001 BLEA, ANITA L 04/24/2002 25.00 4 83C 011008092A 10/09/2001 GUTIERREZ, BRYAN K 04/24/2002 83.74 4 83C 011008096A 10/09/2001 IGLESIAS, ROSIE E 04/24/2002 100.00 4 83C 011008105A 10/09/2001 HERRERA, MINDY 04/24/2002 769.00 4 83C 011008138A 10/11/2001 BOETTCHER, MARY 04/24/2002 819.00 4 83C 011008145A 10/11/2001 BROWN, JESS 04/24/2002 913 .00 4 83C 011008154A 10/11/2001 CAVALLO, JOE 04/24/2002 769.00 4 83C 011008213A 10/13/2001 BIRLEFFI, BRAD 04/24/2002 841.00 4 83C 011008234B 10/14/2001 NORRIS, CARY 04/24/2002 666.00 4 83C 011008250A 10/14/2001 OLIVAS, GILBERTO 04/24/2002 819.00 4 83C 011008255A 10/14/2001 VALENCIA, RICHARD M 04/24/2002 399.00 4 83C 011008339A 10/17/2001 LUEVANO-LARRA, MARIA 04/24/2002 769.00 4 83C 011008345A 10/17/2001 BENITEZ, MARIA 04/24/2002 889.00 4 83C 011008376A 10/18/2001 ATKINSON, AMY 04/24/2002 843 .00 4 83C 011008399A 10/19/2001 APPLEHANS, NATHAN 04/24/2002 100.00 4 83C 011008422A 10/20/2001 MOLINA, JASON 04/24/2002 942.00 4 83C 011008440A 10/20/2001 BREICKLER, SHIRLEY A 04/24/2002 769.00 4 83C 011008446A 10/20/2001 VICENTE, IRMA 04/24/2002 1036.00 4 83C 011008448A 10/21/2001 HOLGUIN, HUGO G ' Date:04/3O/2002 Weld County Paramedic Services Page: 3 Time:16:01:50 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/24/2002 Thru 04/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/24/2002 704.00 4 83C 011008455A 10/21/2001 JUAREZ, DELORES A 04/24/2002 100.00 4 83C 011008458A 10/21/2001 HERNANDEZ, REBECCA 04/24/2002 819.00 4 83C 011008484A 10/22/2001 WILSON, RODNEY 04/24/2002 903 .00 4 83C 011008499A 10/23/2001 DIAZ, MICHELLE 04/24/2002 399.00 4 83C 011008513A 10/23/2001 MARTINEZ, JESSE P 04/24/2002 781.00 4 83C 011008516A 10/24/2001 JONES, QUINCY 04/24/2002 100.00 4 83C 011008526A 10/24/2001 NOLLETT, BAMBI 04/24/2002 843.00 4 83C 011008533A 10/24/2001 SMITHEY, FLOYD 04/24/2002 728.00 4 83C 011008558A 10/25/2001 KATZ, BRITNIE L 04/24/2002 769.00 4 83C 011008577A 10/25/2001 CHISUM, CHRISTIANA R 04/24/2002 789.00 4 83C 011008578A 10/26/2001 MCGILVRAY, CHIRSTOPH 04/24/2002 704 .00 4 83C 011008593A 10/26/2001 BENITEZ, ROSA 04/24/2002 951.00 4 83C 011008597A 10/26/2001 CORIA, REBECCA J 04/24/2002 961.00 4 83C 011008614A 10/27/2001 DYCHE, JACQUELINE 04/24/2002 399.00 4 83C 011008654A 10/28/2001 VAN WHYE, GAIL 04/24/2002 100.00 4 83C 011109002A 11/09/2001 GARMAN, CHAD 04/24/2002 853 .00 4 83C 011109150A 11/15/2001 LUNA, ALEX (ELIAS) 04/24/2002 853 .00 4 83C 011109150B 11/15/2001 MATA, LEE 04/24/2002 1187.00 4 83C 011109201A 11/16/2001 NORRIS, CARY 04/24/2002 781.00 4 83C 011109244A 11/18/2001 BURGOS, JOEL 04/24/2002 789.00 4 83C 011109335A 11/21/2001 WILLIAMS, EDWARD 04/24/2002 819.00 4 83C 011109555A 11/30/2001 DVORAK, JASON 04/24/2002 930.00 4 83C 011209593A 12/01/2001 SIKES, BENSON 04/24/2002 1254.00 4 83C 011209733A 12/07/2001 MORENO, ROBERT LOUIS 04/24/2002 748.00 4 83C 011209811A 12/10/2001 KATZ, BRITNIE L 04/24/2002 704 .00 4 83C 011210074A 12/20/2001 CHAPARRO, EDGAR I 04/24/2002 100 .00 4 83C 011210088A 12/20/2001 LAGEST, JONATHAN 04/24/2002 399.00 4 83C 011210120A 12/21/2001 TURNER, MYSTINA M 04/24/2002 884.00 4 83C 011210173A 12/23/2001 WALDEN, TARRY 04/24/2002 819.00 4 83C 011210175A 12/23/2001 CASTILLO, ISABEL J 04/24/2002 814.00 4 83C 020100090A 01/03/2002 MUNIZ, JESUS SALVADO 04/24/2002 814 .00 4 83C 020100120A 01/04/2002 ORTIZ, CRISTINA 04/24/2002 120 .00 4 83C 020100123B 01/04/2002 MIRELES, CHRIS 04/24/2002 374 .00 4 83C 020100184A 01/06/2002 SMITH, KATELYN N 04/24/2002 774.00 4 83C 020100193A 01/07/2002 MASON, BROOKE E 04/24/2002 966.00 4 83C 020100383A 01/12/2002 TOVAR, ISRAEL 04/24/2002 872 .00 4 83C 020100399A 01/13/2002 ALMEIDA, CRUZ 04/24/2002 748.00 4 83C 020201103A 02/06/2002 LEWIS, ANDRE 04/24/2002 447.13 4 81 020201246A 02/11/2002 SCHROEDER, WILLIAM 04/24/2002 724 .00 4 83C 020301873A 03/05/2002 CARROLL, CHRISTOPHER 04/24/2002 765.00 4 83C 990302382A 03/31/1999 BYMER, TAMMIE Total of 139 WriteOff Entries Totaling 86113 .38 Dollars Average WriteOff: 619.52 Dollars Average Time:210 Days • Date:04/}0/2002 Weld County Paramedic Services Page: 4 Time:16:01:51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/24/2002 Thru 04/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days REV REVERSE CHARGED IN ERROR 1 14.00 14.00 47.00 83C WRITEOFF TO COLLECTION AG 137 85652 .25 625.20 211.77 81 MEDICARE WRITEOFF 1 447.13 447.13 72 .00 Date:05/23/2002 Weld County Paramedic Services Page: 1 Time:11:04 :28 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/22/2002 Thru 05/22/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/22/2002 60.00 4 83C 000503320A 05/08/2000 RUNDLE, CLARENCE 05/22/2002 17.11 4 82 010100785A 01/28/2001 JACOBY, BILL 05/22/2002 90.01 4 83C 010402856A 04/12/2001 CLARK, KAREN 05/22/2002 50.00 4 83C 010503485A 05/02/2001 ESPARZA, MELODY 05/22/2002 923.00 4 83C 010504023A 05/21/2001 YOCUM, STEPHEN G 05/22/2002 310.00 4 83C 010604564A 06/12/2001 HELD, MITCHELL R 05/22/2002 135.20 4 83C 010705140A 07/02/2001 VELEZ-MILLER, ALEJAN 05/22/2002 646.00 4 83C 010806666C 08/21/2001 MORANO, GERARDO 05/22/2002 559.00 4 83C 010806887A 08/28/2001 PISANA, ISAAC D 05/22/2002 831.00 4 83C 010806923A 08/29/2001 HEIDEN, EDWIN 05/22/2002 786.00 4 83C 010906989B 09/01/2001 VARELA, GABRIEL 05/22/2002 719.00 4 83C 010907023A 09/03/2001 TAYLOR, MARK A 05/22/2002 808.00 4 83C 010907034A 09/03/2001 MARLIN, BRANDON L 05/22/2002 769.00 4 83C 010907104A 09/05/2001 WALTON, AMY M 05/22/2002 75.00 4 83C 010907158A 09/07/2001 ROBERTS, DIANA R 05/22/2002 744.00 4 83C 010907238A 09/09/2001 MEZA, MARIA VICTORIA 05/22/2002 831.00 4 83C 010907270A 09/10/2001 MAGADAN, JOHN P 05/22/2002 524 .05 4 83C 010907291A 09/11/2001 RUIZ, JOE V 05/22/2002 654 .00 4 83C 010907498A 09/18/2001 DONEHOO, FRANCES 05/22/2002 25.00 4 83C 010907547A 09/18/2001 VRBAS, JEFF F 05/22/2002 728.00 4 83C 010907581A 09/21/2001 SANCHEZ, YAJAIRA 05/22/2002 776 .94 4 83C 010907629A 09/22/2001 MALDONADO, MARIA 05/22/2002 875.00 4 B3C 010907744A 09/27/2001 HEIDEN, EDWIN 05/22/2002 654 .00 4 83C 010907762A 09/27/2001 TRAVIS JR, STEPHEN K 05/22/2002 719.00 4 83C 010907795A 09/28/2001 CHILCOTT, WILLIAM 05/22/2002 100 .00 4 83C 010907834A 09/30/2001 COBOS, URIEL 05/22/2002 492.00 4 83C 010907844A 09/30/2001 GORDON, ROBERT A 05/22/2002 102.00 4 83C 010907848A 09/30/2001 GORDON, ROBERT A 05/22/2002 794.08 4 83C 011007869A 10/01/2001 TYLER, RUSSELL F 05/22/2002 815.00 4 83C 011007889A 10/02/2001 MALDONADO, MARIA 05/22/2002 399.00 4 83C 011008134A 10/10/2001 WINDYKA, LESLIE A 05/22/2002 760.00 4 83C 011008149A 10/11/2001 ZAWACKI, FREDERICK J 05/22/2002 769.00 4 83C 011008336A 10/17/2001 ALANIZ, ROBERT M 05/22/2002 100.00 4 83C 011008411A 10/19/2001 RIVAS, JESUS 05/22/2002 399.00 4 83C 011008461A 10/21/2001 WOODS, JANIS 05/22/2002 654.00 4 83C 011008472A 10/22/2001 CHILCOTT, WILLIAM 05/22/2002 731 .00 4 83C 011008548A 10/25/2001 ROYBAL, WILLIAM 05/22/2002 749.00 4 83C 011008604A 10/26/2001 WESTHOFF, GLENN 05/22/2002 781.00 4 83C 011008690A 10/29/2001 RUEHLEN, TIM 05/22/2002 860.00 4 83C 011008693A 10/29/2001 JIMENEZ, HECTOR 05/22/2002 859 .00 4 83C 011008704A 10/30/2001 ENRIQUEZ, ANGELA 05/22/2002 704.00 4 83C 011008710A 10/30/2001 GONZALEZ, SHAWNTEL 05/22/2002 715 .00 4 83C 011008752A 10/31/2001 JOHNSON, WESLEY 05/22/2002 927 .00 4 83C 011108761A 11/01/2001 GARZA, KAREN 05/22/2002 769.00 4 83C 011108819A 11/03/2001 GARCIA, LAWRENCE 05/22/2002 769.00 4 83C 011108899A 11/06/2001 BROCKEL, BRETT 05/22/2002 666 .00 4 83C 011108954A 11/07/2001 GUTIERREZ, MARISOL 05/22/2002 841.00 4 83C 011108967A 11/08/2001 CHAFIN, TIA 05/22/2002 769.00 4 83C 011108971A 11/08/2001 MONTOYA, SARA Date:05/23/2002 Weld County Paramedic Services Page: 2 Time:11:04 :29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/22/2002 Thru 05/22/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/22/2002 789.00 4 83C 011108974A 11/08/2001 LUERSON, STEPHEN M 05/22/2002 761.08 4 83C 011108990A 11/09/2001 BLANCO, SOLEDAD 05/22/2002 819.00 4 83C 011108993A 11/09/2001 COBBLEY, SHARON 05/22/2002 704.00 4 83C 011109004A 11/09/2001 HAMILTON, SAVANAH 05/22/2002 860.00 4 83C 011109039A 11/10/2001 CHAIREZ, NATIVIDAD 05/22/2002 73.15 4 83C 011109045A 11/10/2001 HEBERLING, RICHARD 05/22/2002 399.00 4 83C 011109115A 11/13/2001 HARRIS, ANTHONY 05/22/2002 819.00 4 83C 011109154A 11/15/2001 CHILDS, SCOTT 05/22/2002 719.00 4 83C 011109188A 11/16/2001 ELLIOTT, CHARLES T 05/22/2002 903.00 4 83C 011109208A 11/17/2001 ADAMS, JASON T 05/22/2002 839.00 4 83C 011109218A 11/17/2001 GAUCIN, EVANGELINA 05/22/2002 805.00 4 83C 011109225A 11/17/2001 ALLMER, KEITH 05/22/2002 745.00 4 83C 011109227A 11/17/2001 GARCIA, MIGUEL 05/22/2002 879.00 4 83C 011109257A 11/18/2001 GARDNER, BEVERLY 05/22/2002 781.00 4 83C 011109260B 11/18/2001 MAREZ, NORMA J 05/22/2002 781.00 4 83C 011109283A 11/19/2001 RAEHAL, STARLA 05/22/2002 716.00 4 83C 011109283B 11/19/2001 RAEHAL, BABY BOY 05/22/2002 675.00 4 83C 011109284A 11/19/2001 RADLER, BRIAN M 05/22/2002 843 .00 4 83C 011109305A 11/20/2001 BARRON, MARTIN 05/22/2002 899.00 4 83C 011109313A 11/20/2001 SANCHEZ, DENISE 05/22/2002 704 .00 4 83C 011109327A 11/21/2001 GARCIA, LILLIAN 05/22/2002 769.00 4 83C 011109359A 11/22/2001 PINEDA, LIZBETH 05/22/2002 704 .00 4 83C 011109384A 11/23/2001 GARCIA, LAWRENCE 05/22/2002 654 .00 4 83C 011109393A 11/24/2001 GARCIA, ERICA 05/22/2002 794.00 4 83C 011109411A 11/24/2001 ALANIZ, ROBERT M 05/22/2002 171 .25 4 83C 011109421A 11/25/2001 LARSON, BRIAN K 05/22/2002 769.00 4 83C 011109453A 11/26/2001 LUCERO, DANIEL 05/22/2002 704.00 4 83C 011109481A 11/27/2001 KENTON, ROBERT DEAN 05/22/2002 399.00 4 83C 011109483A 11/27/2001 LUCERO, DANIEL 05/22/2002 841 .00 4 83C 011109525A 11/28/2001 MEDINA, BOB 05/22/2002 100.00 4 83C 011109567A 11/30/2001 GRASMICK, ADAM 05/22/2002 1115.00 4 83C 011109574A 11/30/2001 ROMERO, SOCORRO C 05/22/2002 90.49 4 82 011209681A 12/05/2001 MILLER, GEORGE E 05/22/2002 819.00 4 83C 011209683A 12/06/2001 WOODINGTON, DAWN MAR 05/22/2002 394.00 4 83C 011209687A 12/06/2001 TALADAY, KAYLA RENEE 05/22/2002 731.00 4 83C 011209785A 12/09/2001 MORENO, HUMBERTO 05/22/2002 715.00 4 83C 011209793A 12/09/2001 JOHNSON, WESLEY 05/22/2002 654.00 4 83C 011209861A 12/12/2001 YEADON, HAYLEY JO 05/22/2002 790.04 4 83C 011210040A 12/19/2001 ADAMS, GEORGE 05/22/2002 793 .00 4 83C . 011210050B 12/19/2001 SCHUMAN, BETH E 05/22/2002 702 .00 4 83C 011210053A 12/19/2001 SANCHEZ, JULIE 05/22/2002 769.00 4 83C 011210068A 12/20/2001 ROYBAL, JACOB P 05/22/2002 399.00 4 83C 011210115A 12/21/2001 STRONG, KIP 05/22/2002 423 .00 4 83C 011210135A 12/21/2001 VIGIL, ANTONIO 05/22/2002 715.00 4 83C 011210212A 12/24/2001 JOHNSON, WESLEY 05/22/2002 819.00 4 83C 011210259A 12/26/2001 TREVINO, PAUL 05/22/2002 1058.00 4 83C 011210293A 12/28/2001 VIGIL, JOHN 05/22/2002 715.00 4 83C 011210357A 12/30/2001 JOHNSON, WESLEY 05/22/2002 724.00 4 83C 020100008A 01/01/2002 WEBER, MELISSA Date:05/23/2002 Weld County Paramedic Services Page: 3 Time:11 : 04 :29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/22/2002 Thru 05/22/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/22/2002 824.00 4 83C 020100025A 01/01/2002 TAYLOR, JAMES ANDREW 05/22/2002 374.00 4 83C 020100031A 01/01/2002 HERNANDEZ, ERNESTINE 05/22/2002 724.00 4 83C 020100047A 01/02/2002 FINGER, WILLIAM 05/22/2002 848.00 4 83C 020100054A 01/02/2002 AVILA, DEANNA 05/22/2002 650.00 4 83C 020100059A 01/02/2002 FINGER, WILLIAM 05/22/2002 854.00 4 83C 020100073A 01/03/2002 CLARK, KAREN 05/22/2002 724.00 4 83C 020100093A 01/03/2002 TALBERT, SHERRY 05/22/2002 120.00 4 83C 020100105A 01/04/2002 COBBLEY, SHARON 05/22/2002 946.00 4 83C 020100108A 01/04/2002 COBBLEY, SHARON 05/22/2002 774 .00 4 83C 020100136A 01/05/2002 GLANZ, LAURA M 05/22/2002 994 .00 4 83C 020100139A 01/05/2002 MINNEY, ROSITA 05/22/2002 874 .00 4 83C 020100154A 01/05/2002 LANCKRIET, GREGORY 05/22/2002 974 .00 4 83C 020100157A 01/05/2002 NUNEZ, ELENA 05/22/2002 806.00 4 83C 020100161A 01/05/2002 PALMER, JASON 05/22/2002 863.99 4 83C 020100195A 01/07/2002 CLARK, KAREN 05/22/2002 862.00 4 83C 020100200A 01/07/2002 RIVERA, NOE 05/22/2002 824.00 4 83C 020100213A 01/07/2002 MCFARLANE, ZOE SCOTT 05/22/2002 850.00 4 83C 020100219A 01/07/2002 REYES, VANESSA 05/22/2002 819.79 4 83C 020100221A 01/07/2002 MARTINEZ, ELIZABETH 05/22/2002 764.00 4 83C 020100252A 01/08/2002 MAJOR BOYD, AMY 05/22/2002 724.00 4 83C 020100363A 01/11/2002 ERDMANN, EDWARD 05/22/2002 964.00 4 83C 020100372A 01/11/2002 ALANIZ, ROBERT M 05/22/2002 123 .10 4 83C 020100382A 01/12/2002 RODRIGUEZ, JOSE 05/22/2002 1006.00 4 83C 020100393A 01/12/2002 COBBLEY, SHARON 05/22/2002 736.00 4 83C 020100444A 01/14/2002 HOWELL, ROBERT 05/22/2002 954 .00 4 83C 020100475A 01/15/2002 PENNINGTON, THOMAS C 05/22/2002 120 .00 4 83C 020100532A 01/17/2002 STOUDT, TIMOTHY 05/22/2002 120.00 4 83C 020100559A 01/18/2002 PICKENS, STEPHANIE 05/22/2002 724 .00 4 83C 020100562A 01/18/2002 MAYES, CHRISTINA 05/22/2002 834 .00 4 83C 020100578A 01/19/2002 MILLER, DAVID ABEL 05/22/2002 374 .00 4 83C 020100580A 01/19/2002 O'BRIEN, DALLAS 05/22/2002 374 .00 4 83C 020100587A 01/19/2002 MILLER, DAVID ABEL 05/22/2002 374 .00 4 83C 020100593A 01/19/2002 SMITH, MICHEAL M 05/22/2002 924.00 4 83C 020100633A 01/21/2002 ESPINOZA, LINDA 05/22/2002 874.00 4 83C 020100641A 01/21/2002 RIVAS, JESUS 05/22/2002 724 .00 4 83C 020100702A 01/23/2002 AUBROS, FRANSISCO 05/22/2002 1100.00 4 83C 020100729A 01/24/2002 DODWELL, MICHAEL 05/22/2002 820.00 4 83C 020100750B 01/25/2002 VALENCIA, ESAU 05/22/2002 874 .00 4 83C 020100773A 01/25/2002 STRONG, KIP 05/22/2002 374 .00 4 83C 020100777A 01/26/2002 STRONG, KIP 05/22/2002 405.50 4 83C 020100816A 01/27/2002 OLIVAS, JOE 05/22/2002 874.00 4 83C 020100831A 01/28/2002 FAULKNER, JOHN 05/22/2002 764.00 4 83C 020100897A 01/30/2002 SARABRIA, ESTHER 05/22/2002 898.00 4 83C 020100898A 01/30/2002 JIMINEZ, CASIMIRO 05/22/2002 840.00 4 83C 020100926A 01/31/2002 FUENTES, LOUIS 05/22/2002 120.00 4 83C 020201031A 02/04/2002 SCHAFFER, PEDRO 05/22/2002 814.00 4 83C 020201041A 02/04/2002 LOPEZ-LOPEZ, ANTONIO 05/22/2002 894.00 4 83C 020201049A 02/05/2002 MCCONKEY, RICHARD 05/22/2002 736.00 4 83C 020201073A 02/05/2002 ANTHONY, LESLIE D Date:05/23/2002 Weld County Paramedic Services Page: 4 Time:11:04 :29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/22/2002 Thru 05/22/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/22/2002 886 .00 4 83C 020201080A 02/06/2002 GARCIA, TARRARA 05/22/2002 120 .00 4 83C 020201142A 02/07/2002 BOYCE, LILLIE 05/22/2002 824.00 4 83C 020201143A 02/08/2002 MERAZ, PAOLA 05/22/2002 374.00 4 83C 020201145A 02/08/2002 SCHROEDER, WILLIAM 05/22/2002 874 .00 4 83C 020201149A 02/08/2002 SALAS, GERMAN R 05/22/2002 73 .43 4 83C 020201173A 02/08/2002 HEBERLING, RICHARD 05/22/2002 374 .00 4 83C 020201178A 02/08/2002 MURPHY, SHANNON R 05/22/2002 894.00 4 83C 020201181A 02/09/2002 HOSIER, RODNEY 05/22/2002 774.00 4 83C 020201183A 02/09/2002 BOYCE, LILLIE 05/22/2002 814.00 4 83C 020201198A 02/09/2002 MEDINA, CORINA 05/22/2002 120.00 4 83C 020201199A 02/09/2002 MCCORD, HEATHER 05/22/2002 0.31 4 83 020201213A 02/10/2002 WOLFE, DOROTHY 05/22/2002 760 .86 4 82 020201413A 02/17/2002 VILLARREAL, ARNOLDO 05/22/2002 752 .81 4 82 020201677A 02/26/2002 ALONSO, RAMON 05/22/2002 784 .00 4 83C 020301819A 03/03/2002 FIGUEROA-PEREZ, WILS 05/22/2002 826 .00 4 83C 020301848A 03/05/2002 CARD, DORIS A 05/22/2002 908 .00 4 83C 020302349A 03/22/2002 RAMIREZ, GUILLERMO 05/22/2002 1006 .00 4 83C 020302435A 03/26/2002 VALDEZ, TERRY 05/22/2002 682 .16 4 82 020402902A 04/12/2002 ROMERIZ, VERONICA 05/22/2002 720 .86 4 82 020402909A 04/12/2002 SEALS, DONNA L 05/22/2002 288.83 4 82 020402911A 04/12/2002 SEALS, DONNA L 05/22/2002 638.77 4 82 020402924A 04/13/2002 MADRID, ZECHARIAH 05/22/2002 43.37 4 82 020402927A 04/13/2002 MADRID, ZECHARIAH 05/22/2002 677.36 4 82 020402947A 04/13/2002 FERGUSON, JULIA 05/22/2002 626.49 4 82 020402966A 04/14/2002 STAMMEL, MICHAEL 05/22/2002 720.86 4 82 020402968A 04/14/2002 MONTOYA, VALENTIN 05/22/2002 43 .37 4 82 020402969A 04/14/2002 STAMMEL, MICHAEL 05/22/2002 704 .43 4 82 020402979A 04/15/2002 STAMMEL, MICHAEL D 05/22/2002 666.71 4 82 020403020A 04/16/2002 LUCERO, LEONARD 05/22/2002 718.33 4 82 020403161A 04/22/2002 ANGELOFF, BOBBY 05/22/2002 1024 .00 4 83C 020403192A 04/23/2002 ROMERO, BARBARA 05/22/2002 660 .86 4 82 020403258A 04/25/2002 GALLEGOS, SARAH 05/22/2002 704 .43 4 82 020403348A 04/28/2002 PALLARES, NERY . 05/22/2002 869.96 4 82 020403365A 04/29/2002 HESSLER, NAOMI 05/22/2002 00002 TREAS AMB 792 .69 4 82 020403372A 04/29/2002 MILLER, STARRLYN 05/22/2002 704 .43 4 82 020403375A 04/29/2002 GARCIA, ERIKA Total of 183 WriteOff Entries Totaling 120063 .10 Dollars Average WriteOff: 656.08 Dollars Average Time:162 Days Date:05/23/2002 Weld County Paramedic Services Page: 5 Time:11 :04:30 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/22/2002 Thru 05/22/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 161 108177.61 671.91 175.30 82 MEDICAID WRITEOFF 21 11885.18 565 .96 66.67 83 WRITEOFF 1 0.31 0.31 101.00 • Date:05/28/2002 Weld County Paramedic Services Page: 1 Time:09:44:24 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/24/2002 Thru 05/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/24/2002 769. 00 4 83C 010806866A 08/27/2001 TAYLOR, JAMES ANDREW 05/24/2002 789.00 4 83C 011008453A 10/21/2001 TAYLOR, JAMES ANDREW 05/24/2002 399.00 4 83C 011008546A 10/24/2001 TAYLOR, JAMES ANDREW 05/24/2002 719.00 4 83C 011109317A 11/21/2001 TAYLOR, JAMES ANDREW 05/24/2002 926.00 4 83C 020100050A 01/02/2002 TAYLOR, JAMES ANDREW 05/24/2002 25.00 4 83 020100360A 01/11/2002 HANGARTNER, DONALD 05/24/2002 874.00 4 83C 020301796A 03/02/2002 TAYLOR, JAMES ANDREW 05/24/2002 836.00 4 83C 020302002A 03/09/2002 TAYLOR, JAMES ANDREW 05/24/2002 814.00 4 83C 020302205A 03/16/2002 TAYLOR, JAMES ANDREW 05/24/2002 374.00 4 83C 020302274A 03/18/2002 TAYLOR, JAMES ANDREW 05/24/2002 18.85 4 81 020302487A 03/27/2002 HANSON, SHEILA A 05/24/2002 100.00 4 81 020302513A 03/28/2002 THOMAS, KATHRYN 05/24/2002 756.39 4 81 020402746A 04/06/2002 BORG, PHYLLIS E 05/24/2002 514.00 4 82 020402943A 04/13/2002 GARZA, SELENA 05/24/2002 814 .00 4 83C 020403344A 04/28/2002 TAYLOR, JAMES ANDREW 05/24/2002 894 .00 4 83C 020403364A 04/29/2002 TAYLOR, JAMES ANDREW 05/24/2002 814.00 4 83C 020503453A 05/02/2002 TAYLOR, JAMES ANDREW 05/24/2002 886.00 4 83C 020503551A 05/05/2002 TAYLOR, JAMES ANDREW Total of 18 WriteOff Entries Totaling 11322.24 Dollars Average WriteOff: 629.01 Dollars Average Time:97 Days Date:05/28/2002 Weld County Paramedic Services Page: 2 Time:09:44 :25 Receipt, Write-off, Adjustment Batch Report MRR300 I WriteOffBatch From 05/24/2002 Thru 05/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 13 9908.00 762 .15 108.46 83 WRITEOFF 1 25.00 25.00 133 .00 81 MEDICARE WRITEOFF 3 875.24 291.75 54 .33 82 MEDICAID WRITEOFF 1 514 .00 514 .00 41.00 Date : 06/20/2002 Weld County Paramedic Services Time : 14 : 47 : 20 Receipt, Write-off, Adjustment Batch Repor WriteOffBatch From 06/19/2002 Thru 06/19/20 Date Source Check # Branch # Value T RWA Code Invoice Inv 06/19/2002 39 . 96 4 83C 010906994A 09/0 06/19/2002 93 . 90 4 83C 010907073A 09/0 06/19/2002 75 . 00 4 83C 011008109A 10/0 06/19/2002 100 . 00 4 83C 011108773B 11/0 06/19/2002 399 . 00 4 83C 011108825A 11/0 06/19/2002 869 . 00 4 83C 011109172A 11/1 06/19/2002 654 . 00 4 83C 011109398A 11/2 06/19/2002 666 . 00 4 83C 011209583A 12/0 06/19/2002 399 . 00 4 83C 011209587A 12/0 06/19/2002 666 . 00 4 83C 011209596A 12/0 06/19/2002 859 . 00 4 83C 011209610A 12/0 06/19/2002 64 . 96 4 83C 011209615A 12/0 06/19/2002 379 . 00 4 83C 011209628A 12/0 06/19/2002 963 . 00 4 83C 011209630A 12/0 06/19/2002 800 . 00 4 83C 011209701A 12/0 06/19/2002 100 . 00 4 83C 011209712A 12/0 06/19/2002 769 . 00 4 83C 011209715A 12/0 06/19/2002 399 . 00 4 83C 011209719A 12/0 06/19/2002 654 . 00 4 83C 011209726A 12/0 06/19/2002 775 . 08 4 83C 011209731A 12/0 06/19/2002 50 . 43 4 83C 011209732A 12/0 06/19/2002 851 . 00 4 83C 011209738A 12/0 06/19/2002 597 . 26 4 83C 011209746A 12/0 06/19/2002 399 . 00 4 83C 011209796A 12/1 06/19/2002 819 . 00 4 83C 011209798A 12/1 06/19/2002 769 . 00 4 83C 011209807A 12/1 06/19/2002 769 . 00 4 83C 011209807B 12/1 06/19/2002 654 . 00 4 83C 011209817B 12/1 06/19/2002 832 . 00 4 83C 011209821A 12/1 06/19/2002 728 . 00 4 83C 011209843A 12/1 06/19/2002 399 . 00 4 83C 011209847A 12/1 06/19/2002 100 . 00 4 83C 011209854A 12/1 06/19/2002 654 . 00 4 83C 011209860A 12/1 06/19/2002 399 . 00 4 83C 011209866A 12/1 06/19/2002 301 . 90 4 83C 011209878A 12/1 06/19/2002 654 . 00 4 83C 011209886A 12/1 06/19/2002 399 . 00 4 83C 011209895A 12/1 06/19/2002 996 . 00 4 83C 011209903A 12/1 06/19/2002 769 . 00 4 83C 011209922A 12/1 06/19/2002 769 . 00 4 83C 011209923A 12/1 06/19/2002 399 . 00 4 83C 011209926A 12/1 06/19/2002 775 . 08 4 83C 011209984A 12/1 06/19/2002 704 . 00 4 83C 011209989A 12/1 06/19/2002 789 . 00 4 83C 011210019A 12/1 06/19/2002 565 . 85 4 83C 011210048A 12/1 06/19/2002 839 . 00 4 83C 011210091A 12/2 06/19/2002 1115 . 00 4 83C 011210094A 12/2 06/19/2002 719 . 00 4 83C 011210100A 12/2 06/19/2002 399 . 00 4 83C 011210101A 12/2 Date : 06/20/2002 Weld County Paramedic Services Time : 14 : 47 : 28 Receipt , Write-off, Adjustment Batch Repor WriteOffBatch From 06/19/2002 Thru 06/19120 Date Source Check # Branch # Value T RWA Code Invoice Inv 06/19/2002 185 . 00 4 82 011210129A 12/2 06/19/2002 100 . 00 4 83C 011210144A 12/2 06/19/2002 710 .28 4 83C 011210170A 12/2 06/19/2002 855 . 00 4 83C 011210176A 12/2 06/19/2002 716 . 00 4 83C 011210179A 12/2 06/19/2002 799 . 08 4 83C 011210189A 12/2 06/19/2002 654 . 00 4 83C 011210202A 12/2 06/19/2002 100 . 00 4 83C 011210213A 12/2 06/19/2002 959 . 00 4 83C 011210241A 12/2 06/19/2002 819 . 00 4 83C 011210250A 12/2 06/19/2002 904 . 00 4 83C 011210264A 12/2 06/19/2002 798 . 00 4 83C 011210300A 12/2 06/19/2002 995 . 00 4 83C 011210316A 12/2 06/19/2002 831 . 00 4 83C 011210324A 12/2 06/19/2002 704 . 00 4 83C 011210333A 12/2 06/19/2002 769 . 00 4 83C 011210340A 12/3 06/19/2002 100 . 00 4 83C 011210371A 12/3 06/19/2002 716 . 00 4 83C 011210373A 12/3 06/19/2002 781 . 00 4 83C 011210374A 12/3 06/19/2002 399 . 00 4 83C 011210377A 12/3 06/19/2002 774 . 00 4 83C 020100006A 01/0 06/19/2002 826 . 00 4 83C 020100188A 01/0 06/19/2002 810 . 00 4 83C 020100472A 01/1 06/19/2002 844 . 00 4 830 020100560A 01/1 06/19/2002 966 . 00 4 830 020100581A 01/1 06/19/2002 1024 . 00 4 83C 020100620A 01/2 06/19/2002 724 . 00 4 83C 020201124A 02/0 06/19/2002 1064 . 00 4 83C 020201293A 02/1 06/19/2002 874 . 00 4 83C 020201349A 02/1 06/19/2002 880 . 00 4 83C 020201356B 02/1 06/19/2002 724 . 00 4 83C 020201357A 02/1 06/19/2002 1174 . 00 4 83C 020201476A 02/1 06/19/2002 846 . 00 4 83C 020201551A 02/2 06/19/2002 1024 . 00 4 83C 020201711A 02/2 06/19/2002 374 . 00 4 83C 020201719A 02/2 06/19/2002 724 . 00 4 83C 020301769A 03/0 06/19/2002 814 . 00 4 830 020301784A 03/0 06/19/2002 934 . 00 4 83C 020301831A 03/0 06/19/2002 916 . 00 4 83C 020301857B 03/0 06/19/2002 724 . 00 4 83C 020301860A 03/0 06/19/2002 1074 . 00 4 830 020301875A 03/0 06/19/2002 788 . 00 4 83C 020301904A 03/0 06/19/2002 120 . 00 4 83C 020301920A 03/0 06/19/2002 1050 . 00 4 83C 020301934A 03/0 06/19/2002 824 . 00 4 83C 020301948A 03/0 06/19/2002 120 . 00 4 83C 020301963A 03/0 06/19/2002 880 . 00 4 83C 020301969A 03/0 06/19/2002 374 . 00 4 83C 020301978A 03/0 06/19/2002 120 . 00 4 83C 020301990A 03/0 Date : 06/20/2002 Weld County Paramedic Services Time : 14 :47 :29 Receipt, Write-off, Adjustment Batch Repor WriteOffBatch From 06/19/2002 Thru 06/19/20 Date Source Check # Branch # Value T RWA Code Invoice Inv 06/19/2002 120 . 00 4 83C 020301997A 03/0 06/19/2002 774 . 00 4 83C 020302032A 03/1 06/19/2002 374 . 00 4 83C 020302039A 03/1 06/19/2002 724 . 00 4 83C 020302061A 03/1 06/19/2002 946 . 00 4 83C 020302078A 03/1 06/19/2002 814 . 00 4 83C 020302081A 03/1 06/19/2002 724 . 00 4 83C 020302097A 03/1 06/19/2002 120 . 00 4 83C 020302137A 03/1 06/19/2002 836 . 00 4 83C 020302238A 03/1 06/19/2002 736 . 00 4 83C 020302524A 03/2 06/19/2002 1044 . 00 4 83C 020302539A 03/2 06/19/2002 120 . 00 4 83C 020402671A 04/0 06/19/2002 120 . 00 4 83C 020402756A 04/0 06/19/2002 0 . 84 4 83 020503683A 05/1 06/19/2002 150 . 00 4 83C 020503895A 05/1 Total of 113 WriteOff Entries Totaling 70826 . 62 Dollars Average WriteOff : 626 . 78 Dollars Average Time : 159 Days Date : 06/20/2002 Weld County Paramedic Services Time : 14 : 47 : 29 Receipt, Write-off, Adjustment Batch Repor WriteOffBatch From 06/19/2002 Thru 06/1912.0 Date Source Check # Branch # Value T RWA Code Invoice Inv Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 111 70640 . 78 636 . 40 160 . 03 82 MEDICAID WRITEOFF 1 185 . 00 185 . 00 180 . 00 83 WRITEOFF 1 0 . 84 0 . 84 40 . 00 Date:07/25/2002 Weld County Paramedic Services Page: 1 Time:10:50:33 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2002 Thru 07/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 07/24/2002 395.00 4 83C 001108967A 11/21/2000 DURAN DE LUJAN, MARI 07/24/2002 350.00 4 83C 001209690A 12/18/2000 URIAS, JACKELINE 07/24/2002 300.00 4 83C 001209690B 12/18/2000 URIAS, EDUARDO 07/24/2002 296.00 4 83C 001209690C 12/18/2000 CABALLERO, KAREN 07/24/2002 24 .00 4 83C 010806771A 08/24/2001 PALMER, KAREN K 07/24/2002 1171.00 4 83C 010907204A 09/08/2001 SILVA, IGNASIO 07/24/2002 43.00 4 83C 010907691A 09/25/2001 REDMAN, CONNIE 07/24/2002 25.00 4 83C 011008148A 10/11/2001 THOMAS, MELINDA S 07/24/2002 719.00 4 83C 011008211A 10/13/2001 HOOD, LISA 07/24/2002 559.62 4 83C 011008357A 10/18/2001 HOFFMAN, LOUELLA 07/24/2002 734.08 4 83C 011008656A 10/28/2001 TYLER, RUSSELL F 07/24/2002 769.00 4 83C 011008742A 10/31/2001 MCBETH, TREVOR 07/24/2002 224.00 4 83C 011008749A 10/31/2001 PALMER, KAREN K 07/24/2002 160.60 4 83C 011008751A 10/31/2001 HAMBEK, KEVIN 07/24/2002 871.00 4 83C 011108764A 11/01/2001 MENDIOLIA, JOSE M 07/24/2002 100.00 4 83C 011108791A 11/02/2001 PERALES, SARA 07/24/2002 666.00 4 83C 011108796A 11/02/2001 BUSH, ANNA 07/24/2002 819.00 4 83C 011108815A 11/03/2001 VANCE, DOUGLAS 07/24/2002 793 .00 4 83C 011108816A 11/03/2001 RAMOS, JESSE 07/24/2002 716.00 4 83C 011108824A 11/03/2001 PINON, RAUL 07/24/2002 716.00 4 83C 011108862A 11/04/2001 LEIJO, EDUARDO L 07/24/2002 716.00 4 83C 011108881A 11/05/2001 MORENO, CORNELIO 07/24/2002 100.00 4 83C 011108908A 11/06/2001 WEBER, INA M 07/24/2002 819.00 4 83C 011108925A 11/06/2001 STOLLSTEIMER, SARA 07/24/2002 399.00 4 83C 011108930A 11/06/2001 STOLLSTEIMER, SARA 07/24/2002 819.00 4 83C 011108991A 11/09/2001 GARCIA, JOSEFA F 07/24/2002 654.00 4 83C 011108997A 11/09/2001 LOPEZ, REYNA C 07/24/2002 963 .00 4 83C 011109022A 11/10/2001 CASTRO, DAVID 07/24/2002 654.00 4 83C 011109065A 11/11/2001 SANTOS, NANCY C 07/24/2002 100.00 4 83C 011109067B 11/11/2001 ORTEGA, DAVID J 07/24/2002 644 .00 4 83C 011109079A 11/12/2001 WATKINS, COURTNEY 07/24/2002 654.00 4 83C 011109082A 11/12/2001 HILL, JOHN C **SEE N 07/24/2002 399.00 4 83C 011109084A 11/12/2001 HILL, JOHN C 07/24/2002 859.00 4 83C 011109089A 11/13/2001 ROCHA, MIGUEL 07/24/2002 399.00 4 83C 011109116A 11/13/2001 SMITH, HEATHER L 07/24/2002 704.00 4 83C 011109120A 11/14/2001 RAMEY, JAMES C 07/24/2002 25.00 4 83C 011109126A 11/14/2001 TOMTER, DEAN C 07/24/2002 704.00 4 83C 011109142B 11/14/2001 LOVENBURG, BOBBI 07/24/2002 399.00 4 83C 011109145A 11/14/2001 LOPEZ, ADRIANA 07/24/2002 604.00 4 83C 011109263A 11/18/2001 CHRISTIANSEN, BRIAN 07/24/2002 100.00 4 83C 011109291A 11/19/2001 STAWSONN, HEATHER 07/24/2002 153 .80 4 83C 011109294A 11/20/2001 RUNNER, GARY 07/24/2002 819.00 4 83C 011109297A 11/20/2001 DOMINGUEZ, ALFONSO 07/24/2002 704.00 4 83C 011109327B 11/21/2001 HERRERA, SOPHIE 07/24/2002 769.00 4 83C 011109354A 11/22/2001 SANTIANO, MARIA 07/24/2002 789.00 4 83C 011109390A 11/24/2001 THILL, KENNETH GLEN 07/24/2002 704.00 4 83C 011109402A 11/24/2001 ORNELAS, RUSTY 07/24/2002 399.00 4 83C 011109440A 11/25/2001 MCAUGHEY, LACEY 07/24/2002 399.00 4 83C 011109461A 11/26/2001 THILL, KENNETH GLEN • Date:07/25/2002 Weld County Paramedic Services Page: 2 Time:10:50:33 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2002 Thru 07/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 07/24/2002 819.00 4 83C 011109511A 11/28/2001 ROMERO, BERNARDITA 07/24/2002 819.00 4 83C 011109512A 11/28/2001 VELASQUEZ, WILLIAM J 07/24/2002 789.00 4 83C 011109550A 11/30/2001 MOSER, FRANCES L 07/24/2002 915.00 4 83C 011109567B 11/30/2001 TRAMMELL, DANIEL 07/24/2002 269.00 4 83C 011209609A 12/03/2001 MONTEZ, CORALENE A 07/24/2002 166.80 4 83C 011209609B 12/03/2001 MONTEZ, JOSE 07/24/2002 140.80 4 83C 011209609C 12/03/2001 MONTEZ, JO MARIE 07/24/2002 774.00 4 83C 011209678A 12/05/2001 LUCERO, THERESA 07/24/2002 956.00 4 83C 011209773A 12/08/2001 DELPAZ-TORRES, EVARR 07/24/2002 973.00 4 83C 011209801A 12/10/2001 FURLONG, VALERIE 07/24/2002 25.00 4 83C 011209870A 12/12/2001 PARIS, NICHOLAS 07/24/2002 991.00 4 83C 011209892A 12/13/2001 SCHMIER, SUSAN 07/24/2002 79.80 4 83C 011209896A 12/14/2001 SALAZAR, LORAINE Y 07/24/2002 399.00 4 83C 011209981A 12/16/2001 IMEL, KARL 07/24/2002 654.00 4 83C 011210012A 12/17/2001 MARTINEZ, FRANK 07/24/2002 25.00 4 83C 011210023A 12/18/2001 PARIS, NICHOLAS 07/24/2002 452.77 4 83C 011210058A 12/19/2001 MARTINEZ, CRESCENCIO 07/24/2002 710.08 4 83C 011210060A 12/20/2001 BENAVIDEZ, JOSEPH R 07/24/2002 769.00 4 83C 011210069A 12/20/2001 SEYMOUR, MARK 07/24/2002 1310.08 4 83C 011210086A 12/20/2001 BENAVIDEZ, JOSEPH R 07/24/2002 704.00 4 83C 011210249A 12/26/2001 LAMBERT, BERYL E 07/24/2002 758.00 4 83C 011210253B 12/26/2001 GALINDO, ROBERT 07/24/2002 399.00 4 83C 011210261A 12/26/2001 BOSTICK, JAMES 07/24/2002 683 .56 4 83C 020100066A 01/02/2002 RYAN, BETTY 07/24/2002 721.99 4 83C 020100092A 01/03/2002 RYAN, BETTY 07/24/2002 1038.00 4 83C 020100143A 01/05/2002 FURLONG, VALERIE 07/24/2002 894.00 4 83C 020100172A 01/06/2002 GARCIA, JOSEFA F 07/24/2002 120.00 4 83C 020100183A 01/06/2002 GARCIA, JOSEFA F 07/24/2002 1064.00 4 83C 020100189A 01/06/2002 ESCOBAR, SELSO ALEJA 07/24/2002 724.00 4 83C 020100261A 01/08/2002 SHROUT, SCOTT 07/24/2002 724.00 4 83C 020100262A 01/08/2002 JIRON, ALVIN 07/24/2002 120.00 4 83C 020100268A 01/09/2002 MESE, VICTORIA 07/24/2002 724.00 4 83C 020100281A 01/09/2002 PETERSON, KIM 07/24/2002 776.00 4 83C 020100283A 01/09/2002 KEITH, KENNETH 07/24/2002 40.44 4 83C 020100284A 01/09/2002 STEWART, PAM 07/24/2002 826.00 4 83C 020100286A 01/09/2002 CHURCHILL, ERIN 07/24/2002 838.00 4 83C 020100336A 01/10/2002 WEBER, MELISSA 07/24/2002 120.00 4 83C 020100342A 01/10/2002 HOFFMAN, MIKE 07/24/2002 874.00 4 83C 020100453A 01/14/2002 GIBSON, KEITH 07/24/2002 724.00 4 83C 020100483A 01/15/2002 REZA, JESUS 07/24/2002 1042.00 4 83C 020100508A 01/16/2002 HOSMAN, ANGELA 07/24/2002 1074.00 4 83C 020100524A 01/17/2002 BRUDER, MEGAN 07/24/2002 328.16 4 83C 020100567A 01/18/2002 RAMIREZ, SONAY 07/24/2002 120.00 4 83C 020100571A 01/18/2002 REDFERN, KIANA 07/24/2002 374.00 4 83C 020100573A 01/18/2002 LONG, MICHAEL 07/24/2002 764.00 4 83C 020100590A 01/19/2002 ROBERTSON, TYLER 07/24/2002 814.00 4 83C 020100598A 01/19/2002 BOYD, JEB E 07/24/2002 826.00 4 83C 020100600A 01/20/2002 JIMENEZ, DENISE 07/24/2002 120.00 4 83C 020100617A 01/20/2002 COBARRUBIAS, ARACELI Date:07/25/2002 Weld County Paramedic Services Page: 3 Time:10:50:34 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2002 Thru 07/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 07/24/2002 850.00 4 83C 020100621A 01/20/2002 DAY, SYNDEY 07/24/2002 850.00 4 83C 020100621B 01/20/2002 DAY, HOLLY 07/24/2002 874.00 4 83C 020100689A 01/23/2002 PULLIAM, AMBER R 07/24/2002 834.00 4 83C 020100740A 01/24/2002 STERN, MADELINE G 07/24/2002 970.00 4 83C 020100772A 01/25/2002 JIMENEZ, BLANCA 07/24/2002 1006.00 4 83C 020100788A 01/26/2002 BOLLIG, DIANE 07/24/2002 1024.00 4 83C 020100791A 01/26/2002 WATSON, FRANCESCA 07/24/2002 511.57 4 83C 020100825A 01/28/2002 MANDEZ, ROSE 07/24/2002 724.00 4 83C 020100854A 01/29/2002 SANTILLIAN, CELIA 07/24/2002 120.00 4 83C 020100933A 01/31/2002 LILES, CORY 07/24/2002 824.00 4 83C 020100939A 01/31/2002 RIVAS, OLGA 07/24/2002 1212 .00 4 83C 020201011A 02/03/2002 GONZALES, ROBERT EDW 07/24/2002 274.00 4 83C 020201022A 02/03/2002 NOREN, JARRED E 07/24/2002 874.00 4 83C 020201044A 02/04/2002 RICHARDSON, REGINA L 07/24/2002 788.00 4 83C 020201068A 02/05/2002 RIZO, MILAGRO 07/24/2002 926.00 4 83C 020201075A 02/05/2002 HOFFNER, LORI 07/24/2002 736.00 4 83C 020201219A 02/11/2002 RUIZ, ROBERT 07/24/2002 89.73 4 83C 020201231A 02/11/2002 GOMEZ, FELIX 07/24/2002 120.00 4 83C 020201274A 02/12/2002 CRANK, DAVID 07/24/2002 874.00 4 83C 020201316A 02/14/2002 WILEY, ZANE D 07/24/2002 736.00 4 83C 020201350A 02/15/2002 VIGIL, TERESA 07/24/2002 874.00 4 83C 020201450A 02/18/2002 STEVENS, LEROY 07/24/2002 924.00 4 83C 020201492A 02/20/2002 SANCHEZ, NATHAN 07/24/2002 994.00 4 83C 020201522A 02/20/2002 YOUNG, DAVE 07/24/2002 814.00 4 83C 020201539A 02/21/2002 WHITMORE, RICHARD 07/24/2002 866.00 4 83C 020201709A 02/27/2002 FLORES, MARLYN 07/24/2002 886.00 4 83C 020301777A 03/02/2002 LUCAS, SCOTT 07/24/2002 24.00 4 83C 020301807A 03/03/2002 ALISEA, LISA D 07/24/2002 982 .00 4 83C 020301856A 03/05/2002 BACA, KENDRAH 07/24/2002 874.00 4 83C 020302029A 03/10/2002 STAUFFER, RITA 07/24/2002 980.00 4 83C 020302150A 03/14/2002 MANRIQUEZ, CHRISTINA 07/24/2002 918.00 4 83C 020302188A 03/15/2002 MYERS, ANDREW 07/24/2002 824.00 4 83C 020302189A 03/15/2002 RASMUSSEN, GREG D 07/24/2002 769.33 4 83C 020302191A 03/15/2002 GUTIERREZ, RODOLFO 07/24/2002 1186.00 4 83C 020302320A 03/21/2002 MCGREGOR, SUE 07/24/2002 836.00 4 83C 020302322A 03/21/2002 LITCHFORD, DAVE 07/24/2002 832 .00 4 83C 020302323A 03/21/2002 AQUINO, ALFREDO 07/24/2002 892.00 4 83C 020302323B 03/21/2002 DE JESUS, ALEJANDRO 07/24/2002 832.00 4 83C 020302323C 03/21/2002 RODRIGUEZ, SARA JASM 07/24/2002 832 .00 4 83C 020302323D 03/21/2002 SANDOVAL-GALLINDO, M 07/24/2002 120.00 4 83C 020302329A 03/21/2002 BERRIEN, ERIC 07/24/2002 788.00 4 83C 020302424A 03/25/2002 LITCHFORD, DAVE 07/24/2002 966.00 4 83C 020302599A 03/31/2002 SCHAFFER, SHURRI 07/24/2002 886.00 4 83C 020302603A 03/31/2002 LUPIO TOVAR, FORTUNA 07/24/2002 886.00 4 83C 020302603B 03/31/2002 LUPIO, BRENDA 07/24/2002 120.00 4 83C 020302603C 03/31/2002 MEZA, BRENDA 07/24/2002 120.00 4 83C 020302603D 03/31/2002 GARCIA, ADELA 07/24/2002 374.00 4 83C 020402627A 04/01/2002 GUITRON, MATTHEW 07/24/2002 874.00 4 83C 020402691A 04/04/2002 ANDRASEK, CARL Date:07/25/2002 Weld County Paramedic Services Page: 4 Time:10:50:34 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2002 Thru 07/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 07/24/2002 774 .00 4 83C 020402767A 04/07/2002 DAMRON, LAURIE 07/24/2002 736.00 4 83C 020402825A 04/09/2002 CARROLL, CHRISTOPHER 07/24/2002 764 .00 4 83C 020402929A 04/13/2002 KNOX, BARRY 07/24/2002 814 .00 4 83C 020402952A 04/13/2002 SOTO, ROBERTO 07/24/2002 724.00 4 83C 020402953A 04/13/2002 CRANMER, RICK 07/24/2002 764.00 4 83C 020402960A 04/14/2002 SAT,A7AR, JESSE 07/24/2002 814.00 4 83C 020402961A 04/14/2002 RODRIGUEZ CORNEJO, A 07/24/2002 1026.00 4 83C 020402962A 04/14/2002 BONE, MATTHEW 07/24/2002 814.00 4 83C 020402997A 04/15/2002 PEDRO, FRANCISCO 07/24/2002 1044.00 4 83C 020403005A 04/15/2002 HUGHLEY, ELBERT 07/24/2002 834.00 4 83C 020403007A 04/15/2002 CRANMER, RICK 07/24/2002 374.00 4 83C 020403027A 04/16/2002 HUGHLEY, ELBERT 07/24/2002 886.00 4 83C 020403045A 04/17/2002 WHITMORE, RICHARD 07/24/2002 1166.00 4 83C 020403062A 04/17/2002 ADAMS, CHARLENE 07/24/2002 886.00 4 83C 020403154A 04/21/2002 MELTON, KENNETH 07/24/2002 1062.00 4 83C 020403173A 04/22/2002 GIBBS JR, CARL '.. 07/24/2002 120.00 4 83C 020403257A 04/25/2002 SANDERSON, DEANA 07/24/2002 996.00 4 83C 020403296C 04/26/2002 LAMBERT, MARVIN H 07/24/2002 814.00 4 83C 020403338A 04/28/2002 COBBLEY, SHARON 07/24/2002 120.00 4 83C 020403371A 04/29/2002 HUGHLEY, ELBERT 07/24/2002 814.00 4 83C 020503485A 05/03/2002 KRENGEL, PAUL 07/24/2002 914.00 4 83C 020503581A 05/06/2002 POOLER, ERNEST 07/24/2002 774.00 4 83C 020503585A 05/06/2002 MARTINEZ, ROXANNE 07/24/2002 774.00 4 83C 020503718A 05/11/2002 HUGHLEY, ELBERT 07/24/2002 898.00 4 83C 020503742A 05/12/2002 LOPEZ-LOPEZ, SAUL L 07/24/2002 874.00 4 83C 020503770A 05/13/2002 PITTERMAN, DALE 07/24/2002 894 .00 4 83C 020503808A 05/15/2002 LUCERO, SONJA 07/24/2002 874.00 4 83C 020503831A 05/16/2002 TORREZ, MARGARITA 07/24/2002 814.00 4 83C 020503864A 05/18/2002 ROMERO, JASON B 07/24/2002 120.00 4 83C 020503905A 05/19/2002 CORTEZ, JASON 07/24/2002 120.00 4 83C 020503935A 05/20/2002 MCFARLAND, TOREY 07/24/2002 1054.00 4 83C 020503937A 05/21/2002 MARTINEZ, JOHN M 07/24/2002 0.01 4 82 020503952A 05/21/2002 TORRES, ROSE 07/24/2002 120.00 4 83C 020503988A 05/22/2002 RODRIGUEZ, ALICIA 07/24/2002 120.00 4 83C 020504042A 05/24/2002 HAROLD, TRENTON 07/24/2002 120.00 4 83C 020504159A 05/29/2002 MENDOZA, MIRTHA 07/24/2002 774.00 4 83C 020504202A 05/31/2002 JACKSON, JESSE JAMES 07/24/2002 924.00 4 83C 020504206A 05/31/2002 MENDEZ HERNANDEZ, JU 07/24/2002 906.00 4 83C 020604248A 06/01/2002 MESE, JUSTIN J 07/24/2002 120.00 4 83C 020604271A 06/02/2002 GONZALEZ, CARLOS 07/24/2002 874.00 4 83C 020604302A 06/03/2002 RICO, ESPERANZA 07/24/2002 724.00 4 83C 020604512A 06/11/2002 WHITMORE, RICHARD 07/24/2002 814.00 4 83C 020604697A 06/17/2002 KNOX, BARRY 07/24/2002 MEDICAID 120.00 4 83 020705144A 07/01/2002 HERNDON, ANDREW Date:07/25/2002 Weld County Paramedic Services Page: 5 Time:10:50:35 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2002 Thru 07/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Total of 191 WriteOff Entries Totaling 122838.22 Dollars Average WriteOff: 643 .13 Dollars Average Time:183 Days Date:07/25/2002 Weld County Paramedic Services Page: 6 Time:10:50:35 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2002 Thru 07/24/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 189 122718.21 649.30 184.71 82 MEDICAID WRITEOFF 1 0.01 0.01 64.00 83 WRITEOFF 1 120.00 120.00 23 .00 Date:08/22/2002 Weld County Paramedic Services Page: 1 Time:08:30 :16 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/21/2002 Thru 08/21/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/21/2002 130 .29 4 83C 000907156A 09/16/2000 ESPINOZA, JOE L 08/21/2002 590 .00 4 83C 001209643A 12/16/2000 LIRA, JOSHUA 08/21/2002 399.00 4 83C 010302035A 03/14/2001 ALLEE, MARGARET A 08/21/2002 488 .29 4 83C 010403169A 04/22/2001 HOSIER, GEORGIA 08/21/2002 203.04 4 83C 010403175A 04/22/2001 HOSIER, GEORGIA 08/21/2002 389.35 4 83C 010503446A 05/01/2001 SPATHIES, JEAN 08/21/2002 629.00 4 83C 010503757A 05/12/2001 HARVEY, ARTTIE 08/21/2002 50 .00 4 83C 010604515A 06/10/2001 WORKMAN, EVELYN 08/21/2002 25 .00 4 83C 010604515B 06/10/2001 WORKMAN, LYLE G 08/21/2002 72.80 4 83C 010604640A 06/15/2001 PURINTUN, KATHY 08/21/2002 742 .00 4 83C 010604696A 06/17/2001 ISEMINGER, DON 08/21/2002 799.00 4 83C 010605003A 06/27/2001 GOMEZ, PABLO JR 08/21/2002 185 .20 4 83C 010806411A 08/12/2001 HERSEY, LORIE 08/21/2002 75.72 4 83C 010806941A 08/30/2001 SMITH, FLORENCE J 08/21/2002 936.00 4 83C 010907141A 09/06/2001 LIBSACK, TYLER 08/21/2002 957 .94 4 83C 011008093A 10/09/2001 DURAN, LACASTA M 08/21/2002 704 .00 4 83C 011008198A 10/13/2001 BAKER, MIRANDA 08/21/2002 25 .00 4 83C 011008256A 10/14/2001 DILKA, KERRY 08/21/2002 806.50 4 83C 011008307A 10/16/2001 QUIRAM, KARL 08/21/2002 925.50 4 83C 011008378A 10/19/2001 JAMES, JESSICA M 08/21/2002 361.50 4 83C 011008383A 10/19/2001 JAMES, JESSICA M 08/21/2002 386 .50 4 83C 011008404A 10/19/2001 QUIRAM, KARL 08/21/2002 806 .50 4 83C 011008424A 10/20/2001 QUIRAM, KARL 08/21/2002 37.50 4 83C 011008429A 10/20/2001 QUIRAM, KARL 08/21/2002 819.00 4 83C 011008636A 10/27/2001 MARTINEZ, DION 08/21/2002 50.00 4 83C 011008664A 10/28/2001 VAUGHT, STEPHEN THOM 08/21/2002 751.00 4 83C 011008675A 10/29/2001 GISH, JANNIFER 08/21/2002 618.94 4 83C 011108870A 11/05/2001 SORENSON, LOUIS 08/21/2002 100.00 4 83C 011108878A 11/05/2001 SEGURA, SAVANNA 08/21/2002 543 .00 4 83C 011108896A 11/05/2001 FRICKEY, EDWIN 08/21/2002 763 .00 4 83C 011108933A 11/07/2001 LOPEZ, ALFONSO 08/21/2002 237.60 4 83C 011108943A 11/07/2001 EMERY, SHERRYCE N 08/21/2002 949.00 4 83C 011109059A 11/11/2001 ELKINS, MICHAEL 08/21/2002 74.41 4 83C 011109068A 11/12/2001 MCCOY, CONSTANCE 08/21/2002 60.00 4 83C 011109173A 11/15/2001 BENAVIDEZ, AMY 08/21/2002 411.00 4 83C 011109378A 11/23/2001 ROMERO, ISRAEL 08/21/2002 30.00 4 83C 011109489A 11/27/2001 FRASER, DESTINEY 08/21/2002 298.00 4 83C 011209881A 12/13/2001 DAVIS, HEAVENLEA C 08/21/2002 796.00 4 83C 020100322A 01/10/2002 KEELICK, NANCY 08/21/2002 724 .00 4 83C 020100343A 01/10/2002 GONZALEZ, ISRAEL 08/21/2002 120.00 4 83C 020100355A 01/11/2002 MINJARES, AALIYAH 08/21/2002 120.00 4 83C 020100356A 01/11/2002 MILLER, LERIN 08/21/2002 764 .00 4 83C 020100369A 01/11/2002 DUFFIELD, SHERRI 08/21/2002 120 .00 4 83C 020100376A 01/11/2002 GARZA, FRED 08/21/2002 120 .00 4 83C 020100415A 01/13/2002 CARRILLO, ROSE 08/21/2002 802 .32 4 83C 020100457A 01/14/2002 SORENSEN, VIRGIL ROY 08/21/2002 120 .00 4 83C 020100459A 01/15/2002 CATHCART, MATTHEW 08/21/2002 834 .00 4 83C 020100467A 01/15/2002 MARTINEZ, BENNY 08/21/2002 874 .00 4 83C 020100484A 01/15/2002 MARTIN, JOSHUA L • Date:08/22/2002 Weld County Paramedic Services Page: 2 Time:08:30:17 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/21/2002 Thru 08/21/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/21/2002 774 .00 4 83C 020100545A 01/17/2002 BOYD, JEB E 08/21/2002 120 .00 4 83C 020100558A 01/18/2002 ESCAJEDA, CHASTISTY 08/21/2002 120 .00 4 83C 020100614A 01/20/2002 TORREZ, JEREMY 08/21/2002 1062 .00 4 83C 020100625A 01/20/2002 GIBBONS, JENNIFER A 08/21/2002 836 .00 4 83C 020100637A 01/21/2002 PANIAGUA, AURELIA 08/21/2002 120 .00 4 83C 020100685A 01/23/2002 DYE, CYNTHIA 08/21/2002 1148.00 4 83C 020100719A 01/24/2002 MEYERS, EMANUEL 08/21/2002 374 .00 4 83C 020100726A 01/24/2002 PULLIAM, AMBER R 08/21/2002 814 .00 4 83C 020100792A 01/26/2002 HANSEN, JULIE 08/21/2002 120.00 4 83C 020100807B 01/27/2002 AHUERO, CLAY 08/21/2002 920.00 4 83C 020100812A 01/27/2002 PACHECO, MOSES 08/21/2002 772 .00 4 83C 020100813B 01/27/2002 LEINWEBER, RYAN 08/21/2002 120.00 4 83C 020100813C 01/27/2002 BUCHER, BECKY 08/21/2002 374.00 4 83C 020100817A 01/28/2002 NARANJO, JENNIFER 08/21/2002 1134.00 4 83C 020100819A 01/28/2002 COTTON, KATHY 08/21/2002 884.00 4 83C 020100823A 01/28/2002 ECHEVERRIA, STEVE 08/21/2002 212.26 4 83C 020100829A 01/28/2002 MANDEZ, ROSE 08/21/2002 770.00 4 83C 020100837A 01/28/2002 GUTIERREZ, RODOLFO 08/21/2002 724 .00 4 83C 020100842A 01/28/2002 HECTUS, STEVEN J 08/21/2002 814 .00 4 83C 020100860A 01/29/2002 MINNEY, ROSITA 08/21/2002 827 .86 4 83C 020100862A 01/29/2002 GUTIERREZ, RODOLFO 08/21/2002 774 .00 4 83C 020100881A 01/29/2002 BREWER, VINCE 08/21/2002 724 .00 4 83C 020100913A 01/31/2002 MILLER, RYAN 08/21/2002 886.00 4 83C 020100922A 01/31/2002 GUERRERO, JAIME 08/21/2002 120 .00 4 83C 020100924A 01/31/2002 BACHAND, BIANCA 08/21/2002 764 .00 4 83C 020100925A 01/31/2002 DODGE, KERRIE L 08/21/2002 776.00 4 83C 020100933B 01/31/2002 DELONG, SUMMER 08/21/2002 144 .80 4 83C 020100945A 01/31/2002 GONZALEZ, GLORIA 08/21/2002 914 .00 4 83C 020200996A 02/02/2002 KNIGHT, ROBERT 08/21/2002 25.00 4 83C 020201025A 02/03/2002 JOYNER, WOODARD 08/21/2002 521.57 4 83C 020201036A 02/04/2002 MANDEZ, ROSE 08/21/2002 64 .44 4 82 020201070A 02/05/2002 PALMER, MARGUERITE 08/21/2002 25.00 4 83C 020201110A 02/06/2002 JOYNER, WOODARD 08/21/2002 374 .00 4 83C 020201138A 02/07/2002 GARCIA, TARRARA 08/21/2002 774.00 4 83C 020201218A 02/10/2002 JOHNSON, SUSIE 08/21/2002 924.00 4 83C 020201220A 02/11/2002 OLIVA MONGE, CARLOS 08/21/2002 951.33 4 83C 020201266A 02/12/2002 GUTIERREZ, RODOLFO 08/21/2002 1012 .00 4 83C 020201426A 02/17/2002 KEMP, JENNIFER 08/21/2002 724.00 4 83C 020201477A 02/19/2002 SANCHEZ, REBEKAH 08/21/2002 120.00 4 83C 020201668A 02/25/2002 MARCUM, DEVIN 08/21/2002 85.16 4 83C 020201669A 02/25/2002 HERNANDEZ, CAROLINA 08/21/2002 819.33 4 83C 020301797A 03/02/2002 MANDEZ, ROSE 08/21/2002 25.00 4 83C 020301823A 03/03/2002 TRUJILLO, PATRICIA L 08/21/2002 120.00 4 83C 020301847A 03/05/2002 SWANSON, SARAH KELLI 08/21/2002 916.00 4 83C 020301857A 03/05/2002 WALDEN, LARRY 08/21/2002 734 .00 4 83C 020301903A 03/06/2002 URBACH, JEFFREY L 08/21/2002 764 .00 4 83C 020301945C 03/08/2002 URQUIDEZ, DANNY 08/21/2002 229.33 4 83C 020302024A 03/10/2002 BALCZYK, CHARLES A 08/21/2002 530 .51 4 82 020302030A 03/10/2002 CROISSANT, HARVEY • Date:08/22/2002 Weld County Paramedic Services Page: 3 Time:08:30:17 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/21/2002 Thru 08/21/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/21/2002 724 .00 4 83C 020302042A 03/11/2002 SHAFFER, CURTIS 08/21/2002 894 .00 4 83C 020302135A 03/13/2002 CARROLL, CHRISTOPHER 08/21/2002 831.33 4 83C 020302175A 03/15/2002 LOPEZ, JOHN A 08/21/2002 1018.00 4 83C 020302214A 03/16/2002 JONES, TAMMIE 08/21/2002 1098.00 4 83C 020302411A 03/25/2002 MOSER, GALE 08/21/2002 814 .00 4 83C 020402625A 04/01/2002 CASTILLO, LEO 08/21/2002 843 .33 4 83C 020402628A 04/01/2002 LOPEZ, JOHN A 08/21/2002 814 .00 4 83C 020402722A 04/06/2002 WARNER, DARYL L 08/21/2002 1090.00 4 83C 020402750A 04/06/2002 SCHMIDT, BRYAN 08/21/2002 374.00 4 83C 020402780A 04/07/2002 METCALF, SHIELA 08/21/2002 764.00 4 83C 020402791A 04/08/2002 MARTIN, JOSHUA L 08/21/2002 120.00 4 83C 020402823A 04/09/2002 GARCIA, JOE 08/21/2002 120.00 4 83C 020402830A 04/10/2002 SMITH, EUGENE 08/21/2002 724.00 4 83C 020402855A 04/11/2002 CISNEROS, LOUIS F 08/21/2002 120.00 4 83C 020402899A 04/12/2002 BALDERAS, DEANNA 08/21/2002 774.00 4 83C 020402907A 04/12/2002 STEBNER, RANDAL 08/21/2002 814.00 4 83C 020402930A 04/13/2002 LITTVA, DANI 08/21/2002 120.00 4 83C 020402937A 04/13/2002 MARSHALL, ANGELA 08/21/2002 886.00 4 83C 020402938A 04/13/2002 THILL, KENNETH GLEN 08/21/2002 1259.21 4 82 020403071A 04/18/2002 WARBOYS, FLOYD 08/21/2002 724 .00 4 83C 020403125B 04/20/2002 CAVAZOS, VINCENT D I 08/21/2002 1030.00 4 83C 020403156A 04/21/2002 RODRIQUEZ, JERRY 08/21/2002 814 .00 4 83C 020403221A 04/24/2002 NAZERI, DAVID 08/21/2002 1080 .00 4 83C 020403229A 04/24/2002 DAVOR, RAYMOND 08/21/2002 764 .00 4 83C 020403337A 04/28/2002 LARA, AUGUSTINE 08/21/2002 120 .00 4 83C 020403371B 04/29/2002 DAVID CALDERON 08/21/2002 120.00 4 83C 020503433A 05/01/2002 NAVARRETTE, RAYMOND 08/21/2002 886.00 4 83C 020503461A 05/02/2002 BRAVO, JULIAN PEREZ 08/21/2002 814 .00 4 83C 020503468A 05/02/2002 COBBLEY, SHARON 08/21/2002 822 .00 4 83C 020503494A 05/03/2002 POLLAT, JIM 08/21/2002 120.00 4 83C 020503505A 05/04/2002 OLIVAS-LOPEZ, MERCED 08/21/2002 826.00 4 83C 020503647A 05/08/2002 GONZALES, ANGEL M 08/21/2002 39.57 4 82 020503650A 05/09/2002 MEISSNER, RUTH 08/21/2002 57.33 4 83C 020503772A 05/13/2002 AUSTIN, KIRK 08/21/2002 736.00 4 83C 020503816A 05/15/2002 LIRA, FANTASIA M 08/21/2002 120.00 4 83C 020503823A 05/16/2002 MEDINA, DIANNA 08/21/2002 824.00 4 83C 020503869A 05/18/2002 COBBLEY, SHARON 08/21/2002 824.00 4 83C 020503877A 05/18/2002 COBBLEY, SHARON 08/21/2002 774.00 4 83C 020503888A 05/19/2002 WHITESHIRT, GUY 08/21/2002 120.00 4 83C 020503933A 05/20/2002 SOTO, MARICELA 08/21/2002 1072.00 4 83C 020504059A 05/25/2002 MCCRACKEN, PAUL 08/21/2002 724.00 4 83C 020504087A 05/26/2002 GARCIA, ELIAS 08/21/2002 724.00 4 83C 020504157A 05/29/2002 ZAMORA, GALDINO 08/21/2002 814.00 4 83C 020604226A 06/01/2002 MARTINEZ, BENNY 08/21/2002 958.00 4 83C 020604429A 06/08/2002 GARCIA, MIGUEL 08/21/2002 1236.00 4 83C 020604474A 06/09/2002 LINCK, AUGUST 08/21/2002 1024.00 4 83C 020604481A 06/10/2002 ICAL, LOCADIA 08/21/2002 874.00 4 83C 020604553A 06/12/2002 FROMAN, GREGORY W 08/21/2002 764.00 4 83C 020604562A 06/12/2002 LOWRY, SUSAN • Date:08/22/2002 Weld County Paramedic Services Page: 4 Time:08:30 :18 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/21/2002 Thru 08/21/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/21/2002 814.00 4 83C 020604564A 06/13/2002 SARTZ, YVETTE 08/21/2002 666.71 4 82 020604604A 06/14/2002 TORRES, AARON 08/21/2002 814.00 4 83C 020604611A 06/14/2002 WHITMORE, RICHARD 08/21/2002 814.00 4 83C 020604621A 06/15/2002 MORENO, FRED 08/21/2002 120.00 4 83C 020604661A 06/16/2002 ORNELAS, PATRICK 08/21/2002 80 .03 4 82 020604698A 06/17/2002 JESPERSEN, IRENE 08/21/2002 874 .00 4 83C 020604718A 06/18/2002 SCHWINDT, JASON 08/21/2002 784 .00 4 83C 020604761A 06/20/2002 KNOX, BARRY 08/21/2002 73 .36 4 82 020604767A 06/20/2002 CRUZ, CARMEN 08/21/2002 84 .15 4 82 020604769A 06/20/2002 AHLBRANDT-JOHNSON, P 08/21/2002 59.36 4 82 020604814A 06/22/2002 RODRIGUEZ, FRANK 08/21/2002 774 .00 4 83C 020604820A 06/22/2002 DARBIN, DANIEL 08/21/2002 806.00 4 83C 020604893A 06/24/2002 GILLESPIE, LISA 08/21/2002 82 .92 4 82 020604898A 06/24/2002 LOPEZ, JOSE ORTIZ 08/21/2002 1594.00 4 83C 020604918A 06/24/2002 CHASE ALONE, GEORGE 08/21/2002 744.00 4 83C 020604924A 06/25/2002 PACHECO, GILBERT 08/21/2002 60.13 4 82 020604939A 06/25/2002 ROHN, BONNIE 08/21/2002 73 .36 4 82 020604946A 06/25/2002 GARCIA, ANGELITA 08/21/2002 74.42 4 82 020604968A 06/26/2002 EITEL, DANIEL 08/21/2002 120.00 4 83C 020605046A 06/29/2002 LUEVANOS, ALFREDO 08/21/2002 924.00 4 83C 020605076A 06/29/2002 DOWNING, WILLIAM 08/21/2002 726.71 4 82 020605080B 06/29/2002 CAMPOS CASAS, BEATRI 08/21/2002 914.00 4 83C 020705124A 07/01/2002 RIVAS, HECTOR 08/21/2002 120.00 4 83C 020705237A 07/04/2002 FIELD, CHRIS 08/21/2002 724 .00 4 83C 020705275A 07/05/2002 ORTIZ, MARTINO *SEE 08/21/2002 671.58 4 82 020705416A 07/09/2002 GHADERINASRABAD, REZ 08/21/2002 618.52 4 82 020705521A 07/13/2002 ARELJaNO, BRITAWNEY 08/21/2002 739.24 4 82 020705529A 07/13/2002 MENDEZ, ARMANDO 08/21/2002 709.91 4 82 020705648A 07/18/2002 MOORE, PAT 08/21/2002 671.58 4 82 020705663A 07/18/2002 MADRID, ZECHARIAH 08/21/2002 767.11 4 82 020705708A 07/20/2002 TOBBLE, -ANTONIO 08/21/2002 643 .04 4 82 020705725A 07/21/2002 STATIMEL, MICHAEL D 08/21/2002 631.37 4 82 020705781A 07/23/2002 LUCERO, LEONARD 08/21/2002 792 .84 4 82 020705836A 07/25/2002 BRYANT, CHRIS 08/21/2002 894 .70 4 82 020705866A 07/26/2002 MARQUEZ, LYDIA ELVIN 08/21/2002 728.52 4 82 020705895A 07/27/2002 SCHRAM, CLAUDETTE J 08/21/2002 668.52 4 82 020705984A 07/30/2002 ALCANTAR, PAULA 08/21/2002 589.98 4 82 020806064A 08/01/2002 VARELA JR, FRANCISCO Total of 185 WriteOff Entries Totaling 105761.32 Dollars Average WriteOff: 571.68 Dollars Average Time:180 Days Date:08/22/2002 Weld County Paramedic Services Page: 5 Time:08:30:18 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/21/2002 Thru 08/21/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 158 92759.53 587.09 200.61 82 MEDICAID WRITEOFF 27 13001.79 481.55 58.85 Date:09/29/2002 Weld County Paramedic Services Page: 1 Time:10:11:32 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 09/18/2002 Thru 09/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 09/18/2002 874 .00 4 83C 010202505A 03/28/2002 ROCHA-SOSA, RAUL 09/18/2002 641.00 4 83C 011008092A 10/09/2001 GUTIERREZ, BRYAN K 09/18/2002 654.00 4 83C 011210224A 12/25/2001 LARMONIE, EDWIN 09/18/2002 562.26 4 83C 020100316A 01/10/2002 NYE, ANNE D 09/18/2002 874.00 4 83C 020100411A 01/13/2002 CLARK, JEREMY F 09/18/2002 664.40 4 83C 020100436A 01/14/2002 SHANNON, MELANIE 09/18/2002 120.00 4 83C 020100502A 01/16/2002 HOUSER, SHELLY 09/18/2002 1210 .00 4 83C 020100644A 01/21/2002 GALLOWAY, BECKY 09/18/2002 160 .00 4 83C 020100644B 01/21/2002 GALLOWAY, JASMINE 09/18/2002 160 .00 4 83C 020100644C 01/21/2002 GALLOWAY, STEPHEN 09/18/2002 898.00 4 83C 020100650A 01/22/2002 VEGA, SANTOS 09/18/2002 884 .00 4 83C 020100665A 01/22/2002 ANDERSON, FLORENCE 09/18/2002 54 .00 4 83C 020100820A 01/28/2002 WORTMAN, JAMES 09/18/2002 1208.00 4 83C 020200958A 02/01/2002 COBB, CHARLES 09/18/2002 588.72 4 83C 020201004A 02/02/2002 LINDGREEN, CHARLES 09/18/2002 120.00 4 83C 020201032A 02/04/2002 DIOSDADO, LUIS M JR 09/18/2002 520.87 4 83C 020201088A 02/06/2002 ZWIEBEL, MARY 09/18/2002 724.00 4 83C 020201237A 02/11/2002 ANDREWS, EMILY ANN 09/18/2002 790.00 4 83C 020201255C 02/12/2002 LARRALDE, SEBASTIAN 09/18/2002 152.80 4 83C 020201283A 02/13/2002 MAROSTICA, RYAN 09/18/2002 894 .00 4 83C 020201320A 02/14/2002 MORALES, MARY E 09/18/2002 1086 .00 4 83C 020201352A 02/15/2002 CENICEROS, MANUEL 09/18/2002 814 .00 4 83C 020201361A 02/15/2002 CONNELLY, MICHAEL 09/18/2002 630.00 4 83C 020201381A 02/16/2002 LINDGREEN, CHARLES 09/18/2002 120 .00 4 83C 020201408A 02/17/2002 GARNETTE, SHAUN 09/18/2002 918.00 4 83C 020201423A 02/17/2002 GLENN, ROLAND A 09/18/2002 25.00 4 83C 020201453A 02/18/2002 FUOCO, DEANNE 09/18/2002 770.00 4 83C 020201457A 02/18/2002 MULLINS, NORMA 09/18/2002 814 .00 4 83C 020201512A 02/20/2002 CLARKSON, JACOB 09/18/2002 374.00 4 83C 020201527A 02/20/2002 CLARKSON, JACOB 09/18/2002 521.57 4 83C 020201571A 02/22/2002 LINDGREEN, CHARLES 09/18/2002 880.00 4 83C 020201572A 02/22/2002 MCKIM, SUSAN 09/18/2002 120.00 4 83C 020201642A 02/25/2002 BARRIOS, VICTOR 09/18/2002 764.00 4 83C 020201696A 02/26/2002 MERAZ, PAOLA 09/18/2002 120.44 4 83C 020201743A 02/28/2002 MANG, KEN 09/18/2002 1092.00 4 83C 020201747A 02/28/2002 BOSTICK, JAMES 09/18/2002 74.44 4 83C 020301783A 03/02/2002 PISANO, PAULITO 09/18/2002 50.00 4 83C 020301820A 03/03/2002 GOGGANS, APRIL 09/18/2002 764.00 4 83C 020302064A 03/11/2002 LOPEZ, ROBERTO 09/18/2002 1222.00 4 83C 020302071A 03/11/2002 CENICEROS, MANUEL 09/18/2002 764 .00 4 83C 020302082A 03/12/2002 ARIAS, NANCY 09/18/2002 764 .00 4 83C 020302082B 03/12/2002 ARIAS, VANESSA 09/18/2002 120 .00 4 83C 020302088A 03/12/2002 SANSONE, RICHARD 09/18/2002 898.00 4 83C 020302094A 03/12/2002 SANSONE, RICHARD 09/18/2002 798.00 4 83C 020302096A 03/12/2002 MENDEZ, MAGDALENO 09/18/2002 838.00 4 83C 020302114A 03/13/2002 GUTIERREZ, SERGIO MI 09/18/2002 120 .00 4 83C 020302218A 03/16/2002 GOUDY, JOHN 09/18/2002 1058.00 4 83C 020302223A 03/17/2002 RICHNER, CHERYL L 09/18/2002 826.00 4 83C 020302232A 03/17/2002 HUGHES, TAMMY Date:09/19/2002 Weld County Paramedic Services Page: 2 Time:10:11:32 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 09/18/2002 Thru 09/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 09/18/2002 194.00 4 83C 020302330A 03/21/2002 SCOTT, NANCY E 09/18/2002 808.00 4 83C 020302333A 03/21/2002 BARRERA, JUAN 09/18/2002 120.00 4 83C 020302337A 03/22/2002 TANGUMA, ENNCO 09/18/2002 192 .00 4 83C 020302341A 03/22/2002 CARROLL, LAWRENCE 09/18/2002 874 .00 4 83C 020302353A 03/22/2002 GUTIERREZ, SERGIO MI 09/18/2002 120.00 4 83C 020302356B 03/23/2002 MONDRAGON, CRYSTAL 09/18/2002 724.00 4 83C 020302378A 03/23/2002 SALAZAR, BALDOMERO 09/18/2002 755 .89 4 83C 020302385A 03/24/2002 SORENSEN, VIRGIL ROY 09/18/2002 970.00 4 83C 020302417A 03/25/2002 MCCLURE, ROBERT 09/18/2002 764.00 4 83C 020302422A 03/25/2002 ROBINSON, SHARON 09/18/2002 776.00 4 83C 020302432A 03/25/2002 RIES, BRAD 09/18/2002 1376.00 4 83C 020302459A 03/26/2002 SANDOVAL, KOLE 09/18/2002 120.00 4 83C 020402648A 04/02/2002 SILVA, ROSE 09/18/2002 296.80 4 83C 020402737A 04/06/2002 HELM, MARTIN C 09/18/2002 1030.00 4 83C 020402747A 04/06/2002 WEBER, JENNIFER 09/18/2002 50.00 4 83C 020402768A 04/07/2002 TURNER, XAVIER R 09/18/2002 814.00 4 83C 020402976A 04/14/2002 MARTINEZ, PETER 09/18/2002 374.00 4 83C 020403061A 04/17/2002 CROISSANT, SARAH 09/18/2002 1006.00 4 83C 020403209A 04/23/2002 HOSMAN, ANGELA 09/18/2002 934 .00 4 83C 020403340A 04/28/2002 HARVEY, TERRY 09/18/2002 970.00 4 83C 020503699A 05/10/2002 RIOZ, DOMINIK 09/18/2002 908.00 4 83C 020503746B 05/12/2002 CLARKSON, JACOB 09/18/2002 840.00 4 83C 020604399A 06/07/2002 MARTINEZ, ELDER J 09/18/2002 790.00 4 83C 020604422A 06/07/2002 JAIMES, IGNACIO CARD 09/18/2002 764.00 4 83C 0206045258 06/11/2002 OLDENBURG, PENNY L 09/18/2002 748.00 4 83C 020604859B 06/23/2002 PEREZ, EDGAR 09/18/2002 940.00 4 83C 020604887A 06/24/2002 QUEZADA, GREGORIO 09/18/2002 50.00 4 83C 020604944A 06/25/2002 CARNEY, ROBERT J 09/18/2002 724. 00 4 83C 020705322A 07/06/2002 STEfAT,L, DERRICK L 09/18/2002 886.00 4 83C 020806113B 08/03/2002 KINDRED, CASEY 09/18/2002 995.00 4 83C 020806685A 08/24/2002 WHITMORE, RICHARD Total of 80 WriteOff Entries Totaling 51013 .19 Dollars Average WriteOff: 637.66 Dollars ' Average Time:187 Days Date:09/19/2002 Weld County Paramedic Services Page: 3 Time:10 :11:33 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 09/18/2002 Thru 09/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 80 51013.19 637.66 187.26 • Date:10/19/2002 Weld County Paramedic Services Page: 1 Time:12 :07:13 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/17/2002 Thru 10/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/17/2002 175.00 4 83C 000604116A 06/05/2000 LANE, RONALD 10/17/2002 530.12 4 83C 010504217A 05/29/2001 FARLEY, ELSIE 10/17/2002 530.12 4 83C 010604346A 06/03/2001 FARLEY, ELSIE 10/17/2002 720.08 4 83C 010907587A 09/21/2001 KARICH, CLARA 10/17/2002 714 .00 4 83C 010907740A 09/26/2001 KARICH, CLARA 10/17/2002 764.00 4 83C 011008033A 10/07/2001 URBACH, JEFFREY L 10/17/2002 143 .20 4 83C 011008044A 10/07/2001 MARTINEZ, PAULETTE J 10/17/2002 719.00 4 83C 011108994A 11/09/2001 MORALES, ABRAHAM 10/17/2002 100.00 4 83C 011109000B 11/09/2001 SALAZAR, ISMAEL 10/17/2002 888.00 4 83C 011109030A 11/10/2001 HOWARD, NICHOLE S 10/17/2002 100.00 4 83C 011109102A 11/13/2001 ZWIEBEL, MARY 10/17/2002 100.00 4 83C 011109222A 11/17/2001 MASSER, AMY 10/17/2002 469.40 4 83C 011109246A 11/18/2001 RODRIGUEZ, MARIVEL 10/17/2002 641.00 4 83C 011109296A 11/20/2001 HATCH, CASEY 10/17/2002 79. 80 4 83C 011109520A 11/28/2001 DAVIS, ARMAND 10/17/2002 796.00 4 83C 011209772A 12/08/2001 MCCREA, CLINTON 10/17/2002 39.96 4 83C 011209780A 12/09/2001 PADILLA, PLACIDA 10/17/2002 770.08 4 83C 011210021A 12/18/2001 KARICH, CLARA 10/17/2002 834 .00 4 83C 020100007A 01/01/2002 RICKARD, KENNETH L 10/17/2002 268 .50 4 83C 020100029A 01/01/2002 ARAGON, ISAAC 10/17/2002 826 .00 4 83C 020100337A 01/10/2002 HEADLEE, LINDA 10/17/2002 471.77 4 83C 020100338A 01/10/2002 GANTZ, ANNA E 10/17/2002 814 .33 4 83C 020100361A 01/11/2002 KARICH, CLARA 10/17/2002 55 .00 4 83C 020100371A 01/11/2002 KARICH, CLARA 10/17/2002 382 .39 4 83C 020100511A 01/16/2002 CONBOY, CHANDA L 10/17/2002 342 .77 4 83C 020100521A 01/16/2002 CONBOY, CHANDA L 10/17/2002 276.60 4 83C 020100615A 01/20/2002 CALL, MARY 10/17/2002 814 .00 4 83C 020100721A 01/24/2002 MEJIA, BLANCA M 10/17/2002 50 .00 4 83C 020200963A 02/01/2002 WATSON, VERNON 10/17/2002 74 .44 4 83C 020201012A 02/03/2002 MALDONADO, JOSE 10/17/2002 850 .00 4 83C 020201051A 02/05/2002 HOWARD, BRET R 10/17/2002 781.33 4 83C 020201272A 02/12/2002 MANKEY, DAVID L 10/17/2002 764 .00 4 83C 020201296A 02/13/2002 SNYDER, LILLIAN L 10/17/2002 162 .80 4 83C 020201367B 02/16/2002 PRINA, ROBERT 10/17/2002 838.00 4 83C 020201415A 02/17/2002 ANDRADE, NIKKI 10/17/2002 120 .00 4 83C 020201618A 02/24/2002 LEBLANC, RICHARD 10/17/2002 95.00 4 83C 020201622A 02/24/2002 GONZALES, LORENA 10/17/2002 208.85 4 83C 020201623A 02/24/2002 LEBLANC, RICHARD 10/17/2002 25.00 4 83C 020201624A 02/24/2002 CONTRERAS, SERGIO 10/17/2002 724 .00 4 83C 020301866A 03/05/2002 DEVORA, ANTHONY 10/17/2002 94 .44 4 83C 020301872A 03/05/2002 IGLESIAS, ROSIE E 10/17/2002 268.88 4 83C 020301922A 03/07/2002 LARSON, VIOLET 10/17/2002 862 .00 4 83C 020301929A 03/07/2002 WOZNICK, SHANNON L 10/17/2002 898.00 4 83C 020301982A 03/08/2002 GARCIA, JASMINE 10/17/2002 942 .00 4 83C 020301987A 03/09/2002 GISH, DAN 10/17/2002 874 .00 4 83C 020302006A 03/09/2002 CAMACHO, MARKO 10/17/2002 774 .00 4 83C 020302007A 03/09/2002 FENNEY, RYAN 10/17/2002 1066.00 4 83C 020302049A 03/11/2002 KIMES, KEN 10/17/2002 764 .00 4 83C 020302063A 03/11/2002 GUERRERO, QUINTANA I Date:10/19/2002 Weld County Paramedic Services Page: 2 Time:12 :07:14 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/17/2002 Thru 10/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/17/2002 104 .36 4 83C 020302117A 03/13/2002 PAGE, GLADYS 10/17/2002 120 .00 4 83C 020302129A 03/13/2002 BARRERA, JOSE 10/17/2002 774 .00 4 83C 020302155A 03/14/2002 BISHOP, KARISSA 10/17/2002 950 .00 4 83C 020302170A 03/14/2002 HANSON, TAMMIE 10/17/2002 353 .60 4 B3C 020302176A 03/15/2002 MARTINEZ, MARISA 10/17/2002 74 .44 4 83C 020302194A 03/15/2002 HEBERLING, RICHARD 10/17/2002 874 .00 4 83C 020302200A 03/15/2002 VERGARA, ELISEO 10/17/2002 925.33 4 83C 020302222A 03/17/2002 FREDERICK, KAREN 10/17/2002 814 .00 4 83C 020302234A 03/17/2002 ALARCON, ALAN 10/17/2002 819.33 4 83C 020302321A 03/21/2002 BEJAR, JUAN 10/17/2002 1014 .00 4 83C 020302338A 03/22/2002 MARTINEZ, DAVID 10/17/2002 74 .44 4 83C 020302348A 03/22/2002 HEBERLING, RICHARD 10/17/2002 120 .00 4 83C 020302351A 03/22/2002 HERRERA, JOSE 10/17/2002 865.98 4 83C 020302354A 03/22/2002 ROCKENBAUGH, MARLYN 10/17/2002 972 .00 4 83C 020302396A 03/24/2002 WILKINSON, KIMBERLY 10/17/2002 74 .44 4 83C 020302399A 03/24/2002 ERICHSEN, BETTY 10/17/2002 103 .00 4 83C 020302412A 03/25/2002 MONTANEZ, FELISTA S 10/17/2002 764 .00 4 83C 020302440A 03/26/2002 GROVES, STEVEN 10/17/2002 826.00 4 83C 020302442A 03/26/2002 LANCKRIET, GREGORY 10/17/2002 25.00 4 83C 020302476A 03/27/2002 SANTORO, MICHAEL D 10/17/2002 25.00 4 83C 020302483A 03/27/2002 OLIVAS, MONICA 10/17/2002 874 .00 4 83C 020302501A 03/28/2002 HOPP, BONNIE ANN 10/17/2002 120.00 4 83C 020302575A 03/30/2002 MARTINEZ, SHIRLEY 10/17/2002 1042 .00 4 83C 020302586A 03/31/2002 CASTILLO, LEO 10/17/2002 896.00 4 83C 020302604A 03/31/2002 MONTES, ANNA M 10/17/2002 774 .00 4 83C 020402655A 04/03/2002 CONTRERAS, ERIN 10/17/2002 846.00 4 83C 020402711A 04/05/2002 RADLER, BRIAN MICHAE 10/17/2002 810 .00 4 83C 020402719A 04/05/2002 LOSTROH, CONNIE 10/17/2002 784 .00 4 83C 020402721A 04/06/2002 TATRO, NATHAN E 10/17/2002 1044 .00 4 83C 020402758A 04/07/2002 REYES, JOSE A 10/17/2002 50 .00 4 83C 020402774B 04/07/2002 ZAVALA, MIGUEL 10/17/2002 854 .00 4 83C 020402776A 04/07/2002 TORREZ, NICHOLAS M 10/17/2002 886.00 4 83C 020402792A 04/08/2002 GONZALEZ, ALMAROSA 10/17/2002 774 .00 4 83C 020402831A 04/10/2002 LOZANO, SALVADOR 10/17/2002 774 .00 4 83C 020402891A 04/12/2002 ROMERO, ANGELICA 10/17/2002 874 .00 4 83C 020402906A 04/12/2002 HEBERLING, ROBERT 10/17/2002 1006.00 4 83C 020402955A 04/14/2002 MARTINEZ, LAURA 10/17/2002 120 .00 4 83C 020402994A 04/15/2002 SHUMATE, TANYA 10/17/2002 120 .00 4 83C 020403054A 04/17/2002 REYNOLDS, ERIC 10/17/2002 1044 .00 4 83C 020403103A 04/19/2002 PENDRY, ROBERT BRUCE 10/17/2002 874 .00 4 83C 020403127A 04/20/2002 RODRIQUEZ, MATTHEW 10/17/2002 120 .00 4 83C 020403165A 04/22/2002 ESPINO, JOSEPHINA 10/17/2002 879.33 4 83C 020403204A 04/23/2002 GOMEZ, DIANE CATHERI 10/17/2002 954 .00 4 83C 020403293A 04/26/2002 ATANIZ, ROBERT M 10 �' 7 �2O02 814 .00 4 83C 020403298➢ 04/27/2002 CERVANTES, MARLENE 10/17/2002 850 .00 4 83C 020403314A 04/27/2002 SMITH, ASHLEY 10/17/2002 18 .00 4 83C 020403359A 04/29/2002 LEBLANC, RICHARD 10/17/2002 120 .00 4 83C 020503470A 05/02/2002 ROMERO, ANGELICA 10/17/2002 1050 .00 4 83C 020503744A 05/12/2002 LOPEZ, BENJAMIN Date:10/,19/2002 Weld County Paramedic Services Page: 3 Time:12 :07:15 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/17/2002 Thru 10/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/17/2002 886.00 4 83C 020504069A 05/25/2002 LANCKRIET, GREGORY 10/17/2002 814 .00 4 83C 020504150A 05/28/2002 KNIGHT, ROBERT 10/17/2002 826.00 4 83C 020604232A 06/01/2002 HAYES, MICHAEL 10/17/2002 1042 .00 4 83C 020604426A 06/08/2002 MCCADE, CHARLES 10/17/2002 982 .00 4 83C 020604465A 06/09/2002 RUIZ RAMOS, JOSE RAM 10/17/2002 1026.00 4 83C 020604555A 06/12/2002 JOHNSON, BRADLEY 10/17/2002 88.30 4 83C 020604710A 06/18/2002 FORTUNE, GREG 10/17/2002 942 .00 4 83C 020604866A 06/23/2002 VARGAS, JUAN 10/17/2002 934 .00 4 83C 020705253A 07/05/2002 GONZALEZ, EDUARDO 10/17/2002 724 .00 4 83C 020705345A 07/07/2002 WAGNER, BENJAMIN 10/17/2002 946.00 4 83C 020705522A 07/13/2002 LOPEZ-HERNANDEZ, GRE 10/17/2002 120.00 4 83C 020705655A 07/18/2002 CISNEROS, MIGUEL ANG 10/17/2002 814 .00 4 83C 020705727A 07/21/2002 FULLER, BONNIE 10/17/2002 814 .00 4 83C 020705848A 07/26/2002 FITZLER, JOHN 10/17/2002 120.00 4 83C 020705871A 07/26/2002 BROWNELL, CHARLA 10/17/2002 120.00 4 83C 020705886A 07/27/2002 FERRELL, MICHAEL 10/17/2002 784 .00 4 83C 020706013A 07/31/2002 PORTER, DALE 0 10/17/2002 120.00 4 83C 020806186A 08/06/2002 HERNANDEZ, JOSE 10/17/2002 814 .00 4 83C 020806293A 08/10/2002 CHAMORRO, FRANCISCO 10/17/2002 834 .00 4 83C 020806328A 08/11/2002 SOTANO, JOSHUA LEE I 10/17/2002 73 .59 4 83C 020806332A 08/11/2002 PADILLA, PLACIDA 10/17/2002 1140.00 4 83C 020806365A 08/12/2002 ELKINS, MICHAEL 10/17/2002 1220 .00 4 83C 020806387A 08/13/2002 STOLTZ, FREEDONIA 10/17/2002 915.00 4 83C 020806400C 08/13/2002 GONZALES, ANDRES 10/17/2002 1175.00 4 83C 020806401A 08/13/2002 GONZALES, JUANA 10/17/2002 980 .00 4 83C 020806431A 08/15/2002 SIERRA, TERRANCE 10/17/2002 1055.00 4 83C 020806452A 08/15/2002 NOMBRANO, LOUIE 10/17/2002 1145.00 4 83C 020806473A 08/16/2002 MAYLE, JOHN M 10/17/2002 150 .00 4 83C 020806489A 08/17/2002 GARZA, MELISSA 10/17/2002 150 .00 4 83C 020806512A 08/17/2002 BAUTISTA-GONZALES, J 10/17/2002 930 .00 4 83C 020806561A 08/19/2002 COTA, RAFAEL 10/17/2002 870 .00 4 83C 020806563A 08/19/2002 BOWLES, BRIAN J 10/17/2002 1170.00 4 83C 020806574A 08/20/2002 GONZALES, ANTHONY 10/17/2002 1070 .00 4 83C 020806619A 08/22/2002 RICHARDSON, ANGIE 10/17/2002 1200 .00 4 83C 020806625A 08/22/2002 MARIN, SHELLY 10/17/2002 1130.00 4 83C 020806849A 08/29/2002 RIVERA, DAVID 10/17/2002 870.00 4 83C 020806853A 08/29/2002 HILEMAN JR, THOMAS 10/17/2002 935.00 4 83C 020907143A 09/07/2002 WHITMORE, RICHARD 10/17/2002 1010.00 4 83C 020907260A 09/11/2002 FINN, THOMAS 10/17/2002 885.00 4 83C 020907338A 09/14/2002 SCHOOLER, ROBERT 10/17/2002 924.00 4 83C 020907541A 09/22/2002 ORTEGA, JOSE 10/17/2002 69.69 4 82 990604766A 06/29/1999 POUND, DON 10/18/2002 72 .40 4 83C 020201386A 02/16/2002 RAMIREZ, ROBERT 10/18/2002 886.00 4 83C 020403379A 04/29/2002 SCHELL, ADAM R 10/18/2002 120.00 4 83C 020503443A 05/02/2002 HEIMN2\NN, DAVID 10/18/2002 120.00 4 83C 020503454A 05/02/2002 VALDEZ, GABRIELLE 10/18/2002 93 .55 4 83C 020503458A 05/02/2002 SILVA, LUCIO 10/18/2002 764 .00 4 83C 020503460A 05/02/2002 SELLERS, AUSTIN 10/18/2002 914 .00 4 83C 020503469A 05/02/2002 MACENTEE, MICHAEL • Date:10/19/2002 Weld County Paramedic Services Page: 4 Time:12 :07:17 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/17/2002 Thru 10/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/18/2002 724.00 4 83C 020503740A 05/12/2002 BACA, BRIDGETT M 10/18/2002 120.00 4 83C 020503762A 05/13/2002 MARTINEZ, THERESA 10/18/2002 120.00 4 83C 020503859A 05/18/2002 HELZER, BRYAN 10/18/2002 944.00 4 83C 020504122A 05/27/2002 LABELLE, PATRICK 10/18/2002 120.00 4 83C 020604242A 06/01/2002 SODERSTROM, LARRY 10/18/2002 120.00 4 83C 020604265A 06/02/2002 MAZURO, LESTER 10/18/2002 898.00 4 83C 020604387A 06/06/2002 REYES TORRES, MARGAR 10/18/2002 117.62 4 83C 020604389A 06/07/2002 BERKHOLDER, JOHN C 10/18/2002 834 .00 4 83C 020604417A 06/07/2002 LABELLE, PATRICK 10/18/2002 874 .00 4 83C 020604425A 06/08/2002 SMITH, WILLIAM J 10/18/2002 898.00 4 83C 020604451A 06/08/2002 SIERRA, MANUEL 10/18/2002 724 .00 4 83C 020604638A 06/15/2002 MONDRAGON, MICHELLE 10/18/2002 77 . 84 4 83C 020604714A 06/18/2002 SALGADO, ADELINA 10/18/2002 814 .00 4 83C 020604784A 06/21/2002 CARROLL, CHRISTOPHER 10/18/2002 886 .00 4 83C 020604875A 06/23/2002 SANCHEZ, CINDY 10/18/2002 966 .00 4 83C 020604882A 06/23/2002 SOSA, MIGUEL 10/18/2002 906 .00 4 83C 020604891A 06/24/2002 HERRERA, JUAN M 10/18/2002 774.00 4 83C 020604987A 06/27/2002 CARROLL, CHRISTOPHER 10/18/2002 161.20 4 82 020604995A 06/27/2002 TEAGUE, STEPHANIE 10/18/2002 724.00 4 83C 020605093A 06/30/2002 VILLELA NEVAREZ, JES 10/18/2002 64.88 4 83C 020705215A 07/03/2002 AUSTIN, KIRK 10/18/2002 736.00 4 83C 020705219A 07/03/2002 HOUSTON, POLICA J 10/18/2002 838.00 4 83C 020705241A 07/04/2002 KINDSFATHER, HOWARD 10/18/2002 832 .00 4 83C 020705243A 07/04/2002 AVILA, REGINA 10/18/2002 120 .00 4 83C 020705293A 07/06/2002 GONZALES, JASON 10/18/2002 120 .00 4 83C 020705297A 07/06/2002 GUERRERO, ABEL 10/18/2002 120 .00 4 83C 020705298A 07/06/2002 LOZANO, ADRIAN 10/18/2002 946 .00 4 83C 020705357A 07/07/2002 GREEN, RICHARD 10/18/2002 864 .00 4 83C 020705393A 07/08/2002 ESQUIVEL, FERNANDO 10/18/2002 866 .00 4 83C 020705393B 07/08/2002 LEDESMA, ELIZABETH 10/18/2002 916.00 4 83C 020705393C 07/08/2002 VARGAS, VERONICA 10/18/2002 834.00 4 83C 020705437A 07/10/2002 LYONS, RICHARD C 10/18/2002 64 .88 4 82 020705468A 07/11/2002 SCHINDLER, MARTIN 10/18/2002 936.00 4 83C 020705480A 07/12/2002 HERNANDEZ DE JESUS, 10/18/2002 934 .00 4 83C 020705481A 07/12/2002 HERNANDEZ, MARIO 10/18/2002 724 .00 4 83C 020705544A 07/14/2002 FLECHENSTEIN, DEAN 10/18/2002 814 .00 4 83C 020705547A 07/14/2002 RODRIGUEZ, JOSE *S 10/18/2002 894 .00 4 83C 020705566A 07/14/2002 GALLARDO, OMAR 10/18/2002 998 .00 4 83C 020705605A 07/16/2002 WRIGHT, KRISTINE 10/18/2002 874 .00 4 83C 020705623A 07/16/2002 COLEMAN, ROBERT 10/18/2002 1080 .00 4 83C 020705624A 07/17/2002 SALAS, CESAR ANTONIO 10/18/2002 120.00 4 83C 020705645A 07/18/2002 GAVIN, LEWIS E 10/18/2002 1102 .00 4 83C 020705687A 07/19/2002 RODRIGUEZ, OSCAR 10/18/2002 120.00 4 83C 020705719B 07/21/2002 WALKER, MIKE 10/18/2002 724 .00 4 83C 020705745A 07/21/2002 HERNANDEZ, JAMES 10/18/2002 814 .00 4 83C 020705820A 07/25/2002 WILLIAMS, EDWARD 10/18/2002 120 .00 4 83C 020705947A 07/29/2002 AUSTIN, KIRK 10/18/2002 814 .00 4 83C 020705959A 07/29/2002 CISNEROS, AURELIO 10/18/2002 874 .00 4 83C 020705966A 07/29/2002 MARTINEZ, CHRIS • Date:10/19/2002 Weld County Paramedic Services Page: 5 Time:12 :07:18 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/17/2002 Thru 10/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/18/2002 814 .00 4 83C 020705967A 07/29/2002 LYONS, RICHARD C 10/18/2002 936.00 4 83C 020806092A 08/02/2002 WHITESHIRT, GUY 10/18/2002 50.00 4 83C 020806120A 08/03/2002 MORREL, JESUS 10/18/2002 982.00 4 83C 020806140B 08/04/2002 ROWSEY, CURTIS H 10/18/2002 774 .00 4 83C 020806174A 08/05/2002 HAWKER, AMY 10/18/2002 786.00 4 83C 020806175A 08/05/2002 GAVEL, JO 10/18/2002 120 .00 4 REV 020806184A 08/06/2002 BROWN, TYLER 10/18/2002 928 .03 4 82 020806433A 08/15/2002 BACA, DIANA 10/18/2002 618.56 4 81 020806723A 08/25/2002 KING, DIXIE 10/18/2002 950.67 4 81 020806855A 08/29/2002 TUCKER, EMILY 10/18/2002 675.88 4 81 020906999A 09/03/2002 FELKER, CHARLES 10/18/2002 609.83 4 81 020907219A 09/10/2002 BAARS, JOAN K 10/18/2002 618.64 4 81 020907377A 09/16/2002 WHEELER, EUGENE 10/18/2002 623.40 4 81 020907380A 09/16/2002 WINDER, MOLLIE 10/18/2002 770.46 4 81 020907390A 09/16/2002 BACHAND, GEDEON 10/18/2002 618.56 4 81 020907410A 09/17/2002 PADILLA, PLACIDA 10/18/2002 583 .37 4 81 020907415A 09/17/2002 WEBECK, IRENE 10/18/2002 605.07 4 81 020907428A 09/18/2002 ALDRIDGE, WILLIAM W 10/18/2002 624 .68 4 81 020907429A 09/18/2002 MILLER, MARION 10/18/2002 642.30 4 81 020907455A 09/19/2002 VIALPANDO, TOBIAS EL 10/18/2002 624.68 4 81 020907457A 09/19/2002 SCOFIELD, FLOY L 10/18/2002 641.02 4 81 020907465A 09/19/2002 SANCHEZ, JENNIE 10/18/2002 640 .26 4 81 020907480A 09/20/2002 BETZ, LEO 10/18/2002 609.83 4 81 020907485A 09/20/2002 BROUGHTON, DENA 10/18/2002 623 .40 4 81 020907499A 09/20/2002 STROH, ALBERT H 10/18/2002 629.41 4 81 020907506A 09/20/2002 MOLINA, ALEJOS 10/18/2002 666.63 4 81 020907543A 09/22/2002 ELLSWORTH, FLORENCE 10/18/2002 620.60 4 81 020907546A 09/22/2002 STOLTZ, IRENE 10/18/2002 730 .50 4 81 020907551A 09/22/2002 FINNERTY, THERESE 10/18/2002 718 .25 4 81 020907586A 09/24/2002 NELSON, FERN 10/18/2002 651.87 4 81 020907598A 09/24/2002 GOSSETT, LOUISE 10/18/2002 670.61 4 81 020907606A 09/24/2002 ROHN, BONNIE 10/18/2002 708.90 4 81 020907610A 09/24/2002 ESPINOSA, ANDREA 10/18/2002 628.73 4 81 020907620A 09/25/2002 ELLSWORTH, FLORENCE 10/18/2002 194 .57 4 81 020907624A 09/25/2002 WERNER, MOLLIE 10/18/2002 639.58 4 81 020907628A 09/25/2002 PEIF, JOYE 10/18/2002 639.58 4 81 020907629A 09/25/2002 KAISER, LORETTA E 10/18/2002 596.94 4 81 020907646A 09/26/2002 BUSHER, DARLENE 10/18/2002 759.61 4 81 020907654A 09/26/2002 BENSON, ALDEEN 10/18/2002 664 .00 4 81 020907663A 09/26/2002 NELSON, LYLE 10/18/2002 618.56 4 81 020907677A 09/26/2002 BRUNMEIER, HAZEL R 10/18/2002 627.45 4 81 020907681A 09/27/2002 FRANK, JUDY 10/18/2002 611.11 4 81 020907714A 09/28/2002 STEINBERG, NORMA G 10/18/2002 614 .56 4 81 020907721A 09/28/2002 WALTERS, DORIS 10/16/2002 707 .40 4 81 none07722A 09/28/2002 BENAVIDEZ, JR, LUCIO 10/18/2002 618 .56 4 81 020907725A 09/28/2002 QUINTANA, AMY 10/18/2002 623 .40 4 81 020907748A 09/29/2002 STEELE, MARCELLA L 10/18/2002 624 .68 4 81 020907752A 09/29/2002 KAISER, HILDA 10/18/2002 210 .18 4 81 020907755A 09/29/2002 SUCCO, RENA F Date:10/19/2002 Weld County Paramedic Services Page: 6 Time:12 :07:19 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/17/2002 Thru 10/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/18/2002 00001A 2382181 AMB 759.61 4 81 020907758A 09/29/2002 BROCK, LOUISE Total of 246 WriteOff Entries Totaling 153505.99 Dollars Average WriteOff: 624.01 Dollars Average Time:151 Days • Date:10/19/2002 Weld County Paramedic Services Page: 7 Time:12 :07:19 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/17/2002 Thru 10/18/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days s 83C WRITEOFF TO COLLECTION AG 199 125546.29 630.89 173 .26 82 MEDICAID WRITEOFF 4 1223 .80 305.95 370.50 REV REVERSE CHARGED IN ERROR 1 120 .00 120 .00 73 .00 81 MEDICARE WRITEOFF 42 26615 . 90 633.71 27 .02 Date:11/18/2002 Weld County Paramedic Services Page: 1 Time:17 :02 :14 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/15/2002 Thru 11/15/2002 . Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/15/2002 185.00 4 83C 000604195A 06/08/2000 HEDGER, ROBERT 11/15/2002 150.00 4 83C 010705831A 07/25/2001 JOHNSON, DORIS E 11/15/2002 771.00 4 83C 011008139A 10/11/2001 MARQUEZ, ROBERT 11/15/2002 389.00 4 83C 011008144A 10/11/2001 MARQUEZ, ROBERT 11/15/2002 349.00 4 83C 011109037A 11/10/2001 SUTTON, ANITA L 11/15/2002 776.00 4 83C 011109038A 11/10/2001 RODOLLA, SARAGOSHA 11/15/2002 716 .00 4 83C 011209887A 12/13/2001 IRELAND, MILDRED 11/15/2002 696.17 4 83C 020100107A 01/04/2002 KRUSE, DANIEL 11/15/2002 843 .53 4 83C 020100204A 01/07/2002 JEFFRES, EDGAR 11/15/2002 57.54 4 82 020100409A 01/13/2002 MOCK, HENRY E 11/15/2002 831 .33 4 83C 020100547A 01/18/2002 MEADS, GEORGE 11/15/2002 63 .43 4 82 020100688A 01/23/2002 HESS, DAVID 11/15/2002 20.00 4 83C 020100750A 01/25/2002 JONES, GERALD ANTHON 11/15/2002 100 .00 4 83C 020201378A 02/16/2002 RANK, JOE 11/15/2002 819.33 4 83C 020201387A 02/16/2002 RUBENSTIEN, MARVIN 11/15/2002 211.00 4 83C 020201388A 02/17/2002 RODGERS, MARGARET 11/15/2002 120.00 4 83C 020201398A 02/17/2002 PACHECO, MICHELLE 11/15/2002 75 .00 4 83C 020201467A 02/19/2002 KOEHLER, TIMOTHY R 11/15/2002 134 .80 4 83C 020201534A 02/21/2002 PULLIAM, DEBRA 11/15/2002 340.34 4 83C 020301929B 03/07/2002 MILLER, BRITTANY 11/15/2002 645.90 4 83C 020301993A 03/09/2002 STASIEFSKI, BARRY 11/15/2002 1260.00 4 83C 020302244A 03/17/2002 LOPEZ, RAMON GUERRA 11/15/2002 838.00 4 83C 020302253A 03/18/2002 MUNRO, RUTH 11/15/2002 300.00 4 83C 020302373A 03/23/2002 WIETING, JOHN L 11/15/2002 764 .00 4 83C 020302421A 03/25/2002 HEIMAN, ANN 11/15/2002 120.00 4 83C 020302508A 03/28/2002 GOODEW, ABBIE 11/15/2002 975.33 4 83C 020302592A 03/31/2002 HEINZE, RUTH 11/15/2002 819.56 4 83C 020302611A 03/31/2002 OSBORNE, DELORES M 11/15/2002 886 .00 4 83C 020302612A 03/31/2002 GOODE, JAMES 11/15/2002 85.48 4 83C 020402615A 04/01/2002 SOLIS, DANIEL J 11/15/2002 815.33 4 83C 020402630A 04/01/2002 SCHULTZ, LOIS 11/15/2002 374 .00 4 83C 020402673A 04/04/2002 ZAMORA, SAMANTHA 11/15/2002 83 .32 4 83C 020402683A 04/04/2002 HEINZE, RUTH 11/15/2002 836.00 4 83C 020402708A 04/05/2002 TERVO, THOMAS DUANE 11/15/2002 926 .00 4 83C 020402773A 04/07/2002 LAWSON, STEVEN W 11/15/2002 120.00 4 83C 020402787A 04/08/2002 GONZALEZ, DANEY 11/15/2002 120 .00 4 83C 020402801A 04/08/2002 YBARRA, ELIAS 11/15/2002 910 .00 4 83C 020402886A 04/12/2002 NORMAND, PATTI J 11/15/2002 120.00 4 83C 020403047A 04/17/2002 GRIEGO, ERNEST J 11/15/2002 764 .00 4 83C 020403055A 04/17/2002 GUZMAN, PAULA K 11/15/2002 1066 .00 4 83C 020403084A 04/18/2002 TIGER, LARRY 11/15/2002 120.00 4 83C 020403089A 04/19/2002 URESTE, RICK 11/15/2002 774 .00 4 83C 020403104A 04/19/2002 POOLE, DEB 11/15/2002 73 .36 4 83C 020403144A 04/21/2002 SANZO, FAITH G 11/15/2002 73 .36 4 83C 020403166A 04/22/2002 GEIGER, AGNES 11/15/2002 120.00 4 83C 020403227A 04/24/2002 PEREZ, JAY 11/15/2002 822 .00 4 83C 020403236A 04/25/2002 JARAMILLO, JOSE ANDR 11/15/2002 724 .00 4 83C 020403238A 04/25/2002 VELAZCO, JOEL JR 11/15/2002 946.00 4 83C 020403240A 04/25/2002 GONZALES, TYRIE Date:ll/18/2002 Weld County Paramedic Services Page: 2 Time:17:02:15 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/15/2002 Thru 11/15/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/15/2002 849.00 4 83C 020403247A 04/25/2002 RETTELE, SUE ANN 11/15/2002 894.00 4 83C 020403256A 04/25/2002 RINGO, BRUCE M 11/15/2002 814.00 4 83C 020403294A 04/26/2002 MIRANDA, BEATRICE 11/15/2002 814.00 4 83C 020403319A 04/27/2002 STOOS, TONYA 11/15/2002 970.00 4 83C 020403329A 04/27/2002 GARZA-HOLGUIN, ESTHE 11/15/2002 120 .00 4 83C 020403357A 04/28/2002 CLARK, DARLENE 11/15/2002 994.00 4 83C 020403376A 04/29/2002 REICHEL, JOSHUA R 11/15/2002 894.00 4 83C 020403390A 04/30/2002 OLIVAS, SOCORRO 11/15/2002 898.00 4 83C 020403442A 05/02/2002 REGALADO, STEVE 11/15/2002 724 .00 4 83C 020503025A 05/08/2002 DAUBER, DOUGLAS 11/15/2002 838.00 4 83C 020503409A 05/01/2002 DIXON, JEFFERY G 11/15/2002 120.00 4 83C 020503420A 05/01/2002 MAAS, GLORIA A 11/15/2002 414 .00 4 83C 020503423A 05/01/2002 ESQUIVEL, GEORGINE A 11/15/2002 414 .00 4 83C 020503427A 05/01/2002 ESQUIVEL, GEORGINE A 11/15/2002 982 .00 4 83C 020503431A 05/01/2002 WEBER, JENNIFER 11/15/2002 25.00 4 83C 020503464A 05/02/2002 RAMIREZ, LYNDA 11/15/2002 906.00 4 83C 020503467A 05/02/2002 SOTO, MARISOL 11/15/2002 874 .00 4 83C 020503471A 05/03/2002 ARCHULETA, DESIREE 11/15/2002 736.00 4 83C 020503472A 05/03/2002 MONTOYA, MARILYN 11/15/2002 736 .00 4 83C 020503480A 05/03/2002 BERG, GERALD 11/15/2002 1050.00 4 83C 020503486A 05/03/2002 BERNHOFT, DEBRA 11/15/2002 874 .00 4 83C 020503487A 05/03/2002 RANGEL, PHILLIP 11/15/2002 896.00 4 83C 020503498A 05/03/2002 ADAMS, JENNI 11/15/2002 834.00 4 83C 020503500A 05/03/2002 WALTER, ROBERT D 11/15/2002 814.00 4 83C 020503534A 05/05/2002 ANDERSON, WILLIAM A 11/15/2002 894 .00 4 83C 020503561A 05/06/2002 VAN WINKLE, CURTIS 11/15/2002 120 .00 4 83C 020503632A 05/08/2002 MEYERS, LALANIA 11/15/2002 886.00 4 83C 020503636A 05/08/2002 BONNER, BRENT 11/15/2002 120.00 4 83C 020503637A 05/08/2002 DORSEY, MELISSA 11/15/2002 120.00 4 83C - 020503694A 05/10/2002 DAVIS, DAN 11/15/2002 994.00 4 83C 020503704A 05/11/2002 VILLANUEVA, JACKIE Y 11/15/2002 120.00 4 83C 020503704B 05/11/2002 ANDERSON, MIKE 11/15/2002 1162 .00 4 83C 020503721A 05/11/2002 VAZQUEZ, EDUARDO 11/15/2002 826.00 4 83C 020503722A 05/11/2002 KORCH, KHAILA M 11/15/2002 886.00 4 83C 020503725A 05/11/2002 SALAZAR, JESUS 11/15/2002 874.00 4 83C 020503733A 05/12/2002 RODRIGUEZ, KIMBERLY 11/15/2002 814 .00 4 83C 020503742B 05/12/2002 HERNANDEZ, BEATRICE 11/15/2002 814 .00 4 83C 020503742C 05/12/2002 GARCIA, MARIANNE 11/15/2002 774 .00 4 83C 020503743A 05/12/2002 GRIEGO, JAYNE B 11/15/2002 120 .00 4 83C 020503745A 05/12/2002 HOBBS, RICK 11/15/2002 27.60 4 83C 020503751A 05/13/2002 TRUJILLO, JESSICA L 11/15/2002 120.00 4 83C 020503761A 05/13/2002 KENETT, CHRIS 11/15/2002 120 .00 4 83C 020503774A 05/13/2002 ONTIVEROS, HANAH 11/15/2002 974 .00 4 83C 020503787A 05/14/2002 FRIAS, CHRISTELLA A 11/15/2002 846.00 4 83C 020503805A 05/15/2002 SALAMANCA, ANTHONY M 11/15/2002 832 .00 4 83C 020503820A 05/15/2002 BRAMBLETT, ANDREW J 11/15/2002 120 .00 4 83C 020503828A 05/16/2002 TIERNEY, PATRICIA 11/15/2002 874.00 4 83C 020503873A 05/18/2002 ROGERS, KAREN 11/15/2002 1042.00 4 83C 020503882A 05/18/2002 RUBY, MICHAEL A Date:11/18/2002 Weld County Paramedic Services Page: 3 Time:17:02 :16 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/15/2002 Thru 11/15/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/15/2002 874.00 4 83C 020503899A 05/19/2002 MARTINEZ, LEO 11/15/2002 904 .00 4 83C 020503906B 05/19/2002 PALACIO, ANA 11/15/2002 748.00 4 83C 020503942A 05/21/2002 VASQUEZ, AMANDA S 11/15/2002 814.00 4 83C 020503945A 05/21/2002 CASTRO, ERNESTO 11/15/2002 910.00 4 83C 020503954A 05/21/2002 FALK, DEBORAH 11/15/2002 836.00 4 83C 020503955A 05/21/2002 SCHAFFER, SHURRI 11/15/2002 900 .00 4 83C 020503962A 05/21/2002 FELIX, LOUIS 11/15/2002 808.00 4 83C 020503964A 05/22/2002 FELIX, LINA M 11/15/2002 73 .36 4 83C 020503971A 05/22/2002 KELM, JACK 11/15/2002 866.00 4 83C 020503987C 05/22/2002 MULLEK, AUDREY 11/15/2002 120 .00 4 83C 020504003A 05/23/2002 MELENDEZ, SUSANA 11/15/2002 954.00 4 83C 020504016B 05/23/2002 BETANCOURT, FRANK 11/15/2002 764.00 4 83C 020504017A 05/23/2002 SCHAFFER, SHURRI 11/15/2002 1012 .00 4 83C 020504025A 05/24/2002 QUIROZ, HORNELA 11/15/2002 120.00 4 83C 020504030A 05/24/2002 YAMADA, DAWN 11/15/2002 874.00 4 83C 020504037A 05/24/2002 JENSEN, VANESSA 11/15/2002 1018.00 4 83C 020504048A 05/24/2002 MASSEY, JEREMY 11/15/2002 814.00 4 83C 020504053A 05/25/2002 GUTIERREZ, ERICA 11/15/2002 776.00 4 83C 020504072A 05/25/2002 RAMIREZ, PETRA 11/15/2002 886.00 4 83C 020504074A 05/25/2002 CHAVEZ, REUBEN M 11/15/2002 994.00 4 83C 020504075A 05/25/2002 HUTSON, KENNETH 11/15/2002 1006.00 4 83C 020504076A 05/26/2002 CHAMPNEY, DAVID W 11/15/2002 824 .00 4 83C 020504084A 05/26/2002 RIOS, AALIYAH FAITH 11/15/2002 814.00 4 83C 020504088A 05/26/2002 CONTRERAS, ANGEL 11/15/2002 814.00 4 83C 020504094A 05/26/2002 THOMPSON, RYAN 11/15/2002 740.00 4 83C 020504100A 05/27/2002 GLASS, CASANDRA 11/15/2002 996.00 4 83C 020504100B 05/27/2002 CRUZ, DEMETRIOUS 11/15/2002 550.00 4 83C 020504106A 05/27/2002 ROMERO, PHILLIP 11/15/2002 974.00 4 83C 020504116A 05/27/2002 SMITH, THOMAS DAVID 11/15/2002 - 864.00 4 83C 020504119A 05/27/2002 KORCH, CHRISTOPHER J 11/15/2002 120 .00 4 83C 020504124A 05/27/2002 NEFF, REANA 11/15/2002 724 .00 4 83C 020504138A 05/28/2002 GONZALEZ, ELENA 11/15/2002 896.00 4 83C 020504140A 05/28/2002 VALVERDE OLIVA, JOEL 11/15/2002 120.00 4 83C 020504163A 05/29/2002 BRIGHTBILL, HAILEE 11/15/2002 814 .00 4 83C 020504166A 05/30/2002 YOUNG, MARCIE 11/15/2002 874.00 4 83C 020504206B 05/31/2002 GONZALEZ, CHRISTOPHE 11/15/2002 874.00 4 83C 020504211A 05/31/2002 MARTINEZ, LEO 11/15/2002 724.00 4 83C 020604224A 06/01/2002 DOUGLAS, FELISHA 11/15/2002 826.00 4 83C 020604229A 06/01/2002 CARILLO GARCIA, DANI 11/15/2002 886.00 4 83C 020604246A 06/01/2002 RAMIREZ, MARICELA 11/15/2002 836.00 4 83C 020604263A 06/02/2002 MALLARD, ALYSSA 11/15/2002 798.00 4 83C 020604272A 06/02/2002 MARTINEZ, NEREIDA 11/15/2002 73 .36 4 83C 020604277A 06/03/2002 MADDOX, LORI M 11/15/2002 906.00 4 83C 020604282A 06/03/2002 HARMON, 'TIMOTHY D 11/15/2002 1006.00 4 83C 020604284A 06/03/2002 REYES, MARY ANN 11/15/2002 120.00 4 83C 020604302B 06/03/2002 MCLAUGHLIN, CHAD 11/15/2002 724.00 4 83C 020604318A 06/04/2002 DIAZ-CABALLERO, GREG 11/15/2002 764.00 4 83C 020604320A 06/04/2002 BENITEZ, MARIA 11/15/2002 1018.00 4 83C 020604328A 06/04/2002 GARMEN, ELLEN Date:ll/18/2002 Weld County Paramedic Services Page: 4 Time:17:02 :16 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/15/2002 Thru 11/15/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/15/2002 120.00 4 83C 020604336A 06/04/2002 HANSING, CHRIS 11/15/2002 814.00 4 83C 020604338A 06/04/2002 GARZA, LAURO 11/15/2002 800.00 4 83C 020604360A 06/05/2002 MASTIN, JUDY 11/15/2002 874 .00 4 83C 020604382A 06/06/2002 MORENO, FILIBERTO 11/15/2002 145.81 4 83C 020604383A 06/06/2002 GORE, DELBERT 11/15/2002 934 .00 4 83C 020604391A 06/07/2002 HERRERA, JESUS 11/15/2002 374 .00 4 83C 020604393A 06/07/2002 REYES TORRES, MARGAR 11/15/2002 120.00 4 83C 020604428B 06/08/2002 MYER, AARON I 11/15/2002 85.31 4 83C 020604438A 06/08/2002 WALTERS, CLARENCE 11/15/2002 900.00 4 83C 020604458A 06/09/2002 RODRIGUEZ, RUBIO 11/15/2002 120.00 4 83C 020604460A 06/09/2002 MARTINEZ, DAVID 11/15/2002 120 .00 4 83C 020604470A 06/09/2002 ROSSI, SHANNON 11/15/2002 1030.00 4 83C 020604518A 06/11/2002 MIRELES, JOE 11/15/2002 922.00 4 83C 020604521A 06/11/2002 BROOKS, DANIELLE 11/15/2002 73 .36 4 83C 020604538A 06/12/2002 KELM, JACK 11/15/2002 874.00 4 83C 020604547A 06/12/2002 PRICE, JAMES M 11/15/2002 60.81 4 82 020604548A 06/12/2002 MOLINA, ALEJOS 11/15/2002 120.00 4 83C 020604575A 06/13/2002 QUIROZ, JOSE 11/15/2002 120.00 4 83C 020604608A 06/14/2002 NAVAJO, ETHAN 11/15/2002 724 .00 4 83C 020604624A 06/15/2002 RASMUSSEN, CHRIS 11/15/2002 724.00 4 83C 020604654A 06/15/2002 ZAMARRIPA, VILSEN 11/15/2002 814.00 4 83C 020604672A 06/16/2002 RODRIGUEZ, MARTINA 11/15/2002 866.00 4 83C 020604676A 06/16/2002 MCNIERNEY, MICHAEL W 11/15/2002 874 .00 4 83C 020604689A 06/17/2002 STAMMER, DAVID 11/15/2002 764 .00 4 83C 020604709B 06/18/2002 REED, CANDACE 11/15/2002 120 .00 4 83C 020604715A 06/18/2002 OWNBY, PAMELA 11/15/2002 120.00 4 83C 020604720A 06/18/2002 MEYER, JERRY D 11/15/2002 844.00 4 83C 020604721A 06/18/2002 PEREZ, MANUEL CAMARE 11/15/2002 120.00 4 83C 020604724A 06/18/2002 MILLER, CANDICE 11/15/2002 986.00 4 83C 020604734A 06/19/2002 VALENCIANO, RUDY 11/15/2002 64.26 4 82 020604757A 06/20/2002 WILLIAMS, PEARL 11/15/2002 120.00 4 83C 020604809A 06/21/2002 SALAZAR, JEREMY 11/15/2002 736.00 4 83C 020604865A 06/23/2002 STONE, JUSTIN 11/15/2002 1054.00 4 83C 020604879A 06/23/2002 TREMBATH, TED 11/15/2002 374.00 4 83C 020604885A 06/23/2002 TREMBATH, TED 11/15/2002 846.00 4 83C 020604920A 06/24/2002 STANLEY, MEREDITH A 11/15/2002 946.00 4 83C 020604930A 06/25/2002 PADILLA, MAX 11/15/2002 774.00 4 83C 020604966A 06/26/2002 ORTEGA, CURTIS 11/15/2002 786.00 4 83C 020604973A 06/26/2002 PACHECO, MICHELLE 11/15/2002 120.00 4 83C 020605054A 06/29/2002 KELLY, BRANDON 11/15/2002 218.00 4 83C 020605092A 06/30/2002 HEATH, HARRY 11/15/2002 776.00 4 83C 020705358A 07/07/2002 GRINER, CRYSTAL 11/15/2002 1326.00 4 83C 020705362A 07/07/2002 THOMAS, KRISTEN 11/15/2002 966 .00 4 83C 020705440A 07/10/2002 PADILLA, MAX 11/15/2002 724.00 4 83C 020705490A 07/12/2002 MEYERS, LALANIA 11/15/2002 120.00 4 83C 020705822A 07/25/2002 ADAMS, JENNI 11/15/2002 620.30 4 81 020705939A 07/29/2002 BROOKS, MILDRED 11/15/2002 764 .00 4 83C 020705946A 07/29/2002 TIERNEY, PATRICIA 11/15/2002 120.00 4 83C 020806205A 08/07/2002 ROBINSON, CHARLES Date:11/18/2002 Weld County Paramedic Services Page: 5 Time:17:02:17 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/15/2002 Thru 11/15/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/15/2002 874 .00 4 83C 020806284A 08/09/2002 ANDERSON, VONDA 11/15/2002 48.85 4 82 020806366A 08/12/2002 DEASON, ROSAMUND MAR 11/15/2002 1715 .00 4 83C 020806808B 08/27/2002 DERR, MICHELLE **see 11/15/2002 1055.00 4 83C 020806835A 08/28/2002 MCNIERNEY, MICHAEL W 11/15/2002 958.03 4 82 020907025A 09/04/2002 MOTIS, ANDREW M 11/15/2002 51.60 4 82 020907061A 09/05/2002 PERLENFEIN, CAROL 11/15/2002 57.33 4 82 020907167A 09/08/2002 JACOBO, CELERINA 11/15/2002 65.11 4 82 020907223A 09/10/2002 PACHECO, BERTHA E 11/15/2002 1295.00 4 83C 020907228A 09/10/2002 PADILLA, MAX 11/15/2002 69.86 4 82 020907240A 09/10/2002 BENAVIDEZ, JR, LUCIO 11/15/2002 74.74 4 82 020907264A 09/12/2002 JARAMILLO, JUANITA 11/15/2002 59.32 4 82 020907380A 09/16/2002 WINDER, MOLLIE 11/15/2002 65.71 4 82 020907395A 09/16/2002 MOLINA, ALEJOS 11/15/2002 58.99 4 82 020907428A 09/18/2002 ALDRIDGE, WILLIAM W 11/15/2002 ' 60.13 4 82 020907455A 09/19/2002 VIALPANDO, TOBIAS EL 11/15/2002 59.32 4 82 020907465A 09/19/2002 SANCHEZ, JENNIE 11/15/2002 66.54 4 82 020907480A 09/20/2002 BETZ, LEO 11/15/2002 65.71 4 82 020907506A 09/20/2002 MOLINA, ALEJOS 11/15/2002 73 .82 4 82 020907545A 09/22/2002 EICHORN, ANNA 11/15/2002 65.11 4 82 020907559A 09/22/2002 DILLARD, VERA FERN 11/15/2002 66.54 4 82 020907572A 09/23/2002 HERRERA, STELLA 11/15/2002 60 .15 4 82 020907598A 09/24/2002 GOSSETT, LOUISE 11/15/2002 72.75 4 82 020907610A 09/24/2002 ESPINOSA, ANDREA 11/15/2002 54.09 4 82 020907624A 09/25/2002 WERNER, MOLLIE 11/15/2002 63 .68 4 82 020907628A 09/25/2002 PEIF, JOYE 11/15/2002 65.42 4 82 020907636A 09/25/2002 DILLARD, VERA FERN 11/15/2002 60 .13 4 82 020907657A 09/26/2002 DOUGHTY, VIOLET L 11/15/2002 72 .25 4 82 020907686A 09/27/2002 PACHECO, ANGELINA 11/15/2002 103.18 4 82 020907714A 09/28/2002 STEINBERG, NORMA G 11/15/2002 65.11 4 82 020907722A 09/28/2002 BENAVIDEZ, JR, LUCIO 11/15/2002 59.32 4 82 020907748A 09/29/2002 STEELE, MARCELLA L 11/15/2002 64.88 4 82 021007799A 10/01/2002 TARRANT, MARY ANN 11/15/2002 53 .26 4 82 021007806A 10/01/2002 TARRANT, MARY ANN 11/15/2002 59.32 4 82 021007841A 10/03/2002 WINDER, MOLLIE 11/15/2002 60.96 4 82 021007884A 10/04/2002 VIALPANDO, TOBIAS EL 11/15/2002 630 . 94 4 81 021007895A 10/05/2002 KING, TINA E 11/15/2002 854.20 4 81 021007914A 10/05/2002 POWELL, JUNE 11/15/2002 657.75 4 81 021007949A 10/06/2002 DEUTCHER, JUANITA G 11/15/2002 958.23 4 82 021007983A 10/07/2002 SANCHEZ, ROBERTO 11/15/2002 857.58 4 82 021007989A 10/08/2002 MCEWEN, KAREN 11/15/2002 97.74 4 82 021007992A 10/08/2002 MCEWEN, KAREN 11/15/2002 776.09 4 82 021008000A 10/08/2002 GREISCH, ERIC 11/15/2002 648.56 4 81 021008013A 10/08/2002 RYAN, NILEY E 11/15/2002 669.28 4 81 021008022A 10/09/2002 JOPLING, JAMES 11/15/2002 759.46 4 81 021008027A 10/09/2002 CREWS, WILMA G 11/15/2002 687.84 4 81 021008041A 10/09/2002 STEGMAN, FERMAN 11/15/2002 657.66 4 81 021008049A 10/09/2002 WRIGHT, BRIAN 11/15/2002 978.29 4 82 021008092A 10/11/2002 JOHNSON, ALAINA 11/15/2002 866.82 4 82 021008094A 10/11/2002 HOFFNER, JEFF Date:ll/18/2002 Weld County Paramedic Services Page: 6 Time:17:02:17 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/15/2002 Thru 11/15/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/15/2002 819.60 4 81 021008116A 10/11/2002 VIENHAGE, LINDA 11/15/2002 895.60 4 82 021008124A 10/11/2002 CHAVEZ, TOMAS MACIEL 11/15/2002 Patient 927.10 4 82 021008126A 10/11/2002 WALTER, KENNETH ADAM 11/15/2002 774.52 4 82 021008165A 10/12/2002 GALLARDO, ADRENA 11/15/2002 1018.03 4 82 021008178A 10/13/2002 VILLARREAL, ARNOLDO 11/15/2002 928.29 4 82 021008190A 10/13/2002 VIGIL, DARILYN J 11/15/2002 369.09 4 82 021008196A 10/14/2002 RIZO, CONNIE P Total of 252 WriteOff Entries Totaling 144515.16 Dollars Average WriteOff: 573 .47 Dollars Average Time:164 Days Date:11/18/2002 Weld County Paramedic Services Page: 7 Time:1702:18 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/15/2002 Thru 11/15/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 195 124934 .94 640.69 193 .63 82 MEDICAID WRITEOFF 47 12574 .63 267.55 65.36 81 MEDICARE WRITEOFF 10 7005.59 700.56 45.20 Date:11/21/2002 Weld County Paramedic Services Page: 1 Time:07:49:56 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/19/2002 Thru 11/19/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/19/2002 395.00 4 83C 000503744A 05/23/2000 OLVERA, YOLANDA 11/19/2002 881.00 4 83C 010604708A 06/17/2001 HERRERA, ADELLA 11/19/2002 592 .10 4 83C 010705524A 07/14/2001 KONIG, GENEVA 11/19/2002 53 .15 4 83C 010907630A 09/22/2001 GEORGE, NELLENE 11/19/2002 626.46 4 83C 011008371A 10/18/2001 PEDEN, DONNA 11/19/2002 518.04 4 83C 011008580A 10/26/2001 ORTEGON, MARIE D 11/19/2002 44 .79 4 83C 011008720A 10/30/2001 GEORGE, NELLENE 11/19/2002 25.00 4 83C 011109022A 11/10/2001 CASTRO, DAVID 11/19/2002 25 .00 4 83C 020100017A 01/01/2002 RIVERA, LEOPOLDO 11/19/2002 843 .33 4 83C 020200991A 02/02/2002 KUYKENDALL, EVA J 11/19/2002 435 .84 4 83C 020201104A 02/06/2002 LUTZ, ARTHUR L 11/19/2002 461.60 4 83C 020201425A 02/17/2002 KRUEGER, STEVEN M 11/19/2002 1114 .00 4 83C 020201509A 02/20/2002 CARABAJAL, JOHNNY 11/19/2002 82 .69 4 83C 020302110A 03/13/2002 KUYKENDALL, EVA J 11/19/2002 73.50 4 83C 020302281A 03/19/2002 MCKAY, KATELYNN 11/19/2002 819.33 4 83C 020302364A 03/23/2002 MORGAN, MERLYN 11/19/2002 874.00 4 83C 020302365A 03/23/2002 CRUZ, JOSE 11/19/2002 834.00 4 83C 020302375A 03/23/2002 BLACKMAN, NADINE 11/19/2002 819.33 4 83C 020302494A 03/27/2002 MORGAN, MERLYN 11/19/2002 750.00 4 83C 020302568A 03/30/2002 PEDEN, DONNA 11/19/2002 1384.00 4 83C 020302596A 03/31/2002 MEDINA, ADRIAN D 11/19/2002 736.00 4 83C 020303120A 04/20/2002 CALVILLO-HOFF, SHEIL 11/19/2002 764.00 4 83C 020402820A 04/09/2002 FLORES, MARTHA 11/19/2002 1000.00 4 83C 020402958A 04/14/2002 RIQUELME, ALFONSO 11/19/2002 848.00 4 83C 020402998A 04/15/2002 TISHMACK, TROY D 11/19/2002 120 .00 4 83C 020403032A 04/16/2002 CONCHAS, ABEL 11/19/2002 300.00 4 83C 020403037A 04/17/2002 MEYERS, SHEILA 11/19/2002 600 .00 4 83C 020403053A 04/17/2002 DURAN, MANUEL 11/19/2002 73 .36 4 83C 020403098A 04/19/2002 REFAAT, AHMED 11/19/2002 774.00 4 83C 020403111A 04/20/2002 DUNN, BRANDON 11/19/2002 820.00 4 83C 020403113A 04/20/2002 REED, ROBERT 11/19/2002 120.00 4 83C 020403135A 04/21/2002 BYSTROM, ERIC 11/19/2002 120.00 4 83C 020403151A 04/21/2002 BLAS, JULIE 11/19/2002 886.00 4 83C 020403162A 04/22/2002 SMITH, MICHEAL M 11/19/2002 874 .00 4 83C 020403168A 04/22/2002 AMADO, JUAN 11/19/2002 814.00 4 83C 020403177A 04/22/2002 CARLOCK, JENNIFER L 11/19/2002 970.00 4 83C 020403197A 04/23/2002 BAEZ, ANGELICA 11/19/2002 25.00 4 83C 020503415A 05/01/2002 MCCOMBS, PAMELA K 11/19/2002 24.00 4 83C 020503519A 05/04/2002 MASTERS, JAMES 11/19/2002 59.32 4 83C 020503536A 05/05/2002 LAMBERT, BERYL 11/19/2002 57 .97 4 83C 020503538A 05/05/2002 LAMBERT, BERYL 11/19/2002 736 .00 4 83C 020503549A 05/05/2002 MONROE, BRITNEY M 11/19/2002 75.00 4 83C 020503577A 05/06/2002 MCBRIDE, MEGAN K 11/19/2002 986.00 4 83C 020503950A 05/21/2002 PECK, JASON L 11/19/2002 796.00 4 83C 020504071A 05/25/2002 GONZALEZ-MARTINEZ, R 11/19/2002 724.00 4 83C 020504118A 05/27/2002 GARCIA, LEONARD 11/19/2002 764 .00 4 83C 020504126A 05/28/2002 DUNN, ERIN M 11/19/2002 73 .36 4 83C 020604394A 06/07/2002 ZONZO, JOHN 11/19/2002 1022 .00 4 83C 020604475A 06/09/2002 GARCIA, JOE Date:ll/21/2002 Weld County Paramedic Services Page: 2 Time:07:49:56 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/19/2002 Thru 11/19/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/19/2002 1006 .00 4 83C 020604637A 06/15/2002 GARCIA, JOE 11/19/2002 1058 .00 4 83C 020604643A 06/15/2002 GARCIA, JOE 11/19/2002 120 .00 4 83C 020604659A 06/16/2002 HERNANDEZ, JOHN 11/19/2002 898 .00 4 83C 020604733A 06/19/2002 MALONEY, LEA ANNE 11/19/2002 924 .00 4 83C 020604774A 06/21/2002 HERNANDEZ, LARRY 11/19/2002 724 .00 4 83C 020604813A 06/22/2002 OREAR, BILLY 11/19/2002 814 .00 4 83C 020604824A 06/22/2002 GONZALES, LARRY 11/19/2002 1038 .00 4 83C 020604836A 06/22/2002 GARCIA, JOE 11/19/2002 868 .00. 4 83C 020604890B 06/24/2002 PEDROZA, JUAN F 11/19/2002 886.00 4 83C 020604903D 06/24/2002 KANZLER, JALONNA M 11/19/2002 1018.00 4 83C 020604947A 06/25/2002 GARCIA, JOE 11/19/2002 786 .00 4 83C 020604951A 06/25/2002 GRUBBS, PEGGY 11/19/2002 1006.00 4 83C 020604953A 06/26/2002 GARCIA, JOE 11/19/2002 824.00 4 83C 020604974A 06/26/2002 MEZA, LUIS G 11/19/2002 990.00 4 83C 020604976A 06/26/2002 KAMAKELE, DAVID 11/19/2002 120.00 4 83C 020605002B 06/27/2002 MENDEZ, ROSHAUNA 11/19/2002 120.00 4 83C 020605003A 06/27/2002 MCIRVIN, GWENDOLYN 11/19/2002 120.00 4 83C 020605007A 06/27/2002 MAGADAN, JOHN 11/19/2002 740.00 4 83C 020605023A 06/28/2002 JOHANSEN, DUSTY M 11/19/2002 740.00 4 83C 020605023B 06/28/2002 JOHANSEN, ROXANN 11/19/2002 890.00 4 83C 020605023C 06/28/2002 JOHANSEN, BRADLEY 11/19/2002 846.00 4 83C 020605026A 06/28/2002 MANN, KELLEY A 11/19/2002 740.00 4 83C 020605064A 06/29/2002 MARTINEZ, JOSE 11/19/2002 1260.00 4 83C 020605064B 06/29/2002 MARTINEZ, MELTRON 11/19/2002 120.00 4 83C 020605068B 06/29/2002 GONZALES, GLORIA 11/19/2002 1042 .00 4 83C 020605088A 06/30/2002 HOLGUIN, ELENA 11/19/2002 924 .00 4 83C 020605105A 06/30/2002 GUERRERO, MICHAEL 11/19/2002 826.00 4 83C 020605110A 06/30/2002 MAYER-TUCKER, TIERNE 11/19/2002 724 .00 4 83C 020605158A 07/02/2002 RODRIGUEZ, TONY 11/19/2002 880.00 4 83C 020705112A 07/01/2002 MCMINDES, SHANE C 11/19/2002 120.00 4 83C 020705130A 07/01/2002 NAVARRETTE, CANDICE 11/19/2002 814 .00 4 83C 020705131A 07/01/2002 VASQUEZ, MAURILIA A 11/19/2002 1038.00 4 83C 020705153A 07/02/2002 GARCIA, JOE 11/19/2002 886.00 4 83C 020705165A 07/02/2002 GARCIA QUEZADA, DAVI 11/19/2002 906.00 4 83C 020705171A 07/02/2002 HARPER, BEATRICE 11/19/2002 786.00 4 83C 020705182A 07/02/2002 OLIVAREZ, JUAN 11/19/2002 120.00 4 83C 020705187A 07/03/2002 GARMAN, JOSHUA 11/19/2002 774.00 4 83C 020705192A 07/03/2002 MONTEZ, SAMANTHA C 11/19/2002 814 .00 4 83C 020705207A 07/03/2002 DODGE, KERRIE L 11/19/2002 904.00 4 83C 020705223A 07/03/2002 NELSON, DAVID C 11/19/2002 736.00 4 83C 020705225A 07/03/2002 HOWE, ANDREW 11/19/2002 120.00 4 83C 020705230A 07/04/2002 PHILLIPSEN, DANA LIG 11/19/2002 886.00 4 83C 020705240A 07/04/2002 FLORES, JEANNE 11/19/2002 774 .00 4 83C 020705251A 07/04/2002 HERNANDEZ, MARIO 11/19/2002 120.00 4 83C 020705254A 07/05/2002 OLIVARES MORAN, RAFA 11/19/2002 76.95 4 83C 020705272A 07/05/2002 VASQUEZ, ERMA 11/19/2002 120.00 4 83C 020705294A 07/06/2002 GRIFFIN, BRIAN 11/19/2002 736.00 4 83C 020705315A 07/06/2002 GARCIA, IVAN 11/19/2002 824.00 4 83C 020705346A 07/07/2002 FLORES, JEANNE Date:11/21/2002 Weld County Paramedic Services Page: 3 Time:07:49:57 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/19/2002 Thru 11/19/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/19/2002 826.00 4 83C 020705397A 07/09/2002 PEARSON, TANYA 11/19/2002 874 .00 4 83C 020705422A 07/09/2002 JACKSON, ELLIE E 11/19/2002 736 .00 4 83C 020705424A 07/09/2002 NEWSON, TINA 11/19/2002 724.00 4 83C 020705467A 07/11/2002 OLIVAS, PAUL D 11/19/2002 1242.00 4 83C 020705492A 07/12/2002 HICKERSON, WAYNE 11/19/2002 874 .00 4 83C 020705511A 07/13/2002 LUJAN, ERIN L 11/19/2002 874.00 4 83C 020705526A 07/13/2002 DODGE, KERRIE L 11/19/2002 374 .00 4 83C 020705532A 07/13/2002 DODGE, KERRIE L 11/19/2002 892 .00 4 83C 020705534A 07/13/2002 GOMEZ, DANIEL 11/19/2002 120.00 4 83C 020705539A 07/14/2002 MONTOYA, DOMINIQUE 11/19/2002 62 .85 4 83C 020705540A 07/14/2002 ZONZO, JOHN 11/19/2002 120.00 4 83C 020705563A 07/14/2002 JIMENEZ, JOSE 11/19/2002 724.00 4 83C 020705618A 07/16/2002 HURLBERT, AUTUMN M 11/19/2002 120.00 4 83C 020705644A 07/18/2002 DIAZ, RUBY 11/19/2002 826.00 4 83C 020705656A 07/18/2002 HERNANDEZ, MIGUEL 11/19/2002 76.68 4 83C 020705684A 07/19/2002 MCTAVISH, JANET M ' 11/19/2002 924.00 4 83C 020705718A 07/21/2002 PRICE, DANIEL 11/19/2002 120.00 4 83C 020705751A 07/22/2002 AGUILAR, GUSTAVO 11/19/2002 874 .00 4 83C 020705774A 07/23/2002 REYES, MARGARITA 11/19/2002 886 .00 4 83C 020705804A 07/24/2002 MONIES, ROCIO 11/19/2002 120 .00 4 83C 020705904A 07/27/2002 ALARID, FRANK 11/19/2002 814 .00 4 83C - 020705908A 07/27/2002 RAMIREZ, RAFAEL 11/19/2002 120.00 4 83C 020705909B 07/28/2002 GATES, GHANDRA 11/19/2002 120.00 4 83C 020705931A 07/28/2002 STEWERT, SHERRY 11/19/2002 120. 00 4 83C 020705931B 07/28/2002 MAKINGS, MONTY 11/19/2002 120.00 4 83C 020705931C 07/28/2002 STEWART, ASHLEE 11/19/2002 120.00 4 83C 020705931D 07/28/2002 STEWART, AMANDA 11/19/2002 120.00 4 83C 020705931E 07/28/2002 STEWART, JACOB 11/19/2002 120.00 4 83C 020705931F 07/28/2002 STEWART, JOSHUA 11/19/2002 898.00 4 83C 020806067A 08/02/2002 MARTINEZ JR, MICHEAL 11/19/2002 838.00 4 83C 020806263A 08/09/2002 GONZALEZ, TRISTAN 11/19/2002 1010 .00 4 83C 020806386A 08/13/2002 REYES, MARGARITA 11/19/2002 1070.00 4 83C 020806392A 08/13/2002 HERNANDEZ, VERONICA 11/19/2002 1235 .00 4 83C 020806518A 08/18/2002 BALDERRAMA, ERNESTO 11/19/2002 1205.00 4 83C 020806648A 08/23/2002 RIO FRIO, ANTONIO 11/19/2002 980.00 4 83C 020806713A 08/25/2002 GRADO, MIGUEL ANGEL 11/19/2002 1355.00 4 83C 020806747A 08/26/2002 BAKER, CHARITY 11/19/2002 1010.00 4 83C 020806808A 08/27/2002 FOSTER, STEVE 11/19/2002 950.00 4 83C 020806828A 08/26/2002 BARRERA, VALERIE 11/19/2002 327.88 4 83C 020806829A 08/28/2002 RENOAD, BOB 11/19/2002 150 .00 4 83C 020906963A 09/02/2002 BENAVIDEZ, AMY 11/19/2002 1070 .00 4 83C 020907131A 09/07/2002 MARKHAM, STEVEN CLAY 11/19/2002 1115.00 4 83C 020907138A 09/07/2002 MICHENER, DOUGLAS 11/19/2002 150 .00 4 83C 020907195A 09/09/2002 BATREZ JR, REUBEN I 11/19/2002 900 .00 4 83C 020907205A 09/09/2002 EGURE, JESUS R 11/19/2002 1190.00 4 83C 020907212A 09/09/2002 BURANDT, KATRYN M 11/19/2002 1085.00 4 83C 020907217A 09/10/2002 GRAHAM, CHEYENNE 11/19/2002 995.00 4 83C 020907236A 09/10/2002 PING, MICHAEL ' 11/19/2002 995.00 4 83C 020907238A 09/10/2002 KREKORA, DEREK M Date:11/21/2002 Weld County Paramedic Services Page: 4 Time:07:49:58 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/19/2002 Thru 11/19/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/19/2002 150.00 4 83C 020907265A 09/12/2002 WOLF, JULIE 11/19/2002 1005.00 4 83C 020907271A 09/12/2002 LOYA, JESUS DAVID 11/19/2002 1055 .00 4 83C 020907272A 09/12/2002 MONTALVO FRANCISCO, 11/19/2002 72 .55 4 83C 020907362A 09/15/2002 CLERMONT, CHARLES 11/19/2002 870 .00 4 83C 020907482A 09/20/2002 GALLEGOS, SARAH 11/19/2002 1220 .00 4 83C 020907486A 09/20/2002 JONES, BRIAN C 11/19/2002 870.00 4 83C 020907515A 09/21/2002 ANAYA, FABIAN. 11/19/2002 870.00 4 83C 020907537A 09/21/2002 STEINMETZ, RICHARD 11/19/2002 150.00 4 83C 020907556A 09/22/2002 CASAVEO, JOSE ANGEL 11/19/2002 1085.00 4 83C 020907676A 09/26/2002 CORRAL PALMA, CONCEP 11/19/2002 885.00 4 83C 020907691A 09/27/2002 CISNEROS, OFILIA 11/19/2002 150.00 4 83C 020907694A 09/27/2002 KAUFFMAN, AMANDA 11/19/2002 980.00 4 83C 020907703A 09/27/2002 RODRIGUEZ, ROY 11/19/2002 1115.00 4 83C 020907707A 09/28/2002 LEONE, JEFF 11/19/2002 150.00 4 83C 020907720A 09/28/2002 STEWART, TYLER 11/19/2002 1475.00 4 83C 020907764A 09/29/2002 HERNANDEZ-RODRIGUEZ, 11/19/2002 1130 .00 4 83C 021007802A 10/01/2002 MORALES-AVILES, JESS 11/19/2002 1080 .00 4 83C 021007825A 10/02/2002 MORALES-AVILES, YESS 11/19/2002 1340.00 4 83C 021007918A 10/05/2002 HACKETT, JANE 11/19/2002 1400.00 4 83C 021007944A 10/06/2002 AGUILAR-CRESPO, RAUL 11/19/2002 150.00 4 83C 021007976A 10/07/2002 HERRE, ADRIANA 11/19/2002 150.00 4 83C 021008088A 10/10/2002 GUITERREZ, SAMATHA 11/19/2002 1055.00 4 83C 021008091A 10/10/2002 CASTANEDA, CLAUDIA 11/19/2002 900.00 4 83C 021008135A 10/12/2002 VILLEGAS, DIANA L 11/19/2002 1010.00 4 83C 021008148A 10/12/2002 RUIZ, MATEO 11/19/2002 885 .00 4 83C 021008465A 10/22/2002 ROMERO, BARBARA 11/19/2002 1175 .00 4 83C 021008480A 10/23/2002 BERMUDEZ, CARLOS G 11/19/2002 1065.00 4 83C 021008517A 10/24/2002 ABRAMS, EDWARD 11/19/2002 1070 .00 4 83C 021008599A 10/27/2002 CORDOVA, ARACELI Total of 176 WriteOff Entries Totaling 118506 .08 Dollars Average WriteOff: 673.33 Dollars Average Time:151 Days Date:11/21/2002 Weld County Paramedic Services Page: 5 Time:07 :49:58 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/19/2002 Thru 11/19/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 176 118506.08 673 .33 151.09 Date:11/21/2002 Weld County Paramedic Services Page: 1 Time:07:48:53 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/20/2002 Thru 11/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/20/2002 497 .62 4 83C 011109156A 11/15/2001 FRAZIER, DORIS 11/20/2002 270.00 4 83C 011210308A 12/29/2001 MCBROOM, CARRIE 11/20/2002 530.52 4 83C 020100258A 01/08/2002 CHAMBERS, WILLIAM L 11/20/2002 300 .00 4 83C 020100533A 01/17/2002 CUMMINS, CAROLYN 11/20/2002 310.60 4 83C 020100652A 01/22/2002 BOONE, ROBERT A 11/20/2002 50.00 4 83C 020100932A 01/31/2002 BAIRD, WENDY 11/20/2002 961.35 4 83C 020200946A 02/01/2002 CARDONA, ROSEMARIE 11/20/2002 649.74 4 83C 020201048A 02/04/2002 WATKINS, LYLE 11/20/2002 185.28 4 83C 020201195A 02/09/2002 BRITT, FAY 11/20/2002 94.00 4 83C 020201356A 02/15/2002 BEAN, AMBER 11/20/2002 225.28 4 83C 020201475A 02/19/2002 BRITT, FAY 11/20/2002 814 .00 4 83C 020301824A 03/03/2002 SANDERS, HAROLD J 11/20/2002 874 .00 4 83C 020301916A 03/07/2002 GARNER, JEANETTE 11/20/2002 444 .00 4 83C 020302181A 03/15/2002 SALAZAR, PEDRO 11/20/2002 521.80 4 83C 020302203A 03/16/2002 FLOHRS, E EILEEN 11/20/2002 120.00 4 83C 020302257B 03/18/2002 CORNWELL, RYAN 11/20/2002 1084 .00 4 83C 020302317A 03/21/2002 BATES, JEFF L 11/20/2002 814 .00 4 83C 020302525A 03/29/2002 EIKENBERG, KARL L 11/20/2002 1150 .00 4 83C 020302535A 03/29/2002 CURRY, KELLI 11/20/2002 946.00 4 83C 020402653A 04/02/2002 BYRD, JOHN 11/20/2002 73 .36 4 83C 020402754A 04/07/2002 CONNELL, DERRALL W 11/20/2002 874 .00 4 83C 020403029A 04/16/2002 CRANMER, RICK **SEE 11/20/2002 1134 .00 4 83C 020403318A 04/27/2002 DALUGE, SCOTT 11/20/2002 120 .00 4 83C 020403328A 04/27/2002 BUNJES, MAY 11/20/2002 736 .00 4 83C 020403332A 04/27/2002 CRUZ, BRENDA 11/20/2002 736 .00 4 83C 020403397A 04/30/2002 CALVILLO-HOFF, SHEIL 11/20/2002 886.00 4 83C 020503660A 05/09/2002 GOODE, LISA J 11/20/2002 73 .36 4 83C 020503692A 05/10/2002 CAMPBELL, DONNA K 11/20/2002 836.00 4 83C 020503842A 05/17/2002 FAUSSONE, CORY D 11/20/2002 100 .00 4 83C 020504096A 05/26/2002 BETANCOURT, VANESSA 11/20/2002 838.00 4 83C 020604256A 06/02/2002 FLORES-FEMAT, PASCUA 11/20/2002 1050.94 4 83C 020604305A 06/03/2002 CATHCART, MATTHEW 11/20/2002 964.00 4 83C 020604377A 06/06/2002 BLACK, MARJORIE J 11/20/2002 120.00 4 83C 020604421A 06/07/2002 AVALOS, GRISELDA 11/20/2002 848.00 4 83C 020604459A 06/09/2002 CISNEROS, LISA R 11/20/2002 874 .00 4 83C 020604511A 06/11/2002 CLARK, JAIME A 11/20/2002 152 .80 4 83C 020604602A 06/14/2002 AGUILLAR, CESAR U 11/20/2002 886.00 4 83C 020604614A 06/14/2002 CALVILLO-HOFF, SHEIL 11/20/2002 924 .00 4 83C 020604657A 06/16/2002 CENICEROS-GONZALEZ, 11/20/2002 874 .00 4 83C 020604660A 06/16/2002 BARCENAS, JUAN M 11/20/2002 788.00 4 83C 020604677A 06/16/2002 ALBERT, JOHN L 11/20/2002 970 .00 4 83C 020604706A 06/18/2002 FLOOD, KENNY 11/20/2002 814 .00 4 83C 020604726A 06/18/2002 DUFFIELD, SHERRI 11/20/2002 814 .00 4 83C 020604763A 06/20/2002 CHAVEZ, ROSA 11/20/2002 836.00 4 83C 020604830A 06/22/2002 DEGERING, JANIS L 11/20/2002 814 .00 4 83C 020604842A 06/22/2002 SANDOVAL, EUSEBIO 11/20/2002 120 .00 4 83C 020604888A 06/24/2002 CRAWFORD, RANDAL 11/20/2002 120 .00 4 83C 020604894A 06/24/2002 DAVIS, LEVI 11/20/2002 930 .00 4 83C 020604935A 06/25/2002 CRAWFORD, RANDAL Date:ll/21/2002 Weld County Paramedic Services Page: 2 Time:07 :48:54 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/20/2002 Thru 11/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/20/2002 120 .00 4 83C 020605002A 06/27/2002 FLORES, SHARAE 11/20/2002 776 .00 4 83C 020605048A 06/29/2002 BUCCIARELLI, JOSEPH 11/20/2002 120 .00 4 83C 020605050A 06/29/2002 BUSHY, AUGUST 11/20/2002 120.00 4 83C 020605081A 06/29/2002 FLYNN, BRIAN 11/20/2002 120.00 4 83C 020605091A 06/30/2002 LUCERO, EVA 11/20/2002 776.00 4 83C 020605104A 06/30/2002 FAIN, MICHAEL 11/20/2002 786.00 4 83C 020705139A 07/01/2002 EDDLEMAN, SEAN D 11/20/2002 886.00 4 83C 020705236A 07/04/2002 SCOTT, LIA 11/20/2002 914.00 4 83C 020705242A 07/04/2002 TYSON, WAYNE C 11/20/2002 724.00 4 83C 020705868A 07/26/2002 CORDERO, ROSE 11/20/2002 97.52 4 83C 020806342A 08/11/2002 MEIER, GEORGE 11/20/2002 995.00 4 83C 020806358A 08/12/2002 REY, MICHAEL 11/20/2002 1055.00 4 83C 020806429A 08/14/2002 CRANMER, RICK **SEE 11/20/2002 935.00 4 83C 020806493A 08/17/2002 CRANMER, RICK 11/20/2002 980.00 4 83C 020806774A 08/26/2002 PANTOYA, JUSTIN 11/20/2002 1055 .00 4 83C 020907210A 09/09/2002 CRANMER, RICK 11/20/2002 75 .74 4 83C 020907243A 09/11/2002 GAVELL, EDWARD 11/20/2O02 870.00 4 83C 020907314A 09/13/2002 CRANMER, RICK***SEE 11/20/2002 150 .00 4 83C 020907611A 09/24/2002 CRANMER, RICK 11/20/2002 1100 .00 4 83C 020907702A 09/27/2002 WHITESHIRT, GUY 11/20/2002 870 .00 4 83C 021008172A 10/13/2002 WHITESHIRT, GUY 11/20/2002 1235. 00 4 83C 021108823A 11/02/2002 BORQUE-REYES, JORGE Total of 71 WriteOff Entries Totaling 44908 .91 Dollars Average WriteOff: 632 .52 Dollars Average Time:181 Days Date:11/21/2002 Weld County Paramedic Services Page: 3 Time:07:48:54 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/20/2002 Thru 11/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 71 44908.91 632 .52 180.66 Date:11/21/2002 Weld County Paramedic Services Page: 1 Time: 07:49:07 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/20/2002 Thru 11/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/20/2002 497.62 4 83C 011109156A 11/15/2001 FRAZIER, DORIS 11/20/2002 270.00 4 83C 011210308A 12/29/2001 MCBROOM, CARRIE 11/20/2002 530.52 4 83C 020100258A 01/08/2002 CHAMBERS, WILLIAM L 11/20/2002 300.00 4 83C 020100533A 01/17/2002 CUMMINS, CAROLYN 11/20/2002 310.60 4 83C 020100652A 01/22/2002 BOONE, ROBERT A 11/20/2002 50.00 4 83C 020100932A 01/31/2002 BAIRD, WENDY 11/20/2002 961.35 4 83C 020200946A 02/01/2002 CARDONA, ROSEMARIE 11/20/2002 649.74 4 83C 020201048A 02/04/2002 WATKINS, LYLE 11/20/2002 185.28 4 83C 020201195A 02/09/2002 BRITT, FAY 11/20/2002 94 .00 4 83C 020201356A 02/15/2002 BEAN, AMBER 11/20/2002 225.28 4 83C 020201475A 02/19/2002 BRITT, FAY 11/20/2002 814 .00 4 83C 020301824A 03/03/2002 SANDERS, HAROLD J 11/20/2002 874 .00 4 83C 020301916A 03/07/2002 GARNER, JEANETTE 11/20/2002 444 .00 4 83C 020302181A 03/15/2002 SALAZAR, PEDRO 11/20/2002 521.80 4 83C 020302203A 03/16/2002 FLOHRS, E EILEEN 11/20/2002 120 .00 4 83C 020302257B 03/18/2002 CORNWELL, RYAN 11/20/2002 1084 .00 4 83C 020302317A 03/21/2002 BATES, JEFF L 11/20/2002 814 .00 4 83C 020302525A 03/29/2002 EIKENBERG, KARL L 11/20/2002 1150 . 00 4 83C 020302535A 03/29/2002 CURRY, KELLI 11/20/2002 946 . 00 4 83C 020402653A 04/02/2002 BYRD, JOHN 11/20/2002 73 .36 4 83C 020402754A 04/07/2002 CONNELL, DERRALL W 11/20/2002 874 .00 4 83C 020403029A 04/16/2002 CRANMER, RICK **SEE 11/20/2002 1134 .00 4 83C 020403318A 04/27/2002 DALUGE, SCOTT 11/20/2002 120 .00 4 83C 020403328A 04/27/2002 BUNJES, MAY 11/20/2002 736.00 4 83C 020403332A 04/27/2002 CRUZ, BRENDA 11/20/2002 736 .00 4 83C 020403397A 04/30/2002 CALVILLO-HOFF, SHEIL 11/20/2002 886 .00 4 83C 020503660A 05/09/2002 GOODE, LISA J 11/20/2002 73 .36 4 83C 020503692A 05/10/2002 CAMPBELL, DONNA K 11/20/2002 836.00 4 83C 020503842A 05/17/2002 FAUSSONE, CORY D 11/20/2002 100.00 4 83C 020504096A 05/26/2002 BETANCOURT, VANESSA 11/20/2002 838.00 4 83C 020604256A 06/02/2002 FLORES-FEMAT, PASCUA 11/20/2002 1050 .94 4 83C 020604305A 06/03/2002 CATHCART, MATTHEW 11/20/2002 964 .00 4 83C 020604377A 06/06/2002 BLACK, MARJORIE J 11/20/2002 120 .00 4 83C 020604421A 06/07/2002 AVALOS, GRISELDA 11/20/2002 848.00 4 83C 020604459A 06/09/2002 CISNEROS, LISA R 11/20/2002 874 .00 4 83C 020604511A 06/11/2002 CLARK, JAIME A 11/20/2002 152 . 80 4 83C 020604602A 06/14/2002 AGUILLAR, CESAR U 11/20/2002 886 .00 4 83C 020604614A 06/14/2002 CALVILLO-HOFF, SHEIL 11/20/2002 924 .00 4 83C 020604657A 06/16/2002 CENICEROS-GONZALEZ, 11/20/2002 874 .00 4 83C 020604660A 06/16/2002 BARCENAS, JUAN M 11/20/2002 788 .00 4 83C 020604677A 06/16/2002 ALBERT, JOHN L 11/20/2002 970 .00 4 83C 020604706A 06/18/2002 FLOOD, KENNY 11/20/2002 814.00 4 83C 020604726A 06/18/2002 DUFFIELD, SHERRI 11/20/2002 814 .00 4 83C 020604763A 06/20/2002 CHAVEZ, ROSA 11/20/2002 836 .00 4 83C 020604830A 06/22/2002 DEGERING, JANIS L 11/20/2002 814 .00 4 83C 020604842A 06/22/2002 SANDOVAL, EUSEBIO 11/20/2002 120.00 4 83C 020604888A 06/24/2002 CRAWFORD, RANDAL 11/20/2002 120 .00 4 83C 020604894A 06/24/2002 DAVIS, LEVI 11/20/2002 930 .00 4 83C 020604935A 06/25/2002 CRAWFORD, RANDAL Date:11/21/2002 Weld County Paramedic Services Page: 2 Time:07 :49:08 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/20/2002 Thru 11/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/20/2002 120 .00 4 83C 020605002A 06/27/2002 FLORES, SHARAE 11/20/2002 776.00 4 83C 020605048A 06/29/2002 BUCCIARELLI, JOSEPH 11/20/2002 120.00 4 83C 020605050A 06/29/2002 BUSHY, AUGUST 11/20/2002 120.00 4 83C 020605081A 06/29/2002 FLYNN, BRIAN 11/20/2002 120.00 4 83C 020605091A 06/30/2002 LUCERO, EVA 11/20/2002 776.00 4 83C 020605104A 06/30/2002 FAIN, MICHAEL 11/20/2002 786.00 4 83C 020705139A 07/01/2002 EDDLEMAN, SEAN D 11/20/2002 886.00 4 83C 020705236A 07/04/2002 SCOTT, LIA 11/20/2002 914 .00 4 83C 020705242A 07/04/2002 TYSON, WAYNE C 11/20/2002 724 .00 4 83C 020705868A 07/26/2002 CORDERO, ROSE 11/20/2002 97.52 4 83C 020806342A 08/11/2002 MEIER, GEORGE 11/20/2002 995.00 4 83C 020806358A 08/12/2002 REY, MICHAEL 11/20/2002 1055.00 4 83C 020806429A 08/14/2002 CRANMER, RICK **SEE 11/20/2002 935.00 4 83C 020806493A 08/17/2002 CRANMER, RICK 11/20/2002 980 .00 4 83C 020806774A 08/26/2002 PANTOYA, JUSTIN 11/20/2002 1055.00 4 83C 020907210A 09/09/2002 CRANMER, RICK 11/20/2002 75 .74 4 83C 020907243A 09/11/2002 GAVELL, EDWARD 11/20/2002 870 .00 4 83C 020907314A 09/13/2002 CRANMER, RICK***SEE 11/20/2002 150 .00 4 83C 020907611A 09/24/2002 CRANMER, RICK 11/20/2002 1100 .00 4 83C 020907702A 09/27/2002 WHITESHIRT, GUY 11/20/2002 870.00 4 83C 021008172A 10/13/2002 WHITESHIRT, GUY 11/20/2002 1235 .00 4 83C 021108823A 11/02/2002 BORQUE-REYES, JORGE Total of 71 WriteOff Entries Totaling 44908.91 Dollars Average WriteOff: 632 .52 Dollars Average Time:181 Days i Date:11/21/2002 Weld County Paramedic Services Page: 3 Time:07:49:09 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/20/2002 Thru 11/20/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 71 44908.91 632 .52 180 .66 Date:12/12/2002 Weld County Paramedic Services Page: 1 Time:15:20 :54 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/12/2002 Thru 12/12/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 12/12/2002 14.00 4 83C 02079 05/09/2002 ANGELA RIOS 12/12/2002 14.00 4 83C 02080 05/09/2002 JESSE RIOS 12/12/2002 14.00 4 83C 02081 05/09/2002 DIEGO RIOS 12/12/2002 14.00 4 83C 02083 05/09/2002 LORINE WORKMAN 12/12/2002 14 .00 4 83C 02084 05/09/2002 LYLE WORKMAN 12/12/2002 14.00 4 83C 02126 07/31/2002 RICHARD BABB 12/12/2002 22.82 4 83C 001209256A 12/03/2000 BRAY, MARTHA BEULAH 12/12/2002 127.03 4 83C 010302246A 03/22/2001 BRAY, MARTHA BEULAH 12/12/2002 534 .00 4 83C 010907598A 09/22/2001 SAUCEDO, CARLOS 12/12/2002 467 .12 4 83C 010907618A 09/22/2001 BRAY, MARTHA BEULAH 12/12/2002 963 .00 4 83C 010907675A 09/24/2001 BALL, SHAWN L 12/12/2002 69.66 4 83C 010907751A 09/27/2001 BRAY, MARTHA BEULAH 12/12/2002 69.63 4 83C 011109011A 11/10/2001 BRAY, MARTHA BEULAH 12/12/2002 696.51 4 82 011109504A 11/28/2001 ZUNDEL, MARK T 12/12/2002 25.00 4 83C 011210382A 12/31/2001 ROSALES, TRACY 12/12/2002 494.39 4 83C 020100658A 01/22/2002 YOST, JOHN H 12/12/2002 120.00 4 83C 020100807A 01/27/2002 CZAPLA, JAMES 12/12/2002 77.42 4 83C 020302185A 03/15/2002 TOWNDROW, FRANK T 12/12/2002 609.20 4 83C 020302243A 03/17/2002 WYNIA, GREGG A 12/12/2002 608.00 4 83C 020302463A 03/27/2002 GARBER, JESSICA 12/12/2002 935.33 4 83C 020302572A 03/30/2002 NELL, PATRICIA J 12/12/2002 53 .26 4 83C 020402638A 04/02/2002 CECIL, JOANN T 12/12/2002 914.00 4 83C 020503509A 05/04/2002 WEBER, INA M 12/12/2002. 829.06 4 83C 020503517A 05/04/2002 GROHS, GILLIAN 12/12/2002 384.10 4 83C 020503531A 05/04/2002 SHAEFFER, STAN 12/12/2002 776.00 4 83C 020503573A 05/06/2002 HANSEN, JULIE 12/12/2002 559.35 4 83C 020503604A 05/07/2002 SKOGG, JEANNIE A 12/12/2002 775.33 4 83C 020503621A 05/08/2002 BRUG, FRED 12/12/2002 61.00 4 83C 020503734A 05/12/2002 GUEVARA, GINGER 12/12/2002 439.20 4 83C 020503809A 05/15/2002 ANDRADE, ALFRED 12/12/2002 73 .90 4 83C 020503885A 05/18/2002 REEVES, DALE R 12/12/2002 446.00 4 83C 020504011A 05/23/2002 HERNANDEZ, CATHY 12/12/2002 62 .04 4 83C 020604228A 06/01/2002 KARICH, LOU . 12/12/2002 116.00 4 83C 020604366A 06/06/2002 TAYLOR, MAXINE G 12/12/2002 978.00 4 83C 020604679A 06/17/2002 RIOS, VICTORIA 12/12/2002 958.00 4 83C 020604735A 06/19/2002 HESS, JOSHUA 12/12/2002 120.00 4 83C 020604773A 06/21/2002 REYNA, RICHARD C 12/12/2002 724.00 4 83C 020604949A 06/25/2002 CHURCHILL, ERIN 12/12/2002 161.66 4 83C 020604977A 06/26/2002 MARTINEZ, RICHARD 12/12/2002 25.00 4 83C 020605019A 06/28/2002 ROSALES, TRACY 12/12/2002 764 .00 4 83C 020605032B 06/28/2002 RODRIQUEZ, MARY 12/12/2002 920 .00 4 83C 020705112B 07/01/2002 SNYDER, JODY 12/12/2002 724.00 4 83C 020705127A 07/01/2002 ROMERO, MICHAEL 12/12/2002 876.00 4 83C 020705129A 07/01/2002 VILLLARREAL, CHRISTOP 12/12/2002 120.00 4 83C 020705149A 07/01/2002 SANCHEZ, LYDIA 12/12/2002 69.44 4 83C 020705232A 07/04/2002 KARICH, LOU 12/12/2002 764.00 4 83C 020705238A 07/04/2002 SANDOVAL, WILLIAM 12/12/2002 968.00 4 83C 020705338A 07/07/2002 SEPEDA, FERNANDO 12/12/2002 120 .00 4 83C 020705347A 07/07/2002 ATKINSON, FAWN Date:12/12/2002 Weld County Paramedic Services Page: 2 Time:15:20:56 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/12/2002 Thru 12/12/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 12/12/2002 120 .00 4 83C 020705364A 07/08/2002 GARZA, MARIA YOLANDA 12/12/2002 834 .00 4 83C 020705391A 07/08/2002 STAILEY, GRETA 12/12/2002 814 .00 4 83C 020705392A 07/08/2002 APPLETON, NANCY 12/12/2002 832 .00 4 83C 020705480C 07/12/2002 ARGUELLO, THEODORE 12/12/2002 73 .36 4 83C 020705488A 07/12/2002 BERKHOLDER, JOHN C 12/12/2002 1234 .00 4 83C 020705505A 07/12/2002 DEVORE, DOUGLAS S 12/12/2002 814 .00 4 83C 020705508A 07/12/2002 HUBBARD, ERIN 12/12/2002 814 .00 4 83C 020705509A 07/13/2002 HUA, CHING KIA 12/12/2002 1064 .00 4 83C 020705575A 07/15/2002 GONZALES, MICHAEL J 12/12/2002 1090.00 4 83C 020705581A 07/15/2002 RICKFORD, DALE L 12/12/2002 994.00 4 83C 020705611A 07/16/2002 SLATE, SHERRY 12/12/2002 120.00 4 83C 020705620A 07/16/2002 ESKLAR, JUSTIN 12/12/2002 884.00 4 83C 020705622A 07/16/2002 CANTE, CATALINO 12/12/2002 120 .00 4 83C 020705638A 07/17/2002 GOMEZ, CODY 12/12/2002 798.00 4 83C 020705642A 07/18/2002 ZAPATA, ALFREDO 12/12/2002 892.00 4 83C 020705665A 07/19/2002 CHAVEZ, KIMBERLY 12/12/2002 81.50 4 83C 020705673A 07/19/2002 ADAMS, GEORGE 12/12/2002 774.00 4 83C 020705677C 07/19/2002 ALVAREZ, MARIA 12/12/2002 120.00 4 83C 020705711A 07/20/2002 CASAREZ, ANDRES 12/12/2002 920.00 4 83C 020705714A 07/21/2002 DAVIS, JARED 12/12/2002 874.00 4 83C 020705722A 07/21/2002 BACA, HILARIO 12/12/2002 74.40 4 83C 020705741A 07/21/2002 SANO, GERALD 12/12/2002 724.00 4 83C 020705747A 07/21/2002 RAMOS, CARLA 12/12/2002 874.00 4 83C 020705769A 07/22/2002 ESTRADA, J APOLINAR 12/12/2002 886.00 4 83C 020705771A 07/23/2002 RODRIGUEZ, ANGEL 12/12/2002 814 .00 4 83C 020705786A 07/23/2002 CRUZ, FRANCIS CHAVEZ 12/12/2002 924 .00 4 83C 020705814A 07/24/2002 GARZA, MARIA YOLANDA 12/12/2002 894 .00 4 83C 020705823A 07/25/2002 HUA, CHING KIA 12/12/2002 1044 .00 4 83C 020705878A 07/26/2002 REUTER, JEREMY 12/12/2002 350.00 4 83FP 020705880A 07/27/2002 GORMAN, JACKIE 12/12/2002 764 .00 4 83C 020705909A 07/28/2002 GALLEGOS, VALERIE JO 12/12/2002 814.00 4 83C 020705910A 07/28/2002 JARAMILLO, JUSTIN 12/12/2002 914 .00 4 83C 020705919A 07/28/2002 ALISEA, LISA D 12/12/2002 990.00 4 83C 020705927A 07/28/2002 CORDOVA, KYLE C 12/12/2002 120.00 4 83C 020705968A 07/29/2002 BLACK, MICHELLE 12/12/2002 834 .00 4 83C 020706032A 07/31/2002 CASTILLO, CLAUDIA 12/12/2002 1054 .00 4 83C 020805089A 08/02/2002 HANEY, JENNIFER 12/12/2002 770 .00 4 83C 020806038A 08/01/2002 FRITZ, MARY 12/12/2002 81.66 4 83C 020806042A 08/01/2002 MARTINEZ, RICHARD 12/12/2002 631.37 4 82 020806059A 08/01/2002 GRAVES, ELIJAH 12/12/2002 120.00 4 83C 020806086A 08/02/2002 HAIRYCHIN, RONTYNA 12/12/2002 120.00 4 83C 020806113A 08/03/2002 CRIPPS, JACQUELYNN 12/12/2002 958.00 4 83C 020806123A 08/04/2002 BATTERTON, MARSHA 12/12/2002 874.00 4 83C. 020806130A 08/04/2002 SWIFT, HOLLY 12/12/2002 576.00 4 83C 020806131A 08/04/2002 SQUIRES, CHRISTINA 12/12/2002 1006.00 4 83C 020806189A 08/06/2002 KIMMETT, CHRISTOPHER 12/12/2002 1066.00 4 83C 020806189B 08/06/2002 HIMMELREICH, CODY M 12/12/2002 120 .00 4 83C 020806330A 08/11/2002 JORDAN, ERIKA 12/12/2002 1230.00 4 83C 020806357A 08/12/2002 SALAYANDIA-NORMAN, M • Date:12/12/2002 Weld County Paramedic Services Page: 3 Time:15:20 :56 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/12/2002 Thru 12/12/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 12/12/2002 965.00 4 83C 020806400B 08/13/2002 BECERRA, KAREN J 12/12/2002 150.00 4 83C 020806404A 08/13/2002 GARCIA, BERT 12/12/2002 70.52 4 83C 020806486A 08/16/2002 CONNELL, DERRALL W 12/12/2002 54.61 4 83C 020806506A 08/17/2002 CONNELL, DERRALL W 12/12/2002 150.00 4 83C 020806577A 08/20/2002 DEVORE, DOUGLAS S 12/12/2002 71.33 4 83C 020806581A 08/20/2002 DUKES, RAYFORD 12/12/2002 90.00 4 83C 020806590A 08/21/2002 FLORES, LORENZO 12/12/2002 59.36 4 82 020906936A 09/01/2002 JOHNSON, CELIA S 12/12/2002 1004.00 4 83C 020906961A 09/02/2002 WEBER, INA M 12/12/2002 81.00 4 83C 020906961A 09/02/2002 WEBER, INA M 12/12/2002 60.00 4 82 020907012A 09/03/2002 CALL, KAPTAIN 12/12/2002 980.00 4 83C 020907082A 09/05/2002 GRAY, RENE 12/12/2002 1055.00 4 83C 020907111A 09/06/2002 METOYER, KEN 12/12/2002 980.00 4 83C 020907112A 09/06/2002 WILKINSON, MARGARITA 12/12/2002 50.00 4 83C 020907202A 09/09/2002 WILLARD, JAMES E 12/12/2002 935.00 4 83C 020907203A 09/09/2002 CHURCHILL, ERIN 12/12/2002 150.00 4 83C 020907214A 09/10/2002 THURBY, GILLIE 12/12/2002 64.07 4 82 020907411A 09/17/2002 PISHNA, WANDA 12/12/2002 1235.00 4 83C 020907437A 09/18/2002 GUAJARDO-RIVERA, ANA 12/12/2002 1055.00 4 83C 020907476A 09/20/2002 ROMERO, MARIA S 12/12/2002 81.75 4 83C 020907617A 09/25/2002 KLINE, ROBERT 12/12/2002 1130.00 4 83C 020907708A 09/28/2002 SEGURA, ESTEFANA 12/12/2002 1085.00 4 83C 020907740A 09/29/2002 GUTIERREZ, BRYAN K 12/12/2002 65.71 4 82 021007800A 10/01/2002 GARCIA, MIGUEL 12/12/2002 64.88 4 82 021007807A 10/01/2002 LUCERO, MAE E 12/12/2002 65.11 4 82 - 021007813A 10/02/2002 STEELE, MARCELLA L 12/12/2002 1285.00 4 83C 021007822A 10/02/2002 TAYLOR, JAMES ANDREW 12/12/2002 1010.00 4 83C 021007893A 10/04/2002 OSBORNE, RAYMOND 12/12/2002 54 .39 4 82 021007899A 10/05/2002 SIEH, TEDDY 12/12/2002 59.32 4 82 021007940A 10/06/2002 PHELPS, RHONDA 12/12/2002 62.04 4 82 021007964A 10/07/2002 WINDER, MOLLIE 12/12/2002 60.13 4 82 021007973A 10/07/2002 VELA, LUCY 12/12/2002 57.97 4 82 021008002A 10/08/2002 FRANK, JUDY 12/12/2002 64.90 4 82 021008004A 10/08/2002 HIATT, TERRY J 12/12/2002 60.15 4 82 021008019A 10/08/2002 STROM, TODD I 12/12/2002 62.85 4 82 021008087A 10/10/2002 HETTERLE, AMELIA 12/12/2002 920.00 4 83C 021008089A 10/10/2002 GARZA, ANGEL 12/12/2002 57.33 4 82 021008093A 10/11/2002 SANDOVAL, EMMA C 12/12/2002 57.33 4 82 021008108A 10/11/2002 MARTINEZ, ERNEST 12/12/2002 62.85 4 82 021008117A 10/11/2002 VELA, LUCY 12/12/2002 920 .00 4 83C 021008139A 10/12/2002 GARZA, ANGEL 12/12/2002 60 .98 4 82 021008159A 10/12/2002 DUMLER, ELSIE 12/12/2002 980.00 4 83C 021008175A 10/13/2002 KNUTSEN, ISAAC 12/12/2002 74 .47 4 82 021008179A 10/13/2002 DERRERA, PAULINE 12/12/2002 749.70 4 82 021008230A 10/15/2002 GUZMAN, DENAJHA 12/12/2002 1290.33 4 83C 021008333A 10/18/2002 PERRY, MARY ALICE 12/12/2002 1085.00 4 83C 021008364A 10/19/2002 BRENNER, KATIE L 12/12/2002 1070.00 4 83C 021008452A 10/22/2002 SAMROSKA, RON 12/12/2002 150.00 4 83C 021008454A 10/22/2002 GARZA, ANGEL Date:12/12/2002 Weld County Paramedic Services Page: 4 Time:15:20:57 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/12/2002 Thru 12/12/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 12/12/2002 880.86 4 82 021008515A 10/24/2002 RIVERA, SONIA 12/12/2002 678.56 4 81 021008516A 10/24/2002 CHALUPSKY, EVELYN 12/12/2002 1100.00 4 83C 021008525A 10/24/2002 HERRERA, DAVID 12/12/2002 1022.08 4 82 021008547A 10/24/2002 JOHNSON, DONALD C 12/12/2002 760.26 4 81 021008550A 10/25/2002 CROSS, HARRY 12/12/2002 920.00 4 83C 021008558A 10/25/2002 CANO, CLARA J 12/12/2002 843.29 4 82 021008563A 10/25/2002 CARFIELD, RANDY A 12/12/2002 373 .35 4 82 021008569A 10/26/2002 CARFIELD, RANDY A 12/12/2002 950.00 4 83C 021008574A 10/26/2002 MERCADO, FRANCISCO M 12/12/2002 1070.00 4 83C 021008582A 10/26/2002 MARTINEZ, AMADOR 12/12/2002 1240 .00 4 83C 021008594A 10/27/2002 DAHLGREN, MICHAEL A W 12/12/2002 777.10 4 81 021008602A 10/27/2002 PEREA, ISABEL 12/12/2002 992 .08 4 82 021008617A 10/27/2002 VASQUEZ, LINDA F 12/12/2002 647.68 4 81 021008626A 10/28/2002 JERDEE, CHARLOTTE R 12/12/2002 1065.88 4 82 021008648A 10/28/2002 TOVAR, JESSICA 12/12/2002 678.55 4 81 021008710A 10/30/2002 GUTIERREZ, RODOLFO 12/12/2002 790 .60 4 82 021008752B 10/31/2002 ANDRADE, MARICURZ 12/12/2002 821.39 4 82 021008754A 10/31/2002 CARFIELD, RANDY A 12/12/2002 900 .00 4 83C 021108793A 11/02/2002 DIAZ ROMANO, JONATHA 12/12/2002 870 .00 4 83C 021108839A 11/04/2002 SOMMERS, CHARLES 12/12/2002 870 .00 4 83C 021108867A 11/04/2002 LOPEZ-VICENTE, CASIM 12/12/2002 1392 .50 4 83C 021108899A 11/06/2002 MARTINEZ-GUZMAN, GRE 12/12/2002 1392 .50 4 83C. 021108899B 11/06/2002 BENAVIDEZ, CELIA 12/12/2002 1145.00 4 83C 021108939A 11/07/2002 MEEKS, KATHY 12/12/2002 885.00 4 83C 021108992A 11/08/2002 CHILCOTT, WILLIAM 12/12/2002 1035.00 4 83C 021109129A 11/14/2002 GEFELLER, BILL 12/12/2002 870 .00 4 83C 021109137B 11/14/2002 ALVARADO, JOHN F 12/12/2002 1010 .00 4 83C 021109168A 11/15/2002 ROMERO, BARBARA 12/12/2002 59.42 4 83C 980301943A 03/27/1998 BRAY, MARTHA (BEULAH 12/12/2002 39.12 4 83C 980603754A 06/11/1998 BRAY, MARTHA BEULAH 12/12/2002 195.53 4 83C 990100171A 01/07/1999 BRAY, MARTHA BEULAH 12/12/2002 170.02 4 83C 991007425A 10/08/1999 BRAY, MARTHA BEULAH Total of 179 WriteOff Entries Totaling 102031.59 Dollars Average WriteOff: 570.01 Dollars Average Time:170 Days Date:12/12/2002 Weld County Paramedic Services Page: 5 Time:15:20:58 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/12/2002 Thru 12/12/2002 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 83C WRITEOFF TO COLLECTION AG 143 88098.49 616.07 194.52 82 MEDICAID WRITEOFF 30 10040.95 334.70 75.77 83FP WRITEOFF - FIELD PNOUNCEM 1 350.00 350.00 138.00 81 MEDICARE WRITEOFF 5 3542.15 708.43 46.20 Hello