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Home My WebLink About20033449 RESOLUTION RE: CANCELLATION OF 2003 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 2003 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 $1,522,646.85. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the aforementioned list of 2003 uncollectible accounts in the amount of$1,522,646.85 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 22nd day of December, A.D., 2003. BOARD OF COUNTY COMMISSIONERS If": ' WELD COUNTY, COLORADO ATTEST:LI/ EXCUSED Q David . Long, Chairman Weld County Clerk tot B `l 4 Robert D. M den, Pro-Tem Deputy Clerk to the Board M. J. eile (�D AST M: 17/7,— , William H. Jerk" County Attorney at, pa4 Glenn Vaad Date of signature: zy9 2003-3449 AM0001 &I t r gal- . iv- 4,2.-64 MEMORANDUM TO: Claud Hanes, Accounting DATE:December 12, 2003 FROM: Kathy Baxley, Ambulance Service SUBJECT: Accounts Written Off in 2003 Attached are the lists of accounts written off in 2003 . Listed below are the amounts each month for a total of $1,522,646 . 85. 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 . Emspro Sanitas January $124 ,038 . 83 0 . 00 February $162 ,779 . 44 0 . 00 March $89, 838 .55 0 . 00 April $136, 027 . 13 0 . 00 May $137 , 888 . 53 $28 , 666 . 84 June $97 , 012 . 83 0 . 00 July $18 ,757 . 86 0 . 00 August $16, 897 . 33 0 . 00 September 0 . 00 0 . 00 October $20 , 904 . 43 $456,318 .12 November 0 . 00 $80 , 799 . 60 December $548 . 55 $152 ,168 . 81 Total $804 , 693 . 48 $717 , 953 . 37 2003-3449 I I I Date:01/15/2003 Weld County Paramedic Services Page: 1 Time:12 :14:32 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/08/2003 844 .00 4 83C 020201096A 02/06/2002 CARRERA, NORMA 01/08/2003 89.43 4 83C 020201323A 02/14/2002 KNIGHT, PATRICIA R 01/08/2003 529.46 4 83C 020201573A 02/22/2002 KNIGHT, PATRICIA R 01/08/2003 28.58 4 83C 020302510A 03/28/2002 DORSEY, EDWARD 01/08/2003 179.60 4 83C 020402877A 04/11/2002 HEADDY, JOHN 01/08/2003 137.20 4 83C 020402880A 04/11/2002 HEADDY, JOHN 01/08/2003 12 .00 4 83C 020503507A 05/04/2002 FOLDEN, SANDRA 01/08/2003 874 .00 4 83C 020503667A 05/09/2002 PITTMAN, MABLE 01/08/2003 50 .94 4 83C 020604707A 06/18/2002 ANDERSON, ANDY 01/08/2003 79.13 4 83C 020604928A 06/25/2002 FINDLATER, JOHN 01/08/2003 1074 .00 4 83C 020705425A 07/09/2002 BROOMFIELD, BRUCE 01/08/2003 73.36 4 83C 020705661A 07/18/2002 FINDLATER, JOHN 01/08/2003 73 .54 4 83C 020705743A 07/21/2002 DELGADO, MARY S 01/08/2003 120.00 4 83C 020806141A 08/04/2002 CHAVEZ, JENEA 01/08/2003 120.00 4 83C 020806143A 08/04/2002 CASSIDY, ERIN E 01/08/2003 874.00 4 83C 020806223A 08/07/2002 CRANMER, DAVID 01/08/2003 1282 .00 4 83C 020806227A 08/07/2002 DAVIDSON, WANDA 01/08/2003 790.00 4 83C 020806250A 08/08/2002 BASCUNAN, CHITO 01/08/2003 922 .00 4 83C 020806316A 08/11/2002 BARCELONA, RONALD R 01/08/2003 1205.00 4 83C 020806413A 08/14/2002 ADAME, STEPHANIE 01/08/2003 1130 .00 4 83C 020806436A 08/15/2002 ARENAS, JORGE 01/08/2003 1055 .00 4 83C 020806463A 08/16/2002 DELTORO, TIBURCIO M 01/08/2003 980.00 4 83C 020806503B 08/17/2002 LIPE, CHRISTOPHER 01/08/2003 1175.00 4 83C 020806519A 08/18/2002 ALVAREZ, DANIEL 01/08/2003 870.00 4 83C 020806636A 08/22/2002 DENO, MARK R 01/08/2003 1010.00 4 83C 020806692A 08/24/2002 BENAVIDEZ, GENEVA 01/08/2003 1055.00 4 83C 020806733A 08/25/2002 MEDINA, ADRIAN J 01/08/2003 150 .00 4 83C 020806734A 08/25/2002 COLLINS, GLENN 01/08/2003 1055.00 4 83C 020806739A 08/25/2002 FORBES, MARIA 01/08/2003 150 .00 4 83C 020806830A 08/28/2002 CORRALEJO, AARYN 01/08/2003 150 .00 4 83C 020806840B 08/28/2002 HEDELL, BEVERLEY 01/08/2003 1055.00 4 83C 020806902A 08/31/2002 BAREA, JOHN 01/08/2003 1100.00 4 83C 020906943A 09/01/2002 BAKER, CAROL 01/08/2003 150 .00 4 83C 020906968A 09/02/2002 CRUZ, ALEXANDER 01/08/2003 1025.00 4 83C 020906996A 09/03/2002 ARRIAGA, ROSALIO 01/08/2003 1145.00 4 83C 020907033A 09/04/2002 COLE, JOSHUA D 01/08/2003 1070.00 4 B3C 020907052A 09/04/2002 FERGUSON, MICHAEL J 01/08/2003 885.00 4 83C 020907152A 09/07/2002 CASSELMAN, SHAY 01/08/2003 1020.00 4 83C 020907466A 09/19/2002 CALVILLO-HOFF, SHEIL 01/08/2003 450.00 4 83C 020907470A 09/19/2002 CALVILLO-HOFF, SHEIL 01/08/2003 1290 .00 4 83C 020907612A 09/24/2002 CASSELMAN, SHAY 01/08/2003 985.33 4 83C 021108921A 11/06/2002 LOPEZ, JOHN A 01/08/2003 955.33 4 83C 021109096A 11/13/2002 LOPEZ, JOHN A 01/08/2003 1065.00 4 83C 021109180A 11/16/2002 TRACY, WENDI 01/08/2003 925.33 4 83C 021109482A 11/26/2002 LOPEZ, JOHN A 01/08/2003 1130.00 4 83C 021109526A 11/28/2002 LOPEZ, JOHN A 01/08/2003 1025.00 4 83C 021209873A 12/12/2002 BROWN, JAMES 01/08/2003 870.00 4 83C 021209987A 12/15/2002 FRISBIE, JOSEPH C 01/09/2003 654.00 4 82 010201519A 02/23/2001 MCEWEN, KAREN I I Date:01/15/2003 Weld County Paramedic Services Page: 2 Time:12:14:34 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/09/2003 348.00 4 83C 011008574A 10/25/2001 GYDESEN, CAMARYN 01/09/2003 593 .00 4 83C 011109265A 11/18/2001 MARTINEZ, PEDRO 01/09/2003 748.00 4 82 020100126A 01/04/2002 ROBERTS, BRYCE 01/09/2003 46.23 4 82 020100231A 01/08/2002 CAZER, KATIE 01/09/2003 220.60 4 83C 020100604A 01/20/2002 TAYLOR, KATY 01/09/2003 37.44 4 82 020302514A 03/28/2002 WERNER, MOLLIE 01/09/2003 1318 .00 4 83C 020503705A 05/11/2002 CLUSTER-MORRIS, JAYS 01/09/2003 60 .00 4 83C 020503814A 05/15/2002 CLUSTER-MORRIS, JAYS 01/09/2003 836.00 4 83C 020604252A 06/01/2002 GONZALES, JUAN 01/09/2003 764 .00 4 83C 020604272B 06/02/2002 MARTINEZ, BABY BOY 01/09/2003 147.20 4 83C 020604722A 06/18/2002 CONN, ROBERT 01/09/2003 826.00 4 83C 020604938A 06/25/2002 WILLIAMS, JOSEPH 01/09/2003 120 .00 4 83C 020705553A 07/14/2002 GALICIA, KOBY 01/09/2003 826 .00 4 83C 020705565A 07/14/2002 TRUJILLO, MICHAEL 01/09/2003 74.19 4 83C 020705587A 07/15/2002 HARVEY, HARRY R 01/09/2003 1070.00 4 83C 020705637A 07/17/2002 MAGNUSON, GLEN 01/09/2003 668.52 4 82 020705677A 07/19/2002 KRAUSE, KRISTINA K 01/09/2003 934.00 4 83C 020705700A 07/20/2002 VOLNER, MATTHEW 01/09/2003 1066.00 4 83C 020705705A 07/20/2002 MONCIVAIS, B J 01/09/2003 850.00 4 83C 020705719A 07/21/2002 ROSE, RON 01/09/2003 462 .00 4 83C 020705736A 07/21/2002 MCHENRY, KODY 01/09/2003 958.00 4 83C 020705844A 07/25/2002 ROST, JESSY 01/09/2003 1154.00 4 83C 020705882A 07/27/2002 LOMA, JUAN ANTONIO 01/09/2003 820 .00 4 83C 020705950A 07/29/2002 SCATTERDAY, JANICE 01/09/2003 874.00 4 83C 020705963B 07/29/2002 KEEVER, HEATHER 01/09/2003 750.00 4 83C 020705963C 07/29/2002 MERCADO, AMBER 01/09/2003 24.00 4 83C 020705973B 07/29/2002 KLOCKSIEM, JOHN 01/09/2003 774 .00 4 83C 020806035A 08/01/2002 MONTEZANO, MARIA 01/09/2003 774.00 4 83C 020806039A 08/01/2002 SIAS, TEODORO 01/09/2003 724. 00 4 83C 020806059B 08/01/2002 GRAVES, LYNN 01/09/2003 374 .00 4 83C 020806074A 08/02/2002 ROSE, RON 01/09/2003 724 .00 4 83C 020806106A 08/03/2002 VALLES, VERONICA E 01/09/2003 900.00 4 83C 020806111A 08/03/2002 MAYORGA, RAMIRO 01/09/2003 850. 00 4 83C 020806111B 08/03/2002 MAYORGA, VIDAL 01/09/2003 896 .00 4 83C 020806136A 08/04/2002 SIMPER, THAYNE ' 01/09/2003 856.00 4 83C 020806137A 08/04/2002 LEE, JAMES 01/09/2003 120.00 4 83C 020806167A 08/05/2002 SCHMITZ, ELIZABETH 1 01/09/2003 724 .00 4 83C 020806220A 08/07/2002 VALENZUELA, CARLOS 01/09/2003 894 .00 4 83C 020806221A 08/07/2002 SHANNON, HELEN J 01/09/2003 422.00 4 83C . 020806245A 08/08/2002 PETERSON, LONN 01/09/2003 120 .00 4 83C 020806262A 08/09/2002 SREDGISTER, SARAH 01/09/2003 120 . 00 4 83C 020806283A 08/09/2002 LONG, LONNIE 01/09/2003 120.00 4 83C 020806288A 08/10/2002 MALDONADO, BRIAN 01/09/2003 814.00 4 83C 020806325A 08/11/2002 RUGGLES, JEFFREY L 01/09/2003 374 .00 4 83C 020806329A 08/11/2002 RUGGLES, JEFFREY L 01/09/2003 1235.00 4 83C 020806377A 08/13/2002 SCHMIER, SUSAN 01/09/2003 150.00 4 83C 020806380A 08/13/2002 FERRARAS, TAMMY 01/09/2003 1070 .00 4 83C 020806384A 08/13/2002 GOMORA, HUGO 01/09/2003 920 .00 4 83C 020806402A 08/13/2002 PEREZ, EDUARDO i I Date:01/15/2003 Weld County Paramedic Services Page: 3 Time:12 :14:35 Receipt, Write-off, Adjustment Batch Report - MRR300 'F WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/09/2003 150.00 4 83C 020806419A 08/14/2002 HILL, WALTER 01/09/2003 150.00 4 83C 020806420A 08/14/2002 KUWAZAKI, MARCELLA S 01/09/2003 1235.00 4 83C 020806428A 08/14/2002 LUCERO, DENNIS L 01/09/2003 1070 .00 4 83C 020806473B 08/16/2002 MIRANDA, OSCAR 01/09/2003 1130.00 4 83C 020806482A 08/16/2002 PEARSON, HEATHER M 01/09/2003 1100.00 4 83C 020806500B 08/17/2002 HALL, SHALAMAR J 01/09/2003 950. 00 4 83C 020806549A 08/19/2002 PARKER, STEPHANIE 01/09/2003 965 .00 4 83C 020806549B 08/19/2002 PARKER, BRIANNA 01/09/2003 1445.00 4 83C 020806549C 08/19/2002 LEFFORGE, KODY 01/09/2003 150 .00 4 83C 020806565A 08/20/2002 LIDDEKEE, MIKE 01/09/2003 150.00 4 83C 020806573A 08/20/2002 HERNANDEZ, ELIAS 01/09/2003 240.00 4 83C 020806609A 08/21/2002 SEDUSTINE, BENNY L 01/09/2003 1095.00 4 83C 020806612A 08/22/2002 BROADHEAD, ROSALYN 01/09/2003 930 .00 4 83C 020806626A 08/22/2002 KIMBER, WILLIAM 01/09/2003 1165.00 4 83C 020806641A 08/23/2002 GARDNER, WILLIAM O 01/09/2003 150.00 4 83C 020806652A 08/23/2002 INFANTE, JENNIFER 01/09/2003 1020.00 4 83C 020806665A 08/23/2002 GRIFFIN, NICHOLAS 01/09/2003 995.00 4 83C 020806666A 08/23/2002 VIGIL, JESSICA 01/09/2003 150 .00 4 83C 020806675A 08/24/2002 HERBECK, THOMAS 01/09/2003 980. 00 4 83C 020806682A 08/24/2002 SHUTT, STEVEN J 01/09/2003 935.00 4 83C 020806694A 08/24/2002 SHARP, CHAD 01/09/2003 885.00 4 83C 020806708A 08/24/2002 HAMILTON, SAVANAH 01/09/2003 1008.35 4 82 020806732A 08/25/2002 CASTANEDA-ONOFRE, AL 01/09/2003 150.00 4 83C 020806742A 08/25/2002 MAGNUSON, GLEN 01/09/2003 1055.00 4 83C 020806767A 08/26/2002 GREEN, STEWART W 01/09/2003 1055.00 4 83C 020806771A 08/26/2002 HENDERSON, SARAH J 01/09/2003 150. 00 4 83C 020806775A 08/26/2002 SNELL, KIMBERLY 01/09/2003 150.00 4 83C 020806798A 08/27/2002 FERNANDEZ, ROSELLE 01/09/2003 995.00 4 83C 020806834A 08/28/2002 SLACK, NADA D 01/09/2003 870 .00 4 83C 020806910A 08/31/2002 BONGE, ROBERT 01/09/2003 150 .00 4 83C 020806916A 08/31/2002 ASTORGA-GARCIA, GRAC 01/09/2003 975.00 4 83C 020906940A 09/01/2002 GOODWIN, KATIE 01/09/2003 150.00 4 83C 020907006A 09/03/2002 GONZALES, JUAN 01/09/2003 1085.00 4 83C 020907011A 09/03/2002 KING, DONALD 01/09/2003 150.00 4 83C 020907069A 09/05/2002 GARCIA, ALFRED 01/09/2003 1085 .00 4 83C 020907079A 09/05/2002 GONZALEZ, ISAAC 01/09/2003 150 .00 4 83C 020907127A 09/07/2002 KOVACS, MATTHEW SCOT 01/09/2003 1055.00 4 83C . 020907165A 09/08/2002 GITIS, EVGUENI 01/09/2003 870.00 4 83C 020907173A 09/08/2002 MARCELENO, TONI 01/09/2003 1085. 00 4 83C 020907227A 09/10/2002 GARZA, JEREMY 01/09/2003 67.15 4 82 020907239A 09/10/2002 SNIDER, VIOLET 01/09/2003 62 .85 4 82 020907328A 09/14/2002 WERNER, MOLLIE 01/09/2003 150 .00 4 83C 020907382A 09/16/2002 HESSLER, CHRISTINE 01/09/2003 87.62 4 82 021007995A 10/08/2002 GARBISO, MARIA 01/09/2003 980.00 4 83C 021008127A 10/11/2002 TRUJILLO, LARRY 01/09/2003 62 .45 4 82 021008339A 10/18/2002 ERASMUS, MARIA 01/09/2003 64.30 4 82 021008588A 10/26/2002 TORREZ, FELICITAS 01/09/2003 72 .09 4 82 021008602A 10/27/2002 PEREA, ISABEL 01/09/2003 64.88 4 82 021008607A 10/27/2002 TOLBERT, NELLIE Date:01/15/2003 Weld County Paramedic Services Page: 4 Time:12 :14 :36 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/09/2003 65 .42 4 82 021008608A 10/27/2002 FARMER, TOMMIE J 01/09/2003 915.02 4 82 021008688A 10/29/2002 HATFIELD, TANAREE 01/09/2003 64.88 4 82 021008710A 10/30/2002 GUTIERREZ, RODOLFO 01/09/2003 63 .39 4 82 - 021008719A 10/30/2002 CLYMER, DORIS 01/09/2003 65.08 4 82 021008739A 10/31/2002 VANGRAEPSCHEPE, GERA 01/09/2003 53 .26 4 82 021108786A 11/01/2002 MARTINEZ, JULIA A 01/09/2003 62.04 4 82 021108800A 11/02/2002 DERRERA, PAULINE 01/09/2003 62 .04 4 82 021108801A 11/02/2002 PROVANCHA, ELMER 01/09/2003 57.97 4 82 021108806A 11/02/2002 DERRERA, PAULINE 01/09/2003 62.04 4 82 021108836A 11/03/2002 FARLEY, MARJORIE J 01/09/2003 58 .99 4 82 021108850A 11/04/2002 SUGGS, COY 01/09/2003 64 .51 4 82 021108852A 11/04/2002 DIETERLE, ALEX 01/09/2003 62.04 4 82 021108871A 11/04/2002 HOSCHOUER, FANNY 01/09/2003 53 .26 4 82 021108874A 11/04/2002 HOSCHOUER, FANNY 01/09/2003 64 .88 4 82 021108882A 11/05/2002 MOJICA, MARIA 01/09/2003 54 .61 4 82 021108895A 11/05/2002 BENAVIDEZ, ANNA 01/09/2003 65.71 4 82 021108897A 11/05/2002 ARGUELLO, VIOLA 01/09/2003 972 .84 4 81 021108947A 11/07/2002 BENAVIDEZ, JR, LUCIO 01/09/2003 630.94 4 81 021108955A 11/07/2002 HAGGIN, JOHN T 01/09/2003 678.56 4 81 021108994A 11/08/2002 SIEH, TEDDY 01/09/2003 657 .75 4 81 021109008A 11/09/2002 BEHM, HENRY I 01/09/2003 1087.88 4 82 021109025A 11/09/2002 CASTILLO, ELIA 01/09/2003 658 .64 4 81 021109041A 11/10/2002 MCCREERY, ELLA G 01/09/2003 821.34 4 81 021109046A 11/10/2002 KNAUS, KATHERINE 01/09/2003 59.20 4 82 021109052A 11/11/2002 KERCHER, THEODORE 01/09/2003 780 .68 4 81 021109054A 11/11/2002 BROWN, HAROLD 01/09/2003 738.54 4 82 021109095A 11/13/2002 ADAMS, ANDRE 01/09/2003 59.20 4 82 021109117A 11/13/2002 WINTER, DAVID 01/09/2003 678.56 4 81 021109136A 11/14/2002 VILLA, MICAELA 01/09/2003 1170 .23 4 81 021109144A 11/15/2002 STALLSWORTH, RICHARD 01/09/2003 669.11 4 81 021109147A 11/15/2002 ANNAN, LYDIA S 01/09/2003 790.25 4 81 021109155A 11/15/2002 WALTER, LOIS 01/09/2003 887.58 4 82 021109170A 11/15/2002 VIGIL, LORI 01/09/2003 59.20 4 82 021109176A 11/16/2002 GRANTHAM, BRAD 01/09/2003 854.89 4 81 021109198A 11/17/2002 TYS, LOUISE M 01/09/2003 789 .04 4 82 021109254A 11/19/2002 MORENO, RAYLEEN 01/09/2003 1315 .77 4 82 021109258A 11/19/2002 MORENO, RAYLEEN 01/09/2003 791.09 4 82 021109276A 11/20/2002 HURTADO, SANDY V 01/09/2003 860.60 4 82 021109309A 11/21/2002 ZELLER, NATHAN J 01/09/2003 902 .58 4 82 021109334A 11/22/2002 RODRIGUEZ, ALICIA 01/09/2003 818 .53 4 82 021109444A 11/25/2002 BLACK, TIMOTHY D 01/09/2003 183 .72 4 81 021109469A 11/25/2002 KENDEIGH-MCNAIR, EST 01/09/2003 1046.72 4 82 021109479A 11/26/2002 LUCERO, HALEIGH J 01/09/2003 964 .40 4 82 021109492A 11/27/2002 BLACK, TIMOTHY D 01/09/2003 942.46 4 82 021109535A 11/29/2002 BLACK, TIMOTHY D 01/09/2003 789 .04 4 82 021109555A 11/30/2002 RHODES, KATHY 01/09/2003 777.37 4 82 021209572A 12/01/2002 RHODES, KATHY 01/09/2003 853 .57 4 82 021209624A 12/03/2002 WAYMAN, PENNY M 01/09/2003 939.52 4 82 021209637A 12/03/2002 VIGIL, LORI I . Date:01/15/2003 Weld County Paramedic Services Page: 5 Time:12 :14 :38 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/09/2003 870.98 4 82 021209647A 12/04/2002 DURYEA, KELLY 01/09/2003 939.52 4 82 021209650A 12/04/2002 CROOK, DUSTIN L 01/09/2003 1616 .02 4 82 021209660A 12/04/2002 GLANZ, MAREE-CLARE 01/09/2003 AMB 150.00 4 82 021210318A 12/29/2002 KLINE, SIERRA 01/10/2003 11.10 4 70CE 000100273A 01/12/2000 LOYA, JAIDO 01/10/2003 50.00 4 70CE 000100453A 01/20/2000 FRANCIS, TROY 01/10/2003 10 .75 4 70CE 000100453A 01/20/2000 FRANCIS, TROY 01/10/2003 26 .66 4 70CE 000301833A 03/14/2000 ESPARZA, APRIL 01/10/2003 8 .33 4 70PF 000301954A 03/19/2000 KELM, JACK 01/10/2003 8.33 4 70CE 000402475A 04/07/2000 COLIN, MARIA 01/10/2003 50.00 4 70CE 000503465A 05/13/2000 ESPINO, YOLANDA 01/10/2003 6.66 4 70CE 000503744A 05/23/2000 OLVERA, YOLANDA 01/10/2003 25.00 4 70CE 000503878A 05/29/2000 GARCIA, OBED 01/10/2003 8.73 4 70CE 000503931A 05/30/2000 ROMERO, REGINA 01/10/2003 6.66 4 70CE 000705456A 07/19/2000 GATES, LASHAUNTA 01/10/2003 211.73 4 70CE 000806179B 08/14/2000 PANTOJA, VICENTE 01/10/2003 332 .00 4 70CE 000806455B 08/23/2000 HERNANDEZ, JOSE 01/10/2003 33 .33 4 70CE 000907042A 09/12/2000 SANCHEZ, REBEKAH J 01/10/2003 20.00 4 70CE 000907117A 09/15/2000 MASTERS, NANCY 01/10/2003 5.00 4 70CE 000907117A 09/15/2000 MASTERS, NANCY 01/10/2003 6.25 4 70CE 000907117A 09/15/2000 MASTERS, NANCY 01/10/2003 17.80 4 70CE 000907117A 09/15/2000 MASTERS, NANCY 01/10/2003 265.00 4 70PF 000907130A 09/15/2000 HARTMAN, DAVID 01/10/2003 33.33 4 70CE 001008296A 10/27/2000 MORALES, DANIELA A 01/10/2003 26.66 4 70CE 001108767A 11/13/2000 TRIMBLE, SUSAN 01/10/2003 12 .50 4 70CE 001108834A 11/15/2000 SMITH, BETH 01/10/2003 50 .00 4 70CE 001108834A 11/15/2000 SMITH, BETH 01/10/2003 70.13 4 70CE 001108917A 11/18/2000 ENCINIA, VICTORIA 01/10/2003 78.60 4 70CE 001108917A 11/18/2000 ENCINIA, VICTORIA 01/10/2003 98.33 4 70PF 001108967A 11/21/2000 DURAN DE LUJAN, MARI 01/10/2003 77 .52 4 70CE 001109104A 11/27/2000 MARTINEZ, ELIZABETH 01/10/2003 68.23 4 70CE 001109104A 11/27/2000 MARTINEZ, ELIZABETH 01/10/2003 6.33 4 70CE 001209179A 12/01/2000 RANSOM, KARISSA 01/10/2003 4 .11 4 70CE 010100505A 01/18/2001 HERNANDEZ, ERICA G 01/10/2003 100 .00 4 70CE 010201087A 02/07/2001 ENDSLEY, PAM 01/10/2003 25.00 4 70CE 010201214A 02/12/2001 GESICK, CASEY L 01/10/2003 664.00 4 70CE 010201231A 02/12/2001 STROH, RENEE 01/10/2003 16.66 4 70CE 010301910A 03/10/2001 VANCE, JONATHON 01/10/2003 23 .50 4 70CE 010402545A 04/02/2001 WHITETAIL, JENNIFER 01/10/2003 150.56 4 70CE 010402619A 04/05/2001 LOOK, ALBERT 01/10/2003 18.13 4 70CE 010403054A 04/19/2001 SANDOVAL, JOSIE 01/10/2003 33 .33 4 70CE 010403155A 04/21/2001 VELAZQUEZ, EDUARDO 01/10/2003 14 .82 4 70CE 010403207A 04/22/2001 BOBBITT, ELLEN L 01/10/2003 11.66 4 70CE 010604628A 06/14/2001 LONGAKER, BRENDAN G 01/10/2003 26.66 4 70CE 010604780A 06/19/2001 SHIVELY, MICHELLE 01/10/2003 33 .33 4 70CE 010705795A 07/24/2001 BALDERRAMA, OCTAVIO 01/10/2003 9.72 4 70PF 010806280A 08/08/2001 ARCHULETA, MICHAEL 01/10/2003 168.85 4 70CE 010806337A 08/10/2001 VARANO, MEGAN 01/10/2003 196.47 4 70CE 010806685A 08/21/2001 CONNALLY, THOMAS M i Date:01/15/2003 Weld County Paramedic Services Page: 6 Time:12 :14:40 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/10/2003 17.14 4 70CE 010806688A 08/21/2001 MALKASIAN, MITCHELL 01/10/2003 63 .60 4 70CE 010806816A 08/25/2001 PINO, LORRAINE 01/10/2003 100.00 4 70CE 010907034A 09/03/2001 MARLIN, BRANDON L 01/10/2003 33 .33 4 70CE 010907141A 09/06/2001 LIBSACK, TYLER 01/10/2003 7 .29 4 70CE 010907363A 09/13/2001 VAN WINKLE, CURTIS 01/10/2003 12 .66 4 70PF 010907445A 09/16/2001 ALTHAUSER, TIM 01/10/2003 6 .33 4 70PF 010907445A 09/16/2001 ALTHAUSER, TIM 01/10/2003 26.66 4 70CE 010907861A 09/30/2001 IBARRA, JAZMIN YAZEL 01/10/2003 45.58 4 70CE 011008105A 10/09/2001 HERRERA, MINDY 01/10/2003 16.66 4 70CE 011008339A 10/17/2001 LUEVANO-J.ARRA, MARIA 01/10/2003 199.50 4 70PF 011108930A 11/06/2001 STOLLSTEIMER, SARA 01/10/2003 16.66 4 70CE 011109037A 11/10/2001 SUTTON, ANITA L 01/10/2003 165 .87 4 70PF 011109156A 11/15/2001 FRAZIER, DORIS 01/10/2003 49.99 4 70CE 011109263A 11/18/2001 CHRISTIANSEN, BRIAN 01/10/2003 290.00 4 70CE 011209892A 12/13/2001 SCHMIER, SUSAN 01/10/2003 235.73 4 70PF 011210173A 12/23/2001 WALDEN, LARRY 01/10/2003 252.66 4 70PF 011210253E 12/26/2001 GALINDO, ROBERT 01/10/2003 8.33 4 70CE 020100376A 01/11/2002 GARZA, FRED 01/10/2003 8.33 4 70CE 020100376A 01/11/2002 GARZA, FRED 01/10/2003 6.66 4 70CE 020100750A 01/25/2002 JONES, GERALD ANTHON 01/10/2003 33 .33 4 70CE 020100939A 01/31/2002 RIVAS, OLGA 01/10/2003 278.58 4 70PF 020201509A 02/20/2002 CARABAJAL, JOHNNY 01/10/2003 10.00 4 70CE 020301929B 03/07/2002 MILLER, BRITTANY 01/10/2003 50.00 4 70CE 020302064A 03/11/2002 LOPEZ, ROBERTO 01/10/2003 112.50 4 70CE 020302188A 03/15/2002 MYERS, ANDREW 01/10/2003 40.00 4 70CE 020302337A 03/22/2002 TANGUMA, ENNCO 01/10/2003 12 .50 4 70CE 020302599A 03/31/2002 SCHAFFER, SHURRI 01/10/2003 137.93 4 70CE 020403236A 04/25/2002 JARAMILLO, JOSE ANDR 01/10/2003 23.50 4 70CE 020403298A 04/27/2002 CERVANTES, MARLENE 01/10/2003 25.00 4 70CE 020403298A 04/27/2002 CERVANTES, MARLENE 01/10/2003 55.16 4 70PF 020403318A 04/27/2002 DALUGE, SCOTT 01/10/2003 40.00 4 70PF 020403328A 04/27/2002 BUNJES, EVA MAY 01/10/2003 291.33 4 70CE 020503471A 05/03/2002 ARCHULETA, DESIREE 01/10/2003 20.33 4 70CE 020503734A 05/12/2002 GUEVARA, GINGER 01/10/2003 32.00 4 70PF 020504003A 05/23/2002 MELENDEZ, SUSANA 01/10/2003 33.33 4 70CE 020604256A 06/02/2002 FLORES-FEMAT, PASCUA 01/10/2003 36.00 4 70PF 020604809A 06/21/2002 SALAZAR, JEREMY 01/10/2003 99.16 4 70PF 020604842A 06/22/2002 SANDOVAL, EUSEBIO 01/10/2003 72.66 4 70CE 020605092A 06/30/2002 HEATH, HARRY 01/10/2003 40.00 4 70CE 020705230A 07/04/2002 PHILLIPSEN, DANA LIG 01/10/2003 32.00 4 70PF 020705254A 07/05/2002 OLIVARES MORAN, RAFA 01/10/2003 607.25 4 84 021008194A 10/13/2002 MCHUGH-IANGHOFF, DEN 01/10/2003 355.00 4 70PF 021008517A 10/24/2002 ABRAMS, EDWARD 01/10/2003 AMB 150 .00 4 82 021210369A 12/31/2002 HUNTINGTON, AUTUMN 01/10/2003 85.23 4 70CE 910909095A 09/09/1991 ARCHULETA, THERESA 01/10/2003 11.16 4 70CE 910909095A 09/09/1991 ARCHULETA, THERESA 01/10/2003 37.52 4 70CE 920811120A 08/11/1992 GALINDO, MARY 01/10/2003 13.33 4 70CE 941005790A 10/09/1994 APARISO, MARCELLA 01/10/2003 41.66 4 70CE 950704240A 07/12/1995 FLEMING, JAMES Date:01/15/2003 Weld County Paramedic Services Page: 7 Time:12 :14 :42 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/10/2003 26.66 4 70CE 950905989A 09/21/1995 VEDEN, KATHIE 01/10/2003 25.00 4 70CE 951107146A 11/06/1995 GOMEZ, MISTI 01/10/2003 51.17 4 70CE 960200752B 02/06/1996 MONTOYA, CHRISTINA 01/10/2003 150 .66 4 70CE 960201182A 02/27/1996 GONZALES, LISA 01/10/2003 5 .00 4 70CE 960603647A 06/16/1996 DUDICK, JAMES 01/10/2003 53 .95 4 70CE 960905413A 09/01/1996 CONTRERAS, JUAN 01/10/2003 79.78 4 70CE 960905473A 09/03/1996 SPARKS, EDWARD 01/10/2003 6.07 4 70CE 960905629A 09/09/1996 ERVASTI, MISTY 01/10/2003 81.00 4 70CE 960905814A 09/18/1996 GUERRERO, JOEY 01/10/2003 145.83 4 70CE 961107056A 11/14/1996 PADILLA, MAX 01/10/2003 346.18 4 70CE 961107063A 11/15/1996 MARES, JOHN 01/10/2003 25.00 4 70CE 970100640A 01/30/1997 LUCERO, BRENDA 01/10/2003 25.00 4 70CE 970100640A 01/30/1997 LUCERO, BRENDA 01/10/2003 25.00 4 70CE 970100640A 01/30/1997 LUCERO, BRENDA 01/10/2003 16.66 4 70CE 970201126A 02/21/1997 AGUILERA, GABRIEL 01/10/2003 16.66 4 70CE 970201126A 02/21/1997 AGUILERA, GABRIEL 01/10/2003 50.00 4 70CE 970201176A 02/23/1997 LUDWIG, PAUL 01/10/2003 58.00 4 70CE 970402057A 04/03/1997 WILLIAMS, MARIA 01/10/2003 25.00 4 70CE 970402371A 04/16/1997 SICKLER, LEROY 01/10/2003 3.49 4 70CE 970502925A 05/10/1997 GEORGE, ROBERT 01/10/2003 76.40 4 70CE 970603478A 06/02/1997 RODRIGUEZ, KEITH 01/10/2003 10.91 4 70CE 970906136A 09/16/1997 MERRELL, CATHERINE 01/10/2003 32 .50 4 70CE 971006954A 10/20/1997 HERNANDEZ, SIMON 01/10/2003 17.50 4 70CE 971107332A 11/04/1997 SERNA, JUAN FRANCISC 01/10/2003 25.00 4 70CE 971208191A 12/10/1997 VALENCIA, NATHAN 01/10/2003 25.00 4 70CE 971208191A 12/10/1997 VALENCIA, NATHAN 01/10/2003 302 .50 4 70CE 980100059A 01/02/1998 DUNN, ROSIE 01/10/2003 85.71 4 70CE 980402182A 04/06/1998 RODRIGUEZ, ISRAEL 01/10/2003 47.21 4 70CE 980402182A 04/06/1998 RODRIGUEZ, ISRAEL 01/10/2003 25.00 4 70CE 980604083A 06/24/1998 TURECEK, ROBERT 01/10/2003 23 .18 4 70CE 980604083A 06/24/1998 TURECEK, ROBERT 01/10/2003 5 .00 4 70PF 980702099A 04/03/1998 HARRIS, ROBERT JOSEP 01/10/2003 7 .31 4 70CE 980805357A 08/13/1998 GOMEZ, ANDREA 01/10/2003 1.66 4 70PF 980906568A 09/29/1998 RAU, MARY E 01/10/2003 63 .50 4 70CE 981107836A 11/21/1998 BISHOP, SHIRLEY 01/10/2003 8.33 4 70CE 990100687A 01/25/1999 DURAN, CONSUELO 01/10/2003 16.66 4 70CE 990100687A 01/25/1999 DURAN, CONSUELO '... 01/10/2003 50 .00 4 70CE 990604104A 06/06/1999 REVELLO, FRANCIS K 01/10/2003 7.33 4 70CE 990705235A 07/17/1999 DUKE, JACQUELIN 01/10/2003 48 .75 4 70CE 990705559A 07/29/1999 BELL, STEVEN MICHAEL 01/10/2003 6.66 4 70CE 990806420A 08/29/1999 HEALEY, JAMES 01/10/2003 271.66 4 70CE. 990906915A 09/17/1999 RICHARDSON, SHAUN 01/10/2003 6.66 4 70CE. 991108153A 11/04/1999 ROYBAL, FRANCES 01/10/2003 37.50 4 70CE 991209210A 12/13/1999 GUERRA, GEORGE A 01/13/2003 424 .00 4 83C 001209848A 12/24/2000 RHODA, DAVID 01/13/2003 381.00 4 83C 010302342A 03/26/2001 WARD, TERRY 01/13/2003 656.00 4 83C 010705505A 07/14/2001 RODRIGUEZ, RICK J *S 01/13/2003 795 .33 4 81 020100228A 01/08/2002 UHRICH, HAROLD 01/13/2003 424.00 4 83C 020403276A 04/26/2002 ELRIDGE, JASON Date:01/15/2003 Weld County Paramedic Services Page: 8 Time:12 :14 :44 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/13/2003 814.00 4 83C 020503510A 05/04/2002 MILLER, JIM 01/13/2003 120.00 4 83C 020503638A 05/08/2002 VALDEZ, AMANDA 01/13/2003 374.00 4 83C 020503757A 05/13/2002 TRUJILLO, JESSICA L 01/13/2003 25.00 4 83C 020504012A 05/23/2002 TAPIA, CARLOS 01/13/2003 1186.00 4 83C 020504015A 05/23/2002 THOMAS, CHRIS 01/13/2003 128.40 4 83C 020604235A 06/01/2002 WHITE, STEPHANIE 01/13/2003 162. 80 4 83C 020604508A 06/10/2002 PIDRA, FRANCISCO 01/13/2003 533.38 4 81 020705520A 07/13/2002 SEVERSON, KAY 01/13/2003 1020 .00 4 83C 020806112C 08/03/2002 RAMIREZ JR, FRANCISC 01/13/2003 724.00 4 83C 020806132A 08/04/2002 RODRIGUEZ, JAVIER 01/13/2003 724.00 4 83C 020806132B 08/04/2002 RODRIGUEZ, BRICIA 01/13/2003 900.00 4 83C 020806140A 08/04/2002 WILSON, STEVEN "SKIP 01/13/2003 120 .00 4 83C 020806166A 08/05/2002 SHERMAN, LONNIE 01/13/2003 150 .00 4 83C 020806353A 08/12/2002 WIATROWSKI, STEPHEN 01/13/2003 1325.00 4 83C 020806371A 08/12/2002 SPRAGUE, ROBERT 01/13/2003 25.00 4 83C 020806381A 08/13/2002 TAPIA, CARLOS 01/13/2003 980.00 4 83C 020806534A 08/18/2002 XILOJ CHUN, EFRAIN 01/13/2003 150 .00 4 83C 020806542A 08/18/2002 FEATHER, JAMES 01/13/2003 25.00 4 83C 020806689A 08/24/2002 TAPIA, CARLOS 01/13/2003 0. 99 4 83 020806696A 08/24/2002 WOODARD, EMILY L 01/13/2003 648.56 4 81 020806736A 08/25/2002 GOODWIN, ROBERT H 01/13/2003 25.00 4 83C 020806737A 08/25/2002 TAPIA, CARLOS 01/13/2003 1065 .00 4 83C 020806746A 08/26/2002 VALVERDE, HIPOLITO 01/13/2003 150 .00 4 83C 020806815A 08/28/2002 SERRANO, DEBORAH 01/13/2003 150.00 4 83C 020907055A 09/05/2002 JACKSON, MICHAEL 01/13/2003 1085.00 4 83C 020907462A 09/19/2002 GUTIERREZ, LORI 01/13/2003 1070. 00 4 83C 020907468A 09/19/2002 COX, RANDALL S 01/13/2003 876 .00 4 83C 020907548A 09/22/2002 LINDERS, DUSTIN 01/13/2003 81.09 4 82 020907581A 09/23/2002 JENKINS, LORRAINE 01/13/2003 87.86 4 83C 020907660A 09/26/2002 COLLINS, HELEN 01/13/2003 1055.00 4 83C 020907662A 09/26/2002 ZAMORA, ELENA 01/13/2003 150.00 4 83C 021008006E 10/08/2002 FELKER, KRIS 01/13/2003 1325.00 4 83C 021008121A 10/11/2002 RICHNER, RAYMAN 01/13/2003 62 .04 4 82 021008208A 10/14/2002 SCHINDLER, MARTIN 01/13/2003 720.35 4 81 021008472A 10/22/2002 SEVERSON, KAY 01/13/2003 72.55 4 83C 021008510A 10/23/2002 HUSMAN, RICHARD 01/13/2003 150.00 4 83C 021008538A 10/24/2002 HEGGEN, PAULA 01/13/2003 870 .00 4 83C 021008543A 10/24/2002 KARR, LORI G 01/13/2003 930 .00 4 83C 021008585A 10/26/2002 COX, RANDALL S 01/13/2003 945. 00 4 83C 021008621A 10/28/2002 SANTILLAN, DANIEL J 01/13/2003 831.99 4 81 021008683A 10/29/2002 HAMILTON, DOROTHY 01/13/2003 759.05 4 81 021008689A 10/29/2002 WHITE, HELEN 01/13/2003 62 .04 4 82 021108931A 11/07/2002 LOGAN, ERIN 01/13/2003 658.26 4 81 021108940A 11/07/2002 BURBACK, VIRGINIA A 01/13/2003 62 .04 4 82 021108942A 11/07/2002 RHOADS, CLIFFORD F 01/13/2003 1107.24 4 82 021108945A 11/07/2002 VASQUEZ, PRISCILLA 01/13/2003 928. 03 4 82 021108952A 11/07/2002 GARCIA, BRYAN B 01/13/2003 980 .27 4 81 021108993A 11/08/2002 EHRLICH, OTTO . 01/13/2003 1528.50 4 82 021109024A 11/09/2002 ROSE, BARBARA Date:01/15/2003 Weld County Paramedic Services Page: 9 Time:12 :14:46 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/13/2003 975.00 4 83C 021109029A 11/09/2002 LUNA, INDALESIO 01/13/2003 66.54 4 82 021109049A 11/10/2002 KERCHER, THEODORE 01/13/2003 62.04 4 82 021109055A 11/11/2002 HELTENBERG, ZELLA L 01/13/2003 64.88 4 82 021109071A 11/11/2002 ARMENDARIZ, JESUS 01/13/2003 1061.82 4 82 021109076A 11/11/2002 LILES, DONNA 01/13/2003 958 .11 4 81 021109079A 11/12/2002 GUTIERREZ, JOSEPHINE 01/13/2003 150 .00 4 83C 021109092A 11/12/2002 FERNANDEZ, ROMANITA 01/13/2003 1048.03 4 82 021109131A 11/14/2002 SOLIS, MARY 01/13/2003 793 .29 4 82 021109139A 11/14/2002 ARGUELLO, YVONNE 01/13/2003 60 .15 4 82 021109141A 11/14/2002 SIEH, TED 01/13/2003 60 .13 4 82 021109158A 11/15/2002 RHOADS, CLIFFORD F 01/13/2003 941.22 4 82 021109162A 11/15/2002 MICHAEL, GERALD J 01/13/2003 900 .00 4 83C 021109172A 11/16/2002 MENDEZ-RAMIREZ, JORG 01/13/2003 65.71 4 82 021109184A 11/16/2002 SCHEIDING, GERHARD 01/13/2003 63 .68 4 82 021109187A 11/16/2002 SIEH, TEDDY 01/13/2003 64 .88 4 82 021109193A 11/16/2002 DILLARD, VERA FERN 01/13/2003 853 .03 4 82 021109207A 11/17/2002 LOPEZ, JESSICA 01/13/2003 618.56 4 81 021109225A 11/18/2002 DOUGHTY, HUGH R 01/13/2003 64.88 4 82 021109227A 11/18/2002 PACHECO, BERTHA E 01/13/2003 898.92 4 81 021109228A 11/18/2002 TORRIBIO, ALBERT J 01/13/2003 751.28 4 81 021109230A 11/18/2002 BALMER, RUTH 01/13/2003 66.94 4 82 021109261A 11/20/2002 BARRETT, HEIDI 01/13/2003 675.88 4 81 021109262A 11/20/2002 HARMON, THORA A I 01/13/2003 659.41 4 81 021109280A 11/20/2002 KUHNKE, LUCILLE F I01/13/2003 65.71 4 82 021109297A 11/21/2002 LUJAN, ELIZABETH M 01/13/2003 762.35 4 81 021109299A 11/21/2002 VILLA, MICAELA 01/13/2003 732.10 4 81 021109301A 11/21/2002 THOMPSON, RUTH M 01/13/2003 639.06 4 81 021109306A 11/21/2002 FENDEL, ELAINE 01/13/2003 707.58 4 81 021109328A 11/22/2002 DUELL, LUCILLE C 01/13/2003 708.56 4 81 021109333A 11/22/2002 LOOS, FRANCES 01/13/2003 694.51 4 81 021109335A 11/22/2002 MCCUNE, HELEN 01/13/2003 762.61 4 81 021109343A 11/22/2002 GIACOMA, HELEN M 01/13/2003 1005.94 4 81 021109351A 11/23/2002 GUTIERREZ, ABEL D 01/13/2003 707.41 4 81 021109353A 11/23/2002 SWANSON, MILDRED E 01/13/2003 69.03 4 82 021109356A 11/23/2002 ALFARO, ENCARNACION 01/13/2003 58.16 4 82 021109372A 11/23/2002 SIEH, TEDDY 01/13/2003 1160.00 4 83C 021109376A 11/23/2002 BURNS, JOSH 01/13/2003 773 .66 4 81 - 021109378A 11/24/2002 SAUCEDO, EULALIO 01/13/2003 647 .41 4 81 021109396A 11/24/2002 PADILLA, PLACIDA 01/13/2003 828.02 4 81 021109401A 11/24/2002 PAUL, VERA 01/13/2003 628.73 4 81 021109463A 11/25/2002 WEEDER, GRACE 01/13/2003 647 .58 4 82 021109470A 11/25/2002 PRESTON, JANET I 01/13/2003 700 .54 4 81 021109486A 11/26/2002 HURT, NORA 01/13/2003 1085.00 4 83C 021109508A 11/27/2002 HERNANDEZ, JESUS 01/13/2003 1535 .00 4 83C 021109508B 11/27/2002 ADAN, RAYMOND 01/13/2003 860 .46 4 81 021109539A 11/29/2002 LINDSCHMIDT, ROBERT 01/13/2003 1055.00 4 83C 021109562A 11/30/2002 MARKHAM, STEVEN CLAY 01/13/2003 1025.00 4 83C 021209712A 12/06/2002 HEGARTY, EDMOND F 01/13/2003 661.96 4 81 021209731A 12/07/2002 SCHOOLER, BERNICE M Date:01/15/2003 Weld County Paramedic Services Page:10 Time:12 :14 :47 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/13/2003 620 .68 4 81 021209746A 12/07/2002 MICHALIK, EUGENE E 01/13/2003 602 .27 4 81 021209748A 12/07/2002 MENDEZ, FRANCISCO 01/13/2003 570.00 4 82 021209749A 12/07/2002 BURNS, JOSEPH M 01/13/2003 699.08 4 81 021209754A 12/07/2002 WOOD, LULA 01/13/2003 648 .47 4 81 021209764A 12/08/2002 MARTINEZ, BERTHA 01/13/2003 628.73 4 81 021209773A 12/08/2002 JOHNSON, OLGA 01/13/2003 602 .27 4 81 021209775A 12/08/2002 ROWE, MARTHA 01/13/2003 628.73 4 81 021209779A 12/08/2002 WALLACE, GLADYS 01/13/2003 640.26 4 81 021209780A 12/08/2002 BUSBOOM, DOROTHY 01/13/2003 921.68 4 81 021209789A 12/09/2002 SUCKLA, FRANK 01/13/2003 735.27 4 82 021209797A 12/09/2002 BENDER, DAVE 01/13/2003 583 .37 4 81 021209798A 12/09/2002 MENDEZ, FRANCISCO 01/13/2003 638.98 4 81 021209801A 12/09/2002 FELAND, LOIS E 01/13/2003 688.23 4 81 021209811A 12/09/2002 GALLEGOS, MARY K 01/13/2003 730.78 4 82 021209816A 12/09/2002 BALMER, RUTH 01/13/2003 640 .26 4 81 021209818A 12/10/2002 RIVERA, EULALIA 01/13/2003 641.02 4 81 021209819A 12/10/2002 DILKA, LUCY 01/13/2003 648.47 4 81 021209827A 12/10/2002 HOWELL, VIOLA E 01/13/2003 641.02 4 81 021209841A 12/10/2002 THOMPSON, GEORGE D 01/13/2003 638.98 4 81 021209846A 12/11/2002 ALLES, MARIE 01/13/2003 638.30 4 81 021209847A 12/11/2002 ALLISON, LOIS 01/13/2003 627 .45 4 81 021209858A 12/11/2002 PROVANCHA, ELMER 01/13/2003 618 .56 4 81 021209862A 12/11/2002 LOPEZ, SARAH 01/13/2003 600.94 4 81 021209866A 12/11/2002 GUERRERO, MARIA 01/13/2003 618.56 4 81 021209872A 12/12/2002 GORE, DELBERT 01/13/2003 618.56 4 81 021209879A 12/12/2002 ZUMBRENNAN, EVA 01/13/2003 893.17 4 81 021209881A 12/12/2002 TOEDTLI, ELFA F 01/13/2003 590 .94 4 81 021209883A 12/12/2002 CARROLL, KATHRYN 01/13/2003 618.56 4 81 021209894A 12/12/2002 PARKER, BETTY 01/13/2003 618.56 4 81 021209903A 12/13/2002 SEVERSON, JOHN 01/13/2003 780.63 4 81 021209907A 12/13/2002 GONZALES, CHRISTINA 01/13/2003 592.10 4 81 021209908A 12/13/2002 STANLEY, SHERRY K 01/13/2003 661.28 4 81 021209913A 12/13/2002 WRZENSINKI, SHERRY L 01/13/2003 618 .56 4 81 021209922A 12/13/2002 ANDERSEN, DORIS E 01/13/2003 685.78 4 81 021209928A 12/13/2002 INGERSOLL, ROCHELLE 01/13/2003 752 .84 4 81 021209931A 12/13/2002 CARDONA, ROSEMARIE 01/13/2003 641.02 4 81 021209933A 12/13/2002 HARDING-SIPES, RACHE 01/13/2003 870.00 4 83C 021209970A 12/15/2002 DOLEMON, SCOTT M 01/13/2003 870.00 4 83C 021210020A 12/16/2002 KNOX, BARRY 01/13/2003 885 .00 4 83C 021210286A 12/27/2002 WARD, JOHN / AKA PAU 01/14/2003 480 .00 4 82 021209753A 12/07/2002 BURNS, JOSEPH M Total of 482 WriteOff Entries Totaling 224389.69 Dollars Average WriteOff: 465.54 Dollars Average Time:397 Days Date:01/15/2003 Weld County Paramedic Services Page:11 Time:12 :14:49 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/08/2003 Thru 01/14/2003 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 183 124038.83 677.81 158.56 82 MEDICAID WRITEOFF 84 36472 .56 434.20 79.01 81 MEDICARE WRITEOFF 77 54146.07 703 .20 53 .06 70CE COLLECTION EXPENSE 116 6935.30 59.79 1212 .40 70PF PROFESSIONAL FINANCE COLL 20 2188.69 109.43 540 .05 84 TRICARE WRITE OFF 1 607 .25 607.25 89.00 83 WRITEOFF 1 0.99 0.99 142 .00 Date:12/12/2003 Weld County Paramedic Services Page: 3 Time:12 :12:45 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/13/2003 637.33 4 81 030100162A 01/07/2003 CROSS, HELEN 02/13/2003 833 .38 4 81 030100165A 01/07/2003 MARINO, ELVA 02/13/2003 715.10 4 81 030100174A 01/08/2003 FARMER, CLARA 02/13/2003 661. 92 4 81 030100178A 01/08/2003 JORGENSEN, MARY N 02/13/2003 560 .76 4 81 030100185A 01/08/2003 NESS, GUY 02/13/2003 623 .68 4 81 030100191A 01/08/2003 KERNS, LEROY 02/13/2003 612 .74 4 81 030100192A 01/08/2003 NICKEL, WESLEY 02/14/2003 399.00 4 82 010605050A 06/29/2001 WATSON, SAMANTHA 02/14/2003 719.06 4 81 020200946A 02/01/2002 CARDONA, ROSEMARIE 02/14/2003 467 .40 4 81 020605039A 06/28/2002 ADAMS, RANDY 02/14/2003 765 . 88 4 81 021109410A 11/24/2002 DILLARD, VERA FERN 02/14/2003 806 .82 4 82 021209992A 12/16/2002 HARRIS, RYAN 02/14/2003 53 .52 4 83W 021210002A 12/16/2002 HESSLER, DONN J 02/14/2003 793 .03 4 82 021210005A 12/16/2002 MARTINEZ, NATHALY 02/14/2003 793 .29 4 82 021210008A 12/16/2002 REGALADO, STEVE 02/14/2003 928 . 03 4 82 021210037A 12/17/2002 DOTY, ALBERT S 02/14/2003 815 .74 4 82 021210246A 12/25/2002 GARZA, SYLVIA M 02/14/2003 928.03 4 82 021210280A 12/27/2002 SNOOK, THOMAS 02/14/2003 853 .29 4 82 021210307A 12/28/2002 COX, RANDALL S 02/14/2003 AMB 150.00 4 82 030100526A 01/20/2003 STREETER, JENNIFER 02/18/2003 234 .63 4 81 030100104A 01/04/2003 MACKEY, EARL 02/19/2003 405 .24 4 83VA 010100699A 01/26/2001 WINTER, MELVIN D 02/20/2003 114 .50 4 70CE 010301677A 03/01/2001 HERNANDEZ, ERICA G 02/20/2003 62 .04 4 82 020705336A 07/07/2002 GREEN, JAMES HARLAN 02/20/2003 928.03 4 82 021210051A 12/18/2002 CEJA GOMEZ, RICHARD 02/20/2003 793 .09 4 82 021210079A 12/19/2002 GARCIA, BRYAN B 02/20/2003 373 .35 4 82 021210089A 12/19/2002 GARCIA, BRYAN B 02/20/2003 868 . 03 4 82 021210101A 12/20/2002 CHEATHAM, AMANDA 02/20/2003 782 .18 4 82 021210107A 12/20/2002 PUENTE, AYAME Z 02/20/2003 807.08 4 82 021210135A 12/21/2002 HARRIS, RYAN 02/20/2003 928.03 4 82 021210154A 12/22/2002 SANCHEZ, VICTORIA 02/20/2003 857.08 4 82 021210228A 12/25/2002 MCKNIGHT, CYNTHIA 02/21/2003 205 .00 4 83C 000907372A 09/24/2000 BENTON, DONNA 02/21/2003 656 .14 4 82 001108753A 11/12/2000 CARTER, ROCHELLE 02/21/2003 573 .04 4 83C 010604808A 06/21/2001 PARSON, EVERETT 02/21/2003 400.00 4 83C 010705516A 07/14/2001 NAVA, MARIA 02/21/2003 110 .46 4 83C 011008322A 10/17/2001 PETERSON, AUDREY J 02/21/2003 189.00 4 83C 011108849A 11/04/2001 PEREZ, DANELY 02/21/2003 455 .60 4 83C 020201252A 02/12/2002 PETERSON, PAUL J 02/21/2003 100 .01 4 83C 020302488A 03/27/2002 ZARAGOZA, JOE C 02/21/2003 858.00 4 83C 020503804A 05/15/2002 GUAJARDO, NORMA 02/21/2003 38.52 4 83C 020503976A 05/22/2002 PEREZ, EDMUNDO 02/21/2003 724 .00 4 83C 020604353A 06/05/2002 LOPEZ, MARCOS 02/21/2003 120 .00 4 83C 020604612A 06/14/2002 SISNEROS, GABRIAL 02/21/2003 70 .00 4 83C 020605073A 06/29/2002 MOONEY, EVAN 02/21/2003 395 .20 4 83C 020705140A 07/01/2002 PUGH, MERVIN 02/21/2003 AMB 930.00 4 83C 020705429A 07/10/2002 PERKINS, REBECCA A 02/21/2003 736.00 4 83C 020705489A 07/12/2002 NAVA, VINCENT J 02/21/2003 966 . 00 4 83C 020705491A 07/12/2002 MARSHALL, WILLIAM L Date:12/12/2003 Weld County Paramedic Services Page: 4 Time:12 :12 :48 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/21/2003 25.00 4 83C 020705596A 07/15/2002 PANTOJA, JOSEFINA 02/21/2003 82 .60 4 83C 020705906A 07/27/2002 MARTINEZ, DION R 02/21/2003 120 .00 4 83C 020806136B 08/04/2002 PITNER, BARBARA 02/21/2003 120 .00 4 83C 020806145A 08/04/2002 KLINGER, RON 02/21/2003 927.33 4 83C 020806171A 08/05/2002 RANGEL, MAXIMINA L 02/21/2003 982 .00 4 83C 020806255A 08/08/2002 MARQUEZ, JENNIFER 02/21/2003 25.00 4 83C 020806403A 08/13/2002 PERALTA, GILBERT 02/21/2003 126.00 4 83C 020806551A 08/19/2002 MOORE, LARRY 02/21/2003 1085 .00 4 83C 020806593A 08/21/2002 MORGAN, LINDA 02/21/2003 980.00 4 83C 020806602A 08/21/2002 MARTENS, GARRETT E 02/21/2003 1055 .00 4 83C 020806667A 08/23/2002 LARA, ALBERTO 02/21/2003 885 .00 4 83C 020806690A 08/24/2002 PRADO, JUAN 02/21/2003 113 .13 4 83C 020806699A 08/24/2002 BERRYMAN, HAZEL 02/21/2003 150 . 00 4 83C 020806703A 08/24/2002 MARTINEZ, ELICIO 02/21/2003 150 . 00 4 83C 020806745A 08/26/2002 MARSHALL, WILLIAM L 02/21/2003 74 .42 4 83C 020806782A 08/27/2002 CATON, JOHN 02/21/2003 150 .00 4 83C 020806818A 08/28/2002 NELSON, JULIE 02/21/2003 1035.00 4 83C 020806820A 08/28/2002 LANG, MARGO 02/21/2003 930 .00 4 83C 020806875A 08/30/2002 VERGARA GONZALEZ, PA 02/21/2003 1100 .00 4 83C 020806879A 08/30/2002 MCKENZIE, MATTHEW 02/21/2003 1085.00 4 83C 020806889A 08/30/2002 MELENDEZ, LETICIA 02/21/2003 885.00 4 83C 020806897A 08/31/2002 MORT, TYLER A 02/21/2003 - 1740.00 4 83C 020906931A 09/01/2002 SMART, DE VONTA 02/21/2003 980.00 4 83C 020906960A 09/02/2002 ROSANBALM, JAMES A 02/21/2003 150.00 4 83C 020906972A 09/02/2002 SISNEROS, GABRIAL 02/21/2003 1130.00 4 83C 020906985A 09/02/2002 MARTINEZ, NATALIE 02/21/2003 1025.00 4 83C 020906996B 09/03/2002 RADILLA, LUCINDO 02/21/2003 995.00 4 83C 020907017A 09/03/2002 NUNES, JULIANA 02/21/2003 870.00 4 83C 020907063A 09/05/2002 MARTINEZ, OPED 02/21/2003 1100 .00 4 83C 020907078A 09/05/2002 TRIMBLE, SUSAN 02/21/2003 1035 .00 4 83C 020907088A 09/05/2002 LANG, MARGO 02/21/2003 69 .28 4 83C 020907094A 09/05/2002 LIND, JOHN 02/21/2003 890 . 00 4 83C 020907116A 09/06/2002 LOPEZ, MARIA 02/21/2003 84 . 87 4 83C 020907129A 09/07/2002 GUERRA, VICTOR 02/21/2003 1055 . 00 4 83C 020907130A 09/07/2002 MEDINA, MARY 02/21/2003 885 .00 4 83C 020907140B 09/07/2002 PALMA, LORENA 02/21/2003 690 .54 4 83C 020907162A 09/08/2002 MARTINEZ, JULIAN 02/21/2003 980 .00 4 83C 020907181A 09/08/2002 TERRONES JUAREZ, AAR 02/21/2003 1205.00 4 83C 020907198A 09/09/2002 BERNHOFT, DEBRA 02/21/2003 950 .00 4 83C 020907211A 09/09/2002 SANDOVAL, ANDREW B 02/21/2003 1280 .00 4 83C 020907232A 09/10/2002 MINNEY, ROSITA 02/21/2003 920 .00 4 83C 020907233A 09/10/2002 VANDERLOO, ZACHARY 02/21/2003 150 .00 4 83C 020907233B 09/10/2002 VANDERLOO, KIM 02/21/2003 870.00 4 83C 020907237A 09/10/2002 LECHUGA, SUSANA 02/21/2003 1070.00 4 83C 020907250A 09/11/2002 LEIGH, JOSHUA 02/21/2003 1055.00 4 83C 020907268A 09/12/2002 SAMBERSON, ROBERTA 02/21/2003 144 .94 4 83C 020907317A 09/13/2002 MASTIN, RANDALL SR 02/21/2003 870.00 4 83C 020907323B 09/14/2002 MORANO, JUAN JOSE 02/21/2003 1055.00 4 83C 020907357A 09/15/2002 TAKUMOTO, DENNIS K Date:12/12/2003 Weld County Paramedic Services Page: 5 Time:12 :12:49 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/21/2003 1250 . 00 4 83C 020907364A 09/15/2002 MCCLURE, ROBERT K 02/21/2003 1175 .00 4 83C 020907373A 09/15/2002 REIMERS, PAULA 02/21/2003 980.00 4 83C 020907388A 09/16/2002 VARGAS, MOSES 02/21/2003 1205.00 4 83C 020907407A 09/17/2002 MILLER, KIMBERLY 02/21/2003 1182 .50 4 83C 020907409B 09/17/2002 RODRIGUEZ, SAUL 02/21/2003 1150 . 00 4 83C 020907413A 09/17/2002 ROJAS, ERIC 02/21/2003 150 .00 4 83C 020907414A 09/17/2002 OJEDA, RAUL 02/21/2003 150.00 4 83C 020907419A 09/17/2002 THOMAS, LINDA 02/21/2003 150.00 4 83C 020907439A 09/18/2002 SILVA, MARY 02/21/2003 1325.00 4 83C 020907442A 09/18/2002 PARKOS, JEFF 02/21/2003 150 . 00 4 83C 020907451B 09/19/2002 MEYER, ANGEL JEAN-AN 02/21/2003 1100 . 00 4 83C 020907469A 09/19/2002 PARKOS, JEANNA E 02/21/2003 1010 .00 4 83C 020907493A 09/20/2002 CHAGOLLA, VANESSA 02/21/2003 150.00 4 83C 020907511A 09/21/2002 MEYER, AMBER LYNN 02/21/2003 995.00 4 83C 020907512A 09/21/2002 CHAGOLLA, VANESSA 02/21/2003 1010 .00 4 83C 020907517A 09/21/2002 WOODARD, SHEILA 02/21/2003 1349. 00 4 83C 020907549A 09/22/2002 SIMMONDS, NORRIS 02/21/2003 864 .00 4 83C 020907558A 09/22/2002 PINON REYES, GABRIEL 02/21/2003 150.00 4 83C 020907561A 09/22/2002 MARQUEZ, ROMAN 02/21/2003 1121.00 4 83C 020907563A 09/22/2002 MARSHALL, WILLIAM L 02/21/2003 1085.00 4 83C 020907575A 09/23/2002 MILLER, JEFF 02/21/2003 150 . 00 4 83C 020907579A 09/23/2002 SINOLOR, NICOLE 02/21/2003 150 . 00 4 83C 020907583A 09/23/2002 RICO, RICARDO 02/21/2003 150.00 4 83C 020907585A 09/23/2002 RUNNER, GARY 02/21/2003 150.00 4 83C 020907595A 09/24/2002 WETZBARGER, MANDY 02/21/2003 150 .00 4 83C 020907603A 09/24/2002 TURLEY, SANDRA 02/21/2003 1385 . 00 4 83C 020907618A 09/25/2002 GRIFFITH, SUSAN 02/21/2003 1055 .00 4 83C 020907626A 09/25/2002 SOELL, ROBERT 02/21/2003 1450.00 4 83C 020907642A 09/25/2002 MINNEY, JOSEPH 02/21/2003 1190.00 4 83C 020907649A 09/26/2002 SOTELO, EMMANUEL 02/21/2003 1055.00 4 83C 020907655A 09/26/2002 SPARROW, MICHAEL 02/21/2003 920 . 00 4 83C 020907699A 09/27/2002 MARTINEZ, DEREK 02/21/2003 870.00 4 83C 020907710A 09/28/2002 LIRA, JESSE JR 02/21/2003 150.00 4 83C 020907747A 09/29/2002 SALINAS, ALFONSO 02/21/2003 995.00 4 83C 020907757A 09/29/2002 LENHART, STEVEN A 02/21/2003 829.45 4 83C 020907784A 09/30/2002 ORNELAS, EMILY B 02/21/2003 870 .00 4 83C 021007788A 10/01/2002 CLEARWATER, MARTY 02/21/2003 870 .00 4 83C 021007887B 10/04/2002 GARCIA, TARRARA 02/21/2003 71.33 4 83C 021007909A 10/05/2002 PATTEN, ROBERT 02/21/2003 150 .00 4 83C 021007954A 10/06/2002 IZQUIERDO, LAURA 02/21/2003 150 .00 4 83C 021007962A 10/07/2002 CRANMER, RICK 02/21/2003 1035 . 00 4 83C 021007966A 10/07/2002 PUGA, SAMUEL 02/21/2003 1205 .00 4 83C 021007975A 10/07/2002 ADAMS, CHARLENE 02/21/2003 1055.00 4 83C 021008046A 10/09/2002 CRANMER, RICK 02/21/2003 870 .00 4 83C 021008100A 10/11/2002 PADILLA, SANDY R 02/21/2003 975 .00 4 83C 021008103A 10/11/2002 MEIS, JERRY 02/21/2003 150 .00 4 83C 021008134B 10/12/2002 NEWMAN, THOMAS 02/21/2003 885 .00 4 83C 021008150A 10/12/2002 CRANMER, RICK 02/21/2003 150.00 4 83C 021008185A 10/13/2002 MUNIZ, CONSUELO Date:12/12/2003 Weld County Paramedic Services Page: 6 Time: 12:12:49 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/21/2003 920 .00 4 83C 021008187A 10/13/2002 MARES, GUADALUPE MAR 02/21/2003 1110 .00 4 83C 021008285A 10/16/2002 MORGAN, MICHAEL J 02/21/2003 885.00 4 83C 021008356A 10/19/2002 MATA, JUAN 02/21/2003 1400. 00 4 83C 021008358A 10/19/2002 MITCHELL, TERI 02/21/2003 885 .00 4 83C 021008417A 10/21/2002 MONTANEZ, MARIA 02/21/2003 1115.00 4 83C 021008438A 10/21/2002 PARKOS, JEANNA E 02/21/2003 980 .00 4 83C 021008456A 10/22/2002 CRANMER, RICK 02/21/2003 870 . 00 4 83C 021008534A 10/24/2002 COX, RANDALL S 02/21/2003 305 .00 4 83C 021008543A 10/24/2002 KARR, LORI G 02/21/2003 920 .00 4 83C 021008613B 10/27/2002 ROOF, KRISTOPHER L 02/21/2003 980 .00 4 83C 021008657A 10/29/2002 DODGE, KERRIE L 02/21/2003 935. 00 4 83C 021008699A 10/30/2002 DODGE, KERRIE L 02/21/2003 980.00 4 83C 021008742A 10/31/2002 CRANMER, RICK 02/21/2003 150 .00 4 83C 021108878A 11/05/2002 GALLEGOS, RHONDA 02/21/2003 980 . 00 4 83C 021108885A 11/05/2002 CRANMER, RICK 02/21/2003 1055 .00 4 83C 021108943A 11/07/2002 FUENTES, WILLIE 02/21/2003 1010 .00 4 83C 021108959A 11/07/2002 CLARK, DEBORAH 02/21/2003 990 .00 4 83C 021109089A 11/12/2002 GREEN, RICHARD 02/21/2003 870.00 4 83C 021109137C 11/14/2002 TREVINO, JIMMY 02/21/2003 196. 00 4 83C 021109195A 11/16/2002 ROMAYOR, MARIE 02/21/2003 150 .00 4 83C 021109214A 11/17/2002 TIDWELL, JOANIE 02/21/2003 150 .00 4 83C 021109292A 11/21/2002 GALLEGOS, RHONDA 02/21/2003 920 . 00 4 83O 021109354A 11/23/2002 COLUMBO, MARY 02/21/2003 1235 .00 4 83C 021109422B 11/24/2002 SANDVIK, DAVID 02/21/2003 870 .00 4 83C 021109523A 11/28/2002 ARAGON-ESPINOZA, JES 02/21/2003 150 .00 4 83C 021209791A 12/09/2002 ALEJANDRO, NICHOLAS 02/21/2003 870.00 4 83C 021209845A 12/11/2002 BARBER, CHANDA D 02/21/2003 150. 00 4 83C 021210162A 12/22/2002 HURTADO, DUANE 02/21/2003 150 .00 4 83C 021210273A 12/27/2002 RIVERA, JOE 02/21/2003 980 .00 4 83C 021210303A 12/28/2002 TEZOCO, ANGELICA 02/21/2003 930 .00 4 83C 030100009A 01/01/2003 SWARTZ, JEFFERY D 02/21/2003 870 .00 4 83C 030100036A 01/02/2003 RAMIREZ, JOEL 02/21/2003 838.08 4 81 030100046A 01/02/2003 CARDONA, ROSEMARIE 02/21/2003 1070 .00 4 83C 030100110A 01/05/2003 GREEN, RICHARD 02/21/2003 450 .00 4 83C 030100111A 01/05/2003 GREEN, RICHARD 02/21/2003 1115. 00 4 83C 030100243A 01/10/2003 TREVINO, GEORGE 02/21/2003 920.00 4 83C 030100320A 01/13/2003 BARNES, ROBERT 02/21/2003 1175 .00 4 83C 030100326A 01/13/2003 BELL, SHELLY 02/21/2003 1070 .00 4 83C 030100411A 01/16/2003 BARNES, ROBERT 02/21/2003 935 .00 4 83C 030100601A 01/22/2003 DODGE, KERRIE L 02/21/2003 920 .00 4 83C 030100761A 01/27/2003 DICKERSON, RONNA 02/21/2003 870 .00 4 83C 030100790A 01/28/2003 NEWSON, JUAN 02/21/2003 980 .00 4 83C 030100805A 01/28/2003 WAMBOLT, EFFIE 02/24/2003 119. 00 4 83C 010100581A 01/22/2001 FRANCISCO, JULIO M * 02/24/2003 102 .75 4 83C 010302192A 03/20/2001 HINDMAN, LILLIAN 02/24/2003 209 .00 4 83C 010503452A 05/01/2001 HARTSHORN, ROSE MARI 02/24/2003 466 . 00 4 83C 011008552A 10/25/2001 CONTRERAS, OBED 02/24/2003 500 .00 4 83C 011210039A 12/19/2001 BELO, GRACE 02/24/2003 779.00 4 83C 011210054A 12/19/2001 BLANCO, YVONNE I Date:12/12/2003 Weld County Paramedic Services Page: 7 Time:12 :12 :50 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/24/2003 472 .57 4 83C 020100225A 01/08/2002 MAES, FRED 02/24/2003 115 .20 4 83C 020100378A 01/11/2002 HAYWOOD, MICHAEL 02/24/2003 398 . 00 4 83C 020100456A 01/14/2002 FLORES, RAYMOND L 02/24/2003 701 .53 4 82 020100872A 01/29/2002 BROWN, KEVIN 02/24/2003 52 .75 4 83C 020201580A 02/22/2002 BARTHOLOMEW, RONALD 02/24/2003 664 .00 4 83C 020302356A 03/23/2002 GUTIERREZ, VANESSA 02/24/2003 222 .00 4 83C 020403386A 04/30/2002 KENNEDY, DANNY 02/24/2003 75 .26 4 83C 020503693A 05/10/2002 GARCIA, MIGUEL 02/24/2003 25 .00 4 83C 020503852A 05/13/2002 BERRY, RHONDA K 02/24/2003 650 .00 4 83C 020504036A 05/24/2002 GOMEZ, DIONISIO N 02/24/2003 50 . 00 4 83C 020604560A 06/12/2002 BRIGGS, MICHAEL 02/24/2003 50 . 00 4 83C 020604568A 06/13/2002 HUNT, GARY 02/24/2003 814 .00 4 83C 020604597A 06/14/2002 CURTIS, GINA 02/24/2003 924 .00 4 83C 020604630A 06/15/2002 GREEN, ALAN D 02/24/2003 810 .00 4 83C 020604963A 06/26/2002 GARCIA, MIGUEL 02/24/2003 73 .36 4 83C 020605011A 06/27/2002 GARCIA, MIGUEL 02/24/2003 241.60 4 83C 020605086A 06/29/2002 CARMICHAEL, DEB 02/24/2003 300 .94 4 83C 020704813A 07/24/2002 GONZALEZ, MARGARITA 02/24/2003 628 . 00 4 83C 020705277A 07/05/2002 CHAPUT, JEFFREY 02/24/2003 78 .52 4 83C 020705369A 07/08/2002 BALDERRAMA, GUADALUP 02/24/2003 196 .44 4 83C 020705455A 07/11/2002 KOCHER, KESLEY 02/24/2003 270 .52 4 83C 020705542A 07/14/2002 FRANCO, LAURA 02/24/2003 268.00 4 83C 020705609A 07/16/2002 EWING, SHIRLEY J 02/24/2003 974 .00 4 83C 020806260A 08/08/2002 GIRON-CANO, DORA 02/24/2003 717.91 4 83C 020806269A 08/09/2002 CONTRERAZ, PAULINE 02/24/2003 894 .00 4 83C 020806277A 08/09/2002 GALLEGOS, SONIA 02/24/2003 25 . 00 4 83C 020806304A 08/10/2002 COLEMAN, CODY 02/24/2003 153 .36 4 83C 020806388A 08/13/2002 JOJOLA, SAMUEL 02/24/2003 1005 .00 4 83C 020806525A 08/18/2002 ATKINS, JEREMY ANDRE 02/24/2003 84 .61 4 83C 020806544A 08/18/2002 GILLILAND, RUBY I 02/24/2003 1305.00 4 83C 020806580A 08/20/2002 HETHERINGTON, LEE 02/24/2003 915.00 4 83C 020806680A 08/24/2002 ANDERSON, KYLE V 02/24/2003 100 .00 4 83C 020806707A 08/24/2002 PAPPAS, JASON 02/24/2003 988 .60 4 83C 020806862A 08/30/2002 DAVIS, JETT 02/24/2003 1060 . 00 4 83C 020806884A 08/30/2002 FRANK, LEONARD T 02/24/2003 73 .36 4 83C 020906946A 09/01/2002 HUNT, EMERY GARY 02/24/2003 486.64 4 83C 020907010A 09/03/2002 BEHRENS, DUSTY 02/24/2003 995.00 4 83C 020907022A 09/03/2002 GREEN, ALAN D 02/24/2003 50 .00 4 83C 020907032A 09/04/2002 HAMILTON, MARY 02/24/2003 1100 .00 4 83C 020907093A 09/05/2002 HASTINGS, DANIELLE M 02/24/2003 150 .00 4 83C 020907100A 09/06/2002 BAKER, MATTHEW 02/24/2003 995 . 00 4 83C 020907140A 09/07/2002 BAILON, YOMIRA 02/24/2003 1055 . 00 4 83C 020907142A 09/07/2002 BELMAIN, CAROLINE 02/24/2003 150 .00 4 83C 020907151B 09/07/2002 BROWN, WARREN 02/24/2003 1055 .00 4 83C 020907213A 09/09/2002 GOODE, LISA J 02/24/2003 137.33 4 83C 020907242A 09/11/2002 DIETERLE, RICHARD J 02/24/2003 900 .00 4 83C 020907273A 09/12/2002 GALLEGOS, SONIA 02/24/2003 980 .00 4 83C 020907310A 09/13/2002 BOYER, JAMES J 02/24/2003 980 .00 4 83C 020907323A 09/14/2002 GUZMAN, JOSE Date:12/12/2003 Weld County Paramedic Services Page: 8 Time:12 :12 :51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/24/2003 25.00 4 83C 020907336A 09/14/2002 CASTNER, MARY M 02/24/2003 995 .00 4 83C 020907337A 09/14/2002 GONZALEZ, BEATRICE 02/24/2003 885 . 00 4 83C 020907348A 09/14/2002 HERNANDEZ, BRANDON 02/24/2003 1070. 00 4 83C 020907355A 09/15/2002 BACA, MARY 02/24/2003 1190 .00 4 83C 020907393A 09/16/2002 GALINDO, CASSIE 02/24/2003 945.00 4 83C 020907405A 09/17/2002 JOHNSON, KEELEY 02/24/2003 1182 .50 4 83C 020907409A 09/17/2002 GONZALEZ-GONZALEZ, O 02/24/2003 1815 .00 4 83C 020907426A 09/18/2002 DENICOLA, ALLISON M 02/24/2003 1175 .00 4 83C 020907463A 09/19/2002 BENNETT, DONALD V 02/24/2003 1055.00 4 83C 020907471A 09/19/2002 COLMENERO, CHRISTINA 02/24/2003 1145.00 4 83C 020907526A 09/21/2002 MARSHALL, GARY 02/24/2003 150.00 4 83C 020907556B 09/22/2002 GOMEZ, VANESSA 02/24/2003 202 .00 4 83C 020907573A 09/23/2002 HOLGUIN, MARY JANE 02/24/2003 885 .00 4 83C 020907602A 09/24/2002 COSTILLA, MARIA 02/24/2003 1340. 00 4 83C 020907637A 09/25/2002 BLEHM, LESLIE 02/24/2003 150 .00 4 83C 020907724A 09/28/2002 PRESTON, BRANDON 02/24/2003 1010.00 4 83C 020907750A 09/29/2002 MOORE, JARROD 02/24/2003 150.00 4 83C 020907756A 09/29/2002 GONZALEZ, MONICA 02/24/2003 70 .52 4 82 021008231A 10/15/2002 RIPPERGER, KRISTI J 02/24/2003 1220 .00 4 83C 021008354A 10/19/2002 MONTANO, CHERINE Y 02/24/2003 1070. 00 4 83C 021008374A 10/19/2002 PRATHER, DONALD 02/24/2003 44 .28 4 82 021008631A 10/28/2002 PARTRIDGE, RODGER H 02/24/2003 804 .52 4 82 021108794A 11/02/2002 ADAMS, ANDRE 02/24/2003 59 .20 4 82 021108796A 11/02/2002 ADAMS, ANDRE 02/24/2003 829 . 93 4 82 021108809A 11/02/2002 ADAMS, ANDRE 02/24/2003 983 .24 4 82 021108870A 11/04/2002 STAUFFER, SANDRA L 02/24/2003 59.20 4 82 021108892A 11/05/2002 ADAMS, ANDRE 02/24/2003 61.56 4 82 021108918A 11/06/2002 GALVAN, FEDERICO 02/24/2003 798.54 4 82 021109050A 11/10/2002 FENDEL, ELAINE 02/24/2003 65.71 4 82 021109145A 11/15/2002 COLLINS, ROBBIN 02/24/2003 774 .52 4 82 021109302A 11/21/2002 TRUJILLO-GONZALES, F 02/24/2003 74 .19 4 82 021109339A 11/22/2002 WINTER, DAVID 02/24/2003 67 .84 4 82 021109374A 11/23/2002 WILLIAMS, DARCY 02/24/2003 615.38 4 83W 021209666E 12/05/2002 MATHEWSON, DAN 02/24/2003 1120.44 4 82 021209777A 12/08/2002 MASTERS, JAMES 02/24/2003 788.24 4 82 021209782A 12/08/2002 BURNS, ESTHER 02/24/2003 978.50 4 82 021209823A 12/10/2002 BEAUMONT, HAVEN 02/24/2003 969. 52 4 82 021209825A 12/10/2002 MORRIS, JANET 02/24/2003 64 .88 4 82 021209828A 12/10/2002 CLYMER, DORIS 02/24/2003 774 .52 4 82 021209831A 12/10/2002 LOPEZ, ALEXANDRIA R 02/24/2003 1499.86 4 82 021209834A 12/10/2002 LOPEZ, ALEXANDRIA R 02/24/2003 65.10 4 82 021209840A 12/10/2002 RATHBUN, NORMA C 02/24/2003 827 .58 4 82 021209844A 12/10/2002 BLACK, TIMOTHY D 02/24/2003 815. 91 4 82 021209856A 12/11/2002 WITCHER, CLAUDIA 02/24/2003 369.09 4 82 021209865A 12/11/2002 WITCHER, CLAUDIA 02/24/2003 801.96 4 82 021209874A 12/12/2002 PEREZ, MARISA 02/24/2003 923 .24 4 82 021209888A 12/12/2002 DURYEA, KELLY 02/24/2003 1588.58 4 82 021209916A 12/13/2002 ARCHULETA, SUZANNE 02/24/2003 870 . 98 4 82 021209990A 12/16/2002 RANGEL, JULIA Date:12/12/2003 Weld County Paramedic Services Page: 9 Time:12 :12 :51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/24/2003 777 .37 4 82 021210032A 12/17/2002 MILLS, PHEBEE 02/24/2003 . 909.52 4 82 021210063A 12/18/2002 CROMWELL, KATHERINE 02/24/2003 870 .98 4 82 021210075A 12/19/2002 CISNEROS, DESRAY 02/24/2003 65.11 4 82 021210086A 12/19/2002 WILLIAMSON, HOWARD 02/24/2003 1024 .40 4 82 021210112A 12/20/2002 BENAVIDEZ, NICOLE 02/24/2003 909.52 4 82 021210119A 12/21/2002 SAYOTOVICH, J T 02/24/2003 59.20 4 82 021210124A 12/21/2002 SAYOTOVICH, J T 02/24/2003 0 . 00 4 82 021210176A 12/22/2002 ALMEIDA, NORMA 02/24/2003 64 .03 4 82 021210186A 12/23/2002 GAUTHIERE, BETTY 02/24/2003 76 .35 4 82 021210201A 12/24/2002 ERICKSON, NANCY M 02/24/2003 64 .97 4 82 021210207A 12/24/2002 GARZA, JOSE N 02/24/2003 75.94 4 82 021210235A 12/25/2002 GARCIA, ALFONSO 02/24/2003 901.30 4 82 021210236A 12/25/2002 DURYEA, KELLY 02/24/2003 65.11 4 82 021210279A 12/27/2002 FARMER, TOMMIE J 02/24/2003 65 .71 4 82 021210293A 12/28/2002 KOCH, NEOMA M 02/24/2003 68 .44 4 82 021210296A 12/28/2002 HERRERA, STELLA 02/24/2003 75 .07 4 82 021210326A 12/29/2002 VOSBERG, WILLIE 02/24/2003 848 .24 4 82 021210330A 12/30/2002 BURNS, ESTHER 02/24/2003 66 .78 4 82 021210346A 12/30/2002 BENAVIDEZ, ANNA 02/24/2003 1 .66 4 82 021210358A 12/31/2002 GUENTHER, RACHEL 02/24/2003 67 .08 4 82 021210373A 12/31/2002 SCHEIDING, GERHARD 02/24/2003 59 .33 4 82 030100010A 01/01/2003 ALDAY, ROXANNA 02/24/2003 52 .25 4 82 030100031A 01/01/2003 SIEH, TEDDY 02/24/2003 7.25 4 82 030100087A 01/04/2003 SAUCEDA, EULALIO 02/24/2003 1.81 4 82 030100089A 01/04/2003 LUJAN, EDNA L 02/24/2003 3 .62 4 82 030100093A 01/04/2003 MATA, PATSY 02/24/2003 825 .91 4 82 030100094A 01/04/2003 BAKER, VICKI 02/24/2003 66 . 03 4 82 030100099A 01/04/2003 MACKEY, EARL 02/24/2003 76 . 90 4 82 030100117A 01/05/2003 GALLEGOS, MARY 02/24/2003 72 .37 4 82 030100154A 01/07/2003 SCHWARTZ, RUTH 02/24/2003 1055.09 4 82 030100167A 01/07/2003 TYLER, DANIELLE 02/24/2003 68.19 4 82 030100178A 01/08/2003 JORGENSEN, MARY N 02/24/2003 849.52 4 82 030100212A 01/09/2003 PEREZ, MARIA G 02/24/2003 919.63 4 82 030100237A 01/10/2003 BURNS, ESTHER 02/24/2003 802 .76 4 82 030100306A 01/13/2003 MONTANO, RYDER S 02/24/2003 1093 .38 4 82 030100323A 01/13/2003 REEVES, ANGELINA 02/24/2003 887 .58 4 82 030100328A 01/14/2003 FLORES, INOCENCIA 02/24/2003 1112 .76 4 82 030100341A 01/14/2003 CONLEY, WILLIAM 02/24/2003 774.52 4 82 030100463A 01/18/2003 WHITNEY, ANTHONY 02/24/2003 952 .88 4 82 030100469A 01/18/2003 GUTIERREZ, ABEL 02/24/2003 1130.00 4 83C 030100519A 01/20/2003 BARNES, ROBERT 02/24/2003 909.52 4 82 030100543A 01/20/2003 ROMERO, DESIREE 02/24/2003 876.96 4 82 030100567A 01/21/2003 GARZA, WANDA LEE 02/24/2003 749.70 4 82 030100616A 01/22/2003 KELLNER, MARY J 02/24/2003 1149.16 4 82 030100640A 01/23/2003 WILES, PENNIE 02/24/2003 1040 .32 4 82 030100642A 01/23/2003 CHACON, MARCUS J 02/24/2003 1406 . 80 4 82 030100681A 01/24/2003 WAGNER, DARREN EUGEN 02/24/2003 829.63 4 82 030100716A 01/25/2003 BURNS, ESTHER 02/24/2003 1305 .66 4 82 030100745A 01/26/2003 DUE, XANDER MARCUS i Date:12/12/2003 Weld County Paramedic Services Page:10 Time:12 :12 :52 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/24/2003 909 .52 4 82 030100747A 01/26/2003 SAUCEDO, MARCIE 02/24/2003 875.91 4 82 030100750A 01/26/2003 SHOPPE, ROBERT 02/24/2003 1013 .24 4 82 030100783A 01/27/2003 CROOK, DUSTIN L 02/24/2003 901.35 4 82 030100813A 01/28/2003 BURNS, ESTHER 02/24/2003 909.52 4 82 030100815A 01/28/2003 NINO, VICTOR 02/24/2003 1625.52 4 82 030100856A 01/30/2003 CROOK, DUSTIN L 02/24/2003 1488.81 4 82 030100865A 01/30/2003 MILLS, PHEBEE 02/24/2003 849.04 4 82 030100877A 01/31/2003 SAYOTOVICH, J T 02/24/2003 936 . 96 4 82 030100878A 01/31/2003 PANTALEON NAVA, CARL 02/24/2003 909.52 4 82 030100883A 01/31/2003 HOWELL, MICHAEL L 02/24/2003 827 .58 4 82 030100899A 01/31/2003 BORIS, BREANNA 02/25/2003 150 .00 4 83C 021008324A 10/18/2002 CLARK, JEREMY F 02/25/2003 995 .00 4 83C 021008501A 10/23/2002 BERNAL, VICTOR 02/25/2003 324 .04 4 84 021008518A 10/24/2002 FABER, MATHEW T 02/25/2003 768.81 4 83W 021109204A 11/17/2002 VIGIL, MARTY A 02/25/2003 150.00 4 83C 021109488A 11/26/2002 CLARK, JEREMY F 02/25/2003 779.76 4 81 021109515A 11/28/2002 HURLEY, VERA G 02/25/2003 1175.00 4 83C 021209768A 12/08/2002 BENCOMO, CESAR 02/25/2003 1175.00 4 83C 021209821A 12/10/2002 LOZANO, CASTULO 02/25/2003 471.12 4 83W 021209826A 12/10/2002 CARLSON, JILL 02/25/2003 607 .85 4 81 021210160A 12/22/2002 STERTZ, MARGIE 02/25/2003 644 .18 4 81 030100039A 01/02/2003 WATERS, KEN 02/25/2003 613 .09 4 81 030100090A 01/04/2003 WOLLERT, HAROLD 02/25/2003 672 . 91 4 81 030100091A 01/04/2003 SITZMAN, FRIEDA 02/25/2003 751 .73 4 81 030100106A 01/04/2003 BOLLMAN, ROBERT K 02/25/2003 813 .67 4 81 030100115A 01/05/2003 HERRERA, STELLA 02/25/2003 830.18 4 81 030100149A 01/07/2003 KRAUS, LARRY E 02/25/2003 652 .53 4 81 030100156A 01/07/2003 THOMPSON, RUTH M 02/25/2003 909.20 4 81 030100168A 01/08/2003 ABBOTT, IRENE 02/25/2003 672 .91 4 81 030100169A 01/08/2003 JOHNSON, GLADYS 02/25/2003 712 .35 4 81 030100182A 01/08/2003 PENN, WILLIAM 02/25/2003 653 .14 4 81 030100193A 01/08/2003 GOMEZ, GREGORIA 02/25/2003 749.34 4 81 030100204A 01/09/2003 HAAS, HENRY 02/25/2003 749.34 4 81 030100215A 01/09/2003 CARTER, NEWANNA M 02/25/2003 622 .48 4 81 030100220A 01/09/2003 GUENTHER, RACHEL 02/25/2003 595 .82 4 81 030100226A 01/10/2003 CLARK, ERNEST 02/25/2003 616 .39 4 81 030100229A 01/10/2003 SCHIFERL, RAY W 02/25/2003 641.34 4 81 030100230A 01/10/2003 SERRATO, JESSIE 02/25/2003 609.19 4 81 030100233A 01/10/2003 KLEIN, ELIZABETH 02/25/2003 685.40 4 81 030100245A 01/10/2003 STEINMILLER, WILBERT 02/25/2003 631.23 4 81 030100273A 01/12/2003 SIMONETI, RALPH I 02/25/2003 682 .49 4 81 030100275A 01/12/2003 FUCHS, RUBY L 02/25/2003 595 .82 4 81 030100278A 01/12/2003 GINN, WILLIAMS 02/25/2003 623 .68 4 81 030100286A 01/12/2003 SALAZAR, HIGINIO 02/25/2003 863 .42 4 81 030100292A 01/12/2003 NORFLEET, NORMAN GLE 02/25/2003 622 .48 4 81 030100299A 01/13/2003 RICE, JUANITA R 02/25/2003 654.63 4 81 030100307A 01/13/2003 PETERSEN, PHYLLIS 02/25/2003 643 .82 4 81 030100312A 01/13/2003 SHEPHERD, SAM 02/25/2003 623 .68 4 81 030100317A 01/13/2003 ORBACK, ALBERT Date:12/12/2003 Weld County Paramedic Services Page:17 Time:12 :12 :58 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/01/2003 Thru 02/28/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 81 MEDICARE WRITEOFF 173 107003.32 618 .52 47.88 82 MEDICAID WRITEOFF 161 89332 .92 554 .86 77 .02 83 WRITEOFF 3 477.00 159. 00 55.33 REV REVERSE CHARGED IN ERROR 1 420 .00 420 . 00 89.00 83W WRITEOFF WORK COMP 4 1908.83 477.21 79.50 I 83VA WRITEOFF - VET ADMIN 1 405.24 405.24 754.00 70CE COLLECTION EXPENSE 155 6335 .74 40 . 88 1082 .62 83C WRITEOFF TO COLLECTION AG 236 162779.44 689 .74 183 .43 84 TRICARE WRITE OFF 1 324 .04 324 .04 124 .00 7OPF PROFESSIONAL FINANCE COLL 18 1206.89 67. 05 599.89 75A OVERPAYMENT RETURNED 1 556 .72 556 .72 225 .00 1 Date:12/12/2003 Weld County Paramedic Services Page: 2 Time:12:13 :29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/01/2003 Thru 03/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/11/2003 644 .12 4 81 030100623A 01/22/2003 LONGAN, HAROLD 03/11/2003 731.42 4 81 030100630A 01/23/2003 OTIS, WILDA 03/11/2003 709.59 4 81 030100665A 01/24/2003 UHRICH, LOYD C 03/11/2003 652.08 4 81 030100669A 01/24/2003 GIESICK, HARVEY 03/11/2003 765.76 4 81 030100670A 01/24/2003 POTTS, EUGENE 03/11/2003 00001A 2547161 AMB 761.03 4 81 030100690A 01/24/2003 SPRINGER, WILLIAM 03/11/2003 731.42 4 81 030100695A 01/24/2003 MAES, ABEL 03/11/2003 867.55 4 81 030100715A 01/25/2003 FELSMANN, EDNA 03/11/2003 763 .33 4 81 030100718A 01/25/2003 BAREA, LORENE 03/11/2003 672 .13 4 81 030100722A 01/25/2003 SKINNER, HELEN 03/11/2003 905.21 4 81 030100756A 01/26/2003 ABBOTT, RODERIC M 03/11/2003 1107.95 4 81 030100764A 01/27/2003 WARD, ESTHER 03/11/2003 1216.24 4 81 030100785A 01/27/2003 SMOCK, RUBY 03/11/2003 683 .68 4 81 030100800A 01/28/2003 QUINTANA, RACHEL 03/11/2003 683 .42 4 81 030100816A 01/28/2003 BROWN, HAZEL 03/11/2003 693 .88 4 81 030100821A 01/28/2003 BOCKIUS, KEVIN 03/11/2003 771.27 4 81 030100830A 01/29/2003 BAIN, KYRA 03/11/2003 862 .55 4 81 030100848A 01/30/2003 SCHRAEDER, KATHERINE 03/11/2003 711.54 4 81 030100849A 01/30/2003 FENDEL, ELAINE 03/11/2003 711.66 4 81 030100853A 01/30/2003 NORMAND, WAYNE 03/11/2003 698.66 4 81 030100858A 01/30/2003 PERKO, GERTRUDE 03/11/2003 757.88 4 81 030100895A 01/31/2003 ZWETZIG, JOHN 03/12/2003 1265.00 4 83C 020907445A 09/19/2002 FOWLER, JUSTIN 03/12/2003 1055.00 4 83C 020907700A 09/27/2002 ESPINO, ENRIQUE 03/12/2003 1055.00 4 83C 021007908A 10/05/2002 ANDERSON, CHRISTINA 03/12/2003 150 .00 4 83C 021007910A 10/05/2002 ESPINOZA, GABRIEL I 03/12/2003 1265.00 4 83C 021008072A 10/10/2002 DELGADO-PINO, GUADAL 03/12/2003 150.00 4 83C 021008132A 10/12/2002 DOTY, JOHN 03/12/2003 1140 .00 4 83C 021008170A 10/13/2002 CRISSMAN, JEFF 03/12/2003 1100 .00 4 83C 021008418A 10/21/2002 BENNETT, RENEA F 03/12/2003 1175.00 4 83C 021008439A 10/21/2002 BROOMFIELD, BRUCE 03/12/2003 150 .00 4 83C 021108860A 11/04/2002 BALDWIN, DAVID 03/12/2003 1175 .00 4 83C 021108893A 11/05/2002 COVARRUVIAS, ADRIANA O3/12/2003 1040 .00 4 83C 021210161A 12/22/2002 WALKER, CHEYLETTE N 03/12/2003 743.06 4 81 030100239A 01/10/2003 GROSSAINT, LILLIAN 03/12/2003 869.58 4 81 030100259A 01/11/2003 HELLER, RONALD L 03/12/2003 773 .10 4 81 030100305A 01/13/2003 RYAN, ANGELITA 03/12/2003 652 .08 4 81 030100627A 01/22/2003 VANGALDER, JEANNINE 03/12/2003 652 .08 4 81 030100673A 01/24/2003 ROBERTS, WILLIAM 03/12/2003 837.82 4 81 030100818A 01/28/2003 CARDONA, ROSEMARIE 03/12/2003 4 .63 4 REV PACIFICARE 10/25/2000 PACIFICARE 03/13/2003 AMB 486.14 4 83 001008276A 10/27/2000 WOODS, LARRY 03/13/2003 AMB 210 .00 4 83 001008310A 10/28/2000 WOODS, LARRY 03/13/2003 270 .16 4 83C 010705145A 07/02/2001 HEBERLINE, CHARLES 03/13/2003 89.00 4 83C 010806067A 08/01/2001 JUAREZ, JESUS 03/13/2003 140 .80 4 83C 011008029A 10/07/2001 HEYSE, VICKI 03/13/2003 810 .00 4 83C 011008130A 10/10/2001 NOWAK, RUDOLPH E 03/13/2003 606 .00 4 83C 020201132A 02/07/2002 WARD, SANDRA L 03/13/2003 185 .14 4 83C 020201452A 02/18/2002 KENT, IVALEE Date:12/12/2003 Weld County Paramedic Services Page: 3 Time:12:13 :29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/01/2003 Thru 03/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/13/2003 160.00 4 83C 020403226A 04/24/2002 TITUS, KAREN 03/13/2003 75.85 4 83C 020504066A 05/25/2002 SMITH, BETTY J 03/13/2003 83 .34 4 83C 020504221A 05/31/2002 HAMILTON, CORA L 03/13/2003 275.00 4 83C 020604301A 06/03/2002 GARCIA, CARLA 03/13/2003 556.00 4 83C 020604433A 06/08/2002 WARD, SANDRA L 03/13/2003 304 .00 4 83C 020604466A 06/09/2002 GARCIA, CARLA 03/13/2003 502 .58 4 83C 020604817A 06/22/2002 HENDERSON, BENJAMIN 03/13/2003 73 .36 4 83C 020705576A 07/15/2002 HAMILTON, CORA L 03/13/2003 25.00 4 83C 020806098A 08/02/2002 SALAZAR, NICHOLAS G 03/13/2003 70 .00 4 83C 020806098A 08/02/2002 SALAZAR, NICHOLAS G 03/13/2003 487.20 4 83C 020806314A 08/10/2002 SALAS, DIANA 03/13/2003 150 .00 4 83C 020806510B 08/17/2002 GAONA, JOAQUIN 03/13/2003 303 .00 4 83C 020806837A 08/28/2002 SANCHEZ, TERRI A 03/13/2003 995.00 4 83C 020907051A 09/04/2002 TREJO, VERONICA 03/13/2003 25.00 4 83C 020907102A 09/06/2002 SALAZAR, NICHOLAS G 03/13/2003 1055 .00 4 83C 020907288A 09/12/2002 YBARRA, BRENDA L 03/13/2003 91 .33 4 83C 020907433A 09/18/2002 SMITH, BETTY J 03/13/2003 1280.00 4 83C 020907587A 09/24/2002 THERP, KERRY 03/13/2003 150 .00 4 83C 020907675A 09/26/2002 RODRIGUEZ, ANGELICA 03/13/2003 1160 .00 4 83C 020907683A 09/27/2002 VILLEGAS, LEE 03/13/2003 1040.00 4 83C 020907705D 09/27/2002 TOVAR, MARY J 03/13/2003 1415.00 4 83C 020907706A 09/27/2002 THOMAS, LARRY 03/13/2003 223 .00 4 83C 020907730A 09/28/2002 CERDA, ORALIA 03/13/2003 870.00 4 83C 020907741A 09/29/2002 RIVERA-CONDE, JUAN G 03/13/2003 1175.00 4 83C 021007789A 10/01/2002 HOOVER, ROBERT 03/13/2003 1055.00 4 83C 021007798A 10/01/2002 HORA, KAREN 03/13/2003 870 .00 4 83C 021007826A 10/02/2002 TILLMAN, JOSHUA S 03/13/2003 985.00 4 83C 021007832A 10/02/2002 DURAN, ELFEGO 03/13/2003 1160.00 4 83C 021007866A 10/03/2002 HERNANDEZ, MARGARET 03/13/2003 995 .00 4 83C 021007886A 10/04/2002 HERNANDEZ, EDUARDO 03/13/2003 870 .00 4 83C 021007887A 10/04/2002 JUREK, SARAH A 03/13/2003 150.00 4 83C 021007889A 10/04/2002 HEPNER, NATE 03/13/2003 1175.00 4 83C 021007890A 10/04/2002 ROCHA REYES, IVAN 03/13/2003 1175 .00 4 83C 021007890B 10/04/2002 VASQUEZ MORALES, ROD 03/13/2003 150.00 4 83C 021007891A 10/04/2002 SOTO, ELISO 03/13/2003 930 .00 4 83C 021007896A 10/05/2002 ANDERSON, COOPER E 03/13/2003 870.00 4 83C 021007942A 10/06/2002 VIGIL, HOLLY 03/13/2003 1085.00 4 83C 021007945A 10/06/2002 HICKEY, ANGEL 03/13/2003 885.00 4 83C 021007956A 10/06/2002 RIOFRIO, JENNIFER 03/13/2003 1220 .00 4 83C 021007969A 10/07/2002 HANNA, CHAD 03/13/2003 150.00 4 83C 021008001A 10/08/2002 TAYLOR, MEGAN 03/13/2003 150 .00 4 83C 021008016A 10/08/2002 UNRUH, STEPHANIE 03/13/2003 1280.00 4 83C 021008042A 10/09/2002 DE GRISELLES, MARILY 03/13/2003 398.39 4 83C 021008067A 10/10/2002 THOMPSON, CHRISTOPHE 03/13/2003 1010 .00 4 83C 021008090A 10/10/2002 VASQUEZ, ROBERT 03/13/2003 1130.00 4 83C 021008098A 10/11/2002 CRAVEN, TERRI L 03/13/2003 1115.00 4 83C 021008123A 10/11/2002 SANDOVAL, EUSEBIO 03/13/2003 150 .00 4 83C 021008134A 10/12/2002 SALBERG, JAY 03/13/2003 1150 .00 4 83C 021008136A 10/12/2002 VANLANDINGHAM, ANDRE Date:12/12/2003 Weld County Paramedic Services Page: 4 Time:12 :13 :30 Receipt, Write-off, Adjustment Batch Report MRR300 Wr1teOffBatch From 03/01/2003 Thru 03/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/13/2003 1115.00 4 83C 021008147A 10/12/2002 ZONZO, VITO 03/13/2003 1055.00 4 83C 021008155A 10/12/2002 DARRINGTON, LARRY 03/13/2003 870 .00 4 83C 021008162A 10/12/2002 BOLSTED, ROBERT 03/13/2003 1085.00 4 83C 021008182A 10/13/2002 HOLSCLAW, MARILYN 03/13/2003 1085.00 4 83C 021008206A 10/14/2002 CASARES, RENE 03/13/2003 1055 .00 4 83C 021008207A 10/14/2002 HERNANDEZ, JOE A 03/13/2003 1230 .00 4 83C 021008214A 10/14/2002 RODRIGUEZ, ROXANNE 03/13/2003 870.00 4 83C 021008239A 10/15/2002 JONES, MICHAEL 03/13/2003 150 .00 4 83C 021008265A 10/16/2002 GREFFIN, MARLENE 03/13/2003 920 .00 4 83C 021008270A 10/16/2002 SIMPSON, JESSE 03/13/2003 125.00 4 83C 021008309B 10/17/2002 HERBST, SARAH 03/13/2003 1140.00 4 83C 021008317A 10/18/2002 CHAVOLLA, MARGARITA 03/13/2003 530 .00 4 83C 021008343A 10/18/2002 KRIER, JESSICA 03/13/2003 920 .00 4 83C 021008352A 10/18/2002 SMOCK, MICHAEL S 03/13/2003 1070.00 4 83C 021008368A 10/19/2002 BRAVO VASQUEZ, DOROT 03/13/2003 150 .00 4 83C 021008372A 10/19/2002 RIVAS-DE QUINTERO, S 03/13/2003 150 .00 4 83C 021008383A 10/19/2002 GETZ, JUDI 03/13/2003 930 .00 4 83C 021008391B 10/19/2002 TREVINO, FRANCISCO 03/13/2003 1355 .00 4 83C 021008407A 10/20/2002 ROBERSON, RONALD W 03/13/2003 1115 .00 4 83C 021008425A 10/21/2002 TURNER, JAN 03/13/2003 1691.57 4 83C 021008437A 10/21/2002 HUBBARD, SHERRY 03/13/2003 1145.00 4 83C 021008478A 10/23/2002 WILSON, ROBERT 03/13/2003 1100 .00 4 83C 021008488A 10/23/2002 ATKINSON, MARK E 03/13/2003 150 .00 4 83C 021008495A 10/23/2002 RENNER, HENRY 03/13/2003 995.00 4 83C 021008499A 10/23/2002 TORRES, SYLVIA 03/13/2003 870 .00 4 83C 021008546A 10/24/2002 RANSDELL, KIRA M 03/13/2003 972 .50 4 83C 021008549B 10/25/2002 GUILBERT, SHAWN 03/13/2003 1025.00 4 83C 021008560A 10/25/2002 JOHNSON, VANESSA 03/13/2003 1070.00 4 83C 021008566A 10/25/2002 KNIGHT, BRUCE D 03/13/2003 980 .00 4 83C 021008568A 10/26/2002 GUTIERREZ, MIGUEL A 03/13/2003 930.00 4 83C 021008571A 10/26/2002 ALVAREZ, JR, MATEO 03/13/2003 1205.00 4 83C 021008590A 10/26/2002 ROCHA-SOSA, RAUL 03/13/2003 150 .00 4 83C 021008691A 10/29/2002 DUNSHIE, JAZMYN 03/13/2003 870 . 00 4 83C 021108764B 11/01/2002 BRINTON, MATTHEW 03/13/2003 150 .00 4 83C 021108795A 11/02/2002 ESPINO, MARIA 03/13/2003 150 .00 4 83C 021108807A 11/02/2002 BROWN, GEORGE E 03/13/2003 150 . 00 4 83C 021108865A 11/04/2002 MARTINEZ, ISAIAH 03/13/2003 150 .00 4 83C 021108865B 11/04/2002 MARTINEZ, ANDREW 03/13/2003 1080.00 4 83C 021108915A 11/06/2002 ROMERO, BARBARA 03/13/2003 1055.00 4 83C 021108936A 11/07/2002 PALMER, STEVEN L 03/13/2003 200 .00 4 83C 021109221B 11/18/2002 ROWLES, VIRGINIA 03/13/2003 200 .00 4 83C 021109221C 11/18/2002 SILVA, JENNIFER 03/13/2003 200 .00 4 83C 021109221D 11/18/2002 SILVA, ANTHONY 03/13/2003 200 .00 4 83C 021109221E 11/18/2002 CHEVALIER, BRANDY 03/13/2003 200 .00 4 83C 021109221F 11/18/2002 DEATHERAGE, RONNIE 03/13/2003 1085 . 00 4 83C 021109247A 11/19/2002 BARDOE, BILLY 03/13/2003 1055.00 4 83C 021109348A 11/23/2002 GONZALEZ, JESUS MANU 03/13/2003 1085.00 4 83 021109550A 11/29/2002 DOE, JAMES 03/13/2003 150 .00 4 83C 021209604A 12/02/2002 MINILES, ABRAHAM Date:12/12/2003 Weld County Paramedic Services Page: 5 Time:12 :13 :30 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/01/2003 Thru 03/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/13/2003 1175 .00 4 83C 021209733A 12/07/2002 CHAMBERS, JOHN 03/13/2003 955.33 4 83C 021210003A 12/16/2002 LOPEZ, JOHN A 03/13/2003 1640.00 4 83C 021210011A 12/16/2002 LOPEZ, JOHN A 03/13/2003 1590.12 4 82 021210074A 12/19/2002 MORGAN, DAVID 03/13/2003 870.00 4 83C 030100005A 01/01/2003 HONESTO, CARLOS 03/13/2003 1061.12 4 82 030100082A 01/03/2003 SNOOK, THOMAS 03/13/2003 78 .14 4 82 030100115A 01/05/2003 HERRERA, STELLA 03/13/2003 1035.56 4 82 030100173A 01/08/2003 GUTIERREZ, LAURA 03/13/2003 1.81 4 82 030100220A 01/09/2003 GUENTHER, RACHEL 03/13/2003 5 .38 4 82 030100230A 01/10/2003 SERRATO, JESSIE 03/13/2003 53 .07 4 82 030100275A 01/12/2003 FUCHS, RUBY L 03/13/2003 124 .72 4 82 030100278A 01/12/2003 GINN, WILLIAMS 03/13/2003 66.03 4 82 030100317A 01/13/2003 ORBACK, ALBERT 03/13/2003 66 .03 4 82 030100385A 01/16/2003 GARCIA, MIKE 03/13/2003 56 .43 4 82 030100394A 01/16/2003 LUCERO, MAE E 03/13/2003 49.50 4 82 030100455A 01/17/2003 LOGAN, ERIN 03/13/2003 870 .00 4 83C 030100466A 01/18/2003 BRUNNER, ASHLEY R 03/13/2003 1205 .00 4 83C 030100497A 01/19/2003 COX, TONY 03/13/2003 53 .07 4 82 030100539A 01/20/2003 STEWART, ELIZABETH M 03/13/2003 6.29 4 82 030100549A 01/21/2003 LEY, CLARENCE 03/13/2003 1263 .86 4 81 030100555A 01/21/2003 WEBSTER, JOHN B 03/13/2003 150 .00 4 83C 030100573A 01/22/2003 MARTINEZ, BRIAN E 03/13/2003 995.00 4 83C 030100678A 01/24/2003 ESPINZO, DANIEL 03/13/2003 97.24 4 82 030100686A 01/24/2003 CONDREAY, AGNES F 03/13/2003 67.84 4 82 030100746A 01/26/2003 GRIEGO, BRUCE 03/13/2003 68 .75 4 82 030100766A 01/27/2003 WRZENSINKI, SHERRY L 03/13/2003 72 .37 4 82 030100793A 01/28/2003 JORGENSEN, MARY 03/13/2003 65.42 4 82 030100795A 01/28/2003 LUCERO, VINCENT 03/13/2003 135.82 4 82 030100841A 01/29/2003 GARZA, JOSE N 03/13/2003 66.94 4 82 030100847A 01/29/2003 SIEH, TED 03/13/2003 66 .03 4 82 030100867A 01/30/2003 CROCKETT, ERNEST 03/13/2003 20 .00 4 83C 990906673A 09/08/1999 BONNEY, LISA 03/13/2003 385.00 4 83C 991209587A 12/30/1999 TORRES, SOLEDAD 03/14/2003 4.66 4 70CE 02079 05/09/2002 ANGELA RIOS 03/14/2003 4 .66 4 70CE 02080 05/09/2002 JESSE RIOS 03/14/2003 4 .66 4 70CE 02081 05/09/2002 DIEGO RIOS 03/14/2003 4 .66 4 70PF 02126 07/31/2002 RICHARD BABB 03/14/2003 33 .33 4 70CE 000100282A 01/12/2000 PTANTE, KENNETH 03/14/2003 33 .33 4 70CE 000100282A 01/12/2000 PT,ANTE, KENNETH 03/14/2003 13 . 33 4 70CE 000301833A 03/14/2000 ESPARZA, APRIL 03/14/2003 90 .39 4 82 000301903A 03/17/2000 WRIGHT, BRIAN 03/14/2003 98.80 4 70CE 000301933A 03/18/2000 CHAPPELL, ZACHARY S 03/14/2003 136 .81 4 70CE 000301933A 03/18/2000 CHAPPELL, ZACHARY S 03/14/2003 18.33 4 70CE 000403030A 04/26/2000 HELD, NICOLE J 03/14/2003 12 .50 4 70CE 000503878A 05/29/2000 GARCIA, OBED 03/14/2003 123 .44 4 70CE 000604160A 06/07/2000 VEGA, LUZ MARIA 03/14/2003 68 .76 4 70CE 000604255B 06/10/2000 CHRISTMAN, BRIAN 03/14/2003 12 . 00 4 70CE 000604521A 06/20/2000 ALANIZ, DAVID A 03/14/2003 74 .72 4 70CE 000806395A 08/21/2000 ADAME SALAZAR, STEPH i Date:12/12/2003 Weld County Paramedic Services Page:11 Time:12 :13 :37 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 03/01/2003 Thru 03/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 81 MEDICARE WRITEOFF 84 61358 .95 730.46 56 .06 82 MEDICAID WRITEOFF 78 29695 .47 380 .71 100.40 83W WRITEOFF WORK COMP 2 601.73 300 .87 58 .50 84 TRICARE WRITE OFF 1 350.39 350.39 66 . 00 83C WRITEOFF TO COLLECTION AG 125 89838.55 718.71 187 .97 REV REVERSE CHARGED IN ERROR 1 4 .63 4.63 868.00 83 WRITEOFF 8 3004 .41 375.55 705.88 70CE COLLECTION EXPENSE 152 7594.68 49.96 947 .36 70PF PROFESSIONAL FINANCE COLL 15 867.17 57.81 772 .07 75A OVERPAYMENT RETURNED 5 1126 .26 225.25 285 .80 83VA WRITEOFF - VET ADMIN 2 711.50 355 .75 463 .00 Date:12,./12/2003 Weld County Paramedic Services Page: 1 Time: 12: 13:59 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/01/2003 Thru 04/30/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/04/2003 76. 07 4 82 010907495A 09/18/2001 SALAZAR, ANNABELIA 04/04/2003 1366 .00 4 82 011008359A 10/18/2001 TUCKER, DINA 04/04/2003 868 .00 4 82 020201343A 02/15/2002 LIVERMORE, ANDREW T 04/04/2003 374 .00 4 82 020201353A 02/15/2002 LIVERMORE, ANDREW T 04/04/2003 596.28 4 81 020302478A 03/27/2002 BIGA, MARY D 04/04/2003 116. 56 4 82 020302478A 03/27/2002 BIGA, MARY D 04/04/2003 0 .20 4 83 020806341A 08/11/2002 CLARK, JARED MICHAEL 04/04/2003 59.36 4 82 021008551A 10/25/2002 WELLS, CHARLES M 04/04/2003 BANKRUPTCY AMB 950.00 4 83 021109274A 11/20/2002 MALLARD, SETH 04/04/2003 66.62 4 82 021209748A 12/07/2002 MENDEZ, FRANCISCO 04/04/2003 62. 04 4 82 021210110A 12/20/2002 MENDEZ, FRANCISCO 04/04/2003 985.44 4 82 021210176A 12/22/2002 ALMEIDA, NORMA 04/04/2003 54.61 4 82 021210213A 12/24/2002 MENDEZ, FRANCISCO 04/04/2003 82.96 4 82 021210248A 12/26/2002 BAUER, ALBERT 04/04/2003 52 .25 4 82 030100350A 01/15/2003 BROWN, KEVIN 04/04/2003 59.29 4 82 030100533A 01/20/2003 BROWN, KEVIN 04/04/2003 25.00 4 82 030100739A 01/26/2003 FUHRER, ROBERT 04/07/2003 589.51 4 81 020302561A 03/30/2002 MCCUTCHEN, ELVA 04/07/2003 611.79 4 82 020907180A 09/08/2002 NOFFSINGER, JACQUELI 04/07/2003 73 .00 4 82 021008153A 10/12/2002 BRACHT, AUSTIN 04/07/2003 826. 05 4 81 030100074A 01/03/2003 BEER, KATHRYN R 04/07/2003 181.53 4 82 030100282A 01/12/2003 WOLLERT, HARVEY 04/07/2003 758 .23 4 82 030100314A 01/13/2003 SCHMIDT, ALBERT 04/07/2003 692 .67 4 81 030100359A 01/15/2003 FEST, LOLA 04/08/2003 1004 .25 4 82 021109408A 11/24/2002 CORRAL, JADE NICOLE 04/08/2003 34.72 4 82 030100046A 01/02/2003 CARDONA, ROSEMARIE 04/09/2003 980.00 4 82 021008429A 10/21/2002 SNOOK, THOMAS 04/09/2003 544 .80 4 82 021210111A 12/20/2002 JOHNSTON, JACOB D 04/09/2003 56 .43 4 82 030100531A 01/20/2003 APPLE, GERALD 04/09/2003 602 .47 4 81 030100719A 01/25/2003 PFERTCH, DON 04/10/2003 75.20 4 82 020100243A 01/08/2002 RODRIGUEZ, ESTELA 04/10/2003 120.44 4 82 020100413A 01/13/2002 MAES, PAT 04/10/2003 414 .00 4 82 020100452A 01/14/2002 JOHN, SUSANNA 04/10/2003 60 .00 4 82 020100843A 01/28/2002 SCHUMAN, MATTHEW 04/10/2003 62 .04 4 82 020705402A 07/09/2002 FELDMANN, DAISY 04/10/2003 89. 91 4 82 021109144A 11/15/2002 STALLSWORTH, RICHARD 04/10/2003 58 .14 4 82 021210060A 12/18/2002 VARGAS, YOLANDA 04/14/2003 86 .63 4 82 030100818A 01/28/2003 CARDONA, ROSEMARIE 04/15/2003 654.00 4 82 010907801A 09/29/2001 VIKEN, DAVID 04/15/2003 399.00 4 82 010907807A 09/29/2001 VIKEN, DAVID 04/15/2003 900. 00 4 82 020808441A 08/15/2002 MOLLOY, EULAH F 04/15/2003 74 .14 4 82 021008083A 10/10/2002 SHOEMAKER, JAMES 04/15/2003 72 .35 4 82 021008259A 10/16/2002 WEST, JACK 04/15/2003 BANKRUPTCY AMB 995.00 4 83 021109116A 11/13/2002 PHAE, MORGAN 04/16/2003 BANKRUPTCY AMB 1014.00 4 83 020705592A 07/15/2002 MONCRIEF, KAYLE 04/16/2003 260.40 4 81 021210297A 12/28/2002 FRAZZINI, MILDRED 04/17/2003 410 .00 4 83C 000806005A 08/07/2000 MARTINEZ, EZEQUIEL 04/17/2003 390 . 00 4 83C 020201360A 02/15/2002 PAZ, NORMA 04/17/2003 444 .00 4 83C 020604636A 06/15/2002 MONTOYA, MATTHEW A Date:12./12/2003 Weld County Paramedic Services Page: 2 Time:12 : 14 :01 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/01/2003 Thru 04/30/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/17/2003 197.20 4 83C 020705292A 07/06/2002 WAGNER, BRANDON R 04/17/2003 53 .36 4 83C 020705853A 07/26/2002 LOPEZ, CARMEN Q 04/17/2003 120 . 00 4 83C 020806058A 08/01/2002 BRENNEN, MICHAEL 04/17/2003 73 .36 4 83C 020907410A 09/17/2002 PADILLA, PLACIDA 04/17/2003 920 .00 4 83C 020907623A 09/25/2002 NEUKIRCH, PATRICIA 04/17/2003 920.00 4 83C 020907671A 09/26/2002 MALDONADO, ANDREA K 04/17/2003 174.00 4 83C 020907693A 09/27/2002 MANRIQUEZ, LAURA 04/17/2003 150.00 4 83C 020907779A 09/30/2002 MENDEZ, SHERYL 04/17/2003 1125.00 4 83C 021007846A 10/03/2002 KIPPERT, REBECCA A 04/17/2003 150 .00 4 83C 021007901A 10/05/2002 JIMENEZ, JOE 04/17/2003 995 .00 4 83C 021007928A 10/06/2002 PARKER, GLENN 04/17/2003 1145.00 4 83C 021008174A 10/13/2002 MOYA, JOSEPH P 04/17/2003 50.00 4 83C 021008193A 10/13/2002 NORWOOD, DENNIS 04/17/2003 950.00 4 83C 021008473A 10/22/2002 ROGERS, NADINE M 04/17/2003 1130.00 4 83C 021008500A 10/23/2002 MONTOYA, MATTHEW A 04/17/2003 995.00 4 83C 021008542B 10/24/2002 MARTINEZ, RAUL C 04/17/2003 1115.00 4 83C 021008574B 10/26/2002 ORTIZ, EDWARD 04/17/2003 1285. 00 4 83C 021008577A 10/26/2002 CROCKER-SHIELDS, JUA 04/17/2003 1108 .40 4 83C 021008596A 10/27/2002 MORA, VICKI 04/17/2003 960.00 4 83C 021008600A 10/27/2002 MORENO, JOEL 04/17/2003 920.00 4 83C 021008613A 10/27/2002 MCCLINTON, TRAVIS 04/17/2003 116.00 4 83C 021008620A 10/28/2002 LOMA, ANTONIO 04/17/2003 870 . 00 4 83C 021008663C 10/29/2002 GONZALEZ, JOE 04/17/2003 1055 .00 4 83C 021108783A 11/01/2002 REYNOLDS, GARY D 04/17/2003 1190.00 4 83C 021108963A 11/07/2002 VASQUEZ, CARMEN 04/17/2003 870.00 4 83C 021209708A 12/06/2002 BARRELLA-BASTILLOS, 04/17/2003 920.00 4 83C 021209708B 12/06/2002 MONTEZ, GABRIEL 04/18/2003 468.00 4 83C 010907015A 09/02/2001 SOTELO, JORGE 04/18/2003 886.00 4 83C 020201549A 02/21/2002 BARELA, KIM 04/18/2003 160 .21 4 83C 020302265A 03/18/2002 THOMPSON, DANIEL 04/18/2003 175.28 4 83C 020503688A 05/10/2002 HALVORSON, ROBIN 04/18/2003 899.00 4 83C 020705252A 07/05/2002 RAMIREZ, ERLINDA 04/18/2003 1070.00 4 83C 020806554A 08/19/2002 REITZ, CHRISTOPHER 04/18/2003 73 .36 4 83C 020806736A 08/25/2002 GOODWIN, ROBERT H 04/18/2003 995.00 4 83C 020806806A 08/27/2002 REITZ, CHRISTOPHER 04/18/2003 53 .52 4 83C 020907005B 09/03/2002 AVILA, MARIA 04/18/2003 125 .00 4 83C 020907141A 09/07/2002 FLORES, FRANCES 04/18/2003 186.00 4 83C 020907175A 09/08/2002 DOUGHTY, ANDREW 04/18/2003 1415.00 4 83C 020907185A 09/09/2002 ALONSO, JOANN 04/18/2003 256.00 4 83C 020907199A 09/09/2002 BROWN, LARRY D 04/18/2003 1055.00 4 83C 020907640A 09/25/2002 TREGONING, ERIC A 04/18/2003 435.00 4 83C 020907641A 09/25/2002 SALAZAR, JACOB J 04/18/2003 895.00 4 83C 021007870A 10/03/2002 HANSON, SANDER WILLI 04/18/2003 190.00 4 83C 021008054A 10/09/2002 TODD, JUDITH 04/18/2003 375.00 4 83C 021008057A 10/09/2002 MARES, VICTORIA 04/18/2003 995 .00 4 83C 021008137A 10/12/2002 HARO, TITO 04/18/2003 605 .00 4 83C 021008164A 10/12/2002 REICHEL, BOB 04/18/2003 167.00 4 83C 021008288A 10/17/2002 JOHNSON, SONJA 04/18/2003 995.00 4 83C 021008328A 10/18/2002 BENAVIDEZ, AMY Date:12/12/2003 Weld County Paramedic Services Page: 3 Time:12 :14 :02 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/01/2003 Thru 04/30/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/18/2003 900.00 4 83C 021008353A 10/19/2002 PENA, JAMIE 04/18/2003 73 .56 4 83C 021008375A 10/19/2002 VALDEZ, ANDREW 04/18/2003 870 . 00 4 83C 021008391A 10/19/2002 GUEVARA, ISRAEL D 04/18/2003 800 .00 4 83C 021008492B 10/23/2002 PADRON, MARIA 04/18/2003 65 .11 4 83C 021008530A 10/24/2002 EASLEY, BETTY 04/18/2003 972 .50 4 83C 021008549A 10/25/2002 HILL, YOLANDA 04/18/2003 74 .19 4 83C 021008573A 10/26/2002 COMPOZ, PAUL R 04/18/2003 870 .00 4 83C 021008663A 10/29/2002 BECHAND, SUZANNE L 04/18/2003 920 .00 4 83C 021008663B 10/29/2002 IBARA, KRISTA 04/18/2003 1070 .00 4 83C 021108761A 11/01/2002 SISNEROS, KENDRA J 04/18/2003 1750 .00 4 83C 021108828A 11/03/2002 ARMES, CAROL L 04/18/2003 1081.10 4 83C 021108846A 11/04/2002 COLCLEASURE, ERIC B 04/18/2003 1085 .00 4 83C 021108904A 11/06/2002 BAUMAN, MARY KAY 04/18/2003 890 .00 4 83C 021108907A 11/06/2002 ANTONE, LAURA 04/18/2003 975.00 4 83C 021108912A 11/06/2002 WOODS, JANIS E 04/18/2003 1070 .00 4 83C 021108957A 11/07/2002 CHULUUN, MISHEEL 04/18/2003 150 .00 4 83C 021108958A 11/07/2002 BARNETT, CASEY 04/18/2003 870 .00 4 83C 021109002A 11/09/2002 SANCHEZ, NANCY 04/18/2003 870.00 4 83C 021109011A 11/09/2002 ROMERO-SUAREZ, JOSUE 04/18/2003 1850.00 4 83C 021109028A 11/09/2002 KEAR, LONNY L 04/18/2003 1595.00 4 83C 021109034A 11/10/2002 CHLUMSKY, ELIZABETH 04/18/2003 780 .00 4 83C 021109043A 11/10/2002 CHLUMSKY, ELIZABETH 04/18/2003 995.00 4 83C 021109059A 11/11/2002 KOHLERT, BETHANY M 04/18/2003 216.00 4 83W 021109065A 11/11/2002 DELAROCHA, FRANCISCO 04/18/2003 870 .00 4 83C 021109074A 11/11/2002 HAAKENSON, JOEL R 04/18/2003 1055.00 4 83C 021109077A 11/12/2002 JENSON, ROBERT 04/18/2003 995.00 4 83C 021109078B 11/12/2002 CASTRO, ABDULIA 04/18/2003 1220 .00 4 83C 021109084A 11/12/2002 COFFMAN, JAMES A 04/18/2003 980 .00 4 83C 021109088A 11/12/2002 GREEN, TAMMY M 04/18/2003 1035.00 4 83C 021109091A 11/12/2002 STEPHENSON, RUSSELL 04/18/2003 150 .00 4 83C 021109109B 11/13/2002 HAYES, GREG 04/18/2003 920 .00 4 83C 021109114A 11/13/2002 ODRIOZOLA, JAZMINE 04/18/2003 1160 .00 4 83C 021109123A 11/14/2002 GARCIA, DANIEL 04/18/2003 1055 .00 4 83C 021109130A 11/14/2002 SAGE, STAN 04/18/2003 1055.00 4 83C 021109137A 11/14/2002 ALONSO, JOANN 04/18/2003 1070 .00 4 83C 021109149A 11/15/2002 TRUJILLO, HUMBERTO G 04/18/2003 997 .50 4 83C 021109153B 11/15/2002 BERIG, LEVI A 04/18/2003 935 .00 4 83C 021109190A 11/16/2002 ARENAS-LOMA, LAURA P 04/18/2003 980 .00 4 83C 021109213A 11/17/2002 BARRAZA, JASON 04/18/2003 1200 .00 4 83C 021109217A 11/17/2002 BARRAZA, JASON 04/18/2003 200 .00 4 83C 021109221G 11/18/2002 PINO, RORY 04/18/2003 87 .29 4 83C 021109228A 11/18/2002 TORRIBIO, ALBERT J 04/18/2003 1280 .00 4 83C 021109236A 11/18/2002 SEMS, MARK R 04/18/2003 1205.00 4 83C 021109237A 11/18/2002 GRIFFITH, SUSAN 04/18/2003 930.00 4 83C 021109244A 11/19/2002 CARDONA, LINDA 04/18/2003 54 .61 4 83C 021109257A 11/19/2002 NEHRING, LINDA 04/18/2003 1145.00 4 83C 021109279A 11/20/2002 ALTHOFF, T.ARIN K 04/18/2003 900.00 4 83C 021109282A 11/20/2002 ARENDS, JANSSEN 04/18/2003 980.00 4 83C 021109283A 11/21/2002 TAMLIN, TIFFANY Date:12/12/2003 Weld County Paramedic Services Page: 4 Iime:12 :14:02 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/01/2003 Thru 04/30/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/18/2003 980.00 4 83C 021109284A 11/21/2002 BAUMAN, MARY KAY 04/18/2003 1145.00 4 83C 021109291A 11/21/2002 GRIFFIN, GARY L 04/18/2003 950 .00 4 83C 021109294A 11/21/2002 BARNHART, VICKIE 04/18/2003 995 .00 4 83C 021109307A 11/21/2002 MALDONADO, MADEJAH 04/18/2003 450 .00 4 83C 021109308A 11/21/2002 SIMPSON, BRYAN 04/18/2003 1055.00 4 83C 021109319A 11/22/2002 CHANNEL, PATRICIA 04/18/2003 1055 .00 4 83C 021109322A 11/22/2002 CARRILLO, MICHELLE V 04/18/2003 995.00 4 83C 021109338A 11/22/2002 CHAGOLLA, VANESSA 04/18/2003 1730.00 4 83C 021109341A 11/22/2002 ALFREY, BRENT J 04/18/2003 150 .00 4 83C 021109361A 11/23/2002 TREVINO, JESSE R 04/18/2003 150 .00 4 83C 021109361B 11/23/2002 TREVINO, NOAH 04/18/2003 150.00 4 83C 021109361C 11/23/2002 TREVINO, STARLA 04/18/2003 150.00 4 83C 021109361O 11/23/2002 GONZALES, GABRIEL 04/18/2003 150 .00 4 83C 021109367A 11/23/2002 GALLEGOS, ELISA 04/18/2003 150 .00 4 83C 021109369A 11/23/2002 KUTCHER, DIANE 04/16/2003 1085.00 4 83C 021109388A 11/24/2002 RAMIREZ, VINCENT 04/18/2003 1085.00 4 83C 021109388B 11/24/2002 CARRILLO, ANTONIA 04/18/2003 260 .00 4 83C 021109395A 11/24/2002 TREVICO, LAURA 04/18/2003 150 . 00 4 83C 021109403A 11/24/2002 HOLGUIN, HUGO G 04/18/2003 150 .00 4 83C 021109406A 11/24/2002 JONES, STACY 04/18/2003 107.0 .00 4 83C 021109427A 11/24/2002 BUENO, MARIA 04/18/2003 150 .00 4 83C 021109436A 11/24/2002 HUFF, STEPHANIE 04/18/2003 1265.00 4 83C 021109489A 11/26/2002 GARZA, ANDRES 04/18/2003 1025.00 4 83C 021109491A 11/27/2002 SANCHEZ, ELIJAH X 04/18/2003 995.00 4 83C 021109499A 11/27/2002 GRIFFITH, JAMES S 04/18/2003 980 .00 4 83C 021109511A 11/27/2002 GONZALES, ORALIA 04/18/2003 94 .06 4 83C 021109515A 11/28/2002 HURLEY, VERA G 04/18/2003 1070.00 4 83C 021109517A 11/28/2002 REITZ, CHRISTOPHER 04/18/2003 1100.00 4 83C 021109551A 11/29/2002 GONZALES, BARBARA 04/18/2003 1110 . 00 4 83C 021109561A 11/30/2002 KAMAKELE, MARIA 04/18/2003 150 .00 4 83C 021109566A 11/30/2002 GARRISON, VERONICA 04/18/2003 920.00 4 83C 021109568A 11/30/2002 CARDENAS, ALFONSO 04/18/2003 980.00 4 83C 021109568B 11/30/2002 HERNANDEZ, JOSE 04/18/2003 1070 .00 4 83C 021209571A 12/01/2002 FLORES, ROMAN 04/18/2003 1085.00 4 83C 021209586A 12/01/2002 BERLIER, GARY 04/18/2003 150.00 4 83C 021209618A 12/03/2002 FRITZ, MARY 04/18/2003 1265.00 4 83C 021209636A 12/03/2002 FLORES, DANIEL 04/18/2003 150 .00 4 83C 021209644A 12/03/2002 DELROSS, TIM 04/18/2003 1065.00 4 83C 021209726A 12/06/2002 WEBER, RICK A 04/18/2003 980 . 00 4 83C 021209728A 12/06/2002 MCBROOM, PATRICIA M 04/18/2003 1205 .00 4 83C 021209747A 12/07/2002 GIBSON, KEITH 04/18/2003 100.00 4 83C 021209660A 12/11/2002 LARA, ARNOLFO 04/18/2003 73 .36 4 83C 021209876A 12/12/2002 JASSO, JOE 04/18/2003 62 .87 4 83C 021209967A 12/15/2002 NEHRING, LINDA J 04/18/2003 150.00 4 83C 021210098A 12/20/2002 BENAVIDEZ, AMY 04/18/2003 150 .00 4 83C 021210100A 12/20/2002 BENAVIDEZ, AMY 04/18/2003 1070 .00 4 83C 021210117A 12/21/2002 DURNS, MELISSA 04/18/2003 1085 .00 4 83C 021210255A 12/26/2002 GIFFIN, COLBY 04/18/2003 1200.00 4 83C 021210349A 12/30/2002 ALVAREZ, SARA S Date:12/12/2003 Weld County Paramedic Services Page: 5 Time:12 :14 :03 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/01/2003 Thru 04/30/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/18/2003 100 .00 4 83C 030100027A 01/01/2003 OLIVAS, ADRIAN 04/18/2003 935.00 4 83C 030100109A 01/05/2003 HERNANDEZ, MICHAEL A 04/18/2003 150.00 4 83C 030100219A 01/09/2003 BENAVIDEZ, AMY 04/18/2003 1040 .00 4 83C 030100386A 01/16/2003 NEWCOMER, SKYE R 04/18/2003 1055.00 4 83C 030100425A 01/17/2003 MEDINA, ALVENO L 04/18/2003 1040 .00 4 83C 030100453A 01/17/2003 STRAIGHT, KENNETH 04/18/2003 150 .00 4 83C 030100502A 01/19/2003 MCMAHON, JUSTIN 04/18/2003 1145.00 4 83C 030100508A 01/19/2003 ECHEVERRIA, STEVE 04/18/2003 1325.00 4 83C 030100544A 01/20/2003 BERNHOFT, DEBRA 04/18/2003 150 .00 4 83C 030100569A 01/21/2003 GRIFFITH, SUSAN 04/18/2003 920 .00 4 83C 030100574A 01/22/2003 KOCH, LINDA C 04/18/2003 329.00 4 83C 030100605A 01/22/2003 HALVORSON, ROBIN 04/21/2003 125.00 4 83C 010604385A 06/05/2001 LUCERO, AUGUSTINA 04/21/2003 250 .00 4 83C 011209840A 12/11/2001 PARSONS, LEWIS 04/21/2003 1014 .72 4 83C 020201333A 02/14/2002 LUCERO, AUGUSTINA 04/21/2003 157.60 4 83C 020403073A 04/18/2002 NORTHWAY, TRAYTON 04/21/2003 566 .90 4 83C 020503541A 05/05/2002 HALL, WILLIAM JOSEPH 04/21/2003 867.00 4 83C 020604851A 06/22/2002 MCCARTHY, KEVIN 04/21/2003 359.00 4 83C 020604855A 06/22/2002 MCCARTHY, KEVIN 04/21/2003 290 . 95 4 83C 020705119A 07/01/2002 OLSON, JANICE K 04/21/2003 50 .00 4 83C 020806716A 08/25/2002 PADILLA, THERESA 04/21/2003 150 .00 4 83C 020806726A 08/25/2002 LOZANO, VICTORIA 04/21/2003 370 .00 4 83C 020806787A 08/27/2002 LYNCH, JEANNELLE D 04/21/2003 25.00 4 83C 020806805A 08/27/2002 MARTINEZ, DELFINIO 04/21/2003 1310 .00 4 83C 020806819A 08/28/2002 MORENO, MELBA 04/21/2003 50 .00 4 83C 020907509B 09/21/2002 PRITT, KIMBERLY E 04/21/2003 1005.00 4 83C 020907783A 09/30/2002 PASTRANA, MARGARITO 04/21/2003 100 .00 4 83C 021008133A 10/12/2002 NEIDERER, ALEXANDRA 04/21/2003 172 .70 4 83C 021008446A 10/22/2002 MCCLURE, KRISTINA K 04/21/2003 25.00 4 83C 021108817A 11/02/2002 MARTINEZ, DELFINIO 04/21/2003 1235.00 4 83C 021108821A 11/02/2002 NINO, RAMON R 04/21/2003 150 .00 4 83C 021108833A 11/03/2002 MUTTEL, PRISCILLA 04/21/2003 150 .00 4 83C 021108900A 11/06/2002 MENKE, TARA 04/21/2003 1010 .00 4 83C 021108990A 11/08/2002 PADRON, ERIBERTO Y 04/21/2003 1015 .33 4 83C 021109006A 11/09/2002 MIKKELSON, FLORIS 04/21/2003 1080 .00 4 83C 021109026A 11/09/2002 OJEDA, GABRIEL 04/21/2003 995 .00 4 83C 021109078A 11/12/2002 MARTINEZ, MARIA R 04/21/2003 1295 .00 4 83C 021109160A 11/15/2002 ONTIVEROS, LORENZO 04/21/2003 150 .00 4 83C 021109212A 11/17/2002 LLAMAS, TERESA 04/21/2003 73.59 4 83C 021109396A 11/24/2002 PADILLA, PLACIDA 04/21/2003 1295.00 4 83C 021109422A 11/24/2002 MCRAE, MIKE 04/21/2003 123.50 4 83C 021109441A 11/25/2002 MARTINEZ, PAULETTE J 04/21/2003 150.00 4 83C 021109443A 11/25/2002 PADILLA, PLACIDA 04/21/2003 1010.00 4 83C 021109478A 11/26/2002 LEDEZMA, ARACELI 04/21/2003 213 .00 4 82 021109534A 11/28/2002 KING, ROBERT C 04/21/2003 725.07 4 81 021210054A 12/18/2002 PHILLIPS, JOHN 04/21/2003 623 .42 4 81 030100871A 01/30/2003 MCGEE, CLARA 04/21/2003 30.00 4 81 030100871A 01/30/2003 MCGEE, CLARA 04/21/2003 28.78 4 81 030100871A 01/30/2003 MCGEE, CLARA Date:12/12/2003 Weld County Paramedic Services Page:10 Time:12 :14 :05 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/01/2003 Thru 04/30/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 82 MEDICAID WRITEOFF 37 11771.80 318.16 233 .46 81 MEDICARE WRITEOFF 11 5598. 69 508. 97 143. 00 83 WRITEOFF 5 3159.20 631.84 294.60 83C WRITEOFF TO COLLECTION AG 193 136027.13 704.80 184 .46 83W WRITEOFF WORK COMP 1 216.00 216 .00 158.00 84 TRICARE WRITE OFF 1 489.69 489.69 192.00 70CE COLLECTION EXPENSE 139 7697. 92 56. 82 1039.48 70PF PROFESSIONAL FINANCE. COLL 15 1774 .39 118.29 549.13 Date:05/22/2003 Weld County Paramedic Services Page: 1 Time:10 :47 :05 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/21/2003 Thru 05/21/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/21/2003 111.53 4 83C 010301802A 03/06/2001 TRUJILLO, JOAN KAYE 05/21/2003 755.16 4 83C 020100056A 01/02/2002 ANDERSON, JOAN KAYE 05/21/2003 425 .52 4 83C 020201015A 02/03/2002 ROMERO, LOUISE **S 05/21/2003 689.00 4 83C 020302184A 03/15/2002 NOSKO, JENNIFER 05/21/2003 707 .00 4 83C 020403019A 04/16/2002 RAMOS HERNANDEZ, JOR 05/21/2003 717.00 4 83C 020403019B 04/16/2002 RAMOS, RAFAEL 05/21/2003 764. 00 4 83C 020403251A 04/25/2002 WAITS, WILLIAM RALPH 05/21/2003 260 .00 4 83C 020504079A 05/26/2002 WILLIAMS, STELLA 05/21/2003 874 .00 4 83C 020504107A 05/27/2002 WAITS, WILLIAM RALPH 05/21/2003 894 .00 4 83C 020604469A 06/09/2002 SCHWARTZ, DEBBY 05/21/2003 700 .00 4 83C 020604684A 06/17/2002 REICH, DENNIS 05/21/2003 80 .13 4 83C 020705520A 07/13/2002 SEVERSON, KAY 05/21/2003 869.00 4 83C 020705583A 07/15/2002 THOMAS, JAYSON 05/21/2003 120. 00 4 83C 020705714B 07/21/2002 SEAGER, JAMES 05/21/2003 95 .00 4 83C 020806099A 08/03/2002 WADSWORTH, TERESA 05/21/2003 1486 .00 4 83C 020806348A 08/11/2002 JACKSON, HOWARD 05/21/2003 547.94 4 83C 020907029A 09/04/2002 LEWIS, JAMES 05/21/2003 920.00 4 83C 020907372A 09/15/2002 SANCHEZ, LYDIA 05/21/2003 1115.00 4 83C 020907596A 09/24/2002 KASPAR, SHERRI L 05/21/2003 101.00 4 83C 020907599A 09/24/2002 SHAW, AMANDA 05/21/2003 1205 .00 4 83C 020907746A 09/29/2002 MANENTI, THOMAS 05/21/2003 1045.33 4 83C 020907768A 09/30/2002 KASPAR, SHERRI L 05/21/2003 150 .00 4 83C 021007843A 10/03/2002 TERRY, RICHARD 05/21/2003 359.80 4 83C 021007968A 10/07/2002 TUCKER, RAVEN 05/21/2003 1115.00 4 83C 021008044A 10/09/2002 GILBERT, KRISTI 05/21/2003 1062.50 4 83C 021008062A 10/10/2002 ROMERO, ROSE 05/21/2003 102. 23 4 83C 021008113A 10/11/2002 ROTH, RACHEL 05/21/2003 177 .00 4 83C 021008130A 10/12/2002 ROMAN, ADRIAN 05/21/2003 703 .35 4 83C 021008146A 10/12/2002 VANNEST, THARON A 05/21/2003 99.74 4 83C 021008281A 10/16/2002 TAYLOR, SUZANNE H 05/21/2003 220.00 4 83C 021008373A 10/19/2002 SIDEBOTTOM, ALAN 05/21/2003 71.33 4 83C 021008441A 10/22/2002 DAHARSH, CLARA 05/21/2003 80 .01 4 83C 021008472A 10/22/2002 SEVERSON, KAY 05/21/2003 59.36 4 83C 021008503A 10/23/2002 DANLEY, EDNA 05/21/2003 995.00 4 83C 021008542A 10/24/2002 MARTIN, KRISTOPHER 05/21/2003 150.00 4 83C 021108842A 11/04/2002 SERNA, MARISSA 05/21/2003 1190.00 4 83C 021108908A 11/06/2002 VAN HOESEN, JESSICA 05/21/2003 1175 .00 4 83C 021108998A 11/09/2002 HENDRIX, CHRISTOPHER 05/21/2003 1070 .00 4 83C 021109069A 11/11/2002 DIEGO-MARTIN, MARIA 05/21/2003 1040 .00 4 83C 021109107A 11/13/2002 KASPAR, SHERRI 05/21/2003 1055.00 4 83C 021109109A 11/13/2002 RAMIREZ, JOEL 05/21/2003 150.00 4 83C 021109140A 11/14/2002 DARROUGH, RACHEL M 05/21/2003 593 .60 4 83C 021109256A 11/19/2002 SMITH, HEATHER 05/21/2003 1145 .00 4 83C 021109265A 11/20/2002 HERNANDEZ-DELGADO, E 05/21/2003 174 .00 4 83C 021109397A 11/24/2002 SEANEZ, RUBEN 05/21/2003 1025 .00 4 83C 021109507A 11/27/2002 SCHUTTEN, SHANDA 05/21/2003 150. 00 4 83C 021209584A 12/01/2002 VALDEZ, MONA 05/21/2003 150 .00 4 83C 021209601A 12/02/2002 THOMPSON, JULIE 05/21/2003 980.00 4 83C 021209617A 12/02/2002 ZEIGER, JOHN W Date:05/22/2003 Weld County Paramedic Services Page : 2 Time:10 :47 :06 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/21/2003 Thru 05/21/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/21/2003 1900 . 00 4 83C 021209621A 12/03/2002 NEWBANKS, NORMAN 05/21/2003 1205.00 4 83C 021209625A 12/03/2002 ASHBY, AMY P 05/21/2003 1050.00 4 83C 021209629A 12/03/2002 MORAIGN, TATYANA 05/21/2003 1070 .00 4 83C 021209642A 12/03/2002 TREJO, VERONICA 05/21/2003 930 .00 4 83C 021209653A 12/04/2002 MONTIEL, CHRISTIANIA 05/21/2003 150.00 4 83C 021209658A 12/04/2002 LOPEZ, VERONICA 05/21/2003 150 .00 4 83C 021209687A 12/06/2002 VALLES, JUAN 05/21/2003 1145 .00 4 83C 021209692A 12/06/2002 REYES, JOHN 05/21/2003 1055.00 4 83C 021209699A 12/06/2002 SHERMAN, KENNETH J 05/21/2003 1220.00 4 83C 021209712B 12/06/2002 BARRERA, GUADALUPE 05/21/2003 1085 .00 4 83C 021209715A 12/06/2002 DURAN, ORLANDO 05/21/2003 1085.00 4 83C 021209715B 12/06/2002 AGUILAR, LUIS 05/21/2003 150 .00 4 83C 021209738A 12/07/2002 SAMSON, FRANCISCA A 05/21/2003 980 .00 4 83C 021209739A 12/07/2002 FONSETH, VICTORIA L 05/21/2003 150.00 4 83C 021209740A 12/07/2002 RAMOS, MELISSA 05/21/2003 1340.00 4 83C 021209744A 12/07/2002 CRAWFORD, ROGER 05/21/2003 150 . 00 4 83C 021209766A 12/08/2002 ARAGON, MARK 05/21/2003 930.00 4 83C 021209790A 12/09/2002 SANCHEZ, MIKE 05/21/2003 980.00 4 83C 021209804A 12/09/2002 WEISCOPF, JOHN C 05/21/2003 1010 .00 4 83C 021209869A 12/11/2002 PACHECO, MELISSA 05/21/2003 73 .36 4 83C 021209872A 12/12/2002 GORE, DELBERT 05/21/2003 1220.00 4 83C 021209877A 12/12/2002 TRAYLOR, HARRY 05/21/2003 1130 .00 4 83C 021209884A 12/12/2002 GRACE, CHAD 05/21/2003 1085.00 4 83C 021209689A 12/12/2002 TREVINO, SONIA 05/21/2003 1490.00 4 83C 021209905A 12/13/2002 CHOATE, STEVE 05/21/2003 82 .95 4 83C 021209907A 12/13/2002 GONZALES, CHRISTINA 05/21/2003 68.65 4 83C 021209908A 12/13/2002 STANLEY, SHERRY K 05/21/2003 920.00 4 83C 021209917B 12/13/2002 HERNANDEZ, KEVIN 05/21/2003 1060 .33 4 83C 021209923A 12/13/2002 LOPEZ, JOHN A 05/21/2003 1235.00 4 83C 021209929A 12/13/2002 GEORGE, KENNETH S 05/21/2003 1070.00 4 83C 021209938A 12/14/2002 CORDOVA, ARACELI 05/21/2003 57.97 4 83C 021209939A 12/14/2002 HARDING-SIPES, RACHE 05/21/2003 1070.00 4 83C 021209945A 12/14/2002 APPLETON, NANCY 05/21/2003 870.00 4 83C 021209951A 12/14/2002 MAURICI, TONYA R 05/21/2003 150 .00 4 83C 021209963A 12/15/2002 SALAS, AARON 05/21/2003 150.00 4 83C 021209963B 12/15/2002 LARSON, ROBERT 05/21/2003 1130 .00 4 83C 021209969A 12/15/2002 LEBLANC, RICHARD 05/21/2003 150 .00 4 83C 021209982A 12/15/2002 JIMENEZ, GRACIELA 05/21/2003 870.00 4 83C 021209984A 12/15/2002 WATKINS, LYLE 05/21/2003 930.00 4 83C 021209990B 12/16/2002 HERNANDEZ, RUDY 05/21/2003 1495 .00 4 83C 021209994A 12/16/2002 TRUJILLO, VERONICA 05/21/2003 877.50 4 83C 021209998A 12/16/2002 MOSCO, SAMANTHA J 05/21/2003 877.50 4 83C 021209998B 12/16/2002 MOSCO, LISA 05/21/2003 58 .97 4 83C 021210001A 12/16/2002 CATON, JOHN 05/21/2003 1400.00 4 83C 021210007A 12/16/2002 VANDERLOO, CORY 05/21/2003 450 .00 4 83C 021210014A 12/16/2002 WATKINS, LYLE 05/21/2003 930 . 00 4 83C 021210018A 12/16/2002 TRUJILLO, DAVID A 05/21/2003 150.00 4 83C 021210042A 12/17/2002 NAVA, ROMELIA 05/21/2003 1055 .00 4 83C 021210045A 12/17/2002 BOSWELL, JAMES A I Date:05/22/2003 Weld County Paramedic Services Page: 3 Time:10 :47:07 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/21/2003 Thru 05/21/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/21/2003 930 .00 4 83C 021210064A 12/18/2002 ESPINOZA, DANIEL K 05/21/2003 930 .00 4 83C 021210080A 12/19/2002 BURANDT, KATRYN M 05/21/2003 108.50 4 83C 021210092B 12/20/2002 RAMIREZ, LAURIANO 05/21/2003 1055 .00 4 83C 021210104A 12/20/2002 ROMERO, MARTIN 05/21/2003 150 . 00 4 83C 021210114A 12/21/2002 ARGO, RICHARD 05/21/2003 960.00 4 83C 021210116A 12/21/2002 VASQUEZ, ADRIAN 05/21/2003 1070 .00 4 83C 021210117B 12/21/2002 RIOS, LEON 05/21/2003 995 .00 4 83C 021210122A 12/21/2002 GOMEZ, GABRIEL 05/21/2003 1010.00 4 83C 021210147A 12/21/2002 MARTINEZ, DANIELLE 05/21/2003 1160 .00 4 83C 021210157A 12/22/2002 YANES, CHRISTOPHER M 05/21/2003 980 .00 4 83C 021210158A 12/22/2002 MONTES, VERONICA 05/21/2003 1085.00 4 83C 021210165A 12/22/2002 AMADO, JENNY 05/21/2003 980 .00 4 83C 021210175A 12/22/2002 ANDERSON, KAREN 05/21/2003 1115.00 4 83C 021210180A 12/23/2002 GUERRERO-TOVAR, MAUR 05/21/2003 73 .36 4 83C 021210184A 12/23/2002 DAHARSH, CLARA 05/21/2003 980 .00 4 83C 021210197A 12/24/2002 CHAVEZ, ANTHONY 05/21/2003 1300.00 4 83C 021210208A 12/24/2002 GEORGE, WILLIAM 05/21/2003 1070 .00 4 83C 021210210A 12/24/2002 MCDONALD, VONETTA 05/21/2003 1155 .00 4 83C 021210224A 12/24/2002 ALLMER, MIKE 05/21/2003 995.00 4 83C 021210226A 12/25/2002 CHAVEZ, ANTHONY 05/21/2003 1055 .00 4 83C 021210229A 12/25/2002 MAYER-TUCKER, ANGELI 05/21/2003 150 .00 4 83C 021210242A 12/25/2002 MURRAY, JOSEPH 05/21/2003 950 .00 4 83C 021210246B 12/25/2002 GARZA, SYLVIA 05/21/2003 870 .00 4 83C 021210263A 12/26/2002 GEORGE, WILLIAM 05/21/2003 1145.00 4 83C 021210269A 12/26/2002 HERRERA-GARCIA, OMAR 05/21/2003 980 .00 4 83C 021210272A 12/26/2002 CHAVEZ, ANTHONY 05/21/2003 1085 .00 4 83C 021210298A 12/28/2002 LYONS, MICHELLE 05/21/2003 1077.50 4 83C 021210305A 12/28/2002 MOORE, JESSICA 05/21/2003 1077.50 4 83C 021210305B 12/28/2002 YBARRA, ANN 05/21/2003 1169.00 4 83C 021210317A 12/29/2002 WASIKOWSKI, ROSALIE 05/21/2003 1010.00 4 83C 021210319A 12/29/2002 LEWERKE, CATHY J 05/21/2003 73 .36 4 83C 021210321A 12/29/2002 RIPPERGER, VIRGINIA 05/21/2003 870 .00 4 83C 021210329A 12/29/2002 TRUJILLO, AARON 05/21/2003 1055.00 4 83C 021210337A 12/30/2002 NUGENT, NATHAN 05/21/2003 1220 . 00 4 83C 021210339A 12/30/2002 RAMOS, MELISSA 05/21/2003 870.00 4 83C 021210342A 12/30/2002 STINNETT, MICHELLE 05/21/2003 150 .00 4 83C 021210345A 12/30/2002 SCHLEMER, DAVE 05/21/2003 930. 00 4 83C 021210350A 12/31/2002 LOPEZ, MANOLIN 05/21/2003 150.00 4 83C 021210357A 12/31/2002 HARDY, JAY 05/21/2003 150 .00 4 83C 021210375A 12/31/2002 VARELA, MITCHELL 05/21/2003 150.00 4 83C 021210375B 12/31/2002 MORONENESE, EDDIE 05/21/2003 1010 .00 4 83C 021210376A 12/31/2002 MARCELENO, TONI 05/21/2003 995 .00 4 83C 021210378A 12/31/2002 UGARTE, MELESIA 05/21/2003 150 .00 4 83C 030100006A 01/01/2003 MORRIS, DOLLY 05/21/2003 870 .00 4 83C 030100013A 01/01/2003 ORTIZ, JORGE 05/21/2003 1145 . 00 4 83C 030100014A 01/01/2003 SCHULTZ, CARL 05/21/2003 1055.00 4 83C 030100017A 01/01/2003 MALONEY, LEA ANNE 05/21/2003 1115 .00 4 83C 030100020A 01/01/2003 REESE, GAIL 05/21/2003 1205 .00 4 83C 030100022A 01/01/2003 SHEETS, MILLIE A Date:05/22/2003 2003 Weld County Paramedic Services/ / Page: 4 Time:10:47:07 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/21/2003 Thru 05/21/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/21/2003 1100 .00 4 83C 030100028A 01/01/2003 GARCIA, MARIA 05/21/2003 1195.00 4 83C 030100040A 01/02/2003 GUERRERO-TOVAR, MAUR 05/21/2003 1070.00 4 83C 030100057A 01/02/2003 LOERA, MARIA 05/21/2003 1085 .00 4 83C 030100061A 01/03/2003 NEUKIRCH, PATRICIA 05/21/2003 150.00 4 83C 030100063A 01/03/2003 HAYES, JAMES 05/21/2003 1415.00 4 83C 030100066A 01/03/2003 NETTLES, JOSEPHINE 05/21/2003 950 .00 4 83C 030100085A 01/03/2003 HALDERMAN, STACEY N 05/21/2003 52.86 4 83C 030100088A 01/04/2003 PACHECO, GILBERT 05/21/2003 1250.00 4 83C 030100105A 01/04/2003 MADRID, GERALDINE 05/21/2003 1055 .00 4 83C 030100152A 01/07/2003 RAMOS, MELISSA 05/21/2003 150.00 4 83C 030100194A 01/08/2003 RIOJAS, VERONICA 05/21/2003 870.00 4 83C 030100207A 01/09/2003 CRUZ, ERNESTINE L 05/21/2003 1190 .00 4 83C 030100208A 01/09/2003 CLARK, LISA M 05/21/2003 1055.00 4 83C 030100235A 01/10/2003 LOPEZ, JOHN A 05/21/2003 495.00 4 83C 030100252A 01/11/2003 LITTLE LIGHT JR, BRU 05/21/2003 450 .00 4 83C 030100272A 01/12/2003 PEREZ, JEFFREY 05/21/2003 995.00 4 83C 030100302A 01/13/2003 MURCH, NICHOLAS 05/21/2003 1055.00 4 83C 030100309A 01/13/2003 SKARDERUD, NICOLE 05/21/2003 150 .00 4 83C 030100309B 01/13/2003 SKARDERUD, BRADY 05/21/2003 995 .00 4 83C 030100319A 01/13/2003 SALIERS, ARLYN 05/21/2003 1055.00 4 83C 030100406A 01/16/2003 PRIGG, JAMES 05/21/2003 49.50 4 83C 030100465A 01/18/2003 CARPENETER, JENNIFER 05/21/2003 1085.00 4 83C 030100472A 01/18/2003 GUTIERREZ, JOSE 05/21/2003 1475.00 4 83C 030100476A 01/18/2003 VARGAS, FRANCISCA 05/21/2003 150 .00 4 83C 030100480D 01/18/2003 SORIA, JOHNNY 05/21/2003 72 .69 4 83C 030100501A 01/19/2003 WEGNER, JANET 05/21/2003 870.00 4 83C 030100528A 01/20/2003 SMITH, MICHEAL M 05/21/2003 1070 .00 4 83C 030100550A 01/21/2003 SALDIVAR, EVANGILINA 05/21/2003 982 .50 4 83C 030100577B 01/22/2003 VILLEGAS-DELGADO, GA 05/21/2003 1025.00 4 83C 030100612A 01/22/2003 LOPEZ, JOHN A 05/21/2003 870 .00 4 83C 030100825A 01/29/2003 MIRELES, MARLENA 05/21/2003 1055 . 00 4 83C 030100885A 01/31/2003 NEUSCHWANGER, LAWREN Total of 179 WriteOff Entries Totaling 137888 .53 Dollars Average WriteOff: 770 .33 Dollars Average Time:181 Days Date:05/22/2003 Weld County Paramedic Services Page: 5 Time:10 :47 : 07 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/21/2003 Thru 05/21/2003 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 179 137888.53 770 .33 180 .54 : . Date:06/20/2003 Weld County Paramedic Services Page: 1 Time:10:11:39 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/18/2003 Thru 06/19/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 06/18/2003 150. 00 4 83C 000100045A 01/03/2000 MASON, LAURENCE 06/18/2003 938.22 4 83C 011109465A 11/26/2001 BIGA, WALTER 06/18/2003 199.00 4 83C 020907021A 09/03/2002 MILLER, ZACHARY 06/18/2003 960 .00 4 83C 020907509A 09/21/2002 MOSKAL, ERICA 06/18/2003 870 .00 4 83C 021209645A 12/04/2002 MARTINEZ, ROBERTO 06/18/2003 150. 00 4 83C 021209674A 12/05/2002 MAZZARELLI, SAM 06/18/2003 652.06 4 83C 021209719A 12/06/2002 LEWIS, JAMES 06/18/2003 1085.00 4 83C 021210039A 12/17/2002 BACA, DIANA 06/18/2003 1055 .00 4 83C 021210149A 12/21/2002 MASS, ANTHONY 06/18/2003 1220.00 4 83C 021210200A 12/24/2002 PIERCE, LINDA 06/18/2003 950. 00 4 83C 030100392A 01/16/2003 MORADO, MICHELLE 06/18/2003 1385.00 4 83C 030100446A 01/17/2003 LOEB, DARIEN J 06/18/2003 150 .00 4 83C 030100480C 01/18/2003 NARANJO, FRANCISCO 06/18/2003 870.00 4 83C 030100525A 01/20/2003 MUNIZ, MARGARET 06/18/2003 1160.00 4 83C 030100537A 01/20/2003 NEGRETE, MIGUEL A 06/18/2003 1165.95 4 83C 030100546A 01/20/2003 MOTLEY, JOHN G 06/18/2003 1415.00 4 83C 030100547A 01/20/2003 PHILLIPS, MARK 06/18/2003 1070.00 4 83C 030100570A 01/21/2003 PARKER, BRITTNEY R 06/18/2003 1430.00 4 83C 030100596A 01/22/2003 OLIVAS, MACIANO 06/18/2003 1070 .00 4 83C 030100628A 01/22/2003 PITTAWAY, NANCY C 06/18/2003 980. 00 4 83C 030100649A 01/23/2003 MADRID, DAVID 06/18/2003 1280.00 4 83C 030100671A 01/24/2003 MELENDEZ, LORENA 06/18/2003 150.00 4 83C 030100685A 01/24/2003 NEERGAARD, JACOB 06/18/2003 150 .00 4 83C 030100771A 01/27/2003 LUEHRING, JOANN SUE 06/18/2003 935.00 4 83C 030100828A 01/29/2003 PARKER, GLENN 06/18/2003 995. 00 4 83C 030100839B 01/29/2003 LINDNER, DAN 06/18/2003 1070.00 4 83C 030100845A 01/29/2003 PHILLIPS, CHAD 06/18/2003 870.00 4 83C 030100846A 01/29/2003 LANCKRIET, GREGORY 06/18/2003 1175.00 4 83C 030100863A 01/30/2003 NEGRETE, MIGUEL A 06/18/2003 150.00 4 83C 030100869A 01/30/2003 MCKENZIE, RONALD J J 06/19/2003 671. 00 4 83C 001209354A 12/06/2000 VALENSUELA, CYNTHIA 06/19/2003 385.00 4 83C 010302092A 03/16/2001 HEISLER, CHARLES 06/19/2003 244.00 4 83C 010402866A 04/12/2001 TRUJILLO, DOMINIK 06/19/2003 481.00 4 83C 010705520A 07/14/2001 ARAUJO, MARY ANN 06/19/2003 143 .00 4 83C 011008392A 10/19/2001 RIGGINS, GARI 06/19/2003 435. 08 4 83C 011209699A 12/06/2001 BRANDT, DONNA L 06/19/2003 50.00 4 83C 020201005A 02/02/2002 THOMPSON, CHARLES 06/19/2003 375.00 4 83C 020201339A 02/15/2002 ANDRADE, BEATRICE 06/19/2003 318.60 4 83C 020301971A 03/08/2002 OROZCO, OFELIA 06/19/2003 207.00 4 83C 020403386A 04/30/2002 KENNEDY, DANNY 06/19/2003 286. 00 4 83C 020604486A 06/10/2002 BUCK, LONNIE R 06/19/2003 246.00 4 83C 020604655A 06/15/2002 PARRA, DORIS ISELA 06/19/2003 25.00 4 83C 020604843A 06/22/2002 GREEN, BRIAN 06/19/2003 6.61 4 83C 020604932A 06/25/2002 HAGELSTROM, SYLVIA 06/19/2003 38.48 4 83C 020604942A 06/25/2002 HAGELSTROM, SYLVIA 06/19/2003 950.00 4 83C 020705377A 07/08/2002 RIGGINS, GARI 06/19/2003 748.00 4 83C 020705412A 07/09/2002 BARRON, PEDRO 06/19/2003 774.00 4 83C 020705811A 07/24/2002 RODRIGUEZ, SHIRLEY 06/19/2003 724.00 4 83C 020806132D 08/04/2002 MORALES, HUMBERTO Date:06/20/2003 Weld County Paramedic Services Page: 2 Time:10:11:40 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/18/2003 Thru 06/19/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 06/19/2003 1234.00 4 83C 020806289A 08/10/2002 MCCAIN, TAMMY 06/19/2003 120 .00 4 83C 020806307A 08/10/2002 ROBERTS, CINDY 06/19/2003 75.02 4 83C 020806439A 08/15/2002 RUSHING, MAGGIE L 06/19/2003 1125.00 4 83C 020806909A 08/31/2002 WOOD, BROOKE 06/19/2003 342 .00 4 83C 020907157A 09/08/2002 ELBERT, MAUREEN E 06/19/2003 702.50 4 83C 021007819A 10/02/2002 GUERECA, NATHANIEL 06/19/2003 244.00 4 83C 021008344A 10/18/2002 HUNDERTMARK, LAUREN 06/19/2003 168.00 4 83C 021008555A 10/25/2002 RUIZ, MARICELA 06/19/2003 1250 .00 4 83C 021008658A 10/29/2002 DINKEL, DOROTHY 06/19/2003 1055.00 4 83C 021008760A 10/31/2002 BJORDAHL, GREGORY 06/19/2003 73 .36 4 83C 021108855A 11/04/2002 KONTZ, VIOLA 06/19/2003 73 .36 4 83C 021108976A 11/08/2002 FLAHERTY, JAMES P 06/19/2003 1055.00 4 83C 021109051A 11/10/2002 MADDOX, PHILLIP 06/19/2003 150 .00 4 83C 021109062A 11/11/2002 ADLER, LISA 06/19/2003 128.00 4 83C 021109120A 11/13/2002 FROID, DRAVEN 06/19/2003 25.00 4 83C 021109157A 11/15/2002 SALAZAR, JONI 06/19/2003 380.00 4 83C 021109231A 11/18/2002 VELAZCO, JOEL 06/19/2003 25.00 4 83C 021109314A 11/21/2002 SAT.A7AR, JONI 06/19/2003 150.00 4 83C 021109369A 11/23/2002 KUTCHER, DIANE 06/19/2003 984.50 4 83C 021109476A 11/26/2002 VARGAS, SANTIAGO 06/19/2003 192.50 4 83C 021109477A 11/26/2002 VARGAS, SANTIAGO 06/19/2003 591.00 4 83C 021109541A 11/29/2002 BURNS, REBECCA 06/19/2003 130 .00 4 83C 021209611A 12/02/2002 SUBLETTE, TERESA J 06/19/2003 73 .20 4 83C 021209850A 12/11/2002 BERRYMAN, HAZEL 06/19/2003 1085.00 4 83C 021209871A 12/12/2002 URESTE, CELESTINO 06/19/2003 1215.00 4 83C 021209957A 12/14/2002 WHITE, TRACY 06/19/2003 537 .00 4 83C 021209985A 12/15/2002 ZITO, SEBASTIAN 06/19/2003 108.50 4 83C 021210092A 12/20/2002 GUTIERREZ, THOMAS 06/19/2003 1040.00 4 83C 021210125A 12/21/2002 HUMPHREY, BILLY 06/19/2003 358.66 4 83C 021210132A 12/21/2002 REYES, DAVID 06/19/2003 1100.00 4 83C 021210289A 12/28/2002 SATOR, ROBERT E 06/19/2003 65.71 4 83C 021210374A 12/31/2002 TATUM, BONNIE L 06/19/2003 1445.00 4 83C 030100001A 01/01/2003 DAY, BECKY SUE 06/19/2003 1345.00 4 83C 030100007A 01/01/2003 DIAZ, FRANCO 06/19/2003 990.00 4 83C 030100007B 01/01/2003 DIAZ, ULRICO 06/19/2003 950.00 4 83C 030100033A 01/02/2003 CHAJ AJTUN, PEDRO 06/19/2003 68.34 4 83C 030100112A 01/05/2003 HEIKKINEN, HENRY W 06/19/2003 1010.00 4 83C 030100114A 01/05/2003 SATOR, ROBERT E 06/19/2003 1055 .00 4 83C 030100130A 01/06/2003 RISHEL, DREXEL DEWAI 06/19/2003 1145.00 4 83C 030100133A 01/06/2003 CASTANEDA, ARTURO 06/19/2003 1265.00 4 83C 030100136A 01/06/2003 GARRETT, LONNIE 06/19/2003 25.00 4 83C 030100170A 01/08/2003 CONTRERAS, SERGIO 06/19/2003 150.00 4 83C 030100176A 01/08/2003 HAISLIP, CRYSTAL 06/19/2003 1220.00 4 83C 030100177A 01/08/2003 EHRLICK, VALERIE 06/19/2003 1205.00 4 83C 030100179A 01/08/2003 KAMAKELE, DAVID 06/19/2003 25 .00 4 83C 030100183A 01/08/2003 MALTBY, JACOB 06/19/2003 980 .00 4 83C 030100189A 01/08/2003 BOWMAN JR, EDWARD A 06/19/2003 1160 .00 4 83C 030100201A 01/09/2003 GARCIA, ALICIA R 06/19/2003 1055.00 4 83C 030100228A 01/10/2003 FLEMING, AARON S J Date:06/20/2003 Weld County Paramedic Services Page: 3 Time:10 :11:40 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/18/2003 Thru 06/19/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 06/19/2003 150 .00 4 83C 030100247A 01/10/2003 GRAVES, DAVID A 06/19/2003 995.00 4 83C 030100287A 01/12/2003 CLARK, KAREN 06/19/2003 1235.00 4 83C 030100289A 01/12/2003 DAY, BECKY SUE 06/19/2003 150.00 4 83C 030100300A 01/13/2003 ARTEAGA, STEVEN 06/19/2003 78 .54 4 83C 030100305A 01/13/2003 RYAN, ANGELITA 06/19/2003 974 .00 4 83C 030100316B 01/13/2003 TULLEY, LISA 06/19/2003 1205.00 4 83C 030100327A 01/14/2003 SPAIN, ROYCE 06/19/2003 810.00 4 83C 030100343A 01/14/2003 SPAIN, ROYCE 06/19/2003 1175. 00 4 83C 030100396A 01/16/2003 ASHLEY, GILDA 06/19/2003 247 .00 4 83C 030100399A 01/16/2003 WIES, DOUGLAS 06/19/2003 150 .00 4 83C 030100425B 01/17/2003 APADACA, HERNALDO 06/19/2003 950.00 4 83C 030100444A 01/17/2003 DUARTE, PATRICK C 06/19/2003 150.00 4 83C 030100447A 01/17/2003 ANDERSON, ALBERT 06/19/2003 972.50 4 83C 030100480A 01/18/2003 ESQUIVEL, CRYSTAL 06/19/2003 219.00 4 83C 030100496A 01/19/2003 WENCE, JOSEPH 06/19/2003 1100.00 4 83C 030100514A 01/20/2003 DELAGARZA, NOAH W 06/19/2003 150 .00 4 83C 030100530A 01/20/2003 CRANE, RHONDA 06/19/2003 1115.00 4 83C 030100532A 01/20/2003 TRIMBLE, SUSAN 06/19/2003 915.00 4 83C 030100586A 01/22/2003 REYES, PATRICIO R 06/19/2003 960.00 4 83C 030100650A 01/23/2003 SLACK, NADA D 06/19/2003 150 .00 4 83C 030100653B 01/23/2003 FALK, KIMBERLY 06/19/2003 150 .00 4 83C 030100663B 01/24/2003 JEANS, SARAH 06/19/2003 73 .28 4 83C 030100665A 01/24/2003 UHRICH, LOYD C 06/19/2003 1055.00 4 83C 030100676A 01/24/2003 WRIGHT, KATHERINE D 06/19/2003 150.00 4 83C 030100682B 01/24/2003 WARREN, JERRY R 06/19/2003 62 .91 4 83C 030100695A 01/24/2003 MAES, ABEL 06/19/2003 980.00 4 83C 030100703A 01/25/2003 BUCKNER, JOHN 06/19/2003 1400.00 4 83C 030100710A 01/25/2003 FACINELLI, RICHARD 06/19/2003 1000.95 4 83C 030100720A 01/25/2003 COLE, JOSHUA D 06/19/2003 1085.00 4 83C 030100732A 01/26/2003 ARCHULETA, LORENZO 06/19/2003 980.00 4 83C 030100734A 01/26/2003 RAMOS, ANTONIO T 06/19/2003 1145. 00 4 83C 030100741A 01/26/2003 FETTEROLF, ZACHARY D 06/19/2003 1145.00 4 83C 030100742A 01/26/2003 ADAMS, JAMES D 06/19/2003 150 .00 4 83C 030100748A 01/26/2003 RAMAZA, ALBIA 06/19/2003 935.00 4 83C 030100759A 01/26/2003 CRISWELL, MINDY 06/19/2003 150.00 4 83C 030100763A 01/27/2003 AAB, BETTY 06/19/2003 1220.00 4 83C 030100772A 01/27/2003 FIORE, PAUL 06/19/2003 1085. 00 4 83C 030100776A 01/27/2003 ROJAS, JORGE L 06/19/2003 115.00 4 83C 030100799A 01/28/2003 JARAMILLO, EDWARD 06/19/2003 150 .00 4 83C 030100806A 01/28/2003 APODACA, FRANK SR 06/19/2003 150.00 4 83C 030100812A 01/28/2003 RIBAS, ELSA 06/19/2003 1130.00 4 83C 030100820A 01/28/2003 TRUJILLO, TARRY 06/19/2003 1025 .00 4 83C 030100832A 01/29/2003 RIOS, TEODORO 06/19/2003 930 .00 4 83C 030100852A 01/30/2003 DINKEL, NICKOLAS D 06/19/2003 1055.00 4 83C 030100855A 01/30/2003 SANDERS, JOHNNY 06/19/2003 870.00 4 83C 030100873A 01/30/2003 AGUILERA, ROSALINDA 06/19/2003 980.00 4 83C 030100894A 01/31/2003 SANCHEZ-GARZA, ALEXA 06/19/2003 232 .00 4 83C 970603782A 06/15/1997 TUSSEY, KELLY Date:06/20/2003 Weld County Paramedic Services Page: 4 Time:10:11:40 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/18/2003 Thru 06/19/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Total of 146 WriteOff Entries Totaling 97012 .83 Dollars Average WriteOff: 664.47 Dollars Average Time:239 Days II Date:06/20/2003 Weld County Paramedic Services Page: 5 Time:10:11 :40 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/18/2003 Thru 06/19/2003 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 146 97012 .83 664 .47 239.25 Date:12/12/2003 Weld County Paramedic Services Page: 1 Time:12 :15 :08 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2003 Thru 07/24/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 07/24/2003 721.00 4 83C 010301939A 03/11/2001 VEROVAC, RUTH 07/24/2003 410 .60 4 83C 010604615A 06/14/2001 LONGAKER, BRENDAN 07/24/2003 148.40 4 83C 020806890A 08/30/2002 FRASER, BILL 07/24/2003 1180 .00 4 83C 020907019A 09/03/2002 BENZOR, BRIAN 07/24/2003 885 .00 4 83C 020907255A 09/11/2002 HOLLINGSWORTH, KIMBE 07/24/2003 1055 .00 4 83C 020907291A 09/13/2002 GOSCH, HEATHER L 07/24/2003 868 .45 4 83C 021008180A 10/13/2002 STRAUB, RICHARD A 07/24/2003 1310 .00 4 83C 021008312A 10/17/2002 BARNWELL, PATRICIA 07/24/2003 229.00 4 83C 021008315A 10/17/2002 FISHER, BRENT 07/24/2003 - 935.00 4 83C 021008434A 10/21/2002 ORTIZ, GUADALUPE 07/24/2003 1380.00 4 83C 021008625A 10/28/2002 GODINA-FUENTES, JOSE 07/24/2003 64.91 4 83C 021109240A 11/18/2002 PARSONS, ICENTON 07/24/2003 980.00 4 83C 021109255A 11/19/2002 DEVORA, ANTHONY 07/24/2003 506.38 4 83C 021109347A 11/22/2002 UTHE, RAYMOND E 07/24/2003 1130.00 4 83C 021109404A 11/24/2002 KELTIE, ANNA 07/24/2003 67.80 4 83C 021109501A 11/27/2002 CONDREAY, MARY 07/24/2003 920 .00 4 83C 021209722A 12/06/2002 WILKENING, FREDERICK 07/24/2003 1745 .00 4 83C 021209788A 12/09/2002 SASSO, TINISHA REINA 07/24/2003 398 .00 4 83C 021209855A 12/11/2002 DEBORA, MARIA D 07/24/2003 68 .61 4 83C 021210234A 12/25/2002 MCDONALD, WILLIAM JR 07/24/2003 68 .65 4 83C 021210251A 12/26/2002 ROTH, FREDRICK 07/24/2003 67 .73 4 83C 030100068A 01/03/2003 KREPS, BERNICE 07/24/2003 965 .00 4 83C 030100084A 01/03/2003 GREEN, BREANNA 07/24/2003 150.00 4 83C 030100249A 01/11/2003 KNIGHT, DAVID 07/24/2003 60.14 4 83C 030100269A 01/11/2003 GIESICK, HARVEY 07/24/2003 266.20 4 83C 030100412A 01/16/2003 STAMISON, NIKI 07/24/2003 72 .69 4 83C 030100464A 01/18/2003 MCDONALD, WILLIAM JR 07/24/2003 1025.00 4 83C 030100667O 01/24/2003 GILLILAND, MARSHALL 07/24/2003 72 .78 4 83C 030100669A 01/24/2003 GIESICK, HARVEY 07/24/2003 86.52 4 83C 030100718A 01/25/2003 BAREA, LORENE 07/24/2003 920 .00 4 83C 030100835A 01/29/2003 HUGHES, ISABEL Total of 31 WriteOff Entries Totaling 18757.86 Dollars Average WriteOff: 605 .09 Dollars Average Time:275 Days Date:12/12/2003 Weld County Paramedic Services Page: 2 Time:12 :15:08 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 07/24/2003 Thru 07/24/2003 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 31 18757.86 605 . 09 274 .68 Date:08/28/2003 Weld County Paramedic Services Page: 1 Time:11:38:52 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/27/2003 Thru 08/27/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/27/2003 385.00 4 83C 000806005A 08/07/2000 MARTINEZ, EZEQUIEL 08/27/2003 207.50 4 83C 011007895A 10/02/2001 HANSEN, PEARL 08/27/2003 649.00 4 83C 011008542A 10/24/2001 SIEROCKI, MARIA 08/27/2003 25.00 4 83C 011109502A 11/27/2001 HUGHES, SHAWN L 08/27/2003 433 .23 4 83C 020100534A 01/17/2002 HANSEN, PEARL 08/27/2003 463 .23 4 83C 020201245A 02/11/2002 HANSEN, PEARL 08/27/2003 874 .00 4 83C 020201614A 02/23/2002 CALL, TIM 08/27/2003 852 .00 4 83C 020604851A 06/22/2002 MCCARTHY, KEVIN 08/27/2003 344.00 4 83C 020604855A 06/22/2002 MCCARTHY, KEVIN 08/27/2003 73 .58 4 83C 020705845A 07/26/2002 HUWA, ANNA 08/27/2003 739.00 4 83C 020705862A 07/26/2002 ARAIZA, PABLO 08/27/2003 241.00 4 83C 020806803A 08/27/2002 OLIVAS, MONICA 08/27/2003 625.00 4 83C 020806919A 08/31/2002 GUADARRAMA, GORGONIO 08/27/2003 67.83 4 83C 021008104A 10/11/2002 KRAUS, LARRY E 08/27/2003 45.17 4 83C 021008629A 10/28/2002 HANSEN, PEARL 08/27/2003 1345 .33 4 83C 021108906A 11/06/2002 LEINGANG, DENNIS J 08/27/2003 80 .81 4 83C 021109125A 11/14/2002 KRAUS, LARRY E 08/27/2003 945.00 4 83C 021109451A 11/25/2002 LONG, LONNIE E 08/27/2003 100.00 4 83C 021109457A 11/25/2002 LONG, LONNIE E 08/27/2003 1230.00 4 83C 021109525A 11/28/2002 DANE, NICK 08/27/2003 870.00 4 83C 021209932A 12/13/2002 FLORES, CHRISTOPHER 08/27/2003 1060.00 4 83C 021210223A 12/24/2002 ARENAS, HERIBERTO 08/27/2003 1040.00 4 83C 021210239A 12/25/2002 WILLIAMS, DANIEL 08/27/2003 174.45 4 83C 021210282A 12/27/2002 MARICLE, DAN 08/27/2003 820.00 4 83C 021210292A 12/28/2002 GARZA, ESTEBAN 08/27/2003 79.92 4 83C 021210297A 12/28/2002 FRAZZINI, MILDRED 08/27/2003 229.00 4 83C 021210332A 12/30/2002 GONZALES, PAULINE M 08/27/2003 77 .15 4 83C 030100149A 01/07/2003 KRAUS, LARRY E 08/27/2003 135 .00 4 83C 030100155A 01/07/2003 ARAIZA, PABLO 08/27/2003 1085 .00 4 83C 030100159A 01/07/2003 TRUJILLO, KATHY 08/27/2003 455 .00 4 83C 030100271A 01/12/2003 ORTON, TAMI 08/27/2003 100 .00 4 83C 030100481A 01/18/2003 . BUNCE, KAREN I 08/27/2003 521.78 4 83C 030100505A 01/19/2003 CUMMINGS, JOLENE R 08/27/2003 73 .39 4 83C 030100520A 01/20/2003 KRAUS, LARRY 08/27/2003 231.60 4 83C 030100610A 01/22/2003 MIRELES, JENNIFER 08/27/2003 140.00 4 83C 030100615A 01/22/2003 GALINDO, FELIX 08/27/2003 79.36 4 83C 030100677A 01/24/2003 HANSEN, PEARL Total of 37 WriteOff Entries Totaling 16897.33 Dollars Average WriteOff: 456.68 Dollars Average Time:356 Days Date:08/28/2003 Weld County Paramedic Services Page: 2 Time:11:38:52 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/27/2003 Thru 08/27/2003 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 37 16897.33 456.68 356.00 I I Date:12/12/2003 Weld County Paramedic Services Page: 1 Time:12 :16:18 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/01/2003 Thru 10/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2003 155.00 4 CONV 000806289A 08/18/2000 MARSH, DAVID 10/09/2003 299 . 93 4 CONY 010503834A 05/14/2001 LUDWIG, PAUL 10/09/2003 310 .00 4 CONY 010604763A 06/19/2001 QUALLS, PAUL 10/09/2003 52 .60 4 CONV 010705276A 07/06/2001 ORR, CLAIR B 10/09/2003 111.00 4 CONY 010806785A 08/25/2001 LANDOIS, ANDRES B 10/09/2003 269.00 4 CONY 011109462A 11/26/2001 MOTT, CORRI 10/09/2003 779.78 4 CONY 020201435A 02/18/2002 LUDWIG, PAUL 10/09/2003 334. 00 4 CONV 020201441A 02/18/2002 LUDWIG, PAUL 10/09/2003 801.00 4 CONV 020302121A 03/13/2002 PRAZMA, CORRENE L 10/09/2003 253 .36 4 CONV 020503550B 05/05/2002 MARTINEZ, MICHAEL 10/09/2003 125.00 4 CONV 020503659A 05/09/2002 NELSON, DAN 10/09/2003 192 .60 4 CONV 020503995A 05/23/2002 MARTIN, TARA 10/09/2003 909 .50 4 CONY 020604280A 06/03/2002 MILLER, ERIN 10/09/2003 32 .55 4 CONV 020705154A 07/02/2002 LUDWIG, PAUL 10/09/2003 634.00 4 CONY 020705444A 07/10/2002 PUGA, ANSELMO 10/09/2003 229.20 4 CONY 020706011A 07/31/2002 LOYA, JAVIER 10/09/2003 504 .00 4 CONY 020806728A 08/25/2002 POMERANTZ, JUDY 10/09/2003 957 .50 4 CONY 020906988A 09/03/2002 MILLER, ERIN 10/09/2003 765.00 4 CONY 020907116A 09/06/2002 LOPEZ, MARIA 10/09/2003 635 .11 4 CONV 021008035A 10/09/2002 RAMIREZ, MACIEL 10/09/2003 76. 00 4 CONV 021008056A 10/09/2002 MORRIS, MARYNA 10/09/2003 650.00 4 CONY 021008144A 10/12/2002 MUNOZ-PLASENCIA, GEN 10/09/2003 445.00 4 CONY 021008609A 10/27/2002 LEWIS, CLAUDE 10/09/2003 765 .00 4 CONY 021008720A 10/30/2002 GARCIA-ALARCON, JOSE 10/09/2003 68.00 4 CONV 021108763A 11/01/2002 MORRIS, MARYNA 10/09/2003 74.56 4 CONY 021108902A 11/06/2002 MORRIS, MARYNA 10/09/2003 450 .00 4 CONY 021109266A 11/20/2002 PIPER, DONNA 10/09/2003 655.00 4 CONY 021109425A 11/24/2002 MENDOZA, JESUS NOE 10/09/2003 930.00 4 CONV 021109430A 11/24/2002 MARTINEZ, SELIA 10/09/2003 900. 00 4 CONY 021209875A 12/12/2002 PRATHER JR, LLOYD D 10/09/2003 83 .80 4 CONY 021210109A 12/20/2002 OSBORNE, JESSICA B 10/09/2003 420 .00 4 CONY 021210249A 12/26/2002 MCPHAIL, PRESLEE 10/09/2003 480.00 4 CONY 021210276A 12/27/2002 MCPHAIL, PRESLEE 10/09/2003 840 .00 4 CONY 021210324A 12/29/2002 MACKEY, DONALD J 10/09/2003 1210 .00 4 CONV 021210347A 12/30/2002 MILLER, ERIN 10/09/2003 650 .00 4 CONY 030100622A 01/22/2003 PINEDA, JAYDE L 10/09/2003 250.00 4 CONV 030100874A 01/31/2003 MENDOZA, ROSALIA 10/09/2003 217.84 4 CONV 930924104L 09/24/1993 OWENS, PRENTISS 10/09/2003 619.00 4 CONV 940703849L 07/08/1994 OWENS, PRENTISS 10/09/2003 268.27 4 CONV 950402452L 04/24/1995 OWENS, PRENTISS 10/09/2003 365.00 4 CONV 950502688L 05/05/1995 OWENS, PRENTISS 10/09/2003 100.00 4 CONY 960704669A 07/31/1996 PARKER, GEORGE 10/09/2003 152.00 4 CONY 970201251A 02/26/1997 PARKER, GEORGE 10/09/2003 148 .00 4 CONY 980301567A 03/09/1998 PARKS, EARL 10/09/2003 335.00 4 CONV 981208610A 12/22/1998 MEINTZER, RON 10/10/2003 1143 .00 4 83C 010907666A 09/23/2001 CHAIREZ, PATRICIA 10/10/2003 293 .60 4 83C 020301971A 03/08/2002 OROZCO, OFELIA 10/10/2003 779. 00 4 83C 020402933A 04/13/2002 CRESPO, VERONICA 10/10/2003 102 .60 4 83C 020403073A 04/18/2002 NORTHWAY, TRAYTON Date:12/12/2003 Weld County Paramedic Services Page: 2 Time:12 :16:18 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/01/2003 Thru 10/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/10/2003 561.00 4 83C 020503708A 05/11/2002 NAVARRO, MARIA L 10/10/2003 958. 00 4 83C 020705778B 07/23/2002 SPEAKER, A CARL 10/10/2003 75 .56 4 83C 020806616A 08/22/2002 KERBS, LILY 10/10/2003 184.00 4 83C 020907021A 09/03/2002 MILLER, ZACHARY 10/10/2003 14 .84 4 83C 021008260A 10/16/2002 KERBS, LILY 10/10/2003 735.00 4 83C 021008269A 10/16/2002 SMITH, JILL 10/10/2003 184 .00 4 83C 021008618A 10/28/2002 SOUTHWELL JR, FREDDI 10/10/2003 50.00 4 83C 021209655A 12/04/2002 VILLALVA, ROSARIO 10/10/2003 25.00 4 83C 021209870A 12/12/2002 JOHNSON, KALEEN K 10/10/2003 150.00 4 83C 021210242A 12/25/2002 MURRAY, JOSEPH 10/10/2003 75.02 4 83C 021210351A 12/31/2002 KERBS, LILY 10/10/2003 59.63 4 83C 021210355A 12/31/2002 KERBS, LILY 10/10/2003 1045.56 4 83C 021210359A 12/31/2002 KERBS, LILY 10/10/2003 453 .00 4 83C 030100076A 01/03/2003 POWELL, PAMALEE A 10/10/2003 1065.00 4 83C 030100225A 01/10/2003 GRAUBERGER, DEREK D 10/10/2003 54.88 4 83C 030100351A 01/15/2003 KERBS, LILY 10/10/2003 54.88 4 83C 030100355A 01/15/2003 KERBS, LILY 10/10/2003 1045.95 4 83C 030100360A 01/15/2003 MESTAS, LEROY 10/10/2003 45 . 00 4 83C 030100407A 01/16/2003 PETERSON, ERIC 10/10/2003 57 .73 4 83C 030100429A 01/17/2003 LEZHAN, ERLENE 10/10/2003 1220 .00 4 83C 030100579A 01/22/2003 GARCIA, DAVID 10/10/2003 214 .00 4 83C 030100741A 01/26/2003 FETTEROLF, ZACHARY D 10/10/2003 355 .00 4 83C 990100275A 01/11/1999 LUTZ, JOAN V 10/15/2003 35.00 4 CONV 000907225A 09/19/2000 TRACY, LOIS 10/15/2003 485.00 4 CONV 001209259A 12/03/2000 WHITE MARTINEZ, JAIM 10/15/2003 651.00 4 CONV 001209354A 12/06/2000 VALENSUELA, CYNTHIA 10/15/2003 134 . 00 4 CONY 010402866A 04/12/2001 TRUJILLO, DOMINIK 10/15/2003 36.00 4 CONV 010503719A 05/10/2001 WARD, WAYNE 10/15/2003 10.87 4 CONY 010604799A 06/20/2001 WARD, WAYNE 10/15/2003 118 .70 4 CONY 010705721A 07/21/2001 RODRIGUEZ, LEONEL 10/15/2003 251.00 4 CONY 010806154A 08/04/2001 WAILES, MARK 10/15/2003 101.20 4 CONV 010806524A 08/16/2001 RHODES, CAROLA R 10/15/2003 356.28 4 CONV 010907367A 09/14/2001 STRAYER, ELSIE 10/15/2003 145.76 4 CONV 010907438A 09/16/2001 THOMPSON, DOROTHY J 10/15/2003 1155.08 4 CONY 010907492A 09/18/2001 THOMPSON, DOROTHY J 10/15/2003 181.00 4 CONY 011008566A 10/25/2001 RODRIGUEZ, DOMINGO 10/15/2003 844 .00 4 CONY 011008717A 10/30/2001 SHAVER, JUDY 0 10/15/2003 660 . 00 4 CONY 011109028A 11/10/2001 SANDOVAL, PEGGY 10/15/2003 290 .00 4 CONY 011109067A 11/11/2001 TORREZ, ANSELMO 10/15/2003 571.34 4 CONY 011210046A 12/19/2001 WOOLDRIDGE, JUDY 10/15/2003 324 .08 4 CONY 011210197A 12/24/2001 RUSSELL, CLEDA 10/15/2003 292 .17 4 CONY 020100196A 01/07/2002 SENA, LORI 10/15/2003 316 .57 4 CONY 020100529A 01/17/2002 WILSON, ETHEL 10/15/2003 100 .00 4 CONY 020201276A 02/12/2002 ROSIN, FREIDA **SE 10/15/2003 620 .00 4 CONY 020201278A 02/12/2002 RHODES, CAROLA R 10/15/2003 338.00 4 CONY 020201485A 02/19/2002 TEMPLIN, NICOLE D 10/15/2003 364 .00 4 CONV 020302383A 03/24/2002 TAPIA, MANUEL R 10/15/2003 164 .00 4 CONY 020402790A 04/08/2002 ROGERS, KENNETH 10/15/2003 562 .00 4 CONV 020402822A 04/09/2002 SCHWEIZER, MARK AARO I Date:12/12/2003 Weld County Paramedic Services Page: 8 Time:12 :16 :22 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/01/2003 Thru 10/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/24/2003 1025.00 4 CONY 030100514B 01/20/2003 RUIZ, DESIREE 10/24/2003 920 . 00 4 CONV 030100538A 01/20/2003 VIGIL, ELOISE 10/24/2003 335.19 4 CONY 030100542B 01/20/2003 ANNIS, MICHEAL S 10/24/2003 930 .00 4 CONY 030100857A 01/30/2003 FUNK, JAY 10/24/2003 400 . 00 4 CONY 971206108A 12/07/1997 DRAPEAU, STEVEN 10/24/2003 97 .64 4 CONY 990604316A 06/14/1999 CUMPSTEN, LINDA 10/24/2003 423 .00 4 CONY 991108098A 11/02/1999 FUENTES, JR, JESUS 10/29/2003 354 .70 4 CONY 000907365A 09/24/2000 KATO, NANCY 10/29/2003 314 .93 4 CONY 010402979A 04/16/2001 GRAF, ALEX 10/29/2003 165.16 4 CONY 010705145A 07/02/2001 HEBERLINE, CHARLES 10/29/2003 385.00 4 CONY 010706002A 07/30/2001 JIMINEZ, RAYMOND 10/29/2003 135 .15 4 CONY 010907562A 09/20/2001 HOECHER, EDNA 10/29/2003 259.00 4 CONY 011008063A 10/08/2001 HAYDEN, THOMAS 10/29/2003 80 .00 4 CONY 011008505D 10/23/2001 JUAREZ, MARIA G 10/29/2003 314 .00 4 CONY 011109235A 11/17/2001 HOLGUIN, VERONICA 10/29/2003 687.00 4 CONY 020301884A 03/06/2002 HAENDLER, JOHN M 10/29/2003 124 .00 4 CONY 020604412A 06/07/2002 KUTCHER, FRANK L 10/29/2003 11 .21 4 CONY 020604551A 06/12/2002 KATO, NANCY 10/29/2003 198 .00 4 CONV 020705556A 07/14/2002 HOOD, WESLEY W 10/29/2003 936.00 4 CONV 020705799A 07/24/2002 HARPRING, KENNETH W 10/29/2003 472 .00 4 CONY 020705809A 07/24/2002 HARPRING, KENNETH W 10/29/2003 1330 . 00 4 CONY 020806679A 08/24/2002 KRUMTUM, SHAWN 10/29/2003 271.00 4 CONY 020907293A 09/13/2002 HIBBARD, AMANDA MARI 10/29/2003 840 .00 4 CONY 020907513A 09/21/2002 KNIGHT, DOUGLAS L 10/29/2003 615 .00 4 CONY 021008240A 10/15/2002 HERNANDEZ, YANETTE 10/29/2003 15.00 4 CONV 021109259A 11/19/2002 GOMEZ, ALICIA 10/29/2003 1010 .00 4 CONY 021209619A 12/03/2002 GODBY, ASHLEY 10/29/2003 151 . 00 4 CONV 021209742A 12/07/2002 GUTIERREZ, JOSEPH 10/29/2003 750 .00 4 CONV 021209765A 12/08/2002 HOLSCLAW, PAIGE M 10/29/2003 403 .50 4 CONY 021209978A 12/15/2002 HOLT, ROSS 10/29/2003 85 .00 4 CONY 021210336A 12/30/2002 HURTADO, ANA M 10/29/2003 705.00 4 CONY 030100100A 01/04/2003 HUME, GWENDOLYN F 10/29/2003 835.00 4 CONY 030100495A 01/19/2003 INGERSOLL, PATRICIA 10/29/2003 455 . 00 4 CONY 030100778A 01/27/2003 KING, DEBORAH 10/30/2003 420.00 4 83C 000907515A 09/29/2000 DIAZ, IVAN 10/30/2003 491 .00 4 83C 010503954A 05/18/2001 VALENCIA, CAROLYN L 10/30/2003 276 .00 4 83C 010907741A 09/26/2001 SILVA, ELICIA A 10/30/2003 27.08 4 83C 020201524A 02/20/2002 DIAZ, ROSEMARY 10/30/2003 254 .00 4 83C 020302157A 03/14/2002 SANCHEZ, VICENTA 10/30/2003 734 .00 4 83C 020402879A 04/11/2002 STEVENS, MARK 10/30/2003 474.00 4 83C 020403196A 04/23/2002 HARO, JOSE 10/30/2003 177.00 4 83C 020403386A 04/30/2002 KENNEDY, DANNY 10/30/2003 262 .80 4 83C 020705176A 07/02/2002 BELTRAN, SEYRA 10/30/2003 200.00 4 83C 020806093A 08/02/2002 ALLOUR, DANIELLE 10/30/2003 1600.00 4 83C 020907715A 09/28/2002 BISHOP, ROBERT WILLI 10/30/2003 585 . 00 4 83C 021008423A 10/21/2002 GRUIS, WILLIAM H 10/30/2003 192 .00 4 83C 021209732A 12/07/2002 HUNTER, AARON P 10/30/2003 985.00 4 83C 021209837A 12/10/2002 SMITH, CHERYL 10/30/2003 168 . 00 4 83C 021210130A 12/21/2002 HILLS, SHERRY Date:12/12/2003 Weld County Paramedic Services Page: 9 Time:12 :16:22 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/01/2003 Thru 10/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/30/2003 805.00 4 83C 021210245A 12/25/2002 RAMIREZ, ANITA 10/30/2003 568.75 4 83C 030100279A 01/12/2003 SAMPLES, TINA 10/30/2003 536.25 4 B3C 030100279B 01/12/2003 SAMPLES, JAREN 10/30/2003 327.50 4 83C 030100281A 01/12/2003 SAMPLES, TINA 10/30/2003 327.50 4 83C 030100281B 01/12/2003 SAMPLES, JAREN 10/30/2003 492 .30 4 83C 030100723A 01/25/2003 WEST, WHITNEY R Total of 398 WriteOff Entries Totaling 103459.69 Dollars Average WriteOff: 259.95 Dollars Average Time:761 Days • • Date:12/12/2003 Weld County Paramedic Services Page:10 Time:12 :16 :22 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/01/2003 Thru 10/31/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days CONY CONVERSION BALANCE 163 70925 .18 435.12 742 .61 83C WRITEOFF TO COLLECTION AG 48 20904 .43 435 .51 442 .46 70CE COLLECTION EXPENSE 167 8769.78 52 .51 876.65 70PF PROFESSIONAL FINANCE COLL 19 2710. 30 142. 65 735. 53 82 MEDICAID WRITEOFF 1 150 .00 150.00 285 .00 Date:12/12/2003 Weld County Paramedic Services Page: 1 Time:12 :17:42 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/01/2003 Thru 12/12/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 12/09/2003 1.48 4 82 010201409A 02/19/2001 GOETZEL, LESTER 12/10/2003 28.85 4 83C 010604350A 06/03/2001 MARTINEZ, CIRIA G 12/10/2003 94 . 00 4 83C 011008392A 10/19/2001 RIGGINS, GARI 12/10/2003 25.00 4 83C 020302521A 03/28/2002 EDLRIDGE, MONTE 12/10/2003 400.70 4 83C 020402869A 04/11/2002 PALMER, KEVIN 12/10/2003 0 .20 4 83 021210079A 12/19/2002 GARCIA, BRYAN B 12/10/2003 545 . 00 4 CONV 030100018A 01/01/2003 ISAAC, LOVIE Total of 7 WriteOff Entries Totaling 1095 .23 Dollars Average WriteOff: 156.46 Dollars Average Time:665 Days li Date:12/12/2003 Weld County Paramedic Services Page: 2 Time:12 :17:43 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/01/2003 Thru 12/12/2003 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 82 MEDICAID WRITEOFF 1 1.48 1 .48 1023 .00 83C WRITEOFF TO COLLECTION AG 4 548.55 137 .14 733 .00 83 WRITEOFF 1 0.20 0 .20 356 .00 CONY CONVERSION BALANCE 1 545.00 545.00 343 .00 1 Submission Batch Report Batch 711 Batch date 5/21/2003 4:23:41PM Trip Date Job Run Name Current Favor Schedule Event Charles Credits Balance 2003-03-05 0017-A 1,071 BELO, EDUARDO Bill Patient Collections No Bill Sent 150.00Y 0.00 150.00 2003-03-11 0025-A 1,283 BOEHLER,RICHARD Bill Patient Collections No Bill Sent 980.00 2 0.00 980.00 2003-02-21 0002-A 603 CHAGOLLA, VENESSA Bill Patient Collections No Bill Sent 1,055.00 2 0.00 1,055.00 2003-02-21 0022-A 648 CHAGOLLA,VENESSA Bill Patient Collections No Bill Sent 995.00- 0.00 995.00 2003-03-30 0010-A 1,851 CHAVEZ,FRANK Bill Patient Collections No Bill Sent 150.00' 0.00 150.00 2003-03-28 0022-A 1,880 COVARREBIAS,OSCA Bill Patient Collections No Bill Sent 1,145.0O 0.00 1,145.00 2003-02-10 0027-A 335 DODGE,KERRIE Bill Patient Collections No Bill Sent 855.00 -' 0.00 855.00 2003-02-15 0026-A 470 EMILY,ANTHONY Bill Patient Collections No Bill Sent 1,155.00 0.00 1,155.00 2003-02-25 0027-A 780 FABER, KATELYN Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-03-02 0007-A 940 FORSYTHE, SHANNOP Bill Patient Collections No Bill Sent 1,040.00' 0.00 1,040.00 2003-04-13 0026-A 2,301 GARCIA,ALFREDO Bill Patient Collections No Bill Sent 1,040.00' 0.00 1,040.00 2003-02-16 0022-A 495 GLENN,DENISE Bill Patient Collections No Bill Sent 1,085.00 7 0.00 1,085.00 2003-02-01 0016-A 25 LOPEZ,ANTONIO Bill Patient Collections No Bill Sent 965.00- 0.00 965.00 2003-02-26 0011-A 805 MARES,MELLISSA Bill Patient Collections No Bill Sent 980.00-le0.00 980.00 2003-04-12 0015-A 2,253 MARTINEZ,ELMER Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-02-18 0021-A 539 MILLER, TIMOTHY Bill Patient Collections No Bill Sent 915.00/. 0.00 915.00 2003-02-16 0018-A 491 MOLL,THOMAS Bill Patient Collections No Bill Sent 1,070.00-" 0.00 1,070.00 2003-04-11 0025-A 2,219 MONTOYA,DONNA Bill Patient Collections No Bill Sent 1,225.00 -/- 0.00 1,225.00 2003-04-05 0001-A 2,002 NAVA,JOSE Bill Patient Collections No Bill Sent 870.00" 0.00 870.00 2003-03-09 0008-A 1,221 NAVARRO,ALBERTO Bill Patient Collections No Bill Sent 1,070.00/ 0.00 1,070.00 2003-03-21 0015-A 1,619 PEREZ,EVETTE Bill Patient Collections No Bill Sent 990.00--"" 0.00 990.00 2003-02-06 0014-A 195 RENDON,ANDREZ Bill Patient Collections No Bill Sent 1,055.00--"" 0.00 1,055.00 2003-02-17 0003-A 511 RISHEL,DAN Bill Patient Collections No Bill Sent 1,070.00 998.16 71.84- 2003-03-25 0023-A 1,714 ROE,PAMELA Bill Patient Collections No Bill Sent 1,070.00.7 - 0.00 1,070.00 2003-02-17 0012-A 537 SAUCEDO,AURELIO Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-03-17 0021-A 1,474 STICHTER,TERRY Bill Patient Collections No Bill Sent 855.00' 0.00 855.00 / 2003-02-14 0021-A 430 VALDIUIEZ,OBED Bill Patient Collections No Bill Sent 945.00 0.00 945.00 O 2003-03-12 0021-A 1,317 VISCAINO,REFUGIO Bill Patient Collections No Bill Sent 1,055.0 0.00 1,055.00 2003-03-18 0010-A 1,484 VISCAINO,REFUGIO Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-03-27 0008-A 1,766 WALSH,PATRICK Bill Patient Collections No Bill Sent 930.00/ 0.00 930.00 2003-02-14 0022-A 431 WHITMIRE, RICHARD Bill Patient Collections No Bill Sent 855.00/ 0.00 855.00 Trip count: 31 29,665.00 998.16 28,666.84 Total trip count: sKi'.. , `,; .. m,;^ ' . €° i ` . . \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt 5/21/2003 Page 1 Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,087 Batch date: 10/24/2003 3:55:21PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-02-27 0039-A 928 ALLEE, JOHN Bill Patient Collections No Bill Sent 870.00 0.00 870.002 2003-02-16 0003-A 475 APADACA, DANIEL' Bill Patient Collections No Bill Sent 995.0 0.00 995.007 2003-02-27 0040-A 929 APPLETON, NANCY/Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-02-26 0020-A 815 BLAIR, JULIAN Bill Patient Collections No Bill Sent 150.00 0.00 150.00" 2003-02-20 0019-A 622 BROOKSHIRE, COR 'dill Patient Collections No Bill Sent 150.00 0.00 150.00" 2003-02-27 0020-A 901 BURTON, DONALD Bill Patient Collections No Bill Sent 990.00 485.00 505.007 2003-02-22 0028-A 758 DELGADO, HENRY/Bill Patient Collections No Bill Sent 965.00 0.00 965.007 2003-02-18 0011-A 524 DEROSARIO-ORTEGYgill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-02-20 0012-A 612 EIKENBERG, KARL/Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 2003-02-21 0018-A 639 ESPINOZA, DANIEL/Bill Patient Collections No Bill Sent 930.00 0.00 930.007 2003-02-25 0024-A 777 GARCIA, GILBERT,' Bill Patient Collections No Bill Sent 960.00 0.00 960.0O 2003-02-22 0016-A 697 HANSEN, PEARL- Bill Patient Collections No Bill Sent 1,040.00 968.17 71.83' 2003-02-23 0031-A 703 HENDRICKS, KERRYYill Patient Collections No Bill Sent 1,070.00 0.00 1,070.0O 2003-02-28 0034-A 909 HINOJOSA, VIRGINIA, ill Patient Collections No Bill Sent 870.00 0.00 870.0O 2003-02-22 0013-A 674 HOLGUIN, ESTHERBill Patient Collections No Bill Sent 1,280.00 0.00 1,280.00 2003-02-16 0025-A 500 HOLGUIN, JOSE / Bill Patient Collections No Bill Sent 855.00 0.00 855.00 2003-02-18 0004-A 515 JOHNSON, MICHELLE$II Patient Collections No Bill Sent 1,125.00 0.00 1,125.00/- 2003-02-25 0023-A 776 JONES, EVA- Bill Patient Collections No Bill Sent 965.00 0.00 965.00/ 2003-02-22 0010-A 664 KHEMPHOMMA, ADAI'tll Patient Collections No Bill Sent 855.00 0.00 855.00 2003-02-22 0009-A 660 KHEMPHOMMA, VON-gill Patient Collections No Bill Sent 855.00 0.00 855.00" 2003-02-19 0017-A 570 KOCH, HOWARD" Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00, 2003-02-16 0002-A 473 LUJAN, KENNETH/ Bill Patient Collections No Bill Sent 1,085.00 1,012.49 72.51 j 2003-02-23 0030-A 702 MADDOX, LORI/ Bill Patient Collections No Bill Sent 920.00 854.58 65.42- 2003-02-24 0022-A 726 MADRIGAL, JESUS'''.Bill Patient Collections No Bill Sent 920.00 0.00 920.00 2003-02-20 0006-A 595 MARTIN, JOSHUA Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-02-20 0001-A 589 MATA, JESUS— Bill Patient Collections No Bill Sent 1,005.00 0.00 1,005.00" 2003-02-21 0023-A 652 MCKAY, ALEX— Bill Patient Collections No Bill Sent 795.00 0.00 795.00 2003-02-28 0015-A 862 MCKINNIS, KOLTEN"Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-02-25 0003-A 738 MIRANDA, SHANTEL"Bill Patient Collections No Bill Sent 1,695.00 0.00 1,695.0O 2003-02-28 0005-A 844 MITCHELL, TWYLA-' Bill Patient Collections No Bill Sent 1,220.00 584.00 636.007 2003-02-28 0008-A 849 NEGRETE, MIGUEL/ Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-28 0030-A 902 NEGRETE, MIGUEL7 Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-02-17 0008-A 527 NEHRING, LINDA Bill Patient Collections No Bill Sent 1,040.00 968.39 71.61 j 2003-02-19 0012-A 563 NEHRING, LINDA Bill Patient Collections No Bill Sent 870.00 820.50 49.50" RescueNetTM Printed on 10/24/2003 at 3:56:48PM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt WELD COUNTY PARAMEDIC SERVICES 2003-02-24 0020-A 724 NEHRING, LINDA '� Bill Patient Collections No Bill Sent 905.00 850.08 54.92 2003-02-24 0017-A 721 NUNNALLY, THERESigill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-02-28 0006-A 846 PARKER, GLENN," Bill Patient Collections No Bill Sent 920.00 0.00 920.00 j 2003-02-16 0001-A 472 PIERCE, DONNA 7 Bill Patient Collections No Bill Sent 965.00 0.00 965.00 2003-02-27 0028-A 917 PRIETO, EDWARD /Bill Patient Collections No Bill Sent 150.00 0.00 150.00.- 2003-02-23 0013-A 681 RATCLIFFE, RA9HELtlll Patient Collections No Bill Sent 1,050.00 0.00 1,050.00 2003-02-23 0012-A 680 RICE, PAULA�/ Bill Patient Collections No Bill Sent 965.00 0.00 965.00' 2003-02-22 0020-A 746 SEGURA, ANGELA' Bill Patient Collections No Bill Sent 965.00 0.00 965.00 2003-02-19 0031-A 599 STALEY, WILLIAM/ Bill Patient Collections No Bill Sent 150.00 0.00 150.00' 2003-02-22 0036-A 786 STORY, KREG ' , Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00---- 2003-02-16 0017-A 489 TERRAZAS, RAUL ,,Bill Patient Collections No Bill Sent 1,465.00 0.00 1,465.00 2003-02-19 0001-A 545 TREVINO, AURELIA` Bill Patient Collections No Bill Sent 1,125.00 1,070.38 54.62 '' 2003-02-16 0006-A 478 VIGIL, ANTHONY -" Bill Patient Collections No Bill Sent 1,280.00 0.00 1,280.00--- 2003-02-27 0042-A 931 VIGIL, ONESIMO--- Bill Patient Collections No Bill Sent 995.00 0.00 995.00' 2003-02-18 0023-A 541 VIGIL, ONESIMO--- Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-02-22 0011-A 667 VORARTH, CEDEZ-"Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-17 0025-A 573 WEAVER, NICHOLAS-el Patient Collections No Bill Sent 1,145.00 0.00 1,145.00--7 Trip count: 51 46,945.00 7,613.59 39,331.41 Trip count: 51 46,945.00 7,613.59 39,331.41 Total trip count: 51 I 46,945.00 I 7,613.59 39,331.41 I RescueNetTM Printed on 10/24/2003 at 3:56:48PM Page 2 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Subrniasion Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,086 Batch date: 10/24/2003 12:46:43PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance - 2003-02-06 0003-A 178/ ADAMS, GEORGE Bill Patient Collections No Bill Sent 965.00 906.40 58.60 2003-02-13 0029-A 410- ALANIZ, MICHELE Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-02-14 0010-A 419; APPLEHANS, JACKIE Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-02-05 0029-A 152 BERGFORD, JOANNE Bill Patient Collections No Bill Sent 1,055.00 15.00 1,040.00 r 2003-02-13 0003-A 384 BLACKWELL, KAYDEI Bill Patient Collections No Bill Sent 1,070.00 30.00 1,040.00--I*4z- 2003-02-08 0015-A 263- BOWMAN, TARA Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 iti 2003-02-13 0030-A 411-- CLARK, BRENDA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-12 0013-A 358— CRANMER, RICK Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-02-13 0009-A 390— DAVIS, ALFORD Bill Patient Collections No Bill Sent 1,055.00 992.09 62.91 2003-02-15 0030-A 499— DELACRUZ, DENNIS Bill Patient Collections No Bill Sent 1,110.00 0.00 1,110.00 2003-02-13 0019-A 400—' FREOUF, PEGGY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-13 0026-A 407'' FRIEDHOFER, AERYP Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-02-13 0017-A 398— IMHOF, JASON Bill Patient Collections No Bill Sent 1,065.00 0.00 1,065.00 2003-02-09 0023-A 683— JENNEY, HOWARD Bill Patient Collections No Bill Sent 950.00 815.12 134.88 2003-02-03 0035-A 100— KRAUS, LARRY Bill Patient-Pm, Collections No Bill Sent 1,220.00 1,143.26 76.74 2003-02-10 0001-A 297— KRAUS, LARRY Bill Patient A Collections No Bill Sent 1,385.00 1,306.74 78.26 2003-02-09 0020-A 308- LEBLANC, RICHARD Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-02-10 0028-A 336— MATA, ROSIE Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00 2003-02-14 0027-A 436--- MCGEEHEE, RAYMOI Bill Patient n Collections No Bill Sent 150.00 0.00 150.00 2003-02-08 0007-A 253— MILLETTE, ROLAND Bill Patient"- " Collections No Bill Sent 1,055.00 0.00 1,055.00 i 2003-02-13 0023-A 404' NYGREN, JOHN Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-02-12 0014-A 359 PEREZ, VALENTINO Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-05 0008-A 113- PORTILLO, AARON Bill Patient Collections No Bill Sent 1,050.00 0.00 1,050.00 2003-02-14 0025-A 434—' PRADO, JESUS Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-02-08 0011-A 257-a REGALADO, LAURA Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-02-11 0023-A 378— RODGERS, SCOTT Bill Patient Collections No Bill Sent 855.00 0.00 855.00 2003-02-01 0006-A 8— RODRIGUEZ, GLORIA Bill Patient Collections No Bill Sent 1,310.00 1,223.91 86.09 2003-02-06 0015-A x`996- RODRIGUEZ-FERNAt'Bill Patient Collections No Bill Sent 1,130.00 498.40 631.60 2003-02-14 0032-A 4411 ROJAS, JORGE Bill Patient Collections No Bill Sent 150.00 60.00 90.00 2003-02-15 0028-A 474 SEWELL, HUBERT Bill Patient Collections No Bill Sent 965.00 0.00 965.00 • 2003-02-15 0010-A 4531 SEWELL, HUBERT Bill Patient Collections No Bill Sent 1,415.00 0.00 1,415.00 2003-02-13 0028-A 409 TRACY, WENDI Bill Patient Collections No Bill Sent 965.00 0.00 965.00 2003-02-15 0014-A 457' WILLIAMS, RICHARD Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-02-02 0024-A 123 ZONZO, VITO Bill Patient Collections No Bill Sent 995.00 0.00 995.00 RescueNetTM Printed on 10/24/2003 at 12:47:45PM Page 1 H:\reports32\Billi n g\Miscellaneous\SubBatch7.rpt WELD COUNTY PARAMEDIC SERVICES Trip count: 34 31,655.00 6,990.92 24,664.08 Trip count: 34 31,655.00 6,990.92 24,664.08 Total trip count: 34 I 31,655.00 ' 6,990.92 ! 24,664.08 ' RescueNet1' Printed on 10/24/2003 at 12:47:45PM Page 2 H:\reports3Thilling\MiscellaneouskSubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,090 Batch date: 10/27/2003 7:52:21AM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance �Z603-02- 8-A FAR ACA IS�AAC Bill Patient Collections No Bill Sent 855.00 40.00 815.00 20Q3-02-15 0011-A 454 /BORDONADA, ANGEL Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-02-17 0024-A 571 -CHAVEZ, JOE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-03 0022-A 86 .-CLARK, KAREN Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-02-04 0021-A 161 .ZRESPIN, RAYMOND Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-02-15 0018-A 461 ,FLEUGEL, PAUL Bill Patient Collections No Bill Sent 1,140.00 0.00 1,140.00 2003-02-05 0009-A 114 "GARCIA, ANDREA Bill Patient Collections No Bill Sent 1,050.00 0.00 1,050.00 2003-02-26 0005-A 790 'GARZA, CALLETANO Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-02-05 0016-A 127 .GAWRYL (ANDIS), SU Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-05 0021-A 139 -GRANADOS, LUIS Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-24 0031-A 735 /HENRYCH, ALEKSAN Bill Patient Collections No Bill Sent 915.00 0.00 915.00 2003-02-08 0024-A 282 /LOPEZ, GEORGE Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-02-23 0008-A 676 /MARTIN, AMANDA Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-02-03 0023-A 87 /MCEWAN, TYLISHA Bill Patient Collections No Bill Sent 1,065.00 0.00 1,065.00 2003-02-05 0023-A 145 /MENDEZ-PAREDES, [Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-02-02 0042-A 179 "MONIES, ERICA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-02 0023-A 121 /NEGRETE, MIGUEL Bill Patient Collections No Bill Sent 1,175.00 0.00 1,175.00 2003-02-02 0005-A 15 A JEGRETE, MIGUEL Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-04 0003-A 54 --OLDENBURG, PENNY Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-02-03 0024-A 88 -RENOVA, NOAH Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-02-27 0038-A 927 -'SISNEROS, DANIEL Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-02-04 0010-A 64 --SOLIS, JOSE Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-02-01 0008-A 12 -*VILLA, JENNIFER Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-02-21 0019-A 641 ,/ILLARREAL, DAVID Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-02-01 0021-A 30 WEIDENKELLER, SAN Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 Trip count: 25 20,175.00 40.00 20,135.00 Trip count: 25 20,175.00 40.00 r, • Total trip count: 25 20,175.00 I 40.00 1 20,135.00 RescueNetr" Printed on 10/27/2003 at 7:53:05AM Page 1 \\nw16\rescue net\reports32\Billing\Miscellaneous\S ubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,094 Batch date: 10/27/2003 10:06:01AM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-03-12 0027-A 1,323 AAB, BETTY Bill Patient Collections No Bill Sent 915.00 0.00 915.00 2003-03-09 0022-A 1,240 ADAMS, HOWARD Bill Patient Collections No Bill Sent 1,355.00 0.00 1,355.00 2003-03-06 0025-A 1,109 AGUILAR, ADRIAN Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-03-13 0010-A 1,338 AGUIRRE, MARIA Bill Patient Collections No Bill Sent 1,280.00 0.00 1,280.00 2003-03-15 0003-A 1,391 BALES, MICHAEL Bill Patient Collections No Bill Sent 1,250.00 0.00 1,250.00 2003-03-07 0032-A 1,162 BERGFORD, JOANNE Bill Patient Collections No Bill Sent 1,055.00 15.00 1,040.00 2003-03-14 0031-A 1,383 BERGMAN, DEBRA Bill Patient Collections No Bill Sent 1,300.00 0.00 1,300.00 2003-03-15 0029-A 1,445 BERGMAN, DEBRA Bill Patient Collections No Bill Sent 825.00 0.00 825.00 2003-03-11 0029-A 1,287 BERGMAN, JESSE Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-03-15 0002-A 1,389 BERGMAN, JESSE Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-03-10 0018-A 1,254 BERGMAN, JESSE Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-03-09 0001-A 1,213 CARDENAS, HAZEL Bill Patient Collections No Bill Sent 1,175.00 0.00 1,175.00 2003-03-06 0014-A 1,086 CASARES, RENE Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-03-03 0029-A 984 CASH, CARL Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-03-12 0026-A 1,322 CASTILLO, JANET Bill Patient Collections No Bill Sent 920.00 854.58 65.42 2003-03-06 0008-A 1,074 CHAGOLLA, VENESS,Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-03-12 0002-A 1,297 CHAPARRO-BLANCO Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-12 0013-A 1,309 CHAPARRO-BLANCO Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-03-12 0009-A 1,304 CHATTERTON, ALAN Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-03-06 0022-A 1,106 CLARK, KAREN Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-03-06 0022-B 1,135 CLARK, KAREN Bill Patient Collections No Bill Sent 500.00 0.00 500.00 2003-03-01 0022-A 1,019 CROUCH, DANNY Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-03-03 0040-A 996 DEL RIO, DEREK Bill Patient Collections No Bill Sent 870.00 0.00 870.00 I.2003-03-04 0017-A 1,033 DELEON, MARIAN Bill Patient Fil-, how Collections No Bill Sent 995.00 0.00 995.00 2003-03-08 0023-A 1,195 DORSEY, DUSTIN Bill Patient Wahl'hl' Collections No Bill Sent 995.00 0.00 995.00 2003-03-07 0019-A 1,141 FORGASH, WENDY Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 2003-03-07 0016-A 1,137 GALE, SARA Bill Patient Collections No Bill Sent 995.00 242.34 752.66 2003-03-08 0002-A 1,164 GREGORY,TODD Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-03-15 0022-A 1,415 HEBERLING, RICHAR Bill Patient Collections No Bill Sent 1,160.00 1,086.58 73.42 2003-03-05 0031-A 1,098 HUTCHESON, TIFFAF`Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-03-15 0001-A 1,386 KINGBIRD, JOLENE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-10 0014-A 1,248 KOCH, HOWARD Bill Patient Collections No Bill Sent 920.00 0.00 920.00 2003-03-11 0026-A 1,284 KONRADE, TIANA Bill Patient Collections No Bill Sent 1,325.00 1,300.00 25.00 2003-03-15 0020-A 1,412 LANCKRIET, GREGOF Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 RescueNetTM Printed on 10/27/2003 at 10:07:57AM Page 1 \knw16\rescuenetlreports32\Billing\Miscellaneous\SubBatch7.rpt WELD COUNTY PARAMEDIC SERVICES 2003-03-06 0013-A 1,085 LARSEN, AMANDA Bill Patient Collections No Bill Sent 1,005.00 0.00 1,005.00 2003-03-03 0024-A 975 LEBSACK, LARRY Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-03-07 0035-A 1,175 LOPEZ, JOHN Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-03-15 0008-A 1,398 LOPEZ,JOHN Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-03-08 0011-A 1,173 LOPEZ, JOHN Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-03-02 0005-A 938 LOPEZ, JOHN Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-03-14 0021-A 1,373 LOPEZ, JOHN Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-05 0028-A 1,095 MALDONADO, JOSE Bill Patient Collections No Bill Sent 1,490.00 0.00 1,490.00 2003-03-11 0008-A 1,265 MANG, KENNETH Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-06 0040-A 1,152 MARTINEZ, LEE Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-03-11 0034-A 1,295 MEYERS, JESSICA Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-03-02 0015-A 958 MIKUS, MARY ANN Bill Patient Collections No Bill Sent 965.00 0.00 965.00 2003-03-04 0030-A 1,053 MILLER, KIMBERLY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-05 0010-A 1,050 MORRILL, GARRY Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-03-07 0012-A 1,131 MYERS, ANGELA Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 2003-03-06 0027-A 1,118 NABARRO, JOSE AN1Bill Patient Collections No Bill Sent 890.00 0.00 890.00 2003-03-05 0024-A 1,091 NEIGHBORS, TONIE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-09 0004-A 1,216 OLTMAN, CORAL Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-03-10 0019-A 1,255 PARKER, GLENN Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-03-13 0029-A 1,399 PEIF, SHERRIE Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-03-04 0032-A 1,055 PHILLIPS, ANN MARIE Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-03-04 0026-A 1,043 PROPES, RAY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-04 0040-A 1,069 RAMOS, MARIA GUAC Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-03-06 0018-A 1,090 REGGANS, ELIJAH Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-11 0033-A 1,294 ROBLES, DONICA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-09 0007-A 1,220 RODRIGUEZ, TOMAS Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-03-12 0001-A 1,296 ROSEBERRY, RUSTY Bill Patient Collections No Bill Sent 1,505.00 1,232.00 273.00 2003-03-09 0029-A 1,451 RUIZ, ARNULFO Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-14 0027-A 1,379 RUPE, CHRISTOPHEF Bill Patient Collections No Bill Sent 1,270.00 992.64 277.36 2003-03-14 0024-A 1,376 SANTOS, DIANA Bill Patient Collections No Bill Sent 905.00 0.00 905.00 2003-03-06 0009-A 1,076 SEVILLE, SEAN Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-03-14 0005-A 1,356 SHAFFER, RONALD Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-03-07 0006-A 1,117 SMALL, CINDY Bill Patient Collections No Bill Sent 1,220.00 1,000.00 220.00 2003-03-15 0007-A 1,396 SMITH, ROBERT Bill Patient Collections No Bill Sent 1,295.00 1,285.66 9.34 2003-03-05 0033-A 1,101 STOKER, LANCE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-14 0012-A 1,363 STRONG, ANTHONY Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-03-07 0002-A 1,112 SULLINS, LORI Bill Patient Collections No Bill Sent 1,290.00 1,161.00 129.00 2003-03-14 0029-A 1,381 TOBAR, MARY Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-03-11 0001-A 1,258 TOVAR, BENITO Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-03-06 0041-A 1,290 TREVISO-PEREZ, SE(Bill Patient Collections No Bill Sent 1,460.00 0.00 1,460.00 2003-03-09 0002-A 1,214 VARELA, SANTANA Bill Patient Collections No Bill Sent 885.00 0.00 885.00 RescueNetTM Printed on 10/27/2003 at 10:07:57AM Page 2 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt i WELD-COUNTY PARAMEDIC SERVICES 2003-03-08 0015-A 1,179 VASQUEZ, MAXIMINC Bill Patient Collections No Bill Sent 1,005.00 0.00 1,005.00 2003-03-04 0039-A 1,067 VELASQUEZ, MICAEL Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-03-05 0005-A 1,031 VELASQUEZ, MICAEL Bill Patient Collections No B' en 1,020.00 0.00 1,020.00 2003-03-15 0023-A 1,428 WILSON, KYLE Bill Patient Collections No ill Sent 150.00 0.00 150.00 2003-03-10 0021-A 1,292 YBARRA, STEPHEN Bill Patient Collections N Bill Sent 1,265.00 0.00 1,265.00 Trip count 80 74,580.00 9,169.80 65,410.20 Trip cou : 80 74,580.00 9,169.80 65,410.20 Total trip coun : 80 74,580.00 ' 9,169.80 1 65,410.20 ' RescueNetTM Printed on 10/27/2003 at 10:07:57AM Page 3 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\SubBatch 7.rpt • Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,095 Batch date: 10/27/2003 11:27:52AM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-03-17 0026-A 1,486 AGUIRRE SAENZ, LOI Bill Patient Collections No Bill Sent 1,085.00 1,035.00 50.00 2003-02-06 0012-A 193 ALVIDREZ, IVAN Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-03-22 0006-A 1,640 ANTILLON, MARIO Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 2003-03-18 0054-A 1,566 BECHTOLT, LONNIE Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-03-20 0026-A 1,598 BENNETT, RENEA Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00 2003-03-21 0029-A 1,633 BERGMAN, JESSE Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-03-20 0030-A 1,603 BROWN, ROBERT Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-02-07 0005-A 219 CALDWELL, AMY Bill Patient Collections No Bill Sent 1,190.00 919.10 270.90 2003-03-21 0021-A 1,625 CANCINO, JAIME Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-03-16 0003-A 1,419 ERIKSON, ROY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-22 0023-A 1,658 ESPINOZA, DANIEL Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-03-20 0029-A 1,602 GARCIA, MARTIN Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-03-16 0004-A 1,420 HERNANDEZ, ISHMAE Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-03-22 0005-A 1,639 LARSEN, DEBRA Bill Patient Collections No Bill Sent 1,205.00 0.00 1,205.00 2003-03-16 0020-A 1,442 LUJAN, KENNETH Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-03-16 0020-B 1,449 LUJAN, KENNETH Bill Patient Private Invoice Sent 3rd Invoice 0.00 0.00 0.00 2003-03-17 0003-A 1,452 LUJAN, KENNETH Bill Patient Collections No Bill Sent 75.00 0.00 75.00 2003-02-06 0018-A 200 MIKUS, MARY ANN Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-03-21 0010-A 1,614 PRINCE, ELIZABETH Bill Patient Collections No Bill Sent 1,245.00 0.00 1,245.00 2003-03-17 0017-A 1,470 PULVER, KATHY Bill Patient Collections No Bill Sent 1,040.00 968.39 71.61 2003-03-11 0005-A 1,262 REBAS, PEDRO Bill Patient Collections No Bill Sent 1,355.00 0.00 1,355.00 2003-03-19 0020-A 1,546 RETTELE, SUE ANN Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-03-02 0022-A 978 SAGE, NOAH Bill Patient Collections No Bill Sent 1,035.00 1,010.00 25.00 2003-02-11 0008-A 344 SHULTS, CLYDE Bill Patient Collections No Bill Sent 1,055.00 1,005.00 50.00 2003-03-17 0006-A 1,455 SICKLER, CHRISTINA Bill Patient Collections No Bill Sent 1,170.00 0.00 1,170.00 2003-03-22 0022-A 1,657 SMALL, CINDY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-16 0001-A 1,416 TORREZ, BARBARA Bill Patient Collections No Bill Sent 1,115.00 1,089.41 25.59 2003-03-17 0013-A 1,462 TREVINO, SONYA Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-03-16 0014-A 1,432 VASILION, LARA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-22 0031-A 1,666 WOLFE, JADE Bill Patient Collections No Bill Sent 975.00 0.00 197755.300 Trip count: 30 27,750.00 6,026.90 21 723.10 Trip count: 30 27,750.00 6,026.90 21,723.10 i RescueNetTM Printed on 10/27/2003 at 11:28:55AM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,108 Batch date: 10/27/2003 2:37:50PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-03-31 0006-A 1,853 BRUNNER, KENTON Bill Patient Collections No Bill Sent 1,250.00 673.00 577.00 2003-03-23 0004-A 1,670 BURMAN, MISTY Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-03-31 0025-A 1,893 CARLSON, JANAIL Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-03-30 0002-A 1,836 CARR, CLAYTON Bill Patient Collections No Bill Sent 1,040.00 832.00 208.00 2003-03-29 0013-A 1,830 CASTENEDA, JOSE Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-03-27 0012-A 1,771 CHAMPNEY, DAVID Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-03-31 0023-A 1,891 FENDEL, JUDY Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-03-27 0013-A 1,772 ICKLER, MARY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-27 0022-A 1,784 LANCY, GRACE Bill Patient Collections No Bill Sent 1,070.00 991.70 78.30 2003-03-24 0029-A 1,804 LIND, JEFFREY Bill Patient Collections No Bill Sent 1,275.00 0.00 1,275.00 2003-03-31 0005-A 1,850 LUJAN-DURAN, HUG(Bill Patient Collections No Bill Sent 1,310.00 0.00 1,310.00 2003-03-23 0016-A 1,682 MADALENO, NARIAH Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-31 0027-A 1,895 MARTINEZ, MICHAEL Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-03-23 0002-A 1,668 MCCORKLE, CHERYL Bill Patient Collections No Bill Sent 1,080.00 0.00 1,080.00 2003-03-29 0016-A 1,833 MORALES, ERIC Bill Patient Collections No Bill Sent 900.00 0.00 900.00 2003-03-28 0028-A 1,898 PARKER, GLENN Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-03-23 0001-A 1,667 PARKER, GLENN Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-03-29 0007-A 1,823 RIOS, DELMY Bill Patient Collections No Bill Sent 920.00 736.00 184.00 2003-03-28 0021-A 1,876 RIVERA, BRENDA Bill Patient Collections No Bill Sent 1,095.00 0.00 1,095.00 2003-03-28 0005-A 1,797 ROBERTSON, DEANE Bill Patient Collections No Bill Sent 1,310.00 0.00 1,310.00 2003-03-24 0009-A 1,736 RODD, RON Bill Patient Collections No Bill Sent 1,310.00 500.00 810.00 2003-03-23 0006-A 1,672 SCHMITZ, RENEE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-25 0013-A 1,704 SEAROCK, PATRICK Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-03-31 0031-A 1,902 STAPLETON, ROBER Bill Patient Collections No Bill Sent 1,205.00 0.00 1,205.00 2003-03-26 0003-A 1,718 STRAUCH, WENDY Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-03-23 0022-A 1,688 THOMPSON, CRAIG Bill Patient Collections No Bill Sent 1,220.00 0.00 1,220.00 2003-03-30 0015-A 1,859 VALQUIERA, OLGA Bill Patient Collections No Bill Sent 935.00 0.00 935.00 2003-03-29 0014-A 1,831 VILLANUEVA, ALEXAI Bill Patient Collections No Bill Sent 930.00 0.00 930.00 Trip count: 28 27,865.00 3,732.70 24,132.30 Trip count: 28 27,865.00 3,732.70 24,132.30 Total trip count: 28 I 27,865.00 I 3,732.70 I 24,132.30 I RescueNetTM Printed on 10/27/2003 at 2:38:29PM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,109 Batch date: 10/27/2003 3:10:13PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-04-14- 0027-A 2,351 ANDERSON, CHARLE Bill Patient Collections No Bill Sent 965.00 894.05 70.95 2003-04-09 0022-A 2,173 BROWN, MICHAEL Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-04-09 0039-A 2,252 CROUCH, AMANDA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-08-0001-A 2,091 DINKEL, NICKOLAS Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-04-11 0030-Ai 2,224 DISON, DAWN Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-12 0014-At 2,244 ESCAMILLA, DEBBIE Bill Patient Collections No Bill Sent 1,370.00 0.00 1,370.00 2003-04-08-0019-A 2,129 GARCIA, APRIL Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-04-11 0023-A 2,213 GONZALES, DORON Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-14 0029-A 2,353 HERNANDEZ, JOVAN Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-04-12 0028-A 2,272 HERNANDEZ, MARK Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-09 0026-A 2,177 HERNANDEZ, SYLVIA Bill Patient Collections No Bill Sent 435.00 0.00 435.00 2003-04-15 0020-A 2,373 JOHNSON, NEIL Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-11 0022-A 2,212 LOPEZ, JOHN Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-09 0014-A 2,144 MARTINEZ, ERNEST Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-08.-0012-A 2,113 MASTIN, RANDALL Bill Patient Collections No Bill Sent 905.00 0.00 905.00 2003-04-12 0025-A 2,269 MIKNEVICIUS, JEREN Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-04-08x0013-A 2,114 MOIR, TAMMY Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-04-14--0018-A 2,342 PEREZ,VICTORIA Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-04-10 0011-A 2,166 PHAN, PHUC HONG Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-140007-A 2,331 PULVER, KATHY Bill Patient Collections No Bill Sent 1,070.00 998.39 71.61 2003-04-13 0024-A 2,299 PULVER, KATHY Bill Patient Collections No Bill Sent 1,040.00 968.39 71.61 2003-04-12 0024-A 2,268 RAMIREZ, VALERIE Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-04-10 0004-A 2,141 SEVILLE, SEAN Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-04-09 0035-A 2,248 SIMPSON, TORI Bill Patient Collections No Bill Sent 1,095.00 0.00 1,095.00 2003-04-09 0017-A 2,147 SMITH TURNER, JUDI Bill Patient Collections No Bill Sent 905.00 0.00 905.00 2003-04-13 0023-A 2,298 SORENSON, NICHOL,Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00 2003-04-11 0004-A 2,194 TORRES, JOANNA Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-04-13 0012-A 2,287 VISCAINO, REFUGIO Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-04-10 0022-A 2,187 WEIDENKELLER, STE Bill Patient Collections No Bill Sent 920.00 0.00 920.00 Trip count: 29 24,645.00 2,860.83 21,784.17 Trip count: 29 24,645.00 2,860.83 21,71t4- Total trip count: 29 I 24,645.00 ' 2,860.83 21,784.17 RescueNetTM Printed on 10/27/2003 at 3:10:57PM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\Su bBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,110 Batch date: 10/27/2003 3:23:32PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance --- 2003-04-07 0016-A 2,152 BERGMAN, DEBRA Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-04-02 0004-A 1,937 BLANCO, ELVA Bill Patient Collections No Bill Sent 885.00 708.00 177.00 - 2003-04-02 0018-A 1,961 EDWARDS, JENNIFEF Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.0O 2003-04-06 0020-A 2,083 EVANS, JENNIFER Bill Patient Collections No Bill Sent 150.00 0.00 150.00-- 2003-04-07 0023-A 2,159 FRITZLIER, KLAYTON Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-04 0007-A 1,993 GARCIA, ALFRED Bill Patient Collections No Bill Sent 1,220.00 1,140.61 79.39 2003-04-01 0024-A 1,927 GODFREY, CANDIDA Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-06 0018-A 2,081 GONZALES, PETE Bill Patient Collections No Bill Sent 560.00 0.00 560.00- 2003-04-05 0018-A 2,032 HARPER, BAILIE Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-04-02 0016-A 1,957 HOGGARD, HAL Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-04-06 0007-A 2,057 MEDINA-GARCIA, PAE Bill Patient Collections No Bill Sent 870.00 0.00 870.00.-- 2003-04-04 0006-A 1,992 MEYER, THOMAS Bill Patient Collections No Bill Sent 975.00 0.00 975.00- - 2003-04-06 0002-A 2,051 PRIGG, JAMES Bill Patient Collections No Bill Sent 900.00 0.00 900.00' ' 2003-04-07 0025-A 2,172 SMITH TURNER, JUDI Bill Patient Collections No Bill Sent 905.00 0.00 905.00 2003-04-06 0032-A 2,101 TIBBENS, MICHAEL Bill Patient Collections No Bill Sent 930.00 0.00 930.00', 2003-04-05 0015-A 2,025 YBARRA, TRANIDAD Bill Patient Collections No Bill Sent 1,505.00 1,319.90 185.10 Trip count: 16 14,325.00 3,168.51 11,156.49 Trip count: 16 14,325.00 3,168.51 11,156.49 Total trip count: 16 I 14,325.00 I 3,168.51 I 11,156.49 I RescueNetTM Printed on 10/27/2003 at 3:23:56PM Page 1 H:\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,111 Batch date: 10/27/2003 4:13:49PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-04-19 0026-A 2,501 ACEVEDO, PABLO Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-11 0021-A 2,211 ANDERSON, ANDREV Bill Patient Collections No Bill Sent 1,055.00 489.83 565.17 2003-04-21 0030-A 2,715 ARZAGA, NANCY Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-21 0014-A 2,613 CLEAVER, KEVIN Bill Patient Collections No Bill Sent 1,190.00 0.00 1,190.00 2003-04-19 0022-A 2,495 CRANMER, RICK Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-04-16 0011-A 2,388 EGGERLING, SHAWN Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-04-21 0016-A 2,620 GOMEZ, SUSIE Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-04-08 0010-A 2,111 GOODE, JAMES Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-04-21 0009-A 2,532 HANEY, RICHARD Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-16 0026-A 2,404 HEADDY, JOHNNY Bill Patient Collections No Bill Sent 870.00 845.00 25.00 2003-04-16 0014-A 2,391 HOWSER, BRIAN Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-03-23 0013-A 1,679 KARICH, LOU Bill Patient Collections No Bill Sent 1,100.00 1,026.35 73.65 2003-04-16 0013-A 2,390 KELHER, MICHELLE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-17 0020-A 2,437 LATTIMER, JULIE Bill Patient Collections No Bill Sent 1,065.00 0.00 1,065.00 2003-03-21 0016-A 1,620 LOPEZ, JOHN Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-04-19 0027-A 2,503 LOPEZ, JOHN Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-04-16 0006-A 2,383 LOPEZ, LUIS Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-16 0015-A 1,434 LUSK, RONALD Bill Patient Collections No Bill Sent 1,265.00 0.00 1,265.00 2003-04-17 0028-A 2,445 MUELLER, NANCY Bill Patient Collections No Bill Sent 900.00 0.00 900.00 2003-04-21 0042-A 2,788 OGLE, KATHY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-17 0033-A 2,461 TAMEZ, JESSE Bill Patient Collections No Bill Sent 150.00 60.00 90.00 2003-04-21 0040-A 2,786 VASQUEZ, AMBRA Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-17 0030-A 2,447 WALTER, HOWARD Bill Patient Collections No Bill Sent 1,490.00 1,465.00 25.00 Trip count: 23 21,090.00 3,886.18 17,203.82 Trip count: 23 21,090.00 3,886.18 17,2 Total trip count: 23 ' 21,090.00 3,886.18 17,203.82 RescueNetTM Printed on 10/27/2003 at 4:15:25PM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt I I Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,112 Batch date: 10/27/2003 4:29:51PM Trip Date Job Run Name Current Payor Schedule Event Charges Credits Balance 2003-04-26 0004-A 2,668 ACOSTA-MARQUEZ, ,Bill Patient Collections No Bill Sent 915.00 0.00 915.00--- 2003-04-25 0006-A 2,621 COTTON, CATHLIN Bill Patient Collections No Bill Sent 1,310.00 0.00 1,310.00 2003-04-27 0037-A 2,774 EVANS, CHARLES Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-04-23 0023-A 2,591 FAHRNER, STEVEN Bill Patient Collections No Bill Sent 945.00 0.00 945.00 — 2003-04-23 0037-A 2,610 FELKER, DEBORA Bill Patient Collections No Bill Sent 1,340.00 0.00 1,340.00' 2003-04-30 0011-A 2,816 FRANKS, CATHERINE Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00' 2003-04-22 0005-A 2,528 GARDNER, ELIZABET Bill Patient Collections No Bill Sent 1,025.00 768.75 256.25' 2003-04-29 0026-A 2,805 GILLILAND, BRENDA Bill Patient Collections No Bill Sent 995.00 25.00 970.00 2003-04-30 0005-A 2,810 HALE, LINDA Bill Patient Collections No Bill Sent 1,220.00 0.00 1,220.00 2003-04-23 0036-A 2,609 HERNANDEZ, JOSE Bill Patient Collections No Bill Sent 1,245.00 825.00 420.00--"2003-04-24 0012-A 2,654 HILLE, PATRICIA Bill Patient Collections No Bill Sent 935.00 0.00 935.00 2003-04-22 0013-A 2,537 LATTIMER, JULIE Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-04-29 0024-A 2,803 NORRIS, MICHAEL Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00. 2003-04-27 0027-A 2,749 NUNEZ, JESSENIA Bill Patient Collections No Bill Sent 980.00 0.00 980.00- 2003-04-25 0017-A 2,636 OLIVAS, KRISTINA Bill Patient Collections No Bill Sent 150.00 0.00 150.00.- 2003-04-24 0016-A 2,658 PACHECO, MACHELL Bill Patient Collections No Bill Sent 1,175.00 0.00 1,175.00- 2003-04-23 0006-A 2,563 PRICE, BRENDA Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00- 2003-04-30 0014-A 2,819 QUESADA, SANTOS Bill Patient Collections No Bill Sent 870.00 0.00 870.00' 2003-04-23 0020-A 2,588 SIMS, RITA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-26 0008-A 2,672 SWANSON, ED Bill Patient Collections No Bill Sent 1,050.00 0.00 1,050.00-- 2003-04-24 0014-A 2,656 VALADEZ, FRANCISO Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-24 0013-A 2,655 VALADEZ, JOE Bill Patient Collections No Bill Sent 885.00 0.00 885.00- 2003-04-24 0009-A 2,651 WHITED, SANDRA Bill Patient Collections No Bill Sent 150.00 0.00 150.00` 2003-04-25 0015-A 2,633 WILSON, AMBER Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-04-23 0011-A 2,570 WILSON, LEO Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 Trip count: 25 22,975.00 1,618.75 21,356.25 Trip count: 25 22,975.00 1,618.75 21,356.25 Total trip count: 25 I 22,975.00 I 1,618.75 I 21,356.25 I I RescueNetTM Printed on 10/27/2003 at 4:30:36PM Page 1 H:\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,113 Batch date: 10/27/2003 4:35:17PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-05-01 0022-A 2,886 CLYNCKE, CINDY Bill Patient Collections No Bill Sent 900.00 0.00 900.00 2003-05-05 0012-A 2,945 GALLEGOS, DONALD Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00 2003-05-05 0004-A 2,937 GALLEGOS-PEREA, %Bill Patient Collections No Bill Sent 935.00 0.00 935.00 2003-05-01 0018-A 2,882 HAMM, WILLIAM Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-05-06 0029-A 2,992 JONES, ADAM Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-05-02 0025-A 2,879 JONES, DAVID Bill Patient Collections No Bill Sent 1,505.00 0.00 1,505.00 2003-05-03 0014-A 2,923 LEYVA, ARMANDO NC Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-05-07 0002-A 3,003 LOPEZ, JOHN Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-05-03 0012-A 2,919 LUIS, JOSE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-05 0009-A 2,942 LUJAN, MONIQUE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-06 0014-A 2,977 MARES, DAVID Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-05-07 0010-A 3,011 MARTINEZ, GEORGE Bill Patient Collections No Bill Sent 1,295.00 0.00 1,295.00 2003-05-03 0006-A 2,868 MATA, EDNA Bill Patient Collections No Bill Sent 1,130.00 1,025.00 105.00 2003-05-02 0009-A 2,853 MCCLARY, BRIAN Bill Patient Collections No Bill Sent 1,250.00 0.00 1,250.00 2003-05-03 0013-A 2,920 MORALES, FRANCIS(Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-05 0028-A 2,963 NUNALLY, WILLIAM Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-03 0003-A 2,861 OWENS, WILLIAM Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-01 0001-A 2,834 ROBERTS, WILLIAMS Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-05-03 0021-A 2,932 RODGERS, BRENDA Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-05-06 0032-A 2,995 RODRIGUEZ, JAIME Bill Patient Collections No Bill Sent 1,280.00 0.00 1,280.00 2003-05-06 0026-A 2,989 RODRIGUEZ, JUANIT,Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-05-02 0007-A 2,850 RUIZ, SHANNON Bill Patient Collections No Bill Sent 1,370.00 0.00 1,370.00 2003-05-06 0022-A 2,985 SOTO, RALPH Bill Patient Collections No Bill Sent 855.00 0.00 855.00 2003-05-03 0018-A 2,929 TURNER, ROYCE Bill Patient Collections No Bill Sent 1,085.00 1,020.28 64.72 2003-05-06 0023-A 2,986 VILLAFUERTE, CRYS"Bill Patient Collections No Bill Sent 855.00 0.00 855.00 2003-05-04 0017-A 2,916 WEIDENKELLER, STE Bill Patient Collections No Bill Sent 980.00 0.00 980.00 Trip count: 26 25,325.00 2,045.28 23,279.72 Trip count: 26 25,325.00 2,045.28 23 2 Total trip count: 26 I 25,325.00 I 2,045.28 23,279.72 RescueNetTM Printed on 10/27/2003 at 4:36:11PM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,115 Batch date: 10/28/2003 8:46:08AM Trip Date Job Run Name Current Payor Schedule Event Charges Credits Balance 2003-05-23 0045-A 3,607 BENAVIDEZ, SANDRA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-19 0030-A 3,436 CANCINO, JAIME Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-05-16 0016-A 3,319 CARMODY, NANCY Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-20 0033-A 3,480 CEJA, JORGE Bill Patient Collections No Bill Sent 965.00 0.00 965.00 2003-05-18 0007-A 3,373 CLARK, KAREN Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-20 0031-A 3,478 CRANMER, RICK Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 ' 2003-05-18 0014-A 3,380 HAAN, DAVID Bill Patient Collections No Bill Sent 780.00 0.00 780.00 2003-05-21 0015-A 3,564 HENDERSON, DONM Bill Patient Collections No Bill Sent 1,140.00 0.00 1,140.00 2003-05-17 0019-A 3,360 ISLAS, MANUEL Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-05-20 0018-A 3,457 LOPEZ, JOHN Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-05-16 0003-A 3,305 MARTINEZ, MARIA Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-05-16 0014-A 3,317 MORENO, PAT Bill Patient Collections No Bill Sent 1,265.00 0.00 1,265.00 2003-05-16 0015-A 3,318 MORENO, VALERIE Bill Patient Collections No Bill Sent 1,265.00 0.00 1,265.00 2003-05-17 0021-A 3,362 MORENO-HERNANDE Bill Patient Collections No Bill Sent 1,220.00 0.00 1,220.00 2003-05-22 0001-A 3,482 NIRA, AUGUSTINE Bill Patient Collections No Bill Sent 960.00 0.00 960.00 2003-05-22 0009-A 3,512 NOLASCO, FRANCIS(Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-05-19 0032-A 3,438 OGLE, KATHY Bill Patient Collections No Bill Sent 810.00 0.00 810.00 2003-05-23 0016-A 3,510 PEARSON, JENNIFER Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-05-22 0010-A 3,514 QUINTANA, GREGOR Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-05-23 0044-A 3,606 RAMOS, JESUS Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-18 0018-A 3,398 SALAZAR, JAKE Bill Patient Collections No Bill Sent 1,310.00 0.00 1,310.00 2003-05-23 0034-A 3,589 SANDOVAL, EUSEVIC Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-05-20 0030-A 3,477 SHUMATE, TANYA Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-05-22 0037-A 3,565 SOLIS, MICHAEL Bill Patient Collections No Bill Sent 905.00 0.00 905.00 2003-05-23 0018-A 3,536 WHITE-FORDYCE, TA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-17 0023-A 3,364 WHITMIRE, RICHARD Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-05-20 0028-A 3,467 YANES, AMADO Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00 Trip count: 27 25,375.00 0.00 25,375.00 Trip count: 27 25,375.00 0.00 25,3* 00T�- , Total trip count: 27 I 25,375.00 ' 0.00 I 25,375.00 -�� RescueNetT" Printed on 10/28/2003 at 8:47:13AM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt i Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,116 Batch date: 10/28/2003 8:47:54AM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-05-09 0025-A 3,119 ABBOTT, JAMIE Bill Patient Collections No Bill Sent 1,475.00 0.00 1,475.00- 2003-05-14 0013-A 3,224 ARCHER, MYRTLE Bill Patient Collections No Bill Sent 1,450.00 1,359.55 90.45 2003-05-09 0017-A 3,099 ARCHULETA, JOSEPF Bill Patient Collections No Bill Sent 1,400.00 1,318.61 81.39 2003-05-09 0001-A 3,033 BARCELONA, RONAL Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-05-08 0012-A 3,173 BOISVERT, DANIELLE Bill Patient Collections No Bill Sent 1,535.00 0.00 1,535.00-- 2003-05-12 0003-A 3,133 CAVAZOS, JOSE Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00` 2003-05-14 0034-A 3,255 COLLOP, KRISTIE Bill Patient Collections No Bill Sent 980.00 0.00 980.00- 2003-05-08 0016-A 3,177 GERRETSON, FREDR Bill Patient Collections No Bill Sent 980.00 580.00 400.00' 2003-05-09 0028-A 3,157 GFELLER, WILLIAM Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00-- 2003-05-14 0050-A 3,271 GOMEZ, CARLOS Bill Patient Collections No Bill Sent 950.00 0.00 950.00-- 2003-05-15 0001-A 3,276 GREEN, ALLEN Bill Patient Collections No Bill Sent 995.00 0.00 995.00- 2003-05-10 0004-A 3,052 JUAREZ, BENITO Bill Patient Collections No Bill Sent 950.00 0.00 950.00' 2003-05-15 0027-A 3,302 LOPEZ, JOHN Bill Patient Collections No Bill Sent 950.00 0.00 950.00-- 2003-05-08 0020-A 3,181 LOYA, ALEX Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00' 2003-05-13 0007-A 3,201 MATA, ROSIE Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00! 2003-05-15 0006-A 3,281 MORALES, MARIA Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.0r- 2003-05-14 0052-A 3,273 OGLE, KATHY Bill Patient Collections No Bill Sent 795.00 0.00 795.001--- 2003-05-10 0015-A 3,064 QUINTANA, MARIE Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.001 2003-05-10 0022-A 3,074 RODRIGUEZ, JUANIT,Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-12 0029-A —. 3,168 RODRIGUEZ, RUBEN Bill Patient Collections No Bill Sent 1,205.00 0.00 1,205.00 2003-05-10 0005-A 3,053 ROJAS, RUTH Bill Patient Collections No Bill Sent 905.00 0.00 905.00r-- 2003-05-08 0031-A 3,192 SALVADOR, PAMELA Bill Patient Collections No Bill Sent 965.00 0.00 965.00' 2003-05-10 0011-A 3,059 SANDERSON, EZEKIF Bill Patient Collections No Bill Sent 230.00 0.00 230.0O 2003-05-09 0016-A 3,098 THILL, KENNETH Bill PatientA Aci Collections No Bill Sent 1,070.00 0.00 1,070.00" 2003-05-14 0027-A 3,247 THOMAS, CLINTON Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.007' 2003-05-11 0006-A 3,089 THOMAS, JOSHUA Bill Patient Collections No Bill Sent 1,235.00 0.00 1,235.00'- 2003-05-13 0026-A 3,234 WALSH, PATRICK Bill Patient Collections No Bill Sent 960.00 0.00 960.00" 2003-05-11 0003-A 3,086 WATTS, CHERYL Bill Patient Collections No Bill Sent 150.00 0.00 150.0O 2003-05-13 0003-A 3,197 WYATT, NICOLE Bill Patient Collections No Bill Sent 150.00 0.00 150.00-- 2003-05-14 0051-A 3,272 ZAMMARRON, OBDUI Bill Patient Collections No Bill Sent 150.00 0.00 150.00 Trip count: 30 28,475.00 3,258.16 25,216.84 Trip count: 30 28,475.00 3,258.16 25,216.84 RescueNetTM Printed on 10/28/2003 at 8:49:11AM Page 1 H:\reports32\Billing\Miscellaneous\Su bBatch7.rpt Total trip count: 30 ' 28,475.00 3,258.16 ' 25,216.84 RescueNetTM Printed on 10/28/2003 at 8:49:11AM Page 2 H:\reports32\Billing\Miscellaneous\SubBatch7.rpt SuN,tission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,119 Batch date: 10/28/2003 9:50:00AM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-05-30 0002-A 3,726 AGUILAR, MIGUEL Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-05-31 0025-A 3,800 ALVAREZ, GERARDO Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-05-30 0034-A 3,782 ALVAREZ, JOE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-30 0026-A 3,774 ARNOLDY, JOHN Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-05-24 0001-A 3,494 BRASSFIELD, SCOTT Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-05-25 0002-A 3,591 BUJANDA, CESAR Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-05-31 0020-A 3,793 CHAVARRIA, MICHEA Bill Patient Collections No Bill Sent 935.00 0.00 935.00 2003-05-30 0004-A 3,729 CHAVEZ, NICOLE Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-11 0021-B 3,127 COOPER, ELVA Bill Patient Collections No Bill Sent 450.00 380.09 69.91 2003-05-11 0021-A 3,123 COOPER, ELVA Bill Patient Collections No Bill Sent 920.00 887.34 32.66 2003-05-06 0024-A 2,987 DUDLEY, GENETTA Bill Patient Collections No Bill Sent 870.00 808.15 61.85 2003-05-29 0021-A 3,737 DUNKI, ROGER Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-05-27 0007-A 3,663 GUTIERREZ, BRYAN Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-05-27 0015-A 3,683 GUTIERREZ, CLEMEI,Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-05-28 0008-A 3,669 HALSEY, MARK Bill Patient Collections No Bill Sent 780.00 0.00 780.00 2003-05-05 0013-A 2,946 HASEMANN, DARLEN Bill Patient Collections No Bill Sent 560.00 0.00 560.00 2003-05-28 0013-A 3,679 HAVERTY, ANDREW Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-05-29 0006-A 3,712 JAQUEZ, REYNALDO Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-05-29 0005-A 3,711 MALDONADO, MARIA Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-05-26 0002-A 3,631 MALDONADO, MARIA Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-05-25 0027-A 3,627 MENDOZA, VELMA Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-05-27 0025-A 3,695 MILLER, JERAD Bill Patient Collections No Bill Sent 1,595.00 0.00 1,595.00 2003-05-31 0003-A 3,756 MOLL, THOMAS Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-05-31 0026-A 3,803 MONTOYA, GILBERT Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-05-25 0005-A 3,595 MORALES, JORGE Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-05-24 0020-A 3,584 NELSON, JAMES Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-24 0023-A 3,587 PENNINGTON, KELLE Bill Patient Collections No Bill Sent 1,110.00 0.00 1,110.00 2003-05-25 0007-A 3,597 PROVENCE, JOSHUA Bill Patient Collections No Bill Sent 1,230.00 0.00 1,230.00 2003-05-30 0016-A 3,755 RAMEY, JAMES Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-25 0003-A 3,592 RAMIREZ-PALACIOS, Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-05-24 0003-A 3,499 RUIZ, NORMAN Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-05-26 0018-A 3,647 SANDOVAL, EUSEVIC Bill Patient Collections No Bill Sent 980.00 0.00 980.00 i 2003-05-25 0009-A 3,609 THILL, KENNETH Bill Patient Collections No Bill Sent 1,405.00 0.00 1,405.00 2003-05-25 0008-A 3,608 VISCAINO, REFUGIO Bill Patient Collections No Bill Sent 870.00 0.00 870.00 RescueNetTM Printed on 10/28/2003 at 9:51:13AM Page 1 \\nw16\rescue net\reports32\Billing\Miscellaneous\Su bBatch7.rpt WELD COUNTY PARAMEDIC SERVICES 2003-05-24 0019-A 3,581 WALKER,ANGEL Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-05-28 0017-A 3,686 YBARRA, DAVID Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-05-28 0016-A 3,684 ZAMARRIPA, JOSEPF Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-05-25 0004-A 3,593 ZAMORA, RICARDO Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 Trip count: 38 35,965.00 2,075.58 33,889.42 Trip count: 38 35,965.00 2,075.58 Total trip count: 38 I 35,965.00 ' 2,075.58 33,889.42 RescueNetTM Printed on 10/28/2003 at 9:51:13AM Page 2 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\Su bBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,134 Batch date: 10/29/2003 3:06:48PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-06-06 0017-A 3,967 ARMENTROUT, NICO Bill Patient Collections No Bill Sent 1,230.00 0.00 1,230.00 2003-02-02 0059-A 8,253 BANDERAS, CESAR Bill Patient Collections No Bill Sent 720.00 0.00 720.00 2003-06-03 0016-A 3,876 BARNARD, RICHARD Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-06-07 0012-A 3,985 CANCINO, JASMIN Bill Patient Collections No Bill Sent 900.00 0.00 900.00 2003-06-04 0003-A 3,891 CERVANTES-ARANDi Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-06-07 0021-A 3,995 CONNOUR, LINDA Bill Patient Collections No Bill Sent 150.00 100.00 50.00 2003-06-03 0005-A 3,862 CRONAN, WILLIAM Bill Patient Collections No Bill Sent 1,175.00 0.00 1,175.00 2003-06-02 0005-A 3,827 DODWELL, MIKE Bill Patient Collections No Bill Sent 1,265.00 0.00 1,265.00 2003-06-07 0004-A 3,976 DOLOBACS, ARVIN Bill Patient Collections No Bill Sent 1,340.00 0.00 1,340.00 2003-06-01 0028-A 3,857 GARCIA-CASTRO, ED Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-06-05 0022-A 3,936 HERNANDEZ FIGUER Bill Patient Collections No Bill Sent 1,265.00 0.00 1,265.00 2003-06-04 0014-A 3,902 JOHNSON,AARON Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-06-01 0004-A 3,797 LOGAN, ERIC Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-06-01 0026-A 3,853 MERAZ, PAOLA Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-06-06 0015-A 3,965 MOLL, THOMAS Bill Patient Collections No Bill Sent 1,175.00 0.00 1,175.00 2003-06-01 0021-A 3,847 RAMEY, JAMES Bill Patient Collections No Bill Sent 920.00 0.00 920.00 2003-06-02 0001-A 3,815 RAMEY, JAMES Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-06-01 0017-A 3,823 WEBER, JAKE Bill Patient Collections No Bill Sent 1,205.00 0.00 1,205.00 Trip count: 18 18,380.00 100.00 18,280.00 Trip count: 18 18,380.00 100.00 18, Total trip count: 18 I 18,380.00 I 100.00 I 18,280.00 RescueNetTM Printed on 10/29/2003 at 3:07:23PM Page 1 \\nw161rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt 1 Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,135 Batch date: 10/29/2003 3:54:01PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-06-11 0022-A 4,265 BRAVO, PEDRO Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00 2003-06-04 0002-A 3,890 CANCINO, LIDIA Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-06-14 0025-A 4,221 GARCIA, RUDOLFO Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-06-19 0026-A 4,419 GONZALEZ, ABEL Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-06-17 0003-A 4,285 GUERRERO, JAIME Bill Patient Collections No Bill Sent 900.00 0.00 900.00 2003-06-09 0024-A 4,060 HERNANDEZ, ROSAN Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-06-04 0028-A 3,972 KITTSMINLLER, JOSE-Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-02 0027-A 3,866 LANCKRIET, GREGOf Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-06-03 0022-A 3,884 LANCKRIET, GREGOF Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-06-17 0026-A 4,314 LAURENT, MARK Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-04 0015-A 3,903 LUCERO, DELORES Bill Patient Collections No Bill Sent 1,265.00 0.00 1,265.00 2003-06-20 0010-A 4,383 MANNING, HENRY Bill Patient Collections No Bill Sent 960.00 0.00 960.00 2003-06-11 0004-A 4,245 MCDONALD, MELISSi Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-06-11 0004-B 4,248 MCDONALD, MEL'SSi Bill Patient Collections No Bill Sent 810.00 0.00 810.00 2003-06-09 0034-A 4,135 MORRISON, TONYA Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-06-10 0020-A 4,102 SALAZAR, RAY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-09 0006-A 4,021 VARGAS, MOSES Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-10 0027-A 4,120 VELASQUEZ, WILLIAABill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-06-18 0024-A 4,341 WALSH, PATRICK Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-06-03 0012-A 3,872 WOODARD, GARY Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-06-08 0026-A 4,038 YOUNG, DANIELLE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 Trip count: 21 16,710.00 0.00 16,710.00 Trip count: 21 16,710.00 0.00 16; Total trip count: 21 I 16,710.00 I 0.00 I 16,710.00 RescueNettM Printed on 10/29/2003 at 3:54:43PM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,136 Batch date: 10/29/2003 4:08:59PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-07-19 0004-A 5,361 BARELLA, LUIS Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-06 0032-A 4,973 BREWER, SHIRLEY Bill Patient Collections No Bill Sent 1,266.00 0.00 1,266.00 2003-07-19 0002-A 5,357 BREWER, SHIRLEY Bill Patient Collections No Bill Sent 1,221.00 0.00 1,221.00 2003-07-14 0004-A 5,215 BROWN, LEHLIA Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-06-24 0008-A 4,537 CORBIN, ANNIE Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-06-22 0022-A 4,503 CRUZ, JACQUETTE Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-07-15 0005-A 5,244 CRUZ, JACQUETTE Bill Patient Collections No Bill Sent 1,401.00 0.00 1,401.00 2003-06-23 0025-A 4,542 DELANGEL, ROBERT(Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-07-09 0021-A 5,099 DOBBS, ROBERT Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-07 0008-A 5,003 FULLER, JERRY Bill Patient Collections No Bill Sent 1,041.00 0.00 1,041.00 2003-07-15 0006-A 5,247 GAMBOA, JAIME Bill Patient Collections No Bill Sent 1,281.00 0.00 1,281.00 ' 2003-07-01 0021-A 4,792 GARCIA, JOEL Bill Patient Collections No Bill Sent 1,371.00 0.00 1,371.00 2003-07-09 0010-A 5,072 GARZA, SANTOS Bill Patient Collections No Bill Sent 1,221.00 0.00 1,221.00 2003-07-14 0029-A 5,245 GRIMALDO, TANILO Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-17 0013-A 5,335 HOWARD, TIMOTHY Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-11 0025-A 5,158 HOWARD, TIMOTHY Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-14 0005-A 5,216 LOPEZ, JUANITA Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-02 0025-A 4,820 MCNAMARA, WILLIAty Bill Patient Collections No Bill Sent 1,011.00 0.00 1,011.00 2003-07-05 0021-A 4,898 MCNAMARA, WILLIAM Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-07-06 0006-A 4,927 ORIHUELA-GIL, LINO Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-06-23 0027-A 4,548 SHRANK, ALLEN Bill Patient Collections No Bill Sent 1,085.00 1,010.68 74.32 2003-07-16 0021-A 5,279 THOMPSON, ALLEN Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-05 0010-A 4,879 TZUN IXOX, DANIEL Bill Patient Collections No Bill Sent 1,131.00 0.00 1,131.00 2003-06-30 0043-A 4,779 WALSH, PATRICK Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-07-03 0036-A 4,866 WALSH, PATRICK Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-07-07 0018-A 5,019 WALSH, PATRICK Bill Patient Collections No Bill Sent 1,041.00 0.00 1,041.00 2003-07-10 0002-A 5,057 WALSH, PATRICK Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 Trip count: 27 29,801.00 1,010.68 28,790.32 Trip count: 27 29,801.00 1,010.68 28;790:32, Total trip count: 27 ' 29,801.00 I 1,010.68 r' 28,790.32 I RescueNetTM Printed on 10/29/2003 at 4:09:31PM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,137 Batch date: 10/29/2003 4:26:08PM Trip Date Job Run Name Current Payor Schedule Event Charges Credits Balance 2003-07-27 0015-A 5,629 BARRERA-LEDEZMA, Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-20 0006-A 5,366 COLIN, JUAN Bill Patient Collections No Bill Sent 1,326.00 0.00 1,326.00 2003-07-20 0007-A 5,368 COLIN-HERNANDEZ, Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-26 0023-A 5,612 DOBBS, ROBERT Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-26 0025-A 5,614 EALA, HERB Bill Patient Collections No Bill Sent 1,221.00 0.00 1,221.00 2003-07-20 0012-A 5,378 HERNANDEZ, ERNAS Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-07-20 0005-A 5,365 HERNANDEZ, HILARI(Bill Patient Collections No Bill Sent 1,251.00 0.00 1,251.00 2003-07-28 0012-A 5,661 LECHUGA, JANE Bill Patient Collections No Bill Sent 1,266.00 0.00 1,266.00 2003-07-20 0009-A 5,371 MONTOYA, PEDRO Bill Patient Collections No Bill Sent 1,026.00 0.00 1,026.00 2003-07-25 0025-A 5,561 NOBLITT, LISA Bill Patient Collections No Bill Sent 996.00 0.00 996.00 2003-07-20 0001-A 5,358 OROZCO, HERNESTC Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-20 0008-A 5,369 SALINAS, ELOY Bill Patient Collections No Bill Sent 1,251.00 0.00 1,251.00 2003-07-31 0024-A 5,763 SANDERSON, MICHA Bill Patient Collections No Bill Sent 1,236.00 0.00 1,236.00 2003-07-24 0026-A 5,527 SATOR, ROBERT Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-30 0006-A 5,716 STASIEFSKI, BARRY Bill Patient Collections No Bill Sent 2,120.00 2,060.00 60.00 2003-07-21 0014-A 5,445 VILLARREAL, ANTON Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-29 0020-A 5,696 WHITMIRE, RICHARD Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 Trip count: 17 19,940.00 2,060.00 17,880.00 Trip count: 17 19,940.00 2,060.00 17,880.00 Total trip count: 17 I 19,940.00 I 2,060.00 17,880.00.0 RescueNetTM Printed on 10/29/2003 at 4:26:40PM Page 1 \\nw 16\rescuen et\reports32\Billing\Miscellaneous\Su bBatch7.rpt I Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,206 Batch date: 11/5/2003 12:11:47PM Trip Date Job Run Name Current Payor Schedule Event Charges Credits Balance 2003-08-13 0017-A 6,172 ARMSTRONG, JAY Bill Patient Collections No Bill Sent 1,281.00 0.00 1,281.00 2003-08-22 0018-A 6,478 BARNES, ROBERT Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-08-29 0036-A 6,739 BARNES, ROBERT Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-08-08 0021-A 6,016 BARNES, ROBERT Bill Patient Collections No Bill Sent 1,086.00 0.00 1,086.00 2003-08-14 0005-A 6,194 BENAVIDEZ, TERRY Bill Patient Collections No Bill Sent 1,086.00 0.00 1,086.00 2003-08-21 0023-A 6,440 BRANDON, GREG Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-08-10 0026-A 6,097 CHEN, ELI Bill Patient Collections No Bill Sent 1,431.00 0.00 1,431.00 2003-08-07 0010-A 5,965 COSSIO, CHRISTINE Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-08-19 0034-A 6,393 GARRISON, GARRI Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-08-10 0027-A 6,100 GUIMARAES, NAHUAI Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-08-09 0006-A 6,028 HEGGEN, PAULA Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-08-01 0014-A 5,794 JOINER, JAMES Bill Patient Collections No Bill Sent 1,356.00 0.00 1,356.00 2003-08-23 0026-A 6,551 JOJOLA, GILBERT Bill Patient Collections No Bill Sent 1,251.00 0.00 1,251.00 2003-08-26 0008-A 6,601 KNIGHT, STEPHANIE Bill Patient Collections No Bill Sent 1,071.00 0.00 1,071.00 2003-08-03 0002-A 5,853 MORALES, JOSE Bill Patient Collections No Bill Sent 1,326.00 0.00 1,326.00 2003-08-21 0040-A 6,457 PEITSMEYER, CHRIS Bill Patient Collections No Bill Sent 996.00 0.00 996.00 2003-08-29 0031-A 6,730 RIVAS-POMPA, DANIE Bill Patient Collections No Bill Sent 1,101.00 0.00 1,101.00 2003-08-29 0030-A 6,729 RIVAS-POMPA, HORII Bill Patient Collections No Bill Sent 1,041.00 0.00 1,041.00 2003-08-08 0028-A 6,060 SAENZ, JORGE Bill Patient Collections No Bill Sent 1,086.00 0.00 1,086.00 2003-08-02 0014-A 5,832 SCOTT, LARRY Bill Patient Collections No Bill Sent 1,251.00 0.00 1,251.00 2003-08-26 0004-A 6,597 TRINIDAD, LAZARO Bill Patient Collections No Bill Sent 1,536.00 0.00 1,536.00 2003-08-14 0026-A 6,215 VELASQUEZ, WILLIAlk Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-08-17 0012-A 6,335 VISCAINO, REFUGIO Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-08-27 0013-A 6,637 WAFFORD, JERRY Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-08-23 0025-A 6,550 WAFFORD, JERRY Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-08-30 0001-A 6,685 WAFFORD, JERRY Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-08-08 0003-A 5,993 WILSON, RAMONA Bill Patient Collections No Bill Sent 1,281.00 930.75 350.25 Trip count: 27 29,790.00 930.75 28,859.25 Trip count: 27 29,790.00 930.75 28,85 Total trip count: 27 I 29,790.00 ' 930.75 28,859.25 j , r .c RescueNetTM Printed on 11/5/2003 at 12:12:47PM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,205 Batch date: 11/5/2003 11:28:57AM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-03-27 0023-A 1,785 ANDERSON,ANDREV Bill Patient Collections No Bill Sent 1,115.00 510.17 604.83 2003-05-19 0015-A 3,419 ANDERSON, DEAN Bill Patient Collections No Bill Sent 1,220.00 1,143.66 76.34 2003-05-21 0016-A 3,566 AVILA, ROBERT Bill Patient Collections No Bill Sent 1,115.00 1,042.49 72.51 2003-05-26 0012-A 3,641 CLARK, HUBERT Bill Patient Collections No Bill Sent 1,070.00 996.58 73.42 2003-02-03 0028-A 92 FERNANDEZ, 'CASON Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-05-22 0013-A 3,517 GARCIA, MARGIE Bill Patient Collections No Bill Sent 1,190.00 1,116.58 73.42 2003-02-26 0015-A 810 GONZALES, STEPHAI Bill Patient Collections No Bill Sent 1,085.00 868.00 217.00 2003-05-13 0010-A 3,204 GONZALEZ, ALEJANE Bill Patient Collections No Bill Sent 1,055.00 844.00 211.00 2003-03-13 0027-A 1,395 KRUEGER, JONATHA Bill Patient Collections No Bill Sent 1,070.00 856.00 214.00 2003-06-10 0007-A 4,076 MALONEY, LEA Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-13 0019-A 3,216 MCNEECE, MICHELLE Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-04-30 0012-A 2,817 MEYERS, DWIGHT Bill Patient Collections No Bill Sent 1,205.00 0.00 1,205.00 2003-05-22 0020-A 3,529 MORENO, SEVERO Bill Patient Collections No Bill Sent 1,100.00 1,040.74 59.26 2003-05-14 0032-A 3,253 PANTOJA, JOSEFINA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-10 0025-A 4,115 RIVERA, JAMES Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-06-10 0036-A 4,150 RODRIGUEZ, FERNAt Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 2003-02-10 0013-A 319 SCHAFFER, SHURRI Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-06-10 0031-A 4,131 SIPPEL, KAYLA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 I Trip count: 18 17,660.00 8,418.22 9,241.78 Trip count: 18 17,660.00 8,418.22 9,241.78 Total trip count: 18 I 17,660.00 I 8,418.22 9,241.78 I RescueNetTM Printed on 11/5/2003 at 11:29:40AM Page 1 \\nw16\rescuenet\reports32\B i'ling\Miscellaneous\SubBatch7.rpt Submission Batch Report rGiN vL WELD COUNTY PARAMEDIC SERVICES Batch 2,326 Batch date: 11/21/2003 2:11 :14PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-06-11 0029-A 4,272 -ALANIZ, ROBERT Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-04-24 0022-A 2,664 ...BOWMAN, JEFFREY Bill Patient Collections No Bill Sent 1,175.00 1,135.00 40.00 2003-06-11 0035-A 4,279 ,CANNON, ADAM Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-13 0035-A 4,186 -CHAVEZ, GABRIEL Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-30 0032-A 4,758 -CRANMER, RICK Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-02-04 0025-A 168 --CUSHMAN, EDWARD Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-03-02 0004-A 937 --DUNN, GEOFFREY Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-06-13 0028-A 4,179 -ELKINS, MICHAEL Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-05-20 0014-A 3,453 'FARRIS, LYMAN Bill Patient Collections No Bill Sent 1,400.00 1,310.74 89.26 2003-06-12 0018-A 4,119 'GAONA, MONICA Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-02-22 0001-A 638 -GARCIA, CARLOS Bill Patient Collections No Bill Sent 1,475.00 0.00 1,475.00 2003-04-22 0025-A 2,551 -GARCIA, JENNIFER Bill Patient Collections No Bill Sent 1,130.00 960.50 169.50 2003-05-23 0004-A 3,484 -GROVER,ARTHUR Bill Patient Collections No Bill Sent 1,145.00 1,067.05 77.95 2003-02-18 0014-A 529 'HENDERSON, KELSE Bill Patient Collections No Bill Sent 1,250.00 0.00 1,250.00 2003-04-01 0012-A 1,914 4HERNANDEZ, HINIO Bill Patient Collections No Bill Sent 965.00 903.65 61.35 2003-06-14 0032-A 4,228 1-IUGHLEY, ELBERT Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 2003-03-28 0017-A 1,816 JACKSON, CAMERON Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-05-09 0005-A 3,037 'KELM, KURT "JACK" Bill Patient Collections No Bill Sent 1,055.00 902.49 152.51 2003-03-12 0005-A 1,300 'KONRADE, TIANA Bill Patient Collections No Bill Sent 1,455.80 1,405.80 50.00 2003-06-14 0009-A 4,200 "MESSICK, MICHAEL Bill Patient 04. Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-04-19 0016-A 2,487 --MILNER, ELIZABETH Bill Patient Collections No Bill Sent 1,250.00 0.00 1,250.00 2003-06-13 0006-A 4,157 'fvlIRALES, ISAAC Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-14 0001-A 4,187 "MONCRIEF, DAVID Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-04-16 0027-A 2,405 `NICOLAI, LARRY Bill Patient Collections No Bill Sent 1,100.00 600.00 500.00 2003-06-21 0034-A 4,488 -SANCHEZ, BERNARD Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-05-02 0024-A 2,876 SMITH, JOHN Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-06-11 0027-A 4,270 'TITISHIA, CARLIE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 Trip count: 27 23,955.80 8,285.23 15,670.57 Trip count: 27 23,955.80 8,285.23 15,670.57 Total trip count: 27 ' 23,955.80 ' 8,285.23 r‘,670.57 _/ RescueNetTM Printed on 11/21/2003 at 2:12:06PM Page 1 \\nw16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt l Submission Batch Report iuW .,( WELD COUNTY PARAMEDIC SERVICES Batch 2,327 Batch date: 11/21/2003 2:39:22PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-09-11 0035-A 7,165 ABEGG, THERESA Bill Patient Collections No Bill Sent 1,356.00 0.00 1,3s6A0' 2003-06-21 0006-A 4,441 * ARELLANO, JORGE` Bill Patient Collections No Bill Sent 1,040.00 50.00 ��99��0.00 2003-08-08 0016-A 6,011 CHAPARRO, SAUL Bill Patient Collections No Bill Sent 1,131.00 0.00 -1,131.0O 2003-09-27 0015-A 7,642 CHILDS, JEREMY Bill Patient Collections No Bill Sent 1,101.00 0.00 1,101.00-- 2003-07-12 0022-A 5,193 CLARK, DEBORAH Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-12 0023-A 5,194 CLARK, JEREMY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-09-14 0001-A 7,221 CORTEZ, LORENZO Bill Patient Collections No Bill Sent 1,281.00 0.00 1,281.00 2003-07-10 0011-A 5,092 COX, CODY Bill Patient Collections No Bill Sent 1,221.00 0.00 1,221.00 2003-07-10 0016-A 5,109 COX, CODY Bill Patient Collections No Bill Sent 513.00 0.00 513.00 2003-08-26 0028-A 6,621 CRANMER, RICK Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-16 0010-A 5,266 CRANMER, RICK Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-09-15 0016-A 7,267 DITTMER, CHARLES Bill Patient Collections No Bill Sent 1,511.00 0.00 1,511.00 2003-09-18 0017-A 7,354 HOWARD, TIMOTHY Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-08-25 0031-A 6,588 LEGRAND, KIMBERL\Bill Patient Collections No Bill Sent 1,266.00 0.00 1,266.00 2003-09-01 0004-A 6,795 LLAMAS, TERESA Bill Patient Collections No Bill Sent 1,086.00 0.00 1,086.00 2003-09-26 0005-A 7,598 LOPEZ, MARIA Bill Patient Collections No Bill Sent 1,086.00 0.00 1,086.00 2003-07-10 0006-A 5,066 LOPEZ, OMAR Bill Patient Collections No Bill Sent 1,131.00 0.00 1,131.00 2003-07-12 0008-A 5,149 MATA, JESUS Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-09-09 0030-A 7,085 MCNAMARA, WILLIAN Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-09-27 0022-A 7,656 MEDINA, NABER Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-09-12 0023-A 7,207 MOORE, JEFFREY Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-11 0010-A 5,123 PITTS, MORA Bill Patient Collections No Bill Sent 1,221.00 0.00 1,221.00 2003-07-12 0028-A 5,202 RIDER, JAMES Bill Patient Collections No Bill Sent 1,401.00 0.00 1,401.00 2003-06-16 0008-A 4,316 ROSE, TERESA Bill Patient Collections No Bill Sent 1,040.00 0.00 1,040.00 2003-09-02 0001-A 6,816 SOTO, CLAUDIA Bill Patient Collections No Bill Sent 996.00 0.00 996.00 2003-07-12 0001-A 4,805 STANDBY, PMTRA AT Bill Patient Collections No Bill Sent 450.00 300.00 150.00 2003-09-28 0029-A 7,683 VISCAINO, REFUGIO Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-06-16 0014-A 4,357 WISE, LESTER Bill Patient Collections No Bill Sent 150.00 0.00 150.00 Trip count: 28 27,378.00 350.00 27,028.00 Trip count: 28 27,378.00 350.00 27,028.00 Total trip count: 28 I 27,378.00 I 350.00 27,028.00 RescueNetT" Printed on 11/21/2003 at 2:40:28PM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,491 Batch date: 12/9/2003 10:43:49AM Trip Date Job Run Name Current Payor Schedule Event Charges Credits Balance 2003-04-25 0024-A 2,644 ANDERSON, ANDREV Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-02-28 0009-A 851 CHRISTOPHERSON, )Bill Patient Collections No Bill Sent 1,280.00 0.00 1,280.00 2003-02-18 0020-A 538 CONNETT, SUSIE Bill Patient Collections No Bill Sent 1,190.00 0.00 1,190.00 2003-04-21 0041-A 2,787 CONTRERAS, SERGI(Bill Patient Collections No Bill Sent 1,325.00 1,300.00 25.00 2003-04-24 0017-A 2,659 DOOLEY, RYAN SHAD Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-04-17 0007-A 2,419 FIELD, CHRIS Bill Patient Collections No Bill Sent 870.00 785.00 85.00 2003-04-20 0019-A 2,581 HAMLIN, BECKY Bill Patient Collections No Bill Sent 905.00 324.00 581.00 2003-03-30 0022-A 1,874 JENNINGS, PATRICIA Bill Patient Collections No Bill Sent 900.00 720.00 180.00 2003-02-04 0026-A 169 KELLEY, KEVIN Bill Patient Collections No Bill Sent 150.00 0.00 150.00 ' 2003-03-27 0009-A 1,767 MONTES, ILDEFONS(Bill Patient Collections No Bill Sent 990.00 0.00 990.00 2003-04-03 0003-A 1,949 SMITH, PAUL Bill Patient Collections No Bill Sent 1,310.00 1,285.00 25.00 2003-02-15 0032-A 505 WATSON, ROBERT Bill Patient Collections No Bill Sent 1,070.00 998.33 71.67 2003-03-11 0024-A 1,282 WHITMAN, KANDICE Bill Patient Collections No Bill Sent 1,025.00 100.00 925.00 Trip count: 13 13,080.00 5,512.33 7,567.67 Trip count: 13 13,080.00 5,512.33 7,567.67 Total trip count: 13 ' 13,080.00 ' 5,512.33 7,567.67 '� RescueNettM Printed on 12/9/2003 at 10:44:09AM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\Su bBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,492 Batch date: 12/9/2003 11:07:48AM Trip Date Job Run Name Current Payor Schedule Event Charges Credits Balance 2003-05-02 0014-A 2,862 GETTMAN, RICHARD Bill Patient Collections No Bill Sent 1,295.00 0.00 1,295.00 2003-05-17 0022-A 3,363 GRIEGO, FREDERICK Bill Patient Collections No Bill Sent 995.00 716.40 278.60 2003-05-18 0005-A 3,371 LARREAU, KIM Bill Patient Collections No Bill Sent 1,175.00 0.00 1,175.00 2003-05-18 0021-A 3,401 LECHUGA, HECTOR Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-05-23 0042-A 3,604 REYES, LETICIA Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-05-31 0014-A 3,785 ZUNIGA, JESUS Bill Patient Collections No Bill Sent 1,035.00 0.00 1,035.00 Trip count: 6 6,520.00 716.40 5,803.60 Trip count: 6 6,520.00 716.40 5,803 Total trip count: 6 I 6,520.00 I 716.40 ! 5,803.60 RescueNetTM Printed on 12/9/2003 at 11:08:05AM Page 1 \\nw16\rescuenet\reports32\Bil I ing\Miscellaneous\SubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,493 Batch date: 12/9/2003 11:58:20AM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-06-09 0004-A 4,019 AGUILAR, SERGIO Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-06-12 0019-A 4,121 AGUILAR, SERGIO Bill Patient Collections No Bill Sent 980.00 0.00 980.00 2003-06-15 0012-A 4,231 ANDERSON, ANDREV Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-06-18 0019-A 4,336 BICKLING, EDITH Bill Patient Collections No Bill Sent 1,145.00 1,067.05 77.95 2003-06-06 0011-A 3,956 CASEY, BRIAN Bill Patient Collections No Bill Sent 1,925.00 1,576.34 348.66 2003-06-19 0002-A 4,350 COBBLEY, SHARON Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-06-18 0017-A 4,334 FLORES, DERECK Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-06-18 0022-A 4,339 HERRERA, DAVID Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-06-20 0031-A 4,420 ISAQUIRRE, SANDY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-08 0001-A 4,002 KRUEGER, JONATHA Bill Patient Collections No Bill Sent 1,085.00 868.00 217.00 2003-06-08 0018-A 4,027 KRUEGER, JONATHA Bill Patient Collections No Bill Sent 1,010.00 808.00 202.00 2003-06-04 0025-A 3,913 LECHUGA, HECTOR Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-06-07 0026-A 4,000 MARIN, RAYMOND Bill Patient Collections No Bill Sent 1,460.00 1,373.62 86.38 2003-06-20 0024-A 4,411 MCFALL, ROBERT Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-06-11 0017-A 4,260 SMALL, CINDY Bill Patient Collections No Bill Sent 1,100.00 0.00 1,100.00 2003-06-07 0011-A 3,984 SMALL, CINDY Bill Patient Collections No Bill Sent 1,170.00 52.50 1,117.50 2003-06-20 0028-A 4,416 WATKINS, KRISTINA Bill Patient Collections No Bill Sent 965.00 772.00 193.00 2003-06-17 0002-A 4,284 ZAMARRIPA, ANTONI Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-06-05 0026-A 3,940 ZONZO, JOHN Bill Patient Collections No Bill Sent 1,085.00 1,013.45 71.55 Trip count: 19 20,375.00 7,530.96 12,844.04 Trip count: 19 20,375.00 7,530.96 12,844. 4 Total trip count: 19 I 20,375.00 I 7,530.96 I 12,844.04 RescueNetTM Printed on 12/9/2003 at 11:58:46AM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\S ubBatch7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,494 Batch date: 12/9/2003 2:19:08PM Trip Date Job Run Name Current Payor Schedule Event Charges Credits Balance 2003-06-27 0020-A 4,642 ABERNATHA, BRIAN Bill Patient Collections No Bill Sent 1,145.00 977.00 168.00 2003-06-23 0018-A 4,524 ALLEN, DEBBIE Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-06-23 0005-A 4,510 ALVARADO, JOE Bill Patient Collections No Bill Sent 1,160.00 0.00 1,160.00 2003-06-21 0005-A 4,440 AVILA, EMMA Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-06-29 0021-A 4,705 BUNDY, ROBERT Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-06-21 0038-A 4,492 CHAVEZ, CHRIS Bill Patient Collections No Bill Sent 1,010.00 10.00 1,000.00 2003-06-30 0046-A 4,782 DALE, KIMBERLY Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003-06-30 0044-A 4,780 DINGLER, TODD Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-29 0002-A 4,660 DONOVAN, DAN Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-06-25 0017-A 4,595 ELKINS, MICHAEL Bill Patient Collections No Bill Sent 930.00 0.00 930.00 2003-06-28 0036-A 4,720 ESPINO, ENRIQUE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-30 0033-A 4,759 FOOTE, JOHN Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-06-21 0004-A 4,439 GARCIA, DONALD Bill Patient Collections No Bill Sent 855.00 0.00 855.00 2003-06-23 0031-A 4,552 GRANADOS, RAUL Bill Patient Collections No Bill Sent 1,300.00 0.00 1,300.00 2003-06-27 0012-A 4,634 HAGLER, SHAWN Bill Patient Collections No Bill Sent 1,145.00 0.00 1,145.00 2003-06-28 0026-A 4,697 HANSON, JUSTIN Bill Patient Collections No Bill Sent 510.00 0.00 510.00 2003-06-25 0009-A 4,587 HERNANDEZ, LAURE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-25 0003-A 4,581 HERNANDEZ, SAMAN Bill Patient Collections No Bill Sent 950.00 0.00 950.00 2003-06-23 0020-A 4,534 KAMAKELE, DAVID Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-27 0017-A 4,639 LANCKRIET, GREGOF Bill Patient Collections No Bill Sent 1,010.00 0.00 1,010.00 2003-06-21 0022-A 4,472 LEBLANC, RICHARD Bill Patient Collections No Bill Sent 1,175.00 0.00 1,175.00 2003-06-30 0024-A 4,748 LUNA, AZUL Bill Patient Collections No Bill Sent 1,070.00 0.00 1,070.00 2003-06-30 0026-A 4,750 LUNA, FRANCHESKA Bill Patient Collections No Bill Sent 885.00 0.00 885.00 2003-06-30 0025-A 4,749 LUNA, RACHELLE Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-06-25 0008-A 4,586 MALTOS, ANITA Bill Patient Collections No Bill Sent 870.00 0.00 870.00 2003-06-26 0019-A 4,614 MARKER, TRAVIS Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-21 0003-A 4,438 MARTINEZ, NATHAN Bill Patient Collections No Bill Sent 945.00 0.00 945.00 2003-06-25 0011-A 4,589 MESE, VICKY Bill Patient Collections No Bill Sent 1,190.00 0.00 1,190.00 2003-06-26 0018-A 4,613 MONTEMARANO, JAI\Bill Patient Collections No Bill Sent 1,025.00 0.00 1,025.00 2003-06-29 0025-A 4,716 MYERS, LEVI Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-24 0004-A 4,531 ORTEGA-JUAREZ, Mf Bill Patient Collections No Bill Sent 1,220.00 0.00 1,220.00 2003-06-30 0027-A 4,751 REITZ, CHRISTOPHEI Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-06-27 0021-A 4,643 RODRIQUEZ, AUGUS Bill Patient Collections No Bill Sent 995.00 0.00 995.00 2003-06-30 0037-A 4,773 RODRIQUEZ, AUGUS Bill Patient Collections No Bill Sent 930.00 0.00 930.00 RescueNetTM Printed on 12/9/2003 at 2:20:00PM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\Su bBatch7.rpt WELD COUNTY PARAMEDIC SERVICES 2003-06-29 0013-A 4,685 ROMERO, MONTE Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 2003:06-24 0010-A 4,545 SALAZAR, MICHAEL Bill Patient Collections No Bill Sent 1,115.00 0.00 1,115.00 2003-06-28 0027-A 4,701 SAUNDERS, ROBERT Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-21 0036-A 4,490 VALDEZ, MONICA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-06-30 0039-A 4,775 VARELA, LARIAH Bill Patient Collections No Bill Sent 1,085.00 0.00 1,085.00 2003-06-28 0037-A 4,722 VERMILLION, TROY Bill Patient Collections No Bill Sent 1,130.00 0.00 1,130.00 2003-06-25 0013-A 4,591 WALTER, BOB Bill Patient Collections No Bill Sent 1,055.00 0.00 1,055.00 Trip count: 41 35,285.00 987.00 34,298.00 Trip count: 41 35,285.00 987.00 34 Total trip count: 41 I 35,285.00 I 987.00 3 ,298.00 RescueNetTM Printed on 12/9/2003 at 2:20:00PM Page 2 \\nw16\rescuenet\reports32\Billing\Miscellaneous\S ubBatch7.rpt Sus-. .ssion Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,495 ti, Batch date: 12/9/2003 3:04:05PM Trip Date Job a Name Current Pavor Schedule Event Charges Credits Balance 2003-07-01 0005-A 4,762 ALBERT, ROBIN Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-04 0011-A 4,899 ALBERT, ROBIN Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-15 0014-A 5,263 ARNOLD, DIANNA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-01 0008-A 4,765 BANG, JESSICA Bill Patient Collections No Bill Sent 1,131.00 0.00 1,131.00 2003-07-06 0029-A 4,970 BENOIT, KRYSTAL Bill Patient Collections No Bill Sent 1,371.00 0.00 1,371.00 2003-07-04 0036-A 4,952 BLANK, NANCI Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-07-12 0007-A 5,146 CALDERON, ENMA Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-09 0014-A 5,081 CARDENAS, BRANDI Bill Patient Collections No Bill Sent 1,356.00 0.00 1,356.00 2003-07-05 0022-A 4,900 CARLSON, SCOTT Bill Patient Collections No Bill Sent 1,161.00 0.00 1,161.00 2003-07-14 0030-A 5,246 CARRIZALES, JOSE Bill Patient Collections No Bill Sent • 1,191.00 0.00 1,191.00 2003-07-01 0019-A 4,790 COBBLEY, SHARON Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-14 0026-A 5,240 ELKINS, MICHAEL Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-07 0012-A 5,011 ENGEL, JORDAN Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-13 0025-A 5,207 ESPINOSA, ADAM Bill Patient Collections No Bill Sent 1,011.00 0.00 1,011.00 2003-07-03 0020-A 4,845 ESPINOZA, LUIS Bill Patient Collections No Bill Sent 1,521.00 0.00 1,521.00 2003-07-13 0001-A 5,164 EWALD, CHRISTOPHI Bill Patient Collections No Bill Sent 996.00 0.00 996.00 2003-07-04 0028-A 4,941 GALLEGOS, DONALD Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-07-05 0001-A 4,870 GARZA, JACOB Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-07-03 0027-A 4,854 HAYDEN, JEREMY Bill Patient Collections No Bill Sent 1,026.00 0.00 1,026.00 2003-07-09 0033-A 5,132 HUGHLEY, ELBERT Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-14 0008-A 5,219 IXMAY, GUADALUPE Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-02 0019-A 4,814 JOHNSON, JAMES Bill Patient Collections No Bill Sent 1,236.00 0.00 1,236.00 2003-07-08 0029-A 5,069 JORDAN, SPENCER Bill Patient Collections No Bill Sent 1,221.00 0.00 1,221.00 2003-07-15 0024-A 5,290 LANCKRIET, GREGOF Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-02 0020-A 4,815 LARSEN, DEBRA Bill Patient Collections No Bill Sent 1,296.00 0.00 1,296.00 2003-07-06 0023-A 4,964 LIESS, SARAH Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-06 0037-A 4,978 LOPEZ-PELLICO, HAE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-04 0008-A 4,893 MALTOS, ANITA Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-07-07 0015-A 5,016 MCNIERNEY, MICHAEBill Patient Collections No Bill Sent 1,101.00 0.00 1,101.00 2003-07-01 0012-A 4,772 MEZA, JESUS Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-05 0011-A 4,881 MOORE, BETTY Bill Patient Collections No Bill Sent 1,236.00 0.00 1,236.00 2003-07-05 0035-A 4,919 MYERS, AUDREY Bill Patient Collections No Bill Sent 996.00 0.00 996.00 2003-07-02 0011-A 4,806 NOYES, LEAH Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-07 0028-A 5,029 PEREZ, EDEN Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 RescueNetTM Printed on 12/9/2003 at 3:05:48PM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\S ubBatch7.rpt WELT 'OUNTY tPARAMEDIC SERVICES 2003-07=t5 0017-A 5,270 PEREZ, JEFFREY Bill Patient Collections No Bill Sent 996.00 0.00 996.00 2003-07-13 0029-A 5,211 PEREZ, ROY Bill Patient Collections No Bill Sent 1,131.00 0.00 1,131.00 2003-07-09 0012-A 5,077 PEREZ, ROY Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-04 0044-A 5,080 RADER, DOYLAND Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-08 0015-A 5,004 RANDALL, GEORGE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-02 0017-A 4,812 SANCHEZ, VICENTA Bill Patient Collections No Bill Sent 1,281.00 0.00 1,281.00 2003-07-14 0007-A 5,218 SANCHEZ, VICENTA Bill Patient Collections No Bill Sent 1,281.00 0.00 1,281.00 2003-07-15 0031-A 5,297 SEGURA, GABRIEL Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-07 0009-A 5,005 SHUMATE, TANYA Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-03 0038-A 4,868 VIGIL, PATRICK Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-04 0031-A 4,944 YARNELL, JANA Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-13 0003-A 5,166 YBARRA, FRANCINE Bill Patient Collections No Bill Sent 150.00 0.00 150.00 Trip count: 46 41,469.00 0.00 41,469.00 Trip count: 46 41,469.00 0.00 41,4 .0.ao Total trip count: 46 I 41,469.00 ' 0.00 41,469.00 RescueNetTM Printed on 12/92003 at 3:05:48PM Page 2 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\SubBatch7.rpt ' Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,496 Batch date: 12/9/2003 3:29:19PM Trip Date Job Run Name Current Pavor Schedule Event Charges Credits Balance 2003-07-16 0012-A 5,269 AGUILAR, SERGIO Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-27 0032-A 5,646 AGUILAR, SERGIO Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-18 0016-A 5,329 ALLDREDGE, DENNI£Bill Patient Collections No Bill Sent 1,371.00 0.00 1,371.00 2003-07-20 0028-A 5,432 BELTRAN-REYES, JO Bill Patient Collections No Bill Sent 1,296.00 0.00 1,296.00 2003-07-17 0018-A 5,343 BRANCH, TODD Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-18 0029-A 5,352 CHAGOLLA, VENESS,Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-07-31 0022-A 5,761 CLARK, DENNIS Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-18 0028-A 5,351 CLARK, JEREMY Bill Patient Collections No Bill Sent 1,236.00 0.00 1,236.00 2003-07-20 0015-A 5,383 CLARK, KAREN Bill Patient Collections No Bill Sent 1,131.00 0.00 1,131.00 2003-07-17 0010-A 5,327 CLARK, PRENTISS Bill Patient Collections No Bill Sent 1,311.00 0.00 1,311.00 2003-07-19 0020-A 5,394 COSPER, CHANELLE Bill Patient Collections No Bill Sent 1,371.00 0.00 1,371.00 2003-07-20 0029-A 5,435 DIAZ-FUENTES, JOSE Bill Patient Collections No Bill Sent 1,296.00 0.00 1,296.00 2003-07-20 0025-A 5,428 HUGHLEY, ELBERT Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-07-16 0020-A 5,278 JONES, WALTER Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-07-19 0018-A 5,392 LEWIS, BILLY Bill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-07-30 0029-A 5,819 OTERO, MAERO Bill Patient Collections No Bill Sent 1,266.00 0.00 1,266.00 2003-07-16 0014-A 5,272 PILAS, TINA Bill Patient Collections No Bill Sent 1,341.00 0.00 1,341.00 2003-07-16 0024-A 5,282 VIGIL, ONESIMO Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-07-17 0023-A 5,355 WHITE-FORDYCE, TA Bill Patient Collections No Bill Sent 150.00 0.00 150.00 Trip count: 19 19,185.00 0.00 19,185.00 Trip count: 19 19,185.00 0.00 19,185.00 Total trip count: 19 I 19,185.00 I 0.00 19,185.00 1 RescueNetTM Printed on 12/9/2003 at 3:30:05PM Page 1 1\nw 16\rescuenet1reports32'Billing\Miscellaneous\SubBatch 7.rpt Submission Batch Report WELD COUNTY PARAMEDIC SERVICES Batch 2,497 Batch date: 12/9/2003 3:52:33PM Trip Date Job % Run Name Current Payor Schedule Event Charges Credits Balance 2003-08-18 0010-A 6,311 AGUILAR, SERGIO Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-11-07 0020-A 9,068 BARNES, ROBERT Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-10-13 0016-A 8,178 CAMARILLO, SANDR/BiII Patient Collections No Bill Sent 1,326.00 0.00 1,326.00 2003-09-04 0022-A 6,900 CLARK, GREGORY Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-08-25 0024-A 6,581 CLARK, KAREN Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-08-19 0035-A 6,394 CLARK, KAREN Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-09-02 0002-A 6,817 CLOUGH, BROOKE Bill Patient Collections No Bill Sent 1,281.00 0.00 1,281.00 2003-10-13 0015-A 8,177 CULLUM, BASIL Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-08-15 0027-A 6,254 GAMINO, AMPARTO Bill Patient Collections No Bill Sent 1,266.00 0.00 1,266.00 2003-10-01 0009-A 7,759 GONZALEZ, DANNY Bill Patient Collections No Bill Sent 1,071.00 0.00 1,071.00 2003-09-06 0033-A 6,963 HACKETT, TERRY Bill Patient Collections No Bill Sent 1,281.00 0.00 1,281.00 ' 2003-10-14 0007-A 8,215 HAWKS, RONALD Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-11-15 0001-A 9,283 HORNE, ANTHONY Bill Patient Collections No Bill Sent 996.00 0.00 996.00 2003-09-12 0015-A 7,199 HUTCHISON, GERALE Bill Patient Collections No Bill Sent 1,116.00 1,056.50 59.50 2003-10-30 0023-A 8,801 LANCKRIET, GREGOF Bill Patient Collections No Bill Sent 1,071.00 0.00 1,071.00 2003-11-23 0007-A 9,560 MALDONADO, JOSE Bill Patient Collections No Bill Sent 1,131.00 0.00 1,131.00 2003-11-10 0025-A 9,180 MARTINEZ, LEONARE Bill Patient Collections No Bill Sent 1,116.00 0.00 1,116.00 2003-10-12 0006-A 8,188 MCCLURE, CURTIS Bill Patient Collections No Bill Sent 1,011.00 0.00 1,011.00 2003-11-06 0014-A 9,028 MCNAMARA, WILLIAN Bill Patient Collections No Bill Sent 1,026.00 0.00 1,026.00 2003-10-20 0031-A 8,508 PEREZ, DARLA Bill Patient Collections No Bill Sent 1,311.00 0.00 1,311.00 2003-09-29 0008-A 7,697 REED, STEVEN Bill Patient Collections No Bill Sent 1,206.00 0.00 1,206.00 2003-11-08 0032-A 9,108 RHODES, PAUL Bill Patient Collections No Bill Sent 1,086.00 0.00 1,086.00 2003-11-09 0009-A 9,128 RHODES, PAUL Bill Patient Collections No Bill Sent 1,221.00 0.00 1,221.00 2003-09-10 0032-A 7,130 RODRIGUEZ, FRANCI Bill Patient Collections No Bill Sent 150.00 0.00 150.00 2003-10-25 0001-A 8,612 TORREZ, FRANK Bill Patient Collections No Bill Sent 1,041.00 0.00 1,041.00 2003-08-31 0018-A 6,766 VILLANUEVA, EPIFANBill Patient Collections No Bill Sent 1,191.00 0.00 1,191.00 2003-11-13 0032-A 9,260 VISCAINO, REFUGIO Bill Patient Collections No Bill Sent 1,056.00 0.00 1,056.00 2003-10-17 0012-A 8,360 WAFFORD, JERRY Bill Patient Collections No Bill Sent 1,146.00 0.00 1,146.00 2003-10-10 0024-A 8,115 WHITESHIRT, GUY Bill Patient Collections No Bill Sent 1,131.00 0.00 1,131.00 2003-10-17 0029-A 8,399 WHITESHIRT, GUY Bill Patient Collections No Bill Sent 1,071.00 0.00 1,071.00 Trip count: 30 32,058.00 1,056.50 ----34700-1-40_ Trip count: 30 32,058.00 1,056.50 ( ' 31,00150) RescueNetTM Printed on 12/9/2003 at 3:53:28PM Page 1 \\nw 16\rescuenet\reports32\Billing\Miscellaneous\Su bBatch7.rpt Hello