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Home My WebLink About20003212.tiff RESOLUTION RE: CANCELLATION OF OUTSTANDING ACCOUNTS RECEIVABLE FOR THE WELD COUNTY AMBULANCE SERVICE 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 ambulance 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 Ambulance Service in the amount of $856,818.48. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the aforementioned list of uncollectible accounts in the amount of $856,818.48 be, and hereby is, approved for cancellation. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 20th day of December, A.D., 2000. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, CODO dAtil ElliC �T &aj.prmeyeC7rma I dWUy It k= Board±_. �' J ile, r Te the Board org E. Baxter R ED AST RM: Dale K. Halle County ttorne �., s� Glenaad a C , y� 2000-3212 /� AM0001 ° MEMORANDUM TO: Claud Hanes, Accounting DATE: December 14, 2000 FROM: Kathy Baxley, Ambulance Service SUBJECT: Accounts Written Off in 2000 CO - ADO Attached are the lists of accounts written off in 2000 . Listed below are the amounts each month for a total of $856, 818 .48 . All journal entries have been made except for the one for December, which will be after the end of the month. Let me know if you have any questions. January $82, 913 .26 February $95, 875 . 90 March $71, 365 . 89 April $81, 089 . 61 May $97, 313 . 63 June $65, 087 . 50 August $67, 450 . 65 October $182, 688 . 18 November $58, 074 . 05 December $54, 959 . 81 Total $856, 818 .48 20)0-3212 Date:12/14/2000 Weld County Ambulance Page: 1 Time:15:41:23 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/18/2000 Thru 01/18/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/18/2000 155.00 4 83C 960200933A 02/15/1996 SAENZ, SUSANA 01/18/2000 80.00 4 83C 980604201A 06/29/1998 WINTER, REINHOLT 01/18/2000 100.00 4 83C 981107757A 11/18/1998 GRAHAM, CHARLEY D 01/18/2000 500 .00 4 83C 990301853A 03/10/1999 JUHL, KATHLEEN K 01/18/2000 460.00 4 83C 990302320A 03/29/1999 INIGUEZ, JUAN ROBERT 01/18/2000 632 .00 4 83C 990302372A 03/31/1999 MUNOZ, MARIA DELORES 01/18/2000 615.00 4 83C 990402673A 04/11/1999 DEVENING, DAWN 01/18/2000 295.50 4 83C 990503312A 05/04/1999 HUNT, JOSHUA 01/18/2000 200.00 4 83C 990503315A 05/05/1999 MORRISON, MARK 01/18/2000 247.50 4 83C 990503352A 05/06/1999 HUNT, JOSHUA 01/18/2000 620.00 4 83C 990503353A 05/06/1999 CHAGOLLA, VANESSA 01/18/2000 267.50 4 83C 990503381A 05/07/1999 HUNT, JOSHUA 01/18/2000 85.50 4 83C 990503387A 05/08/1999 HUNT, JOSHUA 01/18/2000 785.00 4 83C 990503513A 05/13/1999 GARCIA, MEL 01/18/2000 15.00 4 83C 990503524A 05/14/1999 SARGENT, WILLETTA L 01/18/2000 350.00 4 83C 990503531A 05/14/1999 MCCOY, CONSTANCE 01/18/2000 675.00 4 83C 990503816A 05/25/1999 KOPE, MICHELLE 01/18/2000 815.00 4 83C 990503888A 05/28/1999 JUAREZ, YUSUKE 01/18/2000 270.00 4 83C 990603999A 06/02/1999 HOLGERSON, JULIE 01/18/2000 865.00 4 83C 990604015A 06/03/1999 HOLGERSON, JULIE 01/18/2000 620.00 4 83C 990604044A 06/04/1999 OLIVAS, MONICA 01/18/2000 76.00 4 83C 990604182A 06/09/1999 KOBOBEL, JESSICA 01/18/2000 583 .66 4 83C 990604265A 06/12/1999 KASPAR, SHERRI 01/18/2000 510.00 4 83C 990604332A 06/14/1999 DELAP, AUTUMN 01/18/2000 347.00 4 83C 990604345A 06/15/1999 MORADO, EDWARD 01/18/2000 615.00 4 83C 990604375A 06/15/1999 DELAP, AUTUMN 01/18/2000 525.00 4 83C 990604377A 06/16/1999 HERNANDEZ, LARRY 01/18/2000 760.00 4 83C 990604392A 06/16/1999 PARKS, JEREMY 01/18/2000 665.00 4 83C 990604466A 06/19/1999 PETTYJOHN, MARTIN 01/18/2000 570.00 4 83C 990604477B 06/20/1999 GOMEZ, JASON 01/18/2000 695.00 4 83C 990604484A 06/20/1999 HOWTON, NICOLAS 01/18/2000 270.00 4 83C 990604492A 06/20/1999 HOWTON, NICOLAS 01/18/2000 845.00 4 83C 990604493A 06/20/1999 MONTGOMERY, DESMOND 01/18/2000 81.00 4 83C 990604507A 06/20/1999 KING, ROXANNE 01/18/2000 675.00 4 83C 990604536A 06/22/1999 HERMASILLO, MARTA HI 01/18/2000 218.57 4 83C 990604544A 06/22/1999 MORADO, EDWARD 01/18/2000 585.00 4 83C 990604557A 06/22/1999 GONZALEZ, SAN JUANA 01/18/2000 680.00 4 83C 990604615A 06/24/1999 GONZALES, CHAZ 01/18/2000 675.00 4 83C 990604618A 06/24/1999 STENGER, SHERRY 01/18/2000 175.05 4 83C 990604648A 06/25/1999 BROOKS, ROBERT 01/18/2000 620 .00 4 83C 990604660A 06/26/1999 GRIEGO, FRED 01/18/2000 76.00 4 83C 990604663A 06/26/1999 GARCIA, NATALIE 01/18/2000 270.00 4 83C 990604664A 06/26/1999 HOLGERSON, JULIE 01/18/2000 76.00 4 83C 990604671A 06/26/1999 VINCENT, GEORGE L 01/18/2000 620 .00 4 83C 990604674A 06/26/1999 RINK, JUDITH A 01/18/2000 615.00 4 83C 990604685A 06/26/1999 GONZALES, ESTRELLITA 01/18/2000 38.00 4 83C 990604688A 06/26/1999 HERNANDEZ, LOUISA 01/18/2000 575.00 4 83C 990604698B 06/27/1999 GONZALEZ, ANGELA 01/18/2000 50.00 4 83C 990604740A 06/28/1999 KEEVER, JORY Date:12/14/2000 Weld County Ambulance Page: 2 Time:15:41:24 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/18/2000 Thru 01/18/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/18/2000 765.00 4 83C 990604751C 06/28/1999 GRANADOS, TOM 01/18/2000 103 .00 4 83C 990604776A 06/29/1999 CANCINO, ARNULFO 01/18/2000 620.00 4 83C 990704832A 07/01/1999 NEWMAN, CHRIS 01/18/2000 620.00 4 83C 990704832B 07/01/1999 SPARKS, TAMMY 01/18/2000 665.00 4 83C 990704834A 07/01/1999 RODRIGUEZ-GONZALES, 01/18/2000 400.00 4 83C 990704855A 07/02/1999 GRIFFITH, GORDON 01/18/2000 515.00 4 83C 990704868A 07/02/1999 GUTIERREZ, SHAYNA 01/18/2000 515.00 4 83C 990704868B 07/02/1999 GUTIERREZ, STEVIE 01/18/2000 515.00 4 83C 990704868C 07/02/1999 GUTIERREZ, SHANDEA 01/18/2000 76.00 4 83C 990704873A 07/02/1999 ROMERO, ROSE 01/18/2000 665.00 4 83C 990704876A 07/02/1999 HOLGERSON, JULIE 01/18/2000 7.60 4 83C 990704879A 07/02/1999 STUBBS, KIMBERLY 01/18/2000 270.00 4 83C 990704882A 07/02/1999 HOLGERSON, JULIE 01/18/2000 585.00 4 83C 990704886A 07/03/1999 GONZALEZ, LEO 01/18/2000 76.00 4 83C 990704887A 07/03/1999 LOZOYA, JAIME 01/18/2000 203 .28 4 83C 990704896A 07/03/1999 SPURBECK, JOANNA 01/18/2000 665.00 4 83C 990704902A 07/03/1999 LOPEZ, SOLEDAD 01/18/2000 665.00 4 83C 990704915A 07/03/1999 HAZELWOOD, JAMES D 01/18/2000 625.74 4 83C 990704936A 07/04/1999 CRAIN, VIRGINIA I 01/18/2000 515.00 4 83C 990704939A 07/04/1999 MADRID, CORINA 01/18/2000 270.00 4 83C 990704945A 07/04/1999 MADRID, CORINA 01/18/2000 316.14 4 83C 990704952A 07/05/1999 HARRISON, JODIE 01/18/2000 76.00 4 83C 990704968B 07/05/1999 BEAMAN, CHRIS 01/18/2000 575.00 4 83C 990704989A 07/07/1999 DAVIS, BRADLEY 01/18/2000 76.00 4 83C 990704990A 07/07/1999 HAWS, JASON RAY 01/18/2000 143.15 4 83C 990704995A 07/07/1999 MARQUEZ, NORBERTO 01/18/2000 42.86 4 83C 990705001A 07/07/1999 RECIO, GEORGE 01/18/2000 6.00 4 83C 990705007A 07/07/1999 RODRIGUEZ, RAUL 01/18/2000 76.00 4 83C 990705020A 07/08/1999 KELLY, ALICIA 01/18/2000 525.00 4 83C 990705042A 07/09/1999 PARKER, DEAN 01/18/2000 104.35 4 83C 990705043A 07/09/1999 KEIL, W F 01/18/2000 270.00 4 83C 990705047A 07/09/1999 QUARANTO, MARY 01/18/2000 680.00 4 83C 990705050A 07/09/1999 SIEH, MIKE 01/18/2000 590.00 4 83C 990705055A 07/09/1999 INMAN, KEITH 01/18/2000 220.00 4 83C 990705058A 07/10/1999 HERNANDEZ, DOMINGA 01/18/2000 515.00 4 83C 990705063A 07/10/1999 IKENOUYE, CHAD JASON 01/18/2000 76.00 4 83C 990705084A 07/11/1999 VILLALON, MARIO 01/18/2000 76.00 4 83C 990705086A 07/11/1999 GREGG, CHRIS 01/18/2000 490 .00 4 83C 990705091A 07/11/1999 ROMO, JUAN CARLOS 01/18/2000 370.00 4 83C 990705091B 07/11/1999 VARGAS-ROMERO, JUAN 01/18/2000 635.74 4 83C 990705112A 07/12/1999 HUMMEL, CLARENCE 01/18/2000 270.00 4 83C 990705156A 07/13/1999 SIEH, MIKE 01/18/2000 76.00 4 83C 990705166A 07/14/1999 WALLIS, SUMMER 01/18/2000 355.00 4 83C 990705175A 07/14/1999 HUMMEL, CLARENCE 01/18/2000 76.00 4 83C 990705182A 07/14/1999 DALTON, CODY 01/18/2000 25 .00 4 83C 990705184A 07/14/1999 FLORES, JESSICA 01/18/2000 76 .00 4 83C 990705186A 07/15/1999 HERNANDEZ, AMY 01/18/2000 665.00 4 83C 990705189A 07/15/1999 SANDOVAL, RUDOLFO 01/18/2000 270 .00 4 83C 990705190B 07/15/1999 SANDOVAL, RUDOLFO Date:12/14/2000 Weld County Ambulance Page: 3 Time:15:41:24 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/18/2000 Thru 01/18/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/18/2000 58.00 4 83C 990705198A 07/15/1999 SOTO, DELFINA 01/18/2000 635.00 4 83C 990705207A 07/15/1999 OSORIO, RAFAEL 01/18/2000 635.00 4 83C 990705218A 07/16/1999 RUCOBO, JR. , PEDRO 01/18/2000 270 .00 4 83C 990705224A 07/16/1999 RUCOBO, JR. , PEDRO 01/18/2000 905.00 4 83C 990705231A 07/16/1999 SANCHEZ, NATHAN 01/18/2000 640.00 4 83C 990705238A 07/17/1999 GREEN, ALAN 01/18/2000 935.00 4 83C 990705243A 07/17/1999 QUIROZ, VALENTIN 01/18/2000 810.00 4 83C 990705255A 07/17/1999 SOLIS, PEDRO DAVILA 01/18/2000 620.00 4 83C 990705275A 07/18/1999 LEMAS, KRYSTAL 01/18/2000 76.00 4 83C 990705278A 07/18/1999 SALAZAR, FORTINO 01/18/2000 270.00 4 83C 990705286A 07/19/1999 JUAREZ, YUSUKE 01/18/2000 560.00 4 83C 990705299A 07/19/1999 SIEH, MIKE 01/18/2000 965.00 4 83C 990705302A 07/19/1999 GONZALES, JOHAN 01/18/2000 76.00 4 83C 990705311A 07/19/1999 CONOVER, SUZETTE 01/18/2000 560.00 4 83C 990705321A 07/20/1999 RINK, JUDITH A 01/18/2000 50 .00 4 83C 990705332A 07/20/1999 ARCHULETA, STEPHEN 01/18/2000 124 .00 4 83C 990705335A 07/21/1999 DELACRUZ, EMILIO 01/18/2000 103 .00 4 83C 990705335B 07/21/1999 MARTINEZ, EZEQUIEL 01/18/2000 103 .00 4 83C 990705335D 07/21/1999 DELACRUZ, JUAN 01/18/2000 560.00 4 83C 990705355A 07/21/1999 MARTINEZ, JAVIER 01/18/2000 685.00 4 83C 990705360A 07/22/1999 CASE, KALENE 01/18/2000 76.00 4 83C 990705361A 07/22/1999 SASSO, FREDDY 01/18/2000 665.00 4 83C 990705369A 07/22/1999 DAVIS, BRADLEY 01/18/2000 515.00 4 83C 990705375A 07/22/1999 MOORE, JOSEPH 01/18/2000 515.00 4 83C 990705375B 07/22/1999 MOORE, CODY 01/18/2000 680 .00 4 83C 990705382A 07/22/1999 OCHOA, REBECCA 01/18/2000 270.00 4 83C 990705392A 07/23/1999 CASE, KALENE 01/18/2000 270.00 4 83C 990705393A 07/23/1999 JEAN, DONNA 01/18/2000 620.00 4 83C 990705394A 07/23/1999 CASH, DONNA 01/18/2000 620.00 4 83C 990705418A 07/24/1999 BOHAM, ROBIN 01/18/2000 270.00 4 83C 990705426A 07/24/1999 GLENDENING, VERA 01/18/2000 560 .00 4 83C 990705438A 07/24/1999 CARRILLO, ROSE 01/18/2000 570 .00 4 83C 990705442A 07/24/1999 SALGADO, VICTOR 01/18/2000 665.00 4 83C 990705450A 07/25/1999 SCHMIDT, BRYAN 01/18/2000 535.00 4 83C 990705453A 07/25/1999 VIGIL, JEROME P 01/18/2000 660.00 4 83C 990705458A 07/25/1999 WATSON, ROBERT S 01/18/2000 515.00 4 83C 990705463A 07/25/1999 LUNA, MARGARITA 01/18/2000 515.00 4 83C 990705463B 07/25/1999 LUNA, YANELI 01/18/2000 620.00 4 83C 990705474A 07/25/1999 POTTER, MIKE 01/18/2000 76.00 4 83C 990705517A 07/27/1999 BUCKNER, JOHN 01/18/2000 270.00 4 83C 990705518A 07/27/1999 BLACK, STEVEN C 01/18/2000 515 .00 4 83C 990705528A 07/27/1999 ROYBAL, CORY 01/18/2000 835.00 4 83C 990705533A 07/27/1999 COX, AARON 01/18/2000 620 .00 4 83C 990705535A 07/27/1999 MEYER, LINDA 01/18/2000 515 .00 4 83C 990705536A 07/27/1999 ANDERSON, SHERI LYNN 01/18/2000 270 .00 4 83C 99070S538A 07/28/1999 ANDERSON, SHERI LYNN 01/18/2000 515.00 4 83C 990705544A 07/28/1999 MORRISON, ROBERT 01/18/2000 133 .00 4 83C 990705547A 07/28/1999 GARCIA, JOSH 01/18/2000 780 .00 4 83C 990705554A 07/28/1999 SMITH, TONY R Date:12/14/2000 Weld County Ambulance Page: 4 Time:15:41:25 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/18/2000 Thru 01/18/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 01/18/2000 665.00 4 83C 990705559A 07/29/1999 BELL, STEVEN MICHAEL 01/18/2000 665.00 4 83C 990705570A 07/29/1999 SANCHEZ, MARIA 01/18/2000 620.00 4 83C 990705579A 07/29/1999 MEDINA, ALEXANDER P 01/18/2000 11.00 4 83C 990705608A 07/30/1999 PBR BULL RIDING, 01/18/2000 665.00 4 83C 990705612A 07/30/1999 SCHNEIDER, BIFF A 01/18/2000 690.00 4 83C 990705619A 07/31/1999 RAMIREZ, DAVID 01/18/2000 93 .33 4 83C 990705627A 07/31/1999 TURECEK, BOB 01/18/2000 695.00 4 83C 990705632A 07/31/1999 DELONG, CINTHIA 01/18/2000 190.00 4 83C 990705642A 07/31/1999 PBR BULL RIDING, 01/18/2000 622.40 4 83C 990705643A 07/31/1999 MAES, ANTHONY 01/18/2000 620 .00 4 83C 990805668A 08/01/1999 DAVIS, BRADLEY 01/18/2000 76.00 4 83C 990805701B 08/02/1999 GRANADOS, JOHNNY 01/18/2000 490.00 4 83C 990805702A 08/02/1999 ALEMAN, GERMAN A 01/18/2000 560.00 4 83C 990805727A 08/03/1999 DOMINGUEZ, HERIBERTO 01/18/2000 615.00 4 83C 990805750A 08/04/1999 GUTIERREZ, JESSICA 01/18/2000 560.00 4 83C 990805760A 08/05/1999 CATON, JOHN 01/18/2000 76.00 4 83C 990805818A 08/07/1999 FULLER, KRISTA K 01/18/2000 515.00 4 83C 990805836A 08/07/1999 COCA, RANDY 01/18/2000 620 .00 4 83C 990805843A 08/08/1999 CLUTE, MATT 01/18/2000 680.00 4 83C 990805855A 08/08/1999 CASH, DONNA 01/18/2000 50.00 4 83C 990805881A 08/09/1999 BARON, MARIANA 01/18/2000 515.00 4 83C 990805889A 08/09/1999 GARCIA, MARTIN 01/18/2000 76.00 4 83C 990805904C 08/09/1999 ERDMAN-CISNEROS, ANG 01/18/2000 76.00 4 83C 990805911A 08/10/1999 AGUIRRE, JERRY JR 01/18/2000 665.00 4 83C 990805945A 08/11/1999 DAVIS, JOHN 01/18/2000 855.00 4 83C 990805960A 08/12/1999 HERNANDEZ, GUADALUPE 01/18/2000 795.00 4 83C 990805967A 08/12/1999 COLE, TAMMY 01/18/2000 665.00 4 83C 990805999A 08/13/1999 QUARANTO, MARY 01/18/2000 575.00 4 83C 990806000A 08/13/1999 DAVIS, BRADLEY 01/18/2000 270.00 4 83C 990806006A 08/13/1999 QUARANTO, MARY 01/18/2000 515.00 4 83C 990806023A 08/14/1999 HOLLIS, WILLIAM 01/18/2000 635.00 4 83C 990806070A 08/16/1999 FLORES, EVA 01/18/2000 40.39 4 83C 990806302A 08/25/1999 KASPAR, SHERRI 01/18/2000 595.00 4 83C 990906587A 09/05/1999 QUARANTO, MARY 01/18/2000 385.00 4 83C 990906645A 09/07/1999 GALLEGOS, DON 01/18/2000 680.00 4 83C 991007642A 10/15/1999 CHACON, ERNEST 01/18/2000 780.00 4 83C 991007684A 10/17/1999 HOPE, SUZANNE B 01/18/2000 575.00 4 83C 991007841A 10/23/1999 WILSON, SUMMER 01/18/2000 270 .00 4 83C 991007845A 10/23/1999 WILSON, SUMMER 01/18/2000 665.00 4 83C 991007924A 10/26/1999 ESCOBAR, TERESA 01/18/2000 745.00 4 83C 991008028A 10/31/1999 TORRES, TOMMY 01/18/2000 605.00 4 83C 991108217A 11/06/1999 MCFALL, LAURA 01/18/2000 680.00 4 83C 991108572A 11/20/1999 CORZO, MICHAEL 01/18/2000 764.48 4 81 991209035A 12/07/1999 STONE, DOROTHY L 01/18/2000 475.16 4 81 991209096A 12/09/1999 COMBS, EMILY M Date:12/14/2000 Weld County Ambulance Page: 5 Time:15:41:25 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/18/2000 Thru 01/18/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Total of 192 WriteOff Entries Totaling 84152 .90 Dollars Average WriteOff: 438.30 Dollars Average Time:197 Days Date:12/14/2000 Weld County Ambulance Page: 6 Time:15:41:25 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 01/18/2000 Thru 01/18/2000 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 190 82913 .26 436.39 198.46 81 MEDICARE WRITEOFF 2 1239.64 619.82 41.00 Date: 02/29/2000 Weld County Ambulance Page: 1 Time:12 :28:48 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/15/2000 Thru 02/16/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/16/2000 290.00 4 83C 000100032A 01/02/2000 MORGAN, CAROL 02/16/2000 290.00 4 83C 000100042A 01/02/2000 BENNETT, ALVIN L 02/16/2000 740.00 4 83C 000100084A 01/05/2000 PEARL, MIKE 02/16/2000 545.00 4 83C 000100181A 01/08/2000 MORGAN, CAROL 02/16/2000 290.00 4 83C 000100184A 01/09/2000 MORGAN, CAROL 02/16/2000 520.00 4 83C 000100255A 01/11/2000 ALBRECHTSEN, WILLIAM 02/16/2000 695 .00 4 83C 000100320A 01/14/2000 GUTIERREZ, HECTOR 02/16/2000 650 .00 4 83C 000100539A 01/23/2000 BENNETT, ALVIN L 02/16/2000 290 .00 4 83C 000100542A 01/23/2000 BENNETT, ALVIN L 02/16/2000 60 .72 4 83C 980704744A 07/20/1998 ALLMER, BETTY 02/16/2000 315.00 4 83C 981006989A 10/16/1998 ZAMORA, GISELA 02/16/2000 335.00 4 83C 981006989B 10/16/1998 ZAMORA, BABY BOY 02/16/2000 37.00 4 83C 981107624A 11/12/1998 WILSHIRE, JANA 02/16/2000 36 .00 4 83C 981208248A 12/08/1998 WILSHIRE, JANA 02/16/2000 251.99 4 83C 981208438A 12/15/1998 SWOVELAND, LINDA 02/16/2000 25.00 4 83C 990100182A 01/07/1999 GUTIERREZ, ABEL D 02/16/2000 390.32 4 83C 990100349A 01/13/1999 HEIMAN, GALE E 02/16/2000 25.00 4 83C 990100475A 01/18/1999 GUTIERREZ, ABEL D 02/16/2000 525.00 4 83C 990200957A 02/05/1999 MOQUETTE, DANNY 02/16/2000 620.00 4 83C 990200991A 02/07/1999 TRUJILLO, BARBARA 02/16/2000 525.00 4 83C 990201178A 02/12/1999 PRINTZ, MANDY 02/16/2000 620.00 4 83C 990402571A 04/07/1999 SCHAFFER, SHERRI 02/16/2000 610.00 4 83C 990402577A 04/08/1999 BINGHAM, BEN 02/16/2000 60.00 4 83C 990402833A 04/16/1999 MOCK, HENRY E 02/16/2000 635.00 4 83C 990503656A 05/19/1999 GUREVICH, DAVID 02/16/2000 55 .00 4 83C 990503726A 05/22/1999 WILLS, LYLE H 02/16/2000 60.00 4 83C 990503893A 05/29/1999 HERRERA, HECTOR 02/16/2000 1025.00 4 83C 990503932A 05/30/1999 TURECEK, BONNIE 02/16/2000 515.00 4 83C 990604004B 06/02/1999 APPELHAUS, STEVE 02/16/2000 550 .00 4 83C 990604067A 06/05/1999 TURECEK, BONNIE 02/16/2000 895.00 4 83C 990604118A 06/07/1999 MEDINA, FRANK 02/16/2000 26.00 4 83C 990604595A 06/24/1999 ESTRADA, MARIA 02/16/2000 805.00 4 83C 990704943A 07/04/1999 SALAZAR, JUANITA 02/16/2000 890 .00 4 83C 990704987A 07/06/1999 MEDINA, FRANK 02/16/2000 575.00 4 83C 990705100A 07/11/1999 RUSSELL, CLOYD G 02/16/2000 325.74 4 83C 990705202A 07/15/1999 HOLLOWAY, RICHARD 02/16/2000 465.00 4 83C 990705257A 07/18/1999 SHAW, DARLENE 02/16/2000 124 .00 4 83C 990705335C 07/21/1999 MACIAS, JOSE 02/16/2000 865.74 4 83C 990705349A 07/21/1999 HAGELSTROM, SYLVIA 02/16/2000 270.00 4 83C 990705353A 07/21/1999 HAGELSTROM, SYLVIA 02/16/2000 620.00 4 83C 990705365A 07/23/1999 JONES, WOODY E 02/16/2000 875.74 4 83C 990705451C 07/25/1999 BARRIGA, CORRINA 02/16/2000 625.00 4 83C 990705488A 07/25/1999 ORTIZ, SANDRA 02/16/2000 11.40 4 83W 990705561A 07/29/1999 LOFGRIN, LORETTA 02/16/2000 515 .00 4 83C 990705592A 07/30/1999 HORNE, ANTHONY 02/16/2000 620 .00 4 83C 990805695A 08/02/1999 SMITH, NANCY A 02/16/2000 76.00 4 83C 990805701A 08/02/1999 QUIROZ, BRANDALY 02/16/2000 620.00 4 83C 990805735A 08/04/1999 TAYLOR, JAMES ANDREW 02/16/2000 680 .00 4 83C 990805759A 08/05/1999 MARTIN, PATRICK D • Date:02/29/2000 Weld County Ambulance Page: 2 Time:12 :28:50 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/15/2000 Thru 02/16/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/16/2000 133 .00 4 83C 990805763A 08/05/1999 ALEXANDER, LEIGH 02/16/2000 76 .00 4 83C 990805781A 08/05/1999 VELASQUEZ, JOSE 02/16/2000 890 .00 4 83C 990805808A 08/06/1999 MARTINEZ, MARGARET 02/16/2000 680 .00 4 83C 990805809A 08/06/1999 MARTINEZ„ MANUEL 02/16/2000 430 .00 4 83C 990805814A 08/07/1999 CASPER, LONNIE E 02/16/2000 560 .00 4 83C 990805833A 08/07/1999 PADILLA, ALEJANDRO 02/16/2000 835.00 4 83C 990805848A 08/08/1999 NAVARETTE, JUANITA 02/16/2000 575.00 4 83C 990805857A 08/08/1999 PEDROZA, JUAN F 02/16/2000 515.00 4 83C 990805868A 08/08/1999 LANCKRIET, GREGORY 02/16/2000 620.00 4 83C 990805889B 08/09/1999 ONTIVEROS, DORA 02/16/2000 835.00 4 83C 990805907A 08/10/1999 CUNNINGHAM, DIANE 02/16/2000 175.71 4 83C 990805913A 08/10/1999 PROCTOR, GLENN 02/16/2000 620.00 4 83C 990805914A 08/10/1999 OLSEN, CHRISTIAN B 02/16/2000 1135.00 4 83C 990805917A 08/10/1999 OLSEN, CHRISTIAN B 02/16/2000 635.00 4 83C 990805922A 08/10/1999 GOETZ, ANGELA 02/16/2000 33 .80 4 83C 990805938A 08/11/1999 SILVA, THOMAS 02/16/2000 15.20 4 83C 990605940A 08/11/1999 PAZ, ALBERTO 02/16/2000 76.00 4 83C 990805955A 08/11/1999 MORA, PAT 02/16/2000 630.00 4 83C 990805957B 08/12/1999 HERNANDEZ, RUBEN JR 02/16/2000 665 .00 4 83C 990805979A 08/13/1999 HONESTO, JOE 02/16/2000 620.00 4 83C 990806012A 08/14/1999 SEAR, MELISSA 02/16/2000 76 .00 4 83C 990806017A 08/14/1999 BOND, JUSTIN 02/16/2000 675 .00 4 83C 990806018A 08/14/1999 KARCHMER WILSON, JUD 02/16/2000 665 .00 4 83C 990806039A 08/15/1999 IBARRA, MONARAI 02/16/2000 665.00 4 83C 990806039B 08/15/1999 IBARRA, VANESSA R 02/16/2000 620 .00 4 83C 990806039C 08/15/1999 IBARRA, JEROME 02/16/2000 665.00 4 83C 990806039D 08/15/1999 IBARRA, VANIA 02/16/2000 665.00 4 83C 990806039E 08/15/1999 IBARRA, VANITY 02/16/2000 920 .00 4 83C 990806043A 08/15/1999 GONZALES, JUAN 02/16/2000 725.00 4 83C 990806079A 08/17/1999 DODGE, KERRIE L 02/16/2000 76.00 4 83C 990806088A 08/17/1999 GARZA, ROY 02/16/2000 76.00 4 83C 990806093A 08/17/1999 WILLMS, TRACI 02/16/2000 76.00 4 83C 990806143A 08/19/1999 GARCIA, ALBERT 02/16/2000 665.00 4 83C 990806146A 08/19/1999 RODRIGUEZ, RODOLFO T 02/16/2000 815.00 4 83C 990806148A 08/19/1999 ONFRIY( SALINAS) , BE 02/16/2000 645.00 4 83C 990806154A 08/19/1999 DURAN, MARK A 02/16/2000 75.00 4 83C 990806158A 08/20/1999 WELLS, CHARLES M 02/16/2000 660.00 4 83C 990806168A 08/20/1999 HERNANDEZ-ORNELAS, J 02/16/2000 680.00 4 83C 990806179A 08/20/1999 FLOREZ, JUAN 02/16/2000 805.00 4 83C 990806181A 08/21/1999 MCDUFF, VIRGIL 02/16/2000 705.00 4 83C 990806192A 08/21/1999 CALVO-GARZA, JOSE R 02/16/2000 270 .00 4 83C 990806207A 08/22/1999 COPLEY, COLLETTE M 02/16/2000 635.00 4 83C 990806209A 08/22/1999 GARZA, RICARDO J 02/16/2000 605.00 4 83C 990806222A 08/22/1999 DARCY, CATHENA 02/16/2000 535.00 4 83C 990806229A 08/22/1999 OJEDA, JOVAN 02/16/2000 515 .00 4 83C 990806231A 08/22/1999 WEIDENKELLER, STEVE 02/16/2000 725.00 4 83C 990806241A 08/23/1999 HUNTER, KLINT 02/16/2000 530.00 4 83C 990806242B 08/23/1999 RENE GRIJALVA-SOTER 02/16/2000 76 .00 4 83C 990806247A 08/23/1999 WOOD, ANNA MARIE Date: 02/29/2000 Weld County Ambulance Page: 3 Time:12:28:51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/15/2000 Thru 02/16/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/16/2000 620 .00 4 83C 990806251A 08/23/1999 YBANEZ, FRANCISCO 02/16/2000 228.09 4 83W 990806260A 08/24/1999 SMITH, LOYD 02/16/2000 625.74 4 83C 990806268A 08/24/1999 WILLIAMS, MARY E 02/16/2000 515.00 4 83C 990806291A 08/25/1999 SCOTT, SANDRA 02/16/2000 270 .00 4 83C 990806299A 08/25/1999 SCOTT, SANDRA 02/16/2000 15.00 4 83C 990806304A 08/26/1999 ELY, MEGAN 02/16/2000 76.00 4 83C 990806320A 08/26/1999 KENDLE, JAMES THOMAS 02/16/2000 535.00 4 83C 990806324A 08/26/1999 SANCHEZ-ARRUJO, RIGO 02/16/2000 270.00 4 83C 990806328A 08/27/1999 SHIRLEY, ROBERT D 02/16/2000 820.00 4 83C 990806343A 08/27/1999 FLORES, JAMI JOANA 02/16/2000 590.00 4 83C 990806387A 08/28/1999 BURFEIND, JOHN 02/16/2000 900.00 4 83C 990806391A 08/28/1999 CRISCO, ERICA C 02/16/2000 625.74 4 83C 990806413A 08/29/1999 MANWEILER, MYRA 02/16/2000 270.00 4 83C 990806417A 08/29/1999 MANWEILER, MYRA 02/16/2000 615.00 4 83C 990806426A 08/27/1999 FARREL, JENNIFER 02/16/2000 685.74 4 83C 990806427A 08/30/1999 CAMPBELL, DOROTHY P 02/16/2000 560.00 4 83C 990806429A 08/30/1999 KENDLE, JAMES THOMAS 02/16/2000 270.00 4 83C 990806439A 08/30/1999 KENDLE, JAMES THOMAS 02/16/2000 648.99 4 83C 990806467A 08/31/1999 HILLMAN, HELEN 02/16/2000 755.00 4 83C 990906485A 09/01/1999 CHACON, RUTH I 02/16/2000 665.00 4 83C 990906489A 09/01/1999 ERASURE, RAJEANA A 02/16/2000 270.00 4 83C 990906505A 09/02/1999 CHMIEL, RACHELLE 02/16/2000 495.00 4 83C 990906542A 09/03/1999 TREVINO, NICOLE 02/16/2000 890.00 4 83C 990906564A 09/04/1999 BROWN, JOHN A. 02/16/2000 620.00 4 83C 990906570A 09/04/1999 ARCHULETA, SANDY E 02/16/2000 270.00 4 83C 990906575A 09/04/1999 JACKSON, MARLENE 02/16/2000 231.60 4 83C 990906581A 09/05/1999 GARZA, BRYCE 02/16/2000 270.00 4 83C 990906600A 09/05/1999 ARCHULETA, SANDY E 02/16/2000 700.00 4 83C 990906629A 09/06/1999 KRAUS, KELLY 02/16/2000 625.74 4 83C 990906643A 09/07/1999 COMISH, PAT 02/16/2000 720.00 4 83C 990906650A 09/07/1999 FITCH, NICK 02/16/2000 560.00 4 83C 990906653A 09/07/1999 AJ,ANIZ, ROBERT M 02/16/2000 76.00 4 83C 990906671A 09/08/1999 FRANCO, MARIA 02/16/2000 270.00 4 83C 990906690A 09/08/1999 HJALHARSON, GORDON R 02/16/2000 620.00 4 83C 990906700A 09/09/1999 BROWN, GEORGE E 02/16/2000 25.00 4 83C 990906705A 09/09/1999 FLYNN, BRIAN 02/16/2000 270.00 4 83C 990906729A 09/10/1999 INFANTE, DARREN 02/16/2000 620.00 4 83C 990906742A 09/10/1999 FRANCO, SANDRA 02/16/2000 76.00 4 83C 990906743A 09/10/1999 KITTRELL, KENNETH 02/16/2000 580.00 4 83C 990906761A 09/11/1999 HUMPHRIES, KRIS 02/16/2000 76.00 4 83C 990906766A 09/11/1999 GORDON, MARK 02/16/2000 10.00 4 83C 990906767A 09/11/1999 EDGERTON, BECKY 02/16/2000 25.00 4 83C 990906781A 09/11/1999 FLYNN, BRIAN 02/16/2000 620.00 4 83C 990906788A 09/12/1999 KAMINAKA, JONATHAN 02/16/2000 347.00 4 83C 990906825A 09/14/1999 KELSAY, REGINA 02/16/2000 25 .00 4 83C 990906848A 09/15 /1999 FLYNN, BRIAN 02/16/2000 76.00 4 83C 990906871A 09/16/1999 ESPINOZA, BETTY 02/16/2000 665.00 4 83C 990906872A 09/16/1999 ESPINOZA, LINDA 02/16/2000 76.00 4 83C 990906904A 09/17/1999 HALL, CHRISTINE Date:02/29/2000 Weld County Ambulance Page: 4 Time:12 :28:52 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/15/2000 Thru 02/16/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/16/2000 15.20 4 83C 990906909A 09/17/1999 fATVEZ, FRANCISCO 02/16/2000 620.00 4 83C 990906918A 09/17/1999 GARZA, GILBERT 02/16/2000 620.00 4 83C 990906921A 09/18/1999 DIAZ, DANIEL 02/16/2000 690.00 4 83C 990906956A 09/20/1999 ADAMS, RANDALL 02/16/2000 620.00 4 83C 990906963A 09/20/1999 JIMENEZ, MICHELE 02/16/2000 270.00 4 83C 990907009A 09/22/1999 HOFFMAN, ERICK 02/16/2000 825.00 4 83C 990907036A 09/23/1999 WELTER, CARL 02/16/2000 760.00 4 83C 990907056A 09/24/1999 JONES, RAMICHA 02/16/2000 695.00 4 83C 990907060A 09/24/1999 BALL, JEANETTE 02/16/2000 625.00 4 83C 990907060C 09/24/1999 BALL, JEFF 02/16/2000 680.00 4 83C 990907082A 09/25/1999 FLORES, JANELLE 02/16/2000 515.00 4 83C 990907099A 09/26/1999 HERNANDEZ-ORNELAS, J 02/16/2000 580.00 4 83C 990907124A 09/27/1999 ELIAS, GRISELDA 02/16/2000 585.74 4 83C 990907137A 09/27/1999 BROWN, MARY C 02/16/2000 124.00 4 83C 990907145A 09/27/1999 HADLEY, MICHAEL 02/16/2000 76.00 4 83C 990907157B 09/28/1999 SOLIS, JAMES 02/16/2000 575.00 4 83C 990907174A 09/28/1999 ESPINOZA, LINDA 02/16/2000 70.93 4 83C 990907182A 09/29/1999 BENDER, WILLIAM 02/16/2000 620.00 4 83C 990907187A 09/29/1999 KALLSEN, MICHAEL 02/16/2000 620.00 4 83C 990907193A 09/29/1999 JONES, LUZ 02/16/2000 620.00 4 83C 990907216A 09/30/1999 AMSRUD, JAYNA 02/16/2000 39.52 4 83C 991007316A 10/04/1999 OWENS, TED 02/16/2000 620.00 4 83C 991007376A 10/06/1999 GAURAZELL, JASON 02/16/2000 103 .00 4 83C 991007389A 10/07/1999 CRANE, THERESA 02/16/2000 76 .00 4 83C 991007393A 10/07/1999 FITCH, JUSTIN 02/16/2000 960 .00 4 83C 991007559A 10/12/1999 PENROD, DEB 02/16/2000 515.00 4 83C 991007578A 10/13/1999 MILLER, JEFF 02/16/2000 620 .00 4 83C 991007593A 10/14/1999 AGUIRRE, DAVID 02/16/2000 620 .00 4 83C 991007594A 10/14/1999 DODGE, KERRIE L 02/16/2000 76 .00 4 83C 991007692B 10/17/1999 BROTEMARKLE, CRYSTAL 02/16/2000 515 .00 4 83C 991007818A 10/22/1999 PETRI, ROXEANN 02/16/2000 76 .00 4 83C 991007832A 10/23/1999 DRAKE, ROBERT E. 02/16/2000 270 .00 4 83C 991007866A 10/24/1999 PETRI, ROXEANN 02/16/2000 305 .01 4 81 991007955A 10/28/1999 CHRISTIAN, MYRTLE 02/16/2000 560 .00 4 83C 991108097A 11/02/1999 ARGUERTA, SANTOS 02/16/2000 725 .00 4 83C 991108330B 11/10/1999 LONG, LORI 02/16/2000 515.00 4 83C 991108533A 11/18/1999 VALENTINE, DAVID 02/16/2000 620 .00 4 83C 991108540A 11/18/1999 ENGLE, RICHARD 02/16/2000 665 .00 4 83C 991108544A 11/19/1999 PARKER, GLENN 02/16/2000 535 .00 4 83C 991108546A 11/19/1999 TROXEL, JUDY 02/16/2000 680 .00 4 83C 991108550A 11/19/1999 DODGE-BOLTJES, KERRI 02/16/2000 76 . 00 4 83C 991108596A 11/20/1999 MONTARO, RODNEY 02/16/2000 590 .00 4 83C 991108604A 11/21/1999 ROSE, KATHRINE M 02/16/2000 76 .00 4 83C 991108628A 11/21/1999 AMSRUD, JAYNA 02/16/2000 76 . 00 4 83C 991108656A 11/22/1999 MARTIN, JOSHUA L 02/16/2000 575 . 00 4 83C 991208884A 12 /02/1999 VIZCAINO, PAULINO 02/16/2000 575 .00 4 83C 991209127A 12/10/1999 ROFFE, GABRIEL 02/16/2000 515 .00 4 83C 991209159A 12/11/1999 GRANADOS, JORGE 02/16/2000 605 . 00 4 83C 991209208A 12/13/1999 PETRI, ROXEANN Date:02/29/2000 Weld County Ambulance Page: 5 Time:12:28:54 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/15/2000 Thru 02/16/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 02/16/2000 865.00 4 83C 991209342A 12/19/1999 SANDOVAL, JAIME 02/16/2000 675.00 4 83C 991209406A 12/22/1999 RODRIGUEZ, MARIA 02/16/2000 270.00 4 83C 991209412A 12/23/1999 CALIFF, CHAD 02/16/2000 665.00 4 83C 991209458A 12/24/1999 WALLACE, CARL 02/16/2000 515.00 4 83C 991209476A 12/25/1999 NEVEL, JORGE 02/16/2000 735.00 4 83C 991209487A 12/25/1999 PRESSLER, GEORGE 02/16/2000 515 .00 4 83C 991209503A 12/26/1999 GALLEGOS, MATTHEW 02/16/2000 665.00 4 83C 991209513A 12/26/1999 BAREA, JOHN 02/16/2000 270.00 4 83C 991209590A 12/30/1999 COOPER, WILLIAM 02/16/2000 515 .00 4 83C 991209612A 12/31/1999 CRESPIN, RAYMOND E Total of 206 WriteOff Entries Totaling 96420.40 Dollars Average WriteOff: 468.06 Dollars Average Time:173 Days Date:02/29/2000 Weld County Ambulance Page: 6 Time:12 :28:55 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 02/15/2000 Thru 02/16/2000 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 203 95875.90 472.30 173.49 83W WRITEOFF WORK COMP 2 239.49 119.75 189.00 81 MEDICARE WRITEOFF 1 305.01 305.01 111.00 Date:C3/24/2000 Weld County Ambulance Page : 1 Time:12 : 06 :07 Receipt, Write -off, Adjustment Batch Report MRR300 writeOffBatch From 03/23/2000 Thru 03/23/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/23/2000 617 . 00 4 83C 970301427A 03/05/1997 MARTINEZ, DELORIS 03/23/2000 219 .73 4 83C 980200853A 02/06/1998 GAVELL, EDWARD 03/23/2000 51 . 99 4 83C 980200855A 02/06/1998 GAVELL, EDWARD 03/23/2000 370 . 00 4 83C 980402262A 04/10/1998 KLIMPER, LARRY 03/23/2000 262 .06 4 83C 980805570A 08/22/1998 CAVELL, EDWARD 03/23/2000 112 . 50 4 83C 981006848A 10/10/1998 HOLLAND, STEVE 03/23/2000 507 .61 4 83C 990302201A 03/24/1999 GUTIERREZ, JOSEPHINE 03/23/2000 475.00 4 83C 990503449A 05/10/1999 SICKLER, JULIA A 03/23/2000 730 .00 4 83C 990503835A 05/26/1999 PATTERSON, EDDIE 03/23/2000 25.00 4 83C 990503952A 05/31/1999 BISEL, RANDALL 03/23/2000 15 .20 4 83C 990604380A 06/16/1999 STANCLIFT, TIM 03/23/2000 560 .00 4 83C 990604477B 06/20/1999 GOMEZ, JASON 03/23/2000 785 .00 4 83C 990704862A 07/02/1999 THORMAHLEN, ROBERT 03/23/2000 25 .00 4 83C 990704931A 07/04/1999 TAIT, AMBER 03/23/2000 38 .00 4 83C 990705088A 07/11/1999 RIVERA, DAVID 03/23/2000 905 .00 4 83C 990705211A 07/16/1999 MYRE, SANDRA 03/23/2000 665 .74 4 83C 990705587A 07/30/1999 PALLANSCH, ELIZABETH 03/23/2000 220 .00 4 83C 990805773A 08/05/1999 GOODWIN, GARY 03/23/2000 515 .00 4 83C 990806009A 08/14/1999 PEREZ, JULIAN 03/23/2000 620 .00 4 83C 990806027A 08/15/1999 MUNOZ, ADOLFO J 03/23/2000 76 .00 4 83C 990806055A 08/16/1999 LYNCH, MELISSA 03/23/2000 860 .00 4 83C 990806057A 08/16/1999 NASH, BRANDON 03/23/2000 76 .00 4 83C 990806075A 08/16/1999 MCCANN, SCOTT 03/23/2000 665.00 4 83C 990806077A 08/16/1999 MCDONALD, JAMES 03/23/2000 795.00 4 83C 990806085A 08/17/1999 MARTINEZ, LUPE 03/23/2000 680.74 4 83C 990806085B 08/17/1999 MESE, VICTORIA 03/23/2000 560.00 4 83C 990806099A 08/17/1999 MEDINA, NABOR A 03/23/2000 515.00 4 83C 990806101A 08/17/1999 ZAMORA, GATDINO 03/23/2000 50.00 4 83C 990806117A 08/18/1999 HORN, KRISTEN R 03/23/2000 76 .00 4 83C 990806167A 08/20/1999 LYONS, NATHAN 03/23/2000 650.00 4 83C 990806217A 08/22/1999 VALGARA, LEO 03/23/2000 76 .00 4 83C 990806234A 08/23/1999 STANCLIFT, TIM 03/23/2000 25 .00 4 83C 990806256A 08/23/1999 YBARRA, LYDIA ELVINA 03/23/2000 765 .00 4 83C 990806361A 08/27/1999 MARTZ, DAVID 03/23/2000 695 .00 4 83C 990806362A 08/27/1999 MYRE, SANDRA 03/23/2000 389.00 4 83C 990806401A 08/28/1999 NISSEN, REY 03/23/2000 25.00 4 83C 990806408A 08/29/1999 MCKINZIE, NICOLE 03/23/2000 620 . 00 4 83C 990806445A 08/31/1999 WEIDENKELLER, SANDRA 03/23/2000 525 . 00 4 83C 990806456A 08/31/1999 HAFFNER, JERRY 03/23/2000 755 .00 4 83C 990806464A 08/31/1999 SANCHEZ, CHERRELLE 03/23/2000 620 .00 4 83C 990906478A 09/01/1999 MITCHELL, NICOLE 03/23/2000 535 . 00 4 83C 990906510A 09/02/1999 MONAGHAN, ZACH 03/23/2000 50 . 00 4 83C 990906520A 09/02/1999 PETERSON, JESIKA 03/23/2000 680 . 00 4 83C 990906528A 09/02/1999 SALAZAR, ANITA 03/23/2000 76 . 00 4 83C 990906563A 09/04/1999 SUNG, CHON 03/23/2000 665 . 00 4 83C 990906577A 09/04/1999 EDWARDS, MEGAN 03/23/2000 515 . 00 4 83C 990906580A 09/04/1999 SANDOVAL, FIDEL 03/23/2000 270 . 00 4 83C 990906583A 09/05/1999 EDWARDS, MEGAN 03/23/2000 H E . 00 4 836 990906620A 09/06/1999 TAYLOR, BROOKE Date :03/24/2000 Weld County AmLuiance Paye : 2 Time :12 :06 : 07 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffEatch From 03/23/2000 Thru 03/23/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/23/2000 915 . 00 4 83C 990906625A 09/06/1999 COOLLEY, JIM 03/23/2000 665 . 00 4 83C 990906644A 09/07/1999 LINO TRUJILLO, MARGA 03/23/2000 660 .00 4 83C 990906651A 09/07/1999 MILLNER, CHRISTOPHER 03/23/2000 515.00 4 83C 990906658A 09/07/1999 RAEHAL, ADA 03/23/2000 665. 00 4 83C 990906669A 09/08/1999 RIVAS, MIGUEL 03/23/2000 45 .00 4 83C 990906684A 09/08/1999 HAVENHILL, DENNIS 03/23/2000 270 .00 4 83C 990906688A 09/08/1999 LUCAS, CRISTOBAL 03/23/2000 665 .00 4 83C 990906709A 09/09/1999 CRAIN, VIRGINIA I 03/23/2000 76 .00 4 83C 990906713A 09/09/1999 SILVA, FRANCO 03/23/2000 103 .00 4 83C 990906753A 09/10/1999 PEREZ, GERADDO JR 03/23/2000 745.00 4 83C 990906757A 09/10/1999 NOE, TODD 03/23/2000 735.00 4 83C 990906763A 09/11/1999 ORTEGA, PHILIP 03/23/2000 560 .00 4 83C 990906770A 09/11/1999 JOHNSON, JOHN 03/23/2000 136 .00 4 83C 990906796A 09/12/1999 MARQUEZ-LOPEZ, DANIE 03/23/2000 560 .00 4 83C 990906803A 09/13/1999 LICON, SILIA LETICIA 03/23/2000 620.00 4 83C 990906823A 09/13/1999 RONFELDT, STAN 03/23/2000 76 .00 4 83C 990906855A 09/15/1999 PARGAS, BETH 03/23/2000 25.00 4 83C 990906859A 09/15/1999 LUCERO, REBECCA 03/23/2000 620.00 4 83C 990906878A 09/16/1999 NOSKO, JENNIFER 03/23/2000 76 .00 4 83C 990906886A 09/16/1999 MOORE, MELINDA 03/23/2000 76 .00 4 83C 990906906A 09/17/1999 MOEHLING, RICHARD 03/23/2000 665.00 4 83C 990906910A 09/17/1999 NAVARRO-GONZALES, FA 03/23/2000 270 .00 4 83C 990906913A 09/17/1999 LUCERO, MIKE 03/23/2000 815.00 4 83C 990906915A 09/17/1999 RICHARDSON, SHAUN 03/23/2000 665. 00 4 83C 990906917A 09/17/1999 RODRIGUEZ, FRANK 03/23/2000 685.00 4 83C 990906929A 09/18/1999 ANDERSON, SHARI 03/23/2000 76 .00 4 83C 990906975A 09/21/1999 MUNOZ, RAFAEL 03/23/2000 25.00 4 83C 990906981A 09/21/1999 VILLARREAL, ABRAHAM 03/23/2000 515.00 4 83C 990906991A 09/21/1999 MORENO, NANCY L 03/23/2000 50 .00 4 83C 990907005A 09/22/1999 PETERSON, JESIKA 03/23/2000 515.00 4 83C 990907014B 09/22/1999 ONG, SIMON 03/23/2000 695.00 4 83C 990907018A 09/22/1999 GARCIA, FRANCES 03/23/2000 76 .00 4 83C 990907028A 09/23/1999 MONTOYA, MICHAEL 03/23/2000 386..26 4 83C 990907050A 09/24/1999 NAKAGAWA, JOHN C 03/23/2000 515.00 4 83C 990907081A 09/25/1999 CLARK, ELEANORE G 03/23/2000 620 .00 4 83C 990907107B 09/26/1999 HERREJON, GUADALUPE 03/23/2000 620 .00 4 83C 990907109A 09/26/1999 MONTGOMERY, ROBERT 03/23/2000 470 . 14 4 83C 990907114A 09/26/1999 ANTHONY, WILLIAM 03/23/2000 560 . 00 4 83C 990907134A 09/27/1999 HARDING, MELISSA 03/23/2000 120 . 00 4 83C 990907158A 09/28/1999 NOVAK, ALEN 03/23/2000 665 .00 4 63C 990907218A 09/30/1999 COLLINS, MARY JANE 03/23/2000 76 .00 4 83C 990907218B 09/30/1999 VIGIL, DARILYN J 03/23/2000 60 .42 4 83C 990907219A 09/30/1999 MALASKLY, LUCY 03/23/2000 270 .00 4 83C 990907223A 09/30/1999 .BEARD, ROBERT L 03/23/2000 270 . 00 4 83C 991007272A 10/02/1999 ROCCHIO, JUDY 03/23/2000 515 00 4 830 991007276A 10/02/1999 PHILLIPS, CAROL 03/23/2000 50 .00 4 83C 991007298A 10/03/1999 MANGRUM, RICK W 03/23/2000 25 .00 4 83C 991007299A 10/03/1999 VASQUEZ, SARAH 03/23/2000 120.00 4 830 9910072498 10/03/1499 VASQUEZ, BABY GIRL • Date:03/24/2000 Weld County Ambulance Page: Time:12 :06 ,08 Receipt , Write-off, Adjustment Batch Report MRR300 WriteOffRatch From 03/23/2000 Thru 03/23/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 03/23/2000 765. 00 4 83C 991007301A 10/03/1999 MCCLARY, BRIAN 03/23/2000 76 . 00 4 83C 991007306B 10/04/1999 FREEMAN, JENNIFER 03/23/2000 580 . 00 4 83C 991007310A 10/04/1999 PHILLIPS, ROSE 03/23/2000 725. 00 4 83C 991007323A 10/04/1999 RAMOS, MARY 03/23/2000 535.00 4 83C 991007325A 10/05/1999 HORNE, ANTHONY 03/23/2000 76.00 4 83C 991007346A 10/05/1999 OLDSEN, CODY 03/23/2000 620.00 4 83C 991007347A 10/05/1999 GOFF, TIMOTHY 03/23/2000 665 .00 4 83C 991007358A 10/06/1999 JOHNSON, JR, CALVIN 03/23/2000 515.00 4 83C 991007364A 10/06/1999 JOHNSON, JR, CALVIN 03/23/2000 665.00 4 83C 991007376B 10/06/1999 VIGIL, RAYMOND J 03/23/2000 795.00 4 83C 991007390A 10/07/1999 MEDEIROS, DEBBIE 03/23/2000 515.00 4 83C 991007397A 10/07/1999 DELGADO-CHAVEZ, AMAN 03/23/2000 620.00 4 83C 991007399A 10/07/1999 DELGADO, PAUL 03/23/2000 515 .00 4 83C 991007412A 10/08/1999 MEDINA, BOB 03/23/2000 76.00 4 83C 991007417A 10/08/1999 GUZMAN, RICK 03/23/2000 725 .00 4 83C 991007418A 10/08/1999 LOYA, REFUGIO 03/23/2000 76 .00 4 83C 991007436A 10/09/1999 JONES, WOODY E 03/23/2000 675 .00 4 83C 991007439A 10/09/1999 ARALLANAS, LUPE 03/23/2000 760 .00 4 83C 991007445A 10/09/1999 VALLES, FELISHA 03/23/2000 650.00 4 83C 991007458A 10/09/1999 GUZMAN, RICHARD 03/23/2000 665.00 4 83C 991007462A 10/09/1999 STIMPLE, JAMES 03/23/2000 675 .00 4 83C 991007467A 10/09/1999 SAENZ, PATTY 03/23/2000 675.00 4 83C 991007467B 10/09/1999 SAENZ, REYNA 03/23/2000 620.00 4 83C 991007478A 10/10/1999 ROLON, LORENA 03/23/2000 730 .00 4 83C 991007494B 10/10/1999 SCHLITT, KAREN S 03/23/2000 141 .00 4 83C 991007530A 10/12/1999 ALVAREZ, JUAN 03/23/2000 461 .00 4 83C 991007540A 10/12/1999 RANOUS, DANIEL A 03/23/2000 665. 00 4 83C 991007545A 10/12/1999 ERICKSON, GARRETT 03/23/2000 50 .00 4 83C 991007556A 10/12/1999 GREEN, ALAN D 03/23/2000 50.00 4 83C 991007561A 10/13/1999 GREEN, ALAN D 03/23/2000 270 .00 4 83C 991007562A 10/13/1999 RODRIGUEZ, CRYSTAL 03/23/2000 515.00 4 83C 991007570A 10/13/1999 VARGAS, ISIDRO 03/23/2000 835.00 4 83C 991007580A 10/13/1999 NEUERBURG, MICHAEL J 03/23/2000 270.00 4 83C 991007582A 10/13/1999 NEUERBURG, MICHAEL J 03/23/2000 525.00 4 83C 991007587A 10/13/1999 MOORE, DANNY 03/23/2000 212 .50 4 83C 991007599A 10/14/1999 HEUTZENROEDER, KLINT 03/23/2000 605. 00 4 83C 991007608A 10/14/1999 MANKIN, RONALD 03/23/2000 25. 00 4 83C 991007610A 10/14/1999 ARNOLD, ERIN 03/23/2000 560. 00 4 83C 991007614A 10/14/1999 ROMERO, ROLAND 03/23/2000 515. 00 4 83C 991007650A 10/16/1999 SEPEDA, TOMI JOEL 03/23/2000 76 . 00 4 83C 991007657A 10/16/1999 CENICEROS, ELIZABETH 03/23/2000 535 . 00 4 83C 991007669A 10/16/1999 BENNER, GAYLE 03/23/2000 865 . 00 4 83C 991007692A 10/17/1999 WILMOT, TRAVIS 03/23/2000 620 . 00 4 83C 991007695A 10/17/1999 MATA, CURTIS 03/23/2000 270 . 00 4 83C 991007705A 10/18/1999 FARRIS, SYLVIA 03/23/2000 665. 00 4 83C 991007716A 10/16/1999 iCREIS, DARREN 03/23/2000 525. 00 4 83C 991007768A 10/20/1999 YBARRA, CHRISTINA 03/23/2000 76 . 00 4 83C 991007773A 10/21/1999 VASQUEZ, MARTIN FRAN 03/23/2000 76 . 00 4 83C 991007700A 10/21/1999 SISNEROS, PAUL Date:03/24/2000 Weld County Ambulance Page: 4 Time:12 . 06 :09 Receipt, Write off , Adjustment Batch Report MRR300 WriteOffBatch From 03/23/2000 Thru 03/23/2000 Date Source Check # Branch # Value T @WA Code Invoice Inv Date Patient Name 03/23/2000 700 . 00 4 83C 991007787A 10/21/1999 PEEBLES, DAVID 03/23/2000 575 . 00 4 83C 991007799A 10/22/1999 VALDEZ, PETE 03/23/2000 695.00 4 83C 991007819A 10/22/1999 SIME, TODD 03/23/2000 580.00 4 83C 991007822A 10/22/1999 SORIANO, CHRIS 03/23/2000 850.00 4 83C 991007827A 10/23/1999 CISNEROS, GLORIA 03/23/2000 695.00 4 83C 991007842A 10/23/1999 SIEBERT, GARY 03/23/2000 270.00 4 83C 991007846A 10/23/1999 SIEBERT, GARY 03/23/2000 705.00 4 83C 991007853A 10/23/1999 JONES, WOODY E 03/23/2000 270.00 4 83C 991007857A 10/24/1999 JONES, WOODY E 03/23/2000 620.00 4 83C 991007860A 10/24/1999 RODRIGUEZ, RAFAELA 03/23/2000 515.00 4 83C 991007874A 10/24/1999 RODARTE, MIREYA 03/23/2000 76.00 4 83C 991008039A 10/31/1999 SEAMAN, TAYLOR 03/23/2000 695.00 4 83C 991108223A 11/06/1999 SIEBERT, GARY 03/23/2000 270 .00 4 83C 991108298A 11/09/1999 SIEBERT, GARY 03/23/2000 560.00 4 83C 991108478B 11/16/1999 WINDEN, SARAH Total of 162 WriteOff Entries Totaling 71365.89 Dollars Average WriteOff: 440.53 Dollars Average Time:208 Days Date:03/24/2000 Weld County Ambulance Page: Time :12 :06 :09 Receipt, Write- off, Adjustment Batch Report MRR300 WriteOffBatch From 03/23/2000 Thru 03/23/2000 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 162 71365 .89 440 .53 208 .25 Date:G4/28/a000 Weld County Ambulance Page: 1 Time:09:26 :54 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/27/2000 Thru 04/27/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/27/2000 20 .21 4 82 000100008A 01/01/2000 THOMPSON, LYNN 04/27/2000 930 .00 4 83C 000100129A 01/06/2000 ESPINOZA, DAVID 04/27/2000 545 .00 4 83C 000100153A 01/07/2000 FOSTER, EDWARD 04/27/2000 565 .00 4 83C 000100313A 01/13/2000 PEREZ, JUAN 04/27/2000 565.00 4 83C 000100313B 01/13/2000 PEREZ, JESSIE 04/27/2000 600.00 4 83C 000100390A 01/16/2000 GARFIO, TIBURCIO 04/27/2000 635.00 4 83C 000100407A 01/17/2000 LOMA, JENNIFER 04/27/2000 52.70 4 82 000100416A 01/18/2000 BROSSMAN, FRANCES 04/27/2000 725 .00 4 83C 000100481A 01/21/2000 LUCERO, ROGER 04/27/2000 650 .00 4 83C 000100528A 01/22/2000 TREVIZO, HILARIO 04/27/2000 205 .35 4 82 000100616A 01/26/2000 COVEY, DAWN 04/27/2000 19 .41 4 82 000100623A 01/26/2000 VINCEQUERRA, DOROTHY 04/27/2000 80 .00 4 83C 000100657A 01/27/2000 PALAZZOLO, PAUL 04/27/2000 590 .00 4 83C 000100663A 01/27/2000 TRIMBLE, SUSAN 04/27/2000 80 .00 4 83C 000100692A 01/29/2000 ZAMORA, GALDINO 04/27/2000 590 .00 4 83C 000100697A 01/29/2000 ZAMORA, GALDINO 04/27/2000 545.00 4 83C 000100743A 01/31/2000 FOSTER, EDWARD 04/27/2000 710.00 4 83C 000200802A 02/02/2000 LOWRY, JOSEPH P 04/27/2000 545.00 4 83C 000200806A 02/02/2000 RED EARTH, KIA 04/27/2000 29O.00 4 83C 000200809A 02/02/2000 LOWRY, JOSEPH P 04/27/2000 53 .00 4 84 000200810A 02/02/2000 LICHTI, DAVID 04/27/2000 695.00 4 83C 000200833A 02/03/2000 CLARK, JEREMY F 04/27/2000 650.00 4 83C 000200856A 02/04/2000 KINBLE, DAVONNA K 04/27/2000 650 .00 4 83C 000200923A 02/07/2000 RED EARTH, KENNETH 04/27/2000 695 .00 4 83C 000200948A 02/08/2000 RED EARTH, KENNETH 04/27/2000 650 .00 4 83C 000200952A 02/08/2000 VALENTINE, DAVID 04/27/2000 532 .55 4 82 000200993A 02/10/2000 DELAFUENTE, CASSANDR 04/27/2000 4 .50 4 82 000201037A 02/11/2000 OSBORN, CAROLYN 04/27/2000 545.00 4 83C 000201059A 02/13/2000 GONZALEZ, JESUS 04/27/2000 656 .14 4 83C 000201075A 02/13/2000 MCCRERY, MARY K 04/27/2000 635.00 4 83C 000201136A 02/16/2000 VALENTINE, DAVID 04/27/2000 695.00 4 83C 000201146A 02/16/2000 VALENTINE, DAVID 04/27/2000 290. 00 4 83C 000201153A 02/16/2000 MUNGUIA, WILLIAM 04/27/2000 660.00 4 83C 000201161A 02/17/2000 VALENTINE, DAVID 04/27/2000 695.00 4 83C 000201174A 02/17/2000 LOWRY, JOSEPH P 04/27/2000 290 .00 4 83C 000201193A 02/18/2000 LOWRY, JOSEPH P 04/27/2000 656 .14 4 83C 000201223A 02/19/2000 CONNOR, MATTHEW D 04/27/2000 537.20 4 82 000201241A 02/20/2000 RILEY, FERN ANN 04/27/2000 695 .00 4 83C 000201242A 02/20/2000 LOWRY, JOSEPH P 04/27/2000 80 .00 4 83C 000201249A 02/20/2000 AGUILAR, SERGIO 04/27/2000 290 .00 4 83C 000201269A 02/21/2000 LOWRY, JOSEPH P 04/27/2000 928.70 4 82 000201302A 02/23/2000 DURAN, MAURILLO 04/27/2000 715.00 4 83C 000201315A 02/23/2000 ORTIZ, MIRLA 04/27/2000 710 .00 4 83C 000201317A 02/23/2000 LARA ZARATE, FAUSTIN 04/27/2000 19.41 4 82 000201388A 02/26/2000 HOSCHOUER, FANNY 04/27/2000 710 . 00 4 83C 000201.142A 02/28/2000 ANDOZOLA, JESUS M 04/27/2000 650 . 00 4 83C 000501470A 03/01 /2000 AGUILAR. SERGIO 04/27/2000 80.00 4 83C 000301496A 03/02/2000 MERAZ, JUAN 04/27/2000 12 .39 4 82 000301499A 03/02/2000 STADE, DAVID Date:.04/28/,2000 Weld County Ambulance Page: 2 Time:09:26:54 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/27/2000 Thru 04/27/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/27/2000 4 .50 4 82 000301531A 03/03/2000 KUCERA, NANCY 04/27/2000 650.00 4 83C 000301669A 03/08/2000 KNOX, BARRY 04/27/2000 80.00 4 83C 000301717A 03/09/2000 PADILLA, SANDRA 04/27/2000 960.00 4 83C 000301763A 03/11/2000 BENAVIDEZ, TERRY 04/27/2000 454 .61 4 82 000301998A 03/21/2000 HERNANDEZ, ROSA 04/27/2000 557.76 4 82 000301999A 03/21/2000 MEDINA, PAUL 04/27/2000 525.06 4 82 000302018A 03/22/2000 TOUSLEE, DANIEL 04/27/2000 438.00 4 82 000302020A 03/22/2000 GARCIA, BARBARA 04/27/2000 413.71 4 82 000302027A 03/22/2000 CROUCH, KATREENA 04/27/2000 290.00 4 83C 000302086A 03/25/2000 HOLMES, ARTHUR 04/27/2000 695.00 4 83C 000302165A 03/27/2000 GUTIERREZ, HECTOR 04/27/2000 545.00 4 83C 000302170A 03/28/2000 VALENTINE, DAVID 04/27/2000 585 .00 4 83C 000402317A 04/01/2000 GUTIERREZ, HECTOR 04/27/2000 710 .00 4 83C 000402582A 04/11/2000 RODRIGUEZ, URIEL 04/27/2000 650 .00 4 83C 000402698A 04/15/2000 RODRIGUEZ, URIEL 04/27/2000 385 .11 4 83C 990301674A 03/03/1999 GAVELL, EDWARD 04/27/2000 6 .00 4 83C 990805828A 08/07/1999 REYES, DAVID 04/27/2000 530 .74 4 83C 990805897A 08/09/1999 FITHIAN, BETTY M 04/27/2000 143 .50 4 83C 990806226A 08/22/1999 SIGMON, KEITH 04/27/2000 407 .00 4 83C 990806265A 08/24/1999 CASTILLO, FRANK F 04/27/2000 715.00 4 83C 990806358A 08/27/1999 PIERCE, SHANE 04/27/2000 245.00 4 83C 990806373A 08/28/1999 PIERCE, SHANE 04/27/2000 277 .17 4 83C 990806468A 08/31/1999 NIX, FORREST 04/27/2000 52 .00 4 83C 990906529A 09/02/1999 LEWIS, SUSAN 04/27/2000 124 .00 4 83C 990906659A 09/07/1999 REYES, DAVID 04/27/2000 560 .00 4 83C 990906748A 09/10/1999 PINEDA, MELISSA 04/27/2000 270 .00 4 83C 990906755A 09/10/1999 PINEDA, MELISSA 04/27/2000 356.46 4 83C 990906811A 09/13/1999 NIX, FORREST 04/27/2000 575.49 4 83C 990907168A 09/28/1999 BAESSLER, JANICE 04/27/2000 277.31 4 83C 990907202A 09/29/1999 NIX, FORREST 04/27/2000 765.00 4 83C 991007320A 10/04/1999 MORGAN, DENAE 04/27/2000 780.00 4 83C 991007370A 10/06/1999 CHAVEZ, ZACHARIAH 04/27/2000 245.00 4 83C 991007377A 10/06/1999 CHAVEZ, ZACHARIAH 04/27/2000 620.00 4 83C 991007489A 10/10/1999 BRANDENBURG, SUZAN R 04/27/2000 25.00 4 83C 991007606A 10/14/1999 CALLAHAN, DIANA 04/27/2000 620.00 4 83C 991007623A 10/15/1999 CALDERON, ARMONDO 04/27/2000 50.00 4 83C 991007638A 10/15/1999 BREHM, DAVE 04/27/2000 650.00 4 83C 991007701A 10/18/1999 CONCHAS-LOMA, MARIA 04/27/2000 50.00 4 83C 991007714A 10/18/1999 BARELA, KIM 04/27/2000 515.00 4 83C 991007738A 10/19/1999 FRANCO, JENNIFER 04/27/2000 515.00 4 83C 991007740A 10/19/1999 CALKINS, WILLIAM 04/27/2000 725.00 4 83C 991007752A 10/20/1999 CHICK, SHAMARIE 04/27/2000 515.00 4 83C 991007771A 10/21/1999 CONOVER, SUZETTE 04/27/2000 270 .00 4 83C 991007778A 10/21/1999 CONOVER, SUZETTE 04/27/2000 76.00 4 83C 991007798A 10/21/1999 FRANKLIN, THOMAS 04/27/2000 785 . 00 4 83C 991007826A 10/22/1999 CORNEJO, RAUL 04/27/2000 280.00 4 83C 991007838A 10/23/1999 BRUNNER, CANDACE 04/27/2000 650 .00 4 83C 991007852A 10/23/1999 CLARK, JEREMY F 04/27/2000 76 .00 4 83C 991007863A 10/24/1999 CASE, KALENE Date04/28/2000 Weld County Ambulance Page: 3 Time:09:26 :55 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/27/2000 Thru 04/27/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/27/2000 620 . 00 4 83C 991007867A 10/24/1999 LIDDELL, WENDY 04/27/2000 615 .00 4 83C 991007878A 10/24/1999 KEELS, NIGELEA 04/27/2000 680 .00 4 83C 991007897A 10/25/1999 MARTINEZ, JESSE 04/27/2000 665 .00 4 83C 991007901A 10/25/1999 BENNETT, JERRI 04/27/2000 270 .00 4 83C 991007908A 10/26/1999 GARCIA, MICHAEL 04/27/2000 635 .00 4 83C 991007918A 10/26/1999 PAULS, DIANA 04/27/2000 76 .00 4 83C 991007919A 10/26/1999 CANTONWINE, CAMERON 04/27/2000 76 .00 4 83C 991007945A 10/27/1999 PINON, NANCY 04/27/2000 515 .00 4 83C 991007952A 10/28/1999 BARNES, ROBERT 04/27/2000 635 .74 4 83C 991007953A 10/28/1999 MESTAS, LEROY 04/27/2000 76 .00 4 83C 991007964A 10/28/1999 BARNES, ROBERT 04/27/2000 76 .00 4 83C 991007980A 10/29/1999 AUTOBBE, DEBBIE 04/27/2000 50 .00 4 83C 991007989A 10/29/1999 BREHM, DAVE 04/27/2000 585.00 4 83C 991007995A 10/30/1999 BARNHART, ROY G 04/27/2000 - 50 .00 4 83C 991008000A 10/30/1999 BREHM, DAVE 04/27/2000 50 .00 4 83C 991008009A 10/30/1999 RODGERS, SCOTT 04/27/2000 76 . 00 4 83C 991008012A 10/30/1999 MCCREARY, MARTIN 04/27/2000 270 .00 4 83C 991008018A 10/30/1999 MCCREARY, MARTIN 04/27/2000 665 .00 4 83C 991008023A 10/31/1999 MELENDEZ, ANA 04/27/2000 620 .00 4 83C 991008024A 10/31/1999 ESTALA, PAUL 04/27/2000 575 .00 4 83C 991008025A 10/31/1999 FRANCISCO, JOSEFA 04/27/2000 560 .00 4 83C 991108047A 11/01/1999 MILLER, MICHELLE O4/27/2000 635 :00 4 83C 991108057A 11/01/1999 PAULS, DIANA 04/27/2000 76 .00 4 83C 991108062A 11/01/1999 MEYERS, LALANIA 04/27/2000 515.00 4 83C 991108063A 11/01/1999 DYKMAN, JAMIE M 04/27/2000 560 .00 4 83C 991108066A 11/01/1999 COOK, JENNIFER L 04/27/2000 76.00 4 83C 991108073A 11/02/1999 THOMAS, BILL 04/27/2000 620 .00 4 83C 991108078A 11/02/1999 LIDDELL, WENDY 04/27/2000 270 .00 4 83C 991108086A 11/02/1999 SOLIS, FELICIA 04/27/2000 665 .00 4 83C 991108087A 11/02/1999 CRAIN, VIRGINIA I 04/27/2000 620 . 00 4 83C 991108093A 11/02/1999 LIDDELL, WENDY 04/27/2000 133 .00 4 83C 991108095A 11/02/1999 ORDONEZ, LORENZO 04/27/2000 76 .00 4 83C 991108102A 11/03/1999 VANDERWARF, CLEOPATR 0 /27/2000 575 .0 4 83C 991108116A 11/03/1999 PAULS, DIANA 04`1 0/27/2000 163 .51 4 83 991108130A 11/04/1999 EVANOFF, WILLARD T 01/27/2000 680 .00 4 83C 991108139B 11/04/1999 LOHMANN, LARRY )4/27/2000 795. 00 4 83C 991108156A 11/04/1999 MARSHALL, DEBRA )4/27/2000 76.00 4 83C 991108162A 11/04/1999 NEBUHARA, BOB 4/27/2000 167 .00 4 83C 991108179A 11/05/1999 WADEL, DAVID D 4/27/2000 740 . 00 4 83C 991108184A 11/05/1999 ROJAS, FELIX 4/27/2000 700 . 00 4 83C 991108203A 11/06/1999 STAGGS, VINCENT „,<274/2 7/2000 515 .00 4 83C 991108214A 11/06/1999 BLANKIS, STEVEN /2000 / 46 .59 4 83C 991108216A 11/06/1999 DEEL, JODY 6V, 27/2000 2 7/2000 555.00 4 83C 991108219A 11/06/1999 STOCKOVER, ROBERT -/:97/2000 475.00 4 83C 991108222A 11/06/1999 WATKINS, JACOB 7.27/2000 400 .00 4 83C 991108226A 11/06/1999 DEEL, JODY < -27/2000 76.00 4 83C 991108227A 11 /06/1999 BARCENAS, CFLSO - 7/2000 76 . 00 4 83C 991108227B 11 /06/1999 BARCENAS, MARIA S 7 ra 7/2000 76 . 00 4 83C 991108233A 11/07/1999 THOMFORDE, JIM Date.04/28/.2000 Weld County Ambulance Page: 4 Time:09:26:56 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/27/2000 Thru 04/27/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/27/2000 76 .00 4 83C 991108252A 11/07/1999 FOGLE, MICHAEL 04/27/2000 76 .00 4 83C 991108280A 11/08/1999 RIVAS, MIGUEL 04/27/2000 720 .74 4 83C 991108284A 11/08/1999 HOFEN, BONNIE M 04/27/2000 345 .00 4 83C 991108286A 11/09/1999 REED, ROBERT 04/27/2000 620 .00 4 83C 991108289A 11/09/1999 BAESSLER, JANICE .04/27/2000 665 .00 4 83C 991108297A 11/09/1999 SANCHEZ, ANGEL 04/27/2000 76 .00 4 83C 991108301A 11/09/1999 WENZCH, DAVID 04/27/2000 700.00 4 83C 991108307A 11/09/1999 VALDEZ, ERNESTO 04/27/2000 770.00 4 83C 991108309A 11/09/1999 SMITH, WILLIAM 04/27/2000 825.00 4 83C 991108316A 11/10/1999 HUNTEMAN, JOHN 04/27/2000 76.00 4 83C 991108317A 11/10/1999 MADISON, FELICIANIA 04/27/2000 76.00 4 83C 991108340A 11/10/1999 PHILBROOK, C J 04/27/2000 615 .00 4 83C 991108353A 11/11/1999 EREBIA, FREDDIE 04/27/2000 700.00 4 83C 991108361A 11/11/1999 MILLER, AUSTIE 04/27/2000 620.00 4 83C 991108368A 11/12/1999 NUNEZ, MARY 04/27/2000 560.00 4 83C 991108390A 11/13/1999 THOMAS, BRYAN 04/27/2000 270 .00 4 83C 991108408A 11/13/1999 NORMAN, CHARLES 04/27/2000 620 .00 4 83C 991108417A 11/14/1999 MONTOYA, ELOY 04/27/2000 725.00 4 83C 991108418B 11/14/1999 LOPEZ, JESSICA 04/27/2000 76 .00 4 83C 991108426A 11/14/1999 BRENCKLE, ARTHUR 04/27/2000 270 .00 4 83C 991108461A 11/15/1999 MESE, KATHLEEN 04/27/2000 620 .00 4 83C 991108477A 11/16/1999 RHODES, KANDE M 04/27/2000 76 .00 4 83C 991108484A 11/16/1999 REYES, GERARDO 04/27/2000 76 .00 4 83C 991108485A 11/16/1999 MEDINA, MERCEDES 04/27/2000 635.00 4 83C 991108516A 11/17/1999 JENKINS, AUSTIN 04/27/2000 665.00 4 83C 991108547A 11/19/1999 TRUJILLO, STEPHANIE 04/27/2000 560 .00 4 83C 991108553A 11/19/1999 BURCH, HEATHER 04/27/2000 665.00 4 83C 991108615A 11/21/1999 SCHLUTER, ANN 04/27/2000 680.00 4 83C 991108662A 11/23/1999 ROMERO, ANTHONY 04/27/2000 560.00 4 83C 991108726A 11/25/1999 MARKS, ADAM 04/27/2000 870.00 4 83C 991108742A 11/26/1999 PEREZ, MARGARET 04/27/2000 76.00 4 83C 991108745A 11/26/1999 LAGUARDIA, MARCUS 04/27/2000 76. 00 4 83C 991108754A 11/26/1999 NAUGLE, TYLER 04/27/2000 665.00 4 83C 991108774A 11/27/1999 MCCOY, MICKEY 04/27/2000 525.00 4 83C 991108796A 11/28/1999 MCKEE, DOUG Dg/272000 605.00 4 83C 991108808A 11/29/1999 YARBOUGH, ROGER )`4/27/2000 76.00 4 83C 991108829A 11/30/1999 SORIA, DIONICIO )4/27/2000 550.00 4 83C 991108844A 11/30/1999 LUJAN, GASPER BALDER 4/27/2000 76 .00 4 83C 991208962A 12/04/1999 SLOAN, MACKINZIE 4/27/2000 865 .00 4 83C 991208969A 12/04/1999 JAMES, JUDY 4<27/2000 575 .00 4 83C 991209014A 12/06/1999 MEDINA, DIANA 4 7/,-2 7/2000 620 .00 4 83C 991209017A 12/06/1999 THOMAS, BRYAN /2 7/2000 76 .00 4 83C 991209030A 12/07/1999 STEELE, KEN `' 2 7/2000 291 .74 4 83C 991209229A 12/14/1999 PARSONS, LILLIE A 7 2 7/2000 270 .00 4 83C 991209321A 12/18/1999 RADLER, BRIAN M 7 2 7/2000 495 .00 4 830 991209342B 12/19/1999 LOPEZ, IVAN 7 27/2000 565 .74 4 83C 991209358A 12/20/1999 MCCOY. CONSTANCE 7/2000 515 .00 4 83C 991209456A 12/24/1999 LLAMAS, RALPH Z 7/2000 515 .00 4 83C 991209557A 12/28/1999 RONFELDT, STAN Date:04/28/2000 Weld County Ambulance Page: 5 Time:09:25':57 Receipt, Write--off, Adjustment Batch Report MRR300 WriteOffBatch From 04/27/2000 Thru 04/27/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 04/27/2000 270 .00 4 83C 991209561A 12/29/1999 RONFELDT, STAN 04/27/2000 515.00 4 83C 991209596A 12/31/1999 FLORA, DALE Total of 198 WriteOff Entries Totaling 86032 .18 Dollars Average WriteOff: 434 .51 Dollars Average Time:144 Days Date:04/28/2000 Weld County Ambulance Page: 6 Timer09:26 :57 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 04/27/2000 Thru 04/27/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days 82 MEDICAID WRITEOFF 16 4726 .06 295 .38 64 .94 83C WRITEOFF TO COLLECTION AG 180 81089.61 450 .50 151.42 84 TRICARE WRITE OFF 1 53 .00 53 .00 85 .00 83 WRITEOFF 1 163 .51 163 .51 175 .00 Date:12/14/2000 Weld County Ambulance Page: 1 Time:15:56:23 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 25.00 4 83C 000100034A 01/02/2000 CROMWELL, GINA 05/25/2000 705.00 4 83C 000100218A 01/10/2000 DELCASTILLO, CLAUDIA 05/25/2000 650.00 4 83C 000100342A 01/15/2000 GOMEZ, MARCOS 05/25/2000 695.00 4 83C 000100392A 01/16/2000 HARDESTY, BRIDGETT 05/25/2000 80.00 4 83C 000100504A 01/22/2000 NYCAMP, WYATT RICHAR 05/25/2000 290.00 4 83C 000100614A 01/26/2000 GREEN, RICHARD 05/25/2000 650.00 4 83C 000100739A 01/30/2000 HOVANIC, DAVID 05/25/2000 615.00 4 83C 000200913A 02/06/2000 BROWN, BOBBY 05/25/2000 695.00 4 83C 000200936A 02/07/2000 CUMMINS, WILLIAM T 05/25/2000 545.00 4 83C 000201405B 02/27/2000 BRANDENBURG, SUZAN R 05/25/2000 720.00 4 83C 000301513A 03/03/2000 CERVANTES, ELUTERIO 05/25/2000 80.00 4 83C 000302103A 03/25/2000 ARISPE, VICTOR 05/25/2000 650.00 4 83C 000302196A 03/29/2000 CUMMINS, WILLIAM T 05/25/2000 290.00 4 83C 000302199A 03/29/2000 CUMMINS. WILLIAM T 05/25/2000 650.00 4 83C 000402477A 04/07/2000 CALDERA, VENUS 05/25/2000 290.00 4 83C 000402482A 04/07/2000 CALDERA, VENUS 05/25/2000 80.00 4 83C 000402732A 04/16/2000 GALLARDO, VALENTINO 05/25/2000 545.00 4 83C 000503436A 05/12/2000 CHAVEZ, JOHN DOE 05/25/2000 25.00 4 70CE 920202095A 02/02/1992 LUCERO, CHRISTINA 05/25/2000 16.66 4 70CE 920624057A 06/24/1992 CLARK, GREG 05/25/2000 25.00 4 70CE 920801121A 08/01/1992 SARDINA, JAVIER 05/25/2000 8.33 4 70CE 921205023A 12/05/1992 SHULTZ, JESSIE 05/25/2000 5.00 4 70CE 930724133A 07/24/1993 MARSHALL, ARLENE 05/25/2000 30.00 4 70CE 940100040A 01/02/1994 HERNANDEZ, ALEXANDER 05/25/2000 25.00 4 70CE 940201051A 02/21/1994 RICHARDSON, JENNIFER 05/25/2000 5.00 4 70CE 940402280A 04/26/1994 SHIN, FORREST 05/25/2000 30.00 4 70CE 941207132A 12/14/1994 STEVENS, PEGGY 05/25/2000 50.00 4 70CE 950200712A 02/05/1995 KEENER, PERRY 05/25/2000 21.58 4 70CE 950200805Z 02/09/1995 SHOSTROM, STEPHANIE 05/25/2000 101.33 4 70CE 950201043A 02/18/1995 GERKEN, DANNA 05/25/2000 17.26 4 70CE 950502730A 05/07/1995 GRULE, HENRY 05/25/2000 98.38 4 70CE 950603640A 06/17/1995 VILr,BFAI, MAGDALENA 05/25/2000 12.50 4 70CE 950603825C 06/24/1995 MENZEL, BONNIE 05/25/2000 16.66 4 70CE 950704694A 07/31/1995 ROCHA, CARMAN 05/25/2000 8.33 4 70CE 950708366C 07/17/1995 UGARTE-RAMIREZ, ELIA 05/25/2000 8.33 4 70CE 9507083660 07/17/1995 UGARTE-RAMIREZ, ELIA 05/25/2000 8.32 4 70CE 951006801A 10/23/1995 RIVERA, WILMA 05/25/2000 75.00 4 70CE 951107380A 11/18/1995 MALCHEREK, MICHELLE 05/25/2000 46.09 4 70CE 951208142A 12/24/1995 ENRIQUEZ, ELISA D5/25/2000 50.00 4 70CE 960200752B 02/06/1996 MONTOYA, CHRISTINA 05/25/2000 16.66 4 70CE 960200792A 02/08/1996 BARBER, GARRY 05/25/2000 45.05 4 70CE 960200910A 02/14/1996 MESSENGER, GEORGE 05/25/2000 13.46 4 70CE 960401971A 04/05/1996 GUSTIN, TAMMY 05/25/2000 25.00 4 70CE 960401973A 04/05/1996 TOBAR, TENO 05/25/2000 16.66 4 70CE 9604022090 04/16/1996 EVERLY, SOPHIE 05/25/2000 ,2 22 . '207 °E064, 66A 06/05/1905 EkUENSTEIN. RANDY 05/25/2000 7.53 4 70CE 960603424A 06/07/1996 TRUJILLO, ELIZABETH 05/25/2000 5.00 4 70CE 960603647A 06/16/1996 DUDICK, JAMES 05/25/2000 8.33 4 70CE 9606036549 06/17/1996 CASTILLO, MARTINIA 0 Date:12/14/2000 Weld County Ambulance Page: 2 Time:15:56:24 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch P Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 64.18 4 70CE 960603931C 06/28/1996 DOMINQUEZ, AMBER MAR 05/25/2000 37.99 4 70CE 9606039390 06/29/1996 GRIECO, SHERI 05/25/2000 11.23 4 70CE 960704454A 07/22/1996 GOVAN, TERESA 05/25/2000 25.00 4 70CE 960704464A 07/22/1996 SANCHEZ, TERRI A 05/25/2000 6.66 4 70CE 9611067788 11/01/1996 VASQUEZ, STEVEN DANE 05/25/2000 6.66 4 70CE 9611067788 11/01/1996 VASQUEZ, STEVEN DANE 05/25/2000 3.33 4 70CE 9611067788 11/01/1996 VASQUEZ, STEVEN DANE 05/25/2000 55.90 4 70CE 961208133A 12/30/1996 GUTIERREZ, RUDY 05/25/2000 16.66 4 70CE 970100179A 01/09/1997 HERRERA, ANNA 05/25/2000 4.14 4 70CE 970100640A 01/30/1997 LUCERO, BRENDA 05/25/2000 1.66 4 70CE 970201045A 02/17/1997 KELLNER, THEODORE 05/25/2000 20.00 4 70CE 970201289A 02/28/1997 VUONO, TERRI LEE 05/25/2000 12.11 4 70CE 970301309A 03/01/1997 JENKINS, KIM 05/25/2000 1.66 4 70PF 970301427A 03/05/1997 MARTINEZ, DELORIS 05/25/2000 19.80 4 70CE 970301858A 03/24/1997 BRITTAIN, THEODORE S 05/25/2000 123.23 4 70CE 970402179A 04/09/1997 MARTIN, JOSH 05/25/2000 27.07 4 70CE 970503245A 05/23/1997 GERKEN, DANNA 05/25/2000 69.47 4 70CE 970503377A 05/29/1997 RIVAS, OLGA 05/25/2000 16.66 4 70CE 970603539A 06/04/1997 DAVIS, KIMBERLY L 05/25/2000 3.33 4 70CE 970604077A 06/27/1997 LEBER, L.T. 05/25/2000 24.67 4 70CE 970604154A 06/30/1997 KASPAR, SHERRI 05/25/2000 22.60 4 70CE 970704640A 07/17/1997 SCHMITZ, EMMALEE 05/25/2000 15.37 4 70CE 970805454A 08/21/1997 HAGELSTROM, SYLVIA 05/25/2000 114.28 4 70CE 970905902A 09/06/1997 WOMBLE, PHILLIP 05/25/2000 5.00 4 70CE 970906231A 09/20/1997 GOMEZ, YOLANDA 05/25/2000 43.75 4 70CE 970906468A 09/30/1997 HAGELSTROM, SYLVIA 05/25/2000 10.00 4 70CE 971006529A 10/03/1997 RODRIGUEZ, ESTHER 05/25/2000 25.00 4 70CE 971006544A 10/03/1997 BUENO, CHARLES 05/25/2000 13.98 4 70CE 971007023A 10/23/1997 MORRIS, MARK 05/25/2000 25.00 4 70CE 971007046A 10/24/1997 MARTINEZ, MELANIE 05/25/2000 15.00 4 70CE 971007121A 10/26/1997 ZAMARRON, ALICE 05/25/2000 25.00 4 70CE 971007182B 10/28/1997 CONWAY, STEVE 05/25/2000 5.37 4 70CE 971107276A 11/01/1997 RAMOS, CARLA ANN 05/25/2000 149.99 4 70CE 971107653A 11/17/1997 AREVALO, RIVA 05/25/2000 35.00 4 70CE 971107724B 11/20/1997 MOORE, GEORGE 05/25/2000 25.00 4 70CE 971208076A 12/05/1997 GUEVARA, AMANDA 05/25/2000 8.33 4 70CE 980100058A 01/02/1998 BORGMAN, JIM 05/25/2000 1.52 4 70CE 980100100A 01/04/1998 INGMIRE, CHRISTINA 05/25/2000 12.50 4 70CE 980100259A 01/11/1998 RODRIGUEZ, FELIPA 05/25/2000 1.66 4 70CE 980201168A 02/19/1998 PAYNE, JOHN M 05/25/2000 34.38 4 70CE 980201184A 02/20/1998 IWPER, RHONDA 05/25/2000 66.66 4 70CE 980201263A 02/24/1998 BERENS, KEN 05/25/2000 25.00 4 70CE 980301498A 03/06/1998 MARTINEZ, MARIA 05/25/2000 8.33 4 70PF 980301519A 03/07/1998 CASTANEDA, THOMAS E 05/25/2000 33.33 4 70CE 980301891A 03/24/1998 CARMONA, RICK 05/25/2000 . _ 4 90.02198A 24!17/1999 WIMPY, CLIFTON" 05/25/2000 58.66 4 70CE 980402425A 04/19/1998 VENTURI, KIMBERLEY 05/25/2000 23.32 4 70CE 980402483A 04/21/1998 TELFORD, AARON 05/25/2000 182.50 4 70CE 980502941A 05/09/1998 CHRISTIAN, GAIL Date:12/14/2000 Weld County Ambulance Page: 3 Time:15:56:25 Receipt, Write-oft, Adjustment Batch Report MRR300 WriteoftBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 376.19 4 83C 980503080A 05/15/1998 ROBERTS, KATHLEEN 05/25/2000 6.66 4 70CE 980503215A 05/19/1998 GOMEZ, FELIX 05/25/2000 22.50 4 70PF 980503466A 05/29/1998 GUTIERREZ, DIANA 05/25/2000 9.50 4 70CE 980603567H 06/03/1998 HARTSHORN, ROSE MARI 05/25/2000 4.60 4 70CE 980603704A 06/09/1998 TREVIZO, ALONZO 05/25/2000 16.92 4 70CE 980604065A 06/24/1998 MAY, JENNIFER 05/25/2000 50.00 4 70CE 9806040658 06/24/1998 IRELAND, LINDSEY LYN 05/25/2000 4.46 4 70CE 980704680A 07/18/1998 KATO, NANCY 05/25/2000 19.88 4 70CE 980704683A 07/18/1998 KATO, NANCY 05/25/2000 25.00 4 70CE 980704819A 07/23/1998 HERNANDEZ, CARLOS 05/25/2000 58.82 4 70CE 980704964A 07/29/1998 POARSON, DOUGLAS 05/25/2000 7.22 4 70PF 980805045A 08/01/1998 STIFLE,.MICHELLE 05/25/2000 363.00 4 83C 980805314A 08/10/1998 SCHERMANN, GIL 05/25/2000 100.00 4 B3 980805453A 08/16/1998 SMITH, DESTINEY 05/25/2000 8.33 4 70CE 980805543A 08/21/1998 GRIFFIS, BERTRUM W 05/25/2000 61.39 4 70CE 980805561A 08/21/1998 HANDY, TRISHA LYNN 05/25/2000 25.00 4 70CE 980805575A 08/22/1998 SALDANA, SALVDOR 05/25/2000 17.23 4 70CE 980805736A 08/27/1998 CHAVEZ-MOLINA, MODES 05/25/2000 35.72 4 70CE 980905888A 09/02/1998 VAUGHAN, THOMAS 05/25/2000 53.39 4 82 980906030A 09/07/1998 CLINE, MILLIE 05/25/2000 132.53 4 70CE 980906382C 09/21/1998 CAMPBELL, KELLY 05/25/2000 10.00 4 70CE 980906536A 09/27/1998 RONSTROM, LESLIE 05/25/2000 1.66 4 70PF 980906568A 09/29/1998 RAU, MARY E 05/25/2000 16.66 4 70CE 981006650A 10/02/1998 ALVAREZ, MATEO 05/25/2000 7.12 4 70CE 981006788A 10/08/1998 BENTLEY, DIANE 05/25/2000 7.52 4 70CE 981006834A 10/10/1998 DIAZ, ELVIRA 05/25/2000 500.00 4 83C 981007033A 10/18/1998 FOWLES, KENNETH 05/25/2000 67.80 4 70CE 981007142A 10/23/1998 BOYCE, PATIENCE 05/25/2000 100.00 4 70CE 981007152A 10/23/1998 WELLS, TROY LEE 05/25/2000 12.55 4 70CE 981107380A 11/01/1998 BURKE, GUY 05/25/2000 53.39 4 82 981107570A 11/09/1998 KAPPIUS, ANNA A 05/25/2000 49.70 4 70CE 981107625A 11/12/1998 VILLALPANDO, MELISSA 05/25/2000 3.33 4 70CE 981107928A 11/25/1998 LECLAIR, AMY 05/25/2000 13.99 4 70CE 981107955A 11/26/1998 RAMOS, CARLA 05/25/2000 70.09 4 82 981107990A 11/27/1998 SALTER, BARBARA 05/25/2000 605.00 4 83C 981208082A 12/01/1998 BACA, ALBERT 05/25/2000 485.00 4 82 981208131A 12/03/1998 BOCOCK, ISAAC 05/25/2000 895.00 4 82 981208245A 12/06/1998 SUAREZ, JENNIFER 05/25/2000 440.00 4 82 981208383A 12/12/1998 MUELLER, GERTRUDE 05/25/2000 75.81 4 70CE 981208432A 12/14/1998 HERBST, ANDRIA M 05/25/2000 118.46 4 70CE 981208483A 12/17/1998 SMITH, WILLIAM 05/25/2000 68.33 4 70CE 981208624A 12/22/1998 MELVILLE, ROBERT 05/25/2000 550.72 4 82 981208676A 12/24/1998 RIZZO, GENEVIEVE 05/25/2000 625.74 4 83C 990100018A 01/01/1999 LOBATO, LETA 05/25/2000 -x0.00 4 70CE 990100264A 01/10/1999 BARCIA, EVERGITO 05/25/2000 14'.06 4 709_E 990___264k 0_'_/10/1999 HARCIA, EVER-ITC 05/25/2000 6.66 4 70CE 990100367A 01/14/1999 CORDES, CONNIE 05/25/2000 515.00 4 82 990100411A 01/16/1999 KARPEN, VELMA 05/25/2000 100.00 4 70CE OOnlnn,41A 01/17/1999 HUTSON, MICHAEL Date:12/14/2000 Weld County Ambulance Page: 4 Time:15:56:26 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 3.11 4 70CE 990100496A 01/19/1999 VILLAREAL, JAMES 05/25/2000 6.66 4 70CE 990100660A 01/24/1999 BELL, KENDRA 05/25/2000 78.50 4 70CE 990100699A 01/26/1999 ORDONEZ, JULIA 05/25/2000 15.73 4 70CE 990100710A 01/26/1999 JONES, DANIEL 05/25/2000 13.50 4 70CE 990201038A 02/09/1999 SCHAEFER, JOHATHAN 05/25/2000 16.66 4 70CE 990201041A 02/09/1999 MARTINEZ, DAMIEN 05/25/2000 9.30 4 70CE 990201041A 02/09/1999 MARTINEZ, DAMIEN 05/25/2000 72.85 4 70PF 990201081A 02/10/1999 SHAKLEE, MARY 05/25/2000 134.25 4 70PF 990201545A 02/26/1999 SHAKLEE, MARY 05/25/2000 72.85 4 70PF 990301889A 03/11/1999 SHAKLEE, MARY 05/25/2000 19.66 4 70CE 990301930A 03/13/1999 GONZALEZ ERICA 05/25/2000 575.00 4 83C 990301987A 03/15/1999 TAYLOR, SANDRA 05/25/2000 8.33 4 70PF 990302201A 03/24/1999 GUTIERREZ, JOSEPHINE 05/25/2000 23.46 4 70CE 990302257A 03/26/1999 CARDONA, BRANDY 05/25/2000 34.22 4 70CE 990302298A 03/28/1999 GONZALEZ, ANTHONY 05/25/2000 16.66 4 70CE 990402456A 04/03/1999 FURNEY, SCOTT 05/25/2000 30.00 4 70CE 990402572A 04/07/1999 NAVA, JANET 05/25/2000 76.00 4 83C 990402717A 04/13/1999 SULLIVAN, CHRISTOPHE 05/25/2000 44.26 4 70CE 990402723A 04/13/1999 GOMEZ, GUADALUPE C 05/25/2000 53.50 4 82 990403119A 04/27/1999 SILVA, JENNIFER 05/25/2000 16.66 4 70CE 990503234A 05/01/1999 BUFFALARI, DEBORAH A 05/25/2000 1.66 4 70CE 990503449A 05/10/1999 SICKLER, JULIA A 05/25/2000 3.33 4 70CE 990503449A 05/10/1999 SICKLER, JULIA A 05/25/2000 15.00 4 70CE 990503506A 05/13/1999 JACKSON, WANDA 05/25/2000 10.99 4 70CE 990503748A 05/22/1999 LECHUGA, MARIA 05/25/2000 76.00 4 83C 990503794A 05/24/1999 CHAGOLLA, ROSEMARY 05/25/2000 243.33 4 70PF 990503835A 05/26/1999 PATTERSON, EDDIE 05/25/2000 660.00 4 83C 990604107A 06/06/1999 GARCIA, TONY 05/25/2000 25.33 4 70CE 990604135A 06/07/1999 DAVIS, JED 05/25/2000 150.00 4 70CE 990604267A 06/12/1999 HARRIS, ROY 05/25/2000 472.50 4 83C 990604271A 06/12/1999 BAQWAZA, LILIANA 05/25/2000 30.68 4 70CE 990604279A 06/12/1999 CHIPP, TERRY 05/25/2000 5.06 4 70CE 990604380A 06/16/1999 STANCLIFT, TIM 05/25/2000 665.00 4 83C 990604367A 06/16/1999 PALMA, MARTINA 05/25/2000 202.65 4 82 990604441A 06/18/1999 LUCERO, LEONARD 05/25/2000 186.66 4 70PF 990604477B 06/20/1999 GOMEZ, JASON 05/25/2000 637.50 4 83C 990604631A 06/25/1999 BARRAZA, LILIANA 05/25/2000 30.00 4 83C 990604737A 06/28/1999 BORGMAN, JIM 05/25/2000 37.41 4 82 990704838A 07/01/1999 RUTZ, KATHERINE 05/25/2000 37.41 4 82 990704842A 07/01/1999 RUTZ, KATHERINE 05/25/2000 128.00 4 83C 990704870A 07/02/1999 FLETCHER, PAULINE O 05/25/2000 45.69 4 82 990704871A 07/02/1999 ADAIR, VENITA 05/25/2000 37.41 4 82 990704893A 07/03/1999 RUTZ, KATHERINE 05/25/2000 560.00 4 83C 990705003A 07/07/1999 MARTINEZ, JENNIFER 05/25/2000 16.66 4 70CE 990705063A 07/10/1999 TKEN0UYE, CHAD JASON 25/25/2000 7" 11 0 22 990705097A 77/11/1999 SPECIAL, HILDUR M 05/25/2000 25.33 4 70CE 990705166A 07/14/1999 WALLIS, SUMMER 05/25/2000 665.00 4 82 990705169A 07/14/1999 DOTY, ALBERT S 05/25/2000 __.35 4 70CE 990705182A 07/14/1999 DALTON, CODY • Date:12/14/2000 Weld County Ambulance Page: 5 Time:15:56:27 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 69.69 4 82 990705219A 07/16/1999 CHAVARRIA, MARY 05/25/2000 43.00 4 83C 990705234A 07/16/1999 DUKE, JACQUELIN 05/25/2000 270.00 4 83C 990705235A 07/17/1999 DUKE, JACQUELIN 05/25/2000 37.41 4 82 990705274A 07/18/1999 WOOTEN, NAOMI A 05/25/2000 200.00 4 83C 990705386A 07/23/1999 HUNTER, PAUL 05/25/2000 665.00 4 83C 990705497A 07/26/1999 GRIMM-BAGLEY, TAMMY 05/25/2000 610.00 4 83C 990705499A 07/26/1999 SANCHEZ, STEPHANIE 05/25/2000 314.20 4 83C 990705509A 07/26/1999 PEARSON, HEATHER 05/25/2000 96.67 4 70PF 990705587A 07/30/1999 PALLANSCH, ELIZABETH 05/25/2000 24.17 4 70PF 990705587A 07/30/1999 PALLANSCH, ELIZABETH 05/25/2000 6.66 4 70PF 990805773A 08/05/1999 GOODWIN, GARY 05/25/2000 122.25 4 70PF 990805907A 08/10/1999 CUNNINGHAM, DIANE 05/25/2000 210.00 4 83C 990806025A 08/14/1999 SCHRAM, DAVID 05/25/2000 16.66 4 70CE 990806117A 08/18/1999 HORN, KRISTEN R 05/25/2000 216.00 4 83C 990806136A 08/18/1999 PETTS, CHAUNCEY W 05/25/2000 25.33 4 70CE 990806167A 08/20/1999 LYONS, NATHAN 05/25/2000 25.33 4 70CE 990806234A 08/23/1999 STANCLIFT, TIM 05/25/2000 69.69 4 82 990806286A 08/25/1999 GUZMAN, CIPRIANO 05/25/2000 640.00 4 83C 990806363A 08/27/1999 SCHWITZER, WES 05/25/2000 620.00 4 83C 990906481A 09/01/1999 LOPEZ, SANDRA MARIE 05/25/2000 515.00 4 83C 990906487A 09/01/1999 GROSSMAN, CHRISTOPHE 05/25/2000 200.00 4 83C 9909065429 09/03/1999 EAGLIN, WALTER W 05/25/2000 69.69 4 82 990906568A 09/04/1999 LALONDE, GERALD B 05/25/2000 42.86 4 82 990906571A 09/04/1999 PINKER, ARLONE 05/25/2000 52.86 4 82 990906590A 09/05/1999 PETERSON, DESSIE 05/25/2000 68.69 4 82 990906615A 09/06/1999 ROCKIES, KELLY 05/25/2000 555.00 4 83C 990906616A 09/06/1999 PERCHES, MARCO 05/25/2000 69.80 4 82 990906619A 09/06/1999 BURMAN, ANNA 05/25/2000 Patient 69.69 4 82 990906622A 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10/06/1999 NASON, LANA 055/25!2000 _.-- 4 70CE 88,8465858 .Hinz n 994 M£DEIRne DEBBIE 05/25/2000 500.00 4 83C 991007455A 10/09/1999 GIGGY, MICHAEL 05/25/2000 16.66 4 70CE 991007501A 10/10/1999 LOYA, OMAR SAMUEL 05/25/2000 90.00 4 70PF 991007562A 10/13/1999 RODRIGUEZ, CRYSTAL • Date:12/14/2000 Weld County Ambulance Page: 6 Time:15:56:28 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 695.00 4 83C 991007576A 10/13/1999 MENDOZA, ALFREDO 05/25/2000 675.00 4 83C 991007728A 10/19/1999 HENSON, CYNTHIA 05/25/2000 25.33 4 70CE 991007773A 10/21/1999 VASQUEZ, MARTIN FRAN 05/25/2000 580.74 4 83C 991007835A 10/23/1999 DAVIS, JAN 05/25/2000 515.00 4 83C 991007836A 10/23/1999 VARGAS, MOSES 05/25/2000 720.00 4 83C 991007843A 10/23/1999 GREEN, BRIAN 05/25/2000 3.21 4 83C 991007849A 10/23/1999 KASPER, SHERRI L 05/25/2000 66.00 4 83C 991007881A 10/24/1999 SANTOS, DORA 05/25/2000 144.15 4 83C 991007884A 10/25/1999 JOHNSON, TED 05/25/2000 221.65 4 83C 991007885A 10/25/1999 GEORGE, AYELIFFE E 05/25/2000 665.00 4 83C 991007906A 10/25/1999 GARCIA, BERNADETTE 05/25/2000 395.74 4 83C 991007930A 10/26/1999 MILLS, HELEN 05/25/2000 785.00 4 83C 991008029A 10/31/1999 FLOREZ, ALANA 05/25/2000 37.41 4 82 991008032A 10/31/1999 KAMINSKI, RITA 05/25/2000 37.41 4 82 991008035A 10/31/1999 KAMINSKI, RITA 05/25/2000 76.00 4 83C 991108058A 11/01/1999 HERNANDEZ, BRITTANEY 05/25/2000 279.20 4 83C 991108082A 11/02/1999 HENDERSON, JIM 05/25/2000 44.33 4 70CE 991108095A 11/02/1999 ORDONEZ, LORENZO 05/25/2000 362.00 4 83C 991108099B 11/03/1999 GASTON, TREVOR 05/25/2000 76.00 4 83C 991108109A 11/03/1999 HEHERLING, ASHLEY 05/25/2000 76.00 4 83C 991108109B 11/03/1999 HEBERLING, RICHARD 05/25/2000 25.00 4 83C 991108112A 11/03/1999 SUGIHARA, EVAN 05/25/2000 620.00 4 83C 991108126A 11/03/1999 FRANKLIN, VERNA 05/25/2000 3.96 4 83C 991108140A 11/04/1999 KASPAR, SHERRI L 05/25/2000 665.74 4 83C 991108151A 11/04/1999 HART, WALTER 05/25/2000 410.74 4 83C 991108154A 11/04/1999 LAWRENCE, LLOYD 05/25/2000 695.00 4 83C 991108160A 11/04/1999 REEVES, DALE R 05/25/2000 515.00 4 83C 991108161A 11/04/1999 HARDESTY, BRIDGETT 05/25/2000 63.39 4 83W 991108172A 11/05/1999 CORTEZ, RUDY 05/25/2000 25.00 4 83C 991108182A 11/05/1999 SCHLEDEWITZ, BRIAN 05/25/2000 575.00 4 83C 991108205A 11/06/1999 HARDESTY, BRIDGETT 05/25/2000 515.00 4 83C 991108231A 11/07/1999 COLE, BRENDA 05/25/2000 515.00 4 83C 991108239A 11/07/1999 BERLIER, DAVID 05/25/2000 695.00 4 83C 991108287A 11/09/1999 MCLARID, RACHEL 05/25/2000 76.00 4 83C 991108290A 11/09/1999 GUEVARA, AMELIA 05/25/2000 515.00 4 83C 991108300A 11/09/1999 SORAN, SUZANNE 05/25/2000 76.00 4 83C 991106329A 11/10/1999 GARCIA, FRANCES 05/25/2000 515.00 4 83C 991108333A 11/10/1999 HARDESTY, BRIDGETT 05/25/2000 25.00 4 83C 991108397A 11/13/1999 HERNANDEZ, LOUIS 05/25/2000 25.00 4 83C 991108398A 11/13/1999 BUTLER, ANITA 05/25/2000 515.00 4 83C 991108410A 11/13/1999 COLE, JESSIE 05/25/2000 270.00 4 83C 991108412A 11/14/1999 COLE, JESSIE 05/25/2000 648.99 4 83C 991108423A 11/14/1999 HEINZE, PAUL 05/25/2000 76.00 4 83C 991108455A 11/15/1999 GUTIERREZ, CLAUDIA 05/25/2000 50.00 4 83C 991108466A 11/15/1999 JOHNSON, CALVIN 05/25/2000 76.00 4 83C 9911084'6A 11/16/1999 CRANDALL, GEORGE 05/25/2000 575.00 4 83C 991108521A 11/18/1999 ROSSI, TOM 05/25/2000 345.00 4 83C 991108526A 11/18/1999 SORAN, SUZANNE 05/25/2000 720.00 4 83C 991108570A 11/19/1999 ANTHONY, MARK Date:12/14/2000 Weld County Ambulance Page: 7 Time:15:56:29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffmatch From 05/25/2000 Thru 05/25/2000 Date Source Check ft Branch ft Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 620.00 4 83C 991108573A 11/20/1999 GONZALES, JOSH 05/25/2000 665.00 4 83C 991108574A 11/20/1999 ARCHULETA, MARY A 05/25/2000 76.00 4 83C 991108589A 11/20/1999 ALANIZ, VANESSA 05/25/2000 560.00 4 83C 991108590A 11/20/1999 ALVARADO, RICK 05/25/2000 225.00 4 83C 991108617A 11/21/1999 PHILLIPS, DELINDA M 05/25/2000 76.00 4 83C 991108621A 11/21/1999 CLARK, DAVE 05/25/2000 885.00 4 83C 991108621E 11/21/1999 ARNOLD, JODY 05/25/2000 875.00 4 83C 991108626A 11/21/1999 BURT, JAMES 05/25/2000 639.96 4 83C 991108631A 11/22/1999 FLARES, JULIO 05/25/2000 579.96 4 83C 991108631B 11/22/1999 BRYANT, TODD 05/25/2000 76.00 4 83C 991108660A 11/22/1999 BEAMAN, BRIAN 05/25/2000 675.00 4 83C 991108715A 11/25/1999 HATA, ALFREDO 05/25/2000 175.50 4 83C 991108725A 11/25/1999 ESTREICH, DEB 05/25/2000 25.00 4 83C 991108738A 11/26/1999 HUNTER, SHERI 05/25/2000 575.00 4 83C 991108743A 11/26/1999 BARRAZA, EVER 05/25/2000 665.00 4 83C 9911087438 11/26/1999 RARRAZA, RALHhL 05/25/2000 605.00 4 83C 991108751A 11/26/1999 GARCIA, FRANCES 05/25/2000 220.72 4 83C 991108764A 11/27/1999 GRAHAM, PAULA L 05/25/2000 124.00 4 83C 991108766A 11/27/1999 RODRIGUEZ, LOUISA 05/25/2000 515.00 4 83C 9911087668 11/27/1999 RODRIGUEZ, BABY GIRL 05/25/2000 490.00 4 83C 991108777A 11/27/1999 SPARKS, COLTON J 05/25/2000 995.00 4 83C 991108823A 11/29/1999 ESTES, TROY T 05/25/2000 76.00 4 83C 991108826A 11/30/1999 HERNANDEZ, JOSE 05/25/2000 860.00 4 83C 991108841A 11/30/1999 KUEHN, IRVEN 05/25/2000 270.00 4 83C 991108849A 11/30/1999 KUEHN, IRVEN 05/25/2000 76.00 4 83C 991208860A 12/01/1999 HORNE, ANTHONY 05/25/2000 515.00 4 83C 991208879A 12/01/1999 BENAVIDEZ, BENNY 05/25/2000 720.00 4 83C 991208885A 12/02/1999 HILLIARD, LYNDA 05/25/2000 76.00 4 83C 991208886A 12/02/1999 GEORGE, STEVE D 05/25/2000 665.00 4 83C 991208897A 12/02/1999 WEINZETL, MARLENE 05/25/2000 665.00 4 83C 991208902A 12/02/1999 CARMONA, GRACIELA 05/25/2000 680.00 4 83C 991208907A 12/02/1999 SILVA, TERESA 05/25/2000 515.00 4 83C 991208910A 12/02/1999 HOLGERSON, JULIE 05/25/2000 76.00 4 83C 991208916A 12/02/1999 SALINAS, SELENA 05/25/2000 685.00 4 83C 991208943A 12/04/1999 RODRIGUEZ, JEANETTE 05/25/2000 315.00 4 83C 991208958A 12/04/1999 CORPUS, GUSTAVO 05/25/2000 76.00 4 83C 991208960A 12/04/1999 SNYDER, JOHN 05/25/2000 555.00 4 83C 991208964A 12/04/1999 MULLIS, MARTI ANN 05/25/2000 112.00 4 83C 991208973A 12/05/1999 GARCIA, JOHN P 05/25/2000 665.00 4 83C 991208981A 12/05/1999 SOELL, ROBERT 05/25/2000 189.00 4 83C 991208981E 12/05/1999 SOELL, JANELL M 05/25/2000 189.00 4 83C 991208981O 12/05/1999 SOELL, ALYSSA R 05/25/2000 189.00 4 83C 991208981D 12/05/1999 SOELL, AUSTIN J 05/25/2000 695.00 4 83C 991208982A 12/05/1999 SOELL, ROBERT 05/25/2000 189.00 4 83C 9912089828 12/05/1999 SOELL, JANELL M 05/25/2000 1235.00 4 03_0 991208983A 12/05/1999 PETERS, MIKE 05/25/2000 76.00 4 83C 991208984A 12/05/1999 BLAKE, KRISTA 05/25/2000 670.00 4 83C 991208985A 12/05/1999 FARRELL, ALICIA 05/25/2000 75.00 4 83C 991208985E 12/05/1999 GAYTAN, RICK Date:12/14/2000 Weld County Ambulance Page: 8 Time:15:56:29 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 76.00 4 83C 991208986A 12/05/1999 MARTINEZ, MICHAEL 05/25/2000 905.00 4 83C 991208989A 12/05/1999 CARPAJAL, ANGELO 05/25/2000 76.00 4 83C 991208990A 12/05/1999 MORA, MANUEL 05/25/2000 270.00 4 83C 991209002A 12/06/1999 HELBERT, MARK 05/25/2000 735.00 4 83C 991209012A 12/06/1999 CARTER, CRYSTAL 05/25/2000 332.06 4 83C 991209017B 12/06/1999 THOMAS, FRANCES F 05/25/2000 560.00 4 83C 991209021A 12/06/1999 BARRANDEY, JESUS 05/25/2000 675.00 4 83C 991209024A 12/06/1999 MORENO, SELENA 05/25/2000 515.00 4 83C 991209033A 12/07/1999 STOUDT, ROBIN K 05/25/2000 270.00 4 B3C 991209039A 12/07/1999 ALBERT, ROBIN K 05/25/2000 76.00 4 83C 991209065A 12/08/1999 LAVIN, KATE 05/25/2000 620.00 4 83C 991209066A 12/08/1999 GUERRERO, TINA 05/25/2000 635.00 4 83C 991209069A 12/08/1999 SANDOVAL, JOYCE 05/25/2000 575.00 4 83C 991209070A 12/08/1999 HARDESTY, BRIDGETT 05/25/2000 705.00 4 83C 991209071A 12/08/1999 MENDOZA, ALFREDO 05/25/2000 710.00 4 83C 991209092A 12/09/1999 BERNAL, ANTHONY 05/25/2000 730.00 4 83C 991209124A 12/10/1999 CISNEROS, MICHAEL T 05/25/2000 332.00 4 83C 991209128A 12/10/1999 LOPEZ, KATHRINE 05/25/2000 515.00 4 63C 991209131A 12/10/1999 ORTIZ, BRYON L 05/25/2000 790.00 4 83C 991209139A 12/10/1999 HAFFEY, CHERISE 05/25/2000 515.00 4 83C 991209176A 12/12/1999 CASAREZ, MONICA S 05/25/2000 560.00 4 83C 991209202A 12/13/1999 BARBER, GAILANN H 05/25/2000 710.00 4 83C 991209203A 12/13/1999 GARCIA, MARIA D 05/25/2000 620.00 4 83C 991209210A 12/13/1999 GUERRA, GEORGE A 05/25/2000 50.00 4 83C 991209235A 12/15/1999 VASQUEZ, SANDRA 05/25/2000 50.00 4 83C 991209243A 12/15/1999 KINGSTON, JENNIFER J 05/25/2000 620.00 4 83C 991209252A 12/15/1999 BROWN, BOBBY 05/25/2000 560.00 4 83C 991209280A 12/16/1999 HERNANDEZ, ANGELA 05/25/2000 760.00 4 83C 991209283A 12/17/1999 SOTO, CANDY 05/25/2000 502.50 4 83C 991209296A 12/17/1999 HOLLAND, STEVE 05/25/2000 650.00 4 83C 991209305A 12/17/1999 BROWN, BOBBY 05/25/2000 895.00 4 83C 991209307E 12/17/1999 GONZalES, GABRIEL A 05/25/2000 705.00 4 83C 991209310A 12/18/1999 BENAVIDES, SANDRA 05/25/2000 815.00 4 83C 991209328A 12/18/1999 raQR, LANCE J 05/25/2000 50.00 4 83C 991209332A 12/18/1999 HENDERLONG, ARTHUR D 05/25/2000 560.00 4 B3C 991209333A 12/18/1999 WINFREY, RANDY 05/25/2000 515.00 4 83C 991209334A 12/19/1999 BROWN, BOBBY 05/25/2000 725.00 4 83C 991209340A 12/19/1999 GUERRERO, DAVID 05/25/2000 50.00 4 83C 991209352A 12/20/1999 GILLELAND, ROY B 05/25/2000 76.00 4 83C 991209353A 12/20/1999 TRIGOS, JESUS 05/25/2000 76.00 4 83C 991209363A 12/20/1999 HERNANDEZ, JOSHUA 05/25/2000 1255.00 4 83C 991209369A 12/21/1999 GARCIA, JUAN 05/25/2000 515.00 4 83C 991209370A 12/21/1999 SALAZAR, ANITA 05/25/2000 270.00 4 83C 991209371A 12/21/1999 GERKEN, DANNA 05/25/2000 76.00 4 83C 991209395A 12/22/1999 SNIDER, ALICIA 05/25/2000 _ _-0_ 4 991209397A 22/22/1999 JOHNSON, SHANNON 05/25/2000 665.00 4 83C 991209416A 12/23/1999 SIEH, MIKE 05/25/2000 76.00 4 B3C 991209429A 12/23/1999 GALLEGOS, LINDA 05/25/2000 630.00 4 83C 991209430A 12/23/1999 WALTER, BECKY Date:12/14/2000 Weld County Ambulance Page: 9 Time:15:56:30 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check 8 Branch N Value T RWA Code Invoice Inv Date Patient Name 05/25/2000 840.00 4 83C 991209437A 12/23/1999 OLSON, DANIELLE 05/25/2000 60.00 4 83C 991209438A 12/23/1999 THORMAN, JOANN 05/25/2000 635.00 4 83C 991209440A 12/23/1999 BUCKENDORF, WILBUR 05/25/2000 270.00 4 83C 991209442A 12/24/1999 BUCXENDORF, WILBUR 05/25/2000 705.00 4 83C 991209444A 12/24/1999 SEGURA, JULIO 05/25/2000 615.00 4 83C 991209446A 12/24/1999 RATA, FREDDY 05/25/2000 535.00 4 83C 991209448A 12/24/1999 VASQUEZ, LAWRENCE 05/25/2000 895.00 4 83C 991209466A 12/24/1999 PALMER, CELINE 05/25/2000 605.00 4 83C 991209481A 12/25/1999 RHODES, ROGER W 05/25/2000 890.00 4 83C 991209486A 12/25/1999 MARTINEZ, MAGGIE 05/25/2000 640.00 4 83C 991209491A 12/25/1999 FLORES, ROSEMARY 05/25/2000 270.00 4 83C 991209494A 12/25/1999 DOMINGUEZ, ANNA R 05/25/2000 270.00 4 83C 991209497A 12/25/1999 CAMACHO, JUAN 05/25/2000 446.72 4 83C 991209504A 12/26/1999 HIXENBAUGH, AQ'Y 05/25/2000 690.00 4 83C 991209505A 12/26/1999 WEBER, RICHARD 05/25/2000 65.34 4 83C 991209518A 12/26/1999 KASPER, SHERRI L 05/25/2000 50.00 4 83C 991209522A 12/27/1999 GREEN, ALAN D 05/25/2000 615.00 4 83C 991209532A 12/27/1999 ANAYA, VICTOR 05/25/2000 515.00 4 83C 991209540A 12/27/1999 ELOYD, TROY 05/25/2000 660.00 4 83C 991209551A 12/28/1999 PARRA, TINA 05/25/2000 620.00 4 83C 991209553A 12/28/1999 VEGA, LORINE 05/25/2000 545.00 4 83C 991209558A 12/28/1999 GALLEGOS, SILVERIO 05/25/2000 515.00 4 83C 991209563A 12/29/1999 MORRIS, JOHN 05/25/2000 515.00 4 83C 991209580A 12/29/1999 CERVANTES, MANUEL 05/25/2000 117.57 4 83C 991209588A 12/30/1999 BOOTHBY, SHIRLEY 05/25/2000 72.71 4 83C 991209603A 12/31/1999 KASPER, SHERRI L 05/25/2000 242.00 4 83C 991209615A 12/31/1999 KNIGHT, BILLY 05/25/2000 620.00 4 83C 991209617A 12/31/1999 REALY-VASQUEZ, JESUS 05/25/2000 76.00 4 83C 991209618A 12/31/1999 RASBERRY, TOM L 05/25/2000 30.00 4 70CE AR00029776 03/09/1994 HERNANDEZ, ALEXANDER Total of 422 WriteOff Entries Totaling 108360.00 Dollars Average WriteOff: 256.78 Dollars Average Time:489 Days Date:12/14/2000 Weld County Ambulance Page:10 Time:15:56:30 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 05/25/2000 Thru 05/25/2000 Date Source Check # Branch N Value T RWA Code Invoice Inv Date Patient Name Code Description Count Total $ Avg $ Avg Days B3C WRITEOFF TO COLLECTION AG 224 97313.63 434.44 195.10 70CE COLLECTION EXPENSE 150 4745.89 31.64 954.53 70PF PROFESSIONAL FINANCE COLL 17 1245.10 73.24 479.06 83 WRITEOFF 1 100.00 100.00 648.00 82 MEDICAID WRITEOFF 29 4891.99 168.69 358.76 83W WRITEOFF WORK COMP 1 63.39 63.39 202.00 Date:06/21/2000 Weld County Ambulance Page: 1 Time:11:52 :42 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/20/2000 Thru 06/20/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 06/20/2000 12 . 00 4 83C 99075 08/09/1999 BRIAN ALLMER 06/20/2000 12 .00 4 83C 99103 10/26/1999 DAWN JACKSON 06/20/2000 885 .00 4 83C 000100005A 01/01/2000 GRIMALDO, NIDA 06/20/2000 585 .00 4 83C 000100009A 01/01/2000 GARCIA, ADELAIDA 06/20/2000 640.00 4 83C 000100023A 01/01/2000 MARTINEZ, ANGELO 06/20/2000 290 .00 4 83C 000100038A 01/02/2000 FRANCISCO, JOSEFA 06/20/2000 290.00 4 83C 000100061A 01/04/2000 DAGENHART, JENNIFER 06/20/2000 710 .00 4 83C 000100069A 01/04/2000 PINEDA, MARK 06/20/2000 49.19 4 83C 000100072A 01/04/2000 GONZALES, LESLIE 06/20/2000 695 .00 4 83C 000100085A 01/05/2000 LANG, SHARON 06/20/2000 590 .00 4 83C 000100090A 01/05/2000 CALL, TIMOTHY 06/20/2000 144 .00 4 83C 000100099A 01/05/2000 WOOD, ANDREW 06/20/2000 42 .62 4 83C 000100124A 01/06/2000 GONZALES, LESLIE 06/20/2000 590.00 4 83C 000100125A 01/06/2000 MARTINEZ, SENARAH R 06/20/2000 80.00 4 83C 000100131A 01/07/2000 HAMILTON, AMBER 06/20/2000 925.00 4 83C 000100144A 01/07/2000 BACHOFER, BARUCH 06/20/2000 735.00 4 83C 000100183A 01/08/2000 EHRLICH, JAMES 06/20/2000 650.00 4 83C 000100185A 01/09/2000 BENAVIDEZ, GENEVA 06/20/2000 685.00 4 83C 000100230A 01/11/2000 DEVISSER, JANNELLE 06/20/2000 695.00 4 83C 000100231A 01/11/2000 ESPINOSA, DION 06/20/2000 290.00 4 83C 000100232A 01/11/2000 DEVISSER, JANNELLE 06/20/2O00 58.00 4 83C 000100237A 01/11/2000 VALDEZ, GILBERT 06/20/2000 545.00 4 83C 000100253A 01/11/2000 GARCIA JR, AGUSTIN 06/20/2000 80.00 4 83C 000100273A 01/12/2000 LOYA, JAIDO 06/20/2000 695.00 4 83C 000100282A 01/12/2000 PLANTE, KENNETH 06/20/2000 715.00 4 83C 000100303A 01/13/2000 GUTIERREZ, JASON 06/20/2000 80.00 4 83C 000100317A 01/14/2000 RICHARDSON, NANCY 06/20/2000 545.00 4 83C 000100327A 01/14/2000 HOWLAND, SHARON KAY 06/20/2000 695. 00 4 83C 000100328A 01/14/2000 HUBBARD, ERIN 06/20/2000 80 .00 4 83C 000100330A 01/14/2000 KASPAR, SHERRI 06/20/2000 545.00 4 83C 000100337A 01/14/2000 ALVARADO, ERNESTO 06/20/2000 80 .00 4 83C 000100340A 01/15/2000 SALAZAR, ALFREDO 06/20/2000 121.00 4 83C 000100341A 01/15/2000 HOPE, JUSTIN 06/20/2000 695.00 4 83C 000100380A 01/16/2000 PLANTE, KENNETH 06/20/2000 710.00 4 83C 000100384A 01/16/2000 NUNEZ, ANANIUS 06/20/2000 830.00 4 83C 000100391A 01/16/2000 LITTLENEST, BERNARD 06/20/2000 470 .00 4 83C 000100397A 01/17/2000 GANDARA, YOLANDA 06/20/2000 805.00 4 83C 000100399A 01/17/2000 JANNUSCH, ARTHUR 06/20/2000 438.30 4 83C 000100406A 01/17/2000 DITTMER, GERALD 06/20/2000 895.00 4 83C 000100410A 01/17/2000 WILLIAMSON, CHAD 06/20/2000 790 . 00 4 83C 000100425A 01/18/2000 GAETANO, MARGARET 06/20/2000 545 .00 4 83C 000100436A 01/19/2000 HOWELL, MATHEW 06/20/2000 775 . 00 4 83C 000100466A 01/20/2000 ERIVES, OFELIA 06/20/2000 885. 00 4 83C 000100468A 01/20/2000 BEARD, ROBERT L 06/20/2000 50 . 00 4 83C 000100484A 01/21/2000 CHAPMAN, BRIDGET 06/20/2000 1055 . 00 4 83C 000100486A 01/21/2000 CASEDY, MICHAEL A 06/20/2000 755 . 00 4 83C O00100518A 01 72 /200? CISNEROS, JOSE 06/20/2000 725 . 00 4 83C 000100526A 01/22/2000 CAMPBELL, LINDA 06/20/2000 685 . 00 4 83C 0007.00533A 01/22/2000 HERRERA, REGINA Date:06/21/2000 Weld County Ambulance Page: 2 Time:11:52:43 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/20/2000 Thru 06/20/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 06/20/2000 650 .00 4 83C 000100534A 01/22/2000 ARELLANO, ALICE 06/20/2000 80 .00 4 83C 000100548A 01/23/2000 ALFARO, JESSE 06/20/2000 695 .00 4 83C 000100550A 01/23/2000 SANDERS, JEFF 06/20/2000 625 .00 4 83C 000100568A 01/24/2000 HALE, GEORGIA 06/20/2000 290 .00 4 83C 000100573A 01/24/2000 FLETCHER, EMILY B 06/20/2000 710 .00 4 83C 000100583A 01/25/2000 HOWLAND, GENE 06/20/2000 681.14 4 83C 000100589A 01/25/2000 MARCANTEL, RONNIE 06/20/2000 545 .00 4 83C 000100598A 01/25/2000 ORTEGA, TRISHA 06/20/2000 635 .00 4 83C 000100605A 01/26/2000 QUARANTO, MARY 06/20/2000 80 .00 4 83C 000100629A 01/27/2000 LLAMAS, ERNIE 06/20/2000 25.00 4 83C 000100631A 01/27/2000 WANAMAKER, LAURETTE 06/20/2000 845.00 4 83C 000100662A 01/27/2000 MENDOZA, ALFREDO 06/20/2000 314 .30 4 81 000100672A 01/28/2000 SVETLOV, NATALIA 06/20/2000 18.09 4 82 000100672A 01/28/2000 SVETLOV, NATALIA 06/20/2000 580.00 4 83C 000100694A 01/29/2000 EREBIA, ANNE 06/20/2000 590.00 4 83C 000100696A 01/29/2000 GARCIA JR, AGUSTIN 06/20/2000 280.00 4 83C 000100698A 01/29/2000 EREBIA, ANNE 06/20/2000 80.00 4 83C 000100708A 01/29/2000 TINS, REBEKAH 06/20/2000 80.00 4 83C 000100710A 01/29/2000 RICHARDSON, NANCY 06/20/2000 865.00 4 83C 000100717A 01/30/2000 KREUGER, CHRISTOPHER 06/20/2000 290 .00 4 83C 000100722A 01/30/2000 KREUGER, CHRISTOPHER 06/20/2000 545.00 4 83C 000100754A 01/31/2000 SCHANTZ, RICK 06/20/2000 25.00 4 83C 000100755A 01/31/2000 SMITH, JENNIFER 06/20/2000 290.00 4 83C 000100760A 01/31/2000 SCHANTZ, RICK 06/20/2000 710.00 4 83C 000100761A 01/31/2000 PEREA, SANDRA 06/20/2000 64.49 4 83C 000100763A 01/31/2000 CABARETT, CHARLES 06/20/2000 376.60 4 83C 000200768A 02/01/2000 ZONZO, JOHN J 06/20/2000 60.50 4 83C 000200975A 02/09/2000 LANE, REBECCA M 06/20/2000 695 .00 4 83C 000200976A 02/09/2000 LEBO, DESIREE 06/20/2000 80 .00 4 83C 000201049A 02/12/2000 EMERSON, JOHN 06/20/2000 25 .00 4 83C 000201053A 02/12/2000 REYES, ROSE 06/20/2000 695 .00 4 83C 000201372A 02/25/2000 MONTOYA, DEBBIE 06/20/2000 695 .00 4 83C 000201430A 02/28/2000 SOTO, STANLEY CARL 06/20/2000 695.00 4 83C 000301483A 03/02/2000 VILLEGAS, LEE 06/20/2000 290 .00 4 83C 000301498A 03/02/2000 WARENBOURG, BONNIE 06/20/2000 671.14 4 83C 000301899A 03/17/2000 ERICHSEN, BETTY 06/20/2000 290 .00 4 83C 000301962A 03/19/2000 MARTINEZ, PATRICIA 06/20/2000 605 .00 4 83C 000302007A 03/21/2000 LOPEZ-MENDEZ, FREDER 06/20/2000 816 .14 4 83C 000302065A 03/24/2000 PRATER, STEVE 06/20/2000 650 .00 4 83C 000302125A 03/26/2000 DELATORRE, EZEQUIEL 06/20/2000 695 .00 4 83C 000402306A 04/01/2000 SILVA-VASQUEZ, VICTO 06/20/2000 695 .00 4 83C 000402319A 04/01/2000 KEITH, KENNETH 06/20/2000 820 .00 4 83C 000402397A 04/04/2000 GONZALES, MONICA 06/20/2000 590 .00 4 8)C 000402524A 04/08/2000 JUAREZ-HERNANDEZ, AU 06/20/2000 715 .00 4 83C 000402530A 04/09/2000 LOPEZ, JAIME 06/20/2000 650 . 00 4 83C 000402557A 04/10/2000 PELICO, GUILLERMO 06/20/2000 665 .00 4 83C 0004027) 6A 04/15/2000 SERNA, OFELIA 06/20/2000 635 .00 4 83C 000402938A 04/23/2000 TUBERVILLE, TAMMY S 06/20/2000 290 .00 4 83C 000402940A 04/23/2000 TUBERVILLE, TAMMY S Date: 06/21/2000 Weld County Ambulance Page: 3 Time:11:52 :43 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/20/2000 Thru 06/20/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 06/20/2000 675 .00 4 83C 000403017A 04/26/2000 YANEZ, EDUARDO 06/20/2000 675.00 4 83C 0004030178 04/26/2000 ZAVALA, MATILDA 06/20/2000 80 .00 4 83C 000403017C 04/26/2000 GALLEGOS, ANTHONY 06/20/2000 590.00 4 83C 000403035A 04/26/2000 REED, SANDRA 06/20/2000 650 .00 4 83C 000403083A 04/29/2000 SCHOFIELD, BRIAN 06/20/2000 616 . 14 4 83C 000503186A 05/03/2000 WALKER, LEWIS 06/20/2000 695.00 4 83C 000503215A 05/04/2000 ROBERTSON, MAGGIE 06/20/2000 695.00 4 83C 000503268A 05/06/2000 YANEZ, EDUARDO 06/20/2000 290.00 4 83C 000503273A 05/06/2000 YANEZ, EDUARDO 06/20/2000 545.00 4 83C 000503286A 05/07/2000 SANCHEZ, MARTIN 06/20/2000 545.00 4 83C 000503288A 05/07/2000 GONZALEZ, ROLANDO 06/20/2000 755.00 4 83C 000503288B 05/07/2000 GONZALES, DAVID ROLA 06/20/2000 665.00 4 83C 000503336A 05/08/2000 GARCIA, MARIA D 06/20/2000 650 .00 4 83C 000503337A 05/09/2000 YSLAS, ROBERT 06/20/2000 80 .00 4 83C 000503685A 05/21/2000 ANDERSON, KEITH 06/20/2000 710 .00 4 83C 000503723A 05/23/2000 STOSS, MIKE 06/20/2000 825 .00 4 83C 000503729A 05/23/2000 BARROS, MANUEL 06/20/2000 695 .00 4 83C 000503948A 05/31/2000 WAITS, RICHARD 06/20/2000 191 .56 4 83C 980603630A 06/06/1998 KOONCE, ELDON 06/20/2000 142 .60 4 83C 980704247A 07/01/1998 KOONCE, ELDON 06/2072000 158 .75 4 83C 990604336A 06/14/1999 BARTZ, LAWANDA G 06/20/2000 400 .00 4 83C 990604563A 06/22/1999 HOLYFIELD, DONNA 06/20/2000 259 .40 4 83C 990705387A 07/23/1999 KOONCE, ELDON 06/20/2000 650 .00 4 83C 990806397A 08/28/1999 ALLEN, CLIFFORD 06/20/2000 805 .00 4 83C 991108077A 11/02/1999 GOODNER, DOUG 06/20/2000 54 .00 4 83C 991108107A 11/03/1999 GOODNER, DOUG 06/20/2000 50 .00 4 83C 991108265A 11/08/1999 HOWARD, JULIA 06/20/2000 108 .00 4 83C 991108281A 11/08/1999 HICKS, NATALIE 06/20/2000 25 .00 4 83C 991108522A 11/18/1999 GARCIA, ROSA MARIA 06/20/2000 76 .00 4 83C 991108713A 11/25/1999 FRANCIS, JIM 06/20/2000 680 .00 4 83C 991108729A 11/25/1999 NANEZ, ANTONIETTE 06/20/2000 555.00 4 83C 991108734A 11/26/1999 FERNANDEZ, GUADALUPE 06/20/2000 69 .69 4 83C 991108769A 11/27/1999 MONTOYA, MICHAEL 06/20/2000 76 .00 4 83C 991208868A 12/01/1999 BRUNNER, GERHART 06/20/2000 620 .00 4 83C 991208936A 12/03/1999 SANCHEZ, RUBY 06/20/2000 76 .00 4 83C 991209112A 12/09/1999 AENCHBACHAR, KENT 06/20/2000 645 .00 4 83C 991209196A 12/13/1999 HIDALGL, MICHAEL 06/20/2000 256 .06 4 83C 991209419A 12/23/1999 KOONCE, ELDON 06/20/2000 306 .18 4 83C 991209427A 12/23/1999 COLLINS, MAXINE 06/20/2000 25 .00 4 83C 991209547A 12/28/1999 LOBATO, AMOS 06/20/2000 620 .00 4 83C 991209605A 12/31/1999 ICKLER, SHANDY Total of 139 WriteOff Entries Totaling 65419 .89 Dollars Average WriteOff : 470 .65 Dollars Average Time:152 Days Date:06/21/2000 Weld County Ambulance Page: 4 Time:11:52 :44 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 06/20/2000 Thru 06/20/2000 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 137 65087 .50 475.09 151.81 81 MEDICARE WRITEOFF 1 314 .30 314 .30 144.00 82 MEDICAID WRITEOFF 1 18.09 18.09 144.00 Date:08/10/2000 Weld County Ambulance Page: 1 Time:11:56:44 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/09/2000 139.00 4 83C 000100066A 01/04/2000 MAGADAN, JOHN P 08/09/2000 290 .00 4 83C 000100196A 01/09/2000 MORGAN, MICHAEL J 08/09/2000 740 .00 4 83C 000100219A 01/10/2000 PADILLA, MAX 08/09/2000 25 .00 4 83C 000100271A 01/12/2000 PAULSON, DALE 08/09/2000 780 .00 4 83C 000100304A 01/13/2000 ROMAYOR, MARIE 08/09/2000 80 .00 4 83C 000100352A 01/15/2000 RODRIGUEZ, DENISE 08/09/2000 115 .42 4 83C 000100408A 01/17/2000 DUWALDT, SCOTT 08/09/2000 392 .36 4 83C 000100440A 01/19/2000 BORLAND, ANITA 08/09/2000 125.64 4 83C 000100441A 01/19/2000 SHULTZ, THERESA L 08/09/2000 58.00 4 83C 000100450A 01/19/2000 DAVIS, AMANDA 08/09/2000 80.00 4 83C 000100495A 01/21/2000 REDIN, PATRICIA 08/09/2000 675.00 4 83C 000100501A 01/21/2000 MEEKS, KATHY 08/09/2000 290.00 4 83C 000100507A 01/22/2000 MEEKS, KATHY 08/09/2000 80 .00 4 83C 000100536A 01/23/2000 RUIZ, IVAN 08/09/2000 65.00 4 83C 000100547A 01/23/2000 BROWN, BREANNA 08/09/2000 605.00 4 83C 000100556A 01/24/2000 RIOJAS, GILBERT 08/09/2000 660.00 4 83C 000100560A 01/24/2000 SMITH, LONNIE 08/09/2000 290.00 4 63C 000100574A 01/25/2000 MARTINEZ, MARYANN 08/09/2000 795 .00 4 83C 000100594A 01/25/2000 TYSON, DARLENE 08/09/2000 80.00 4 83C 000100661B 01/27/2000 MUNOZ-PEREZ, ADRIAN 08/09/2000 715.00 4 83C 000100671A 01/28/2000 WARREN, ALAN 08/09/2000 695.00 4 83C 000100721A 01/30/2000 MENDOZA, ALFREDO 08/09/2000 80 .00 4 83C 000100752A 01/31/2000 MICHOLIK, EUGENE E 08/09/2000 795 .00 4 83C 000200772A 02/01/2000 SMOCK, MICHAEL S 08/09/2000 815 .00 4 83C 000200775A 02/01/2000 GORSKI, JASON J 08/09/2000 425 .00 4 83C 000200781A 02/01/2000 GUSTUS, DOUGLAS W 08/09/2000 910 .00 4 83C 000200785A 02/02/2000 INGRAHAM, RENDA 08/09/2000 650 .00 4 83C 000200798A 02/02/2000 ICKLER, SHANDY 08/09/2000 132 .00 4 83C 000200811A 02/02/2000 MAGADAN, JOHN P 08/09/2000 80 . 00 4 83C 000200817B 02/03/2000 HEDIN, MARK 08/09/2000 520 .00 4 83C 000200821A 02/03/2000 WELLS, CRAIG 08/09/2000 671 .14 4 83C 000200838A 02/04/2000 DAVIS, JAN 08/09/2000 935 . 00 4 83C 000200842A 02/04/2000 WEIDENKELLER, RICHAR 08/09/2000 545 .00 4 83C 000200862A 02/05/2000 SCHAFER, LARRY 08/09/2000 80 .00 4 83C 000200886A 02/05/2000 SOTELO JR. , TAYDE 08/09/2000 735 .00 4 83C 000200887A 02/05/2000 CARLSON, TERRY 08/09/2000 695.00 4 83C 000200891A 02/05/2000 ROYBAL, ALANNA 08/09/2000 . 80 .00 4 83C 000200894A 02/05/2000 GONZALES, KAYLYN 08/09/2000 290 .00 4 83C 000200897A 02/06/2000 CARLSON, TERRY 08/09/2000 660 .00 4 83C 000200908A 02/06/2000 PLANTE, KENNETH 08/09/2000 80 .00 4 83C 000200909A 02/06/2000 BAKER, CHRISTY 08/09/2000 79 .57 4 83C 000200910A 02/06/2000 PREWITT, WILLIAM 08/09/2000 755 .00 4 83C 000200912A 02/06/2000 BALDERRAMA, BANESA 08/09/2000 289 .87 4 83C 000200914A 02/06/2000 SALAZ, ANDY 08/09/2000 695 .00 4 83C 000200915A 02/06/2000 RECK, DOUG 08/09/2000 545 .00 4 83C 000200917A 02/07/2000 YANES, JENNIE 08/09/2000 590 .00 4 83C 000200928A 02/07/2000 RODRIGUEZ, MELCHISID 08/09/2000 870 .00 4 83C 000200931A 02/07/2000 STANZER, JAY 08/09/2000 290 . 00 4 83C 000200933A 02/07/2000 STANZER, JAY Date:08/10/2000 Weld County Ambulance Page: 2 Time:11:56:45 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/09/2000 362 .00 4 83C 000200934A 02/07/2000 BOWLES, PATRICIA 08/09/2000 25 .00 4 83C 000200981A 02/10/2000 CERVANTES, ROBERTO 08/09/2000 80 .00 4 83C 000200985A 02/10/2000 ARENAS, ELIZABETH 08/09/2000 590.00 4 83C 000200994A 02/10/2000 MALLARD, SETH 08/09/2000 290 .00 4 83C 000200999A 02/10/2000 PARKER, JILL L 08/09/2000 665 .00 4 83C 000201001A 02/10/2000 JOHNSON, STEPHANIE 08/09/2000 571 .62 4 83C 000201011A 02/11/2000 PERDOMO, JOSE C 08/09/2000 571 .62 4 83C 000201011B 02/11/2000 CASTANEDA, FREDDIE A 08/09/2000 571 .62 4 83C 000201011C 02/11/2000 SANTOS, TOMAS 08/09/2000 760 .00 4 83C 000201023A 02/11/2000 GAMMON, STEVE 08/09/2000 650 . 00 4 83C 000201039A 02/12/2000 EDWARD, JASON 08/09/2000 515 . 00 4 83C 000201046A 02/12/2000 WEELBORG, AMY 08/09/2000 715 . 00 4 83C 000201054A 02/12/2000 GARZA, ANNE MARIE 08/09/2000 925 .00 4 83C 000201057A 02/12/2000 KREUGER, CHRISTOPHER 08/09/2000 635 .00 4 83C 000201060A 02/13/2000 SEAR, MELISSA 08/09/2000 290 .00 4 83C 000201063A 02/13/2000 KREUGER, CHRISTOPHER 08/09/2000 565 .00 4 83C 000201066A 02/13/2000 ARCHIBEQUE, CHRISTOP 08/09/2000 695 .00 4 83C 000201082A 02/13/2000 ESTALA, LUCIO 08/09/2000 615.00 4 83C 000201087A 02/13/2000 WATSON, SHANE 08/09/2000 403 .50 4 83C 000201108A 02/14/2000 WELLS, CHARLES M 08/09/2000 38.00 4 83C 000201112A 02/14/2000 WELLS, CHARLES M 08/09/2000 139.00 4 83C 000201115A 02/14/2000 ROYBAL, KRISTINE 08/09/2000 109.00 -4 83C 000201115B 02/14/2000 SALAZAR, JOHNATHAN T 08/09/2000 109.00 4 83C 000201115C 02/14/2000 TORREZ, HALLE ALEXAN 08/09/2000 545.00 4 83C 000201116A 02/14/2000 ROYBAL, SAMSON 08/09/2000 650 .00 4 83C 000201133A 02/15/2000 CONNELLY, MICHAEL 08/09/2000 290 .00 4 83C 000201179A 02/17/2000 SEAR, MELISSA 08/09/2000 290 .00 4 83C 000201197A 02/18/2000 WITT, CAROL ANN 08/09/2000 605 .00 4 83C 000201239A 02/20/2000 HAILEY, SCOTT 08/09/2000 155.00 4 83C 000201261A 02/21/2000 TAYLOR, SUZANNA 08/09/2000 80 .00 4 83C 000201276A 02/22/2000 MECIA, MANUEL 08/09/2000 80.00 4 83C 000201281A 02/22/2000 CARMONA, ANEL 08/09/2000 825.00 4 83C 000201298A 02/23/2000 JAQUEZ, LULU 08/09/2000 590 .00 4 83C 000201299A 02/23/2000 RAMIREZ, VIRGINIA 08/09/2000 25 .00 4 83C 000201310A 02/23/2000 PANTOJA, JOSEFINA 08/09/2000 25 .00 4 83C 000201311A 02/23/2000 GUZMAN, GABRIEL 08/09/2000 290 .00 4 83C 000201312A 02/23/2000 CARMONA, ANEL 08/09/2000 372 .43 4 83C 000201320A 02/23/2000 HERNANDEZ, JIMMIE T 08/09/2000 715 .00 4 83C 000201321A 02/23/2000 QUILLER, LUELLA 08/09/2000 80 .00 4 83C 000201324A 02/24/2000 GRAHAM, CHAD 08/09/2000 80 .00 4 83C 000201328A 02/24/2000 DONNELLY, MARGARET 08/09/2000 695 .00 4 83C 000201333A 02/24/2000 CARMONA, ANEL 08/09/2000 541 . 88 4 83C 000201334A 02/24/2000 GREEN, ROBERTA 08/09/2000 730 . 00 4 83C 000201339A 02/24/2000 MILLER, JOSH 08/09/2000 381 . 00 4 83C 000201345A 02/24/2000 LOSTROH, KODY 08/09/2000 80 . 00 4 83C 000201352B 02/25/2000 GONZALES, THOMAS 08/09/2000 121 .00 4 83C 000201357A 02/25/2000 WTNNETT, MICHELLE 08/09/2000 290 . 00 4 83C 000201366A 02/25/2000 SEXTON, SUSAN 08/09/2000 780 . 00 4 83C 000201379A 02/26/2000 HERZOG, JOSHUA J Date:08/10/2000 Weld County Ambulance Page: 3 Time:11:56:46 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/09/2000 515 .00 4 83C 000201393A 02/26/2000 GUTIERREZ, POLO 08/09/2000 605 .00 4 83C 000201404A 02/27/2000 KOCH, HOWARD 08/09/2000 545.00 4 83C 000201405A 02/27/2000 BRIGHT, JERRY F 08/09/2000 656.14 4 83C 000201410A 02/27/2000 DAVIS, JAN 08/09/2000 80 .00 4 83C 000201417A 02/27/2000 SHEETS, HARPER 08/09/2000 80 .00 4 83C 000201424A 02/27/2000 SONTAY, JULIO 08/09/2000 305 .00 4 83C 000201426A 02/27/2000 GONZALES, RENEE 08/09/2000 50.00 4 83C 000201427A 02/28/2000 MARTINEZ, MINDY 08/09/2000 80.00 4 83C 000201448A 02/29/2000 PARSONS, KENTON 08/09/2000 930.00 4 83C 000301741A 03/11/2000 FLOOD, MICHAEL 08/09/2000 290 .00 4 83C 000301895A 03/16/2000 CRAMMER, TOM 08/09/2000 695 .00 4 83C 000301920A 03/17/2000 CASE, KALENE 08/09/2000 290 .00 4 83C 000301923A 03/18/2000 CASE, KALENE 08/09/2000 545.00 4 83C 000301968A 03/19/2000 KREUGER, CHRISTOPHER 08/09/2000 290 .00 4 83C 000301969A 03/19/2000 KREUGER, CHRISTOPHER 08/09/2000 545.00 4 83C 000301995A 03/21/2000 BJORDAHL, GREGORY 08/09/2000 290 .00 4 83C 000301997A 03/21/2000 BJORDAHL, GREGORY 08/09/2000 710 .00 4 83C 000302083A 03/25/2000 MENDOZA, ALFREDO 08/09/2000 366.00 4 83C 000302108A 03/26/2000 POWERS, FRED C 08/09/2000 80.29 4 83C 000302115A 03/26/2000 PREWITT, WILLIAM 08/09/2000 820.00 4 83C 000302291A 03/31/2000 PADILLA, MAX 08/09/2000 695.00 4 83C 000402492A 04/08/2000 WATSON, SHANE 08/09/2000 695 .00 4 83C 000503323A 05/08/2000 DYKES, CURTIS 08/09/2000 - 80 .00 4 83C 000503495A 05/14/2000 MARTINEZ, ROSALIE 08/09/2000 25.00 4 82 000503911A 05/30/2000 KOENIG, GEORGIA R 08/09/2000 605.00 4 83C 000604290A 06/11/2000 COLEMAN, THOMAS 08/09/2000 273 .47 4 81 000604305A 06/12/2000 DELGADO, JUANA 08/09/2000 99.20 4 81 000604310A 06/12/2000 DELGADO, JUANA 08/09/2000 590 .00 4 83C 000604507A 06/19/2000 COLEMAN, THOMAS 08/09/2000 695 .00 4 83C 000604642A 06/23/2000 COLEMAN, THOMAS 08/09/2000 665.00 4 83C 000604677A 06/24/2000 COLEMAN, THOMAS 08/09/2000 545.00 4 83C 000604705A 06/25/2000 COLEMAN, THOMAS 08/09/2000 740 .00 4 83C 000604783A 06/28/2000 MORRIS, LOUISE 08/09/2000 615 .00 4 83C 000705450A 07/18/2000 GARCIA, NOE 08/09/2000 555 .00 4 83C 000705620A 07/25/2000 MARTINEZ, ANTHONY 08/09/2000 705 .00 4 83C 000705670A 07/27/2000 BULLOCK, CINDY 08/09/2000 3 .33 4 70CE 910707026A 07/07/1991 GOMEZ, FELIX 08/09/2000 25 .00 4 70CE 920202095A 02/02/1992 LUCERO, CHRISTINA 08/09/2000 41.17 4 70CE 920309005A 03/09/1992 LUNA, ROSA 08/09/2000 33 .33 4 70CE 921012149A 10/12/1992 BENAVIDEZ, JESSICA T 08/09/2000 36 .59 4 70CE 921122013A 11/22/1993 VALDEZ, PAULINE 08/09/2000 8 .33 4 70CE 921205023A 12/05/1992 SHULTZ, JESSIE 08/09/2000 25 .00 4 70CE 930403018A 04/03/1993 SANDERS, CARL 08/09/2000 16 .66 4 70CE 930615063A 06/15/1993 TERRAZAS, ALICIA 08/09/2000 5 .00 4 70CE 930724133A 07/24/1993 MARSHALL, ARLENE 08/09/2000 50 .97 4 70CE 931013304A 10/24/1993 CASAREZ, ROGER D 08/09/2000 129 .24 4 70PF 940100293A 01 /16/1994 RAMOS, BRENDA 08/09/2000 25 .00 4 70CE 940201051A 02/21/1994 RICHARDSON, JENNIFER 08/09/2000 5 .00 4 70CE 940402038A 04/15/1994 VIGIL, MARSHALL Date:08/10/2000 Weld County Ambulance Page: 4 Time:11:56:47 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/09/2000 5 .00 4 70CE 940402280A 04/26/1994 SAIN, FORREST 08/09/2000 25.00 4 70CE 940704114A 07/22/1994 BOYCE, MARY ANN 08/09/2000 25.00 4 70CE 941005825A 10/11/1994 MORGAN, SARAH 08/09/2000 50 .00 4 70CE 941106260A 11/02/1994 PINEDA, GREGROY 08/09/2000 25.00 4 70CE 941106824A 11/29/1994 MARTINEZ, MELANIE 08/09/2000 15.00 4 70CE 941207132A 12/14/1994 STEVENS, PEGGY 08/09/2000 67 . 94 4 70CE 941207417A 12/30/1994 HOWARD, CHRISTINA 08/09/2000 75 .00 4 70CE 9502008052 02/09/1995 SHOSTROM, STEPHANIE 08/09/2000 50 .00 4 70CE 950704343A 07/16/1995 URIBE, REBECCA M 08/09/2000 16.66 4 70CE 950704694A 07/31/1995 ROCHA, CARMAN 08/09/2000 8 .33 4 70CE 950708366C 07/17/1995 UGARTE-RAMIREZ, ELIA 08/09/2000 8 .33 4 70CE 950708366C 07/17/1995 UGARTE-RAMIREZ, ELIA 08/09/2000 2 .61 4 70CE 950805388A 08/28/1995 TRUJILLO, MICHAEL 08/09/2000 55 .22 4 70CE 950805388A 08/28/1995 TRUJILLO, MICHAEL 08/09/2000 4 .16 4 70CE 951006801A 10/23/1995 RIVERA, WILMA 08/09/2000 30.26 4 70CE 951107380A 11/18/1995 MALCHEREK, MICHELLE 08/09/2000 7.68 4 70CE 960200792A 02/08/1996 BARBER, GARRY 08/09/2000 17 .50 4 70CE 960301710A 03/23/1996 OLIVA, MARIA 08/09/2000 53 .42 4 70CE 960401971A 04/05/1996 GUSTIN, TANMY OB/09/2000 25 .00 4 70CE 960401973A 04/05/1996 TOBAR, TENO 08/09/2000 16 .66 4 70CE 960402209C 04/16/1996 EVERLY, SOPHIE 08/09/2000 25 .00 4 70CE 960502939A 05/16/1996 PRADO, ERIK 08/09/2000 5.00 4 70CE 960603647A 06/16/1996 DUDICK, JAMES 08/09/2000 30.75 4 70CE 960603931C 06/28/1996 DOMINQUEZ, AMBER MAR 08/09/2000 25.00 4 70CE 960704464A 07/22/1996 SANCHEZ, TERRI A 08/09/2000 6 .66 4 70CE 961106778B 11/01/1996 VASQUEZ, STEVEN DANE 08/09/2000 16 .66 4 70CE 970100179A 01/09/1997 HERRERA, ANNA 08/09/2000 1 .66 4 70CE 970201045A 02/17/1997 KELLNER, THEODORE 08/09/2000 9.68 4 70CE 970301350A 03/02/1997 GURROLLA, LETICIA 08/09/2000 7.67 4 70CE 970402517A 04/22/1997 LUDWIG, ELIZABETH A 08/09/2000 11 .68 4 70CE 970402687A 04/30/1997 WITT, CAROL ANN 08/09/2000 118 .51 4 70CE 970402691A 04/30/1997 WITT, CAROL ANN 08/09/2000 50.00 4 70CE 970503245A 05/23/1997 GERKEN, DANNA 08/09/2000 139 .66 4 70CE 970603907A 06/20/1997 ESTAL, TONY 08/09/2000 • 075 .00 4 70CE 970603966A 06/23/1997 HUBBARD, ERIC 08/09/2000 3 .33 4 70CE 970604077A 06/27/1997 LEBER, L.T. 08/09/2000 11.23 4 70CE 970604080A 06/27/1997 RIGGINS, GARI 08/09/2000 27.75 4 70CE 970704233A 07/03/1997 KRAMER, DANIEL 08/09/2000 11.66 4 70CE 970704280A 07/04/1997 CAMPBELL, KAY 08/09/2000 25 .00 4 70CE 970704324A 07/06/1997 HERNANDEZ, PAUL 08/09/2000 50 .00 4 70CE 970704455A 07/10/1997 GALLEGOS, MARIA 08/09/2000 13 .68 4 70CE 970805744A 08/31/1997 MENDOZA, ERICA 08/09/2000 2 . 50 4 70CE 970906231A 09/20/1997 GOMEZ, YOLANDA 08/09/2000 11.71 4 70CE 970906231A 09/20/1997 GOMEZ, YOLANDA 08/09/2000 75. 00 4 70CE 970906468A 09/30/1997 HAGELSTROM, SYLVIA 08/09/2000 10.00 4 70CE 971006529A 10/03/1997 RODRIGUEZ, ESTHER 08/09/2000 25 . 00 4 70CE 9"1006544A 10 /03/1997 BUENO, CHARLES 08/09/2000 77 .61 4 70CE 971006748A 10/11/1997 ROHN, DANA 08/09/2000 23 . 50 4 83 971007182B 10/28/1997 CONWAY, STEVE Date:08/10/2000 Weld County Ambulance Page: 5 Time:11:56:48 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/09/2000 21.21 4 70CE 971208407A 12/19/1997 PORT, BOBBIE JO 08/09/2000 7.57 4 70CE 971208603A 12/28/1997 GONZALES, JR, PRUDEN 08/09/2000 6.66 4 70CE 971208659A 12/30/1997 GOVAN, TERESA 08/09/2000 8.33 4 70CE 980100058A 01/02/1998 BORGMAN, JIM 08/09/2000 10.00 4 70CE 980201168A 02/19/1998 PAYNE, JOHN M 08/09/2000 14.97 4 70CE 980201184A 02/20/1998 COOPER, RHONDA 08/09/2000 19.22 4 70CE 980201184A 02/20/1998 COOPER, RHONDA 08/09/2000 8 .33 4 70PF 980301519A 03/07/1998 CASTANEDA, THOMAS E 08/09/2000 8 .33 4 70CE 980402399A 04/17/1998 QUIMBY, CLIFFORD C 08/09/2000 10 .00 4 70CE 980402483A 04/21/1998 TELFORD, AARON 08/09/2000 33 .33 4 70CE 980502849A 05/06/1998 STALNAKER, RITA 08/09/2000 3 .33 4 70CE 980503215A 05/19/1998 GOMEZ, FELIX 08/09/2000 8.33 4 70CE 980503324A 05/23/1998 PRINTZ, JOY 08/09/2000 17 .50 4 70CE 980603567B 06/03/1998 HARTSHORN, ROSE MARI 08/09/2000 33 .33 4 70CE 980603603A 06/04/1998 LORRY, JOHN A 08/09/2000 20.00 4 70CE 980603610A 06/05/1998 MAVRIDOU, THEANO 08/09/2000 17.13 4 70CE 980603704A 06/09/1998 TREVIZO, ALONZO 08/09/2000 40 .00 4 70CE 980603704A 06/09/1998 TREVIZO, ALONZO 08/09/2000 70 .09 4 70CE 980604065A 06/24/1998 MAY, JENNIFER 08/09/2000 4.85 4 70CE 980704683A 07/18/1998 KATO, NANCY 08/09/2000 9.92 4 70CE 980704819A 07/23/1998 HERNANDEZ, CARLOS 08/09/2000 4.99 4 70CE 980704870A 07/26/1998 FLORES, MICHAEL 08/09/2000 9.87 4 70PF 980805045A 08/01/1998 STIFLE, MICHELLE 08/09/2000 40.75 4 70CE 980805240A 08/08/1998 GARCIA, LAWRENCE 08/09/2000 15.09 4 70CE 980805240A 08/08/1998 GARCIA, LAWRENCE 08/09/2000 50.82 4 70CE 980805616A 08/23/1998 MONTES, VICTOR 08/09/2000 51.83 4 70CE 980805616A 08/23/1998 MONTES, VICTOR 08/09/2000 24 .97 4 70CE 980805616A 08/23/1998 MONTES, VICTOR 08/09/2000 585.00 4 83C 980906131A 09/11/1998 BAUERNFEIND, ROLAND 08/09/2000 20 .19 4 70CE 980906153A 09/12/1998 SOTO, HECTOR 08/09/2000 1.71 4 70CE 980906356A 09/20/1998 REEL, MATTHEW 08/09/2000 33 .33 4 70CE 981006650A 10/02/1998 ALVAREZ, MATEO 08/09/2000 26. 00 4 70CE 981006827A 10/09/1998 STARKOVICH, CHARLES 08/09/2000 126.76 4 70CE 981107628A 11/12/1998 ESTEP, CHRISTINE 08/09/2000 10 .00 4 70CE 981107928A 11/25/1998 LECLAIR, AMY 08/09/2000 37.50 4 70CE 981208483A 12/17/1998 SMITH, WILLIAM 08/09/2000 25. 00 4 70CE 981208574A 12/20/1998 VILI•ARREAT , THOM A 08/09/2000 50 .00 4 70CE 981208574A 12/20/1998 VILLARREAL, THOM A 08/09/2000 407 .50 4 70CE 990100177A 01/07/1999 KNIGHT, STACEY 08/09/2000 6 .66 4 70CE 990100367A 01/14/1999 CORDES, CONNIE 08/09/2000 8 . 33 4 81 990100669A 01/25/1999 BALDERAMA, EDGAR 08/09/2000 43 . 72 4 70CE 990200950A 02/05/1999 TURLEY, HEATHER 08/09/2000 33 . 32 4 70CE 990201041A 02/09/1999 MARTINEZ, DAMIEN 08/09/2000 160 .14 4 70CE 990201264A 02/15/1999 CHMIEL, RANDI LYN 08/09/2000 17 . 50 4 70CE 990201569A 02/27/1999 PIERCE, WILMA 08/09/2000 72 . 70 4 70CE 990302093A 03/20/1999 MARTINEZ, GENESIS 08/09/2000 37.50 4 70CE 990302298A 03/28/1999 GONZALEZ, ANTHONY 08/09/2000 5 . 00 4 70CE 990302300A 03/28/1999 TROUT, JESUS A 08/09/2000 8 . 33 4 70CE 990402456A 04/03/1999 FURNEY, SCOTT Date:08710/2000 Weld County Ambulance Page: 6 Time:11 :56:50 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/09/2000 316.44 4 70CE 990402459A 04/03/1999 HESS, DAWN M 08/09/2000 16.66 4 70CE 990503234A 05/01/1999 BUFFALARI, DEBORAH A 08/09/2000 13 .33 4 70CE 990503748A 05/22/1999 LECHUGA, MARIA 08/09/2000 20.00 4 70CE 990503893A 05/29/1999 HERRERA, HECTOR 08/09/2000 25.00 4 70CE 990503897B 05/29/1999 MONAGHAN, COURTNEY 08/09/2000 49.81 4 70CE 990604267A 06/12/1999 HARRIS, ROY 08/09/2000 39.93 4 70CE 990604279A 06/12/1999 CHIPP, TERRY 08/09/2000 50.00 4 70CE 990604299A 06/13/1999 RIOS, LAURA 08/09/2000 10.00 4 70PF 990604737A 06/28/1999 BORGMAN, JIM 08/09/2000 37 .50 4 70CE 990704886A 07/03/1999 GONZALEZ, LEO 08/09/2000 16.66 4 70CE 990705063A 07/10/1999 IKENOUYE, CHAD JASON 08/09/2000 14.90 4 70CE 990705463B 07/25/1999 LUNA, YANELI 08/09/2000 6.66 4 70PF 990705499A 07/26/1999 SANCHEZ, STEPHANIE 08/09/2000 635.00 4 83C 990705607A 07/30/1999 REYES, DORA 08/09/2000 3 .33 4 70CE 990805702A 08/02/1999 ALEMAN, GERMAN A 08/09/2000 257.50 4 70PF 990806009A 08/14/1999 PEREZ, JULIAN 08/09/2000 72 .00 4 70PF 990806136A 08/18/1999 PETTS, CHAUNCEY W 08/09/2000 33 .33 4 70CE 990806179A 08/20/1999 FLOREZ, JUAN 08/09/2000 715.00 4 83C 990806191A 08/21/1999 RUYBAL, CHRISTINA 08/09/2000 170 .00 4 83C 990806374A 08/28/1999 PLUCKER, MARTIN 08/09/2000 196.66 4 70PF 990806387A 08/28/1999 BURFEIND, JOHN 08/09/2000 129.66 4 70CE 990806401A 08/28/1999 NISSEN, REY 08/09/2000 90 .00 4 70PF 990906505A 09/02/1999 CHMIEL, RACHELLE 08/09/2000 330 .00 4 70CE 990906651A 09/07/1999 MILLNER, CHRISTOPHER 08/09/2000 206.66 4 70PF 990906788A 09/12/1999 KAMINAKA, JONATHAN 08/09/2000 185.96 4 83C 990906794A 09/12/1999 TURNER, LASHONDA 08/09/2000 310 .00 4 70PF 990906878A 09/16/1999 NOSKO, JENNIFER 08/09/2000 253 .33 4 70PF 990907056A 09/24/1999 JONES, RAMICHA 08/09/2000 480 .00 4 83C 990907058A 09/24/1999 DELONG, CINTHIA 08/09/2000 705 .00 4 83C 990907065A 09/25/1999 PLUCKER, MARTIN 08/09/2000 685 .74 4 83C 991007326A 10/05/1999 LOGAN, RUTH 08/09/2000 17 .50 4 70CE 991007393A 10/07/1999 FITCH, JUSTIN 08/09/2000 16 .66 4 70CE 991007501A 10/10/1999 LOYA, OMAR SAMUEL 08/09/2000 830 .00 4 83C 991007505A 10/11/1999 SITZMAN, DARREL 08/09/2000 20.00 4 70CE 991007582A 10/13/1999 NEUERBURG, MICHAEL J 08/09/2000 8 .33 4 70CE 991007606A 10/14/1999 CALLAHAN, DIANA 08/09/2000 8.33 4 70CE 991108182A 11/05/1999 SCHLEDEWITZ, BRIAN 08/09/2000 25.33 4 70CE 991108233A 11/07/1999 THOMFORDE, JIM 08/09/2000 124 .00 4 83C 991108295A 11/09/1999 MOHR, TRAVIS J 08/09/2000 171 .66 4 70CE 991108300A 11/09/1999 SORAN, SUZANNE 08/09/2000 70.00 4 83C 991108435A 11/14/1999 FORMAN, SHANE 08/09/2000 327.00 4 83C 991108450A 11/15/1999 WERNER, TALITHA 08/09/2000 1015.00 4 83C 991108469A 11/16/1999 MILLIKAN, JERRY D 08/09/2000 115.00 4 70CE 991108526A 11/18/1999 SORAN, SUZANNE 08/09/2000 378.47 4 83C 991108539A 11/18/1999 LESJAK, DAVID 08/09/2000 605.00 4 83C 991108595A 11/20/1999 ALLMER, MIKE 08/09/2000 226 .39 4 83C 991]08673A 11/23/1999 TAYLOR, PAMELA 1 08/09/2000 73 .57 4 70CE 991108764A 11/27/1999 GRAHAM, PAULA L 08/09/2000 12 .66 4 70CE 991108826A 11/30/1999 HERNANDEZ, JOSE Date:08/10/2000 Weld County Ambulance Page: 7 Time:11:56:51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 08/09/2000 560 .00 4 83C 991209022A 12/06/1999 MICHAELIS, TRACI 08/09/2000 325.25 4 83C 991209133A 12/10/1999 SHIELD, KAREN 08/09/2000 700.74 4 83C 991209216A 12/13/1999 WOOD, JERRY E 08/09/2000 16.66 4 70CE 991209243A 12/15/1999 KINGSTON, JENNIFER J 08/09/2000 298.33 4 70PF 991209307B 12/17/1999 GONZALES, GABRIEL A 08/09/2000 270.00 4 83C 991209316A 12/18/1999 YOST, LISA 08/09/2000 13 .33 4 70CE 991209333A 12/18/1999 WINFREY, RANDY 08/09/2000 79.58 4 70PF 991209358A 12/20/1999 MCCOY, CONSTANCE 08/09/2000 630 .00 4 83C 991209433A 12/23/1999 PEVERLEY, RICHARD W Total of 303 WriteOff Entries Totaling 74805 .85 Dollars Average WriteOff: 246. 88 Dollars Average Time:607 Days Date:0K/10/2000 Weld County Ambulance Page: 8 Time:11 :56:51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 08/09/2000 Thru 08/09/2000 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 152 67450.65 443 .75 185.81 82 MEDICAID WRITEOFF 1 25.00 25.00 71.00 81 MEDICARE WRITEOFF 3 381.00 127 .00 226 .00 70CE COLLECTION EXPENSE 132 4997.54 37.86 1108 .58 70PF PROFESSIONAL FINANCE COLL 14 1928 .16 137 .73 547 .57 83 WRITEOFF 1 23 .50 23 .50 1016 .00 Date:10/10/2000 Weld County Ambulance Page: 1 Time:11:20:12 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2000 344 .20 4 83C 000100180A 01/08/2000 KARICH, LOU 10/09/2000 50 .00 4 83C 000100553A 01/24/2000 MANDEZ, ROSE 10/09/2000 745 .00 4 83C 000100564A 01/24/2000 WAMBOLT FIRING, ETHE 10/09/2000 685 .00 4 83C 000100676A 01/28/2000 RAPELJE, DANIEL 10/09/2000 290 .00 4 83C 000100685A 01/28/2000 RAPELJE, DANIEL 10/09/2000 570.00 4 83C 000100694A 01/29/2000 EREBIA, ANNE 10/09/2000 270 .00 4 83C 000100698A 01/29/2000 EREBIA, ANNE 10/09/2000 25 .00 4 83C 000100709A 01/29/2000 SIEBERS, EDWIN 10/09/2000 748.00 4 83C 000200830A 02/03/2000 SISNEROS, DARLA 10/09/2000 885.00 4 83C 000200846A 02/04/2000 GILBERT, WILLIAM 10/09/2000 25 .00 4 83C 000200889A 02/05/2000 HALL, COLE 10/09/2000 124 . 88 4 83C 000200955A 02/08/2000 SPITZER, ALICE 10/09/2000 710 .00 4 83C 000200992A 02/10/2000 CRAIN, VIRGINIA I 10/09/2000 330 .00 4 83C 000201018A 02/11/2000 NICHOLS, ROBERT 10/09/2000 298.00 4 83C 000201048A 02/12/2000 HILL, WILLIAM 10/09/2000 695.00 4 83C 000201056A 02/12/2000 MANUEL JR, DENNIS 10/09/2000 611 .14 4 83C 000201078A 02/13/2000 WAYMAN, PENNY 10/09/2000 152 .64 4 83C 000201095A 02/14/2000 HILL, WILLIAM H 10/09/2000 650 .00 4 83C 000201111A 02/14/2000 AFRIDI, AMORY 10/09/2000 543 .80 4 83C 000201230A 02/19/2000 SNELLING, HOLLY A 10/09/2000 985.00 4 83C 000201340A 02/24/2000 WINTERS, CHRISTOPHER 10/09/2000 695.00 4 83C 000201445A 02/29/2000 ESPARZA, APRIL M 10/09/2000 290 .00 4 83C 000201447A 02/29/2000 ESPARZA, APRIL M 10/09/2000 442 .20 4 83C 000301471A 03/01/2000 LONGORIA, ABBYGAIL 10/09/2000 755 .00 4 83C 000301476A 03/01/2000 SALAZAR, JUANITA 10/09/2000 80 .00 4 83C 000301478A 03/01/2000 MITCHELL, ED 10/09/2000 80.00 4 83C 000301489A 03/02/2000 TREVINO, VANESSA 10/09/2000 755.00 4 83C 000301502A 03/02/2000 GALLEGOS, MARISELA 10/09/2000 545 .00 4 83C 000301504A 03/03/2000 RILEY, AMY 10/09/2000 80 .00 4 83C 000301511A 03/03/2000 MUNOZ, ARIANA 10/09/2000 760 .00 4 83C 000301553A 03/04/2000 PEREZ, JOSE RUBEN 10/09/2000 80 .00 4 83C 000301555A 03/04/2000 DEVISSER, JANNELLE 10/09/2000 545.00 4 83C 000301572A 03/04/2000 BENAVIDEZ, GENEVA 10/09/2000 720.00 4 83C 000301601A 03/05/2000 YELVINGTON, TAMI 10/09/2000 290 .00 4 83C 000301602A 03/06/2000 YELVINGTON, TAMI 10/09/2000 472.80 4 83C 000301606A 03/06/2000 LAING, JEFFREY 10/09/2000 470 .00 4 83C 000301629A 03/06/2000 HARRISON, GREGORY T 10/09/2000 80 .00 4 83C 000301630A 03/06/2000 HERNANDEZ, JERALINE 10/09/2000 650 .00 4 83C 000301649A 03/07/2000 GARCIA, SARAH 10/09/2000 185.19 4 83C 000301654A 03/07/2000 GIROUARD, JANNETTE M 10/09/2000 840 .00 4 83C 000301678A 03/08/2000 HERNANDEZ, RAFAEL 10/09/2000 560 .00 4 83C 000301679A 03/08/2000 KRUEGER, CHRIS 10/09/2000 760 .00 4 83C 000301679C 03/08/2000 MCCORMICK, BRANDON 10/09/2000 650 .00 4 83C 000301691A 03/08/2000 NARANJO, WILLIAM 10/09/2000 725 . 00 4 83C 000301695A 03/09/2000 OJEDA, GABRIEL 10/09/2000 650 .00 4 83C 000301702A 03/09/2000 WHITE, ANGELA 10/09/2000 590 .00 4 931' 0003017022 03/09/2000 WHITE, BABY BOY 10/09/2000 680 .00 4 83C 000301705A 03/09/2000 SAND, TRISHA 10/09/2000 428 .00 4 83C 000301722A 03/09/2000 SEE, JASON )ate:10/10/2000 Weld County Ambulance Page: 2 'ime:11:20 :12 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name L0/09/2000 930 .00 4 83C 000301741B 03/11/2000 LITTLE EAGLE, WINONA L0/09/2000 25.00 4 83C 000301750A 03/11/2000 MAESTAS, BRANDON L0/09/2000 80 .00 4 83C 000301761A 03/11/2000 FESLER, JOHN 10/09/2000 770 .00 4 83C 000301781A 03/12/2000 HERNANDEZ, ALFONSO LO/09/2000 710.00 4 83C 000301785A 03/12/2000 GARZA, ROY 10/09/2000 905 .00 4 83C 000301793A 03/13/2000 PROSPERO, DEJARENAY 10/09/2000 650 .00 4 83C 000301833A 03/14/2000 ESPARZA, APRIL 10/09/2000 730.00 4 83C 000301854A 03/15/2000 GAONA, TONYA 10/09/2000 725 .00 4 83C 000301858A 03/15/2000 ARAGON, LEROY A 10/09/2000 785.00 4 83C 000301883A 03/16/2000 TRAYNOR, CONNIE 10/09/2000 555.00 4 83C 000301897A 03/17/2000 GALLEGOS, EUGENE 10/09/2000 710 .00 4 83C 000301905A 03/17/2000 CAMPOS, JESUS 10/09/2000 715 .00 4 83C 000301910A 03/17/2000 BARRERA, CHRISTINE 10/09/2000 565.00 4 83C 0003019108 03/17/2000 FERNANDEZ, FLOR 10/09/2000 670 .00 4 83C 000301910O 03/17/2000 REYES, MAGDA 10/09/2000 670 .00 4 83C 000301910D 03/17/2000 FERNANDEZ, MARY 10/09/2000 855.00 4 83C 000301917A 03/17/2000 RISHEL, DREXEL 10/09/2000 695 .00 4 83C 000301919A 03/17/2000 MARQUEZ, DANIEL 10/09/2000 710 .00 4 83C 000301921A 03/17/2000 MORGAN, CAROL 10/09/2000 605.00 4 83C 000301925A 03/18/2000 HERNANDEZ-ORNELAS, J 10/09/2000 80 .00 4 83C 000301930A 03/18/2000 REUSSON, TRACY 10/09/2000 695 .00 4 83C 000301933A 03/18/2000 CHAPPELL, ZACHARY S 10/09/2000 55.00 4 83C 000301935A 03/18/2000 CARDONA, DIANA 10/09/2000 80.00 4 83C 000301938A 03/18/2000 BONELLO, KIMBERLY 10/09/2000 80 .00 4 83C 000301938B 03/18/2000 BONELLO, EMILY 10/09/2000 845.00 4 83C 000301948A 03/18/2000 VALENTINE, CALVIN 10/09/2000 695.00 4 83C 000301958A 03/19/2000 RANDOLPH, TRISTEN 10/09/2000 1105 .00 4 83C 000301978A 03/20/2000 KIDWELL, KIMBERLY 10/09/2000 590.00 4 83C 000301983A 03/20/2000 HORNE, ANTHONY 10/09/2000 290.00 4 83C 000301990A 03/21/2000 HORNE, ANTHONY 10/09/2000 785 .00 4 83C 000302001A 03/21/2000 LOPEZ, GERARDO 10/09/2000 290 .00 4 83C 000302003A 03/21/2000 LOPEZ, GERARDO 10/09/2000 54 .50 4 83C 000302022A 03/22/2000 RASBERRY, VICTOR 10/09/2000 80 .00 4 83C 000302023A 03/22/2000 ORONA, YESENIA 10/09/2000 590 .00 4 83C 000302040A 03/23/2000 SANCHEZ, REBEKAH 10/09/2000 640 .00 4 83C 000302043A 03/23/2000 THOMAS, FRANCES F 10/09/2000 290 .00 4 83C 000302050A 03/23/2000 GARCIA, RICKY L 10/09/2000 760 .00 4 83C 000302052A 03/23/2000 BICKEL, BRUCE 10/09/2000 695.00 4 83C 000302054A 03/23/2000 MARTINEZ, JOE 10/09/2000 795 .00 4 83C 000302057A 03/23/2000 STANDING SOLDIER, EA 10/09/2000 290 .00 4 83C 000302060A 03/24/2000 MARTINEZ, JOE 10/09/2000 80 .00 4 83C 000302062A 03/24/2000 SALAYANDIA, ALBERTO 10/09/2000 825 .00 4 83C 000302068A 03/24/2000 SISNEROS, DANIEL J 10/09/2000 290 .00 4 83C 000302092A 03/25/2000 STORY, DONNA R 10/09/2000 25.00 4 83C 000302094A 03/25/2000 HORST, HANNA 10/09/2000 100 .00 4 83C 000302097A 03/25/2000 HILL, MIKE 10/09/2000 770 .00 4 83C 000302110A 03/26/2000 LOZANO, SALVADOR 10/09/2000 665 .00 4 83C 000302113A 03/26/2000 STURGIS, CARY 0 10/09/2000 25. 00 4 83C 000302124A 03/26/2000 HAYES, RITA L Date:10/10/2000 Weld County Ambulance Page: 3 Time:11:20:13 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2000 670 .00 4 83C 000302127A 03/26/2000 MELENDEZ, LETICIA 10/09/2000 710.00 4 83C 000302131A 03/26/2000 SOLIZ, NICHOLAS 10/09/2000 795.00 4 83C 000302135A 03/27/2000 BRAATEN, IVAN DUANE 10/09/2000 369. 10 4 83C 000302145A 03/27/2000 ALONZO, PETER T 10/09/2000 50.00 4 83C 000302155A 03/27/2000 JOHNSON, JR, CALVIN 10/09/2000 80.00 4 83C 000302160A 03/27/2000 HARRISON, GREG 10/09/2000 80.00 4 83C 000302166A 03/27/2000 BADIAL, JENNIFER 10/09/2000 710 .00 4 83C 000302183A 03/28/2000 RAY, HAROLD 10/09/2000 815.00 4 83C 000302191A 03/28/2000 MCGUIRE, SUSAN R 10/09/2000 730. 00 4 83C 000302193A 03/28/2000 MOORE, HEATHER 10/09/2000 54 .50 4 83C 000302223A 03/30/2000 QUALLS, JOSHUA 10/09/2000 290 . 00 4 83C 000302242A 03/30/2000 STANDING SOLDIER, EA 10/09/2000 675.00 4 83C 000302244B 03/30/2000 KUHRTS, STEPHEN 10/09/2000 660 .00 4 83C 000302255A 03/30/2000 KLUG, KOBY S 10/09/2000 615 .00 4 83C 000302259A 03/30/2000 CLOSSON, CHRISTOPHER 10/09/2000 436 .00 4 83C 000302279A 03/31/2000 REAY, ETHEL M 10/09/2000 80 .00 4 83C 000302293A 03/31/2000 MORRIS, MATT 10/09/2000 695.00 4 83C 000402312A 04/01/2000 TOVAR, JOCELYN 10/09/2000 585.00 4 83C 000402316B 04/01/2000 PANDO, GUILLERMO 10/09/2000 790. 00 4 83C 000402322A 04/01/2000 GREEN, KAREN E 10/09/2000 545 .00 4 83C 000402324A 04/01/2000 BURT, JAMES 10/09/2000 605 .00 4 83C 000402326A 04/01/2000 MUNGUIA, WILLIAM 10/09/2000 80 .00 4 83C 000402327A 04/01/2000 GARCIA, JOHN R JR 10/09/2000 860.00 4 83C 000402331A 04/02/2000 CORDOVA, HELEN 10/09/2000 136 .00 4 83C 000402333A 04/02/2000 NOLASCO, LUIE 10/09/2000 80 .00 4 83C 000402345A 04/02/2000 BENNETT, MICHELLE 10/09/2000 80 .00 4 83C 000402349A 04/02/2000 SEGUNDO, AMPILIO 10/09/2000 80 .00 4 83C 000402359A 04/03/2000 BROOKEY, JUSTINE 10/09/2000 735 .00 4 83C 000402373A 04/03/2000 SMITH, OTIS 10/09/2000 765. 00 4 83C 000402380A 04/04/2000 CORTEZ, ROBERT 10/09/2000 755 .00 4 83C 000402386A 04/04/2000 FOX, MATTHEW 10/09/2000 670 .00 4 83C 000402387A 04/04/2000 RIGGINS, MARK 10/09/2000 80.00 4 83C 000402396A 04/04/2000 GRONQUIST, MARK 10/09/2000 890 .00 4 83C 000402399A 04/04/2000 JUMP, JUSTIN 10/09/2000 200 .00 4 83C 000402417A 04/05/2000 MALDONADO, CAMILLA 10/09/2000 605 .00 4 83C 000402428A 04/05/2000 LAURENCE, DOROTHY 10/09/2000 555 .15 4 83C 000402439A 04/06/2000 ANDERSON, DORIS 10/09/2000 710 .00 4 83C 000402452A 04/06/2000 HILLJE, KYLE 10/09/2000 760.00 4 83C 000402453A 04/06/2000 BOWEN, PATRICIA 10/09/2000 80. 00 4 83C 000402474A 04/07/2000 FRAZIER, ROBIN 10/09/2000 695 . 00 4 83C 000402494A 04/08/2000 BOND, STEVEN 10/09/2000 645 .00 4 83C 000402495A 04/08/2000 DRESSLER, ROSE 10/09/2000 625.00 4 83C 000402496A 04/08/2000 HUERTA-PEREZ, JORGE 10/09/2000 590.00 4 83C 000402497A 04/08/2000 COLLINS, THOMAS 10/09/2000 545 .00 4 83C 000402513A 04/08/2000 CARSON, DEMETRIA 10/09/2000 695 .00 4 83C 000402527A 04/08/2000 PENA, JESSICA 10/09/2000 545 . 00 4 83C 0000402539A. 04/09/2000 HAMLET, MATTHEW 10/09/2000 226 .00 4 83C 000402551A 04/09/2000 GENTRY, MATTHEW 10/09/2000 290 .00 4 83C 000402562A 04/10/2000 STEEL, JAMES Date:10/10/2000 Weld County Ambulance Page: 4 Time:11:20:13 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2000 650 .00 4 83C 000402565A 04/10/2000 SIEH, MIKE 10/09/2000 590 .00 4 83C 000402567A 04/10/2000 SANDERS, NANCY 10/09/2000 80.00 4 83C 000402568A 04/10/2000 COX, PAULA 10/09/2000 290.00 4 83C 000402570A 04/10/2000 RIZO, TOMMY 10/09/2000 665 .00 4 83C 000402571A 04/10/2000 FULTON, DEBRA 10/09/2000 80 .00 4 83C 000402576A 04/11/2000 STALL, KENT 10/09/2000 80 .00 4 83C 000402583A 04/11/2000 NAVARRETTE, RAYMOND 10/09/2000 25.00 4 83C 000402584A 04/11/2000 HOLMES, KENNETH 10/09/2000 580.00 4 83C 000402591A 04/11/2000 DEVISSER, JANNELLE 10/09/2000 545 .00 4 83C 000402592A 04/11/2000 GALLEGOS, MARISELA 10/09/2000 545 .00 4 83C 000402606A 04/12/2000 TROTCHIE, JACK 10/09/2000 40 .00 4 83C 000402609A 04/12/2000 CHEATHAM, MIKE 10/09/2000 710.00 4 83C 000402615A 04/12/2000 DIAZ, MICHELLE 10/09/2000 143 .00 4 83C 000402617A 04/12/2000 NIELSEN, DEBORAH 10/09/2000 595 .00 4 83C 000402624A 04/13/2000 BARRIOS, ANTONIO 10/09/2000 835 .00 4 83C 000402633A 04/13/2000 KLUG, PENNY 10/09/2000 735.00 4 83C 000402640A 04/13/2000 HERNANDEZ, ALEX 10/09/2000 666.14 4 83C 000402643A 04/13/2000 ERWIN, LUCILLE 10/09/2000 60.00 4 83C 000402646A 04/13/2000 RILEY, AMY 10/09/2000 80.00 4 83C 000402654A 04/14/2000 MILLER, JADE 10/09/2000 25 .00 4 83C 000402659A 04/14/2000 SANCHEZ, LUCY 10/09/2000 545 .00 4 83C 000402661A 04/14/2000 ANDRADE, MEGAN R 10/09/2000 290 .00 4 83C 000402673A 04/14/2000 HOFFMAN, ERICK 10/09/2000 545.00 4 83C 000402684A 04/14/2000 HOLMES, MICHAEL 10/09/2000 875.00 4 83C 000402689A 04/15/2000 ELLISON, DARIUS 10/09/2000 293 .20 4 83C 000402693A 04/15/2000 SWANSON, GARY 10/09/2000 15 .00 4 83C 000402709A 04/15/2000 WOOD, LULA 10/09/2000 695 .00 4 83C 000402717A 04/15/2000 HOSTA, JOSE 10/09/2000 80 .00 4 83C 000402734B 04/16/2000 HASKETT, NICOLE 10/09/2000 80 .00 4 83C 000402736A 04/16/2000 PALMA, ETOLINA 10/09/2000 695.00 4 83C 000402746A 04/16/2000 SAINT, KIM 10/09/2000 836.14 4 83C 000402756A 04/17/2000 BAIRD, NORA M 10/09/2000 650.00 4 83C 000402759A 04/17/2000 HEIL, MARY T 10/09/2000 290 .00 4 83C 000402762A 04/17/2000 HEIL, MARY T 10/09/2000 80 .00 4 83C 000402769B 04/17/2000 BAREFOOT, ANDREW 10/09/2000 705.00 4 83C 000402771A 04/17/2000 MCCARROLL, DAISY L 10/09/2000 80 .00 4 83C 000402797A 04/18/2000 BARSALONA, RAYMOND 10/09/2000 545.00 4 83C 000402807A 04/19/2000 MYERS, DENNIS 10/09/2000 675.00 4 83C 000402811A 04/19/2000 NAUGLE, WILLIAM 10/09/2000 288.00 4 83C 000402830A 04/20/2000 HERTEL, FREDRICK 10/09/2000 940.00 4 83C 000402832A 04/20/2000 RUPP, ERIC 10/09/2000 660 .00 4 83C 000402836A 04/20/2000 MYERS, DENNIS 10/09/2000 605 . 00 4 83C 000402877A 04/21/2000 REYES, LUCINO 10/09/2000 545.00 4 83C 000402878B 04/21/2000 REZA, SHELLY 10/09/2000 650.00 4 83C 000402879A 04/21/2000 TOUBEAUX, EMILIA 10/09/2000 545 .00 4 83C 000402885A 04/22/2000 BENEVIDEZ, THOMAS 10/09/2000 80 . 00 4 83O 000402887A 04/22/2000 BERNHARDT, TONI 10/09/2000 253 .50 4 83C 000402894A 04/22/2000 REYES, JOHN C 10/09/2000 290 . 00 4 83C 000402915A 04/22/2000 KING, ROXANNE Date:10/10/2000 Weld County Ambulance Page: 5 Time:11:20 :14 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2000 650.00 4 83C 000402917A 04/22/2000 SANCHEZ, DAKOTA 10/09/2000 650.00 4 83C 000402925A 04/23/2000 APRISPE, JESSIE B 10/09/2000 780 .00 4 83C 000402932A 04/23/2000 ODENBAUGH, VALERIE 10/09/2000 685.00 4 83C 000402933A 04/23/2000 GALLEGOS, CHRIS 10/09/2000 815.00 4 83C 000402939A 04/23/2000 GILROY, DAVID 10/09/2000 545.00 4 83C 000402943A 04/24/2000 APRISPE, JESSIE B 10/09/2000 38.86 4 83C 000402957A 04/24/2000 HUGHES, MINDY 10/09/2000 625.00 4 83C 000402958A 04/24/2000 SHUMATE, TANYA 10/09/2000 770.00 4 83C 000402961A 04/24/2000 PROCOPIO, NICK 10/09/2000 80 .00 4 83C 000402966A 04/24/2000 REEDIN, JASON 10/09/2000 256 .32 4 83C 000402967A 04/24/2000 OCHOA, GLEN A 10/09/2000 681.14 4 83C 000402979A 04/25/2000 DITTMER, BERNICE 10/09/2000 425. 00 4 83C 000402987A 04/25/2000 HOLSCLAW, EVAN 10/09/2000 1025.00 4 83C 000402988A 04/25/2000 THYFAULT, JERAMY 10/09/2000 865 .00 4 83C 000402990A 04/25/2000 CORDOVA, SEVERO 10/09/2000 290 .00 4 83C 000402994A 04/25/2000 HEIL, MARY T 10/09/2000 645. 00 4 83C 000402997A 04/25/2000 LYNN, LORNA 10/09/2000 200.00 4 83C 000403001A 04/26/2000 GONZALES, GRACE MARY 10/09/2000 855 .00 4 83C 000403002A 04/26/2000 HASTING, MARK 10/09/2000 290 .00 4 83C 000403003A 04/26/2000 BUSH, ASHLEY 10/09/2000 80. 00 4 83C 000403007A 04/26/2000 DEI.AFUENTE, LEON 10/09/2000 519.02 4 83C 000403020A 04/26/2000 SCHUPMAN, KRISTINA M 10/09/2000 716.14 4 83C 000403026A 04/26/2000 HARRIS, ROBERT JOSEP 10/09/2000 695.00 4 83C 000403030A 04/26/2000 HELD, NICOLE J 10/09/2000 700 .00 4 83C 000403033A 04/26/2000 MORRELL, GIESELE M 10/09/2000 765.00 4 83C 000403043A 04/27/2000 GUZMAN, ROSA 10/09/2000 590 .00 4 83C 000403052A 04/27/2000 HASTING, MARK 10/09/2000 650.00 4 83C 000403058A 04/28/2000 ANDRADE, EDWARD 10/09/2000 307. 90 4 83C 000403073A 04/28/2000 SCHIEL, BETTY A 10/09/2000 865 .00 4 83C 000403086A 04/29/2000 JOYNER, WOODARD 10/09/2000 561.14 4 83C 000403088A 04/29/2000 WOODRUFF, HELEN 10/09/2000 596.14 4 83C 000403100A 04/29/2000 KOONCE, LYDIA 10/09/2000 545.00 4 83C 000403113A 04/30/2000 NEZ PEACE, DENNIS 10/09/2000 896 .14 4 83C 000403120A 04/30/2000 NAKAMOTO, ELTON 10/09/2000 695 .00 4 83C 000503161A 05/02/2000 TIBBENS, BRIAN 10/09/2000 50 .00 4 83C 000503165A 05/02/2000 JOHNSON, CALVIN 10/09/2000 905. 00 4 83C 000503173A 05/02/2000 CHICK, GUY 10/09/2000 750.00 4 83C 000503190A 05/03/2000 SCOBEE, DEANNA 10/09/2000 645 .00 4 83C 000503190B 05/03/2000 KRAFT, DAVID 10/09/2000 695.00 4 83C 000503203A 05/04/2000 BENAVIDEZ, GENEVA 10/09/2000 695.00 4 83C 000503228A 05/05/2000 ESPINOSA, ADAM 10/09/2000 775.00 4 83C 000503235A 05/05/2000 CELLS, JUAN 10/09/2000 290 .00 4 83C 000503254A 05/06/2000 ARCHULETA, ANTHONY 10/09/2000 85.50 4 83C 000503267A 05/06/2000 CHRISTY, ROGER L 10/09/2000 650. 00 4 83C 000503289A 05/07/2000 AREL7.ANO, CESARIO 10/09/2000 650 .00 4 83C 000503312A 05/07/2000 BAREA, ADRIANA 10/09/2000 80 . 00 4 83C 000503317A 05/08/2000 DELACK, PATRICK 10/09/2000 25.00 4 83C 000503340A 05/09/2000 BRADY, PAULENE 10/09/2000 755 . 00 4 83C 000503379A 05/10/2000 ADAMS, WILLIAM Date:10/10/2000 Weld County Ambulance Page: 6 Time:11:20:14 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2000 80.00 4 83C 000503384A 05/10/2000 AKER, SHERYL 10/09/2000 545 .00 4 83C 000503416A 05/11/2000 HERNANDEZ, RENALDO 10/09/2000 715 .00 4 83C 000503446A 05/13/2000 CHAVEZ, SANDRA T 10/09/2000 725.00 4 83C 000503465A 05/13/2000 ESPINO, YOLANDA 10/09/2000 290.00 4 83C 000503467A 05/13/2000 CHAVEZ, SANDRA T 10/09/2000 590.00 4 83C 000503500A 05/14/2000 DAVIS, TIANA 10/09/2000 695 .00 4 83C 000503503A 05/15/2000 GOODWIN, MARK 10/09/2000 425.00 4 83C 000503511A 05/15/2000 HARRISON, GREGORY T 10/09/2000 650.00 4 83C 000503519A 05/15/2000 ESCAMILLA, MARGARITA 10/09/2000 675.00 4 83C 000503525A 05/16/2000 GONZALES, JAVIER 10/09/2000 240 .14 4 83C 000503529A 05/16/2000 WOODRUFF, HELEN 10/09/2000 710 .00 4 83C 000503535A 05/16/2000 FOGLE, MICHAEL 10/09/2000 80 .00 4 83C 000503536A 05/16/2000 HARRISON, GREG 10/09/2000 80 .00 4 83C 000503537A 05/16/2000 VANELSACKER, EVE 10/09/2000 42 .48 4 83C 000503547A 05/17/2000 DUWALDT, SCOTT 10/09/2000 161.42 4 83C 000503556A 05/17/2000 DUWALDT, SCOTT 10/09/2000 795.00 4 83C 000503561A 05/17/2000 VIZCAINO, PAULINO 10/09/2000 670 .00 4 83C 000503569A 05/17/2000 BARGER, SHANNON 10/09/2000 650 .00 4 83C 000503600A 05/19/2000 BOLTJES, RICK 10/09/2000 80 .00 4 83C 000503603A 05/19/2000 HORNE, ANTHONY 10/09/2000 840 .00 4 83C 000503626A 05/20/2000 ANDERSON, DANIEL 10/09/2000 590 .00 4 83C 000503661A 05/21/2000 COLIN-PEREZ, ADAIR E 10/09/2000 605.00 4 83C 000503672B 05/21/2000 PENA, JESSICA 10/09/2000 50 .00 4 83C 000503674A 05/21/2000 DILL, CODY 10/09/2000 695 .00 4 83C 000503688A 05/22/2000 CISNEROS, AURELIO 10/09/2000 80 .00 4 83C 000503691D 05/22/2000 GRELLE, DAN 10/09/2000 755 .00 4 83C 000503692A 05/22/2000 GRELLE, DAN 10/09/2000 80.00 4 83C 000503695A 05/22/2000 DILKA, ED 10/09/2000 650 .00 4 83C 000503720B 05/22/2000 BAILEY, MOLLY 10/09/2000 795 .00 4 83C 000503722A 05/23/2000 COFFEY, LEO 10/09/2000 565.00 4 83C 000503732A 05/23/2000 SOTO, ALMA 10/09/2000 795.00 4 83C 000503734A 05/23/2000 CABANELA, MICHELLE 10/09/2000 735 .00 4 83C 000503736A 05/23/2000 LAZARIN, CYNTHIA 10/09/2000 290 .00 4 83C 000503737A 05/23/2000 CABANELA, MICHELLE 10/09/2000 590 .00 4 83C 000503746A 05/24/2000 HARDESTY, BRIDGETT 10/09/2000 775 .00 4 83C 000503763A 05/24/2000 ATAYDA, ARTURO 10/09/2000 780.00 4 83C 000503840A 05/27/2000 ARCHULETA, DESIREE 10/09/2000 80 .00 4 83C 000503852A 05/27/2000 TREVIZO-TACAVERA, SA 10/09/2000 720 .00 4 83C 000503861A 05/28/2000 DRAKE, NORRIS L 10/09/2000 545 .00 4 83C 000503872A 05/28/2000 TOVAR, MANUAL 10/09/2000 80 .00 4 83C 000503895A 05/29/2000 BROWNLEE, TODD 10/09/2000 635.00 4 83C 000603985A 06/01/2000 DRAKE, NORRIS L 10/09/2000 695 .00 4 83C 000604003A 06/02/2000 PADILLA, MAX 10/09/2000 870 .00 4 83C 000604041A 06/03/2000 BARNES, ROBERT 10/09/2000 545 .00 4 83C 000604066A 06/03/2000 KIEL, ROBERT 10/09/2000 80 .00 4 83C 000604078A 06/04/2000 CANO, DESTINI 10/09/2000 695 . 00 4 83C 000604197A 06/08/2000 MURRISON, BRENDA 10/09/2000 290 .00 4 83C 000604208A 06/08/2000 MURRISON, BRENDA 10/09/2000 695 .00 4 83C 000604216A 06/09/2000 STIMPLE, JAMES Date:10/10/2000 Weld County Ambulance Page: 7 Time:11:20:14 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2000 650 .00 4 83C 000604221A 06/09/2000 JIMENEZ, ARNULDO 10/09/2000 555 .00 4 83C 000604237A 06/10/2000 CRANE, SHAWN 10/09/2000 695 .00 4 83C 000604257A 06/10/2000 SOLIS, AURELIO 10/09/2000 545.00 4 83C 000604302A 06/12/2000 RILEY, MICHAEL 10/09/2000 58. 00 4 83C 000604327A 06/13/2000 SUTTON, GARY D 10/09/2000 915 .00 4 83C 000604380A 06/14/2000 BROWNLEE, TODD 10/09/2000 58. 00 4 83C 000604405A 06/15/2000 SUTTON, GARY D 10/09/2000 710 .00 4 83C 000604515A 06/19/2000 PAULSON, SHARRI 10/09/2000 290 .00 4 83C 000604521A 06/20/2000 ALANIZ, DAVID A 10/09/2000 695.00 4 83C 000604583A 06/21/2000 GERDES, LISA 10/09/2000 635 . 00 4 83C 000604592A 06/21/2000 SUTTON, GARY D 10/09/2000 660 .00 4 83C 000604599A 06/21/2000 SCHAVE, TANYA 10/09/2000 555 .00 4 83C 000604600A 06/21/2000 GAMEZ, RAUL 10/09/2000 545.00 4 83C 000604640A 06/23/2000 PAPOL, JAMES 10/09/2000 865 .00 4 83C 000604649A 06/24/2000 VEGA, JOSE 10/09/2000 656 .14 4 83C 000604706A 06/25/2000 GARCIA-BUENO, JESUS 10/09/2000 695.00 4 83C 000604725A 06/26/2000 YOUNGS, LOUIS 10/09/2000 710 .00 4 83C 000604726C 06/26/2000 LINO-RAZO, JUAN 10/09/2000 425 .00 4 83C 000604744A 06/27/2000 GARZA, ROY 10/09/2000 80.00 4 83C 000604766A 06/27/2000 MARTINEZ, CHRIS 10/09/2000 720 .00 4 83C 000604819A 06/29/2000 BERWANGER, THOMAS 10/09/2000 660 .00 4 83C 000604822A 06/29/2000 MORALES, HUMBERTO 10/09/2000 815.00 4 83C 000604979A 06/21/2000 ERICHSEN, TAMMY MICH 10/09/2000 650.00 4 83C 000704861A 07/01/2000 COLE, JESSIE 10/09/2000 425.00 4 83C 000704865A 07/01/2000 GARZA, ROY 10/09/2000 635 .00 4 83C 000704869C 07/01/2000 BOCANEGRA, GUADALUPE 10/09/2000 605.00 4 83C 000704874A 07/01/2000 PORTER, TERRY 10/09/2000 710. 00 4 83C 000704885A 07/01/2000 STEVENS, CHARITY 10/09/2000 545 .00 4 83C 000704892A 07/02/2000 BARRON, GUADALUPE 10/09/2000 605 .00 4 83C 000705034A 07/06/2000 CAMPOS, JULIO CESAR 10/09/2000 695.00 4 83C 000705120A 07/08/2000 GUILLEN-CARRILLO, LU 10/09/2000 650 .00 4 83C 000705127A 07/09/2000 HERRERA, CARLOS 10/09/2000 555 .00 4 83C 000705174A 07/10/2000 COMACHO, HECTOR 10/09/2000 665.00 4 83C 000705241A 07/12/2000 GOMEZ-ORTIZ, GUILLER 10/09/2000 80 .00 4 83C 000705256A 07/12/2000 ROICE, MICHELLE 10/09/2000 605 .00 4 83C 000705313A 07/14/2000 DEHERRERA, JESSICA 10/09/2000 290 . 00 4 83C 000705318A 07/14/2000 DEHERRERA, JESSICA 10/09/2000 590 .00 4 83C 000705329A 07/14/2000 STRONG, MELISSA 10/09/2000 545.00 4 83C 000705341A 07/15/2000 BRAND, ARTIE 10/09/2000 545 .00 4 83C 000705379A 07/16/2000 CORTEZ, ROBERT 10/09/2000 139. 30 4 83C 000705591A 07/24/2000 TIEMAN, LEO 10/09/2000 545.00 4 83C 000805847A 08/02/2000 MARES, LEONARD 10/09/2000 695 .00 4 83C 000805936A 08/05/2000 MONTANO PEREZ, RUBEN 10/09/2000 660 .00 4 83C 000806203A 08/14/2000 BUCK, KENNETH 10/09/2000 605. 00 4 83C 000806237A 08/15/2000 HEADING, MARK 10/09/2000 670 .00 4 83C 000806442A 08/23/2000 BUCK, KENNETH 10/09/2000 605 .00 4 83C 000806443A 08/23/2000 TROTCHIE, JACK 10/09/2000 650 .00 4 83C 000806445A 08/23/2000 BAKER, JIMMIE D 10/09/2000 80 . 00 4 83C 000806453A 08/23/2000 GONZALES, ANTONIO Date:10/10/2000 Weld County Ambulance Page: 8 Time:11:20 :15 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 10/09/2000 545. 00 4 83C 000806483A 08/25/2000 GADDIS, TRACY 10/09/2000 715 .00 4 83C 000806530A 08/26/2000 BUCK, KENNETH 10/09/2000 840 .00 4 83C 000806559A 08/28/2000 BALENSEIFEN, GENE 10/09/2000 545 .00 4 83C 000806560A 08/28/2000 BUCK, KENNETH 10/09/2000 695 .00 4 83C 000806564A 08/28/2000 CHAI, ERIC 10/09/2000 705.00 4 83C 000806565A 08/28/2000 ESTRADA, STEVE 10/09/2000 645 .00 4 83C 000806585A 08/28/2000 BELL, JAMES 10/09/2000 545 .00 4 83C 000906911A 09/08/2000 CANAVAN, VICKI 10/09/2000 240 .00 4 83C 980503155A 05/17/1998 KLEIN, JASON 10/09/2000 76.00 4 83 990301975A 03/14/1999 LITLEFIELD, KEITH 10/09/2000 60 .00 4 83C 990603956A 06/01/1999 SUTTON, GARY 10/09/2000 76 .00 4 83 990604262A 06/12/1999 MATTENY, JESSICA 10/09/2000 76 .00 4 83 990705339A 07/21/1999 MACIAS, JOSE 10/09/2000 207. 50 4 83C 990705352A 07/21/1999 BETZ, LAURA ANN 10/09/2000 10 .00 4 83C 990907163A 09/28/1999 GLENN, LINDSEY 10/09/2000 620 .00 4 83C 991007983B 10/29/1999 BARRON, DONNA 10/09/2000 620 .00 4 83C 991007983C 10/29/1999 BARRON, JOANN 10/09/2000 620. 74 4 83C 991108824A 11/29/1999 MAYFIELD, RUDY H 10/09/2000 415 . 17 4 83C 991108833A 11/30/1999 THOMAS, CLARK 10/09/2000 110 .88 4 83C 991208909A 12/02/1999 GONZALES, LESLIE 10/09/2000 270 .00 4 83C 991209043A 12/07/1999 JIMENEZ, JOSHUA 10/09/2000 635.00 4 83C 991209069A 12/08/1999 SANDOVAL, JOYCE 10/09/2000 292 .03 4 83C 991209135A 12/10/1999 KARICH, LOU 10/09/2000 126 .00 4 83C 991209407A 12/22/1999 HUNT, CAROL V Total of 367 writeOff Entries Totaling 182916 .18 Dollars Average WriteOff: 498 .41 Dollars Average Time:179 Days . Date:10/10/2000 Weld County Ambulance Page: 9 Time:11:20 :15 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 10/09/2000 Thru 10/09/2000 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 364 182688.18 501.89 176 .11 83 WRITEOFF 3 228.00 76 .00 502 .00 1 Date:11/15/2000 Weld County Ambulance Page: 1 Time:10:18:49 Receipt, Write-off, Adjustment Batch Report - MRR300 WriteOffBatch From 11/14/2000 Thru 11/14/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/14/2000 855.00 4 83C 000100503A 01/22/2000 RODRIGUEZ, DAVID 11/14/2000 50.00 4 83C 000100578A 01/25/2000 KENNEDY, MARVIN 11/14/2000 625.00 4 83C 000200888A 02/05/2000 GALVAN, JOSE 11/14/2000 81.50 4 83C 000200935A 02/07/2000 JAVALERA, THERESA 11/14/2000 80.00 4 83C 000301745A 03/11/2000 MAYES, TRENTON 11/14/2000 25.00 4 83C 000301954A 03/19/2000 KELM, JACK 11/14/2000 710.00 4 83C 000302379A 04/03/2000 CERVANTES, MELISSA 11/14/2000 25.00 4 83C 000303192A 05/03/2000 GIBSON, WILLIAM 11/14/2000 695.00 4 83C 000402438A 04/06/2000 RAEHAL, ADA 11/14/2000 705.00 4 83C 000402446A 04/06/2000 SANCHEZ, JULIE 11/14/2000 75.00 4 83C 000402454A 04/06/2000 PANTOJA, BENITO 11/14/2000 25.00 4 83C 000402511A 04/08/2000 REHFIELD, GARY 11/14/2000 960.00. 4 83C 000402522A 04/08/2000 DIAZ JR, FRANCISCO 11/14/2000 665.00 4 83C 000402632A 04/13/2000 LANG, SHARON 11/14/2000 BANKRUPTCY 705.00 4 83 000402652A 04/14/2000 TAYLOR, PAM 11/14/2000 BANKRUPTCY 290.00 4 83 000402678A 04/14/2000 TAYLOR, PAM 11/14/2000 785.00 4 83C 000402753A 04/17/2000 JACKSON, BRENDA 11/14/2000 284 .00 4 83C 000402774A 04/18/2000 JOHNSON, VANESSA 11/14/2000 656.14 4 83C 000402847A 04/20/2000 HEBERLING, RICHARD 11/14/2000 605.00 4 83C 000402935A 04/23/2000 STAUFFER, BARBARA 11/14/2000 99.70 4 83C 000403018A 04/26/2000 THOMPSON, ALEX 11/14/2000 420.00 4 83C 000403077A 04/28/2000 RIOS, JASON 11/14/2000 710.00 4 83C 000403160A 05/02/2000 MEDINA, ALEXANDER P 11/14/2000 417.01 4 83C 000503130A 05/01/2000 JACKSON, DAVID 11/14/2000 825.00 4 83C 000503155A 05/02/2000 LEE, NICKOLE 11/14/2000 179.60 4 83C 000503175A 05/02/2000 GREFFET, ERIC 11/14/2000 290.00 4 83C 000503216A 05/04/2000 RAMIREZ, TOBY 11/14/2000 710.00 4 83C 000503224A 05/05/2000 LANG, SHARON 11/14/2000 705.00 4 83C 000503233A 05/05/2000 WILKERSON, LAURA 11/14/2000 290.00 4 83C 000503237A 05/05/2000 WILKERSON, LAURA 11/14/2000 710.00 4 83C 000503239A 05/05/2000 NEWTON, TERRY 11/14/2000 870.00 4 83C 000503261A 05/06/2000 FERGUSON, FRANK J 11/14/2000 560.00 4 83C 000503263A 05/06/2000 NERE, JOSE EDUARDO 11/14/2000 80.00 4 83C 000503282A 05/06/2000 GRIECO, JERRY 11/14/2000 650.00 4 83C 000503287A 05/07/2000 MARTINEZ, TOMMY 11/14/2000 356.14 4 83C 000503290A 05/07/2000 VANGORDES, LLOYD 11/14/2000 735.00 4 83C 000503305A 05/07/2000 GUERRERO, ALICIA 11/14/2000 755.00 4 83C 000503308A 05/07/2000 MORADO, JOSE 11/14/2000 725.00 4 83C 000503309A 05/07/2000 SCHAFFER, SHURRI 11/14/2000 715 .00 4 83C 000503324A 05/08/2000 RAMOS, MELISSA 11/14/2000 605.00 4 83C 000503342A 05/09/2000 LANG, SHARON 11/14/2000 780.00 4 83C 000503353A 05/09/2000 SPEARS, RAMONA LEE 11/14/2000 25.00 4 83C 000503364A 05/09/2000 HOFFMAN, CHRIS 11/14/2000 590.00 4 83C 000503365B 05/09/2000 ONTIVEROS, MARIO 11/14/2000 290.00 4 83C 000503366A 05/09/2000 RAMIREZ, DAVID 11/14/2000 16.00 4 83C 000503390A 05/10/2000 ELLIS, EMILY 11/14/2000 98.00 4 83C 000503394A 05/10/2000 ELLIS, EMILY 11/14/2000 516.80 4 83C 000503412A 05/11/2000 REDDIN, JOHN D 11/14/2000 650 .00 4 83C 000503423A 05/12/2000 TANG, SHARON Date:11/15/2000 Weld County Ambulance. Page: 2 Time:10:18:50 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/14/2000 Thru 11/14/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/14/2000 290.00 4 83C 000503429A 05/12/2000 LOZOYA, STACI 11/14/2000 755.00 4 83C 000503468A 05/13/2000 GONZALES, RAFAEL 11/14/2000 545.00 4 83C 000503476A 05/14/2000 VELASQUEZ, CANDIDO 11/14/2000 25.00 4 82 000503487A 05/14/2000 MELLIN, GLADYS 11/14/2000 290.00 4 83C 000503501A 05/14/2000 MARROW, BRAD 11/14/2000 695.00 4 83C 000503502A 05/15/2000 GARCIA, OBDULIA 11/14/2000 840.00 4 83C 000503521A 05/15/2000 SIME, TODD 11/14/2000 80 .00 4 83C 000503532A 05/16/2000 WALKER, DEBBIE 11/14/2000 80.00 4 83C 000503551A 05/17/2000 MESE, KATHLEEN 11/14/2000 695.00 4 83C 000503558A 05/17/2000 LOPEZ, ELISSA FRANCE 11/14/2000 25.00 4 83C 000503570A 05/17/2000 MOODY, LAURA 11/14/2000 503.63 4 83C 000503574A 05/17/2000 MCCOY, COLLEEN L 11/14/2000 605.00 4 83C 000503575A 05/17/2000 LOZOYA, STACI 11/14/2000 590.00 4 83C 000503576A 05/17/2000 SMITH, ROBERT L 11/14/2000 80.00 4 83C 000503580A 05/18/2000 MARTINEZ, CHRIS 11/14/2000 409.69 4 83C 000503581A 05/18/2000 GROGAN, OSCAR 11/14/2000 701.14 4 83C 000503584A 05/18/2000 RUIZ, SOPHIA 11/14/2000 290.00 4 83C 000503588A 05/18/2000 LOZOYA, STACI 11/14/2000 650.00 4 83C 000503591A 05/18/2000 SOLL, RAE 11/14/2000 25.47 4 83W 000503596A 05/18/2000 SANDOVAL, MARIA 11/14/2000 545.00 4 83C 000503604A 05/19/2000 SALINAS-VILLANUEVA, 11/14/2000 726.14 4 83C 000503612A 05/19/2000 SANDERSON, ROBERT W 11/14/2000 473.48 4 83C 000503621A 05/19/2000 ZAMORA, BLANCA 11/14/2000 80.00 4 83C 000503633A 05/20/2000 YBARRA, BETSY 11/14/2000 715.00 4 83C 000503642A 05/20/2000 GARCIA, JUAN 11/14/2000 545.00 4 83C 000503672A 05/21/2000 PENA, BABY GIRL 11/14/2000 835.00 4 83C 000503684A 05/21/2000 SMILER, RICKY A 11/14/2000 616.62 4 83C 000503691A 05/22/2000 STURTEVANT, TAMARA 11/14/2000 616.62 4 83C 000503691B 05/22/2000 BASS, TATE 11/14/2000 616.62 4 83C 000503691C 05/22/2000 GRELLE, MORGAN 11/14/2000 935.00 4 83C 000503708A 05/22/2000 ROBINSON, JIMMY 11/14/2000 686.14 4 83C 000503714A 05/22/2000 SNOW, FRED M 11/14/2000 605.00 4 83C 000503718A 05/22/2000 ROYBAL, WILLIAM 11/14/2000 80.00 4 83C 000503720D 05/22/2000 RILEY, DENISE NICOLE 11/14/2000 290.00 4 83C 000503735A 05/23/2000 STRONG, COURTNEY 11/14/2000 675.00 4 83C 000503751A 05/24/2000 WILSON, BILLIE JO 11/14/2000 80.00 4 83C 000503754A 05/24/2000 GILDEZ, MOLLY 11/14/2000 290.00 4 83C 000503758A 05/24/2000 HERNANDEZ, MARGARET 11/14/2000 50.00 4 83C 000503766A 05/24/2000 MARLIN, JEAN 11/14/2000 364.00 4 83C 000503782A 05/25/2000 MORRILL-SANDERS, DEB 11/14/2000 29.00 4 83C 000503801A 05/26/2000 MOORE, DOROTHY ' 11/14/2000 425.00 4 83C 000503820A 05/26/2000 UNDERHILL, DAVID L 11/14/2000 650.00 4 83C 000503830A 05/27/2000 MCWILLIAMS, MIKE 11/14/2000 660.00 4 83C 000503837A 05/27/2000 HIRL, ROBERTA 11/14/2000 80.00 4 83C 000503858A 05/28/2000 JONES, MATT C 11/14/2000 685.00 4 83C 000503881A 05/29/2000 GARCIA, DAVID JR 11/14/2000 290.00 4 83C 000503888A 05/29/2000 VALDEZ, GILBERT 11/14/2000 412 .75 4 83C 000503900A 05/29/2000 KEITH, EDWARD 11/14/2000 80 .00 4 83C 000503903A 05/30/2000 HONESTO, JOE Date:11/15/2000 Weld County Ambulance Page: 3 Time:10:18:50 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/14/2000 Thru 11/14/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 11/14/2000 545.00 4 83C 000503909A 05/30/2000 VARfAS, ISRAEL 11/14/2000 80.00 4 83C 000503917A 05/30/2000 WILLIAMS, JAMIE 11/14/2000 870.00 4 83C 000503947A 05/31/2000 SANTORO, ADRIANNE 11/14/2000 705.00 4 83C 000503963A 05/31/2000 PETTYJOHN, MARTIN 11/14/2000 605.00 4 83C 000603964A 06/01/2000 MARTINEZ, JESSE P 11/14/2000 720.00 4 83C 000604010A 06/02/2000 REEVES, WILLIAM 11/14/2000 292.00 4 83C 000604088A 06/04/2000 GARBISO, PORFELIO J 11/14/2000 - 370.00 4 83W 000604120A 06/05/2000 HALL, COURTNEY 11/14/2000 80.00 4 83C 000604136A 06/06/2000 HALL, DALE 11/14/2000 BANKRUPTCY 570.52 4 83 000604170A 06/07/2000 TAYLOR, PAM 11/14/2000 425.00 4 83C 000604202A 06/08/2000 GALLEGOS, DONALD 11/14/2000 705.00 4 83C 000604206A 06/08/2000 HEIDENREICH, CLINT 11/14/2000 850.00 4 83C 000604224A 06/09/2000 GON7.AT.FZ, JOHN C 11/14/2000 650.00 4 83C 000604258A 06/11/2000 HERNANDEZ, MARISELA 11/14/2000 590.00 4 83C 000604332A 06/13/2000 KAYALA, PETER 11/14/2000 80.00 4 83C 000604379A 06/14/2000 HAWKER, JAMES 11/14/2000 725.00 4 83C 000604430A 06/16/2000 JACKSON, JASON 11/14/2000 695.00 4 83C 000604433A 06/17/2000 HOLGUIN, JAIME 11/14/2000 75.00 4 83C 000604449A 06/17/2000 HERRERA, GLORIA 11/14/2000 696.00 4 83C 000604490A 06/18/2000 MARTINEZ, JESSE P 11/14/2000 25.00 4 83C 000604493A 06/18/2000 KINDSVATER, CYNTHIA 11/14/2000 596.14 4 83C 000604527A 06/20/2000 JOHNSON, MARY ANN 11/14/2000 75.00 4 83C 000604566A 06/21/2000 HERRERA, GLORIA 11/14/2000 80.00 4 83C 000604634A 06/23/2000 JANWAY, DARICE 11/14/2000 695.00 4 83C 000604680A 06/24/2000 PETTYJOHN, MARTIN 11/14/2000 99.20 4 81 000604724A 06/26/2000 JENNINGS, ANTONIE 11/14/2000 590.00 4 83C 000604763A 06/27/2000 MOORE, RYAN 11/14/2000 710.00 4 83C 000604839A 06/30/2000 GOMEZ, JUANA 11/14/2000 99.20 4 81 000705164A 07/10/2000 ANSON, ELIZABETH 11/14/2000 626.14 4 83C 000705168A 07/10/2000 SNOW, FRED M 11/14/2000 605.00 4 83C 000806008A 08/08/2000 YSLAS, ROBERT 11/14/2000 485.30 4 81 000906711A 09/01/2000 MCCLURE, NATHANIEL W 11/14/2000 515.10 4 81 001007618A 10/02/2000 PERALES, SILVESTRE 11/14/2000 422.63 4 81 001007793A 10/09/2000 MIERA, GREGORIO 11/14/2000 354.20 4 81 001007799A 10/09/2000 OKEEFE, WILLIAM 11/14/2000 329.30 4 81 001007812A 10/09/2000 LOMELI, TONI 11/14/2000 438.50 4 81 001007819A 10/09/2000 CAMACHO, MARIA 11/14/2000 291.50 4 81 001007834A 10/10/2000 KAISER, KATHY 11/14/2000 372.23 4 81 001007844A 10/10/2000 REMPFER, LEONA H 11/14/2000 316.50 4 81 001007864A 10/11/2000 PACHECO, BERTHA E 11/14/2000 316.50 4 81 001007891A 10/12/2000 LECHUGA, RODOLFO 11/14/2000 371.43 4 81 001007892A 10/12/2000 GROOM, MARION A 11/14/2000 301.50 4 81 001007918A 10/13/2000 REMPFER, LEONA H 11/14/2000 380.22 4 81 001007947A 10/14/2000 ADAIR, GEORGE 11/14/2000 210.00 4 83C 991007865A 10/24/1999 VIGIL, TASHA C 11/14/2000 232.27 4 83C 991108101A 11/03/1999 LARSON, VIOLET 11/14/2000 634.74 4 83C 991108465A 11/15/1999 MCDONALD, CHARLES 11/14/2000 66.04 4 83C 991209329A 12/18/1999 LARSON, VIOLET Date:ll/15/2000 Weld County Ambulance Page: 4 Time:10:18:51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/14/2000 Thru 11/14/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name Total of 146 WriteOff Entries Totaling 65153 .35 Dollars Average WriteOff: 446.26 Dollars Average Time:175 Days Date:11/15/2000 Weld County Ambulance Page: 5 Time:10:18:51 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 11/14/2000 Thru 11/14/2000 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 125 58074 .05 464 .59 189.35 83 WRITEOFF 3 1565.52 521.84. 196.00 82 MEDICAID WRITEOFF 1 25.00 25 .00 184.00 83W WRITEOFF WORK COMP 2 395.47 197 .74 171.00 81 MEDICARE WRITEOFF 15 5093.31 339.55 50.80 Date: 12/14/2000 Weld Count ; Ambulance Page : 1 Time: 14 :56 :04 Receipt, Write off , Adjustment Batch Report MRR300 WriteOffBatch From 12/13/2000 Thru 12/13/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 12/13/2000 73 .50 4 83C 000100471A 01/20/2000 SANCHEZ, DIANA 12/13/2000 87 .25 4 83C 000200978A 02/10/2000 BROOKS, JEANETTE D 12/13/2000 695 . 00 4 83C 000301651A 03/07/2000 RAMOS, JESUS 12/13/2000 25 .30 4 83C 000301810A 03/13/2000 COTNER, FRANCIS 12/13/2000 109 .00 4 83C 000301852A 03/15/2000 TORRES, GABRIEL 12/13/2000 500 .00 4 83C 000301922A 03/17/2000 FREEL, JOEL 12/13/2000 287 .00 4 83C 000302114A 03/26/2000 HIGH, ARLAN 12/13/2000 417 .03 4 83C 000402394A 04/04/2000 PEIF, JOYE 12/13/2000 290 .00 4 83C 000402458A 04/06/2000 PHILPY, ESTER 12/13/2000 595 . 00 4 83C 000402475A 04/07/2000 COLIN, MARIA 12/13/2000 58 .00 4 83C 000402726A 04/16/2000 VARGAS, KATHERINE 12/13/2000 1075 .00 4 83C 000403102A 04/29/2000 STILLWELL, JOYCE 12/13/2000 177 .50 4 83C 000503178A 05/03/2000 RODRIGUEZ-SANCHEZ, A 12/13/2000 821 .14 4 83C 000503221A 05/05/2000 CAMPBELL, HAROLD 12/13/2000 665 .00 4 83C 000503435A 05/12/2000 WAKEMAN, MARGARET 12/13/2000 475.02 4 83C 000503457A 05/13/2000 LOPEZ, GUADALUPE 12/13/2000 695 . 00 4 83C 000503481A 05/14/2000 SCHWINDT, BRANDON SC 12/13/2000 38 . 16 4 83C 000503523A 05/16/2000 OWENS, TED 12/13/2000 290 .00 4 83C 000503531A 05/16/2000 SCHWINDT, BRANDON SC 12/13/2000 650 .00 4 83C 000503654A 05/21/2000 CARMONA, RENE 12/13/2000 821 .14 4 83C 000503689A 05/22/2000 CAMPBELL, HAROLD 12/13/2000 616.62 4 83C 000503691A 05/22/2000 STURTEVANT, TAMARA 12/13/2000 616 .62 4 83C 000503691B 05/22/2000 BASS, TATE 12/13/2000 616.62 4 83C 000503691C 05/22/2000 GRELLE, MORGAN 12/13/2000 80.00 4 83C 000503691D 05/22/2000 GRELLE, DAN 12/13/2000 650 .00 4 83C 000503720A 05/22/2000 NORTON, MICHAEL 12/13/2000 785. 00 4 83C 000503800A 05/25/2000 PLUCKER, MARTIN 12/13/2000 58.00 4 83C 000503802A 05/26/2000 PLUCKER, MARTIN 12/13/2000 695.00 4 83C 000503897A 05/29/2000 NOLETT, SHAWNA L 12/13/2000 290 . 00 4 83C 000503904A 05/30/2000 NOLLETT, SHAWNA 12/13/2000 705.00 4 83C 000603982A 06/01/2000 BECHTEL, KAREN 12/13/2000 725 . 00 4 83C 000604062A 06/03/2000 WOOD, KENNETH 12/13/2000 555. 00 4 83C 000604098A 06/04/2000 WEIDENKELLER, STEVE 12/13/2000 555. 00 4 83C 000604113A 06/05/2000 SMITH, CAITLIN 12/13/2000 306.88 4 83C 000604160A 06/07/2000 VEGA, LUZ MARIA 12/13/2000 555.00 4 83C 000604172A 06/07/2000 RODD, RON 12/13/2000 130. 00 4 83C 000604178A 06/07/2000 ZAMORA, ARTHUR 12/13/2000 795 . 00 4 83C 0006042558 06/10/2000 CHRISTMAN, BRIAN 12/13/2000 690 . 00 4 83C 000604256A 06/10/2000 RIES, BRAD 12/13/2000 695. 00 4 83C 000604261A 06/11/2000 TILLMAN, KATIE 12/13/2000 795. 00 4 83C 000604262A 06/11/2000 RIVERA, BEATRICE 12/13/2000 80 . 00 4 83C 000604280A 06/11/2000 RODRIGUEZ, IDA 12/13/2000 670. 00 4 83C 000604317A 06/12/2000 STROHM, DANIEL 12/13/2000 80 .00 4 83C 000604323A 06/13/2000 SCHAEFER, CHERYL 12/13/2000 580 . 00 4 83C 000604314A 06/13/2000 RODRIGUEZ, JAMIE 12/13/2000 650 .00 4 83C 000604373A 06/14/2000 BARRON, JOSE 12/13/2000 290 .00 4 83C 000604401A 06/1S/2000 STROHM, DANIEL 12/13/2000 765-00 4 83C 000604403A. 06/15/2000 SLOAN, TRISHA 12/13/2000 675 . 00 4 8.15 0006044225 06;16/2000 FRIAS, ALFONSO Date:12/14/2000 Weld County Ambulance Page : 2 Time:14 :56:05 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/13/2000 Thru 12/13/2000 Date Source Check 4 Branch U Value T RWA Code Invoice Inv Date Patient Name 12/13/2000 865 . 00 4 83C 000604438A 06/17/2000 KENITZER, LANCE 12/13/2000 290 . 00 4 83C 000604441A 06/17/2000 KENITZER, LANCE 12/13/2000 665 . 00 4 83C 000604459A 06/17/2000 BROOKS, JEANETTE D 12/13/2000 555 . 00 4 83C 000604489A 06/18/2000 SMALL, CHRISTY 12/13/2000 40 . 00 4 83C 000604497A 06/18/2000 RAMSEIER, MARJORIE 12/13/2000 735 . 00 4 83C 000604499A 06/19/2000 STEELE, JAMES 12/13/2000 650 . 00 4 83C 000604504A 06/19/2000 ALANIZ, JOEL 12/13/2000 650 . 00 4 83C 000604505A 06/19/2000 WRIGHT, KRISTINE 12/13/2000 695 . 00 4 83C 000604560A 06/21/2000 ROBERTS, THOMAS 12/13/2000 870 . 00 4 83C 000604609A 06/22/2000 STROHM, DANIEL 12/13/2000 780 . 00 4 B3C 000604613A 06/22/2000 SAIGHMAN, PHYLLIS 12/13/2000 650 .00 4 83C 000604618A 06/22/2000 RODRIGUEZ, ANNA 12/13/2000 695 .00 4 83C 000604643A 06/23/2000 RIVAS, MIGUEL 12/13/2000 785 . 00 4 83C 000604662A 06/24/2000 SEATON, TROY 12/13/2000 695 . 00 4 83C 000604698A 06/25/2000 WILLIAMS, CLINTON 12/13/2000 815 . 00 4 83C 000604726A 06/26/2000 LINO-RAZO, RUBEN 12/13/2000 755 .00 4 83C 000604777A 06/28/2000 SCHUMAN, KAREN 12/13/2000 650 . 00 4 83C 000604782A 06/28/2000 BOYCE, LILLIE 12/13/2000 715 . 00 4 83C 000604840A 06/30/2000 STROCK, HEATH 12/13/2000 80 . 00 4 83C 000604844A 06/30/2000 STROCK, HEATH 12/13/2000 740 . 00 4 83C 000604849A 06/30/2000 NOYOLA, JESSICA 12/13/2000 670 .00 4 83C 000604852A 06/30/2000 STROCK, HEATH 12/13/2000 695 . 00 4 83C 000604857A 06/30/2000 SMITH, MIKE 12/13/2000 715 . 00 4 83C 000704858A 07/01/2000 BARRON, MARTIN 12/13/2000 80 .00 4 83C 000704905D 07/02/2000 BLIEK, KODY 12/13/2000 80.00 4 83C 000704905E 07/02/2000 BLIEK, TESSA 12/13/2000 520.00 4 83C 000704921B 07/02/2000 GALVEZ, VIDAL 12/13/2000 80 .00 4 83C 000705000A 07/05/2000 HUGHES, TROY 12/13/2000 80 . 00 4 83C 000705058A 07/07/2000 KENT, ERIC 12/13/2000 545 . 00 4 83C 000705190A 07/11/2000 BOYCE, LILLIE 12/13/2000 339 . 78 4 83C 000705268A 07/13/2000 MASICH, MARILYN 12/13/2000 290 .00 4 83C 000705282A 07/13/2000 FINLEY, MIKE 12/13/2000 545 .00 4 83C 000705342A 07/15/2000 ALVARD-PINEDA, LIBER 12/13/2000 80 . 00 4 83C 000705397A 07/16/2000 BASTARDO, ALICIA A 12/13/2000 650 .00 4 83C 000705552A 07/22/2000 ALVARADO, ARMAND 12/13/2000 945 .00 4 83C 000705597A 07/24/2000 ONEAL, DAMIAN A 12/13/2000 780 . 00 4 83C 000705597C 07/24/2000 ONEAL, BIANCA 12/13/2000 650 . 00 4 83C 000705687A 07/28/2000 CASTENADA, MICHAEL 12/13/2000 80 . 00 4 83C 000805939A 08/05/2000 ESQUIVEL, GABRIEL 12/13/2000 290 . 00 4 83C 000806039A 08/09/2000 BOYCE, LILLIE 12/13/2000 290 . 00 4 83C 000806231A 08/15/2000 LIDDELL, WENDY 12/13/2000 605 . 00 4 B3C 000806424A 08/22/2000 HUGHLEY, STINSON 12/13/2000 690 . 00 4 83C 000806541A 08/27/2000 HOVANIC, DAVID 12/13/2000 655 . 00 4 83C 000806633A 08/30/2000 HOVANIC, DAVID 12/13/2000 473 .60 4 83C 000806674A 08/31/2000 BROWN, PATRICIA 2/1..3/2000 32 . 11 4 83C 310906811A 00, 07, 2000 HERNANDEZ, KRYSIAL 12/13/2000 710. 00 4 83C 000906921A 09/08/2000 HOVANIC, DAVID 32/13/2000 437 . 83 4 81 000907048A 09/12/2000 RUEDA, JOSEPHINE C 12/13/2000 _ 90 .00 4 83C C•090.7085A .9, 14/2000 CARL, JAMES Date: 12/14/2000 Weld County Ambulance Page : 3 Time:14 : 56 :05 Receipt , Write-off , Adjustment Batch Report MRR300 writeOffBatch From 12/13/2000 Thru 12/13/2000 Date Source Check # Branch # Value T RWA Code Invoice Inv Date Patient Name 12/13/2000 695 .00 4 83C 000907133A 09/15/2000 CHAVEZ, FLORENTINO 12/13/2000 80 .00 4 83C 000907154B 09/16/2000 MCCAMMON-WHALES, LIN 12/13/2000 730 . 00 4 83C 000907172A 09/17/2000 HOVANIC, DAVID 12/13/2000 740 .00 4 83C 000907186A 09/18/2000 GALVES, MARIO 12/13/2000 80 . 00 4 83C 001007760A 10/07/2000 FLORES, CANDY N 12/13/2000 545. 00 4 83C 001007931A 10/14/2000 GONZALEZ-TRUJILLO, J 12/13/2000 545. 00 4 83C 001007931C 10/14/2000 CAMACHO-GONZALEZ, JA 12/13/2000 650 . 00 4 83C 001008003A 10/16/2000 GREEN, JAMES D 12/13/2000 695 . 00 4 83C - 001008156A 10/21/2000 DOMINGUEZ, AURORA 12/13/2000 43 .71 4 83C 001008185A 10/23/2000 SIMMONS, RICHARD L 12/13/2000 80 .00 4 83C 001008291A 10/27/2000 ERDMAN, RON 12/13/2000 605 .00 4 83C 001008338A 10/29/2000 BAZAN, NICHOLAS 12/13/2000 290 .00 4 83C 001008386A 10/30/2000 ERDMAN, RON 12/13/2000 327 . 94 4 83C 991108153A 11/04/1999 ROYBAL, FRANCES Total of 112 WriteOff Entries Totaling 55397 .64 Dollars Average WriteOff : 494 .62 Dollars Average Time: 171 Days Date :12/14/2000 Weld County Ambulance Page. 4 Time :14 :56 :06 Receipt, Write-off, Adjustment Batch Report MRR300 WriteOffBatch From 12/13/2000 Thru 12/13/2000 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 111 54959.81 495 . 13 172 . 16 81 MEDICARE WRITEOFF 1 437 .83 437 . 83 92 . 00 Hello