Page 200 - Financial Workbook December

Page # 3 210 + 05/17 $57,870.07 $3,454.50 $3,454.50 $10,857.00 $0.00 $9,047.50 $5,757.50 $0.00 $0.00 $25,662.00 $0.00 $0.00 $0.00 $591.82 $0.00 $869.21 $0.00 $0.00 $374.43 $437.30 $0.00 $0.00 $200.84 $2,473.60 $54.65 $95.53 $150.18

180 06/17 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$11,923.98 $4,935.00 $4,935.00 $3,125.50 $3,125.50 $202.52 $167.99 $370.51

150 07/17 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$5,980.05 $1,316.00 $1,316.00 $493.50 $493.50 $213.68 $632.49 $846.17

120 08/17 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.57 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$14,088.72 $2,796.50 $2,796.50 $200.48 $632.49 $554.13 $974.32 $2,406.99

90 09/17 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$20,000.20 $4,935.00 $4,935.00 $374.98 $562.11 $852.21 $3,803.24 $5,592.54

A/R Aging by Service Date Towne Square Care of Puryear - SNF December 2017 30 11/17 $30,873.46 $18,140.84 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2,467.50 $0.00 $4,441.50 $0.00 $6,909.00 $0.00 $809.51 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $245.05 $0.00 $0.00 $0.00 $0.00 $0.00 $131.48 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3,820.89 $4,191.78 $0.00 $0.00 $5,006.93 $4,191.78 $0.00 $0.
10/17
60

Current 12/17 $24,720.88 $0.00 $0.00 $0.00 $3,454.50 $0.00 $0.00 $0.00 $0.00 $3,454.50 $0.00 $111.50 $0.00 $0.00 $129.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $98.96 $0.00 $340.21 $0.00 $0.00 $0.00

Future Cash $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Total + 12/17 $183,598.20 $9,705.50 $9,705.50 $10,857.00 $3,454.50 $12,666.50 $5,757.50 $2,467.50 $12,173.00 $47,376.00 $1,184.49 $111.50 $259.25 $794.34 $1,137.39 $869.21 $1,432.97 $1,537.82 $374.43 $437.30 $4,777.56 $8,111.63 $200.84 $21,228.73 $54.65 $95.53 $150.18

TOTAL Payer: Medicare A Coins from Insurance MAI TOTAL Payer: Medicare A Coins from Medicaid MAM TOTAL TOTAL Payer: Medicare B Coins from Insurance MBI TOTAL Payer: Medicare B Coins from Medicaid MBM

Date: Jan 18, 2018 Time: 16:43:44 CT User: Zach Bell Resident Name (ID) Curd, Russell (CURDR) BERKLEY, TREVA (BERKT) Fitzgerald, Thomas (FITZ T) Flanary, Dolores (FLAND) Jeter, Daisy (JETED) Palmer, Bertha (PALMB) Smith, Martha (SMITHM) Payer: Medicare B MCB Beane, Jo Nell (BEANJ) Beazley, Rosalie (BEAZ R) Bell, Elsie (BELL E) Conaway, Harvey (CONAH) Flanary, Dolores (FLAND) Kemp, MARION (KEMPM) Krolak, Donald (KROL D) MITCHELL, JAMES (MITCJ) Moon, Clara (MOO