Page 202 - Financial Workbook December

Page # 4 210 + 05/17 $0.00 $0.00 $150.97 $0.00 $167.07 $0.00 $111.56 $429.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6,325.37 $6,325.37 $0.00 $0.08 $0.00 $0.00 $0.00 $0.00 $0.14 $0.00 $0.00 $819.82 $0.00 $820.04

180 06/17 $0.00 $0.00 $51.65 $0.00 $0.00 $42.86 $0.00 $94.51 $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

150 07/17 $0.00 $54.52 $0.00 $0.00 $0.00 $161.35 $0.00 $215.87 $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

120 08/17 $0.00 $11.62 $0.00 $51.13 $0.00 $161.35 $0.00 $224.10 $141.34 $141.34 $0.00 $0.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

90 09/17 $0.00 $0.00 $0.00 $143.37 $0.00 $0.00 $0.00 $239.01 $217.39 $217.39 $495.00 $0.09 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $495.09 $0.00 $0.00 ($225.00) $0.00 $0.00 $0.00 $0.00 $753.00 $0.00 $0.00 $0.00 $528.00

A/R Aging by Service Date Towne Square Care of Puryear - SNF December 2017 60 30 10/17 11/17 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $62.52 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $269.04 $0.00 $33.54 $0.00 $33.54 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $502.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1,961.83 $6,004.43 $0.00 $0.00 $1,961.83 $6,507.13 $0.00 $0.00 $0.00 $0.00 $831.00 $831.00 $0.00 $0.00 $0.00 $0.00 $

Current 12/17 $28.45 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.45 $0.00 $0.00 $121.92 $0.00 $0.00 $33.09 $0.00 $0.00 $3,681.68 $2,492.76 $0.00 $6,329.45 $464.36 $0.00 ($25.00) ($633.20) ($723.96) ($116.68) $0.00 $1,506.00 $0.00 $0.00 $1,057.00 $1,528.52

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 ($6,045.00) ($6,045.00) $0.00 $0.00 $0.00 ($12,090.00) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ($347.94) $0.00 $0.00 ($347.94)

Total + 12/17 $28.45 $66.14 $202.62 $257.02 $167.07 $365.56 $111.56 $1,500.58 $392.27 $392.27 $616.92 $0.14 $502.70 $33.09 ($6,045.00) ($6,045.00) $3,681.68 $10,459.02 $6,325.37 $9,528.92 $464.36 $0.08 $1,412.00 ($633.20) ($723.96) ($116.68) $0.14 $1,141.64 ($347.94) $819.82 $2,737.57 $4,753.83

TOTAL Payer: Medicare B Coins from Private MBP TOTAL TOTAL TOTAL Payer: UnitedHealthCare MCO UMC

Date: Jan 18, 2018 Time: 16:43:44 CT User: Zach Bell Resident Name (ID) Beazley, Rosalie (BEAZ R) Bell, Elsie (BELL E) Conaway, Harvey (CONAH) Flanary, Dolores (FLAND) Kemp, MARION (KEMPM) Krolak, Donald (KROL D) Palmer, Bertha (PALMB) MITCHELL, JAMES (MITCJ) Payer: Private Pay PP Beane, Jo Nell (BEANJ) Bell, Elsie (BELL E) BINKLEY, WILLIAM (BINKW) Flanary, Dolores (FLAND) MITCHELL, JAMES (MITCJ) Noel, Peggy (NOEL) SCOTT, CHARLES (SCOTC) WILLIAMS, ARLON (WILL