Page 200 - Financial Workbook July

Date: Aug 25, 2017 Towne Square Care of Puryear - SNF
Time: 15:01:58 CT A/R Aging by Service Date
User: Zach Bell August 2017 Page # 3
Resident Name (ID) Total Future Cash Current 30 60 90 120 150 180 210
+ 08/17 08/17 07/17 06/17 05/17 04/17 03/17 02/17 + 01/17

Payer: Medicare B Coins from Insurance MBI
Kemp, MARION (KEMPM) $54.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $54.65 $0.00 $0.00
Moon, Clara (MOON C) $95.53 $0.00 $0.00 $0.00 $0.00 $95.53 $0.00 $0.00 $0.00 $0.00
TOTAL $150.18 $0.00 $0.00 $0.00 $0.00 $95.53 $0.00 $54.65 $0.00 $0.00
Payer: Medicare B Coins from Medicaid MBM
Bell, Elsie (BELL E) $54.52 $0.00 $0.00 $54.52 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Conaway, Harvey (CONAH) $202.62 $0.00 $0.00 $0.00 $51.65 $150.97 $0.00 $0.00 $0.00 $0.00
Kemp, MARION (KEMPM) $167.07 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $167.07 $0.00
Krolak, Donald (KROL D) $204.21 $0.00 $0.00 $161.35 $42.86 $0.00 $0.00 $0.00 $0.00 $0.00
Palmer, Bertha (PALMB) $111.56 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $111.56 $0.00
TOTAL $739.98 $0.00 $0.00 $215.87 $94.51 $150.97 $0.00 $0.00 $278.63 $0.00
Payer: Private Pay PP
Barrera, Beatrice (BARR B) ($50.00) $0.00 ($50.00) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Jones, Elaine (JONEE) $0.00 $0.00 ($990.00) $990.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Kemp, MARION (KEMPM) $14,715.00 $0.00 $0.00 $0.00 $0.00 $3,630.00 $4,950.00 $5,115.00 $1,020.00 $0.00
Noel, Peggy (NOEL) ($4,950.00) ($4,950.00) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Paschall, Joetta (PASCJ) ($1,815.00) $0.00 $0.00 $0.00 ($1,815.00) $0.00 $0.00 $0.00 $0.00 $0.00
Prince, Cathy (PRINC) ($1,013.00) ($1,013.00) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
RAINEY, BERNICE (RAINB) ($1,810.00) $0.00 $0.00 ($310.00) ($300.00) ($310.00) ($300.00) ($310.00) ($280.00) $0.00
Smith, Martha (SMITHM) $2,796.50 $0.00 $2,796.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Wright, Mary (WRIGM) $4,986.23 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $380.23 $4,606.00 $0.00
TOTAL $12,859.73 ($5,963.00) $1,756.50 $680.00 ($2,115.00) $3,320.00 $4,650.00 $5,185.23 $5,346.00 $0.00
Payer: Resident Liability PL
Brunzel, Sandra (BRUN S) $656.00 $0.00 $656.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Conaway, Harvey (CONAH) ($549.04) $0.00 $0.00 ($81.40) ($467.64) $0.00 $0.00 $0.00 $0.00 $0.00
Erwin, Wanda (ERWI W) ($6.00) $0.00 ($6.00) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Estes, Brenda (ESTEB) $1,115.86 $0.00 $1,115.86 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Flanary, Dolores (FLAND) $0.00 $0.00 $224.52 $969.99 $0.00 $0.00 $0.00 ($1,046.54) ($147.97) $0.00
Hudson, Edith (HUDS E) ($4.00) ($4.00) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Jeter, Daisy (JETED) $1,115.37 $0.00 $788.00 $327.37 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Krolak, Donald (KROL D) $1,108.10 $0.00 $1,108.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Palmer, Bertha (PALMB) $2,512.00 $0.00 $1,006.00 $0.00 $1,506.00 $0.00 $0.00 $0.00 $0.00 $0.00
RAINEY, BERNICE (RAINB) ($310.00) ($310.00) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Smith, Billy (BSMITH) $241.38 $0.00 $0.00 $0.00 $241.28 $0.10 $0.00 $0.00 $0.00 $0.00
Sykes, Helen (SYKE H) ($4,877.78) $0.00 ($4,394.36) ($483.42) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Sykes, Martha (SYKE) $819.82 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $677.25 $142.57 $0.00