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( ICI w t x a t~ rxr-`~IVSEr C'0 MNUN1 1;A F II'!IN;:i C', ` 1) 0. 01,1 q k.y k, I''IIf'IFil:,ti E;AI'EWN L 77. 47 U2, 91 '3J,+4 5V,0r:1 IIXJ.0 t 0XE:Li L;CILICJT`( T1 00 0. 170 0. (t{I R If r.:':.a! EXPEN'_iC:13 i tti, 4k. A 1:15, 65 1+:14. C1Y 1 ;'7 f'1' : f 1'€ 1 <r clg 2 .1641 Or 177. M 45.0 4 ' J7'1 . iO Not IrVClarllf? t:i 75;`Sl? . . r, 17 I r; As of fLOUPEOtONAL MED1CAt '-N`T6P Ollu?i^i2 ~eaeral Ledger in %vary P44E 1 Al: Aiccunts 61L P<riod 3 F:,,-aI Year Au 0!nt kalance Current 10 Naae Falk F,rvard Fe7iLd Balance fieneral :edw Ceaannt - 0-101-0 CASH 1N BANK -OPERATING IS, 629.4; ReceieEs Jour~ral RJ i,ui5,f Ca<_h C sGurser,ertts CO 3,330 42 5,6,75, 75 3^a,rn 0°103-1 1N'1ESTN.ENTS - iRLA$URY NOTES 300,OiD.00 ?6U,00 U°1GJ-? INVE34ilEltTS -CERTIFICATE OF DEPOSIT UU,000.00 0-104.6 86,000,00 ' TAOTE•PREM/OISI' 906,25- S06.25- 0.111.0 ACCOUNTS RECEIVABLE 446,466,43 JE 1 236 6J 12131/91 84.0C- Recelpts Journal RJ 9,554 86- ^s,638.86- 936,927. S7 0.115-0 ALLORA'ICE FOR OOUBIFUL ACCTS 415,004.23- i 415,084.23• O_IWO ACCTS RECEIVABLE -NON PATIENT 110,939,64 i l n, 939, 64 0-Ili-0 STOCK CERTIFICATE - BETHLLHEM i 2,286,66 2,296,00 0•122,0 INTERE6f REC'EI'VABLE - THOLES 133.15 ' 13315 0.122-1 INTEREOT REWYAM - NOTE 24,941,68 JF 1 237 OJ 12/31191 6,247.92 1/1: ACCRUAL 31,239.60 0-125-0 NOTE RECEIVABLE - LONG TERN 137,188.73 937,198, 73 0-160.0 FURNITURE L EQUIPMENT 2,123,00 21723,00 U°I65-0 ACCUMUlp16D DEPRECIATION OIM4- JE 1 237 OJ 12131191 45,35 1 MONTR COMPUTEN 867,19• 0-21)2.0 CURRENT ACCOUNTS PAYABLE 0.00 Voucher Journal VJ 1,714,83 :u . iY4vk+RP~ H As 0 F'n" PEA en?ral Ledger ui ~uaaary 'age 2 4 i M11 N:I VU nS~ P2:gd 3 4i-:al "ear a2 ActGUnk 8elance rurrv t 10 Nacre Folio i0 ar rerliC Pa lagte dereral Ledger tronaeat Cash Disbursements CD 1,7;4,83 0, 0o 0.205-0 FEDERAL NITNIIOLDING 0,00 0.00 voucher Journal U; 36640 Cash Oisburseaents CD 36t. 11C 0,00 0.206.0 FICA 0,00 4.00 Voucher Journal vi 15648 Cash Dlsburseaants CG k56,&8 0, PO 0-207-0 POND INTEREST PAYABLE 0,00 .2,01:,94 0.210.0 SONGS PAYABLE 22,072,94 9U,00000- 0.321 ; FLNO BALANCE 9u,00C 00 1,880,562,53- 0.326 4 880, 362 53 GAIN LOSS CURRENT YEAR 10, 908, Net Incooi (loss) NI 2,234,46- 13iU771- i 0-401-1 INTEREST INCO,yf - T NOTES 103.69- 703,69 - 0-401-2 INTEREST INCOME NOTE REC. 12,495 84- , Jf t 237 Od' 12131191 61247,92• 1/12 ACCRUAL 0 401 3 INTEREST INCOhE i£RT DEI, ID, 743,76• 966,57- 0.402-1 SAD HOT RECO'JERY T LfWj 766 57- 11920.45- 0-402-1 BAD DEBT WOVERY • MISC. I,826,35- 2339- j 0 403 0 STOCK pIVIDENDS bETHI£NEN 23,39• r ' 0100 Receipts Journal RJ 12,00- f200- ~ ' . i::L, i tic".•,,;' •xiJ. ,n'.-,:}(7iJr4A'L' ~ H FS VI DuoT,'~~ r~.ok sEaIGMAL nE ..aL ~,;~~r af37P/3t LPdgPr in Saw; F+ii ~.ige AC Ci~int5 O?L PPricG 3 fiscal Year 31 Account balance Carrel; 10 class olio Foru)r6 F'tri0d Ualanca Gawal Ledger Cwsaent 0-445-0 9ED;CAL kE''OkDS I,294.48.. 0.5:5 0 ADMINTSIPATIVE ADJGSTMENTS 11394,4$- JE 1236 J,;3L65 dJ ki/113i B4. Co 0.601.0 SALARY EIFOlt 1,215,6; Cash Disburseeents CD 51120,00 2 U48 0o 166.ar, U 61b 0 PAYkOI.I iAJES 71 381 Voucher Journal 70 VJ 156.68 0 618 0 EMPLOYEE PENEFIT5 540,35 .54 Cash Disburseeents CD 180 "0,21 0-631.0 PUFES6IONAL FEES 270 81 Voucher Journal VJ 2, 500.G'U 3u0,UG 0•b59•o COLLECIIl~I CiPCNS'E 1,391,64 keceipts Journal RJ_ 560,63 0-660.0 PORECIAIION ErpmEO 2,550.33 90.76 JE i 237 GJ 12/31191 45.35 1 WIN CONPOT£R 0 b08 0 CDMMNNICATJGN3 13fi.i1 157.78 Voucher Jain VJ 77.47 0.694-0 POSTAGE WENSE 245.25 116.00 Voucher Journal VJ 58,00 9-999.9 lncose Transfer 174.00 t Net Igroae (Lass1 N 10+908,25 I 2,239,46 IJ,147,71 1. 701a) balance Forvard 0.00 Total Activity 0,00 Total Balance O T'c tr.Rtl RS RYSR n~;ROagssR RaRlata C;lCxs;RCxM tst I W t: DEi-:rl'9rp PATIENT CASH FEroF,-r h1fi,h1G: AN1I Ems, l,i~~ I'~I 127, `al C~f'-1 .1 ~ P1ai':',.rl 'J_ •,ni _ t "i.En:j 1, `/~r"Jl 1~Iail~i;', id•li•1'! _ 3'i.'it:'I_',, '9k I,rL_lo3 I , 141 TIE rn.1 X71 ttClFr rr 1'~!ill ~ ~ t' r:>t) 7 r .rtl titJU11U:.r, !tOlttil!' ! 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WIII1'1_l7h1la, 1rUNN(Y ';3p ;iF3y1", 1) IA i; ,fAh1r: S b' U 01r,1 12 ; 1o 9.1 25: if, 5 1 all W IL }:r(;, f AMl[Lr~ ;3C1 1 Q0 6101. o Wkr~3}Ir, +irlAr~~A s.. ! 1 :'.%9 i IPrt N1iX 1 S NF1hll hl it ~-'v I,'t Ni) f - I-I IONci '?r• ~ s r r } i I 4 c~ R ECEIVE 0 1992 FLOW FV11ONAL MEDICAL CENTER Balamca )rwat SLIMMai•ized By Division and Departmarit CITY OFDCiVTON LEGAL DEPT. Decemh~.~r ^1, 13'31 Anaets k At-irCiT3 ,:UF:'F'ENT ASSETS -,;'iSli IN DANK - (JF'Cr WrING C:A:3H IN BANI., - F'AYFOLL YPJ'Jfui7"`1C NTa TREAC311RY BILL 3E3,., ,t,. (0 7 TNOTE-FREM/DIS+:: 906. 23 AC:+:(111N"f :EC:C:I':ACiLF' 936)827,67 ALLOWANCR FOR DOUBTFUL Ai::C:TS (4lc0 84, 23> ACCTS f:EC:EI+lAC<LE -NON PATIENT 110,'33"x.64 SPOOK :FP.TIF IC:ATE: - BETHLEHEM 202130. 00 SURPLUS C,Ek:TIF'ICATE - THIS (:).0(:) REC L i VABL.E - C T`1 Or' DENTON 0, 1:10 INTEREST REC:EIVABLE T-NOTE5 31,372.73 NOTE REC:F.IVASLFE - r:URRENT 0,00 Total CURRENT ASSETS 1066,733 64 OTHEF' A i"3E1 5 NOTE RECEIVABLE. ° L.ON,3 TERM ':Wj iES.73 F'URN11Uli'C: 3, f-WU1r.,P1ENT 2f 723. 00 AI UMULATED DEPRECIATION (862.1'3) Total OTHER ASSETS 339 049,54 Te,tal Astats ~2r 005 783.18 ' rmrrrrdrrrYRRw Liabilities LIAHILITIEEI CURRENT LIAHILITIE:i CURRENT WNDS PAYABLE 0, u0 CURRENT ACCOUNTS PAYABLE 0, q0 FF,DERAL WITHHOLDING 0.00 rIC,A 0,00 BOND INT f, F'AYASLN. 22,072.94 MCEDICAID' ltiE 0,00 Tc,taY RENT L.IAOILITI'ES 22072,'34 LONG TERM LIAMYIl.7IE~3 BONDS FAYAM / 900000.00 DEFERRED INCOME - CITY 0000 Total LON13 TERM LIABILITIES 90y000,00 Total Liabilities -Wrll2a072.94 FUND EALANC:E FUND BALANCE 1,8809562,53 GAIN LOSS C:URRENT YEAR tap 147,71 7r•.tal FUND PALANC:E 1, 8'x:3, 7100 24 k Total 3 Totaal L iabil Itims Amd CapitAl 21 00Sa780.1E3 wrarrrnnrrrrrrrn I -y k:CE,VE FLOW P:E*IONAL MEDIt:AL :EM-_R. JAN-91992 Income bs _atwnent CITY OF upn A:tUAI 6s c, Pkarr•43rtgga! If PyPvIOU5 A::tUal LAL D4NfN 1 Period(s) Ending December 31, 1'3:11 and Ncwember 19)3& De,: O 1 , 1,301 NiI 210 9 1931 IN"OME T DILL s 7 t) (I >E*** INTir:!S3'" INf::DME T NOTra ii,(t(t (t, ;i i r~•* 'NT;:.:.t. r IW.:0,?C: NOTE C'.Fa 6 247.9-2 62111"/,9 1r;1t:.. 1+v7 E.F:E' irV LJimE - :E.P.T DEF' 6(, tr*t BAD DEL, I' hta:i'VL:r"( (il3ENI'IE;i r L, . i IVEF:Y - T. LrWIB i4lf) [4 F*, Gt:'OVERY - EWINFL Do *d *4 t„i} DEBT PEi::UVEF'Y - MISC.. Q.r;)() 0. (;(.o x~ x N. STOC:} blVIDENDb--l;HTNLEHEM 12.()(I Q.(.) l K.xtt.41 MINERAL P!GHTS - ARCHER CO (+,QO ().OG MED h"Al I%'.EGUF:Dc" (t, (:)(;t 1, 3'3=1.43 ;t MISC'ELI:.ANEOUS IWOME (i,Q) 0. 00 * GAIN/LOSS SALE Or EQUIP I:).1)r:+ 0.00 Total `r•IC:0ME E„ .:J'1.'32 706a2140 1.3 W - f DEDUCTIONS OF' REVENUE BAD DEST WRITE-C)F F C+. r:tU 0.00 1** ::QNTRACTLIAL. ADJUSTMENTS r:tt:t (t, OO ~t ~tµ ADMINISrPATIVE: ADJUSTMENTS 184.00 (0529.00) 1W19 Tctstl 7?E:DU_:'rl•ONS OF I:;CVENUE _~(S4,(>C+) r`(5 x13 _ w.r_M_.u_ _MWrr T:,tatl In~~c-mo 6, 175.' 1'. y7, 11:.4(+ 636, 7 EXPENSES SAL.AF Y EXPENSE 049. 00 3, 0724 C)p 66. PAYPrdL.L TAXES 156068 231,11, (52 6G. 7 EMPLOYEE UENE:F'I TS 90 , 27 90. 4217 100. C) f I +l F8,lj'frrrAL FEES yr:t(r,(K) (21560 1 06) 36,0 LEGAL. FEES C+, 00 b, r;)ty tt*.A.* GPrPATING SUPPLIES (t,t;u;) tt,Ctt;r *•>`o•tr t;:OI.LF;C:TIQN EXPENSE 560169 1 x 0060 SS 55." DEFRJtJ. I AT I ON SPSNOES 45.38 90, 16 WC+, ) P,EPAIP EXPENEI# i;)() 0 .06 ~F** P INTEREST EXPEND, 0dor;) tr;xk~t PeNTALILEABE kPOIBE r),isft r:t,bb t.*** I NSUPANCE EXP KA9 i•), s}() rt, C)ft _':OMMLIN I CAT I ONS 77 , 47 82.91 93.4 POSTAfiC 0F(,ENSE 518.r:u:t 58 00 100.0 j TAXES - AF.'i;HVP': COUNTY C). pt:) o, U4 *ttK~t Total EXPENSES 3,936.46 21135.6% 184.3 . Gross Pr,.,flt rL,:ss) u2x239.46 ~4x977.75 4°,r7 Net In:.:,me (Loss) :t0 233.46 4x 977. 7S 4,",'.+:t j aaxaanma~„a Amrt~,x~caaea u,gr.,mat I , f , As ;f `LON RE810NAL MEDICAL CEN-ER 3enaral :edger in Summary Page All Accounts S!L Period 3 fiscal Year 92 Account Balance Current Name {olio rorvaed %eriod 3alance ;ieneral Ledger Coament . 0•:C1.0 CASH IN BANK • OPERATING Rlceiols Journal 15,628 41 RJ 9,006,;7 casr, isa,rsea!r,ts C4 3,330,42- 21, 304 15 0.143.1 1NVEa'~El1T3 Ik£AoUNY !TOTES 204,400,00 300, 004, OC 0.103.2 14YES7"E1'T3 • 11,10,FICA7E Or DEPOSIT 84,10090 ' G0, 004, 04 0.104-0 INOTE-PREMlDiSC 906,25- - ACCOUNTS RECEIVABLE 30625 946, 46b~ 43 JE B 236 OJ 12131191 84,00• Receipts Journal RJ 9,554,86• ' 9, 638, 86- 0.113.0 ALLOUANCE FOR OOUBTFUL ACCTS 436t827,S7 415, OB4, 2~- 415, 064, 23• 0-118.0 ACCTS RECEIVABLE -NON PATIENT 110, 939, 64 0.111.0 STOCK CERTIFICATE • BETHLEHEM 60,939,64 2, 280, 04 0.122.0 INTEREST RECEIVABLE - T•NOT98 2;280,04 13315 133,15 0.122.1 INTEREST RECEIVABLE MOTE ` 24,94L6B JE a 237 12131/91 6 247,92 x r 1112 ACCRUAL 0 115 0 NOTE RECEIVABLE 00 TERM 31,239,60 917,101,73 i d O•:b4.0 PURNiTURE 6 EDUIPMENY 93),16873 2, 723 40 c 2 0 159•? ACCUMULATED OEPRECIATIOH ,123,00 016,84• JE 1 237 OJ 12/31/91 45,35•. 1 MONTH COMPUTER T 4.202.0 CURRENT ACCOUNTS PAYABLE 862,19• y VoucMU Journal VJ 1,7N,83• 1{ i ;FC4{SV R.~4. Y TS a `mot Al of 01/01132 'LOU k(MMAL MFOhAL "EVEP Oenerol ;edger in ;weary All Ac<Owata °+4e ? OIL Period 3 F1aca1 year 92 IAccount Folio Yaee Balance Current Forward Period Baiance ......_.....,-Benerai Ledger Coeeent Diabursesenta CD 0,00 G•209.0 FEDERAL WITNNDIDING O,OG Voucher Journal VJ 0,00 Cash Oieburseeente CD ••••-•••-••366.OG J6b, 00• ` 0,00 0.106-0 flCA 0,00 Voucher Journal VJ 0'00 Cash 011bunesente CD ISb,6B 156, 68• 0.00 0-207-0 BOND INTERE9r PAYABLE 0,00 22, 61.94- 0.21 0 0 80N09 PAYABLE 22,072,94• 90,000.00- e i•311 0 FVMO BALANCE 90,Od0,C0• I, 880 96;, S3- 0.326.0 44IN Lon CURRENT YEAR 060,562,52- 10,900.21- Nit lncate (Lase) N1 2, 2J9, 46- 0.401-1 INTRRLa' INCOME • T NOrE3 903.69• 0.101.2 MAW INCOME • NOrp AEC, 903.69• 12,4l8.W- JE i 231 :i{l 1f/31111 E,241,92• is . 1112 ACCRUAL 0 00! J IN7ERESr INC VC 18,143.16• 46a, 91- ~ 0.402.1 BAD 0"T RECOVERY • 1, LEWIS 966,91• S 11020.35- 0-402-3 BAO DEBT RECOVERY • misc. 11870,35• k f,' 23, 39• , 0.403.0 BfOCK 01VIDENDB•BEfNIENEM 23.39• Rlcelott journal RJ 0,00 12,00- 12,00- 1 r m ~ I Ip5JI At of F1011 RE61ONAL MEDICAL CENTER 1 9ir0T1?2 Oanaral Ledger in SutaarV Page 3 A31 Ac.;;,acts alt Pt;,od 3 Fiscal Yaar 32 Account 94;d~ce Currant 1D Nile Folio Forvard Fariod 8alanct 9enaral ledger Coolant . ,3-05-0 NEDIUL RECORDS 1,394,48- 925 0 ADMINISTRATIVE ADJUSTMENTS 1,!31.69 - JE 1 236 OJ 12!31 91 94,00 1,219,6,; 0.60;•0 SALARY EXPENSE 3,122 00 Cash Dfiburiiatnts CD 2,048.00 7,168, QO 0.616.0 PAYROLL TAXES 391.70 Youchar Journal VJ IE6,dd 548.39 0.61810 EMPLOYEE BENEFITS 180.54 Cash Dlibureefento CD 90,27 270.81 0.631.0 PROFEB810NAL FEES 2,100.00- tlouchor Journal YJ 900.90 0.653.0 COLLECTION EXPENSE 1,640,00- 1,991,64 Receipts Journal RJ 560.69 2, 559.33 0.668.0 OEPRECIATIOM EXPENSES 90.16 JE 1 237 8J 12/31/91 49,35 1 MONTH CONFUTER ( 136. Il i ' 0.688.0 COMMUNICATIONS 167.18 ' f Voucher Journal VJ 11.47 245.25 j 1 0.644.0 PO TAN IxPE I F`~{~ iid~ob 1 Voucher Journal. 98.00 E . 114.00 ; j 9.999.9 Well T►anaf r 10,906.25 I 1 Nei lncoae (Lois) NI 21239,46 13,147.11 y Total 1411ec4t Forva + 0.00 Total Activity 0.00 r Total Balance 0,00 rnurrarnrnrrauerrruuurwa+rmr>IUre F f r F. ' -AS40 r i 1 i ~n DECEMBER PATIENT CASH PEPOR'T -;hIG IN# P~ D AN'LE, Af'EN ;'!i 1 X7'3 $20 ,,:;!:r 1 7'!1 JLAELL 3ci 1 -S ,G t-'15.00 t i 3i' 1 r ~~r.L.L., `I~.1•:LFa '3 1,~J?:i 1y7.~'ip 1' /r./'.11 2, P) I 14 1 ' Z•il .•r'T it •,.Il lili lt:) r yi~~ia 'l11 i'."L'~i ~A'f 'I iF{T, . IEr { 1D"ci $Irui !;i + l~/'ir; .:/ii `91 1 21 t; OW1:N, KATE IL" :,,NI 01~ l1 ! .1 ~.,r )l,7t lt)[) 1+ 7 $5o.. 0C! 1 / f. l'J1 Cf~h,F, :~iFWYL 3r;, C,r.<5r $7g.Crry 1';::'.,r'sl C,AMfSRLE"ru:;U, L.AUP'A wLi 17 1'7 $lia,!uj 1 ;/1,'31 ::AVINi33, l.l:iaiNNFi 3!i 1::641 GiU,i)C 19 /91 +.HAPIi:ELL!?R:' MFIF:CNI 3!;t 12Er:i10 5u,t;,q 12/11/'?il :'(7kLG:`/~ L.ii1 ~ U7460 13l CC/RTEZ NAt:I5A 15 71215 $~Cr. QQ 10/31 /'31 CR:05;3, TER:F:I 215 '?1.118"/ $56.N:t 12/1/91 DANILL TCIMMYC 9 15331Q >~aQ,00 12/2/91 01iAN, LEON 1< 30 227909 $15.t~r> 12/4/' 1 UUUALL, F;'ACHEL 15 64457 $5'00000.) 10/31 1 . DUVALL, F'ACHEL 1 1 1 6047 $GCI,CrC, 11/30 1 t;,c1 12112 4!4 , MADIAZCIR., MELODY 3t:s 01F33 $,MCi, r'PF,E,, OAR'Y 3 2t2k371 12/d/"91 ERWIN) P.OSLMARY 15 Ei°sse) s5i).iIO 1(1/31/'31 r:F:WIN, k003r-MAF:Y 1'S 14505(:) $50.1)0 11/30/x91 E5PIND'3Ap MA;-'TlNA 2z 2,bG600 $10.00 1212,/'31 F•ENL*r''p JDANNE JCr 7354 i)0'N.) 12/17/'31 F-02TEF'1 BET"( 25 212/2667 $2: , b4 12/21 1 31 C;1 'nSVD4 $5.00 12" 1'3/'31 r tal raN, ,;:LINT 12/s./'31 . a.l J trhll+{ 1 EL a 01LEWEATF{, MILDR:ED 0000c)t;, ir'4537 37.°;,1:(1;, 1'2/2/31 :-I 1031203 $4i00 12/2/31 1300UWIp1, DIANA GORDON, ADA J C'tt)nt}Ctt;, 231009 $40.0x1 12/2/131 T $46.00 12/ 14 / 13 1 ,F:EMILLICIN 1lL L.OF:lrS f3 . l1 27060 r HAI:TJiF; LINDA 3133049 $.:1:1Cl000 1~'/~6/ !1 SF/2/'31 ;•{AL.I;LRT, ?.IF>F'1F t;itjc;rt~t?tl 61149 $2e), e)(.1 111838 $5tl.oo 12/6/31 I{Ni'F'I:7 DAVID 30 ,r3r,, 12/132'31 EIAF,ki4i~ Zr'LLA 313 247'334 $10 ? HF.NRI1 J,.: , V iR.'13INIA 30 187045 $50. 12/2/'31 HEFtkF JF:D, THOMAS :-r 34 33789 $105 06 12)6/31 /'/dl F'IINVLl , DAVID 25 176204 $41'.). 1) IT lId4Joe.b, TINNIE 30 270882 $5.00 12/hJ°jI 1 Hu *At+CE LISA 30 223659 $5C,.0 12/5/Si 1:Ai'HK:YN ,"iQ /155158 $25!.00 1 /4/81 IWUCHU!•:WU, NNr.Dl 26 1F3802W $44, x;11;1 1d/lB/S1 { Page 1 iF 1 4 1 NONE N4 P C JUHN50N, li,/.EL 30 ±'.415 :I.J1:1 1.; t:'~1 JOF-r,izj rUr1, ..AUC'A o WGga b ziC;, /2, 91 JC1K{M;TfI]hl, F'AULA 31:1 ; •JI~JC~:3 S . i i6, 1 JuN_`:,, '3" )NLEY 1::) i It:' 1 C>/ 1 /':1 'GN(.'~ ^I'r~r•1Lf:'/ 11:; 1:15115 ~''~.7r:' 1~/L/51 slWr,,.l E:Y. h )'/E IirJ£~AH{/1 t1E:Hf?: e:3::8"~:'~ $S,1~C1 X3/'31 RUGE:n, -1, ;o PION Jci ;.:1 'J TwS.:ji LAblJ. JN, THYF~F'W aJ a1a. CIC' nc ,..31 HARLOW, JOHM 1/::u /'hl :1WaON, iHT1'L.P::'r' 3t1 5(:)26 $10,Or.'1 1'::/6/9l MAYF'IE:LD, MICHAE1. b 171331 V25.Cu:l 12/1 /9 1 MI.:PP11)(71 PAIJLINE 9.13 89-"f:18 $12,";0 12:::'1/')1 Mi: KAY, C,APOL 5 1 C".,: 3f C $10.01:1 4 2 /2/ 1 •'ICICREP E.iCBR1C U 'D 2!~ 1t:1'JH rhi 12/2/1! MQRABITOr VWLLPI 13 4(175 4:)1:) 12/2/91 MOPINCi, Gf:1E15GF'Y 30 ::33G0>3 r10,CIC1 12/5/ 1 NLWELL, AUSTIN 30 1 ON63 115. I:1(:) 12/6/ 1 OL.G~U1N, E'RAN_IOjj:A '3 1'::'3551 ?~.0C1 12/2/ 1 PATLI.I KANLA 40 :;WWI 11 $744, 5'3 12/9/ 1 PATEL, K.AML.A 40 22111 $$$648,21 12/j/ 1 F'CISEINS, NILL'IE 001:100C1 11:4590 $25.0x1 1 :ii1LA5, Ht7F:'rE,Nra1A 3 Sli'17'31 ad..1:10 12/2/91 SAMAYOA, GAHP1EL.LA '3 K35~7:: $2u, >0 12/2/91 SAXE, r.RENDA 31:1 ::42'303 $20. C)O 12/7/181 EJIAAW, ANN 30 1S354'2 $56,1:IC1 121 •15/'31 SMITH, NORMA 00000C1 12372E $50.00 12/2/51 E30WAtRD? MASON 25 247254 tV5. t, 121/2/91 ;3Tw1RF', 5U'31E r,IC10000 44341331 $5O,rx) 12/1::/51 STA I L:-JUN, SAMANTHA 5 1305133 $50, Cu:l 12'/2/"dl ~iWCIFJ)p JAC:K;IE 3C1 265932: $2p,Clr1 12/14/ 3 ;4TF,, MUYELLE are 144483 ~2w.00 12/7/51 'THOPT,30N1 DEANNA ru;1041:14 144061- $81:x.00 1:;/d/ID 1 VOWNSCNO, F'CbERT W t}CioO; 10 2493;7 $2'0,01. 12/' /'31 I• Jr•113L;rAF`F, ::HAPLES 30 130634 $10160 Su/1s/si WALI.AC.E, ADRIENE 23 28642 $2(1,1:10 12/V91 I WALISTON, LARRY M. 30 1'1370x4 2 1'31 1`:/11:1/'31 v1HT13UN, WALLAiJE ~.,5-001:1000 1F31,J2so 8114.'315 12/2/91 i WHATt.EY, DONNA 30 :301234 $2.150 11/3/si WH I T1; OMH, BONNEY 30 )3y7.faF@@J { $16, 00 12/ 11.}/511 WIL1Mfs`F, J(;mFtB 25 i'WJ6~11 58. 6r) 12/2/x31 4 WIEEE, PAMaLA 30 18'3'3x)'3 $10.00 I /12/51 WRIUHT, SHARA L 5 ::10144 820.001 12/::/'31 S r P et 2J ~1 , 1 _pq sn~xaY++.y~ i i `r! SJSJr' TOTAL: ~4.96 { t i t 1 f i f Y j t ' DEC 20 RECT OFFICE OF THE CITY ATTOfiIYYi,r,i~ r `rife MEMORANDUM { To e~ Jo R I~f~~rA,660 9x, utiveMDireator of Finance FROM Jeanette Scott, Legal Assistant SUBJECT'S Flow Regional Medical Center Balance Sheet for November 30, 1991 DATEi Decembar 20, 1991 Attached for your information is a Copy of the November Balance ; I sheet from Flow Regional Medical Center, Should you have any questions in this regard, please let us know, !lave a XAppY HOIaIn#Y j ~ ~>11190N I it t Y,•'.1 ~ aatte Saott I js i Attachment I t 4 "lkdlcalcd to Qrarllly Sarvlca" l- -01 ~ia.• cZ!l )h Lze+t J6ilil fYio' vi: ; j' ~ A l S a nn GI 1eF. i.:' tJ11 E,"l P'1 .4~r,br::1 Y DEC 167991 Cf7}'OrOkNr F+IYF.IJI_L ia1 I!~1) A~ , ~i fi fu , ( I'v~;1.iLc (c It Al , rJY+r r 4 f fJ: 346r •}e W. a 0ISIJ6TF'UL ACCTS f ~ 1 Uh34 , =:3 ) ri + Ir, ',::Ei 6,TVF~['LE? ..N@h 'ATIIJJT 5. I E 1'!F'7 _,yrF BrTHI.ra IEf" ~rl ' L..J5 r, r'7If Ar.: - Tr 411 .TY nf" Urr~rnN l (lil [Nrc 'L C,'' Ft:+::ETYAC<LL' - r._ a. NdTG° C, NOTE F:CC'EIL'AL'+LC t;;IJF'FENT 124. 3w" " .!t xl C:URRI:'NT +93E'T5 L FIEF i , 15641449.83 ,r NpTC FCC:CI.1{11cL.C - LONG TCRM 037r 133.73 F'UPNITURE & LQUIFMCNT ACa::U1ULATwp UCFSECIATIdN ' ~.I~t;l ct,a: UYHFF: A,35aTS (816.84) 939,1)'j4 T-:-t I 21 ax4 WCCmeoma ua.ym Lietb;<Iitl~u LIAPlL.ITIt;-J CaLJR' :ENT LIANILITIES kl~ "LIRRCINIT PONDS F'AYANLE CIJPr,,,CNT A+::":OUIjT" f'AYpL{l.C 00 rE:pG'FtAL WITHHOLDING (1,t5(1 oc) BOND INTEREST PAYABLE rlrr MCGICAIl3 PAYABLE .2,(17<'.'34 ` TotA'J,,.CLIRkeNT LIABILITIES 157%. LdNQ TF:R:M LIApILIrIES 8ON 3 "'A`IA6LE OFiF'faRPED INC:(JME 3r;1~ eic;l(1, (u;l CITY 4 ¢t5 Tatat LONG TERM LIAI+ILITI.6', 'Jl'Ir (lty1;1.14 ? Total Liabilities 12, (:177:. '34 FUND DALANCG FUN!; DALAfi L' i r k1817r X62. ~W } GAIN LOS' i..U>Crvr YEAR 10090e.25 T!-ntal FUND 13ALAnu:E i r 8'3I 1 470, 7E? T;,taI LiahiIitir~a and C:apit'Al aooemmaes!a,ra~>bm~ ' a A,:tUal af, ei i'f3rC Efl+dta7E _J 'r'EdV _I.ii 1 F'eriadr:s7 Ending No.embe '10 991 _ird Jctot, lr 19'31 LNiE.f<:"',.;'' I-kv C"fE - T I:,IL.. INTCRr3r 1NI:UN - n cr r.VEI +3tx! INY G` I JC - .!F) r 7. r.47.:+ 1::,q,tl II•!:'ME - C'Ef.:'r DEF' ; 1£f.57 Cii rr•';KI. '~'ti ~F''.5i {-`iU..: ~•~Li~. I, f!r,' ':1, OS;i I':"i ra0 DE RI-C['VERY i. LEWIS 1:) lc} 1raLO.Cs ;i DAC ;)rLD ~,,ECC1;L'F:Y SENTIfiEL Ut:; ;1. J0 AA t:A1) D[Pr F,E~:.OVrF'Y 2313 STOCi "VIDEJ? DU ' ETHL--HEM C;, c:u;l MINFEPAL FIGHTS Ak: FF U I;1, I,if,1 cr, 00 K' 4( MEOI+::AL PECOPUS 1 4. 4a 1;1.04 a + r i MI' '!ELLAIJEOUS INCOME ~ , c;1c;1 4, r:10 ~**1t "A IJCC -ALL CF ; VUIF' 4. c;u:1 1J0 Tata1 1NI:OME: 7r 642. 40 '3r361.92 r76.7 Y DLDU T 1 ONrc OF PEVENUE DAD DEPT WPITE..-Orr 0, tyc:1 00 *~1 C':(3NTF.'Ail*:TIJAL ADJUSTMENTS 6. 4.1r) 1:1.00 1** ADMINI,IV ATIVE ADJUSTMENTS (52'3.00:1 0602.65) 87. E3 r:rt~ll r y UEDUCTIONFi F 1:E:LPIUE -Y(5219.60) t602`,65:1 07.0 `rcpt al inc.-me 71 113. 40 ~9 3"191 27y y76. c:1 t EXI''ENOF.S SALAD'' EXPENSE 31072.00 2#048.00 150.0 F'AYROI..L. TAXF 7 2'35.02 156.68 130. r.1 E:MF'LOYEE ;IENCF'I Ca '30.47 ':!c). 27 , 10r;1, c:1 PROFES810NAL FEF3 5C 1.00# 0.00 ***+I ',-MAL r'EE5 CI,f11t 60 j OPERATING SUPP,IE9 c;r,,jC,t C~.OC1 ***t CULLECITION EXPENSE 1 r Ci•.1u.63 ssr:1.95 101 . 6 ! DEPRFC;IATION EXPENSES 34.76 Oe? 1t* µ >:XF'6NS 1:1.40 4.00 ~'iF1Ex j I~dTEF'^aT EXPE 0,0c;1 il,flr:1 ^Plth ./LEASL P$NSE 0. c}CI el, 1:u5 INwUPF1NI:C EXP~W$~ r;1, 4cj 0, 00 COMMUNICATIONS 82, s1 84,87 17.7 t POSTAGE EXPENSE 58~ 00 So. 00 100.0 TAXES . ARCHER, iMUNTY ' 6, C1c;1 0.04 _ F 'r,:tal EXPENSES 3r 426.77 62. 3 3vct~~ F'r tfft (L:.~~i J~'330.50 83,'3 I . Net 1'n,;oma cLc.ts5 4,'377.75# W1 9WI:1.~JC1 8319 x - 3 du..~a.rx:n~m nramrls.emmre yaaam 4 a 1 r i r, As rtur Rf6lOslAL MEOI:.. OEkT£f. l General Ledgrr Ia g aaael ;sga 1br i. A., Accounts VL Feriod 2 Fiscal Year 32 kr:o~nt Saiave "orent Nsae Falio Forward Porl:d Balance 8eneral Ledger 'ment . IN BANK - OPERATING 11, 7U '?S 4;liPts Journal ;aan Dltturs~+eats Cp :,530.2v~ 1.90, 46 l S, 629,11 -t03.1 lNVESTr.ENT3 - TRfASUR~ !1a~i3 390, 000.Oa 300, a44, 40 1 4 103 2 INVESIMENTS URIIFICATE Or 6EP0911 i SO,000.GG 1 80, 600.00 ~•144•d iNOTE•PREM/DISC 906 2S- 906.25 • ` 0.111.0 ACC3UNIS RECEIVABLE i# ' 9S1,2S6.3D JE 1232 0J Il/14131 3S),GO- JE 4 233 0J I1122/91 17240• R+c+ipts Journa9 RJ 4,:64,87- 4, 7$9, 07 946x466.43 0.1154 ALLOWANCE FOR DOUBTFUL ACCTS 415,004.21- 415,004.23- 0.110-0 ACCTS RECEIVABLE -NOR PAIIENT 11!x269,64 Roc+lph Ja rnal RJ 270,00- 0-111.0 STOCK CER' IFICATE • IETHLEHEM 3 2, 200, 00 i 2, 200, JO 0.122•C INTEREST RECEIVAILE • T•NOTES 133.15 133.15 0.122.1 INTEREST RECov*c -VIE 10,743.76 JE t 234 01 11!29!91 6,247.92 1112 INT ACCRUAL 2~r99L60 0.125 6 MOLE RECEIVABLE - !OHO TERM s 4 93'7,188, 73 ~431,158.73 ~ 0.160.0 FURNITURE r, COUIPMEMT 2, 723.00 21723,00 a•16S•0 ACCUMULAIED DEPRECIATION ` 726,00- it 1234 eJ 11!29191 90,76• 2 M08 COMM 816, 04• ! . 4 j 9. µ 3, of FLOW RE'110NAL MED!CAL MIER i2i16/91 ieneral Ledger In Suaearl ?aye 2 A : Accounts S/L Period t Racal Year 32 Acsour't Balan:# Currey' :v +aae Folio Forvard Period Salanca Seneral .adger Coaaent C 5 :UFBENT ACCeUNTS PAYABLE 0,00 f 23S !!123;31 19.00 CCRRECT FSB CHECK 'Faucher %o,;rra1 1,.04,35- far.'risCurelser,ts CJ 1,153,35 0,00 0.00 9.205.0 FEDERAL 0,00 7E 11J5 OJ 11/29191 45,00• CORREC' FSB CHECK Uoucher lournll VJ $14.00 C I ash Dlsburseean+s CD 549,00- ' 0, 00 0,00 0.206-0 FICA 0,00 voucher Journal 9J 135,02 Cash Dif4urlefiehts CO 235,52 0.00 0.00 ` 0.107.0 BOND INTEREST PAYABLE 22, 072, 94• ' :2,012.94- 0.210.0 BONDS PAYABLE 10,000.00- 10,000.00. 0.321.0 FUND BALANCE l,SBO, 562,53• I, goo, 362, 83• ' 0.326.0 GAIN LOSS CURRENT YEAR 6, 930, 50- Net Iecoae (Loos) Nl 4,917,15• 14,908,28• 0.401•! INTEREST INCOMBk T NOTES 903, 69• e 1 903.6?• 0.401.2 INTEREST INCOME • Mott REC ~ 6, 2~1, 42• ; JE 1234 01 11/29/91 b,247r92 1/12 INT ACCRUAL } 12, 495, 84• R 0.401.3 INTEREST INCOME • CERT DEP 966,57• i , 966, 57. s 0-402.1 SAD OUT RECOMY - 1, LUIS J 1,820,35• 1, 820, 35• 0.402.3 BAD Out RECOU£RY • N18C, 23, 34• I I 23, 39• i a I u 1. WTHMVy watr.• e! 0 As f FLOW RESIONAL MEOICAL ;ENTER E!?; General Ledger in Suomi Page 3 All Accounts VL period 2 Flscat Year 92 Acrouct Balance *'arenk iu Nate Folio Forward Period Balance General Ledger Ldllent RUMS OC4 Re<eipts -at RI 1~394.4e- 0 5250 AOMICSIPAIIVE AMiTMEITS fi42.65 !E 04, i+ 11/14191 357,0 J£ 1233 OJ ;1122191 1)2'40 529 00 1,131.55 0.601.0 SALARY CO TM :,94800 Cash Qisbursaaants C0 3,012.00 5,120 00 0 616-0 PAYROLL TAXES ISM Voude J4umat VJ 235,0: 391.10 0•bf8 0 EMPLOYEE KNEW$ 90.21 { Cash Olihvsaents CD 90.21 180.54 0.631.0 PROFESSIONAL FEES 0.40 Rsceipks Jaurnai RJ 2,S40.G0- 2,900.00 0-659.0 COLLECTION EXPENSE 590,15 Retefpts Joamal R! 1,006.69 s E 1,941,d~ 1 0.668.0 DEPRECIATION EXPENSES y 0.00 i j J£ f 234 OJ 11129191 90116 2 No$ CONPUTER 90.16 i 0.688.0 40MMUNICATTONB ' $4,81 Voucher Journal 82.91 161.18 G 694.0 MIASE E9E406 t !19100 4cuchet Journal VJ 0.00 116.00 f 9.999.9 Incau Trmfor I 51930.50 Net Woo (Lose) NI 41911.19 10,900,25 1 i ~ s„ ! x. f E2/16;31 FLOW RE61CRAL MEDICAL SEVER uenetal Ledger it 3Uaaarq Al; Aceountr °+9e 4 Oh Period 2 Fiscal year 92 Account Balance Name Folio urran! Forward period Ba;alce Denetal Adger Ccaeent ?atal Baianca Forward J4u ""Al Activity otal Ba;ante 4,40 a~a ~i~airtes~~e~:=S~t~urtatactu~~afreafaas i j r i t f l i r G 1 C t t V {n:LWY9Sµ1 •''!E 1. J ,441 ;!'t,LuL SEI•ELL ^;CI 1 t rs $ j v 11/ i 91 DAPTCL, 1'"17 $'1 (1,'117 11 it .i' U-1 8 L 1 3 :3AMMY 2I $t !E."')I C)r ,-Nf 3}I'1, i _i .+1111 I(:, (1 . 1'{ LI}:_.•' i 1.~3ril.A:.i 'iii: ' i / c+i. 7 li s. S I /1JNYF,UM, 0'' :w :ALDWELL, NA(A)::`/ i!;:ira,;IV II2x:''7 ::AMF'( i_ HtF:7t_ .:61!::5 $7~, nl.1 1 1 / 1 3/':11 ~ , l 1 CAVINES3, L.EANNE 3tj 12641 $ 11:1, 1j 6 :,HANr_,"-„LLCF'i MPRM1 t..w ^il 60 1. 1 $2. i:.a a i (1.1 11/1W/31 OFUZY, L. t69 $1tjrt,tjt:o 1./1/51 -OV6:F', J+t~~IAN ^a 3943J3 kll:>. 00 1 f /4/'31 tlANIILO, OMMYr 3 1`,331('.1 $2:1,00 11/1/31 DI:EDE , EAr'L a() 1::74(10 $20, CI(:s 11 / 12 1 DELAF'IELD, fui DA 242444 $333,1x7 10/7/ D Ii.L.I ON, 1 aA 0 S'v,C1'J5 (+111.00 1 1 / 11 DOWLAT, 3() 282269 $20. oo 1 1/2(1 91 EIL.ANU, JCA'r;JLFIN ;CI 1115796 $25.C>0 f 1/;3/91 EMAUTAZAP, MrLODY 3G 1634GS, $20,t10 10/31 "St tr".3F'INUiA, MAN',TMA 23 2~UOo $wll.rat~ F'ENLE'/, JOW-INE 76354 $ toe), 00 f 1 / f 9/'3 t F'UL:"ONO DIk:J 3x;1 1395'34 $56 11C1 l1 /4/01 13ArLIN, HAZr-,- 3(:1 ;6565: , $20.011 11/W/3t ! GEORGE, k pErEl'C 0 1 5730 1 $6(r, CI('I 1 1 / 1 /'31 +:i I LDREATH, M I LDRED C)oo(Po(:1 199537 $25.00 1 1 /S I (31i.LILAND, SRENDA 30 2p,2Cr3$ $10.110 11/3/'31 3000WIN, DIANA 9 191203 $30,(.10 11/1/31 :'10F DON, ADP J 1CIt1t}Cu1 201 rm:* , $44Y 00 1 1 / 1 /411 orP:EGOPY) ARTHUR WCI le452t $8.0C) 11/26/'31 GREMILLIUNs OE:LORFS 34 2766x1 $40, 00 S 1 /1'3/'31 1UEVAF'A, POW.PT 25 35169 s5. 00 10/'3/'31 HACVP.:, LINDA 30 1"3049 $42,3,51 11/~id1 HARP:213, DAVID 30 t 1183S $56, 06 11 / 110/'31 HARPI<3, ZELLA 30 247n4 $ICIO 1:)o 11; 114/'31 HOWAF:D, TINNIE 30 27E39'3:? $5.(7x,1 HLJC`I:.ALCPj LISA 30 21231C,zS $50. Cu:l i l /7/ 11 HUF.ST, ANTHONY 30 313783 +$15,gCS 11/23/SI . Y M % Page 1 2 IK.Y4xNa + bvGAtM I Nri' L_ "L . IN+30L1), 13L.AD`/S JJIMI~fiN, HAZEL 207,<lil 1: At:.- AN, Lfawt-rTEr ;ti 1 } :EY E'2q.lac;1 ! 1/%,''31 E SAL!, , 3 30 nA . $61i, rl l LL, 3TAllLY ~C -7 1 i34 7 t4tr, !ir 11!' "31 W -,I it NUt4 _IIW:L;PI, 7!rE:F: N •a''. :1FJ6, x.:.i 1, 1.11;'. r L; _tul, 1, sH IF.LL Y P1AYF IEL:, MII_HACL 1~1 MCN: :DE, AULTNE *9 OIDDXG .la l lr'5/'~1 ~I:'C'I_JRC1,1 "}'NE.: jgOcjtr{, A, `11_1~Li1,_jU.L7H, I.. 1J01 PJ, f;lfl 1i 1r J: Ar:ULYN rjOC)1)c)r.i Ml.'I'AY, CAPOL W t~c.Or,1 MUUIW ROEL:;s V } $2s,60 11/1/'J1 'T R-rj1;11;I )00 11<":'2U . 17> An1'I'L11 VALEPI ~S~r (Iq 11/6/'31 _ SU/24/91 MURIPIts, r3pf:,, till a3Fd ~.'c $1CI,Olj r}E:WE[,l , AUSTIN 0 11 /5/91 S08~r;y AIU4lELL, I1,1{ TI5 81Cr,lj(1 11/6/ F'ANNELLr ~ 10Y 25 4G 334 $S , ()C1 11/14 1 t,E7'1S 1:I,I:rp P I EPSON , ' (•'+5TAL $ 1 10/10 1 000 061:; 1 U'34a $5p, cyCj 11 / 1 / PLUMLEE, JAMES : CS 2476'3c1 RACMSI:YI AM$EF, $1w1, 7C1 10/2/1 ll 4 IS $ 1 . I Cu; F•:QDF:II:;U6:Z, GONIA ~ 61 11/1/'31 EO^7CJ RODE I CyUEL $30, 0c) 10/ 4/01 r iUNIA ~5 260370 $30.()1;> ,a• RUUDIC}., FELLA 31;t <:67847 10/L..,, ~i 3WLASp HORTEr15IA $25.41] 11/1 /'31 y $25, 3AMAYUW, +dAl3RIELLA 189'3'D 1 QQ 11/1/91 9 M)672 ,n ~3laUMr t! ifJMAS OCIC;r000I 7 o() 1 l i 1 /x11 x1, $r 'flzl 11/1/31 Sa~xt:, tIF;ENIM 34 42-3,c1 SH(iW, ANN ~ $21.1, C)0 11 !T/91 ~r1E1.E10N LINDA f)tj0(IC)(r wW:'63 $25. 0C) 11 / S /91 ~ ITHI NOFMA 1)41)tjl~l;! T 133726 , $56. (W) It/l/91 AF: , :;USIE jCrl)1)fllr 1434'9:3 06 rx 51'ATESON, SAMANTHA 130593 $,,,rCr.ljl;l 1111, $1 SWC+RUr JAI;};IE 30 ::6,'x1932 $35, {al:: i t I/ I I'D I / 1 /91 TATFr, MWELLE 30 144482 $2s, no VA};IL, SUNIL v ; g 1)373 11/6/91 WAGSTAF'F', +~HA t.ES yL, 3rj $50. )o 11/1/,Di 1386,1 $10,t)C> 11/1g/Sl WALSTUN, PRENDR 30 1'3W'rcj4 $14x.06 WAT1cIN3, BC:+::1CY S 11/2E,/fl.1 WATSO,l, WALLAC:E c)(10000 I U 1,J.. 132 $~10, Ij1t l l / 1 /'3 S 1 d $1x.10.1)0 r S 1 y Page 2 9 s I i n~Rwa NAME OL DONNA X11 L.BUF'N, DERff}:' ~r,l J y irj }4. c;lc;l J :1 x':'91 1 l'1, +7t;r WL+.f'E, I FF ;,CE wUr,rHtr,~~ ry'C'i ' 131 G17. S 11'11;91 yU, •ANF; / 21 x1 ' , ' ~ 1, Cl l 1 • i •r i i il;l,' y l ~ i J ~ j Y Ii Y+, .r, ,nzr w~,.. t;, rtIAUF3tBrl.r4AwanFtPTA _ I M SiCyyµ, healr M 1 RESOLUTION NO,~ A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF DENTON, TEXAS RECOGNIZING THE PETITION OF FLOW REGIONAL MEDICAL CENTER, INC. TO BE DESIGNATED AS THE RECIPIENT NON-PROFIT ORGANIZATION TO CONTINUE EXISTENCE AND ADMINISTER ASSETS IN LIEU OF DISSOLUTION OF THE FORMER FLOW MEMORIAL HOSPITALI AND PROVIDING AN EFFECTIVE DATE. WHEREAS, in December, 1990) Flow Regional Medical Center, Inc, (the "Center") filed with the District Court a plea in intervention and a motion requesting that the Center be designated as the recipient organization to continue existence and administer assets in lieu of dissolution of the former Flow Memorial Hospitals and WHEREAS, in the above-referenced motion, the Center advised the Court that Flows assets presently consist of cash in excess of $2600000 and a note receivable for $1,900,000 and that the Center is the proper recipient organization to administer these assets and carry out the intent of the H.E. Flow Will and provide, insofar as it can, for the health care needs of all the people of the City of Denton and Denton County, Texas regardless of their ability to pay for such care) and WHEREAS, the Council is advised that the Center may request that it be designated as the recipient organization of the assets of the Flow Foundation, which presently consists of approximately one million dollars) and WHEREAS, over the years, the City receives, on an annual bamis, many requests for funding from agencies who provide health related services in the City and there have been, and will continue to be inadequate tax dollars to grant those requests and provide funding) and WHEREAS, the Council wishes to commend the center for taking steps to ensure that the above-mentioned funds will be distributed to nonprofit agencies providing health care services located within the City and the County re ardless of their ability to pay for such care, and thus, establishing a significant resource for agbnoios providing health care services to the citizens of the City) and WHEREAS, the Council wishes to express that it does not wish to object to the Motion filed by the canter, and indeed, views the requested designation as the commencement of a new era in health care funding in Denton by the Centers taking a lead role as the primary funding resource for non-profit health care agonciesl and N 4''rt~4n}7 .aftuir F7 F. WHEREAS, in making a determination not to pursue an objection to the Center's motion, the City Council believes it appropriate to also relinquish its role as a direct provider related services in the futures NOW, THEREFOREoP funds for health BE IT RESOLVED BY THE COUNCIL OF THE CITY OF DENTOM S' That the City Council commands the Center for taking positive steps to ensure available funds to provide for the future health care needs of the citizens of Denton, regardless of their ability to pay. .In errttee.roleaofttheCcityCinnprovidingnresourcesCforenon- agencies providing health care to citizens of Denton i.ugardless of their ability to pay. SEC'PION rr1. That this resolution shall become effective immediately upon its passage and apprroval# PASSED AND APPROVED this the,~,T"-/ day of 1991.. BOB CASTLE69"Yt MAYOR ATTESTt JENNIFER WALTERS, CITY SECRETARY BYI i APPROVED AS TO ISdAL FORMt DEBRA A. DRAYOVITCH, CITY ATTORNEY BYt i k r PANE 2 - 7 r.a'K4'n I I JAN 2 91991 ;1 Cl1Y A1hNAr,E 3ltff~ff. C'"OfDBNrON,MAS MUNICIPAL 8UILDINO / DENTON, TEXAS 76201 / TELEPHONE {8171566.8200 Office of City Attorney C January 29, 1991 Ronald H. Clark, Esq. Henderson Bryant A Wolfe 8th Floor, MBank Bldg. P,4, Box 239 Sherman, Texas 78091 Re: Denton County vs, city of Denton Cause #87-4366-C Dear Ronr Enclosed is the information you requested regarding other City- County hospitals and a 66PY of the Denton County's file on Art, 717-m-1-proceeding excluding plaintiffes petition, Flow, the petitioners requested on Novoiber 3, 1986, that the hearing be postponed indefinitely, it was never resat and was dismissed in August, 1990. Neither the city or the County filed an answer. Sincerely, e ra A. Drayovitch City Attorney DADtlah Enclosure xc: '41pX,d Vo-"' Hqr roll, City manager I .I.JtN1hM 1 r OTHER CITY-COUNTY HOSPITAL ARRANdEMENTS FOR INDI08NT CAIN PAYMENT Seguines Their City Attorney, Steve Kosub, says that the City and the County split indigent care costs 50-50. In the past couple of yyoars, they have not had to pay for indigent care as the hospital is operating in the black. Hondo% Their City. Attorney at the time in question, i.e. 1986- 1119, is now the County Iludge. The now city attorney has been h there a year and a half and thinks it is split 50-50. However, he was going to check on this and get back with me if this wasn't the case. I called to remind him. Sweetwaters Their City Attorney advises that the city and the county split the cost 50-50. Also advised that this was a good deal as Sweetwater's population. population constitutes 80* of the County,s Wichita Fallss The City and the County lease the hospital to 'a non-profit corporation. Through 1988, neither entity had to pay any indigent care costs. I am checking to verify if this continued through August, 19894 i i { E f tai. ' N0. 8~~~6ag~~ J Fll.~p At arekCk hi EX PARTS § IN THE DISTRICT COURT 1 6 1986 § DENTON COUNTY, TEXAS OLADYS WHITTEN DENTON COUNTY HEALTH FACILITIES cLtrsKn+orniCrpWtloaar ur,r,r;: I DEVELOPMENT CORPORATION .58+1k bISTR~PCT-.C011 !s ORDER OF COURT AND NOTICE_0F SETTING OF HEARING THE STATE OF TEXAS § COUNTY OF DENTON § p WHEREAS, in Cause No. in the District Court of Denton County, Texas, Judicial District, styleds "EX PART, DENTON COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION," said Denton County Health Facilities Development Corporation, as Petitioner and as a public agency, has initiated and filed such action as a proceeding in rem in accordance with the provisions of Tex. Rev, Civ, $tat, Ann. art! 717m-1 (Vernon Supp. 1986), for the purpose of obtaining a declaratory judgment as to the authority of the public agency to issue and deliver $10,000 "Denton County Health Facilities Development Corporation Revenue Bonds (Flow Regional Medical Center Project) Series 1986" (the "Bond") and as to the legality and validity of all proceedings, including all actions and expenditures of funds, taken or made and/or proposed to be taken or made in connection with or affecting the proposed issuance, sale and ultimate delivery of the Bond, which will be issued under authority of the General Laws of the State of Texas, particularly Tex. Rev. Civ. Step. Ann. art, 717m-1 (Vernon Supp. 1986), that said securities as above described, are for the purpose of acquiring, constructing, Providing, improving, financing and/or refinancing a health facility) all being more particularly described in the said Petition of the said Denton County Health Facilities Development Corporation, on file in the aforementioned cause, This proceeding is filed as a class action against the taxpayers, property owners, and a VOL.0226PAOE 115 r i i~ residents, if any, of the said public agency, and all nonresidents, if any, owning property therein, and/or all others having or claiming any right, title, or interest in any , property or funds to be affected by the proceedings and/or the issuance of the securities, or interested or affected in any way thereby, or by the proceedings, including all actions and expenditures of funds, taken or made and/or proposed to be taken or made in connection with or affecting the securities. Petitioner, among other matters, alleges its capacity to institute and maintain these proceedings and among other prayers for relief, has prayed of the Court for a Declaratory Judgment as to its authority as a "public agency" to issue the above-described securities and provide for the payment and security thereof as set forth in the Petition, and as to the legality and validity of all proceedings taken and/or proposed to be taken in connection therewith, and as to the legality and validity under all other subjects or inquiry appropriate for determination under Tex, Rev, Civ. Stat. Ann, art. 711m-1, §20 if any, NOW Th,.REFORE, BE IT ORDEREDt NOTICE IS HEREBY GIVEN TO: All taxpayers, property owners and residents, if any, of Denton County Health Facilities Development Corporation, a public agency, and all nonresidents, if any, owning property therein, and/or all others having or claiming any right, title, or interest in any property or funds to be affected by the proceedings and/or the issuance of that certain $10000 "Denton County Health Facilities Development Corporation Revenue Bonds (Flow Regional Medical Center Project) Series 1486", or interested or affected in any way thereby, or by the proceedings, including all actions and expenditures of funds, taken or made and/or proposed to be taken or made in connection with or affecting the securities, including the legality and validity of the Asset Transfer Agreement by and among Flow VOL, 0226PAGE i16 ; ORDER OF COURT AND NOTICE OF SETTING OF HEARING - Page 2 Regional Medical Center, the County of Denton, the City of Denton and the Board of Directors of Flow Memorial Hospital, which provides among other matters for the transfer of Flow' Memorial Hospital to flow Regional Medical Center, and all such persons and the Attorney General of the State of Texas are hereby commanded to appear for hearing nd trial at 10:00 o'clock A.M. on the first Monday after the expiration of twenty (20) days from the date of issue of this Order, and show cause why the prayers of the petition of the Denton County Health Facilities Development Corporation above-described should not be granted and the proceedings and the securities validated and confirmed as therein prayed. By this Order be further on notice that the date of hearing above defined is specifically decreed to be . "Itl the nth day of November, 1986 at 10:00 o'clock A,M., in the Court Room of the _A District Court of Denton County, Texas, in the Denton County Courthouse, 401 West Hickory Street, in the City of Denton, Denton County, Texas, Be further on :...ice that at such time, place and date the Court will proceed upon full and final hearing upon the merits of all matters and prayers within the Petition of Denton County Health Facilities Development i Corporation then still pending, and all other relevant matters as to the validity of the Bond procedures and validity thereof then before the Court by way of consolidation, intervention or otherwise, if any, i The Clerk of this Court is hereby ordered to cause a copy of this Order to be published in the Denton Record Chronicle, which is a newspaper of general circulation in the county where Denton County Health Facilities Development Corporation is wholly located to the extent of its defined limits and in which it maintains its principal office, and also in the Austin American statesman,. a newspaper of general circulation in s Travis County, Texas, This notice shall be published in both such newspapers of general circulation prior to the date set for hearing and trial above, once in each of two consecutive ys G ORDER OF COURT AND VOL, O APACE / NOTrCE OF SETTING OF HEARING - Page 3 -01 , calendar weeks, with the date of the first publication in each such newspaper of general circulation to be not less than 14 days prior to the date set for hearing and trial above. A copy of the Petition, together with any exhibits attached, and a copy of this Order, shall be served on the Attorney General of the State of Texas at least 20 days before ` the time fixed in this Order above for hearing and trial) provided, that the Attorney General may waive the service when he has been furnished a certified copy of the Petition, order, C and a transcript of all pertinent proceedings relating to the matters set forth in the petition, All parties described above in this order in general terms and without naming them, and the Attorney General of the State of Texas, shall be considered as and are heceby made parties defendant to these proceedings upon completion of said publication and citation requirements, and the Court shall have jurisdiction of them to the same extent as if individually named as defendants in the Petition and personally served with process in the cause. All parties made defendant; to this proceeding are hereby further notified that at the date, time and place set above for hearing and trial, the Court may in open court announce without further published notice such additional dates and times, if any, as may to it appear necsss9ty, or apprq~riate to allow full hearing and trial as to the issues relevant to this proceeding, and from time to time thereafter further continue and extend such dates and times of hearing, if any be required, by j announcements in open court or by subsequent written order as provided by the Texas Rules of Civil Procedure or rules of court, without further publication, All parties shall be present at such originally published or subsequently announced i adjourned or continued hosting and trial dated to insure notice thereof. ;r VOL, 0 `226PA61 i18 fa~tznsi'g n'V w~j{ 4 GARDERE 64 WYNNE ATTOANEYS ANO COLINSCLOAS 1500 DIAMONO ONAMACCx TOWER AAOW O, WYNAI II/IAI WAR E. AIMNIN OALLAS, TCMAS 70201 01ppMI ►,DaaN Nllrl JINAIr►.FIN DOW LAS S, LANO NATNIANN E, ►p1MW M. DOWu/ ADAMS LAURA M, iAANH "Mµ110,1.11, JR, JIN C. AONMW III KILN ARM$ 6Y644 E. lIAIAIto TCLE.PNONC 214.070.4500 VAIR.IMr4l" O~AAA O,A0}w16A M, Nd A1t10 IA1161. 41414, JA. 041At E. Lyy4N 160"" N.~I OM. JA. XAMNIN W. AMOS" JO, NIA1 L. PAWNS TELCCOPIEA 114.570,4ee7 0000 H, MACAAMAA gINO1y IIUCASAN JOw M,$AAA pqMANY LOU OA144A CAOLEI OARWVN $030110 J. MAI, JA. LAAAr L,BCOOSA~ ' TN"A A, NuAhUm 04111" N M AArw allow M AIONAl00 M4C/lMr AA N. H. 111/ MAAN a1t,~11N SIIMNM J, ONNI ![LCN 73,0107 AIIW N. lWAf JuO SohmoW, JA. C~0'4OLAWWM, JA, lAMA1hCfL/A1~00A' JAY A 6AANIr LA41Y 1, COUNLIV D,1y~S II ~S LAA" J, ooostoAAWA JOaM F. OygA NAJ~Ol01, MIMN 0 L1U 4% STAN. JA, WILLIAM H SAUDI H. HAtti" S. PAA"A MA I IN IIkwAM 0.4*m ,~OcKtly 14061 Al J. HAMMOAIS JOAN M. MOA/AN, JA. DAxe A. $AO4/A " 004th? Tf1Ah1A1 11104441 E N,WMpN, JA. OW L. NO*AN"A OIIN A. NALM OOA""W RS A Mtle DWILA1 A. NAAANoN %PAAN 04. N0. *UN AM S. ~rw00N r W, C"A JM . HANMNON Xtwg 14KMO A, TuIU DAN IRk OLO k1 ~ .NOAM A J'TyMy" 01"A A. COLT, JA, JA" W. W, NAANMII November 3, 1986 N. ""AAA VAN I"RIO 011 J. N"A"M CanA HAAaO HONMAN TAIpMr R, YAWINII M14NAlt O. CANTO J61N N NaMW, JA. J4NM NOAar OWA L, Wn NU"AI A. DAOV4N IN (kW1 0, Nom NIN. J. O'SAMN AM:NMO L. WAOCOACA OANNI J, QoAx1 f 8614//00 d0AA41, JA, M L A, O'NtK HAA01pp N. WAIAIA, JA. JAWI A. 00"W" U. CNAII INAI"t? ROM ONNSTIIN OMr O, WyIACI At L. NANNY Dwo N. JUOION AtAx J, hANAl4 WALLOW 0. WAIr1NAl ANON 1, DOAOI' H, OIAAAD klltlr EoNYAO ► hAAW. JA. N, MAN WANIANN SA440 0.0"11 Jew 7, Nw OAVII C nA►eN, JA, OAAL W, Wn"N W, 0041AI OV40, JA, 016IN1 H. Nat JAWI Ea A4AIANT '+1I A/YINAArkw The Honorable hack dray 188th Judicial District Court 4f Denton County Courthouse NOV 401 West Hickory Street 51686 ,e,'00nten, Texas 76201 q~rp Ref 8x Parte1 Denton County Health Facilities nU~llt,~F~NP 444 pF Development Corporation QNC No# 86.36288 Dear Judge Grays By order dated October 16, 1986, the Court has scheduled a hearing in the above-referenced matter on November 12, 1986 upon Petitioner's request for a declaratory judgment qn behalf of the Petitioner, Y respectfully request that this hearing be postponed indefinitel ; As you are aware, the Attorney General of the State of Texas is a parry to this prooeedingo Discussions are `currently underway between the Petitioner and the Attorney General's office concsrniag the subject matter of this proceedingA During the time t~~.at these discussions continue, we have agreed on behalf of Petitioner that the Attorney General shall not waive any rights he may have, including any right to object to venue; URIBIT A i The Honorable Jack Gray 158th Judicial District Court Denton County, Texas November 3, 1986 "A ; a 2 ral's are Office hopeful may be that Genera our discussions with the Attorneybe completed so that the heari ng can rescheduled in approximately 30 flays. As soon as) s we are in a position to do so, we will contact the Court to request a rescheduling of the hearing. RespeOt~~fully yours, / ~Z17 C+ Robert Butterfield, Attorney for petitioner f CRB/ds ccs - Ann* SwartzEsq. i i t t t } t i i ~ i J1 1 e3M51^•A.\ 1ti P•M1YIehY.~ t y UR c ~ 111 TUN ATTOUNElY CIHNE'{lA ya /0 !le'/JC?py/2 ~4 OF TI6; [Ag ar 414, .7 oil JIM MAIwror November 7, 1986 AT OSkNNV GHNNUAL FEDEPAL EXP B~r~ Gladys Whitten, District Clerk Denton county courthouse 401 West Hickoryy Street Denton, Texas %01 RE1 Ex Partet Denton County Health Facilities Development cor- poration# Cause No. 86-3628-8 Dear Me. Whitten$ Lnclosed herein is the original and two copies of the Attorney Generals Motion to Transfer Venue and First Original Answer in the above-captioned cause, Please file the original of this instrument in the Court's records and return two copies, with your file mark thereon, in the enclosed self-addressed Federal Express envelope. Thank you for your assistance. Very truly yours, 4GW Anne L. Rohwartz Assistant Attorney General AL8tn1b Enclosures rs~alnnn•talnn A111+KMMq (1011" 11111r,1NNO AUNTRIV, TMXAA 1A'►1 eOR,lM i i f9 1 j r No, 86-3628-8 Q, hoy I EX PARTE S IN TH Drs dol, 24 DBNTON COUNTY HEALTH FACILITIES S OF DEN CO ~ ~.,1fX DEVELOP149NT CORPORATION $ 5 198TH JUDIC L TSTF ry ATTORNEY GENERA ' S MOTION TO TRA_ N.MP'LR VENUF. AND FIRST QjjIQjNAL 1 - a WER I TO THE HONORABLL JUDOA OF SAID COURTI COMES NOW the Attorney funeral of the State of Texas and files this his motion to transfer venue and in support thereof would re- spectfully show the following: Motion. to Transfer Venue I, The above-entitl%d action should be transferred to Travis County pursuant to Rules 2$7.299 of the Texas AU1ee of Civil Prooe- lure because there exists in Denton County a Combination against Movant instigated by influential persons by reason of which Movant cannot expect a fair and impartial trial in Denton County where this action is pending. II. More specifically, Movant requests this action be transferred to a District Court of Travis County where, under Art. 717%-l Sec, 2, Vernon's Tx Stat Ann, mandatory venue also lies in this Cause. ATTORNEY GENERAL'S MOTION TO TRANSFER VNNUg AND FIRST ORIGINAL ANSW9R - PA0Z I - J s; A'J1 is/ilyY J TII. Denton County Health Facilities Development Corporation (here- inafter "Petitioner") by letter has requested this court to indefi. nitely postpone a hearing previously scheduled for November 12, 1986 so that discussions regarding this litigation may oocure This letter is marked Exhibit A and attached hereto, to which the Attor. ney General also consents and agrees. Further Petitioner agrees therein that the Attorney General "shall not waive an rights have, including any right to object to venue." The Attorney Geeeramay l and Petitioner have also mutually agreed that the affidavits re- quired pursuant to Rule 257 Texas Rules of Civil Procedure to sup. Port this motion to transfer venue need not be obtained in order to protect and preserve this motion to transfer venue during the period of negotiation. Answer IV. The Attorney General denies each and every, 411 and singular the allegations contained in petitioner's Petition and demands strict proof thereof. WHEREPORR PREMISES CONSIDERED, the Attorney General requests that his motion to transfer venue be set for hearing at the conolu Sion of the postponement, with notice to Petitioner, and that upon completion of the hearing the Court grant the Attorney General's mo- tion to transfer venue and transfer such cause to Travis County, ATTORNEY GENERAL'S !NOTION TO TRANSFER VENUE AND FIRST ORIGINAL ANSWER PAGE 2 ~r y Texas, taxing costs incurred against petitioner. The Attorney Gen. oral further prays for a Judgment that Petitioner take nothing by its suit, and that the Attorney General go hence with all coats be- ing taxed against petitioner, and for such other relief, general and special, legal and equitable, to, which he may show himself justly entitled. Respectfully submitted, JIM MATTOX Attorney General of Texas MARY P. KELLER Executive Assistant Attorney General for Litigation 0880RAH LOOMIS Chief, Insurance, ranking and Securities Division SUSAN LEE VOSS Chief, Public Finance Section Assistant, Atrornoy Genera 11 State Bat No. 17859500 P. 0 Odx 12548, Capitol Station Austin►.Texas 78711-2348 (512) 463-2002 ATTORNEY GENERALIS MOTION TO TRANSFER VENUE AND FIRST ORIGINAL ANSWER PAOL 3 - a 1 CERTIFICATE Ot~ SBRVYCE This is to certify that a true and correct Copy of the above and foregoing instrument has been sent, certified mail, return re- ceipt requested to C4 Robert Butterfield, Gardere & Wynne, 1500 Dia. mond Shamrock Tower, Dallas, Tekge 75201, Attorney for Petitioner, On this the 7th day of November, 1986. &Udd ANNIS Los i f i ATTORNEY GENERAL'S MOTION TO TRANSFER VENUE AND FIRST ORIGINAL ANSWER - PAGE 6 i No. 86-3628-11' FILED, DENTON COUN'T'Y HEALTH FACILITIES Q IN' THE 158TH DISR~I2ICT DEVELOPMENT CORPORATION; COURT d: 02 PLAINTIFF WILLIAM "BILL" BERKA, DEFENDANT Q DENTON:COVNTTO TMS DEFEN'DANT'S ORIGINAL' ANSWER TO THE HONORABLE JUDOS OF SAID COURT.& NOW COMES William B'erka „ hereinafter called Defendantp and files this Original Answer in the above-styled and numbered cause as a party defendant, and respectfully shows the Court as foliowes I. Defendant William "Bill" Berka is Chairman of the statewide Texas Association of Concerned'Taxpayere, Inc. (T.A«C.T.) and serves as Chairman of the Committee on Public-Debt.. He is the owner of real. property located at 11709 Marblehead Drive Lexieville Texas ;,c, in Denton County. An a property owner pa ng Denton County taxes and as a citizen of Texas he is a person both affected by and interested in these proceedings. Defendant is statutorily entitled to becoming a named party by this pleading to the petition filed before the time set for a hearing as set forth in Article 7t7m-1p Section 4 of the Texas Revised Civil Statutes. Defendant is also protected as a citizen of Texas by the supreme and paramount provisions of the Texas Consti- tution. Article Y, Section 290 Texas Billof Rights. Ir. Defendant generally and specifically denies each and every allegation alleged in,Plaintiffts Original Petition and demands strict proof of each required element by a preponderance of the credible evidence. Irr.. This case presentti a fundamental question regarding the transfer of government property to privates interests who will exercise control of snob public property for the creation of debt without any public vote or meaningful supervision by elected county or city officials. Defendant asks this Court to carefully vmeig& the. implieatioiner ~th&. decision-in this case will raise particularly in view of the fact that present Texas law does not require the Attorney General to review the legality of tax-exempt bonder issued by nonprofit corporations. This question is especially, timely in,view of concerns by state officials that millipns of dollars in fees to-bond lawyers banks and insurance companies are being made^by r64.0stment of low-cost mone at higgh~er interest at the expense both of the VoS. Treasury and ha credit rating of the State of Texas. rV. Although only $100000 in bond sales is involved in this Initial proceeding a favorable ruling in this cane will be used to allow the private interests being given. financial control over public property to employ government assets for unlimited tax-exempt debt with no limitation on fees provided to bond lawyers and financial advisors. In Section V on page seven of Plaintiff►e original petition this Court is toldt ItThe Petitioner shall be paid out of money from the pro- coeds of the sale and delivery of its Bond issued in accordance with this Act or out of other funds legally available therefor, an amount of money equal to all of the Petitioner's out-of- =at expenses and costs in connection with the issuance sale, and delivery of such 2rond, including Without all finanoing, legal, financial advisory p ,n g, an o er expenses and costs in issuing such Bond.t► V. Defendant asks this Court to strictly review the contract for transfer of public assets in view of the paramount provisions of the Texas Hill of Rights and the Texas Constitution and the best interests 1 1. of the publiao. ' It is elementary Texas law. that when a proposed action is of doubtful constitutionality public, officials have a duty to refrain from acting.. Defendant asks that this Court review the related provisions of the 'texas Constitution-and Bill of Rights which together entitle the Defendant to a t(,mppoorary in unction an the, facts as alleged and set forth in PlaintiffI's 0 9ginal petition. f Vr.. The framers of. the 1875 Texas Constitutiou were familiar with political gohedtes to plunder the public-'& assets particularly during Reconstyiotion. While. no comparable financing vehicles existed more than a century ago, sufficient clear and un;ant gguuous language was placed in our hifhest law to pravout the Plaintiffrs,proposed looting of the taxpayers' property as proposed in this case. Article 3► Section 52 of the Texao.Canstitution,states itr petinent parts „ i. cou lend its oredt or to pub o none o` er a value ll AI gko Zt 1Z asaoci= ation corpora ion. w tsoeyer.««" Article 11, Seatiotx 3 of the Texas Constitution states in pertinent part: ' Mondocir ,g tZ oother municipal.corporation ]Lmer a sutsoriber to the capital of. an4y pveto. cg~@;orpora asamer in orY make any appropriation or donation to the same . or i'n Aaywi ldatr. s relit .w«~~ Article I,. Section 17 of the Texas Bill of Rights provides in pertinent parts irrevocable or qncontrollable grant of eneaial Article It Section 3 of'tho Texas Bill of Rights also statest 11= free even, when they form a social compact ggaal 92 Mat ~rp v euee Me g~~ 1810. ray& pu is emo ueiens o . . L .oonsa- bubx c Belvicoge-11 Hisao related'oonstittrtional provisions when properly applied in harmony to ether prevent the Plaintiffs to rant any thing of value to )Ay individual, association or corpora Ion whatsoever and prohibit the county and oity from anywise loaning its credit or making an uncontrollable grant of special privileges. Further the contraotts torus providing for Indigent health care. based' ort income violate the oquaUty mandated; by Article If Section ,3 and'3a which denies any grant of separate pprivilegesrnot, based. gpoaon public services rendered. Under-our Texas Bil of 173ghts special privileges to indigents are forbfddez except in aoneiderq, of pubYia services rendered. Article Ia Section 29 of they Texas Bin of Rights provides that any law contrarryy to any provision in the Hill of Rights or the Texas Constitution ..shall be void." VTt. Defendant requests a jury trial with regard to any and. all facts issues required to pro srly apply the aforestated constitu- tional provisions as required: by Artircle r Section 1~5p. Article V Section 10 and Article 717awl) Section f of the Texas Revised Civil Statutes. Defendant herebfr tenders his 13 jury fee without waiving his right to request such a jary trial in open court. VIII. Defendant specifically opposes any contemplated Ong* in venue outside the countyy, of the class affected by this proceeding and does not waive the affidavits required by Rule 257 proving the alleged existence in Denton County, of +fa combination against Havant instiim gated by influential persons by reason of which" the Attorney deneral contend& he aannot 11expeot a fair and impartial trial in Denton 'County ~ where this action in pending." Attly deneral►e Motion at Paget 1. 2 • r I S:r;!'WAY4 r 11 J l PRAYER FOR RELI F' WHEREFORE$ PREMISES CONSIDERED, Defendant asks this Court to: i. Review each constitutional provision cited by Defendant together and issue a declaratory judgement declaring that the proposed trans- for of public assets is contrary to bath the Texas Constitution and the beat interests'of the people; 2. Issue a temporary injunction based on the plain and unambiguous words of the Texas Cons itution which require no construction that prohibit the Plaintiff, its empl6voes and a ants frost taking a action pursuant to or based upon the cantraaf which contravenas the best interests of the people and the Texas Constitution; 3. Award any and all costs against the Plaintiffs and equity, to justly law or in which Grant the such other and entitled to. Defendant may show further himself raliefp in Respectfully submitted, c Samuelson Attorney for Defendant Rt. I Cedar Shores Estates Morgan Texas 76671 81;7-62W124 State Bar No. 17567200 C~'~Trw'~ _ATE OF' DELIVBRY_ This is to certify that a trues and correat copy of the above and foregoing Defendant's Original Answer has this day been mailed to Mr. Co Robert Butterfield, 1500 Diamond Shamrock Tower Dallas, Texas 75201 and Anne L. Schwartz P.O. 13ox 1'2548 Capitol Atation, Austin, Texas 7871 t-2548, by oertified maid,, return receipt re" quested. SIGNED this 12th day of November, 1986. Eric, emus sort r y I ?rr I I ry..s.'P:Yj1 1 i! saliva w...w ~••))•••),b 817-565~85401 west hickory I denton, texas 76201 PHI LIP 0, PICK District Judge 168th judicial District ` Denton County, Tex December 14, 1987 Attorneys Mike Whitten 218 N. Elm Denton, 'taxes 76201 Rai 86-3628-D, Ex Partes Denton CanCtCCpalth Facilities The above entitled and numbered cause has been traneferted from the 158th Judicial District Court to the 362nd Judicial District Court as of Daoemhar l1, 1987. Plaase direct all requests for setting$ to the Court Coordinator of that court. Her name and address arfl Kathy Toomer, Coordinator 362nd District Court p,0. Box 2146 Denton, 'texas 76202 Please also note that the cause number now ends in the letter "U". To the avoid confusion please make sure that all of your corvauntdee with this Denc'o County re 04 coordinator and the District Clark's office change. I Thank you, P • Sherri Pargueon 158th Court Coordinator cot Eric Samuelson Anne L. Schwartz Rt 1, Cedar shores Ustate P.O. Box 12M, Capitol Station Morgan, Texas 76671 Austin, Tax" 78711-2548 t 1 :V GARDERE&WYNNE ATTORNEYS AND COUNSEI>~ SUITE I"00 rr ff qq~~ +'1 n I I I NORTH O DALLAS, TIi AS 0901 Ego AUG ` I 9 AH ' 54 WRITER'S OIR ECT DIAL NUMBER TELECOPIER 2U979.49lY 214.979•A boo A C Uj1+ L CABLE, OAgWYN DISiRiLT~C6CRIS 0 H CO, tX TELEX 73.0197 (214) 979-4864 • 8Y~ UPIitY July 31, 1990 District Clerk P. 0. Box 2146 Denton, Texas 76202 REt Ex Parts: Denton Health Facilities Development) Cause No. 86-3628-D Dear Sirs: r have enclosed the original and two copies of a Motion for Dismissal Without Prejudice and an Order for Dismissal Without Prejudice relating to the above-referenoad case, Please file the original and ons Oopy of the Motion for Dismissal Without Prejudice and present the Order for Dismissal Without Prejudice to the Court. Please return a file stamped copy of the Motion for Dismissal Without Prejudice and a signed copy of the Order for Dismissal Without Prejudice to me in the enclosed self-addressed stamped envelope. Please feel free to call me with any questions you may have. Sin rely yours, Lawrence B, of at in LBO/rl Enclosures cc: Ms. Anne L. Schwartz P. 0. box 12948 Capitol station Austin) Texas 78711-2648 r' Mr. Eric Samuelson f Route i, Cedar Shores, Estates Morgan, Texas 16671 j sr2suc+o~ " ;y 1 , E z NO. 86-3628-D FILED Ex PARTH s 1990 1415 -I M 9154 § IN THE DISTRrc 'RT OF DENTON HEALTH FACILITIES $ DENmO~$~N ~ A301tX DEVELOPMENT S ~pt~rY 3 362ND DlsiItlCT ~ S9AL WITHO T RE17Ubrc'~ TO THE HONORABLE 3UD09 OF SAID COURTI Now Comes Plaintiff in the above-styled and numbered cause, and moves the Court to dismiss the above-styled cause without prejudice as to the Plaintiff for the reason that Plaintiff no longer desires to prosecute this case at the present time. WHEREFORE, Plaintiff prays that the court issue its order for dismissal without prejudice as requested above, Respectfully submitted, w . C, 0 RT 717 N, H1600 Dallas, Texas 75201 ATTORNEY FOR PLHINTIFF 77243/Of10i 4 1 4 f MOTION FOR br4MT85A WTmR+nreM nr,~,Y~tr,r solo Page z r j , N 4MtitRN~ 1. Y , NAMES OF PARTIES ACTION Damages CAUSE M 86-3628-D Ex Fartet Denton County Health EST, TIME DATE PAID 11-12-86 Facilities-Dayelopment Corp, VS FILED October 16, 1966 By def. DATE RECUESTED DATE FOR TRIAL ANNOUNCEMENTS SET BY L-l-9o Siyat~.r~ba~.4, l94U G►s,1tt , .y r`r~ I}f i t f , I . i. r~. W 3 ',U~Y.tl, .p~Y1B Iq. .'al ju vu.e'.I .:nlN..-... i... . e.WNi. 14c$1Mdiln~4WrM il~Wr+M ~ ~ ••••~'"J .•v.. `M.S,~~lVrv'd1G!A.aA[GS~'.nyaW' y 1 4AWLroy) A21a'!!6M2~ 1 G O'CLOCK. M NO. 86-3628-D AUG -3 19go 018TRlor CLERK Benton Cotrnly, ToM „ EX PARTSt § IN THE DISTRICTnCQI OF § Deputy DENTON HEALTH FACILITIES § DENTON COUNTY, TEXAS DEVELOPMENT § § 362ND JUbICIAIy DISTRICT OR L~I2 F02 DISMISSAL S4ITHQI~M PR • ~p on this day came on to be heard the motion of Plaintiff to dismiss without prejudice its cause of action, and having considered same, the Court is of the opinion that the motion should be granted) It is, therefore, ORDERED that the cause of action is hereby dismissed without prejudice to the refilinE same. 1 SIGNED AND ENTERED on this the day o° 199b. E JUME'PRESIDIVO .4 37249/Ok04 a r y, f; a i r ORDER FOR hTAMISaAS WITHOUT PREJUbXCA - Solo Page s VOL0343 P00681i s I hYlm'4ry rJ6fi1 CONTRIBUTIONS TO FLOW HOSPITAL Source: Various (Budgets, CAFR, U.P. reports) Fiscal Year • 1971-71 $ 112070U 72-73 125,000 73-74 0 74.75 1620000 75-76 1781199 76.77 202,750 77-78 2100 500 78-79 114,563 79.80 99,563 80-81 15,99$ 81.82 0 8283 0 p 83.84 1250oU0 0 1.,84.85 450,000 jxtr-~ O ~ 85.86 4. 210, 000 oil f 86.8/ (year to date) 20MUO i g9~~~ $2,zu~,z7u Does not include cash-lloW loalls, nor non-payment of utility Gills/roductious to utility accounts. 1 i. ~b853~ nN/r7/k7 ~i N3;'4Tp~ H 4 t I DENTON LOUNIY,. 1E1A6 FOR1[6A61 OF INDIOE47 ME FUND 9XpfkOSTURY6 FOR 7NE FIVE YEA" AFTER 19PT 36, 1968 198/1 5987 5988 1969 1990 5991 1992 1993 ANNUAL M ACTUAL ACTUAL ACTUAL WOCBY FORECAST FOALCA6T FDREGAAT FOUCAlt ORONTN ' IN0309NV "m Par44041 $arvleaa 00 40 •14,1576 656,174 $59,544 46,4317 066,904 470'"16 S ` 6upW lta. 40 r0 $506 41 tl00 $1'570 611665 41,787 •1,x:14 j Oth4r O4rvle.r L Char. $450,000 $756,370 6662,7.(8 6700,000 61,2D0,000 f1r272,000 11,346,320 41,429,210 Capital Outlay 60 60 !7.440 49,000 $9,540 010,112 010,719 !11•,82 Total 7A61pant two 6450 000 0350370"-! ~ 4681~_~_+_- ' 63,270,674 61 346 915 81477 170 945S, 194 ~ir ,304 6767 0179.... -...........,1 r r 3S•T6X 1 i E 1 2 q4, Sw8 1. i 3 i , f t~M+✓A:,..r,.. .....1 'a. n. n.,. .I ...a.e.. r. u. w. ..mw:!dh ijWillrf.AilNVt K4.MgINJMWN'YA'wwm HOgMyM•W` TIM STATE ~r E\r\41 n ' \L r1rtZ is •C'~ CLC'I COUNTY 0? DG; TOt1 X wr, the undersigned Lh;::e parties, I:aino the GOn^issio7er3' Court of the Count-? of Canton, Texas, tlio City of Denton, Taus, and the Board of Directors of VloW ''nstorial Hoapital, all or Denton Count}•, Taxas, pursuant to mutual Rosoiutions harotofore pasted by tho Commissioners' Court of the County of M nton and the City of , Denton, haraby dissolve the organization of said hospital tinder I Revised Civil strituto Article .14941 And hereby r,a-organize said Hospital undor the rrovisions of Toxas Revised Civil Statutos, Article 4494i-1, which Article is incorporated into this contract, with and subjact to the following conditions, terms, and covaAants to which all parties.heroto, and their successors in office, shall be mutually bound, to-wits + x. , The City of Denton, h(t,reinaLter ::aCerred to as OiVt anu Lh,: County of Denton, herainsfter referred to aq COLN%TY, shall retain title to'all hospital lands, physical assets and facilities, except as may be he;'oafter granted by resolution of the rospoctive govorn•- ing bodio,i. Any matter requiring a vote o;i the part oa both the City and County other than the exponditura or transfer we funds shall be passed upon the affirmative vote of any six (G) Members of said eombinod governing bodies at a joint mooting, and anv oiaht (0) members of the combined Commissioners' Court and Citv Council shall constitute a uora;n to act on any hospital matter requirinq approval of. City and County other than the eranstor of City or County funds, tho-pladging of any City or County Asset, or the term- ination of this dontr60t aA providad bolow, Any docisien on the part of dither of said bodies to authorize tho transfer of (undo, or pludgQ arsots, to Plow hoekpt 1, 'n;;roinaftor roforrod to ao 110SPIYAt„ shall be docid(od under ttt:iutinq law (iRrtinont to the rc:3- poctivo hodirn, g C~ ._LrlL~u.~Q~t 1. all Q. J y 1 ' R11M1,Fq C(1 Y11i 4(l;µ 1 Tho City and County shall oxerciso all IiuLhor., tv over !,o Board of Directorr, of rloa, •~or~ori.31 I;nopiCal, hcrcinn.tcr rcrcrr,~d to as DOARD, consistent with the intent of saki Ar iclo 41194i-1. The Director of finance of tho Cite, and the Auditor of the Count,;, shall oath havo the authority as authorized under the laws of the State of 'Tcxns to examine all. hospital book3 and records lit anv reasonable tiro, either separately or together, All donations and grants for the benofit of the tioapiral, in- eluding benefits of trust funds, maybe made; direct' _y to the Board of Directors of the Hospital out shall be subject to approval by City and County if. any condition, obligation or limitation is con- nocted with any such donation or benefit, All funds transferred by the City and County to, or aor the benefit of, the Hospital shall be basod upon a written dotailed budgot, as described below, and no spacial transfer of. Citv or County funds within a budget voar may ho made without tho submisi: - ion and approval of a budget amendment or eunplomont prior to anv such transfer, Cho said City and County agree to provide all funds 1 necessary to balance said budget after, Said budget is exnniined, Acr.art- ed and approved by the said City and County. 1 CTho City and County shall t'ransfe,r funds to tho Hospital in the following proportions{ For each dollar transferred, the City shall, commit 50 oar_ cWnt and the County shall commit 50_per-cone, after the amount of aach transfer has been authorized by both, This porcontaod of fundin%i is valid only for the year Actobar 1, 1971, through Septcmiser 50,1972, co be ro-nogbtiatad therobftor, SS, The initial Doard shall consist of tile, following sown appoint- monts, throe of which worn appointed by. the CJ.tv', And four oL' which were appointed by the County, with tho tares of office ea not out by each name, 111a terms altar, bojin eh thn nxncution dato of thLs contract, and It is apociUcally provided that the terms shall Ox. Y w,Zr i a r ~ r y pira on tho fir3t .,'id sc.ond anniversary of t< ~e asr ~lnv of Il~ next complete fiscal year of inid hospital, depending on 'ho initial term, thon each new appointment or roappointiont shall be for a term of two yearn beginning with the expiration date of the initial term, as provided in said Arttclo 4494i-1'. ;1o member shall carry over into a new tern' unless properly reappointed, as all terms autcmatically expire as indicated. The initial apneintees.and thQir terms are its follows' COWTY _AP?OI:y:'wCS_ TEPit 6:PYPAT,IO? f DATS 1. Mrs. Paul N. Simpson 2. Dir. Qa.lter Pay 3. Mr. Carl Degan, Jr, 7 4. Mr. Al Testa. 7 CITY APPOVITE23 'r'fJ(t!`t EXPIPATION 0d'TP, 1. Cr. Charles Saunders /e/• 7 3 2. Dr. John Carter 3. J)r. . ~~11e+►sa/ /c r/ 7r3 County appoints two members for two year term and two for one year tern, City appoints two members for two year term ttnd one for one year termo it shall be the duty of the Board to appoint a Hospital Au ministrator having the qualifications established in the By-Laws, and to confirm the apnointMor't', of the Assistant Administrator and the Comptroller (or Controller). The Board shall exocute a written contract with the Administrator for his services wiWh such provis- ions as may be agreed upon, but no such employment contract shell exceed a term of Pour (4) years, and shall provide itor removal for caua,i. The Board shall concur in and approve any written contract the Administrator may negotiate for the tlmploymenc oP the Assistant Administrator and the Comptroller (Controller) prior to any such employment. The Board shall have final authority in all matters oe hos- pital polLeye including managament policiaa, . in tho 0ovornrr,ant and operation of the hospital, The mattors 'of quorum and voting aia i 1 as gover,nod by said Article ;494i-1 and tLo Oy-L,iiws. All official } acts of the Board affA.ctinq the management or operation of tho i Y: l VW4Y / l 1 PtEY!iI x.11 'said hospital shall bo t~Y ,,ricticn rcaolution. Y'.c1 yN on during an ~fEic,al Board »sccting ihall duly pasood up 'aL ed in the minutes of the BOard- excrsA of 'L'o to 'oud- All expoodituroa of 110050ital -unds in the h, the city and "he a card, ro vod by allocation shall be aPp County prior to any such "Venditure. of the Board 3urin7 It shall be tho duty and responad nel.auditing firs to cake each fiscal year' t ongaho att indopen letter, year. Such enga9cmont contract, or and county, as to its tor^ssF an audit of that fiscal by the City shall be ar~provod 3ointly and it shall provide that true copies of all audit roports. and lnt- ! oriel, includinh the auditors managemont letter and conf shall be furnished simultaneously to the Board, the simultaneous,- information, City and the County• and may appoint advisory committees, to serve ,,ithout The 5o f tion, under terms and for purposes which said Boar:! dee^sa ! conhons~n ! ! oommitto©s other than advisory shall be as provided prop3r'. All ~,sittea shall 1 in the By-Laws. All meetings of the Board and its e E provisxooutf< ~eiong~og the Ooen to tot be open to the public accarding Civil Statutes, Article 6252-17, as Raviaed Texas session Act, s amended, r I1Y~ tal Administrator shall have the authority and roe- Tho Hospi o>o ruts in to do any and all acts necessary and ap, ponsibility " oration of plow Memorial Iospital wit„ tnu 'adminiatration and op t15e hoard In its By-Leila in the franoworl~ of the p olicios set by 4 from, all employnos and and by Rasolution, The lino of authoritfrom snid Administrator pozaonnel of tho tsoshital shall be to and. it,s1' snlaried par,,o~ti~a1 point and diacharlo all hdgp who ahnil apt. cctvo the apttoin'4- 11 and om(>loyoos, provided that nlso Board muff o Cnp,n~> olc+r (Cr,sttrol ' sstan. Atlminisstrator and th Mont of the Aeni r r4r i ~L • w4VII • 1 fvTMltiwq' {f who shall oach or bot!~ bo cntitlud to a hearing beLo.o riot to dismizsal by the ,administrator, as sot forth in ;hn p ~ido the hoard, tho Ci ' The Acir;inistrator oha11 nac!ti month pro enditures, and '~it'~ and t110 County With a summary 0f accounts and ov .,p YY list of all accounts to be desici;ated uncollectible. tv. The annual budget for each fiscal year of the hospital soalater. no be pz0parccl by tho Acl^jinistzator, and presented. to the aoar that fiscal year, and the ~3oard than the first day of `Say proceeding irty (301 c'at's shall present sang to the County and „he Citv within th thereof, or no later than the first day Of k7uns Pr-" of its receipt t ceeding that fiscal year. The hospital budget ahall• be commidered a public rocord and be readily available at all times. The budget shall set out estimated bad debt 10.9g accoUnho to be indigent carp and punts when determinable by iase county A,1adi The bud5st shall be compatible with the organ'izationalharts which shall divido the hospital organization into departments sub-departments. The hospital budget shall be consistent with the form of rican Hospital accounts and method suggested by the Ame ~.sf;ociatio;s, em- suffici3nt in detail to show all income, revenues, 100 109 # em and pondituren of funds, and salaries of all hospital norsonn fiscal year of the hospital shall begin the first day of October and and the 30th day of 5eptembor. V$ shall By-Laws of the hospital, and all amnndments tharcto, The By-Laws I roved by rho Cil:y and the Cou;ity be proharad by rho hoard. and app prior to Adoption. 1 shall bo rnada pursuant to Ilia tarm3 and conditions; Such by-Lawn of this ocnttiaCt, and jollornily follow qui.clolinL1 nr,tnblia!~Qd eher.o ' tor, by tho AMorican tlbopital, A9nooinl:,ton. 1 T A copy of such 3y-LAWs And %tmundmr;n'lo c ' urn ' . ` n.~ttuv -ho City, the County, and ".ho r;uncrior to Any resolution of the Board, and no rcaolution or other act o the Board shall be con trarv''ther^to. ^N 441tio transfor of the ^_unds approved by the City and tho Count:', Y, upon acccptanco of r oular annual hospital budnot, shrill be r,,ade to the aoard in one of 'the Collowinq manners in cash on or,' ba- fore rabr.uary 1 of the approved budget year; or, not loss than 1/13 of said sum on or before the 1st day of each :nonth duri,na such bud- got year; or, in throe (3) equal payments of. 1/3 each, bectinning February l of such approved budget year. The pavr%ent option shrill be made by City and County, respectively, at the time the budget .s finally approved, VYY, The Board shall raruire bonds of the Administratbr, the assist- ant Administrator, the Comptroller (,.,jr Controller)', and oL all other hospital employees who rec*ive or pay out any Ironies of the hospital. The amount of such bonds shall be determined by the Board, and the cost thereof shall be borne by the hospital, Ito such bonds, however, shall be for less than Ton 'thou'sand 010,000.001 nollnrs. VYII, This contract shall romain in full force and og Coct until amen.t- ad or torminatod by a majority vote of all of tho throo partios hers to, separately, unless sooner torminared by the dissolution of the: Gr9an'2A1' -^n uridor Article 44041.1 by joint Act ae the City and County. Such dissolving of the organization shall automatically Germinate this contract. IX, ".illo ;untrsct to hcca^~o o:'foetivo on m^tohor 1, 1971, t,lhon , dpprovad by all partsioa hargto. i •.-...'«w-~,I~•.....«+•-...il.rila'~•.•7`QMPlI +P?'~"A.,.+~'w;rwiLN: ~,c..• ,11^:r .IA'/'.,i .~..J w.. dr11 G: 11, '~..I s.>•; inMCa~y IIIM1r h .~nJ^ ~ J chat ~ r,:'; r1.,' . ~ l VL '~1'• til.., n^iul♦ ~C I. n.1.,,•. •C~.'A~.I i r1 rw. n^. ..rv r' I r wll `1 I, «~.:;'I , .,,;`r ;1 . .,n' v 6!J'GG.I~.~L I•~r~ / / ~ I I lam'✓,'~ ~r I 1• ,un .:birv ' ~ ~ I ,I 1 . GrluJ ull V. ....rIV I YY~+n nu..rVil.rw J •r 1 w.. I I 1 1 j~ ' ~ i 4 r u r r u V I r I ' .\/I ..I JuJII'i + +111:1 ~.i .iwvli.. „ , 4 r H M rv ~I H N I I V I r III JI V..r~ ✓I , VVoII•rr u..r~rlu: , ' 1 yr'4 V:r iI Q''~'i IIV r :I , rrr...~....1''..' -•'.r-~% r/./vT .•1✓=•~. ±..J, 14p, i.Il•Y• ✓w 1111, • •iw •.Y • . V V r .I r Y IIV • , AN,ilov'"In itl.ftt / ay 0f ~•~z✓~ 1n71. ;1I r... r r... )+X t4, VVVI+AY, fir.. ! ; AY,or v 1r • 1V1 411 ~L I: , C ti ;u'1 a 1,17„J n v ` . H~n/r I ♦ . ly ♦ I ;101'.Ll.~ ~ii•lilr, ISI~, Lalanai~•la~~ 07. . 1 ~/,,r~r Ir .I l.+.i• r~ • w ...r.w-r..l.+rwwr...rrw biLL ly. t~;hr; ~ ~'ot~neils,an Yw+~... r•r••.rr•r.rr r rrwr~M r.wrrw~.rr..• 11i111QLU f1. "tMtl'1' r C'ulsftCi 11;sn r ArrnoV"a 1:111.4 day oc t 1101111 or 0InYCT01(a ov Mw.M`,,jj4 ~i+,r 1. "w .r urwrr Wr.1.+rrr~ly wl~ t ' ItS~♦ G111~r 111j1 11♦ n.SUtli .i ~JI 1'•11 ~S, i.~II CIi , rwr1. r . I/ 41.r r4 r 4 J r'r".•"" ""'emu i Olt, J01111 I;, ITI;IS r" f ~Ilt 1. VAN- :1. u Xlil'$111r APPROVEq 1 1 ciry ATTORNEY I . r . I I F 1 I. Y. (rl> 11 4 V, 1(11 ~GO11 It (1,IlY'YYY?/L.f e'„ /'.L~6+''l'.. ~g , ' ly P6000J f i fs.~ Fill , 14, y n E 7 is I J6» J~Ifhe~ - "n~?D.N! Gwl?.74p~y11 II i 1....~ I , I ~ !I ! I f j , I f9 r" 't ~ - _ I ~ , ~ J, i ~ f r~ lp+ ~ l I~ t • '1t~P.xcty! I G!' i ~ 1 1 ~ ~ I f d y , ,o o i s' J id. rJ~'~tlarL( r(0/ 4e) to I ; ,)R ~ I ~LO11tk KrtUY1(~o < I v 15 e' l i i i I I e a s, ii X39, 5~{3 Ky-~ Il :i vZ~s~ (~aD (oOtO real j 1 I~ 1 j i Ir , +I it f i y j r.r j, .1 ~A LLOYD HARRELL PAGE: BY MR. LEVICK: 4 Lloyd Harrell, City Manager for thn City of Denton, since Feb. 186 - City Adminiatrator of Liberty, Missouri. Chris Hartung was his predecessor in Denton 5 Chief Administrative Office for the City, he has supervisory responsibility over all the City departments other than legal and Municipal nudge. 6 Flow is a City-County hospital under the statute. 6-7 it was the City's assumption was that Flow would pay its bills. 7 All the leases I've seen have the clause contained its a requirement of law. f 7-8 The City contributed $200,000 to Flow. 10 The City agree to indemnify the County up to $400,000 provided all the conditions outline were met. 11 $200,000 was a one time payment. The money was either appropriated in the budget or a budget amendment setting aside the funds to make the payment. An amendment to the budget would be taken before the council and approved by the council. j 12 The Settlement Agreement had various obligations of different parties: (1) pay $200,000 as direct payment; (2) Flow Foundation paid the hospital $400,000 and (3) the City contracted ' with Flow for srdrvicas in future years and to pay those future years the sum of $200,000 per year which would pay back the Flow Foundation. 12-13 Payment could no longer be made once Flow ceased to exist beoauge the services contracted could not be provided. ; 13 There was an allocation in this year's budget for $200,000 which has not been spent to this point because the hospital no longer exists. 17 The City's position is not to agree to your assumption that the Act impose a financial responsibility on the City. ii 1 i l IN THE UNITED STATES DISTRICT COURT 1 FOR THE EASTERN DISTRICT OF TEXAS 2 SHERMAN DIVISION 3 SCIENTIFIC LEASINO, INC. ) 4 V, CAUSE N0. 5-84-64-CA 6 CITY OF DENTON~- g ) 7 IN THE UNITED STATES DISTRICT COURT 8 FOR THE EASTERN DISTRICT OF TEXAS 9 SHERMAN DIVISION 10 BANK OF LINCOLNWOOD ) 11 V. 1 CAUSE N0. 5-89-65-CA 12 CITY OF DENTON 13 } 14 ORAL DEPOSITION f 16 OF 18 LLOYD HARRELL 17 18 r ~ 19 ANSWERS AND ORAL DEPOSITION OF LLOYD HARRELL, } 20 a witness produced at the instance of the Plai 21 miff t ak6t in the aboV e styled and numbered cause on the f 22 17th day of May, 1989, at 2,25 o'clock p,m., before 23 Vicki C, Oreen, a Certified Shorthand Reporter in and 24 for the State of Texas, at the Office of City Attorney, 26 215 S. McKinney, Municipal Building, in the City of V & H REPORTING SERVICES - (214) 226-2266 ORIGINAL, Y.c9. 'Mn1'MpRVry. i Denton, County of Denton, State of Texas, in accordance 2 with the agreement hereinafter set forth, 3 That pursuant to information made a part of the 4 record at the time said testimony was taken, the 5 following includes all parties of record, 6 7 APPEARANCES: 8 On behalf of scientific Leasing, inc, and Hank of Lincolnwood; 9 Larry A. Loviak 10 Baker, Mills & Mast, P.C. 50.0 Trammoll Crow Center 2001 Ross Avenue Dallas, Texas 75201 12 13 On behalf of the City of Denton: 1a Ronald Burley Clark Henderson Bryant & Wolfe 15 500 MBank Building P.O. Box 239 46 Sherman, Texas 75091 Also in attendance: 17 19 Debra Drayovitch, City Attorney, Denton 19 I_ N1) 9 X 24 WITH .84 DIRECT CR085 $E2I= $ECROS,S 21 Lloyd Harrell 3 17 J 22 23 E.X H I H I T g 24 PAaE 9 Flow Memorial Hospital Agreement dated 14 25 July 27, 1071 V & H REPORTING SERVICES (219) 226-2266 CAUSES i_iz -4/- VERSUS f o-{ Teas STIPULATIONS FOR THE DEPOSITION(S) Ops S/1C4 me-iOv ,'vg's u,,/ Al ///k' TAKEN ON _ $ ~I BY$ The attorneys for all parties present follows to the chocked items stipulate and agree as nEPOSITION TAKEN PURSUANT T 9i .._,.,,,..Notice Subpoena Agreement Court Order Other EXAMINATION AND SIGNATURE $Y WITNESS, waived. gofore any officer authorized to administer oath. If original deposition is not signed before any officer authorized to administer oaths within (y) das and 1 returned to the court reporter taking such deposition, a J certified ropy may be used at the time of trial or hearing just as if it were the original. The original deposition is being delivered to the witness .0 the witness' attorney of record for examination and signature by the witness with the agreement that the court reporter has no further responsibility for the corrections, delivery to the custodial attorney or providing a certified copy of the deposition. r Letter shall be sent notifying the witness that the deposition is now ready for examination and signature in the court reporter's office within (20) days. i OBJECTIONSs Reserve all objections, except as to form of question or responsiveness of answer until time of trial, which objections are waived if hot made at the taking of deposition. 1 Reserv9 all until time of trial. Make all at time of taking of deposition or 611 will be waived. _ Make objections in accordance with the Rules of Civil Procedure. NOTICE OF D9LIVERY/FILING OF CERTIFICATtt Pursuant to Rules of Civil Procedure. . Pursuant to Rules of Civil Procedure, except notice to be sent by regular mail (not certified, return receipt requested). ATTORNEY FOR Io ATTORNEY FOR ATTORNEY FOR- ATTORNEY FOR j . ai e. CAUSE r. S-c}~G/.~S- ,~iJ ft. ('v C s ti~ VERSUS ~ 7 v__V1 ~-1 y 0/ 1' STIPULATIONS FOR THE DEPOSITION(S) OFt &/)-I x. TAKEN ON BY r _ L Fl~rr~_ f~ . L e' y1 r k The attorneys for all parties present stipulate and agree as follows to the checked items, DEPOSITION TAKEN PURSUANT TqW Notice Subpoena V Agreement Court Order Other EXAMINATION AND SIGNATURE BY WITNESSs Waived. i X Before any officer authorized to administer oath If original deposition is not signed before any officer authorized to administer oaths within (gip) days and 1 returned to the court reporter taking such deposition, a certified copy may be used at the time of trial or hearing just as if it were the original. The original deposition is being delivered to the witness; , the witness$ attorney ofrecord for examination and signature by the witness with the agreement ~ that the court reporter has no further responsibility for the corrections, delivery to the custodial attorney or providing a certified copy of the deposition. Letter shall be sent notifying the witness that the deposition 1 is now ready for examination and signature in the court J reporter's office within (20) days. OBJECTIONSs ~X Reserve all objections, except as to form of question or responsiveness of answer until time of trial, which objections are waived if not made at the taking of deposition. Reserve all until time of trial. Make all at time of taking of deposition or all will be waived, 'J Make objections in accordance with the Rules of Civil Procedure. NOTICE OF DELIVERY/FILINO OF CERTIFICATEt Pursuant to Rules of Civil Procedure. Pursuant to Rules of Civil Procedure, except notice to be sent by regular mai (not certified, return receipt requested). A ATTORNEY I:OR._ P1 ATTORNEY FOR. ,0I!A f+~ ATTORNEY FOR ATTORNEY FOR wp~ f "i (.rti'nFf ;I 1 Whereupon, 2 LLOYD HARRELL 3 the witness hereinbefore named, being first duly 4 cautioned and sworn to testify the truth, the whole 6 truth and nothing but the truth, testified on his oath 6 as followsl 7 DIRECT EXAMINATION 8 BY MR. LEVICKI 9 Q Hi Mr, Harrell, I'm Larry Levick, could you 10 state your name for the record? 11 A Lloyd Harrell. 12 Q And your occupation? 13 A City Manager, City of Denton, 14 And how long have you been the City Manager? 16 A Since February of 1986. 16 Q What did you do before you were City Manager 17 of Denton? 18 A I was the City Administrator of Liberty 19 Missouri, ' 20 Q And who was your predecessor? 21 A Chris Hartung. 22 Q I'm talking about your predecessor in Denton. 23 A Yes, Chris Hartung. 24 Q How long was he the City Manager? 26 A I want to say approximately eight cr nine V & H REPORTING SERVICES (214) 226-2265 E 7G7G4 I j I years, I think it was in that time frame, r 2 Q Do you know who his predecessor was? 3 A No, I can't remember the fellow immediately 4 before Chris. I can tell you the previous two fellows. 6 but not right after Chris. 6 Q And who were they? 7 A Jim khite and Homer 81y, 8 Q Okay. What are ~ your responsibilities as tw..e 9 City Manager? 10 A I'm the Chief Administrative officer for the 11 City, 12 Q And what do your responsibilities entail? 13 A I have supervisory responsibilities over all 14 city departments other than the legal dopertment and 15 the Municipal ,judge. 18 Q Are you familiar at all with the lawsuits i 17 Sank of Lincolnwood v. City of Denton and Scientific 18 Leasing v, City of Denton? 19 A Just that I know that the papers were served 20 and there is ar. ongoing lawsuit, That's about the 21 extent of my know? edge. 22 Do you know what these lawsuits are about? 23 A Not directly, I know they involve equipment 24 at Flow Hospital, and that's about all, ; 26 Q Okay, well, I'll tell you very quickly, Flow ~ V & M REPORTING SERVICES (214) 226-2266 f h and Lincolnwood entered into a Lease on October 3.. ! 2 1985 and Scientific ZINC Financial Services entered 3 into a Lease on September 25, 1986. L* NC is now j a Scientific Leasing and these were to :ease scaa::inq ~ „ 6 equipment CAT scanners. Is the City a , Y governmental 6 entity? 7 A Yes, 8 Q And is flow a public hospital? 9 A well, Flow 14 4 Was Flow a 11 A It's a City-County hospital under the 12 statute, Sure, if You want to define that as a public 13 hospital, but it was a City-County hospital. 14 4 Is the iltatute you're talking about 15 4494(1)(1), is that the famous statute? 16 A It's (i), I'm not sure it the (1) is t"ere. 17 Q Okay, Are you familiar at all with the Texas, 1e Indigent Health Care Act? 10 A I know what that is. I don't know the 20 details of the Aot, but I know gentr811y what that Act 21 is, 22 R Okay, Now at a point in time Flow entered 23 into these leases with LINO and Lincolnwood, Now, 24 would the City assume that Flow was responsible for i~ 26 debts? i V b H REFORTINO SERVICES - (214) 226-2266 1 'I . f I i. 1 A I'm not sure how to answer that - - - I th.r.i, 2 the City's assumption was that Flow Hospital would .a, 3 its bills. Yes, J 4 Q Okay. Are you familiar with any !cases that 6 the City may have entered into over a one year perioc « 6 I'm sorry - which term was over one Year. 7 A Yes, I see those leases from time to time as 8 they come through the process. Yes, 9 Q Are you familiar with these non-funding ] 10 clauses? 11 A Yes, 12 4 have you seen any leases that have the non- 13 funding clauses that were over a one year period? 14 A That have 16 Q 'that have these? 16 A The funding-out Clause? 17 Q Yes. 18 A Yes, to my knowledge all the leases that Y+ve 10 seen have that clause contained therein. It's a 20 requirement of law. 21 Q Do you know from the t a period 198+ _ through 1996 22 if the City contributed 5790;998 to Flow? 23 A I have no idea, 24 Q During your tenure, have you known the City 25 to contribute at all to `low? r V b H R9PORTIN0 5rRVICES (214) 226-2266 Y u; s h. t J 1 A Yea, I am aware that during my ten-.--e- 2 $200,000 contribution was made by the City to 3 Hospital, 4 Q was this pursuant to a Settlement Ag:rt•'14' 5 reached in a lawsuit? 6 A Yes. 7 Q Do you know if this money went for a-.,- a payments to the two Plaintiffs in this case? 9 A I'm not sure how the money was spent. nO 10 feel the council had any knowledge of those. 11 Q Could the money have gone to either of 72 Clients? 13 A I assume it could have. 14 Q Are you familiar at all with a $400,0011 16 indemnity provision to the County of Denton, 18 A denerally, I am familiar with that clelit"' 3 17 Q And, what is your understanding of thal to cl use? In other words, ir, it a« your understandir)IJ ~ t' 1 19 if the County is sued, that the City admits no 20 liability but is still obligated to fund to the 21 tip to $400 M0 , 22 MR, CLARKi I object tr, 23 form of the question. It's calling fe%' r 24 regal conclusion from a person who is 26 lawyer. V & H REPOR':INO SERVICES - (214) 226-226 C' 1a e A I BY MR. LEVICK: 2 Q I'm going to show what's been marked as 3 Txhibit No. 3, Turn to page five. Now we'! read what 4 :'ve read before. The City and County specifically 6 deny any liability for the debts and obligations of the 6 Hospital. Board; provided, however, that in the event 7 any actions are asserted against the City or County for e such debts and obligations, the City shall defend and 9 hold harmless the County from such action for a total 10 sum against both the City and the County not to exceed ii Four hundred " .,.,list nd dollars ($400,000). Are you 12, familiar with that provision? 13 A Generally, yes, W Q Now before this are you aware that the 16 Zity executed this Agreement along with other parties? 16 A Yes. 17 MR, CLARKi -We're not as of yet to we haven't had a chance to look and say that ig is the exact same Agreement that was 20 executed. You represented that it was copied 21 from Court's file, so he can't testiff that 22 that was that Plaintiff's Exhibit Nc.. 3 23 is, in fact, a true and accurate copy of that 24 particular Agreement, 26 MR. LEVICK: Okay, but it's my V b h REPGRTINd SERVICES - (214) 226-.2166 eso ~ix2nN 3 1 I understanding that this w::. oe r ; .0 e ewe.., at 2 some time and we will J 3 MR. CLARK: We can check it, yes. 4 MR. L2VICK: Okay. Thank you. 5 BY MR. LEVICK: r e Q But, you are aware that a Settlement 7 Agreement was executed at some point in either December 6 87 or January 88? 6 A Yes, 10 Q And, the City agreed to indemnify the County - 11 for up to $400,0007 That is your understanding? Is 12 that correct? 13 A Provided all of the conditions as you i~ 14 euti:ned were met. 16 Q Okay. Now, was tki3 approved in the City's 16 budget before the City executed this document? 17 A No. 1s Q Are you familiar with the 5200,000 payment 19 that is a settlement payment that came out of this 20 lawsuit? 21 A Yes, i 22 Q Now, it is my understanding that that was i z. I 23 paid over three years or was to have been paid over ! 24 three years? 28 A The 200,0007 V b H REPORTING SERVICES (214) 226 2266 1 1 Q Or was that a one titre pay 2 A it was a on. t:m,e payment, 3 Q Was that noney paid? 4 A Yas. 5 Q Nas this money did tliz money come o•.;t c'. C 8 the h:M 's b~ „ .y aget? 7 A It came out of the City funds yes- 8 Did it come out of an approved budget item? 9 A I just can't recall the exact trail history 10 of that amount. It was either appropriated in a budget 11 and spent o; there would have been a formal budget 12 amendment setting aside funds to make that payment. 13 Q And if there was a budget amendment how 14 can you explain how a budget amendment works? t5 A That would have been taken to the ~iti i 16 Council and approved by the Council, in ordinance .crM, t 17 ao a formal amendment to the budget, 18 Q So this would of all had to have taken place 1 19 before this money was paid? 20 A Yes, It would have to be an appropriation, 't 21 yes, 22 Q okay, But, it might have not come from the ? 23 official budget as approved fOr that fiscal year? f 24 A it would have come from that budget or "a 1 r 26 budget a formal budget amendment on that budget, V 6 REhORTIM0 SERVICES - (214) 226-2266 i i ,Y f } F V Y' 1 ~ y~ I yes. 2 Q Okay. you were prose nt wl;en :1r, XCC;-ace 3 testified as to some sort of thres Year payment for 4 :stti.mant are you --do you know what he was 6 teztify;.nq about? 8 A yes. 7 Q ^~an you explain w}•.at `.:.e three ent J year payment was? r 9 A In the Settlemont Agreement you will note 10 various obligations of different parties, and one of 11 the obligations being the $200,000 direct payment, In 12 addition to that, the Flow Foundation paid to the 13 hospital an additional 6400,000. The City in :urn 14 agreed fc contract with Flow Hospital for strvioe:, in J t5 :•w::re years and to , . t M pay in thoae fst,.... loar:. the s•.,,,. 18 cf $200,000 per year which in tarn would be paid back 17 to the Flow Foundation. 5o I thinlt that's what Mr, 18 RoQrane was referring to as far as the three year is commitment. 20 Q Is the City honoring this commitment as of 21 ;r 22 A No. 23 Q To date? 24 A No. 26 Q And, why not? t g REPORTING 8"V:CHS - (214) 226-2266 M 7 .iJ 4 n• - N I: I i C i A The City has taken the pos.ti,ri, t~,at aymer.~ 2 could no ' ongor be -30,0 c ;ce F' Ow tlospi i :eased to 3 exist because the services contracted fr., could not be 4 provided, . 6 okay• You say that Flow EE, aorr: you 6 said that the City entered into this Agtohrnent to pay 7 $200,000 per year. Was this all approvfV) by the 8 budget? 9 A There is an allocation in thiL7sar'c budget 10 for 9200,000, which has not been spent a,_ this point 11 because t.-he hospital no longer exists, 12 0 so what might happen to those f;nds might 13 they be part of some budget transfer? 14 A They could be, More than 14r.the,: would 15 4Ust pimply return the fund balance at end of the 16 fiscal year, 17 Q Now, when this Agreement was ~,,<,~•a"Qd or. t 18 City agreed to Lund this 5200,000 per ya,- ir, addition 19 to the other $200,000 24 A Yes. 21 Q Wag this approved at that pot., ne at 22 theexecution by some tort of amendment tho budget? 23 A No, because those were futur+: ,r pa the so 24 t".at would be made to they would not ha,,, .,cen 28 reflected in any budget document other she c;~rrent E t V & N REPORT2NO SERVICES - (214 -:266 . rv VtiM4~ K 1 1 !is.al year, 2 Q $o, w"at would the p_act1_,e be t:^e near 9 :a! :fear yow the City would ;gee: and decide if 4 ey .c;;ld al'ocate that 5001000? 6 A That's correct. 6 Q And what if the City could not allocate it 7 A ':hen, they couldn't allocate it. That would 8 ae a decision of that City Council at that point. s Q And that means that you would not fund the io money pursuant to she Agreement? 11 A That's correct, 12 MR. LEVI M I'm going to ask 13 that this be marked as Deposition ExAibit No, 14 4. J 15 !Deposition Exhibit Na, ~,.as is marked for identification,) 17 EY MI), LEVICKs 18 % :rave you ever seen this document? y 19 A I think I've seen a document similar to thtr 4 20 within the last year or year and a half yes. 21 Q In what context would you have seen that 22 document? 23 A I think during the settlement proceedings ane. k 24 uG :otl-h, this came to our attention and was showw% by 4 i t 28 dtfferent parties at that point. 1 V L REPO.°1'"*Nd SERVICES \2141/ 226-'':66 P d i 7 k I I Q And sat is your underaYa:ding o'. t is 2 document? 3 A pea'-:y dc: "::ow. We did not 'hip ur 4 41-zument that was entered into baclc _S"i, 6 Y.".in!f at t'-.at point ca':ed for certain respot%-.bi'.iti 8 on the part of the City and County. Sul to -1111 7 knowledge, as least since I've been here, certainty 8 this Agreement has not been followed and adhered to by 9 the various parties. 5o it was somewhat cf a curprtse 10 wl en it was revealoA 11 Q Okay. No,t, io 1t your understanding 'hat 12 pursuant to this Settlement Agreement, whether this be 13 the right one or whatever, that the City transferred r t 14 aii its interests in flow? J 15 A That's correct. I i 1 t8 0 Do you know what the City's interests .cv I 17 was? 18 .':P„ CLARK: object to i l 19 calling for legal conclusion, 20 BY MR. LEVICKs t 21 Q Did the City hold title at all to the 22 buiiding7 23 MR. CLARK: I'll object to 24 calling for t.".is gvaeztion calling for r 26 legal conclusion from someone who is not s j r `l. ' 6 REPORTINC SERVICES - (211) 226-2265 1 z I I lawyer. He'. c:;vious+y not qu.::_..ed s 2 $ t: t l off:.. ^ 3 BY MR. LEV:CF: 4 bid the City awn t e 5 A re31i; don'` ':::aw. wan not involved 6 that kind of detail as to the o:tact cwnerChi; .tz t 7 t.at we may have had or may not have had, 6 Q Do you have any andersta ndir.g what the 9 awnarz.nip interest might be? 14 A No. f Q okay. Did you understand that the City had 12 any obligation at all to Flow during your years as 13 City .Manager? 14 A need you to clarify that question. 16 Q Okay. j S 16 1 What do you mean obligation _ ,that 17 obligation'. 0 Q bid the ".ity have any tort of `.'nancial 19 abligation to Flow? 20 A To my understanding, thore was no finaneiai 21 obligation in and of itself to flow Hospital. f°hat was 22 a legislative decision '_bat eras made eaoh year by the 23 City Council; 24 Q Did you understand that the indigent Health f 26 Care Act imposed some sort of liability on the City? r i JI + d..OAT!90 3ERV?CE5 f24.4i ' 226-2266 4 ~ k ! Y ! t i t R ^t a 2 Q To Flow? 3 A don't .,ndersta.%,. that. and t at'r not 6 Jltay. What is the City's position? & A The City's position is not to a_r^e :c ! u. 7 aaau~,ption that that Act did in :a:t impc o a responsibility on the City. 9 Q Ooeo the 'n digent. Health Care Act impose any 10 responsibility on the City7 ti M5. 'JRP.YOVI"CH; Cbsection, He'a 12 calling for a concluzian by someone who's not t3 an attorney. And I think he'o al:^ady 14 answered it. 16 2Y MR, LEV!M 16 Are you aware at all of a resolution artnnc; 17 1575 where the City and County agreed to contriaut 18 jointly to Flow until the 1975A Bonds wera paid in I; to 1994? Have you ever heard of that? 20 A No, not specifically. 21 Q Have you heard of it genera::,? 22 A Well gonerolly, ! do know that there aro somo t . E 23 bonds outstanding regarding Flow Hospital. 3 ~ 44 Do you know 25 A Excuse me, r V & H REnOR^.'I"!^, SERVICES - (214) 226-2256 t y J 1 Q I'm sorry gc aheac. 2 I'm .:.:t .^.Ct 9:;rf, CF 44.e Part:CUlar detai 3 as you have recited thee. I'rr, nct n-re if 4 o: rct. 5 k =o yo ;t o:: e ..e ^ity over heaped r t u e financially with these bonds? 7 7s i dan't know, :40t that I am aware e Nent :f: the record.) 9 "Ir. Lavick will now be address•'s5 10 McCrane with the next question.) Al E: MR. LEVICR: 12 Q Mr. :?C-.~r'nne, I want to talk to you aboat 13 theos 1975 ~cnds. no ycu know if the City has ever 14 made ar.y payment: :n these 1971 bonds? 16 A The only thing : cat speak to is the time 18 "at I've been here sines )ure of 94, the City h,as 17 n?var made any paymentW or, the bonds. s 1e Q Is that something that you cc--Id 7z-~-.Id 19 heel: to see if before tune '84 the City may have ever 20 made a payment on these bonds? _i 21 A I would have no way of knowing. 4 y 22 (Mr. Levick is now addressing +!1 23 Harrell.) 24 Y Okay. Did you snow if the City has ever -,ade 2s ary rnyments on these bonds, and I'm now addressing ;i cE .^-~;n+rr ~"s3VI".ES (,^:41 226-226L i Y, i; d 4I; ~ ~ ` Y this to ::r. l?arre::. sc'»'.. have :o 2 A No, my re.'po nse would be m,i:ur to 3 Xv0.-ane. have no kn cw edge of what happened pr q .val "at :ogard, But, oincc I've been 9cre. 6 there have beer no payments. 6 14R, LEVThat to al. : nsv LL :t 7 Thant: ycu. 6 CROSS "MMINATION 9 BY X-1., CLARK t 10 Q ilike to show you what's been marked as 11 Ex::ibit A to a "omplaint in one of the cases here, the 12 ~omplaint is styled Scientific Leasing, Inc. v. City of 13 Denton. :.ase No. 5-89-64-CA and attached to it is a 14 :".aster Lptze 1lgreemant with the Lessee shown as Flow 16 Xemcr:.ai Hospital and the Lessor shown as LILAC 16 ::nancial Services, also known as Lease investment 17 lorporation. Now, that Lease is dated September 25, 18 :5St, so that would be a date after you tool: ov^r ycu: 19 duties as City Manager? 20 A That's correct, i21 0 Do you recall that Lase being preaer.te-. i 22 the city Council fc. its approval - Eo that Flow :quid 11 s r 23 then enter into that Lease? 24 A No, this Agreement was not presented to ':::s { 26 City Council, , r S P REPORTIM0 SERVICES 214) 226-22i6 r , • s i, C J 1 C Ard at - :'.6 an 2 cunCil -neetlrgs esCep' a:-cr. ~ 3 A Yez. 71r 1 4 i bra y7u' e3CC^g 7 - 6 lease r.: cit.r_ . c,mer.to that might ob' 19ate the ( g ::ir rental payment: of S9rv2« 3 month zs• a1:{ty ilon . 7 for a tots! cf 5523,00,". Wou'.d tha, be some: yk g ti,at night be brought to ,bur atter.tior.? g A Yes, :'m sure it would be. ip Y Most definite:y, given the a:.c3 of the City 'n ii budget. if there was any evert the sli,htcot hint 12 .hu. the City might be liable for a lease of 5533400( is would you as City tanager have that brought to your. . 14 attan It ion tb A T certat:'y would, Mr. -"ark, tg Q And wat that Laase e'r:r brouq::: bcfc:c - Council for its app.°Ava or ~ b' enzinq my wk,..-,? . ~ . i ig A No. i 10 b:d the hospital. what we've boon ?t 10 Flow Hospital, while ya'a've bee., City aaaager, come j f 21 the City and re rp"-..,.lst . -If its :ca..ec C: ?uent a~ . 22 purchases or personnel dacis.o:ta i :Lr1rg or, ppay~-.entt 23 cf things? 24 A No, they did not, 26 Other thin there shcrt rtquects for IF 1 r ( : '1 . ~ i /+O ' V U M tl . V .ri1 V ' ` u } ~ 'I u Y C ~ 4 G V 7 f•• I( k; N i I,y Ill• 1 1 1 add.It 41 onaI funw-. tu.:.t M,ay :.airy see:. r..ade 2 tir9 :cr at c!w... `or t.e p::ai boarw or t:ze oard c£ trustees sr;.= o. the ' :r.vite ^e L':.y Cn::nci: , o o:'er ee o: g .n:2r`br: ~ith cr control any o`. hei. a t ^i ` s 5 tic 7 A,: ti : the did appr:ve g his S:; ~,fdJ ".a: ua- ta!',eC about in the °5/Sr 1 g wan that des.g:.ted fo.- any by t"-: f"..'..`i 1 : ri 10 11 1 ac, it Was nor it was ::Gt. 12 MR. CLAOX: :'1: reserve the 13 remaining questions until a .ime o' t::a?, 14 MR. LEVICK; ::ave nc:.".ink } 1g .r.rther. ':hank you, ~g ""he deposition ad^ourr.rd at 2; fC t 17 3 18 STATE CF :'ERAS 1 19 y~~nny OF DALLAS 1 20 Subscribed and sworn to me by the said aitnens. i'. 21 Lloyd Harrel., on this the day o: 22 ~ .089 23 Notary Public in and'for 24 the State -.4 Texas § 2b My Commission espirso: s, 1 t, a REpOvT!,tiC Sv°VjCZS i " 41 ^.c •rf fi t~ 1 ,"r,cr •~r•_,rrN 2 '"he witaeSS Lloyd Farrell. stnt~- 8 make the . -aagcs to hi:. 4 :est',.cny as o;irinn:' b e 8 10 i 12 13 i 14 JJ 16 L: oyd Ha rre 17 STATE OF TEXAS 18 •~OVNTY OF 19 , Subsoribed and sworn to before :no ~p 20 "t"Am on this the day of . ° 21 22 23 1"OLKy Pub11C in and `or the State of Texas, 24 '4y COmm:salOn expires; t r ti 26 _ V b og?pSm:"1C SERVICES - ("14' 1 i A ' tNI1lZ,~q~ STATE OF '"EXAS 2 COUNTY 017 DALLAS mh. 3 s is to csrtifn that 2. 4 .'Led Shortha:,d Reporter _n and ~c. g• ;s 6 :'e%az. reported in shorthand the proceedings :^.al a• _ 8 :-"-d ?!ace set fcrth in the captfc: he;ecf, 3:,~ V "c= the ;-eat of my ability the a;oove and fc: 7 n+~.V s p:uca co,,r,'_h a full. true and ^c::ec' ~ c 9 tha said prcceed:.yga, 10 "ur= .It tc nuleo 205 and 206 you will receive a } econd csrtificate page when this as filed. 11 12 Certwfiod to on this 18th day of May. 1989. 13 14 Kow bR1~ENj CSR NO. 4056 16 V G N REPORTINC SERVICES 3501 dKnoll Point i 18 Garland, Texas 75043 (214) 226-2^46 E 17 18 ~cmmiasion Expires; 12,'3:9: 7 19 20 ' 21 22 { ,I ti 29 24 r y t 25 . V G u 'bw?JRTI"IG SERVICES - 2.4) 226-2216 r I 9 ilx'd'GfY1ay[} R09 ~E ~ I 77 ~ 2 pI .tr,~s.. Lloyd Harrell. s~tlatez that ~ w:;?:e. 7 4 :::r^ -y as cr1Y:r, y: don t• R . • , ll~4tCLY~. r 9 10 11 12 13 14 16 - 18 Lloyd Harrell 17 S"P-Tt OP TEXAS ) '~OUNTY OF 19 Subscribed ands orn to be re ;ate Ile ac::: 20 witness on this the &t day of - A. D. :ye; 21 1 22 Nat Public in and !or 23 th State c: Texas, 24 My Commission expires; 26 F., ; j y S :4 zEnORMIC MV: CES - l :14 ` s- 22 i t + t ~r v , ~i FLOW MEMORIAL HOSPITAL Financial Statements and Schedules September 30, 1980 and 1979 I h (With Accountants' Report Thereon) i i n A 1 f 1 VRdWlY it 1 Cerlified Public Accountants Suite 1500, 2001 Bryan Tower Feat, Marwick, Mitchell&Co, Dallas, Texas 75201 The Board of Directors Flow Memorial Hospital: We have examined the balance sheet of Flow Memorial Hospital as of September 301 1980 and the related statements of revenues and expenses, r changes in fund balances and changes in financial position of unre- stricted funds for the year then ended, Our examination was made in } accordance with generally accepted auditing standards, and accordingly 3i included such tests of the accounting records and suck other auditing procedures as we considered necessary in the circumstances. The P financial statements for the year ended September 3O, 1979 were examined by other auditors whose report dated Jranuarr 12, 1980 ; ' expressed an unqualified ;;pinion on those statements. In our opinion, the aforementioned financial statements present fairly ' the financial position of Flow Memorial Hospital at September 30, i§80 e and the results of its operationg, changes in its fund balances and the changes in financial position of its unrestricted funds for the year then °ended,'in conformity with generally accepted accounting principles applied on a basis consistent with that of the preceding year. Y 9 Our examination referred to above was directed primarily toward formulating an opinion on the financial statements of Flow Memorial Hospital, taken as a whole.' The current year's supplementary data included in Schedules l and 2 are presented for supplamenta'ry analysis purposes and are not necessary for a fair presentation of the financial position and results of operations and changes in financial position of I' Flow Memorial Hospital, The current year's supplementary data have been subjected to the auditing procedures applied in the examination of the basic financial statements and, in our opinion, are stated fairly in all material respects only when considered in conjunction with the financial statements taken as a whole. November 28, 1980 a, t . ~Q~eJ l N rn H ea.M ~r' nn orna~&i p 'E~y+ ~Al ~Q~~aj b?g+ a~ p,„ tf n p Np a a I~' C S "P3 p04 " ° ~ryh Ilp+ ~N ' 6~ yVpp1 ~ A ~ 10 ag A ' I]. M O P' ~1 K F~M Iryp n w~ w r{ pW„~ ~ ~O ~G p N R ~ M1pp 4tla~.lryp q~ M r'1 ~6 !f @ ~~i Ov ~ O /p~paWp EOQ7 X41{ AGt' ~ y11~y j~j~ ~p ~ O f6 pp. `B fyA p C~ M W pA N R~C f9 Ifr1E 1+ F~+ W~ 41 tll v ~ n a o CL ~ Or a r+ tt $-j n C M C W W C~wwN N w I w W 1JI O. d+ N ~ ~ V ~ U, ~O t 6 tpp ~p~ppp~~ ppy.~~ yy....++ pppp In tlI~F~VNtJ OW~N'o WpY. N Y P ~O N,O CO~ .wl ~ 1 i V w 01~p VW pyp~ eeSn V V~h VCNf V, Y h~ W 4 ON VWi V b~ W to O1 pVp Oe 1-~ ~;ri W {$1 m b' I w n~ ag Y W ~ S w rr y a n n } p LA v VMy~ J {A VNNI yy~~ W ~ W N O~ H O~ N N OwO N I~ i V V V V V yy w~a~oo rn ~N~G WN w { V y M r o~ tOOtnn~~ r V y V V V V V j H lA w N O~ O N ul W - i i j j F 1 S Y 3 t I i 4 t } s a 5 i e i 1. FLOW MEMORIAL HOSPITAL Statements of Revenues and Expenses Years ended September 30, 1980 and 1979 j 1980 1979 Patient service revenue (note 2); Inpatients Outpatients $ 81281,696 6,8263886 ' 853 800 746 931 Total patient service revenue 9,13 , 9 7,573,81 Deductions from, patient service revenue: Contractual adjustments - Medicare and Medicaid (note 3) Proviaion for doubtful accounts 526,859 311,563 Charity services 567,018 5450903 Other 370,288 382,058 Total deductions from patient service 139.134 98.519 revenue Net patient service revenue 1 603 299 1 3 8 043 7,5 2~, 9 0235,77 Other operating revenue Total operating revenue 164 086 134 701 75 Operating expensesr Nursing services Other professional services 2,6580930 21,131,25 General services 2,292,352 21112,181 0enerel and administrative 1,503,579 1,279,776 Depreciation and amortization 908,796 183,948 r Tntereat 339,916 295,767 Total operating expenses 73 937 55 032 777 ,5;'~ 7,- 2 Excess of operating expenses over operating revenues 91,227 28 3 4 Nonoperating revenue (expense), Unrestricted contributions (note 7) Interest income 262,710 3199158 lain (logs) 04 disposal of equipment 27,329 25,968 Net nonoperating revenue 357 44 764) -A W9 0,3 Excess of revenues over expenses s` 1 $ yl gee accompanying notes to financial statements, i 1 FLOW MEMORIAL HOSPITAL Statements of Changes in Fund Balances Years ended September 30, 1980 and 1979 c UNRESTRICTED EMS 1980 1989 Balance at beginning of year $ 3,627,281 3,596,490 Excess of revenues over expenses 2093169 13,008 Transfers from restricted fund 46,911 _ 17,783 Balance at end of year $ RESTRICTED FUND Balance at beginning of year $ 11,970 11,441 Restricted gifts and bequests 34,941 18,312 Transfers to unrestricted funds 46 911) 17 183) Balance at end of year $ See accompanying notes to financial statements, Y } i 1: A Y I j PLOW MEMORIAL HOSPITAL t Statements Of Changes in Financial Position of Unrestricted Funds Years ended September 30, 1980 and 1979 ' 1 1979 Funds provided; 1980 Excess of operating expenses over operating revenues Less item included in operations not requiring funds; $ 81'227 287,354 Depreciation and amortization Funds derived from operations 339 916 29 67 Nonoperating revenue and expense, net 25,16$ , 13 Funds derived from operations 290,396 300,362 and nonoperating revenue Proceeds from long-term debt 549,085 3081775 Transfars from restricted funds 168,404 323,994 8 46 911 17 783 Funds urea; . Additions to property, pleat and equipment, net ; Curtest installments and repayments of long-term debt 500,980 426,217 Increase in boardwdesignated funds 133,614 133,399 Increase in werkiag capital 13,863 81887 115 943 82 049 i Changes in components of working capital; Increase (decrease) in current assets; Cash and cash equivalents Patient accounts receivables 19,885 31,128 Due from 0OVernmental agencies for settlement 237)552 (132,365) of cost reimbursements Accounts receivable -other (19,201) 61125 A Inventories (24,960) 48,549 Prepaid expenses 78,742 37,194 4 016 42 722 Increase (decrease) in current liabilities; 29 ,0 Current inatAllments on long-term debt Accounts payable 34,337 51t285 Accrued expenses 157,$74 (161,285) 121110) 56 S 6 Increase in working capital LIM 0, See accompanying notes to financial statements. i 4 !f t i i V . h.A FLOW MEMORIAL HOSPITAL Notes to Financial Statements September 30, 1980 and 1979 f (1) Summary of Significant Accounting Policies i The Hospital reports in accordance with the "Hospital Audit Guide" published by the American Institute of Certified Public Accountants. The following are the more significant accounting policies used in the preparation of the accompanying financial statements, some of which are unique to non- profit hospitals. (a) Restricted funds are used to differentiate funds, the use of which is limited as to use by the donor, from funds on which the donor places no restriction or which arise as a result of the operation of the Hospital for its stated purposes. Restricted gifts are accounted for as additions to the restricted fund balance. (b) Third party contractual revenue adjustments are accrued on an estimated basis in the period the related services are rendered. The estimated amounts are adjusted to actual based upon completed coat reimbursement reports at the Hospital's year-end; however, such amounts are subject to audit by the fiscal intermediary. Such adjustments, if any, are included in contractual revenue adjustments in the year of determination. (c) Patient service revenue is recorded at list prices, with con- tractual adjustments, charity service and policy allowances and provisions for uncollectibleaccoun e id ducted to arrive at net patient service revenue. i (d) Property plant and equipment is stated at cost, or in the case of property donated to the Hospital, at the fair market value at the date of the donation, which is then treated as cost. Depreciation is calculated using the straight-line method over the estimated useful lives of the respective assets as follows: Years Land improvements 5„30 Buildings 15-35 i Fixed equipment 5„30 Major movable equipment 3.27 Equipment acquired in lease transactions which are in substance financing arrangements (capital leases) are accounted for as installment purchases. The capitalized lease obligations r reflect the future lease payments discounted at the `interest ' rates implicit in the leases and are depreciated using the ` straight-line method over the estimated useful lives of the j` capitalized equipment. (Continued) i, 2 FLOW MEMORIAL HOSPITAL Notes to Financial Statements (e) Inventories, consisting primarily of pharmaceuticals and supplies, are stated at the lower of cost (first-in, first-out method) or market. (f) Investment income, unrestricted gifts and gains or losses on disposals of equipment of the unrestricted funds is recorded as nonoperating revenue. (g) Accrued pension coats are funded annually. (h) Income taxes are not provided since the Hospital is a nonprofit institution exempted from Federal income taxes. (i) Certain reclassifications have been made to the 1979 financial statements to conform to the presentation of the 1980 financial statements. The Hospital is jointly owned by the City and County of Denton, Texas and operates under the authority of Texas Civil Statute Article No. 4494(i)-l by a joint City-County hospital board without taxing powers, The Board is compoaed`of seven members; four appointed by the Commiasioners Court of Denton County and three appointed by the City Council of the City of Denton. (2) Total Patient Service Revenue A substantial portion of total patient service revenue is generated by patients who qualify for Medicare and Medicaid programs funded by govern mental agencies. The approximate percentages of such revenue included in total patient service revenue were 33% in 1990 and 30% in 1979. (3) Due from Governmental Agencies for Settlement of Cost Reimbursements `i The Hospital's cost reports for all years through September 30, 1979 for Medicare and Medicaid have been examined and final settlement determined ;s by the governmental agencies' intermediaries. The net receivable from governmental agencies for settlement of coat reimbursements of the r~ Hospital at September 30, 1980 and 1979 amounted to $25,000 and $440201, x respectively. a t e S 1. ' i (Continued) 1 3 FLOW MEMORIAL HOSPITAL Notes to Financial Statements (4) pension plan The Hospital sponsors a money purchase pension plan with an insurance company. All full-time employees who have completed one full year of continuous service and are at least 25 years of age are eligible to participate in the plan. Under this plan, the employees must contribute at least 2% of their earnings and the Hospital contributes an amount equal to 5% of the employee's earnings. The pension plan costs approximated $48,619 and $29,062 for 1980 and 1979, respectively. (5) Long-term Debt A summary of long-term debt at September 30, 1980 and 1979 follows; 1980 1979 Denton County - City of Denton, Texas Hospital Board revenue bondae 1975 series $ 280,000 285,000 1975-A series 280:0.00 280 000 0,000 S J Capitalized computer lease 171,490 210,393 Equipment noted payable 256 866 143 8366 9ee0 35 H9 IM Less current installments 132,230 971893 Long-term debt, excluding current installments $ 856~12~6 82®1,336 E The revenue bonds were issued in connection with a major facilities improve- meat and expansion program between 1975 and 1977. The related bond agreements contain various restrictive covenants, including first lien on all revenues of the Hospital, limitations of additional long-term obligations and restriction of funds ($46,364 at September 30, 1980) to f' comply with the redemption provision of the bond agreements. The repay- ment provisions followr (a) 1975 series - payable annually each July l in amounts o£ $5,000 through 1982 and $10,000 through 1986 with the remaining balance of $2300000 subject to mandatory redemption annually front July 1, 1987 through 2000 in amounts ranging from $10,000 i to $25,000. The interest rate is 6,98%. (b) 1975-A series - payable annually in amounts of $60,000 due July 1, 1981 and 1982 with the remaining balance of $160,000 payable annually in amounts of $20y000 beginning July 1, 1987 through - 1994 Interest rates range from 7% to 7.25%. `r (Continued) Y I NMkM CiLtlJYI !k R + e I 4 FLOW MEMORIAL HOSPITAL Notes to Financial Statements Annual minimum lease payments for the capitalized computer lease and the present value of the minimum lease payments as of September 30, 1980 are as follows: Year ending September 30: Am ounk 1962 ? 1982 $ 56,781 1983 56,781 1983 56,781 s~ 28 Total minimum lease payments 390 Less amount representing interest 9 ,73 ( Present value of minimum 27 243) lease payments $ 1714 Oe Equipment notes payable are collateralized by equipment with a depreciated cost of $280,304 at September 30, 1980, Scheduled payments on the notes including interest are as follows: Amount Year ending September 30: 1981 1982 $ 109,280 1983 69,308 1984 65,195 1985 33,905 15 758 jt {6) Unrestricted Fund Balance $ The sources of the unrestricted fund balance are as follows; Se tember 30 9 ME € Operations $ (969,652)(1,1530821) County of Denton 10696,871 11696,871 ; City of Denton 393,166 393,166 Flow estate bequest 240,461 240,441 Federal grants 2,125,281 2,125,281 Pledges and gifts $ 372 23 32 j (Continued) i acl'2 srn l{lRybry i1 11 I 1 5 FLOW MEMORIAL HOSPITAL Notes to Financial Statements f (7) Flow Memorial Hoa ital Foundation Inc, Flow Memorial Hospital Foundation, Inc,, a tax-exempt, pot-for-profit organization, was established to preserve quality kospital and medical care for the residents of Denton County, Texas, The Foundation's _bylaws provide that all property and money given to the Foundation be distributed to or held solely for, the benefit of the Hospital. In the absence of donor restrictions, the Foundation's Board of Directors have discretionary control over the amounts to be distributed to the Hospital and the ;f purposes for which the funds are to be used, since the Foundation is a separate entity, its financial statements are not included herein; however, at September 30, 1980, the Foundatic.,'s total assets (unaudited) amounted to approximately $863,000. F, A aummairy of the contributions received by Flow Memorial Hospital for the years ended September 30, 1980 and 1979 is as follows 1980 X79 Unrestricted contributions - recorded in the Hospital's statement of revenues and expenses as nonoperating revenue Restricted contributions - recorded in $ 44,712 32,412 the Hospital's statement of changes in restricted fund balance 1 (8) Employee Inauraace Benefit an Effective January 1, 19791 the Hospital established an Employee Insurance Benefit Plan for the purpose of Providing health and welfare benefits in the 'event of inJury or sickness to its employees, Employees may obtain dependent coverage by remitting a monthly premium to the Hospital. Additionally, the Hospital obtained excess risk insurance coverage for i health and welfare benefits exceeding $100,000, !:.1 ; ' of 1 'Ale ~ Y schedule 1 j. FLOW MEMORTAL HOSPITAL Patient Service Revenue Years ended September 30, 1980 and 1919 f Routine Services 1980 19 g { Special services; $ 2,316,876 Intensive care 1,958,484 Coronary care 136 920 Nursery s 3190468 Obstetrics 311035 Tabor and delivery 369,520 278431 Operating room 464,550 422,268 Recovery room 286,735 212,205 161hr9ency Voom 342;010 255;603 { central supply 85 905 52~335 Laboratory 308,216 252,319 y Blood bank 584,23) 494,154 Radiology 794,081 737,343 Nuclear medicine 55413 59,932 Pharmacy , 563,184 4730412 Intravenous therapy 109,669 86;1)9 k'. Anesthesiology 750,189 443,240 Electrocardiology 517,015 3720099 Physical therapy 331,925 258,098 Inhalation 'thera 159,127 -144,056 Social services py 114,712 135,109 r 518,247 5140842 i ~ le--- -37,0 3 20 I Sea accompanying accountants, report, 8 i j, E.~ IN r E } i s ~ II Schedule 2 PLOW MEMORIAL HOSPITAL Operating Expenses Years ended September 30, 1980 and 1379 1480 1979 Nursing services; Routine care $ 1,078,834 939,422 Intensive care 133,938 1850536 Coronary care 267,731 656 Nursery 226;788 192,856 Obstetrics 1300557 121,826 J,abor and delivery Operating room 211,700 178,197 Recovery room 214,543 169,093 Emergency room 340992 31,583 ; 359 847 311 956 ; 2p 2 1 12 1 Other professional services. Central supply ',86,828 220,081 Laboratory 390 974 361 202 Blood bank o , Radiology. 32,423. 34008 Nuclear medicine 272,042 214,424 { Pharmacy 53;450 47,239 ~ Anesthesiology 442,105 393,568 Slactrocardiology 208,635 207,847 } Physical therapy 121,389 62,622 E~ Inhalation therapy 62;14$ 72,635 Social services 192,345 301,242 In-service education 821$09 70,796 Medical records 18,617 14,971 12 890 111 240 f 2 2 ,112, General services Dietary 498,435 432,080 Plant operation 654,280 5410947 Housekeeping 256,462 227,068 Laundry 94.4 2 7 681 1, 03,5 i General and administrative services, Administrative 389,032 3190163 Fiscal _ 519,764 464 785 ,9 8 ; (Continued) r 2 Schedule 2, Cont. FLOW MEMORIAL HOSPITAL Operating Expenses 1980 1979 Depreciation and amortization: Land improvements $ 40966 51022 Building 82,613 81,905 Fixed equipment 64,414 70,749 Major movable equipment 187.L923 138 091 339916 299o1767 Interest $ 73.937 5~0.i2_ , E See accompanying accountants' report. i { r 7j c f f; i l q 191.x1111 r CN41pN4 ~4f '1~ . ' IJU C1b 5utrtl.b59~11 FLOW MEMORIAL HOSPITAL BALANCE SH59TS January 1983 - 1984 FE S 2 2 {nnq 1984 1983 1988 19R Ass~:ts Liabilities & Fund Balance Current: Current: Cash and Investments $ 347,645 $ 466,167 Current Notes payable 187,283 $ 212,090 Accounts payable 11169,324 111750828 RacOtbles Patient (Net of Allow~nces o noes) 30074,371 3,037,892 Accrued Expenses 405,347 4279572 Due Government Agencies _ 636,469 121,428 Other Current Assets 19006,548 697,364 Total Current Assets 2,3980423 19936,918 Long Term Debt 11259,934 994,808 Total Current Assets $ 41428,564 $ 412010423 Total Liability $ 3,658,357 $ 2,9319726 i Property Plant and Equipment Fund Balance Donated Capital $ 404550779 $ 4,455,779 Land and Improvements $ 183,242 $ 161,469 Pledges and Gifts 569,396 542,817 Building 20943,464 219430464 Fund Balance 9-30 (1,180,404) (177,452 ' Equipment 408841W 4 743 040 Revenue & Expense summary 3180066 ( 65,416) Less Accumulated Depreciation 4 619 002) (41351,942) Total Fund Balance Net P P & E 31392,630 3,496,031 4,162,837 4765,728 Total Unrestricted Funds $ 7,821,194 $ 7497,454 Total Unrestricted Funds $ 7,821,194 4-71697 1454 ` aN.15 e. .a' 1a 4.41 Mk%ae !A~ b, i~ Page-2- FLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT January 31, 1984 CURRENT MONTH YEAR -TO -DATE P R 1 0 R Actual Budget Actual Budget Year-to-Date Adult Patient Days $ 3,146 $ 20945 $ 109930 $ 11,685 $ 11,425 Average Per Day 101.5 95.0 88.9 95.0 92.1 Newborn Patient Days 340 403 1,665 11599 1,429 Average Per Day 11.0 13.0 12.7 13.0 11.6 Gross Patient Revenue/ $ 492.60 $ 487.32 $ 522.90 $ 491.28 $ 431.09 Patient Day Total Expense/Patient $ 374,41 $ 392.79 $ 417.72 $395.98 $ 373.53 Day Month Charm Bad Debt Recovery i October $ 293,948 $ 227,787 $ 20932 November 70,669 220,915 7,287 December 769133 659810 3,787 January $ 62'42 2114,133 % of Net Revenues 9.3% 13.5% L ' .3% i i d yg~ 4 F • F Page 3 FLOW MEMORIAL HOSPITAL, INCOME & EXPENSE STATEMENT CURRENT PERIOD January 1984 YEAR TO DATE Budget Actual Prior Year Budget Actual Prior Year REVENUES $ 707,167 $ 697,056 $ 596,054 NURSING $ 21828,667 $ 2,533,637 $ 2,320,393 765,928 883,995 7160115 ANCILLARY 3,063,712 3,301,869 206040857 29,042 19,032 160060 OTHER 116,167 74,742 60,065 (293,994 1(3999447) (2130557) DEDUCTIONS OF REV. (10175,975) (1y259,329) (8870580) $ 102089143 $ 11200,636 $ 11114,672 TOTAL NET REV. $ 40832,571 $ 416500919 $ 40097,735 i EXPENSES $ 4410281 $ 436,263, $ 424,089 NURSING $ 11765,124 $ 196679224 $ 116669014 335,474 370,405 300,359 ANCILLIARY 103411896 1,4020047 10216,603 1939922 168,002 1729702 GENERAL SERVICE 175,688 713,101 707,412 87,546 85,199 729757 ADMINISTRATIVE 350,184 331,100 282,595 123,875 1180017 92,918 G. & A. 495,501 452,156 3940927 $ 11182109 8 $ 1,177,885 $ 11062 725 TOTAL EXPENSE $ .4 728,393 $ 4,5.65L628 $,I ,.67,551 ; 26,045 220750 51,947 OPERATING PFT.(LOSS) 104,178 850291 (169,816) 52,083 599399 28,135 NON OPERATING REV. 2080336 232,775 114,400 $ 78,128- $ 82,149 80,082 $ 312,513 $ 318,066 $ 55 416) } y IC(41~j..4{W.g14n h•.'.WLi~i •rF.ei114:...F. F.. „Y`~. sl. ♦ i I 'AWA4, w„w { r L 0 W M E M 0 R I A L I 1 0 S 11 1 T A L P a g o 4 SUMMARY OP CASK RECEIPTS AND DISBURSEMENTS January 31, 1984 Current Month Year-To-Date Beginning Balance $ 37,084 $ 11,043 Cash Received from; Active Patient Accounts $ 9151129 $ 30914,615 Dad Debt Accounts 41924 18,930 Cafeteria 12,114 45,789 Appropriations/Donations 44,693 1109635 Other 56,962 2820442 Total CASK 1 033;822 4,372 411 16TAL CASH AVAILABLE $a g $ 44 Cash Disbursements: Payroll $ 534,942 $ 2,0610137 Payroll Taxes 143,096 352 696 Patient Refunds 226001 83,019 Capital Assets' 430605 Notes Payable 120697 720382 Other 320,878 11733,323 Total Disbursements 11 037614 40346 cash Balance 292 $ Cash Investments 292 717 292 717 ; Total Cash $ I I_ Cash Received as a % of Revenue 60.4% 71.3% a • l ' k 1 IYl 7J 'J T Page 5 f FLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE January 311 1984 h , Current 31 60 6,1 - 90 91-120 Total Trade Vendors $ 2650083 $273,234 $ 1800582 $ 35$53 $ 754,452 Fees Payble 1010466 68,772 639263 23;3,501 Accrued Payables 21,144 11,144 Estimated Payables 1520577 1529577 Audit Fees 17,650 _ 17,650 Totals $ 5471920 $ 342,006 $ 2430845 $ 35,553 $ 10169,324 j_ i k , - x . x. o.r..e.. xui• Pi e.:4wltaY.(F.Vd,~3% I fto~ a Page 6 F L o w 11 E 14 0 R I A L If O S P I T A L AGED ACCOUNTS RECEIVABLE SUMMARY January 31, 1984 Primary Payor Current 31-60 61-90 91-120 121-150 150+ Total of A/ Medicare $ 363,845 $ 2019994 $ 81,106 $ 33,137 $ 20,234 $ 27,514 $ 727,830 15.9% Medicaid 62,935 510998 10,624 4,897 20193 -55,790 1889437 4.1% Blue Cross 65,578 175383 1,035 - 83,996 1,Fj% CommercialInsurance 4930579 216,517 76 11767 - 714,939 16.6% 1 Self Pay 232,139 324,647 374,012 317,098 261,325 1,356,335 2,u65,556 62,6% $ 1,218,076 $812,539 $ 466,777 $ 3550208 $ 285,519 $ 1,439,639 $4,577,758 100,0% 13, In-House 4119600 f Total Accounts Receivable $ 41989,358 A/R by % 226.6% 17,8X 10.2% 1.8% 6,2% 31.4% Days of Revenue Accounts Receivable 8818 In-House 1,0 Total .f i r ....,....gym _ - RF r +I ® 09. 00 !.h U7 11 tP 19f 14 (A AllI IM 1'14111 I'AIrP } - - r '0411If'N1 PA T.IU 1'I II;. 1i71ANMIIn1 Milt.,..... ADI M.OR... IIY. OT T th, , D. , 411'11.11IMiL"", JIM11Y 100111C101 IV 171' A'1111II. t)n IIJ111F1Y I B. D'T E AMOIINT . , . 40 PZ!0 HANN 6I'1 4 D_Ca I1tlN ik 76401 It1/R6/pay ..q1. 15;1 ' AVR)[TT, DARDARA ANN 40000140 C-R CC IWOTON Co. ,JAIL F„ MCKIIJ TUN Nance Aft M H r f~'~+d}A~~I~ytal Rat~Rfdq~ion Y pn00ER,PnuLn Benton County Jail I 0070IN3 IP 1i1 Dh)1(.E17, JUfi Rol TON T% 76% 1 I"/0 /03 -Id3, .6 ~1 DARNCTr,L. 11. 4007.066 ER f;P 11AUNF11,L. H, box 13~=p 1 Dalanre After Menlo Hoafln lantal Retardation * 13n~+ N, CLM DENTON TX 76201 10/.0/153 -40, 00 DECKiPA7TY 460'70610 LR 0P BUCK, PATTY 1517 hd11E Balance After 11adICpld / M DNTtlN TX 76301 11/16/63 -"23.00 DECI(,PATTY 400fl146D ER BP lIRCK,I°ATTY 017 ROBE y r Balance After Mod) aid DXAITON TX 76%01 II/P7/03 ^11, bU nELLAR,ELIZADGT11 100091P.9 IP RP I)ELLAR,I:LIZAUETH DNT NV1t6 ErJ 1!R 10 DENTtlNaIanCO After nodictfd 10/1%/83 -pG.bb • S1~L~ .2 p DLAIR,CHARLES R 10069449 IF, EP ULAIR,CHAWIS R AT 2 tax 934 DENTOIJalance After ModlAald TX 76KOI 11/15/e3-0,Celt. 60 • OLAIR,CIIARLE6 RURERT 700%^6919 OP 6P DI.A?.CHARLEB kbDERT AT DU% 934 Indigent Care ti DENTON TX 76PO1 01/16/64 ^6.1.79 1M 116009, DONALD R 00007716 IF SP 00008,DONALO AT S BOX 3E T[UOAIndigent CArTX 76271 00/16/ D2 -1, 918, :4 4 DOWLRS,ANNA 0 40002065 ER UP BOWLES, ANNA U Box 39 Balance After 11ed1 A1d 71UQA TX 7671 08!13/63 ^11, 0> • BULLARD, ANN SUE 10008340 IP SP DULLARD,ANN BUE. Balance AFtepp ddif9Ald ` 1606 VILLAGE EAST kl0 OENTbN TXM16201 03/01/03 -1,121.40 CLARK, FLLA M 10060407 iP 8P CLARK, ELLA M IO: N WOOD DENTOPI dleeid Sal Xng7t6t10Cosstr~jj gent-CA O' d CULLUM, JERhYE DFANNE 40091;160 Eli CC CULLVM, JEhRYE DEAN14E DENTON CO JAIL DENT0tlalance AfteOPWINlilPWI Ret~,,1%On r r naTsCN,EILEEN L 0001U030 TP UP DOTSON,EILBEN 1015 B RUDDELL NPO pENoTtl b~entpn Count TX y Jg2l ebt 07/n0/15u -z.157.71 N ddffc pd 7S98a 1}R1VER, BU2FTTE M 10000034 1P 6P 11R1VEA,JENNIPER P, b, btlX 134 LEW1C4VtLLEaid Not TX7b101 Y 0l %19/64 -700.39 HOAN,LILLiE 10064041,! 1P Mc BAMIA,PEOQY 1128 THOMAS_ DENTONndlgbnt Car~X 76251 11/10/815 • Jf !-25, 00 EIOERR,MATILDA 4006..",0J6 ER rID EOERE,ROMMARY 400 B RUDDEILL 0129 DHNTOBNalante AftOTXltedi~fllI 09/ 14/6+'3 -96.60 • ELLtS FELEC1A 10033470 IP MD ELLIO,PELECIA 717 SUN VALLEY UE~ITtlryalance AfteTr,XM07~66Ca01d 06/20/63 -!91.60 FRiTTB,Rbb1N 0 10072163 tp 8P FRITTS,RbbtN Q ggalaoce After Medl 1d " r 1319 BRYN MAWI DFNTbN TX 7601. 1a116/03 "944,29 QARNCR,WILLIE 40097163 ER CC GARNER, WILLIE DENTDN to JAIL DENTONDZ Indigent4, 4,76201 01/17164 -Rol'o0 r A OARIA FRANCISCA 40069064 FR MC OAR2A,Pt1AIJCIOCA Denton County Jail bSZ N DRADBHAW DENTON 7X 7601 10/159/153 -IV'10 OtiN M KENWETFI E 40090029 ER CC OENTRY,KCNNBTH E DENTON CO JAIL Balance After i&t1d DEN7tlN T>l 76001 Dl%03164 -96.90. OON2AlE2,A1JEL 40090130 Fq CC oONtnLEt,ANEt Balance After Ibd Id DENTON CO JAIL DENTON TX ~ $1 01/03/84 -61,70 ~ OnEEN,WLA K 40036109 ER SP ORIERIJ,DARLA K Denton Countyy Jail 310 THOMAS N20 DENTON 7X 76201 04/16103 -9411.915. ORGEN,bARLA K 70025590 OP BP OREEN,bARLA K 1236 MCDONALb ST Indi Ant Card DENTON TX 762201 01/04/04 -90,00. r HhMp1pN RANDY PAUL 10021074 1P SP HAMPTON, RANDY PAUL R7 2 BOX 0a1 Indigent Carq DENTON TX 76x01 04/77/63 ^600,40 r Indigent Care y 1 04): UI: ol, O(r I I'II P/114 CVIAIII IY fit III IN I (160(1 L' } v PA'IIr..NI, PAT 11), 1'T IC, (10ARAIJHIn HAMV , AT)pRliD9 CITY. OT LIP.. Ute.T)TE, AMOUNT,.. HUAt(n, CIIM(I. I.Ii 40040'//7 If t;_1 JAIL, UP.bIIUN COVNTY 1)I;N I'UN OLINIUN TX 76801 D1/07/H4 -1.40 J 1I(IAf11L 0IAlt1.1:9 I'. 4007 1UJ tN CC JAIL, 0i:N1(IN 0001J1Y MCKINNEY 111. 1,10111UNton CDUnty '7X11 4r 71,.01 01/11/04 ••86,00 JOHNSON, AMY LYNN 10037770 11' t.P JOI ItJ8pN, JG'AIJ ll. Denton county 1411 J :1017 uwAt(T RD 49 DEN ION TX 16ZOI 04/17/07 -7, 31,0, 80 Indigent Care b JtII11P3rIPb JEAN N. 400561 06 VR UP J01IN130N, JEAN 11. 3017 STEWAR r NY UENTtlN TX 76061 OrJ/'b/87 -1:17.:;4 Indigont Care w t. ANUE'n D, MAII T 114 I.. 40097931 F.R 11C LANDIa(G, HART I M L. 1:,^.29 CMIRULL IILVD DCN UENTt1N TX .76x01 00/51/03 4,:0 , LOCKRIDOC,PATTY AMAND 40043960 EH SP JKRI(Y LUCKnIDOC RT 1 DOX O08 SANGER TX 76866 07/16/43 -99.00 J LOCKI)IDGE:,OATTY ANNE: 10060112 IV 9V LOCKRIDOL,JERRY NT 1 BOX 300 SANGER'gont Caro TX 76066 11124/83 -1,694.00 •,J I.UCKRIDOC,PCPPER DAWN 100)'511'! III SP LUCKRIDQE,JERRY ItT I, BOX 300 SANGERigoRt Caro ^ , w 7X 76sb6 01/03/04 804, M .0 , i Indigent LOPE2, IDA 11. 1000490 11' SP LOpEZ,FUNK W. GENERAL DELIVERY L1TTL(I ELM Coro TX 7006b 09/13/03 -1, 163. 89 J ant v LOPR2,JESSICA J. 1007,9125 IP 5P LOPEZ,FRANK GENERAL DELIVERY LITILEl I.M CArB TX 76069 01/63/84 -2,7191. 10 J HOROANItU 0TV Indigent Care 10057073 IP CC 11LROAN,.GORDON AT I BOX 379 SANGER TX 76066 :7,037.00 NOLL,HEtJRY U 00090051 ER CC NULL, HENRY p Indigent Core DENTON CO JAIL MCKINN UENTON TX.76201 01/03/04 -86.00 11 O'REAR,ORVILLC 10091,870 1P Bp O'HtiAn,OnVtLLe Denton county jail AT 8 BOX 166-A DENTON TX 76201 10/02/03 -909. b0 J pWE1JB,Jf BB1E 10069185 Ip SP OWCND, JEBBIE Ill ant Care 8x81 N MILL LEWppIBVILI.C TX 78067 11/27/03 -198.00 PEREZ, ANY 70021761 W BP 9ALAV, 80PHIE 1010 CHOCTAW pCNTrd r Of Proton iv7 o6Q01oiy0/ 17!(93 -164, 24 J w PHILLIP8,0ARULYN U 70023820 OP BP PFNLL1Pe,CAROLYN U 020 ROBERTSON BT DENTON90nt CAre TX 76$0l 11/91/03 -'13.63 J PITTB,CALViN 40077471 En m 0 PITTS,LISA A 800 0 RUDDELL APT 014 DENTONjnte After 7X4762011,111/t/03 %0 r1-3.oa PUNSALANO,ANTUNIA 0. 4007131918 EA DAI PUNBALANO,ANTONIA Q.. BOX 12 TWIN LAKES MHP DEI'TONnCe After MAkdi76 Od 11/17/83 -31,00 J iIt nIiYNOLOB,TEARI LOVONN 1009100t jr ADD RENOLDB+ANNIR M 417 BERNARD 00 DENTONnca After1TX176201 10/11/03 -189.16 J AtdH,CATHY 10070474 IP BP nICH,CATHY 1107 N ELM DENTONncO Alter Medicaid 12/00/63 -180.09 Balance After Mont pp }~ealth~p taat Retardd toq~ J ROBLCS,ANTONIO 0. 40071239 En MC RDBLES,ANTON10 0. 8414 KENT DENTON TX 7U%l 10J17/03 r .OA W 800 PATR101A GAIL 10061703 Ip MU ROOEnt9,PATRICIA GAIL 904 8 R L7e~ajl' Balance After aNnce After` MaX 76 d(ea~d01 l 12/10/830/1,3 7/$3 D306. 1,8 ~ BAMPBbN, MARK STEVEN 400BOOM13 ER CC BAMPBO UDOEUL 1,71 pEND 086 N,MARK STEVEN 301 E M ENTtlN V 7.00 Denton UER6,RU7H1& LEE M1OO4gB50 En HD RVTHIE LEE SANDERS SAN SIB.0M17H,H22 DENTON N Y T Y76201 0e/09/03 ' Count JaI J aa ~e { -31100 V MAWYER,NtOMIA 40072240 ER MD SAWYER, NE0111A 806 U. RUDDELL 176 DENTGNance After 17>d1 76 C03 101~21/t13 14.78 J no (ice After Modita~d . 8AWY6RrPATR[CK p. 400701,40 ER Mb BAWYHR,KIMDERL 8414808 After Medicaid J Sir I Y 806 a RVDDELL 0176 DENTON TX 76208 10/18/03 -1 ^6,00 a J 1r Nr -Al 0 1: i6 02 PED 1944 CHARITY wivonr PACE 3 1 ' S PATIENT,.. PAT. ID pt FC. OUARAMTtm NAML • r ADBltEli:;, . BCALLECTTOr CITY, UT 2111. . BIB. D'rL, AMOUNT. , . ' . rJOHN R . 4009nODB ER CC JAILr pE'NTtlfJ COUNTY - F. MCKINNEY ST. DENTON TX 76201 01/12104 -06.00 BHAFER,BTEVE A 40092140 ER CC tiHAPER,9'fEVF.R Denton county Jell j DENTON CO JAIL DENTON TX 76001 01/12/84 4IM4, EAPNE4T if, 40072100 ER CC JAIL, pENTON Cf1l1NTY -100, 00 MCKINNFY ST, Denton county jail 13HITHPDANDARA DEN TON TX 76ZO1 01/19/a4 -1^!4.00 10053200 Ip MU SMITH, BARBARA 106 AVE E #111 Denton Cnunty Jail W41 TH, ELLA M DENTON TX 76001 09/2N/03 •20. 00 ' f0064030 ip MC &FIItH,ELLA fI aalance After Maditoid r 0:09 CAIIROLL BLVD DENTON TX 76201 11/07/01 SMITFI,JANE 10071288 IP ADD SMITH, JANE Balance After Medicaid '45.00 I 1!310 PETERS COLON' SMITH, RANDY ZEE RD CARROLLTON TX 78006 12/16/a0 -41,07 10067049 TP MD SMITH,BARDARA Balance After Mental 40101 Mental Rolarddtion 106 AVE E H141 DEkTOk -21. JU 87EPANBNLRAYMOMD DOY TX 76x01 11/19/03 10072619 !P 9p BTEPANg4I,RAY140N0 DOYLE 9404 AVON Balance After Modlcaid r 9TOUT,MICHAEL DENTON TX 76Z^.01 12/19/a3 -ao,75 100719.^.6 SP CC STOUT-MICHAEL PO DOX lab Balance After Mental Health Manta! ROtardatlOD f' 6TOUTrMICHAEL AUDREY TX 762x7 12/x3/83 09,00 • 40044204 ER MD STOUT, MICHAEL P- CI. BOX 136 AUDREY . .Q f - j 'ipL1N0,MARY F . 40070199 ER B TX 76227 07/16/03 130. 17 Ili P B1'RIPL1N0,141CFIAEL _ Balance After Medicaid j 5117 B COLONY nLVD THE COLONY a0/a9 -dI,00 87MIPL1N0,MARY PRANCI 10031450 IF BP STRIPLINO,MICHARL WAYNE 0117 S COLONY BLVD, B THE COLONY TX 70006 lb/2 Indigent care I /0079679 Ip BP 'BTRIPLIkOrMARY 7X 76006 06/10/@3 -1,&4[19,30 ' STRIPLINO,VINCENT J. ndl ant Caro 0pp 930 E. MAIN LPW t1V[LLE TX 70'067 01/04/04 -1,609,10 fWOMAE1,00 E 10029709 IP Me, THOMAS, ED e 1,0. BOX 144 Indigent Care THONOPHANH,VANIBDNE BANDola Medicaid 76466 06/07/@3 -gn,gD 40070090 EA Mb DENTON bEY• CENTER Bal LOOP 8BH 4C'@After M@dlCaid WEST, Lplti 1 DENTON YX 760D1 SO/r^0/a3 - 40080434 ER MD -IEBT,LDIB -0gonce After Medicaid p0 ` 900 LAMEV DENT N WHITE, VGgNA F. TX 76Q^01 11/20/03 4007.3611 ER MD W1iITE,DALE 18. 00 PO POX 8869 Balance After 1 C 1~ • I YpiIN, LYNN 10066830 Ip MO YD11Nr LYNN DEN1'pN T 1761' 1 10/a7/a3 -47.00 707 611ance After Medicaid + t,-..:. DABDWOOtl MANOR LhWISVILLE TX 7067 11/10107 -57.00 - Balance After Medicaid E.... -62, 40, 43 r I 3, i i Ae. .N.Y.r I,~ I A,+Z~OCy,IHili\M rkY. lath:, b.•w pH at.,::.,..r.i.»N I»:AH d'»':+Y MiaNfiJJNac A, r.'..,;.rw,.(b F t 4 "k 5{ "p ) k/UI II II 14!14 N II 1 3 f' • fl I I H I. F' 11 If 'I PAUI•. I ('AlJCNr NMI: ('Al 11) UMMU DLO-UAL NL'W-CIIU NLW PAY W U NAL PC TYPk CYCLe LnT.rMr AGC PG TYPE J ~r J AHIRI,DR101b n IoOPO32R DD/P7/03 Goal60 174, 06 ••27.60 031.00 SP IF, 1 01/26/C4 6 1 Flt QUARANYDA INFORMATION rw AOIIMU1,6111 A A9I111 PO BOX 70 PO DENTON NTUU, T% 76203 Arrangements not kept ARMIJO, RENA 300.101122 06/07/03 2, 017. JA 440, 110 0. 00 9. 490. 11 MO IP 2 233 1 Y► GUARANTOR INFORMATION rw RENA ANMIJO 9313 NOnnltl •IHE COLONY, TX 76096 Medicaid denied/Ho response j t 31ADWELL,CLAUDE 10010307 04/06/n3 6, 911. U0 0.00 -4,692 00 619, 00 $P IP 1 01/16104 16. 1 rw GUARANTOR INFCRMATION rr CLAUDE BAGM.L PO BOX 2913 DENTONt TX 76201 Arrangements not kept J nt.A"LEY,DEBORAH H 10010066 04/10/03 1. 115, 9D 223. 40 -1, 137.76 22t. D9 SP IP I tim/rm 69 1 all GUARANTOn INFORMATION rw DANIEL D ULAKELRY RT 6 BOX 134 4 DBNTON, TX 76201 Balance after Insurance/No response nRUOKe,ADOY 10060094 11/13/tlJ 734.90 -104.60 09 00 060. DO BP IP 1 11/14/88 64 1 L ww GUARANTOR INFOnMATION ww HOWARD C RHOOKB 2 Refused to pay J PO 40% 204 ABOYLE. T% 76226 DROOKS,LINDA SUE 1002n041 OD/26/O3 471,76 713.38 0.00 1, lob. 13 BP IP 2 Ito l rw GUARANTOR INFORNAT'ION ww RICKEY 0. DROUKO 1226 AMHURST DENTON, TX 76201 Insurance dented/No response J BURROWS,AAVI1. W 10029122 07/12/03 10, 034. 00 433.10-10,402, 05 060.10 SP IP 3 00/09/03 76 1 wr GUARANTOR INFORMATION rr ARVIL W OURROWO 306 LOOP Zee ONO DENTON, TX 76201 Oaiance after PIcdicare/No response J CALLAWAYiRAYMOND 00011396 01/2t/83 7,973.06 415.06 -7r163.015 3,'120,00 SP 1P 3 06/07/0^1 74 - 1 f•: k,a'N f(AR JNPDi rr ,TH"0 8 CALLAWAY 1011 IRVIN BRIDGEPORT, TX 76026 4 AV~ 1 ~057119 0al4nce after insurance/ No response , J CNAII)LLR,MMV r • QUA" NIOA u Sorov/no j, t366, vn j, 7;14. en n. 00 m tai, vfi gp aP n 64 ! NI'MMATION na OARY CM6NDI-V4 1011 L•ntitJCGMT VMTON. TX 76201 i Arrangements not kept DAVIS,DANNY 10014736 03/30/03 1,119.24 701.99 0.00 2,621,20 ADD 1P t Mr GUARANTOR INFORMATION rr DANNY DAVID N29 MIA' CORINTH, TX 99997 41. t No respomo J EDWARDS, SHELLCY BETH 100389,72" 00/27/00 70$, 00 144.30 -20.00 901. 30 BP 1P 2 2/1 ar GUARANTOR INFORMATION rr CORRY CU4716 EDWARDS 710 ROBERTO DENTON, TX 76801 1 3 q7 l ; 1 No r reespoosponse J E99IEN,AMID D 10031714 06/16/03 3, 961. SO 0.00 0.00 3031.130 ADD IP 2 14 GUARANTOR INFORMATION rr AGNES D 9901EN 224 l 8801 WINKLER 06 HOUSTON, TX 77017 No response FARRI13, ORIAN SCOTT 10047041 00122/D3 4D7.45 22, 718, k2 0.0 23, 174. 67 ADD rr GUARANTOR INFORMATION rw UAMC9 AUTHOR FARRIS 1221, g$RNARC ; DEfITOMr; TX.,.76201 Ho response GARROY"T 1. 00 011AR 1 _..,.o. t ' kr ryy~ ~ lNPCRMATJON 11Ml0O, 46499 00%19/93 994 46 V1 i~y1 4 CIpN O~QARR87T O. Ott 719x46 N7t7 0~ 6f' IP- 1 09%3GJB3 lit4 1 009 CiNM4ER9 DtiNTON,; TX 76201 Refused to pay OARRUr ,L$ON 0 - ' 10070134 12%11/93 f, 470, 6D 0.00 -i'634'30 931.24 CC) IF 1 61/04/64 07 1 • M' rM GUARANTOR INFORMATION rN LEON 0 OARRETT 60e cHAMBEmO DENTON, TX 76301 Refused to pay ~ GCIN, Dan 00036710 01/00/nJ 7, 919, 40 0. 00 -6. 403. 9R 601 48 Sr 1P 3 02/16/03 360 1 All rtt OUAnANTOR INFORMATION rw IM0 (MIN PO 8tl%31 AUIMM TX 760P7 balance after Insurance/ No response v1 Gg1.46MITIL hKfRIC Ih 1001:+421 0;1/kl/Il'J p, ;171. 90 197. 0b 0.00 ;4b^2N. 90 BP IF) 4 rw OL1An ANTOR INFORMATION wa PA1RICI.A o0L.D5M M Pon B nUDnEtI, IMP DENTON, TX 76601 IAl 1. ~ 0ONIA1.EJ, ERNEOTO Insurance denied/NO response J 100/7240 07/14/83 4,295.70 798,05 0.00 6.093, 76 ADD SP g rr GUARANTOR INFORMATION rr ERNE870 GONIAL$2 104 J0}419UN 06 DENTON, TX ,76201 74 1 - No response J i 0 r, ` . .'i y, 46 1 I4i. s, ,u'. 1 i.5,"'" ,.:ail r,~ '`ll~43?' , ~>ZSY.51a1~1,.'«:Yetlik., Nr,r},-s 1it. . ..•r . RwOM'...:.i-•. n , « n. r. v.J w. ~...n, r k. ..ir. kill .yy kn ~ri ~~1~'111V. .•e e61FJ`x, ~.Y.1 "~`2'f ihM`•lV.nb1AI ^`A1 r' a PAUL'. U W It 1 f I• (I f' I` FI C 11 N 'I 01 FLIT 1404 PO TYPE rr I'ATItNt NAMC VAT IU 010010 UL:O°0AL NrtW-Clio N01 °PAY W-U DAL PC TYPE CYCLL L97, PMT AQC o OD02'010 12l22luU 1,499.70 0, U0 -90.00 1,302 70 BP if, a 03ngemen 836 1 URlptl'fH O K NT 2 BOX 1b MANOUM, UK 73994 Arrangements not kept r y ww GUARANTOR ft IN FONrIA'r10N NY JACKIE 0N[pp11Fl 07!1'.2/03 193 l tl0027899 09/12/Hl 3,9 4.15 95,00 .0 t1R071L[ER, JASON K CRESCENT OAK DEECFI E3TATF 119C LAKE SHORE A/rra FRISCO, rtw GUARANTOR 1NF01111AT1QN RAY PARK -2710.00 3, 344, L5 SP IP W. not kept y rr IL r 10042'792 00/06/03 t, 077. 34 0, JUO, 66 0. 00 10, 79t9, 00 HP IP 7 170 S IIALPAIN,UARIIARA 0, wr DONALD HALPAIN P, d. BOX 134 LITTLE ELM) TX 76060 No responso rr OUARANTOR 1NFdn1mlm 19 1 10006914 02/29/03 1 470,90 1,999.96 0,00 3,430,45 SP Ir 3 , ALLEN RANTO J, RT 2 BOX 226A AUDREY, TX 76727 Arrangements not kept HAUOGA ,i rtr GUARANTOR INFORMATION ALLEN J. NAUGHT 279 1 L0002244 02/03/03 799,59 429. 0D 0,00 1,193 40 SP IP 8 r HAYUI:NANT 10010E C/O MRS. MCCRACKpN NT 4 BOX 15-8 RBANOKk, ArTX 761262 rangeme is not k`p09t3 w W wr GUARANTOR 1NFONMATION rtrt CLYDE HAYDEN L ellt HA29LWOQt),PATh1C1A 40020060 HAELWLO/D3 49.00 1i 1351365BLU15 0. LE11 WISVILLE,STX 75067 8 Arrangements not kept rtrt GUARANTOR INFORMATION wrt JIM HAZELL47dU 1110 1 L0036907 0,7/00/03 e, 096, 99 8, 033 JOHNODW OLARICE 11:0 E HICKORY OENTON, TX 76201 No response wr QUARM70R INFORMATION FRED JOIINSUN . D0 0,00 4,009,40 SP 1P 3 ww OH/31/83 153 1 , 10024594 08/13/03 1,091.10 400.16 -20,00 1,464.:5 SP SIP M J0HNQON,ANTOCYNTHIA rrt CYNTHIA JOHNSON :219 SHERATON CARROLLTON, TX 78006 Insurance dented/No response ~ rr GUARANTOR INFORMATION 167 1 10030700 07/03/03 2,422,a5 977.35 0. 00 3, 899. 90 ADD IP 2 r PO BOX 1668• DENTON, TX 76201 No response JO14NSdN,JQHN F. wr JOHN p.' JOHNSON 40 r» QUARANTOR INFORMATION 55 EIP JUMAZ, FORENCIO 1OQ60762 IQ/2410 $3.60 216R96. 7580% 109. OAU4715O TX 76227IF 2 No re26/03 sponse 9o I w 44 GUARANTOR INFORMATION rr PLURENOla JUAREZ 010 ] KIRKHAM) TRACY MAR18 10009036 03/06/03 1,071.9b 63500408 (SILL OLEW00 19V1LLB, 8 TX A 75067 IF 3 1n'renyam0nts not kept rw OVAAM70A INFORMATION rrt DAVID M.'KIRKHAM 03 LATHAM,QLBNDA J 00040162 11/00/02 6, 141,l3 p0' do C0LLINSVILL6,Il1. 13 SP W 3 X01 /0e/after insurane/Nolresponsr ~ « Mr GUARANTOR INFORMATION rtr DAVID LATHAM w 02/16/00 21 027, 60 1, 177. 02 -1,790,611 1, 907. 34 0P IP 3 07118/0 ance/N0 responso MAPLES, JENNIFER 3 r insur 103 1 8329 QR9EN OAKS OENTON, TX 7'6201 Balance arte 142 1 GUARANTOR INFORMATION rtr CHARL10004604IR W MAPLES 43.55 2,020.41 O.00 2,071,,6 SP ER 3 yf MCINIB. ROIIRRT 60045634 12/2a/O2 121 E COl L94L LEWIBVILLR, 7X 76067 Arrangements not ekpt - r w GUARANTOR WFORMATtON SAMUEL MC[NtB GUARANTOR OR INFORMATION 00049064 AHANOUIR 04/26/70 MOSHTAGHI 600.00 0.00 "17e. 00 426,06 SP IP 3 DI/04/84 R8 0 MOSH IO 4691 9 CORNELL PR£SNU, CA 93703 140 response ~ rrt OVARA rtr 130 1 1 111111 I NELSON, 01 ANNA 11 00090000 1A/02/S2 021, 75 yRT' 2bBOX 2201 OAUBREY, TX 76727 1P 1 Arrangements not kept r ~r OUAAANTOR INFORMATION BILLY NELSON 215 L 10006;19:1 02/11/03 81 L09,20 -'466, S5 O. UO 4, 692. 310 SP SP 8 ~ i N£WTON,S+IAAt<A 1020 DICRRA OkNTON, TX 76201 Arrangements not okpt rr GUARANTOR INFORMATION rw KENNETH NEWTON 1' 00000503 12/01/OS! 920. 06 2, 262, 50 0.00 6,702.60 SP IF 1 12/01/82 213 W i NIX ANNA M RT I BOX 47-C LCWIOVILLE', TX 76067 No rosponio ; GUARANTOR INFORMATION rtrt ROSS NIX gp.}Lt d... v,nlri. ii s f)I fi I1 I'IIIA N II 1 I I: 11 1' I I! A I' it If I i I'AUP U PA ItrNr No NC PA1 11) UlUCI19 IIL4W,UAL NCN$IIU Kw-!lily W-O UAL VC TYPE CYCLC LD'I'.PMf RAP. PG' TYPO • f, M I NOLAN, JUANA D 1000:1134 03/06/03 1. 1414. 25 (d 4i O. 19 U. OU 1. G::. AO ADZ) it, MY W f 1 xr OUARANTUR INFORMATION xx RAYMOND NOLAN IDOU DOYD Dr.MTUN, TX 7601 Insurance denied/ho rosponso 0 !ti NORMAN. DRANDON. D 40000749 09/60/03 OD, 00 e. 9A1. a9 77.171 0,619.30 SP I:A 3 04/01/93 241) I Mw OUARANTOA INPORMAT10N xw ORANOON NORMAN, D nT 2 DX 366 PILOT POINT', TX 76258 Ilo re5ponsa tI wwxw N-O TOTALS rxwr 101 213,04 -42,244,90 08, 732.83 117, 700. 48 ~e • • ~ s a r r" , A~ ..a ,YU1p M. vn . 1? ,gat 4 ;I W 01 Hill VX34 W N I '1 L - O F F R F P O R T PALL 4 y p PATIENT NAME PA1 111 0113010 P¢0 DAL NLW-010 NLW-PAY W°0 DAL PC TYPE CYCLE LOT.PMT ACE PG TYPL AL-AllAFAJI,AMINA 70012(144 01/01/03 122.00 0.00 0.00 1213.00 OP Op 2 .'.10 2 ♦ as Ul1ARANTOR INFORMATION as ALI AL-KIIAFAJI 673 C. UNIVLN(1317'Y OR DFNTUN, 7X 76P01 No rvspense vI ALKHAPAJI,AMINA 10036049 07/03/03 362.90 303,34 0100 716,29 BP IF 2 07/00/83 102 2 w as GUARANTOR INFORMATION as ALI ALKIIAtAJI 623 E UNIVERSITY DR DENTON, TX 7620J Insurance denlod/No response ALLEN, RICHARD EARL 40043640 07/14/03 06,00 0.00 0.00 06.00 13P ER 4 201 a ra OUARANTOR INFORMATION as HISNRIFTTA ALLEN 340 NDRTHSHORE LEWISVILI.E, TX 73067 NO response M AMOS, OF.DDIE W 40032000 06/07/03 60.70 0. 00 0100 66.75 SP ER 2 230 2 w ra GUARANTOR INFORMATION ao DEBBIE W AMOS 220 E. CONGRESS DENTON, TX 76201 Arrangements not kept ANUREWS,KFITH 8 40046190 07/0"3/03 06.00 0.00 0.00 06.00 HP ER 1 199 R w Ilr GUARANTOR INFORMATION as KEITH 0 ANDREWO P.0, BOX 6841 DENTON NTSU, TX 76203 Moved left no address ARMOR, TERRY W. 40024127 00/0D/D3 O6, 00 xu. 00 0.00 06.00 13P ER 271 2 w as GUARANTOR INFORMATION +,a TERRY W. ARMOR RT 2 BOX 49 AUBREY, TX 762:7 No rouponso w ARMSTRONG, JULIE L. 40040407 07/03/03 78,60 0.0o -40,00 30.00 SP ER 2 01/04'/84 23 $ w No GUARANTOR INFORMATION as JAMP.D R. KILLINDSWOATH 620 6TH AVE MARION, IA 02302 No response ARNOLD, STEVE L. 40027690 00/19/03 147.60 0.00 0.00 147,60 ADD ER 2 7206 2 + wl GUARANTOR INFORMATION •o STEVE L. ARNOLD 409 W. ROUND GROVE RD. M006 LEWISVILLE,NMDS~W/Insurance dented W ' ARRINGTON,JOHN WILLIAM 40027146 OD/17/03 BR: 00 0.00 0:00 R2. 00 SP ER 0 260 2 r as GUARANTOR INFORMATION ya JOHN WILLIAM ARRINGTON nT. 1 BOX 163 PRISCO, TX 70034 NO response V ASHCRAPTiSHELLY 10016319 04/00/03 1,986.70 031.70 -11 986.70 831.70 6P IF 06/01/03 240 At • so GUARANTOR INFORMATION ra CHARLIE ASHCRAPT P,0. BOX 6S AUBREY TX 762:/ No response/Balance after insurance w ATCHLEY,VER1 R. 40040610 07/03/33 104,20 0100 0,00 104.90 SP ER 2 210 $ 0 ar GUARANTOR INFORMATION a(( JERI R. ATCHLEY 104 SOUTH MENRILL NEW DOSTON , TX 7007RO response ~ 3 A7H9RTON,SHERRY 0. 10033004 06/91/83 821.60 219.00 0.00 1041;40 SP IF 4 209 9 r rr GUARANTOR INFORMATION µa SHERRY D, ATHERTON PO BOX 061 LAKE DALLAS, TX 70060 Arrangements not kept M BOYER, MARY ANN 40020078 00/21/03 76.10 0.00 0.00 76.10 SP ER 4 200 9 ' • ' No GUARANTOR INFORMATION LINDA K BOYER 4998 VANDERBILT WHITEHALL, OH 40213 No response ROZARTII, DAVID A. 40023908 00104/03 60.00 0100 0.00 60. 00 SP ER 2 779 2 0 00 GUARANTOR 114P6RMATION rr ALLEN SO7.ARTH PO BOX BJ1 LITILC ELM, TX 78069 No response SRADY, MARK WAYNE 40024104 00/06/(33 121.25 0100 0.00 121, 60 OF CA 1 967 I No GUARANTOR INFORMATION Na MARK WAYNE BRADY 9106 CHERRY WOOD OENTONs TX 76901 No rasponso ~ BRANDENDEAGER,PATRICIA 40024390 00/06/03 199.00 0.00 0,00 149.00 ADD ER N0 267 2 ♦ 1111 OUARANTOR INFORMATION 00 PATRICIA ORANDENOEROBR 1910N,RUDDELL0108 OENTON, TX 76201 Arrangements not kept w DRANHAMs9n9NOA 40000103 11/21/83 100,00 0,00 0.00 100.00 ADD ER 2 71 2 40 ON GUARANTOR INFORMATION as BRENDA BRANHAM 809 13174 LAKEV#EW DR 060 LAKC DALLAS, TX 70068 ~ No response BRAZELL,JANOR 8 40080491-11/93/03 68.30 0.00 0,00 68.00 ADD ER 2 69 2 0 00 OUARANTOR INFORMATION MI KENNETH BRAZELL GOLDEN TRIANGLE MHP LOT 028 ARGYLE, TX 76296 q No response i I 1 ~i D1 f 1+11 1404 1r w II I T E 0 P P R L' 0 R T PAGE D PAT IJ NT NAME PAT ID DIOI:IIO DEO -DAL NUW-0110 NEW-PAY W-0 DAL PC TYPL' CYCLE LOT, PMT ACC PG TYPO Jr 1111EWER, GARY E 40031960 06/44/03 8U. 20 140.30 0.00 16a.60 ADD CH r^ ti YY GUARANTORS INFORMATION r0 GARY E BRRWCR RT 4 DENTON, TX 76^201 ^2 No response 1 90 DgCNJNi JOAN D b 40400314 00/29/03 05.00 .213. 32 0.00 29n. OU nP BA I 70 GUAAANTOR INFORMATION w• RICHARD DROWN FIT 4 BOX 6 M7 OAINEOVILLE, TX 76340 Refused to pay 6t J nROWN,STF.LI.A 9, 40040019 07/27/$3 1GR. 10 0.00 0.00 16z. 10 er an 2 ISO $ 40 •r OUARANTOR 1NrORMATION r• 9TELLA 3. DROWN RT 2 BOX 331 PRICCO, TX 70034 No response BRUCE, BARBARA A. 40016911 04/07/n3 116.40 0.00 0.00 116. 40 11 OF P,q g 300 2 V a<r GUARANTOR INFORMATION rr BARBARA A. BRUCE 1001 E OAK ST DENTUN, TX 76201 No response CHAFFIN,POLLY 4007706 11/20/03 104.25 0,00 0.00 194.20 ADD en P lit r w rM GUARANTOR INFORMATION rr POLLY CHAFFIN OEN DEL DEN70N, TX 76301 No response ~ CORTBZ+MAnISA W. 40049467 07/09/n3 96.00 0.04 0.00 06.00 $P ER 3 4r ~ GUARANTOR INFORMATION sr JAHRO A. RICHARD 302 B CLARK 9T 210 GRANDE CT, TX 78005N0 response 944 y J CUSTELLO, OTT0 A. , in 40042170 07/00/03 119.00 0100 0.00 115,05 $P ER 3 4v GUARANTOR INFORMATION *0 OTTO A. COSTELLO, SR RT 2 BOX 49 CAPRICORN MHP DENTON) TX 76201 203 2 CUCH,ROY L No response 4Y' O GUARANTOR INFORMATION 40041220 07/0D/D3 131.2D 0,00 -60.26 46 00 $P ER 2 09/1x/80 142 ' 2 NOY L COUCH 201 01110 TER OANDUSAY, OH 44870 No response COX,DSLLA 10008551 02/17/03 11610.05 193.00 -10-08 1,993.00 ADD IF 0 00/16/85 50 2 4e rr GUARANTOR INFORMATIC14 GARY COX 418 DWJQHT LEWI8VILLE, TX 70461 Np response DAVISP CHARLES C, 40047474 07/27/03 231,00 ^2$0,50 0.00 011,e4 or ER 2 Y 00 GUARANTOR INFORMATION wJJ CHARLES C. DAVIS 1004 JOHNSON ST411 DENTON, TX 76201 No response 112 01 ~ DAVI$i CHNISTINE 0. 10037463 07/07/83 379.70 0,00 0100 029,70 BP Ip .3 200 2 40 Nx GUARANTOR INPORMATION 1F J1 JOYCE DAVIS HT 1 BOX 1199 FRISCO, TX 75034 No response 1 DAVIS,RHONDA!I. 40044182 07/17/$3 64.75 49.00 0.00 112.75 13P EA %P M!< GUARANTOR INFORMATION M4 DARLENE DAVIS ROD WELCH DRNTON, TX 76201 4 No rospons@ 52 y BQNAL090fJiJOHN C yl 40043424 47/15/83 58.00 0.00 -40.00 10.00 BP ER 4 01/90/84 9 2 0r GUARANTOR INFORMATION +,+1 JOHN C DONALOBON geOG W HICKORY APT N4A DRNTON, TX 16701 No rospoase E4GLSBTON,0ELVIA B 10033798 06/27/03 2,690.90 170,20 -0,488.24 ' 07R.96 MO 1P 0T/2gj0g 4q'" 2 I 41 04 GUARANTOR INFORMATION wM BELVIA E EDOLEBT4N P O BOX 93 AUBREY, TX 76227 No response/Balance after insurance ROUAE,PATIENC9 0 10040293',07/23/03 1, 340. SO 8$9,14 -1,336.30 890,64 0P 1P 2 09/23/03 131 'R w @+t GUARANTOR INFORMATION rr SAM I BOVAE 2480 W LOUISE 010 DENTON, TX 76201 No r@sponso/Balance after insurance j1 ESPAAZA, M 112 GUARANTOR ANTOR DAVID INFORMATION 40041715 07/07/63 56, Co - 84. 00 OF ER b 248 2 00 DOU 0.00 tr JUAN DAVID SSPANZA Bob 0 40041040 07/04/80 57, 2n 0 4>0 OLAB LiTTLII ELM, TX 70068 Arrangements not kept BST6A,DON1Cti 4 Y JIM GUARANTOR INFORMATION 0* RANDY ESTOP 0 CO 5>,20 SP ER 2 211 R 103 STSDMAN DENTON, TX 76201 No response f EBTILE, DONJ ALAN 40041881 47/07/83 66.00 0. 00 0< 00 60. Co SP ER (1 GUARANTOR INFORMATION STEVE ALAN ESTILE RT 4 LOT el BXIICUTIVE MODILR HOME PARR CORINTH, TX 7621147 R u No response ...4 a e a! U1 f 1:R V) 114 W Ir 11 .C N U I 11 1.'I' 0 It 'r r I'A01' 6 E'AtlrMr NANd VAI lD DIUf:11G IWO-DAL NN-C119 NE:H•PAY W:8 UAL FC TYPE CYCLV LOT AGE PO TYPE , EVANS, JAMES 04 100.091 06/03/11:1 1, 2D51 10 31, DO -1, Pay. 64 46, 96 SP 1P 4 08/04 7 Jq1' R ww GUARANTOR INFORMATION ww JAMPO 0, NVANET 1611 W VANDERBILT N4 STF.PHENVILLB, TX 76401 " ♦ , No respon %3alance Sitar fnsuranco GALLE000, MARIA 40003790 02/14/83 97.60 1.15, 00 -00.00 183. 00 ar ER 3 09/12ii , 142 R w+ OVAAANT04 INOORMATION ww AAnOARA GALLroan PO BOX 625 FRIRCO, TX 7UO34 ArrangemantAiliot kept r,l GAMON,JE11I'MY LUC 10033132 06/in/03 796.15 0.00 0400 796. lb ADD If, 4 224 2 ♦ ww GUARANTOR INFORMATION w+ JACK 0 DAMON BOX 030 KRVM, TX 76249 Moved left 'go address rr ' OARCIA,DP.NIEL RENEE 40041717 01/07/03 87,09 0100 0.00 07.Ob SP ER 3 " i :04 2 ww GUARANTOR INFORMATION ww SHIRL P, NOBLES 171b JAMES LOT 90 DENTON, TX 76201 No rasp ~ GAACIA, TOMADA 10036154 07/01103 631.00 0.00 -417.40 213.013 SP IP 2 I w+ GUARANTOR INFORMATION ALEJANDRO GARCIA 3509 HUtBACHE DENTON, TX 76201 Balance ,Asurancoi% ratponso GARDNER, JAMES P. 40043069 07111/03 112.00 0.00 0100 112, 50 OF ER 2 I/~1~, ` +w GUARANTOR INFORMATION JAMES F, GARDNr•.R 1190 MCCORMICK DENTON, TX 76201 No rosp?fJ~ :03 R M + GARNER, KARtB22110 40097013 08/16/a3 67.00 0.00 0. 00 67, 50 SP LR 3 s :D1 2 1 ♦ N+ GUARANTOR INFORMATION w+ KARISSIMO GARNCR P.O.BOX 1772 ADS E PRAIRIE DENTON, TX 76201 No response. I GAR"IITT, FRED DOUGLAS 10039708 01/20/03 0,446.30 -1.80 -0.239.00 20b.90 SP 1P 2 08/29/03 94 2 ♦ r+ GUARANTOR INFORMATION +w FRED DOUGLAS GARRETT 304 8, RUDDELL 067 DENTON, TX 76201 No rosp"Ses r 0E6,ROYAL BENJAMIN 40038069 06/24/03 108.00 0.00 0,00 108100 BP ER 1 219 2 P w# GUARANTOR INFORMATION ROYAL BENJAMIN GEE 025 SKINNER DENTON, TX 76201 No rosponse W ¢ I I GENOV998,PLYNN 10023169 09/09/83 1, 195. 18 0.00 -926.02 231, 63 SP IF 0 08/31/03 246 2 w+ GUARANTOR INFORMATION +w FLYNN QENOVZ"E 3925 BRODKHAVEN CLUB DR. #1128 DALLAS, TX 70234 r Arrangements not kept 1 GENTRY, KAREN L 00024602 09%11/1!2 2,765.42 DO ••20 B47. 03 166.09 OF IP 3 02/22/03 328 2 ! 40 GUARANTOR INFORMATION JAMES R WINTRY 326 PEACH #P DENTON, TX 76201 Balance after Wuranco/Noresp6noe w f 690 GUARANTOREINFORMATION ww00RENEgGROPPRION3 336 QO to? W MABBEY #9B DENTONP SP IP 1 O1o 390 „ R i TX 7G2g1 Moved left n no address 4SOROEIDEANA':G 40038023 66/06/83 06.06 26 0 CEDAR 0.00 L 06'00 OF ER 1 21 ' w+ GUARANTOR INFORMATION +w DEAN 09DROE 13w : 1 R r, OENTON, 8 76 TX 70067 No response tlL~Bp OP 3 04/00/103 302 it i rr ` 0ONZOt1ARANTOREINF'ORMATION +w70003516 M6/11/03 E2 604.00 B 0.00 -543, ^..0 eW 66v80 i 201 Arrangemen, b not kept ill GRAY, II I 40016010 04/04/83 70.00 -o.00 0.00 75,00 EP ER 1 k qq9 R yr ! wr GUARANTOR INFORMATION ww..JAW GRAY 1130 MORSE bEN70Nr TX 76201 Moved lof a,address V 200 2 GUARANTOR INFORMATION +M FAITH GARY 1809 CRESCENT OENTON, TX 76201 Arrangementi,not HALtirKATNLCEN K 40642612 00 7!08/03 173;b0 q' 00 -89. 72 49, 4S SP ER 4 07/11/83, 'kept 1y1 Qtl 0.00 17i. b0 BP ER 3 2011 a r ww GUARANTOR INFORMATION KATHLCEN K HALE P.O. BOX 480 107 JACQUELINE SANOER, TX 76866 I~ ' V HAL6,KENNETH L 00028308 01/21/03 30.0t) 69. 72 0.00 107, 7R 6p ER 4 No response 190 2 4p , GUARANTOR INFORMATION QORA HALE RT 1 BOX 136A PONDER, TX 76709 Insurance donfodAo response r J-' 01 P60 1984 WA 179-OFF REP OR T PAO97 A y. PATILNT NAME PAT 10 OISCHO 090-96L NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE L8T.PMT AGE PQ TYPE HAMMAN, JEREMY B. 40000000 07/04/03 06.50 0.00 0.00 86.00 Sp ER 4 059 R Or GUARANTOR INFORMATION *4 ORIAN HAMMAN $084 W OAK 144 DENTON, 7X 76201 No responso HAMMAN,KEVEN L, 4R030BD7 05/29/83 72.30 0.00 0.00 72.30 SP ER 1 *0 GUARANTOR INFORMATION KEVON L. HARMAN 2027 DOWLING GREEN DENTONt TX 76;01 No response 247. fi 3 r HAMMONS,JOB 0 40017109 04/09/83 149.75 0100 0.00 149.70 SP ER 2 04/11/83 294 2 GUARANTOR INFORMATION r* 003 D HAMMOND 1309 MOIINOO DENTON, TX 76201 No response 7 HAMMONBi JOHNNY 10000671 03/11/63 00 409. 70 ' 0. 00 -4, 510, 20 890, DB "Jp IP 2 04/06/83 261 2 GUARANTOR INFORMATION JOHNNY HAMMONO 3016 TITAN TRAIL 0816 TITAN TRAIL DENTON, TX 76ROI • No response j HAKMONB,LINDA A. 40019374 04/17/83 89.70 0.00 0.00 09. 7E OF ER 3 229 2 OUARANTOR INFORMATION *0 BOBBY L. HAMMONS P. 0. BOX 2391 DENTON, TX 76201 No response 1 HARRIOON, DILLY J. 40010620 04/03/GU 63.00 0.60 0100 63.00 Sp ER 1 ` r* GUARANTOR INFORMATION JIMMIE POWERS 410 S. LOCUST DENTONi TX 76001 No response 30e 2 NA**RT,THOMAS 0. 40046701 07/00/03 81.00 297.00 0.06 370.00 BP ER 1 l9 2 GUARANTOR INFORMATION ON THOMAS E. HART STAR AT 01 BOX 343 ROCKPORT, TX 70943 • No rosp,)nse n HARY VICK18 L 40016909 04/08/03 06.00 0.00 0.00 06.00 8p an 2 GUARANTOR INFORMATION CLARENCE L, BODKINS BOX 307 AUDREY, TX 762127 No response w98 L ' HtNDEGONj 1001779 04/11/04 HENDERSON 428.00 1,7139.70 0. OD 8 BRADSHAW E SP IF 2 182 12 AW D9NTONNTON, TX 76801 Insurance defiled/No response t HICKS, LINDA ;D 06032076'07/60/02 216.60 0.00 116.60 100.00 SP IF U 11/15/83 78 9 GUARANI OA INFORMATION r* HORACE HICKS PO Box 039 LITTLE ELM, fix 70068 Balance after Insurance/Ro'response ' HODGEtl, TROB • 10641610 IF 1 ON, GUARANTORTINFORMATION *0 RNNt8 MOHome 1.414, 90 2 704 MOONLICHT0DR1 DENTON679. TXD 76201 No response 125 2 ~ • HULSSY,CLIPTON C 10038990 47/29/03 6,943.70 -&6,00 -6,607.70 310.20 BF IF 4 09/06/83 140 2 r GUARANTOR INFORMATION CLIPTON C HULSEY 214 C W SHADY SHORES DLNTON, TX 76POI • Balance after insurance/No responso r' HUNNICUTT, KIM 8. 40026147 60/14183 99, 00 0.00 0.00 99. 50 SP ER 3 209 13 GUARANTOR CNPORMATION DARRULL HUNNICUTT PO OX 119 LAKE DALLAOi TX 70065 No rosponso • l JAWAiJOE 00030001 11/19/07 nh.00 0,00 -100.00 572.00 SP IP 3 01/03104 29 R M* GUARANTOR INFORMATION WILLIAM JAMME 4719 STRICKLAND THE COLONY, TX 76 06AreaAgoMonts not kept • r JARRELL,EAIC It, 40042010 07/09/03 ISO. 80 0100 0.00 188. B5 Sip EN 0 200 1 04 OUARANTOR INFORMATION M* DENNIS JARRELL 1400 N ELM NI DENTON, TX 74201 No rttpunsa • JOHNSON,DONALD C. 40011504 03/16/03 48.00 0100 0100 40,00 DI' PR U 322 tr r M* GUARANTOR INFORMATION r* 'DONALD C. JOHNSON LOOP 299 SINGING OAKS IIPB DENTON, TX 76201 Ito response J6HNOON, EVAN J 10042077 00/07/03 733. S0 0.00 0.00 733. 09 SP III I] 191 2 MM OIIANANTOII INPDIIMA711N4 VVAN .1 JUHNUUN 121b KN10111 004TUN, 'IX '/61101 Arranq,~wuul. nol l,kpl • n ; NI NINOONj JOANNA 40046091 07/,74/03 Y15.00 0. 00 0.00 1b, DU III, t:H I I'll k *0 GUARANtON INFORMATION DENNY CHAMORRO PC BOX 1040 OFNTUN, TX 761101 IN rnspunsr • c .M r,.l 01 rrn 1904 b N I 'I I' n r r N L Ir U N T PAON a' r I+AI IGNr NAMC PITT 111 111110110 YCO-UAL MCW-CHO NCO-PAY W-U PAL PC TYPE CYCLE Lai, PfIT AOC PO iYPC s ~ r' JON60, CHAD W, 400301104 O7/R9/03 110,00 0100 0.00 90, DO rip CR 1 ?47 R - xw GUARANTOR INFORMATION ww 1aNNY BULL RT 2 PR 10(:0, IX 76034 Arrangements not kept , KBNNCHER,PEARL A. 10000444 02/03103 2,009.60 0,00 -2,034.60 1160.00 BP IF 4 03/03/83 acid 11 • wr QUARANTOR INFORMATION rw ALDCRT KCNNHMER 812 WOOD HT, DENTON, TX 762D1 Arrarigemonts not kept KNAOR,DALE P. 4000OR37 03/02/03 139,00 261,40 0100 400.40 SP ER 0 lob S - r wx GUARANTOR INFORMATION ww DALE P. KNADE 1103 FULTON BT DMNTON, TX 76201 No response - KRANTI, CHARL68 10006213 02/22/83 2, 230. 66 0, 00 -2, 162, 00 48, 00 SP IF 4 04/13/03 294 V xw GUARANTOR INFORMATION ww CHARLES KRANTZ 920 DUNCAN DENTDN, TX 7601 BalanCO aflOr insurance and Medicare/No KUKMYO, JULIA 00039297 07/04/02 It 914, 85 0,00 -R50.00 1, bb6, 66 ADD tP 1 06034/00 .16 re2spOnSo, • +w GUARANTOR INFORMATION xx JULIA KVKNYO P O BOX 2933 DENTON,'TX 76201 Arrangements not kept LARSON,WAYNE H, 40033464 06/10/93 111.00 0,00 0.00 111.00 Bp ER 3 n3 C r r *4 GUARANTOR INFORMATION xx WAYNE H. LARSON 1690 CO HWY 6 LACRECENT, MN 66947 No response • LAWSON,JAMES E.,JR 10031144 06/08/03 020,00 0,00 0.00 3@0.00 ADD IP 3 236 " '2 ww GUARANTOR INFORMATION rx JAMES E, 4AWOU% SR RT 1 OX 1469-1 LITTLE ELM, TX 78060 Arrangements not kept LAWBON,RVLF,TTB 40010860 03/13/03 109.00 0,00 --16.:0 42,00 8P ER' 3 06/06/93 972 2 r • GUARANTOR INFORMATION ww CARRIE LAWSON 100 N RUDDpLL DENTDN, TX 762201 No response LSE,MICHARL D. 40024906 00/00/83 129,00 0100 0100 129,00 ADD SR 2 R69 2 ♦ x+ GUARANTOR INFORMATION wx MICHACL D. LEE 2000 FT WORTH OR 032 DENTON, TX 76201 LCE, RICHARD A 40032393 04/06/83 100100 0, 0o 0.00 100.00 BP ER ~o response +x GUARANTOR INFORMATION xw RICHARD A LEE 1426 KNIGHT ST DENTON, TX 761101 No response 234 C LRHo RDBIN L 40009946 03/09/03 112. 76 0,60 0100 112, 7b Sp ER 0 327° 9 • wx GUARANTOR INFORMATION rw DEWAYN6 LEE 8210 MYRTLE ORNTON, tX 76201 He response LEE, SHEILA L. 40043937 07/16/93 6br00 0100 -36.UO 20,00 BP ER w 0e/20/013 140 C r r xx GUARANTOR INFORMATION wx SHEILA L. LEQ 1426 KNIOMt DENTDN, TX 76POI Balance after Medicare/No response s L"FTIN,ReOINA GAIL 10012706 04/21103 2,906,06 602.40 -21761. 77 706,68 8P IA 3 06/90/8O 169 R ` • GUARANTOR INFORMATION +w RODDIC Lte LOFTIN 102 SALEM CT LEWISVILLt, TX 75067 Batahco after Insurance/% response LOG^ Des 40022204 04/27/03 06.26 0100 0, 00 e0: 2e or ER S ,170 . R ' ♦ w+ GUARANTOR INFORMATION •w DEE LOGAN 622 6 LONDONDERRY #307 DENtON, TX 76201 Balance after Insurance/NBoaresponse CtGAN,MANTIN W 40047367 07/97/93 66,00 0.00 0,00 06,00 ADD aR Q / ♦ GUARANTOR INFORMATION wx DANNA LOGAN 2240 N COWAN APT 0276 LPWI4VILLt1 TX (6047 No respdnse MACK) 01IR 10010744 O3/09193 410.70 -13,00 -293.20 104,60 BP IP 3 04113/80 294 2 +r OUARANTOR INFORMATION w+ PHILLIP MACK 730 SUCK GATNEBVILLE, TX 76,440 BOlanto aftor Insurance/No response J MADOGN, MARY ANNETTIT 40022196 04/99/03 93,00 0, QO -60.00 43. 00 OF to 1 Op/stofm 207. 12 1♦ x• GUARANTOR INFORMATION wx MARY ANNETTE MADDEN 2000 PT WORTH DR 046 DENTON, TX 76PO1 1' ONN tR 8glanco after 1nSUraOCe/No response ~ • h1«+IGUARANTOR INFORMATION xM40JAMB8tOOUOLA98MADISONI 00 1.070309 TWIN OAKS MHPDDtNTD , TX 742D1 230 it , No response i 1 ii d li 01 FRO 1984 WR I79 ~aPP 4 a P 0 R T PAGC9 ~',.._..._.PATIENT NAME PAT TO _DISCHO O40°OAL NEW-CHG NEW-PAY W-0 DAL PC TYPE CYCLE L57, PMT AGE PQ TYPE I,j._... _ MAGANA,DORA L. 10029932 06/03103 703,85 0,00 -537.0a 164.47 0P SP 2a lance I l8S 2 GUARANTOR INFORMATION r• ELIDERTO MA9ANA 2113 DAIGHTON 01R' PENTON. TX 76201 Balance after nsurance/No response MARCHANT,FREDERICKS 00043281 OJ/l6/0 123,70 10,00 36.00 10x.75 SP ER 3 12/131133 50 2 44 OUAAANTOA INFORMATION 44 FREDERICK MARCHANT 0234 RUNYON LCWI5VILLE, TX 70006 NO response ' 46'6N. KATHY J 00043a23 67/07/02 117.50 56.00 10.00 107,05 6P 111 3 06127/63 99 e *A GUARANTOR INFORMATION 40 RICKY MARION 301 LOOP R60 OL12 DENTON, TX 76201 Balance after insuranco/No response ~ MARK8,1iHAAt1N BYLVIA 400526924 ODl16/63' 145.70 0,00 ^100.36 4139 OF ER 4 26/13/83 833 2 ~s MN GUARANTOR INPORMATION 40 SHARON SYLVIA HARKS 429 DEWDERRY LCWISVIL1.6, TX 70067 Balance after Medicaid/No response 150JAM58 Lot094 DENTON, TXD 76801 No response 240 St OVARANYOR INFORMATION 44 LUIS 10030344 MARTINEZ83 340, 60 1701 0. .340.60 IF R ~ l MARTINRZ,WANDA HARWELL 40035677 06/16/63 63.60 0.00 0.00 63,80 BP 6R 2 921 2 a 44 GUARANTOR INPORMATi9N 40 DENJAMIN MARTINEZ 2311 STELLA APT 117 922 WOOD DENTON, TX 74201 Balance after insurance/No response MCCALLUM,APRIL 40047342 07/27/83 06.00 0,00 0.00 06.00 'ADD RR it l6S 2 44 GUARANTOR INFORMATION GRADY MCCALLUM PO POX 291 LAKE DALLAS, TX 7"b5 No roSimso MCCANN,,XAN 16034882 66/90/63 710. 10 04.25 0.00 049.40 $P IP 1 146 2 64 OUARANTOR INPORMATION «4 PAUL MCCANN 511 AMARILLO DENTON, TX 76201 No rosponse • 'MCCARTY. AODBIE D 10021764 04/s29/03 1,460.77 0. 00 -L 441. 24 19.51 OP IP 1 06/06/83 240 2 44 GUARANTOR INFORMATION 44 R018IE O MCCAATY 1200 ECTOR DENTON, TX 76901 Balance after insurance/No rotponso KOK! NOSY# TRANS 10039766 07/16/83 006.95 0.00 0.00 306.90 8P IP 4 198 2 0 40 OUARAN70R INFORMATION 44 THANE MCKINSVY ST 2 BOX 664 LARMIE, WY 62070 110 response r MCKINZfit, TRACEY 40040106 67/02183 122.0 0.00 0.00 128,20 6P ER 2 210 L' GUARANTOR INFORMATION r4 MARGARET MCKINZIE 202R LOUtOR t101 CSNTOII, TX 765101 Arrangements not kept • { MCKNIQHTIDONALb W 00645662 11/29/62 4J S. DO 0.00 0.00 419.00 OF CR 4 429 2 ~ i 40 DUARANTOR INFORMATION 44 D014ALD MCKNICHT PO SOX 747 PILOT POINT, TX 76208 Arrangements not kept 226 2 S + MHRKIN,6AMV0L W. 40036717 06/20/93 06,00 0,00 0,00 06,00 ADD ER 4 44 GUARANTOR INFORMATION 4* OAMUFL W. McRK1N 704 AVENUE X LUDDOCK, TX 79401 Balanco after insurancoiNe rosponse MERRICK,OAYtO R. 40043010 07/10/03 62.00 -20,00 0100 42,00 BP EM J 103 2 OUARANTOR INFORMATION 44 MARY L. MERRICK 2218 35 PT WORTH DR DENTOih TX 76701 No rosponse. V MORIRIELD,JUBTIN J. 40017207 04/09/03 40, 70 0.00 O.Do 48.70 SP ER a .9b R GUARANTOR INFORMATION 4w 11000RLI, MEARIPIULD RT 1 p0X 31 i111UME, TX 76070 No rosponse Cy 'HII.ROY, GRINDA 7001;70oa 07/09/03 6Y.25 0.00 0.00 67. 25 RP UP 4 203 12 44 GUARANTOR INFORMATION N4 DRINDA MILROV COX 131 AUDIMM TX 76227 No resp6nsD 3, Ob7, d0 2a. 00 -2, 506 98 007, 67 St' IF 4 00/10/03 207 i2 MIMS$0.C. 10013746 03/24/03 A 40 GUARANTOR INFORMATION to 11.6 111 M0. POO 6 AUDOtLL UEN7oN, TX. 7620J Arrannemonst not kopt HtM6HARRY L 00047464 00991[13 30.00 J4, 00 0,00 72, 0U SP CR 4 3116 8 44 GUARANTOR 1NPORMATION 44 ELSIE JACKOUN 700 C1IAMOERO DENTON, TX 76901 Aerangomcntr, nut. ktlpt 411, t I y PGI Jga4 WA I TE -nF F R E P a R 7 PAGE' 30 p .T1EN, NAME PAT In DISCIIO PEG-DAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE L,BT,PMT AGE PO TYFa T MIMD,FRANK,'II1 40033490 06/10/O3 61,50 0.00 0.00 61.30 8P ER 3 06 P • * 44 GUARANTOR IIIPORMATION r4 ELt2ADETH RITCHEY 1321 HOSE ST DENTON, TX 76201 NO response MITCHELL,OARCARA 1_01kt7A 10023200 06/22/00 2,3913,96 406.90.-2,834,06 291.79 9P IP 3 06/$4/43 gQk z • 44 GUARANTOR TNranm ION r4 BARBARA LORB'rTA MITCHELL 814 UKSNNER ST. DENTON, TX 76201 Balance after insurance/No response MOORS, CYNTHIA 111);ANNV. 10036002 06/30/03 619. 96 D. 00 0.00 619.95 8P IP 2 rr GUARANTOR INFORMATION r4 THOMAS 0, MOORE 3437 LIVINOBTON CARHOLLTON, TX 70006 218 2 MOSES, CYNTHIA Y 00049049 07/14/02 370,03 133. 8D 0.00 403,00 Sp IP Chaartt01/00/0/jo rospo16o7 k * 40 GUARANTOR INFORMATION r4 WILLIAM MOSES AT, 2 00% 497K DE'NTtlN, 7X 76201 Balance attar insurance/NO response ~ MURPHY, KEVIN P 30024149 08/08/00 422.20 0.00 0.00 422, 28 ADD Its R 44 967 2 GUARANTOR INFORMATION r4 NEVIN P MURPHY AT 3 LOT k7 LEWISVILLE MOBILE HOME PARA LEWIGVILLa, TX 7$06!r NQWLAND AUDR6Y 00092203 09/29/00 463.70 0.00 -00.00 303. 70 0P IP No responsa 44 GUARANTOR INPORMATION 44 ELDRIDGE NDWLAND AT Q BOX Itlo ARGYLE, TX 76226 7 011$8/04 7 2 Balance attar insurance/No response A NORWDODoRUTH 10026664 06/80/133 1,993,80 0,00 -1,677,50 318.70 OF IF, 2 06/18/83 W31 2 or, rx GUARANTOR INFORMATION r4 RUTH NORWOOD 2911 BROOKHOLLOW DENTON) TX 76201 I Balance after Madlcare/No response DOONNELLi KAb6Y L 00001136 07/26/02 11146.90 O, 00 -48. 00 1, 101, g0 SP IP 4 07/11Z/83 204 2 n rr GUARANTOR INPORMATIDN 44 TIM OCONNCLL AT 1 OX 126 P KRUM, rX 76$49 ~ No response ~ ODELL,IIAVA 00051191 01/231/03 180.58 0.00 0.00 180.0$ ADD RR Iutz r rr GUARANTOR INFORMATION 44 DAVA ODELL 1017 WILSON DENTON, T% 76.Q Movdd loft no address 376 8 O08LL, JAM 9 RAY A 40019408 84/17/03 46,00 0 QG 0.00 40.04 8F ER 3 ww^6q R R' rr GUARANTOR INFORMATION rr JAMES RAY OOGLL 400 BOOTH STREET BANOBR, TX 70266 Ito response OGKIN8,DEBRA 0 A 0000,17(39 ,10/96/02 109,60 d. 00 0.00 109. BO 8P aR 4 463 2 r * •r GUARANTOR INFORMATION r4 DAVID 06KINB AT P BOX 204 DECATUR, TX 76234 Moved loft no address i ~ r D7TINORR, WITT 100118799 08/19/b0 1, 882, 86 97, 80 -11001. 60 300, 69 OF IP rr GUARANTOR INFORMATION 40 BRETT nTTINGER 47/01/0! 163 2 ~ Rt 1 BOX 08°AA AUDRGY, 7X 76$27 Batanco after lnsuranca/No response A PA31KQ, MARK A 40011694 03/16/00 64.00 520.10 -'120. OtT 464,02 OF RR a 09110/83 Ik6 2 r r4 GUARANTOR INFORMATION rr MARK A PARKO PO DO% 26VI DENTON, 7X 76201 Balance after Insurance/No rospbnse I PAYNE, HIM R. 40032JR0 '06/04/S0 114,00 0100 -01. 20 132, 80 6P FIR I 11/16/63 77 2, r 44 GUARANTOR INFORMATION rr PHILIP PAYNE RT' 1 Dd% 388 8 8ANt3al3, TX 76166 Balance after Insurance/No response A F PAYNB,LORINDA 40040020 07/19/03 140,00 O,'dd 0140 340.OU BF, CR 4 rr GUARANTOR INPORMAT'1ON 44 BILLY POINTER 198 2 0229 I;AWSS TOR COLONY, T% 9999-1 No raSponsr, ~ PAYNO)RAY M 10080187 08/C6/O3 884,60 -22.78 -324.40 207.44 8P SIA 4 06/210/03 216 2 e rr GUARANTOR INFORMATION 4r DENNIS PAYNE AT 2 D0% 618 neNTIIN, 1'% 76801 i Bplanro after fnsuranco/NO response tM PaNt?, YRAC,9Y L 40D40017 07/t32/U3 661 U5 0100 0100 66.00 ADD ER 1 192 2 0 ar GUARANTOR INFORMATION #0 DANIEL PI! NtZ 11T 8 L,01' 003 }IAYH2I.L RD M1141 110411Ti Tk 76,401 PIJRCHQO,tlGRGIn R 40Ox0938 04/241"3 0".00 0,00 No responsa rr GUARANTOR INPORMATION 411 RICARDO PBRC11411 P, Lt. UUX 791 OP11111 000IXtI 1bu34 CII No rtis 04/0/133 r07 2 R ~ 1 ti tQ h 01 FED 1904 WR I Ta -0P P IT EpaA T PACE l1 PATIENT NAME PAY 1D DSSCHO DEO-DAL NEW-CHO NEW-PAY W-0 VAL PC TYPE CYCLE. LBT.PMT AOE PG TYPE P6RRZ,0111%1701,1 10022700 05/03/03 830,811 231.40 0.00 1,ObV.2D ADD IP I rr OUARANTOR 1NPORMATION DENTURA PEREZ SID SMITH 4121 DCNTON, TX 76201 Arrangemonts not kept 1[157 2 PICKERINO,OAIL D! 40031049 05/31/93 102.70 0100 -42.20 110. DD SP ER 3 07/22/03 174 2 rr OUARAA1N.rTOR INFORMATION rr OA1L D. PICKERING TRICKHAM RT - DO% DO BANTA ANNA, TX 7607$ PROBHrMARION D No J response 10MAR 00103/03 1,994.00 -.^2.75 0,00 1,971.25 OF IP 1>4 2 rr GUARANTOR INFORMATION rr MARION TON D PROBB PO 80% 665 PILOT POINT, T% 76200 Arrangements not V.ept °RUIITT, BRANDON A 40032625 06/06/a3 63.00 0.00 0.00 63,00 BP ER 2 200 12 *r OUARANTOR INFORMATION *r ALLEN PRUETT 4100 $$LCNE DENTON, TX 76$01 Arrangemonts not kept PRUETT, JOHN L 40020018 04/21/83 109.25 0.00 0100 109.25 ADD ER 4 ROD 2 00 GUARANTOR INFORMATION r* JOHN L, PRUETT 1512 W. OAK DENTON, TX 76,201 Moved loft no addrass PRUETT, JOSHUA 40011421 03/16/03 501q0 0100 0100 00-10 OF ER 3 GUARANTOR INFORMATION JENNY PRUITT RT U BOX 420 PAIN OROVE- MO 65640 No response 32^4 g PUNCH, 6LNORA 40010779 03113/93 107.215 0: 60 0100 IV, 25 OF ER 1 324 $ *r GUARANTOR INFORMATION r* NLIA PUNCH 1115 HILL OT DENTON, TX 76201 Medicare denied/No'relponsa PUNQH,LINDA M 00050210 10/27/81 160,00 157.40 -05.00 262,40 SP IP 3 07/1[6100 197 k 0r OVARANTOR INFORMATION *r LINDA M PUNCH 109 S RVODELL 019 DENTON* TX 76201talanco after tnsuranco/No response RANDALL,AMY P 00090541 09/le/02 254,65 -0,00 ^10.00 244, 611 $P OP 3 10/20/60 104 R *0 GUARANTOR INFORMATION ANY RANDALL RT 2 B0% 189 LCANDER, TX 78641 No response Rgat)YpSTBV$N10 40001072 02/04/83 166,25 0100 0.00 106.20 ADD $R NB 306 2 *4 GUARANTOR. INFORMATION **..$TEVON REEDY, 0 POD 69 AROYLB, TX 76276 No responso RQYNOL09,0RANDON D. 400,10530 07/31/tIJ 06,00 0100 0.00 56.00 $P ER 2 104 $ ` w* OUARANTOR INFORMATION *r JANET RUYNOLOS 627 BERNARD 60 DENTON, TX 76$01 No response RICHARDQON,JRNNIFOR ANNE 10039170 07/16/03 9612, Still 241,90 0.00 1,204.69 -0P IP 4 07/18/133 190 It *M GUARANTOR INFORMATION 40 VICTORIA ANNE RICHARDSON 3501 DRIERCLIPF DENTON# TX 7644401 No rotp00So ROACH,TAMMY A 00057703 09131/02 0, 076,Ob 0,00 -20.00 3,056.05 8P 1P 4 04/16/03 209 $ r* GUARANTOR INFORMATION 04 ROBERT W ROACH Rt 3 BOX 306 DENTON, TX 76201 Arrangemonts not kept ROBLES, RIIDNRT $ODIR 40041701 07/67/83 06,00 0100 0100 56,00 ADD Eft- 8 r' 04 GUARANTOR INFORMATION *r $H1RL P, noULEO, 1710 JAML'B 401' 90 DENTON, TX 76POINo responso 201 2 R0DRI0U92i JOQB'r JR. 10010734 6"00/03 4220 00 167.36 -342, DO 203.06 UP IP 1 00/09/00 109 2 *0 GUARANTOR INPORMATION r* 0009 R01 iQUDZ, JR. 2214 MenCNDRD OUNTON, T% 76201 No response R08S, JIIRBMIAH A. 40032922 06/07/03 D6.00 0100 -15.00 41,00 9P ER 2 09/08/83 146 2 *41 GUARANTOR INFORMATION HANUN ROSE 12800 FTWDRTHDR %S DENTON, T% 76201110 responso dCllHIDT, PLDIUI OVAN 4000{t511I 04/30/113 147.25 0.00 0. 00 147, 711 till 1114 A 273 R GUARANTOR INFORMATION No P6ORA ULAN UtHIMJJT TWIN LARCH MHP LOT JOO OLNTON, TX 76;:a{ 110 rt'911o650 DHAW,CARY W 00062166 01/pv/03 DID.50 0.00 -416.60 100,00 RP IP J 04/06/03 001 2 ON aUAHANIOR IN1-1114MAI IIRI ON aAnY UHAW 'llh MIN VA1lY In1141(111. 1X YG 1bl ' M raiupammlo Iw 1. 4hpt 'tQk'✓AXdSaMnL'~trA Y!.,_, ,l1vd,,wiM.tr,11Y{j rW1 ,4o', , ,,woo" ~du! i 5 U1 rGn 19I14 H It I T L - 0 1' 1' II C 1' 0 FI T PAQL' 12 PATIENt NAME PAT 11) D10C110 VtiU-DAI. NE14-010 NLW,-f'AY W-U DAL PC TYPE CYCLE 01T. PMT AQE PQ TYPE J J RHERWOUD, JOYCC A. 40040060 07/G0/UJ D7, aD 0. 00 0100 07, a0 or L! Ft ~ 106 2 Mw OUARANTOfi 1Nr0(1MATtON wn JOYCE A, SHERWU30 P519 UTCLLA 819 Df.NTUN, IX 76801 Arrangements not kept SHUFFIHLOP 11 ILLY W. 40017978 04/12/03 64, 2D o, DO 0, OD 64.25 SP ER 2 293 2 y ww OVARANTOR INFORMATION BILLY W. DHUFI'I(;,LD BOX 531 612 6TH DIRECT BANGER, TX 76266 J No rosponse UMl1F16 OLIVETI IIL 000645DO 01/16/0 70.20 0.00 -84.00 00.20 BP ER 3 04/14/03 790 2 i QUARANTOR INFORMATION OLIVER I SMITH PO BOX 20n2 DENTON, TX 76801 Arrangements not kept OPLAWN,PAULA 40070299 04/28/03 39.50 0.00 0.00 39,50 or ER 4 04/25/83 901 2 r QUARANTOR tNrORMATION OERALD BPLAWN PO SOX 606 LAKE DALLAS, TX 70065 Ro response J BT INNaTT,)ACOUELYNFf 00067087 DO/16/UV 269,01 0.00 "102.01 00.00 8P IP 3 01/27/94 0 2 Mw GUARANTOR INPORMATION +w WAIin8N STINNRTT 8913 nEQAL DR DCNTON, TX 76801 Balance after insurance/No response AT1PPECi MAF1Y P. 40014298 03/90/03 107,7b 0.00 0100 107.75 or em 4 307 2 „ y w+ OUARANIOR INFORMATION +w RUBY STIPPRC 101 INCA CIRCLE DENTON, TX 76201 Balance after Slue Cross/No response J TASKBR,DILLY DEAN 40020096 04/24/03 107.26 0.00 0.00 107.25 BP ER 4 203 2 y 4w OVARANTOR INPORMATION ww BILLY DEAN TASKER PO BOX 1700 ROWIE, TX 76230 Arrangements not kept .0 TAYLOR, DOROTHY E. 40010090 04/13/03 100.00 0100 0.00 104,00 or an 3 293 l1 y ww OUARANTOR INFORMATION +w BCROTIIV TAYLOR BOX 461 dUOTIN, TX 76847 No response 40 TAYLOR,RAGINALD 40040043 07/30/03 47.75 0.00 0.00 43.75 RP ER 2 00/02/133 Ina 2 v w» GUARANTOR INFORMATION RBOINALD TAYLOn 617 CHAMOCRS DENTON, 7X 76:01 No response 14 TRACHOUT,NATHAN R. 40006206 02/83/83 06,60 lei 30 0100 240.10 SP Elf 3 271 2 r GUARANTOR INFORMATION +w LINDA TEAOHOUT AT, 7 BOX 59 DENTON. TX 76201 Arrangements not kept ,V TOTEN,HANNAH L 00069997 01/12/80 210.00 0100 -60.00 150.00 BP IP 0 08/10/03 175 2 ; y +w OVARANTOn INPORMATION DAWN TOTEM AT 6 BOX 164 DENTON, TX 76201 Arrangements not kept TRAMMBLL,LARRY 70019976 07/05/D8 58, $5 0.00 0.00 Del. 91) or, of 2 2I0 9 W OVARANTOR INFORMATION ww LARRY TRAMMELL PD BOX 118 PILOT POINT, TX 16209 No response q0 TRAMHELL,RENA 40040973 07/23/03 207.00 0.00 0.00 207.00 BP ER 1 190 2 +r +w OUARANTOR INFORMATION RENA TRAFIMRLL BOX 663 PILOT POINT, TX 76208 Arrangements not kept +Y TUNNELL, INDIA 40020029 05/21/03 78.00 0.00 0100 7B.00 SP ER R 250 2 rr OUARANTOR INFORMATION PAUL L TUNNELL 1514 09TH BY OALVESTON, TX 77500 Balance after gluo Cross/No response r ' VA00UB2, TA14IRIH E 40046090 07/95/03 71.60 0.00 0. 00 71, 60 ADD ER 1 109 2 + +w GUARANTOR INPORMATION JOE VABOUE2 AT 7 BOX 90 DENTDN, TX 76201 No response two WARMOTH) DEAD IS 10012276 00/19/83 to 900, l0 0.00 -1'580.00 370.02 0P IP 3 04/00183 277 2 1 OVARANTOR 1NPORMATION +w RICHAnD WARMOTH OLD ORCHARD APTS APT 02049 LEWIBYILLE, TX 70067 W Balance after insurance/No response WBBB,JtMMY D. 40016529 04/07/03 74.43 0100 0.0o 74,40 BP BR 2 290 2 +w GUARANTOR INFORMATION JIMMY D. WEBB AT 5 COOPER CREEK RD DENTON) TX 76201 WH17ODoPHILLIP 0. 400;4059 03/043 49,10 4.00 0.06 49.90 ADD 0R No 49POnso ~ C ~0 0 OUARANTDR INFORMATION DARRELL WHITED 1710 LINDEN DENTON, TX 76201 No response to OL FEN '1904 W R I T@- O P P REP q A 7 PATIENT NAME PAT 70 AIOCHp DEG-UAL NEW-CHO PAOC l3 NEW-PAY W-O UAL PC TYPE CYCLE LUT,MMT AOt! NQ TYPe 10023603 01)/04/03 11607,1tl r Hw79wEGUARANTOR INFORMATION ww RU08ELL H WIDER(; 0 00 -1, 201. 9D 301).$0 MC tN 07/22/03 194 8 000tl0R00K INILKIN8,JE88I@ R, 40049076 07/30/83 $009 DENTON, TX 7001 Balance after Bluo Cross and Medicare/ ~ ww GUARANTOR INFORMATION ww J8081B 70. DO k, WILKINB 0100 0,60 70-00 Op ER 2 No response W1LLtAMB,4RT 7 BOX 20A DENTON, TX 76201 No rasponsa JO6 p t;BtiICA LYNN 40042327 07/09/83 M 40 OUARANTOR INFORMATION ww EDMUND 0. WILLIAMS Db.00 0,00 0.00 e4,00 OF / $3l MOCKINOU1h0 LANE ntN70N, T%19R76.w0l 200 P W09 ')UARANTOigONR INFORMATION 4002034: OD/St.^/03 60.2b 0.00 Balance after insurance/No response 1UAR ww DEBRA R WILLIAM$CN 0100 6020 $1, to $114 HBATHBR GLENN DALLAS, TX 70221IHlance 21)4 k after 1nSm'anco/NO response WILLINQHAM,87LLY H, 10024902 OB/23/03 2,106,40 0 ww GUARANTOR INFORMATION rw BILLY H WILLINGHAM 0,40 -1,8$9.16 31)7,29 OF 1h 2 . 07/$9/do lO7 8 2107 B@RNAND DENTON, T% 76201 Balance after Insurance/fio response WILLINQHAM,CHERYL MARIE 40026023 00/13/03 $7.80 0,00 0.00 57,00 ADO an 3 r w• OUARANTOR INFORMATION ww CHERYL MARIE WILLINGHAM 902 W OAK 8T N2 DENTON, TX 76904 No response 263 2 Wt00 SRBhroA A , 40023369 06/02/03 79,10 0.00 -40.10 31,00 OF ER 1 08/011#05 11)4 1? ww OVAINAN7DR INPORMATION ww BRENDA A. WISE 124 VtN00NV2LLE U@NTON, TN 76201 No response WITHOROW,AOBINN 0, 40000911 06/27/03 163,28 0.00 r ww GUARANTOR INFORMATION ww ROO1fNL B. WITHERCW 1)10,0 00 SMITH LOT42 TA2 tlE:1NTON, ONi ADD HR 1 216 TX 76201 lia response W0000,JAMEB C 40048670 07/31/1)3 109.76 0.00 N ww GUARANTOR INFORMATION ww MARY WOODS 0100 109,76 ADO OR 8 1193 2212 PT WORTH DR 03 DENTON, TX 76$0l j WORLEY,J0IINNY 40023442 06/03/03 40,00 0100 0.00 Balanco after insurance/No rosponso wr GUARANTOR INFORMATION Mw JOHNNY WORLEY 40,00 OF ER 1 OD/04/03 273 2 PO BOX 66 RT. I ARTHUR CITY, "X 70460 " WROO,RAY 40034266 06/12/O3 74.00 0,00 No response h i wa GUARANTOR INFORMATION• RAY WRp@ D, 04 74;00 OF ER 3 ` RT 1 BOX 2T AUAREY, T% 76227 No response 0732 $ Yt10K, MICHELLE 6 70007960 06103183 120.00 ~ M 04 GUARANTOR INFORMATION ww DONALD YECK 0100 -60,00 65,00 OF OF 3 06/06/03 R40 2 600 DRIPTWOOO OENTCN, T% 7b$O1 Arrangements not kept VOUNO, ARLRII 70013396 07/00, L 1 67. 90 ~ Mw OUARANTf1R SNfORMATION ww PAUL YOUNG 0. 40 -04.00 13, d0 MC OF 900 Live OAK NTdN, 7% 76241 07/R7/fy3 lp9 2 tl(i XIRGENPl1BN,JIMMY B. Balance after Madlcare/No rasponsa w• GUARANTOR INFORMATION ww4003171'J 06/03/03 D'l, 00 0100 0100 67.00 BP ER "w JIMMY 0, 17IIOENFUNB 013 BA40WCOG MANOR L@WIOVILLL, TX 7D067 242 t! XIROW130, BYOPHIN R.,11 10030237 06/04/03 1, 294. 90 0.00 1 14 Nw GUARANTOR INFORMATION ww POLLY ZJFB5NI08 0. 00 1 , $99. 1)6 ADD 11, No $ response PO BOX 741 NOANOKE, TX 76860 230 @ 21MMORMAH, TOMMIO LOU No response w• OUARANTOR INFORMATION rKYOTO~ak LEB122MMRRMAN34,7b 0,00 0,00 39,70 OF OF 3 206 $ loft OA9V[8W BRYAN, 7X 771)00 No respenso O wrww W-0 TOTALS 911, 062, l3 -1)'J, 520, VI ll, L$L 77 470 14:f, %U r) u' q~rlltrm,« w , , 11 'A _yyP [I i 01 FUB 1904 WR I TE~OFF REPOR T PAGE 14 - PATIENT NAME PAT ID 0100119 EEQ-UAL NEW-CHO 14EW-PAY W-0 6AL PC TYPE CYCLE LUT.PMT AVE PG TYPE A RICHEY,TONYA R 00097141 00/06/01 040.00 0.00 -100.00 740,00 OP YP 1 03/08/93 330 0 T ♦r OUARANTOR INFORMATION rw RICHARD RICHEY P. 0, BOX 407 CHICO, TX 76000 Bankruptcy r wrwr W-0 TOTALS 048.00 -100.00 0. 00 746.00 T r w T T r P r i i, 1Z 01 FR11'19(14 wfl I T r UPr li [PaR T PAGE 10 ` PAT1CHr NAME PAI 11) DIUCOV UCO-11AL NEW-CHU NEW-VAY W-0 DAL PC IYPE CYCI,L LBT.rMT AGC PO TYPE A ~ AVURY,JVOTIN M 00003764 01/31/03 It ODD. an 74,30 -1,177.13 201,03 BP 1P 3 01/19/04 l3 6 46 01♦ GUARANTOR INFORMATION ON LANAR AVERY 1100 LAGUNA DONTUN, TX 762D1 No rnsponso BACA,AMOER 40073066 10/20/00 04.00 0,00 0,00 64.00 ADD ER 2 11 3' A *0 GUARANTOR IWORHATION 010 DARLtNE DACA 1199 0 MILL LEWIHVILLE, TX 75067 No r6l[lDnsc @g DAOL99, DEANA K. 40ORWA3 OD/LJ/03 65.10 0100 0100 63.10 BP ER 4 953 6 4 011 GUARANTOR INFORMATION 0101 R091IRT VAOLEY 673 CAMPBELL 6'r DRNTON, TX 76201 no response BAKUR,DARLA 0. 10035012 06/29/03 1,127.30 219.90 -061,04 402.16 6P IP 1 09/12/03 7S 6 A +N GUARANTOR INFORMATION 11r RUSSELL WWI 1711 1/2 W HICKORY DENTON, TX 762010alance after insuranca•No response r QAKLR, 7CRRY L, 40OR7641 05/17/03 OD. 00 0.00 0.00 85.00 Sr ER 4 206 6 • *0 GUARANTOR INFORMATION •+1 SHANUI4 BAKER OP20 FISHER THE COLONY, TX 75006 No response DALLARD, MICHAEL D. 40044618 07/ 10/63 129. 7D 0.00 0100 129.7b RP ER 4 195 b " M% GUARANTOR INFORMATION *11 MICHAEL 0. DALLARD 34 KINGBWOOD LAKE DALLAS, TX 70060 No response r ' PAN0,R6DECCA ANN 40040374 07/12/03 122,20 0,00 0100 123,20 SP CA 4 202 6 4 00 GUARANTOR INFORMATION REBECCA ANN RARE 4312 VISTA DE LAGO WAY i'AIR OAKS, CA 90620 No response DAOILIO,MIAUAL RUY5S 40044125 07/16/93 69.20 0,00 0.00 69.20 8P ER 4 141 b AM GUARANTOR INFORMATION NO MIOUAL REYES PASILIO 932 6 RLM 0 DENTONr TX 76201 NO response BATTLG, JAnnUA L. 40035000 06/10/63 62.20 0100 a. 00 62. PO SP ER 4 230 b GUARANTOR INFORMATION *0 LAWRENCE! BATTLE DSO SKINNER DENTON, TX 76201 No rosponso ` PUCK, WILLIAM, PR, 40024984 00/00/83 158.71) 0.00 0.00 too. 70 0P ER 9 960 b Mai OVARANTOR INFORMATION 40 WILLIAM 09CK, SR. AT. 2 BOX 319A PERRYVILLO, MO 63776 No response 09LL,KATHY D, 40043409 010113103 71,64 0100 0,00 71.60 OF 'ER A 190 6 fi NO GUARANTOR INFORMATION ON JOSEPH W. DELL PO BOX 790 113 BIRCH ROANDKO, TX 7&P q 0 response BOLLOo KOLA 40030207 05/20/83 133.00 0.00 0, 60 133, 50 60 HR 1 Rob 6 •0 OUARANTOR INFORMATION wr KOLA BOLLO 1400 ELM 116 DGNTON, TX 76901 No response r. 09NNSITs JOHN M 40069061 10110/03 54.00 0.00 0.00 06.00 ADD ER 4 1Itl 6 • 44 GUARANTOR INFORMATION rw JOHN M BENNETT 805 8 GRANT MARSHALL, MO 99999 No response BERAY, CYNIHI 10010401 06/00/83 1)027.39 459,30 0. 00 Pi '286. 69 aP IP 1910 6 40 R ! ` A NFORMATION CYNTHIA PERRY 1110 MORDO DENTON, TX 76:01 Rrangemonts not kept DJELOE, OEPORAlI ANN 10036267 07/00/113 1, 906. 19 446, RG ^071, 00 It 061. 19 1X4 1P b Ol/96/04 6 6 OUARANTOR INFORMATION 1101 DONALD OMAR OJELDE 0022 VILLAGE OROEN OT BAN ANTONIO, TI~ 7 )a rrn g ants not Xopc BLAWFLOYO DALE 40044661 07/le/03 92.40 5.06 O.OD 79,40 OF BR 4 00 6' 00 GUARANTOR INFORMATION r0 FLOYD DALE bLAOG 1114 ALICQ DEHTDN, TX 762101 Na rosponlo OLAIR,RAII6GN9 ANN 40043416 07/10/00 09.00 71.60 0.00 160.60 OF ER 4 101 b M Of GUARANTOR INFORMATION rr RAELENO ANN BLAIR PO BOX D46 FARMER BT, OANOER, TX 762'664 p # . CQL9MAN, PAM M 10005701 0030/00 1118.90 0.00 0.01) 180195 912 1P No re 6/ /03 1'11 6 N# GUARANTOR INFORMATION YM DAVID 0 COLrMAN AT 2 009 24U AUDROY, TX 76297 . No i •4, -l. , x11 F, a cNt i r I•' 01 IHf11 11414 W II I I 1' - U I' f If f: P 0 14 '1 PAPI! 16 tsAtamr NAHU J'AI' IN 11111C110 IJUD-11AL NEW-010 14GW-PAY W-0 SAl. PC IYI'0 CYCLE. LOT. PMT AOC PO TYPE COLLAZUiDONNA 10(113;!:160 09/13/0Y 6R1,'JU 1;10.:10 0100 70;1,00 AUD II' 4 62 6 • oo QUARANTOR mr,04MATI0I1 I'110MA9 C01.1 AZU ACI WAINWRt014T UrNT[11J, 1X 76201 Arrangrnnirnts orrI kept COLLETTiTEBS QAIL 40n0160G 11/20/11:1 96.00 0100 0,00 96.00 ADD NR 3 64 6 M of GUARANTOR INFORMATION *w QAVLAN M. 000QHrR'fY RT. 1 DOX 007 DE:NTON, TX 76201 No response J COLLINn,ANTHONY 400,17976 07/U1/03 71. ^0 00 0.0 71,,70 or Cn 2 214 6 Y *o OVARANTOn INFORMATION WO ANTHONY COLLIND 906 REED RT APT U nQ6 BOLIVAR KALAMA27p, MI 49001 J. 1o response COLLINDWOFITH,DARLA 100,71277 04/27/03 1,017,20 977.40 -810.00 :,104.60 HP 1P 1 01/1yy/04 19 6 • ON, QUARANTOR INFORMATION DONNIL COLLINU1,10R7H 604 CARDINAL AP2 DQNTON, TX 76201 Arrangements not kept CDLfl1ONiLARRY E. 10011724 03/10/03 OD L 20 0.00 -667.20 ^..14.00 HP IP 2 11/03/133 90 6 11111 ON OVARANTDR INFORMATION #0 LARRY P. COLSTON 4021 11000Y CRL•EK RD K78HIHME, PL 32741 No response 5 COLWICKiLAVRA 10006004 10/02/63 037,40 277.00 0.00 L 110;25 EP IP 62 6 y to GUARANTOR INFORMATION JOE COLWICK 2810 BERNARD DENTON, TX 76201 I?o ratponse DANIIL,RjQK U 40020970 04/23/03 70.70 01 DO 0.00 70, 7d ADD ER p pppri3 6 10 4 QUARANTOR INFORMATION RICK D DANIEL 607 W OAK DENTON, TX 76<01 Balance after insuranco/'le response DANIIL60N,NATHY A. 46043200 07/11/03 06,00 0,00 0.00 06.00 SP ER 11 204 6 1 ♦ No OVARANTIR INFORMATION KATHY A. DANIELSON 710 W PIONEER !1216 IRVING, TX 70061 No response ~ DAOD,RARD O. 40033370 06/09/63 130. 7D 0.00 .000 00,70 oP CR 2 ggG ` to QUAAANTOR INFORMATION RAU 0. ))ADD 2113 STELLO 13T BENTON, TX 76201 Balance after insurance/t~o rosponso { DAUGHERTY, TERG6A C 40030101 06124160 73. 2b 0.00 0,00 73,25 BP ER } 219 6 ~0 OVARANTOR 1NPDAMATION No YORUBA C DAUQHCRTY PO BOX 43D LITTLE ELM, TX 75060 No rosponsa ~ DAVILA,NOAMI 40000717 04/13/03 70.00 0,00 0.00 70,00 SP ER 3 350 b v OVARAWTOn INPORMATION n9NIT0 DAVILA 0040 ADAMS THE COLONY, TX 79006 No response J DAVIB,ALVIN RAY 10096000 00/13/63 2,262,00 161.00 0,00 2,423;00 SP IP 3 230 6 40 Of QUARAN'OR INFORMATION No ALYIN RAY DAVID AT 1 BOX 140 ARQYLE, TX 7624.6 No response J DAVID, 6RADLUY W. 10004098 06/24/00 1, 074, 16 0.00 -904. 10 970.00 OF 1P 2 09/ 19/GO loo 6 t♦ OUARA14TOA INFORMATION 00 ARCHIE C. DAVIS 0007 796HLEY LN N2nO DEMTON, TX 76201 J ' Balance after Insurance/NO rosponso DILK,RONALD ALLAN 40035073 06/10/63 73,20 0100 0100 73. 25 ADD ER 0 831 6 V OUARANTOR INFORMATION RONALD ALLAN OELK 4900 NOLAN PTWORTHi TX 76119 No response J DELLAOANA, WARREN E. 40019307 06/20/03 06.00 0.00 0.00 116.00 SP ER 217 6 40 QUARANTOA INFORMATION WARREN E. DEI.LAQANA AT 2 BOX 300 PILOT I1DINT, TX 76256 No response ,p DOMPDIY,NATHAN 40044786 07/10/03 136.20 0100 0.00 (30,20 ADD ER 4 191 b 40 No OUARANtOR INFORMATION #0 NATHAN DEMPSEY COLI.EQE INN APT$ 3112 pOnELOL DENTDN, TX 76201 w o rosponsa DgNNY,ROQBR DONALD 10031306 07/138/63 80940,90 0.00 -2,940 90 700.00 0P IP 2 08/31/00 154 6 V OUARANT'OA INFORMATION NORA SHARON VANUr.N OCACH 8427 PRINCE DR LAKR DALLAB, TX 70064 40 Balance after lnstiranco/No rosponso D87RICK,DARLINL L. 40000029 0011010 90.86 3726.35 0.00 076,60 SP ER 2 51 6 40 QUARMITOR INFORMATION DARLENO I. 001"RICK AT 3 9OX 937 QAINESVILUo TX 76240 No reEpenSe d i f N 01 KL'D 1984 WR I TE - arr R EP 0R T PAGE 17 PATIENT NAMF. PAT ID DISCHO DHO-DAL NEW-CHO NCW-PAY W-0 UAL PC TYPE CYCLE LIM PMT AGE PO TYPE i FLOYD,nOQ9A O. J0036937 07/66/83 1,999, 55 0,00 -1,739.64 189.91 3P IP 2 01/23/04 5 6 1 GUARANTOR INFORMATION 4* ROOER FLOYD RT 2, M1BTY MEADOWS Re PnteCO, TX 75 ,74 Ile response PO1I18M JAMR'S VONDEAAL 400,70164 06105/63 137, 60 0.00 -37. 60 100.00 SP ER 11 09/02/93 192 6 GUARANTOR INFORMATION JAMES VONDERAL PONTENO 315 RUTH ST DENTON, TX 76201 H0 response FOAD, JGRRY 14AYNE 40034011 06/14/03 50100 0,00 0.00 00.00 SP an 3 06/15/03 231 6 GUARANTOR INFORMATION *x KENNETH POND NT, 4 3401 WALTON DN. DENTON, TX 76PQ r a response FORT6i OHARLOT78 40001149 06/04/83 07,00 0100 0.00 07,00 SP ER 238 b GUARANTOR INFORMATION CHARLOTTE POnTE 016 CROBSTIMnER DENTON, TX 76201 tqo response PORT9, DAVIDAGB L 40034666 06/14/e3 011 00 0,00 0100 60100 or ER 0 230 6 OUAAANTOA ]NPFOMATION nETTV PORTE 1210 MORON DE'NTON, TX 76!01 NO response ~ PDRTUN6,6UN10S R 40041843 07/06/03 06.00 0100 0100 06.00 BP ER 3 209 6 4* GUARANTOR INFORMATIDIJ *w KENNETH FORTUNE FIT 4 BOX 287 DENTON, TX 76201 No response POSTRR,OSARLD DRWAYNE 40028979 08/11/03 90,69 -54.20 64,20 90.00 BP ER 3 09/11/63 146 6 r 4* OUARANTDR INFORMATION DEARLD OEWAYN8 POSTER RT 4 809 319-Y DAVIS LANOINO RD 8LI0ELL, LA 70486 Insurance donied/No response POB7ER,JAN100 10036903 07/11163 9)415,09 -22.70 0.00 9,,792.84 OP IP 3 190 b N* GUARANTOR INFORMATION LAWRENCE POSTON 1306 MOZIN00 DENtON, TX 76201 Arrangements not kept POUTCH,SHGRI M 10030104 06/06/61 950.95 0127,130 -7,120,76 357.99 8P 1P 1 07/16/93 14~J 6 p* GUARANTOR INFORMATION JIMMY D FOUTCH 117121 MONCAYO DENTON, TX 76PO1 Balance after Insurance/A0 response OREINER,LORETTA 8 40040167 07/30/133 96,00 0100 0.00 56.00 MC ER 4M OUAAANTOA INFORMATION *w LORETTA 8 ORLINRR 600 EAOLE OR 4133 DENTON) TX 76201 Insuranco donfod/No response 6 GRIPFITHiTSRRY L, 1001107012 05/99/60 1,061,29 503.65 -1,Ob0,00 554,M4 9P IP 1 06/15/83 150 6 N 44 GUARANTOR INFORMATION ANTHOMY B. ORIPPITH WODDOLBN APTB 477 0AINEOVI41-t, TX 76240 Arrangements not kept GRIMSNAW,TOM DRYODALS 40042392,07/09/03 fib, 00 0,00 0.00 56,00 SP EN 3 2o5 6 OUARANTOR INFORMATION TDM ORV80ALE ORIMBHAW RT2 BOX276 AU3ROY, TX 76227 No rosponsa ORINOTRAD,MARY JOAN 40047616 07/10/03 109. On 0.00 0100 lei. Ob "I$ ER 3 203 6 OUAAANTOR 1NPORMAT ON *4 MARY OZAN ORINSTEAD 5216 YAOER THE COLONY, T9 75056 No responso GROSNIND,JUD17H 00027524 OR/R6/02 371.10 0.00 -28.00 346,10 SP IP 4 07/25/83 191 6 OUAAANtOR INFORMATION JEIIRY 001INMO RT 4 OX 160 DENTON, TX 76201 Arrangements not kept KARA M BILL JOHN 10024760 05/14/83 1,O63,90 50.77 wItgio,60 104.07 SP IP l 06/20/01 168 6 r OUARANTOR INPORMATION DONNA HARM 1814 CHOCTAW DONTON, TX 76201 No response ~ HARRIS#NANOV L OD029926 05/02/00 134,90 0;00 -70.00 44.90 SP IP 3 00/03/83 102 6 I rj 4N OUARANTOR 7N(IORMATION *N AGLGERT'HARRIO OT I VOX 110 C LINOMY, OA 73062 Arrangments not kept ~I HARRIS 4HULIA L 00029991 04/6/02 113,00 0100 0.00 113.00 UP UP 2 07/12/02 661 6 * NN OVARANrOR INPORMATION *4 RflULIA NARNIO 104 0 NUODaLL 04 D@NTON, TX 76201 Arrangements not kept HARAIO,VIVIAN 10006305 0010/03 606.75 1,465.76 -Is 010.06 1+006.65 UP 1P 3 0811003 IOU 6 GUARANTOR 1NFDAMATION ALON20 NARRI4 220 RUDDELL 417 OENTON, TX 76201 Arrangements not kept A M 01 FES 19(14 WA I Tk-0FF A N P a A T PADS 10 PATIENT NAAE PAT ID DISCHO BEG-BAL NEW-CHO NEW-PAY W-O DAL FC TYPE CYCLE LDT,PMT AQE FD TYPE r r HARTLINE,MICHIFAL 40019077 04117/03 70. 79 0.00 0.00 76,7b ADD ER N9 Pal 6 OUARANTOR INFORMATION ww JOYCE HARTLINE RT2 BOX 773 DENTON, TX 76201 No responso r HICHOO MARTHA 00032056 OS/30/80 204.20 0.00 -00.00 206.20 ID /P 4 07/08/63 908 6 r* QVARANTOR INFORMATION ON, MARTHA HICK13 1900 SAMM BA68 BLVD 012A DENTON, TX 76201 f~ Hl00$,BCOTT A Arrangemonts not kept 40p26635 00/10/83 ?/.00 0.00 0.00 97.00 6P OR 3 261 6 r GUARANTOR INPORMATION SCOTT A HIOQS RR 1 BOX 41U T SANOER, TX 76266 No response P1 H7LKER, TIRBBA L 00032150 01/27,163 46.73 0.00 0.00 46.70 6P aR 4 070 6 r 0#1OVARANTOR INFORMATION +t* TEREOA H11.Ktri 6072 S OTBMMONS DENTON, TX 76201 No response Al HILLI BRINT J 00032193 01/24/93 139.20 0100 0.00 1361 r5 VP ER 4 373 6 r *0 12UARANTOA INFORMATION rw BRENT HILL 1101 WOODMERP, LEWISVILLE, TX 76067 No response 1 HILL, ETHEL 0, 10038106 07/12/53 990,00 0.00 -906. 00 34.00 SP IP 1 00/10/03 170 6 r ww OUARANTCR INFORMATION ETHBL Q, HILL 1643 CHAMBERLAIN CARROLTON, TX 70007 talanco artor B1uo Cross/Ho response r HILL, JAMES M, 40032433 06/04/53 107. 30 -22.75 -67,64 66, 91 SP an 2 11/13/03 60 6 wr GUARANTOR INFORMATION *w JAMES M, HILL $470 MONTE CARLO ARIZONA CITY, AR OD233 HILL,RHONDA D 100315DO 06111103 1,097, 00 0.00 678. ptl 809.00 SP IP 3No ropo2nso 228 6 *M GUARANTOR tNPORMATION ww RONALD HILL AT 4 BOX 430 BOW11E, TX 761230 Arrangements not kept h HILLS SHALLYN R 40031577 06/04/9'3 56,00 67. 00 0.00 mm tl0 or an 12 r *0 GUARANTOR INFORMATION ON, HERBERT HILL, C/O ONE WAY PREIGMT 1138 LONG POINT OALLAO, TX 76247 103 6 }1 I HILLIARD,BBVIRLY A 40037727 06/30/01 67,00 0, DO 0100 67.00 $p OR R No response 218 6 GUARANTOR INFORMATION JOHNNY HILLIARD 502 JANNIE D2NTd14, TX 76201 No rosponso HILL1AAO,HU3ERT LSE 10OU6045 00/19/93 1,270,70 0,00 -1, 022, 46 800,74 BP 1P V 07/26/03 191 6 r ON GUARANTOR INFORMATION rw HUDERT LOU HILLIARD 1710 WHITEOAK D91,17ON1 TX 76701 Balance after insuranco/No response AN f r HILLIARD, MICHAIdL 01MIK6Y1' J 40047334 07/97/03 SR, 25 0100 0100 iis. 25 UP art 8 15$ 6 GUARANTOR INFORMATION *r WALTER HILLIARD P, 0. BOX 820 LAAN DALLAS, TX 7065 No responso Al HUTCHIBpNi,MARY ANN 40017425 04/10/83 09,00 17,70 -53.00 op, 70 or ER 8 09116103 1if) 6 GUARANTOR INPCRMATIC14 4* 00I V. HUTCHI(ION 8031 N DONN28 BRAE DENTON, TX 76@01 Arrangemonts not kept Al j IRWIN#LOU ANN 40033680 06/11/03 195.00 0.00 -20.00 170,00 IP ER 3 11r/tt7/63 34 6 QUARANTOR INFORMATION *w ROBERT W. IRWiN PO BOX 230 KRUM TX 76849 No responso h IV9Y, HUOLUN8 WALKER 40040UB7 07/10/63 150. 01) 0.00 0.00 160. 60 6P ER 4 M* GUARANTOR INFORMATION Mi HUHI.ENE WALKER Ivey 500 U DONNIE BRAE 0130 IICNTON, TX 76i!Ol 198 6 04 i JACKSON,CLIPPORD 40040790 07/3I/O3 54.00 0100 0.00 06.00 15P OR 2 r' GUARANTOR INFORMATION w* PAYSY LANTRIP BOX PILO BPLNC$R RD DENTON, TX 76201 Ito response 304 b i JACKOON, DONNA 0, 10030180 O7/1!/n3 70$2.31.1 232, 3D 01 CIO 934,60 OP IP ry QUARANTOff INYpRMAT10N ON TIM JACKOON 197 b HT k UOX 126A BANOEft, TX 7671,1, rn.,lq .,p dACKOONP WN000 D 40027301 05/10/1)3 40. 2D 0, OD 0100 40,96 till en 4 00/1WWI 1259 6 A* GUARANTOR IVUHMATION w* ffAYMUNU TIMITIt fit P OUR U74 AUDRUY, IX 76287 No respunsn AI ; i s ieGauttilt...:xmt'' `xi.:..p: ....u~. - S• t. ,1 i,. MPVu '4 4vs` P\ \ t Y' 1 rt;i t i l,\ ew-7W~tN+bTltt -,5~`l'icfk02 s+i. 1 vko, t;o ~ia1\~ h111 `1kA1fl1lIJ+~ SA~'LM~MT` 5 ~(~~1 i ,N.SR\ ~ W ,1►ieMiNl+n>~k trV'NSINV kJWX Ilk ~.mNCS+.`~~~s,Lrt ~ q~~;lkFr~~ V',5 ~oi: 't5.~1 t'+1 111 ~ r~ti•, 1; u yv Mvtvlc WN 1( 4111 km {IN Itt'M t ;ktyr +o+watwvr~vc ttK~ut1~N wt .w0'+ '~ki1;1'r1 1 .x,aK~cL~t~^t~t httk,ky Ik~t+*!~~t ~ I~,I ;k-~a t' . ,r:'++ ~~~j , r;l ~ 1{;y t~k jlt tl~ as tlUAl1AN1't" 44%0V\111 4 RM kkr51 ,>t' 1 1 1~i [ 11' `h' KARIN, DAN tk kl '.;1.4{1' ai glll`111 k ^ dkl; q : l , { 1 ~1, II . ~i s~ OIMNANIUN iNP0111WON II IN 14 Ih~41~1i I 'fly ~ 1 n, i. LANR1 JANIII y~h 4 MM QUMIANIM Ilq'111111AI111N Id v"Mle I A 1lilt [ LANi1RA7tJ11}MIN4 N, IIIh4II!1 ,v~i If~l~llll' 9t1i1 'lll f~l 1 ~I~'1~1ICI ~1I l•``I~ Ilt ~.F {t~11 ♦o QUMINJIil11 IIIPII WAI Ifill IA ,IJ Ih LAMOOMKOORN Vii M Jir'Ilr/{{J III~IFJI f f'I! f~a ~1 ?'t{' , Ili fs' t o r~f~ i', I d'l Alhlih 2 1,1~~~~' ~ ri ~ X111 ( ~ ~ ~ ~ ~ f j h tl ' sr OVAkM1(ofl 01m)"HA iM to LAML1N.t.JIRik fi f r, / ~f~y F! r, Jr'~1r,~ !!1'J~l~ I I , ~ 1 I.1 lr. . +f! r ; t ~a~,rralrl~+ I+w1~Nh'I Kdl r Irrrr~ !1 11 ~/~ll~ f ~ , ~ Prah/r1 / R~~INIFIr'~~~F~fFji~; iMICICffRM~A 1lrW!AMfIAFJrAIf AMI~?WM3FA/IfMA ! f%//~~~~ltf/ /,l;rl 'jr.r a'l 1 f~ t~ lp+; re's ~i l t 1 ' rr lful►Mr?'!SM I:tM+1Ah~''p"'rtty / r „rpweeP .,r~+t+t pf t l:' !r 11 1 rr 1 'T41"4~✓I°/F,'1~f 1 E fpY/~ f/IhI'Ar,~ t ,:p►"tI J .yMjd.1y'f MICrSMltA`"';!Jy .r' ~r/!//; 7r;: a ow FFr iW n w, y O1 FEB 1994 NR I TE - bPP R EPORT PACp 14 ! ^ ~ PATIENT NAME PAT ID DISC11C DP.O-DAL NEW-CHO NEW-PAY W-D DAL PC TYPE CYCLE L8T PMT ACE FO TYPE a JACKSON, JAMES RANDALL 40042914 07/10/83 164.00 0100 0.00 -16(,00 5P SR 3 220."1 6 GUARANTOR INFORMATION ww JAME9 RANDALL JACKSON RT 3 BOX 92••A PR39CO, TX 70034 No response JACKSON,LUK9 M. 40041410 07/06/93 61.79 0.00 0.00 61.76 ADD ER R 910 6 GUARANTOR INFORMATION JAMES L. MATHID At. 2 BOX 426A SANGEA, TX 76266 No rospor3e 2 JACKGONi THOMAS 0 40030230 06/ l0/Ht! 811. 50 0.00 0.00 60.00 BP LR 4 90 6 GUARANTOR INFORMATION MARY JACKSON 410 PAISLEY DtNTON, TX 76201 No response JONRD,OAMUBL T 40032000 06/04/93 61.26 • 0100 -24.20 07.06 BP EN 2 07/19/03 136 6 OUARANTOR 1N#GRMATION GENEVA JONEO 200 E PRAIRtE DENTON, TX 762201 Balance after Blue Cross/No responso UON1119P TANSY INFORMATION 40009310 62/10/B3 105 Y6 0.00 -04.60 71.10 9P ER 3 00/21/03 317 6 RIO RAILROAD AVENUE 8ANGER, TX 76266 Balance after insurance/No response 4ON28iV1CKI6 L- 10011294 03/11/83 709.70 266,20 -900,60 145.40 SP 1P 4 00/101133 119 6 sell GUARANTOR INFORMATION *r VICKIE L JONES 9RO SCOTT OR OENTONi TX 76901 Balance after B1ue,Cr6se/No ra9ponse 2 JORDAN, JAWAN 0, 40030210 00/20/83 79. 25 0.00 0.00 70. 25 BP ER 2 2240 6 GUARANTOR INFORMATION JOIiN if, JORBAN 1600 WHITE OAK DENTON, TX 76201 fnsurance denied/No Posponse JUAA8Z, L6VON KELLY 40071917 04/00/!13 9D. 00 O, 00 0100 SO: 00 SF CR 1 270 6 GUARANTOR INFORMATION 08CAR 0. JUAREZ RT. 2 DON 19 CAPRtCDNN MHP DOTON, TX 76201 KgR1M, SAM 40010,,.-( 03/20/03 I59. 60 0.00 0.00 11n. to BP KA 4 No response w* GUARANTOR INFORMATION SAM KARIM 603 EAGLE 018 p0 BOX 10109 DENTON NTOU, TX 76203 01.2 b LAMBS JAN111 40039336 06/00/S3 61 60 0.00 0.00 61, 60 OF ER 2 N0 rosi onsp GUARANTOR INFORMATION JANI4! LAMB 12 POX CIRCLE DBNTON, TX 76201 No response 241 b LAMONAT,JOWkNV 6. 10012011 03/16/83 1,600,90 2,70 -1,486.40 177.27 BP IF 0 04/14/83 293 6 GUARANTOR INFORMATION JOHNNY 13, LAMBERT. 601 N WEAVER OAINeSVILLO, TX. 76240 Balance after Insurance/No response LAMBKRTlMARCRS K, 40036901'0b/20/83 147,40 0,00 -0100 149,46 ADD ER 4 07/03/8") 916 6 GUARANTOR INFORMATION 0* LEONARD; LAMBERT RT I.BOX 1006 UNIVERSITY MHP DENTON, 'TX 76901 ' LANAIS) LINDA D IDOOD721 02/16/03 4,316.60 0.00 -31901.50 460.10 SP IF U NO 04%100/93 302 6 ~ GUARANTOR INRORMAT?ON LINDA 0 LANAIS RT 2 OOX 09 LOT 010 ANOYLL'o TX 76226 Balance after insuranco/No response LANDRY, PAUL NYERRYN 40ON9745 OblowSa 67. 00 0,70 0100 70,75 OF ER 2 210 6 GUARANTOR INFORMATION PAUL NTUARY" LANDRY 14011 CONORdSS DENTON, TX 7b203 110. respomo ' LANGFORD, UAROARA J,. SCO33900 06126/01 1,945.39 0.00 -1, 600. tl1 009, 08 OF IP I O1/R5/04 7 6 OUARANTOR 1NFORK47IDN SCOTT A. LANOPOlm 100 STEVEN SANOEN, TX 7Q66 Balance rafter fnsuranco/110 responso LALWNIIIYI IIUDY A 4002b004 00/14/93 77. 76 0,00 -64. 713 I1a, 00 9P ER 4 06/10/93 200 6 GUARANTOR INFORMATION JUDY A LAOWRBY 1122 OLD LRS CT VENTDNi TX 76201 Bdlauco After Blue Cross/% rospunso LAWTONi 0010 J 00040300 01/20/O3 46.00 0100 0.00 46, 00 9P 1:R a 377 6 40 OUARANTOk 1NPOli11ITI DN r*. NDOA LAWTON 17D1 YCAO•.flYI.N 0171 D0410N, TX 76.."01 Ilolnnco after Insurunco/Ilu rr.spensa L(IAL, 09RN14L 40046480 07/01/113 97. try (1100 0100 93. 26 9P ER ✓ lg6 6 *r 9JARANTtlR INPORMATIU,N DERNICk LOAL 620 ULAND DUNION, TX 16101 Mb rusponsa n4 yRM4iM'MM.IY,2y{N,F+,. FYW.F ~2NIMAW1~1r*1)W +J .av k4 '~11Y1}`1.4~~i}a `.S a i Ol FED 1904 WA I7P-0 FP R EHUAT PAGE 90 PATIENT NAME PAT ID DISCHO BEG-UAL NEW-CHG NEW-PAY 0•0 NAL FC TYPE CYCLE LST.PMT ACE PG TYPE' i LE6, D ILLY J 100037,.1 03/07/0.1 4, 417, 90 , 407, 90 -4, 094. 36 731.04 BP IV 1 03/29/83 70 6 ^ GUARANTOR INFORMATION DILLY J LEP P 0 COX 906 AROYLP, TX 76.180 Balance offer Insurance/!lo response 1 MCCULLOUGH,ROBERT T. 40036964 06/20/03 62.00 0.00 -27,00 36.00 SP ER 4 01/00/04 Q9 6 GUARANTOR INFORMATION *r RODERT E, MCCULLOIIOH 3400 FALLMEADOW *3110-r. DE.NTON, TX 76801 MCCINiRtN,JAM69 EDWARD 40040346 07/21/03 149. 20 0.00 0.00 542, V0 MD ER No response 190 h / GUARANTOR INFORMATtON JAMES EDWARD MCCUnRIN 1001 LAl TTEMORE DPNTON, TX 76701 Insurance denied/No response M00AD6, SARAH L. 400466198 07/90/03 85.00 6.00 0.00 on. 00 1UP PR 1 109 6 GUARANTOR INFORMATION SARAH L MCDADB' 606 WILSON DCNTON, TX 76:01 No response MCDAD8,TAMMY L. 40019908 04/80/03 9U.00 0,00 00 69.00 SP ER 4 00/31/53 846 6 0* GUARANTOR INFORMATION TAMMY L. MCAADO 8601 MINGO RD VILLAGE CAST ANTS 0904 DCNTON, TX 7L:'Ol No rosponse MCOAUGH, OMILY 0 70010046 00/120/B3 1215.00 0100 -20.00 10D.00 SP OP 1 09/82/00 163 6 ^ M* GUARANTOR INFORMATION EMILY G MCOAUGH NT 2 BOX 38 EC AUBREY, TX 76P27 Balance after Insurance/No response H*01*IRIH~ODTHY INFORMATION 40019970 0412O/tlO 09.60 469, U6 0100 629,06 48P 4 lS b O UAR A , ION TlhOTHY J. MORRIB 1616 W OAK APT 0107 DENTON; TX 16201 Arrangements not kept 11t1RRIS,V. J6ROMB 10040694 07/2083 300.80 -88.70 0100 327.00 SP IP 1 1S9 6 r GUARANTOR INFORMATION V. JCROM6 MORRIS 11045 LAURSL AVE BLOOMINGTON, CA 912316No response ' MORROW, DAVID H.,JIL loolu S3 03/94/03 671.60 0.06 -h90. e0 46.30 SP IF 3 00/20013 207 6 / **-GUARANTOR INFORMATION DAVID H. MORROW, on. AT 0 NOX 303 TWIN LAKES MHP DCNTON, TX 6 OJ ~aanee after insurance/No response MOR89, MARISA L. 40039489 66/89/03 63. 00 0.00 0100 63.00 SP ER 2 G6/30/83 910 6 ^ GUARANTOR INFORMATION SUSAN TODD 308 LOOP 980 8N-10 01NOINC DAK13 APT1; DENTON, TX 76201 No response NICHOLAO7NORMAN K 40030099 06/16/83 118,00 0,00 0,00 110.00 ADD PR 4 990 6 OUARANTOR INFORMATION NORMAN K NICHOLAS AT 7 COX 44100 DE!NTON, TX 76901 No respens0 r NLOUAHANTQR INFORMATION *4 VICTOR NIELSEN2 812. 91) 12090GREEN-60,00 CRIOR DENTON, TXID76201 t Ualenc0lhir Insuran7o/No Asponso N**nOUARANTIA CH.DANIELLIXNFORMATION **4QDONNA KbNIKBSH 80.70 1140AVS E 011200 DENTON,7TX 67620159 No rosponsu 231 6 NILSB, LAURA L. 40030910 00/01/61,+ 560. 30 0.00 0.00 160. 00 13P OR 1 70 6 r GUARANTOR INFORMATION LAURA L NILES 908 SAWYER DENTON) TX 76901 No response NIPPER, TONYA L. 40667149 10/01 /e3 110.00 97,80 0.00 207.00 ADD On 3 be 6 r M MA14159 INFORMATION JOHN NIPPER 7100 NTPMMONO Nil? AT 14 OX099 DENTON, 7XIle'176-002 ros!ions0 NOLAN,MICHA9C. EOWARDlJR 40040379 07/91/00 04.00 0100 0100 U4,60 ADO CA 1 IV" 6 OUARA14(M INFORMATION MICHAEL 11DWAnD NOLAN, JR 1444 W OAK0130 DENTON, TX 76801 No response ~y NORMAN, LONNIU 0 40030010 06/26/83 91,1100 0.00 0100 73100 at, 8N 1 00 GUARANTOR INFORMATION LONNIE 8 NORMAN OIY STANLHY ST pSNTON, TX 761201 flu ru7punse .l9 b r 'I NMMAN,ROII WILLIS ADOIJ310 05/24/03 4U.00 63.80 0.00 Sob, 20 ADD CR 4 03/RS/RU 166 6 OUARMITOR INFORMATION ROU WILLtH NORMAN JUDO OAK 020 DITNTON, TX 76701 No rosponse i t . ,G r - - - - - - - - - - - - I_ 11 01 rED 1994 Ir PATIENT NAME WR I T E~4PP N EP tlR r FAT ib DIBCHO PAUL, NEW-CHG 21 Fr1 NEW-PAY E i W-4 nAL PC 7YPp OVCLE l.B't, PMT AOE PO TYPE PATTERBDN, WANDA V AT GUARANTOR INFORMATION *«00062669 09/03/aR ODb.bd MICHAEL I ATTEREON 0.00 O. 00 358.68 1D IP pATTON,Hf*ir 21 d2 LAKlV1NW C R N 2$7 LCWIBVSLLE, T 1 10/16/92 647 6 7 067 AT OUARANTOR INFORMATION *w40013 9 97 PAT7/63 % No 39. 00 0. 00 response TON 0,00 36. 00 AUD No re 327 BRADDHAw BT DENTON, TX en 4 03pons(? 310 0AWABITTICHt1T,V98ARUT 76701 No response 6 40097903 06/17/8 } GUARANTOR INFORMATtD ww ~ 40.00 .000 p. 00 r N VCSARUr PAWADITrICHOT 48.QO gP ER 3 pAYNB,OHRlBT 11619 3 206TH LAKbWDOD, CA 00719 110 response :99 4 I LYNN 40040347 07/03/83 . 0100 no GUARANTOR INPORNArIDN r* CHRISTI LYNN PAYNE 168,70 01 B 0.00 166, 70 $p P-R PlLLOW~ SANDY K. 901 LRNARD 0194 DpNTDN, TX 7605 Ho rOSponso 1d6 d r . OUARANT 10007092 00/14/83 3,4DO.,D OR INFORMATION *4 BANDY K. PILLOW 0'00 ;2, 890, go 960.00 ADD pITTS,CRYSTAL N POD 7s0 L9W18VlLLp, TX 1P N 04/18/5 7(0067 flalance of or insuraric0e/No rospdnse GUARANTOR INFORMATION no 00066 SHtRLEY0p1~TBb3 30, 00 518, UO Bp ER d. Od d. 00 1 RABAOO,WILLIAM 200 SOUTH MUDD9LL APT07 VINTON, TX 76;Z 1 091 b 4UARANLIA 1NPORMA7ION no 4000i6o4 02/07/63 39.39 • alance after insurance/No response GUILLERMO RADAGO BOO S O,OD 31 De ap ER D40 80, RUDDI:LL NO. 91 1 bENTQNr TX 76201 2/9 6 RA00ALR LIA MARIE 10020063 04/21/113 rangement GUARANTOR INFORMATION on, LORAN RAGSDALB 924, bD 3G „7D -BDe. O!T 74, 27 B1 IP 4 A 04 eo/S3s not k 134 6 RAHIHI,NAD$ 1029 DUNTON DENTON, TX 761101 No response 04 GUARANTOR 1NpORMA7lON **400D204p. oo/lp/43 104. 7D NAOE RAHIMI 0.QO 0100 104,79 op ER RAMBq,KEVIN Q, 110 AVR 0 6l0 STONEHILL APTS, DENTON, TX 762201 170 6 OUARANT 9 INpORNATInN 40020067 04/91/0,3 102. 1t+ 0 No response KEVIN S, RAMn0 ,00 -l0. 00 RAHS9Y,THanggA,q nT 2 LAKE SHORE Nil ~OENTUN, YX E769013 Arr ng°muB not kept k rv no.OUARANTOR INPORMATION **1tl001410 02/09/80 647.69 BOYD RAHSltiY 119-40 -149, 60 617, 66 by IP a ROACH,JW RT 2 BOX 487 nT 2 BOX 487 AUDREY, TX 196 6 v on OVARANTOR INFORMATION **1004149Y 07/96/83 L,040.,69 0, 00 -1,000,49 48, 20 Mc IP 73622703/1"" .1W ROACH 110 responso ROBERIJON,DBBp1E 0, OT 3 DO% 362 OENTON, Tk 76.01 09/19/0g11 OD GUARANTOR INFORMATION **40030926 06/31/83 Arrangmentl not kept3~ 6 012RRY ROhanSON 143.20 T 00 0. 00 143, 99 0 CR ! ROBfiRTB,JSRP C, AT 1 BX 621PD kRUM, 7X 7b014Y No rospense 949 6 41JARANTOR INPORMATION *R406UE0HOY03/19/93 48.00 0.00 0,00 46,00 Bp en 3 ROB&RTS, MDRR16 2219 PT WOOT14 OR N92 pENraN, TX 76901 Arrangements not 1:4Qptg 6 • fl* GUARANTOR. INFORMATION *M0Qpg7g92 d1/16/60 142,00 .00 022111 RODBR7H 142. 00 SP en 2 R4fi$fITB, RYAN W. 34~dulROH LEtltBViLLE, TX 701067 No responso 082 6 OM QURYANR INFORMATION rw70002490* 02/R0d9RT& 097,99 ~ Or 00 -0211.60 lab bD 'Bp OP 4 03/40/[13 008 b ROBORTSON, TER&BA A 016 THOHAb I.CWl8V1LL&. TX 76067 ArrarlgOlAdnts not kept x* 70 GUARANTOR INFORMATION w*UR96A A7ROORRTEON 73.00 0.00 O,Do 26=•D L0Ut4fI Nob DP.NrONQ47XA07b7tl11P N Medicaid denied/Ilo rosponsu6 ROBIN6ON,RO[1&RT DAVID 40630773 6061/63 90.60 0.00 0.00 90, 60 ov In > M QUARANTOR INFOIJMATJCN *w nONEAt t1AVID n0U1NWN HJ4 MAD18ON LEWI6VJLI,t"., Tk 79067 No response r' 'Ji'iJA!~dp','e r1i~17 ~:N 11r~Y~N!Nij111~j1~( r~ 1t F Ql F881984 WR 1 TE~DPF R E P 0 R T PAOt WQ PATIENT NAME PAT ID DISCHQ 9EC-DAL NEW-CNQ NEW-PAY W-0 DAL I'C TYPE CYCLE LOT,PMt AGE VQ TYPE f . I ROCHA,LISA M 40004863 02/19/83 79.79 6,00 0.00 83,95 DP OR 4 170 6 QUARANTOR 1NPORMATION *w EMITARIO RbCHA 611t HEADLCU LN DEN1'0N, IX 76901 No response RDCKWOOD, PETER P 4000-7110 03/03/03 71.60 0.00 VIVO 71,00 eP ER 1 C30 6 QUAAANTOR INFORMATION CHARLES OR ROCKWDOD 610 SERENADE CAN ANTONIO, TX 78816 110 response RamonNTNT J 00006461 01/02/03 57.00 100.00 0.00 10$.00 Op ER 1 107 ARAOR INFORMATION *0 TERRY I RODGER8 194 BLUE OVID DENTON, TX 76201 Arrangements not kept 6 1 RODOLICO,RALPH 00000527 -01/05/83 49,00 0.00 0.00 49,00 or ER 1 *0 GUARANTOR INFORMATION *w RALPH RODbLICO 3922 TITAN TRAIL DENTON, 1'X 76:01 NO response 397 6 RANDERS,BONITA 0, 10031059 06110/83 1,215,05 b4. 10 -972.60 3227,27 SP IF 0 06/127/&3 170 6 GUARANTOR INFORMATION MICHAEL SANDERS AT 1 BOX 773 SANQEA, TX 76266 No response 1 SANDPIRSrELAINE R 700112414 06/27/83 44.75 0.00 0,00 44.79 BP OP 1 06/20/83 Win 6 " GUARANTOR INFORMATION 44 ELAINE R SANDEnO AT 4 324 OAKWOOD CA DENTON, TX 76801 No response s SANDSRS,SSSNBA p, 40039070 06/128/S3 06.90 0.04 0.00 06. 00 DP ER w gin 6 00 GUARANTOR INFORMATION SIEENVA F. SANDBRtl 7065 tlHANAFiAN DR, BEAUMONT, TX 77706 No response h SANDERS,YVETTE 00060410 01/18/03 Ron. 15 0,00 -683,94 148.21 SP IP I 08/10/83 170 6 *0 QUAAANTOR INFORMATION *w FLOYD SANDERS 402 FRONT OT BULPHER SPR1NOb, TX 75442 No response SANFORD,VAN0BOA 10004612 02/11/03 1,0012,95 462, 03 -537,16 634,12 8P IP 4 03/94/00 301 6 40 GUARANTOR INFOAMATION *4 BEULAH DANFORD P D BOX 7551 DENTON, TX 76201 Balance attar Insuranco/No rasponso FIANPORb, WAYNIi 40040743 07/04/83 120.20 0100 0100 120,20 SP ER 2 GUAAAN70R INFORMATION w* WAYNE SANPORD PO BOX 846 HINLEY DRIVE LAKE DALLAS, TX 70060 210 4 SANTI4LAN(ROBA No response 17362 04/1 0.00 070 00 an q QUARANTOR INPORMATION **400ULIO SANTILL/03 AN OR. 00 000 SOUTH-RUDDELL #137 dDENTON, TX 76241 balance after Blue Cross/NO response BAUL0,JDYCB M 40027440 05/0/83 67,00 0,0D 0100 67.00 OP rR A 206 6 r~ 40 GUARANTOR INFORMATION CHRISTINA SAULO AT 1 BOX 489A DENTON, TX 76201 No Nospons0 y 8AVLS,L90IA J 00060892 Ol/12/113 23,00 O,O0 0.00 .3.00 SP 0p 2 380 6 GUARANTOR 1NPOAMATION ROLAND GAULS AT 1 BOX 4UYA DENTON, TX 76201 No responsd OAVAQ0, L6TA KAY 100'26797'-09/76/03 12,420. 80 0. 00 -2, 304, 50 65.70 Sp IP 2 06/27/03 .T19 6 *0 GUARANTOR INFORMATION LETA NAY 8AVA08 PO DOX 1411 DENTON, TX 76201 Balance after Insuranco/NO response i SCHVI,7 40D3JPOI Ob/q1/83 65, 25 0.00 0.00 6D, 80 ADD OR Nil $44 6 GUARANTOR 1NFyOR MATION *4 DIIBRA L OL'HULTZ 1905 8 WALNUT SHERMAN, TX 70090 No rnsponso SMITH, MARY L,. 4002134711 94/24/83 07.1b 394 3D *Ro, 92 430.00 MC ER 00/10/83 1417 6 r"i *w OUARANTOA 1NPORMATION *w MARY L, SMITH P212 FT. WORTH OR DENTON, TX 76201 Balanco After ModlCaro/No response I W, SMITH, RUSSOLL EUQBNB 40040699 07/97/63 6b. DD 0.00 0.00 60,B0 till ER 1 1Y4 6 NN QUAAANTOR INFORMATION *0 JANET IRCNC CDWART Fro POX Dtl177 190 FICRIP'IUnt' APT D OCNTtIN, TX 76POb 1 BHlTlIr0UT11 ANN Nu rosgousd 1004019407/19/03 blt1, IB •-'19.75 0.00 067.40 ADD 1P 4 1 09 6 / Of GUARANTOR INFORMATION RUTH ANN SMITH 9906 DIULLA 06 VeNTON, tX 76201 No rosponsu R d A 61 FEB 1984 w8 I 1 6-0FF N °P0A T PAGR PATIENT NAME PAT ID DIBCMG DCC-VAL NEH-010 NEW-PAY W-0 DAL F{' TYPE CYCLE (.5r, PMT AOL PO TYPE ~ r w, BMITH, SHARON V 10030914 06/14/83 2,960. 10 0, 00 -21677, 10 6D.00 SP IP 2 11 /30/63 63 6 Nw QUARANTOR INFORMATION Nw DAN SMITH 1017 WILLOWOOD DENTON, TX 76201 Balance after insurance/No response 8MITH,81DDLIt,RUSY 10000361 02119103 2,$42. 3b 0. DO -2, 069. OD 47.127 SP IF, 4 0!}/.71/63 746 6 ww OUARANTOR INFORMATION Nw BIDDLE RUBY SMITH 2724 MILL POND DENTON, T% 76201 Balance after insurance/No response SMITH, WILLIAM S 40046393 07/24/03 60.20 0.00 0.00 65. 2b BP ER 1 191 6 NN QUARANTOR INFORMATION Nw WILLIAM C SMITH 0212 PT WORTH DR #74 DeNTON, TX 76PO1 No response SNOLLIN0,ROBSRTA B IODt3126 04/08/83 3,096,09 40,60 -31335:65 300. SO SP IP 2 00/10/63 173 6 ww GUARANTOR INFORMATION wN RUSSELL 84CLLING P 0 BOX 304 DENTON, TX 76201 Balonco after insurance/No respoi)se SOL18, MDNA M. 40076797 00/93/83 60,6o 0100 0.00 60.65 SP eR 4 203 6 Nw GUARANTOR INFORMATION Nw SUSIE SOLIS 120 W WALTERS LEWISVILLE, TX 70067 Arrqugments not kept A, QOTO, OILDHRT F 40044ObV 07/16/83 87.00 0.00 0.00 87, 00 SP en 2 198 6 NN OUARANTOR INFORMATION NN OILDERT F 9OTO BOX 10 PRISCO, TX 70034 No response QPACSK,MICAH 1002b8tl6 05/17/83 016.36 0,00 0.00 315.06 SP IP 3 00116/83 207 6 Nw GUARANTOR INFORMATION Nw MISTY SPACEK AT 3 BOX 93AA2 DENTON, TX 76QOL NO response SPAIN, VIRGINIA 10010471 04/14/83 770.10 878. 15 -1, 366, 120 2e&.03 UP IP 1 04/23165 195 6 r rN QUARANTOR INFORMATION rw ED SPAIN AT 2 BOX 40A DECATUR, TX 76234 Balance attar insurance/No responso SPENCER,DONAL,D VINCENT 4004209707/10/83 122.00 0.00 0100 122.00 ADD ER NS 205 6 ^ ww QUARANTOR INFORMATION wN DONALD VINCONT SPENCER 165 OLD ORCHARD 01021 LEWIBVILLE, TX 70067 respo 3/6 Se 3 BPIVEYs DOROTHY GAIL 10017130 04/09/83 76e. 7b 246. 40 -400.00 410, Ib SP IP 2 tan 1 r' NN OUARANTDR INFORMATION NN DANNY RAY SPIVEY 616 CORONADU DENTON, TX 7.6201 05/13/63 204 6 Balance after fnsuranco/No response SPLAWN,SHERYL LYNN c 10021657 00/21/63 2, 286, 60 508, 60 -2, 201.29 007.91 BP TP 4 07/07/03 163 6 ! Nw OUARANrUR INFORMATION wN CLIFFORD A. SPLAWN AT s D0% 240-H DRIDOEPORT, TX 760Q^6 No response SPDON. RAYMOND D 40O45569'07/2I/tI3 06.00 0.00 0.00 66.00 ADD RA 1 174 6 40 GUARANTOR INFORMATION wN RAYMOND D SPOON 1610 VILLAQE EAST APT N2O1 DCNTON, TX 76201 QTHVENSON, (1TACY LENORA 10049942 11/Q9/83 070.416 225, 60 0.00 796: 05 SP tP 3 10/06%83 onse b1 6 Nw4UARANTOR INFORMATION wN NOLON DAYNE STRVENSON 1428 MICHIAL DENTON, TX 76201 Refused to, pay STEWART, MARSHA F 100130323 01/20/04 934. 00 0.00 0.00 934.00 SP r p it 6 ww OUARANTOR INFORMATION NM MARSIIA F STEWART 20 IIRHITAQB PARR NORTH LITTLE, AN 999999Rofusad to pay nTBWAR7, MARSHA P 40073171 01117/84 812. 7b 0.00 0100 0;2,7t) 8P 631 14 6 Nw GUARANTOR INFORMATION wN MARSHA P STEWART 20 )IERITAGC LITTLE MOCK, AK 77116 Refuted to poy TAPIR, VIVIAN 40030033 05/231/83 136,50 0.00 01 00 136, 50 8P ER 1 246 6 60,0I)ARANTOR INFORMATION MN RAUL TAPIA 203 PINS?` 8T UANOER, tX 76266 No roSpitlso J TATIi, JAMfiB DR IAN 40044653 07110/03 1bU: 7U tl, bq 0, OU 16d, 70 Bf' Elf 4 19~ 6 wN OUARANTbR INFORMATION wN JAWS BRIAN TATt? LAKRVIISW Alnl+Ollt PO IIOX Oif) LANE DALI.AO, T'X 70060 TAYVJR, CHARLGNfI krdnpe,ents not 1003364 06/30/11J 411. DO 96. no 0.00 I45 Oq SP (11, i kept' 40 GUARANTOR INPORMATION wN CHANLLtni'TAYI.011 Ure 731 LUNUUNOLNRY APT 1.112 IIt:~11U3J, TX 76201 Ilalnuca attar InSBri<ncu/I!0 raSpnllaa ~ • ` \f II:eY.V?1. of WYµ:l.•u.,., i.. irv.. i I 01 vrn i9114 41 R I "I C U I' F" R R 11 n It T PA0e 24 a PArIEN'r NAME PAT 11) UIGGHO DEPT-PAL NLW°6110 NEW-PAY W-0 DAL PC TYPE CYCLE LOT. ?MT ACE P0 T'YPff TAYLOR, CW4ISt0PHER J 400331777 06/OU/110 60. 70 0.00 0.00 60, 75 8P EN 2 638 6 w* GUARANTOR tNOORMATION *w DEUURAH A TAYLOR 2132 UW 67TH OKLAHOMA CITY, UK 73159 Balance after insurance/No response TAYLOR,LARRY C. 40025629 05111/03 127,70 0.00 0.00 127.70 eP OR 3 264 6 s* GUARANTOR INFORMATION r* WRY C. TAYLUn 615 MALONE DrNTON, TX 76201 No response TAYLOR,LINDA L 10016939 04/06/1J3 6201 20 267, 10 -BO. U0 837.40 BP IP 2 08/20/93 160 6 4* GUARANTOR INFORMATION wk SCOTT TAYL014 334 IOOP DW40N, TX 76POI Arrangements not kept VC98, JERALD W. 40033623 06/10/83 90,00 0.00 x, 00 10.00 BP en 3 234 6 *w OVARAN7nn INFORMATION ww .JERALO W. VVBS RT I UX 20J PJBREY, TX . 762227 No response VEBT,TAMMIU 40000161 03/02/U3 04,00 8.00 -10,00 0:.00 SP en 3 07/01/83 76 6 ww OUARANTOR INFORMATION KELVIN VBBT 810 EMERY DOWN, TX 76201 Arrangoments not kept i VINCENT,NUBSELL O. 40039628 07/01/83 109.20 0.00 0100 109. W5 SP OR 2 210 6 GUARANTOR INFORMATION *0 RUDSELL CI. VINCENT AT. 2 BOX 1620 OUINLAN, TX 78474 No response VINSON, SHERRY DIANN 70010194 00/10/03 63,25 b0, 50 0. 00 120, 7n SP OP 1 157 6 OUARANTOR INFORMATION ww SHERRY DIANN VINSON PO 11OX 861 LAKE DALLAS, TX 7006b No response j DI A INFORMATION *w0tl071730VW 14/133 5713.00 RT. 02 BOX0071 D 0 0AINLIS 00 SP OF 2 11/22/83 71 6 LLE, TX 76240 Arrangements not kept WADKINOtMEVIN 0, 40047227 07J27/00 07.00 0.00 -40.50 43.00 SP OR 2 01/06/84 26 6 GUARANTOR INFORMATION *w KEVIN O, WADKINS 420 BERNARD 051b DENTON, TX 76201 No response J WALDEN, MARTY L. W. 40017298 04/09/03 190.40 00.90 0.00 113, 09 SP OR 2 244 6 *M GUARANTOR INFORMATION w* WIVARY WALDEN 62d ULAND DPNTCN, TX 76201 Arrangments not kept WALDROP,MICHAEL 4003009D 00/29/03 123,20 0.00 0.00 123,26 SP OR 1 940 ' A ` 40 GUARANTOR INFORMATION ww MICHAEL WALDROP 2405 W PRARRIE 010 DENTON, TX 76201 No response WALKS,MICHARL EDWARD 40042749 07/10/03 06,~P 1OZ 10 0.00 107.05 or, ER 8 l40 6 w+l GUARANTOR INFORMATION *w MICHAEL EDWARD WALKS BOX 474 HIL.4810E BY LITTLE ELM, TX 70068 Arrangements not kept WALKERoELIZABATH (BOTH) 07, R7 00BOX 104 0100 ACORN RANCH O DENTON, Oft 4 TX 76201 No response 252 6 ~ sparl90 WALK9R,MICHAEL L 40026046 00/14/83 115.20 0100 -98,20 23.05 OF OR 8 12/09/0 54 6 *w GUARANTOR INFORMATION w* MICHAL•'L L WALKER BOX 604 DEAOPAV99o TX 79309 No response WALKER,GUOAN`L 40089324 08/20/03 96.76 0.00 0.00 96, 7b SP in 1 200 6 ww OUARANTUR INFORMATION ww SURAN L WALKER RT 6 104 ACORN RANCH DENTON, TX 76901 No response ~ r WALKCR,TERESA R. 10006906 09/21/00 147,60 0.00 0100 IA7.60 SP IP 3 02/01/63 044 A rw GUARANTOR INFORMATION y4 YORUBA N, WALKER 1906 NW 20TH AMARILLO, TX 77107 NO rosponso J WALKBAs TRACpY'A 00072139 07/211/02 17010P 01 60 0100 170, OD to IP 3 0011 6 *w OUARANTOR INFORMATION *w KELVIN WALKCR P U BOX 094 LITTLE ELM, TX 75068 No response i WILL1140HAM,ROURCCA .70012364 06/96/08 613.20 0.00 0100 63.&40 BP DP 1 215 6 ww GUARANTOR, INFORMATION *0 GREGORY WILLINONAM 945 GRANT AVE 016 JUNCTION CITY, KS 66441No responso' j Y e g1r .e ' +.n ,o~.a 'r.,'• "w~yy. r. r...r,.+. ~♦wo ,.`,~w~-rr I4 M. W,Yw bd' •'^AY Y,M-Ye e''M...w .n.Wr.. r.-.r .r ._.r~~E' 71 PE019134 WR I TE~BF P R Ef' OA7 PAQE21 j PATIENT NAME PAT ID DISCIIO DEO-BAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LST,PMT AWE PO TYPE i WILSON, TP.RAI R. 40020714 00/23/03 03.50 0,00 O. 00 03100 OP ER 4 2b2 4 M GUARANTOR INPORMATION YBRRI R, WILSON 131D LOCUOT On DENTON, TX 76201. No response WINCHESTER,SANDAL M. 10030444 07/13/130 640. DO 0100 0.00 640. DO OF IF 4 174 4 GUARANTOR INFORMATION MM SANDAL M. WINCHESTER RT 1 BOX 20 GRAPEVINBr TX 76ODD Arrangements not kaef ~ W3MDH4M, BOBBY W 40040600 07/31/1.13 0.75 0.00 0.00 97, 79 OF ER 2 103 6 OvARANTOR INFORMATION BOBBY J WINDHAM 992 8 CHARLES I#319 LEWIDVILLE, TX 70067 No response ~ WINDOM,08CROR L. 40020702 04/23/03 61. DO 403.25 0.00 464. 75 OF ER 4 206 6 GUARANTOR INFORMATION GEORGE L. WINDOM 114 PARMA CT OANOER, TX 76266 No response ~ WINTER, GARY A 40030371 00/27/03 84. 00 0.00 0.00 04.00 ADD eR 3 243 6 GUARANTOR INPORMATION GARY A WINTER 1809 LATIMORE DPNTON, TX 76201 Arrangements not kept j WIOINAERiDONALD K.40020961 09/24/03 30.26 99.25 -40.00 94,00 Or FR 4. 12/17/83 44 6 GUARANTOR INFORMATION DONALD K. WISINOt!R 1629 CEDAR KEYS LUWISV1LLVi TX 75067 No response W10NIEWHK3,ALLEN P 40024046 60/00/03 196.00 0100 6.00 196.00 -8P ER 2 267 6 ^ OUAAANTOR INFORMATION ALLEN P. WI8NtUWOK1 116 MARSHALL DENTON, TX 76201 No response WOOD,CINDY K 4DO05520 05/11/03 09.60 86.00 0100 11b.'40 ADD ER 3 121 6 GUARANTOR INFORMATION CINDY K WOOD 990 8 CIIARICb 029& L.EWIOVILLE, YX >5067 Moved left no address W WOOD,MARION J 40010072 06/26/03 82.75 0.00 0.00 02,75 SP Eft 1 219 6 ^ GUARANTOR INFORMATION JORKPH WOOD BOX 2030 OENTr1N, TX 76201 Unable to locate ~ WOODS,DEBRA 70912737 06/20/03 25.00 0100 0.00 20.00 0P OP 1 92 4 *r GUARANTOR INFORMATION JUHN WOM3 620 TEXAS DENTON, TX 76201 Balance after fnsuranco/No respe ,0 30,00 i WOODGUARANTOR INFORMATION **70D8DRADJ.7W/13/03 OODS 1.3 20 W620 TEXAS+BDSN70N, TX0 76:01 tlP 4 0Toresponse 41 4 Il E WOODS, DIKOFISHA 40031411 06/02/03 91.28 0100 0.00 91.25 or an 2 243 4 ti ff GUARANTOR INFORMATION SHIRLEY ANN WOODS 607 BOARDWALK OHNTON, TX 76201 No response WOOLAVIM EVA LEE 10003762 02/10/133 714.48 ••544,03 -42.90 127,02 SP Tp 2 OV w/133 292 6 M* GUARANTOR INFOAMATION RVA LOS WOOLAVOR 2109 DEOR09TOWN DENTON, TX 76201 No respons0 WORK13 GLORIA 0 40024560 05/07/83 701 30 20910D 0.00 07,40 ADD E;A 2 No rOSponsn 121 6 GUARANTOR INFORMATION OLORIA 0 WORKO 102 9TH ST BANGER, TX 76266 N*rp UARANTORpINFORMATION 40WILMOUT047193 77,00 10170LAOUNA 01 DENTON,77X0576201 ER 1 No response Ion 6 9.00 .00 1 I W**GGUARANTORDINFORMATION **40JUNRY9DON/WR2GHT 107.00 2PC BOX 11014KRUM TX1976V49,00 ER 1 Oq(Iro ponso 20l 4 ti WA1000AMMY L 40026677 05/15/03 113.OD -.10.00 O, DD 100. U0 0h LA %1 Rufused to pay 204 6 GUAAANTOR.INFORMATION TAMMY L WAIOl1T 3419 HUMMONODIRD DENTONi TX 76VOI YANCGY, CHARLDO 9. 46027906 00/20/03 30100 0100 0.00 000.00 SP EA 4 2150 4 r GUARANTOR INFORMATION CHARLES K. YANCEY AT 1 BOX 7 LAKE DALLAO, IX 70065 Ito rospenso i ~~14Atkn~/afi63Y lY!C'oD P,a. . ..a,o ..m.,,.. r.n, Arn .wyv ' f 1 a.11M V 1 Y , ~ ' ...,,,,w+anyli~lrq{~ridlWrnuu-.u.~euv+.M'rHiaMpw+r.vanww~q*s1KQa.~4H'Mh :w1 (I1 FED 1904 w11 11 E••0FP RIEI'DRT PACE 3b PATICNf NAME HAT [D DIOCHU BE0-UAL NEW-CHC NEW-I'AY 14.0 VAL FC TYPE CYCLE LBT. PMT AGE PQ Type YANAIE, PAMELA MAC IOOPUD97 08/89/03 1, b30, 00 3901 66 -1,416. 00 609. 07 OP IP 2 07/_'6/03 I d'' 6 1 ~w OVARANIOft 1N*OF4MATION „w YANKIC JOCF4'H Rr 1 i7UX FU-F AUOREn TX 76227 rrangcmonts no dept YARD, ROHR MARIE 40040106 07/20/03 04. 10 P01.44 0.06 915, 04 13P ER 1 152 6' ww GUARANTOR INFORMATION ww RANGY JAMCB YARD U11 LEHRNAN DENTON, TX 76201 No responso VAT0B,JUf3'f2N A 40029118 09/24/07 100,70 0.00 0. 00 100.70 SP ER 2 202 6 ww GUARANTOR INFORMATION ww .;UD'rtN A YATER RT 0 BOX 43 TWIN LAKES MHP DENTON, TX 76ROI No response - YOAKUtb KARA 10000837 03/02/87 346.00 .b0, 60 0. 00 606, 00 an IP 3 03402119a ww GUARANTOR INFORMATION KARA YOAKUM SOX 204 AVOREYo TX 76227 Never applied response 4V/Ho YOUNG, ANNVITA 40030176 06/00/UO 60.75 0.00 0. 00 60. 7D 8P ER 1 ww GUARANTOR INPORMATION ANMI:TTA YOUNG 204 a RUDDELL 046 DENTON, TX 76201 NO response SS9 6 YOUNO,ARLBE NORMAN 40040502 07/00/03 92. 3D 0100 -34.80 08,07 MC CIS f27 09 27/83 ww GUARANTOR INFORMATION ww ARLRE NCIiMAN YOUNG 900 LIVE OAK DENTON, TN 76201 Balance alter lnsurancebbl4o rosponso * YOUNG, DEBORAH G 10034939 06/30/03 1, S73. 70 376. SO -1, 600, 44 .602. I I L3P 1P 2 00/OD/83 1 ww GUARANTOR INFORMATION rw BILLY YOUNG 100 WANE OR SANDER, TX 76266 Arrangements not kept b YOUNG, JAM88 EDWARD 40027746 00/27/I13 84, 50 0.00 0.00 89, 60 SP ER 2 ~ ww GUARANTOR INFORMATION ww JAMES EDWARD YOUNG 600 PARK LANE DENTON, TX 7b2U1 No response 246 d YOUNQ, JARRAD J, 4004DB90 07/10/03 06.00 0.00 0100 06.00 8P ER 4 w• GUARANTOR INFORMATION ww LORRBTTA YOUNG 16ID N 000TON PL TULSA, OK 74506 Unable to locate 6 J YOUNG, VERA M, 40OLOGOO 04/61/83 103.75 0.00 -01.00 72.75 MC ER 04/26/90 CCb ~ ■0 QUARAN'JOR INFORMATION ww VERA M. YOUNG 825 DENTON UtINTON, TX 76201 Daience after Med tare/No response A eww» W-U TOTALS wwww 42x977.41 -85,616,32 f L20 300. 73 491 719. 82 4 .J r I • :Mti:tlti~ 4bti1q'4 V41 1 ~i I t lU Ul FE11 19M iJ rl I T K U r P A E P a n r PACE 27 , c rAT19Mf NAME PA7 1D f01UGFl(i DCO-DAL N8W-CI1U NRW-PAY W-a UAL rC TYPE CYCLE LBT.PMT ACB PQ TYPE E c Mw»r WRITE-OPr QAAND TOTALO nxpx 207,100.50 Olf192.le 7% 710.09 21d 001,99 C ~J C iJ C • 4 J C J J J f tr U•M~+M11MYiMH1wNAN. .+bt 5n~.~. . .«:.:ru.r wN.W`YairMRlllt +114CMhH.gKrNYW o>d~k7N7lliYMN1/~iSiriN~i[{'li~`^^q~1.7~ i it eel, April 11, 1984 ~ f'L..... J Mrs, Williams made the motion that "Administration convey to both the City Council and the County Commissioners Court, the 8oard's formal request to those entities for the following; 1. Specific financial assistance to repay $ 673,411 due fiscal intermediaries according to the audited financial report prepared by peat Marwick Mitchell and Company for Fiscal Year 1983, less any alternation to that balance owing at the time that payment is to be made to the intermediary; such assistance shall include some method of assuring the procurement of funds necessary to repay the intermediary and funding assistance in the pay- ment of any obligation incurred by the hospital in t this plan to repay : the intermediary which would otherwise Jeopardize the financial stability t of the hospital, 2. Development of some specific method of providing annually recurring fund- ing to the hospital for its capital requirements which exceed the hospitaiIs ability to generate such from its operations, at least for the next five s years and in accord with its 5-year plan 3, Specifically of the County, that the Commissioners Court determine whether, or not they will accept financial responsibility for patients treated under an order of protective custody, or as a prisoner of the County fail, or for the self-pay portion of Medicaid patient bills, and further, that the County agree to reimburse Flow Memorial Hospital for all bonafide indigent care provided each month to County residents in need and served by the hospital, 4. Committment<to financing of a medical office building needed by-Plow Memorial Hospital to enhance its ability t o offer medical seryyis s those in the 'service area," This motion was seconded and passed unan mously b the 8iembors 7 Y present. i 1. { f _ r, - ,z I 7x6W9k LpN, YIYRY~I , FLOW MEMORIAL HOSPITAL BALANCE SHEETS Dec, 31, 1983 b 1982 1983 1982 1183 1982 Assets Liabilities & Fund Balance Current: Current: Cash and Investments $ 3780825 $ 414,932 Currd"ht Notes Payable ; 193,936 Accounts Payable e + Patient Receivables 9890687 $ 1026 21 $971 (Net of Allowances) Accrued Expenses 412j077 413,600 239719916 3,0951235 Due Government Agencies 113,9$1 _ 12 1 Other Current Assets 1,063,615 747,296 Total Current Assets $ 1,770,361 $ 200130088 Long Term Debt $ 1,385,847 $ 1 03. ,.7 Total Current Assets $ 4,404,35.6 $ 40267,463 Total Liability $ 3,166,208 $ 30053,014 Property Plant and Equipment Fund Balance , Land and Improvements $ ' 1830242 $ 161,469 Pledges and Gifts $ 569 39 64 Building 2,943,464 2,9430464 Fund Balance 940 3,909;494 4 326;442. Equipment C924,634 4 738 141 Revenue a Expense Summary 236j916 136 49) Less Accumulated Qe+reciation P 4'6_) 4) Total Fund Balance $ 4,716,308 $ 4 7 NetPP&9 ~ 3,467j168 3 629 119 1 G Total Unrestricted Funds ; 71871,514 $ 7 78, 6,582 Total Unrestricted Funds $ 7,871,614 $ 70786,682 i T. Ilk h Page-2- PLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT December 31, 1983 CURRENT MONTH YEAR - TO -DATE P R 1 0 R Actual Budget Actual_ Bu_ dget Year* to-Date pate Adult Patient pays 2,409 2,946 7;700 8;740 8,;606 Average Per Day 77.7 96.0 83,8 9510 92,4 Newborn Patient Days 470 403 1;279 1'1198 ' Average Per Day 1612 13.0 1319 13.0 10069 ,5 Gross Patient Revenue/ $ 596,76 Day $ 487.32 $ 640.43 $ 492,61 Patient $ 413,12 Total Expense/Patient $ 468.10 $ 392.79 $426,79 $ 397,06 $ 367,78 ' r Day a J i Month Char{ty Bad Debt Recover ; 0 October $ 293,948 $ 227,,787 $ 2,932 November 74,669 220,916 70287 December 76,133 66,810 3,787 j $ 440,750 $ 614,612 $ 140006 3 ` i % of Revenues 1016% 12.4% .4% 1 3 N Page 3 FLOW MEMORIAL. HOSPITAL INCOME A EXPENSE STATEMENT December 1983 CURRENT PERIOD YEAR TO DATE Budget Actual 101 r_Year 8ud9et Actual Prior Year REVENUES - $ 707,167 $ 602,687 $ 650,740 NURSING $ 291210500 $ 1,836,681 $ 1,724,339 7650928 856,957 6249060 ANCILLARY 21297,784 2,4rI7,874 1 898 742 i 29,042 16,374 130123 OTHER 879125 65,710 44,006 .(293 994 298 559) (2231914) DEDUCTIONS OF REV. (881,981) 859 882 67 023) $ 11208,143 $ 101771459 $ 964,009 TOTAL NET REV, $ 3,6241428 $ 3,450,283 $ 26983,063 A EXPENSES, $ 441,281 $ 411 844, $ 408,583 NURSING $ 1,3239843 $ 11230,961 $ 1,241,926 { 3360474 3640980 307,282 ANCILLIARY 1,0061422 1,031,643 916,243 1930922. 182,779' 180,314.: GENERAL SERVICE 681,766 645,099 634,709 87.646, 90,200 779710 ADMINISTRATIVE 262,638 245,902 209,838 123,876 123,684 109,607 G. $ A, ----371,._,,6,26 33419 302,109 + 1,182,098 $1,163,487 $ 11083,396 TOTAL EXPENSE $ 3.5461296 $ 3,397,743 $ 3 2 4 ,8 4 { 280045 $ 139972 $ (1190387) OPERATING PFT,(LOSS) $ 78,133 $ 62,640 $ (2210761) 62 .,083 59,647 30,041 NON OPERATING REV$ 3 J661250 1731376 86 78 7a 126 $ 73,419 AL 3 6 $ 234t3$3 $ 2351916 $ 126 496 s. El :r FLOW MEMORIALHOSPITA'L - Page4 , SUMMARY'OF CASH RECEIPTS AND DISBURSEMENTS DECEMBER 31, 1983 Current Month Year-To-Date Beginning Balance_ $ 136,913 $1 11,043 Cash Received from. Active Patient Accounts E 1,028,019 2499086 Bad Debt Accounts 31787 14,004 Cafeteria 91960 33,675 Appropriations/Donations 620698 68,942 Other 150-,_312 1 244 7,76 226,480 30338,589 Total Cash - TOTAL CASH AVAILABLE $ 10816689 $ 3,3499632 Cash Disbursements. $ 598,488 $ 105261195 Payroll 720412 2090600 Payroll Taxes 16,462 61,018 Patient Refunds 40055 43406 C4ppital Assets 16,670 590686 i Notes Payable 636,618 1,4120445 Other Total Disbursements 3 2JQ ! Cash Balance 3- Cash Investments 292;71 Total Cash 329 801 S 329,80 i Cash Received as a of Revenue 75.3% 74,9% f R Page 5 ti FLOWMEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE DECEMBER 319 1983 Curren _ 31.60 60-90 Total Trade Vendors $ 320,626 $ 2089565 $ 92,972 $ 622,163 Fees Payable 104o685 63,263 68 678 226,626 Accrued Payables 320681 32,681 Estimated Payables 92,717 929717 Audit Fee I5,400 5 400' f Totals $ 566,108,.. $ 271,828 _ $ 151,650 $ 9$9,597 j i' , Refunds $ 6,749 y , u'.:aw .s .,JlU 1{+n'-lfilw.l4Nili4iYlia4'u,,I~Cl:4YN10+111~XiiF4,41✓Jk44,j 1 a+WiiNeir~iriq~} AchN~ite y,,p¢11 1 It I Page 6 FLOW MEMORIAL H 0 S P I t A L AGED ACCOUNTS RECEIVABLE SUMMARY w. December 311 1983 Primary Payor Current_ 31-60 61.90 91-120 121-150 160+ Total 4of A/EI - Medicare $ 212,625 $ 147,954 $ 64,0813 $ 30,018 $ 20,181 $ 17,462'$ 582023 12.3E Medicaid 61,294 17,133 86631 2,661 2,046 61,196 152,961 3,61 Blue Cross 66,126 18,286 83,412 1.41 f Commercial Insurance 676,758 227,550 76 1,767-- 806,151 18.3% Self Pay 212,114 - 276,571 393,807 307,192 2057 10381,898 2,428s239 64,0% $ 1,188,417 $ 686,494 $ 456,897 $ 341,638 $ 279,284 $ `1,460,55V$ 42413,286 100, OX In-Hoose t 276,122 Total Accounts Receivable 4,680j408 A/R by % 26,9% 15x6% 10,4% 7.7% 6.3% 33,16 - Days of Revenuec Accounts Receivable 52.7 yt' In-House 5.8 Total 98.5 gMviW~SYeR"M.p11dA«in'. s i _ Ll. ...,,..I. «n...l.ruyrMN r~1W.nY1NtPLRYlI41. yy. '.~'WYi14Y~ I I~ WA4ACS SATEY PRECINC* i 486ALKER (847) 388.2240 PRECINCT 3 WON COURT 1$771 484.7410 SANDY JACOBS B, E. SWITZEA PRBCINC7 2 PRECINCT 4 (2$41438.31721 18171 482-303 BUDDY WILE, JUDGE SIXTH FLOOR - JOSSPH A. CARROLL COURTS OUILo IN13 401 Wear HUM . OENTON, TEXAS 16201 18171 387.1212 18171 =a1.3414 METRO 424.1145 May 23, 1984 andeHonorablehCityOCouncilrt, Mayor City of Denton 215 Bast McKinney Street Denton, Texas 78201 1 and j Mr. Jeffrey Hausler, Administrator and Board of Directors Flow Memorial Hospital 1310 Scripture Street Denton, Texas 76201 Ladies and Gentlemen; Enclosed please find a Memorandum prepared for us by an Austin law firm regarding indigent health care and Flow Hospital, s' Please study it and let us know when we might have a meeting of the Council% Board$ and Court to discuss it, { peeasef)youuhavea any ouesmions or comments about this, et s know of th, Yours very truly, BUDDY C'DLEy County Judge _ h; BC;Jg, Enclosures i< )A. V I 1 tyB~I0RANA_I1N i i i k t: :t s; Blakarstaff, HoAth SMIIOY United Hank Towet', Suits 1419 400 West 16th street Austin, Texas 78101 M s_ s1 i i -01 !avlv;.~~ rNpp(J~ V i i i S M8M0RANDUNt TO: Denton County Commissioners Court PROM: Htekeestaff, Heath be Smiley DATE: November 23, 1983 SUBJECT: Indigent Care and Structure of Hospital Queatiana Presented 1. What are the county's obligations In regard to the medical care of noedy residents who are treated at Plow Memorial Hospital? Speelfieally, is the county required to pay the bills of physicians who have treated Indigent patients? 2. If the hospital Is to be restructured, what are the options available? Short Answers 1. The county's obligation for medical care of Indigents is less than Its responsibillty for the care of paupers. i 2. Although the questions have not been specifically addressed by the courts, the weight of authority suggests that the county would be liable for physicians' bills incurred In the treatment of paupers but would not be liable and should not pay the physicians' bills of Indigents. 3. The decision of who Is a pauper is one for the Commissioners Court, A person who Is unable to pay his medical bills may be indigent but would not be a pauper unless he was without means to support himself or herself, 4. The City of Denton is currently authorized to assist In moetIng the cost of the care of indigent or noody patients and agreed In 1975 to provide nn annual contribution to the hospital. c, ,,I 1 n 6. If the structure of the hospital Is to be changed the options Include (a) a county hospital, (b) a county hospital authority, (c) a county hospital district (4) a sale or lease of the facility and (6) a management contract for operation of the hospital by an outside entity. 1. BACKGROUND r Current statue of Flow Memorial Hospital ' t Item 9 of the will of H.S. Flow left the bulk of his estate to a award of trustees ' composed of the Denton County ,judge, the Mayor of Denton and the cashiers of the Denton County National Bank and the First State Bank of Denton. The 'funds were to be used to construct and equip Flow Memorial Hospital, The trustees were given the power to make an arrangement with the city and county and/or any other organization to administer the hospital. The hospital was operated under the provisions of article 449411 V.T.C.S. In 1971, the city, the county and the Board of Directors passed mutual resolutions and executed an agreement reorganizing the hospital under article 44944-10 V.T.C.S. That agreement provided that the hospital's deficit would be borne on a 60.60 basis by the city and county during the first year of the agreement. Thereafter It would be renegotiated. In 1980 the city-county joint funding committee recommended a formula for future allocation of the funding responsibility of the hospital, but It Is our understanding that no specific contract or allocation formula was adopted at that time, In 1976 a reimbursement contract was executed In connection with the issuance of hospital bonds f j k i -2 - a Yi4A f. I,a l~ J H. DBNTON COUNTY'S RNSPONSIMUTY FOR TOR CARE OF HER PATIENTS A. Current Proceed M Impeating Counties' espon _tyfor I gnat Care The obligation of counties for medical care of indigents is the subject of much debate and study. A lawsuit Is currently pending in the United States District Court for the Eastern District of Texas which seeks to declare that all counties have a broad responsibility for the treatment of Indigents. The suit was brought by Bast Texas Legal Services against Smith County. The plaintiffs have attempted to bring all 264 Texas counties In the suit as class defendants. Proceedings In that case have been abated by Judge William Wayne Justice pending the resolution of Stephens v, Bowie County, Stephens was brought by East Texas Legal Services against Bowie County, to the district court the defendant, Bowie County, and the Texas Association of Counties, as amlous curiae, urged that the case be dismissed on abstention grounds, Abstention Is a doctrine which provides that a federal court should abstain from deciding a case when the federal constitutional claim rests upon unsettled Issues of state law which, if resolved, could eliminate the necessity of deciding the federal claims, see e, , Railroad Commission of Texas v, Pullman Co., 312 U,S. 496 (1941). The district court agreed and dismissed the ease on that ground. The case has been appealed and is now pending before the United States Court of Appeals for the Fifth Circuit, It the Fifth Circuit rules in favor of the plaintiff, it Is likely the cuye would be remanded to the district court or appealed to the United States Supreme Court, If the Fifth Circuit rules in favor of the county, the plaintiff could either abandon the , f federal court challenge or sock review by the Supreme Court, No matter what decision is made by the rli'th Circuit, It Is unlikely that there will be a flnal, substantive judlelal , l -3- i I decision on Texas counties' obligations to indigents needing medical care any time In the near future, Dallas County Hospital District v. Grayson,. County, No, 931483 (69th Dist, Court, Grayson County) also raises questions regarding medical care for needy citizens, The Dallas County Hospital District rendered care at parkland Memorial Hospital to residents r/~\ of Grayson County who were unable to pay their bills. The district brought suit against Grayson County under section 5 of article 4494n which provides In part; If care or treatment is given to a resident of a county outside the Hospital District which has not contracted with the Board of Managers for such services, and said non-resident is wholly without financial means except such as are derived fro'm.oharity, that County shall, upon presentation of a certified statement that care or treatment Was necessary for the preservation' of human life and was actually performed, be obligated to reimburse the Hospital, District in an amount not to exceed the aotual cost of the service rendered, The ease was recently tried before a jury and Involved charges lnourred` on behalf of three Wayson County resistants, The jury was unable to reach a verdict on one claim and ruled in favor of Grayson County on the other two. The judge granted a new trial In the case where the jury could not reach a verdict, granted judgment for the county on one of the claims and granted judgment against the county notwithstanding the jury's verdict on the other claim. It is not clear at this time whether either party will appeal. A major issue Involved whether the statutory standard of being "wholly without financial moans except such as are derived from charity" refers to the ability, to support one's self or to the ability to pay one's medical bills, The district court's charge was subject to the Interpretation that the statute referred to the means to pay medical bills. Obviously this is a standard which would bring a substantially larger group under the ambit of this statute, Many people may have means to support themselves but do not have the moans to pay a large medical bill. The distinction between the two groups Is essentially the same as that, discussed holow, botwoon Indigents and paupers, 1 «4 I I, i a The Governor recently appointed a Task Force on Indigent Health Care. The panel includes a broad cross-section of citizens, Steve Biokerstaff of this firm Is a +nember as are County Judges Bacus (Wichita), Brown (Andrews), and Cranek (Colorado) and county commissioners Griffin (Tarrant), Haynes (El Paso), Wilder (Brooks), Salinas (Hidalgo) and Tyson (Dallas), The committee includes representatives of hospitals, physicians, governmental bodies and citizen groups, It will report to the next Legislature and presumably will recommend legislation which could impact on the counties' responsibility for medical care of indigents. Thus, a major factor In any analysis or planning activity regarding a county's Indigent care responsibility must be the realization that further judicial or legislative definition is likely. While changes cannot be expected immediately, there Is a very good possibility that the duties of counties will be changed or clarified within the next two years, IL Current Texas Law on a County's t:es m ibillty_for Indigent Care 1. Differing Levels of itesponsibiflty for Indigents srtd Paupers j The Texas statutes which relate to a county's obligation to medical care of Indigents and paupers are section it of article 2381 and article 4438. Section 11, article 2361, Vernon's Texas Civil Statutes provides as follows; "Each commissioners court shall; 01I,Provide for the support of paupers and such idiots and lunatics as cannot be admitted into the lunatic asylum, residents of their county, who are unable to support themselves. Article 4438, VernoWs Texas Civit Statutes provides the following, s "If there Is a regular established public hospital in the county, f the Commissioners Court shall provide for sending the indigent 3 9 i I, sick of the county to such hospital, if more than one such hospital exists In the county, the Indigent patient shall have the right to select which one of them he shall be sent to," The statutes do not specifically state that a county Is liable for the payment of medical bills. An historical review of the origin of articles 4438 and 2381 and of the authority of the county commissioners is helpful and necessary In determining the nature of the counties' duty. Articles 4438 and 2351, V.T,C.S„ were originally passed as part of the same enactment (Chapter 84, General Law of Texas, 18th Legislature, 1878, page 61). The portion codified as article 2361(11), relating to the support of paupers, appears as subsection 9 of section 4 of the 1878 Act, and that portion codified as article 44380 relating to sending Indigent sick to a public hospital In the county, was section 21 of the same Act. From the use of both the terms Indigent and pauper in the same Act and in connection with different powers and duties of the county to each, It appears that the Legislature intended for a distinction to exist between the two terms. This distinction is the basis for much of the difficulty In resolving the legal Issues associated with medical care for needy citizens, The difference between lhdigents and paupers may have been evident to most oltizens when the current statutory scheme was enacted more than a century ago. The distinction is not so apparent In. today's vastly different society, The Legislature in 1878 established the authority of a county In regard to paupers and Indigents but did not set forth any criteria for defining either class, In the -mine Act the Legislature authorized the county to settle all accounts against the county. Acts 1878, 15th Legls„ ch. 34, p, 51, 08. V,T.C,S., art. 2351 (10), The effect of this statute is to provide a procedure by whloh the commissioners court can decide whether a person qualifier, for assistance and the nature of that assistance, i Only two Texas cases have Interpreted articles 2351 and 4438. In Monghon & Sisson v. Van Zandt Count v, 3 White § W. 198 (Tex. Civ. App. 1888), the Court held that nsupport" as used In section 11 of article 2361, V.T.C.S. means supplying proper care, attention and treatment during sickness, The court further determined that where adequate provision had not been made by the commissioners court to furnish that necessity, the county could by contract bind the county in any reasonable sum necessary for the support of a pauper, Without a previous contract, If a physician gives his professional care and attention to a__. pauper, an Implied contract to pay for such services exists on the part of the county, It is important to note that the eommissloners court In Monghon do Sisson, supra, had entered an order which found that the resident who received medical care was In fact a pauper, In Will" aey County v. Valley Baptist Hospital, 29 S.W.2d 466 (rex, Civ, App,-.San Antonio 1930) no writ), the court found that despite specific authorization by the county judge and a promise by him that the county would pay the expenses of medical treatment outside the county for a resident of the county who subsequently died, the county was without authority to pay those expenses. The court found that 'the deceased was not a pauper within the meaning of article 2361. Further, even It he was within the olass defined as "indigent sick", article 4438 only authorized the commissioners court to send the deceased to a public hospital within the county, The court in Willae Countv, sutra, noted that the commissioners court had taken no action to declare the deceased a pauper and no such matter had ever been presented to them, In concluding that the deceased was not a pauper based on the facts In that ease, the court noted that he was a farm hand, worked for wages, was always able to and did support himself and his family, had no property, and had been from time to time i In debt to his employer. The court further noted that "So far as the record shows, he was no worse off, financially, than is usual among those of his class," fie had never sought nor received charity from any source and the question of his classification as a pauper had never been raised or considered by the county or any public authority, The more fact that he died without leaving an estate sufficient to pay his medical bills did not render the county, as a matter of course, liable for them, Finally, the court concluded, "Under the provisions of article 4438, V.T.C.S., the County was under no duty to send Sarbosa (deceased) to any hospital, there being no public hospital in the county." Other than the two eases cited above, all amplification regarding the distinction between the two categories and the differing levels of responsibility has come from attorney general opinions, In 1979 the Attorney General issued Attorney General Opinion MW-33 (1979). Ironically, that opinion was specifically addressed to Denton County. The opinion concluded that, absent valid contractual arrangements, the county was liable for the medical expenses Incurred in treatment of the county's resident indigents at the city. county hospital, The opinion did not discuss whet was Included in medical expenses, The issue of potentially differing levels of responsibility for indigents and paupers was neither raised by the county's question nor specifically addressed by the opinion. The discussion In the opinion, however, utilizes the two terms Interchangably, This intarohangable use of the two terms was the most far reaching effect of the opinion i' and has been cited In much of the litigation regarding the eountle-' duties with respect' to the needy sick. It Is the opinion of this firm that the Interchangable use of the i tt•M terh was Incorrect. We feel confident that the Attorney General never specifically consioar%,d the Issue of whether the terms Indigent and a pauper had Idontleal monnings with respect to the county's obligation for masdical care. Any attempt to road the .8. i E opinion's casual use of these two terms as a holding that a county has Identical obligations to indigents and paupers produces an overbroad Interpretation of the Attorney Ih Oeneral's ruling, There Is a fairly long line of Attorney General opinions which have recognized a distinction between the terms Indigent and pauper. Sea e.g. Attorney General Opinion Nos, M-171 (1987), C-334 (1964), 5-126 (1964), A-1638 (1949), 0-2633A (1941), 0-2633 (1940). The distinction is of extreme importance since the statutory obligation of the county Is different In regard to the two classes, These opinions rely on articles 2351(11) and 4438 along with the language of the court In Wlllaoy County as establishing that a county Is obligated to provide medical care to paupers but is required only to send indigents to a public hospital In the county If the county has such a facility. An obvious instance In which this difference In responsibility Is important is the one posed in _Wlltacy Count, The individual In question was not a pauper, Thus, the county's responsibility did not extend beyond sending him to a public hospital within the county, Since there was no such hospital, the county had no duty to send him to a hospital outside the county. The more Important distinction, particularly for counties such as Denton which have a public hospital, involves the extent of the county's obligation to pay for an Indigent's medical care. Article 4438, which relates to indigents, providos only that the county Is required to provldo for sending them to a regularly e.stabllshea hospital In the county, It does not specifically Impose an obligation to provide medical ogre outside the hospital or to pay for any medical Care. Obviously, if a county maintains a county or a clty-county hospital It Is Indirectly paying for an Indigent's hospitalization, The statute does riot, however, requh,e any direct payment to the hospital, Neither -9- K, l does the statute specifically provide for payment of the physician bills incurred by or on behalf of an indigent, 2. Obligation for Payment of an Indigent's Phyeieian Bills The question regarding county payment of physician bills of Indigents who are treated In a public hospital has been addressed on at least three occasions in regard to county hospitals organized under article 4478, at seg. As recently as 1981 the Attorney General stated that a county could not pay the bills of physicians who treated Indlgents while on the staff of the county hospital, Attorney General Opinion MW-393 (1981). It. answering a similar question 40 years earlier the Attorney General said: It is our opinion that the statutes contemplate that all paupers and indigents who are suffeelpgg from any illness, disease or injury and In need of hospltafizatlon should, Insofar as practleable, be sent to the county hospitals. As pointed out in Opinion Nor 0-2422 the county would not be liable for the claims of the hospital physicians for taking care of such patients. The commissioners court is authorized to appropriate money for the maintenance of the County Hospital as pointed out In Opinion No. 02422, Article 4438, supra, authorizes the commissioners court to send 'indigent sick' who may or may riot be 'paupers' to the county hospital, sl * LJ You are respectfully advised that It is the opinion of this department that under the facts stated the commissioners court should not nay the visiting physicians for services rendered for paupers and Indigents at the County Hospital. Attorney General Opinion 0-2633A (1941). See also Attorney General Opinion 0-2422 (1940). These opinions were decided In regard to county hospitals established under article 4478 rather than elty-county hospitals such as Flow Memorial, which opened under article 44941-1. The opinions relied in part on the specific language of article 4478. Although U e opinions are not procisely on point, they, along with the limited nature of .to- K YJI~JSMi!1f r'e/ARYI~ Ir[[R'}( ,I the obligation Imposed by article 4438 for counties which maintain public constitute reasonable authority that the eounty is not required to paytheh bills of Physicians who treat indigonts, l While a county is required to send indigents to any public hospital in the county, the obligation with regard to paupers Is grester. The Attorney General has stated that a county Could specifically y Pay for a pauper's medical aid and medicines outside of a county hospital even though It could not do so for an Indigent. Attorney general Opinion 0-2833A (1941). Although the opinion does not Specifically define medical aid, f it is our Interpretation that the term would include the physician's bill In the ease of a pauper.2 See Mon hg,on do Sisson Y. Van Zandd~ ~ount~ 3 White $ W 198 Tex, Civ. APP. 1-- 8- 8-----6)I ~f•, Willacy_Court V. Valley Baptist Hospital, 28 S.W,2d 488 ilex. App.-San Antonio 1930, no writ). Clv. Likewise, a county has been said to be authorized to contract with out-of-oounty hospitals fur the care of paupers but not of indigents, Attorney General Opinion 11-1838 (1949), While the issue has not been oleuvly and finally decided by the courts, under the authorities acted above, we believe that when and If the Issue is directly presented, the courts would find the county to be liable for lfn this memorandum we have not speclfleally addressed the situation of medical prisoners bills of county prisoners since the medical care of Issues, $ee Attorney 0enoral Opinion 11-703 (1978), opens a separate set of 21n that opinion, the Attorney flanoral hold that the county was not required t Pay the Physician's bill for services rendered to a pauper in an article 4478 dMinty hospital. The holding was based on the specific language of article 4480 which provided that physicians on the staff of an article 4478 hospital are to serve without pay from the county, A Similar limitation Is not presont in under which low ate l~l article Me 44941- mor 1` the opinions decided undera artflospit o. iclesa4478eand 44490 Lire helpfult nda owhich is the statute mowihathanalogous we believe It would be Incorrect to rely on them as ostabllshin that the county has absolutely no obligation for tho physicians, bills of paupers admit ed to public hospitals which are not organized under article 4478. .1(_ y FNPt 4! t the necessary doctor bills of paupers even though it would not be liable for the physician bills of indigents. 3. Deteruination of Who Is a Pauper and Who Is an indigent The definition of the terms pauper and indigent and the method for determining who falls in which class was discussed by the Attorney General in Attorney General Opinion No. 0-2833 (1940). He said: "ln a general sense a person may be said to be a 'pauper' who I$ very poor, but the term Is usually understood in our state to mean a person so indigent as to be dependent on the public for support, The term certainly cannot be applied to a person who has always been able to support himself and those dependent upon him..." (Quoting from 32 Tex. Jur, 811-812,1 The term "Indigent" has been defined by the courts on many occasions. We quote the following definitions: "A, person is indigent who Is destitute of property or means of comfortable subsistence; one who Is needy or poor," J neau County v. Wood County, 85 N. W. 387, 388, 109 Wis. 330, "Word 'indigent' when used In connection with admisslons to county hospitals, Includes inhabitant of county who possesses required qualifications of residence, and has Insufficient means to pay for his maintenance in private hospltal after providing for those who legally claim his support," Goodall v. 86 to, 34 Pno, 2nd 310, 316, 11 3'96, M.. Cal, App, "To be Indigent does not mean that a person must be a pauper, cad, within the meaning of the statute relating to the commitmont of the insane to the Clovernmont Hospital for the Insane, an Insane parson with Insufficient ,astate to pay for his maintenance In the hospital after providing for those who could claim his support Is indigent," 2p2 no v. District of Columbia, 45 App. D.C. 64, 69. fhus;,it may be seen that all paupers are indigent persons, As to whether or not an Indigent person Is a pauper will be determined by the degree of his Indigeney. This is a question of fact for the com misioners court to determine In their sound discretion. If (lie { W i commissioners court determines that an Indigent person Is a pauper the court would be authorized to aid him as such under Article 2361, Sub. 11, supra. We have boon unable to find any statute requiring any particular mode of procedure whereby the commissioners court determines the question of pauperism nor any statute requiring the making up of a roll of adjudicated paupers of the county"' As discussed above, the statutory scheme appears to contemplate that the determination of who is a pauper be made by the commissioners court under the claims procedure established In article 2361 (10). Individual determinations would be subject to appeal to the district court. Tex. Const., art. V, 08, V.T.C.S., art. 1908. Mere Inability to pay one's medical bills would not be sufficient to cause the person to be classified as a pauper. 4. AuthoMty of the qty to Pay for Indigent Cerra Since Flow Memorial Hospital is organized under article 44941-1, V.T.C.S., the specifies of that statute have a bearing on the responsibility tot Indigent care. While article 2361 and 4438 apply solely to counties, article 44941-1 discusses the authority of the city to contribute to the cost of Indigent care. Section 6 of article 44941-1 provides in part; Said county and said city, respectively, further shall be authorized to 'enter into contracts with said Hospital Board for the care and treatment of Indigent or needy patients, or for any other hospital services, and each shall be authorized to expand money and make payments fo said Hospital Board pursuant to such contracts, and to levy ad valorem taxes, and to plodgo any, of their funds or resources, for the payments to be made under sold contracts. This is direct statutory authority for the City of Union to contract with the Hospital for the care of Indigent or needy patients. In July of 1971 the city and county executed a contract to become effective on October 10 1971, For the year October 1, 1971, through September 30, 1972, the city and county agreed to transfer the funds necessary to balance the hospital's budget. -13- ..o Owl r. The necessary amount was to be provided equally by the city and county. After t first year the Amount to be transferred was to be renegotiated, he , When hospital bonds were Issued in 1975 the city and county adopted resolutions agreeing to provide a specified Amount to the hospital board. The agreements w executed at the request ere of a purchaser of the bonds and were to be effective during 1 the time the 1975-A bonds were Outstanding. The 1975-A bonds were sold to the First Denton County National Sank and the First State Bank of Denton, These last bonds that series mature on July 1, in this 1994, although they may be redeemed in 1986.3 Under agreement the county and city are each obligated to pay annually an amount equal to the principal and Interest of the bonds,4 Neither the Intent nor the enforclbijit the agreement Is entirely clear, y of One possible interpretation is that the traasfer must be made each year, while another interpretation is that a transfer must be made only when there Is a deficit, The beneficiary of the agreement Aurpose of is the bondholder and the the agreement was to provide security to the bondholders, but both the statute and bond resolution provide that the bondholders have no right to payment ou of funds raised by taxation, While there are questions about the extent and offs t of tho agreement, there is an agreement by both the city and the county to contribute a measurable annual amount to the hospital, 3The other series of bonds mature In 2000 and may be called in amount of the 1987, two Issues was $6701000, The interest rates vary aceording to the series and the maturity of the bonds, but they range from 11.08% to 7,25 The tote! 4There is an alternative amount which is the ruin that would be generdlod by tax of 101 per $100 valuation on the county tax sold. a Is k(jyed to the tosser of the two alternatl ves, 1,1 t it a Since ed the that' the transfer r req requi rement Interest requirement will be the 31 operative one, pal t11)d -14` i 0 6. Conclusions Regarding a County's Responsibility for for Medical Care of Indigents From the foregoing It can be concluded that, (1) The obligation of counties to provide medical care for needy residents is in a state of flux. There are court oases currently pending which could have ( far-reaching effects on all Texas counties, Additionally, the Legislature considered legislation In its 1983 session to define that obligation, it is t likely to consider additional legislation to 1885, whatever the responsibility of counties is today, it is likely to be changed by the courts or the Legislature within the next two years, (2) The county's obligation to needy residents is Imposed by a statute passed In 1876. 'rho only cases construing it were decided by the Court of Civil Appeals in 1886 and 1930, There are several Attorney General opinions on the question, They are not entirely consistent, but those which have considered the underlying gnestlons and specifically addressed them generally hold the same thing as reflected in point 3 below, (3) Although the Authority Is somewhat sparse and Is far from recent, the current law appears to be, (a) There is a distinction between paupers and Indigents. All paupers are Indigents, but not all Indlgents are paupers. Basically a pauper is dependant on the public for his support, If a person Is without means of comfortable subsistence but has been able to support himself, he might be indigent but he would not be a pauper, Likewise, a person who has been able to support himself but who Is unable to pay his medical bills would not be a pauper. -15- ViWH14ai.:9iaah I (b) The determination of who is a pauper and who is an Indigent would be left to the sound discretion of the commissioners courts (c) The county has an obligation to provide medical care for paupers. Although the eases do not specifically address the question, the obligation appears to extend to the payment of medical bills. (d) 'The county's obligation to indigents is to see that they are sent to a public hospital in the county. That obligation doss not extend to paying physician bills incurred by Indlgents, (o) The City of Denton, as well as the county, is authorized to contract with the Flow Memorial Hospital Board for the care and treatment of Indigent or needy persons and to spend funds pursuant to such a contract. IU 4aPCION$ FOR DIFFBtt~NT OWIAN1ZATtON OF ROMMTAL It the county desires to pursue a different form of organization of the hospital, there are four major options. Additionally there Is a possible option In which the administration of the hospital could be reorganized under the joint control of the city and county, see e,g., V.7.C.9., art. 44941, but since such a procedure would essentially maintain the current system of joint city and county participation, it Is not discussed, The four options which would provide a change are set out below, (A) County Hospital Authority Article 4494r, V,T,C.$., authorizes the creation of a county hospital authority. , ueh an authority has no taxing power, The only bonds It Can Issue are revenue bonds , sApparently Denton County has a process for doing this since a description of services provided by the Dontan Clty•County Modica[ 84rviees Coordinator refers to the Denton County Pauper Roll and Indicates that the classification is subject to approval by tho commissiones court -lA•• fOlN ,l 1 Q: f payable from the revenues of the hospital's operation, The initial board Is appointed by the commissioners court, once bonds are issued, however, the bond resolution may provide a different means for appointing a majority of the board. Thus, once bonds are issued, it Is possible and likely that the commissioners court would lose control of the appointment of the board. (s) County lllospitat Article 4418, et seq., V,T,C.S., authorizes the creation of a county hospital. Although the limits of the county's taxing authority are not increased when a county hospital is established county tax funds may be used for the operation of the hospital. 'Cho initial hospital board and the succeeding members are appointed by the commissioners court so the court has some measure of continuing control. The county may establish a county hospital without an Alaction, Attorney General Opinions H-777 (1976), 0-4889 (1942), but an election will be necessary if tax supported bonds are to be issued. While the county Is authorized to Issue tax bonds, It may also Issue revenue bonds. V.'f.C S„ art. 4494r-3, in such instances an authorizing election would not be required. (C) County Hospital District Article IX, section 9 of the Texas Constitution authorizes the creation of hospital districts, In order to create such a district a special legislative act would be required. A bill authorizing the creation of the Denton County Hospital District was enacted in 1989, Acts 1989, 81st Logis., ch. 230, p. 677, It provided, however, that "if this district is not confirmed within 60 months from the effective date (May 18, 1989) of this Act, this Act is hereby repoaled.11 Since the district was apparently not created during the five-year period, the legislation was repealed on May 160 1994, Hospital districts may be authorized to levy a tnx of up to $46 per $100 valuation. An election would be required before levying such a tax. -17- i i f' f The creation of a hospital district provides an Independent tax base for the district, It adds another tax to those residents of the county must pay, but it also provides that the county and municipalities located In the district lose their power to use tax funds for hospital purposes, The district assumes full responsibility for providing hospital and medical care to the needy inhabitants of the district, except that the county and cities may still support mental health and mental retardation services and public health clinics and services, Tex, I Const,, art, 1X, $§9, 13, While the district would have authority to issue tax-supported bonds, It could also issue revenue bonds. V,T,CfS., art, 4490-1, An election would not be required for the issuance of revenue bonds, but the district would be authorized to conduct a non binding advisory election before Issuing revonue bonds if It chose to do so. V,T,C,3., art, 4494r-2,1, dale or lease of hospital Sale or lease of public hospitals is an option which has been chosen by some political subdivisions, The sale or lease may result In a substantial payment to the county which In some counties, such as Collin County, has been dedicated In trust to the provision of indigent care. Another aspect of this course of action Is that it removes the county from the hospital business, While that removal Is often beneficial to the county, it has the effect of placing the decisions regarding the health care services to be offered and the prices to be charged in private rathor than public hands, Under this option questions obviously arise as to whether a sale or lease is consistent with the i )tent of the H. li, Plow testamentary trust. The question Is partlculariy serious in regard to the sale option. -18• I 1 l ti IrHvUI'd'P Y i . I rl Y~ Management Contract Another option Involves the use of a management contract. The hospital would remain under public ownership, but the board would contract with a management company to operate the hospital. The details of such an agreement would depend on the nature of the agreement that could be negotiated, but It Is likely that day-to-day administration of the facility would be given to a private entity in return for some payment, it is likely that such an arrangement would be for a shorter period than a lease. tai &M1Wy of Options 1. Advantages and Disadvantages of Each Option The use of any of the five options outlined above pre-supposes that the current hospital board agrees to the transfer or contract and further pre-supposes In the case of a transfer of ownership, that a successful arrangement can be made regarding the outstanding 1978 and 1978rA series bonds. Given the small size of the issue and the relatively low interest rate, It probably would make little economic sense to refund them unless anew construction project supported by a new issue of bonds is contemplated. We have not explored In detail the actions necessary to transfer the obligations of the outstanding bonds to a new entity, It should be possible to make such a transfer, but there is no necessity at this time to Analyze all the options relating to all potential courses of conduct, Such analysis can be pursued if and when It Is decided that a particular type of restructuring is desirable. Of the five options, the only one affording the county a signlflcant amount of control over the hospital and flexibilllty In Its funding Is the article 4478 county hospital option, The commissioners court will have contlnuing authority to appoint the board, and the hospital can be supported by general obligation or revenue bonds. The hospital authority option is likely to result in n loss of comity control and the hospital Is limited to revenue bonds to meet its future rtcods, ag. fi Y: The hospital district option would depend In large part on the contents of the bill enacted by the legislature to authorize the district, Typically, it would have the flexibility of Issuing revenue or tax bonds. This option would relieve the county of the responsibility of overseeing the hospital, but would keep the facility under public administration, It would relieve the county of Its Indigent care responsibilities, The District would constitute a separate taxing entity with a significant ($46 per $100) taxing authority. While this new taxing authority would relieve current burdens 'hich fall on the county and would provide a significant source of revenue for the hospital, it could result In a major addition to the tax burden of the citizens of the county. The lease/sell option would remove the administration of the hospital from persons who are responsible to the voters and taxpayers. It could result In a major source of revenue to the county, but the question of responsibility for the Indigent care would remain. If a decision is made that this option is consistent with the Flow trust and is desirable, professional valuation of the hospital should be obtained and a public hearing and bidding process should be followed, The management contract option would probably result in a removal of most day- to-day administration decisions from the public board to a private company, It Is likely, however, that a contract would be for a shorter basis than a lease, g. Impact of Options on County's Indigent Cage RespoasiWiities Whatever the extent of the county's Indigent care responsibility is, it will be met In one of two ways. Either the county will make a payment to the hospital of funds raised by taxatlon to pay for the cure of needy residents or the cost will be absorbed in the operation of the hospital, In the latter Instance, the cost of indigent care will indirectly be borne by paying patients of the hospitals. Under a hospital district, the county is relieved of its responsibility for indigent care The cost of indlgent care will -20- qqP1 t~ r be borne by the district's taxpayers or by the hospital's paying pctients, If the hospital is sold or leased, it Is likely that a claim would be made by the private operator to the county for the cost of care of paupers and perhaps of other needy citizens. Any payments would be made from county tax revenues, It Is possible, however, that the terms of the sale or lease could Include some contractual obligation on the part of the private operator to provide a specified amount of charity care, It Is also possible to use the proceeds from the sale or lease to establish a ,rust fund for payment of indigent care costs. In the absence of one or both of these alternatives, payment would likely be made from tax revenues. Under a management contract, the ability and the Incentitive for the operator to look to the county for the cost of indigent care would depend on the provisions of the contract, Aj,, whether reimbursement to the operator Is a fixed fee or is based on revenues. The issue would be a subject for the Initial contract negotiations. The operatlon of a county hospital would result In essentially the same situation that exists now in regard to the county's payment for indigent care, if the hospital operated with an excess of revenues over expenses, the cost of indigent care would be indirectly borne by the paying patient. if the hospital ha da ideficit, the county would be paying for the cost of caring for the needy by subsidizing the facility with tax funds. A hospital authority Is likely to bill a county for the cost of Indigent care whether It operates at a deficit or a surplus, aln,,+e, at feast In regard to non-paupers, the county's responsibility Is satisfied by sending the needy sick to a publle hospital, there Is a reasonable argument that no further payment is required, The authority would have no taxing power and theoretically It would be necessary to operate the hospital In such a way that the paying patlents provide sufficient revenue to meet the -~1- l 5 r expenses they generate as well as the expenses generated by lndlgents and persons with bad debts. I i i 1 , ; { ;f i 4 i f { N r I,MgU{9 tt~ Brackenridge Hospital City of Austin JUN 1 3 June 7, 1984 Mr, Chris Hartung City of Denton 215 5ast McKinny Denton, Texas 76201 Dear Mr, Hartung; Attached you will find a coppy of the agreement we currently have with Travis County. Should you have any questions please do not hesitate to contact either James Kirschner or myself at 476-6461, extension 1636, Sincerely, F Richard S. Schirmer Hospital Fiscal Data Analyst Y RSS;pam r Attachment Jjp~> 1 d 601 east 15th Street, Austlh, Texas 78701.1996 (W)476,6461 5 I k '1311; STAN nr '11MA5 INOW ALL MEN BY 111ESIi' PUS1?I1CS : COW1'1' 01, Tl'.'kVIS 1 r CITY-COUNTY IiCAL111 AGRMOTP This contract and agreement, made and entered into on this the clay of 19_1 V, by and botwoen the City of Austin, a home rule municipal corporation of Travis County, Texas, by and i through its duly authorized officials, hereinafter referred to as "City," i and the County of Travis, by and through its duly authorized officials here- inafter referred to as "County," is hereby agreed to as follows; I. The City agrees to furnish quality hospitalization, hospital r. ! services, and physician services to all indigent persons who are residents of Travis County, Texas, outside of the officially designated city limits of Austin. It is understood and agreed that, such sprvlces sliall be provided at Brackonridge Hospital and that the County Coironissioners shall be consulted by the City in advance and in writing prior to cluuiging the locution of whore such services are to be provided but that the decision as 'to any change I.n location shall be made solely by the City. II. The County agrees to reimburse to the City those billable charges incurrod for furnishing hospitalisation, hospital services and physician services for those indigent persons who are residents of Travis County and , who rosido outside of the officially dosignated city limits of Austin. III. i It is understood and agreed by both parties that each will use the sav,to standard of indigency and residency. For purposes of this agreement, a R Z.2'q.) . person is eligible for indigent care Lf his or 1101. fin:urcial situation falls ieithin the 1973 Office of Economic Opportunity (OL'O) Poverty Guidolines. The j st;uidard for indigency may be changed at any time by the mutual agreement of j the City and Count), as evidenced by a writton addendum attached hereto. For purposes of this agreement, a person is deemed to be a resident of the required locale if he or she lives in the locale with no intention of j, presently moving out of the locale. A person shall not be considered to have gained a residence in any place to which he or she has come for temporary (l purposes only, without the intention of making such place his or her home. IV. The County will provide the personnel and miatorials necessary to lit I ff implement a procedure for the evaluation and subsequent admission of indigent l 1 patients who reside in Travis County but beyond the corporate limits of the I fr i~ City of 'Austin, 71te City will provide space at Brackenridge Hospital, or such F other building which may be used in the future for indigent care, for County Porsoiinel to perform their evaluation task. Before any person can be classi- fied as an indigent hereunder, ho or she shall sign and swear to an adiaavit to the effect that he or she meets the criteria of being indigent as described ' t to them by admission personnel and that he or sho is a resident of the County of Travis, residing outside the corporate limits of the City of Austin, County personnel must certify that a person living outside the officiall. designated city limits of Austitu does meet the indigent status, and City f agrees to withhold hos;iitalization, hospital services, and physician services on an bidigont basis for which the County would be responsible until such person has been certified by County personnel. No person, howovor, will be denied emorgonc;, care by the hospital for the reason that his or her financial stattis cannot be readily dommined. / V. Ilie City will submit its requost for reimbursoment to the County { monthly, along with a report to the County Auditor providing an itemized restore of the name mid clinic card ntnnber of thelpationt served, tho nature f of the care provided, and the individual charges covered in each bill. 7lie Comity will remit payment to Hospital within thirty (30) days of receiving billings from Hospital. The City will provide separate bills for its hospital services and the physician services provided by the emergency physician group y` and the Central Texas Medical roundation physician Services program. 7ho t~• , hospital and the two physician groups involved will submit charges to Medicare, Medic, aid, and other third party payers before billing the County, The Coianissioners Court of Travis County and the Cowity Auditor must approve the i form of the billing procedure and monthlyre).ort and the sufficiency of the i information therein, If County givos notice tt. City thrz such monthly reports ii lack sufficient information, City shall provide such other information in its possession concerning indigent services and charges for those indigent persons j within Travis Cowity, Ilia City agrees that the rates charged for indigents I residing outside the officially dosignated citylitmts of Austin will not be i higher than thoso charged for persons residing within the above described city limits for the scone services. The County shall be responsible only for those charges for emorgency physician services, wider contract with tho City, house staff coverage, and hospital services which are reasonably 'till required and necessary for the health taro of the indigent patient. VI. This agreement shall take offect as of January 1, 1970, and shall ~ as con Anue thoroaf'ta.r wnless terminated by oitlior party as provided heroin; i provided, howover, that continuation of this agreement beyond the first year i. is contingent upon the funds being available for each oP any of the budgotary e.~. z L 1,1, I 1 ;j } i /fr 1. • !r yecu•s covored by this agreement. County reserves the right to amend its procedure for the evaluation turd subsequent admi s.ian of indigent patients withi.tt ninety (90) days from the date of the signing of this agreemont. This agreement shall be continued yearly thereafter tutless either party gives ninety (90) days' written notice of its desire not to renew the agree- ment to the other party, !j VII. The City agrees to indemnify, save and hold harmless Travis Cowtty 1 from any liability, claims, or damages as a result of the City's operation of n its hospital in the treatment of indigent persons, to the limits allowed by law, i VIII. The Cat tnty shall have full access to 611 City records and reports j! with respect to the furnishing of hospitalization and hospital services to 'j indigent persons. i; 1'IMMM. INTO this the _Lli day of 19 7/'t CITY OF'AUSTIN i' l ty nager l~ ATTEST; if ty er w_ Cowry OCR TR/Wtq w • „ , BY: <d Ion r County Jud o •A i1 n" T r FLOW MEMORIAL HOSPITe AL > toio scmprunE (811) 387.6861 DENTON, TEXAS 76201 Jaffrey E. Hausler Admtnlatrator May 31, 1989 Honorable City Council City of Denton 215 East McKinney Street Denton, Texas 76201 and Honorable Commissioners Court County of Denton 401 West Hickory Street Sixth Floar Joseph A,^.arrol.l Courts Bldg. Denton, Texas 76201 Ladies and Gentlemen: On behalf of all of us at Flow Meorial Hospital, I want to express our sincerest appreciation for your show of support ? of Flow by providing funds to help resolve the balance due Medicare for the Fiscal Year 1983. The amount of money aside, the fact that the City and the County have come together in a very tangible manner is a very positive step for you, for Flow and for our citi2onry. While many,+.asues are before us yet, the initiative you have established;t:hrough your action serves well to give us all direction and optimism for tho future. 3 T want you to know that your community hospital has made significant progress due in part to an active, dedicated Board of Directors, and also due in part to your interest and support, i will trot expound in this letter to you, but I want to assure you that among other significant develop- Monte at Flow, we appear to have turned the financsa of Plow 4 around to a positive, stable situation. We have taken steps i to assure that the financial lose and repayment due Medicare of Fiscal Year 1993 does not recur under this a fdministrat:ion, ~l SERV1Na DE'NTON COUNTY SINCE: 1980 I i A 5.41 L Honorable City Council, City of Denton Honorabla Commissioners Court, County of Denton May 31, 1984 page 2 of 2 At present we show a positive bottom line for the current year to date, substantiated by a recent interim audit report performed by our independent auditors. We are taking steps to minimize the possibility of any "surprises" such -is experienced last year, Finally, I am enclosing a copy for each of you of the budget package for the Fiscal Year 1985 (October 10 1984 through September 30, 1985), This budget was approved by the Board of Directors at*their meeting on May 24, 1984, r hope you find this budget satisfactory. In conclusion, please call me if I can ever assist you in any way with hospital matters. And again, our deepest thanks for your assistance. Sincerely, affray r , ausler k Administrator i i J'EH/kt act Honorable Chris Hartung, City Manager ' Honorable Don Hill, County Auditor Board of Directors, Flow Memorial Hospital Denton Record Chronicle a s 4, \RlMH$ p t f s 1 t , 1 FLOW MEMORIAL HOSPITAL MANAGEMENT PLAN 1 984'- 1 995 r t avwatw~y ~WisaM.~NN 5 i tty SECTION I REVENUES PAGES 1 - 3 l SECTION 11 EXPENSES PAGES 4 - 7 SECTION III INCOME STATEMENT PAGE fl SE'CT10N IV STAFFING - fTE'S PAGES 9 - 10 SECTION V CAPITAL 5XPENDITURES PAGES 11 - 13 r i a, ' Yh~Ndltgy ~(jlit 4 t. I SE0T 1 NUES RFUE i ~s II 1 U t 1 f FLOW MEMORIAL HOSPITAL COMPARISON OF ROUTINE REVENUES 8UDGET YEAR 1984 - 1985 if 1984 1985 Variance COST CENTERS Estimated Budqet Amount Percent ' Medical Surgical, 21',,/2C $ 1,470,339 $ 1,670,460 $ 2005121 13,6 % Medical Surgical, 3A 1,012,612 1,142,340 1291-728 12.8 % Medical Surgical, 38 922,590 110080600 869010 9,3 % ICU/CCU unit 8810748 988,236 136,488 16.0 % OB/GYN 685,884 761,640 75,756 11,0 % Nursery 3309220 3599208 28,988 8,8 % Neonatal Nursery 534,492 597,240 62,748 11.7 % Total Routine Revenue $ 5,8071885 $ 61527,724 $ 719,839 12,4 % 1 j t I FLO14 MEMORIAL HOSPITAL COMPARISON OP ANCILLARY REVENUES BUDGET YEAR 1984 - 1985 Ii COST CENTERS 1984 1985 Variance Estimated Budget Amount Percent Operating Room $ 516,360 $ 5569272 $ 39,912 1.7 % Recovery Room 107,410 113,532 6,122 5,7 % Labor & Delivery 591,494 694,420 22,926 ~ 4.0 % Emergency Room 608,464 660,252 51,78$ 8.5 % Central Supply 11508,959 1,629,696 120,737 8.0 % Laboratory/Blood Bank 2009,013 212779732 168,719 810 % Radiology/Nuclear Medicine 1005,474 102030081 97,607 8,8 % i Pharmacy 21638,769 2,792,250 153,481 5,8 { Anesthesia 425,845 459,912 _ i 34,061 8.0 % i Cardiopulmonary 1,239,723 10289,691 49,968 4.0 1 Physical Therapy 189,105 219,600 % 28,795 15,2 ~ ' Home Health 3717,24 363.110 861 4 7 (2,3 ~ Total Ancillary Rev?nue 11 392 940 X12,158,448 766 508 ._..,r_ 6.7 % Total Patient Revenue $17,200,825 $18,696,172 $ 1,486,347 8.6 % 1 2 l S to 1 FLOW MEMORIAL HOSPITAL 4 COMPARISON OF OTHER O984ATI1985EVENUES COST CENTERS 1984 1985 Variance Estimated Budget Amount Percent I Cafeteria $ 133,945 $ 141,642 $ 7,697 6.0 % f Gift Shop 21,444 189000 (30444) (16.1)% j Medical Records Abstracts 51871 5 400 (471) (8,0)% Recovery of Bad Debts 1120018 180,000 67,982 6,1 % Miscellaneous Revenues 5,500 _ 60888 1,388 n22 % I Other Operating Revenue $ 278,778 $ 361,930 $ 73,152 26.2 % 1 E i f- 3 E Ai, x<c . ' ws i -0, 4,1 y J' i r f u I f i i SECTION I1 ' EXPENSES i , 1 E If ` i i i s r i t f irk l I f FLOW MEMORIAL HOSPITAL COMPARISON OF NURSING SERVICE EXPENSES BUDGET YEAR 1984 - 1985 1984 1985 Variance COST CENTERS Estimated_ Budget Amount Percent } Nursing Administration and Education $ 227,286 $ 182,790 $ (449496) (19,6)% Medical Surgical 2A/2C 8680152 753,958 (114,194) ' (13,2)% Medical Surgical 3A 525,942 464,576 (61,366) (11.7)% ICU/CCU 636,742 591,360 (44,382) (7.0)% I OB/GYN 255,102 247,521 (7,581) (3.0)% Nursery/NICU 454,938 442,344 (12,594) (2.8)% Operating & Recovery 4079724 3640985 (42,739) (10,5)% r Labor & Delivery 407,358 430,512 23;154 5,7 % i Emergency Room 527,772 531,526 3,754 .1 % Total Nursing Service $ 4,310,016 $ 4,0091572 $ (300,444) (7,0)% Expense i 4 A J FLOW MEMORIAL 11OSP1TAL COMPARISON OF PROFESSIONAL SERVICE EXPENSES BUDGET YEAR 1984 - 1935 ii cast CENTERS 1984 1985 Variance Estimated Bud Zet Amount parcunt Cardiopulmonary $ 460,794 S 4111,804 E (45,990 Pharmacy 660,630 722,531 61,901 9.4 T Radiology/Nuclear Medicine 516,060 478,034 (371226) (7,2}g Laboratory/81ood Bank 825,696 89i,276 65,680 7,9 Z Physical Therapy 119,316 134,792 16,476 13,0 x Anesthesiology 305,244 3205693 16,449 Behavioral Medicine 4420860 495,680 62,87.0 ?1,9 Central Supply 841,434 871,396 29,962 3.6 !Iedleal Records 165,798 183,442 17,044 f 10,6 % , Nome Health 268t644 5_ _ 263,784 ~»~.4yIIGO) r~.~ l1} Total Professional Service Expense g 49606,476 $ 49777,21>, $ 170,756 31I x i r qP1 t , FLOW MEMORIAL HOSPITAL ti COMPARISON OF PROFESSIONAL SERVICE EXPENSES ii BUDGET YEAR 1984 » 1985 i COST CENTERS 1484 1985 Variance Estimated Budget Amount Percent Cardiopulmonary $ 460,794 $ 414,804 $ (45,990) (10.0)% Pharmacy 660,630 722,531 61,901 9,4 % Radiology/Nuclear Medicine 516,060 478,834 (37,226) (7.2)% Laboratory/Blood Bank 826,696 891,276 65,580 7.9 % Physical Therapy 119,316 134,792 15,476 13.0 % Anesthesiology 305,244 320,693 15,449 6.1 % Behavioral Medicine 4425860 495,680 520820 11,9 % Central Supply 841,434 871,396 f 24,962 3,6 % Medical Records 165,798 183,442 17,644 10,6 % i Home Health 268,644 263.0 . 784 $ A 660) 1.8 % Total Professional Service Expense $ 4,606,476 $ 41777l232 $ 170,756 3.7 % 5 1 O mk M+F!Wa FLOW MEMORIAL. HOSPITAL y COMPARISON OF GENERAL SERVICE EXPENSES y BUDGET YEAR 1984 - 1985 i .COST CENTERS 1984 1985 Variance Estimated gud4et Amount . Percent Dietary $ 600,240 $ 646,056 $ 45,816 7,6 % Plant Operations and Maintenance 947,940 10024,788 76,848 8,1 % Environmental Services 330,864 306,556 (24,308) (7.3)% Laundry 114024 99,744 (15,180) Security (13.2)% 51,606 51,506 (100) Grounds Maintenance 13,176 11,697 (1,479) (11.2)% Nutritional Service 39,528 43,269 3,741 a 9,5 % Total General Service Expense $ 2,098 e18 $ 2,183,616 $ 85,38 4.1 % I 6 FLOW MEMORIAL HOSPITAL 4 COMPARISON OF ADMINISTRATIVE SERVICE EXPENSES ,Y BUDGET YEAR 1984 - 1985 CAST CENTER 1984 1985 Ver#ance Estimated Budget Amount Percent I Finance $ 184,789 $ 233,365 $ 46,576 26.3 % Business Office 457,500 482,820 25,320 5.5 % Personnel 69,174 76,971 7,797 1 Purchasing 41,724 45,616 3 % 3,892 9 91,3 % Administration/ Public Relations 223,260 241,104 17,844 10.8 % Quality Assurance 48,678 89,376 40,698 83.6 % Gift Shop 35,868 240208 (11,650) (32.5)% General S Administrative $ 1,700,436 -1 1962,396 261 960 15.4 % Total Administrative Service Expense 21761j429 $ 3,155,856 394,427 14,3 % Total Expense $13,77611()9 $14,1261276 $ 350,077 2,5 % 7 I W'W Il i~ a i 5CCr10N 11I fff NCOHE S rArE11EPlr i 4 n} `2f r I ~ FLO14 MEMORIAL HOSPITAL INCOME STATEMENT BUDGET YEAR 1984 - 1985 F 1984, 1985 REVENUES Estimated Budget Amount Variance i i Percent' I Routine Revenue $ 59807,885 $ 6,527,724 Ancillary Revenue 11,392,940 $ 719,839 12,158,448 765,508 Total Patient Revenue $17,200,825 $18,686,172 $ 1,485,3A7 Other Operating Revenue 278,778 351,930 730152 TOTAL REVENUES $17,419+603 $19,038,102 19,038,102 $ 1,558,499 8.9 % Deductions From Revenue 3 $ 393 515 .3,996,304 $ _ 6040789 1 NET REVENUES 14 s 086 088 _~...r~_.__ $15,039,798 953 660 6.8 % , EXPENSES Nurs ng Services Professional Services $ 4,3101016 $ 4,009,572 $ (300,444) 40606,476 417771232 170,756 General Services ' 2,098,278 2,183;616 86,338 Administrative Services 2,761,429 3;155,856 04,1427 f ~ Total Expenses $13,776,199 $14,126,276 $ 350,077 2.5 % 1 INCOME rROM OPERATIONS 309 889 913,522 $ 603,633 194,7 Y, NON OPERATING REVENUES oun a" Rion $ 40,356 $ 16,170 Interest 32,782 $ .201000 12 782 EXCESS OF REVENUES OVER EXPENSES 383 021 $ 957,708 574,681 150.0 % 8 I R G 'i I i ti a scc7rGN Iv STAFFING ~ FTF'S 1 i ~ t ri FLOW MEMORIAL HOSPITAL STAFFING - FTE'S BUDGET YEAR 1984 - 1985 L j ACTUAL FTE'S BUDGET FTE'S BUDGET FTE'S VARIANCE OCT '83,- MAR 184 PER DEPT LEADS AFTER REVIEW ACTUAL FTE'S Nursing Administration 6.6 5.5 .4.9 {1,7 In-Service Education 2.2 2.4 1.6 .6 fledical Surgical 2A/2C 43.8 38.5 37.5 (6;3 Medical Surgical 3A 27.6 27,5 22.5 5.1 ICU/CCU 28.6 30.0 23.5 ((5,1) OB/RYN Post Partum 12.6 11.0 10.5 (2.1) Nursery/NICU 1919 18.5 1815 1.4 Labor & Delivery 13.9 1510 1510 1.1 Operating Room 10.1 9.5 7.2 2.9 i f Recovery Room 3,2 3,0 2.7 Emergency Room 9.7 910 g,0 ' j Total Nursing Services 178.2 169.9 152.9 (25,3) 25.3 24.3 1.0 Behavioral Medicine 23.3 I , Central Supply 910 9.0 7.0 2 0 Cardiopulmonary 15.3 16.9 12.9 2.4 Radiology 10.9 11.0 915 (1.4) i Pharmacy 8.4 8.5 8.0 ( •4 Anesthesia 5.0 510 5.0 Physical Therapy 5.5 5.5 4.0 1.1 9.0 1 , f Medical Records 9.1 10.0 1 Total Professional Services 86.5 9112 79.7 (6.8) i i s41YAWA I ....1.1....4} xe B I FLOW MEMORIAL HOSPITAL STAFFING - FTE'S BUDGET YEAR 1984 - 1985 (CONTINUED) ACTUAL FTE'S BUDGET FTE'S BUDGET FTE'S VARIANCE OCT '83 - MAR '84 PER DEPT HEADS AMR, REVIEW ACTUAL FTE'S ' Dietary 29.6 30.0 29,0 { ,b) Nutrition Service 1.9 2,5 210 ,l ! Plant Operations 14,9 14.5 11,5 (3.4) Security 4.5 4.5 Environmental Service 29.5 31.0 28.5 (l ,0) "Laundry 7.9 6.5 6.5 1.4 Grounds Maintenance 1,0 1.5 1,0 Total General Services 89.3 9015 83.0 (6,3) E S j Administration 3,0 310 3,0 j Quality Assurance 2.5 3.5 1.5 1,0 Auxiliary 1.0 1.0 5 'g E Purchasing 2.7 2.5 2.5 2 Personnel 4,0 4.0 30 (110) Public Relations 1.0 1.0 110 i Home Health 12.1 13.0 10.0 2,1 Finance/Data Processing 7,4 7.8 7,5 Business Office 28,7 27.0 23.2 5.5 Total Administrative Services 62.4 62.8 54.2, (8.2) Total Hospital 416.4 414.4 369.8 (46,6) 10 W. ka,,, , dYZY4i~ j I I 1 i i IsCCT10N v CAPITAL CXPCN'6ITURCS i h i f 1 s f. 4 FLOW MEMORIAL HOSPITAL CAPITAL EXPENDITURES BUDGET YEAR 1984 - 1985 ITEM NEW REPLACEMENT DEPARTMENT DESCRIP____TION EQUIPMENT EQUIPMENT In-Service Education Opaquo projector $ 650 $ Slide Tape Recorder 650 Medical Surgical 2A Pediatric Scales 10000 (3) Cribs 31600 1,600 medical Surgical 2C A(6d)ltElectric Bads Medical Surgical 3A (5) Electric Beds 72500 Orthopedic Cast Cart 895 20400 (3) Adult Aheeichairs ICU/CCU (8) Electric Beds 12,000 Behavioral Medicine securReityArea 10,000 Magnavox TV Monitor 31170 System 800 privacy Fencing 15000 Office Furniture Labor & Delivery open Crib1,000 Mobile Warmer 3,000 (2) Transport/ 61200 Delivery Beds 10,600 Petal Monitor Portable Ultrasound, 16,500 3,000 OB/GYN - Post Partum (2) Electric Beds Operating Room Orthopedic Power 9,500 Equipment 6,650 Cystoscopy Equipment 3,200 2) Tran9port Stretchers A1r-Powered Dermatome 2,000 Bidirectional Doppler 39645 6 000 Recovery Room (3) Recovery Room Beds Life Pak 6 81645 Defibrillator 4 Nursery (5) Basinettes 3,500 Mobile Infant Warmer 3 "M Olympic Bili-Lite 11000 f ~i t • 1 r I FLO14 MEMORIAL HOSPITAL CAPITAL EXPENDITURES BUDGET YEAR 1984 - 1985 (CONTINUED) ITEM NEW REPLACEMENT DEPARTMENT DESCRIPTION E UQ IPMEN'r E UIPMENT Neonatal Nursery Tektronix Monitor S 51775 Ohio IC Incubator 60000 Auto Syringe 11200 (2) Stainless steel Cribs 1,650 Air Shield C-300 Incubator 31575 Olympic Bili- Dosimeter 11800 Emergency Room Pediatric Stretcher 21900 (2) Adult Stretr.hers 50800 Electric Thermomwr 500 Radiology Room If - Radiographic Unit 116,000 EKG Gate 3,200 Anesthesia Ohio Anesthesia Machine 10,000 (3) Cardiac Monitors 17,400 I Ultrasonic Doppler 550 Respiratory Therapy (2) Pressure. Monitors 41390 Gould Diagnostic SPirometar 17,000 Pediatric Aerosol Tent 1 Ventilator Overhaul 40000 Blood Gas Analyzer 22,000 EKG 2-D Echocardiograph 35,000 Physical Therapy Arm Whirlpool 1,640 Electro Stimulator 1,000 Kinetic Continuous Passive Motion Device 3,200 Central Supply Adult Emerson Pump bOff Pediatric Emerson Pump 600 (3) Gomoo portable Suction Units 2,175 Medical Records Microfiche Reader- Printer 35000 (2) IBM Selectric Typewriters 10800 12 t 1lRYQA M i 41 FLOW MEMORIAL HOSPITAL CAPITAL EXPENDITURES BUDGET YEAR 1984 - 1985 (CONTINUED) DEPARTMENT ITEM NEW DESCRIPTION REPLACEMENT E~U1P--i4ENT _ E UIPMENT Environmental Services Scrubber/Buffer $ Laundry $ 2,000 120" Flatwork Ironer ' Maintenance HUAO 67,250 East Wing Roof Overlay 3000000 Metal Entrance Doors 33,000 Van/Pick-up 1,500 OR Renovation 161000 External 81'n a 15 000 10,500 (20) Patient Room ' Renovations Renovation of Existing 89000 Ancillary Areas Finance 3001000 IBM PC with Software 10,000 Business Office (2) 1B11 Selectric Typewriters j Personnel 1,900 IBM Selectric Typewriter 900 i $164,625 $1,013,310 h Total Capital Expenditures $1,1~ 77x935 h s i 13 i . f~n1 f Y FLOW MEMORIAL HOSPITAL Five Year Income Statement Projection As of April, 1984 In Thousands) 0 1984 1985 1986 1987 1988 Total Gross Revenue 17720 18960 20290 21310 22380 100660 Deductions from Revenue 3900 4170 4670 4900 5370 23010 Net Revenue _ 13820 14790 15620 16410 17010 77650 Operating Expense 13580 14410 15270 16190 16840 76290 Excess of Rev, over Exp. 240 380 360 0 170 1~ 1 i r I i i f i 1 i 3 i 1 1 FLOW MEMORIAL HOSPITAL Five Year Capital Expenditure, Operating Projects, and Intermediary Repayment Plan as of April, 1984 in Thousands) 1984 1985 1986 1987 1988 Total Capital Expenditures 1251 772 732 321 403 3479 Operating Projects 151 205 130 130 130 746 Intermediary Repayment 673 -0- .0- .O- -0. 673 Medical Office Building -0- 1250 .0- .0- .0- 1250 Subtotal 2075 2227 862 451 533 6148 Hospital Contribution 240 380 350 220 170 1360 Total Subsidy Needed 1835 1847 512 231 363 4788 { F ~ i a s 1 7 r rwla MFN1AIAt pwif" CA l* sxr lwfm /s lip r ► or ~NPMa f milwoArir - Rea Wittily 1060 O.R. - Room R9404*1100 folios 4 Rotwoo Room - 99MATe1 116#0 ~AfJ1lraAitE - SIWAK t TrAr+~ + ~lf1FIWA6 19ttoo ~ I~MAr~I~ +GOPtATI~I ~tP4sA00p y10o0 ~6AIJIrTPATi~d - MW41 slit PCOW 1)( Wi0mFwlr So, 000 W01% , STerltoom l OW1004 1 + Rgut ro-noo 491 &H RIAItrnaA+Iea - 1+UR~ 400too t~uArwo RuITS - RcrlPtAtMI of ~0 PA71i~lf Room 40,oeo NyRrlAY - 1 tfforAriw Fu SYNA s1+rlfrAr Ii,m ~INtf6~Y - Olh+ ~Nllfd JITn RfeFs+PPlrr I~,PM OIa1NtAY - OAto ~frPSlrc I~lorif.,c (~O,If6+tY ~ ~kN ~r'rl~flr! 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WOM orrIcy FRO%1 DALLAS/FORT WOM lo-W-1 FILES ► VMARD W. T.REUTZMJYT JANUARY 9, 1984 CIT'Y OF DWON - STATEMENT I IMPLICATIONS OF FLAW t1EMORiAL HOSPITAL Attacue) are the following documents relating to the formation and operation 'of Flow MewriAl Hoapitalt I - Tne last will and testament of il. 2. Flow - Flow MataoYial Hospital agreament'betvaen the City and County - A resolution by the City council of the City of Denton relating to funding of operating deficits - State statutes relating to joint City-County hospital boards ~Tne significant provisions of these documents are outlined, The following are the key provisions of these documents so they relate to the poteotial inclusion of the hospital in the financial state ueuts of the County and/or City under the provisions of NCCA Statement 71 1. Under the lost will and testament of N.E. Flow, he gave the bulk of his estate to the City and County to be used to create a Flow Memorial dospital for the oensfit of the City of Denton and Denton County. 2. The City and County subsequently enteral into an agreement resulting in the formation of a joint City-County 'uospital board in Accord- Lulea with state statutes. file key terror of this agreement are as follows a. The City and County retain title to all hospital, land, physical assets and facilities, o. The City and County agree to provide funds as necessary to balayce the budget of the hospital. The agreement of fiscal year 1912 was for each entity to provide 502 of such amount, with this percentage to be negotiated thereafter. c. Three ooard membera are appointed by the City and four by the County) 1 i P°64 ( °i. ,J' • . ,fuUtB C h01{C' i. rr,~':' EXTRA FILE COPY (For Working Papers, Pre-Audit, etc,) r } CnT OF DZWOX OFFICE FR UN Z gF~FICEa~ ,s n~:nr•„ran. d.► The City and County have access to the hospital's b-'kyc•f:. records and reports. -:~~8 , y,.. a. The City and County shall approve hospital expsuditures in excess of budget. 3. The state statutes governing the formation mad operation of Joint City-County hospital boards have the following ksr provisioast a, The hospital board is the joint agent of the City and County, b, Although acting as agent, the hospital board shall constitute a separate entity in the exercise and performance of its powers, duties, and functions, c. The hospital board may sue and be sued separately. d. The hospital board may buy, sell and own property, e. The City aad County shall approve dispositions of property. f. The hospital board may issue revenue bonds, although the issuance must be approved by they City and County. S* The hospital board may not levy taxes. kICliW W. KBEUTZPELDT Pat i i M1Iff ANN.: ~k ' 1. 77- Q• Plow MEMORIAL N06p2TAL • y'; 1~ m: will or Plow (M so Exhibit 40 Attached 16 ft the rasidne of his Estate to the lol3ovl4hareta,) 4 Truett"I County Judge of Denton County b. Mayer of the City of Denton , a. Cashier of the Denton County National sank d. Cashier of the Pirrt state lank b! Denton T. The residue vas left to the Trustees to erects a City-COanly hospital !or tAe behelit of the City of Denton and Menton ConatYr Texas. ~3. on July 10p 11, the City of Denton, County of Denton, and the,soard of Direoters of Clow Memorial Moapdtal entered into an agreement to rs-orgahiza the Moapital utder,V.A.c,B, Article 4494!-1. The'City and the County retained. title to all hospital lands r physical anete and facilities. (Bee Exhibit 16" attached bereto.) „ the City and County agreed to provide a22 trade neeeeaary1 to balaaee' the budget alter the budget is examined, aocapted and f Apprew d by the city and county. Per the fiscal year oetober'1, 1971, through 6eptanbar 30, 1972, the City and county agreed to fund the budget on a SO/SO basis for '1 she amount decassary,to w anoi Year on1 Y, do fir re-cagotiated tharealtai On October 80 1975, the City of Denton And the County of Denton passed Resolutions agreeing to each Annually. transfer' to the MOSpltal Beard the leaser efr ' at An amount equivalent to the pzinoipal of and interest en the Series 1975 and the Series '1975-4 bonds (in the process of'bainq issued by the Mospital Beardt•this requires .844,902.00.for 1960), or b. the Amotat that a tax of 100' on the 8100 valuation would produce an the county tax 1.011 ,{Assuming the then f ourvent rate of collection)' this is $ Z 9 S. S~ Zy L p be #e d, , on the 1978 tax roll,) This i61nt reaelution wAa passad at the request at the prospective pdedhaeer O! the ebeve Mentioned b6nds,' )Soo Exhibit "d" attached hseete, The minimuM amount detirMlned by alther "tl".e1.'"b" above s Page, 21 1 I ~Y ./-.,y. N).,Ty~!y~Lypyry~.T~!"4f.1,.~:~y,~ t 1 le;SlP:n•y, {t ti rll , , 1 ' h 4 TAI 2,4 OP CON1ENSa " I r 41 A, DCNTON COUNTY PUBLIC HEALTH DISTpje' • • Numbs Sufrar . retell Taka■ ts state a Draement..,r .1,.,, ,,...,...,......I 1 eparsmAnt of Wealth Agreement. . .................b Newspaper Artiol• reporting on brat Public goaltb Dis'triat............:...'...,..b.......:..:r I List Dt 'contributions by County town' and oitias to Health Districe V.A,C,S: Article 4441a - Statute under which S'ealth District was erected... B, COUNTY-NIDE PUBLIC FREE LIBRARY PRIVSLEOE! summary,,.r...,r,,..,,:...r.,,..r.... r,..:. ..K,... Revi Revision on Agreement,......r.r ................1,.....,..,. 17 Raal of Agreement..,..,., Letter t"Ity Of Dahten from CDgMiseienara~ 19 Court informing of option to reduce ocntributign. ..........................................22 C, PLOW MLMORIAL BOSPITAL' Summary.......... ' will Of b. Ei Mow..........r ..............'.r,..,,,.rr.,.,.r24 ..,.....:...r..,..r,,,.,....,,~....,..,..28 „ PSew Memorial hospital Agreement.......,........ .............30, V,A,C,S. Article 44941.1 - SiAtute nder which beint CeuatY-City abapital was Creatod.................1s Various Resolutiene relavuq to bondi.iysued , by rloW Nespltal,....,.,., ........{......42 TEXAS BECISTER exeoipt ahOwinq District Attornayl,s 06irry Cobb) request for Xttorney General's opinion r6gardiuq indlgenti.,....... 46 Litter from .terry Oohn Crawford, County, Judge., transmitting all Floe Nerpital documents to mark white. Attorney benekal......... ,..:.41 V.A.C.S. Article 4435 regarding indigent YSOk...rr,.v.....,.48 i D. CITY-COUNTY CIVIL DErENBL , . ' Sumpiary ~ ...........................................4f ' POYmAtien-Agrermees..'.:•,..,..r........ bG ' E, CITY-COUNTY MEDICAL SERVICES ' .......,i.r.,..,........,4 Bxeerpt from city Council Nlnutea....,,,,,, Excerpt fYOm'Comnieel0 nert~ Court Minutes:,,.,...... „ peiDn of S♦rVLd*o provided.,.... . . .....:60 Art. 449411 - I zar+Tg rlsvBwc Title 71 e XVIInettt domain , Sec. 16, For the purpose of carrying out any power, duty, or function authorised by this Act, said Hospital Board shall have the right to acquire the fee simple title or any other interest in land and any other property by condemnation In the manner provided by Title 82, RbvL$ed Civil Statutes of Texas, 1928, as Amended,t relating to eminent domain, Said Hospital Board shall have the same rights as counties and cities under Article 8268, as amended, of said Title 82. f The amount and character of interest in land or other property thus to be acquired ~sl N be determined by the Directors, t Artlole J71b et ego. Inwetumeut of tends Sec, 17. The law as to the security for, and the Investment of, W; funds of counties and cities shall be applicable to funds of said Hoapi• tai Board, The Bohd Resolution, or any trust indenture executed in t connection therewith, may further restrict the securing and invest- merit of funds'of said Hospital Board. Also, said Hospital Board shall have the power to Invest all or any part of the proceeds received I from the sale and delivery of Its bonds, until such proceeds are need- ed, in direct obligations of the United States of America, to the ex- tent authorized in the Bond Resolution or any trust indenture execut- ed in connection therewith, OttmulaU4e efteatl confllating 1a~.s Sec. 18, This Act shall be cumulative of all other laws on the sub- ,iect, but this Act shall be wholly sufficient authority within itself for the issuance of the bonds and the performance of the other acts and procedures authorized hereby, without reference to any other laws or any restrictions or limitations contained therein, except as herein spe- elfically provided, and what- any bonds are being issued udder this Act, than to the extent of any conflict or Inconsistency between any provisions of this Act and any provisions of tiny other law, the provi• sions of this Act shall prevail and control, provided, however, that any Hospital Board shall have the right to use the provisions of any other laws, not in conflict with the provisions hereof, to the extent convenient or necessary to carry out any power or authority, express or implied; granted by this Act. Acts 1966, 69th Leg„ p, 1030, ch. all, t XbtorleoC Net.. 1 TWO of Aeel enee to said joint hospital boardat provid- An Aot authoritint theoreatfon of lolnt Inr for the eentrel, eperotion, powers, du- county-olly hospital boards, without taxing ties, and lunetlens of said joint heseltal powerst providing f6p the powers and boards, Inctudine the sewer to Fetus. W1. funetlohe of countlel ahd 911141 with rtfsr. end deliver revenue bonds, pfoYlding for a 48 i. t would be Is 60 than SOt of flow Hospital's Proieo~ed dotidit. J rL 5. !hs funding at the amount needed to balance Plow Hospltal~~ , 'I I budget continued on a S0/60 Doris until' sudget Year 1g79, when the Qity of Denton pledged 25t of the amount of re OoPAty of Denton pledged 30% of the amount efjeafed losses add the profacted loses, 64 Verbon's Anaatated Texas Statutes, Artiale 4438 provides as followsI i "Yt there is a regular established public hospital in the eoubty• the commissioners court shall provide for sending the Indigent sick of the county to such hospital. If more than one suah hospital exists in the county; the iAdlgent patient shall have the right to seleot whiah one of them he shall be sent to.." y• Plow Hospital is anticipating ahaegiAg off W3 0 000.00 for Providing medical services to charity and medically indigent during 14an, which it also the approximate amount needed to balance the 1580 Plow loapital sudget. r o n s 9 T Y 0 H 8 ' 40 - to view of all of y ' the above facto, a. "is Dentan County fulfilling its statutory requirement to "provide for sending the indloent sick of the county to the,public hospital by providing- and Jointly owning Plow Manorial Hospital? b. 'Are Denton County and the City'of Denton re.qulred to Jointly and equally fund.the amount needed to balance Plow medorial Bespbtal's.bud90t7 c• Is banton,County solely responsible for pravidinq flow memorial Hospital with eunds'naeessary to balance the budget, UP to the ameumt of the dharge.off for inatgent bare, even thatlgb,Dantdn county it prcvlaing a hospital taoijity tl for the indigent sick of the county? r 8'r City,of Denton funds budgeted...,,,, 1114,583.06 'Denton County funds Ledge ted. ..,q,., P $229,126,00 PAgo 23 ~ 1 ' Y f y~~, L •~'C fir.. rwt, a 1 { I r%SStiM . i J .1 wo TZE STATt OF TEXAS r ' ' • ' " rt r,o r • , , ";fr { . OOUNTY OF DENT01tt' KNOW ALL klENrBY r• i TSESE PRESENTS= , I ` That I, Flows a single mars, of the Oounty of Denton State of Texas, being of bound mind and dia posing memor,do make pubiiah'and deola re t?iia ,mY, iast Will and Testament, hereby revoking 'a I' I wilts by me at +aa , rr ~ , 1. 11 yr time herotof6'" made; I desire and dirso,ti bh►t all of my Juat debts and' iurteral ex~lneee ahd the oost ,of euoh monuieenL se may be suitable be ' paid out of m estate my as ao6a after my death as may be fo=d • •',eoAVenletlt, " , XTEU go i..1-8176 g devide and bequeath to my belbped,0'ouaina, Otis1 Ihmori;Ear1 Irmon;Ethel. Tnmon and Iola Oampbell!•of Denton, r Texati; A1i0o Oolt or Shernan,Texae,Birdie Laaeq of11►a,Texas , J.N.Russell of nioo ' ;Texaa,.Maua~tendlln otflaoo,Texae and • ' Ona Oitiaon ot, beoeai'ng,New,Mexiao, e►oh the aum qt $8000.00. ' + ''`r I ive devise ' . g , and be4ueatli to ISrs,L dia Ford •oS ' Nn 't on, token of my appreoiation ;of the dare and attention abe rendered ml beloved a,iater ASiaa Oertie Flov,, in her life r • time, and the we'. and attention she' has rendered and i ' 4, now ~'rand oring me, the aum of $10,000,00', x T29' 4 , ' xn the event of the death of on of th Y' a beneficiaries ' 4 mentioned in .1" tome Two and !lbrea c t hie•Will'tief6re my death, then suoh bequest shall 'Ws e•a ' and beoome null and void. r L'give;deviee and bequeath to the Soottibh ' Itlghte home tor, Crippled Childran,,at Da,21ai ' Texas • the aum of 010,600.60. ' X'Si I ve,dovieo,nnd boquoath to Uuokner+a ' Orphano !tome ' at Da13aa,Toxoa, the sum of 610,000.00, ' r rr 'r.KHrQrr ' a:nT\4i . i~ , , 1, ITEM 7. ' I give,devise and bequeath to the Cumberland Presbyterian Orphans mom* atmnton,Texss, through Ito Board of Ministerial ' Aelief, the sun of $80oo.oo, ' ' ITEM S. ' J Ylgive,devise a»d bequeath to the Kiwanie Club at Denton; Texan, to be used as 4' ipart' of the Crippled Ohildren "FLnd . , "the out of $1000.00. ' Xw order to ereats'A'F ow Memorial Hospital for the benefit of'theCity of Denton and Denton County,Texaa, as a City-Oeuoty, Hoa^ pr'T giva,davise and bequeath to, th ty ~gdgs of Denton ' Omaty,Texae, the or of theClty of Denton thhier. o! e Denton County National g~ar~h"o bentor~, sad the oa + ghier at The I pirs,t State Bank p! Denton; and to their reaPeotive suoeeasors An ofPi;oe, ae trustaaa, all of the rsmainder,reat and residue et, my estate in trust,"to'be used by them en•,a Board of Truatesa of; the'F`1'ou }4emori[1 Hospital,,, to construct and bquip a modern and efficient Hospital, and I authorize and empoiver•au'2 'Board of Trustees "to make such arran event with the 8 City of Denton j and County 'off' Renton acid/or any, other' OrBanitation that risight• , undertake to properly administer suob"Hospital, buao arrangements ' as may in the, jud c{msnt of, avid Board 'of Trus teas be to. the bent interest of bald Hospital end -the people of Denton'e • nd Denton County. xTETd to . I nominate, eoagti tuto and appoint m 7 good friend A,1J.>iarne exeoutor o: thi.a my :ast will and tostament,, and I direct that no bond or other security be roquired'6f him so-such executor, and that no ather'aotion be had'ira thoCountyCourt in the aciminis- I, trationlond eettlement'of my'oatatethan to,probate and record ' this will and return '•n inbentor' e Y, pPraiaomcnt and list of claims of my as tate♦ S'''' ~ ♦ I1TU 11 ♦ 17'/y,' . In the event of Lho deoth of the onid n,ld♦bnrne or his ina» bility to oorve no ouch oxeoutor from any opuoc, I nominate oonaLiLuLmand epl,oiynt~hr.w,d,ISimbroui;I% nn oxooutov of.L},yio my r /..y.:, '!.,',Tea,. .Sr+.'~'i•'+t+?V"M MIb ► 1 ~•.~,at~ y, t +'kM ~ w~.M,.►,y'..,"F~Y.... M...:.1W 4 'ahSlMie ri last Will and tegEamant and diroot that ourlt De no bond or other ss•. Y roquired of him as such exoouior, and that no other motion be had in tho Oount • settlement of my estate yCourt in t!{e adm n stratioq and' • s 1 1 Other than to ' and, retprn an. ' Probate and record this mil I 'I l inventory$ ppraisement and list estate, Of olaima of Tn the event Of the dea• th or inAbiliby of botb't R4M#BArns and Dr,W,O,gimbrou he said oo»atituEe and to cab as ezeeutors \ app oint r,2,BAVage As ' T noailnate, wi11 end teetaaeat ~Seoutor of this my lost ' con dit4048 With with the Same powers and under the mane referenoe to bbnd'ind the notion of the ae ia,yrescribea for the acid Oourt •td•5arna and Dr.W,0-Ximbrough, 7 axpreaaly atthori a ' . m Said 6keoutor to ea"tabe and personal ae11,.auoh real neaeas'ary to ,Property belonging to mp,eetate ne may bo I p Pro ery barr y out the irisrpoeea of this will T expressly Author iza and emporver the for goord,of Tzuateea + auoh F1ox Memorial lloapltgl bo aell.an and ' I,and all real estate property belonging to acid state term rrustpind, to laces ' ' ' instal' development; and for genaral.pures spy and all real ,estate belo pos nging to said trgab estate t Invest the , to invest and re. . P~eoeeda of Sales and oolleations, hive oonat to borstruot Meted auoh build i auoh'e uS in8a and other improvements, a and nd bu y 9 }linen and other proi,orty y y.be neoeaa, , *Proper Oen8 as ma .11ItiOn'And operation arY,,fOr at DUbh bobpItiloand' to In.,, vent Arid re-inveat the llsnde that maybe bri hand not%immediaLe., 1 1Y neoded, and uea the prooeods as a ,of said Trust >rat nte for part.of the trust tyrfdw the pbnefit'of suet plow Alen,eri81 onpitsl~ , And mike euehor rangemente aS the • the op i eration thereof, they p10Y deem beet for I iLrthor donire and diroot that all buSldinga oonat 1 , rooted G hh r - t ~ ,.....It1,.,►D.fLY14•'~l,~Y!•X~,, rs~~l~,~ y. ~ Me. r..~ ~.r1~-..1..:~, t./":• f ~•r CW N.W .r ~ r.. '.•a~q~ Ly/: ;',:,.1'1,~ ' r'• i .Pr Ww ,t blomnrisl Hoapitrl sh&14 be of modem for the use of~saoh Flow, fire proof oonatruction, and that if 1h the judgment of,the ' Tryatoea my preaaint home should be a suitable'plaoe for such lip hospltal,they shAll have the right in their Jadpment to'move the dwelling nex on said promises to the rear of the lot for nurses or other auxiliirj buiiding. X turther desire ahq. lireot that my executor shall receive as compensation for his services the sum of,.A5b0j.00; tube paid either.'at one timC'oi W two~oi three installments as the :.,,work , a6ttIing ml estate progresses, and aa*may be' found oonpeaient by my said '6xaoutor. Xt,is'my desire that there be rtb'litigation over my'estate, ;rnd olbfat end'X rrill,devise and direot•that eaoh of tbq bepefioiariea'aooept the bequests herein made to each, reapeotively,, a,nd it' any of tk i legatees named herein shoul.d'oonteat this -will, sue to set the'aame'asi4a,,or in eny'woy,rend er, aid ind comfort to any other person or perscns who might tie onntosting this w~11, ,suing, to set the same is,tde: or seeking to 3efest the purposes ` of this will, then it is my desire that such,legateeaor ;agsteea ' take no part eT my estate and tlat the legnoy,or;log6oisa berein .rliequeathed`to such legatee or legatees ;hall li~poe•And become a part of tbo,xesidue of my, estate. IH T1r,4M61M A11MOP I have hereunto set my hand on this the 12th der of lanuat:r. A.b.1948, in the presence of OsO.M.Hopkins arid vatt.o i'gan, wbo Attest' the same" lit my rsquost and in my presence and is the pressnee of SAO .0th i ! Zhe, above inettvmont was now her signed' by i .r.xlowv, the Testator, in our prosonou orld vra his raquont and n his z proeonoe and in the preeenoo o a they sign ov names boreto as attesting witnoae~„ ' 1 ~ ' , • '7~''1'4T:T3,'R17i5"W19'~s?,`'91'3 . X, YG :x.L'i:(43wyae ~saaayye .R9 i aw All ~ pia-.,r tei~.r, r,r~r•,+~r~r~iK~•~:t•:tw.:.::;,. "~,xa'ur+:•ir:3.n+.. ` • .1: },.ytJy'.q .t1:L : isL ,~f • '•.1, f.•?..~JR•N;tnW! t' ow z THE STATE Or TCY.AS x . MW,WMRYAL'I10,"rTAL hem COUNTY OF DEHTOrT X r WD, tho undarsigned throe parties, being the Commissioners' • Court of the County of Denton, Texas, the City of Denton, Toes, and the Board of Directoro of flow Memorial Hospital, all of 'Denton +i -County, Tomas, pursuant io mutual Resolutions heretofore passed by I the Commissioners' Court of the County of Denton,anil the City of Denton, hereby dissolve the organization of ''said Hospital,under Ravice~t Civil Statute Artiole'44941.and,hereby re-organise Raid 8ospital under the provisions of Texas Revised Civil Statutes, Artiole 44941-1, whieh.Artiola is incorporated into this contract, with and subjoct to the following conditions,' t'arms,'and.eovanantis to which all parties hereto, and their successors in office, shall be 'mutually bound, to-wit: The City of Denton, hereinafter referred to as CZTX, and the County•af Denton, hirainafter rofarrad to as COMM. shall retain title to all hospital lends, physical !assets and facilities, nxcopt as may be hereafter granted by resolution of the'respaotive govern- ing bodies, 'Any matter requiring a voce on the Part of bot h the City and County other than the expenditure or transfer of funds shall be passed upon the affirmative vote of any six (G) members of maid combined governing bodies at•s joint meeting, and any sight (S) members o: tha combined Commissioners' Court and Citv Council $hall constituto a quorum to act on any hospital matter requiring approval of City and County, other than the transfer of City or County funds, the plodging of any City or county asnot, or the term- ination of this contract at provided bolowa Any decision 'on the F part of either of said bodies to authoriie the transfer of fundo, or plodgo ,insdtc, to rlow Memorial tiIospktal, horoinaftor rororred -to a'n { I r , HOSPITAL, shall to doeidud vendor axio U neq law portinant to the roe- puotivo bollion. ' X 13 L 7- S • Page JO , i. t LtLL ',0.'.21x..';.'. t', , •,,,f~' ~ _~-.,tiy`, .ay....,y ,,~]{~y~~i r r. ueF-Y. i daalimn~ 'Y .the City•and County shall exorciso oil authority over thej„ Board of Diroctors of Flow Momorial Hospital, horoinaftar referrod to as BOARO,.consixtant,with the intont of said Article 44941»1. The Dliecear of Finance of the City, and the Auditor of the County, shall each have the authority as authorized under--the laws of the State of Texas to examine all hospital books and records at any reasonable time, either separately or together a All donations-,and grants for the banefit of the gospital, in- eluding benefits of trust funds, may be made directly to the Board of Direotors'of the Hospital but shall be subject to approval by City and County if'any oot8itlon, obligation or limitation Is cony ,netted with any such donation or benefit: ; All funds'. transfarred by the City and County to, or for the bensfih.of, the Hospital shell be based upon a -written detailed budget, as described below, and no special transfer of City or County 'funds within a budget year .may ba made without'the submiss- ion and 'approval of a budget amendment or supplement prior to any such transfer. Tha.said City and Count y agree to provide all funds , necessary to ba,ianoe said budget after said budget is examined, aoeoht j ed'hf~d approved by the said City and. County: The City and County shall transfer funds to,the Hospital in the 'following proportions ;For each dollar'transferrod, the City shall commit So o r.c t I And the COUn;y shall oommit 50 er cent, aiftor the amount of each trap~9fer has been authorized b 'both, This pardontage of fund'inq In Valle only,:cr the year Octob 1, 1971, throuoh,Beptembee 30,1972, to be re-hagotla 4d, thereafter, xt, The Initial Board shall consist of,tho following seven appoint- mantel three of which wars appointed•by the City, and four of which ware appointed by the County; with the,torms of office an sot out by each namo. The terms shall begin on the cxooution date of this r + contract, and it,ia spocifically irovidcd that the torms shall ox- r, I 3 .2- page 11 1. ~W,fL'~y,_'.... ~"~11r:11L:eFl nr',111'fl'^'y r,C!♦ , _ • R. 1 3 ~ . • • " `.tt', taffy ,F piro on tttio firat and $ocond nnnivoranry of, tho. 1A6t 11ny Of tho , >loxt comploao Pfaonl your of said hoapital, doponding on the, s initial term', Ithan oath now appaintmont dr rooppointmont shell bo '!or a term of two yoars boginninq with'tho o?.•pigation date Of the initial terrtil as provided in-said Areiala A494i-1.• Hd meml+or shall carry over into a new term unlosa proparly roappointod, aq all, terms automatically :expire as indicated, '~j o initial appointees and thou' terms ara 4s followJsJ. COUNTY P T"1TCt b TE~1U1 EXPyiAzxON bn1C /0-I+7 Z 1. Mrs, Paul 11. 31nP281), 2. Kr. wafter Ray /~Q 4. 'Mx. Al Toots /D•I~ T3 C9 TEW~ E)'P7ItATTt!N DA'Tri 1 1 • cTTx ArroTrlr>; • 1, Dr. Charles Saundore 73 1 2, Dr, John Carter !O-/-7L f 3. Jar, D&ree4l SEeemg~ i•~71°Q /D •I.7.3 s county appoints two members for two year tbrm 'and two for one year term, City appoints two membors for two ,year term and one for one ' year term, it shall be the duty of the Board to appoint, a. Hospital Aa- ministrator having-the qualifications ostablishod in the By-Laws, s and to confirm the appointmont of the Assistant Administrator and the Comptrollor (or'Contr, tgolllar) The Board shall execute a written ' contract with the Administrator for hib,servican with such pravia• Iona as may be agromd .upon, but no, such omploymdnt contract shall exceod a torn of four (4) yeors, And shall provide for removal for oauso. Tho Board shall concur in Any appr,ivo Any written aontrnct UIC, Adml/lintrAtor tray nogotinto for tho' omplbyront of tho Aasintnnt ` Administrator and tho Comptrnl)or (Controllor) pridr to.ativ such omploymonls. The Ilonrd shnl'), huvu filial aufh,~rl iyy In All mAttors of lion pitnl pul tuff,, ineladinq monnll(Anit pnlician, in tho govltrnmeInt and j n)iur;~t:llni of tho 11411ti111Lu), 'Aid WACtIVII nr,llpor1 1m nntl V61A)Nn ar.n lilt quv,a`1t,41 11y 111011 Artlu.ll. 44941-) ,unl Bhu'Ily-lduwn. All OrIIIJ.)l tlttty uC UPI 1104111 nl Yu?ll JlIq I,IIIJ 111011P.1-11 11111111 : M' iyloetll:loo r%P thA F 'w w1-iw•+~•r9*+.,r+a,feq~.. Ktu,..aCµ~as~ ?2r.~+5uu:.....:d. ~`r.-~ _ ' w... .:Y,ti9,.; .','•L J,. ;,n~~~•Q. °"~..•.YiF'~~.~L~... 't, .1.YtS. n:na, e hospital shall be by written resolution, All said rosolutions duly paoaod upon during 'an official.DOard mowing' shall be.rofloct. 6ed,in the minutes of the Board. All expenditures of hospital funds in axoess'of,the total bud- get allocation shall be approvgd by the Ooard, the City and the county prior to any such,oxpendittre. It shall be the duty and respondibig ty Of-the.Board during each fiscal year to engage an independent audit14 firm to make an audit'of that fiscal yoar, ' such engagement eont;act, or letter, Shall be approved.~ointly by•,Nhe City and County, as to its terms, and it shall provide that.,true copies o! all audit reports and mat- erial, including the auditors managemsnt`letter and confidential information, shall be furnishad simulEanaously to the bond, the ,City and the county. ' 1ha.Board may appoint advisory committees, to serve without compensation, under terms and for purposes whidh said Hoard deems proper. 'All oo.nmittees other than advisory shall be as provided in the By-Laws, Aii meetings of the Board and its Cxeoutive Comraittoe ahal; be open to the public aecord.ing to the provisions of the Open Seedion Act, Texas Revised Civil Statutes, A.rticla'6292-17, as amended. „ rYI, r The. Hospital Administrator shall have the authority and rea- ponsibility to do any and all acts necessary and apol-opriate in the administration one, operation of Flow Memorial Hospital with in the framoworh of the policies not by the Board in Its by-LOB and by posolution, The line of authority from all employees d1nd poraonnol of tho;hospital shall !)*.to and troA nail A(iminfotrator, f who shall, appoint and dinoharoo all hospital snl,ari'od poraonnol, ..and employees, provided that the Board must appvovo the appoint- mont of the Anaintnnt"Aothiniotrntor and the Compl;rollor (Cmntrollor); ' •rl'~• r M'..r4114' A'i`rM11YY~4,,,~f., %~•,V I !51[jM1JiQI I ' " I Who shall cash or both bo ontitlod to n hearing beforo the;Of, prior to cliamissal by the Administrator anrd w,••• as sot' forth in the The Administrator shall 'nnch.month Y Laws, Vrovido the Board and the County with a s• r l ummary of aaaaunte and oxpendituros, thane d CA ty 1 with a Sist.of ;a11' accounts to be designatod iuioalleotible. The annual budget for each fiscal P Year of the hospital shall 1 rePazod by the Administrator and than the first day of }!a prosented:'to the Board no later Y Preaoeding that.-Fiscal shell present saraa'to year, and the Board the County a \ nd the city within thirty (30) days of tte receipt thereof, or no later than the first duy Of Tuna aeeding that fiscal year. Pre- The hospital budget shall be re considered a public r+►cord and be adil Y evsilabla st all times.' The budget shall set out estimated gcii't care and bad debt loss in one account aunts when date ' to be separatia acc- rminable by the County Medic 1 .gervicee Consultant. I The budget shall be compatible with'the Which shall di rganizat oional chant, vide tha hospital organization into daps an$ sub-dapartments. rtmsnta The hospital budget shall be consistent with accounts and method suggested by the American " merica n' Ho r spiral and a A u!!lcient in detail to shots al1'income, revs u es l an Pandituras of fr.7ds l losses, ex- r and salaries of ail hospital hsrsonni fiaeaj year of the hospital shall begin th 1• The 1. P 4 first day of, Actobor,and end the 30th daY o , Of SeRtcmber, V ; Ths I)Y-Laws of tbo hospital, and all amnndmanta be propared by `he. Board and aPp'rovad by the city. thoraYr, shell and the County i prior to adaption. i 8uch Y Laws shall be mado pursuant to the terms and conditions of this 'contract, and gonorallY,'[o11ow ouidolinon,astabliahod thora- s f for by tho Amarican uaapital Asnociat,on. I 4J- 1 , fego ?4 t. r, a .wr. ~y. , , ..GYM.-r"".L~LMwl~fw. •P /-r •r..r. ...r r, ~s A,copy of such Dy-LA" and omondmento shall be furniahod to the City, the County, and ~bo Adrainis'trator, : Dy-Laws, are superior to any resolution of the Board, and -no rosolution or othor act of the-Board shall bo contrary;•thoreto. , VI. The transfer of the funds approved by the City and the Countv,i upon acceptance of the regular annual hospital budget, shall be .'made to the Board in one of the' following manners 'in cash on or be- fore February 1 of the approved budget yeaxr or, not lees than 1/12 of said sum on or before the lst day of each month during such bud- get year; or, in three (3) equal payments at 1/3 each, beginning 'February 1 of such approved budget year. 'rho payment option ahall -be made by City and County, respectively, at the tine the budget is finally approved. VST. The Board shall.raquire bonds,of the Administrator, the Assist- ant Administrator, the Comptroller'(or Controller), and of all other .hospital employees who receive ox pay out any monies of the hospital. The amount of such bonds shall be determined by the Board, and the coat thereof shall be borne by the'hospital. No quch bonds',' however, shall be for less than Tan Thousand ($10,000100) Dollars, . This contract shall remain in full force and affect until amend- ed or terminated by a majority vote of all of the three parties here- too separataly, unless sooner terminated by the dissolution of the organi2ation under Article 44941•l,by joint act o£ the City and County. y Such dissolving of the organization shall automatically terminate this 1 i 1 oontgact. _ Ix. This contract to become offoctive on 'October 1, 1911, when approved by all partlos' horoto. raga 7s 77''.~•''._~.. wl,~r{ A'1'!: 1.4 j'MT+rl+e!Y~ xw+7 ;w+.~ ..ILiY . w ,r z 1'..1; !-r X :,.Ms!6Y •.yl1"~'+K••r-S•~,. • I i•,/\' 1.14' r4ronavF~ V1l` J 14iY Yf1, dYy GL~ VuSy1 14F,~ 1 I ♦i ' 1 'I r oaV Nwrc !I I ylw..• s ~j'•~(~/ Da:;:o:; acsu:~ , MINTY h !r« p: C: 0 d MINTY f~ , • 4 . OGs0?` ),r «S.0l;s?t9l ; ~l vs-sinn rlnr,ri r , ,1 ,'•1 . ' ' ' yy1.ao-lnot : a. 1 ' e 06 n , 1 • `1k~01'tdE~• L,ry\4il 1. V.z.ILt~Sj~Qli.t . ' ~ • ' 1 , ' Vil .,fliwl y,+IwwrrY wl~n«i - t •II' ' ' • I '1 YYY.Iw,~'~VVIYLY f $1?PItoVCO h1sSn g~~ d+Y o! ~ ~ , ! ~ . . . , .'.-•----...L~wll 1'091. s CY1'Y, 09 '1 !7~!! " , . y /nail y+r(CrJ/rJt Cdurq~nn F". I ` , , . ' (G.~rt NwwdZ;~ 1. 1~{b' L1l I\4~'l~""-""' ' I. \I. • 't DRI ROlSl.r VI Cilt~~l'JCt'~'.5~0C\u ~~~Nda 1 I r i 1 ~ D>:LL J , l;3U, CounaSlnan - . fiALU J., 4h7;7~Y, Cdlsnetihidn ; APbROVCD titie day e~ 1 14910 YW,wr«Y.WrI 1. , DOARd' or of,tr.c7imu or . hLOU 'tpt41;,J. I:U'- 144L LIT ! • ~ rtll,/ CU'~lILI:l:•, ill LitUl::rl\J, JIJ'H'411dnCr ~ - ' , I , •I~YI.111 ~ ' ~ II lsu ,Srtsr,il rhl+t~rf:,f!/ ice' ~ ' v Ct'IhA W~.«A,I~Y>;F~. - J I L"V.Lf lYfYw:~`il+aL~1U.~r' r v.ru M, ~lwaZ i '~'.'IrwSew~.h lyl •r, ~t'I~g74/ '•'~.,tA. .t~,tr ."YXh l ;»y"3.fJAt^►''~!41l•: !.Ynrt'i0`.ljk3{!(r~11~ i el>Y»rr I 1 , .w fir., y, • ~ ' ' ~IQiI~.( ~Yl~ r~C„7•'n ' ti~•1•~X.~nwins'1l~} ,annr,.uen ;n, a ; i I . ♦Ih~' Y. 1 1 I'IIRS,,PAUP 1•DS il'SOIr' X004' ' fI I♦ ~ 11 1 1 1 ' 1 •~NC~. ow,T..illj SY I F.~+•Y~ _ ~ N,7'7 • ♦ ' . "r fix: ♦•i«.,,.. - ~Wlvl I rjK~I 9 I r r A RESOLUTION by the City Council of the City of Denton, Texas, relating to making pprovision for the operation of the rlow Memorial Hospital, WHEREAS, the City Council of the City of Denton, `herc,tis, and the Commissioners' Court of Daneon County have htlretofOra executed a contract affactivo October 1 .411 uhtroby both political subdivisions agreed to provide ,jointly 4 fundsrfor the operation of the Flow Memorial Hoapitall and WHEREAS, the Denton County•Ctty of Denton, Texas, Hospital 00ardi the operator of said hospital, as the ,)oint agent of saiJ'uity and County, is in the proca,aa of authorizing the isstianoa of bonds in order to provide for hospital impprovemants, and•tho prospective purchaser o! one of the series o£ tionde has requested the existing arrangement of the City and County i be clarifiedi now, therefore, THE COUNCIL OF THE CITY OP DENTON HERESY RESOLM : S CT10N The resolution heretofore edoptod by the Commisu onars Court of Denton County, Texas, s true copyy of which is attached hereto as an Exhibit (and made a part heroof r h for all purposes) is hereby approved, SECTION It The Mayor is authorized and directed to (i) furniai`h a c'artified copy of this resolution (with its attached Exhibit) to the County Judga of Dahton County, and (ii) ign a copy of the attached Exhibit showing approval by the City of Denton, Texas, through this governing body. SECT10j~ ji This resolution shall be in (ores from and j a after -r s passage and is is so resolved, N PASSED AND APPROVED, this the 7th day of October, IM, E; ayor, ty o anton, exas ATTESTi • a ty seeratury, ty o ,intan, Texas I (CLty Soal) 'r F N } i 1 s y' ~wra.r~~.~y. r. ~+•r.~r rr~wr•ryu wV•. r.y rr • 1~ wrru•. . •r rwwYtr.w •rti•~r.r'r~~• r j . r • r F r Art. 44941 HEALTH-PU13LIC Title 71 w 9"I'd of Mmutl Mrs of oltycounly hospi. 1 Purchases and contracts Asti was; not ryuired to ex"uts bond condl. Atoned aratnst lost of county funds trans. A board of rnenarere of a Ollyeounty Ierred to such board, but beard members hoepJtal, operetlnll pursuant to this article, were liable for any ritisappllalion of funds did not haw to adyertlse top bids for pup. and wen to follow all appliable statutes ehue of n,aterllla and supoiiee In exeeas matins to u/e sad dare of Aub114 funds, Of 1180, and was not re0ulrsd to adyertise op,Atty.06h.1011, NO, V-904. for bldg en sehlraou In 1x6646 of 11,000, 51atlmunt 14% rate which eouhl he levied oO.Atly.oen,3111, Vo. V-111, by 00ra Uetoners court of War County The provlslone of arts, 1161, 1160, and ton b081111 i Purpaa In 60nnOtion with 21181 rel"Mil 16 btda (Of material and sup• )Wnt operation of tttentorlal hosoltAl with piles and to the reyulrernentl soy/rhlar i - city of San AMOn16 was not to axe*" too AdMIllinr for bids by oouattle and cities, On 1100 valuatlop, Id, do not apply to A eitycounty hospital a• Iacarporated city and county jointly labllshed pursuant to this Article, op, Atty. MAJrlWMA a CQn111Q, \o, 1V1V-11 t red operating haPltal under OQ, statute were not liable for damns for The ComrnJstloners' COUrt of NOlan COUn. peraenal Inlun61 sustained by employers, ty May I*nllY approve And ratify 4 Ore. while PerfOrmlht dullee in connection Mth vlous unauthop(ted expenditure of the hospital, cawed by 114914"0* of 6111e6pa Hoard of MAMMA of a Oity.Oounty hose . i sewanU, Or QmploYerM 0p,Atty,04n,1161, tal If they in Ilp Id, No, V-lUl, , Art. 44941---I. Joint oountydlty hospital boards a Resolutions oreitting bonrdl,t des! Bastion Section I. The commissioners court of any county, and the gov- erning body of any city (Including any Home Rule Chatter City) lo. Gated wholly or partially In said county, shall be authorized to adopt ` resolutions creating a joint county-city hospital board, without taxing A p Igz owers, to constitute a public agency and body politic, and to be des. B ardd' the „ County-City of Tess, Hospital ; blreotOrel nppolnttnentl boards os eepamte endties Sec, 2, Said Hospital Board shall consist of seven Directors, to be x appointed and serve as hereinafter provided, and said Hospital Board shall constitute a joint agent of said county and city for hospital pur- poses, and shall act solely for the joint benefit of said county and city. Although acting sa such joint agent,.said Hospital Board shall constitute a separate entity in the exercise and performance of the powers, duties, and funtations authorized by this Aot, and with refer- t once thoreto said Hospital &4ard shall set and proceed independently, and nay sue and be sued separately, in its own name, capacity, and behalf. Terms of dlrectorsl reitnbursetnent for expensed ehairntnn And sedretury'l oftlders Sec, 3. In the resolution of the commissioners court creating said Hospital Board four Directors of said Board shall be appointed, with two being designated to serve for two-year terms of office, and with two being designated to serve for one•yeav terms of'office, At the expiration of the term of office of any Director appointed by the ' 42 Y4 i f. t f 14 . . Ch. S COUNTY HOSPITAL Art. 44941-1 commissioners court, said commissioners court shall appoint his suc- cessor to serve for a two-year term of office. In the resolution of the governing body of the city creating said Hospital Board three Dirac. tors shall be appointed, with two being designated to serve for two. year terms of office, and with one being designated to area for a one-year term of office. At the expiration of the terns of office of any Director appointed by the governing body of said city, eatd gov- arming body shall appoint his successor to serve for a two-year term of office. It is the intention of this Act that at all times said Hospi• tal Board shall consist of four Directors appointed by said commis. stoners cotrtand three Directors appointed by the governing body of said city. All Directors shall serve until their successors are appoint. ed, except-that in.'the case of any vacancy the unexpired term of of- fice shall be filled by the appointment of a Director by said commis. sioners court oz' the governing body of said city, as the case may be, which appointed the Director whose death or resignation has caused the vacancy, All Directors shall be eligible to succeed 'them. selves In office. Directors shall not receive any remuneration or emolument of office, but they shall be entitled to reimbursement for their actual expenses incurred in performing their duties as birec• tars, to the extent authorized and permitted by the Hospital Board. The Directors shall elect one of their number as Chairman of the A Hospital Board, and he shall preside at meetings of said Board and perform such other duties and functions as are prescribed by the Board. The Chairman of the Hospital Soard'shall have a vote the same as the other Directors, 'Che Directors shall elect a secretary of the Hospital Board, who may or may not be a Director, and who shall be the official custodian of the minutes, books, records, and seal of said Board, and who shall perform such other duties and functions as are prescribed by the Board. The Directors shall be authorized to elect any other officers of said Hospital Board as they deem 'neces- sary or advisable; and said Directors shall be authorized to appoint or employ such agents, employees, and officials as they deem necea• sary or advisable to carry out any " power, duty, or function of said , Hospital Board, Said Hospital Board shall act and roaee,i by and through resolutions adopted by the Directors, and the affirmative vote of four Directors shall be required to adopt a resolution. Aequlli4lon of hoepItAl rmilltteel purchase or stile of propertlt donations Sec. 4. Said Hospital Board shall be authorized to purchase, con. struct, receive, lease, or otherwise acquire hospital facilities, and to Improve, enlarge, furnish, equip, operate and maintain the same, t Further, the Hospital Board shall be authorized to own$ hold title to, l receive, encumber, sell, lease, or convey, any interest In real or person. f Al property, Includint gifts, grants, and donations from any source. f" 48 M J t; t i t 941 HZALTH- PMLIC Title 71 xrsnsfer of hospital f"111Hes W boards; contrasts for care and treaansnt of needy patients, federal and state funds Sec. d, The county and the city, respectively, which created said Hospital Board shall be authorized to lease, or to convey and transfer the title or any other Interest in, all or an ctllties, including all real acid personal toy part of their hospital IA. said Hospital Board, upon such terms apndpeonditlonsina thereto, to be determined by the parties. It is provided, however, if that said Hshall o$, pital Board shall not be authorized to encumber, sell, lease, or convey Any real or personal property unless such encumbrance, sale, lease, or conveyance Is approved, prior to the final consummation thereof, by resolutions of the coma lssioners court of said county and the govern. ing body of said city, respectively, Said county and said city, respec. tively, further shall be authorized to enter into contracts with said Hospital Board for the care and treatment of indigent or needy pa. tients, or for any other hospital services, and each shall be authorized to expend money and make payments to said Hospital 8~ard pursu• ant to such contracts, and to levy ad valorem taxes, and to pledge any of their funds or resources, for the payments to be made under said contracts. Said Hospital 'Board shall be authorized to apply for, re- ceive, and expend 'any available funds from the federal or state gov. ernrnent for hospital purposes, Purther, said county and said city, i, respectively, may adopt resolutions authorizing and designating such Hospital Board as the lawful agency to apply for, receive, and expend any available funds from the federal or state government for county or city hospital purposes; and to the extent of such Authorization the Hospital Board may apply for, receive, and e\rpend any such funds. Bond Isaus Sec. S. For the purpose of carrying out an lion authorized by this Act, said Hospital Board shall betAuthorized to issue its revenue bonds to be payable from, and secured by a pledge of, all or any Part of the revenu Hospital Board and the hospital f oilltes, Income, said resourtet of the Said bonds MAY be additionally secured by mortgages and deeds of trust on any real or personal property, and said Board may authorize the execu• tioe and delivery of trust indentures, or other forms of encumbrances to evidence same, Said Hospital Board shall have no right or power whatsoever to levy taxes of any nature, and All bonds issued by said Board shall contain substantially the following statement; "The own. er hereof shall never have the right to demand payment of this obii• gation from taxes levied by said Hospital Board,' If o the proceedings authorizing the issuance of the bondssa yo required Part of the proceeds from the silo thereof may be used for payirtg' in. terest on the bonds during the period of the construction of any hog. 44 4 (1 xU'Wa, . rti . $j `a ~ Est ~e4~ .1 j Ch. S COMTY HOSPITAL Art. 4494i- I Pita' facilities to be acquired through for the payment t of f operation the issuance of said bonds, and tal and fa`tittles to the maintenance expenses of said hospi- gal extent, and for the period of time, specified in said r the principal oP and Interest the payment in o l creation of reserves for the invested, until needed, to the extentbnds; and such er provided may a Y. the Bond Resolution or an and in the manner p in I therewith, any trust indenture executed In connection } 7 Ynre+elt rarer wddillonai r Sea, 7. Said bonds may be issued to MP&HtY bonds ature serially or otherwise within not to exceed 40 years from their date, and may issued s bear interet at any rate or ratan not to exceed and the authoriyatiop of any such bonds, the Directors roe . ,o per annum, I i the subsequent issuance of additions! ari y provide for r lien bonds, under such terms or'dondi 1l PA as mangy' or subordinate i proceedings atrthorizin Y be set forth in the g the issuance of said bonds, all within the dis• oration of the Directors. Said bonds and any interest . taininr thereto, shall be negotiable i nstruments coupons seder bonds may be made registrable as to principal alone ord43 to both 1 principal and interest), and the MAY be F maturitq, and may be issued In such o m&da redeemable prior to ner, and under such to , denominations, and man. 1, Conditons, and deWlt cuted, as provided by the birecttlrsiin the pr de dings authorizln th issuance of said bonds. , and shall be axe- sale and at a Said bonds may be sold at public or private shall,b the Directors, price ovided that the interest cost to said edete o , includta W B by g any discount on the bands, shall not exceed 6%pier Board, calculated by the use of standard bond interest tables currently In us bYins ~ p annum urance companies and investment banking companies. e ApprorQ of bond lotus Sec, S. Notwithstanding the foregoin Hospilal`goard'shall not deliver my said Of bonds unless, the issuance there. ° approved by resolutions adopted by the co said eountYand the governing body of said ci stoners court of ty, apectively, Sec. Q, ~"f+ for rsr► M and faoWtiee All hospital facilities of said Hospital Board shall be oiler. ated for the use and benefit of the public, but it shall be the duty of said Board to establish And collect sufficient charges for services an facilities, and to utilize all other available come, iri order to atlable sources of revenues and In. operation and pay all expenses in connection with the ownership, a pal of and Interest non its bonds` and totCreaeteUand ~mat pay the prinel, and any other fLWds as provided In the proceedings authorizing the 48 s { .n , .•t Art. 44941-1 REALTH-. PUBLIC title 72 issuance o4its bonds, In the proceedings authorizing the issuance of its bonds sold Hospital Board may prescribe systems, methods, rou• ' tines, and procedures under which its hospital facilities shall be open. ated and maintained, \otlts Of bond romotutloel petition for election, adoption of bond r+nolutlon Sec.. 10, (a) Before authorizing the issuance of any bonds, other than refunding bonds, the Directors shall cause a notice to be pre• pared stating that the Directors of said Hospital Board intend to adopt a resolution (herein called the "Bond Resolution") authorizing the issuance of bonds, on a named date, and stating the maximum amount and maximum maturity thereof, Such notice shall be pub- Iished once each week for two consecutive weeks in a newspaper haw ins general circulation In the county and the city) with the first pub- lleation thereof to be made at least fourteen days prior to the date set for adopting the Bond Resolution. (b) If, prior to the date set for the adoption of the Bond Resolu• tion, there is presented to the secretary of said Hospital Board a ped- tion signed by not less than ten per centum (100,5) of the qualified voters residing within the county and any part of the city which Is not within the county, praying that the Directors order as election be -hold on the proposition of the issuance of the bonds, such bonds shall not be issued unless an election Is held and such bonds are dilly and favorably voted at said election. Such election shall be called by the Directors and held within said county and any part of the city which is not within the county, substantially in accordance with the proce- dures proscribed in Chapter 11 Title 22, Revised Civil Statutes of Tex. I as+ 1926, as amended.' If no such petition is filed, the Bond Raso)u- tion may be adopted on the data set therefor, or witbin not to exceed thirty days thereafter, and the bonds may be issued and delivered without any election In connection with the issuance thereof or the creation of any encumbrance pertaining thereto. It is provided, how- ever, that the Directors may call such election on their own motion, If they doom it advisable, on the proposition of the issuance of such bonds, without the filing of any petition, ' Artleu rot tt iea. . Xxemlbation and approval of bonder reotr►eloo. Sec. 11. All bonds permitted to be Issued under this Act, and the appropriate proceedings authorizing their Issuance,' shall be submit. ted to the Attorney General of the State of Texas for examination. If he finds that such bonds have been authorized in acoordance with this Act he shall approve them, and thereupon they shall be regis- tared by the Comptroller of Public Accounts of the State of To!.as; and after such approval and registration such bonds ahaU ro Incon- 40 ti Ch. s . COUAWY HOSPI'T'AL testable in any eoult, or other forum, for any reason, ,an 9a11W I . valid and binding obligations in accordance %rith their terms for all purposes. Refnndiag bonds $ec I2, Any bonds Issued under this Act may be refunded by the issuance of refunding bonds for such purpose, in such manner as may l be determined by the Directors; and any such refunding bonds shall ) be Issued as provided herein for other bonds authorized under this Act, except that the rep#uitding bonds may be Issued to be exchanged for the bonds being refumded thereby. of Public Accounts'sUl register the refunding bond$ and d liveroltlhee same to the holder or holders of the bonds being refunded thereby, in accordance with the p'rovisioM of the proceedings authorizing the re. funding bonds, and astq such exchange may be made In one -delivery, or In several installment deliveries, Bonds nr 102W and authorised investment t { ;Sea IS, All bonds Issued under this Act shall be legal and autho. razed Investments for all banks, savings banks, trust companies, i building and loan asaoclations, savings and, loan associations, Insur• ! arcs companies of all Idnds and types, fiduciaries, trustees and guardians, and for ail interest and sinking funds and other public { funds of the State of Texas amd all agencies, subdivisions, and instru- mentalltles thereof, Including all counties, cities, towns, villages, school districts, and all other kinds and agencies and bodies politic. Said bonds also shaes Of distHotso ll be eligible and lawC fuI'security for all deposits of public funds of the State of Texas and all agencies, subdivisions, and instrumentalities thereof, including all oountles, cities, toms, villages, school districts, and all other kinds and types of districts agencies, tent of the valuo of said boni ds, whenaccompanied politic, unm turgid Interest coupons appurtenant thereto, j nepoerwr~ Sec. 14. Said Hospital Board may select a depository or deposito- 1 vies according to the procedures provided by law for the selection of counts' and city depositories, or It may enter into a depository Con. , tract Vith any depository or depositories selected by the county or the I cltY# and on the same terms, Exemption of Wilities from taxation Sea 16. Recgniziiog the fact that all hospital facilities of said Hospital Board will be held for public purposes only, and will be do. voted exclusively to the use and benefit of the public, such hospital faeWties. 14a11, be exempt from taxation of every character, 4? • r~ r „ k C ,r Art, 44941-! HEA1,TH ptrelIl; ? Title 71 • rmid$nt doMAlp 5 Sec, 18, For the purpose of carrying out an function authorized by this Aat, said Hospital Board Power, shall have the right to acquire the fee simple title or any other interest in land and any other property by r 82 condemnation in the manner provided by Title , Revised Civil S tatutes of Texas, 1928 to counties eminent and domain, cities Said d Hospi , as amended), relating tal Board shall have the salve rights as uner Article 3288, as amended, of said Title 82 The amount and character of Interest in land or other property thus to be acquired shall be determined by the pirectors. t.wta• tits a ,tp, Inrsstntape of lurtds Sec, 17, The law as to fu the security for, and the investment of, nds of counties and cities shall~be applicable to funds of said Hoaof .l r~ Board, The Bond Resolution, or any trust tai indenture executed in ment of funds of said Hospital shall have the p Board,ricAlso, said ospitAl Board ower to invest all or any part of the sand invest. proceeds received from the sale and delivery of its bonds, until such proceeds are need- ed. In direct obligations of the United States of America, to the ex• tent authorized in the Bond Resolution or an - ad in connection therewith. Y trust indenture exeout• " C roulaure etteeti conflicting laws See, 18, This Act shall be cumulative of all other laws on the sub. Ject, but this Act shall be wholly sufficient authority %rithin itself for the issuance of the bonds and the performance of the other acts and procedures authorized hereby, without reference to any ether laws or l any restrictions or limitations contained therein, except as herein spe• clftcall Y provided, and when. any bonds are being issued under this Act, then to the e..,ctent of any conflict or inconsistency between any provisions of this Act and any provisions of any'other law, the provi. Mons of this Act shall prevail and control , provided, hoivever, that any Hospital Board shall have the right to use the provisions of any other laws, not in conflict with the provisions hereof, to the extent convenient or necessary to carry out any power or authority, express or implied; granted by this Act. Acts less, 89th'legg„ p. 1030, ch. all. t 7114 of Ace, X"torieal Net$ o• to said ~olnt A0•01W beardtl prorld• C• An Act suthoMllng th• artatlen of lolnt "144 Me for 1M control, operetlen, UntY~dltY hospital sea tdl, tvlthout taxlnr U••, and fueolt"I. of Yid D•Wr'•t provldlnr for peWr• du. tUnatlons of count," And aIN•lp W4 Ad boards, Includln lolnt b0lpltal M ¢8 and dtltver revnu• nd$, 0MIdles for l; i .Art. 4494c-1 H"TH-PUBLIC MALTH-P1 Art. 4494c-L Use of honplts) operating funds for Improvements to hospitals in minutes o/ saf counties of 23,000 to 23,100 all or any par In All Court* It this State with not less than 23,000 inhabitants or more than close the hosp 23,100 Inhabitants according to the last preceding federal census, the Commission. ` OY hospitr ers Court may use excess money in the county hospital operating fund for making county shall b: permanent improvements to the county hospital and for the payment of county bonds Issued for the eonstrmotlon and improvement of county hospital faculties: Sea, 2' Y Amended by Aota l781, 67th Lek., p, 588, ch. W. 6 117, W. Sept. 1, 1931. operisUitc ILI I Art 4496-L Joint county-elty hospital boards such county th • • • • • • • • • • to ft atime a, which date she Sea 15, Repealed by Acts 1979, 66th Leg„ p, 2129, ch. 841, § 6(a)(1), off, Iron the data Jan. 1, 1982 such time and said county an • • " • • • • • • • • selling or leash Section I of Acts 1919, 66th L'eg., ch, $41, hospital lot constructlan of a medical office of their right t action the coat regealing 13 of this. anicla 9'natied the building by private Individuals, Conn Art a week for tv PtOPOMY Tait Coda constituting Title I of 3, § $2. requlret that the lease serve a public the Tax Coda purpose and provide for payment of ede considering suc ' quate rentals. OP.Auy.Oen.1917, No. H- least fourteen 966, there is no net Notes of Deds(ons Absent valid contractual orraagaeents, given by postir t ge+tKal 00111011 County is liable for medical gapenses "YO prior to t InOUrmd In treatment of county's resident a l This article aufteaes the CIty.County indleonts at elty-county hospital, Op,Atty, I' I Hmpful Board to Iftm land adjacent to the Gen,1979, No. W%V-33, Sea if[ Catlrt, as man; coun Art, 4494J. Salo or lease of county hospital In counties having assessed valua• ty shall tion under $26,000,000 dm vote the t Any county in this State having, an assessed valuation of ro'et t for ad leased or shall Court valorem tax pu set of lest than Twenty lfllllon Dollars ($20,000,00) and having or lease tlhe not a county hospit~belonging to said county and operated by such county, may, and sustained by a such county Is hereby authorized to sell or lease such hospital, provided the held under and Commisdioners Court of such county shag find and determine by an order entered Statutes of 192 In the minutes of such Court that It Is to the beat Interests of such county to sell It such or lease said county hospital,' The proposed sale or lease shall not be considered pet Court v lIn rfuy p i by such Commissioners Court unless and until said proposed sale or leads shall be W approved by a majority vote In an e(eotion to be hold in such count for the cour cr person purpose ofd y court i n person + etarmininqq the will of property taxpaying voters living In the county, such county hap; ; n reference to such subjeoL Such oleotion shall be ordered b the Commissioners Conn of any such county upon petition of not less than ten by cent 10ne of such time time as; i voters and shall be otherwise held under and govarned by the election provisions hearln~ the Cot of Article 4418, Revised Civil Statutes, 1925, of ,he State of Texas, such de h petition It E • Amended by Aosa 1979, 68th Leg,, p• 2:116, nh, 841, § 4(b), oft. Jan. 1, 1962 itt discretion sit ~ • Section I of the 1979 amendawry act en• ` its final detertl gets the pro Tnri Coda constituting T1 - Us I of the Taz cods. a' 1 Sin 4. If Art. 4494L Sala lease, or closure of county hospital by county been the C given, , nven Afon" Text of article as amended by Art 1982, 67th Leg,, p, 2263, ch. 583, § 7 such hospital wt o I Authority ao sell, )ease, or clew Court MAY Maki Section 1, Any county In this State having a county hospital which Is suoh county has j operated by said county, may sell or lease such hospital, provided the Commission. authorized and i ; ers Court of sold county shall find and determine by an order entered in the hosPlfal by the 4 0 4.0" "a I I" +ell!hs!RI;e.+ y Sim f r L 1!111,1 15~111 R t 1 r 1 y• 0 ILL , I P!2 irlF'ACIr INTRODUCTION AND BACKGROUND This Statement by the Nailonul Council on Gov. ernmental Accounting (NCaA) pruv(doa authnrliutlre 1) Accounting and financial reporting for state and forth . guidance on defining the governmendutresalareprenrtinguw fnllened• 10001 e Nut lonOmt., guided G by the principles nset Accounting uncll Illy, The NCGA due process procec (NCGA) ll Statement 1, In CoVer n deelMernn uthis nm,m bi, The NCOA of Ftissued a is. and F'inanc/ul Reporting Principl s t Issued cIn u1979~ cussion be,morandu1m, MIn hearings f ep the Issues Through widospread acceptance, Statement I and sub. rased In the discussion moc werq held a sequeni NMA pronouncements Oro acknowledged as April 1981 NCGA dellbcmatmor including co d In the primary authoritative statements of generally ac• Lion of comments recelved on the discussion memorun. Cepted vernmertts, principles a esec rl ip state do and dam. led to Issuance of the Juno 1981 "Definlilon of local a expl cif Sul However, those ae "reporting p`not Reporting Entity" Exposure Draft. Comments on thus provide explicit dance to defining the on. exposure draft led to further NCGA deliberations prior tfty" for governmental financial reponing, to the approval of this statement. 2) Nc'GA Statement 1 stares: "A comprehensive annual financial report env. Bring all funds and account groups of the gov ernmentul unit--Including app ropriate com• binod, combining, and IndivrTul fund state. notes schedufes;narrative f ezplan tiolal: and slat sti• cal tables--should be prepared and pub. Ilshed," This requirement does not, however, Indleate the or ` gonizutlons, activities and functlons to be Included or excluded from the reporting entity, 3) Statement I also uses the term ,entity" to refer to the level of aggregation to be used In the financial to. ports of a governmental unit; " the individual funds and account groups shotnid continue to by the basic why reported upon In the CAFR (comprehensive annual ti. WOO report), but that the primpm reporting entity focus of separately issued OPPS (general purpose financial statements ► should be upon fund type and account group financial Informa• tion. ' This statement considers onl)- the orgnnizations, oc• tlviiies and functlons which shauid to Included in OP S, 4) The NCGA believes that the crileriu fur defining the roporilog entity of a governmontul unit should he ' established to clarify the argunitutiuns, functions and acilsities of povetnmont which should he Includod in the ganerul purpose finonclal stulemunts (QPFS)'of thul governmental unit, In pttrticulur, there is u need fat otilorki tot Inclusion ill the finuntlul siaiamunis of u reporting entlly wllh a separaiely~ elected lugisiutlvc body of finunciul data on sopurate agancios of govern, must, such is puhlle authorities, whose officials are up- pointed ralhorthan electod, S) The NCGA believes that critoriu fur defining ihv reportinp chili), should he developed fur S0,41Nl reasons. Among these arot A) Compwrubow,v, users of (inunelal teponK mu), wish to muku comparisons umuttp units of gov* NCGA ATATIMQNT 3 4 PAN i i_ a ernmgnt or between time periods for a given nificnntly influence operations and accountability for government, Critertu for the Inclusion or ex• fiscal matters, Oversight responsibility implies that a elusion of units of government would- assist governmentul unit Is dependent on another and the do. users in making such comparisons, pendent unit should be reported as parr of the other, B) Comprehensiveness. Criteria for defining the The manifestations of oversight responsibl1hy are des. reporting entity would help the users of the fi• cribed in paragraphs 10 and 13, below. nancial reports by reducing the possibility of arbltrary exclusions or inclusions of various or. 10) The most significant manifestation of over. gganizations, sight-which ordinarily Is accompanied by other as. C) Responsibllily a dcontral, Users inicre tted in pects of oversight as described In paragraph 13-is fi• evaluating the performance of governmental nancial Interdependency. To the extent that a separate entities need to be able to identify the opera. agency produces a financial benefit or Imposes a finnn- tions for which their officials are responsible, cinl burden on a unit of government, users of financial Specific criteria for the reporting entity Inclu- statements need to know the mcgMtude of such activhy sion or exclusion can help fulfill that need, and Its present and prospective impact on the reporting entity. Manifestations of financial Interdependency in. elude responsibility for financing deficits, entitlements rte' ENTITY DEFINITION CRITERIA to surpluses and guarantees of or "morai responsibility-' for debt. 6) Several different sets of criteria for defining the reporting enflty have been proposed. The NCOA be. 11) There may be circumstances where factors other liaves that specific criteria should he established since a than oversight Lire so significant in the relutionship be. concept without specific criteria may he impractical for tureen a particular agency and a reporting ontify that use In Implementing a definition. exclusion of the agency, from the reporting entity's 0. nancial statements would be misleading. These other 1) The NCOA believes that the definition critorla factors Include: a) scope of public service (defined in should be broad enough to include all governmental ac• purugroph 14), where there may, be only partial over. tivitles, organizations and functions necessary to sight; and h) special financing relationships, where achieve the desired objectives of comparahlllty, com• there is no oversight, There muv also be circumstances prehansiveness and responsibility and control. A broad where the deggroe of oversight is so remote (as In the definition may cause inclusion of some sepurato ugcn• case of eanuln Industrial 6velopmettt corporations) clos that have riot boon previously Included by nil re- that the relullonsh(p of the agency to the entity is best portinp entities, However, the NCOA believes that a described In a note to the flnanctul statements rather broad deflnitiun.Is necessary to provide users with all thunln the financial statements, necessary informodon 8) In 'developing the reporting entity definition APPLYING THE CRITERIA criteria, the NCQA assumed that all functions of gov ernment sire considered to be responsible to elected of. the )2) 'rho g NMA criteria believes indicates that a that pohe Agncy hoe to ficials at the federul, slate or local level. Therefore, all included ncluded I rhe the CO should functions of government must he a part of either fed- ni In the reporting entity The NCOA recop. eral, state or local government and should be reported nnes that professlonol Judgment is necessary In looi- at the lowest level of leggislalive urthorlty that is consis• vldual fact situations to determine whether a particular lent with the criteria of this statement. There may ho organization should he included In the reporting cnttty. instuncos, other (Nun joint ventures, where It Is dlffic,., The Appendix includes several illustrations Intended t0 to determine whether the statcniontz of a specific sepa• assist in the application of these criteria. rate agency should be lncludud in the financial state- 13) MANIFESTATIONS OF U1'1l;RSIaHT, The moms of a stole or a particular local government of the state, Stow and looul overnmcni fiscal officials should following further guidance Is provided cancerning the confer to resolve such prubloms; a possible solution various manifestations of oversight sex forth In para. might be to Imeludo the uporiq in the financial state. graph 9. ments of one reporting artily and disclose it In the notes to the financial stutemunis of the other entity, A) Selectlon of po+erninp authority Thu govern. Ing authority Is thus person or pursoti,c. board, 9) The NC OA concludes that thr husk -hut not the Commission or other buds which pussehW,, final dvciston•muking oullinrity and Is hold only--crlloriun for Including u governmvmtul deport, primuril~ uvvountuble for decisions. Whon the monl, agency; tnsmuthtn, commission, public authority gµoverning uulhorily is uppninied b$ elected of. or other govgrnmentul urpunizntlon in a governmionlal ficluls, a determinallon mint be made its to unit's reporting onttty for gonetid purpose financial re- whothcr the appotntmenl Is outhorkadvo• One ports is the dxercise of oversight ruspunsihllhy over m'ude K on elected officiul prlneipulk hevouse such agporae, by the goydrnwritul unit's ulucted offb he or she is in an o1flelu1 rodlion, where the cluls. Over§Ight rospansibllit) Is derived from the gov po0lon (he person is uppo,nted in hus little ornmental unit's power and Includes, but Is not li tcd +.vtnllnuing tinhuge to the cleviod nineiitl te,it•, to, fipunclul Interdopendency, selection (it governing appointmentol u chuirmun for a churituhlu uo authority, dosiortution of nianagomcnl, ahllity to sig. 1lvlly), Is not authoritutlvvc, An uuihorituiise WE ! s NCOA STATEMENT 3 uppointmenr is one where the elected offlctul nutinNins it significant continuing refatianshfp disbursement of funds? With the u pointed effaelul with respect o10 f car, (Trust and Agency lypc funds would be included,) Who holds r} ing out important public functions. I►I tllle to assets? (Ownership of assets Would csignalion Of man>gement, The manage, indicate Who possesses the right ment of an agency consists of those Individuals adion• responsible for the day-to-day operations of to rre audits. (This may' show ability to control,) the governmental agency. When management 4) REVENUE CNAI2ACPERISTICS, Where is appointed by and hold accountable to a gov ern ng Authority At Is included in the entity, revenues are , In In contra means of a public the activity being managed will fall within the levy or charge, contrast to being grant ro• entity C01116. there should be the presumption to , A governing authority may be ceremo• Include the aggency's revenues or expondi• r niul in nature and not possess the powers of ap• lures within Inc reporting entity, For par, polntment over management, In this case, the Poses of this crherion the following defini• organizational edlationshlp must be examined, (Ions apply and the terms and conditions of an employer, ivmpksyae relationship should be used as an in. of „Public. " The origin of Aor for dicatlon of whether the Actlvlty should be In. making the levy or charge hliest?wl h rluded in the entity. elected Officials of the entity, or ersons t') Ability to signlncanlly Influence operations, pp peratlans appointed by the elected ofNctals, or The ability to significantly Influence n there exists should Include, but Is not limited to, the au• a delegation, but not on e; thnrfty to review and o Prove budgetary the to. rogation;ofthepowertolevy orchorge; yuesls and budgeter} adrustmenls and amend, the uuthorlly or power would Include the manes, sign contracts as the contracting au. b) " of 14 Ability Levy to determine the nature and type thorhy, apprOVe the hiring or retantlb of key of pax imposed or lee collected mono@ario! personnel, exercise control over a or charge, " The )mposition of a cinI1 and Personnel, monetary payment, the proceeds of Properties come or disposition of datermIne rel. which are Applicable to and for thebone. fit Of the citizens served by the level of Arco is of the services being provided, overnmenl Imposing the ley or charge. `t Acca+' for Meal matters, When abso• T-he yy lure authority over all funds is vested within termination ro levy would lncludo the do. the Jurisdiction of either a constitutional of. of the terms Of levy and as. floor, a many errant offlciul or a governing ou• tablishmenl of the method of administra• gg lion; flintily that is Within the entity, [he activity 14) SCOPE OF PUBLIC SERVICE, This erlterton should be included In the entit y When respon• fnr determining whether the statements o(a specific tsi for the fiew f of an agency is agency should be Included In the financial statements of outside the direct Cai purview of a governing au• thorhy or managemani deemed within the on. a reporting entity embraces the following aspects: • airy. Judgmanl is to uired to determine the line A) Whether the activity is (or the benefit of the re• of fiscal accountabli rY and lit appl)cabtllly to nrting entity and/or its residents, Including the activity within the entity, f3 Likowiso, (udpment Is necessary when the gay, ) %thor the arnin aclfvfty Is conducted within the g authority or management of all it l enc mu>>' flat be clearly within the entity, bulfiscal an f s generally ayutileblr to)the ciptizelns 1rAu actlsilles, or the results thereof, are directlyy to. Wed to Ir, When the lines of fiscal rrsponsibtll• IMPLEMENTATION AND I Ate nap Clvdr~ the following speclflc areas of EFFECTIVE DATE fiscul responsibilities should be reviewed in de. Per the the reporting of an np entity for IS) The criteria used in datermining the scopc of the purposes poses of defininimam g the porting entity: enNq' for financial reporting p crihed In a note to the (Inanctulrsatements 1Thc note 1) R the UDOE authorizations TARY AUTIJORIT VI, Who os• should refer to how the spccCI elements of oversight testes the authority for final approval over c1din slbfltty and other crhort'rlc a Were considered in de• ail ors'? Who of budgrlury appro ri, fr 9 whether In include nr exclude spdeiffc agencies may auihuriae rcvfsluns id the tram Iha amflly dehnition, In any Instance whereamtheree a)tnrovad budgot'1 Is u pes)thc response to rho rrhuNu set forth herein, the 2111 RPLUS/r)6ICITS, Who is res onsiblc Belly c reasons for excluding such t (OrI es tr th fat funding Mims and operating doficlem, emit} shall be disclosed, Iles" is this ruspunslblhty u legal Of u mdrul Iii) Legal one'? Who overns or ty ale ls'thr use of g theo ot should n at a l hnygt on- surplus funds? ifnw ere surplus funds d1s• tnr In defining g the repnnlnA ontuy, Al lthouugh gh Irituf ao pposed ail taints My exist, the NC'R bohevea that They do not FISCAL MANAbRMBNT, Who nverns pfUclude Implemcntallun of the 911111y definition lhr procuss controlling the collecllNun And wontdiu, nut Lupul ennt prccludr rulntimpls em mae ydting IhIAS tha de dufinhlreporrinpbut Woulun, NCGA 009MINr 3 - PA061 h t earitTr.{~.;,. %h '171 fmplamenwHan problems will vary and Jurisdictions, en gnificat ta ion P lem will va y and imuo e Ing the reporting entity dnce e Of ofrhho te pro criteria forma io the pre is required, In some instances there may tielu I may to note ous year, and the stgteme nts deviate from statutorily mandated reporting re ulre• Of Prior years should be indicated b} u Rents; In others the resppnsibility or authorhy to issue disclosure. appropriate foot• general purpose reports will be unclear, Therefore , h may be necessary to solicit the su and legislative branches nt both the rs ale and local level to effectively Implement dtese reporting entity criteriu. The provisions of this statement need not he applied to immaierial items l6) This statement slgll be applied prospectit•el to financial T statements for fiscal years ending after y t This statement was adopted by the Affirmative votes of Camber31, 1982, Earlier statements tot application I ding q t bDc- ut members Gornile, Farrell•Donaldson, not re r 31,d, These criteria for de onltfen of there on, phy, oust, g Qross, Ra Harmer, Ives, Man, S Mur Vaughn, Ing entity are broader than What many officials consid• points, Raftarv, Rogan, S embers, Schlaneorer, Vaughn, e rad the reporting entlly' in the puss; and camPurutive grounds that red t statements comparable with print years mn µailison and William,', vfe of the the Hay statement dissented are on the ecisio U not he difficult to prepare; (7ttsarnmcr+tul units should uty dance ordcd wit Preparers tempt s prepare pro forma financial statements a i Prand and sufficient goi• auditors fficient to provide usef ppvernmenial ul com• PP Y Prehonsive annual financial reports, f 3 0 10Aft14 NCdA 9TA7NM9NT 9 i t _ APPENDIX mu a 10 the land on which a The following examples illustrate the application of the museum m is sr 3) 1F coonstcityructed. holds al The title entity definition criteria to particular situations: nonprofit corporation which Is seum supported is pported operated by a through citizen Conte principally I) tas A school system is separately chartered city levies an annu al tax ibutions and endowments, The , however for the purpose of from the the city In which It exists The school system was Partially deferring the cast of maintenance of the established by an act of the slate legislature which de. museum buildingg andgrounds. The proceeds ofthis tax signated a school board the governing authority, are remilled to the nonprofit corporation and expended Members of the school boald are elected by the public. by it. The nonprofit corporation operates under the. The school board has control over hiring and firing em• governance of a board of directors elected by contribut• ployees, the power to contract for schools, purchase ng members and feasts the property from the city for equipment, etc„ and has the power of emineril domain. S1 per year. The tchooi (ward is Facilities of the museum are free to can. required b an act of the state legls• tributing members and open to the public for a mini. Wore to submit an annual budget to the city council for mum fee on weekends and no fee on other days, approval and Is prohibited from spending of Obligating Concses lusionth , of,e Thu properlyShould ids - funds in excess of the maximum amount dpproved by ptrpnbur the museum corporation is not. The sax levied f hapartrepo ofrt the Ire led f edcity entityi or Ire city council, Taxes are levied by the city council and museum are co~Jecrad and distributed to Ifte school system by Kevenue Fund If its purposes are so restricted, This the ell)-. The school system also receives funds from the fund should also record the distribution of the proceeds slate and county, The school board doeu not have the to the museum, addition, the notes to the city's ip authority to borrow funds or Issue bonded indebted. nth th statements s should describe the relationship ness, but the city,counell may and does borrow funds with the museum, and issues bonds for the school systems, Concluslon. The school board Is a part of the report. 4) Factst A ppublic benefit corporation was created Ing entity of the colY, even though the school system is by a city to facilitale urban renewal within the bound. Separately chartered from the city and is governed by arias of the city, A governing board is appointed by the an independently elected school Board. The overriding city and title to various properties transferred to the factors are: The cllyy~ counell is responsible for approv. corporallon, which then proceeds to raze existing struc• ing the school boa3s budget and establishing spending tures, operate temporary-use facilities (such as parking I(mitutions. The city council is responsible for funding lots) and provide addlllonal fnftastucture necassur to deficits. The city council is responsible for levying taxes attract new development. Ffnancing of Its activities ~s in and collecting and distributing the funds to the school the form 'of federal grants and city advances or sub. board, The school board cannot borrow funds, but the sidles in money and services, City advances or subsidies clry may and does issue bonds to finance school system In turn may be financed from the sole of bonds to be re. operatlons, (13ul a school distrlct governed by an yy taxes. elected school board might be Excluded from the city tfrConduslonttThn corporation Is p art of the entity If the city coundl has no approval authority over even though the majorhy of its financing may be pro. the school district's budget, is nor responsible for vided through federal grants, The overriding factors y financing the school dlstrlct's deficits and does not issue are; The governance is by city appointees, the public bonds to finance school district construction,) s the o: ervices rendered are wholly within the boundaries of 2) Faetst A public benefit corporation was created to benefitnhehc! y byireturnntgraroperty to Its f tax rolls by a city to provide' subsidized public housing In accor. and providing employment for Its citizens, The corpo• dance with federal legislation, The mayor appoints rallon's transaction, should be Included In the ell), en. members of the governing board for staggered terms; dty's reports and Its activities described In the notes to they, In turn, elect a chairman, The governing board the cily's financial statements, m log executives; authorizcs contracts of subsidy with the VS. Department of Housing So Urban De• ve)opment pursuant to the fatter agency's regulations S) Factst An Industrial development corporation Is and stullitory authorizations, and causes the cot ore. created by an act of the state legislature (or city coon. lion to construct, own and operate public housing facllf• ell) for the speelfic purpose of promoling and develop. ties within the boundaries of the 01ty, The financial Ile. Ing commercial, industrial and manufuciurfng entarpisu billly of the housing agency is essenlially supported by and uncourugfng emp)o}merit within the boundaries of t the operating and debt service subsidies received under the specific elf). The members of the board are all up, contract from the federal government, although see, pointed by the muyot, except for several other elected vices or cash subsidies may be, and from lime to lime officials who arc bourn members ex offic u, The luw no. are, received from the city as well, thurizea the corporation to Issue industrial develop. Concluslont The housing agency is part of the city en. Mont bonds after upproval by The tit}} council. The tiq', even though the financial support is Primarily pro. bonds do not constitute indebtedness ttf tikher the city vided by the federal government, The overrding fuc• or the stute and are secured solely by revenues rceelved tors aret The city created the ourporalton: the gover. from the commercial oftlunizatluns on whase behalf the nonce Is appointed by the elty; and the public seNVice is bonds are Issued. The clly assumes on responwhillly for rendered wholly within the boundurlesuf the cot) The the duytcs•duy opuruting expenses of the eprporailon; agpency's Itonsactiuns should he Included In the c~iyen• Such expenses ure financed by fees charged to the eom- Ipy's reports, merclul enterprises, dcaA arArlfMeNr 3 4 rAae e r Conatuafoftr,The corporation is not a part ofosthe sit entity since the city has assumed no financial r onsiy statement.) The corporation's transactions should o. Wit whatsoever for the corporation, The cop Ora. sration's hown as a debt service fund should be the epo and the wren. tion s activities and debt should be disclosed in a note oral long term debt o Count group of tihetddy. The cor• to the financial statements (But, where the corpora. lion's debt Is secured In part by the city's moral oblige. oveotation rsightlrelationship antdethe ~,morayabliga lon"ro. Lion to replenish the corporation's debt service fund, lationship; Its activities and the scope of the "moral ob• should that become necessary, or where the city issues bonds on behalf of an InduVrial development corpora' ingationt should be reported in a note in the state's fi• Lion to create a revolving fund to make loans to corn. nancial statements. 1 martial enterprises, the Industrial development corpo• B) Factst A public benefit corporation was created { ration should be treated as part of the city entity.) b y a state to provide mass transit (subwa)s and buses) 1 activ entirely within the al ' 6)' Factsi A county flood control district was created a CityiOf the )$-member board a(dire ctors, 11 are op. by stare stature as a flood centrel and reclamation dis• g g p oundariesof trict. It is a political subdivision of the state as is the city. Theo ity owns all heatransit faciliti s and provides o the county, and has the some boundaries as the county, capital construction funds for new facilities, Operating Since the creation of the district, the county has reiin• subsidles are provided by the city, state and federal quished all of its flood control and water drainage ac• tivilies to the district, The governing body of shed strict governments. Is (he governing body of the county Among its duties, en though The corporation is pan of the tit} s ap. majority It approves the district's budget, determines the dis• even though the ate and of the governance is some trio's lax rates, serves as the board of equalization for pointed by the state end the state t provides. some the valuation of property within the district for ad vol. oper rill ng subsidies, The overriding factors area All the Orem tax purposes, approves contracts and determines fadclhlles are owned by the city, the corporation is seer. when to Issue bonds authorized by the voters of the dis• IIsubsidized t n t city and the public son-ice is ran. Irisi The management of the district Is the res onsibili• dared wholly within the ho ndu a the The car. ty of the district's director, who Is apppointed by the ov appropria transactions should be repported within the erning board of the county. The district has 700 em. appropriate fund types of the city The cribed in the ployeas as compared with 6,500 employees for the activates and transactions should be described to the county. The annual g@en~eral fund budget of the district notes to the state's flnancol, statements rather than In. Is about $1S,CM,0(f0 as compared with about eluded in the state's financial statements. 5146,0R1,U0(1 for the county, Contlusloni The district is a part of the county mill tyFactat A n ty was ll corporation was organized o'r by since It is overned by county elected and Appointed of- p y a ci-.and the city wa the sole member of the en'rpo• llclals and is pcrformfng ss~sak Is essenllull • a normal g ration--for the sole purpose of conducting an elec. slals type function (Le., flood control within the Ironic data processing service activity. The city entered county's boundaries). The district's transactions should Into a contract with the sing son-lees; providing Permitting the be reported within the appropriate fund types of the tole o sc of data processing o r ental og the safe of such services to other governmental a picas; county. A capsule summary of the district's operations granting the city power to approve capital and opernt• should be disclosed in the notes to the county's finan• Ing budgets; and providing for distribution to the city slut statements, be disc) and other customers of carnin s from opcrollons, as de• 7) FRctst A public benefit corporation was created Comefined' rpro rata to purchases Tae city Is the primary cus• by a state for the sole purpose o assisting a as create ' accounppting for approximulely 90 percent of distressed city to refinunce Its nuistandinp~ short-term rder to provldo floxiblilty doomed necessarprln~ cquta~ debt and to finance new construction, All hourd mem• Ilion of physical faellifics, computer hardware and sofl• bers of the corporation arc appointed by the governor ware and skilled computer personnel outside the can. of the state, Corwin city taxes were declured to be state 111`01119 applicable lo' city government's acquisition of taxes and diverted to the corporation so that the corpo• facilities and personnel, generally. ration could make debt service paymonts on its dobt, Concludont The corporailen is part of the city entity and the state assumed a ,moral obligation" for the cot, for financial reporting potation's debt. purpOSes cvut Ihuuyh legal sop. ConduyiebThe corporation Is u parr of the city on. urution exists and certain udministr4ove requirements lity, even though the oily hus no oversight responslWhiv of the sin arc not applicable to it, The city created the ` for the corporation, because the cnrpurullnh's transac• corporation and controls the operuuons °t'the corpotil. lions are intoggral to a complete comprehension of the thin I is tight its approval ov , its gets a nd it might to city's financial standing. (See paragraphs I I and 14 of receive ,its right of derive df aver Its par is uu its right ro ecoirs earntnu, derived from Its purchases. PAOR I NCOA STATIMINT 3 K THE-NATIONAL COUNCIL nunc(al Accounting Standards Board and the Amcricun ON GOVERNMENTAL ACCOUNTING Institute of Certified Public Accountants, The National Council an Governmental Accounting local cstatea ndcfederal governmental occouo unis I auc r (NCOA) develops, promulgates and interprets prlncl• ditors, and managers, practicing certified public pies of accounting, financial reporting and relAled fl, accountants, governmental account] ng/financial man, naneial management acNville3 for governments In the agemant educators and members at large. Within site United States and Canada. While accounting and re• appropriate membership classifications, Councll mem• porting for governmental Operations that are similar to hers ore elected by vole of the Council to serge fouf- business enterprises closets' parallel' commercial year terms, The Council and Its;Sxccutlve Committee accounting and reporting, there are environmental are assisted by the NCOA Committee of Advisors, conslderat(ons which may require modification of com• comprised of representatives of accountingg, public In. mercial accounting' practices and professional pro, serest, and governmental organizations, The work of nouncemenls as they Apply to pfoprietor> funds of gov• the Council Is facilitated by project area Task Forces ernments, NCOA's responslblllitles Are directed to state (which Include Council members, Advisors, and others and provincial governments and to all classes and units who possess an expertise or viewpoint relative to the f of local governments and quasi-governmental units, project) that research issues and draft recommondn• The genesis of the National Council on Oovernmen• Ptions roj for Council consideration, tal Accoundnit dales to the 1934 formation of the Na- The NCOA Rules of Procedure provide for several tional Committee on Municipal Accounting, which types of Council Issuances; began the work of formalizing accounting, auditing, 1. statements reflect the conclusion of at least a and financial reporting standards for governmental majority plus one of the Council as to governing units under the •ponsorshipp of the Municipal Finance principles and explain and Illustrate their applica- Officers Association (MI+OA) The name change in tion,,including alternative applications where such 1949 to the National Committee on 0oveenmental alternatives ore deemed appropriate Accounting emphasized that the authoritatK-e pro- 2 Interpretations are issued by a majority plus one nouneements apply to states and all types of local gov of the Council to clarify, elaborate upon, or ex• i ernmenis, The National Council Is the successor to the plain a Council Statement. a principle or illustra• Notional Committee, [Ion, or related matters, The NCOA was established In 1974 through the 3. Exposure drafts. proposed Statements, back. sponsorship of the MFOA as a continuing body. To us• ground papers, working drafts and discussion • sure that principles and procedures for government are memotando may be Issued by the Council as nec• in conforml~t y- with generally accepted accounting prin. essury to solicit comments and assist in resolvtng ciples, the NCOA maintains close Ilaison with the Fit Issues. i r ti NCQA STATIMINT 3, 'AC! T r, NCGA Members GOVernmeniaf Accounting/Finandal lltanagement Educators State Finance Officers Leon B, Hap distinguished professor of accounting, 'Frank L. Greathouse, chairman, director of State Arkansas, Feyeltevllle, Arknansasion, UnivorWy of Audit, State of Tennessee, Nashville. Tennessee Car) 0, Orne, professor of accounting, School of Man. John F. Rogan, stato finance director, State of Wiscon• agement, University of Alaska, Fairbanks, Alaska sin, Madison. Wlsconslo Edggo~r A. Vaughn Jr., state auditor, State of South Canadian Finance Officer Carolina, Columbia, South Carolina J. E. Molloy, acting general manager, Management Local Gavernmen! Finance Officers Studies Systems and Budget, Edmonton, Alberta 'Joel M, Schlangee. viee•chafrman, director of finance, V.S. Federal Financial Executives Clof Roanoke, Virginia Gerald Murphy, deputy fiscal assistant secretary of the 1119. Anderson, assistant director/controller, Illinois treasury, U.S. Department of the Treasury, unicipal Retirement Pond, Chicago, Illinois Washington, A.C Marie D. Farrell0onaldson, auditor general. City of 'Ronald J. Points, associate director, U.S, General Ac. Detroit, Michigan counting Office, Washington, DX. 'W. Gary Harmer, admfnistratorloducatIonal re• sources and clerk •ireasurer, Salt Lake City School Cily Chief Executive District, Salt Lake City. 'Utah 'Martin H. Ives, first deputy comptroller, City of Now Orville W. Powell, city manager, GalnesrlEla, Florida York, New York Beverley R, Schirman, accounting manager, City of At'i Large Everett. Washington . 'Hyman C. Grossman, vlce•presldentlmunlelpal rat. Practicing Certified Public Accountants Ings, Municipal Bond Department, Standard fi Poor's Corpporation New York. New York 'Donald H. Cormic, partner, Alexander grant 8 Friadu K, Wallison, partner, Rogers and Wells. Attor. Company, San Antortio, Texas nc}'s, Wushinptan, O,C, William J, Raftery, partner, Main Hurdman 4- Crans• 'Pkecutlve Committee member, town, New York. New York James L, Wllllams, partner, Detoitte Haskins & Sells, Donald W Beatty, executive secretary Houston, Texas James S, Remis, director i O 'AOa 1 NCGA STATEMENT 3 1 p:{Yd'kJS~ 7 5 FLOW MEMORIAL HOSPITAL BALANCE SHEET Nov. 30, 1983 & 1982 1983 1982 1983 19Y2 Assets Liabilities & Fund Balances CURRENT; CURRENT; Cash and Investments $ 502,135 $ 538,453 Current Notes Payable $ . 1970808 217,765 Paient Receivables 2 872 483 3387 329 Acceutns Payable 998,081 1,2160486 Net o Allowances) ' ' ' ' Accrued Expenses 554,864 550,948 Due Government Agencies 1134961 1210427 Other Current Assets 111210967 745,021 Total Currenti.Liabdlltias' $ 11864,714 $ 2,106,615 Total Current Assets $ 41496,485 $4,670.,803 Long Term Debt $ 11461-1273 73 $ 1,0814065 Total Liability $ 31325,987 $ 30187,670 Property Plant and Equipment Land and Improvements $ 18,9,242 $ 161,469 Fund Balance Budding 21943,464 21943,464 Pledges and Gifts' $ $69,003 $ 541,362 Equipment 4 889 143 4 713 069 Fund Balance 9.30.83 30909,994 4,6290327 $ $ Revenue & Expense Summary 162,296 (46149) Less Accumulated Depreciation (4,645,054) (4,276,696) ~...,i..... Net P P & E $ 31470,796 $ 3,541,407 Total Fund Balance $ 4,641,29b $ 6,024,640_ Total Unrestricted Funds $ 19967,280 812120210 Total Unrestricted Funds $ 1,967,280 $ 8,212,210- Current Ratio 2.4 to 1 t - ~ ,._.....,eu,;xkuw~~::.aninva<u.Mau,w+yAtiwti/~t'k~NWY+WYb1ly 1 i r • w," JMvI N Page 2 FLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT Nov. 30, 1983 C U R R E N T M 0 N T H YEAR - TO - DATE P R 1 0 R Actual Budget Actual Budget Year-tp-Date- r Aduit Patient Days 2588 2860 5318 $796 5678 Average Per bay 86,3 95.0 87,2 9510 93,0 Newborn Patient Days 377 420 798 793 873 Average Per Day 12,6 1310 1311 13,0 14,3 Gross Patient Revenue/ $ 627,46 $.603;55 $ 613,43 $ 495,30 $ 417.36 Patient Day total Expense/Patient Day $ 415.94 $ 414,77 $ 418,26 $ 407.97 $ 366,32 Month Charity Bad Debt Recovery October $ 293,948 $ 227,787 20932 November 70,F69 220,916 7,287 December January - M February - - March - April - - , % of Revenue 13.4% 16.4% .4% i f I w I FLOW MRM0kIAL HOSPITAL Page3 INCOME &'EXPENSE STATEMENT NoV. 30, 1983 & 1982 1 CURRENT PEROID YEAR-TO-DATE BUDGET ACTUAL. PRIOR YEAR BUDGET ACTUAL PRIOR YEAR REVENUE $ 707,167 $ 5910291 $ 590,679 NURSING $ 11414,333 $-1,233,895 $ 1,1739600 766,928 803,210 624,312 ANCILLARY 1,511,856 1,5600916 1,264,682 299042 21,366 15,272 OTHER 680483 39,321 30,882 y (293,994) (2741323) 215 139) DEDUCTIONS OF REV. (687,987) 561 323) 46 109) { $ 1,2081143 $ I,141,644 $ 11015`124 TOTAL NET REVS , $ 2,416,285 $ 2,272;809 $'2,419,0b:: ; . , s , EXPENSES $ 4410281 $ 416,669 $ 4060708 NURSING $ 882,562 $ 819416 $ 633,342 ; 3 3359474 328,142 307,705 ANCILLIARY 670,948 676,651 608,961 193,922 163,622 179,087 GENERAL. SERVICE 387,844 362,320 354,396 87,546 78,882 661678 ADMINISTRATIVE 175,092 155,701 132,128 123,875 890119 104,088 0; & A. 247,761. 2108455 192,602 $ 11182,098 $ 1,0761434 $ 1,064,268 TOTAL EXPENSE $ 2,3641,197 2t224,243 $ 211219428 $ 26,045 $ 65,110 $ 149,142) OPERATING PFT, (LOSS) $ 62,088 $ 48,666 $ (102,373) 2 003 66,864 28,122 NON OPERATING REV. 104,167 113,730 56,224 ` L.7 ]8L, 121,974 $ 21,020} TOTAL PROFIT (LOSS) 156 266 4 162,296. $ (%149) i 4 ix FLOW MEMORIAL HOSPITAL. Page4 SUMMARY or CASH RECEIPTS AND DISBURSMENTS Nov, 30, 1983 Current Month Year-to-date Beginning Balance $ 83,781 $ 11,043 Cash Received fromi ~r- Active Patient Accounts $ 1,044,613 $ 11971,467 Bad Debt Accounts 79287 10,219 Cafeteria 119623 23,715 A p ropriations/Donations 69244 13,244 Other , 68s_390 75,168 813 "Total Cash 1 128 057 2j0931813 j TOTAL CASH AVAILABLE $.1,21i;~ $ , , Cash Disbursements; Payroll $ 472,171 $ 927,707 Payroll Taxes 69,;147 137,188 Patient Refunds 160709 44,556 Capital Assets 349400 39,550' Notes Payable 24,655 43,115 Other 457,643 7751827 Total disbursements $ 1 074 925 $ 1 967 943 I Cash Balance Cash Investments 290 688 290 688 Total Cash 497"601 '88 I ~ E Cash Received as a % of Rovvwr a 78.9% 74,8% s 3 9 r , 1 :4.W* 1. k' i pane 5 FLOW MEMORIAL N0SPITAL AGED ACCOUNTS PAYABLE November 30, 1983 Current 31-60 60-90 Total Trade Vendors $ 246,023 $ 252,922 $ 101,918 $ 600,863 Pees Payable 102,113 59,266 580678 220,057 Accrued Payables 46,447 46,447 Estimated Payables 108,564 1089564 Audit Fee 22,150. 150 i Totals $ 526,297 312 188 $ 16~ 00159y 998 081 { i ! / 1 . E i 1 j i i . i.. ......Dour. w+..+a.n. T..rv...n✓us.»..,.,,I l Page 6 F L 0 W M 6 M 0 R 1 A L H O S P I T A L AGED ACCOUNTS RECEIVABLE SUMMARY Nov. 1983 Primary Payor Current 31»60 61-90 91-120 121.160 150+ Total X of A/R Medicare $ 329,931 $ 1330886 $ 66,716 $ 10,427 $ 9,230,, $ 15,769 $ `6660959 13.31 Medicaid 41,940 110822 11,067 12,157 1,572 26,102 104;660 2,6 i i Blue Cross 670910 12,483 - » - - 80,393 119 Commercial i,surance 682,912 197,398 19767 » - 7829077 18,3 2010671 3440424 343,300 273,501 2380008 103320376 2,733,279 64,0 ~ Self-Pay { 1176;"$x$ $ 1mr, nT $'T3' $ ~ $ 796~_ $ M`;M , S TTrr,= $ ' In-House 26611,49 Total Accounts Receivable A/R by % 28.8 16,4 9.~ 619 6\8 32.2 i' ~ 1 Days of Revenue; Accounts Receivabbe 91,0 j In-House 6.9 111 Total t w.YM\IYJ'I N.AM.M ~ y.ie lY .i . 1 R,1. . LYj 'V f FLOW MEMORIAL, HOSPITAL BALANCE SHEET OCTOBER 31, 1983 and 1982 ASSETS 1983 1982 LIABILITIES & FUND BALANCES 1983 1982 Cash and Investments $ 464,647 $ 399,142 Current Noes Payable $ 156,740 $ 228,616 ' Patient Receivables (net Accounts Payable 11008,315 1,152,169 of allowances) 31828,948 3,349,671 Accrued Expenses - 6169774 607,514 Other Assets _ 1,299,346 861,288 Due Government Agencies 1 121 427 Total Current Assets , Long Term Debt $ 11281,685 1 123 922 j Total Current Assets $ 5,592,841 $ 4,500,101 Total Liability $ 3,214,417 $ 3,133,638 f Property, Plant, & Equipment Fund Balance Land & Improvements $ 1620349 $ 1610469 pledges, & Gifts $ 6699003 b 508,298 Building 2,943,464 2,943,464 Fund Balance, 9/30/83 5,073,884 4,829,327 Equipment 567 683 4 9 371 Revenue R Expense Summary 4D,322 25 1 8 Less Accumulated Depreciation 4•1468,0611 ) 4 252 270) Net property, plant & 204 786,3-,644,034 Total Fund Balance' 5 683 209,5410,497 Equipment 1 TOTAL UNRESTRICTED FUNDS $ 8,797,626 8 144 136 TOTAL UNRESTRICTED FUNDS $ 8,7971626_ 8 144 136 L - - - r . 1 Curront Ratio 3,0 to 1 4 .a•.•• •,.:«n1olr,a. ealiCiRti~afF>r.:5:t .ddiMtl4NtY1~1.~i 1 ktW,+.vv„{y y 1 Page 2 PLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT OCTOBER 31, 1983 CURRENT MONTH P R 1 0 R Actual Budget oar-to-Date Adult Patient bays 2,730 2,946 21870 Average Per Day 80,0 95,0 92,6 Newborn Patient pays 421 434 418 Average Per Day 13.6 14,0 13.6 Gross Patient Revenue/Pt, Day $ 600,14 $ 487,32 $ 413.42 Total Expense/Patient Day $ 412.06 $ 392,79 $ 359,08 i t Mont: Charity Ba. d Debt Recovery October $ 293,948 $ 227,787 $ 21932 of Revenue 21.6% 16.7% .02 % j 1 I F: :A: VC14 Y. { .+.,w Page 3 FLOW M E M 0 A I A L HOSPITAL INCOME AND EXPENSE STATEMENT OCTOBER 31, 1903 YEAR-TO-DATE BUDGET ACT_____ UAL____ PRIOR YEAR r REVENUES Nursing Service $ 707,267 $ 642,604 $ 582,921 Ancillary 765,928 757,707 640,370 Other 290042 17,955 200716 Deductions of Revenue (316_,035) _ 315 584 (249,481 Total Net Revenue $ 15186,102 $ 1,1029682 $ 994,626 EXPENSES } Nursing Service $ 402,437 $ 362,332 $ 389397 Ancillary, 3749318 388,626 338,495 General Service 193,922 198,697 174,399 Administrative 87,546 76,819 66,367 G & A 101_,_833_ 02,753 79,108 226 $ 1,O~i7,786 ~ Total Expense $ 16160,056 1,119, 3 Operating Profit (Loss) $ 26,046 $ (16,544) $ (53,230) Non-Operating Revenue 52_0$3 2$,j1O2__ S TOTAL PROFIT (LOSS) 78,129 L.2 0 1.3 2 2. S. (25,128) ti i l l.'A9~y'NLL I YA Page 4 I:L0W MEMORIAL HOSPITAL SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS - Current Month Beginning Balance $ 11,043 Cash Received. From, Active Patient Accounts* $ 926,854 Bad Debt Accounts 20932 Cafeteria 12,192 Appropriations/Donations 79000 Other 16,778 Total Cash 965,758 i Total Cash Available $ 976,799 I Cash Disbursements; Payroll $ 465036 Payroll Taxes 67,841 Patient Refunds* 27,847 Capital Assets 5,150 Notes Payable 18,460 Other 318,184 _ E. Total Disbursements 89300.18 ' Cash Balance E 839781 Cash Investments 2g~y,686 TOTAL CASH $ 3740469 *Net Patient Cash as a % of Revenue 70.6% l~~N f 1.11TiRYN F 4 Page 5 PLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE OCTOBER 31, 1983 Current 31-60 60-90- Total Trade Vendors $ 312,720 $ 239,760 $ 70,830 $ 623,310 gees Payable 950622 58,678 59,151 213,451 f Accrued Payables 560206 56,206 Estimated Payables 95,448 96,448 Audit Fee 19,900 i 19.800 { Totals 579 89b 298 438 129 98 I-- - z . $ 11008 , 316 f f i i j ~ F Pvu,vpvpEq~iyMUff4@T r i Page 6 FLOW MEM091AL 110SPITAL AGED ACCOUNTS RECEIVABLE SUMMARY OCTOBER 31, 1983 r _1: primary. Payor Current 31.60 61-90_ 91-120 121-150_ - 150+ Total % o A Medicare $ 3231670 $ 1090819 $ 57,414 $ 23,723 $ 41729 $ .159407 $ 6349762 12.2% { Medicaid 45,402 12,306 16,410 20159 702 52,397 139,375, 3,2% Blue Cross 80,513 48,642 149971 21930 10177 7,030 155;164 3,6% Commercial Insurance 4939433 293,450 115,262 37,846 551829 40,782 19036,602 23.6% J Salf- Pay 260,137 259,597 216,545 219,830 203,910 1,3421002 22 6020 67~ $ 1 2, 03,155 7 3-71 . 42W Or 6 W Ls78G,344H8 266 347 4 $ 4,367,924 100% f In-House 272,538 total Accounts Receivable LL L40 462 t { A/R by % 27,6% 16.6% 916% 6.6% 6.1% 33,6% Days of Revenues t, Accounts Receivable 91,7 In-House 5.7 t Total i n F4F>3 dal'. I p FLOW MEMORIAL HOSPITAL BALANCE SHEETS SEPTEMBER 30, 1983 7 1982 l 1983 1982 Assets Liabilities and Fund Balance Current; Current; ~ Cash and Investments j $ 368,778 $ 399,386 Current Motes Payable $ 162 479 Patient Receivables Accounts Payable 8090988 $ 1,1I3,018 (Net of Allowances) 316860801 2 981 109 Accrued Expenses 4409676 4620016 ( Duo Government Agencies 160,903 122,247 Other Current Assets 689,468 690,229 Total' Current. Assets 1,664,046 $ 1,930,662 Long Term Debt 665958 829~44 Total Current Assets $ 416369047 $ 3,9709724 Total Liability $ 21230,004 2,759006 ~ Property Plant and Equipment ! Fund Balance Land and Improvements $ 1610469 Building 2 943464 $ 161,469 Pledges and Gifts ` $662 002 $505,208 Equipment 00 209430464 Fund Balance 9.30.82 4,278,328 30769,09$ 4 6$ 4 68 '618 Revenue A Expense ~ 9670 in 787 -Lesg Acoumulsted ' y Summary 7958666 09,319 eprebiation 4 439 947 4 214 744) Net P P 8 E 3,2.,30 8, 43 $ 3J726807 Total Fund Balance 5 635 886 4 783 2$ Total Unrestricted Funds 7 866 890 _71643 6631, Total Unrestricted Fun z ds 7 866 89 7 643 631 I E r a . ,n»I•+a... dax. r, f,„„NA wrrNw;»., i;.yr54,Q.:Jiytilb '^"~`a~v~aUXAfIE i~ FLOW MEMORIAL HOSPITAL INCOME & EXPENSE STATEMENT SEPTEMBER 30, 1983 CURRENT PERIOD YEAR-TO-DATE BUDGET ACTUAL PRIOR YEAR BUDGET ACTUAL PRIOR YEAR ' REVENUES I $ 615,533 $ 642,887 $ 686,931 NURSING & 3B $ .7,386,396 $ 7,5341346 $ 6,6681765 6410628 795,377 863,426 ANCILLARY 7,6991'416 8,811,798 7,002,360 26,417 190692 62,408 OTNER 317,004 295,079 276406 196 021 388 227 427 569 DEDUCTIONS OF REV, 2 340 132 3 147,706 --(20 1 6061058) $ 1,088,557 $ 1,069,729 $ 885,206 TOTAL NET REV, $ 13,062,884 $13,493,517 $ 110423;613 EXPENSES $ 406,340 $ 406,490 $ 389,326 NURSING $ 4,864,080 $ 4,926,719 $ 4,324,]'52 289,669 319,933 256,772 ANCILLIARY 31476,908 3,839,687 3,166,673 176,229 1910608 229,860 GENERAL SERVICE 2,102,748 21096,611 2',064,346 71,848 74,146 69,213 ADMINISTRATIVE 862,176 883,966 8596908 103,260 119,197 119,000 G, A A, 112391000 fA33I I26 978r 209 1 048 326 1 110 2r4 -1 062 861 TOTAL EXPENSE $ 12,643,912 $-M078,009 11067,187 $ 429231 $ (40,846) $ (177,656) OPERATING-PP'T, (LOSS) $ 618,772 $ 416,508 $ 55,g86 32,083 61,377 91,667 NON OPERATING REV, 3841996 380,048 463.433 76 314 !0 832 85 988 EXCESS OF REVENUE OVER EXPENSES $ 903 L7.68 795,556 509 319 s f i . v 1 A lie»Paa D 3 5 FLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT SEPTEMBER 30, 1983 CURRENT MONTH YEAR -TO -DATE P RIOR Actual. Budget Actual Bud-get Year•to-Gate, Adult Patient Days 2,782 20860 34,123 34,675 33,830 Average Per Day 92,7 95,0 93,5 95,0 92.7 Newborn Patient Days 462 420 4,633 6,110 49733 Average Per Day 16,4 14,0 12,4 14,0 12.9 Oross Patient Revenue/ Patient bay $ 606,72 $ 428,88 $ 467,83 $ 423.01 $ 396,92 Total Expense/Pai;WtDay 398,79 356,83 374,69 351,94 335,88 Month. Char Bad Debt-: RecovarX October $ 51,973 $ 960063 $ 5,636 a € November 1210181 117,974 4;446 s December 610228 106,636 6}666 January 80000 99,706 9,$34 Pebruary 28,903 109;131 4,092 March 620296 6946 12,762 i April 20,149 429 08 160021 i May 16,406 361734 3-696 o June 380112 70,269 9,111 July 330118 5H260 2,163 August 31,161 291,024 60993 t` September 39,739. 49,41 5,191 $ 6040966 $1,166,051? $ $5,330 % of Revenue 3.2% 7.6% $06% k 4 A'wR[vy i jr FLOW MEMORIAL HOSPITAL AGED ACCOUNTS RECEIVABLE SUMMARY SEPTEMBER 30, 1983 Primary Payor _ Current 31-60 61-90 91-120 121-150_ 150+ Total % of A/R Medicare $ 3059131 $ 1219119 $ 25,694 $ 6,635 $ 3,273 Medicaid 430618 11,572 11,407 15,815 $ 477,567 30.9% 10,784 840 19,722 98,033 2,2% Blue Cross 61,382 44,231 90611 1,846 7 013 Commercial ins, 6250018 208,668 77,763 130,545 j 1'963 125,946 2.0% Self-Pa 57,889 21,892 1,021,655 Y 364,240 247,620 25 573 266,634 211,934 1346,g84 2,677,786 60.8 $-1,299,389 $ 633,110 - _ - $ 376,028 406,243 28_ 0,949 $ 1,406,266 $ 4,4001985 10010% IN HOUSE 261,9_12 $ 4,652,897 A/R by % 29,6% 14.4% 8.5% 9.2% 6.4%, 32.0% E Dayys of RevonUei Accounts Receivable 93,8 In-House 6.4 . Total 99.2 O,h'6;4Atlq !y Page 6 PLOW MEMORIAL H0'Ss'ITAL SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS SEPTEMBER 30, 1983 Current Month Year-To-Date Beginning Balance $ 169610 $ 29175 Cash Received from; ' Active Patient Accounts $ 1,053,437 $ 12,289,572 Bad Debt Accounts 69991 86,333 Cafeteria 120153 141,810 4 Appropriations/Donations 69244 392,633 Other 2510973 19146,464 Total Cash 1,329 7798 140055,712 TOTAL CASH AVAILABLE' $ 1,3461408 $ 14,057,887 Cash Disbursements: Payroll $ 440,134 $ 598489172 ' Payroll Taxes 68,234 8840338 Patient Refunds 47,160 380;632 Capital Assets 1331106 Notes Payable 161,422 479,188 Other 628,415 6,351,608 Total Disbursements 1,30 36,365 14,046,$44 Cash Balance: $ 110043 $ 11,043 Cash Investments $700464 270,_464 Total Cash $ 2810607 $ 281,607 Cash Received as a % of Revenue 78,0% 80.7% i j a i ~yfj~lmb..CWw.ra.,y., . ..,o.cn..iu.v:..-o.+sFmpt:mµ.+b W`lM1VY14131)i h n Page 6 r L 0 W MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE i SEP'i","MBER 30, 1983 i Defferred f Payable Current 31-60 66.90 Total Trade Vendors $ 310,568 $ 192,971 -0- $ 5030529 Fees Payable 970449 690161 -0- 166,500 Accrued Payables 48,944 48,944 Estimatod Payables 78,623 780623 Deferred Audit Fee $ 17,650 17x650 17 650 $ 535,674 $ 252,122 -0- $-805,346_ i Il M 1 FLOW MCM0RIAL HOSPITAL BALANCE SHEET SEPTEMBER 30, +983 Current ;Assets; 1983 83 1982 Current Liabilities; 1983 1982 Cash--operating $ 60231 $ 4094 Current Notes Payable $ 152 479 Interest & Sinking 4o677 12,763 $ 223,282 serve Fund X478 39,797 Accounts Payable , 631,108 942,764 ReRepair Fund 240 Accrued payroll 426,722 408,767 19,787 Due Medicare 150,903 Investments/Board Designated 290,6s (`oes Payable 1740250 121,427 $307,683 Bond Interest Payable 7374 200,702 Bonds Payable 10 000 12,685 Total Cash & Investments $ 301,214 X000 _ 1-00 1 3849144 Total Current Liabilities $ 1,551,836 $ 1,919,627 ;Accounts Receivable 91651,552 Less; Allowances 1'031+6920) $ 354 0766 1 Other Liabilities; Net Patient Receivables 654 Deferred Income 4,722 ► ► Long Term Notes Payable 261,236 409-344 Other Receivables 869484 1869364 Bonds Payable 410,000 qOp Inventories - 450,610 318,287 Total Liabilities ...2 0 LO Prepaid Expenses 61 74,734 $ 21217,794 $ $,748,971 t :Total Current,.Assets $ 4,508,703 $3,846,423 Capital; City of Donton: 3,166 'Property, Plant & Equipment;: County of Benton $ 1,696 393,,971 165 $ 189 3930166 $ f Land 547 Endowmentplow Estate 2400961 2400461 Building & Improvements 3,0837 7;385 37,648 Fed. Grantso Hill-Burton 1,8680910 1,668Furniture & Equipment 4t5646243 3,067,385 Federal Grants 256,371. , 2680910 -4,16811004 Pledges and Gifts 861,888 505,371 208 Accumulated ' ► ► Gen, Fund Bal., Beg, of Yr, (291,266) (686770) f, Depreciation 4 438 601} 4 213 668 Current Year Net Property, Plant & Equip, 3 2 5 7q _ _796,083 _ 3-»- -'6. 1 1-112-30-- ma y-- 3►6r.. 72.,2 269 Total Capital $ 5,521,483 TOTAL OPERATING FUND $ 4,669,721 , $ 70739,277 $ 74418,692 TOTAL OPERATING FUND ' $ 7,739,277 $ 70418,692 Current Ratio 2,91 to 1 k --.,.w,n.rvwai4MF5pYAf'/Sl FLOW MEMORIAL H'OSP'ITAL STATEMENT OF OPERATIONS/September 30, 1983 % of Supplies Total Direct Operating Revenue Revenuo Salaries & Other Expenses Profit (Lass), Daily Hospital Care 16 $ 209,665 $ 121,822 $ 11,749 $ 133,616 $ 75,949 Psychiatric Care 5 75,891 36,124 36224 39,348 36,643 OB/Post Partum 3 470065 18,679 31439 22,118 .240047 ICU 2 24,330 15,685 51930 21,615 21715 Nursory/NICU 5 74,445 32;795 7$45 40,140 34,305 Coronary Care Unit 2 30,058 285440 3,250 31,690:: (1,632) Labor,& Delivory/Birthing Center 6 730225 25,925 8;468 34,393 38,832 Operating & Recovery 3 470619 21,560 150788 370348 10,271 Erne r ncy Room 4 607689 18115 276106 45,221 16,468 Cent al Sup ly r, 119,017 7,269 64,298 61$67 57,460 LabQr,etory% ood Bank 1850251 680831 680831 116,420 Radiology/Nuclear Medicine r 916188 14,388 290441 43,829 47,359 Phemacy/1U 15 2110695 10,321 23*206 33,626 1701'069 Cardiopulmonary 7 101,704 18,444 18,946 37$90 640314 Anesthesia 3 36,084 130319 10,805 24,124 111960 Physical Therapy 2 22 067 7 100 1'505 8 606 13o462 IM ~ Total "Jg6;'g8E Deductions of Revenue $ (91,289 $ (01,2'9 Choity',& Sad Debt (282,298 (28 ,2 8 Employee Health Ins. Expense $ 539'849 $ 53,849 (5 Medical Records 389 $ 100046 60003 169049 (15,66tl - Gift Shop/Grounds Maintenance 1,644 2,665 30622 6,277 (4,633 Cafeteria 11$20 25F669 290026 540586 43,0$$5 Plant 15,931 809133 96,064 96,064 e Environmental; Services 32,n02 91997 42,699 42,699 Fiscal Affairs/Data Processing 7,610 50796 13,406 13,406 Business Office/Credit & Collect 26,125 10,720 35,845 35,845 Personnel 31627 2,728 6,255 6,256 Administration 61222 10214 7,436 7,436 Quality"Control 2,929 219 31188 3,188 General & Administrative 44 32,138 32,138 320094 Depreciation 33 207 33 2O7 33 207 Gain (Goss) From Operation (34,456 Non-Operating Revenue 489265 48,256 Foundation $ 3 122 ItIn Total j.1010180 $522,232 $ 662,027 $ 11084,289 $ 160921 1 r -r FLOW MEMORIAL H0SPrTAL STATEMENT OF OPERATIONS/Yea"-to-Date SEPTEMBER 30, 1983 % of Supplies Total Direct Operating Revenue Revenue. Salaries & Other Expenses Profit (Loss) Oai1y Hospital Care 16 $ 26598,290 $ 1,534,655 $ 163,794 1,688,449 $ 909,841 Psychiatric Care 5 863,222 420,103 390683 469,786 401,936 OB/Post Partum 4 563,690 225,859 300676 , 256,535 29 ,056 ICI 2 335,705 224,626 40,890 266,216 70,489 Nursery/NICU 5 8569365 401,833 74,286 476,919 380,446 Coronary care Unit 3 478,906 364,233 519460 4160683 63,223 Labor & Delivery/Birthing Center 4 637,369 307,627 90,863 398,490 238,$79 i Operating 6 Recovery 4 636,866 260,062 170,139 430,221 2060634 Emergency Room 4 573,642 2075933 328,487 6361420 37,122 Central Supply 8 11314,369 93$67 600,331 693,698 620,671 Laboratory'/Mod Bank 11 1,7520936 721t657 721;567 1,031,379 s Radio1ogy/Nuclear Medicine 6 9461339 188,521 273,912 462,433 482,906 Pharmacy/IV 16 2,5350696 1400067 492,663 632,720 1,942,975 Cardiopulmonary 8 102260637 238,252` 215,162 453,414 773!223 Anesthesia 3 463,768 173,121 1239632 2960763 167,015 Physical Therapy 1 _201,466 84,248 28,112 1120360 89,106 Total 100% $ 16,9740654 $ 49864,317 $ 304360337 $ 8,299,654 $ 7,674000 Deduotions of Revenue $ (9479008? $ (947,688 ~2 006.,670 ~ Charity Bad Debt (2,006,670 Employee Health ins. Expense $ 5560011 $ 556,&11 66$,011 6,660 $ 1340614 39,761 174,375' 1169,815 Medical Records 201185 23,813 200668 44,471 (24,266 Gift Shop/Grounds Maintenance 135,401 337,907 3310987 649,994 5141493 Cafeteria 186,609 757,652 943,261 543,261 Plant 4090615 1230341 533,016 6,33,016 Envi ronmental Services ' . 169,571 ` Pascal Affairs/Data Processing 94,494 760077 169,871 276,108 1b54063 4300161 430,161 Business Office/Credit & Collect 36,197 27,062 63,269 (63Personnel 71,537 340937 106,474 Q06%94) Administration 33,404 60966 400370 (409370 qualit Generay A Admol 17,725 3440916 3440916 327,191 eneral8. Adrtiinistrative 4 3gg 431__,199 431 149 Depreciation $ (21773,887) $ 1,582,358 $ 20903,620 4,4850978 $(7469,866) i Gain (Lots) From Operation 41$,036 Non-Operating Revenue 342,584 3421684 Y 4A $ 12,785,632 Paundation Total 8 e , - - .ra Ye,fC3 FLOW MEMORIAL HOSPITAL HOME HEALTH BALANCE SHEET SEPTEMBER 30, 1983 ASSETS LIABILITIES Cash $ 57,565 Accounts Payable $ 24 Payable Due Plow ' 4,611 Accounts Receivable 66,940 $ 124,504 Accrued Payroll 7,680 Inventory 1,844 Total Liabilities $ 12,215 Total Current Assets $ 126,348 E UIPMENT CAPITAL $ 116 Furniture &`Equipmer+t $ 11615 Pledges & Gifts Less Accumulated Depreciation (1,346 Gen. Fund Sal „ Beg. of Yr. 113,816 3 Net Equipment $ 269 Retained Earnings Current Yr. 473 . Total capital 114,403 TOTAL OPERATING FUND 8 126,618 TOTAL OPERATING FUND $ 126618 I~ !4I i 11 i M! • r FLOW MEMORIAL HOSPITAL HOME HEALTH STATEMENT 0fi REVENUES AND EXPENSES SEPTEMBER 30, 1983 REVENUES Patient Revenws $ 28,565 r Deductions of Revenue $ 3829199 Net Revenues (---491 _ (89 349) $ 19,916 $ 2920850 EXPENSES f i Payrol l& PICA Purc, Service $ 20'000 $ 241,372 ? Supplies 30335 14,296 f Travel/& Repairs 569 15,774 Employee Benefits 2,107 17,903 Depreciation 21763 Net Expenses 269 Excess of Revenues over Expenses $ 2" $ 292377 61 LO 1.1 $ L0-95 473 I i MR-::,r;4lj AI u„ 01 me 1933:1 WA I 1 r'0FF R r P 0 A T } PAGE l PATIENT NA~hIE PA# IU DIBC110 DEO-DAL NEW-CM NCW-PAY 14-0 DAL FC TYPE CYCLE LOT Pill AGE PO TYPE OAP ALLEN,JULIVS . 10045144 08/19/83 2,736.95 109,60 0,00 2.846.55 ADD IP NO ) 44 OVARANTOIt INP01111ATIDN 44 JULIUH ALLEN 400 BIRD OAINCBVtLLE, TX 761:40 24 1 Unable to locate ISr f ARNDLO, 8TETSnN 00003R51 01/10,00A 494.00 1,615, 05 0; 00 20 099. 55 ADD OP 3 146 1 r 4Y QUARA14TOR INFORMATION 44 TRACY ARNOLD 749,.N CHIN14 CHAPEL LEWISVILLE, T% 79067,_..;.Unable.to locate 4r, DAULHA, NANCY L ODOM= 011,1110.'? L 283,45 131145 0.00 1,314. 90 BP IP 4 220 t GUARANTOR INFORMATION 44 GEORGE DAUM AT I BOX 346 DECATUR, TX 76204 Arrang@nont not kept j DELL,DANIRL JOE 00005760 01/p3/03 831.63 0.00 0.00 631.65 BP IP 3 312 1 44 OVARANTOR INFORMATION 44 JOGEPH JR UP.LL PO BOX 928 ROANOII(:i. TX 76262 No response i ♦ DELMARM OANT lA00 V. , 8R 40042071 07/ 10/83 912. 45 0.00 0100 212.49 ADD ER 148 141 I 4w OUARANTOn INFOAMATIDW 40 BANt'IAGO V. BELMAREZ, 3R. 603 EAGLE OR, DENTON, TX 76201 Unable to locate DENWETT, CAMILF P 10006104 OW117183 1,096,40 -737, 40 4M 00 (309 l5 11D IF 031OP/03 274 1 r i 44 GUARANTOR INFORMATION 4M CAMILE O BENNETT tMO LINDEN__DENTON, TX 76201 No. responE9..__... 60 0NUNrHURAT,WARAPORN 00006494 01130/82 1, 175.00 0.00 -90,00 1,085.00 BP IP 4 11/29/83 2 1 Sy t 44 OUARANron INPOnMATION 44 WARAPORN BHUNTHURAT 1607 W OAK #111 DAMON, TX 76201 Arrangemant not kept 16. BRADY, VALERIE 10048593 08/28/83 770,70 19D, 00 01 00 096.00 ADD IP NO 84 3 OUARANrOR INFORMATION .,CECIL. BRADY 9500„FTWORTH,N13 ._OENTON,, TX 7620111nable.to_locate.-_._. M BRE94E1,R9VA J 00000980 07/01/82 1,915.50 O.00 °1,291.23 684.27 IO IP 1 07/117/83 127 1 411 OVARANTOR INPORMATION 44 LEBLIE DAMN PO; BOX 182 TIM& TX 76211 Arrangement not.kept ORI CE; VIOLA 00008979 01/17/83 P04,25 0.CO 0,00 204,25 BP FR 3 018 1 r is OUANANTOR I14FORMATS011 44 VIOLA BRICE C120_RONSONAENTON, TX 76201 No r@SponSB_ >y DRIBCOH,RODERT L 00009102 07/10/82 531.20 179,00 0,00 410.20 BP IP 3 09/24/82 24 1 r t 44 OVARANTON INFORMATION 44 THELMA BRIOM: P O BOX 1776 OREENVILM TX 75401No response_.'. j DROWN, GRANT A. 10003630 091/0/03 5, 697.. 30 a^.,, 993. 69 0.00 8.675.99 PP IP 3 22 1 j M4 GUARANTOR I?JFORMATION 44 GRANT A. DROWN AT, 3, 64, ; 86„ BFNTDN, TX_ 761:01 No. response 'to BROWN,WILRON 0 00010090 09123/02 264.73 0.00 0,00 264.70 BP IP 3 11/24/02 434 1 r 44 OVARANTOR INPORMATION 44 WIL8014 DROWN 2704, MILLPOND DENTON, TX 76201 Account with,Terry Lewis now to BRUCE, DEIRNIE 10006294 02/SB/O3 700.95 172.00 0.00 07. 90 BP IP 3 902 1 44 OVARANTUR INFORMATION] 44 OURN15 BRUCE 144 VINBONVILLA LN DENTON, TX 76201 No .response ♦ BVRNAU,RYAN C 00010700 11/09/02 2,082.35 0,00 -100.00 11932.35 I0 iP 2 05/16/03 199 1 44; GUARANTOR INFORMATION M■ JODY DURNAU 109 MUMS= BANOER, TX 76266 No response 40 CA01,6, OMA LEE 10007402 07./I10/03 2, b70. 45 0. 00 -2, 260, 9,9 310.00 ADD IP NO 03/30/83 246 1 ` 44-GUARANTOR 111KOAMATION 44 OMA LEK CAOLE PO BOX 204. PILOT POINT, TX 76250 No response CAOLE,PAM91LA 10006120 02/17/03 523.35 01 00 0.00 D74,35 BP IP 0 190 1 44 OUARAWON INFORMATION 44. CA04C TOOL. CO/REUDE AT R BOX 243--A AVOREY, TX 762e7 No.reSp6As@ V' GAIN CANDI M. 10010904 04/14/E)3 477.25 0.00 0100 417.25 ADD IP NO 230 l r4,0UARANTOR INFORMATION 44 JANE CAIN PO BOX 2619 I)VNTON, TN 76201 NA response- u. I, JN 1 1 01 OtC 19113 W k 1 T E- 0 F F R E r 0 R T . PATIENT NAME PAT 10 1//00110 fiCO-kAL NEW-CHO NrW-PAY I4-0 DAL F'C TYPE CYCLE LBT.PIIT ACE FO TYPN L 1 07/09/02 Cw4LOUAAAWORkINFurviATIUN *0M1OAGDCHOT 0, CALLAHAN 120.00 4pp'DOX 10740 LAKE DALLAS,, TXP 79063 3 No respOnsB._ l7 t X41/ , ' . _ No_ros once P J 06/02/ ~ CPOVARANTtlR8INp0kMAYION 010KAYHRYN LYON803 1,031.79 Sg bgarlERCEO 704? CGLtlNYa4TXRP7d056 2 60 1 ` CANTRELL,JUAN 000116411 01/24/03 722.03 141.90 0.00 863.93 ID IP 4 190 1 *4 GUARANTOR 1NPORMATION JOAN CANTPCLL BOX 116 TIDOA, TX 76271 NO rosponso CANTU,ANMANDO 10031904 06/13/03 1,074.30 2,371.93 0.00 3,949.85 SP IP 3 06/13/03 164 1 er dUARANtOR INFORMATION 44 ARMANDO CANTU 301 CORONADO_DR N1064 DEWON, TX 7620I_Arranoemeot not kept V CANTU,ARMANO0 RIVERA 10033017 06/19/03 P4 084. OD 0.00 0.00 2,084.83 0P iP 4 162 1 44 GUARANTOR INFORMATION 4* ARMANDD RiVERA CANTU 301CORONADd DR *1064 DENTGN, TX 76201Unable to.locate 201OW03 1,4 .70 CM+Ai0GUARANTORIIINFORMATION J0LORRAI015204 CAROOILE Ntl 00BOX1~45 1PILOT2POINY, T% 76P99 _ 4 No,Orel;000..... 4 _ l Iv• CARR MEL196A 100212713 03/03/83 780,20 203.90 0,00 1,034.10 8P IP 1 202 1 r r* OVARANTOR INPORMATION *4 ROBERT CARR 1117 PAISLEY DENTON TX '/6301 No p _ CARROLL,CHA18TtN5L 00012096 01/02/03 6D9,65 312,20 0.00 971.89 ADD IP N8 01/03/03 17 1 r il* 46, I CARTERAKARBNR INFORMATION **10015396'02/31/03LL 377.90 391.00 11% 77 O00 PILOT P9b9T70TX8P762I~ .~4 N resDon30 ~ 209 1 << ~ , 10 41 OUARANtOR INFORMATION *4 ALDERT CARTER P.O. 101P DENTGN, TX 76201 Arrangement not kept 6 1 CARMR. W. .10001068 09/09703 797. 20 09.00 0.00 956.20 SP it 4 7 1 ' OVARAWOR 114FORMAYIDN R.N, CARTY AT 4, 00X 413 DENTGN, TX 7620t No r@spon$Q_._. 1 CAWTHON, EVA 000126b9 ,01 /16/03 1, 383, 60 0100 O~ 00 11383,65 SP 1p 3 01/11/83 314 i *4 OVANANTOA INFORMATION 4* EVA CAWTHUN 132 HIGH SCHOOL OR LIM SVIL.LN, TX 75067 No retponso ty CHAPFIN,0IN0ER D 40033040 06/08/03 63.79 272.00 0.00 333.75 ADD CR 140 16 1 r QllARANTOR INFORMATION 44 MIKE CHAF'P IN +1613, L,,1TY111ORE DENTGN; TX 76201, ,ALV1N E IOOJ90130 04/24/03 5,021.50 13,00 4,141.13 867.37 ADO Ip NO 07/26/83 .129 1 If< i CNANOLAR 140 OVARAt1rDR INFORMATION ALVIN R CHANDLER AT.1_ BOX 38 FROM DENTGN, YX 7640$ Unable to locate 1,; CHOICR, RONALD I IL C0p1 M 10/00/02 1, 341.99 -52.00 385. 00 I, 104. 93 GP tp 2 04/11/83 193 l 44 OVASIANTtlJt 1f4FtlRMATiON *4 RONALD 00010E 605 ,W1L8U14 8T DEWTDN, T% 76201 Arrangement not. kept ( CO508,ERICA ANN 10003350 02/07/03 1,212.75 I, 107.64 -833,75 1,486.64 RP IP 3 04/03/113 14 1 b OVARANtOR INFORMATION 4* LUI© CODOO 910 8 LOCUST DENTGN,, TX 76201 No response CtlD06,NAR1A C. 40OL6768 04/00/113 56.26 169.33 0100 420.60 SP OR 2 164 1 • 44 GUARANTOR INFORMATION MARIA C. COOO$ _ 515 SMITH N20 DENTGN, TX 76201, No respoASe... ' 611 COMLL, 01NDY KAY 10010990 04/00/03 940,05 20,30 0100 961.13 SP 1p I 129 I , OVARANtOR INPORM01014 CtNOY KAY COODBLL 1600 65NA ORNTONI TX 76201 NO response E ey~ { CONDIT BTRVC U. 40019920 04119/03 203.75 0100 0100 903.7d ADD Ek NO 224 1 v I ( *0 OUARANTOR 1NPORMA'I1014 *N. STEVE R. CONOIT 1002-EPHON0 429L6WISVILLR 7X,_ 101 067.Unab1@ t0 IOOate „,•N narr;n r ryy, • DURHAM, LELA 70004294 03/21/03 411,78 697 DO 0.00 10069.95 UP Op 3 03/81/83 78 1 SM GUARANTOR, I NVDnjAT I ON +M LELA DURHAM RT. 2 BOX 161 ARGYLE, TX 76226 NO response r j v DVRHAII, LELA 8 00019422 01 /31 /03 ^.7.00 2R. 2D 0100 49.25 8P CA 4 294 1 r GUARAMI01+ INFORMATION *4 LELA CUE DUUHAM - R_T,.2. IlOX.l01 ARGYLE, TX 76226 .._...._1._110-response FURNTBS,PEORO 11 00023467 10/24/01 2791 25 0100 -501 OA 229.20 UP ER 4 11/83/03 8 1 I~ GUARANTOR INFORMA7101J PEDRO FUCNI'CS 8338 SUN PLOWER ARLINGTON, TX 76014 Arrangemant not kept r, GARCIA,AL.ICIA 10019410 04/01/03 770.10 40, 00 -616.12 802.09 8P TP 4 05/05/03 190 1 OUARANTOR INFORMATION wr PANFILO GARCIA P 0 IICIX 1345 DENTON, TX 76201 No response ♦ 0ARRGTT,FRE00IE D 00024323 06/213/00 231.19 0,00 -35.00 202.15 ID ER 3 .06117/03 167 1 r 44 GUARANTOR INFURMATIOH 0* ROGER HENnCR00N 117 8 CRA14VORD DENTON, TX 76203 i ..Arrangement not kept ♦ ; GARVIN,PATRICIA A 40000404 02/01/03 41.00 3aa.00 0.00 369.00 8p aR 3 SO 1 r Mr GUARANTOR INFORMATION DILL GARVIN AT 4 BOX 22Q WINN080R0, TX 75494 -No, response. ♦ GILL, SHEILA 10002947 02/07103 10176. 99 373.65 -L, 176. DD 373.65 SP IP 4 03/03/03 273 1 ♦ *4 GUARANTOR 1NrORMATION .w CAROLYN 0ILL PO RDX .1074 LAKE DALLAS, TX 79068... NO response. 10 OLORIA,HERMINIA OOORD544 12/07/02 1,058,38 0,00 0.00 1,068.35 SP 1P 1 359 1 0 xM GVARAHTOR INFORMATION JOE GLORIA 716 JUNO, DENTON, TX .76201 Arrangement not kept i 0100 0 940 GUARANTOR INFORMATION ew00WILLTAMIGOVAN08 304 07 PC nOX 74-11P.0.00 D NTON~4TX8776201 IP 3.. Arrrangement not kept91 ' ! ',O ORAHAM,TAMMY M 00026435 11/03/02 980.2B 298.85 0.00 1,273.10 8P IP 1 78 1 NO OVARANTON WP-WMATION kr TAMMY GRAHAM 020. POSS. OEN.TON, TX ,76201 ♦ ~ S GNAV68,CWYC6. 10006773 08/00/03 19, 107, 55 7o447.50 -1, 770.00 200J0,05 6P IP 3 03/31/83 136 1 1(0 OU60WOR INFORMATION *0 CLOYCE ORAVES AT 2 43X486 AUDREY, TX 761!5?7 NO response. ♦ GRMC HAROLD RAY 10OR2341 OD/02/03 852.60 0.00 01 00 852.60 ADD IP NS' 213 1 44 GUARANTOR 1NrOAMATION «r HAROLD RAY ORL:C'N . ..Unable_tO,.lOCate. 3630 8_ADAMB tIN FORT IIORTHt t% .76110 r, GAMOLD,VICTORIA J OOD27616 09/92/02 1,426.60 0.00 0.00 1 4 6 60 SP 1P 3 430 1 l;,y ea GUARANTOR INFORMATION at MARK ORIBWOL,D AT 7 SME01400D #90 DENTON TX 7620 No response ♦ 09080dT,TODD A 10004740 02/11/83 2,403,10 0.00 0.00 2,400,10 HP IP 3 200 1 NO OUARANTOR INFORMAYION ae TODD OR08COST 011_MQVNI RC DENTON, TX 76201 .No responsa_ , * GRDVG,LTNDAL J CDOP7656 01/31/63 1,659:60 59,90 -1, 4J 4. 5S 300.97 SP IP 363/04/00 133 1' 49 OUARANTOR INFORMATION LINBAL JR GROVE 604 NEPYUNe BENTON, TX 76201 NO response GUEVARA,RORKRT 00027763 00/01/01 U73,90 0100 -D8:00 515.95 1D IP 1 11/09/03 22 1 410 rw OVARANTOR INFORMATION NO ROBERT GUEVARA AT 2 BOX 363 PILOT POINT, TX 76258, Arrangement nWkapt ♦ HENRIC,JACKIR D 00031494 19/0/0P 691.1$ 0.00 0.00 691.lG ADD IP NO 01/10/03 348 1 le OUAAAMTOR INFORMATION NO GARY H9NNIE. PO BOX 741 AUnREYt tX 762,+7. Arrangement not kept - HERMAMN,TOR86A 40039323 06/r9O/03 271. 25 0.00 0100 271.25 SP BR 2 154 1 « NO GUARANTOR 10FORMATION NO ROYCE HERMANN PO BOX 1013 ROANDAC, TX 7676;. __1.110 response ~ r l •:7F~i7 -41 I 01I1L0 1957 WA I TE••nFF REN0R T pAOE 4 JJ PATIENT NAME PAT ID DISCNO DEO-DAL NEW-CHO NE14-PAY IJ-O DAL FC TYPE CYCLE l.ST.pMT AGE FO TYPE I~ HGnHAt4DEt, DURA E 00031666 l1/no/0u N90. 92 0100 -25.00 070, 92 up IP 3 O 0 S3 65 44 OVARANIUN INFORMATION ~!t DURA HKIINANnri 1:101 ROYD 5T DEWTON, TX 76p01 I M Arrangement hot kept IIICKS,13DNFIA 11 00020 on f0/14/118 106 95 32p, 93 0 GUARANTOR IIFORMATION DONNA HICKS 0.00 019.90 t; I 3 01/29/03 64 t 687 OERfJAftB BT 084 DEWTpN, r i% 76 6x'.01 _NO rBSpOn58 • HIGD(JN,RODERT O 1000790& 02)27/03 4 08;1. 00 3,464.00 tl. DO D, 447, 50 up Ip 3 1 y 4* GUARANTOR 1f1FURMATIUN *4 NUDLRT D FII000N p8 60X 2722 DEN'Tpl:, TX 119 761?OS , Arrangement not kept 14 INTON,MANDY 10036640 07/00/13) 2,176.89 0.00 Ih4 GUARANTOR INFORMATION NO RICHARD I;INTD61 0.00 2,176,88 tP 3 145 t M AT I THACKlrRVtLLE, nµ 73459 09 ..N0. r05pOnee.. HODGES, DONALD IJ 00038599 10109182 7.1. 12 127, 70 0100 848. W SP 1P ! e* OVARANTOR INFORMAT1CII4 44 DON HODGES 9116 8 LOCUST DENTDN, TX 76201 10/06/02 Its Arrangement not kept HUNTER, DOROTHY J 00034POO 08/16/82 231,59 0.00 0.00 231,99 Bp OP NS 09/27/92 E: NO OVAAANrOk INFORMATION NO DOROTHY HUNTER: 473 1 y 1007 FAIJWIfJ DENT ON, TX 762201 .--No response. JACKSONPCYN1'41A A 'I J ~ 00034979 11/16/82 6,079. 69 230.50 0, 00 6, 310. 19 8p !p 3 ti l NO 01JARANT00 INFORMATION *4 14CRUHAL JACKSON 1700 MORSE DCNTON, T% 76709 1 i • Arrangement not kept E • JACKSONiPATRICIA D 00035212 11/23/82 279,90 0.00 0100 279.90 SP IF) O 01/03/03 37 l 04 GUARANTOR INPDNMATION *k JOE JACKSON . 1121 141LL ST DENTON, TX 76201 N0 response_. 3 • )ACK8aN,RI0KY 1002D042 80117/83 638,80 1,039.20 0.00 1+67$,00 'BF Ip 3 too NO OUARANTOR INFOIIMATIDIJ 44 HICKY JACKSON PO DCX 141 PILOT FOINT, TX 762.18 pt 1 ..Arrangement not kept JUARCI, ROSEMARY 0007740£1 01/21/03 125,00 184.78 0.00 309-7S dP up 3 ` M4 GUARANTOR INFORMATION 4* LYDIA PERU DEIJTON; TX 76201 208 RVAU4l.4 ART 97 97 1 y _No -re9 nse rI KAM NANOY J 00037998 09/29/02 261.67 0.0 0,00 b6l.68P 3 10/110/11-0 ".1 Y4 OVARANTOR INFORMATION 44 JOE KAYO 13 0 VILLAGE 46 OAINESVILLEs TX 76428 I j+ y rrengemeo ent not kept _ KEMp, JANICt M 00037044 So/27/p2 653.20 0.00 0.00 W. 29 Sp tP 3 400 1 M 4* GUARANTOR INFORMATION 44 JANICE KEMP 900 RUDUELL 0133 DR14TON, TX 76201 _No response.. • KIM, WMILY J 00030831 01/18/03 074.90 67.00 0.00 942.40 OP IP 3 4* GUARANTOR INFORMATION EMILY KLxTTB 641 ONFENLAND LEWIBVILLE TX 70067 92 i I Unable :to .lOCate i, KOERNER,LU ANN 00039073 06/1,7/79 1,022.39 Db.00 -00.00 11790,39 up OUARANTOR INFORMATION 44 GARY KEDRNCK Op% Sx.s_ 3b 1 M q PILOT POINT, TX 762I98 p 3 10gemant not kept y, KAAHL,SHERRI 00039164 01/04183 6b9.25 0.00 0.00 669.29 SP OP 3 - Arranngemen301 i GUARANTOR INFORMATION STEVE KRAHL AT 1 BOX 619 OATNUBVILLE, TX 76240 y No p KRAN77,CAROLY:: 00039174 01/04/07 1,176,09 0.00 ~70.OD 1, 106,05 up ER • 1 08/09 01 120 1 4* GUARANTOR INFORMATION CAROLYN KRANT'1 /03/93. PO DO%, 1434__ OENTtl14, TX 76£01 I ' ._.NO.retpon5e.._ y LAIRD, DILLY D. 40026114 06113/83 226.40 0.00 0.00 226.46 80 ER 3 1* OVARANTOR. INFORMATION ON DILLY D. LAIRD 8000 FTWORTH OR 016 DIEWON, TX 76201 1197 t I • Unable to Date rt 1 LAMDENT,MARK H. 70006713 04/19/03 290.95 0. 70 0.00 307,70 9P OP 3 04/19/93 120 1 *4 OVARAWON 114VORMATION 44 BETTY LAMDSRT PO SOX 472 BOYD, TX, 76023 NO_re5 p01112,._... • SJ . _ fie". I I FS 1 y „ I l d rY/ 01 DEC 1983 W0 1 I'E-0F'r RHPOR T PAGE 5 PAIIIINT NAMD PAI' ID DIISCHO nEG-DAL NEW-01f) NEW-PAY W-O SAL PC TYPE CYCLE' 1.81'.PMT AGE f10 TYPH wl ~ 'J r ♦ ~ LAHKIN, JOSHUA 14 IOU34672 06/27/0 2. 173. 30 0.00 0.00 21 171.35 SP IP 1 . 184 1 'I J 44 OVARANTON INFORMATION 44 DANA M LAMKIN 109 MASSEY SOX 80 DENTON, TX 76201 Arrangement not kept • LAWSON,KATWERINF:A 000,1007 09/b0/011 467.77 0100 -79.00 394.97 SP IP 3 00131/83 92 I J r4 OUARANTOR INPORMATION 4a L E LAWSON 328 ROBERSON DE14TbN, 1'X 76201 Arrangement not kept • LE ALANC, DOUGLAS 10053936 09/19/03 890.49 0.00 0,00 880,45 SP IP I Unabble to locate 73 l MM OVARANYON INPORMATION 4a DOUOLAB LE IILANC AT 4,.X:18 EXECUTIVE MOBILE HOME LAKE DALLAS,...F%..,79065 M LE 0LAIIC,SHARON L.OU18E 40037335 06(82/03 56.00 0.00 0.00 56.00 SP ER I Unable t0 10Cate 162 1 ' 44 OUARANtOR INFORMATION 44 DOUGLAS LC DLANC AT 4 EXECUTIVE TRAIL PARK X38 bENTON., TX _„76201 , LEWIS,OTI8 C, 40039414 06/29/83 176.99 86.00 0.00 232, 115 SP ER 2 100 1 a4 GUARANTOR INFORtATION a4 OTIS C. LEWIS 910 83. LOCUST Y MOTEL DENTON, TX 76201 Unable to locate 0 LINDAMAN,DRYAN L. 10001196 02/06/83 2,202,40 83.95 0.00 2,286.38 HP IP 3 2q 1 J wM GUARANTOR [WrORMATION 4a DALE LtNDAMAN DUX 756 JUSTIN, TX 16247 --No response aY LOGAN, KELLY R. 10005064 02/14/03 1, 121, 88 0.00 0.00 1, 121.85 8P IP 3 260 l 44 GUARANTOR 1NFORMAT1014 a4 WILLIAM WATTS AT 1 POX 784 SANDER, TX 762266 ~ No response. 40 LOPEZ,.JOSE SANTOS 10019091 04/Al/(13 1,027,50 0100 0.00 1,021.85 tip IP 4 224 1 ~ _44 GUARANTOR INFORMATION 4a JOSE SANT09 LOPEZ 2829 LCUIRE 035 DENTON, TX 76201 ___Ho.response...,..-. . LOPEZ, GYLVIA 0 00042069 10/03/02 833, 95 1,854. 14 -50. 00 2j638.09 VP IP 1 11/89/93 3 1 ~ 44 OVANANTOR INFORMATION 4a GAV1NO LOPEZ AT I BOX 127 PILOT POINT, TX 76258. Arrangement not kept ¢ HAGEN DONALD H 00042Sd0 12/20/t1R 3,865,10 0,00 0.00 3,565.10 sp tP 3 178 1 GUARANTOR INFORMATION 44 DONALD MAGER 914_BOLIVAR , DENTON) TX 762"01 Ho response 1i Ma4VGUARANTORSINF'ORMATIC14 10001426 6,962,+0 26.20 TXp 74240 NO response 96 1 y MAAEZ, KATIILEPN R 00043307 07/04/02 1, 290. 70 0.00 $0 00 1,240. 70 SP tP 1 06/84/83 185 1 ,J1 44 OUARANTOk INFORMATION a4 PEONO ;MAREZ 1317, AN_ACONOA, 8W W0AT9HE10HT ALSNNCUROUfi,_ 1411, ,07105 Arrangement not kept y MAV9,PATRIrIA D 000444D4 12/06102 2,343.30 49 00 0.00 2j392,30 SP IN 1 10/21/112 204 1 w M4 GUARANTOk INPORMATION 44 RAY L BALLARD 214E SCOTT GAINE9VII.LE, TX 76240 No response y MCCO'.4ELL,0EANA L, 40021842 04/28/03 93.80 137.75 0.00 231.78 8P ER t 83 1 44 GUARANTOR [14POnMAt10N 40 DEANA L. MCCONNELL 3419 N,_ ELM DENTON, TX 76201 No response yy MCCONNEL4, LANA 14 00044042 12/24/02 Z630.40 96, 00 0,00 2,7R6.48 10 IP 4 83 1 4R OVANAI4TOR INFORMATION 4a OAYLON 8 MCCONNELL PO BOX 363 RANGER, TX 76266 No-response y MCCOnM1CK,LYNDA 0 10099302 05/09/93 11197.60 310.40. 0.00 1,807 99 Bp 1P 1 205 1 ~ 44 ODARANrOR INFORMATION 4a JOHNNY MCCORMICK AT 3,00X_74 DENTON,.TX 76k01 NO response._, . y MCKAODItN,JANE' E tOO20087 04122/03 396:48 428,00 °883.60. 837,88 SP IP I O9/B9/8'J 63 1 r/ 4• GUARANTOR 114FONMAT1014 .4 JANE B MCFADDRN . RT,5 009 159 DENTON, TX 76201 _ No response MEYRN, [IONNA 1. 1001066D 06/03/03 40.00 260.60 0.00 308, 60 SP OP 2 109 1 04, GUARANTOR INFORMATION 44 DONNA L MRYCR „1721 TEASLBY LN M 306 DENTON, TX 16201No response j y i I; I i:'e1G 4Ri5' ` 01 GEC 1903 WR I TF OFF R EPgn 1' P4096 PATIENT 140)ME PA'r ID DI5CI10 UGO-UAL NEW-CHO NEWI-PAY 14-0 UAL rC TYPE CYCLE LOT.PHT AGE FO 1YPE ~ IM I, 4w MILLER, JACK IF. SUZANNE 10011773 03/14/03 414.35 100,00 ^10.00 544.30 UP IF 2 04/11103 100 1 xx OUARANIOR INFORMATION No DAnRE14 WAYNV HILLER 1410 DOGWOOD LEWISVILLE, TX 75067 NO response 40 M ILLER, P I NA I V LOU (0006963 00/00/01 606 VO 0.00 ^306.20 300.00 OP IP 1 06/02/03 .102 1 so OUAnANTUR INFORMATION xx PINNIE 1.0U MILLER 1406 CHANDLER HWY TYLER, TX 75702 Arrangement not kept f10 MILLS,CINDY G 0001738/ 10/126/02 5,121.90 535.05 -1,047.36 4,610.09 SP IF 3 0x/16/03 195 1 rx OVARANTOR INFORMATIUI4 xx STEVEN MILLS 2900 FT WORTH DH 029 DENTON, TX 76201 No response #40 MITCIIELL,.T14011AS L 0004766: 12124/02 210.00 0.00 -I, 00 249.00 SP ER 4 0R/09/83 267 1 wx GUARANTOR INFORMATION wx THOMAS MITCHe1.1. 38 INDIAN TRAIL LAKE DALLAS, TX 75065 _ No response to OKONKWC,PEACS C 00051391 01/12/03 7,474.00 96.25 °200.00 3,311.05 OF IF 3 05/17/03 148 1 wx DUARANTOR INFORMATION xx EMMANUEL OKONK140 2404 LOUISE 05 DENTON, TX 76201 NO response 40 PARKER, PATRICIA ANN 10000714 02/Ot/03 1, 753.25 107.70 0.00 1,061,00 OF IF 3 261 1 wx GUARANTOR INFORMATION xx JESSE L. PARKER A0£l.M0-,KENZ.IE, LEWISVILLE, TX 79067 - Arrangement not kept 40. PETEnOON JAI159 10025179 06/02/03 13,780. 95 0.00 0. 00 13, 700: 99 SP IF 2 100 I xa OUARANtOR 1NFO1114ATION xw JAMES PETEF19ON 1001 WHI19HUROT APT 1170 DALLAS, TX 75221 response ty PRENTICL,SHEILA E 00OD4775 01/09/03 851.50 210.90 -100.00 970.40 SP IP 4 0;1/28/03 139 1 xx DUARANum INFORMATION xx RICKY PRENTICE RT 1 BOX 527 PILOT POINT, TX 76280 _____,UOdb1¢.t0.~.lOCdt¢... 4110 ktlfllfJOON,ELLA t000994 04/11/03 028.01 4544 15 0.00 1,200,00 8P IF 2 .417 l ~ xx OUARANTOR INFORMATION xx MALCOLM ROOI14SON 1224 MCDONALD DENTON, TX 76201' No.response i4o ROB11J8UN,PRAIJKIE D 00018206 10/00/02 426.70 0,00 0.00 426.70 Sp IF 3 11/15/02 422 1 , xw OVARANrOR IN-FORMAIIO14 xx DONALD ROBINSON OENORAL DELIVERY KELLER, TX 7624$ No_responSe ; to ROBLES,ANDY 40014120 03/21/83 260.25 0.00 0.00 260.25 SP ER 4 246 1 xw AUAAANTOR INFORMATION xx ANDY ROBLES IRS,WALTERS_ LOUISVILLE, TX 75067 No response AnULES,JOP S. 40000071 Of/31/133 96.21 114.40 -17.00 193.65 SP ER 3 03/08/03 92 I r] xx GUARANTOR INFORMATION xx JOE 9 nODLES 30.4 H IJOOD $T DENTON, TX 16201 No .response RODDY, JUDY A 40001756 0;1/07/03 140.60 0.00 0.00 140.60 SP ER 3 793 1 V4 GUARANTOR IIJFORMAT1014 xx RODDY 2401P,ATRICIA LN OARLANO, TX 70042.. NO response V ROORIOUEZIDANNIE L 0005OD60 12101102 231.35 0.00 0.00 231,35 SP ER 1 365 1 xx GUARANTOR INFORMATION xw DANI41E nODNIOUEZ 2.17 6YL E_ DENrON, TX 76201 { IOUEL;BODERT LI1F. 4009(736 RODR 0 07/09/133 300,20 0.00 0.00 3011.20 OF ER 3 142 1 xw OVARANTOR INFORMATION xx ROBERT LEE R11DRIOUEZ 700 DRIFTWOOD YAAI1. DIENTON,,TX %6701 _ "No response,. { to' R0410,BERTA 60OU9154 07/08/02 291. DO 0.00 0100 291,50 10 IP 2 01/29/63 E11 1 xx OUARANrTIn IIJPCRMATIO14 04 BEATA ROSS 4307„10T. iTAVET LUBBOCK, TX 79410, ~ V MOOR, PAMELA 0 0005922220 10/11/02 11164.05 0.00 0.00 1,164.00 8P IP 2 416 1 x~ OUARANTOR INPORMAT1014 xx BRITT ROSS 1266 NORTHWOOD LEWISVILLE, YX 15067 „ %0 UALINAn,AHALEC 11. 1000+1060 01/10/03 1,756.90 0.00 0 NO rQSpOn4¢ ~ 00 107D6.90 SP IF 3 142 1 L xr OUARANTOR INFORMATION wx AMALUO D. SALINAS 722,CRAWFORD _DENTON, TX, 762201 ___Unable to ..locate r~ • V. ,i n -r r M r t., t~ F' P h R T. _PAmr 7 00 }yrlA crw•. ~{l F L w., pA011 7 ' wr 01 DEC 1'103 WA I T G -0FF R rP 0R T 1w t,ATISENt 7JA14G PAI 10 UIUCd10 11C.0-GAL IJf.W-CHO NCO,-PAY W-0 UAL FC TYPE CYCLE LST,P" AGE. FO TYPI: 1 W I 1 n SALtflAB, NANCY 00099964 10/ 16/03 J74. 30 0. 00 1674. 30 400, 00 GN DP 3 I UnEblenF~.O lOChtOl g 1 W 4x OUARANIOR ti$ORMATION x4 RUt1EN SALINAS log DANIEL8 DFNTON, TX 76601 !!~1 ! OCHOFIELD,NINA M, 4004?129 07/00/03 297. 00 64.00 0,00 371180 GP en 3 Uodble t01~OCdte 1 J yi 4 gat GUARANTOR INFORMATION xx NINA M. SCi1OFIF.LD PO BOX 349 171 BURROW ST LAKE.DALLAS, . TX___15069_._.. _ .f , SIMH,VICKI L 40037a94 06/09/93 61.60 057.09 0.00 413.69 SP ER 2 06/06/03 114 1 40 ..II 4x OUARANtOR INFORMATION a4 RtCKY SIMS 2500 PT. WORTH DR N7 DE14TONo TX 76201 Moved left no address „ r 9tEVBNO,V101.BT 00066909 10/21/92 1,193.80 0.00 0.00 1,153.00 SP tP 3 406 1 V as GUARANTOR INFORMATION a4 VIOLET STEVEN9 1 O BOX 238 CELINA TX 79009 Vo,responso 712 f 11+ TARASUFF,PAVL A. 10027689 OU/03/U3 1,129.09 0.00 0.00 1,179,09 GP 1P l xx GUARANTOR INFORMATION aR PAUL A tAIIASOrF 6272 8 HTE11MONS CORRiNtH, TX 76021 Unable to lotate 10011900 03115/03 2,407.69 7,806. S9 0.00 10,014.90 Hp 111 3 04 1 M y TEAOUV,NHRO R [WF9RMnriON *x PATRICK O•RGAR 8109 STCLLA DENt9N, tX 76201 Arrangement not kept. RR GUARANYTOR y er y 1HOMPSONiOALYNDA, 10011930 03/14/83 630.00 7.,839.30 0.00 3,469.30 GP [P 2 92 l No.rBSponSe _ ax OUARANtOR tNFORMATIO14 ax MARY THOMPSON „P9 BOX, 465 KRUM, TX 76249 y j TTLI.MAIJ,SHAIJNAN L13ANNt 100523939 05/10/83 1,246.95 76:00 0.00 1322.96 SP P 2 ITO reSpOn31 23 1 ; e► Rx OUARANTOR INFORMATION ax POMMY C. TILLMAN PO BOX 921 C/O E0 TARRATER kiD0dREGT, CA_ 93550 T U1t1 BOBBY D 00049716 12/31!82 117. 50 0.00 0.00 112.50 EP ER 4 33'5 1 y, 'VARA OUAkA eY aR NT011 INFORMATION ax DORIS 71MMON8 RT 2 01X_1064 17ENTON, TX 76201 Account Worry Lewit now --TORRUS1FpANOCS A 00069906 OS/12/83 1,995,35 0,00 -1,20b.27 389.0n HP IP 3 06/27/83 157 1 r W 04 GUARANTOR INPORMAYION a4 JUAN TOnREO 1919 MCIHICA14 BENTON, TX 76201 _ Arrangement not kept TUCKER( LAWRENCE 10003473 02/06/83 2117. 69 0.00 0.00 9x9. 69 HP 1P 4 209 1 w ~ 4a OUARANTOR INrORMATION xa LAWRENCE TUCKER aO9 PLUM 8ANOER, TX 260 ........Unable to Iotate.. r TVRNCR,WENDY 10006161 02/l0/R3 977.85 293.69 °10.00 1,19i,20 HP !P 3 04/21!83 192 1 11A xx OUARANI'OR INFODMATIUfd 04 LARRY TURNUR 627 BERNARD Iola BUNTON, TX 76201 Arrangement not kept I 00 TWtNFR,14AYNC RURERT 10093299 09/04/03 022.39 233.90 -10:00 1,044.89 RP IV 2 11/17/03 14 1. AYrangeineAt not kept ax OUARANtOR INFORHATION xR N• WAYNE' TWINER TWIN LAKES MHP LOT #193 DENTON, TX 76701 VAN HUSO,TANYA D. t0022190 09/76/83 3,549 55 0.00 -'2,438.84 1,109.71 HP IP 4 00/08103 115 1 ~ ~ J}x OVARANT'OR INPORMATtOll xx TANYA A. VAN HUSS 4407 OSBORNE OREENVILLE, TX 70401 Bneb18 t0 10CIte w VANCOUR, TINA 10018E 100i6996 04/07/03 740.29 235.40 0.00 1,003.70 Rp IP 2 S70 S NO reSponSo ' as OuAnANTOR INPORMATI(IN ax KENt4E'IH H VANCCUR 25 CHURCH ST OONHASSER, NH 03501_. _ WALDEN, TOMMY CHAP) t00t9998 04/OI/O3 292.20 I, 160.90 0.00 it 453. 10 SP to t 176 1 as GUARANTOR INF0nMAt1CIN a# RUSSELL WALDEN 629 ULAND DENTON, T,X, 76201 No.easpodse WILSON, 1E14RY•LA14E 1002983a 06/03/03 676.39 90,00 0.00 774.99 6P to 2 1,44 I ~ 40' as OVARAN100 INFORMATIUN aR TERRY LANG WILSO14 903 TEXAS DENt0N, TX 76POI Moved left no addreSe • M ~ T' 7~ f /'~I;.. ,t -r{/ •t r1.„rj+.y t(1'`'r; ,'11;~7.1~ y~ f 1110. 'iaw+Oz ar.. tl ~Y1r.NFYl1rn {Mk p rrr 01 OGC 1480 W R I T L U P F R G P O A I PAV 0 PATIENT NAME: PA-r 11) U19CH0 RE0-DAL NEW-C140 NEW-PAY I4-0 DAL FC TYPE CYCLF. L9t.P11T AOE PO TYPE I 41: WIOR,KALED.LEE 40039009 06/30/03 62.70 1,379.70 -00.00 1,387.49 SP ER 2 07/99/83 188 1 ' OUARANIOR INPURMATION er DANNY MF* WIDE Ala WITHERS UENTON, TX 76901 MOYed left no address tt YONACICA M4tAND 10007743 10/00/03 8,044,90 0.00 0.00 2,044,96 9P IP 4 03 1 rN OUARANTOR INFORMATIC14 w4 8ENTANO YONACIO CIRCLER RANCH ROANOKE, TX 7626.x, ,Unable. to locate „ 146 r. «MpM W-0 TOTALS itxaaf 172,709.11 -21,160.31 44, 060. 71 196, 400. 01 1 ; !S` M4 Ifs rt! lit ' 1 11~ i~ . 00 w { I, 1 ~I I 1 1 I wR t TE•"aaa R4tra(I T PAGE q v of O1 DEC i9U3 ' f>At1GDtt HAMf: PA1 11) OJiAJIO UEO•"DAL NF.W°CH0 HG.N-PAV 11-0 UAL FC TYPE CVCi.E L9T.P11Y AGE F'0 TYPE 1 v - A y OAHDNEI4, P)I I l.L IY C. 4001 1606 0:1/ 16/UJ 48. 00 O. Ud 00 26100 76 ER 3 11 /67/03 response 24 ~ e* OUARANIOR INFORMATION pHlLL1P E. GARDNER 18 FOX CIRCLE UEt4TUN, 7k 76.01 No NO Ye3pOnS0 . 232 2 I OhIIII)SON,W)IIA D. 40017491 44/10/63 111.00 RT."UO DDX 0100 AUUREY,0TX 8P EA . - _.2._ Unable to locate +i* OVARAtITOR INFORMATION DERRULL OARWBUN 40046806 07/110/03 69.50 90. 90 O, 00 119. 00 ADD ER NB 39 2 GILL, JERRY LEE OUARAN TUH INFORl1Ai lUN DORtO MARIE O1LI. R7 A DO%. 4_3 OENTON, 7X 76201 UM1ab1e t0 locate ` 40093977 00/17/83 134.10 0.00 0.00 134,10 ADD ER 1 0000EY, KATOR INFORMATION KATHIE 0006EY ATd li(Jx_ i?7 CAPRICORN MHP DENTONf T% _?6201_. Unable 10 locate Oll/+RANTUH 102 2 qw OONZALEB gARA 0 40010871 03/[2/83 48. 00 0.00 '10.00 36.00 8P ER 3 00/26103 199 2 V OUAAANTOR 1NFORMAYION FAEDDIF GONZALES 2300 8OLIVAR DENTON, 7X 76201 Arrangement not kept r'... 90000077 04/80/03 17 276 2 V ORfiEN,RaDEHT D. .90 RV D-00 0.00 f1 TW11J LAKR8, a9q 1DENTON, TX a '/6201 3 Arrangement not kept so. OUARANfOR INFaRMATtC1N DEVANE GREEN 0 R ,J ARINBLHY OEDRA 00027490 00/1//02 176.80 0100 0.00 176.90- BP ER 9 47 NO response - 4* OUARANTak INFORMATION 4* DFDRA ORIM3LEY AT 1. 6U% 6qA. AROYLE,, TX, 76226 1£8 P V HALL,OLEHDgLL "8COT7" 40039166 06/VO?aJ 96,00 43.90 0.00 144.90 HP ER 1 - lOtate. *4 OUARAMOR 114POIAIIATION 4+) OLENDELL "BCOTT" HALL 792$, LOVIBE 024 DENTON, T% 76201 _...Unable to 190 P V ,0, HOUSE, RRONDA JOLKWlf 40031361 06/08/83 792. 90 0100 HUTCH1f941N,. K9 67501 2..,... ..Unable t0 locate OVARANf1R INFORMATION 4* DREW HQU9E 00012010 03/18/03 46.00 0.00 0.00 48.00 BP ER 287 P 6) HOWARD,CARRIG L OUARANTak IhIFOftMATIt1N CARNIE HOWARD AT k,6OX 1,09 PILOT POti4T, 7X 76299 NO response HUFF,LORIH JOAN 10010213 03/08/03 72.39 819, Is -964.00 999.00 9p IP I 04/07/03 239 9 V 4* OVARA4TUR INFORMATION JAMES KELLY HUFF MW 9400 71MDERLINE GRAPEVINE, 7k 76090N0)esp0n40 y, 0003617e 12/16/02 94133 0.00 -704.60 iem b7 8P 1P 3 02/16/U3 209 2 4OHN9OH, JAVA K V OUARANIOR A INFtlHM61`10N NOR11AN Ja11NUON AT 3.80% 977, DECA7ER, TX 76234 Arrangement not kept ' V y, KROHNINO, JA11H8 EUGENE 40027967 OD/19/03 aa, 80 50.50 0.00 $44.00 ADD ER NO qD ¢ nl@At not 0 OUARANIDR INFORMATION JAMES EV09NE KROEN1140 AT, 1 BOX 0620 IIENTON, TS 76701 Arrange kept 114 v 40 LAROCHE,DAPHI4E L. 40041060 07/06/03 96.00 54.00 0100 112.00 SP ER ~3 Unabti► t0 locate . M4 OVARAHTOR iNFORMAIIUN DAPHNH 1.. LAROCHE AT 4 [10%,61 EXECUTIYU MUP LAKF. DALLA., TX 78068, 1 62 2 40 LHH,PAUL. LAWRHNCtS 40032840 06/06/83 $14 70 -99.10 0.00 96.00 9P FA 3 t 04, OUARANTOR INFORMATION PAUL LA14RENCF LEE 990 )36. CHARL.E9 M227 LEWIEVILLF, TX 78067 Unable t0 locate LEEiBhIHLfA 10017497 00/06/83 20b.00 8 q9 -80,80 191,19 SP tP 2 _ 09/06!00 209 2 All 40 ' *4 OUAAANTOH INFOAMATIO14 AHCLIA LGH 1429 KNIOHT dT DENTON, 7X , 76201 . ,,...Arrangement not kept - 95e 0 LYN99,SANDRA KAY 4001J934 03/10/03 40.00 0100 0,00 48.00 9P &A 3 44 GUARANTOR INVORMATIC14 *0 9A14DAA KAY LYNEB 830 ROSH DENTON, TX 76201, NO CeepOnse 397 1J ' OANDOVIST;CATHY L 0006001 11/09/02 90.10 0 00 0100 48. 10 HP gR J k OVARANTdN I14FOnMATION CATHY EANDOUt9T 3312 04101.E DEN70N, TX 76905 r qtr. p 4i ~,~~:'1 {"l rl 3 t~St i,, l.t111 ri ,id: i .1),I~ , R 1 i . A: ;./I 01 III',C I'7t33 4t N 1 T r 0 r 1= n F: F' U R 'I' : PADS 30 PArICNr NAML PAI 111 UISCHO PCO-UAL IJCW-CHO NEW-PAY W-0 UAL PC TYPO' CYCLE LST. PI11 ABE r'0 TYPE 46, 9ATTPHWHiTE, JUE 40013893 03/26/0:J 166, 2D 0. 00 -100.20 58.05 RN ER 4 04/11/R:1 234 2 j *a OUARANtUR 1I3F0RMAtIOH JOE BA11CRWHITi AT 1 BOX 4 LIVINGSTON, TX 77351 Unable to locate C S0OtT,PAMEI.A A 40089041 05/09/U;i 70.09 0.00 0.00 70,05 EP ER 3 09/10/113 705 2 OUARANtOR INPOUMATIOW *a CHARLES SCOTT 948 B CHARLES 0405 LEWISVILLE, TX 75067 , ,,..Unable to locate SHAVER, SHEAR I RENE 40072969 10/24/133 72.00 0.00 0.00 72,00 SP ER 2 36 2 IIf OVARANTOR INrORMATI0I4 4* SHERRI RENE S}IAVEn AT. 2 CHIIJN CHAPEL RD LE1418V1LLE, TX 75067 Unable to locate 1 • SHOWARD, RONALD DEAN 40019937 04/20/113 40,00 0.00 0100 48.00 SP ER 4 2223 2 OUARAIJTOR INFORMATION *a RONALD DEAN SHOWARD P, 0. BOX 65 NRUN, TX 76249 ....Moved left. no address r~~ MI SICKAVOOSBI CURITS fir 40031189 06/01/03 96.00 0100 0.00 96.00 SP ER 2 182 ^a « r as OVARANTOR INFORMATION as CURIT8 R. GICKAFOORE 1416 BOLIVAR DENTON, TX 76201 Unable to locate iw SMITH,JOAMN 40070203 10/14/07 69.25 0,00 0.00 69,25 SP Eft 4 46 2 M OUARAMrOR INFORMATION as LEONARD C. SMITH 530 ROSE DENi'014- TX 76201 Unable t0 locate. I SPA11148,8HULLRY MARIE 40064339 09/28/83 105.00 0.00 0100 105.00 SP ER 1 be 2 M #4 OUARAfJtOR 114PORMATION a* KENNOTH SPARKS DESERT SA14DB MOTEL 0206 DENTONI TX 76201 ,_.Uoabl@ t0 locate 4 40 SPLAWN, AMANDA 8. 40038739 06/:9/83 211.00 73.29 D.00 98.25 RP ER i lot 2 OVARANTOA INFORMATION) as JAMES D. SPLAWN gT„4, LOT 41 EXECUTIVE 11HP DENTONP, TX 76201 ST JOHN. 11000T 8. 40051542 08/10/83 92,50 86,25 0.00 17U. 75 SP ER 4 101 a f r GUARANTOR INPORMATIOIJ *a ROD90T E. ST JOHN 143$ N.;L000ST, DENTON, TX 76801 Unable to'locate ~ i BTAtJF'PELO, 61-1E111 95000294 04/25/03 17,110 0.00 0100 17. 50 SP OP 2 bb 2 ~ OUARANrOR INFORMATION a* SHERI STANPIELD AT 4 80%,347 El. C1ELO LAKE DALLAS, ,TX.._750&5..UnAble to locate,- j • STANLEY, KYLE 40048514 07/31/93 02.05 0.00 0100 82,05 SP ER 2 173 2 r *r OUARANtOR INFORMATION ar KYLE STANLEY TIMBER CREEK APTS 0306 LEWISVILLEI TX 75.067 Roved loft no address 81FAMRA, *+403 OJ 91.00 0.00 RD l CARROLL 2 129 $ 0VARANrOk INFORMATION CAROL StFAMER 1810 PETERO COLONY _ TON, _T>t_..79006,_,Unabl@,tOlocate. . j~ 1 w 13TEWARD,OARY 00067025 00/13/82 901.60 0,00 -25.00 1376.60 RP IP 2 06/09/03 176 2 V { GUARANTOR INFORMATION as DARRCLL SICNARU 1013 TEXAS TEMPLE, TX 76501 Arrangement not knot r STOKER,OHErtRY RUTH 400130104 04/21/93 61,20 0,00 0.00 61,29 SP ER 4 223 2 OVARANTOR INPORMATtO14 CHARLOTTE MOAGAN RT., 3. BOX 50 LEWISVILLE, TX, 75067 Unable to locate 0 UTRITTMATTENiLISA MARIE 40060055.09/00/03 116.50 0.00 0.00 116,50 SP BR 3 83 2 OUARANTOR INFORMATION JAMES A. STRITTMATTER 601 MULKEY LANE OENTON, TX 76201. Moved left no address 9TUADIVANT, KELLY 0 400$956a 00/114/93 64,50 0100 0.00 64, 50 SP ER 2 90' 2 OUARANtOn 111r0IIMATION JON STUADIVANT __910.L000ST 43 DENTDN,,, TX 76201 _._;MOVed left no address rJ , TALLE141', SCOTt F. 4001640404/06/03 113. 25 0.00 -5. 00 109.25 911 ER 2 11/04/03 R7 2 «1 OVAflANTgk 114PORMATInN a* SCOTT. P. TAL.LENT PO 00> 50072 DENTON, TX 76201 Arrangement. not Xept 1 40 I r d 1 a „ I ~r O1 l1fSC 14fJ3 ; .,.........«....ala.~..~IS W R f Y E ~ U F jr- f~ E P O R 7 PA9B 1l PAi1E:N1 NAIp! VA[ fU 1)15Cl10 KO-DAL NLW-CH9 WW-PAY W-O UAL VC TYPE CYCLE LST.PMF AOC PO TYPE TOACKER, T11111Y U 40030007 06/VI/113 197. 50 0. OU 0.00 197. 00 SP ER 1 194 2 as OVARANTOR INFORMATION as TIMMY 0 111AC9UR 990 9 CHARLES APT 11226 LEWiSVILLE, TX 75067 NO response j Wlt-JlGrN,CARCJL. A 4001675604/16/03 74.70 0.00 0,00 74.70 0P ER 3 04/In/03 asa^7 2 ON OUARANruii INFORMATION +a CAROL A THIES9CN 1402 OAKLEY.AVE DALLAS, TX 79216 Unable to locate ~ TINDER, STSLL,A 70006709 04/11/03 241. 75 10.00 -166. 00 93. 75 ADD 4P 143 05/10/83 q2 2 ~ as OUANA1110n INFORMATION aw STELLA TINDER 923 TIIOMA9 DENTON, TX 76201 NO response M TIVIS,PA1'(ItCK M 40011678,1 09/I0/R3 09.79 0,00 0.00 go. 70 HP ER 3 199 2 v `I +4 OUARAWOR INFORMATION aw PATRICK M TIVIJ 2514 HOSELAW1 DENTON, TX 7620t Moved left no address TDLIVER,PATRICIA A. 40034899 06/12/00 73.00 0.00 0.00 73,00 ADD ER f1S 169 2 v wa OUARANTOR INFOIIMATJO14 ww PATRICIA A. TOLIVER 5224 NASH THE COLONY, TX 75086 No response TRAYLOR, ZENILL 40006503 02/24/03 66.'25 0.00 0100 66. 29 SP ER 3 270 2 00 OUARANTOR INPOWATION Mw PATRICIA A WEATHERS 2939 TANNER DALLAS, TX 79219 N0.1 eSpOnSe L THUSSELL,CYNTHIA A 00070369 12/1!6/01 123.45 0.00 -50.00 73.45 SP ER 4 06/18/03 t05 2 +a OVARANTOR INFORMATTON as RANDY TRUgSFLL AT. 1 SOX 640N OANOER, TX 76266 NO response TUCKER, CLARA 11ARIC 40002503 02/10/93 95, 45 99.79 0.00 195.20 0P ER 3 197 2 J ~ OVARANTOR RJFOfiMATION wa FREDDIE TUCKER DOX_73 PILOT POINT, TX 76P!)e _.N4.reSpOnSe r TYBON,MICHAEL A, 40066029 09/RS/03 56.00 0,00 0.00 56.00 SP ER 3 64 2 40 OUARANTOR INFORMATION wa MICHACL A, TYSON 521 WINDSOR Nil D6NTON, YX 76201 UPCHURCH,BODnY R 00070912 014/19/DB 167,75 0.00 -100,00 67.75 SP ER 3 11/16/83 15 2 ~ w+ OUARAIJYDq SHFORM ATION ON L, A, UPCHURCH P 0 SOX C. KRUM TX 76249 Arrapgelnant not kept 1r ~I , URBA14, TERR1 L. 40012052 03/e9n/93 Ill. 25 0.00 0100 111.29 RP ER 3 253 2 ' . v OUARANTOR INFORMATION ON TCRRI L. URBAN 916 PRY 8T 53I6 DENTON, TX 76201 No response yV VAUGHN,JAM89 14, 40014946 03/31/03 09.50 0,00 0.00 59.50 gP ER 1 244. 2 V ww OUARANTOR IfdPORMATION aw JAMES A. VAUGHN 262 RIIfOWAY CIRCLE LEWISVILLE, TX 70067___..prCalfgement not kApt . M., VELA,T9AllEL 40040779 07/31/03 42.25 0.00 0.00 42,25 OP ER 2 08/01/03 121 2 V ww OVARANTOR INFORMATION +w ISAOEL VELA 715 CRA14FORD DENTON, TX ,76201 No response w, VELA,RAPAE1. 40020397 OD/10/03 78.00 0.00 -60 00 10,00 SP. ER 3 06/06/03 178 2 a+ GUARANTOR INFORMATION ww RAFAUL VELA 7t5.N,CRAWFORO DEIITON, TX 76,-01 NO,re9p011se w, VEHNEAKgo EDWARD J 00071400 01/29/03 1,069,25 0.00 10000.25 61.00 SP IP 3 02117103 201 d I wa OUARAW011 INFORMATION w■ HICHAR0 VEONESKE 32133 40TH PL SW APT. F-0 REDERALWAY, 14A 98003NO response r Y+ WALKER,ELIYABETHA 00071977 Ol/Ot/03 40.25 0.00 0100 40.25 SP ER 4 304 2 a a INFORMATION ww ORE00 WALK01 706 9CHMIT2 DENTDN, TX 16201 i~ s OUARANTOk _..:.:Arrangement not kbpt WAL4ACS,RODOEh J 00072101 01/04/03 70.00 0.00 0.00 70.`00 EP ER 3 311 2 y ww OUARANTOR INFORMATION RODOER WALLACE lot CORONADO NA DENTON, 7X 76301 Moved left no address WARDnfP, PAM_ 70014565 07/27/03 90.60 0.00 000 90, 60 SP OP 126 2 V _ OVARANtOR INFORMATION NO PAM WARORIP 604 GREENLAND LEWISVILLE, TX 75067,, Roved left no addrlSs w! v a. 1PXi~t~(Q%j 111 I .III, S 4 01 UI£C I9UI3 W R I '1 E O F' F A E P O R 7 PAOF..Ln JI PAt1EI11 WAHE PAI ID UIOCHO OEO••BAL I4EW-0140 (dEW-PAY 14-0 DAL VC TYPO CYCLE LST.PHI AOE PO T11PF N' ~Y WAt80N,SHA14F: 70bb 40067043 10/bl/U3 121175 0.00 0.00 121. 73 0P ER 3 59 2 Ii as OUARAN)'ON INF'OIIMATION wn CHARL.I:B HENRY WATSON HT 2 BOX 490 11AYHILL ROAD D[IITUN, YX 76201 Moved left no address 0 I WHIIEIKAflEM LOUISE 40064271 09/R.1/83 96.00 96.00 0100 112.40 bp ER l 66 2 1 J wa GUARANTOR INPORMATION as LAVERN L. WHITE CCA.116 Id... MAIN _LEWISVILLE, TX 75067 _,••,,,,.Bndble,to,lotat0 WHITE, LGE 40000796 02/04/03 49.00 0.00 0,00 49.00 UP ER 3 299 2 as OUARANTUII INFORMATION aw LEE WHI'TF. 313. THOMAS 03 DENTON,.TX_ 76201 NO response 610 WHITE, TIMOTHY DALE 40042319 07/09/93 6:1. 75 0100 0100 63.75 Sp ER 3 142 2 J j ww GUARANTOR INFORIIATIC114 as TIMOTHY DALE WHITE LA PAIRE APT Ht" DENTON, TX 76001„•, . Unable to locate r WILLIAMtaIUAMEO 40099620 09103/03 9150 0.OD 0.00 93.50 VP ER 3 Be 2 J b; aw OUARANrOR INFORMATION aw JAMES WILLIAMS 249 BAILEY ST DENTON, TX 76201 Unable to locate I y NITT9,CONIIEY ANDY 40063430 09/19/03 105.60 0.00 0.00 105.50 9p ER 1 - 73 2 1I Unable, to locate, , r! as GUARANTOR INFORMATION as GREG CARTER. „_DOX 413i_RT.4 LAKE.DALLASt TX 79065_._. r WOOLEYITEAHIIA 40007403 02/97/03 51.00 0.00 -25.00 26.00 SP ER 3 07109/90 149 2 r► aw OVARAI4TOR INFORMATION wa RALPH WOULEY, W 1719 JAMES 0102 DLNTON, TX 76201 Moved left no address • YATLO,RONALII LEG: 400&0091 04/21103 110.00 0.00 0100 110.00 RP ER 1 Unable to locat123 2 J OUARANTOR INPORMATION 04 RONALD LEE YATES RT., 4 LOT_5D, EXECUTIVE MHP LAKE„ DALLA91_TA•.79068_. _ aaaw W-O TOTALS waaw 9,169.45 -2,922,43 1,095.19 6,301.17 r. Sto uer i ~~+IMSd~>k4 4Doli94g6 Dox JI00lshtrap AV"' Denton,Dtx. 76201 D'OD 97 J5 SP ER - Roved left no address 2 l y I , 1 • •I 11" fMbaa'.vFi I a i 01 DEC 1903 W R 1 'I' E tl F P R C P 0 £1 T PAGE t3 .V PAt1EN( 11A11E PAT 11) DIUCHO 11C.0-DAL Nr_W-CHH NL14-NAY I4-0 DAL VC TYPC CYCLE LOT.PMT AOE FO TYPE ♦1 0.00 312, l l n00 OVARAtITORAINFORMATION rx00MARY4DAVLERJ/02 318.19 3329 E UNIYERSITY OENTON, TX 762ofMissing packets 271 4 ` DROUN,0AL£,L 40007909 02/97/83 43.00 0.00 0.00 43.00 EP ER 3 ' 276 + • ~fh xx QVARANTOR INFORMATION ax LYNN OROUN 206_TMO,MAH.:OAINE9VILLE, 7X..76$40,_, MI$sjng_Pagk4t5_..... ; nRYl3ON,ANOELA N 00010405 09111/02 991. J9 0.00 0. 00 291, 19 UP 1P 2. 446 4♦ QVARANTOR INFORMATION rx RODERT 0nYfl0N 160 OAKRIOGt LEWISVILLE, TX 75067 Missing packets... ♦ { DURRiKATHERINE 700177319 09/07/03 27.75 0.00 0.00 27.79 UP OP 3 0~ 4 • ;`4 xx GUARANTOR INFORMATION xr KATHERINE BURR NT 9 10 OAK VEND ClH f%NTCN, TX 7620_..Mi.ss1ng packets ♦ CLAY AUORtiY DHANIJON 10019933 04/21/113 1, 062. bti 0.00 -1,066,14 I'~6. 44 HP IP 3 09/97/03 lee 4 DENtCIN, 7X 7620SH135fAg,packet3 rx QUARANlOR INFORMATION xx TIMOTHY V. CLAY TWIN-LAKES 11HO LOT 2:11 40 11014ARDo _ORR INFORMATION 00033530 HARLEYY HUNARD UU 92.10 aPH 0 g OP,X.209 0.00 ARGYLE, TX 76x26 ....Mjsting„packets, . r L LYNCH ROOF M 10010063 04/01/03 1,410.40 915.90 0.00 1,934.30 UP 1P 1 03128/83 236 4 xx OVARAVOR I1400RHATIO14 xx MARK E LYNCH RT 2 DOX,.99OA AUDREY, TX 76227 Missing, packets 4 ♦ AIEDEL,8UE,A 40007502 09/27/03 94.00 62.00 0.00 116.00 EP ER 3 120 4 MK. OVARAHTOR INFORMATION x!< PETER RIEDCL, WILLIAM fi7_.1 QQX 314 _AROYLM,, T% 76226_ry9 Packet} : _ _ ' t ~ i1xrM W-0 TQTALB xxxa 3,801. 13 -t,066,14 J,026.40 0,761.39 i « r E , _ _ 6UTYON JUDY E 70007380 04/25!83 125,00 1606 HANCOCK GAINSVILLE6 TX 16240 UP 220 + Missing packets • • OUIRANTORI SELF TYSON, MICHAEL A 40066029 09/28/83 66.00 0,00 0,00 66.00 Sp ER 64 4 621 NINDSOR111 DENTON, TX 76201 Missing packets. i r • ' ,p1. t[~( rF. M;, 1 ~ r'.1' r ' y~. '1 ~ ~I ~.~tl ` . r,~9 I T ly f Y i i 1 f,t 01 Dr.C 1903 IJ R 1 T F' - U r r R V. P O R T PAGE. 14 E'ATIGIJI IJNSE PAI 11) UIUC110 DEO-DAL NEW-Clio N@U^PA1' I4-0 DAL KC TYPE CYCLE LBT,PMI' AGE rO TYPE y M. ApCdCK,O1IGLLY F. 40063497 09/10/03 124.29 0100 0.00 124.25 ADD ER NB i GUARANrgv INFORMATION rr SHELLY F. ADCOCK 414 PRY ST 09 DENTON, TX 76201 73 6 Unable to locate to AOUILAR,HELLI8A 40030341 06/1"0/03 8A, 80 0.00 -67.60 16.90 RP ER 4 00/03/03 120 6 *r OUARANTOR INKORMArItlN r* LOUIS AOUILAR 200 8 RUDDELL 031 DENTON, TX 76201 Arrangement not kept 4r ANpERSO1J, J111 00002634 01/124/03 IGLOO 0.00 -75. 79 7y. 25 ADD ER N8 09/12/83 203 b ww OUARANTOR INFORHAT1GFl rw ELNOOD ANbEiRpCIN RT d BOX 104A MIDLAND, YX 79701 Unable to locate 6 APPI.EDEE,.OEOFF A. 4003(3133 09/O2/03 90. 25 0.00 0.00 98, 29 SP ER 3 *a GUARANTOR INVORMATIOIJ OEUFF A, APPLEBEE 316 FRY ST0376 DENTON, 7X 76201 Be b . Unable to locate 4P ANHOLD,HiCHAEL L 40046104 07/23/03 96.00 0.00 0.00 96.00 SP ER "IN OUARANIOIJ INFORMATION ra MICHAEL L ARNOLn 0440 VIENNA VILLAGE LEWISVILLE, T% 79067 130 b ~ Unable to locate 1 ♦ AfV1UtTT, DA(t9fN P 4002,2304 04/;2q/133 65, 25 0. 00 0100 6B.26 ADD ER NB w* 2L3 6 OUARAM OR INFORMATION *r DOTTIE ARGUITT 114 CAROLYf) ST SANGER, TX 76260 Unable. so locate 06 AHKINH,GHAROLYN R. 40000564 022/02/03 38.00 0.00 0.00 38. 00 BP ER 3 301 6 GUARANTOR INFORMATION r* SHAROLYN R, ASKING RT 2 BOX 233 AUSREY, TX 76227 ATW,1.L, LEE JAMES 40056707 00/00/03 56.00 0,00 0. 00 56.00 ADD ER NS y w, 1302 CARVER ODEBBA, Y - No response r* OUARANrOfi INFORMATION LEE JAMES ATWELL I ~ 99 6 _ X 79760 ......,Unable to locate AZIM1,14ASOUE T. 4002,7616 05/03/03 48.00 0100 0,00 48,00 BP ER i *w OUARANT011 IIJKORMATION MASOUD T AZIMI Po Box 816271 DALLASr T% 79381 No YAS1MnaA. 211 6 4I DAILEY, JACK 40084884 OU/20/03 97. 30 0100 0.00 97.30 Apo ER NB 1 vw GUARANTOR IMFORMAT10N wx JACK R. DAILEY HT,2 BOX 336 MAUILL, OK 73446 q8 6 ~ j _..__..Unable,to locate ' `S HALL, CHARLIE JR. 40042764 07/10/83 ft, 35 0.00 0.00 122.35 ADD BR NS GVAOA14TOR INFORMATION *r CHARLIE JR. GALL 141 6 CROBBRtlADB MOTEL 00 2494 HIP! 78N BNERMANr TX 75090 Unable to locate Ali OARNetT,CHANLES 00004605 12/19/09 78.00 0.00 -35,00 43,00 kp ER 3 09/16/B3 76 6 f wa GUARANTOR ItJP01t11AT 10N wq CHARLES UARNETT 1607 W_ OAK, 0101_ DENTtlfJ, T% 7620E ; I ..Unable to_looate. OATI,LARRY n ~ 40030843 00/30/83 104.90 59.200 0 J 91 6 1 4* OVARAWOR 114PORMATIO14 r* LARRY A UATT ,00 163. 79 SP E8 l19 AVE O N110 DENtON, TX 76201 Unable to locate , #0 BECK,PATTY 70000430 00/09/0;1 130.29 43.70 0.00 182.00 GO OP 2 OUARANTOH INFORMATION *IF PATTY VFCP. „(117 POSE .t1ENTON, TX 76201 70 6 ..No response ' A t~l IfeNNETL, TONY 40034060 06/11/83 7&00 01OU 0.00 76. GO Sp Hq 3 f 44 OUARANIOR INFORMAH011 wr TONY,URNNETT 1313 E SHADY DROVE 0103 IRVING, TX 79062 570 b NO NASpOnSA. on/ B*t*gGUARAWOR INPUNMAtION * 70BERTHA OGN9DM~3 59. 35 0.00 0 00 Bq. 3J ADD Op 14IDS G y 1 AT_P,HANAQR, TX, 76566 Unahle-t0 IOCdEe fl10Olflk, DDBkY JOE 40073918 10/20/03 5B. 20 DID() 0, 00 09,20 GP ER w* OUARAMTOR 114FORIIATIOI4 xr BOBBY JOE I1100INS 309 KIRKLAND BANGER, TX 76266 33 6 r f Unable to locate +l DISHOP,DRONA I) 00006734 11/03/82 1022.40 0100 -100 92,40 SP ER 1 08/12/03 111 b GUARANTOR INFORMATION rr DAVID BIOHOP 1820 NUDUEIL 0219 DENTOM, TX 70201 + 1 6, li 1}X4+\y{ r, , w' bl UE!{: 1Rf1:1 41 R[ 1 li 0 f f' R E P T 0 If PA1'IE',Nf 11Ai4E PA I' t1) 1)ICC110 RE()•-OA(, New-C)IU NCW-PAY W-0 DAI. PAJU 15 PC TYPE CYCLE LST.Pf11' AGE FG TYPE'. , AISHOP, JERAY C 0000677D 01/12/0,1 - ! OUARAWOA INFORMATION an J6HftY SIAHCIP 43'00 ^49.00 0.00 413 . 00 8P ER 2 a • POD 8301 DENTON, TX 76201 Arrangement not kept49 6 DI.ACR, DAVID C 40096796 dU/t!R/8:1 I ON OUARANtCR INFOIRNATtOH *r DAVID C ULAC1t 56.00 d.Od 0.00 56.O0 8P 4009. UIVItiG XS DENTUN, 7% 76P.OIR 0 Unable t0 locate 99 6 ALAISUEI-L, I.AOA1Jh DUF i 500005:18 02/ 1 Y/03 ~ a* OVhPANTgIJ IPIF'OfffJATIIIIJ *w 1,510. 65 0. 00 +L 353, 40 107, 25 XP CA 95704 Unable LADANA 8VE ULA13UftA. ZIPS NORTHDANK X34 8TOCATON, 13 1to locate 247 G • VUL IVEA,JAMCS M ~ OL OUAtlANTOR tIJFCItpfATfOW w*40012111 03/iq/O3 111. 00 0100 JAMES 11 DOLIVER 0.00 111.00 XP ER P12 NORTH 8T T L EWISVILLE, T% 79067 3 ^296 6 ~ ROTKNL JAt1E'8 ROGER, JR HD response ~ 40094700 00/91/(13 61.80 0.00 00 NO OVARANtOR INFORMATION JAMES ROGER DCTKIN, -in 0, b1, 80 ER ~ RT 7 BOX 31 DE NYpIJ, T% 769Y.0 01 Stl1 6 • DCIUSL6'Y,08NIVC 1. 40044781 Op/04/83 8 unable t0 14eat@ ' 0.00 *r OUARANrOk INFORMATION DENIGE L IIOUSLEY 5013 EVEAOLE 88.75 0.00 EN N THE COL L 7$ ADD ER N9 OIJY, TX 75056 ll5 6 ~ Unable to locate D()WCR8,JENFA 40001969 08/00/113 r as OUARAWTOR INPORIIATICI! ON TSMMY ACIIJCRO 91 6 D t)IJtOHT LE00 65. 00 0. O E 65. 00 SP ER ) WI9VILLE, 7K 75067 NO response, 094 6 DIIACKEfJ, 04 1AN 40013054 03/00/1)3 QVARANTOk !1lFpftllAYICfJ CYNTHIA BRACKEN 48. 00 0 UO 0, 00 48. 00 XP ER I N 405 WALNUT CREEK AILS, TX' 76020 o response 280 6 DRAINARD,JABON C J' 40058680 00/14/83 9b 00 0, pp 0.00 36,00 wr 0UARArIT17R ADD ER 146 Unable to Jlocate ' t08 6 WFORMATIfill r* MARK URAINARU HOLIDAY LOUOE 017 GENERAL DRLIVERY LEWISVILLE OENTON, T% 7690t ORAUOA1CK,WANDA 40043150 07/11/8:1 q *a OUARAIITUR INFORMATION KELLEY DRAUORICK 3.50 0.00 O.OO q3, 9d hDU ER NS 0012 F1' WtlRTH DR LOT M90 DENT0IJ, TX 76',\01 U ebl_ 141 b • DRAVONL<RrKAY E, R 4.to locate r* OIJARANTUN INFCRMAY1g1J w*400IJ742 06/03/03 70, Od 0.00 0.00 70-00 MC ER KAY E. DRAUGHLER 1303 STRATFORD DEWTON, T% 76001 876 b UREIlE'R, TH01%!A1 BHAWPI Refused to pay i ~ aw OVANANTUR 1NF011MATtOfJ 04 FELLOWSHIP 06/14/83 67.00 0.00 FELLOWSHIP CHRISTIAN A1'HLMES 9701 LEEDS A000KANSAS7CITTY ,BNMO ER 8 164 6 ~ • i ~ DROADUG, DOLLY I 64!09 ...k4..rASpOeSB_ _ *r OVARANWN 1NFORMATIOIJ r*70DOLLY2DROADUS 8018 03 74.75 Q OO HEA 59, 79 19,rO XT OP A 3 061P1/p3 • RCCEH TRAIL D6NfON, 7% 76305 HO„TASpopSa',; 1,63 b DROIJN,ERIC I, 400D3Opb 00/1p/03 ON OUARANlpR IIJFOft1lATitlN as YVETIF DRUWIJ 96.70 0.00 O.OD 96. 70 AVD ' f0% MAIN SAN _ Mt TX 762266 ER N8 104 6 + GROWN, OALp L Unable t0 IOCet@ wr OUAAAfITOR IININFORMATION wa40030010 051.O/S3 61.50 0, 00 OALC 1, 11ROWN 0.00 61.00 ADD ER Ng ' • _ AY l 1lQk 773 BANOfiR, TX 76,66 Unable t0 iOCat@ 186 6 DROWN, KATY 40063108 09/10/D3 OVARA14TOR INFORMATION wr KATY DROWN 76, 79 0 0.00 7b. 79 A ER IJ8 100 • ~ X05 9 M tI.LEk LEIJIBVILLE, 7X Y5 75067 73 6 UAOIJN,MARY 40015109 11/00/03 Una6,l.A t0 lOC@t@ 40 OUARANTUH INFORMATION r* NANCY DNOWN 54.00 0000 0.00 54,00 8p ER tlpggtl CtlOr CIO Y7777 4 24 6 r ~ OROIJPLBHIRLfSV ff. 021619 to 1Acate ~ r r* N,9HRLUII lNFtlRMATIpN w*1004~O92 7/30/03 159.70 0.00 0,00 150;70 ADD EA NAUAab1A t0 10§et@ 17lII 6 •OR0N GENERAL DELIVERY E1 11AYHILL AD„0$NTON, TX,:_7bu01 :a ~f f X'51 Iti~v. , ,'~y.7 rata v,~.tan ,~.fyy,td'eYs.{ i r r varruN.V r<nar,nxSl x AI IICC 19R'I N R I T V. - 0 F If R F. P 0 R T phdF l6 1 PAT11-F11 NMI, PAY 11) JI`,;LIIO REO-UAL IIEW-WO NlH••PAY 14-0 DAL FC IYPE CYCLE LOT. PMT AO! FO TYPE ' DRYAN, 111AIJK LEC 400671R0 10/0:1/RU in. 79 IO1. 79 0. 00 180. 90 ADD CR 148 40 6 r, MN OUARAHTOR IWONMArI(IN 17IIA14K Lf:E. IIRYANI 9321 INKFR PARM(NGTON, MA 67903 Unable to locate w, (IEIRNS. BRYAN K 400V4f)H3 09/09/113 47. 00 0,00 0,00 47.80 8P Eft 2 09/06/03 209 6 rr► OUARANIDII lI1FORM4T10)! war TERESA DI-OCK FIT 1 UOX 91 AUDREY, TX 76227 No response wlI RURREI.LIJF,1'r 40019190 01/17/113 92.10 0.00 -60.00 32. l0 ADD ER NO 09/30/03 62. 6 NN OUARN1100 INFORMATION an irm OURRELE• 2761 MILLPOND DENTON, TX 76201 Unable to locate 40 w IIUf1.ER, JOHN, t 40003129 02/Otf/00 3R. 00 0.00 0.00 18.00 ADD ER 118 248 6 ~ as OIIARAWnR INPORMArlON Zk NANCY BUTLER, C 206 LANEY RI) DENTON, TX 76201 Unable to locate BUTLFR,KIH0ERL.Y 40019139 04/17/03 s1. 00 46.70 0.00 97.70 SP FR 3 40 6 *4 OUARAWOR INFORMATION ON RICHARD BUTLER RT3 DOX87 FR19C0, TX 79034 No respoAse DUTBON, A1414 II 40032421 06/00/U3 61.90 0.00 0. 00 61.90 ADD ER NO 170 6 w 14- OVARANraf! INFORMATION ON, ANN 11 OUTSON 7609 PHOENIX #309 HOUBYLI% Tk 77030 Unable to locate 176 b CAIN,L18! A 4003/443 06/09/83 104.39 0.00 0100 104, 3b ADD ER NO va OUARANTOR INFORMATIOIJ ,fe RALPH CAIN FIT 9 BOX 24 DENTO11, TX 76201 No response CAIN MARTIN 5 40012901 03/23/03 $0.00 0,00 0,00 90,00 ADD ER 148 293 6 w e4 OUA ANWR 114F•ORMATION *4 RALPH CAIN CAPRICORN 14HP 13 DENTON, TX 76201 He,_MB$pOn58.' ` w { CALDWELL, UOBD IF. JEAN 40014698 03/JO/B3 74.00 0.00 0.00 74.00 ADD ER NO 249 6 NO OUARANTOR INFORMATION tk WILLI' CALDWELL 213 AVENUIC 0 HIS DENTON, TX 76201 No response ~ CALOW64L,JOAN L. 40040394 07/06/03 14.90 119.90 0,00 [34.00 8P FR 3 4B 6 NN OVARhfJTUR INFORMATION r'1 JOAN L. CALUW8L4 400 8.__RUDDELL NtQP DENYON, TX 76201, .N4 ae$pon$e. CAMFBELL, IIEPFERY J 40013831 03/26/83 141,20 60.25 -75.00 134.50 SP ER 4 00/10/03 p109 6 No OUhRANfOR INFORMATION ON, MONTREY CAMf'UFLL * RT 1 BOX 391-H H0098, TX 79661 CAMPIIW., SHARON K 40020901 04/24/83 61.90 41.79 0.00 103, .9 SP ER 4 48 6 NO dUARANTOR INFORMAYlU11 w11 PATRICK CAMf dFLL 3609. BNI.NRCLIFF DENTON _o TX 76201 N0 ra$ponse. 46 j CANNON, TAIfMY L, 40027666 09119103 B6.00 0.00 0, 00 M6.00 ADD FR NS 199 6 rl r nr GUARANTOR INFORMATION sp JERRY CANNON FIT. P. BOX 141C ARGYLE, TX 7624416, Unable t6 locate 0100 C00UOUARAf T[IRFINPORMATION Rio FI00all 4VE/C10/83 ARON 330.69 14160ELM COFPEVIL(A K85 67337 ER 4 NO,rosp0nSe 162 6 Nil, CARON IJAYIJIS R 40032664 06/04/03 92. 90 O.OD 0.00 92.90 RP ER 2 176 6 r rE OUARANION INFORMATION *f WAYNE R CARON P. 0. BOX 118 CAA L,EWISVILLE, TX 79067 Unable to locate 1 40 CARn.RATH1 40071693 10/1LI/03 99.00 0.00 0100 99.00 ADD FR 148 41 ` 6 OR OUARAWTUk INF'OlIMhTlpfl re fiATHI CARR _ BOX 141, JUSTIN- TX 76247 __.VA4b1$ EO,loceto 1 r CARR,ROdrRT N. 40017936 04/)0/U:I 28,00 0,00 0.00 28.00 SP ER 2 04/14/03 •331 6 OR OUARANTtfR INFOAHA110I! ON, RODRAt R. CARP 1117 PAISLEY DENTON, Ilk 76201 No response ♦ : CARRIIALKS MkL198A 400,19910 06/29/03 134. 90 0.00 0.00 84, 90 OP ER 2 194 6 of OUARANtON INFORMATION 1w SYI.VIA_CARRIZALEB 4316 71110THY DR. FT WORTH, TX 99999 _ ,,NO response 40 z I sxa.rvMe~ 01 IIF.C 19113 W A 1 T G- 0 P P R L P 0 R 7 NAGS I% J I PATIENT NAME PAT 10 DISCHO DEG-•BAL NEW-CHO NEW-PAY 14-0 DAL FC TYPE CYCLE LOT,PI1T AGE PO TYNE CARROL.L,DANIEL A 00012104 01/02/03 71.79 0.00 0.00 71.75 9P EN 1 333 6 J na GUARANTOR INF'ONMATIRIJ aw 1t?RRY 0 CANPOIA. AT I DOX IVOAA PONDER, TX 76299 No response v CARROLL, MOL3.Y 40018707 04/19/03 tOR. 85 0100 0.00 10£3, 08 OP ER 3 227 6 as OVARAWOR INFORMATION 4a 11OLLY CARROLA. 3706 BLUE,DONNETT FLOWER MOUND, TX. 7D067NO response.. CARTER,DAVID 9 00012211.11/10/02 38.00 0.00 -9.00 33.00 SP ER 2 09/16/03 199 6 J Yw 4VARANW1 INPORMATI014 nw JAMES CARTER RT 2 HLV H37 DECATUR, TX 76234 No response M CAR7'ER,9EITH ALLEN 40000096 03/OZ^/03 76,00 0100 0100 76,00 Sp 6A 4 273 6 aw GUARANTOR INFORMATION wa KEITH ALLEN CARTER RT, 3 BOX 49 FRISCO, TX 75034 NO response CARTER,9HIRLEY J. 40037933 06!22193 169.00 0.00 0.00 168.00 ADD EA NO 161 6 aw GUARANTOR INFORMATION ww OLEN CANTER AT .1 l5 MILLER. RD.DENTON, TX 76201 -Unable to locate CARts:Ao TONY 40033284 06/09/83 96.00 0100 0.00 06.00 8P ER 3 174 6 J a4 GVARANTOR INFORMATION ww TONY CARTER 911 LOOP _.28p,a9. DENTON,. TX 76201. No rPaponse..,. v CAUrILLO,JUANITA 10014028 03/73/03 679.30 0.00 -6x3.44 95.06 SP IP 3 04/28/83 2J7 6 ~j aw OVARANtOl? INFORMATION as VICTOR CASTILL.O LIO E HIGHLAND OENTON, TX 76201 No .r@scems@. w CASTILLO,IIYA14A ddO12975 01/19/03 42.65 0.00 0.00 42.65 SP EA 3 316 6 ~ na OUAAAIJrOR INFORF3A1'ION nw MYRNA CABTILIU 019 SMITH NF4 BENTON, TX 76201 No.response. j CAOTILLO,f1ICHARD L, 70007034 04/RO/33 165.00 0.00 -92.00 73.00 DP OP 4 06/06/03 179 6 rl ww GUARANTOR INPORMA11014 ww RICHARD L, CASTILLO 8712 FT WORTH OR 091 DENTON, TX 76201 No response CHAII01'-, DAVID 40018042 113111/03 R8. 79 0. 00 0.00 Oil. 75 SP EN t 04101/03 5344 ` 6 ON 6UARAN'rON INFORMATION NO DAVID CHABOT PO BOX 173 JUSTIN, TX 76247 NO .r@Spons@.... r CHAMUEALAIFI,JEFFREY 40013800 03/26/03 613.35 0.00 0100 69.35 SP ER 4 249 6 J aw GUARANTOR INFORMATION as ADRIANA CHAWRLAIN AT 3 BOX 35PO DENTpN, TX %6201 NO relKnSe CHAMDERO+OWDIA MAE-. 40016079 04/08/93 40,50 0, 00 0.00 40.50 8P EA 2 04/11/83 232 6 OUARANrRR tUPOnMATION ww JAMES CHAMBERS 3021 ATLAS_ UENTON, TX 76201 _ _ No response _ CHANCE110R,0030Y I1 0 000197D% 11/21/02 174.07 0.00 0.00 174.07 SP IP 3 01/10/83 373 6 u V* GUARANTOR INFORMATION aw RUB CHANCELLOR AT 1,BOX 60JP AVOREY, TX 76827 NO response. CITAPMAN.KURTIS L. 40017037 04/09/03 48.00 0.00 0.00 48,00 SP ER 2 235 6 wM OUARANTOn INFORMATION 44 LOYD CHAPMAN AT. 2 BOX 60 AUDAEY, TX 762227 _ No response CHANPEI.L, PAMELA J 40024407 00/07!03 92, 90 0. 00 0.00 9x. 80 SP EA 2 207 6 'i an GUARANION 1NFORMATIOI4 aw PA11CLA J CHAPPELL 117 E COR014ADO BENTON, TX 76201 No response CHARALSON,RICHARU A 00012972 01/11/03 3B.00 0,00 0.00 3n,00 SP ER 2 374 6 'r as UVANANTOR INFORMArmit aw MICIIAEL COIJCLI. 810 N DIXON OAINESVILLE, TX 76240 NO,response._.... CHADTEEN.CINDY 00012930 01100/02 200100 0.00 _IW O1 41.99 BP 1P 3 68/30/n3 93 .5 ww OUARAWOR INFORMATION as KEHRY CHA11TCISI4 916 SUN VALLEY DENTON, TX 76201 No response al f CHAVIM PAOLO 40011919.03/10/03 79.40 0.00 0 000 NTtlW, TX ~q,40 SP ER , 2 288 6 IN OVARANTOR 1NFONMATIOH 44 PABLO CHAVRt 90 r Arrangement not kept J$ S.: V Er~4 All r. ,r `f y~ r.;=x,11 ,l r;J•..7 .1 •q;~.rii "r•. r~. 1. , ' a ✓P of UFC 19131 (J R 1 1 R IT I, v it 6' P 0 It 7 PAM . ~O. ,I ~ PAT I011 wogF PAT IT? Dlf;CllO HCO--DAL IfEWCHU MM-PAY it-O ITAt- Ft: TYPE CYCLE L.i3T, PHT AOC FO TYPE .r; CHECi9ER, CARA MARIC. 40072$009 0412(mi l 06. 60 0. 00 0 00. M 60 [iP ER l 216 6 OUARMIrtir? INFORMATION NN DENNIS VR CIIE,';[,F,k PO BOX 90611 1011 SCOTT LENTON, T% 76201 y Nu rosponse CVIRC EIJE, TREVA A OUARANf01t 00013169 06114/82 113 69 143, 50 0.00 857. 15 OP ER 2 12/07102 16 6 ' x4, INPOHMAIIUH u« A CItrtECMY_ AT 2 p[U; IF![i--V, k0Y8{?.CITY, Y% 7$089 1 No response J CL.ANfUI:, k1CKY L 6001%199 06/211/03 56. 00 0. 00 -15.00 41.00 8P ER 1 09/2-1/83 64 6 r Ol1ARAWTCIN 1PJFORMAYIOIJ xN RICKY L. CLANION PO BOX II;?2 LAKE DALLAS, TX 75068 NO reaponae CLAR9,CHRIO K 6001=6 01/~WC3 81,50 0,00 0.00 81,130 SP OP 3 N4 OUARANTOk INFORMATION N4 JUG CLARK ? 306 6 111 W1LL[1W Ht1p0 DH UEIJTOtJ, T% 76201 he response CLARK,CONNIE J 00013342 09/01/C? 633.98 0.00 -500100 133. 8R C;p IP :1 05/11/03 204 6 44 OVARAMTOR INFORMATION) Nx J1MMy CLARK RT $ DOX 165C AROYLE, TX 762'".6 Arrangement not kept CL0iPK,LILI.IF:,D 40005415 08/201113 30.00 0100 -16.Or, 82.00 SP ER 3 11/18/01 13 6 44 OUARANIOR INFOn11ATIUN 44 DESU1E CLAW 11 324 I VERCRKST LEWISVILLE, TX 75067 ' No response.. CLMIK, SEAIJ N 40049710 08%04/05 71. 00 0.00 0.00 71. 00 ADD ER too Oil OUARA11TOR INFORMATION 04 M.OIE CLARK 1x108 OAK PARA DR 11220 LEIJISVILLE, 7k. 79067 Unable. to lotatell8 b CLARK,8HeRRY ANN 40044679 07/t0/03 121.70 0.00 0.00 ISM. 70 HP ER 4 134 6 OUARAI4TOR 114FORIIAT1011 SHERRY AN>t CLARK 220_OAK- PARK, DR. L.81418VILLE, TX _75067___611able..t0-locate _ 40 CLYMER,PAMELA C 00013945 01/17/03 991.25 34.00 -491.20 66.00 SP OP 3 11/23/83 2 6 GUARANTOR INFORMATION 4« MIKE CLY110 Pp DO,% h ,4,92 LAVE 1361168, TX 79065 No response ~ COATCIP444WRA A 00014019 02, ID/132 723, 00 °07. 84 -23. 00 1IP I6 SP IP 3 02/1.9%83 232 6 A4 OVAkANTOIt RJFC?ftMATIUIJ a« DEtlRA Cl?AT8 AT 1 SOX 69 AVOREY, TX 76227 M04ad.left-no address COCHRM4, LOU19C 40002032 02/09/C3 40. 79 0.01) 0100 40.75 80 E8 3 294 '6 + N« GUARANTOR INFORMATION N! LOUISE COCHRAN 732 AL(!XAfJOPR UENTON, T% 76201 No rosponse COORELL, LARRY 0 40008047 03/01/1)3 124. 89 0. 00 U. JO 124. 85 fiP ER 4 214 6 Ns OUARAIJI'M IJPORrtATICIry N« LARRY D COODELI_ RT 7 BOX 427 DENTON, TX 76201 es No. response. • COLEMAPI,APRIL 0001450 10/01/02 124.00 0.00 »44.00 80.00 SP ER 1 II/?5/83 6 6 4N OUARANION INFORMATION Nr ARCHIE COLMAN AT 2 nOX 245A AVJRE1', TX 76227 NO response DAl.1 qN. UETTY J. 40049092 OIE1711F17 44.00 0100 0.00 49.00 SP ER 3 879 b I 44 OVARAIIIOR II0?ORMATI0I4 N« EVERRrt COULD 625 PT 11OnTH DR 026 DENTON, T% 76201 No-response f J DALTOPI, O@TTY-J. 46049072 07/19/93 76.00 0.00 0.00 16.00 eP CA 4 133 6 «M OUARAWOR INPOPHATION ON JIMMY (.EE DALTOIJ 820 ROM ST DEIJfR4b 761.'01. I No response f M ' OALTCN, WWI J. 400-1.1136 06/08103 90. 30 0.00 0, 00 90, 30 8P Eh 3 179 6 ! r, > f 40 OVAIlANTOR IfJFCftMATIOI! ,}N JIMMY lEF DALTOPI 820 f1013E UENTCIN, TX 76201 ' No rooponse.. roe DAL.TUN,USIF.R J 400461,09 07/29/03 109.00 0.00 0100 169.00 SP an t 129 6 46 nUAnAl4lon INFURMATION N« J1 M1Y OAL.f011 e20 ROBE DEWON, TX 76201 No response ; I/ DALTOIGEWPIER J. 4005760 00/11/0:1 $7.00 0.00 3.00 $7.00 SP ER 2 04 OUARANICIR Mr(INf,STION «N JIMMY DAL.TON 020 ROSE BENTON, TX 76^4,01 y',. 6 No. response , i _ r M ' 'ARC"~ I!. t a l`r 01 Off, 17113 IdN 1 I F. -'Urt F.P Uft T PAGE 19 I'ATILrIf IrnMl! PAI ID 1) 15l;NU OC0 -tln4 MgW-(.H!> NEW-PAY W-CI UA1_ F'C rYPH CYCLE LOY, Pill* AOE PO TYPE: ly DAL ION, R ICHARD 40()617.'3 09/ 13/CI;I 151. 30 0.00 0.00 131. 30 nP EN 4 70 6 ~I 4 a* OUARAMIOR INI+ONMATIUIJ *4 JIMMY DAI.TON 920 RODE t)EwON, TX 76x01 Arrangement not kept) W DALTUN,RICHAND II. 400 ^ 74 00 94.75 8P EA 3 1"87 6 OUANANtOk IMFORMAT1pf1 **JIMMY/ DALTatl 800 ROUE 8T '/9 0. 00 O.UENlrcm TX 761"01 _ Arrangement not kept V' UAL',"101,111CHARD H. 40017659 04/10183 48.00 0,00 0..00 48.00 8P ER' 2 *a OJARANTOR INPURNAYIOtI a* 9UDANNA DALTOM 020 RD13F bENTON, TX 76201 232 b o) No response nAI.TON, A 1C11Allb H. 40019994 04/20/03 40, 00 0100 0. 00 48. 00 HP ER 4 OUARANION 111FORMAr1011 *a JIMMY DALTOM 820 ROSE VVIT014, TX 76201 223 6 !y No response DALTON, RICHARn H, 400470113 OD/ 18/8:1 67. DO 0, 00 0, 00 67. 50 8P EA 4 No response 196 6 y a* OUANANIOR INFORMATION *a JIMMY b.AI tON 020 ROSE DENT0I4, TX 76201 I t~ l DAP41fiL9,JASON 0 00016`64 00/13/02 96.32 0,00 0.00 963i ADD IP NO 12/23!861 656 6 ' OUARANTOH 114FORMATION *a CHARLE9 DANIELS RT,2 LOT-61 L.AKESHORE DENYON, TX 76201 Arrangement not kept VOWNEY,11ILDRE1) 40010547 04/03/03 40.00 0. 00 0.00 40,00 ADD ER 1 ' OVAAAMTOR INF'ONMATION MILDRED DOWNCY STONE" HILT. APTS 0216 DEN10% TX. 76201 Moved left no address0 6 11 0UWIJHY,111LDRRD 40060592 09/10/113 72.00 0.00 0.00 72.00 ADD ER 4 *s OUARANTCIn 111FORMATI0IJ MILDRED DOWNEY ,210 NORMAL;,DENTpN, TX 76201 _..I(oved left,.n'o address9 b ' i DOWIJEy,MILDRED 40062978 ^9/t7i 53 12"0. 90 0100 0.00 120,95 ADD 2R 1 OUARANTON THrONMAY1014 *a MILDRf'D DOWNEY 210 NORMAL DENTON,- TX 76RO1 moved ieft no address 6 EMORY,MIIINIE P 0002040-1 10/15/09 30,00 0.00 0100 313.00 ID UR 2 412 6 OUARANTOR IMFOIIMATIOII MINNIE F.MORY 942 RCOTT DR DENTON! TX. 76201 N4 response •'i 1 OARNI!TT, AEL.LY L 00024372 !2/19/82 172, 55 n.00 -$0.00 192. 55 SP E,Q 3 03/09/03 267 OUARANTOr, 1NVDRMATIU4 'HARLG8 MARTIN 62D rT WORTH DR M17 C/O A MARTIN WTVTOM, TX 76201 Arrangement not kept OLADDEN, CALF JIDWARD 4001054 03/ 10/03 40.00 0.00 0.00 40,00 OP ER 3 03/P2/03 254 6 I ` AUARAIJTCIN INFONIIATIDW as OALE. HOWARD OLADDEIJ 11139 ENOLIBH ;INDIAIJAP01.18, IN 46903, No reS,pOniB OUMEZ, W AALDO 40003168 02/ 12/03 44, C19 0.00 0.00 44r f35 130 ER 3 908 6 ' OVANAWO" 111PORMATIUN REYIJAL00 OnMV 2416 W C1AK 423 OENTON, TX 16201 NO response, , 000DWINIf!Rk(DURICKE 00026104 12/14/O2 1115,75 0.00 0100 155.75 HP ER 3 #K OVANANIOR 1NPORMATIO11 *a rREDP:RICK 00OD14fN RT 3 OOX 4SPP FAI000, TX 75034 350 6 No response. . OnANT;nr6VGW 40014069 10/30/03 79.00 0100 0,00 79, 00 OP ER 3 1 ' as OUARANTOR INPURMAY1014 TCRAY ORArN 403 N ELM NB UENTUN, TX 76201 Arrangement not, kept 6 HMf1tV,CARL LAWNENCR 70017876 09/011/03 402.00 0100 .,150, 00 257.00 13P O') ti* OUANANIUN INPORMAT10N MICHAEL JOHN HIfIT014 3 8 ritlo Al 80 6 ' PO DU% %9;NT, t THACKRRVILLE, OK., 734;f4_ Ho response HOWELL, A U11A P 000036E10 l0/t'd/92 }U9.09 0.00 040 109.09 ADD iP N5 Ol/06/133 412 b OVARAIITOA HJr•'ORMATICItt AORA PEAR HOWELL 3400 FALL I)RADOWII 43202 UEM1'014. TX 762011148"01 t0 lOCate ~y KARIMPOUA,AUDOLIIGHUI 10012916 0:1117/0:1 1,7.45.89 0.00 ••1,097;60 140.05 OP IP 3 013/19/"3 104 6 _ f* OUARAIJrUN INFUNMA11011 44 ADDOL11E1101 KAR211POUR ~ P O UOX,0924 LENTON, TX 76201 00 response . r 1l,Wyr4y I~ R , .t. c<:,p, yf UI DI'C 191LI W !1 ! T I: fl r' I' + r l E f FAOE , ~ 1'n111711 1141^l U 11 T 06 I1f:17 •I n5' _ . ' 1'Af 111 I,IG!:1 r4 Il1.V-UAI.. IIf. W- Clf; I4-11 UAL 1 1, I 'r YPF: CYCLE 1. 1'. Pf1T AGE F0 1'YI'E , A r KOVIbl'ANCLA r 400(244F17 00/Ofl/U3 06, 00 19.00 0, 00 IOD.00 A00 ER WB ' 5p tlUhN Allllllt 11J10411Al'I(IN r~ PANVLA S K(li_IJ 4b 6 "v - i 170P. F'ALt.MEADgW 02 DCMTUN, TX 76201 Unable t0 locate y 1.611KItbOEnllt j 40099436 O91Of,1(I3 D4 00 34.00 0.00 93.00 ADD EN N5 p+ OUARAt}fCIR RlI°ONI1nT1C11J rp L'EOIIt J, LMIECINJ VO DOX 683 CARAVAN 116-YEL 09 DENTON, TX 76208 Unable t0 locate 6 LANG,JAWD P, 400(17608 06/(!3/03 6P 20 10 . 44 OVARAN'blt fUl"WIMATION JAI-1119 P, LA,df 1f.OB 00 ELM 04 VFW d. ViON, 72 T% x2.0 76101 ADD ER IJS Unable to locate 199 6 ' . 4Y • '.EI(,FRANCE:8 EVOil 70016035 08/19/03 150.00 0.0n 0.00 190,00 8p OP 4 NN OUARAWOR 11,'POIIMATION pp MANY LEI' 2417 CHARLOTTE N 11 DeNTON, TX 76201 Unable t0 locate 107 6 r LEPARn. JAN 8 400134.":7 031R4111'I Np CUARAIITOR INFORMATION M4 JAN 3 LEPANU R1 1 94.00 00 0.00 99.00. ADD ER Ns 2291 6 • r CAPRICORN N I OENT(IN, TX 76201 00 response • LITTLE,IIICHAEL 11 40039263 06/19/1J3 96.00 124.00 -29.00 199,00 ADD GR pr NIS OVANANTOH ftIFONrIAf'IOIJ 44 nANYOD I.ITrLE ,2900 f'T, WCIRTH OR LOT 1138 DL:ITOW, TX 7620IUr1ab101t0 locate ~2 MADRY, CAROLYN J (PRIVEMAII) 40043699 07/14/03 ~ 90. 90 0.00 0.00 40. 90 EP ER q Nd OUARANIOR INFORMATION „p CA40LYN J (FREEMAN) MAURY 683 SWEETDRIAR LEW19VILLE, TX 79067. _ Unable t0 locate 134 6 W 4 • MAOISCIIJ CLOY~i It. 40JB0026 09/OU/03 192.79 0.00 0.00 1522.79 BP ER 3 + Np tlUANMJi(Irt IRFORMATION p4 CLOYJ R. MADISON DAVIS TRAILCR PARK M11 LAKLi DALLAS, TX 79069 Moved left no Addrass MAII0I1AM, 8TCPHEN D. 40042917 07/09/03 113. 99 0.00 . 114 OUANANIDR INFORMATION pp SrCpIIfN D, MANOIIAH 0,00 Sf318L 8p ER 'J. 102 6.... LOT 143 6bUJH PADRE IBLAND, TX 00000Move d left no address •I IJANUHL„ CUR`tl9 L. 0 0.00 99. 29 8P ER 8 ! i 4001"714 04/U7/O3 99,29 0.0 Moved Pit no address j 4N OIJARANTOr1 INFCIftI4AT1QN pp CUNTIJ L, MANUt•I_ 91.1 DUBHF.Y 2WZ 6 ! DEfJTgIJ, TX 76801 M • MARKFIAM,OIMA r 40009041 O3/OV?O3 67x29 ON OUARANI'Ori 114FORMATICIN 44 HENRY MARP.IIAM RO 5 Aux P.313 TWIN LAKES NHP DE EN 3 267 6 NTgN, Tx 76201 40 response r MARLCJIXoPATRICfA ANN 4002160f1 04/P7/03 Ad, 00 94, 70 0.00 107. 70 tip ER 1 r4 OVARANTOR INFOfIMATIUII pr PATA101A ANN MARLOWE RT, .4-V - OX 4% "'ANOKE, TX 76P6c 120 6 ~ MARTIN,OODDY J • 00l'13521 ln a/23/0$ 147.00 0.00 0.00 1117.00 RP CA J 04 OUAMAWTOIt ItJFU1DIArlgft dp Dtl90Y MARTIN 343 6 i y f 11[02 AV814UE 0 DKNTON, TX 76301 o response • j MARTINE74, 04ERIAHNE 40009996 02/2uO3 70.79 0.00 0100 70. 79 8P ER 3 219 6 1 i r► OUARANIOR INFOIIIIATIUN px ROSARIO MARTINEZ P. D., DUX 379 .LITTLE ELM! T% 75068 No res 40040701 07/U'l/b3 96.00 0. OO 0. 00 96. 00 tip 8R w i ; MASON,A NOEL L" INFORMATION 4r DANNY CARL MABUN 3000NE STIMMON81144 LENt8VILLE, TX 75067~Unable pto locate 1[00 b II I• r1IA8bH,0RE0 ' it I 00043044 11/23/92 124,00 0.00 0100 pr OUARANICIA INFUftMAT10N 4r 124, 00 SP ER 3 { ORCO 11ABON fORO 373 6 _SIERRA_ DENTUN, TX 7"201 respodaA. I r I MCDEG, DONIIA 70004x09 0.1/19/133 3G, 29 AN OVANANtfIf( 11F0RMATION r4 DbtlitA MCREI; d. 00 0. 00 36, 29 RP tlP 3 296 6 r PO BOX 904 TON DEAN, TX 79409 No response •I 11CCALL, JOBOPH 40026387 00/ 14/U:1 49, 40 0. OO 0100 49, 40 RP CA NO NOS Ouse, '.00 ' b i OVARAWOR IIIFCJIIMATICIN r4 MAROARET MCCALI. N, 0., 0U7(, 17,4., AkOYLq, 7X 76k1'6 3 i r , lip i7 ~ 1114 of ncc 1983 IJ >a i r E,--a.F H a E P u a r PAGE 21 ~ 3 PArI6'NT NAMV PAT IA 111SCHO UFO-UAL WrW°CHO VE14-PAY I4-0 DAL VC TYPE CYCIX L.ar. PMT AGE F'0 TYPE MCCOOL,MICHAEL RAY 4005109%9 05/24/03 56.00 0.00 0.00 96 00 8p ER 2 191 6 0yARANT0A INFORMATION HICHAEL RAY MCCOUL 1415 NOBLE hEIJTON, TX 76POI Moved loft no address MCCOkMACK,CORENE M 00044803 01/03/03 314.00 38,00 0.00 71,80 8P Op 1 204 6. OUARAWOR INPOHIIATICIN TOMMY LRE MCCORMACK PO BOX 534 LITTLE ELM, TX 78068 NO response « 1 MCCUROY, CAROL U 4001922226 04/ 17/83 64.5D 97.00 0.00 161, 00 Op Eft 3 204 6 f GUARANTOR INFOIMATION w* CAROL 1) MCCURDY _ OEIJLRAL.DULIVERY MODE81'0, 1X 95080 No response MCDADE,JILL. J. 40015414 04/02/03 108.05 0.00 0.00 108.89 HP CR 1 240 6 0 **.GUARANTOR 1NVORMATION LECIJ MCDADE 903 ALLEN ne'1JTON, TX 76201 Arrangement not kept ONO MCOEB,WILLIC J 40010090 00/09/03 53.75 0.00 0.00 53, 75 9p CH 3 266 6 0 + S OUARANI-09 INFORMATION *a MARY 11C05V RT.,2 SON 116 H. 0. W. E. WV ON, TX 76201 NO response MCGEE,1411-1.1E R 40090227 00/22/03 111 00 0.00 0.00 111.00 SP ER 4 192 6 r f OUMANroo INFOkMAT1014 WILLIE R MCOFC -41t RUTH 8T DENTON, TX 76201 No response a1 ~ MCKEEVRR,MIOHAEL ALLAN 40057978 09/01/93 60.25 0.00 0.00 UO.25 OP ER 2 89 6 ~f GUARANTOR INFORMATION MICHArL ALLAN MCKEEVEN 910 0. FLli Oil DENTON, TX 76201 Unable to locate ! MCKINZ1E,WILMCR 40020939 04/23/83 48.00 0.00 0.00 4N. 00 HP Ek 4 221 6 M OUARANI'UR 1MF'011MAYItlN IJiI.MGR MCICIN2IL 208 8 HUUDELL N51 DEI41`011, 7k 76201 NO response i MCKIJI0HT,CHEnYL L 00040674 01/04/03 68.75 0.00 0.00 66.75 VP ER 1 r 331 6 ! I. II* OUARANI'OR INFORMATION CHCRYL MCKHIGHT 7070 W PERNEI.I. LCWISVILLE TX 75067 Unable to locate MEADOR,8ANORA K 40033730 06/11/03 159.60 0.00 0.00 159,60 tip ER 3 169 6 r OUARANTOR INFORMATION BANDRA K MCAOOR _ 1808 nnLIVER DENTON, TX 76201 Arrangement not kept + ! 1 A{ MBUOAF'C, CLtIJTDN HENRY, JR. 90018491 04/19/83 54,73 0100 0.00 84, 79 Lip ER 3 230 6 { GUARANTOR INVORMATICIN CLINTON 115NRV MEDCAFE, JR, 1224 MCDOICALI) DENTON, TX 76201 NO response ° r 14EEK8,JOHIJ V. 00046128 l1/15/8:? 200.60 0.00 0.00 200,60 RP ER 2 381 6 ~ w* GUARANTOR INFORMATION *0 JOHN MEEKS IIOX 534 JUSTIN, TX 76247 No response ; r. ` MERNIETT,TERRY T. 40009490 03/07/83 62,25 0,00 0,00 62.25 Ann ER NO 11 260 6 r ~ M* pUARAIJTOk INFORMATION TEARY T. MGRFIYETT 6590 LAZY RIVER DR DALLAS, Tk 76 004 1 No response r' I METAWE, WWA 70019060 01/31/03 40.50 0100 0. 00 40. 50 8P CP 2 122 6 + OUARANTOH INFORMATION ISAAD METANE 905 CENTRAL 0T 02 DENTON, TX 76201 No response 'io MEY6'R, CHONG AUK 40011140 03/14/81 82.00 0100 x•65, 60 16.40 OP EA I 04/1!5/03 $20 6 OUARANTOR INFORMATION CHOW dUK MEY0 3501 ONIERCLIFF DENICIN, TX 76201 No response V III MILAZZ.O 0AH A 40032450 06/05/83 56,00 0.00 0.00 56.00 8p EH 2 170 6 « I* GUARANTOR INFORMATION SAM A MILAZZO 920 W IIICKORY DENTON, TX 76201 Arrangement not kept MILL11, PARK LEE 400211516 00/23/03 69. 99 0.00 0.00 69.05 Hp r..A 4 50 6 { GUts AWrcm IIJ1 iRMATION MARK L(Th MILLCH 333 UCNWAnD DE14tON, TX '/6;!0) Unable t0 locate N 111LI.EN, 111CIIAI l WAYNE 400:09111 OS V30/03 lA. 50 0, 00 0.00 11.'50 [if, Cl( 4 170 4, OUARAwuil INFDIIMArICIIJ IN DAVID 0. MILLF,IC 1709 WIIITC; UAK IIENrUIL TX 76101 Arrangement not kept ~Alj lHAGtdtvW+lYrS:1(*11sr:+~leAiN,`M',trcr,~rm.UUt.., i . i w , ,.l{ y; I •iJ of mur 19n3 14 R 1 1' E u r r R E P a U r PAYIHIIT IJAHL PAI ID nIRCM(I 0E, +nL IU.'W--CHO IJCN-•PAY 14-0 OAL FC TYPE CYCLG L6T.PHt ACE FO TYPE Iv r t V 11f1.1.9,1.I:1A U 00017415 11/O1/(u:! 140.39 0.00 D,00 140. 3U 6P Eft l 349 6 ar OUARAMOR IIJPOTIMATION nw L13A III1.I_4 DUX 625 LAKE DALLAS", T% 78069 r No response 46 1 M101?1.116, 1RMA 0000944 LO/1011m POP. 00 0.00 -25,00 179.00 (!P LP 3 09/31/03. 104 6 OVARANIUR IMPORMATIUII as J'JVC14AL MIRELL3 1017 CLEVELAND DENrON, TX 76201 No response MISS, AIELI5RA 4 00047707 01 /20/113 30. OU 0.00 0.00 3D. 00 4P ER 4 307 6 NO OUARANTOR INFORMATION wa MYRON r1nr 11013 WOODROW LAIJE 08111'0!, Tx 76801 ' No response 4 MOPOAN,TER69A 6 000401,V6 11/07/02 115.53 O1O0 -10.90 104..63 4P lP 3 11/09/13 22 6 as OUAgANTOR INFOPMATJOW s+ MARK MORGAN 2301 nOLIVAR 5T DeNrOW, TX 76201 4V No response.. • PARI(ER, SHAUfJDRA C 40054637 OE3/2l/SJ 116,30 $10.00 0.00 226. 50 EP ER 1 64 6 V* 4UARAIJ OR INFORMATION wa TUMMY PArWO 604 FALL MEAnaW Rl DWraN, tX 76201 No response 0 PLOIKIN,RMICUr LYLV 40027604 05/17/a:1 70.00 0.00 -31.00 47.00 1P ER 2 10/25/n3 37 6 +n GUARANTOR 1NPOrmATIUN w+ ROOERT L,YLE PL0'rKIIJ 9 CHARLES ST AYE N1 DO4rON, 11A 0215.4 No response 0 REM ROCK A 00()96161 07/ 12/02 M. Sa 0.00 0.00 e55, H4 I D En 2 449 6 aN OVARANran INVORMATION wa RUCK RE00 POD 202 4ANOER, TX 76226 + .No response RUDER to, VEYIN C. 40039aDO 06/P'4/03 77. 25 0.00 0.00 77.25 ltf ER 2 l94 b ~ r; R a+ OUARANTOR INFORMAT ICIIJ KEVIN C. RODERTI NONTHWOOD MHP H136 LEWISVILLE, Tx 7DO67, Moved .left no address 4 I RMIN5ON, UONNIE J ,1003031!2 OD/Rh/43 b6.00 0. 00 0100 $6.00 SP ER I 145 6 a+ ou/mAww INFORMAT1014 44 CATHY ROUINSON 1040 6 CHARLES LEWIEVILLE, TX 79067 unable to locate i RanIt4901J, nEUECCA 0005/204 11/01/01 Vol 00 0.00 O.OD 203.00 tip' ER 1 - wa OVANAfltaft INFORMATION ++a RF:nECCA f10UINHUN 399 6 350 TWIN LAKf{S MHP tlENT4N, T%- 76101 ~ Unable to locate 0 ROULE4,ANrOW10 40010467 04/14/03 44,19 0,00 0:00 44. f5 UP R 3 200 6 as tlUARANI'f1h SNF41t11ATlOIJ as ANCUNtO RULES 1,n WALTERS LtI41SV1LLE, T% 75067 ._No response 4 , RIICHvSmR,0lfAft ro 40036006 06/17/10 66.00 0.00 0.00 06,00 OP En 4 a+ GUARANTOR INF'aRt1Ar1OIJ aN CHARLES ROCHESTER 165 6 ~ I 629, FTWdRTfJDR 1126 UElItON, T% 76SO1 Refused to pay ( .I RODERIC11,01MOLEY R. 000US403 06/07/tl2 121, W6 0.00 0.00 131, 26 4P ER 3 07/12/02 542 6 j~ I sN dUARAfJfan fIJFDR11AtIUI4 +a URAOLEY R4UERlCK It T. 6 NO 940 HOArtaKE, TX 76263 No retpOnso RODR I OUM ANDY A 000511549 10/11/op. 199. 20 0.00 000 199. 20 SP ER 2 416 6 NN GUARANrtlR w tlJr0itr1AT1aN aw ANDY ROLIRLDUEt ki%,AV1 E uENrUN, fx 76001 ND response j' i 1 n0DRIOU1id,M1nAN9A 00058743 11.09/03 54,75 0.00 0100 be. 79 ID ER 1 '9L 6 ar OVARAWOR INIORMATION sa I11RANDA JIODAIOUEX 294 DAILEY PONDER, TX 76299 C t , No Yeiponse S5 b 0 "DIIANLMHE"OY 01AN(i 40054049 01/06/03 100, 79 0100 0.00 100. 79 4P Eh 3 • I 44 CUAR4Hr(1n 1NFaRMIl TICIN as SHERRY ROMANO TO4 WILLfAMR PC)T1rS2C'vAOH, TX 717Y7 ,_.Na response.. , RUM III KC E • 0000404401/0 r/U3 141.90 0.00 O1UO 1X1.50 4P ER 3 310 d r wa OUnRANr(Nt IIIFORNATI(1f4 a+ MiC11AEL 604E 51100 PRAMS bEIJiUN, TX 7620E No response ♦ + nOYCE, PAT 00099306 MOM* 117,25 0.00 0.00 117. 29 DP ER O 434 b V sw OVARAWO(I NIFORMATIOIJ +a PAY Rny11E 504 4 RUDUELI. APT 101 DENfOIL T% 76201 N5,r4sponse Y , 1 , V ~1 b ! i ?kYp.Yda~ C. 64l4Ydif I DI DI '.C 190'1 NR ! r r -uFP htP 0a T PAf1f5N1 Ifnl'IE: PAT ID OlDCI10 IIEO-Ilh~ IJGN• CHO NE'ii-PAY 14-0 DAL PC TYPR CYCLE LST, PNT AOE FO TYPE I~ t1 ROMLURRAINE 700098661 00/20/03 01, 25 0,00 O.00 01.25 HP OF, 4 j **.OVANANTOR INFORMATION JOHNNY RUYE P.O. nuX 62 RFLLER. TX 76':98 143 6 No response 116 RI1tl8LI.L. CINIIY 4000,1106 02/09/03 00. 00 0100 0100 30,00 ADD RR 3 244 4 { 04ARANT01i INFORMATION) CINDY NUOUELL RT.4 045 DENTON, T% 769901 u bl@ t0 locate 6 *rt** tJ-0 TOTALS ***k I0. 629. 03 r0. 150, 70 ,r 9A0.11 14.447.24 I *F ~I 4 1. tr 40 ,E V IV ` r 40 r~ 1 ■t I wct~m t i V~ w IIEC 1fiE7:1 lrr, t rr. Ilr•r ntran r w.. ,.y f Af 111 IIl•`.IC610 UF.O•-full, NP:W-CFI!) NE-PAY I4-0 BAI. VC TYPIi CYCI.r 1.8T. f 11T AQE r0 tYPh: wwww WRITC-OPF GRAND TOTA49 wwrp n0.j, 300. nQ i -30, 307. 90 ! . 4 1~ 9A, I~ i l 1 1 e f r 7 !1 419. 01 III: C'I'7(ICf GIIARI 1Y PI1-0rI I' PAGE I . f'Ar 1Y.141'.. PAT. III Pt' Ff (I11ANANTOn NAME, Al)DOr.E5 C17Y. ST 2IP, . 1) IS, 07E. AMOU14T., . lb 1, AbAM9,A41DEILA 100391000 If' 111) P[IYI'f. (ION"IE 5033 A7.TEC THE CUL.ONY TR 76066_07i20183 -25.00 " Da~ance after Medicaid f, v AObdA1C,RCINMAn)' 4003154:1 CO MU ACIIUA'I'.,(IORIi1JANY 400 S. HUDOCIA. P1A' DENTON TX 76r^.01 03/22/03 -13,00 Balance at~tner Medicaid 1r AL.)ACO, J'JA14 10099634 IP Mf: CARp(I_HY„IIJLIA A. 7.7.0,1 DEWWJUOK CA UI.LTUN Tx 70007 08!01183 -13.00 J} ~ Ai1CIJpENF7V, CARL IJAYfIIi 90076713 CN CC ATrER13ERNV, CARI. NAYME b&NTbIJ CO JAIL LkalrIance D fitter Medicaid. . . TX 76410 1 11766/03 »212. 00 DUYD.OnA C. IC045.174 (T) 9r 011YO,OMA E. C/O HOUND 34098@5tyAS011A r4Jai1 TX 76201 00/14/03 -16.00 • 40 UWOCHRR,L.ILIA All L 40020969 ER aP OIWCH68,LILLIAN L. 1102 OVOIJARD St Oalant@1) 14~ONNedicdld TX 76,101 04/29193 -42,00 Balance aEaft~ur Medicaid DVt;4DIJ, LARRY G. 40059313 EN GP UVNROW, LARRY V, 1501 LATT1110RE bF.W ON tx7620109/09/83 »19. 00 PUPPCiJ, LARRY EDWARD 40029779 1:11 SP DVRROU, LARRY EPWAPD PO NOX 2^.637 1121$ B11 1'. 9T at) g,t4T014Medicaid TX 76201 05/$7/83 -16. 36 ' 4. CAVALLARO, TCMAS 10064909 IP SP CAVAL.LARO, TOMAS 9000 DISSUNNET Uya&dnCO f'(1f~Tfl epp Medicaid ~ 1( 7x 77074 11110!83 -530:45 Cbx, eabERT C Order a rqu4tive_Custodg_ . 10064537 t.R CC COX,RUOEHT C 0ENt0N COUNTY JAIL EJT N T8 '!6201 09123/S3 -16.50 ' Depnton C~UI1~ Jail r 0ARN00011.ANOELA 10021244 1P 110 DARROVOIi,MARY LUJ 19E 512 8 RUDUELL Mfbb b•IJ N Tx 76201 05/06/03 -60.Q0 V' VARnDUGH,0LVATA L. 110064113 tt@P MAditeld I~ ER ;iP OnnRUUGH,OLLIt 1109 H(CKtlIiV bEfJ7UN Tk 76201 09/21/83 ^13.00 1j a c f@N Ne~{Ceid.__ _7_ . DU$S, MANV L. 10061343 CR SP DO8k3, MARY E. 06 00x 47e~ , FULL L~K ~ UAL.Af7 Tx 0069 .'04/lQ/83 _t6. 00 (r 100327113 CR MD• EdLLCR,JA(JIC(C L. 100ry . H1LL1400D ala(AICL9N18V1iLLeaid RL.EkR, BARN I1Jl, TX. 7506706/07/03 1 h. 00 V , 1J B(ILOAO,14ANY , after Medicaid ' I 10051019 I P 01 3 MAUR I C Ib 1910 RUI)DELL 41206 DENTON Tk 7611!01' 10/03/83 30.00 V rfIANt2,JAM99 CLAYTOIJ 10060341 IP CC UENI'ON COUNTY JAIL E. MCKINNEY ST bENTON... _'Y% 76801 10/1$/83 -1,00Y,10 I 0AR7A MPiVA(IIA Denton 10049022^9 EP NO finRZn,EP li'ANIA 730 OpEE11111001) WI N Ja11 TX 76201 00/12/$3 26.00 60 f>~ ' OF:IJ1'RY,KfiNNSTII 40071698 CR CC OENtCIIJ COVIJTV JAIL. IlENT014 COUNTY JA BalILanc%0IJ HMadicald TX 76803 10/19/$3 -115.00 Denton Co ~~yy Jait Al i 01PW ULAW 10003038 IP UP 010OE1, CLA14 qT 2 BOX 73 AU}~ EY TX'74297 02/09/83 -0. 05 Order oU0I4p pr ~qdive Custod HUI,IANUrIJONNA 1' (00407')2 iP 110 HOLLANO,OLAIJ S 4113 ULArJO y M TA 76201 4181V4/0 »50.9.79. g 8fi.~NMedicaid i' UObE.LL all 6atancPPIJ TX 76201 l0/2E1/$3 -10 , JACKSON, CARL 400724.0 ER Mb YOUt(O, JOYCE 104 tl R Balance after Medicaid,:_ . ,00 1 1 JACKSOIJ,CHARLOTTE n 9.)003505 UP MU JACASOM,CHAnLOYTE A 304 8 NUDVVLL 993 ntillON TX-7620 1 07/OY/93 -11.00 Balance after Medicaid + JAMES,MARLVsU 7002 1175 OP SP JAM¢9,CHARLCS AT 2 BOX 103V VVIVON YX 76POI 10/39/83 A1. 23 JAPIva, Indlgant We V b III 8bx 1037 DLNTON tk Y62 f 01 10/31 /03 -790, 00 r EUtJAn Indigent Care JGPfCQATpJACK IIAR1l I0049206 EPIC JCffCOAT CHARLES ACK H 60, RT 1 DO.X 194 A AVbR81' TX~76A '09/13/S3 -30,(BO Balance after Medicaid $U1LlAr1 E 40)5146[1 CR Sp ~ gARv TX VI 0nNY D 0001783S ER 0P Nt710 KCL1A 29 r J141.1614 E 719 141JORANDtl1) Texas ReDENTON hab/ {tIatiLLE on._ T_X _ . 76201 76240 . , 10/14/02 08/l0/$3 -17. 100, 00 OAIIORAV . Misty 1lerpan' Charity 51,Y96.D0 r , w.,u,..JJ !.n air( II; IS J9 0t Orc 1uJL r:I IAR I1'! 111i1'I11Jr PAOH 2 y, PAl WWI.. Al'. 10.. P1' f C, !:VAUAWOR IJAMF. , , AUDnESB... , C[7Y...... ST 111. 010 DTE. At50UNT,.. K)11RLF., ItJr 11 10090938 IP 90 KIMOLf. MNL.VIN .'.@00 FT NORTH UP 07 DtNTON TX 76200 04/I6/83 60.00 ~ KINOBLGY. LUIf, I005CJ300 P,R 11C V.IIJtiGLEY,LOiS R1' I UbX 2060 CARRUt.LTON TA 75006 09/03/83 -34.00 Balance after Medicaid - V.,1 ` LAIJIIERB,JIARTIIJ L. .40057531 UP MC LANDENO.MARTIN L, . 2229 CARROLL ULVO DEN DEMON ,__.TX.._7.6201..08/3l/@3. .34..00 f Balance after Medicaid V LEE, URENOA 40063133 CR MC LEE,ONENDA 2800 H114AI_E DR DEIJ ON TX 76201 09/18/80 -34,00 Balance after Medicaid L.P:IIM414, CATHUPINC E 10064842) CR MD LENTEN'LF:HIIAN 340 KNIPP HOUStON TX 77024 09/24/83 -16.00 Ir Balance after Medicaid . LYNCH,LINDA SUE 40065203 ER MD LYNCH, LINDA RUC 200 8 NUDDHL.L OV7 OENION .;T;f,_74201.01/25/83 ••198.50 Balance after Medicaid 4w MADISON,JANE1 HANDY 40062235 NR NO MADISON,JAIJET HAAUY 1204 MCDONALD DENTON TX 7G201 09/16/63 -54,79 Indigent Care VANN,KATHY 100:+65'/2 IP VP AIJST114 STATE: HC19PITAL 0410 GUADAL.UPE ST AUSTIN Yr 78767 07/09/83 -415.40 r P tient escaped from Austin St, Nospilallrotained at Flow/No res~onse Care _..___TY.74?66.02/41./® X1.,136.00, NAATIIJE2,CYt17H1A R. I00042f6 )P BP 11AR1')NE2,CYEITHIA If, I~O._$OX.,16} lndfgont SANGER y HATA,7140MAG 10053613 ER BP MATA,AMHLIA 990 $ CHARLES #220 LWISViLLE Td 70067 06/17/03 -31.00 r ` Balance after Medicaid MCOATH,DAVID R. 40056152 ER OP MCUATH.DAV1D R. 62,1 BOLIVAR DONTON TX 76201 06/26/63 -101.00 ' Wigant Cm -80:00 MCDATH,PRANCEB U 70021689 OP SP IiCUATH,DAVID R 623_iiOLIUAK DRN,,,, T7J+r,41..10/64l133 indigont Care y,~ MCOATH,PRANG IB U 00044503 IP SP IIC0ATH,PRANCIS 663 DOLlYtR DRNTON TX 76201.11/13/62 -2,980.16 Indigent Care I MCBATH, VERONICA 10053460 tP NO ALMA MCOM'H 1002 R, SYCAMORE DENTO)J tX 76201,Oq/~^4/93 -31.75 40 Balance of o~ Medicaid 33 MCCUL,0M, THELIIA 40051955 ER EP MCCOLLOM, 1HEL11A IJ..PARK BT LITtiyL ELM , Tt 70060,08/1,1/63 -51. EXpire1/N0 AV"" TX 76201 09/14/03 -351. 7D y MSIER,WARRaN 10052561 IP @P MCI ER,LJARf2EtJ PO BOX 10)1 LEtdit7N Order pf p tactive Custody 11YIE1J,WARREIJ 10054351 )P BP MCI UP, WARREN I210 LINDSAY PFfJfppp~N TF 76901.09/63/63 ^336.10 y, mVYER9, UREIJOA 70020615 UP NO MEYENB, fIRV)DA 406 CARDINAL APT llrni r eEe~ haCtlYe CUeROdy 76901, 16/10/93 '-116. 00 , ealanc 8 LJ Medicaid Yk TX 76401 10419/83 -10. 00 V MURENO,CHRISYOPHhR 40071797 6R NO MORE-140, ERNESTINE 514 RAILROAD , 'PCTEkBCENMhDtik.INE 00053606 Ip NO PEYEkSEN,MADEL)JJE kT 4UUX 09-0 BalancA110~gg oaf EY Medicaid '7X 76227 10/08/82 -334•;01 Balance after Medicaid, POOL,DARBAAA L 10032019 IP SP POOL,DARnAnA L, _ PO BOX 2102 DENTON TR._(6201._06/1"Cl -1' 608. W I I Expired/ No Assets POOL,DANOARA L. 10034742 1P SP PUOI.,1iARDAAA L. PO BOX 2102 DENTON 7X 76ROL 06/27/63 -f, 177. 15 EXpirdd/ Ir0 Assets AVED,DWOL63 40073405 ER CC RUED,DLIUOLAS DGNTON CU JAIL DE)JTtlN TX 76"a0l 10/46/03 -99,46 to Benton COUM Jail NEEDY, DINA M 400'/1303 Ell NO RECOY,DIVA FI 112 I,EXINOTON DENTO TX 7401., 10/17/03 -20,.76 Balance after Medicaid 31 1 ROnVn6UN,I.9TA H 00001844 lP SP ROnER9014,LCTA 1104 ORRENWOOD DCNTUN TX 76ROI 07/13/66 -3"•4.10 b 40 1 Expired/ No asset$ . 11088,PATRICK 10036986 1P. ell A'JOTIN STATE HOSPITAL 11110 OUAOALUPE BT, AUSTIN TX 78767 07/05/03 -167.30 y latient escaped froal Austin St. Hospital/retained at flow/No response 1r r ~ % .q • ' _ t~ ~ rl' V 'i~Y 5 f • {V~~, r11 hYA' t r.Wt.. :.q Si I I 1., 1i 'liv NI OI BGC 'I JU '.I L'I IAP ~ 4.~ I!'f IrC.I'tlRl fnr;t: 7 _ t t,,, PAf ww... PAT 10.. PT F'0. OUARAWMR I4/0C ADnRC,93 . CITY , . BT 1.1P.. BIB. DI'E, AH(JUfIT... ' r 1 fTANOF.RR, JAWW_-'TT 100-14U73 IP 140 SANr.(',ftC„JAN14,11 01b 13111TH DENTON TX 76?01 Ota/13/83 -107.00 f Balance after Medicaid 6HENHAN,MARTHA W11_1'UN 100P2233 IP fl!: 6IIPPHAN,11AR1114 WILSON 2224 CAMIIII.L nLVD DGItI'OM TX 76701 06/16/83 -'30.20 1+ Balance aftoe madicald 41 lUmm, LYNN JANf•.f 1004097% IP MO ftHUnkR.LYWN JANET P. O. BOA 3038 OEEP,R1' 4 brNtON T% 7br^.01 09/07/03 •'314.00 ` i. SHUBER,LY' Balance after Medicaid NN .1AIJL:T 70018854 OP SP FiIIUDCR,LYNIJ JANET PO BOX 3038 OtIJTpN TX 76901 09/11/03 -41.00 4 ! Balance after Mudfcaid SINnLX11014,A1.I-It (:00,7901 F:R MO hIHOLCTON,ALI_fL•: (27.1 CARROLL• BENTON T% 7620) 01/16/83 -76,.00 ` Balance after Medicaid 5MITH, E$TNfifILLr1L 40060337 ER IX SMITH- F'HTNERl.E1JE 300 COltO1JAUtl DRN194 H BENTON TX 76201 04/04/83 -34. 00 ' I Balance after Medicaid SMt716RANDY LCE 10061109 IP MO 8141711,UARUARA 106 AYE C 0111 DENTON TX 76.1?01 10/24/83 -21.00 Balance atter Medfeaid + 911ttH SHERRY It 40039600 Ell 110 BARBARA J BHITH 106 AYE E 11111 DE14 CrJ T% 76201 06/26/03 -.8.00 B~lance after Medicaid G111t16514cnwe 1) ,10067324 CR 15D BARBARA J SMITH 706 AVE E 0lif DF.'IJ1'OtJ T% 76..^.O1 10/02/E3 -9.00 efttor Medicaid - . _ 8111711 8N&RRY D. 40041610 ER I1D BARDARn 8111TH fOb AVE G 0111 Balance 1) NT014 TX 76201 07/06/03 -5.00 Balance after Medicaid 46' 6tANUIFER,IIA11VIN LER 10002277 1P 11C 81A110LFR9,IIARVIN LEE PO 00% 273 KR01 T:( 7(12249 02/10/83 61.90 ; E Ir Indigent Care BTANLrY,.KATiIERif1C C. 70004464 OP I1D BTnNi_F.Y,KATHEgINE L 208 8, gUDbEI.L 051 BEt:fON TX 16701 00/26/83 -61, 00 f ~ FiTARN411,KF;NWETH 4007$937 9n CC DEMON COUNTY RHSRIFF OFC 5. l4CKIUNEY 87 BalanceDAN~~r1JNedicafd:_.Yti-y6cos~ld/ lei I29,00 to' I Benton ComUy~y Jail f1TEVEN3, OVOROG E. 10047090 1P 5P STIZVENS, OEOROE E, ;?901 14. BELL 0164 DEI(Ttflf TX 76201 08/77/93 -3,302.39 Indigant Car A V STEV9146, Ot?OaOF: EARL. 10013639, IP GP, $TGVi.1J0, QEORCE EARL. 1901 BELL 0164 DCNTON T% 76201 03/24/03 -l, 037. 05 Explrod Npp assets__ I BTOUY,MICHAEL 10001746 IP 110 STOUf,IFICHASL PO Rox 136 ~U[+REY, 1'X,76777 09/29/93 °90:00 401 Balance a for Medicaid I STOUT, E1ICHAEL. 40068611 ER 110 0 (0U T, IIICHAEL P. 0. Box 136 AU fTY TX 76921 10/07/03 -13.00 ealanc0 of or Medicaid 9TRINJFIF.LD, t11LL. L 40046404 P:R ADD $TR1NOPIPLOo llILL 1.. 101 MAGGEY DEIJ ON TX 76201 07/94/03 -1i1, 20 indigent ~!Are.. I TtVI$, JAMEO D. 10037976 IN 11C TIVIB, JAMES U, 6TAf( R7 QAiNB9VSl.lS T% 76eg4Q 07h4%83 »330. 00' Indigent 0 U99GRY,CINOY A. 4006$317 ER MD U95Ef°Y,CI14BS' A, 100 FRAME BalanteD.14Vt04Medicaid T% 76201.09/15[S3 11S,OO at or 1 IJILk1RRhN,11ILL1C 11 10049067 If 14C WILKIR40N,141LLIG 11 ..a4 CARROLL BLVD DENI'17N T% 76201 04/07/93 -14,90 ii i I 9eFFter Medicaid.__. IIILLII100AT1,AIJIIA MAlIIE f0008f09 IR SP 4JlLLItJUHAM,A1(NA h1ARiG ftT 2 Box 14011 Balance ARGYLL TX 76996 10/13/93 °30A,37 v Retardation + IJRfONT,J114M(E 11. 40049706 ER $P 41R1MiT,0UJAl,b RO% 932 RT kftU WR 01 ~jNatg McAtal TX 76201, 00/02/03 0.00 iw'f WRIaimJD9/JUA WILLIAM 40011334 ER 140 I01014,ANN 11AgIE 2211 W HICKORY APT 0 DEI0011 TX 76201 10/17/03 -14,60 . - t Balance after Medicaid V,k TOTAL CHARITY CIIAW-OPP AMOUNT S 101668,73 j AMOUNT BILLED TO 0011`011 COUNTY: S $6,226,67 , _ 60 l f 01 NOV 1963 iJR 1 7E-OPF R EP 0R T PAGE 1 PATIENT NA146 PAT ID DISCHg BEG--DAL NEW CHO NEW-PAY W-C DAL PC TYPE CYCLE LST,PMT AOE FG Type AJAYI, JANET H 10019297 64/22/83 2, 028. 20 401 6.26, 65 -20. 00 43, 134.80 8P IP 4 O6/Ol/~io 4 I J rr GUARANTOR INFORMATION rr SYLVESTER AJAVI 220 HA14N 03 DENTON, TX .76201 response.., 1 AM0A0SPj14tLLtAM 100266R3 09/20/03 $33,10 0.00 0.00 " 933,10 SP 1p 4 II rr OUARAtiron INFORMATION rr WILLIAM AMOR06E RD.1 CADIT,-PA 16023 No respopse9 1 k ANDREWS, ANN P 00002816 02/25/31 Y89.20 0. 00 -30.00 709.20 Sp IP 4 ' 08/20/83 68 1 ' J - rr GUARANTOR INFORMATION rr ANN P AND95149 1541 MEADOWS St LOT g17 11411AN MHp DENTON,_ TX . 76201 Arrangements not" kept j ANYATONWU,GLORIA N 00002915 04/30/82 2,0 3,90 0.00 -1, 000. 00 43.90 Sp tP 4 09/07/83 GUARANTOR ot kept INFORMATION rr GEORGE ANVATONUA _ PC POX 23034 T14U STATION DRNTON, TX _7620f Arrange moms n 'I ARCH9R,RENA L 00002960 11/20/62 639.10 C.00 -143.00 496,15 8p 1P 4 00/il/83 87 1 rr GUARANTOR INFORMATION rr JEPFSREY ARCH4R ,RT.7 DOX 4380 DENTON, TX_ 76201. Arrangements not kept ARIRIATU, JUSYINA M 00003061 Ol/15/93 S62, 75 0.00 0100 582. 79 Sp OP 2 A= rr OUARANTCR-INFORMATION-rr_ LAWRENCE ARIRIATU 2420 LOUIS DENTON, 7X:_.76201 No response 1 Ir' SAIN,LARRY DAVID,11 10020733 04/85103 1,802.00 115,30 -1,629.60 287.75 WP lp 4 00/16/83 t13 l „I #1 GUARANTOR INFORMATION rr_ LARRY OAV1II PAIN RT.5 BOX 90 SILVEADOME- DENTON,.TX 76201 No response J L DARTON,URFPAEY W. 10028371 00/27/83 1,013,50 37,70 0.00 1,051,28 SP IP i -05/31/83 151 f J rr GVARAIJTOR- INFORMATION rI~ JERRY PARTON 1 BOX 43-0 JVBTIN,.-T%. 76247._._ . Arra40111 nts hot kept y- V , BECKNER,MILDAED 00008454 11/24/82 292.00 O,OD -20,60 266,40 MC IP 4 03/02/83 44 ' rr GUARANTOR INFORMATION +r MILDRED DSCRNER. - _1523 HIOHLAND PARK RD -.DENTON, -YX 76201 Arragements not kept BELL,KATHY D 00005819 01/21/83 1,231. 65 0r00 0.00 1,231,65 SP IP 3 pg l J ~ - r+ GUARANTOR. INFORMATION rr.... JOSEPH JA DELL.. r, _ _ ptl BOX 928-- ROANOKB, Tx .76962 , Arro ants not ke t P DURHAM, LRLA 10090352 04/2L/83 046, 65 0.00 0, OC D46.65 Sp tP 4 `'1I1 j rr- GUARANTOR.INFORMATION rr LSLA DURHAM AT 2 BOX 181..AROYLE, TX. 76225.- Arrangements tot. kept J H8ASLIP,02OROE 00030981 11/05/89 2,696,75 0,00 0,00 g, 696. 75 SP IP l it rr-OVARANTOR INFORMATION rr GEORGE HSANLIP . AT-2 BX. 1186 DENTON, TX 76201 NO nmp~nse 1 ~ HELLINOER, CASSIP, 10038339 07/11/83 376.65 274; 70 0.00 ` 631,60 Sp - 1P 3 ` f J 4r GUARANTOR INFORMATION rr CA88I9 H6LLINDER 1303 8 GRAND GAINESVILLE, TX 76440 Arrangements tot kept HSRM6ArJEWNIFCA 10041648 07/99/83 1,450,05 1 984.70 0.00 3,430,30 SP tP 9 -rr GUARANTOR INFORMATION rr GLENN H5RME8 AT 4 SOX 420 GAINESVILLE,' TX 76^.40 g. _."Arrengaements tot'kept g 11 Lr HE97ANB, ULWANA C 00031914 01/14/63 029.00 370.24 -711, D8 480, B6 SP IP 3 I' m ` rr GUARANTOR INPORMATIOI7 rr DOUG HESTAND PC BOX 45 TIOOA,- TX .76eYf 09/17/83 Arrange~ents Plot kept ` J HE8THR, OLtMON L, 10011815 03/18/83 607.00 0.00 6.00 604600 SP IP 4 j 1 J OUAAA14TOA INFORMATION TIM HRATER AT 2 ROYAL OAKS 0471 DENTCN,.TX: 76201 Rofu.Pedg1o Pay f.' V HCLMAN, KATHY 00032981 08/10/89 71 797.85 0.00 4.00 ~ "7r 797. 85 lip IP 2 eg t ~ +Ir'GUARANTOR INFORMATION rr DUI! HOLMAN 1 700 ROLLING RIOOE LLWIAVILLE, TX 75067 Arreng9onts not kept %0 1NWANG,ALI09 00034785 12/30/92 21220,60 0,00 -1,347,76 879,84 ADD 1P NS 02/23/63 *41 GUARANTOR INFORMATION rr J08EPH INWANO 2200 Wr- HICKONY 07 DI;NTON,- T% 76201 Unabl'e,to lOOate G tJ_ . J 1 L y ~'LW1„rAt11d MVNYa,y ry. 1 . ..M... w W,G ..IYi r'lta.n4/~aiu.W Wh low I s I1rl 01 140V 19011 W R I T S- 0 P F R E P O R T PAOE 2 PATIENT NAME PAT ID DIOCHO DEO-DAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE L8T,PMT AGE PQ TYPE j Il 4 i JESBUP,RU80ELL A 000D0709 10/28/62 1,645.00 0.00 0.00 1,645,00 8P IP 4 ~ q 40 OUARAI4TOR INFORMATION 44 LARRY JESSUP 1214 SPRINOW000 LEWISVILLE, TX 79067 No reSp6nSe 1 1 1 L+ JDHNSON,KARLA 14. 10016451 03131103 061.65 0.00 0100 06S,66 8P IP 1 04/01/83 213 III) J ;11111111, 44 GUARANTORINFORMATION KARLA M. JOHNSON 25 WASHINGTON CT, QASNESVILLE, TX -76240 _ Arrang~mentOot kept y,. I JOHNSON, LIWOA 8 0003620') 10/21/02 779.10 0.00 0100 779. 10 8P IP 3 07 1 . i J 44 GUARANTOR INFORMATION a4 LINDA 8 JOHNSON 624.E SOUTH 8T 14HITEPOCROo TX 76273 • No response 4 j JOHN8014, MAN16 W 00036893 10/ 15/62 269, 70 0.00 0100 269.70 SP IP 2 01/21/03 38 J Unableo loots ""1 ^41} 44 OUARUANrOR-INFORMATION 44--MANIE JOHNSON -.1201 WATERMAN CROSSING- HOUSTON, TX 77069 •y QUA. 00 0,00 0.00 600.00 8P IP 3 12/14/82 36~ 1 J JOHWOUA LRANTOR TRR IRNFORMATIDN 40 WALTER 00036668 JOHNSON 82 600. 904 SCOTT OR DGNTON, Yk 76201 NO resp nSe Vi'f JOHNSTON,LORETTA M 000366YO 08/24/82 725.50 0,00 0.00 720,50 8P OP 4 434 1 f -<4-OUARANTOR INFORMATION rr LORETTA JOHNSON ROUTE 3 CENTERVILLE,.IA-- 04544 No response ~~+4 KENNEDY,EARNFor 00037900 19/11/82 385.05 ' 0,00 0. oo 000,05 8P IP 2 0 1 J / 44 OUAPANTOR-INPORMATION.4~ ERNEST KENNEDY . 1102 DBLAND .WACOo. TX- 76703 - No res Asa i f„ AIRDY, V9RNCN 00030752 11/22/82 1, 684 96 0.00 0.00 1r 584. q9 8p ]A 3 344 i r f ._..:.4* . OUARANrOR INFORMATION ..V9ANON KIRBY ,......1003- KERLEY 8T- . DENTON,-. TX. 76201 Arrangemment ; dOt kept,- ___J MCAFFEN. 003434A 01/29/03 32o012.66 400 5 ELM 02 0.00 OUARANtOR.INFORMATION RONALD L. MCAPP99 1 Arrangement; ht kept DENTONp6Y 8X4~76201 ..IP 2 V MCCARMACM,CORBNS M 000446PO 01/09/83 957. to oloo 0. DO OUARANTOR-INFORMATION 44 TOMMY LES MCCARMACK . PO POX 534 LITTLE ELM,-sTX__73068~-- Nd resp9n50 ~F J ~ I 1✓:i MCDANIEL,VINCENT CHAD 40005704 02/21/80 102.76 10173.95 0,00 1,196,70 RP ER 3 17 1 / GUARANTOR -INFORMATION 44 BRGNOA MCDANIEL._.. 1414 N RUDDELL -DENTON, TX 76201 ko rA9 n4A MEEK, JANET 10004836 02/13/80 886. 16 399,15 0.00 U267, 30 8p TP 3 16 1 { ; 44 GUARANTOR INFORMATION «4 CLAY MEEK RT i BOX 57 AT 1 BOX 57 LEWISVILLE, TX.. 75067.-. _,NO reS gnse Po METCALF, LINDA 00046474 05/10/82 499,10 0,00 -00,00 469.10 10 IP 2 06/10/R3 I 1 " J w 4 OUARANTOR INFORMATION 44 L114DA METCALF .910 8 LOCUST- DENTOW,.YX .76201 Arrangements not lk 11 MILLER, JACKSE 10008407 -02/96/83 618, 95 123.40 0.00 742.3D 8p IP 44 OUARAI4TOR INFORMATION 44 GARY MILLER AT 4/EXEC NHp 673 DEI41014, Tx 76801 _ No reggfise V MINNICK,BYNI1HIA 10007185 02/20/83 2,382,75 0.00 0,00 2,382,75 8P 'IP 4 q6 1 44 OVARANTOR INFORMATION 44 SMITHIA MINNICK rO BOX 2621_.0ENTON,_TX -76201 UnabiA to locate ~w NHACIir J1188IG L. 00049017 12/1'1 /62 803,65 $03.35 0.00 11717.00 8p IP 3 t .44-OVARANTOR INFORMATION 44 ARCH19 NEACS DOX 242 JUOTiN, TX 76247. No re9poA9A 1 + V NOIRATRAN0, PLTRA 0005035107/34/62 1, 386, 63 0100 -10,00 L 376 60 8P IP 4 08/16/83 71 1 J 44 GUARANTOR INFORMATION 44 PETRA NOIRANTRANO 1422 N LOCBUr DENTON, TX_.76201. Arrangements,oot keyt_,..... I 1f,r i? 1., 01 140V 1903 lJ A I T E- 0 F P A J: P 0 A 7 PAGE 3- PATIENT \ ~ i. PATIENT NAME PAT ID D1SCH0 BEG-DAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST,PMT AGE FG TYPE IAF V , PAYNE,OAIL 10008270 b2/13/03 410,79 0100 0.00 410.78 ADD Ip NS 256 1 J ' rr GUARANTOR INFORMATION rr GAIL PAYNE AT 1 SOX $8-A KELLER, TX 76288 4 j PURVIS. NANCY 00089298 09/03/02 407,60 0.00 ••90,00 357.60 SP IP 1 06/28/83 er GUARANTOR INFORMATION rr KE1044YH PURVIS _PO BOX 50068 DENTON, TX. 76201 Unable12t6o_loga1tc-,.,,,_. { RAWLS, PEL IC IA A 00058731 19/20/02 1,103,24, 0.00 0.00 1,10'.1.28 SP IP 3 3a rr GUARANTOR INFORMATION rr BERNICE RAWLS P 3.13OX_348 AUBREY,. TX 76227 No response I J REED, HARVEY F 00086069 12/01/82 2,049.38 30,00 0.00 2,137.38 SP tP 1 129 1 / I rr GUARANTOR INFORMATION-rr HARVEY REED 8116 NARRAGANUETT 043 SAN DIEGO, CA _ 92107._. No response-- . i 4 REYNOLDS,.TEARY 00056791 11/91/82 64S. 50 0.00 0.00 648.50 SP IP 3 12/14/S2 348 1 rn GUARANTOR INFORMATION rr J09 REYNOLDS _ P-0 DOI 181 JUSTIN,.TX _76247 _ No reSpOnse_, SMITH,ELLEN, J 10000065 01/26/83 0,00 1,632.38 0.00 1,632,39 SP Ip 3 rr GUARANTOR_INFORMATION-rr_.t4ALTER RODDY. _ res0`ouse_.I J ' -P _]f1 - -2822 LOVIBE 023 2822 LDUISE 023 DENTON, .-TX_--76h 4.01 No BM1TH,pH1CLip K 40000487 02/01/83 5.00 1* 222, 25 0. 00 227.25 SP ER 3 _ Ntl reSp 0se,.• I, rr GUARANTOR INFORMATION.** PHILLIP K SMITH 7422 HENDEASON RD LITTLE: ROCK, AN 79710 BNYDER,DA14IE 10071624 04/27/83 730.60 0.00 0.00 730.60 SP Ip 1 187 l ~j.J _-rr GUARANTORINFORMATION rr :.DANIE SNYDER 90X.878 MEBOUITE,_7X 78049. 1. BfEPHGBON, DONALD 14• 10019891 04/0/80' 4, 099, 05 Gd%8572 SAN0.00 DER, 7P104' 60 8p 1p 3 spo I - GUARANTOR INFORMATION rr DONALD W STEPHEEON X 76966 No rense- 1w STOKHS,UVELYN L 40044257 07/16/03 61. 70 434,75 0100 496, 50 Sp 4 Bb 1 I J rr GUARANTOR INFORMAT10N,rr SVELVN L STOKES 922 PT WORTH DR DENTON, TX -76201 0f No ,response _ ' V STRAN06,PRANCES 40031304 06/01/83 86,90 174,88 0.00 831.05 SP ER 2 104$01 J , rr GUARANTOR INFORMATION rr A.E. STRANGE -708 FRAME STREET DEN70tJ,. TX 76701 No_response V STRAN06,PRANCIS F 40036527 06/19/83 611,25 0.00 0.00 68.28 Sp ER 4 4 133 1 1 ; rr GUARANTOR INPORMATION JAMGS D STRANGE . _ 205 A IJEDO RD DENTON,. TX 76201, 1. STRATTON! CYNTHIA' 0, 10030823 06/09/83 1,079. 120 0.00 0.00 I, 079,95 RP 10 3 146 1 J ! ; rr GUARANTOR INFORMATION ♦r JOH14 D. 8TRATTON 707 DEWBERRY LEWWtLL9, TX -78067 response it STUART,NALINDA 10092390 04/30/83 738 78 339,90 0.00 1,078;68 SP Ip 1 67 1 .J __rr OUARANTOR INFORMATION rr JOHN STUAAT 3210 FALLMEADOW #223 DEWON, TX.. 76201_ Unable to locate 1r / V TAYLOR,INF M 10097886 06/93/03 13,314 40 0.00 0.00 13,314,40 SP IP 1 06/20/83 126 1 J ! rr GUARANTOR INFORMATION rr GARY TAYLOR 8077 STANLEY, THE COLONY, TX 75056 No response V TIMMONSr DORI$ 14 10017628 06/11/01 39j279.00 0.00 0. 00 39, 279, 00 SP Ip 3 140 1 J 1..- .►r GUARANTOR INFORMATION rr DONIS W TIMM0148 209 E.PRAIRIE ST.. DENTON,_TX. 76901.___ W:!.Rgmants not k9 t V14AtHUAH,C140MBO EVA 00071888 19/30/82 4,240.75 0.00 0.00 4,240,75 ID IP 4 ) rr OUARANTOR INFORMATION rr IGNATIUS-CHO110O 6248 LLONDONDSRRY LN DE140% TX 76201 Unableto loyalte WALKGR,OINA 0. 40018935 04/04/03 40.00 2 976.50 -10,00 31014.80 SP ER 1 06/27/03 36 1 . rr GUARANTOR INFORMATION rr LARRY WALKER RT 4 BOX 19 DENTON, TX ,76201 No rOtipOnse I !t V y 01 140V 1985 W R 17 E- 0 F F I - R P O R T PAGE 4 l PATtENT NAME PAT IO DISCHO LEO-DAL NEW-CHO NEW-PAY (4-0 DAL FC TYPE CYCLE LST.PMT AGE FO TYPE L WALKER,MICHULE C 00072074 O1/Oft/83 438.16 0O00 800 0.00 rr GUARANTOR INFORMATION +r.CLAUDE WALKEH P 1 SANDY, S75755P a 01/29/83 No rasp nSe 1 J lv W$LOORN,CAROL A. 00075122 12/23/68 2,940,05 0.00 0.00 2,940.05 SP 1P 3 12/23/00 3~3 1 `II rr OUARAN TOR INFORMATION rr TRAVIS WELVORN SOX 633 JUSTIN, TX 76247 No reSS nse J L WEE1LLDORN,A14DREW 10041234 07/26/83 2,411.10 132.25 0,00 2,043.35 SP IP 1 J r- - rr GUARANTOR. INFORMATION CLAUDE WELLBOR14 2712 DELLAV8 OtNTON, TX 76901 No response 1 i WEST, Boat) IU 00073387 08/29/62 981.83 0.00 -00.00 901.03 8P IF, 3 10/03/83 29 1 J.' er GUARANTOR INFORMATION r♦ JIMMY WEST 1512 R1rE AVE -GAINHSVILLE, TX- 76240 No response WHITFiKRLLY M. 10044351 00/16/83 3,520 25 345.15 0.00 3,870.40 80 IP 4 J rr GUAAANTOR INPORMATION rr RODNEY WHITE P.O. SOX 26 LAKE DALLAS, TX 70069 Unabl@ t0 locate 4r' WNITE,MARLUNR 40031734 06/03/83 109.35 603.55 O,OD 711.90 8P ER 2 f3 J er GUARANTOR INFORMATION rr RODNEY WHITE 2800 FTWORTH OR.M10 DENTON, .TX. 76201.. Unab18 t~ 1oce4e WHITLOCK, JAtJAR D 06074070 12/18/82 1, 098, 65 0.00 0, 00 1) 096. 65 8P SP 3 3f6 xr GUARANTOR INFORMATION wr GARY R WHITLOCK RT2 BOX 91- AUDRGY, TX '76227 ReluSEd to.P1yI J WILLIAMS, CRA 10 10017366 04/08/83 776,65 0100 0.00 776.68 ADD IP 2 04/06/03 1 J rr GUARANTOR. INFORMATION rr CRAIG WILLIAMS 9300. FT. (JORTH_ORV 031.DiruION. TX .76201- Moved. ierl~qg~ no eddres5 WtLLIAMS,MILDAFD'E 00074914 06116/82 292.00 0,00 0.00 292,00 SP IP 3 07/14/82 $03 1 ` J rr GUARANTOR INFORMATION rr MILDREED WILLIAMS 000 8._ DOIS-O"ARC -TYLER, 7X 76702 No response 4 WILSON, CARL W. 10001220 02/00/63 3,063.55 0.00 0.00 30OLB. 55 ADD LP NS { J re GUARANTOR. INFORMATION rr CARL W. WILSON L007 DOYD IRVING, TX 70060 _ No reSPanse_ 1 1wWINDHAM,CA69Y D 10008001 02/28/83 1,665,30 -13.00 0.00 1,652 30 SP 1P 3 i J rr GUARANTOR INFORMATION rr 14ELVIN WINDHAM vi . _ 630 PRICE LEWISVILLE) TX .80067' No response,. 1r h WISEE,DCAOTHY 10006468 02/46/03 3,496.50 0100 0.00 3,496.05 SP 1P 3 245 t J er.GUARANTOR INFORMATION rr. DOROTHY W198 _ .647..MILTON_ LEEWISVILLR,_TX _75067_. No,response WITT,LASHANNA A 0007580 09/01/82 826.95 0.00 b,00 ¢26.95 SP IF 3 46 1 { rr OUARANTOR.INPOAMATION rr DAVID 14ITY BOX 723 LAKE DALLAS,.TX:-75060_ No reS nS4„ WOOD,KA1HY L 40610829 03/13/03 68.60 723.80 0.00 792.45 8P RR 3 113 1 J *0 GUARANTOR INFORMATION rr .CHARLES E 14COD _ -806 COTT DENTON, TX. 76201. No resPon" WOOD, LAURA 10005239 02/14/83 665.75 170.40 0.00 836.15 SP IP 3 20,1 1 J JIr GUARANTOR INFORMATION -~r WILLIAII WOOD 4901 ROBERTS THE COLONY TX 76096 No response, WORRALL,819VEN A 300761144 09/10/82 31431.90 -202.20 15,00 3,134.70 SP 1P 2 06/06/83 Log J e4 GUARANTOR.INPORMATION er STEVEN WORAALL 370 W MAIN 019 LEWISVILLE, TX 76067._ petused to payt +Nrr W-0 TOTALS errr 167, 794,130 , -5, 152. 04 J V l 94, 072. 44 P16, 714. 40 JORDAN' KAREN K 00037283 09/03/82 %7,00 0,00 0.00 957,00 SP 1P 1 424 1 J i A"OUARANTOR INFORMATION DENNIS JORDAN 409 $2ND Sanger, TX- 76226 - I , response- - 1 h ii l 01 NOV 1993, Wa l TE-0FF A E P 0 A T PAGE 9 PATIENT NAME PAT 11) DI9CHO BEG-DAL NEW-CHO NEW-PAY W-O DAL FC TYPE CYCLE LBT.PMI AGE FO TYPE F J L ABBtlTY,CNRIettNE M, 40048363 09/02/03 56.00 0.00 0.010 96.00 BP ER 2 Unable to locate QUARANtOA INFORMATION BENJAMIN ABBOTT P. O, BOX 654 DRNTON, TX 76201 I 4. AHME0,NABWIA E OOOp151S 09102102 267.30 0.00 -169.00 !02.30 BP 1P 1 06/79/03 125 2 I J ww GUARANTOR INFORMATION •w I9MAIL pA8YON1 1017 W PRAIRIE 46 DENTON, TX 76201 Arrangements no kept.. ~n AL-KATHIRI, ABDULMOHBIN' 40033607 06/10/03 92.50 0100 0.00 c2.00 BAI Flt 3 140 2 ! GUARANTOR INFORMATION +w ABDULMOMStN AL-KATHIRI 3400 JOYCE 012.0 l,tNTON, TX 76201 NO response ti.• ALLEN,MARK T 00002087 09/16/92 70,25 0.00 01 OD 70.25 to ER 3 12/06/92 411 2 - - i GUARANTOR INFORMATION - MARK ALLEN 505 FRAME DENTON. TX. 761201 NO response_ L ANDERSON, DANNY 0 4001215$ 03/19/83 131125 0.00 0.00 131, 25 8P ER 3 Unable to locate 4w GUARANTOR INFORMATION ww DANNY D ANDERSON 1900 W ESPLANAQE 0338 RU CHAROONNAY KENNER, LA 70062 ft. ARRIOLA, MBNRY 40057440 00/30/83 113.75 0100 0.00 113. 79 BP ER 2 61 I J +w GUARANTOR INFORMATION -HENRY ARRtOLA - - - °T 2 BOX- 72 OENiON,- TX -76201 - Unable _t0 10Ca B,__ _ 111 4,~ AVALOSi ANTONIO 40061731 09/13/83 56.00 0,00 0,00 56.00 SP ER 4 Unable t0 locate w+ GUARANTOR INFORMATION ANtONIO AVAL09 -2515 W OAK A23 DENTON;, TX76201 - Arai DAKER,BARBARA A 400274B4 05/91/83 91.25 0.00 0.00- 81.29 BP. ER 4. 2 .____Arrange Ants not_.kept ww GUARANTOR INFORMATION ww,. FREDDY BAKER SHORE LAKE OALLAS,. T%_.75065 _ 1v BAKER.7ItJA L. 70005558 04/O3/e3 147.90 0.00 -79.00 69.50 BP OP 4 05/16/93 164 2 I w+ QUARANTOR,INFORMATION ww P09TINA L. BAKER 4103 WALKER DR -GAY CITY, TX- 77414 No response,., 1. BARQQER, MARTHA BWEATMAN 40011017 03/14/03 90.05 0.00 0.00 00.05 Bp ER 3 5232 2 I J No response. _ wwbUARANTOR INFORMATION **..MARTHA SWEATHAN DAR9ER-- P.- p,. B0X 1561 DENTONr..TX 76201 1r OARNETT, CONNIE M 00004614 09/09/82 10.87 0100 0.00 10.87 DP ER 3 10/00/92 N0, re ponce Z_ J ww GUARANTOR INFORMATION w+ BOBBY DAR14ETT ..923 N CLEMENTS GAINESVILLE, Tk..76240........ TX 76266 IP 3 10/04/03 .e 2 0 _._46rigementS not_kept 1 4 wN OVARANTOR - INFORMATION wwO0 RUBBN I BARNETt 10/18/80 265,02 PO 0.00 BOX - 291 -70.00 0A11QER, 195,02 SP a; 411r DwwpOUARANTORBINPtlRMaT1ON w+40ALFUNSOO640AZA 74,79 PO BOX577 OFRISCO, TX 78034 [iR No rasponse J V AARTBi TI110THY 0 40010903 03/13/D3 62.50 0.00 0, 00 62.$0 0P ER 2 232 9 t ; DEIJTtlN, T%- 76201 N• GUARANTOR tNFORMATION ww OARRELL DARTS --1417 OVAIL RUN RD RT 4 No V BATCIT,WTLLIAN P 40026742 05/15/93 97.00 0.00 0.00 57.50 WC ER 3 ( Qq 2 OUARANTOR 7NPORMATION w+ WILLIAM P DATAIS NAB 2769 W OAK DENTON, TX 76201 NO r4sr nse , V DAYSIJLI6 A 00005189.01/17/83 117,10 0.00 0100 LL7,10 SP ER 3 288 2 h A J RANTOR INPORMATION ww JULIE MOLT 115 LEONARD LEWlOVILLE, TX 75067 b DAYS TRANSA 40006751 07/28/03 4100 0.00 0.00 43.00 BP ER 3 248 2 , ww GUARANTOR INFORMATION ww TERE9A DAYS 214 W DROCWT OMERMAN,-T% 79040. MO re9 nse..,, V GARCIA,PA11ELA DUE 40037426 06/22/03 122.35 46.00 0100 170.35 ADO ER N8 27 Unable to 10Ce1I _ww GUARANTOR INFORMATION *4 GAUL GARCIA 2237,W PRAIRIE M4 •B ..OENTON,-TX _-7520!.__ i V J 1a ~ k Y i` IZA 1. 01 MY 19D3 E- 0 F F R E P O A T - - PAGE 6 PATIENT NAME PAT IS D18CH0 DEG,-DAL NEW-CHO ;;LW-PAY W-0 SAL PC TYPE CYCLE LST. PMT ADE FO TYPE HENRY, KENNCTII 00031667 12/19/62 134.50 0100 0.00 134.50 SP ER 3 GUARANTOR :NP3RMAT10N KEN14RYH HENRY PO BOX 1311 DENTON, TX 76201 No r/s"nso I~ J L HULLOWAY,WAYLA A 00032961 10/11/82 115.00 0,00 0.00 119,50 IO ER 2 J - OUARANTOR INFORMATION r* GLEN MONTYA AT 1 SOX 131 PONDER, TX- 76259 No re pons0 C 1 V JOHNSON, MICHAEL 40055191 05/23/53 62.00 0.00 0.00 62. 00 8p EA 2 - GUARANtOR INFORMATION rr MICHAEL JOHNSON 1415 N, ELM. DENTON, TX 76201 Unable to locate j JONES, LILA P 00036996 01/28/83 103.75 0100 0,00 103,79 SP ER 4 I- GUARANTOR INFORMATION LtLA JONE8 516 CROSSTIMSERe DENTON, TX 76201 No response 2 j JONES, RgV, R. V, 40004723 02/18/83 37,00 0.00 b.00 39.00 Sp ER 3 GUARANTOR INFORMATION REV. R, V: JONES _ _202 OAINE8 SULPHUR SPRI170, TX 75482 No response 2 J 1 JONE9,8HARON L 00037104 12/17/82 131.10 0.00 0100 131.10 SP ER 3 01/11/83 319 GUARANTOR INFORMATION SHARON JONES _ _2500 W HICKORY M28 DENTON, TX 7620I_Arrangements n2 ot kept V,I JUSVCE,OTEV8 N. 40036808 06/20/83 52,50 0100 0100 52,50 SP ER 4 3 GUARANTOR-INFORMATION r*-STEVE N. JUSTICE TWIN LAKES MHP #279-DENTON, TX 76201__.._. Unable-L ---__r_ J 4 o locate ~I i KEATIyO,MICHARL H. 400091RO 03/09/63 75.00 0,00 0,00 75,00 8p ER 3 GUARANTOR -INFORMATION MICHAEL H. KEATING - "R T. 1 BOX 156- AUBREYr TX .76227 Unable t0 locd! ! KELLER,CHAISTOPHA 00037659 01114/83 1,2 34. -1,229, 17. Ip 3 04 GUARANTOR -INFORMATION r* . ROGER _K KELLER lZ. aO _ Sg1p0ARKANSASg0GAINESVILLE, STX 76240----..02/17__/03 6240 -OD/17/_3 NO_ra pOnSe MAOIC,8AMI11r L 00042805 01/16/63 143.75 0.00 -25.00 SSE,75 Bp ER 3 02/28/03 246 0 J f GUARANTOR-INFORMATION BAHMIE MAGIC 119 WAY149 RIGHT- DENTON, TX 76201 _ - No-response 1 V MARTIN,MELANIE J 40039141 06/28/03 06,00 0,00 0100 56,00 SP ER 1 Ig5 OUARANTOR INFORMATION . MELANIE J MARTIN DESERT. SANDS MOTEL. AD0M #215 DENYON,_. TX___ 76201.-_ Unable- to 1940 MAWN,DEANNA KAY 40050841 00/08/83 56.00 56.00 0.00 112,00 8P ER 3 .**,OUARANTOR INFORMATION *r SHEILA MASON 994 80, CHARLES 0410 LEWISVILLE, TX_ 75067 _NO response-- 7 V MCCAIN,RACHAEL M 00044602 01/R9/83 38100 0,00 0.00 39•00 SP ER 4 GUARANTOR INFORMATION-rr OARY LEE MCCA114 AT 8 #263 TWIN LAKES DENTON, TX 76201--.- NO response 2 J MCCANCRrBCOTT 40003906 02/15/83 112,25 0,00 0,00 112,25 8P ER 3 OUARANTOR INFORMATION SCOTT MCCANCE 4901 DANLEY CT LEWISVILLE, TX 75061...,._. _ ND response- -'2 J MCKEDW14,MILE9 P 00045633 01/30/83 23.00 0.00 0,00 2100 Bp ER 4 GUARANTOR INFORMATION *a KELLY MCKEOW14 P.O. SOX DID- KRUM, TX : 76249 Unable t0-loeale__ M[TTB,DONALD R 00047712 09/24/92 301,89 0.00 0.00 301,89 8p IP 3 10/28/82 407 2 GUARANTOR INFORMATION 00014,11 MITTS 15775 N HILLCREST RD. SUITE $08 0466 DALLAS, TX_ 75248 No response J V MORENO,CHAISTOP H 00048470 09/22/82 114. 0,00 0100 114.40 8p ER 3 405 2 LI.J ' GUARANTOR INFORMATION . JAMIE MORENO 512 RAILROAD.AVE DENTON, TX_ 76801. NO res onse I k L Ol NOV 1983 Id R I T E- 0 F P R E P 0 R T PACE 7... PATIENT NAME PAT ID OlBCHtl DEO^OAL NEW-CHO "EW-PAY (J-0 DAL PC TYPE CYCLE LST.PMT ACE FO TYPE MUWERY.PATRICIA A. 40018149 04/tWO3 96.00 208.00 0.00 x64,00 SP ER 2 rr GUARANTOR INFORMATION rr PA1R1CIA A. 110WERY P.O. BOX 62 CARTER EDITION LOT 2 DENW,% TX _76201 No response„ 2 _ J PARKER, JERRY A 40OB6921 00/28/63 58.30 O.OD 0.00 58,30 SP EA 2 64 2 4i 1 GUARANTOR-INFORMATION +r GARY PARKER TWIN LAKE$ MHP 083 DENTON, TX 76201 _ No response. P!NA,ANNA 60093082 12/30/02 193.49 0,00 0,00 103. 45 SP IP 4 12/30/82 306 2 f'; J 4 ri GUARANTOR INFORMATION r+ ANNA PENA 4300 VALLEYCR58T DR ARLINGTON, TX 76013 No response PENCE, JAMES L 00093219 01/10/63 122. 10 0.00 0.00 122, 10 6P ER 2 299 2 r+-GUARANTOR INFORMATION +r -JAMES PENCE RT 1 BOX 2 AUBREY, TX 76027. No response L PETRILLO,FRED J 00053744 08/09/82 291.02 0.09 0100 291.28 SP tP 3 10/04/82 453 2 rr GUARANTOR INFORMATION r+ FRED PETRILLO 1212 JOHNSON DENTON,-TX 76201 , No response t PHILLIPS,MIKE P 00033842 01/28183 30.00 34,90 -35.00 34.90 SP ER 4 0 r+ GUARANTOR INFORMATION rr .MIKE PHILLIPS 3/12/83 224 2 J 910 FUTRELL MESQUITE, TX_ 75144 _ .,Re(used t0 a P y PRlCf:,MICKEY D 40029413 09/10/83 77.75 0.00 0.00 77. 70 SP ER 2 74 rr GUARANTOR INFORMATION +r MINNIE SHITH 416 D1110HT LCW18V1LLE,"TX 73067 Unable to„coca e 1r ! PUTMAN,DOODY R 4001OD48 03/12/83 80.75 0100 0.00 80.75 8P ER 2 3Q2 2 rr GUARANTOR INFORMATION rr BOBOY R PUTMAN '`_i. -1421 LtNDSEY- D$NTOIJ,-TX-76201.__ pneble, 0 ~cate , 4w r PUTNAM, ALTA f1. 4002771'7 09/20/83 83.00 0.00 0100 83.00 M08 ER 3 GVARANTOR INFORMATION rr ALTA M; PUTNAM _ .2800 FT, 1408TH DR. LOT 76 DENTON,-TX 76201 _Unable io'locate V RAYMDIyDi STEVE D 40058844 09/04/03 235, 75 0.00 0l 00 235.78 SP ER 3 h +a GUARANTOR INFORMATION rr STEVE b RAYMOND -LEWI8IILLE TAKE DSNTpV, TX _76201- e o_i ocavo REAULL02A.ANTONIO 00099859 09/IB/82 f24.90 0:00 0,00 124.80 ID CA 2 412 2 I V jJ I J ' rr GUARANTOR INFORMATION rN ANTONIO REDULLOZA 519 FRAME 8T DENTON,-.TX .76201 _ _No response L RHOFEARN,WAYNE ARTHUR 40026962 Ob/16/83 200, 70 0.00 0.00 200.75 ADD ER Ne 1b7 , J rr OUARANTOR-INFORMATION rr WAYNE ARTHUR REOPEARN - RT 2 LOT 29 MAYHILL RD,DENTON,.TX1620t _,Unablet0--1o4ate,___ REEVER,GARY L 00086;242 12/21/82 DS, SO 0.00 01OO 98110 6p ER 3 O 9 - rr GUARANTOR INFORMATION ,rr GARY REEDER STOIJEOATE NORTH 027 LEWISOLLE, TX ' 78067 Una a 0:1.OCage „ t RICHARDSON,K E NNETH b 00057067.12/29/82 178.00 0.00 oloo 178.00 SP op 3 314 2 rr OVARANTOR ! J INFORMATION Mr JACKY RICHARDS014 _ AT. I BOX 41 DENTON, TX 76201 _ Arrangements not kept / • R0901148,DARRELL E 00057724 08/12/82 102,00 0.00 0,00 192, 00 ID ER 2 416 GUARANTOR 8 . " •~,I ,J , {{I/1 INFORMATION +r OAR05LL E ROBBINS 3400 JOYCE LANE 0235 DENTON, TX 76201 Unable t0, locate itr ROWAN, )ANNIO J 00089279 06117182 163. 39 0.00 0,00 . 163,38 ADD ER. NS B J rr OUARANtOR INFORMATION KIINN6TH AOWAtJ 2206 PONTIAC ON ARLINOTUN, TX 16013 Noved left_no a2 ddross„ rrrr W-0 TOTALS 44104 7,650.10 -1, 609. 90 40 3SO. 50 6,42$. 10 MtCWA JGANIC A, 40030264 06/29/83 11,70 0,00 0100 11,10 SP ER 1 05/31183 153 2 ORAt ~AkTOR INFORMATION "t JCANIt A. MUM 321 W. PAARRIC OCNTON, ix 16201 Rofused to pay 4r V , lop- 14t" . it K, 1. 01 NOV 1963 14A I TE-0PF REP0A T PAGER PATIENT NAt% PAT IA DISCHO REO-BAL NEW-CHO NHW-PAY W-O DAL FC TYPE CYCLE LST,PMT AGE PO TYPE i 1n AOUIRR6, PL;T6 70008453 00/07/B': 494.50 0.00 0.00 494, 00 SP OP 2 170 4 'i rr OVARANTOR INFORMATION rr JESSIE ',OUIRRE RT 1 99 W AVOREY, T% 76227 Missing packet `I t*r ANDERSON,AUDRA M 00002500 10/2302 100.00 0.00 0.00 100.00 8P SP 3 374 4 J rr. OVARANTOR INFORMATION rr -RANDALL ANOERSON 115 MARTIN LEWISVILLE#--TM-. 75067 171ssigg-packet- r*rr. W_0 TOTALS ♦rrr $94.00 0.00 0.00 544. _ 50 J I V J I V _ J . 1r, ,J , I V . it 1r b jjJ i v \ 01 NOV 1983 l+ R[ Y£ - O F F REP d R T PAOE 9 ff, PATIENT NAVE PAT Id DISCHQ BEQ-DAL NEW CH4 NEW-PAY W-0 DAL FC TYPE CYCLE LST.PMT AGE FO TYPE t ~ J Y,.. L AHANOTU PAYRICIA A 00001803 04/30/82 104.80 0.00 -04.00 20.58 SP IP 4 07/19193 105 6 J rr GUARANTOR INFORMATION *41 EJEM N AHANOTU PO'POX 9218 14T STA DENTON, TX 76203 Arrangements not kept. A. AKINBr 11ELVA K 00001594 06111182 214.21 0100 -20.00 189.21 SP IP 3 09/12/92 50 6 .J rr GUARANTOR INFORMATION xr DARYL AKINS PO BOX 321 AUBREY, TX 76227 Arrangement; not kcpt_ ,w L j ALEXA14DgR,JOSH C 1000hV37 02/22/03 2,536.70 0.00 -2,343.56 193,14 SP IP 4 10/08/83 27 6 ` J rr GUARANTOR INFORMATION rr SAMMY ALEXANDER _ RT 2 BOX 29 . SANQER,-.YX - 76266 No responsq.. r kw ALLEN KIROTIN 00002063 01/98/83 41.80 98.20 0100 140.00 SP ER 1 161 6 rr QUARANTOR INFORMATION rr..LYNWCOD ALLEN 817 OLUESONNET OR DENTON, TX 76201.._ NO r6spOA$0,'_ V ALNAJJAR,PUA.0 00002379 12/08/92 38.00 0.00 0,00 38.00 SP ER 2 3r2.8 6 j .J wr GUARANTOR INFORMATION rx FUAD ALNAJJAR 2320 W PRARIE APT 205 DENTON, TX 76201 No response _ (v ANDR990% ANDY R 00062843 11/04/82 230,81 0.00 -60.00 170.81 SP IP 9 08/18/03 78 b J rr GUARANTOR INFORMATION xx JOHN R ANDERSON P 0 BOX 159 -LAKE DALLAS, TX 78068._. _ ,..Arrangements nq,p kept _ "1r♦ ANDERSON, RANDI, R 10000826 01/31/83 104.88 52.67 0.00 457.72 BP IP 4 60 6 J i rr GUARANTOR INFORMATION rw IIELINOA PANNELL 201 N WASHBURN 201 N WASHBURN DECATUR, .TX 76234 NO,rOSpOW_. Ar ARIAB.MIQUEL GONIALE2 40062279 09/19/93 124 75 0.00 0.00 124.75 8P ER 4. 45 6 J r► GUARANTOR.-INFORMATION xx MIGUEL.GONZALEZ ARIAS. Y-110YEL 0910 LOCUST -BT.-DENTON, TX-- 76201 Unable to_IQyate 4 ARMBTfiONO KRESHELLB 00003129 10/21/82 153.88 0.00 -20,00 133.85 BP ER 3 10/07/83 25 6 rw 0 ARANTOR INFORMATION xx LEMUEL ARMSTRONG 6326 BOWLING BROOK. DALLAS, TX -75241 ARMOTRONO,09TH A, 40011603 03/16/R3 78.70 0.00 0.00 70, 75 MD ER 229 6 xr OUARANTOR. INFORMATION xr TRACEY SHUPP 309-PRIEST KILECN, -TX 76541 NO,_Tespogse___ r'.I 1r ARRANOO, CRUZ 40042335 07/09/93 26.70 0.00 0.00 26. 70 SP ER 3 07/11/93 U3 6 'J rr GUARANTOR.INPORMAYIOII rr_ CRUZ ARRANOO 2800 FTWORTH #34 -DENTON) tX 76201._ _ linable to locate I I E V AYER9,JAN10E K 10019436 04/19/93 680.70 21. b8 -847.39 129.00. 9P Ip 3 .06/27/03. 127.'. 6 Iy J rr GUARANTOR INFORMATION xr . OAVID.D AYER9 _ PO. BOX345 VALLEY VIEW, -TX 76272-_ Val NO res J 0.00 1 OwwLQUARANTOR INFORMATION rx4014ANCY4DAILEYlB3 41.80 110 LEONARD LEWISVILLE, TXSp7DO67 3 251SQ__6 j1 1r BAKER CHARLIA M 00004176 09/20/92 198,39 0.00 0.00 199.35 SP IP 3 11/122/82 407 6 J i w# 0UARANfOR_1NFORMATION.xx CHARLIA BAKER 7212 FTWORTH OR #103 DENTON, TX -76201 NO response_... V " BANDA, ADAM J 0000434.1 09/25/82 175.03 0100 -50.00 128.03 OP IP 3 09/31/93 154 6 r rw GUARANTORINFORMATION rw ADAM BANDA 7200 BERNARD DENTONt TX 76201 Arrangements not kept_ fr _ BraBGUARANTOR. INFORMATION wr4tlVIAQIU P 9 BARBEp_ 43.00 - 1415aJANIE DENTON, .1X9 76201p..__.ER_.. ~ ............No. resp146 6 ^n>e_-b. L J I tr BARNETT, BONA M 00604622,0/0.1/82 242,55 -103.00 0100 139.55 DP ER t 194 6 j *4 OUARANtOR INFORMATION rw L H BAR1491T PD SOX 2492 BUNTON, TX 762101 _ Arrdnger.4nts,not kgpt i V.; BARNETT, RICKY R 00064705 09!16/82 45.50 131.18 0.00 17&.68 ID ER 3 161 6 J rr OUARANTOR-INFORMATION xr RICKY,9ARI4ETT-. - .102.PIREWOOD LEWIBVILLE,-:TX._75067-.... . No respOns,q,,,,,,,,__, ...1 11 .I ; ~ a u J ,it 1 1 01 Nov 1983 IZ R I T E- O F F R E P 0 H T PAGE 10 .-i PATIENT NAME PAT ID D[SCHO nCO-DAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LST,eMT AGE 50 Type. / BARRY, SUDAN S. 70007954 04/26/83 93.76 0.00 -59. 12 24. 64 MC OF 05/1Q/93 173 6 w* GUARANTOR INFORMATION SUSAN S. BARRY 315 PRY 81REUT OENTON TX 76201 92 4 _1110„re ponse - b i J .00 l DECKERINO, ANOELA H 70002381 02/29/03 101.20 0,00 DELI V1ENNh0 MOP 695OF 246 *K GUARANTOR INFORMATION) ANGELA H. DECKeRINO GENERAL DE J , tin 1r GONZALES, JANIC 40039711 06130/03 70. 00 1. 60 S LC+CUST1 ODENTON71. 60 76201 ER 2 Unable to loca6e l- HEROD GUARANTOR ONPORMATION JANIE 0014ZALER **00031765 01/23/93 68.00 0.00 0100 38,00 Sp ER 3 292 6 J GUARANTOR INFORMATION L* -OEOROIE H601) - - - 2216 CHILDS- DALLAS, TX '75203 7b01 UnaresponSlOCdte. I. ~w HUGHDANKB,DRETT A 40047696 07/2S/03 60.79 0.00 0.00 60.75 ADD ER HS OUARANTOR INFORMATION DRETT A. HUGHDANKS 2009 BURNING TREE DENTON, YX to, 0 V JENKINSiJAMES A 00035634 12/23/02 98,75 0.00 -73.75 20,00 9p ER 3 09/24/93 64 6 ' J Ij , *0 GUARANTOR INFORMATION JAMES JENKIN9 - -BOX 601 JUSTIN, TX ..76247 Ref@9ed_ t @ P4Y. 4 4 JONES, 4If1MIE LOU 40045516 07/21/03 126.25 0.00 0100 196.25 9p ER 1 102 6 llnabl4 t@..1gcAte,___ GUARANTOR INPORMATION LLOYD EDWARD JONES - -156 6TEMMONB FRWY- LGWIBVILLE, TX --75067 - JCNES, MtSBRY C' 40016933 04/09/93 00.30 6,00 0.00 00.30 SP ER 2 202 6 J 1 Arran94ments-not,.kep~ M* GUARANTOR-hJF19MATION MERRY C. JONES 2520 CHARLOTTE 14208--DENTON, TX 76201_.. . b JON2SPRONRLL 00037160 01/12/93 93.60 0.00 0.00 93.60 SP ER 2 293 6 1°~ J N6 'response GUARANTOR INFORMATION + DAVID DE11ARCO AT 4 BOX-70- ROANOKE, TX -76866 - - ~,.i V KALAF,CHAD T 40061061 09/11/03 •56.00 0,00 0.00 56,00 SP Gp 4l b GUARANTOR INFORMATION MUEN KALAF 2201 W PRARRIE - DENTON,-TX 76201 ..._.Una41Q-.2.1444!@. ! J 0, 00 0, 00 1QL 25 9P ER 3 UOd6~0 t0 1@cat8 V KNOX, GRIRR RAYDORN 40033116 06/09/03 12t.25 44 GUARANTOR INFORMATION OR19P RAMAN KNOX Q5OOPTWORTHDRNS DENTON, TX 76201 _ A+ OMITI40 JGNNIH L. 40012790 OVO'2/83 111170 26.00 0.00 137.70 Sp ER 3 2L6 6 00 No .C 4P se._ . i SLY.. LEWI9VILLE,._.YX 75067 i V WHEELER,RLEOOA INFORMATION 4000JSNN19 L. SMITH 73643 1!2/07/02 32.00 30400 Kt -6,40 25.60 MC IP 1 02/11/93 263 6 I` J P 5 @♦ OUARANTOR INFORMATION i.90NA WHEELER 1920 AVENUE C n"_40U, TX 74201 4r NtLLIAMtION, HAL H, 40005945 09/21 /83 79. 25 0.00 0.00 79.25 OF PER 4 252 b { ~ ' No r4s onse-_ _...I +f* OVARANTOR INFORMATION HAL H. WILLIAMSON _4212 RIO ORANOR DENTON, -TX 76201. i,',', 1v W1LOON,FRANK N 0007530 LB/3l/a,7. 05.50 0100 0.00 65.50 SP ER 4 309 6 rA GUARANTOR INFORMATION FRANK 14ILSON 621 NORTHWEST SECONn ST MOORS, OK: 73160 No re44onse ftr WILSON, JOE 40006322 02/23/93 67, 75 0.00 0.00 0.75 BP . ER 3 250 6 ! ; J !J Mr OUARANfOR INFORMATION JOE WILSON AT, 2 PILOT POINT, TX 76259 No WOO" V WILSON LUNNIE J 00075432 12/21/82 137.00 0100 0,00 13y 00 Sp OP 3 310 6 i *4. GUARANTOR INFORMATION 40141419 WI1.9014 200 0. RUDDULL 1429 DEHTON, tx 76201 No respons@ j i ftv WOOD, AN14RTTE, M 40005464 02/60/113 169,45 0.00 0.00 169.40 SP ER 3 5262 b GUARANTOR INFORMATION ANN91TR WOOL`, M P.O.. BOX 5547... ORLANDO, FL 32855.---. i 1 L, Ol NOV 1983 W R I T E 0 P P A E P 0 R T pilOE 11 J ' PATIENT NAt*.' PAT ED DIBCHO BEG-UAL NEW-CHO NEW-PAY W-0 f.`AL PC TYPE CYCLE L8T,PMT AGE PO TYPE ~r WORRALL, KENNETH 0, , JR. 40036g16 06/20/83 133. 90 0,00 0.00 133-90 Bp ER 4 132 6 rw GUARANTOR INFORMATION rw KENNETH D. WORRALL, JR. .107 S. HATCHER LEWIBVILLE, TX 75067. _Unable.t0.locate__ w WRIGHT, ELLEN 4003709$ 06/21/83 90.00 0.00 0100 90.00BP ER 4. 132 6 ~r GUARANTOR INFORMATION rw ELLEN WRIGHT 380 PLEA MARKET--DENTON, TX -_76201-- NO.TOSpOp90 11 t., GHT, HELEN p INFORMATION .wr000761 3 1 WRIGHT /83 144.78 P.O. 0O BOX 2 16.80 Q6, 90 OP TX 76201ER 3 02/16/93 . NO 259 6 _ . i ~ J ARAN reSpoA OnS4 WYNN, WILLIAN PAUL 40014107 03/27/03 57. 50 0.00 10.00 07.00 8P ER 4 218 6 j J - ww GUARANTOR INFORMATION sw__BHIRLIZY WYNN - - 3212 000-0-LIIIK . DENTON, T%- 76201. No response www4 W-0 TOTALS wwwr 7,277.56 -3,384.98. J 1. 105. 25 3,997.83 1. ~ E'1t 1 , 01 NOV 1983 W R I T E O P P R E P O R T PAGE 12 PATIENT NAME PAT ID DIBCHO BEG-DAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LBT,PMT AGE PO TYPE { wwwr WRITE-OFF-GRAND TOTALS rrrw 183,316:96 10,143:32 ' 541 $58. 19 227,131,83' 1 ~ 1 1 I : I 1 J *4 1 fiC~~"a'!fj-.~3d051StiV~eva~,. v,.a.,:,. I 16:04: S4 OS NOV 1901 CI IARI FY NE!'OR"! PAGE 1 l PATIENT ' PAT, ID. PT PC. OUA11ANTON_NAME.....; ADDRCS9............... CItY..`.... ST YIP. DIS.DTa,--AMOUNT;- ACUr.F,8sIERRY J 111 40058992 ER 3P Rn'!HY ACUFF P. O, b8x 164 ouNT[:R TX 75059 09/04/83 -24.00 Balance after Medicaid - t.. ANDERSON,'I'ENEGA 10030064 IP RP ANDF'NSON TERESA AT 2 BOX JOL7 DENT014 TX 76201 06/09/63 -2,089,69 Hill Burton Criteria ~AANDLD,tNMA - 400111338 CO MD AIINOLb,IRMA - BOX 310 CORNER OF FIR KRUM - --YX 7624903/M0 83 67:00 Medicaid not persued by Buianess Office 1 BAKER,LINOA 100.0097 IP OP BAKER, JIMMY AT I BOX 65L. AUDREY TX 7682) 04/RY/03 34.90 Balance a'ftq Medicaid BENNETT, DARN IN II 40058(128 En BP NI rA BENNI;TT IO2 MASSEY OR DENTON 7X 76201 09/04/173 -20. 00 rter Medicaid i DElIMEA,DEVERLY - -IOD3t947 IP SP UEN11EAiRALPN-- 9tl2 JANNIE ---bENTtlN BalTXance 76 a421"0671$/83gi~777.'53-'_-- Hill Burton Critoria j LICHMEA, TONY NMI 10056380 1P SP BT.'R17FA,RALPH 326 8 BOWIE TULIA TX 79OUS 10/04/03 -31154.85 ' Hill Burton Criteria DERRIO'0E0NOE 10043347 IP SP OVOR 10, GEORGE 797 8 OLD ORCHARDN104 LEWISVILLE TX 78067 00/04/83 -1-229. 35 i , Order, o. Protective Custody 4004 'tA MC anic.-mr, 4 BOYFTTEMBMCVE LEE 10042170 IP BP NOYE7TEM8TEVE I. kT 2 BOX 634 HANDY DA DENTON "Tx !6 O2 07/29/6334'90 _ 4r Balance afte dicaid rr kkee J • EE 509 CAMPBELL UEMTON TX 7b201 OY/26/63 -073.85 • Ofed left`no assets OURROW,LARNY E. 40098O75 CA SP BURROW, LARRY E. IDOL LATTIMORC DENTON TX 76201 09/02/93 -13.00 Balance after r~djcald _ J ~j 614AN0 1SABELLA 2. 40694183 ER 8P CNANO. ISADELLA -2. _ _ 2514 W. HICKbkV 02'- DENTON - TX 76kot 09 P./83 Balance after Redtcatd J DURHAfi,1NF F 10024378 IP SP UUNLIAM,LGLA AT 2 BOX 181 ARGYLE TX 762P6 09/05/133 -0,56080 + - Indio# t care f7, PtNECH,TAN IGA 10030443 IP MP FCNECH,TARISA 6215 FTWORTHDR 8S DENTON TX !6203 06/07/83 -293,46 J ppce ofteO,diem 1~'LECNiDRiAN 30040344$ iP CO FLECK,bRIAN _ 1963 N MILL LEW1>3VTlL>r`'-`7Be)R 796217 08 . 0".1/B~._.. 2:90--- Balance after Rental HepllhAotal Retardation- J f FLOWERB,D000LAS R. 40066037 ER CU DENTON COUNTY JAIL E. MCKINNEY ST, DENTON TX 762201 09 a / -7 .35 k6l~ _ _ ..oentOn ,~f~i FCL0AH,INF FEMALE 10095533 [N 8P FOLOAR,MAURICiO O0 19JO RUOUELL 006 DENTON TX 76 10q 1010¢¢y3~~/83 763.05 J FbLOAR; MAA`Y - fObSY'b1q IP !3N FOLOAR FAURIdld- 1910 AUbbVL.L--0906 DrNT6N-- - AYR br S16~t)3i/03 =5 346.-83 FOSTER,MILDRED 400594iR CA MD rOSTCR,MILDREb BVNDIAL 14UR81N0 HOME PILOT POINT NT All Button 01 , QQrr %an 769 298 8 07~06%a83 l7 78 7 7 al 7 iedi'c,a . PULLEN,ROOER N, 40017816 ER PIU h'ULL.CR,LINDA O. 900 PARKWAY DENTON T 6201 0 /111/83 -12.60yM J 9aJi ~dpgc % 11 e5depter Ma1d id _ OAFCNKBERO;FIiEDER1CKE Gr1027003 lP MP CREtNEUE(10;FNEDENICK AT 1 BOX- 20" ORAPEViN7; _ 0 1 r 83 -T, 643, b$ 11a BaT>tn after Mggdd5/83 J ; ~i NAkUINrRICHAl1p L iJN 40067969 ER CC DCNTON COUNTY JAIL E. MCK[IJNEY 87 DEN1'tlN 62 S 10 5/83 -56.00 VI HARDNICK,INP PE 1001893D IP MP IIARbW1CK,MARY E 940 BPRiNQWOOD 1•EWf8VILLC DYX 76061 04/t5/63 -40,40 J , 8QI"encc efttgr ppggddispfd _ NEa3fAND, Js1HdN N EN I1P 14C9IAWDA DAVITS AT 6 030170 'AUtlUUTA_ DI:NTUN° In ig7149c1 A J HOUStlCT7, CARLBT S 00033390 ER 8P LIOUfitlSN, T! D, 802 W OAK N3 DEMYUN - % 76 tlJ 7/L4/84 970.45 V HVI Burton drimid HUUSpGN,CARLET S I0050300 1P 8Q HOUBUEN,RObfRT 1241 ANNA DENTDN X 76201 04/ 0/83 -.1664.40 Hill Nurton_Crit la HOUSnt% CAnLP 909"'- 1005:1016 1P 13P.. HTIURbEN; AODERr`.._ 1401 ANTIA DENTON TX 76901 09/~~f/83';1;'g5C3. 96 I Hill Burton' Criteria' , e< L 16x05: 15 Ot MUV 1963 CHARITY IH:PUIJ1' PACE 2 L .l + PATIENT. . , . PAT. 10... PT FC, (JUARANTOR NAME... ADDRESS, CITY, 8T- tIP..:._ UIS: DTE: AMOUNT.. ~ HOU^adEJJ, 9UE _ 40063174 13R 5P RDb NOUBDEIJ - 80P. W DAK 113 - DENTDN ' a01 U971G/tl3 ~64.g0______ J T>t 7tin ~I J HOUSOEIJ,SUE C 40056723 CR UP ROD IJUUBDEtJ 902 W OAK N3 UENTON HTX 76 01 OSmA/%3 -52.00 HIiL Murton Crrrttert L J I HOUSDEN,SUE C 40055794 ER SP ROD HOUSUEN 802 W OAK 113 17EN701J TX 76801 Oq/OA/13 -•39.00 tBn Crltgri~ HUNTKR,RUDY - 40087534 ER H IN Our HUNTE(R,RUDY - -2229 CARROLL UVLD DENTDN Ca 7b2 09 18 3 I7: 20"- ~lg~cat~ JACKSON, ERICA C. Btan , 10030007, IP UP JACKSUN, ERICA C., - 2304 DEItRETT pR_.t1A_ AUSTIN 78749er 0 _ -11,765.03 J J / GpN,Ep17H P. 10083034 1P CO JO}JNGOIJ,WILLIAM 1702 WE9TWODD 99 36, DENT014 T% 6801 06 08%565.78 JOHN TX 6 6 UHMSUN,I_UGILLE 40083289 LR UP JtlHNDDN,I.IICILLE _ 611 N DRApBHAW UEJJT-bNV _Hill our, t1d) t - a1, a -a, 1en. qv- JOHNSON, WILLIAM E _40051468 ER. SP-_JUHNSON, WILLIAM E..- 1708 WROTWOOD DENTDN_ Die ~6201e08s/ M/13 3_ -219.80 J lit 1 Saxton CritQria fy+ JON", RULENE 10020501 IP MO JIINEU, RULENE 810 RAILROAD AVE SANGER ~X 76266 04/89/03 -B8.00 J a c9 a t 11gd( J011CS, SARA _1_0003774 ER 3P JI7NE6, SARA M - - 606 HUMDLEY p 0 bbX 6 LAKE_-bALLA§'-- B TXn7901ip580.M1.lgg99i~ttlC~>3 JONES, SARAH 11 10006013 IP MD JONED,RARAH M P 0 BOX 504 LAKE DALLAU Died W& 6oOa/16'03 -945._75 J tV KVEN,EULA J. 40096129 8R Me KEEN,EULA J. 300 CARDINAL NJ7 DENT0I4 TaX 76201COa8/86%53 -85.134 J K1kbLLI'NF.t1...._... t600093E"JP SP P. iMULtf, MELVIN 2000 PT WhRTH 00'N% DEN(ONOb)an7~tatQrOjla¢{c 3'- _612. a, 1. 1 n bra+7k>6 J KINDLE, LE5L[E 100509,2A IP SP P. IMIILF, MELVIN 2500 FT WORTH OR N7 UENTON " A 7648 9 O~f/083-20, 685, 1S KIMDL>,LEBLIE 5. 70016308 DP SP KIMDLE.MELVIN $SOO FT WORTH DR 07 DENTDN HT)i 76'W htul/83 -3,727.60 ' it !c {tgf~ n J ItINDRELL,DARfIARA 1004(M6 fP-CO k1k15AE:LLbORMAI4 DO% 65. VALLEY V/CW".._.fl:Y>~'~6r2Ya -71,-46 I KNOX. DEMEVA 10044400 IP MC KNOX, GENEVA x889 CARROLL GLVb, DENTON Balance aft r Na a a 1 I N tal Re rd ion J eX 7b1al LANGLEY, KENNY 10036531 IP CO LANGLEY, KENNY 413 GONHAM ALLEN Ba 7xn9~7~9 er0 /fSDC/q~ _40.07 999 J Balance. dit9r Me~ce} ea th tat Retardgtlon..~_ I LAW!#tlFi,bf113{'IAYN5 4002430f3 CR Nb UARRET'f,ItORI3IG - -ry13 CRO5911110ER6 UkWTON TX 7bROJaOtl~.:9.89 y{ LAWSON,DDR41A'!NE 40029305 ER MD OARRETT,ROBBIE 913 CROBST1MOURS DENTONNot wpiItot~OfVID1hPr~)UN5 month 10.10 / LE5'rrR,SUSIE 40021891 ER MC LEBTER,SUSIE DENTDN NURSING CENTER DENTONNot written f~6t ache d~ eE Mon 21 00 I a ae J I 0660=1 IP IiP LON0,NARK AT 2 lO 01LOW00b 89TA LEW16VILLE LONC~,?1ARf( dd6e pp 0 3 I.EC 40 o Xr7s g~OteC~iwe ~uStodY~g6.00 J LUCAD,KENNY 69577 ER CC IUCAU,HENRY LEE DENTUN CO JAIL DENTDN TX ~62 t 1 ` I MAbLBCK, HOLA 0000755 !P EP ItA01.OCK, NULA 603 JACKSON DFNTON Gell'fio~bCalJlbfll/89/63 -D63.60 II tJ I HtCS1N, fDtll bENIUE 16046529 JP'tlt MCCAIN, TDrll' tlENifir 1918 DUNNJNO-TNES DENTDN ...111<1r96ttt6~3t Ob7FR/H`3 »d2: 97 » NO-RUAIJ, OORDDN A 00043b11 IP SP MOAPAN, GORDON AT I BOX 379 13ANGERBalance ditTeJrc MOW %14109111 *VIN ion Hf11 Burton Crlterfa , W k f 4. ti 16:05136 01 N0V 1983 CHARITY REPIIR't PACE 3 ~ l it PATIGNT...... PAT, ID.... P'I' rC COARANIOn NAME........... ADDRESS.. CITY 8T YIP. blfl DiC:`AMOUNT:: ~ r- _ _ ,..TI B r. ^b6 MOROAN,MISTY 10039734 IP SP MDROANi GORDON AT 1 BOX 379 BAtJtlEq + Hi 09/"8/8-111, $80. 76 I / ~pp ppp Criteria MORGAN,MIS[v 10097073 11% 12C MURLAN,OaRDON RT I BOX 379 SANGER ~rton -300.00 ~ Hill 7l Burton Criteria MOhOAN,6Hrme, 10627106 IP SP MORFAN,GORDAN HT 1 BX 379' - 8ANOER rrX 76266.05/94/53223, 300. 62--"-"'- LO Hill Burton Criteria NEACE,ORAN 0 00049D58 ER OP NEACF,(IRAN. 1317 DOLIVAR DENTDN IR 76Rb1 Il/27192 3,374.39 ' _ HI t Burton Criteria Lo. RALSTON,MARY (0015193 IP SP RALSION,11ARY 14209 HERTIAOE CA 02- DALLAS TX 70o34 03/21/g3 -307,80. J Ordar of Protective Custody RAMSttY, KRVe'ML 11 00035409 'IP MIS hAMSrY, TERRY 04 WHtPPOORWILL-HILL' L8W18V11.1-A7- -'YX 75067- t '/`9702`"" Balance aftererficald RENCH,JCFF 8 10043992 IP CU NFNCH,JFFF 9 90 MANHATTAN OR DENTDN TX 76801 OS 09/83 -59.93 Balance after Mental Health Mental A tardation- A R1CH,FTHEL 5002:1370 IP MC AICH,1!THEL =29 CARROLL BLVD DENTDN TX 76PO1 08/17/83 -43.90 J Balance after %dtcaid RINEY, HAZEL '4606293N'ER MC IIINEY,,4AZEL 723 N WOOD bENYON'--'- TTX'76DbI OB/1878g3 -14 V 9b - aalance after Medicaid ; ROS9,VENNIE JEANETTE 10040913 IP MD ROSS,VERNIE JEANETTE P.O. BOX 623 RT 7 MAY DENTON TX 76201 07/23/03 -25,00 Balance after Medicaid V1 RUNION9,ELOIF HUHSHEL 10038610 IP MO RUNION5,EL0IE HURSHEL 629 N RUDDELL D£NTON TX 76201 07/19/53 -34.00 Balance after Medicaid J OA1N,~JEBSICA R 000991140 IP MD , SfN, INMY OP4 OXON OAIKtrAV%LR----7YX_76940"09/f07g2 - 118'S0'- 1r Balance after Medicaid SALAS,PRANCES PAULINE 10039394 IP MO SAL„d,FRANCES PAULINE 649 FERGUSON LEWISVILLE TX 70067 07/19/83 -$92,30 Balance after'Medicald SNIDER,KENNETNI P 1004336P 1P N: ONIDBR,KCHNETH P 200 N,RUDOELL DENTDN 7620$ 0!3/16/83 -'02.50 7 Balance after Medicaid 9Pl AK ,`IRVIN D, 40u59631 99 SP CPEAKE,`tIIW3N 8: PD BOX 60 SOUTH MA7NY'AUDREY rg 76"~HT 04706'/53""~13b:`Bb"" 1. 9111 Burton Criteria STANFOnO,INF M 10057206 IP flP STANFORD,JAMES all DOLPHIN LAKE DALLAS NI 70065 10/08/03 -416,0$ NflY Burton' Criteria' 4_ . STANPORD, JAMES 066922 ER SP 8TANFORD,JAME8 H JR. all DOLPHIN LAKE DALLAS Hill 7$060 0y/87/03 -02.75 , HI11 Burton Crltoria - _'91ANPORD, PiSY9Y H. , JH•- !b'OB6`/B4° IP. '1P ST-iNFOND;'JAMEB 14, 31 I DOLPHIN LAK9 DALL LAKE'6ALCAr.--'-T1c 7806d""[ODDS/S3 =p', 405. 99 _ ! tr 9111 Burton Crfteria 3 !I 8TANr0RD,PATSY LYNN! 40060425 ER SP JAMES STANFORD 311 LOLI•IN LAKE DALLAS TX 7$06$ 09/09/93 -161.70 / _ __._.-11111,BurtoACriteria f 13TRINOFIELD,RhOERT HA 10038S02 IP MU 81nlN0rIt:LD,1<IL1-IAII L. 109 MA089Y 034 DENTDN YX 76201 01/14/03 234, 04 ~j.,.._ Balance inter Crippled Children I TN{1NAS, NOdS9Y' M YNBMAiI, ROt19tIT : 1 00392/19 i P "Sp ri 3017`C 11000711 _OL+NYON__..__-.._ It-Y6a01 -00m~4763 =B, 4711` Sfi I teri THbNOPHAIJIT VANiSONE 10037938 IP MD THONOPHAfg1,P1IONE 30PO FiNCHER RD FTWO HiT B611 C 7/10a J ' RTH _ T% 76117 07/``0/S3 47.00 rylI~ THAV19,f1AVib 40066466 ER CC 'hI11VI8,DAV[0 0EN7ON COUNfY JAIL D£NTUN Benton to, T% 7620) 0~/9q/S3 96.78 J "YUN1}}D;. WILLIAM A ft5bl'966'q`1P"EP` 1UR_NSA2,WILLIAM A P.0. flax 4*12 S TX 7K&O 0479093'=9,334:90 t+,r', Indigent Care VAVOHN, MARY JAI IC 10039220 IP MD VAU0HN, MARY JANE 1230 7111N LAKES MHP DENTDN ;X 76201 0/9/0 -01-00 Oa anta_0a1ar MadiOa1d WHITTED,NELLIE M ICD31060 lr CO 4jlgTrED,J11 AT 4 BOX 173 ROANOKEBdlante after 6Mental 969 Health Mental «BatareNOn 41tLKtIJSDN,ZfENNI9 H" 10021691 IP iP 6111.KINS'ONi6tNN19'M 2169 N Wl Dewro `---Tr7be0r'66/90/9r•:l0,7J11 19 4 HI11 Durton Criteria :J _ r . ...r,.ar.~kW. xbIJM4,a Gt 9:4T.?ryN YJ S 1 J6:05.16 Ol NUV 1993 CWARITY RH111114'F PAOE 4 V ~ PA11 F1T , . PAT 10 Pl pc. OUAiiAN1'OR ?DAME . , ADDRE139.. C i7Y _ . -S't"32p', ` Did pTGfAMOUNT, T r V! IJ WILCIihJWAId,T(=Rf:9A Ii-- 00070104 0 MD WILLIHOHAJ-J,T-f A _ D1J2 AVEC THE C6LtlN 4 - TX 75056 I1%20/92 541,:82"'"` f~ f Balance after Medicaid J WJDWELL RO%ANNA R 00078796, IF ADD WISWELL,ROXANNA LITTLE ELM CLINIC LITTLE ELM TX 75065 Died Left n011/26/98 3 149,29 WITHROW,DANIRL HURL 40059498 ER SR WITHROW, DANIEL HURL 2250 DROADWAY HOUSTON TX 77001 09/05/83 -56,00 J Denton county jail GOLfF,OCOPT BRIAN 10020200 10 Sp WOLV~P,Schff iiRIAN -42S FERN ST IJE9'f-FlAR~'f`tiFl•0- CT"U167 0024W03 ~ 513 0'6" " t WOODS. fIUhIONA, 80006967 Elt- MD WODDII, fiUMONA Order of Protective Custody 312 RUDDRLL 0107 DENTON TX 76201 02/86/d3 -28,40 --Balance"5fter Medicaid LD BOX 032 RT 1, KRUM,TX DENTON TX 76201 00/02103 -5.00 J Balance after Medicaid W01614, JOVUA W 4000,6964 en 11f1 ANNOMARIE R01210NT 2411' W HICKORY 030 OENtON Tk 'IM2ibf 641hb%SO-_--- 43. bi5 s L , Balance after Medicaid W1210NT,.IOSHUA W.,„-,_ 40093552 ER MD Wn1mir ANN, MARIE - 2211 W. HICKORY 030 DENTON_ TX 76201 00[19/83 _19.5O YANCE,CHARLES E 40067944 ER CC DENTON COUNTY JAIL E. MCKINNEY DT DENTON TX 76201 10/04/83 -141.50 J Denton Co. Jail l 1r • 293, 9413,_23 { J t r; J J i „ 1s k J i ...1 01 OCT 198:1 WA I TE-0Fr REP0itT PAOF 5 PATIENT NA11E ~ PAT 1p p1SCH0 DEO-DAL MEW°CHO Nl?W-PAY W-0 DAL FC TYPE CYCLE LBT,PMT AGE FO TYPE ii ;i I. COL0ELL,ELILA0EIH ANN 1001096 04/P2/03 1,386,49 339 79 1, - 104, 1'6 613:04 ADD 1p '"NR'-09710/83 23"`_1-_ Ml xr OVARANtOR tNFURMATJUN rr MICHAEL 1). COLWELL DID N DIXON GAINeSVILLE, f% 76240 Moved loft no address FAIN; DOLDREB'M 40042974 07/14/53--- _100, 50 -326.900:00 - 427 40 8P ER _-3 rx GUARANTOR INFORMATION xx KJNNETH FAIN by 1 1123 JOHNSON bENTON T%i 76205 No response f rtl11TFR, EUGENE ODEL 10n,'130¢ 06/17/00 246:75 '201.00 0, 00 447: 75 ADD '_SP `NB' - `qq -•_S_ r' rr AUARANTON INFORMATION wx EUGENR ODEL FOSTER 1610 STATE HWY 121 LEWISVILLE. T% 76067 • Unable to locate -rRANKlKENDRIC DARNELL -""100029,AI 02/07/83'5i135. J0`---- 11.00._. 0100"'l, *o GUARANTOR INFORMATION xx CORLIS FRANK 109 8, 8T JOSEPH BT EUNICE, LA 70939 232 r 1`~ V No response ` "Ott:DEi01NOER'M ~ ._....004255 47 11/10/132 .......-372:.17.....,....0.00 _ 0:00 _ 372; 17 RP IP rr OUARANTOR INFORMATION rx HOWARD 4IBSE GENERAL DELIVERY OAL00,18, NE 68966 No response r/ HALL, NICKL:_. ..-..__..__._._-00424988 01 /08/0,1 1,9H1:10-._.,_....'0:00 ^L 263, 64 • rr GUARANTOR INVORMATIO14 rx NICKI HALL 317;46` 8P IF' 2 "0271 /33' - w~2b 1 4149 DRUID 03 DALLAS, TX 75209 No re5Wnso 14A41MON8,RU80SLL 10006199 0,7/16/83 '122. 10 -10 75 - 0.00 340.89 BP ''Tp' 'g-_..~_.._ it wM GUARANTOR INFORMATION rx VInOIN1A KISER 700 N WAOOUNER ELECTRA,TX, TX 76360 No response II 4 HARVILL ,DANK M Y 1 OUARtNTY, G .40004970 02/19/H3 671: 00-.'-_'-' 4" 00 67 EP -'£R- 3 3~..Yl x' INFORMATION xx DANNY HARVILL, 0 BOX 399 LAKE DALLAS LAKE DALLAB#:TX 70060 No 2 ' R'+( response ^-'21 1 11i ''Il/ , ......w. .',:y s i.. i~iL ,'-j S~k':H" ~'i i V !'}ly aYU?f~'~': 1~tl9c11„ b; h,^ ha IP- v aw OWARANTON INFORMATION rx J.P. HAOKIN3 309 KtRKLAND SANGEN, TX 76266 Arrangements not kept 1! KELLY, Jpf*J'"ANDAEFf"- t'4041id1S 47Y29/B3 - 979;'74-'7"i 947:39- ` 0 00 2T92Si 09'-`Sp"--lp -S `1. xM GUARANTOR INFORMATION xx JOHN R, KELLY THIN LAKES MHP 099 DENTON) TX 76201 33 ` 'loa ; ;Unable to locate ~ ~ e xx GUARANTOR INFORMATION xx LUANNE MONTI 1901 EDWARDS 02 DENTON, T% 76201 No response REDIKtIR,BQRTEN__._ 00055970 41%16753 Ifib97 69 ""168 40 -___0 00 11T866 O9'"BP IP' 3" I J \N~ µ rr,GUARANTOR INFORMATION xx DERrGN 4EDIKER RFD 9 TWIN LAKES MHO 094 DENTON, T% 74261 No response f)) I7 ROORI4U627RACHEC °____-___.._"O005B683 7R/43/82 D90:64 ---0.,00 __-_.-40'00" 793.60. HP ` xx GUARANTOR INFORMATION xx DOMINGO RODRIGUEZ llIIq JOHNSON ORNTON, TX 76201 Unable to locate f """BANDERBi RGNEE"" t0015.~7q 03/31713 -Cr`668:'60 'Y It136 7D------ 40.00 _ 2i 964, 80 ' SP IF "'-1 "-'"09/03/83 x/r GUARANTOR INFORMATION xx KENNETH SANDERS RY 1 BOX 902 AUBREYo TX 76277 No response ♦ r BIMMONBtCR-JANLTTE-"" 10019396`04/16/03" 948;30-1-;019. 44 0.'DO-"2, NTDR INFORMATION xx DONALD SHAW 2302 MCCORMI 01674 BP " 1P'y--'3..09/07/80- 74 -"--.1""---°--".--I + ~ CK DENTON, TX 76201 Arrangements not kept QG - • rtx~ A OUARBCOTT`T _.._.00069263 0C/46/83 `0; 40_- _._0; 00 °.-762. 00 -SP xx GUARANTOR INFORMATION xx JAMES SIMMONS RT 5 BOX 210 DEOATURi TX, 76934DP f _ No response{{ • 2/WELL 247.'20 p0 E8TB8 0,00 247.20 ADD'" - ER " 'II"` Bb --1---.-_ I+ ' ` Y"BOWRLUARANTtlRU INFORMATION rx40040013 MICHELE 07/02/03 ;49 - ~ 349,49 BP 3 01X1'/83" 441 0119 PKY tB TX T 74201 3 SPARKS, UQVCE L 00069426 07/17/82 345 _ IP. 1 ~~I. 0x GUARANTOR INFORMATION xx JOYCE BPARKB 5404 HOUBTtlN PLACE DEN70N Noaresponseocete , • •---...W.~._.._._...... .art 'i::~..._,,,.i~y i • i yy T ~I71 l IIr,'Sn , tt" 'k"411 1 t 13 itti k 'a r DI OCT t9U0 ~ r WR I TE -tIFF R E P Q R T PAOE2 PATIENT NAME PAT Itl pI8C110 DEO-DAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST.PMT AOE Fo TYPE $PRINO; 8HANNA K _-40022725 04/30/$3 96:00 `1;352:80 0, 00 G 608, 80 ADD- - ER "WB ww OUARANTOR INVORMATIO14 ww VONNIE 8PRINO 115 AVE 0 0117 DENTON, TX 76201 Unable to locate y -BTAEV6G;DANITA __._-_I00.7060$ 04/827dJ 1 Ob91 "f0'- 0: 00 6. 06- l Ob9. 70' AVD ---Ip' GUARANTOR INFORMATION +w DANITA BTREVEL 8179 MEADOW RD 0247 DALLAS; TX 75231 159 I I,t17L f Unable to locate J!!, y 7EUYO MAD rOR S.' INFORMATION ww1009aA0 S. 30412 OT/10/03 1'J 943. OS 121. 76' d. DO 2,664, 80 SP . JP- "_3 5427 PRINCE OR, LAKE DALLA9r TX 75065 73--l' Unable to locate ~t -THdMP$pN UUtlY V oOO69401 -12/21 /02" 437."40 - 0:'00 -15;-00 402.40 8p___IP_. _3_--0571b783 ' -"-13$-'1- r GUARANTOR INFORMATION ww JUDY V 7HDMP84, 604 CARDINAL OF 7 DENTON, TX 76201 No response ly TRA11MCL1:';DEMP$IE L 00070177 06/2910• 440:43 "0.00_ 35.'00 406.-43 . BP ER-_--$-".067991$3 9q f - ww GUARANTOR INFORMATION aw DEMPSIE TRAMMELL P 0 BOX 948 PILOT PU[WT; TX 76258 No 7esponse yl' WALK, DEBBIE 00071g26'09/10/$;t__t'i 123: I0'_-0.-00'`G723~-i0- $p ""1P `-2-0971"1782--'"~386____t_.r, -___,I ~flL OUARANTOR INFORMATION wr RANDY 8 WALKS P 0 BOX 679 PILOT POINT, TX 76250 No response WALLACE;DAVID 100450011 08712/83 ' 1. 454:00-' 69.'00- O. 00 1x 523. 00 WC"-- IP ""--4 36 ww OUARANtdR INFORMATION to DAVID WALLACE 1510 ORE00 BUNTON: U 76201 Unable to locate WALCACE,'$HECTA"M` ' 00072207`12/23/82 ---1, 466,-65 -`"37 75-- 0:.00"'1, 604 40' $P _Ip r rw GUARANTOR INFORMATION +w TROY WALLACE 1906 MOZIN00 DENTDNr. TX 76201 res 3 No ponse WAT8O1-J; FAANCE$ _ y "_00072890'06/20/$2 300,00 0.'00 _'0; 00 330:004P Tp 3" -07/14/$4'--...-468_'-"'1'6'_ ww OIAARAtNTOR INFORMATION rw EDDIE WATSON 624 SMITH orNroN, TX 76201 No response `-WATTS; PAMP'EA-R _ 00072900 Ig/t4/8>? 1;443:'b0_._-00:00_-- --0:"00 1473.60' $P IP y 2_12/t4/02 oUARANTOR INFORMATION PAMELA WATTS _ ---4-71 PUtr 602 KRUMr TX 76249 No response ti `w , " 4Q 1JH170UARANRTORHINFORMATION +w RICHARD OLEN / W ITFIELD 00 ' " 1305 7 LOOP 280 N-0 BENTON6 TX C 76201 -unable to locate " + - ~J • w+ y 14HITF]'ELDrA1CHARD`OCENN_. .40089709 09J06Y83 216,79 -'~(J,'700 00 240..4'J eP ER __.21 ---I - WiLCOXApAN00~DINFORMATION ++0d074302RICHARD 12/t7/82FI1T~'6yA~tl0 103000NARLEO$T00o` tiH$94AS0 TX 75090 Unable to locate I Ir ~ RAYMOND 74309 12/ t7/82 Its 208-~--•-1_ lL GUARANTOR INFORMATION ww 0 RT 1 BOX 006-99 AVBRKY, TX 76227 No response WfLKBR$CN;KATHY-p' 00074401 03/11/02 479.38-_ 39.00 -118.38 400:00' 8P_ OP_ _3---0$/22/f13'___.~'40"`I__ OVARANTOR INFORMATION r« RODNEY WTLKEROON ' ~ PO BOX 1735 MT PLEA$ANTr TX 7114913 No response y ` WILL 1AMM-CLORIA J 600"/471610/24/09 "-40; 75 -27075 0 00'- 311.'$0 $P"-'ER ! OUARANTDR INFORMATION +w VBNtTA WILLIAMS 620 WITH DENTON, TX 76203 WILLIAM$,HEATHER - =1;75$;28 -393:33_.SO-'..IP.---_3__..04/10panse i 00074740-11/10/02-' 2, 177,!$9 No resi83 OLARANTON INFORMATION +w RICHARD NILLAIM$ 348 PARKWOOD LCWIUVILL&, TX 79067 I ' posse I ~ WILL LL GUARANTOR NN If>'FR NNFORMATION -00074781 DAVID 1WILLI2/24/AM2 863, OP--- O. OD -63. 02 500, O0' SP _ IP-"-'4"" 02/x3/83" --'2ClO `-I----- - i B 1906 JACOUELINE DENTON, TX 76201 No resPoriso y WP WHO TOTALS weww 34x075.00 -4,497 48 W , 1~. 7s218.09 41,790 .61 i. l `.~'Y F~ /'.\T{ y M Yx{ K ~K W,I W N M M'Wl M YA .v „N rY r x~x ~ M YR W b YII M x~. M ptl N IW Y,i r r ~ 1 r i k. r j WR I TE -UPF AEP OR 7 PAGE3 , 01 OCT 1909 i J PATIENT NAVE PAT 1D 018CH4 000-UAL IJEW-CHO NEW-PAY W-O DAL PC TYPE CYCLE LST PMT _ AAOE PO TYPE - • iVICKI D.' 40092909 OS/14/03 120.139 0.00 0.00 120.05 SP ER 4 AJAX .I w+ ,VICKI TON INFORMATION +w VICKI O. AJAX 2204 9 RUDDELL APOD DENTON, T% 76401 unable to locate f~ - -4.4 2 GUARAN 400D3ab6 OB/fb'/83._....., - 36'. 00-,.._._.. 6: 00 _ -0:00_ 5b: 00 _ADD ._6R._._. Nf3----_~-._._ ASLRTT JUtlY K - + ! ww OUARANTOR INFORMATION ww JUDY K ASLETT 316 FRY APT 0206 DENTDN, TN 76201 Unable t0 locate ~J DALN9, LEONARD U 40009:103 04/ 13/03 133. 75 0.00 o.00 133. 78 ADO ER -N9 ' Roved left no address o8 - 2 ` x+ GUARANTOR INFORMATION 4* LE014ARD U DALES 1424 LATTIMORE DENTON, TX 76201 I~ DARDFN MiHDA J 4003400 06/12/83 140.40 . "..0.00 0;00 -140.40 ADD P ww GUARANTOR INFORMATION rw JIM DAR DEN lib 9TEWAAT FiORtA, It. 61661 Unable to locate y n _ 40031066 06/04/83 60. 25' 0. 00 0; OD ' . 69, 29' '9P ER 2 1 Is i. R, not kept L DEWA01', KAY Arra G +w GUARANTOR INFORMATION rw CHR19 DEWAO[ -_.n ___..67._ ._4 y' '40046377'07/42/83 109:25 "'pO:ObpOX 390 DOYHIi10'n`d IJADD YCA 762Ng Unable t0 locate UUC CAAR,KATWI y ww GUARANTOR tNtgAMATION ww KATHI CARA 2311 9TELLA k139 DENTON TX 76201 y iA AbDQ4947-02/Y9J83.__....b6:00._ 0.00 0,00 66. 00 8P ER 3 '221.`... 4 FEADINSMACK,JA 2800 FT WOR111 DR k97 DENrON, TX 76201 No response' V ww OUARANTOR INFORMATION rw MACK PEAOINB, JA ----1FIELD9 LA9146NDAAG 00022004 12/29/62 40.76- 0.00 0.00 40:75 13P ER- -.4 TOR INFORMATION rw ALICE FIELDS 804 9 RUDDELL k41 DENTON, TX 16201 Arrangements not kept c . ` ww GUARANTOR ~ OARC IAA YGl ANDA V 40000044 0113]/S3 39-00 _ 0.-00 0. 00 __31. 00. 9P PO'9O% 144 ORCHARD, TX 77 ww GUARANTOR INFORMATION ww DUS QARCtA A64 No response. r, ! 474 2 (71 ww INFORMATION Mw00W1GLIE OARRET0T3_......._38:00 96608COYT DSN~ON, TX9 7bR08SP ER I + No rep once OROVARANTORH E -40034902'06/14/83-' 88,'70" At$D 109 OAR2A~NGTL - S 126 JOHNSON DI:N'~1Ni T% 70201 Unable t4 locate J j NEIL GARYA L~ wr OUAAANTgA INFORMATION ww 0: 00-- 70.'00 _99 30'_ SP ER 4 4411 R i_-. 99.-30-, Ott .-'GRAHAM, S 00OR6310 0f>2G/83 ww GUARANTOR INFORMATION *w G ORAHAM 625 FT WORTH DR MRb DENTON, YX 76201 No response w - J'i all ( f -OR IFFIN, PHILLIP-L 00027276 10/24/84 0- 00 ".118, 25 ' 8P ER'. - 4 , rr GUARANTOR INFORMATION ww pHtG41P GRIFFIN 12611 SINOINO ARROW' AL9000EROUtII NM 87123 No resPonse ti. OUARSNOi 86V6RGY A ----00027699 01/212/83'" ER 141 GUARANTOR INFORMATION ww DAVID GUARINO AT 7 BOX 59 W DENTON, TX 76201 Arrangements. not kept - HACKEM 9HANNONi K 40001059 02/00/83 39: 00" ° 70: 75" `0. 00 105 76 ' eP ER 3 _ Al ` r rr GUARANTOR INFORMATION wr ROREAT HACK9TT, L 1106 PEAVY AD DALLAS, TX 79219 No rQapona@.. .._HARREN;GRRGCAY`PHILLIPS---'400'Jb30C05/87/03_.__-.96:35"D,`00'-- 0 Oq" 96,35...DP.'_ ER•_._-R...-`_. --33- it- - •w GUARANTOR INFORMATION x* GREGORY PHILLIPS HAHREN lbs N OLD ORCHARD LkWtBVILLtt, YX 711067 Unable to locate ' 4n, HARR16+'J1timttii'J _..._4DOOSfi14 OR/20/83` - 14:'911"" 128:40 0;00 143 65 9P ER' 3 b2/21'l83" 55 ~1 j 607 RUTH DgNTDN, TX 76401 No, response. 19 OUARANTOR INFORMATION ww', JIMMIE HARRIS, 0 ww - I~ HARR18 MAUAICES 40061393 08/10/83 77 0 00____..77.95 Unable to locate u ~t ww GUARANTOR INFORMATION 4w MAUR1Qt3 S. HARRIS 21101 W OAK 046 DtINYdM, YX 70801 ~r~i 1 S I);i4.W'V h 01 T 19IIU IJ R I. T C- 0 1- F R E P 0 R T PAGE 4, PATI 4T NAME PAT 10 DICCIIO DEG'-DAL NL•,i-C140 IJEW-pAY W-0 DAL FC TYPE CYCLS LBT.PMT AOE FO TS PE HAAAISON 11UWARD M 00030130 01/29/83 38:00 a, as 0.00 44.'29 ADD ER NS_. 233 Z_._ INF GUARANTOR INFORMATION FN HOWARD HARRI130M lilt W UNIVERSITY 03113 DENTON, TX 76201 No raspDnsD HAWKING, TAMMY--" - 00030635 01%27183 39: 73 0:00-- - 0. 00 39.75 SP ER 4..___ 247-__._2____. NN GUARANTOR INFORMATION FF PAULA HAWK1ND BOX 624 LAKE DALLAS, TX 75065 No response KENNEDY;"ELAINE 70000600 02/07/03 74, 75 14 00 0.00 09.28 6P' UP' _4....... ___._.26_..__2._..._ NF GUARANTOR INFORMATION FF ELAINE KENNEDY 211 SHERMAN DENTON, TX 76201 Refused to pay yi KRAMER, DRODIE -L _4003GA99 ,06/90/93 49.00 0. 00 0. 00 -48.00 ' ADD ' ER NS_,__._ ---1027--2'- Of OUARANTDA INFORMATION ++t DEDAIE L KRAMEA 1207 SAM N0U$1UN VICTORIA', TR 76977 Itt„'~ 5 DENT 24. TX 76201 Unable locate • 104 SP.. -IP.-.`301708/9 3- 3-t'yY---2-~------~~, BOX s ~ r LIL{_IE,LYDIA D 0004 106 11/20/82 124 04- - _Q OU- 0 0. tl0 1 l GUARANTOR INFORMATION WADE LTLLIE AT 2 656A00' No response NNFF W-O TOTALS NFFF t,790,79 0100 222.20 1,972 99 1 s pp . _ _ _.._,.__....._....._o-.. .r__._..- Ir ~ fw 1r I r . . . W f w y _ ~e-r br f7'-"eras .a ,tpf ..,pt~y.q r...e.n..l..1'.r ~~~p}yrIf Ol OCT 1900 W R I T E- 0 F F R E P O R T PACE'S rr PATIENT NAME PAT ID OIOCHO DEO-RAL NEW-CHO NEW-PAY N-0 BAL PC TYPE CYCLE LOT PMT AGE FO TYPE J~ _ _..JONEA{ TAIBEY" b0037218 01/147133 103, 00 0 00 __Z,40-__ 100- 60 6P` M QUARANTOR INFORMATION rw SAM JONES 810 RAILROAD GANGER 'TK 76266 Missing Packet t ~ - - 6cNSpaNG,JEppREV`p_____._.__..._00030976'05724762_ .00__._8l'0;-l IP 40 1111 GUARANTOR INFORMATION 11rF DAVID KNIFONO p,0, BOX 465 LITTLE HLMr TX 75060, I r Packet 9 _4 MCHANAN JEFF_.0 40005006 62/21/(33 - GIRO 0,00 '.._._-0, 00 01 00-'- 0P - "ER - • .3 Missing r-~ wr OVARANTOA INFORMATION *4 OEDDNAH MCMAHAN' 252 CAYUGA TRAIL NORTH LAkB 1t10WAr TX 76240 Missing Packet RODERTOi'JDE"00D - -000374330 l716703_ _ 335: 99 0: 00__ . ~ "-0.00 358. 59 ep _-IP__..._3 258•..•.-'.4 ~ , «M GUARANTOR INFORMATION ~k JIM DOD ROBERTS RT I BOX 651C 8AN0ER{ T% dEr Missing Packet W-0 TOTALS war 750 20 -2,40 0.00 747. 80 « Y. tip ! 1 • , 1. U r C lgfl 4~cciT q.,lr..;.._ r _,Ltj:1'h•I{ •.<{yr1{h{ C,'c5' f { ~"1{ ~r, r /SV9A?N PAGE 6 W R I T E O F F R E P d R T 01 OCr 1993 W f~~ PATIENT NAME PAT ID 018CH0 0EC-0AL NEW-0140 NEW-PAY W-O DAL FC TYPE CYCLE L9T PMT AGE FO Y E + " i y 403060LENVIOW 00 CT P7aWOR0T16 8 T% 76110 I 4ankr 0uptcy l40 6 BALt,AB. LAOVNWA JEAN 10017796 -1, 165' 36 4013.65 l y i rrt GUARANTOR INFORMATION BYRON J0 II 10/14/02 204:70_.__..0:00... _ 0.00 ...804:70. 0p ER' 2 i No ORIPG A K' 60-0 WESTWOOD OUNB JACKSON, 7N 00301 Bankruptcy j -rr GUARANTOR 1dR 1NFORMAYltlN rr BRYAN GRIFFIN 40007617 02/20/03 67. 50 47.70 0, 00 117. 20`' OP ER" " 3... . ltEOTERiOUARAI4TdR INFORMATION E02ABE 015 9 EOWARD4IVILLE STAUNTON IL 62095 Bankruptcy rr rr TN KK5TER I I W 0 O0 I rrrr W-0 TOTALS kr%M 5.459.66 11916.90 ` 456. 35 - . , 1 i W 40 I i ;w 1 t J oc OCT 1983 WR 17E-OFF RF.PnRT PAQE 7 J PATIENT NAME PAT 1D D18CH0 BEO-SAL NEW-C1S0 NEIJ-PAY W-n UAL PC TYPE CYCLE LBT.PMT AGE FO TYPE - MCOUt t IL I I BA M 40078458 09/22/93 68. 95 4890 0. 00 109. 85 SP ER -4 - - 51 6 ' ear GUARANTOR INFORMATION Mar JAMES WW. MCOUECN AT, 2 BOX 144E AROYLE, TX 76226 Moved left no address J, " MOOREi GARY A _ ___---_------.__"40036992 06/19/83' ------56 °00 0. CO -0: 00 -56'. 00 SP__ ER----_.4_ r MR GUARANTOR INFORMATION rr GARY A MOORE P:6 BOX 272 TIO0A, TX 76271 Refused to pay III , PARKER. GARY L, 40059099 09/04/83 66.55 O60 0 00 66.59 6P ER- 3 GUARANTOR INFORMATION rrr GARY L, PARKER 2830 N LOCUST DENTON, YX 76201 No response "BALAZAR,.APRIL-NICOLE 40053761 09118/83 94 29__..___0.00 0.04 9q: 29_ ADD} _..ER_--.. NO J ► 0* GUARANTOR INFORMATION wr JUAN FRANCISCO SALAZAR AT 4 EXECUTIVE NHP DENTON, TX 76201 Unable to locate 46 - 98--6 r'I g*0 GUARANTOR INFORMATION *4 CALVIN W. SSEAALE 64.60 626 EAST 2ND NORTH AVE 2TEXASDCITYR, TX~`77590 Unable to locate p ~.__-..BELLARBi-JAMGH. E ----00061079_.11/26/81__...._..96: 28 -._._.0. 00 ;,60;~00.,.__._ REL 22-'9P"--- -""24`-'-6`_e_ i ~ 44 GUARANTOR INFORMATION rr* MARY A 9tsLLARB Pd Btl% 3q5 PILOT POINT, TX 76298 Arrangements not kept 40, 81ENKOW99Al DOROTA 70008933 05/14/83_ --6t. 50 ' 0. 06 0. 00 61. 50 tip OP _ 3..:. -........._139 rM GUARANTOR INFORMATION 4N MARION ZIOLKOWSKI 5505 ALPHA RD 01005 DALLAS, TX 75240 No response ~Cl --6IMI6Nil1NOBTTE_4 40091799 00/11/83"-- - 101s. 19 0:00 000 106. 15 OP ER-4-.. LA rrr GUARANTOR INFORMATION rar HUGH SWEN 6$7 JUPITER DENTON, TX 76201 Unable to locate ki S1NGL. ON, DOYLE R 40010016 03/09/03 51.60 40. 50 0. 00 92. 10 9P ER 3 " 170 6 00 TINA SINGLETON 017 ROSE I%NTON, TX 76201 Unable to locate M SMITN;GEtlRBERWINFORMAT1OfJ..,_0006117401/08/83__ ._.38;00 0.00 G. 00- " 38,00 9P ER' 11" 2._ .-._266'--6 goo wr J GUARANTOR INFORMATION QEORGti SMITH $34 SOUTH DELL AVE DENTON, T% 76901 No response f 6/09/aa3.__.~"-99:'10 ----`0:00_...._...,.0, 00_.-.._. p9:Y0..SP.__..ER...._..3--------__.~_.....,113~_6.___..- ~ 8TANLVY,B11:LY-'R _...:~_...___.__..-40033409 0 No res onse ear GUARANTOR INFORMATION sr BILLY R. STANLrY 504 9 RUDDELL#154 DE14TONo TX 76201 response i 9TULTZ',DEBORAII'A,.... - q ~ 0024143 09/05/03_ 83:00_-__...D.00"'-"'0'.00 63.00' 6P°""ER"'-"'g ---_-_-I44_---6---- , , . rw GUARANTOR INFORMATION Or OEDORAH A. 9TVLTZ 5$09 RAMSEY AD BOX 89904 THE COLONY, TX 79056 Unable to locate '-9USTAITA',JOANNE 0006912201/13/83-------97:05 0:OtI"_.__.-0.1001_:L97.05_.9P_.._EFl.:._...2.____.- _--••26l"°5" M0 GUARANTOR INFORMATION Vr JOANNE 9U9TAITA 365 CROCKfTT 14EWI6VILLEa'T% 78467 Unable to locate „i if f 6WIFT,JON M 40016941-04/08/83---72.-00 50 10..__.._..,0:00'"__129.10 9P ER --2'_.•04/11793--•-_•1 DD' Ut rr GUARANTOR INFORMATION rM JON M SWIFT, SR P•0. BOX 199 ARQYLS, TX 76226 No response ! YANK6tlLY, LARRY 40013872 03/21 /d3' 54,00 -'--7:00 61: 50° WC' ' ER 4-"-"--' - __._a Y ++a GUARANTOR INFORMATION #0 LARRY TANKSOLY 614 YALE LEWISVILLE, TX 79067 No response G '+;_.....THOMPSON,GQOACK M._._. _ 00069344 01/2U/03 32,'00 - ..0 .00 ...0:00 3L• 00 -SP -pp- 3 rr OVARAATOA INFORMATION WO R09 THOMPSON BOX 410 KRUM, TX 76249 No response - - T~SOMOUARANTOR61NpORMATION 40045951'07/21/03"` "59.'45 0 00 '0'00 ""`'bq 49" " ADD ER' S 71""`6"»---'•_.__ rrr JAMBS L 7HtlMPBtlN p O 80% 97 COUNCIL HILL, OK 74426 "Unable to locate TIMMDN9,JOYCE L 40003139 02/I2/d3----40.'75 0"~00 0 00 4 40 75 e* 9P 4R4 3 .7R7» 6---- .Ld i GVARANTOR.INFORMATION rr JOYCE L TIMMON9 130 BUX 2896 DENTON, TX 76201 No response ,.M,.i(r 1G4, 1 1 rA/ 01 [ICT 1783 { WA I TE -OFF A EPaA T PA068 PAT(ENT NAME PAT ID UIOCIIO BEO-DAL NEW-CHO NEW-PAY 14-0 DAL FC TYPE CYCLE LAT,PMT AOE FO TYPE ITQ0P8 HARCY R. 40017504 0,1/10/03 3Br 00 0.00 0.00 38.00 4P ER 2' 0 I rJ 44 OUARANTOR INFORMATION k* DAI14Y 41UROEON Bankruptcy 3 _:.._.-.170' -6_ - "I GENERAL bELtVEAV LEW1fiVILLE, TX 75067 Bankruptoy I TQWNLEY, ALaERT J '40004277 08/16/:'3 46,00 0. 00 _ 0: 00 46.00 ER_ ._.3..s-po _ 226._..6. ~ tlUARANTtlR INFORMATION 4k ALDERT 70WNLEY, J 2103 t/>? N ELM BT CEN70N, TX TX76201 ~ No response No response TR I11M, LAURA 10001074 42/13/03 70: 78 0:00 0.00 70,75 AP op -a- _ 275 6 *4 GUARANTOR INFbgMA7101J 4k C/O R E WIL9Eg80N 347 IJ1Ntlt1EgE DENTbN, T% 76201 No response VAUGHN,MAPCELLA J' - 00071365 01104183 83.00 0100 -0.00 03.00 BP ER 2'- _ 266. b f, *r pUARANTOR INFORMATION MARCELI.A VAUGHN 918 DERNARO OENTbfJ, TX 76201 i' No response I WAU R, DANtJY 40011051 IP/07/82 140.00 34: Ob 0.00 IS 6, 00 ID ER t + *s OUARANTOR INFORMATION Mr DANNY WALKER 115 ~ 916 WEAVER OAINEBVILLE, TX 76840 Na response v WARb,6tLLIE-T 7000D22D 00/30/83 74..75 0,00-- -~59.79' 1B,00 8P OP 1" Ob7137D3 lf0'"""6- ar OUARANTOR INFORMATtON 4* BILLIE F. WAAD 639 WILLOW LEWISVILLE, TX 75067 Na response WAOHINOTON, LAAHON L';" 70401402 07/17/(13 66.00 ...0.00 0.00. 66.00" OP , OP -----3- - 72D 6 OUARANTOR INFORMATION 40 JESOIE WASHINGTON 993 1/2 HILL ST'DENTON, TX 76201 No repponse r v (1 .__..4A5HllNOTON W(f.LIE M -00072694 10/06/82 94.60 0.00...-__ 0, 00 94, 60 BP IP _-T OVARANTOA INFORMATION r* WILLIE WAVONOTON 624 PARK LN DENTONI TX 76201 ~t. No response WEDD,MICHAEI R 00073031 11/00/82 90.50 - _0,00 -77.00 -14."90 BP ER ` 2 63/10/83-"' OUARANYOR INFORMATION 4r MICHAEL WEBS - RT 2 10X 109 ARGYLE, T% 76226 r No response . ~y -WEST, PATSY'9U6 70005189 03/99/93- 49,-75 O.-Od:._ _ Or 00 . _...49, 70 _ GP - OP" ' 4 7- 03130/83 -I BD b i GUARANTOR INFORMATION 44 PATSY SUE WEST Pb BOX $70 KRUM, TX 76749 4qj No response W l WHfTELEYiBUDIfY -40006330.02/83/43 -46:25.__-._:.. 0.00. 0 00 .46.-29: 8P ER_ _ 3. OUARANTOK INFORMATION BUDDY WHITELEY 219 6 ~ CI 721 HLTTIE DENTDN, TX 76241 No response I W r ' " WILKINS, CHRI9TI L_..._. 40002396' 02/20/83 41. DO 4S: OD 0:'DO- 84 80_ SP Ep 3 *r GUARANTOR INFOAMATION 0* - W JOHN WII.KINB AT, 7 BOX 450 tlgNTON, TX 76201 No response ' WILLEY,A008RT A",JRr 4002080404/111/D3 40:00 I 4: d0 0 0b 4B 00 ' f *r QUARA14TOR INFORMATION rr ROBERT A. WILLEY, OR 0,00- MO 00 0.301 DOW SYCAMORE DENTQN, TX 76701 No response "'WILLIAMBiEDWARD,A 40007114 02/26183 545:50 r', r1I OUARANTOA INFORMATtON A* EDWARD WILLIAMS, A AT 8 009 6371 DENTONo T% 76261 No rosp rnspEk 3 10!! b I,~QQ onse I1 W , WILL IAMBIF.URN C 0007470814/01/42 90.30 0.00 -0 00 90 30''8P" ER" 1 365" b rr GUARANTOR INFORMATION r* BURN WILLIAMS 8311 B7ELLA 0842 tlENTtlN, TX 76.. 01 WILLIAMB,`JAMBD R No response { W 00074773 01108/03 77.75 -0,00-1---o-001 _•71 Ap .ER.. Of GUARANTOR INFORMATION JAME4 WILLIAMS l272' 6 I, No response •'I W1LLIAMB,JOYCE C 3 0RIOL4 APT L 16 DENTDN! TX 76701 107 4/02 326° `-6 w 1 i 00074883 11/09102 _140. 93" 0 O. AO 0, 00 748; 43 _ SP tp ~ --3 , *A OUARANTOR INFORMATION JACR WILLIAMS BOX 891 PONDERa, TX 76209 No response W YUNK; DANIEL R' 4005713604/89/03 DD: 00__._..__0: Ob A. 00 SP _ ER_.. _ 2..-- + *4 GUARANTOR INFORMATION *r RICK PUNK 59.00' NONE CAMPJN0 AT TOWER DAY LAKE . DALLAS, DEN TON DENTON, TX 96901 _ r I : I Unatrig•,t4;;lpeeka LEI W 'r ~.~1.,y~MIY A,Y'rln~lr.l6 Jr'_"'_-_Yf..Y-,1: , ate' rt' M• .Y.ry-•Y" =.tC.s.._ Y ~ { 1 v 4JJY1lYFkA ea,i. h+kY a 1 01 QCT 1988 IJ R I T E - 0 F F A E P p R 7 PAOE 9 ~ PATIENT NAME PAT 10 DYBCHO UEO-UAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LST,PMT AOE FO TYPE NS 1ACKEAY,)CARY O-_. 00077057 11/24%U12' 1b;6ti 14.40 -114.40 16,60 MC ..EA. 4 "0370U/03---- 1tM UUARANTUR 1NFdRMATIpN JERRY ZACKERY RT 7 DCX 02 UdNTON, TX 76201 ' No response ' Nt W-0 TOTALe 2,6ae.65 -V51. 65 - - - 312,00 2, 669,00 J lei ! W II , fr ~ I 40 r 'E I I' r E a F.. w . _ - i - i lot 71 rJ d'.6t~1 k M 7 01 OCT 1903 WR I TE - OFF R C:P0R T PACE 10 kilo t„ r1 PATIENT NAME FIAT ID OIBCHO 110°11AL NEW-CIAO NEW-PAY W-0 WAL FC TYPE CYCLE LST.PMT ACE FO TYPE J { wwwx WRITE-OFF ORANO IOTALB wxxx 491664.19 -4,793.93 0,208 64 49,121.30 r ,V - t I .r ~ 6 r rl. , i -r - w pp ~ r• , If I,! r• x ,a 13: 13 04 oc f 1903 C11An I l Y R001f t PAGE 1 f) V. PATIENT, PAT, ID.... PT FC, UVARANTOR NAME....,....., ADDAESS CITY..,......, ST ZIP, Olt DTE. AMOUNT.,. jJ 4 BERRYMAN,CARLA A 00006395 IP MD RERRYMAN,CARLA 512 CARNES 0AINESVtLL9 TX 76240 11/03/92 -221,90; DREWER,QARY E. 40056004 ER CC DBNTON COUNTY JAIL MCKINNEY 8L Balance after Medicald ENTON TX 76201 00/26/83 -70,00 160 ~enton County Jail 77 gA NOLOA LA 11920 RUDIIELL 307 8TRA7PORD 124 oaNante after MedITX1 CLARK CLOA 10006179 IP MC CLARK 762bS 02/22/53 -664.10 ) 40 g~a79eft No Asset: CLEMENTS,STEVFN M 10024704 1P SP CLEMENtS,ANDY 909 LAGUNA nE(JT01J T 6^ 5 1 /S 14.49 J ualaM1CO after Mental I1ea1Qg IentaN Rel~ardatl7on V CONNOA,ROOIIJ LYNN 70009461 OP MD CbNNOR,ROD211 LYNN BX 46 TWIN LKS MHP SE~ITON 7% 76801 05/07/83 -25.00 J a ante after Medicaid DAVtB,DENNIS K 40062758 EA CC OAVtM DENNIS K DENTON COUNTY JAIL DENTON TX 76201 09/17/03 -76.25 b Dahton county jail J DAVIS,DENNIS K. 40062143 ER CC DENTON CO. JAIL MCKINNEY ST, p"N"Neoun TX 76201 09/15/83 -61.35 D 4y EBERENOU,DAMIAN M. enton ty Jd1 1 C 10075666 IP CO EBEREI40U,DAMIAN 11, DtlX 7702 NTSU 8T NTON NT9U TX 76203 05/21/93 -1,7'$0.20 J FARRIS,ELI2ADETH 40056517 EA CC OENTON CC JAIL E. MCKINNEY I pMadleft No Assets 76205 08/27/93 .-16L 90 Denton County Jail iJ FELTMAN,EMMA 40044505 EA MD FELTMAN,EMMA P. 0. BOX 56 LAKE DALLAS TX 75065 07/17/83 -10,00 V 0OLOSMITH,ANEA3HIA b 00025767 lp MD OtlLD6H17H,PATAICIA Balance after Medicaid 1129 MORSE t2ENTON- T% 1>6201 Ol/OS/93 -691.51 t tlalNNance.,after Medical d7. 60 ALINDA 10043636 IP MD ORAY,ROSALINOA 2522 LOUISE 025 DE TON TX 6201 09/05/93 63. b0 ORAY,ROS 96 le MCA after Medicaid - J , OAE9N,WILLIS C.,JR. 40041014 ER MC OREEN,WILL16 C.,Jn, 1619 UNDERWOOD pSIVTbN TX 76201.07/04/93 17,90 Galante after Medicaid 60 HAADYYKASHA A 00029470 IP MO HAADY,CYNTHIA 112 8 RUDDELL 021 3ONTON TX b^w01 09/22/92 -101,70 alanto after Nadi - DEN HAiTEN,CAROL p 10011460 1P SP HATTLN,CAROL D 710 SMITH 9T 801 nee V after MedlcX 6201 03/20/83 340.55 ;I HSRNANDEZ,AMADA 10040277 tP MC HEANANDE2iAMADA 909 BALDWIN DErrIT[JtJ TX 76(201.07/115/93 --22;00 - iJ Balance after Modlcafd 4,, HER291,YHOMAS D 95003539 OP SP TEXAS REHABILITATION DISABILITY DMYERMINAT AVOTIN TX 75769 070013/03 -11,yy ;Il) 5✓ Da lenCe.after 7e><as Rehabilt,tation_ H06T9N,006 J. 40069512 ER CO HtlO79N,SOD J. 301 9 MCKINNEY DENTON DENTON TK 76201 09/16/93 -200,40 Denton County Jail HOCTEN,R09ERT 95004067 OP SP DENTON COUNTY JAIL 215 E MCKINNEY., .DRNT014 TX 76201..01/06/93 -571;00 ' Ir jail HOOTENiR06ERT 95004875 OP 9p DENTON COUNTY ~'A1L 9HER Denton County IFFIS DEPT, 215 a DENTON TX 76201 04/07/113 -171.00 Denton County Jail IJ HOWARD,CAA10 A 10039956 IP SP HOWARD,CRAIO A R7 1 BOX 390 AR4YLE - TX 76226 07/20/93 -2,979,39 V HUDIJALL,pEARL 10043503 1P MO HUDNALL, In agent tire J { 00ARL D90ATUR CONVALESCENT. DECATUR TX 76234 69/04/93 -16.00 Balance after Medicald y' JONES,PANBY M 00037093 1P MC JDNES,pANSY AT 4 OAtN%SVILL9 TX 76249 11/l7/91-58,330.30 1~ rri! NANTAN,BRIAN S 70003306 Op SP K 1 urton Criteria ANTAK,BAIAN 8 125 N MAIN ST $alance after 7e% a9%Aehab11103/ 7/93 -13,63 r„ AGATON,ACDNGY EtJEAibALANtl talon ARTHUR 40089628 EA CC K9ATON,ROONKY ARTHUR. 305 E HCKINNKV DENTON BaENIC14 after Medicaid, 76201.09/06/93... 72.00 l~ K9 'J, y 0 00037614 IP MD A AYP I 9L Do JOA NN 1710 VILLAOE EAST 020 D9NfCll TX 76201 O WV193 -60 00 _ L89Y,9HERI A 40055600 EA MD KEL96,8AASAAA 1559 gRtARWOtlD LSWI,BVILL9 TX 7506705/24/83 -0,00 I 8allande after Medicaid ' J ;~,1 1 , C'., :1(. i 111 Yi YI 1• ,I ,~ry' ~ i ' ~x1a<i~vav a,. rr` t.raq 13r30 04 OCT 19213 CHARITY REPORT PAGE 9 1 IJ t Sr PATIENT . . , , PAT. ID-- PT PC, GUARANTOR NAME,.......... ADDRESS,,,,,,,,,,,,,, CITY., BY ZIP,. 018,DTE• AMOUNi',., 6 KENDALL OLIVER 40D31510 ER SP KENDALL,OLIVER C/O WELDON WERNER 180 1RVINO TX 75060 06102/83 -183,45 Died left no Assets KENDALL,OLIVER L 50007136 IP 8P KENDALL,OLIVER C/O NELSON WERNER 160 IRViNG TX 75060 02/06/93 -1,845. BS `J Died left no Assets KIRK,JE81E DALE, 9R, 40055944 ER CC DENTON COUNTY JAIL MCKINNEY STREET DENTON TX 76201 08/26/83 -84.00 J y - _ KIRK,JEBSIE Denton County Jail 40060279 OR CO K[RK,JESBIE pENTONCOUNTV.'hTL DENTON TX .76871 04/04/83 -15,00 Denton county jail KIRK,JESSIE DALE, SR. 40050212 EA CC KIRK,JE9SIE DALE, SR. DENTON CC ,PAIL DENT014 TX 76201 00/83/93 -66,05 Denton County Jail KIRK,JESS19 DALE, OR. 40000641 OR CC DENTON COUNTY JAIL MCKINNEY OT, LENTON TX 76201 00/25/83 -130.75 KLEIN, Denton county jail AEAALD 40062100 ER CC DENTON CO. JAIL MCKINNEY ST, DENTON TX 76201 09/10/03 -133.00 410 MARTINE2,CYNTHIA 10027069 IP MD MARYINET,CVNTHIA PO BOX 161 Denton County Jail SANGER - TX 76266 00/84/03 -195,03 ~I Balance after Medicaid W ~ MCCAtlRY, JpHN W. .40060297 ER CO MCCROAY, JOHN W. MCKINNEV DENTON ENT01J TX 765205 04/09/83 -56.00 Denton Balance County after Medicaid 3 -199.92 MCDADE,MIMNIE 10011845 Ip MD MCpADErLEf7N 903 ALLPN DENTON T% 76201 03/10/93 MCNARV,MAV18 40045850 Eq 8P MCNARV,MAV18 309 4098 DENTON TX--76201 01/10/93 - -159.50 #0 Indigent Care MI7CHELL,IVDRV R, 40009610 ER CC MITCHELL, IVORY R, 300 E MCKINNEY DENTON DtNTCN TX 76201 04/06/63 -56,00 ' Denton County Jail . MOHAIA;DEVBTAA R 00047011 IP 9P MOHAIR, DEVETRA 100 SO RUDDELL 019 DENTON. TX 76201 06/27/02 -335,00 40 Balance after Medicaid J MORENO,CHRISTOPHER A. 10639866 IP MD MOAENO,EANESTINE 012 RAILROAD AVE, DENTON TX 7690t 07/26/83 40.00 ` Balance after Medicaid f MORR!$0N,7HDMAS C.,JR 45003497 tlp Sp MtlRRIBpN,THOMA6 C.,JR, PO BOX 114 SANDER TX 76266 06/29/03 -10.63 ; d after TeXAISXA@7h6a0btlSitl2/!4/97 -0tti, OS r NtlgTON, MARV J 00050006 IP SP NOATON, MARY J 2t14 KIMBALL RD ~BAiAAapp nca 6VI aiJfter Madicat lon r QWEN,JOE R. 40057242 $R CO DENTON COUNTY JAIL p lA 210 E. MCKINNEY DENTON --''-TX-76401 08/30/03 -76.00 V Indigent Care .00 1 PUNCHnJpHNBHRAH M1CHE O40054975 CA HD GOBtl2p4 IP 0i pUNCH~JCHN90A,4H MICHEL W.PRA9 0125 DKON Tx 76901 IRIE DEBe ance NTON aflen.Med1 T% 1761201 ig/ _27/03 -1.3 . 3 r Balance after Cri7led Children .~9{02 143,39 RAMQS,EALINDA ALDACO 100441952 IP SP RAMtl9 ERL1NpA ALOACtl 410 BERNARD DENTON X 76201 00/01/03 -1,034, 1S Indigent Care ! BERNARD QIndigent Care TX 76201 07/47/83 -gZ,Sts J RA90R,LOTTA pL1ZA8E7H 440041300 On Sp 0014807 ER SP RASOA,LOTTADP 603 5 TEXAS BY DENTON 7X 765201 03/09/03 149.85 AECOVERY,A000UNT8 0005BA17 IP ADD , indigent Care .TX 00000 02/01/83..,...+300 25 JtNTON TX 76901 11/20/02 -90150 J RGYONLDSCRODIN D. 40042535 EA MD REYONLDB,AN19 1008LARCOOTCN DENTON Care TX 76401 04/00/53 -55 w Balance after Medidafd 4. 80 RQ9ERT8r110RR18 40057036 ER CC DENftlN COUNTY JAIL H. MCKINNEY Oi1NTO14 TX 76801 09/29/03 85.50 ~ NO ROBE,OAAV LEE 40006702 EA MO ROSS,VERNIE JEANSTTE AT 4 BOX . XECUT[VE I lndigent care dicaid 16201 06/20103 -31.00 I'~ RO80,VSRNIE 70010491 OP 8P A008,VERNIE RT, 4 DOINi9 Badlaenencee aftafterar.Me Me 7k 6701 06/02/03 30.00 r dicai~ ; s ? g-_ I .15:13:46 04 OCT 1989 CNAkITY BkPOkT PAGE 3 % PATIENT.PAT, 10..., pT FC, GUARANtOR NAME......,.... ADDRESS CITY...,.,.... 81 ZIP., DI8,DTE. AMOUNT.., 4bo SELLEH8,PE00Y L, 10001428 1P MC SELLER8,PEOGY L. 319 WITHERS J T% 76201 02104/83 -948.00 I Indigent Cara SH9PHARD,SYBIL D 40643592 ER MD SHEPHARD,8YD1L D 608 CHAMBERS DENTOW TX 76201 07/11/83 -13.00 Iva V BMITH,ANOELINE C. 10024214 IP MC SMITFL ANGELINE C. 2229 CARROLL BLVD DENTON diter Madl7Xi76201 09/16/83 16.80 ! BMITH,HOYE GENE .J 1001629S 1P 8p BMITH,HOYE GEIJE RT 4 BOX 199 ROANOME TX 76262 04/09/83 '412.44 87ANLEY,8AkDARA LUCIL 40049494 ER MD gTANLEY,6AR8ARA LUCtLLE 703 ALEXANDER Indigent Care J DENTON TX 76201 07/21/83 -13.00 Balance V STANLEY,ROY DEWAYNE 40010297 ER MD DAVENPORT,MARITA 9, 627 BERNARD 422 DE NTON after HediTXi76201 04/02/63 -31.00 STUBBLEFIELDlDUBTY E 10091464 1P 8P BTUBBLEFLELD,CECIL 416 SMITH BaWco after Medicaid j ~ Ir DEN70N TX 76201 04/18/83 -1,780,09 8TU08LEP[4LD,8ARA E. 40099879 on 9p 81'U11111.EFIELD,6ARA E. 416 SMITH Indig4nt Care DENTON TX 76201 09107/83 -64.00 J indigent Care j 40 THOMAS,WILLARD E 40094082 ER CC THOMAS,WILLARD E DENTON Of) JAIL DENTON Tk 76201 08/t9/83 -62.00 Denton - VANDERORIFF,IRA L. 40039641 ER MC VANOERGRIFF,IRA L, 29th LOUISE #7 DE 4r NTOidCounty Jai1TX 76201 06/17/83 -31,00 J VANDEROkIFF,1RA L. .40042729 Ek MC VANOERORIFF,IRA L, 2916 LOUtBE BRODKIfOOD Balance after Medicaid DEN70N TX 7601 07/07/83 -31.00 Balance after Medicaid t ~ WALLER,,BOBKATHERDINE M 70016639 OP MD WALLER KATHEkINE M 1602 VILLAGE EAST APT DENTOI2 YX 76201 08/23/83 -29.00 WELCH 40046909 ER MO WELCHrDOBBV D. 2601 MINGO RD #104 DBalance ENTON after Medicaid 176201 07/26/83 -14.80 J WERT,KENNETH RAY 40093043 EA MD WE8T,LOIB a Ance BftAr MellCdid J P.D. BOX 644 908 LAKE DENTON TX 76701 00/19/03 -9.00 t WHEEL& THOMAS, WAYNE 10066377 Ip MO DENTON bEVELOPMENT CENTER Balance after Medicaid i i too TX 76POI 02/17/83 -26.40 J Balance after.Nedicaid: __.I ; WHITFIELD,R1CHARD 0. 40060477 ER CC DENTON COUNTY JAIL 301 E, MCKiNNSY 17ENien TON County Jail 7X 76201 04/10/83 -0.00 MW i W1LKt?RBON,AWA J 100129967 SP MC WILKERSON,ALVA J 2224 CARROLL BLVDDENTON J TX 76401.06/07/83 - -17,00 NILLIAMS,pAyMONO 40064032 ER CC DENTON CO.' JAIL Balan00 after Medicaid '3 j MCKINNEY 97. DENTON TN 76201 04/21/83 -89,70 ' V nton County Jail . . . WtLLIAMB,VIA0INIA 00079077 1P 6p WtLLtAMB,VIROINIA RT I 9OX 994 ~BeiDedELeft MO Assets OK 74849 01/10/83 -4,494.31 J ets J WOODBON,htIRfABT18B 40091401 ER MD FANNIE WOODSON RIMS 1014 E. HSCKORY. DENTON TX 76901, 06/!0/93 -31.,00 WYL8R,8HIRLEY A 70009663 DP Sp WYLER,8HIRLRY A 1908 ROY Balance After Medicaid BAINEBVILLE TX 761040 09/43/83 -13.63 2UBRADT,PLORA M 00077249 10 Sp ZUDRAOY,FLORA ROWE LOT 40 JEN1 N afterTexas 12/91/94 798,14 4r ndigent Care J ' V -39. 738. 71 I V r j ; J ` tA0 V iv.r4,wfq ! t ! rr FIRST ! r s a v o MEDICAL K C p 1 h1 M a, m 1 k ~0 DL V,.F...L OPING i } ;a J A N AS r P I A L V 11 V13 ,a IN r D ENTON IT 'YAi! Kal\4 n51~k'Z'en,a~»!h>~i1i:~,•~n•.Uarse~l7Y~.WYw N.rsli7i AA~i~JA~Y ! afirA$bGf1~~kVila~.Ain,p ,~t}. I I First Texas Medical; own the huspltai, have nol fm'ested the funds Who We Are and access:11)' to m;tiritaln and upgrade the hos. pil"tl trs it should hln•e been. As a result, 1'Inv What We Do ! IONIs11ul is, according to ,t 'ILs,t.e heparttuent Irirsl IL'sas ,llediatl Is ;cn orµartiLatloit of 65 of I fe;dth blu('b{I, „hclo{v arcrafe for ar lnciiity PII)' L'ms Who provide ;I variety of ateclyd Its age." services throughout Denton County. 1Ct" Now I lospital is ht vloht loll of sever, fire had a presence In this Courtq'sIrl 1952 and and Life Safety code reclulrIIlls. I'Itese oI during lhisllnu', tu've beat cununhled ra liof.rtfnns'; hloty Is not prolc`<'tod from these prot'ldllg (111,11}; Innovative giedic'al son Ices. requirements clue to Its age, Ifoweref, neither Nk'vo helped 1113ke ntedlrrl care morn the City nor the County h;ts developed mly 'Iccesslhle liar our patlents with com'ellell, long•r:urgu p5luns for rct'ersing this sliuadoll. hoots;uour Deiuori,i.etvlsvfllcandC;urolhon bW year, ohl, concein about the Plow Centers sQtmlfon prortlpted I lrst ltsu~ medical to t.' Vih've looked for ncu, {{a', to suitml It piopasal to tile Cltyan<I Coumy of } s provid° services Demon to bm. Flow I lospltal and umsu'uct ;l ser), ICs and s o home Ile, yI such is outpiWent nety hospital m nr, cnsY io the I;txp,ly ery, anc! u recently opened (eR111acer 1111) ucatraremont senl cruslces, The provide funds Io provide th(or e Inclgent rare r I io' ({thick Is, by hlw,the financial responsibility servlces rvIII 1 our Denton fac1111y has brought t nets' af(lie County) 1111d%voul Ij;JS'e(tn-ltedtilenc~w o D emon County which hefctre were only av;dlah1el11Dafl.ts lti»pitalltto,t laXpayfngclttly lmtry bbjecdvc In all our efforts )ur pr 111 this prOpOSal w;ts I•elecled, Irh'st has teen to dellver iI care to the IlU.0U0 7('X'Is NledlIA pursued (I oltllnns ro pro. Ntlents for rvlioni the provide rare in Demon y1dC fuuu'e hospltaf wre fc51' our Delttor NV to ea Cumtty. p;aients. its ;l t•esttlt, First III Aledlrll,por• t chased The 1xinfon 6steopathIc l dos tl;ilitnd First Texas Medical proceeded with pLtns to replnm .utcl expand I the flclll(yby 24 beds. Wants to Replace A Hospital The New Hospital In Denton Will Provide Vt are curtendyaw:ddrlg approt'uf front the The proposed Itlt;st 'lints medical Center It.xas Health Pacllltts Conunisston to build Hospital, which {vllt be located adaeent to the I'Itsl Itxus A4edic';II Center I Itts 5ital In Donlon, 16'st fLxus ,1ledlc,ll; Center Iienlon, will piri> ` Vfl've applied to theSI;ttC to bind dais 50-bed {'fide general ntedlrtl/surgh;d,;utd obstetrical replacen1elli hogpil;+l heciluse the are con. sen ices- fills 50-11)e1 hospital %vill also provide Ihe il y n eqptipnluu 'and facilltles ncces• ,i corned about pr the cIuallly hospial care m In Uenlalt for the luturc ) for qumilt) pausal C;tre If approved, this hosplud 11'111 fain the ' the phy:vleLats of tfirst IL%%,\ledlccid III )(I prliCtlce primarily oil Plow ,\leousrl;ll i'Irsl 'lls;ts 1kdlr;tl heath cure dellt!et)'sys• Jios)itttl; In Bicl, 9p >crcertl of these ilt tent In DC1110n Counly to ful'liler enh;utc•C i ) l- pallent c;lrc. clans' llo5plhtl oure has II provided al blow. Bul. over Ills years, {ve VC seen I'IUN' I lospiml deteriorate, T1te Cin, Ilnd Ccitlnty, which jolnti), l Ai {k~>f'n~.l !~.53,kr4•n , t 0 ucrt,i,t~1ti ; rt<# 4RL G 4~ir~13; ' ! It l Won't a New Hospital Hurt FIOW blow Memorktl h:1s beell phlCec! ill a Memorial, vulnembic posltlnrl by not taking :in aHgres• Which is SU stye Iwsturc in an lncreasingl' competitive pported envlrohilteltt flow C.,111101 c } gpcct to be pro- By Tax Dollars? tcrtcd from coml)uftlon fotct•el•. Already, i 1~reslg ac I luspll it it 1s apitlied io the Slate to li;rscd on itopul tlloll 1ni lllznliun pro. ut Jcc9luns, the consh'uctli111 of I li'sl /litios Meiji. :1d(I nbstelric:d scn•lces In direct conlpr call Centel. 110-SIA:11 sholll(11111I advereclynffecq lftli)n will flow, ; NIOWIfospil:11,Ffr,,t,lltl:lsdlcplacenlenthcn• 7lvu prlv:ue psycltlattle 6c•ilkles have ~q)pllceltort,s pell(11ng for lre:anterit centers In ryl, pital, not it IC I dly new hospital ill Benton, the Denton area 'i'ltese, , woul(I ' c!lrccill• 'IWenty six ofthe proposed 10he(Is:nc tlrC;ui} Comp text cd ete Will) f~lott~s iirirgra OiltCar, e i r ln,eclylrc:tttd ou'ncd by fllsl 11xi1s A1cc11eaL lire ernilies hawAcen a ttdcl in the IttaGh rlrc t lihty elghl pntfeiits- or it 75 percent dclfvcrysystent and are littemming lo till lt, !or u11t50ditd [S 011 hospitulitihhc alrett!(Icvcl lct'Cl 190++',11emorl:tl calt reru 1fn a vhihl• ludon; hla 10 e fnsti the do sci, requires ac'Iknt :md it,) uttedtliln ,11oa} wllh Welt scnlres pro. Investment I 11 the future, no(p rotecituil from vicled ih!ough t he enncei'trrntnlc+lt (•catter:utd poiw1:11km grotvtll 11) d1e Demon :treil will cOmpelltion. -411Y 1111 38 beds lvldiout hn rtctHt flow A t t' f Iuspllal, g Got' intent Lt face, poptd:ltioll grotsth Is a'majo! file. T the Future for to hC rbnsldcred In 1)1:tiul6tg 1,61. 111C. u c 1 Nlrst health '1bx,1s ,Mdlud i. ccniunite(I to pnn fdhlq r,u c. )eoton Cotllity is the frttu'Ib, rralcay s Xtutrbtti, culullf 111 the Ihlltul SrUes. f y the ~ouoty; J')jlis t m(,tire A u ntrlslingilhuLf ftDemo se sas 11nte the rephte'cntenl llospit,tl Is conililc'tul in rvlces and slatr,oGlhe "Iit 1987, , 1.71 to l ,mis iledic;lf expeCls the Denton itll Ccntor> halv lhtles nee riltl e g"ON'n rront29 to 4b physfcl;los C'vcryetff0il at biIld ill RMJ)ottse 1c1111ecoujity s l;r0wlh. f Ir t~fklxi ~},11c~11i tl~C'entkr I lospltai Ill Berton. Other Factors .`~7o- Mru4i~r/rIGr . /lrnioria/,/(mr~r7rr//rrac Affecting the r,~rn,} ,sff.yt'nr/~nrc , ,rnr~b 1 l6ruGlerrr 6'r!/rr! Hc s~p~tal Delivery ry mrnn~/e~~~nrr „ri O Health roe~auc/i!~/r /rr~e~I/rr.~r/u~yiiryiie!/rr/filarr p Care 1} h !s lntctcsting 10 note lhnl dtc naniey the County canttflhltrs Io Mote. is being pitlil by - `fie •yrririv,n ; the County l lspayers as a wlt0le, I3UI, aj)proel• •(^rt ; ear • 1/r/rrrG~et~/ stately 80 percent etf tltc i+t(Ilgeitl pAl ienlx who uscNlotl~l}osplrtl cruUCf'bni tvllhin lhcCilyof Benton, Ultly :gtinbshnntal}' four pCrCtnt of the indigent pAllents come rrom the southern t coonnnritlc's in Baskin Count': 1 c i• ya ~7 , ~~~~`ti*"4~shl b~y~ky,ya~.o! •,_n 4i5t00 > +)"i°~~5',Si~J-`~N~Mn ,vr''tllya ~•r.~ 4A,; t. doe, jtir, i I . Vii: !ti i 0 ver the past several months, the Denton County news media have reported the hearing procedures of First Texas Medical's application to build a 50-bed replacement hospital in Denton. As a result of this 3 M hearing and the attention it has received, s there have been many issues and questions raised about our organization and about F the delivery of health care in Denton County, y~ Because you are of special concern to First Texas Medical, we'd like to take this opportunity to explain our position and our objectives in this entire process. I4 t . ~n'f'i~~n.xrrA~J[~~v tAk~CJr,I~ i..r ht,,i rx+f ryt+ygj' r>;aii~1V+,-U?l~i`4~;`Nyuimsr~u FLOW MEMORIAL HOSPITAL BALANCE SHEET August 31, 1983 1983 1982 1983 1982 Current Assetss Current Liabilities: Cash-.Operating 201980 Current Notes Payable $ 297,689 1 Interest & Sinking $ 11202 $ 174,119 Reserve Fund 14,481 Accounts Payable 626,036 767,216 Ree v FFun 21 394 200412 Accrued Payroll & Taxes 393,153 402,373 Group Health Insurance ,341 19647 Due Medicare 150,903 121,427 r Investments/Board Designated 330,464 298'680 Fees Payable 182,927 248,687 ~ Bond Interest Payable 4,374 9 331 Bonds Payable - Total Cash & Investment $ 4120152 $ 3579308 Total Current Liabilities 9 $ 10559082 $ 1,7230053 Accounts Receivable $ 4 456267 $ 3 388,763 Other Liabilities: Less: Allowances 831 856) 313 209) Deferred Income $ 309639 Net Patient Receivables ~I;6 4;~4Tf" Long; Term Notes Payable 263595 $ 29,088 477,676 Other Receivables $ 860455 $ 115,405 Bonds Payable 420,000 430_,000 Inventories 4429024 274,897 Total Liabilities. Prepaid Expenses 2 74,903 $ 2+3590216 $ 20659,$11 Total Current Assets $ 4,620,114 Capital: $ 3,898,057 City of Denton $ 393,165 $ 393,165 Property, Plant 6 Equipment: County of Denton 1,696,871 10696,811 Endowment Flow Estate' 240,461 240,461 Building & Improvements $ 3,067,385 3 06);385 Fod Federal Gee Ora, Hill-Burton 1,868;910 1086$0910 Furniture & Equipment 4 543 515 4,656 050 Grants 2560371 2560371 4j1060 Pledges and Gifts 5610887 604,498 80 ~ 0447 $`7;7UD93R Gen. Fund Bat,, Beg, of Yr, (291,266) (686,770) Accumulated Depreciation 4 405 394 (4 169,675) Current Year 778+ 5s 7 162 56, O *Net Property, Plant & Equip, $ 3}243,053 $ 30591,307 Total Capital ` $ 5,604,551 $ 40829 $53 ~ TOTAL OPERATING FUND 7 863,767 _$7L489 364 TOTAL OPERATING FUND 7,863,767 $ 7+489,864 -~I Current Ratio 2,79 .sta....:, . .,,,LIM,k.aV:4`m.4:h!aS4YSi'.3~+~t:M{~~J•c~'x`~Ia~~~~, . ' M' P l OMW t ~W 1 { Page 2 FLOW MEM0RIAML HOSPITAL STATISTICAL STATEMENT AUGUST 31, 1983 CURRENT MONTH YEAR -TO -DATE P R 1 0 R Actual _Bu d W Actual Budget Year-to=0ate Adult Patient Days 2,687 2,945 31,299 31,826 30,881 Average Per Day 87 95,0 93 95,0 92 Newborn Patient Days 469 434 46182 49690 40348 Average Per Day 15 14,0 12 14,0 13 Gross Patient Revenue/ Patient Day $ 505,80 $ 415,04 $ 465,00 $ 457,32 $ 394.33 Total Expense/Patient Day $ 405,12 $ 345,33 $ 373,86 $ 351.51 $ 333,48 Month Charity Bad Debt Recovery October $ 51,473 $ 960063 $ 50636 November 127,181 1170974 40446 December 610228 1069636 6;566 January 80000 99,706 91934 February 28,903 108,131 41092 March 52,295 89,946 12,762 April 20,149 42,208 16,021 May 15,406 36;734 3,595 June 36,112 706M 7111 July 33,718 68,250 21183 August 31_1761" 29,1,024 60993 $ 465,226 $ 10169,931 $ 79,339 % of Revenues 3,2% 8.1% i 1 w,.rawnr f, 1 Page 3 FLOW MEMOR,IPL HOSPITAL STATEMENT OF OPERATIONS/AUGUST 31, 1983 w % of Supplies Total Direct Operating Revenue Revenue _ Salaries & Other Expenses Profit (Loss) Daily Hospital Care 16 $ 2211830 $ 123,370 $ 12,045 $ 135,415` $ 76415 Psychiatric Care 5 70,080 340990 41434 39,424 30,656 OB/Post Partum 3 409335 20,462 20840 230,302 17,033 ICU 2 23,925 18,3,42 3,374 216716 21209 Nursery/N1CU 6 83,235 359898 50487 41,385 41,850 Coronary Care Unit 3 43069 280868 41087 320945 10,514 Labor & Delivery/Birthing Center 5 70,897 27,141 99765 366906 33';991 Operating & Recovery 4 54,054 23,316 130562 36,868 17,186 Emergency Room 4 606767 16,428 279313 43,741 170-026 Central Supply 8 1069821 70721 461042 530763 5310$8 Laboratory/Blood Bank 12 164,120 mu 661127 66,127 970993 Radiology/Nuclear Medicine 6 87;876 16,765 24;010 39,775 48,100 Pharmacyfiv 14 1850866 120324 34,191 46,515 39,361 Cardiopulmonary 7 94,336 20,526 18,397 38,923 650413 Anesthesia 3 400663 16,766 79460 23,216 17,447 Physical therapy 2~70265 3 3 f0 690 11 396 total 'a161I' %8' i Deduotidns;of Revenue $ (83,334 $ $ $ $ (83 j,334 { parity & Bad Debt. (166,353 - (156 d$3 Employee Health ins. Expense 48,685 48,685 (48,'6 Kidical Records 696: 10,988 50044 16,032 (16 1' df.tt Shop/Grounds Maintenance 1',914. 21686 11825 40411 (2,4 Cafeteria 119039 27,958 30,764 58,722 479683 Plant 15,696 590298 74,994 741994 Environmental Services 34,798 14,134 48,932, 48;932 Fiscal Affairs/Data Processing 7,185 6,440 14,226 14,226 Business Office/Credit & Collect 23,453` 12,676 36,129 36,129 Personnel 30302 20013 6,315 (2,315 Administration 60182 6,220 12,402 .,402 Quality Control 30068 746 30824 (31844 General a Administrative 22. 41",027 41,027 (410005 Depreciation -33 083 331083 (33483 Gain (Loss) From Operation 3 450851 Non-Operating Revenue 30,315 30,315 FoUndation 3L13.7s•_ 3,132 Total 1,167,690 T 4.414 $ 1,088,382 $ 790298 l N VYMR Page 4 FLOW MEM4RIAL4I'~HOSPITAL STATEMENT OF OPERATIONS/YTD AUGUST 31, 1983 % of Supplies Total Direct Operating Revenue Revenue Salaries Other Expenses: Profit (Loss) Daily Hospital Care 17 $ 2,388,725 $ 104120833 $ 1410999 $ 1,554,832 $ 833,893 Psychiatric Care 5 787,832 383,980 36,458 4200438 367,394 --1 OB/Post Partum 3 506,$25 207,I80 27,237 234,417 2720108 ICU 2 311,375 2081941 34,660 243,601 67,774 Nursery%N1CU 6 7810920 368,839 66,940 435,779 346°,141 Coronary Care Unit 3 4486848 336,793 48,200 383,993 64,855 E Labor &'Delivery/Birthing Center, 4 564,144 281,702 82,395 364,097 200'0047 Operating & Recovery 4 589,236 238;521 154,352 392,873 196,363 Emergency Room 4 5120853 1890818 3011381 4911199 21,664 Central Supply 8 16195;362 86,097 546',033 632,130 563,712 Laboratory/Blood Bank 11 105670685 652,726 662,726 9149959 Radioloo/NuclearNedicine 6 864,151 174,134 244,471 418,605 4361646 Pharmacy/iV 16 2,324,100 129,736 469,458 699,194 1,724;906 CardiopWonary 8 11124,932 2190808 196,216 416,024 17089908 nesthesia 3 427,684 1595802 112,827 272,629 156,056 Physical Therapy 1 1790399'- 77,148' 26,607 1030765 761644 Total 'b 14%00b40101 47UT $ A9474",M ~`~';'I4'1,VbU "T; 6TG;292 b fi , Deducations of Revenue $ (8661799) $ $ $ $ (866:799 Charity & Bad Debt- (1,724,371) (1 754,371 11" oyes Benefit Expense 601,162 601062 R69Medical Records 6,170 124,668 33,768 158326,166 bi.ft Shop/grounds Maintenance 189641 21,168 170036 $81194 (19ja3: Cafeteria 1230870 2921348 3020961 696,309 471039 Plant 169,678 677,519 847,197 847,197 Environmental Services a Purch. 3770073 913$44 490,417 4900417 Fiscal Affairs/Data Processing 86,884 699281 1560166 1166,1661 BusinessOffice/Credit & collect 249;984 144,333 394,317 394,317 Personnel 32,670 . 241334 57,004 (57,004 Administration 65,316 33,722 99,038 ;(99,038 Quality Control 30,435 6,747 37,182 376182 General & Administrative 17,682 312,777 312,- 77 296,095 Depreciation 397 993 397,93 397 993 Gain (Loss) From Operation $ 449,481 Non•Operating'Revenue $ 2944329 294,329 Foundation 34042 349342 ~ ~ Total ,S 12,479-,_625 ~4 446 _ 5 X7.6,..? 1 } 1► $ 778,152 Of i ti rage 5 F L O W M E M 0 R I A -L N O S P I 'T A L SUMMARY OP CASH RECEIPTS AND DISBURSEMENTS AUGUST 31, 1983 Beginning Balance Currant Month Year-To-Date $ 84,906 $ 2,175 Cash Received from; Active Patient Accounts $ 1,175,461 Bad Debt Accounts 6 993 $ 11,236,135 Cafeteria 22,625 799339 Appropriations/Donations 75,000 1290657 Other 170,860 386,289 rd"tal Cash 1 439 939 492 "TOTAL CASH AVAILABLE 12 726 912 Cash Disbursements: M Payroll $ 469,603 Payroll Taxes 203,793 $ 5,40A,036 Patient Refunds 546872 816,104 CSpital Assets 811 303,372 Notes Payable 148,762 1330106 Other 730,394 3270766 Total disbursements ~ 508~~ 5 723,093 12 7 Cash Balance Cash Investments 330,464 Total Cash 330464 Cash Received as a % of Revenue 90,5% 80.9% ....,...N2 F.. +.n.1.rv...,a .,u.wn..v.,.y wwrwaMwea.yY ' r 'Y 1 I I i, C• Page 6 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS RECEIVABLE SUMMARY ~ AUGUST 311 1983 Primary Payor Current:: 31-60 61-90 91.120 121.150 160? Total_ L of A/R Medicare $ 411,457 $ 1210762 $ 34,676 $ 60978 $ 91831 $ 240834 $ 609,638 14,6% Medicaid 20,976 ,.19,779 130822 3,355 10,473 80,069 149,474 3,6% Blue Cross 649354 23,710 60273 60988 10483 19086 103,894 2,6% Commercial Ins, 417,399 203,799 189,343 78,509 24,544 441078 958,572 23,0% Self-Pay 248,119 2490723 256,359 213,006 188,931 1,1529163 2,3081301 56,4% Balance after Ins. 160, 60393 50283 51084 7,711 120316 36,947 ,9% R 1,162,465 $ 625,166 $ 505,756 $313,920__ $ 242L973 $ 1,316,446 $ 4,166,726 100 % j 43 j In House 315 f TOtal•A/R _ } = A/R by % 27,9% 15,0% 1212% 7,5% 6,8% 31.6% Number 'of Accounts; 71239 Days of:Aevenuel Dar Receivable 95 ^ In-House 7 . Total ..W...102 i ,.iN#V8b Page 7 4, ~ FLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE AUGUST 311 1983 Deferred Payable ~ Current 31.60 60.90 Total Trade Vendors $ 2550121 $ 221$11 -0- $ 4769432 Fees Payable 980402 63,125 -0 161,527 Accrued Payables 479138 479138 Estimated Payable 102,466 102,466 Deferred Audit Fee $ 21=400 21,400 21,400 $ 503,i27 $ 284,436 -0- $ 808 963 r ti . i $.w.x13 ~b.".!M 11 L14 I~ r cX:e ' I r Page 8 ti FLOW MEMORIAL HOSPITAL HOME HEALTH BALANCE SHEET AUGUST 31, 1983 ASSETS LIABILITIES Cash 66,878 Accounts Payable-= $ 24 Accounts Receivable 68,196 Payable Due Flow 429 126,074 Accrued Payroll 6,232 Inventory 1,844 Total Liabilities $ 60685 Total Current Assets $ 126,918 I E UIQ PMENT CAPITAL Furniture & Equipment $ 10616 Pledges & Gifts $ 115 ; Less Accumulated DepreciAtion (1,3 46) Gen. Fund Bal., Beg. of Yr. 113,815 j Net Equipment $ 269 Retained Earnings Current Yr. 6,572 _ Total Capital $ 1200602 TOTAL OPERATING FUND $ 127,187 TOTAL OPERATING FUND $ 127,187 i r 1 v s rr, . , !nn R l Page 9 w FLOW MEMORIAL HOSPITAL HOME HEALTH STATEMENT OF REVENUES AND EXPENSES AUGUST 31, 1983 REVENUES Patient Revenues $ 36,475 $ 353,635 r Deductions of Revenue (7 ,4111 (80,699) $ 29,064 $ 272,936 Net Revenues EXPENSES $ 221,372 Payroll & FICA $ 20,898 19735 100961 { Purc. Service 13,795 Supplies 897 26211 17,205 ` TravelA Repairs _ 20762 Employee Benefits 269 Depreciation $ 266,364 Not Expenses $ 25,741 6 572 Excess of Revenues Over Expenses $ 3,323 $ , r yi~y y r 1 uoaoau 11 F FLOW MEMORIAL 46SPITAL BALANCE SHEETS AUGUST 31, 1983 & 1982 1983, 1982 1983 1982 Assets Liabilities and Fund Dalance Current: 10 Current. Cash and Investments $ 469,030 $ 393,314 Current Notes Payable $ 2970689 $ 1746119 Accounts Payable 809,416 11040,601 Patient Receivables 3,692,607 3,1651197 Accrued Expenses 4030759 4160935 (Net of Allowances) Due Government Agencies 160,903 121,421 Other Current Assets 585,995 4660205 Total Current Liabilities- $ 1;661,761 $ 1,7530082 Long Term Debt 704,134 9360158 I Total Current Assets $ 40747,632 $ 4,023,716 Total Liability $ 21365,901 1 $ 2,689,840 Property Plant and Equipment Fund Balance Land and Improvements $ 161,469 $ 161,469 Pledges and Gifts $ 5620002 $ 5046678 Building 2,943,464 2,9430464 Fund Balance 9-30-82 40278,327 3,825,927 Equipment 4 6 44 657 665 Revenue•A Expense Summary 784,724 596,307 Less Accumulated Depreciation _(4,406,740) 4~170~662 Net P P & E 3 243 322 $ 3,591,936 Total Fund Balance $ 5,625,053 4 925 812 total Unrestricted Funds $ 719901954 7 615 662 Total Unrestricted Funds $ 1,990,954 $ 1,615,662 Current Ratio 2,86 to 1 4 MNf\IM1M rn+.~'j t., FLOW MEMORIAL HOSPITAL INCOME & EXPENSE STATEMENT AUGUST 1983 CURRENT PERIOD YEAR TO DATE BUDGET ACTUAL'. PRIOR YEAR BUDGET ACTUAL PRIOR YEAR REVENUES 615,633 668,582 $ 618;112 NURSING $ 6,7709863 $ 69891,468 $ 6,08I,834 641,618 7369985 6629779 ANCILLARY 7,057,798 8,016,421 6,3389934 26,411 216822 20,168 OTHER 290,587 275,387 195,198 (1950011) 5s 011) 264 O92) 181 242) DEDUCATIONS OF REV. 2 146 121) _(21759t478) _(21077t499) $ 1;088,667 $ 1,163,297 $ 1,119,917 TOTAL NET REV, $ 11,974,127 $ 12,423,788 $ 109538,467 EXPENSES $ 405,340 411,702 $ 398,434 NURSING $ 4,458,740 $ 4,521,229 $ 3,935,426 2899659 320,682 294,316 ANCILLIARY 39186,249 3,619,754 209000801 176,229 179,959 178,002 GENERAL SERVICE 1,927,519 1,905,003 1,824,796 719848 78,986 72,461 ADMINISTRATIVE 790,328 809,820 784,695,: 1030260 122,794 791744 G. & A. _1,.135,750 102110929 859`12081 i 1046026 $ 1!114,123 $1,622,967 TOTAL EXPENSES $.,,1;498,686 $ 11,967,~735 $ 10,304,,926 42,231 $ 49,174 $ 96,860 OPERATING PFT. (LOSS) $ 4759541 466;053 $ 233,541 32,083 33,447 33,357 NON OPERATING REV, 352,913_ 328,671 36II9766 $7`5914 82,621 $ 130,217 $ 828,464' $ 784,724. 606o3071 r i 5 a..e 16tfl%fOi 3l AUG 1983 CHARITY REPORT PAGE! 1 PATIENT...... PAT. 10..PT PC. GUARANTOR NAHffi ADDABSB....... CITY.., ST ZIP,. 018.DTE AMOUNT, V _ ALLMANOMARY E 10619925 IP MC ALLMAN,THOMAS A I4t9 BOYD DENTON care TX 76201 04/22103 75.47 AWA[ViDODASSY J 00003673 IP MD AUBAEV,JAME8 iOl 8LM RD LOT 10 g4IVA TX 76241 11/06/89 70.00 ` E MCKINNEY after Medif~id,6201 07/ 1' , 40046666 SR CC DENTON CO JAIL d n 25/83 139 . Da o DATY,DOWL_ Dent pn Co, Jail _ ! BRBWER,GARY 40049918 8R CC 8RMR,OARY OENTON CO. JAIL 0 NONCo.JailTX 76201 08/05/83 76,00 V 6ROWNiNORA E 00009944 IP MC BROWN,MiTCHEELL AT 3 BOX 1120 DECATUR TX 76234 01113/83 3500 1~ Balanco after Medicaid BROWN,RANDALL 40051690 ER BP DENTON COUNTY JAIL MCKINNEY ST. OENTONCO.•daiT,' TX 7bSt01 OSltl/83 -02.75 Balance after Medicaid Oili.2/83 723.83 - f9 76201 40 BURROVQH6 CLARA 00010897 SP MD SURROUONS,CLARA 1509 SNYDER OENTON COUNTY JAIL 4alancN TX 7b701'Sl/22/S2 160.00 CHENAULT, DANIEL. 00012999 OP SP CHENAULT,DANIEL DEN On Co. Jail 600 BTEMMONS CARE INN 8ANfltiR TX 76266 06/10103 -18.80 10022329 tP MC CLARK OLAA lddl gant Care CLARK, OLOA CDRNI8N,M10HELLE 00010214 ER CC CORNI8H,KATHLEEN AT 1 BOX 1065 C/0 TUR DEN ON TX 76201.11/07!82 19.10 • V eaIansg afteer Nadi Cggal 20: 00 ' 0100IN8,NtLl1E 10094452 IP MD DIGOIND,WiLLIE $033 WAGNER THE COLONY T% ~6b6b 06/97/83 Datce after Medic Id 416 PAY N1 5O EAKER,MAH19 DELLA 10025096, IP MC MAKER, MAMIE OKLA 0900 T 76201 06/30/63 gaii88qq¢a after NedlaId FARR1S,rLIZA65TH ANN 40061906 MR 9P OENTDN COUNTY JAIL MCKINNEY BT99V DENTON r% 76201 08/11183 «74.76 ` D9ntonn Co,.Jail, SUNDIAL NURBINO HOME PILOT POINT TX 76258 06/2i/B3 -11.00 FtlglggiMiLORED 40037210 8q MD FtlBTER,MI40RED ga~g~ga after Medl,ggyy~idd 76.07 V HARAIg,VIV1AN _.10006309 IP 8P HAARIB,ALONZO 2$0 RUDDELL M17 DENTON Ti( 76$01 Q2l1S/S3 g~gnce after'NAni N~egea M~~28163 -7 Ea, p tar dat nn. 66 ~EINTON, TX 76D~ HAWRIN8,61LLY OBNB 40091966 BR MD TUCNER,CUARA MARIE 1820 RUDDELL 0116 gpjj~ 0 at pnee,a(tar &i ald HtLLi P5Q0V SUE 1001$292 70 NO HILL, PEOOY 8U[i 6'20 FT140ATH DR 065 D 1440N, ~X 74201' 03/!7/63'-t, 693, 65 BalancCe after Medic ayid _38,00 HOPFMAN,KARL,W _ .40000929 EN CC HOPPMAN,KARL,W 901 WISTERIA RpenoonACOJaii TX 76080 02/06/63 710 N ELM Qdeceased left no aggX 7690! 11/04/0$ -284.00 1 ett ow + HORTON,PAUL E 00033357 1P ADD HORTON,PAUL. 514 9 211 NbO NMI ' TX 7906%) 06/07/83 " -06,70 NU aelance after Cripp~ 04 ghlide n ' ~DOLEBTWI,DOINA WINEL 10034254 1P CO HUDDLE8TON,0INA WINELL 209E KAWBAB 6 6H2RMAN 7 090 Obl9B/B3 -990.76 8[~1~n9 after MentTT h li tai rdatl JACKSON,CHARLOTYK A 10029577 IP MO JACKSON,CHARLOTTE A 304 8 ROOD LL N93 BO61N~TI~N ~C f3 `ef ~b 0' '50 JONES, RACHEL 10007260 IP MD MCOAOE#HAZEL 104 S RVDDELL 05 - D~Ns eft6r ke414 {~6kOl 09/27/83 1,489 60 e WOO aft r Madi aldy _ KELSEY,SHERRY A 40038283 ER. MO WALTER AVRETT 490 8 CHARLES #222 g. }",~.g9 a VILLfter fled'{Xi 506y 06!95!83 15, 00 i i. KENOALLiOLIVER 10043719 IP SP KgNOALL,OLIVfiR AT A SHADY SHORES DD9HnteldgO9N % 6201 09103/83 -2,994'15 K8V KATHRYN S. 40043036 ER NO K6Y,KATHRYN A. 819 N, Lk UST DgNTONd'1aft.n0 a 9t;~~0f 0711f1d3 tt.00 ggaa''ayp a after MediW 46201 06/24/00 10.60 It~ _ KINMON,RUBY F. 10035244 10 MO KINMON,RUSY F. 312 S. RUDDELL 4107~ t)BN7t~N LBWt8,80HR8A D88t f000b336 Ip Mb LEW18,8CHRCA 0E81 1229 MORSE n~ ?wafter Asdi~X16201 016118/S3 91.19 Balance after Ned4sid I i. r; ( 16;71,14 31 AUG 1983 CHARITY REPORT PAGE 2 V ' - ' PATIENT PAT. ID, PT PC, GUARANTOR NAME.... ADDRESS, . CITY...... ,BY ZIP.. DIB, DTE _ AMOUNT. LINDSEYiJANICE 40DS2235 OR CC DENTON COUNTY JAIL E. MCKINN9Y BY. OENYON Tk 76201 08/12/93 -6t;00 Dentonn Co. Jail . • RATA AMELIA 70002407 OR BP RATA AMELIA 990 8 CHARLES #720 LEH1tlVILLE YX 75067 07/25/83 2$ !!ppd~{{Rnent Carre Ylf.7tlOb7 03/24/.@3 -10,00 MATA,AM9LIA 70003371 OP BP MATAiAMEL1A 990 8 CHARLES 220 I,npE4IIAVILL6E 7 03/06183 -66.50 V 7806 MATAiAMELIA 70004635 OP MC MAYA.AMBLIA 990 8 CHARLES #220 LOWI8V1L% a YX Iisont Care ' MATHIO, JAMES L 10006039 ip Sp MATHIS.JAMES L AT 2 8DX 126A NOR Tk 76266 02!1083 38,15 40 BG Ian a after Mental H$alth Mental Rotardatio~p MAY CAAOLYN ANN 70013529 OP SP MAY CAROLYN ANN AT. 3 BOX 72 I BVtLLE TX.. 7b240 07/1I183 136.26 T gg QQehablNtalon b MCCAIN,YONI DENISE tO011656 IP Sp MCCAIN.TDNI DENISE 1912 BURNING TREE D T4N TX 16201 04/13/93 295.80 l] gala after Montppl~.Health M ntag Retardation MCCRORYiJQNN 10041143 IP CC MCCACRY JOHN DENTON COUNTY JAIL DRACIN Tk 76201 ~7/ 3/83 -651.00. , 140 DArttCo Jaf1...T%.,7.61101 07/i16/98. .-157.50 MCCROAY,JOHN 40046740 OR CC DENTON CC~1M1'YNJAIL E.MCKINUC BY p,B~N~pn 40 MIYCHELL IVORY 40051652 8R SP DENTON COUNTY JAIL DENTON CO. JAIL ~ndlTgBN o ere11 TX 76201 08/!1/83 „56;00 ;jrf NABH KRISTOPHER 10014868 IP 9P NASH,PRICILLA 604 STAR pp0AiNtltl WLttLB tTX 16240 03/30/03 87.56 P~ILV~ePdiTMedi{d7bitti8.04/79/82 _137.19 OWEN,CAROL _ 40039216 9R MO ONBNiOARbI RT,Q BOX 217 after Madleeaa{{d +0 PHILI:IPS NITA 10000602 tP 90 PHtLLI0SsNEVA 2229 CARRCL BLVD 1Y1I1~~ i Tx 76201 01/29/63 -47.50 Balance after Medicaid PRYOA,NORA 1002VB44 iP Sp PRYOR,NOKA 2224 CARROLL BLVD. ORWON TX 76201 06/02/93 -19.30 34.00 i ROVES, CLARA T. 40032641 OR MC AEVES CLARA T. CARE INN OP SANGER WA48~1after 17ediW476066 06/06/.@3 RO BtNSBJ6ANDMT /0017713 IP MO ROA9tNSED4I JOAN ARD M RY 06 1 LOT PECAN 3b GROVE CIRCLE frA~~~Il~1.D %7t72400 06/ t/02 -4 528. 90 k Attou Nno}t peAutd u~0on i04in 15!83 -t, 997.75 40 ROBgiJAN1YA JOYCB, 16029742 IP CO RO86,KiT`Y, A, AT .2 BOX Ae. admitted ORHjWffLW,'MedlWd7$eiNt;a44%""'rek 86 SAAK,TCDD SCOTT 40021799 9A SP SARK. ANG19 AT. t BOX 1750 ESPaRI~a~aafter MenuXH~$10t 4Ml~t~ TRkt,~rdati14 90 ti Balance, after Medlga1d a 6AUL8,CHAALCIE M 00060749 tP to 6AULGiCHARLCIE OX 134 AVIREY Care Tfi'16229 10179182 -7 679,$0 . RE ~ SCHAUPEATiTEARY LEL,. 10030032 tP ADD SCHAUPERT,TERRY LEE, 1310 SCRIPTU IDeNTONt YX"76201 07/11/63 .-983t,t0 r $MITH:ANGELINA C. 10029621 If MC SMITH ANGELINA 0. 2229 CARROLL BLVD. MW Protactlvq'Kugwt 06/07/93 -31.00 Balance after Medicare and,MedVid BMITHO'ANOCLINE C. 160124214 IP MC 8M1TH,ANOKLINB C. 2229 CARAoLL BLVD gDENIM a TX '!61201 ob 16/0 L6 J -41.00 ~ V SMITH,DEI619 10004190 IP 9P SMITH 0001E 5404 PRtNCSS.@ 0f LaA1~j1LItArBMadid7sl06b 02/11 /93 -y7.,;0 ealanca ~~1lftor Manta1 Healthh Mental Ret reation ~ SMITH,81EVEN L. 40008542 OR MD SMIYH,STEVEN L. PC BOX 1101 LAME DALLAS Yk 25065 00/041 -22.50 to Ba0 after Medi d 1 -2 91EVENBrALL19 P. 40024753 OR MC .@TEVENB,RITA E. RY 4 LOT S9 EXECUTIVE D 76861 011l11'I/6 to 4: 00 cg r Ba1 c fd X 76dbt 08/05/8 BTUHBLEP1HLD#DUSTY 10043610 IF 9P EPIELO,CECIL EARL 416. SMITH after Nadi SUB L n N 'Care 7k 76201 OS/10ld 3 _l,O6F,Q0 BTUSILEP18LDrAARA E 0006/84'! lP AP BTUBBLEPIELD,CBCIL 416 SMITH 1I 219110 45 1'~1 Indigent Cara y~~ V 16:21:20 31 AUG 1983 CHARITY REPORT PAGE 3' i 'law PATIENT PAT,ID,.,. PT FC, GUARANTOR NAME,....,..,.. ADDRESS...... CITY.,.,.. 8T YIP DI8 DTE AM"T, a %0 STUROLEFIELD(SARA E 40046900 OR SP BTUDDLEFIELD,SARA E 416 SMITH ffDn❑E~dNT~O~Nt Tk 76201 07/24/83 -160-05 TAYLOOR,JOSEPH 40039016 OR ADD TAYLODR,JCSEPH 12b7 TIFFINY L6 ~ 1L~ 7% 75067 06/11/83 13.00 TERRY,RRAD 10032241 IP CO TERRY,BRAD 9427 PRINCE DR 4aaAVUL 'SMediV79067 06/1,6/83 -77_88-» , TEgRY,RRAD 10044998 [P SP TKARY,SRAO 9427 PRINCE OR GLARE DALLABCtIYgt~fu~tB'& 06/12/83 -660.39 ! V p THOMAS,ROURT D 40050098 OR SP THOMAS,ROBERT 0 1090 8 CHARLES 0312.. l.~t~10CLO TX 75067 08/08/83 -193,95' t 4 I~ ~a~t rro. Jail TRAVIStOONNIE 40049926 BA CC TRAVIS,DONN[E DENTON CO JAIL Tk 76$01 08/08/83 -O6 00 Denton Co. Jail UNMATCH$O,CASH 00070096 1P CC , WILSON, JOH. Medicare Reversal of Deductible TX 00000 02/01/83 204,00 UNMATCH$O,CASH 00070896 IP CC , TX 00000 02/01/83 -260,00 ~ ORiffEY, ORAL Medicaid Payment A V UNMATCH$p,CA9H 00070896 IP CC ( 73'00 . Gorman, H. Medicare Reversal-.of_Oeductll?Ie..___._.._._~Tk 00000 02/0L/S3 ` 4r WALLACE,DAVID LEE 40003159 OR CC DENTON CO. JAIL DENTON COUNTY JAIL DE'NTON TX 76901 08/16/83 -14.80 WALYERS(MARTHA 0095435 [P SP WALTERS.MARTHA 4 MIDDLE RD- Dg~Nq~MCO, Jail -•Tk7620107/07/83 °21.00 I ~ WALTERS,,MARtKA A 10024438 IP CO WALTERS,MARTHA A 4 MIDDLE RD _ D&~ after Mentr~kHgrb ~i1M ~~4p~3rdatl 0 63 i WALTERB,MARY 0033199 1,P MO WALTER8,MARY 1080 EDMUNDS UAWIEW eTak 715067 06/22/83 -22:08 ~ i after idi { WELDO%STEVEN TODD 700t8808 OP CC DENTON CO. AUDITORS CARROLL COURT RLDO;` 4 kptoo. Auditor 076901 08/06/83 ' -127.00 A/8 -10.00 i NILLIAMS,LADOSHA,M.. L0030955 IP MC WILLIAMS,LADDSHA M. 9OX 97 B$IL OINTMBdt TX 762 5 9 06/09/83 aj13 478.88 S ! W1 LLINCHAM,ANNIE 10031110 IP SP WILLING HAM, ANNIE OSLO W UNIVERSITY Balance a after fter.Red1 HBa1201 dA0~I4ee 04// y s1 YOUNG,JOYCE 40020829 ER MO YOUNO,JOYCL 104 8 RUDDELL 208 DENTON • X7620 M24/83 rdatl-800 Balance after Medicaid ~j i, _ _ -•-__~31i761, 77._....1! t w • r ; +11 'r M! ' E to V ~ , W R I T E tl F F E P O 9T.PM7 AO FO YOl 9Ep 1903 PAT ID Df9C110 BEG.-~iG • PATIENT NAME T I _ 7YPfi CY GAL, NEW-CHG NEW~PAV, 14-0 B FO 0.00 -663.04 739,6 IP 06 ADAMS,D98NA R 00001131 12/21!03 1+403. 45 400 OAK LANE DR LAN91NG1 MIDD40906 . N9 unable to locate 94 t V i ON GUARANTOR INFORMATION NN JOHN ADAMS - JMr 10b~V1~ 05. 90 .0. 00 0. 00 205. DO ADD 0-146 ADAM9,JAME9 P. 6a1T1 INKER PRAMINOHAM, M9 70204 Unable to 100 4 40077930 05/20/93 Q05.90- V rr OUARANTOR INFORMATION rN JAMV8 P. ADAMS -49.00 240, 66 I0 IP 3 Ofl71B/93 79 1 Na respons4 ADAMS,KELLY J dtlDOUGLA !ADAM/02 409.66 -120.00 sox 273 9ANOER, TX 76966 Nr GUARANTOR 1NPORM4TION Nr DOUGLAS ADAMS ALOHAMOI,HAMDAN A 00001917 12/91/92 840,00' a0- 00 W DENTON66 1762013 Ar OaA0eMent$ not Fk pt 1 ;I• V' No GUARANTOR 1NPORMATION wN 14AMDAN A ALOHAMDI 11 94 00 { OF IP 1 07/06/93..-._ 59~ 1 ..38 3g _ - 994,,00- ALLAM,MDHAMMED M 00001950 03/07/01 1+029.39 0,00 Nr ION NN MOHAMMRO At-LAM PO BOX 5125 ALPINE, TX 79930 Arrangements not kept V GUARANTOR iNFtlRMAT 0100 ARANTrOIANE M 00002956 09/g4/92 370.83 12dBOHENDGR90N 019 OBAIDOEPORT, TX `76026 100 response 362 ^ 1 , Nr GUARANTOR INFORMATION NN MARK A AflANT O 00 _ bd0 d0' 9P IP 3 09/09/92 J 094 ! 00()03601 00113102 , 00 0.00 0 ARIOPE,NATALIE D 301 BELLAIRE DHNTON, TX 76201 Arrangements not kept , „ 71 Nr PVARANTOR INFORMATION Nr DANNY AR10E - ~ _ if43 1 Od003293 of/01/83 1, 376, 7l1" 01,00 0, 00 li7b. 1b 9h1P 1 f: ARRIOLA,GLENDA 9XLVERDOM9 MNp 099 DENTON, TX 76801 Unable to 1003te No GUARANTOR INFORMATION Nr GLENDA ARRIOLA f03 1LLti, iX1679ob7 EA~ 1 Unable t0 locate d ARTGRDGRRY+L9C 00003327 10/04/92 02,. 6 93. 3 0 LEWt9V0100 r Nr GUARANTOR INFORMATION Nr LEG ARTERBERRY 00o00022 0009/88 sti9:95 1017 00 0.60 gig. AWWAD,NAVERT 76801 No r! ponce 600 , W MARIE N7 AENTtlNa 7X O0 Nl NN GUARANTOR INFORMATION NN KARIM AWWAD " 00# 00003055 1005192 945.06 b40HINKLE AYER9,JEASICA PRBO AVERS 24 DENTON947X0576Q0! I~f 1 No response r NN GUARANTOR INFORMATION NN _ „f ! 9AOLEY,SHERRY A - D 06 3 il37;'A5 gP 1P O 00003996 19/04/812 1.1137, O6 61-06 Nr INFORMATION * TERRY BAGLEY P.0 VOX 841 DENTON+ TX 76201 No response GUARANTOR TOY J • lI 00004010 07/13/92 850.00 p0 0tl% Igp2bpANGGR,~7k 076266 Ifi # Ara gements notlkept 1- y I~ ` rN GUARANTOR INFORMATION Nr CHAMP 9AI4G9 No rag once AILE9+CHAMP P 6455 0 29TH 9TAG Od ET -NO ~1l9 RTH ST PF.1'GRGBUR, PL 03702 r II J 0004419# 09/10/02 '719 '70 . . 0.0 d - d0 •9P GR.. # pJ^~ 366 BAKER, DEBRA Nr c. GUARANTOR INFORMATION Nr DEBRA DARER • DARRON,PHYLLI9 00004097 d269.91' 50440MARTELL ODALLAS,, TX 75206 $ No roponse !83 "t 'd• + GUARANTOR INFORMATION Nr 0040618 BARRON 9/93/0 - a 466 1 I. 0-1 AAfl1H,JG6NI8 A 00004560'09/23/02 l 441;,15 90gd0AWRGNCB OGAING6VILLt2, TN 7b~ d Unabla.~to locate 04 GUARANTOR INFORMATION NO GARY A EARTH 00005670 11/87/8[1 655,63 0 00 b 00 605,63 8P °!fY a tiZ1Dl%9G' __.@7G JJ. 09LCHVR, KARLA J RT 5 BOX 168 DENTON, TX, 761201 ,No response 1 Nr GUARANTOR INFORMATION NN JIMMY D 9GLCHfip I' -'"9ERNHARDs4IARY E 00006009'tf/0"a to 16e, 00 5, 169 3TX 9P 7 1"1 range # 300 1 R GUARANTOR INFORMATION rr DAVID DERF(HARD -bi 0 MILTON LGNl9VILL8, T% 76067 ' Arrangements not kept • ,al` Li !I w r 1!►1',. lr, , pig` r Ol REP 1983 W R I T S- O F P R E P 0 R 7 PAGE 9 PATIENT NAME PAT ID D18GHQ DEO-DAL NEW-OHO NEW-PAY W-0 DAL. PC TYPE CYCLE LOT PMT AGO PO , TYPES , r PURRYsTINA 00006307 105` 1 . INFORMATION rrROCKYM021NOd 82 1r594.86 250.00 -071, 94j '652. 09 SPENCER RD DENTON89 DP ON 76D01 3+~ No/res/ons' TX BP , . .---1P -4,_O...R/.24%80 --T.- J 11IN0E ,DARBY A 00406619 12/27/82 030.BO 0,00 26, 00 300. SO S 1~.' rr GUARANTOR INFORMATION rr RANDY D BINDER AT 1 BOX 187 PRtBCD, T% 75604 Arrangements not kept L r BLACK,WILLIAM H 40007070 10/00/02 1,013.40 0;.00 0.00 11010.40 8P to - "b'-13/24/89 _006 1 rr QUARANTOR INFORMATION rr WILLIAM BLACK AT 1 BOX 151) OORDONVILLE, TX 00000 No response, BLAND+ BESSIG 00007302 05/22/82 1,526,00 0. 40 0 00 1, 520, 00 '8P IP ~ ~3-. 40 -~1 : ^ ON GUARANTOR INFORMATION rr DEBBIE BLAND RT 2 BOX 974 AUBREY, T% 76227 No response ' GLAND, DIANNA L 40003001 62/12/03 94.20 147, 00 6.06 243.25 ADD _ pR~ '_N8~ 1111 i ~ - rr GUARANTOR INFORMATION ON RONNIE L BLAND 326 EAOL2 DONTON, TX 96201 Arrangements not kept DOLDIN, SHERRY L 00007760 02/18/82 411. 76 0. 00. b, 00 477 7p BP iP 4 3 OBrr2/8ti - _ _---bbD + f - ON GUARANTOR INFORMATION er RICHARD SOLDtN PC) BOX 372 SANGSR, YX 76266 No response n J DOWLING,BRBNDA S 00008185 12/10/02 '6, 597.30 0.00 .-0.60 61 b97, 10 _OF GUARANTOR R41NFOflMAT20N rr 0000Bp76 Y 11/ObN89 N01~274,2lS - 18RT.S 0;'SOTWIN L 01,97 DgpTDNIp7%62-1 1 0 J ArYen9emg POt k$t DtlYD f__ _ X er GUARANTOR INFORMATION rr MICHAEL S BOYD 530 S KEALY 04 LVIBVILLIL TX 75067 Arrangements not kept, i BRANCH,BEVERLY J 00000601 09/28/82 540. 47 .O,'bd 0.00 646'47 0 'IP~3 `10%14%02 i33d~`~f + rr GUARANTOR INFORMATION rr CHARLES BRANCH AT _1 BOX 331 SAN99R, TX ,76966 No response BAICE, COLETTA 00000946 03/90/02- 1244,`60 b, bb 0.00 244, b0- OF - 011-,__ rr GUARANTOR INFORMATION rr COLETTA BRICE 711 8 HANCOCK COLO SPRINGS, CO 00903 •No response j - BRIMMER,MARQARGT J 000OjOB4 06/20/82 dab, 25 ° Q.pO.._.._.... 0, b0 4no R$._ SO 1o_,._""..4__.06/00112:._,._._-461.W i rr QUARANTOR INFORMATION ON WILLIAM BRIMMER P. C. BOX 61 DRID05PORTr Y% 76026 Arrangements not kept ; J - - ORI9GDE, ROBERT L 00009109 01 / 10/93 5, 149.96 6.00 0706 -tit-149 90 re GUARANTOR INFORMATION rr THELMA BRISCOO P D BOX 1776 *099NVILLE, TX 76401 No response ; 3 (2T3 _ _ 1 , BRIS 0SoROTSRT L OOD09167 12/04182 Sr 482. 2p - 0. 00 ` 0,00 Si 4B$, 211.. 5P 10 bR INFORMATION rr THELMA BRIBOOE P 6 BO% 1776 OREENVII.LE, TX 70401 No response BROCKFKVLLY L 00009302 19/91/02 167; 43'-'---74,00 0.00 -241, SP 01710/83'...___..iitl . 1_. TX IP, y AAANV ROCK AT 4 BOX 374 ROANONE, TX 76269 rr OUARANYtlq INFORMATION No, LINDA BROOK J ` SROCKt;TT, JULIE D 000099$3 00114/02 973.00. _0, 06 0, 00 073, 90 ADD " IF 3No` No response jai -~4~1 ON GUARANTOR INFORMATION re EDOIE OROCROTT RT9 00X38 CAPRICORN MHP DENTON, TX 76201No response u I'I' IIROCKUARANT4RNiNPORMATION rr000JUL1E4B01/10/03 845, 90' AT 0.00 Q 0.00 045;'90 'Ann 1P NS • . 1+34-_ 1 00 G BOX 38 CAPRICORN M DONTON, TX 76201 NO response .._1P f f i f BROWN, SHERRY L 10013094 03/26/83 1,401), 70 408, 90- _ d. bb "G 097r b0 .ADD fj Of GUARANTOR INFORMATION re 11010 L BROWN 3J00 PALLMEAUOW #2219 DBNTON, TX 761201 Arrangements not kept u 1--- pptlHNU, DflCW E 0001 0109 it/01/89 Sl6 60 ~ 0,'00 ~ 0 b0 - 01 er GUARANTOR tNPtlRMAT1tlN re pgSW DROWNS 1124 W. MAIN L6WISV1~'tiQ SP' "TP f _ _ ~i.-1 ,tt• „j It LLD, TX • 76067 No response s, l` ✓ ~ W i Id 1 i r" 01 SEP 19p3 WR I TE-0Pr REPOR T PAOEO 4 PATIENT NAME PAT ID DIBCHG DEO-DAL NEW-CHG NEW-PAY._ W O DAL FC TYPE CYCLE LBT.PMT- 6Ofi0 TYPE ORYSON, ADELLE 00010397 09111/91 1, 107. 50 0,00 0. 60 - - ~ ' so GUARANTOR INFORMATION so I10r:nT BRYRON 160 107, 90 ADD 1P 055- i`y DUCKLEY,VICKIE J 00010469 10/94/02 531,57 P0,0OARtD00;OO~w7gb31~97 rtiP.780p7"3"'111/Q9/6QSe y alit `1 xx GUARANTOR INFORMATION xx GREGORY D BUCKLEY COX 542 LAKE DALLAS, TX 75067, NO respOrisA r S'!nt,,1 BURCH,LIRA s'+ 00010995 00/a3/82 1,540,70 0100 6, 60 1, 540. 70 ADD ]P 3... 14 GUARANTOR INFORMATION xx BILLY BUNCH RT I BO% 301 DANDER, TX 76266 074 1 _ r~ Arrangements not kept CARDINALi MARK A 00011776 1Q/10/Di1 933. 261 - 0. 00 - 6,00 9b3, 26 - _.1P 3 01r'03/03 ----1265 " 1 xM GUARANTOR INFORMATION xx MARK CARDINAL NO response - CARLTON,WAYNO L 00tl119b0 1Q/l9/02 061.00 b00X00p1 MI0 00 C1T061.do 99P60 0P 0 ax GUARANTOR INFORMATION xx WAYNE CAR41ON PO POX 372 LITTLE ELM, TX 75068 104 No response Ij , 6ANNEd9KENNd1H R 00011916 11/06/09 11139. b9• 6,'00 -1i 503.24---336.33 Rp.._.1P'~J too GUARANTOR INFORMATION xx KRNN6TH R CANNES 456 PRICE DR L8WI8VILLE, TX 75067 No 'response .r QHGRdY, K!'NNL1H L 000!9971 08/14/90 277.00 'a , 60 6. b0 Co AD"' - R ~N8 '00g f rx GUARANTOR INFORMATION xx KENNETH CHERRY 609 PECAN DOWIE, t"% 76236 -No response dLARk,BILL18 06013300 07/16/0$ d6b,55 0.00 b bb 066 7B -ID IP 0 W .i Nx GUARANTOR INFORMATION xx R08RRT CLARK 201 VANDRRPILT' 0EN10N YX 76201 kept f Arrangements not Qk7a 10 CLARk,GUARANTORCHRI0T0PHL INFORMATION xx 0001RI303CKY4 !1/9CLARK4/82 2', 547. 0.00- O 110 21547 l0 BP 506 4 pOAS xx 91 NDRYH81D0 LEW18VIt.LE, 7X 78067 No response , CLARK,Ol818 00010379 i l /06/82 033.35 0, 00 0, Ob 033, 39' 8t! xx GUARANTOR CLARGUARANTOR INFORMATION xx JOHN CLARK RT 4 BOX 236ROANOKE, TX 76262'- No response IN L 00613496 05/14/82 5,772, 25 0. 06 ^100 00 6;072 2$ BP J~ IP 2 03 13)8J 174 j xx GUARANTOR INFORMATION x+t RICHARD CLARK 9201 VANURBILT CT DENTON, TX 76201 No response J dLARk~ tlHELI:IC W ....00013940 '19/14/52 40, 78 1.047.-6D 0 O6._1-0 066; O'9"Bp 6R....-2_..___ •x GUARANTOR INFORMATION xM JAMES CLARK AT 1 BOX 66 AUBREY, TX 76297 No response CLARK, TRACY L 00013493 08/29/02 690. 26 0. 60 0. 00 0110: 25 OP 'IV" 4--~ CLAVYWIANURA 00 GUARANTOR INFORMATION xx TRACY CLARK 06013649 DARK AT 1 9D\ 96 PONDER, 1X 76289 NO response OUARAN70A INFORMATION xx NOOERT CLAYTON 21S/82 8, 300, 10 01 CO ' ` "0 dd 2„3005 73P 7P `8?13Ni2/kH/B2 CLAYTON MONTE LAROd NE ALOUOUBROUE, NM 971Q3NO response 00014266 00/14/09 000.00 0.00 -20.00 400. 00' 8P IF _ 3 64/30/9L' 124" `1, xx GUARANTOR INFORMATION xx OAYLEN COFROY PO POX 130 LOIA AD OANORR, TX 76266 No response r 060PRO, PAUL f . 00015032 10/27/09 929 10 0: D 00 00 GUARANTOR INFORMATION xx VERLENE COOPKR Iii - b 01/20/00 DOq'' 1 j PQ n0% 116696 CARROLLTON, 7X 76011 No response C GtAj ANTORRV INFORMATION M* GUARANTOR INFORMATION +x LANNY 07/27/03 61D.10 0100 0.00 61D.10 ADD IP---- OOb16063 TELFORD CCOVENTTCCN 70 95500 LOU19U 0106 02NTON) TX 76201 'able to locate ~4 1~ {~u CRISP 00 tog. 70 BP IP 3 f2/111/62 993 xa GUARANTOR INFORMATION xx 0JOORPH 16063 F. d, tl0X 465 KNUM, TR 7X 76949 No response J t J OS R0p 19E+3 WR I T9 PP REPORT PAN 4. PATIENT NAME PAT, ID DISCHO 090-DAL NEW-CHO NOW-PAY W-O, DAL_•FC:TYPE-CYCLE_.LST,.PMT,,AGS a FO 'TYPRI ~ , A r •-rr, i , M GUARANTOR CM+PI INFORMATION ww0o GEORGE CUPp 7/92 070,94 0.00 0.00 676.94 SP IF 3 12/26/62 339 1 4 RY 2 BOX 900 eAN0ER1 T% 76266 No response l ' OURNBTT,BVA INFORMATION w*00016501 09/10/B2 247,10 0.00 6.00 2'47.10 Be IP 3 iR/07/62 35t 1 1 RR 2 BOX 227 K SD . WAgDB TRAFALGAR,, IN 46181 !y J BVA CURNETY ko_response.. bALTON JIMMY L 00016766 07/0tl/02 211.00 O,OD O,OD 251.50 ADD E.. - ww GUARANTOR INFORMATION +iw JIMMY BALTON 020'ROSE BY DENTON R, NO 4i10 1 , TX 76201 No response 'DOilGUARANTOR INFORMATION wwDDSTEVE4DALTON 82 1,02E 80 RT 4 LOY 06 SMP OENTON,'T% 76201 No response - 0" 00 • 0. 00 1, Oils, e0 Bp IP 1 30 pAU09N,0146RI L 00417160 11/08/02 1,014.24 0.00 -10,00 10 004.2D 8P IP_ 2 06/17/63 76 1 . u ww OUARANTOR INFORMATION ww DAVID A DAUDPN AT'1 BOX 061 RED OAK 1X ,70104 Arrangements not kept " V EY C 00017640 0d/20/0ff 613.40- 0.00 0,00 ^613,46AD0 NB 08/20/82 DAVI IP GUARANTOR ~B7p TOR INFORMATION ww MARK DAVID - AT 2 BOX 16 RWOE DENTON , TX 761301 No response bSATDN JAMDB E 06017659 11/08/02 Is 033 70 0.00 d. 00 " 1, 033.7d BP If;., ¢ II97~»~'1 rw GUARANTOR INFORMATION ww JAMES DEATOM 433 HILTON LEHISVILLE,,TX 70067 No response 1 DOGUARANTORRINFORMATION ww00VICTOR SR,DEHOYOSH1467.4D AT 'I DOX 409 AA~DBNTON40TXBP76901 4 Arrang tints not kept Arrange 1 J Si b9 y 0.00 -19.Oq _41 B, 118 BP 4 1P' _ _1_ 00/31%l 93. _1. 3 DILLARD,JULIE 00016610 10/07/61 - 431 ww pUARANTDR INFORMATION ww DAVID DILLARD C/O OILDE 300 BP HOUSE GENTRY RENO NV 89002 g t~ ` D0D68. LAURA A 00018622 00/20/82 1,140.00 0 00 106, 00 f 1646 00 iD- IP' 0-. db%Oq@~I pts not I@ 1 I i 11 rw OUARANTOR INFORMATION ww PRESTON DODDS 00 BOX 428 KRUM, TX 76249 No response, 44 BdWOV, 8U81> 00016095 13/22/62. 1 377, 40 0.00 0 00-. 1 3".'46- BP •_-lA _ 951 f- 1 1J1 ♦w GUARANTOR INFORMATION ww SUB99 DOWDY 306 RUDDELL M98 DENTON) TX 96201 Arrangements not f'ept 3 U N DRAKdoJANIS L 6b019000'Ob/19/S51 605.00 i15. 18 0.40 7@6.96 --ADD L/ ww OVARANTOR INFORMATION ww BTAN',DRAKS AT 2 BOX 170 PILOT POINT, TX 76208 No response DUNCAN, MARY 1 06019190 09/0/02 411.79 0. 00 0 00 4i1. 98_._SF I-p.__ b- ° TO%gB76it 4~ 94Y~1 GUARANTOR INFORMATION ww MARY I DUNCAN 900 REDWOOD DENTON, TX 76201 Arrangements not kept J 11YOR,RICHARD B ww00903/82 532. O 60 PO DOX 323 OAKRIOOEOMHP6a0AdINESViLLE,YX 16240 GUARANTOR INFORMATION PATTY DYER Qnti.Ret ke t.. ` y... •...~''il~ DYBON,JO ELLA OOD19630 09/24/62 64a.20 0. 00 -200.06 496. 2d BP IA-'-d 06/01/83 ~1 - l _ . v i rw GUARANTOR INFORMATION NO JO ELLA DYBON 2000 FT, WORTH 034 DENTON, TX 76201. Arrangement; not. kept .d GASLA ww66607/d2. 380.74 613 0.00 GUARANTOR INFORMATION DAVIVEA8LEY 1 966, Y4 ADD Ipu` MS"`107ial0~_ D~4` C 14TH BY CORPUS CHRISTIEI YX 78464 `Unable to locate _ b91.O6'_Abb -I0 N9 160_ ~ gLSSoMICI1BLL8'LNPORMATIOM w»000DANIEL DONSO 80164 O7%14102-~-~2d4;`71 --701~8HADY~S~dRoB jWAKB DALLA81 Y%,,7tS060- Unable tplopete +@bq l 1 _ ADb _IP`_ `N8- Tb'il}r*IStE 41~_ "i ` 1+ ,1~ 1 ww GUARANTOR INFORMATION ww DELLA STONE AT 1 80X A KANDpOLIB, K8 67404 NO response, , r 'r' •1X1•✓:. r .t r i9 1 Of app 1083 WR I TEOFF REPORT ry r, PATIENT NAMt: PAGE PAY ID DtOr,HO DAL FC TYPE CYCLE LRT,pM7 A 00=007 d»DAL-..NfiN Ci10_._ NEW PAY _W-l) AGEe {1 O,+eI?~+{'Yf~ ' ELMf1ALLAMY, f _ _ - - F YP6 01/28/79 398, 60 0.60 0.00 398, b0 ADD Ip" NS 17%09/22 877 j - i1 ,1 , ww GUARANTOR INFORMATION w* AIIMEU H01/90 320 FULTON DENTON, TX 76201 Arrangements not kept ELM RIMY L 00010362 1R/04/02 1 281.10 w* GUARANTOR INFORMATION *w 0.00- 0 00 ' 21 061, Od-yip KENNETH RLZY RT 2 Dbk !ql AUDRfiY, 7X 76227 No response 1771 p, EMORY TOMMY L 1 fM1 ,1s 00020412 01/07/tl2 917, 60 IP { W 10/07%98 V60if t " *w GUARANTOR INFORMATION TOMMY G 0,00 0, 00 967. Go --Bp, 923 1/2 HILL tai DENTON , TX 76201 No response RBPINODA,MARIA 00020DOO 10/30/02 1, ODD, C9, 706 PAISLEY DE w* GUARANTOR INFORMATION *w MARIA EBhINOBA 0 00 ' 1, ObD.7i6ADD ' IP H0 J l/111/62 306 1 DENTON, TX 76201 Unable to locate E VAN B, 'r ERl;BA ~ 10027820 OD/94/03 793.19 -14.00 .0,00 767.494 ADD ~1 4_ w* GUARANTOR INFORMATION EVAMB. ROYCE 3661 gtlANOKE DENTON, TX 76101 FANNING+DONALD W No response rw GUARANTOR INFORMATION wxf030NALD WIFANNpNG 350.00 _O.OO 0.00 380,00 BP !P 3 - - 148 1 ' DD% 6 RANCHETYE EO KELLER, T% 76242 no response FARHANt,FARIOA 10022416 00/02/87 649, q0 0, OD *w GUARANTOR INFORMATION FARIDA FARHANI 0.00 640,00 ADD IP STARK HALL 7WU #704 D6NTON YWU,' TX 16204 311 1 F9AGIN9,LAKEI9HA L Unable to locate * GUARANTOR INFORMATION w*00 JIM PH 1AGIx11NB 4/01 L DBD, 10 1110,39 b0 0 MCDONALD tl0 DCN p JIM FE - , DBD20~ Op IP 2Eit 1 ~ r TON, TX' 76101 No response FLANAGAN, DONALD JA 213 1 W w* GUARANTOR INFORMATION ww00DDNALb OR/FLANAGAN 617,60 - 0.00 p, l,V OO TX, IP N9~ 316 pREOTpN GA OAINE9VIL L0, TX 76140 Unable to locate ~ PbROMAN, LORI L 00022002 10/90/01 062, 16 0, 06 0, 00 2 , 2.1- 06 0--40- if 1 ww GUARANTOR INFORMATION w* Li FOREMAN ' 105 FAEOH MBADOW DR ROANOKfi1 TX 76261 X16 YN A „NO r@sponse { _ w*CIA,OAROL 00694063 '11 /2I m- 06"167--o' .06..w. h9A.47...__69q•!f'7.8p.~ IFI""~ "OO%bDI93' 64` 0VAAANTOR INFORMATION *w RICHARD GARCIA ' R41D 11 OAK 1130 DENTON, YX 76201 - ' ONf3K GUARANTOR R@fused to pay 40029946 041@ 0/80., _ -04,30---.994 ; 46b bb - _479 D9 ONs OR° 7v§ ` ~ _ ~1- -1 f 'F INFORMATION SANDRA GAOKEY 912 CARDINAL DR 0171 DENTON TX 76201 GONIRY,WEO OUGENE Unable to locate ' w* GUARANTOR 1NRORMATtON w* WEB EUGENE GENTRY I 4400401 0011941 06/l4/NT 110, 30 149; 60 0 Op gD'I 40` dbO "L3ti`° N~ + DC "7 1 A PO~BOX 130 HUNDLIIY DR l.AK4 DALLAS, TA 7Dtl66 05opPR1ON, tlOfiRT 04121/23 `17, So 066.'Oo 6, 00 ,p Unable t0,J0cat@___-4~. 1 ww GUARANTOR INFORMATION w* ROBERT GEOFFRION DfiNTONDD3 075, T% ADO 76 6.20 'NEl 109 PT, WORTH DR 106 Unable to locate 0ONZAL111,11ARDARA 0. 40000654 02/21/f13 40.70 233. 26 6, 00 274 00 8P ww GUARANTOR INFORMATION DARDARA E, GONZALEZ go ,-b' J - 1102 BOUYKLANO PARK BHRRiVEPOAT, LA 71111 A3 W 1 GRANTrtlTf;VGN'1 00026DSfi 61/17/03 ` 402.70 ' Unable.teJo.~ate d. bd ww GUARANTOR INFORMATION *w TERRY GRANT 0, tlD 402 363`. Atib 6p~"Tjg' OONORAL I10LIVERV p1L47 POINT, TX 76206 Unable tlltY ONAY,JAMES RANDALL locate 100007/09/63 bbb, bD' 0,'00 0; 0D ww GUARANTOR INFORMATION *w JAM90 Nfi1 RANDALI. GhAY ..Unable to GENERAL DELIVL+RY I.ITTLO ELM, T%, 78061 BIZ I GRAY,JAHRO RANDALL locate l 4004416 DB/07/93 677; 78 -6100 b. Ob --1' 7 7D -"'Ab0 ww GUARANTOR INFORMATION *w WINSTON WREN AT 1' BOX L42 A PRIBCO, 7X 76014-11~ 1 i ;1; Unable to locate J~As' i Y. 1 121 R 0 P r, H PATIENT NAME PAT. 11) 018CHO 1IEO-DAL NEW-CHO NEW-FAY_~ IIAL_TpC.•YYPg_CYCLB ST_,_pt]Y.~_ _ pQ ~pAGB b A"7 r-~ ; OUT IERRtt2,GCOROINA IOOROD33 00120/tl3 227.90 0.00 0, OD 227, 80 ADD IP NO i;0 h0 ` rx OVANANTOR INFORMATION wr DEOAGINA OUTIERRE2 2608 N. LOCUST DENTON, TX 76201Unablo to locate HAGAR, JUDY 00026110 0170010310'060. 76- 6, 66-- 0. 00 ' 1, 0012. 70~ SP-' CP _ 2 1 response e; rr GUARANTOR INFORMATION rx CURTIS HAOAR TWIN LAKE MOP LOT 274' D9NTON, YX 761201 No 6 1 ' ,4► i--7. HMRAGUARANTOR INFORMATION 00OQCURTIS HAOAR/tl3 700,09 0.00 000 031126 755.85 ADD I TXP 7620180 N it8 response _..3 HALL, GLORIA A 00028480 01 /03/93 21 267. 75 1 107.00 0.00 7, 1278.76 SP ~ Ip 1 Stab 1'-" ~ Ax QUARANTOR INFORMATION rx CONNER HALL PO BOX 401 DENTON, TX 76201 No response HANCOCK, tLLEN 60000944 09718/02 760,15952.65 0. 00 11 020, 00 SP IP O 11* V- rx GUARANTOR INFORMATION rx PAUL HANCOCK BOX 076 FR19CO, TX 70034 Ho response ° r+ 21ANCOCit,MIKE 00028986 07/29/82 44.00 .b. 00 -16.00- 9t4 00 Sp'--1p 4 ^NC6-/ib/ S rx OUARANTOR INFORMATION xlr MIAH HANCOCK 701 1/2 MOSS OAINESVtLLB,'TX 70240 OxxDQUARANTOR INFORMATION r»OOTTERRY gHARDAWA00 941.40 7ibil LATYIMORS DENTON,4TX 876201P No response F HARMOtti (JANbA L 00029679 00/20/tit 2, [6b, 10_._d, 60 0, t10 A-206.10 SP ` IP b- -_S9/!2.4783 -Y.-vO65---_ i_- rr GUARANTOR INFORMATION rr CHAALES 7,HARMON sox 119/DbUGLAB LITTLE ELM, TX 76068 No response _ . NARVEY)OK C 00030379 10/21/02 21 701. 35 6.'00 _ D. OD Sty 731, 50,. yp-- tp..__ 3 xx QUARANTOR INFORMATION xr EMMETT HARVEY AT I BOk 194, IA WHI7309OAO, TX` 76307 No response + - 60. 7A 00 tl, 00 -9, 46b~ 74 •"Ab3 10r N9 rx QVARA RAMTOR TOR INFORMATION xx SAN708 S HERNAN SRNANtlEi HORNAND52, R 1009716 07 4 glb FnAME 09NTO% TX 76201 Wo response !i9 -HICKS, 502AI♦6YHA 00038009 Ob/30/d.T 739.40 SA, 60, -225',,00 6401"40 6F 2I+ t Ab Ageme is noty0 rr OVARANTOR INFORMATION xx DENNY HICKS 301 CORONADO 01069 DENTON, TX d 70201 kept' { NILLIA~t3, RONNV q 000323134 10710192 9i6, b0 .0, 00 tl`dp_b6 "Abti f- rx OUARANTOR INFORMATION rr SONNY HILLIARD I1t?b PRRRY.0904 IRVtNO, TX' 70061 No response. S IitNDIi hAMI T o06394t20 01'/t'0/03 1; 144, 60 0. 0 06 W Hf -6, 60M71 -iAC 00 dfL__" T MR GUARANTOR INFORMATION xx ROBIN Htkb1 2 76005 Unabl e t0 locate,' , wiLmim JANTOR INFORMATION xxObbILL,HOLME80700 ' 679, 76 BOX 772 SANQER -00-~819. 76 Sp ER Unable to locate @3!! i ":e I HOLT, 9M141 US INFORMATION rr 0003n016 ROnER H01/19/01 2,245.66 ~00. 60bt! -000, 00 1"940. 60_ . SP Ip "0R/29783 ' 1--f-* 40 A GRANDY LAKE, c6 80447 fl 1 HG170', AdbCRY _ - Arrangements not kept. 100RD76q 00/29/83. 379;30 6. 00, "0 00 '077 3U ADD- YP~; Unable to locate JY9Q-'-' I , ' J xr OUARANTOR INFORMATION rr R03ERY'HOOD 3209 HALL DALLASt YX 76901 (Ij HUIMMNATALIE 0003396! 21/23/03 1, 10 0.b0 0,00 1 2131 10 0 . 10 'r If - ttfff t ('V re GUARANTOR INFORMATION rx NATAL19 HUDOINB 270. 1131 DALLA D D NTON, I _._"0. Refused to pay NUN7EA, gHIRl.6Y I J 60034397 09700/d0 0; 372, s6 00 $ tl0 6' 375$ ~J9 is 7 7 A30 11 201 "]P `N9 012)12121 W + 80^" `~br 1 t, .11: er CUARAN76A INFORMATION rr BILL HUNTER p tl BOX 372 AUDREY, TX 761127 OAabte to locate s 1 I I a QO 7 N R I T E- S P Y REP U R T i O1 5¢P 19113 r r TYPE PATIENT NAME PAT ID D1000 DEG-DAL-. NCW-010.•.,..,NE,W-N11Y.,,-_ W~f1 DAI._ f~.TVPE CVCL6,_LO7. PMT A06 350 ..~+...-.a , 00054546 OS'/f7/02 I/Ob4,6b 0 MD IP 3 - , HUTCHISON,NICY E .bb 0 tl0 O .O DES 60 NTON, (X r xx GUARANTOR INFORMATION rx NICY HUTCHSION SO0 D RUDb¢LL WO 76201 No r05pOn50 7b20I Moved 1eitn0 address 1 t 'i r + JACKSON,A¢pDIR L 00034903 18/15/92 ZZ 457, 6J 03 O LOOP 208 APT 23.64 03 jO4 -0 to x4 GUARANTOR INFORMATION *x JIM LEV JACKSON 4 er y5 00030402 04/24101 11704.00 0,00 -5.00 11099.00 9P IF 4 0£l/19!93 _ xx OUARANTOR INFORMATIONI 00 ANOODHIRA JAPARI 43-2 D UNIV PL STILLWATpR, OK 74074 JAFARL ANOODHIRA OD03591y7 80/tllOa 443, 85 b. DO 75, 00 365. QD.. 9P OOb9 7--p07%j3¢nts not kept • JARDJNS,DONALD P 0 BOX 1004 LAK9 A DALLAS, TX 7 No response xx GUARAN;U'I INFORMATION xx DONALD JANDSNE _ 00039076 06/14/92 317.56 0.00- 0.00 317, 9d SP IF 3 49/44%09 444 t_ JEFFCOA A nT,3 BOX 194 GAINESVILLE, TX 76240 Arrangements not kept + *0 GUARANTOR TOR INFORMATION DON FENL¢Y w xx _ d16-'"-`I OOHNOONo »x00CAb8IE DjJOHNbUN 1'1367,10 jigoI! HICKORY ]DENTTON so , X 076201p p Arrangements not kept Hb1 1 " IOHNEON,GRADY O 00036199 12/14/01? QO& 95 0,00 0.00, 206,4ti AI1D It N6 + xx GUARANTbR INFORMATION xx GRADY JOHNSON 700 CONTOUR DR MRXIA, T% 76667 Moved left no address 60036749 06/01702 494. 10 O b0 0.60 - 444, 15y BP IF l JONSS,CHAD W AF I BOX 43 AUBAI:Y, T% 76227 ko response I• xx OUARANTOR INFORMATION wx PAUL JONES + JONES, CHA% D 00036704 09/03/02 922, 111 tl OO 0, tl0 288. bi 6P 11~ 3 18/ 1479/1 363 1 1 + xx GUARANTOR INFORMATION x» JIMMY ROGaRS PD DO% 90 D9NTONJ TX 76201 _ Arrangements not kept {{I • JUNBS, CYNTHIA J 00036795 bU/30/01 * D60.42- R0. a - SOX 39A tlAUORE 69. 42 76227 ifs ~lrrflngem00n S not kept xx OVARANT13R INFORMATION xx RANDY W JONES 0.0 LA,FLAMM9 OLORIA J 00034394 09/94/82 1,320.40 90X00202 LAKE DALLAS, Tit 76066Ip No response xx GUARANTOR INFORMATION xx PLAMMS ROBERT LA 1 _ _ 014 I LAMBENT, WENDV A 00039620 10/22/02 1, 041..80-.... _ 6g7 O GUARANTOR INFORMATION CORA LAMBERT QERNARDbNlS -DSNTONi I%8P7b2ol O Arrangements riot kept r r~ + xa xx 0, at- I 00 LANIRtP,LORI A 06009941 60/26/02 006,18 AT 2 BOX C16.2 oAUERRY0bTk2,76287.jP Arrangements not kept y_r ,1• LawTOUARANTOR INFORMATION w400MICHA04f LANI'R62 422.' 000 GO -n b6_. . 4$12,6 bP tp 3 - 1>#/2~flb$ Ob4 ` 3 • AT. I BOX tOAA AVSR9Y Tx 76227 Arrangements not kept LAWRIIN05,t.RAH N 00040053 01/26/133 782.96 "494.75 0, 00 LQ97 bt1 8P tS not kn t r w x11 GUARANTOR INFORMATION xx LARRY LAWRENCO L110 OAKWOOO OENTON, TX 76201 Arrangamen t'R 7i -L9ATH VICKI 8 00040d7O 10/12/02 126.00 d. 00 b 00 _1261-66 -80 GUARANTOR INFORMATION xx VICKI LEATH RT2 SOX 027 FRISCO, TX 75034 No response } + R09 1 X11 ' L¢AVELL, CIIARI•£9 ti 00040394 l1 /16/08 1, 267. 20 O, GO d 00 ' 1 r 007, 80 SP TP ._...3 _ kept ? xx GUARANTOR INFORMATION x» CHARLES LOVELL 1603 MERCEDES OBNTON, TX 76901 Arrangements not w 9 LER, FRANCES E 00040061 12/31 /52 563.00 6, 00...._. Ob 603.Ob' ADD' -E►i Y^NS 244 xx GUARANTOR INFORMATION wx MARY L¢6 1300 Rt009WAY CLEBURNE, TX 76631 No response _ 1 Wool 1 y . ,r.Ar.. .vu. .ryw•_n.MU .r . w's-w ..~ayr.i..~.~ ~ -1f Cl Ot:[.'703 WR 11 E -OFF R EP OAT pAOES PATIEN4 NAME PAT ID D1SCHO B50-DAL • NEW-CHO NEW-PAY W-0 DAL RC TYPE: CYCLE Bt,PMT-_ AOtf FO TYPO LEW191MARY K 000411fl10/01/02 7,664,66 6,3913.10-181141. 06 1+713,40 DP IF 3 02 12/03 17 1 '',I ww GUARANTOR INFORMATION ww TOMMY LEWtH 109 MASSEY N3 DBNTgN1 T~ 76291 No response 'J 10NTi JtlI1N Og p/B8 336. 1. LOFTIONA UACTOR INFORMATION *0T80RI LIGHT 60 7bO0 0 PLEASANT O P AD COLLEYVILLE, TX 76233 No response IIIE R OOD417YQ I l/SO/V2 1739, 70 0.00 0.00 239, 4D Mn 1P 3 807 l V l rr GUARANTOR INFORMATION rw SHIRLEY LOFTIN P 0 BOX 121 DDNTON, TX 76801 No response V.. _ [.OFEZ,PRANRIE 40000906 02/22/E3 38.00,_...._.00.00 0.00 Sfa.00' BP_ ,.ER'___~_.-_. ww GUARANTOR INFORMATION rr JOSE LOPEZ 2028 LOU19E 030 DENTON, TX 76201 No response, LrrE2,PATRICIAtNFORMAtJON +x00042036 05/20/98 490.00 -40. 00 b762A00 '_..1p_ ___NS O %18%t33 147 1 wW 01 Unable to locate " L YON9, DOTTY D 00042631 12/03/011 tUb. 78 - 0, 00 C. 00-......103, 76 rw GUARANTOR INFORMATION wr BETTY LYONS 9000 PT WORTH DR LOT 19 DENtONi TX 76201 LYONS,BETTY D - Arrangemmti not k f 1 00042549 Ol/29/03 40. y9 00 0, b0 4D 76~ 9P- EA-_ Ho response wr GUARANTOR INFORMATION wr JACK MAYS 6200 WHILE A WAY AMARILLO, tX 76901 1 MA DRIp1BECKY 00042796 07!06/92 1, 446, 2D 0,00 O.UO lig4b,~a6 9P _ Ip 1 ` rr GUARANTOR INFORMATION wr DAVID MADRID AT 1 BOX 843 EULE90, TX 76039. 493-""1"'-" Arrangements not kept 0.00 ,72 .40 M#0 OUARANTOA INFORMATION ww00JEFF~MANIEBp/02 3,7[}9,40 0.00 1 007 LOOP 205 06•N3 DENTON,`TX 76201 4 MNo res 4+58 t1Yb. MANNING, EDWARD L. 40010761 01/13/03 00.00 200.70 O. DO - $6O. 7B_..20 • 09HICKbRY bENTOM, TX 76801 1k> response OVARANTOR INFORMATION rr EDWARD L. MANNING -.17,00...........0 btl 9i31O.70_.80 Ip wr 1/13/93 9,113,70 0 MARTIN,JANET L 00043630 b 8 231"""""t rN rw GUARANTOR INFORMATION JANET MA g71N 01 1 TRUt;LbVE OAINEBVILLtI, rX ~ -76240 No response 'HATEHUALA, TOMAS ' 00044084 11 /20/02 it 341', fb O; bb a D0 i, 341. Iti Ada `tP` Ne i fY297Ar#- ,'2qT 1 , ww OUARANTOA INFORMATION rw TOMAS MATSHUALA 9D96 STELLA M22 DBNTON, TX 76201 Unable to locate ` MATH19 OUARANTOA INFORMATION 6ANLA L. CANLA L. 4000DO60 D2/21/03 ,.OD. 26 11 jdl, dd 0. DD 1, 939. D9 .ADD NO ~ '1 f l 1 f Moved left, no.address MAY rr GUARANTOR INFORMATION rw JIMMY MAYMATHt9 Af103 BOX 72. OAINEBVILLE, TX 76240 No response MAB rr004AR Y3/b2 6,42A 96 09,116-- No GUARANTOR INFORMATION MIKE MCC 0 OD `610211 bb TX 70973 TS SOX 1211 dIISLDYVILLE>TP response u J MCCOY, DONNIE W 06044933 01/19/03 91, 00 27-b, 16 " 0, 00 36 C: Its 9P BA 7 y q rw GUARANTOR INFORMATION ww AARON MCCOY 112 D WOOD DENTON) TX 76201 No response ry f; MODDNALD,LEq A 00040829 09/06/82 699.60 0.00 0,CO 699 66 `9P ERy 3 ebb 1 VII ro OUARANTOA INFORMATION wr DILL MOONALD AT 6 BOX 29E ROANOKE, TX 76262 - No:response F MCOAUGH, KMNNETH 60046460 11/13/09' 9b: 2D 1 fi 1 I 0r GUARANTOR INFORMATION rr ':ol KENNETH MCOAUGH AT 2 BOX 799-A SANOEA, TX 76266 No response _ ..J ....L ....d_..,._.. S is ti 019EP 1901 HR I TE -OFF R E P 0 R T PAOL*9 PATIENT NAMD PAT ID DISCHO DEG-DAL NEW-CHQ NI1W-PAY W-O DAL FC TYPE CYCLE t{sT,pMT AOC} FO IVPE MCKINNEY, HEATHER D 00040609 00/0/82 5$2. OD 0 00 0. 00 62$.06., 6P IF I 041 i ww GUARANTOR INFORMATION kk MICHAEL MCKINNEY RFD 0 TWIN LAKE$ 0241 DENTON, TX 76201 r O ' _._.P 4 579 1 MCGUHENi SUSAN GUARANTTOR 0O C145992 02 1,01 9, 30 INFORMATION kwSUDANMCGUEEN P0. BOX 2129 LINDSAY, TX 76250 response y M (GUARANTOR INFORMATION kw00CLIPTON IMILLS 02 31419.90 260.00 00 FT WORTH OR LOT 12940DENTON,~TX 761 - 206 l _ _No -response-_ _ r M11-1-S,RITA 00047425 09/96/02 1 889.'90 , 0.00 01 DO 1,259,90 '9p IP 4 371 1 wk GUARANTOR INFORMATION kk GARY MILLS BOX 620 LAKE DALLAS, TX 75060 No response; r MINTER,FLORENCE 00047022 06104/02 840,00 0.00 0.00 040:00 9P IP 3 OylOblOil 4y4 I_ xx GUARANTOR INFORMATION kw FLORENCE MINTER 609 PARKLANH DENTON, T% 76201 No responso ~4w __4 0 • MOGUL, TERESA 0 00047003 00/tlQ/82 400, 06 DO O riNT6 - 6TX A66 10 4 11 /04%dII W~4b0 1 , kw GUARANTOR INFORMATION kw TERESA 0 MOGUL 206 8 SYCAMORE D Unable to locate r 1 !0/21/s2 39 MONK. WANOA J 00047477 09JOBJ08 364, 06 0. 00 0. 00 364.'66 _10 r rtw GUARANTOR INFORMATION kw JIM MONK AT I BOX 1770 AUSREY, TX 76227 No response r 3 OB/1'//e3' S9b 1~ MONTOOMSRYiBARL N 0004s017 11/29/90 1,439.40 O. DO -5,149.92 . 890.48 Bp y IF • kw GUARANTOR INFORMATION xw UAR1. MONTGOMERY 2212 FT WORTH DR #104 DENTON, TX 76901 r Roved left no address MONTOOMERYi MINNIE L 00040041 10/09198 1,096.04- 0, 00 0. 00 1, 09o., 04' sp IP 3 OSll3lB3 08"7 1 + ww GUARANTOR INFORMATION kR LEIGH MONTGOMERY GENERAL DSJ URY' KYAWICK, VA 92947 No response r MODARs K12218 06040949 07/21/s8 570. 10 0, 00 b, 00 579. G` 80,77-115 w4t GUARANTOR INFORMATION kk LINDA MOORS 09 WALNUT LANE 6AIN69VILLE,, TX 76840, No "Sponsor r MORENtl„ItlIIN 00049520 09/29/08 1,040, 40 0, 00 0. 00 1, 043. 4p BP ER 4 564 .1 kw GUARANTOR INFORMATION wk JOHN MORENO 609 RAILROAD AVE DENTON T% 76201 Unable to locate r MCA IN NORMA 00040494 08/03/82 L476:'b0_.._-_..6 60 O,'Op_-1,4 $.00 9F 1P+ C "Zsr~7ff4/sx`__ `OR4v ..1 ! • $0 GUARANTOR INFORMATION 211 TE0DOR0 MORIN 320 W EL.LA KIN09VILLE, TX 79363 No response, I r 1. ) MORONEY, FELICITY 00040'IS6 01/03/00 542, 60 6' 00 0, OD 64111 613 Abb i0 -'A-bi/tV - 941 • ww GUARANTOR INFORMATION kk PUL161TY MURONEY PO BOX 1062 NACH921 M9 39120 Unable t0 lo r MOR1410,GP.NR C 00040769 10/10612 845.07 0.00 6.'60 845,07 ' 80 I0_.-_3--'i1/60%82 325 - ' wr GUARANTOR INFORMATION kw OLNE MORRIS 500 HOWAD LAKE DALLAS, TX 76065 No response 4P 3 18/21/88 ifb4 1 MOTE,JULI((ANN 000441515 12/Sx1J02 1 ,0315.10 0.00 0.00 11030 l5 so 10 • + kw GUARANTOR INFORMATION xk GARY 5 1E PO kUx 941 LAKE DALLAS, TX 75065 Unable to loCate _ "OS~ ~ 1 MkwLGUARANTOR INFORMATION kk~OJOHNNY MULLlND2 244,60 1000 ANDOVER dODALLAS+4 TX 75920i6 No response • y30 1 MUNUEN,CHARLENB M 00049046 10/06/nix 430,30 O'60 0.00 409.06 00' 1p 1 10I07)o@ - M 1 + j +e GUARANTOR INFORMATION kk CHARLBNE MUNDEN 200 WEBB RDAD N4 DENTON, TX 76801 Arrangements not kept "HURRAY, RICHARD 0 00049508 i 1 / 19182 004,46 - O OO b, GO 004, 46.. ADD `-1K __7-N>3"- 114 GUARANTOR INFORMATION kk RICHARD MURRAY GENERAL DELIVERY AROMORG, OK 00000 Unable to locate r ♦ i i 11A - - i, , 'h}I '•~~~~1 . r4 PAGE l0 01SEP 1983 NR I T4~UPF RGPOR7 _ PAT 11) DIBCFIG DEG-DAL._ N94-010 NEW-PAY„___W-C). DAL,--.pQ TYPE.CYCLE_.18Y, Pf~T~'_, _~Og. F ti 7 ` PATIENT NAME 22 1 ~•i NELSON, ttA7HY J. 1tlD15766 04/51/83 640.25 . 2, OD9, 85 0, 00 2.950. DENTON, 10 T% Bp I 76201 P 1 No response Nw GUARANTOR 1NPORMATtON Nw JOHN PRGD NELSON 2005 LOUIBE 0106 _ - . 1 NB4IDBRRY,ALVIN L OOO5tllf2 f0/i12/OB 724.00 304,00 0,00 1,626, Od Bp IP 3 LO/061667 No nse NN GUARANTOR INFORMATION wr ALVIN L NEWBERRy PO 5U% 1122 GAINCBV[LLt, T% 76240 respo J 56 1 NEWBY, HOLLY D. 40035067 06/0/03 5& 00 140.10 0,00 804,15 Sp ER 4 b Nw GUARANTOR INFORMATION ww RAY A. NEWDY 910 8 LOCUST DENTON, TX .76201 No response 0. 00 21 ..EMMAN,AIHBERLY L. 10018737 04/18/63 2,424.751 P.O BO% 8920 NT OTA424. MHPPN350 OBNTON, 7X 76p0113 NN OUARANTOO INFORMATION ww DON NEWMAN, Unable to locate,.~.• ' N 253 I Ii PEREYlANDY 000800b5 12/22/62 3d4.8g BBIORO6G DHN0ON, ,t354.200fADD 6R Unable t0 locate I ww GUARANTOR INFORMATION ww ANDY PEREZ r.+ PNwEGUARANTOR INFORMATION wwp00=94 61/16593. 2,ht?,95 2020CRAWRQRD ODEN2,739.90 6P Ip.. 3 dl%10/93 8.I9! l~m~ MACLOVIO PEA TON, T'X 76201 No respoM1Se PEMEZi tlAN1tltl 00093512 10/92/02 ' 1,066.66 0, 00 0,00 to t 6, Do 9p IA ~ 3:`'T No response 3a 314~~ 1 ~ GUARANTOR INFORMATION ww 8ANT0B P90MI 1114 DUNCAN 87 DENION, TX 76201,. re i - 10 k GUARANTOR AT 70BOX L04-9 0 DtiN26i tld BP IP~ 4 SO/172/8C V ~O1[t Y TON, TX 76201 No response PIT&PORD, 000542JOHN10PITCHFORD to06f.80 i L4 1 p011A0A, D0R0iNY ANN. 40049014 08/05/83 910-00 0.06 0 00 276 00 80 liR b i f wN GUARANTOR INFORMATION ww JOHN POWAOA 210 MASSEY DENtON,., T>i '!6201 No response -85. 00 231; 50-_tb 0--v-64156h-3 1124'- r 1 , OUIOLCY,JUNM M OOOUDROJ 07105162 #61,00 0.00 4 NN GUARANTOR INFORMATION ww JUNE OUIOE.EY 2001 PAISLEY DIiNTON, T% 76201 Ng response, GO 0.06 1, 476 38 -ADD Il.. NB RBAL, OR1?Bi6 Otlg5D6b5 01 / 1'7/63 1, 476, 35 O l DOX fOB A AUDREY, TX „ 74227 . Unable to locate ~w w4 GUARANTOR INFORMATION •w OR96% REAL RT 39 d, OO 2P _..IF~ - 27. r- - -ARMILLARDs' MODER7 10043560 00/04/60 395, 80 60 G-60 ww GUARANTOR INFORMATION ww ROD6Ri REMILLARD 208 N NOOO' L6WISVILLg, TX 7DO67 UnAble to locate nCHAR 01/20/g3 $ 099.70 0.00 T3 OPQNDitR,` TX 7bU%9 Refused t0 pay AMNAUD,RICARO A OO Nw AUARANHAA INFORMATION ww RICHARD RENAud PO 009 3 I 2ib.. r r" Af;TNU~PORD DQNNA G 00056531 03/02/142 2, 595.40 aI 00 ~0 2, 5Ii5, 4b-' ADO -t€~" 'lvt£ db1 3!$ .6,$__~I w+s GUARANTOR INFORMATION wN CLINT Rti71i5RFOA0 976 0 CHAAL96 0412 LEWIBVILLE, TX 90067 " y Unable to, locale Eqy- !f/10/,UQ 474 1 h1PFV,bANAA M OOOD745D 00/lb/O0 465,314 q q0._._ 0. 60 4113,35 10 • Arrangements not kept GUARANTOR INFORMATION ww ANDY 91PPY 424 RUTTIE DENfgN, T% 76201 R~+A GUARANTOR 00059750 In/31/02 1,'780.4tl 0.00 ^0'74 75 ,1~ 185.70 8P IF 3 tl6/36J1I'3 " 'i7 ! INFORMATION ww NANCY'RYMAL 1727 23RD AVBNUB N,N CALGARY ALBERTA, TX 00000 ;IV Unable to locate i NNww , W-0 TOTALS wwMw 193,117 8J 18,724 50 -77 1- •I1 , ' . T1wF M f VN~ s 7j r. (f ~ M~-}A~*+'^tM~ti1`..w.-1'.^nT'X'NppR,~, w 01 8EP 1953 i ~•f r ~ ~ W N 1 T E -OFF R E p g R T PATIENT NAME PAGE 11 4 PAT ID DF8CH0 OL!0-UAI,., NEW GHO TOT_ -PMT A06 0 T PE r L AOANAKA, JAMCS E ! r wrfl I rt#~f ObJAME 11/bU/69 69. b0 0 00 bb Ib ER i{ 06/3s /83 ww GUARANTOR INFORMATION ww - JAMES ASANAKA lObB pBAK 40.00 44, DEN7tlN, 7k 70901 ABNEY, DANIEL, It 40004996 09/19/63 _ _.71.60 _NO response Q - rw GUARANTOR INFORMATION ww D 1 0.00 63100 iA.6b Bp ' ER -06/R6/B3 X157; Q 1 AN EL ADN9Y, E RT I DOX OF NEWART, TX 76071 S ADAMS, 9011 H No response i , , `4 ww GUARANTOR INFORMATION wwObU011 A9 lb/9D/d9 49, l0 0. OD 9.00 lkl Sid, J EDITH ADAPIB 42, 131 EP . ER 3_... 11 a- - ~-T J ADAMB, JEAhMY W p0742 , 00% '1068 ANOR8SVILLE, TX 76067 - NO response r, Nw GUARANTOR INFORMATION ww000U1179 l~'/Ob/tl9 -0,00 190,00 40,00 60.00 bp -OP DOUGLAS ADAMS 3 OQ/16/63 tb9 Q nse WB, 1. 46709 response ADAMB,KRIB7IN 70003897 03/J5/(33 06.70 - .r #11 GUARANTOR INFORMATION ww PATSY WEST 0,00 0.00 3 8P Op _ 003 N LOTH SANOteR, TX Tx 76266 J ADKINS'MAR01E 8 COOMBS 19/09/82 67, 80 06,01 d ~ j W 0.00 155,-56 ADD' ww MAR01E 8 ADK7NE PO POX 623 (FOPF) DENTON) T%' /6001 Roved loft no eddreSS116~~Q AOUIRRC,JESDE 000b144b 01/47/83. 47.'2b 0.00 0.60 47.90 8F "'ER q._.._____._ _ r ww OUARANTUR INFORMATION ww NLICIA AOUIRRE P.O, DCX 21 AUDREY, TX 76976 AOULL,OAVID No response - 5 J 400101167 OO/s3/t13 54 . 50- ww OUARANTOR INFORMATION wN DAVID AOULL R 0- " 3f4 TEXAS 06'O6EN7ONS4T%0 76901Arrangements not kept. AL8UNDY, OANDRA 00001719 10/03182 107, 93 0.00 D 00 107; 43 8p IP "b._..__ ww OUARAN7gp INFORMATION ww SANDRA ALRUAOY ~ 1616 E HICKORY DRNTON, TX 76801 ALD6N,ptLLY W, No response 40000911 OO/09/03 46 , qd 0.06"" 46. 36 eA ww GUARANTOR INFORMATION wN DILLY W, ALDER 1410 W OAK OENTOA, TX 7,6961 AgvdnqeMQnt$ ALLEN,ALICO M 0001 10/90/09 463.50 0-00 -909.60 176.90 SP Ip 3 'tlb/31100 not kePg3 Q f 4V, i ww GUARANTOR INFORMATION ww ALL 169 05 ALLEN f 119 S MGADtlW 9ANAER, Tx' 76266 No response ly ALLEN,ALICE M Q0001974 12/00/D9 916,40' I ww GUARANTOR INFORMATION ww ALICE ALLEN 0,00 L714.99 196,8p" C87"Jl/da ey3' 118 8 MEADOW BANGER, ix 76066 wr'' by response, ALLENMARY K 00009113 10/19/82 171, 04 0. QO 0, 00 171, 04 ADD ER NS""79A1A/ea! 724 ww GUARANTOR INFORMATION ww EUODNE WAIL P O Ddx 359 LITTLE 6LM, TX 750611 Una61e to 10CAte ALLEN, VANIiBUA 00002100 07/19/82 194, 59 0, 60 0. oo 194, S9 SN ' Ip 3"`71ti71~1&C': 404 Et. L„ r wN GUARANTOR INFORMATION wN RODENT ALLEN 915 HILL STREET 091111& TX 76901 No response ANDERSON, BHARdN D. 40094160 05/05/03 60.00 0.00 0100 60. 00 Eq' _ . • , ww OVARAN7OR INFORMATION wN LARRY ANDERSON gp 906 SAULLTON LAKE DALLAII,' TX 75065 ' No response ANTHONY,TONYA 0 NN OVARAN7tlli INFORMAT 40009'1tl9 bb/On/d3 61. 75 - - 119. 76- 0. Ob.. ION wN RODRRT ANTHONY 3400 JOYCE 969 DgNTON, TX 76901 ARNI61LA,0LENDA SUE Arrangements not kept 40000794 03/0D/03 40.75 0,()6 o, Ob , 76 ' BF ER' 1 ~ NN GUMANTtlA INFORMATION ww 45 OLENDA 6UR ARRItlLA 1Sb ri; SILVER DOME MHTP MSS DENTON, T% yb9bf r_.... ADMERANDA,DAVID Unable to locate r i 00000470 10/19/02 197.60 6,66 NN GUARANTOR INFORMATION wr DAVID ASHORANDA 1 ' Q , 1114 UNCAN DENYON, TX 76241 No response r .......~I~ ..1,71 f M 0 Ol 09P 1903 W N I T E- O F F R E P O R T PAGE II' I PATIUNT NAMO PAT ID DIOCHG DBG-HAL NEW-010 NEW-PAY W-O,BAL FC_TYeE _CYCLE- L 811. Ry_FQ T P „ 4 ATKINB,HELEN 00000074 12/07/82 163, 60 0. pd 0.00 .........103; 60 9P OR _ I 260 _2...._ ww GUARANTOR INFORMATION xw JERRY ATKINO GENERAL DELIVERY LITTLE ELM, TX 7606S Unable to locate ATKIN80N, REBECCA 00003684 09/0R/D8 199.00- .._..00,-00 ^71, 16 IDiI 04 "OP tIA 2 0-5/, 1,3/03 111 2 WF' 4w GUARANTOR INFORMATION 4w ANTHONY WACHILER 101 W PARNELL LEWISVILLE TX 7DO67 No response 0 L~ I AIWOOtl,LAURA L 000036611 11/04/02 51. 70 0.60 0.00 BS. 70 ADD OR NO ...POl 6 xw GUARANTOR INFORMATION 4w LAURA ATWOOD 0601 TEAULEY LAND 0233 DENTON, TX 76201 .Vnable.to.locate_._.. EAILEV,.IUUITH B 00004077 1$/08/02 16.00. 0.00 6.00 10.00 SP OF 3 01/12/87 267..E 4x GUARANTOR INFORMATION x4 WILLIAM BAILEY C/O LINDA BOYD 16 DORSET LN SATELLITE BEACH, FL 32937 `.I 4V N@:.reoose-- DAK6R, FREd 00004260 10/04/00 140.'77 0. Ob d 00 _ 142,77 SP. _ OP 3 _11712182 SD~ ~tl~ 44 GUARANTOR INFORMATION 44 FRED BAKER 2212-103 PT WORTH DR DENTON) TX 76201No response nAKus, LINDA M 406OD309 02/01/93 *6 1. 00 0.00 0, 60..... 61.00 ADD _'_dR.___Ne._..__ 210 S2 4e OUARANTOR INFORMATION wx SELF SAME AUDREY, TX 7622Y NO response I , RAKER, ROBERT C. 40026072 05%13/03 ~ '40.00 ""0,00' 0. 00 49, 00 ADO• - OR ,Ng 110 2 w4 GUARANTOR INFORMATION xw ROBERT d. BAKER x9308 CARROLL BLVD DENTON, TX -76201 Arrangements not kept Bxw9GUARANYOR INFORMATION ww40FAUSTINA2LOBAKER 40, 60 MRY DOLOT 3 ODENTON, TX 676201 Y 3 No response DALLOU,CYNTHIA M 40000416 OP/01/93 64.30 6.06 0,00 64.30 gF a 3 209 Sf JJ 4r GUARANTOR INFORMATION xx LARRY DALLOU 007 9 TAYLOR AAIN9130LL6 TX '76240. NO response BANK9,JIMMY 0 00004390 10/13/80 76.00 -0.00 -20,00 !66:56 slp--"ER 31'`yob/0'419'U'_._..._1ad,___ x4 GUARANTOR INFORMATION 40 AORA HOWELL P 0 BOX 203 DANGER, TX 76266 Arrangements not kept DARFIELO111 HAY L 00004031 12/09/02 30.00 UO d 00 . on. 00 ' SP xw OVARANTON INFORMATION 4w KENNETH DARFIELO 100 RUBY LbNOVIEW, TX 78604, No response J - -WNE9 DONNA K Odo04tl7R OD/ 10/92 -0s V06'" 16 ..tl xw GUARANTOR INFORMATION wx MARY DARNER RT 2 BOX 23302 AUBREY, TX 76227 No r@Sponsa BARRA,HBATHER C 00004796 10/116/$0 1ld:0U 0 00 0 60 ii&66 ADD -01ft Ng ~ 3I0` 2 wx GUARANTOR INFORMATION xw GEORGE BARRA RT I BOX 22Y FRISCO, TX 70004 Unable to locate " DARRONi rRANCSS R 00004083 12/1t0/OR 00 xw GUARANTOR INFORMATION xx FRANCES CARRON I30R CBNYRAL DENTON, TX 76901 No response UARRON, PHYLLIS 99000263 02/03/03 31.120 0 00 _ 0. OO 01.20 xe GUARANTOR INFORMATION 4x PHYLLIS DARRON 6844 MARTEL DALLAS, TX 76221 • i'1 No response 00005001 10/14/fat 168,80 b. 00. . d.bb 160. D0 DP - gp '3 317 D. . +rI B#0TGUAnTAMMY ANTORRI , INFORMATION ow 00nAnfT - +N M No response ODU08J18 JA/OA/1A/LA/7 PD BOX 755 SANDER. TX 70066 BATTERS, AM A Ih 11130/02 70, 20 0. 00 0, U0, 70. go ADO rq NO 078 °°tI . er OUARANTOR INFORMATION 4e RAM UA7 DATTLSR, 0AH A o00ot1124 'TLGS BOX 169 AROVLE TX 7b2S?6 No response 19/S6/02 on, 00 0100 0100 38.00 Me I:R-3 209 iJ 44 GUARANTOR 1NPORMA1ION xN SAM DATILUS POX 169/0 AT 9 BOX 40 ARGYLE, TX 76226 Vet i~ ~ F .•j~,+-~ i'. ' 1,1'~„it, r.,~'bt~ ~<~A ~r ~ ~i e i; y~ "'1""• "ro^7ry'sT' EI i n'n'. F81 1KMdl~jlf'~' ~ ' bl OEP 1900 WR I Tt 0FP RR100RT PAGO 13 i PATIENT NAME PAT IU ,llI8CN0 DEC-DAL NEW-CHO_,NEW-f'tlY W-p _DAL _F0 TYPE CYCLE L8J PMT AOE PO TYP Y BEARtlEN, DAYLE 40041650 02/07183 30. 06 B. 00 0, 00 be, 00 6P ER 206 xx GUARANTOR INFORMATION wx GAYLE nEARDEN PO BOX 677 LAKE DALLABi TX 7506D No response DECK, DOWYL., n R 3 400 142 f2 y ;xx GUARANTOR INFORMATION xxdNA7BECK/21083 38, 00 817 0R08E b8N7dN, tX3B7b2018p 8 Arrangements not kept _ 600 5JllR 0/01/8P 174.70 0.00 0.00 1742 SP EN 1 0nse£! 396 2 rx GUARAN'tbR INFORMATION ww EONA BECK 817 R086 OL'NTON, TX 76 76841 No response r' BELCHER, Dt3gtll6 J 00000689 00/62/89 liq, 87 0,00 1i 75 a9pI8I~R PILOT GUARATOR xxtl0ptDEBBIE 15983 02/17/08 60.78 71otl0 ERAL tloL01 0 VERY 306 .B No POINT, response., TX 7b2C .1Q6 _...2 no GUARANTOR INFORMATION x„ ARTHUR DENEFIELD _.__u' 2210 FT WORTH DRIVE 1082 DENTON,'TX 76201 Arravoments .not_kept_ BENNY,MARGUERIT 00006114 01261g;? 70.10 q b0 0,00__- 70.10 8P IP °8 0 /29/82 1Op - Q`-J ar 40 GUARANTOR INFORMATION wx MAROUtAll DENNY +PO BOX 1764 DENTON, TX 76001 No response ~ . tlERGER, CHARLNB t 00006254 1 l/22/g2 110, $Q 0. QO 0. 00 lbb, i20 lb xx GUARANTOR INFORMATION xx CHARLES BERORR 1701 W. OAK 10214 ONNTONI TX 76701 No response . DEPTRAM, JEWELL H 00006411 W99192' Pig OD 0. .r HI 75 ,r *0 xx JOHN D[iRTRAM 21 ROYAL OAKS BLVD HICKORY CREEK, TX 065 »0 GUARANTOR GUARANTOR IINFORMATION Yangements:not._kept 18 B*Y1LHN O TIGEN1 OUTHUNB 4675 8068 0 00 THOUSAND OAKS PT WORTH TX 16101 - Unable tp tocato NN, 6DOUARD 00006DU is/07/8O 18.06 0, 00 0, OD id' 00 SP Eq 0 01/88%83 268 GUA BILbGARANTOR INFORMATION xw EDOUARD DIEDEMANN 0912 FT WORTH 10101 DENTON, TX 76201 No. response IJ 0l LLME[ER,CHRIDYINEN 00006977 12/08/82 451. 90 '6,00 625 40 26 60 8p IP~ 3 04/Ifb/88N 13i SI`4 l~` € W no GUARANTOR INFORMATION xw RUDY BILLMEIER BOX 634 PILOT PONT, T%, 76258 No response ! _ y DINGIIAM, TYLER b 40088986 bb/01 /83 D6. 00 O: bb b, dd` bG; bb `ADa L Eii - "Td • IB} GUARANTOR INFORMATION xx TYLER D DINGHAM 410 N GLASS DENTON, TX 76201 NO Yesponse v BIS 1OP, JAtl0U6LVNV 000067BO 67/24/89 45, 6 "'o" 00 25 0o 'go, 60 ADD u .8R_ -Ne - 6372!163 ..._._-I131 iF ~ 1 00VILLA76,008T #266~ 01 0080N OTIX' P 76201 v D[BHOPALYDIORMINFORMATtON xxObU067h1bL05/31/225 170.00 101 a Ne..resppppnse GUARANTOR INFORMATION no LYDIA D18HIP 11!29 CORDELL bONTON, TX, 76201 4 04/O5/8y f44 - - _ No rasp onse ' W BLACK, VICKIB L. 76000021 01/31/tl3 00.00 O, Ob 0.00 - 3y,. 00 MD" - ►x GUARANTOR INFORMATION rw OtORGE JOHNSON 1020 R99D OONTON, TX 76201 No response BLACK,WILLIAM H 00007062 12/01/02 123,k6 0,06 6 bo GUARANTOR BtlYNNNCORMATION xx0ptl070'JbWILLIAM 01/03N83 f d. 20 1 DO% 1090. O 00 Ib GORDDNVILtE, TX .761tAD ko response BLACKWELti r "d.66 2G , GO' tR' Wir Mx GUARANTOR INFORMATION xx BLYNN DALCKWELL 010 CARDINAL 1006 DENTON, TX 76201 No response 10 0LAG0,JNTOTOR IIDL 09/17/83 $q, 00 0.00 "0 60 24 60-9P,", Itl 6 ' i0/I1/8ii '319 00 GUARANTOR INFORMATION JANRL v wx JANGLLS BLAbG m4 ALICE DENTON, TX 76201 NO response W y` ..wow 1 I; t A, 'J (s 01 8RP IgU3 • r'' ~ ,~'d O WR I TE-0P If J . PATIENT NAME !'AT In 01tlCH0 DEp-DAL NEW-CHO NC-PAY W- i' 4J R 0 DAL TFC TYPL~ CyCIL LdT, PAGE 14 PMr _ _._.~AGE ~i f! BLANK(: WILLIAM L 00007393 l2/22/01i 47. OD 0.00 Nw GUARANTOR INFORMATION ww 0 176 0sponse WILLIAM L DLANKE 102 TRINITY DENTON, TX 7620I , No response 0 BLANK6NSHIP,pLV14 RAY 40OD12661 08/11/03 72.00 0. DO Q wr GUARANTOR INFORMATION rw ELMS RAY BLANKENSHIP 0,00 72.00 ADD tiff ^r --r 632 N WOOD DENTON, 7X 76901 197 Q. s , Moved left no address' , ! BLAYLOCK,TERRIS R 00007476 10/30/62 - rr 33.00 0100 0.00 all. 00 - ADD OP ND - _ i GUARANTOR INFORMATION wr REX M DLAVLOCK 306 RT 9 Dk 1017 06N70N, T% 76801 No response BODKINS, MARGARET B 00007668 11/14/82 91, OD • 0. 00 -'O ,DO ` 91" Ob Sp +F» GUARANTOR INFORMATION ON PAULA DOOMINS BOX 384 AU BtlNILLA,RICHARD J DRSY, TX 76697 NO response Y 1 00007093 12/27/40 116,40 rr GUARANTOR INFORMATION rr 007090 BONILLA 16,40 0 00 -00.00 b~,AO 4P ER 4 -`b~/10/B0 614 E DENN97T 013 LEWISVILLE, 0X 76067 114 Q dbOTY, JOI [ Arr~~gg w ants not kept 00007444 06/67/02, AdA. 62 163. 70 01 00 a 1132, 08"gP- ER O o9~la/8a tC l II - rw GUARANTOR INFORMATION rw JOI BOOTY 84211 LOVISE ST M6 DENTON, TX 76203 No response 010THWELL,MARIJON C 04007944 06/00/09 SPb, AO moo 0, 00 " 198,+00 6p GP 3: _ "14 ' ww GUARANTOR INFORMATION wr ARTHUR DOtHWIeLL 920 CONGRESS OENTON, TX. 76901 Unable to locate _ y 3 r 7*4 Gr ARENA 070013046 SQ/iq%4P 4L 46------b7. 0 -40. 00 33, B0 9P u gR 0 T"JO%~3 - EN 6030 4 ST6MMON8 D6NTON, TX 76901, 7 DOWMAN,~TRACYRLINFORMAT1tlN rr DILLL BOW 210 s ~ res os nse Y b ` ` ly; l rr GUARANTOR INFORMATION wr 40000096 01/3I/133 On. PAUL BOWMAN 10 0. 00 0, u0 bb, 10 ADD ~HR NO P,0 BOX 963 RQANOKCo TX BOYD, JULIA t; 7696$ ' Unable io.locate ObS ;1 06004240 69/0 -9/132 36. 00 0. 66 0 OO O8. OY1.. rr GUARANTOR INFORMATION rr: JULIA E ~OYD 4760 N COLONY DLVE THU COLONY,,TX 76066. SOYD MICHAEL L 00006992 01/g1/OO 4J. 7O 0, 00 " 0 00 4 7b OP 3Unable- to-locate- GUARANTOR _ rr OVARANTOA INFORMATION rM MICHAEL SOYO DttO 8 KeALY 04 LEWISVILLE, Tx y'bob7 No response bOIARTH,'SHARON L -60005409 b. tlD l 1/16/13:!' 40.70 0, 00 "''4d 7b• AUD ' r'' rr GUARANTOR INFORMATION rr SHARON DOYARTH 1120 DRIARWODD LBWISVtLLE, TX 70067 0 `NS W `499 ff ~-1"I DRAtiy;NANCY J Unable to locate yrJlr✓ 00000040 1/U1 40. 00 - 0, 00 `b 00 40 00 0P ADO N13..:. "y 840 " 9 ww OVARANttlA INFORMATION ww RI)061tY BRADY RAbPOD 02 KRUM, TX 76249' 'r bRANDENDURD, r I OANIIiLLE OOtlUO9S 00/00/63 bl::ab b b0 0 00 61 RSA 11 wr GUARANTOR SP $R m ' INFORMATION rr 4' WAYNE L. BRANDENBURG OLL DENTON; Tx. 76201 nab 0 to locate WBR,SARA 4 Unable to locate R6 I+ 0030140 09/29/60 33, 60 6. DO aAO.Od 03. 60 .ADD 6`h BON GUARANTOR INFORMATION wr SARA BREWER 316 PRY pE ■ NTON, Tx 76261 Unable to locate DR0YN6RS, JOSL'C 000096555 !t2>24/b2". ....x1.40 0.00 O bO 49 40 _A6D QR -.Ng Of OUARANTOO 1NPORMATtON rw JOEL BROTHERS Nil 3000 N.G STEMMONB LEWIAVILLE, TX 78067 QI` R a DRtlWN CHR1S00PA9 00004738 04/04/09 25.45 tl,00 0.00 _ 9d, 4t1 ID Eft`___1HO..~D13~S2 if ;l~ rr GUARANTOR INFORMATION ON DANNY DROWN 7100 S 4TSMMbNS DSNTDN, IX 76201 No response.._ f. _DROWN DCNALD H t✓ 00009773 fOl19l02 139. 60 0; 00 .0 00 -00 60-130- #A -*0 rr GUARANTOR INFORMATION re DONALD BROWN tllq 7 w ✓ 306 AVQ O N30 OENTDN, TX 7600! No Pesponse f Y e '0 t r Ol sap 1903 WR I TE-0PP RIP0R T } pAT1ENYNAM6- PAT ID, DItlCHO BEi-DAL.__NEW-CHDNEW-PAY1. pAOfl iD W-O:DAL ~C'TYPE~YQLflI ~BT PMT AGE 11'FO 1rT PE Mr - SIRCWN,JDNATIIAN d 00009n4D 00/96/n2 400.44 0,00 -300.00 100,44 SP 1P" - _3 04/27183 1.07 --ii w4 GUARANTOR INFORMATION ww JOAN 011OWN RT 1 BOX 362E DENTON, TX 76901 NO response. Wj!. BROWN,LgR9TTA _ _ 00009910 67/17/02 X56 4w GUARANTOR INFORMATION wwLORETTABROWN 9d8 50 0. 00" 90 70 67;80 10 BR ~t~ Arrangements N NUDDELL DENTON, TX 76901 'Aarrangements ts not not kept BROWN, DUMAN K 00040066 00/03/82 53.66 0.00 0.60 Md. 60 EP . _Ep ----'1 094 ~ - v ww GUARANTOR INFORMATION ww RICKY BROWN 625 FT WORTH OR #96 DENTON, TX 76201 Arrangements not kept" 4 BURUE88, MICHELLE OODJO606 19/27/DP, 07,-711 0. DO "0.00 _ 67. 75 A00 04 GUARANTOR INFORMATION ww DEBBIE BURGESS 0213 N BELL #917 DENTON, TX 76201 Moved left no address BURMUIBYER BROOKE 00010777 07/90/02 n6, 05 01 OD 0.()0 B6, $5 1IP ER 0' 405 GUARANTOR INFORMATION 40 OROOK9 BURME187ER 1040 N COWAN 0147 LEWISVILLE# TX 75067 D~~T, KENNETH C 60010967 09/$7/82 Tip O,_2g"... 0. b6 --6.'06 133, 85 Rp ER ~A 308-"`-0 , .'t ; GUARANTOR INFORMATIDN ww KENNETH BURT 1002 COLLSOE PKWY LEWIOVILLE, TX 75067 Unable to locate ' 9UTTON+DORIS A 40002978 02/10/03 64.35 0.00 0.00 qP ER O - 597, , . >Z Ilw GUARANTOR INFORMATION ww D3RIO A BUTTON PO BOX 963 ARAYLS, TX 76226 No response WILLIH 000 CALDWflLL, 1136110/07/09 l S 5. 5D 0. 00 0. 00 116. 50 I D tfA t 968 r. 44 GUARANTOR INPORMAY16N 4w WILLIE CALDWELL 9D00 FT WORTH DA LOT 40 DENTON+ _ Tx 76U201 ble t0 locate 2 ~ CAMPEELLrJ5RRY L 00011494 10124/@2 107,26 0.00 0.06 107. 25 ADD - GR _ Ng GUARANTOR INFORMATION ww JERRY CAMPBELL 16RJ W OAK Apt 166A DENTON, TX 76201 NO response Iv CAMPBELL,KATHY M 06011602 09/15/02 66.65 0 00 -l6 00 466 65 OF 2~ 3 64%$$%g0 - 13$ '3T` ter, we GUARANTOR INFORMATION 40 JOHN 7 CAMPORLL 900 LONDONDERRY 0166 DENTON) TX `76901 f t.. CANtl, GAIL Nerespons@ N 00011697 09/26/99 548.00 0.00 0.00 S4R.00..0 lip -4 "3df 0 , ~F w► GUARANTON INFORMATION ww OAIL dANO AT -3 1009 OAN HILL "DENTON, TX 76001 No rospOnse -OARL91ON,CHAISTOPH ww0tl0INOBR CARLEYON -41.'20 10026L~DM[N9 LANG LEW1-06 _ ILLDAbn'- 1A-Ns _ _.__-A.1;..._ Q~ , TX 75067 „v w rdngements.:i~f_kept._. u + CGRRDLL',ANITA 1 00019065 10/15/69 144,25 O,UD O,60 (44.00 ADD_._.AR_ _.¢rD Oils '@` ww GUARANTOR INPORMAT16N 4w ANITA CARRELL P 0 DOX 610 LITTL9 ELN, YX 75068 rv No-rosponso CARRIx.L,RDARA J y CD L 00012088 08/14/02 ' 323.91 0.00 0 00 W 120 91 AbD IP H9'-fd/lt/t3$ 5 Of GUARANYOR INFORMATION ww JANN19 CARROLL BOX 233 KRUM, 7X 76249 90 1 No response y 11 ON, KAREN 0 00010161 10101192 60.00 0 Otr 6,00 60, 00 ADD M4 ER 718 '36 0" 1 GUARANTOR INFORMATION rw KARON CARBON AT I SOX 104 C, ObADONVILLB, TX 76245 No response y y CARTC,R,FRANCflB M 60012269 04/04/02 115.Od-`"" 0 d0 6:bb 06'_ by-_-_ER BOX 117 AVBREY, Tx 76227 No response ; y GUARANTOR INFORMATION ww JAMES CARTER pr, CARTER, JAMED D 00050986 0946182 26.00 0, OU 0.00 26.00 0p ER 3 6'91$$/90--- 57f rlt ww GUARANTOR INFORMATION 4w PRANCEO CARTER P 0 BOX 117 AUDREY, TX 76227 {r No response y " dASTANUBA,THERESA 00012B42 00/21/82 140,10 0 00 4l db 1bO ld 0d BR "3" :00144/g5"` 131" $ W,I ww GUARANTOR INFORMATION ww J099 CAOTANEDA 104 0 RUDDELL APT#2 DGNTON, TX 76201, to r S4 L at 88P 1903 WR I TE-nPr R BPDRT 0AG616 PATIENT NAME PAT In 618CH0 DEQ-DAL N9W-CH0 NEW-PAY.. W-O, DAL,, -FCTYPE CYCLH 1~9T PMT A,QE " FO YP6 J CHABTEEN+9141AL9Y 00011?949 Il/S5/82 39.35 0.00 0.00 38.00 BP RR Q 290 9 Li, wr GUARANTOR INFORMATION wr JERRY CHA9TE8N P. O. BON 180842 ARLINGTON, TX 76011 „-Nq rosponse; HAVIO, JDHNNY A 4003020 Ob/14%03 d9. 75 - 0.66 0, 00 d8, 7s ADD ~Rp 'N9_~ 7fi., 2 r G Orr GUARANTOR INFORMATION wr JOHNNY A CHAVIS 19D3 BERNARD D1INTON, TX 76201 Unable to locate iJ 12% . _ bHI99NHALL,IIARL9Y J 00015102 10/00/n2 156.01 tl,00 0.00 166 at .:9P __Ip._...3 Ob/02 379 -0- 2"._ rM OUARANTOR INFORMATION rw 9DWAnD CHI9ENHALL AT 7 OOX 4430 DENTON, TX 76201 No response CLARK POUQLAB 00013399 l2/30/nA 44.75, a. OD 0.00 54.70 9P EA 0 240 L rr OUARANTOR INFORMATION ww DOUGLAS CLARK 28 FOX CIRCLO DENTON, TX 76201 No response CLARK, EVgLYNN 0 40004772 02/10/93 39.60 127.00 0.00 66.60 ADD ER Na 164, i wr GUARANTOR INFORMATION rM FRV 2351 MILL RD #3 LEW[BVILL5i TX 75067 NO response • CLARK, NORMAN 60613405 09/2O/02 39,'7t1 0,00 -0. 00.._.._36.7d 9p lp _3...._.__ - 046 Q OVARANTOR INFORMATION rr RONJTA CLARK 109 N.WOCD 69NTON, TX 76201 Arrangements not kept w. " CrwROUARANTCq INFORMATION rr00JOHNOCLARK03/82 111.50. 0.00 d. 00 1f7.b09P --[2R'-- - 272 k.'~~ AT 4 DOX 736 ROANDKE, TX ,76262- No response CLARK,6HbNA p 00013591. 119131/82 45.00 ^__-0; 00 C, 00 4b. 00_ Bt;.YIP 3 -244____.. a~.. { NN GUARANTOR INFORMATION wr GERALD CLARK 1512 ORIBOLK 0AIN96VILL11, TX 76240 Unable to locate a 013099 01 -36 CwrRQUARANTOR INFORMATION ww000ERAL0 CLARK/93 75,50 181200R298L8 5GA1N9VILL9~ fXDD76240j~ oorespo se/3'u " i4i $ W COFERi NE 0001490 46 2d `7. 00 BOX t4 "TRONTON4b7 5 76234 Unable to locate ANYDR INFORMATION DONALD CDFER " t .,r1 CDODRLL,AMY A 00014989 11/971OR 115. 26 -0.06 0. 60 116. GO ' 9P ER-._.-..4 Q70 Q _ y I F rw GUARANTOR INFORMATION rw JAN9T STEPHENSON 449 ,1,110799 LEWIBVILLE, TX 7067 No response 5b1t k! COLtlfiRT, DIANE 00014401 `1! /03/92 ' - 60. id- d d0 _0 DO 9d '7d'~ ADD fi rr OUARANTOR INFORMATION wr DIANE COLDfiRT 043 CONTENNIAL DRIVE LEHIBVILLE, Tx 75060 COCLEIY,LINDA P 00014986 O9/19/62 104.1i 0,06 O.OO 1A4.'11- 9P-~ T A1T,4n ements n$t kept R 9 i 73oJd7.. R91r re GUARANTOR INFORMATION ww CHARLES COOLOY AT 2, BOX 24#9 9AN09R,, TX 76266'.' No response_ _ CDYLR,RAVMCND D. too63090 d2/b9/83 y 04+7;'72 7b.__--g10 56._.--26 do -ASd~IP~"Alf' rr GUARANTOR INFORMATION rr P90AY BTORY bet SCRIPTURE! D #11 DENTON, TX 76901 Unable to locate • I CRAYQUARANTOR CINfORMAYtON wr 6000901 JE 00/94 /N 9 09. 00 2 . 608fiA (BL6. ou AND ' DALLAS, 8b-. 6P 023 y _ No rosponse~- " 070` w2 y CROWLEY, MARY N 00016974 10/06187 46, 60 O, bO 0, 00 40, O6 r we GUARANTOR INFORMATION rr MARY CROWL9Y fog MASSEY DENTON, TX 76901 No response CVR11919CCTT W 00016576 12/29/02 70.75 b, 00 0 00 _ _ 16: 76 ADB 2 u i t, rr AUARANTOq INFORMATION wr D991110 VfON[CK 20b CROSBY ADANO96 'TX ` 76962 Unable, to locate No DANIML,AV9RLPL9R? 1007146 04/90/83 0 A w _ b6`o0 67.-75. 00.... 7TX 76201 UnablP10 locate QUARANTOR INFORMATION ww VICTORIA DANIEL 919 AVO E 0266 D9NTON TON, 7X 76201 Unabta t0 o l locaocte ice:... _ 1 ~ ~ a ~j.., ~„f.~ r , ~y„ v~i.~, ~~,,f~6. S+r!'1~ ~~~~Z;~~~t►1 ~~~I~b t~~~~+~'~ , _...r , ,.~I , . ~1Y 01 flap 1963 WR f TE UP P nvvuRT PAGE 17 v' . PATIENT NAME PAT 1D DIOCHG DEG-DAL NEW-CHU NMW-PAY W-0 DAL _,,FC,7YP~,CYCLL,M_~OT,•PMT__ A0~ FO .7~P6 ~ } J tlAl1G!lERTY,MICHAEL F 00617194 00/04/82 310.74 0.00 Q.GD 11L.7fS OF EA 1..__ jyj_p" ww GUARANTOR INr0gMA1lCN ww LEE ANN DAU011EI1TY P O IIOX 007 ROANEKR, TX 76262 Arrangements not kept J DAVID, DANNY 00017051 01/20/01 147,05 0.0611 PILOT O POI- 67. Go 76950 IP i O.-.' GUARANTOR INFORMATION rw L. E. DAVID B 0 No response fia 1, J 1i DAVIS, CRIS D 00017350 10/1b/09 149, Go 0100 0.00 1-19. 00 DP ~p g ww GUARANTOR INFORMATION ww CINDY WaOT PC BOX 28D3 DENTON, TX 76201 NoDresponse ~RbS y~ l 1 J DAVl9i DONNA, M 40000075 02/00703 47.10 , ) GUARANTOR INFORMATION ww SHIRLEY DAVIS 1180 0 FT WORTH DR DENTON30TXAb76201R *0 Unable to locate E w DAVIGUANANRRLYINFORMATIGN ww00p 762D 01/26/U2 125,00 7O10D DIIAO$HA000 i W DINT9G,Qb SP ..ER 4 d4o My nN, TX 76801 No respome J - OAVIg, RHONOA L 00017574 01/90/62 /L112, 00 6-00 6.66 DE1.'00 ' Elr `IR 4 _r.-._ 056-""_a'°"-' ; , . r *0 GUARANTOR NFCRMATION ww DARLEINE DAVID 800 WELCH DENTON, TX 76201 No rasponse J DAVIB RONALD 4000020 08/17/80 40,75 0.00 0 00 _ ..40 y5 ADO._ r ww GUARANTON INFbRMATION rw RONALD DAVID 7043 8TEMMON6 LAKE DALLAS, TX 75066 Unable to locate J bAVIB, WILLIAM J 00017669 01/09/83 186.00 0.00 0 06 1Lo-Db - ADD ER NE >23b t!"" " pw GUARANTOR INFORMATION ww WILLIAM DAVID 340 WALTERS LEWIDVILLE, TX 75067 Unable to locate DAY, CAAOLYN 00017731 00/1009 90.00" . 0. 00 -b. 00 15, 00 9P 70, 04 GUARANTOR INFORMATION ww TIM DAY AT 3 LOX 78 OAINIOVILLH, TX 76940 No response DAY,DAVIt1 00017749 00/67702 10.00 6,o0 0,00 _-_..,10 00'Id EA-.... 1.....117 1B[0 r ww GUARANTOA INFORMATION rw OWEN DAY 54130 0 VAN NATTA FT WORTH, TX OCOGO No.respoose J Dww, AUARANTdR INFORMATION wwtlOgtlDNIY bAYRS/84 63.10 0, 00 0. QO b9, 10 a0D MANOR SANGBA, TX 76266 No response J DEMP911Y, TANA 8 00010093 04/14/09 .46. 00 0,-00 `_d, bn 46 00 ADD `i7P id@''6i%Eb7tl0 `4~4"" Mw GUARANTOR INFORMATION ww TANA buMPDSY 519 CUMBERLAND ALLON, TX 75002 UAablo to locate .J DENNoY, RODOCA D 0001010 01/00/03 47. AO 32, 70 . _0' 00 7V, 9b" A0b BR ND 2tl3__ . 2._ ww GUARANTOR INFORMATION ww RUDGOR DONNBY 53127 PRINCE LAME DALLAS, TX 75066 Unable to locate' DILLINDUR, CAROL N 00010031 09/20702 01.00 0, 00 0, 0d 81, 00 SP 10 . 3 " 11T08/02 03d"lI - 'j w Nr GUARANTOR INFORMATION ww JOHN DILLINOLR AT 2 BOX 9-0 DRID09POATo TX 76096 No response 1 J tl40 LGUARANTORLINFORMATION 00 60010700 JGSSPHINIE 19/14/09 00 690.06 6 BOARDWALK oO DENTONp Ty DF Ip 3 roll 9bl-" !t 76901 to, No response J DUWNGUARANTDq INFORMATION 10/00/00 09.10 0, d0 w2b,'0q........_54, 15 HP irR a `04/'l"J/&(f " 1'41 ~ _ . u_ 04 694J EAST EIGHTH OTR90T TULSA, OK 74114 Arrangements„not kept E DUDLAN, 0HhAnA M 00019003 OS/2l/03 130.00 0.00 0.00 10b, 0G Adb it 'W 900 ¢ V Nw GUARANTOR INFORMATION wn SHERAA DUOLAN 209 NORTHWOOD LEWISDILLN, TX 75061 Unable to locate D URDEN,dRTTOR GUARANTOR tNRORMAf1DN 040193 CLSVE 6411/111 DUROIN /02 19,01 0.00 50 _ KINGDW00d.bd .01_-SF ..IF.. _3. ,.0'11h17NO- _ ._pq5~' it 401 I D ESTATES LAKE DALLAS, TX 75065 jd 1. _ _ . ......._~WHo,:rOSpcnse_....,~ ~ v v ~ . 1. 0.1 i `i~7DRf,^Sr~~, 4 u 01 0SP 1923 WR I TE -pPF n FP0RT It PAGE 19 PATIENT NAME PAT ID D18CHO 890-DAL NEW-CHG NEW-PAY W-0 SAL PC TYPE! CYCLE 'LET pMT AOE G YP `A DUkLRri tlAVitl n 00019400 40/43/02 J9. 00 0.00 0.00 Igl oo SP OR 3 11/16/97 393 9 NN GUARANTOR INFORMATION rr DAVID DURLSY 9932 CHARLOTTR 07 DENTON, 7X 76201 No response /62 07. 7f 0, 00 0.00.__w 67,_7 Ep ..__1p - __3-'-_-6 OUTIONo UTRVEN C _ 008TEV0N D2/00 , ' 1/Q6%BO 1167 R' r , ' w rw GUARANTOR INFORMATION rN No 3400 JOYCE _.....244 DYON,HAT71E reapOn9e ' 00019500 12/31/09 95.77 0.00N15X 6.094920126.77 NTADD' TX 0p 7b20N8 01/R6/03 s'. r* GUARANTOR INPORMATION rr HATTIE DYER 0 , ~•`1 Unable t0 locate EDRON,VINCENT A 00019006 12/96/82 .25.-Op 6.00/9 SMITH O DENTON6b 1X 0,.. 76201 GUARANTOR INFORMATION rw VINCENT EDRON 6 IP 3 respJlq/SO 4' No ea .nee EDENS, NADINE M 0001 901 12/04%02 43.50 0,00 0 tl0 43, 9p 8P OR 1 R :1 u, rr GUARANTOR lNPORMATION •w NADINE EDENS 616 CHINCHAPEL LEWISVILLE, TX 76067 No response 4y EDWAnoS,DELOREO 00019960 09/06%DA 144.ed 0,00 O,bO 144 HO 'ADD EFI N9 _ - 3bO R C, ww GUARANTOR INFORMATION rw DOLORES EDWARDB 212 W40DGROVB MESQUITE, TX 76149; No response E0RE8, DANIEL SCOTT 40011129 03/44/83 bb, 60 O, pO p 00.__.-....6b, 60..ADD -'gft _..NR_:._ - _--..-170_~•~dv.~ , 0- ww GUARANTOR INFORMATION Nr MANY JEAN RICH 201 SHADY SHORED DENTCN, TX 76201 NO response ~i ONSLOW, PATRICIA 00020637 07%31/tlil -44: 00_._._._-b, Ob O dp 44 Od' BP ' Yls ``b 111710702 9f "II - ON 4UARAN70R INFORMATION rr WILLIAM ENSLOW GENERAL DELIVEY LOWVILLEi NY 13367 No response ESOUIVUL, MAR4A 00020018 07/98/82 109. 56 0,06 0. 00 109, btl ADD.'-- 1P N 0response %00 40' n wr OUARANTO INFORMATION Nr LUIS ROQU1VEL 2204 LOUIDE 410 DE 10, TN t 400 '-k Y' y~ , Y6201 y r~ EBTEP,DONICE 00020034 06/40/031 `76,9A O.bb... ..,0 Ob yF, gA ADD Ne-_fCrtl478#_. __*40__._.0_ _ Of GUARANTOR INFORMATION rr RANDY ESTOP - 103 81080MAN DENTON, T% 76901 No response ' ,Jp SOTRADA, ER IC 40009966 02/ 19/03 no. 7b 0, 00. 0,00 1 0* GUARANTOR INFORMATION rr YVETTE ESTRADA 106 MANNER SANGER, T% 76966 No response D%AN0402A9E1HP 00090990 i1/OIt/01.. 111,00 6.06 ...._...-O,Ob .__..Ce,.00..,,10-"4441 1 _06)1A781I- bb0", a_ GUARANTOR INFORMATION rw HARRY VANS No response 0627 LEDOE07400 P7 WORTH, TX 76132 PARMERI PHIGLIP J 00091436 01/16/03 126. Ob ` b, 06 C. b0 I'~b. Ob. ADD wr GUARANTOR INFORMATION Nw MARGARET PARMER 0904 GUINN DALLAS, T% w76217 Unable to locate , P'EL15A,7RAVIO 8, 40020076,015/1V03 40. Ob _ -6.00 _..0Ob 40. ed..-ADD git.-NB.' wr Nr ` GVARAN150R INFORMATION TROY 660150 MOTEL b 064 OEN70N, T% 76201 Move d left no address PLOW11RB,BILL CHARLES 46080610 00/04/03 107.9D 0.00 0.00 107,90' 00 0""-A 170 2 t: wr GUARANTOR INFORMATION ON DILL CHARLES PLOWERO RT. 1 DOX 226 AUBREY, T% 76227 Unable tO.locate, 0A11A,9Y,L6LA D 000238'3001/A-1/00 47.136 - 0(7,600:06 "`""(Ib pB" ADD ""TiR__._.NO_ _.__.104 Q ' ww GUARANTOR INFORMATION rN RODGER 4AILL0' RT 2 BOX 808 AUDREY, TX 76227 Moved loft no address rj GIf , L ` GAILLBY,NICHAEL L. 40039476 06/00/03 03.06 0.06 e:Ob 03 bd ADD Olt "`Ntl'° a ww GUARANTOR INFORMATION NN MICHAUL L. GAILLISY RT 1 0093171 MAD19ONVII G;, T% 17864- U4ablal to locate E ' OARDINI, SANDY 40617007 04/1083 104;'46 0; b0 ` 0: b~ 1bh lb" Ab0 ksR " NB ' 141 Q --7 77T rw GUARANTOR INPORMATIO14 ww SANDY OAnDINI 620 APOLLO DANTON, TX 76201 „ Unable to locate us ufir' t~nr► frAS111F11 {MIII'+ I'Ni III Ghlflhf bf'IHIlq hN~frl l:pr) 1,I i! 1 !i I ; ! ';II t i J f : ' I'f I I ! Jj I ' ' I ■M q{1hNhllfUll flNflll{}Ivlfldf Il I~rll( ~1 f f I 4[flY4rr'Y/1!{il!NII~F ! !1/111ir/!~~~ ~~f1~J11 l {J, i 1. rf lirl/lrWlllrl+ llif /NrNf°I1 Nl I1 Y/~1~~,'If ~ J! ~F' it sirt+s✓: i 3 li/ ,r~};f„,, i !r ~,i' Jf~ ~ f+ vsasf►'R/v ~;yJ✓YrlEncl rr ! h. 1 FI.S .Sf'fu, 1'I✓1' i ( r i1f,; i~ ,J_ 1 :►p 'i+7fr1~tV1~1~,Af ow "Aw" N:,Or. J J w a.r}l$HMf SSA ~'M"'ii•%'' „r,, =,l , :1i 'Ci7fvN M" ,.;i`c• ."/J f/ :f r, 1j~_ Irk J/ ra+ 3Y/IYiNA':.~ ~.YO✓ r.' i ✓'r,. r y~jMMM~iy .M~'4fF4'(~" wj/ rt/ . r4--.cW~AlRril~ allr'dMN/' fY d.tk~~r.' ;fjJ S. i ?..~1~. { Amw `.wes C /a XRyyfQ1: M!aA'" ~ ✓ ':,W,'Y~'. 1 .F' ~ ! ~,l~ ~ r~ W. 'low 'o wwr..iMyt,. ;f F'Mf.Y~YM~.i?WT' ~ r Will ar-v {I a ♦ ]YVxIN1W,W WMY„„I.._«:. «rr. ~.rwiuY/Mow:..., Ar_.._.-...........u r.4.....+r_._Y,.._.nW. y~y~M~YWM..r 01 SEP 19110 W k I T 8- O F F R E P 0 R T PAGE I9 r, PATIENT NAME PAT ID DISOHO - PRO-DAL NEW-CHG_ NSW-PAY W-0 SAL -PC YP,F~CYCLE LDT PMT AaB GARIA, DENNIS 00024921 1010410g 173,00 0, 00 0 GO 170 OR- SP CR 1 Of GUARANTOR INFORMATION 10• LEON GARXA 31113 RCtl87gNS OENTON; T% 76903 Arrangements not kept. ....__Y . ' aEORGq, KATHt1RINEA .00074997 01 /96/03 47, Q0 0. 00 0.611 - 1.47. 9b ADO ER N8 219 Q ; r , x10 GUARANTOR INFORMATION Mx KATHERINE OROROE 910 CHANLES 0209 LEWWILLE, TX 75067 linable to-locate GIDRONDrJ. D. 40040417 07/041110 90.00 0.00 0,00 90.00 9F aR P S7 R NO GUARANTOR INFORMATION NO J. B. GIDDONO P,O.DOX 2600 000 DONNIE DRAE DENTON, TX 76801 , r-.-.-~ tllLh, 7 NA M. 40D167a7 04/07/83 4'2, 40 , 0,00 6.0o 49. 40- ADD ER NO 010 OUARANT0 INFORMATION x10 TINA M. GILL RT 4 009 19 DITNTON, TX 76801 Unable to locate OOLDRICH, ROD A 40007734 02/28/113 43.00 0100 0.00 43,00 ADD OR NO 194 __.2 00 OUARANTOA INFORMATION rx DOD A VOLI)RICH RT'1 OOX 8 LEW18V1L40, TX 70067 Unable to locate 7 ONXALSS; CATHY 40040180 07/119/83 '86. 75 Q. 00 0100 06. 70 RP OR - 9 Db _ Q x* OVARANTOR INFORMATION 001 RAY OONIALER 910 8 4000BT019 DENTON, TX 76201 Unable to locate ONIALEX, 90TE44E 40006090 09/2003 3q, 00 0. 00 0, 04 3q. 0O: -ADD - ap flJOW-Q , 1010 GUARANTOR INFORMATION *0 JULIO GONIA1.8t 500 R RUDDELL 134 DENTON, TX 76201. Unable to locate OONZAL112,LUIBA 4000S602 06/09/03 126,90 0,00 0.110 lQ6,QD ADD 6A'~~Nd 90 Q 1001 OUARANT60 INFORMATION 01x LUIS GONZALEI 004 8 RUDDELL APT 063 OENTSN, TX ,76901 Unnable: o_.lacete__ _ GpNZALBZ, R$YNpLDp 400491116 07/00/83 98, 00 " 0, 00 0 OA 11 . 90, 00 _ADD eR__.. 3 df: W- R xx OVARANTOR INPORMATION xx REYNOLDO OONIALRX Y-MOTEL 04 DENTON, 7X 76201 Unable to locate OOTHAM,HEATHER 11LOIR4 40026010 06/10/S0 '164-05 0.00 0:60 - 16A,OA ADD .-.ER 2._:_ xx GUARANTOR INPORMATION x01 ROBIN GOTHAM 710 RHERMAN DENTON; TX 76901 Unole to locate r j ORAY(tlRUCB A 40011210 0O/1A/80 40,00 64.70 0. 00.-..— ..1i2.74,,.ADp !?H ~ ND 45 Q., 'I x01 GUARANTOR INFORMATION x10 DRUCO A GRAY 1004 JOHNSON; 06'DENTON, TX 76701 Unable to locate _ OREEN,TEMSSFI6A p 40002716 06/07/03 19x,60 0,00 0.40 1d3 db ADD 138 - x0 GUARANTOR INFORMATION e0 LARRY GREEN RT Q ALLOT p01NT, T% 7620E Unable to locate GRIOGG,OANURA 0. 40010106 03/21/110 69.10 0.00 D 00 62,10 ADD OA Un8 ~ 16q 9 0x GUARANTOR INFORMATION 1010 SANDRA 0. OR1OGS PIONEOR APTS 000 LSWISVILLE, 79 Y5067 1~~...._r~_._..._. , ' GRIMES, JAMES D 40090002 05/01/00 ~ 76, 16 - 0. 00 _ 4, OD 76, 710 _.-ADb ~ .,BR _ NBb1A 1010 GUARANTOR INFORMATION #0 JAMES D GRIMES 011 DAVIDSON TRAILOR PK LAKE DALLAS, TX 70065 Unable ta.locate.... OUgAlArROORAT 40019119 04/17/09 94.00 0.000,00 94,00, ADD SA N9 196 9'A wM OUARANTOR INFORMATION 0101 WANT OURRIA 601 S. JSPPOASON PILOT POINT, TX "76Qtl9 J - Uble OUNTBR, CURTIS RANDALL 400129670 00/27103 _ 53,00 0,00- 0. 00- ' 60AO ADD -0-4 Y a j1 #0 GUARANTOR INFORMATION 00 OU0118 RANDALL OUNTER RT 1, log 114 SUNSET, T% 76270 Unable t0 locate J eY HAOGARD,bEAN T 00090167 1S/110/82 I01.04 0100 ' 0.00 I01,00 9P ER -._...4 276._._ 1?.._..,•.._.,,.. wx GUARANTOR INFORMA71ON 1001 DOAN HAGGARD RTC I POX 60 DBNTON, TX 76PO1 Ho.responae HALRiOTSLLA 40006001 02/26/80 46. BO'-- 0,0046 00 ADD _...__._..._.__-12Y"• 2.:__ •M GUARANTOR INFORMATION 1010 STELLA HALE 043 W. WALTEAD LEWISVILLK, TX 75067 Unable to locate 'lloo : v..:, .:.,.vv. .u.~:.-.nr:... w:.u.SWi.ai WJN tIC °+.dLtd. r",yY~gbL; rr•J':d: link X,f f f: 1 1 PAGH' 90 ~ W q 17 E- d P P R 0 P d R 01 SOP 1903 ~ ~ t 1 X PATZ9NT NAME PAT SD OtOCHC. 9E0-DAL NEW-CHO. - N!W-PAY. _PC.7YPE-OYpLI?-_49TJ T_ - Ape Po fm D%11/03 Ili! ' HALEY, JBR11Y pBAN 40025595 00/11103 01, 80 0. 00 0, Otl 51. LD ADP OR 3 p xw GUARANTOR INFORMATION'** )ERRY DEAN HALEY 797 OLD ARCHER LN. APT. 9010 LEW70VILL6, TX 75067 u HALL,MADALEAN 00020514 Ot/16/03 tOD.120 17tl60 ~ L VILLAGE liA9T N901 GpBNtON, TX 7bli0l wx GUARANTOR INFORMATION ww MABALK N HALL .__61Z able.to.-locate__- ' 0.00 HALL,RODRRT L, 40091600 05/97/03 69.00 04, 66VILLAOE NAST M901L OOBNTDNr TXR 161201 Mx GUARANTOR INFORMATION wx R0dt1gT L. HAIL Iingb e-to"-IOCate c . - H GUARANSHEILA TORI gOA HAMILTON 39. 70, T'IO 09, 70 ADD Eq Unabie 00>: 9 #0 BOX 36CCUNITYLOOQS D1iNTONr TX 16901 .t GUARANTOR INFORMATION Of gHgtL OHgtLA HAMILTON R o -locate1-LaN- II HAMMOCK,NBNNBTH J 0060 761 OA/bb/OJ O4. 00 bW OAK 0 oo `1}9Nt[N,1 0 76801 1 spanse It Nx GUARANTOR tNPONMATION Nx KEN,`lNTH HAMMOCK L269 NO re V~ - + HAMPTpN,CHR[9T18 400061/09 02180/03 45, 7d 90160 0'.60 136, LNS 9P 0~1 d xx CUARANTCR INFORMATION xw MARY HAMPTON P,n BOX 017 LAKE DALLAS, T% 75065 MO espOnSe HARDCA0TL9iOEN9 C 66029279 01/12/03 104. b0 y O,Utl - 0 00 104 50 ADD EA N9_ - ~N9 L'N ar A3 FOX CIRC. DuNTON TX 76761 Una[ o to locate - ri ~G xw OUARANtpA INFORMATION w• 0!?NL HAgOCASTLE P UM BTR6ET BANGOR, TX 74966 prraA.__ j C. 0449B/93 90.00 0, QO 0. 00 30Op 8P OR ___5 001 L HARRIUAAT N 0. b0 0 0p 43 d0 X 9 menu not kept Nx OUARANYDR INFORMATION xx PAT HARRIS tl33~_.k,_.. 06030304 bA/I1/BO 40.00 R HARTMAM,VAN J 4Lb N KEALY L1iWIOVILLEr TX 75067 MoVed left no address ww GUARANTOR INFORMATION ww VAN HARTMAM d0: ~b 0, 60 0, 00, do, 70 ADD ` fiR Nd 11E0110/02 UM4,06 to locate } F16AOULARi DAVIO 914 TEXAS pENTONr T% 76201 QUARANTOA INFORMATION DAVID 40009011 0110/02 Nw wx _ -f _ 40001879 09107103 49.Ob AL 0, by 4.00 45'-'06 ADD " "9R Ne' k43 l'i HaIKAL,QHntt 12434 LOUIBE N91 D9NTONi T% 76201 Unable to Locate ~.l •187._.....0. Ne , #0 GUARANTOR INFORMATION #0 ONA21 46062933 OQ/RY TX 76!101 ) ' ROUARANTDR lNPORMATION ww JdHNNYHHHN1g/ti3 !00;16 0 00 - Di 40 !08270 ADti `9R Hg v LAB WOOD Or DBNYON Unable to locate goo HODOGSi OgPFBRY L OOb02615 01/21 /93 69.75 o, Ob 0. 00 '64, yd' AYIO r{R Nd" ti. G wN GUARANTOR INFORMATION'Nw BNN19 HODGES RT D 6Ok 7 ACORN RANCH DENTON TX 76201 ' HOD09#,LARRY 00638600 O'f/L0/9L ltlb; 7e5 b; 00 6. 06 190, b 10 X41 ~ xN GUARANTOR INFORMATION NN LARRY HODORS Refused to pay 4460 3410 BRIAR CLIFF DEN7ON T% 76 OOtl32BRl d7/R7/Bt! 91.00 0 00 -0o, 00 17.16 ' DP 0R 4 .-Otl%R47C3 GUARANTOR INFORMATION OLAN HOLLAND HOLLAND A g +110 MANZ DGNTON, TX 76201 Arrangements not kept HOLMANiFgl001LLA A. 40000699 OD/e]/D0 40,06 b, 00 tl."bO 411,00 AOA tR N9 00 OUARANTOR INFORMATION xx PRISCILLA A. HOLMAN RT R BOX DD DENTON, Tk 76801 Unable to locat" 70NO749 06/O3/03 41, d0 _ O, 00 0.00 . 41 00 ADD do Nv. c HULET+MAAIA 4124 LUVANT PLOAONT GROVE, TX 75017 Unablo to locate Ne GUARANTOR INFORMATION MARIA NULET _...w w G . I xx HUNT9Rr WAl T8N 00094910 iI2/94/e0 . 1,796.9$ ' 0; 00 b 00 I, 796 C5- GN l P s ^-oenb/~e -aAf if '1+ ex GUARANTOR 1NPORMATtt1N xx WALTER HUNTER BDX 4i6 LAKE DALLAS T% 75465 Refused to pay ~nM lit .+r,l,l l' ti lid j: WR I T 3-0Fp Nap ONT 0mw21 1 01 Orp 1903 T y AGE 0 7 PATIENT NAMh PAT, 11) IUISCHO PEO" DAL NEW-CHO NGW-PAY.-__W DAL,_ PO TYPE CYQL,f#_,,(~ ; P; C r P$ TOR INFORMATION ww 03459TH 1//10/03 65. 50 O. QO Q DO bD.bO ep DR 0 HYD5,KENNE 00004695 01 424 HRTTIR I)VNTONI TX 74201 V pg Arrangements not kept , I . 976 2 19l8NARTiTOMMY 00034G62 Ql/19/E13 72. OD O, OD O. tl0 7R 00 ADD EA NR - eM OVARANTOR INFORMATION wN TOMMY IOLLHART 639 CARDINAL 6-It DBNfON, TX 16201 Unable to locate J 4D. 00 S1p ' EA D Ot,/ 10/09 ' 83 R 00, oo 0.00 _25.00 v' 000303 D4 09/21 /82 JACKSON,KNISTA L No response Nw QUARANTtlq INFORMATION ww HERCULES JAC000N p0 3OX 2669 UENTON, TX 76203 v _ _ . _ _ .._..1.~.._•_-.~ JARMAN, CHRfNT03 HCSR 0, 440061.-7 D2122/83 60, 001 o.66 0.00 66-06 1b Ofl J 4 ^R dM GUARANTOR INFORMATION ww CHRIOTOPHRR 0. JARMAN AT 1 DDX 109 CtlpPBLL, TX 76014 No responso v JRNNINpO,BARRY TODD 40OR7009 06/39/00 .06,90 0100 0.00 56 90 ADD '1114- 146 106 __..G. wr GUARANTOR INFORMATION er OARRY TODD JBNNINOS 1906 S 318T 8T. BRYAN, TX 17003, Unable to locate y MMr. _ _ _ JOHNSON, JUDITH 40097009 0/17/83 . A19. 10 0.00 0.00 >9: 1d AbD --AR 4. _~$T16709 1a3 2 ww GUARANTOR INVORMATfLN ww JUDITH JOHNSON 8419 YSLLOW870NR D6NTDN, TX 76201 Unable 119 DUAL ST DLSNYDN, 7k 76201 Nodlsplo0flfl _.OSy. Q 4_ . v JDINER GUARANTOR ,BHIR48Y IJNFORMATION BRUCE 00036699 00/ JOIN3f1 10/09 167.2 Do p V JDNRO,DEBRA G 00036014 1J/9D/02 204.00 0.00 6ODRIV114A.-90 -O Np`TXgR762p1`~~bx/112/80 19 II J SAGEBRUSH *0 GUARANTOR INFORMATION MARK JUN69 wr ww (Ngr84pOnSe_.J.._..- -R~36 ~ .2~_ JesEOUARANTDR INFORMATION 0003705 1 41.26 A00000 0100 4S, 25 AD$ OR pT 370 W MAIN LBWIBVILLR, TX 75067 r._.un bla-ta-.locate JONSB+TINA M. 40012940 03/22/80 48. 00 44 76 _ 0. 00 113, 05 ADtl -..`GR N GUARANTOR iNPORMA7ION LLOYD 0ON88 156 019MMOND FWY LEWISVILL6, TX 78067 .,J 4M ww • neb1A to-loaate L'IL .1. LANTRIP,PATRICK W 40090591 06!06/83 b6.00 b 00 0 00 66 n0 0lt gR" u SI e► GUARANTOR INFORMATION *0 PATRICK W LANTRIP HILLCRSBT MHP DBNTON, TX 76901 Movdd left no address.. .a LeABURBi 09DRA L 40001090 02109/03 36.'OO 0 00 0 Ob ynt}. 06 SP - kA 0 ; 00 GUARANTOR INFORMATION *e DEBRA L L9 0UNB 9429 LOCUST DENTON, TX 76001 No response ;jam LEE, 9HBILA t0D27Q43 Otl/31/89 1,479.60 0 DO -Ii 831, 6D 1A0,'OO Op IV 4 6b/114/S3° b+7 M• GUARANTOR INFORMATION wf} dHg1LA LRR 1428 KNtOHT BY DBNTDN,. TX 76901. No response V ."Ip..."@ Q4Jo8/0`J' 146 LB$,SHBGIA L 00040640 01/15/03 0100 =0i 366; 60 ,537,iQ,..00 W er GUARANTOR INFORMATION we SH941A LBO 1219 1/2 SCRIPTURE DBNTON, YX 76201 NO respOnfe L68,11HeLIA L 00040661 09/93102 301107 0,00 0100 001'.117 Bp RA: _ 11 . `094#0 ou rfe O3IAAANTOR INFORMATION ww UH941A LBB 1428 KNIGHT ST DENTONi.TX 76201 No response v LOtl, BHBLIA L 40010709 03/26/03 661,00 0, 0Q' 40. flff_ fD;1i0" Hp BA C ~74J41f/~13 1'10 4 GUARANTOR INFORMATION ew 9H841A L 60E 1214 1/2 eCRtPTURR DRNTONt TX 76201 Nc response LOP AgDtJANNA 00040840 01J17J83 116.1m 0.00 0 b0 116 BD ADb ~p flA aki (t ee GUARANTOR ',APORMATION we JANNA LBPARD AT 0 BOX 1 DONTON, TX 76901 Unable to locate y', ! L3H10, JIMMY 1. 000411179 O1101103 UU, 00 0.00 93. QD 15.00 ADD BR N60Y 00l20lOD 741 9 ew GUARANTOR INFORMATION ww JIMMY L, LBW18 RT 7 COX 110 DENTON, TX 76001 aSpodfe "o v w PAGE RR 019EP 1903 WR I7E-OFF RRPORT J PM7 PAT 115 QISCHO DEC-CAL NCW^CHD N6W-PAY ,W-O DAL ,_FC,,TYPg, CYCLH _ L87, _ -__AG6 . ^FO YYPt S PATIENT NAME _ J 00041152 12/70/04 1, 068. DO 0. Op 916. 90 141. 70 BP ]P 3 00/94%83 t kept100 . 4 M LEWIO,SARAH 0 no ,M 1832 PANHANDLE aSNTON, T% 769O1 Arrangements wr GUARANTOR INFORMATION ww DAVID LSW18 t 00041406 11114/OR 75.00 - 0.00 °i0 00 6b 00_ -OP IP " 3 04/29/83, 1n0 LINNiJORRY d ww GUARANTOR INFORMATION ww .lORRY'DDN L1NN 703 N i87 SY GANGER, 7X 76906 No response 00041483 19/31/87 1,035,90 Co 99,-1,830 90 25 00 0P IP 0 64/10/61 133 a LIPPE,&HRRRY M pO BOX 464 ROANOIt9, T% 76260 ArraOgements not kept _ ANIOR INPDRMA7tON ww GRAD LIPPR W ww OUAR C' LIU,CALEB _ 00041609 09/2002 41.60„ 0, 00 26.00 15.00 tiIP ER "O~ 06101/93 W 9a a ww INFORMATION ww CALU6 41U dal WINDSOR 443 DENTON, TX 16201 No response GUARANTOR LOCF91000,PA77Y 70000693 05/11/03 49,00 0,00 0 00 49 00 RAI OF 3 RT _ Mw OUARANYOR INFORMATION ww JERRY R, LOCKRID06 .rW a DtlX 308 9ANORR, Y% 76266 No responss li► C fi 12tl" Q~ LOFTIN,OERALD 40007644 02/47/05 IDS. 00 70, b0 0 00 »174,008A UR 3 ww QUA GERALD INFORMATION ww GERALD LOFTSN P.0 Bo% 279 LAKE DALLAS, TX 75050 NO response 41r G -6- 00 LOtlM10,PATRICCA J 00041905 11/19/02 15,00 40, 6HE HAVtfN EST, LAKE DALLAS) pX .75060 I7l14/t1G aGbw 4 ~ I w ww pUARANTOR INFORMATION ww PATRICCA LOOMIS NO rASponsa 10131/82 30.50 0.00 0 00 t1D 6d_LL.O~ aR LOOPUPbKORR1 L 00041947 we GUARANTOR INFORMATION ww GERALD E LOOPdR RT t box _ I0 AUDRE'Yv, T% 7632117 NO r esponse C _ Aa !d LL a 46000374 04/01/0 1015. 50 Ri' n 000k 364 60ANOSR,DYdo"'90 66 ask Lopez, ALIOIA ` ~Noaresponse t ww GUARANTOR INPORMATION Mw ALICIA LOP92 , 38 tl0 YD )tA 1 1130 sI 7 0004RDbA lO/06!94 08.00- 0,60 "0.66 i LOPUI, IMF P A 922 CLSVNLAND DSNTDN, TX 7b4ol No response { ww OUARANTOR INFORMATION ww DAVID LOPEZ 1 ' LOPEY,PAUL Yp__ NuYrASponse80'~ 46!t ....-p 40 00042044 12/06/02 86101 0,00 0 04 OD 01 dF OUAAANTOA INFORMATION ww A4101A LOPEZ Ptl DON 173 SANGER) T% 70426 ~,#.b0 SA 61R" " 1 21b7Q71A'S - - -4 00040047 0006/90 OD LUMAN, TAMARA 1944 ww GUARANTOR INFORMATION wrt TAMARA LUMAN SAD1I8 4EWIOVILL9, YX 75007 prrengements not kept ~4y 'LUNDORON,RAYMOND A 00042317 01/16!83 50.70 1 4/bLAKEVIEW00AZLE,b19 76090 dRAy No rosponse 6 00 GUARANTOR INFORMATION rw LARRY LUNDCA9N r 42, w 309 HE77Y 158070"1 al. 60 SP ICR_ t!' p YM 1 00649465 b llRO/dD 14'7,.90... 0. 00 d, 00 No esponse LYNCH04ATHY L N, TX 76201 d ww GUARANTOR INFORMATION wr WAYNE LYNCH ~y r 193 .._l f9:. if btl " .60 0 UR. 4 G 45/83 48. 06 106. 60 01 MACHUCA#AMELIA 40013691 03/ 4Y 41, Of GUARANTOR INFORMATION 00 )one m. MACHUCA 12x4 g6RNARtl DSNTOM, TX 76001 No response /dg- MARPLII+IfANRY a 00040366 08/09/94 1p?,59 0 OD 0 O0 167.59' SF 1P° p i7 ~ 449 OORDONV1LLa, TX 76445 No response 099"" ww GUARANTOR INFORMATION ww HENRY MARPLO PO BOX MATHa90N,RONNIE a 00044067 01106/93 39,00 T401tN LAR89 M4 0147 3AUNTtINAbT% ¢4tl1 Unable t0 locale GI,~ of GUARANTOR 1NPURMATtON 00 RONN1a MATH69ON "MATTHEW9i WAY CLIFFORD 4003479900/07!03 00, 0b"__ 0,'215 0; OD if8 llb 923 » A ~a ww GUARANTOR INFORMATION ww OARAY CLIFFORD MATfHEWG 1 90 H1WAY HOUSE pAP1LLION, Na 09140 URSb1A to 106etA « W wjt ° ti': 4(I 01 BEp 10130 C W n 1 T H- 0 F P R O N p R T ` PAGE 23 PATIENT NANE PAT ID DISCHG BEG^BAL NEW-CHO NSW-PAY W.O UAL PC TYPE,OYCLE LOY PIY AOE p i' MCDONALb, LAVLRNE 40006087 02/20/D3 II 120- 70 tl, nd 0.- 00 120. 70 ADD ON Ng _ ww GUARANTOR LNPORMAYION ww LAVERNE MCDtlNALU 343 W WALTERS LEW18VILLU, TX 7p067 -Unable to locate - 184 C~ - MCINTOSH,CAROL ANN 40031339 06102103 72, 50 ww GUARANTOR INFORMATION *0 CAROL ANN MCINTOBH 006 WALBASH WICHITA, X00 ADD ' AR NB ' Sq A 6721 t: Unable to locate MCKINNEY,CARDL J _ w wr OVAAANTtlN INFORMATION ww 7d002i256 02/24/03 0.00 124, 70 06. 70 , 6800 BP OP - NOEL MCKINNEY AT 1 DOX 97 MUANSTER, TX 762152 4 NO 0 response onse 3 108 2 MCLEAN, KELLEY 11 00040160 00/14/02 137,05, 0.60 1 pD ' 136 00 SP Tp Of GUARANTOR INFORMATION ww WILLIAM MCLEAN PO DpX 49 NOWATA, OK 74048 2 06/13%93 No response MEDLOCK,CHARLES H 00046060 01/14/03 Og.00 0,00 ww GUARANTOR INPORMATION ww CHARLES MODLOCK 0, 00 38 Od 62 RR ~",rs jZ30 _ P. O. BOX 4073 0FiN7pN, TX 76x01 No response MEDLOCK,KELLEY B 00046078 11/10/00 106.30 0,00 n. oo .lob, 06 of, _9A-1___3__.__..__.._____ ww GUARANTOR INFORMATION ww KELLAY MEDLOCK 1200 8 EWING DALLAS, TX 70216 267 R~ No response METOALP, EODIBY M OOO4640B I1/Ob/BR 70. 06 0.00 6, 60 - 7;1. O0 OF 1!R -I . ww GUARANTOR INFORMATION ww ODAIST METCALF 308 S RUDDELL NAO D . ANTON, TX 76201 No response 209 it w MICHARLiPATTY ANN 40030400 06/24/80 163:96 .....RO. bo 0 00",- 177, 05 AOO `BR Ntl "'~'6'S-`--°~-- - - ww RUARANTOR INFORMATION ww FATTY ANN MICHAEL 1000 LAKESIDE' LtWISVILLE, TX 70067 Unable to locate MILLORiOARSARA B 00046792 12/14/DR 103.10 0.00 0,00 10d 10 ADD ew GUARANTOR INFORMATION ww LEE MILLER 343 WAL7ER6 LEWIOVILLu, TX 70067 #61 pV Unable to locate , MILLER,TRACEY 00047241 0020/02 Jo Igo, 10 0 00 ^I, 006, 1R '44.'03 ADD "'1P ww GUARANTOR INFORMATION Mw TRACOY MILLER 821 RAOLE DR CANTON, 7X 76201 Arrangements not kept MOODY, JAYS L 00040106 10/11/62 160.00 d• 00 -2.00 163. 09 Dp _'tf 0-_..b0/OC%D3 190 ` @ Of GVARANTOR INFORMATION ww L%19 MOODY AT I DOX 174 CHICO, Ti 76000 No response ` MORAGUARANTORLIP wwOtl040a9TNOMORALN2 00. O bb 446" " AT 4 sox 06 FAISCO, 7X 70034 No response i MORALBS,TIM N 07040400 01/23/113 70.76 ...D,00 0.00 79.70 01 0 ww GUARANTOR INFORMATION ww TIM MOpALE6 AT 5 / ~ MOASNd,JUAN Unable to locate _ 00048646 12116102 110 GUARANTOR INFORMATION ww JUAN MARINO 06.00 pn,boxO94040D6NTONP 7X777b20101 @~ One yUnaOle to locate S . j MORGAN, ALOI OE V 00048690 09/21/02 1120,00 0100 0.00 _ 1 gb, 00. BP , IF...`. D 11}/07/64 Oaf" 1I i{ i w♦ GUARANTOR INFOAMATION ww BOYCE MORGAN 1~1 J700 WH176 OAK DEN7bN, TX 76201 Arrangements not kept. . " ' MORRIO,LARRY M 00048627 12/10BR 118: 00 0.00. -b, dtS- Otl . gp ..._'6p- "-O_._.~_ _ _ -7 7A ww GUARANTOR INFORMATION 00 LARRY'HCRRIS AT 7 box 80 D1INTI1N, Ti 76201 20~! 4 No response 271 MbRR1E,AE7HA A 00040900 12/0009 1Df.7tl 6,00 0, 0' . M' GUARANTOR INP'OAMATION ww RETHA MOAN18 O i 'Bp SR'" I'l i - 710 SAtHKDR SULFOq OPR 9PAIN tN0E, TX 7648211o response MOTE, DONNA 00049100 00/10/82 00, 00 - 0.'00 0. 00 Ot3;"00°` Ot - AR ._,_G ~ ww GUARANTOR INFORMATION ww WILLIAM MOTE 004_---2_ BOX 1012! LAKE DALAE, TX 76060 No response _..W..:._.....:~..,. _ ~ J i t,< ,F r t° ...._.1i.1\L.i.J.a,i..~4,L+i\.,9,V Ml wA:3JUYhi • Of SEP 1903 N R [ T (i - tl F P 'w'!"t'° y 7 ?r; ~Y j RE „ PATIENT NAME P O R T PA09 24 PA r ID p19CF10 LEO-DAL N¢W^CFIO Nl:WPAY W-Q OAL PC TYPE CLG LET, p11i GE , T MOWERYr REBtTCAH L 00049109 07/r97/02 139,20 0.00 0,00 139.20 9P gp *0 GUARANTOR INFORMATION PATRICIA MOWERY 401•• Pd BOX b@ 01?NTONJ Tx 76201 No response r. MULLING, G9RALpIN9 _ 00049004 07/06/62 90, y0 _ 0, 00 0. UO 90, y0 -6P 4, GUARANTOR INFORMATION BRUCE MULLINS DUX 273 LITTLE ELM, TX 70069 NO response I- NGWMAN, DDYD O 4Y_ OOI) OS/96/03 149.73 0.00 14q.70 ADP OR Nq.. iv I GUARANTOR INFORMATION BUY I) NEWMAN R. 0. W. E NIB .D&NTDN, 7X 76201 @l9 @ ^ i Unable to locate Y NGWMAN, KIMD9RLY, L 40007016 02/96/93 67, 00 0.00 0-00 67.00--ADD- 'EA NB _ r 6 GUARANTOR INFORMATION KIMDEALY NGWMAN, L p,0, BOX 6923 Nli DENTON, TX 76201 Unable-to locate 167 "@W y 1 • i OHARON D. 40SHAR 02190193 60, 00 0, 00 0. OD 60. DO ADD ER Ng a>I p* GUARANTOR OR INFORMATION SHARON D. NORRSB P O BOX 6914 DENTdN N7BU T% 76903 141~~ @ 1 Unable to locate DOOR. I,PATRICK 40019140 04/17/60 _ G ! GUARANIV INFORMATION PATRICK OOOKI 00 0, 0C _ 0. 00 6 7b. 00 ADD fiR _ _._-lOb @ @492CHAROLEYTE N6iJ22 DBNli TX 76901, URMAND, JURY 00051599 09/!0/02 106.00 0,00 0.00 IOR.do 60 ..tlq_.-.aUnabie._to.loCeto__'_ L GUARANTOR INFORMATION +t* JORY ORMAND 400 CARDINAL C3 D9NTON 7X 76201,` 342 w f2 _ No :'espouse OBTH67MBR PAUL RAYMOND 40022296 04/99700 46: 00 -0.00 0. 00 AB.'Op OP - ER G GUARANTOR INFOAMATION PAUL RAYMOND 0911 AT, 1 Box 06RC DENTON) 79 76201 070 _ Unable to locate pA]NTER,ROY A 00052150 10/06/60 46.00 _ 0, 00 0, ao 46. 00 OF" . BR 1 u.._.~,.` . • 4 , GUARANTOR INFORMATION ROY PAINTER W MAIN APT 41 - L9WISVILL0, TX ...75067 330 ' _....pARN6R,l1RBNDA LEE 4uKNET 0RAN 164, b5'°"_ _.0 ob 0, bd _ 364, bb ADtl , i{ ranyeroon.t not kept_ C, GUARANTOR INFORMATION KENNETH RANDALL DALL WEBS Oft ~--It~" ` 1900 JOHNSON DENTON, TX 76201 Unable to locate PEACE, BEULAH 0 00062920 09/16/02 100,48 0.00 0,00 100, 9b Bp BR O L GUARANTOR INFORMATION BOULAH PEACE 704 CHAMBNRS DGNTON, YX 74,901 ObD 2 _ No response r 10, PEREZ) PABLO 00063496 10/94/62 143, 5a 0, ad '01,66 JVO. Do' - so ` 'EA'-,. 4 GUARANTOR INFORMATION 44 PAULO p6R01 967 Q 1114 DUNCAN DENTpN, TX 761201 ~ , No response PERRYP ANtONY 00663661 01/96/93 12J, 26 ` 0.00 . . 0, 00 191:1 Adb J1R"` `Nii k gUARAMTbR INFORMATION ANTONY PERRY 730 ALEXANDKR DENTON, TX 76201 lti4r._ "J Moved left no address PERRYY,, BOBDY _ 00053567 10/07111`02 _ 114, 4,0..-"-Il~f. I t 100 GUARANTOR - Dit7 6 , lot INFORMATION RICHARD PERRYMAN 305 AYE 0 N14 DONTON,• TX 76801 NO response 0E11R1,11HOMAS A 40532344 06/07/93 110, 00 0 00 0.00 118.Oq ADD 99 ' NS GUARANTOR INFORMATION $NARON L 0E741 fib ` TX Wb? 2 I. PHILLIPG,Dbnoli I OO0D30bb D9/03%02 121I. 18.._.. pOQOp-CHARL~tIOp@3a.,19kw1AVrSpB/ iiii-w- llUMb]6/104%B tl. w OUARANTOA INPORMATION MURAV R PHILLIPS O 2 PO BOX 070 BANGER, 7% 76266 ° No response M PITTB,MARK C 000043JO 09/03/02 102. 711 GUARANTOR tNPORMATiON MARK PITTS 0. 00 0.00 IOL+, 75 `BF ' Elf "1 _ { 900 RODOBLL N06 DENTON, TX 76201 9b9,~_.2 I r RAHBARNODH7, HAMIb No response Y, 60055021 01/02/00. 70,25.__.___ b. O4,` 0.04 `J0. "26 "AbDV i!R' " 112" rt4 1+ GUARANTOR INFORMATION 'HAMID RAHBARNtlDHS 1116 NORTH 86LL 41 DENTON, 1X 76251 unable to locate 242 " 0 L . np Ij...,e, .<'IMnY\NV::'a.u-vH',I~IW,~q~yrry s+v.~1~w 01 REP 19b0 wr"t 9 WR ! T E~OF F R EI'ORT~.L.. ,.C4pi SY,P PA08QS PATIENT NAMb PAT ID DIBOHO 1180-tlA4 NCW-CMG N$kµPAY N-O BAi. P Yp CV RANDALL,JdNNATHAN. 40014771 03/31/b3 110.50 0.00 d, OD 110. 90 ADD er GUARANTOR INFORMATION rr JOHNATHAN RANDALL 749 BUMMER LAKE DALLAS, YX 76066 NB 163 Q Unable to locate 1 RBED,RODIN D 12/07/09 i9bDS p '6s' - RBBDOUANN~~ 1INPDRMATION *o JOHNNY 11991) 91LO 0CUST. 00 N3Q D IPlQS.N70P',35 TX ADD NS 765018R it66 Q+ 1'Lr:~ "t'' Moved left no address t _ 1 12l01/04 133. 2D 0.00 D: 0D 103,20 ADD 8R NO - Q74 Q ~7 q INFORMATION rr VIRpINtA RECD 1400 N ELM 43 DWON, TX 76$Ol' Unable to locate gHDpl10, RdDIN _ ee OVARANTOR INFORMATION •e00JAMESSRHOD88/9Q 106.00 (1, p0 p 00...... l}1q.OR 8F Op dOX 992 T106A, YX 76Q71 No rosponse rMee W»O TOTALO rrrr 35, DEEP 49 -12,86Z30 1, 710. 30 731„1144. 34 . J 1 1. . _.1._ ....i..,....,. , .-tea... ..a r r ~ '~i4 'art l klfl~l T PAGE 24 N R E I d R T f,OB R I T E p P p . .Y... Ol OEP 1900 _CYCLE L$T,PM_ f 1 PAT i1~ f1IBCHD BEG-DAL NEW-CHG NEW-pAV... W-0 DAL F'C_TYP6 FO 7YPB PATIENT NAME 300. Otl Op OF 412 4 W{ BEAGLE, DE R' 0000o215 06107/78 308.50 wat MOTINGG O0PNYON, TX 00000 Missing packet fy GUARANTOR INFORMATION KK PAUL DEADLY ~7*"~ . I CAATI;R, DIANti $ 00910977 Otl/S7/02 J$ 00 0.00 0. D0. g ADD qP N9 3dtti 4 'I ,4 ` RY 3 pd% 4$ Lf7Y4E ELIf, 7% 780ba nable to iocete ww GUARANTOR INFORMATION w* KEITH CARTER U i 007 4 CARTER,I;AREN 00012310 09/49/02 46.00 0.00 0100 Ib 60 OP ER avitsing packet "}W p0 DOX 1012 DENTON, TX 76201 Kw OUARANTOR INFORMATION AWIRRT CARTER / ` IL.._... 00%i GARY 0 00016946 04/17/$1 Y07.00, 0, 00 0.00 4117, 00 $P ER 0 qLb 4 410 OWtOHT LEWIOVtLLR, T% 76067 Missing packet µll *w 4UARANTOR INFORMATION K* GARY COX 140 -...4._. pAUAHTRYvJUOTIN L 00017210 07/10/RO 176,10 10.0OELDRt0080dGAINESVILLE,OTX 76240, Missing packet wK GUARANTOR INPORMATIO Kw RONN111 DAU0HTRY bAVI$,JR WILLJAM J 000176$1 01//00/03 0/03 47.60 00 ~EWt$Vt47.60TXAD76O67R Hissing 944 4 ~ 3 `Og/ili3%$4 5b3 4 _.~...:,g packet K* GUARANTOR INFORMATION **CODg09B9L{09Ji0tl/040 S42 WAL7ERB t0A~00 O. OD 0.00 fb4.00 tip IF * 6TIER,J56gE N Missing packet GUARANTOR INFORMATION 609 YOUNO ATRUaT NOCONA, T% 76;2 8$ KK RUO88LL $t<7IER MiSSing packet ' FERRYMAN, KELLY 40000747 04/03/03 _130, 00 O, Ob 0. 00 $0.00 OP E K* DONALD FERRYMAN PO POX 664 DANV2LLP, AR 74033 H GUARANTOR tNF0AMA7fON 3 3109 4 " 70000894 00/10/03 14,00 00.0WINDMORE100dRJNTH~ 00 065O F ~Missing packet I~ POL$GUARAND 111 K* GUARANTOR INFORMATION K* LANCE POLE _ i w ! FRANKLIN)LEONARD,JR 40046699 061231a3 126.78 80.00 77 -TWIN LKS 96.16 D9NT0N, 8% Tg1k 4Mtsitng4p i9Dt 903 -4.:._,., ~.I G GUARANTOR INFORMATION LEONARD . RANKLIN, JR GgRVIA9,JhNATHAN LD6 00044976 01130/03 743,16 -727,65 0,60 E04 15,50 TkF yb40f JMissing packet,1b G ' *w OUARANTOR INFORMATION Kw WAYNE 09AVAIS - 222E _a .00 ORAHAM,B W 00044009 01/16/03 60,20 ~~60Pt WORTH on 096 BDEN7ONSo g7bs?OL Mlesing packet ww OUARANTOR INFORMATION 4* D GRAHAM ti...__._ - } qHA 4 4 i I~ HAMD1,ADgllO 00029h54 14101/06 305.00 pH0 Do 0.00 n0b. 00 ap to Y$LC$ D6PY NTSU DENw N, T% 76933 4 OMissin4 Packet GUARANTOR tNFORMATtON MUD HAMO! ~ 00099005 06/49/02 441:10 0 60 0.00 Stet, id OP'_'tP 4 HANOLO,OENNI$ OUAAANt'0R INFORMATION TMBLMA NANOEL 1101 DROWNWOOD LEWI$VILLE, TX 76067' Missing packet 4 r* if HOLY, CORY P. 0, 00 90.00 HP' . 40a1737a OA/10/03 40.00 AT, 00 ,1 POX 43bJ PRtOCO, 7%, 74094 Missing packet it GUARANTOR INFORMATION ROGER BOLT _ tlR fF, Kr w* --1. 00033401 OM15/D3' 99.'70,-, 0,00 09.70 $F - OR it'_" packet ew GUARANTOR t1f3V 4" 4.~W iiOU$GNTOR O INFORMATION R D MOUEDEN T 1 DOAK 141MO~0 DO fRNTCN,1®CO, TX, YK 76201 78034„ Mf Hissing packet !I HULLONOU1Ot,L1$A A. 400090$0 00/66/03 09,00 ~0~00 p 0,00 " All, 36 ADO dA N9 AT 4 GUARANTOR INFORMATION w« LIBA A. HULLCMOUtOT W~S "JAC ACMOON,AI0CIA 0000 AY J1/3b/D9 146 .46 u Ob 0 ,10' 146 40 9P IP 09 yg~ ~ J Ib ~ . w* GUARANTOR iNF NFCRMA71tlh aw RWICM6Y JACKSON Gi(NENAL DELIVERY P2LO7 POINT, TX 764DO _...,1941n aC AE -1 Y 9i F I ti Dl OPP 1903 WR 1 TR - nPF A EP OAT pAgp27 PAY19NI NAME PAT 1D DISCHG DEG-DAL NEW-CHO NEW-PAY,__ W-O-DAi.,_ FC..TYPE CYCLE„_L3Tr PMT_ -,FO _,TYPE_. JACODSON, KARREN L 00035394 01 /93/03 WAS, >2D 0.00 0.00 242.25 ADD ER NO- 29C_. ww GUARANTOR INFORMATION ww KAMPEN JA"USnN 1021 VINE BT D2NTON, TX 76201 Missing packet - JOHNOON,DOLVANG 00035906 02/07/77 164 30 0.00 0.00 134,3 y~, ww GUARANTOR INFORMATION ww DOAN A JOHNSON OX 93 9ANG9A, TX 76266 Missing packet JONE9+DAYAN K 00036110 06/04192 923. 15 0.00 U 06 -923 10 0 404 ww GUARANTOR INFORMATION ww RICKRY JONES PU BOX 1093 DENTON TX 76201 Missing packet ~ 3.5W19OTI11 0 40013692 03/26/93 27.00 0~ 00 0. 00 970 Bp . 6R-----.q. _ ._.1dq-. _4 ww GUARANTOR INFORMATION ww IT19 0 LEWIS 419 HRADLES DENTON, Ti X 76201 ' Missing packet L%LIE,WADE G 0004LP44 01/15/03 51.70 0.06 0.00 C1. 75 OF IR` ._......3p4..,, A...._.,.' 4 ww GUARANTOR INFORMATION ww WADE LILLIE RT. 9, BOX 06A DENTON, TX 76201 Missing packet a LINSON RANDOLPH 00041459 10/01/09 1, 690, 36 0 00 0. 00 3, 6q0, 3d __,.-_4 w ew GUARANTOR INFORMATION ww DOROTHY LINSDN 1011 R HICKORY DENTON; TX 76201 Missing packet LOOw9GUAOBERTO INFORMATION 00042051 05/110/02 911.60 -"O,00 0.00 ~-011 6D ADD_ ~Ip N9 4til' 4' ww JOSS LOP92 901 LAGUNA DENTON) TX 76201 Missing packet . i ~ LYNOH,RiCHAAD 0 _ 00009203 09/09/93 915,76 0,00 0.00 90."70...99 Rii 2._• .OD/f4793`.~ `1~-4-.._."4~__T t. ww GUARANTOR INFORMATION ww RICHARt C LYNCH 507 MADDOX DRNTONi TX 76201 Missing packbt 3 Rbq_._.. A 220.00 - b. OO CIAO—, ,00 9p ~hP ' _ _HOADON, VAUGHN W 06Q 5971 046071 12/MRADOR06/92 Itb JAM08 @0 20, 76201 ~ _ . ~'1 ww GUARANTOR INPORMATION ww - Missing packet Missing packet 06 MOROGUARANOt INFORMATION ww00JUAN3MARINO3/S2 72170' PO SOX 940 ODINTON, TX 776201 _ p7g_,_.. 4 NCW9Y#PATR101A SMRWER 40020916 04/21/09 66.10`.._.. 93,00 ......0 60 10,-90 .:.IR_.. 127... _A.....-.. , ww GUARANTOR INFORMATION ww PAULA URIWIR 4319 OLD FORGE DALI.Ab, TX 75211 Missing packet wwww W-0 TOTALS ~www 5056.40 -90.75 J 011- V I.... ,cif. r 7PI r~I 1F~~3~ , Lr 0189P 1403 WA I T6-0PP REPORT PAGE R8 61:,0-BAL NEW-CHC,_ , ,NEW•PAY__- WT0.6AL_ pC _TYPE_,CYCI,E,•_LtlT, PMt _ __690- F0„_,TYPE, i` PATIENT NAME, PAT 10 DIBCHB y 04 95 80 1P 9 6/02/03 198 5 I MATTH6W6 CAROLYN L 10019060 00/14/93 651.75 104.95 -651.75 104.95- rr OVARANTOR INFORMATION r CAROLYN L MAT7HEW8 1007 W98TWOOD LEWIBVILLHi TX 75067 Bankruptcy ~i rrrr W-0 TOTALS wrrr 651.75 -651,75 #Ao _ _ . _ _ - ' t _J O• W ~W i qw "W a. • A • r A. .i~ f IN Y / . r M L. I. /.J. A'NA f`'., H~ryl /1', IY W'YrY' ~.1M ' '.IwIIIIrRa/1 •,1IFID'R•H. r_ ,I ! Z d fi 0! pEP1gd0 WR I2 E -OFF REPORT PAOE29 PATIENT NAME PAT ID DISCHO _B90-DAL .__NEW-CHG NOW-PAY W-0 DAL FC_TYPE CYCLE.,_ LS7, PMT _ -Aq6_----PO _ TYPLr_...-.ti+ 601 9ADBERRY, 6V6LYN, A 10000409 02/04/80 1, 009. 40 513, 014 _089102 992.9 6- BP 43/5261X7 156 rw OUARANTOR INFORMATION ww CLYDE SADOERRY AT 1 AT I ROANOKE, 7X 76262 Unable to locate 13ALYUR,TRINA D 40600121 0262/03 97.50 1,458 !0 0.00 1,5X0.69 9P Y. TX 76266 Unable to locate ry OUARANTOA INFORMATION ww RODOER D BALTVR WORKS 102 91H S7 SANOER, 0,70 0100 0.00 068. 70 V !P 0 61/19/03 275 6 NORAD rr GUARANTOR INFORMATION rw DETTY SA . OANOER9, EMTY A 000004 11/30/02 41)003094 021331X3 ~16. 1715 CROW DCNTONi' 7X 76201 No response ti5 -6 - - • 9ANDERX JA Eq W 75 0 00 0.00 70.75 SP ER 0 f ey ww OUARANTOA INFORMATION ww JAMES W 8ANDER9 300 W LACY CUERO, YX 77954 No response V • SAND6R8, R1IXANN 00060392 09/20/82 1,200.70 101. 130 -0. 00 . 1, 330.20 SP ER 4 03/01/00 42 b r ww GUARANTOR INFORMATION rr ROXANN XANDEwRX 924 X CHARLES #424 LEWISVILLE, TX 7DD67 N .response_.... 9AWPORD,MARYLYN L. 40080900 05/31/20 56.00 _......0 00 0.06 Ob,00" ADZ) 1IR_..,_A 1?0 6 r ww tlUARANTOq INFORMATION wr MARYLYN L. SANFORD 515 WOOD 9T bENTUN, TX 76201 Moved )eft no address SANFORD,VINCENT R. 400128705 05/00/90 6P.'46 0.00 0.00 ~ 69.40 ADD 9A 100 6 1 r rr OUARi,dTOA INPORMATION wr MARILYN SANFORD 016 RUTH DENTON, TX 76201 Moved lefi no address ~i♦ 9ANMIOU04IISMAEL 60060590 02/97/el 600.00 0,00 -l00 00'~ 00q,00 Ab0 IP 45%16/93 SOX 6y ' µj; A O INFORMATION ww ISMA9L XANMtOUEL bin ACME 0EN70N '7X 76201 Unable to locate 9ANNANARAYAA 40021616 64/24/63 100.135 0.06 4,06' _-160,85 ADD ER A 107 6 r wr DUARANTOA INFORMATION rw RAYA A. BANNAN 521 WINDSOR 059 DUNTON, TX 76201 Unable to locate ~ BATTEAFIBLD, JAY 0 40026791 0b/1b193 91.25 . 0.00. O, Od- 91 26 ' _-166 6- » 41 Unable to locate r GUARANTOR INFORMATION rw . JAY D EATYSRPIELD 606 PEARL 97 DUNTON, TX 762 ww 9ATTBAFI9LD, AY 0. 40020524 65123/X3 14.50 0.06 0.60 14'.'06 - ADD' Kh_ ~~11 F r ww OUARANTOfl INFORMATION wU JAY 1). OATTERPf9LV 606 PEARL DRNTON, TX /61241 BR Unable to locate 99 b • ' 9AU694 DONALD 000607711 tl9/07/09 0J4,10'. 01 b0 _ 514;46 ID utPv- -_f--j-g7I))32_ -J 31596 r rr GUARANTOR INFORMATION rw DONALD SAULS 026 PEACH OUN1ON, TX 76001 No response - 169 b.... TX sR 7..651._01 4 No re03/spo}6/90 Ise SAULS,FAYRICK C 00060936 12/O4/B2 6,302.70 } to 0.00 °54.16-201218.60, N351 DEN7ON,, bp,, wr QUARM70R INFORMATION rw PATRICK GAULS TWIN LAKES MH 0. P 6 "'I 0 0i 240, 9D ADD - 1 P 9AVAOANTOR 10042273 07/O9/SO 1 ,610.- 96 ! Nw GUARUARANTOR INFORMATION wr LAWRBNCg 3AVAOE LOT 69 9C0TT9'bRiV1 QLAIAE, M2 4007, Moved left no eddrdts W N 904M1D7, DIANA 10016995 00/31/00 11 126,50 . 491, 95 6. 0o - 1, 596, r rr ' 41s Abb _ _ # 76201 Moved left no address w rrt OVARANTOR INFORMATION JEFF9NELL 309 MASSEY 023' I)BNTON,TX NB 29 _ b 9004MIOTPGARY R, 400099013 05/09/X3 54 , 51. A5 OP dA _.6._..." IY6 wrt OUARANTOR INFORMATION rw OARY A. SCHMIDT AT C BOX 09-1-0 CORRAL PARK AAGYLH, TX 76926 • No,rosponse SCHAOBDER,DANbACE C 00061290 30/16/02 614,00 0 40 b Ob" O3t4.0 ponse r rtw GUARANTOR INFORMATION wrt GUYNBITHE SCHRORDEH 1316 MYATLB OONTON, 1X q' 9p 76203 !P 0 No reess /141t 390 6 i' i1HOHULT2 (MILL#>iL1NDA B 4004094 07/04/93 144,35..._ ..0.00_..- 4 Utl AAA-30 OF b6.. _.6.__. 4r''{ wrt OUARANTOA INFORMATION rw LINDA 0. SCHULTZ !MILLS) AT 1 BOX 900AU2A9Y* TX 76927 Unable to locate s i. '4 Ol nep 19n3 WR I TE-0PI' RCP0RT pAOL'no W PATIENT NAME PAT ID 510280 D1i0-DAL NEW-CHp NEW-PAY IJ-O.DAL PC TYPE CYCLE LOT, PMT,,. „ AGE FO TYPE f OCHUYLERiYVRCSA H 40020330 05/10103 02.50 0100 0.00 02.04 EP ER 2 110 6 M.I ww QUARANTOR INFORMATION ww TERESA H SCHUYLER 1715 SOMA DENTON, 7X .76201 Unable to locate 716 SCO17,NANCV L 00061630 01/24/0 97.00 0.00 6,00 97, 50 SP CA 3 '_WO 6 ww QUAAANTOA INFORMATION ww NANCY SCOTT 3219 TAYLOR LAMAOVE, TX 77660 r SECRlST,DONALD MACK 4000824E 02/09/83 39.00 D.60 0,60 36.60 SP CA 3 X03 6 41 ww GUARANTOR INFORMATION wa DONALD MACK OCCREST 2020 MITCHELL ARLINGTON, TX 76010 No response a SSDbKR1 GN,KRIIOA87A K INFORMATION ww 00461 061770 770 t0/1019EOD0 182 46-1-75 0509 00 ACME 576 00 - 461,76 .9P_._tP- ._.QD/115/03 185 b.•_ ww OHNTON, TX 76901 No response GEOUNE,RAMIRO J 00061504 10/16/02 324.70 0.00 -100,00 224,70 9P -1P 3 05/911%92 10 6 f, N 00 OUARANTOR INFORMATION ww RAMIRO SLOURE 2425 LOUISH 089 DENTON,, T% 761201 Unable to locate ,DAVID 40009172 00/09/23 63,96 229 60 0 00 295 96 9P HR 3 l20 6 I+` 99RNAww OUARANYCR tWORMATION ww CONNIE 9OSA 8912 FT WORTH OR 070 DGNTONi TX 7690t -NO, response__._. 11 0CX70N, CUATIS M. 40090957 04/92/63 54, 10 01 00 d 00 _ 54 !0 9P CR 4 1311 6 40 ww DUARANYOR INFORMATION ww CURTIS M. 89XTON OBNERAL 09LIV90Y L17TL6 F.LM, TX 75060 Ro. respoAm--_._.___ 8HAW,JUW8 A 00069224 10/011/92 66-.- 6,00 _...,.0.Do_ 1708.L;b_ 0P OP 1 354 b ~r r ww QUARANTOR INFORMATION ww RAYHdND SHAW AT 9 90X 3939 PILOT POINT, TX 76259 No response OHEPPARDiCLAUDIAA 40027401 05/19/03 78,50 247.'20 '0. 00 -395,75 009 C 6901 RD response ww, OVARANTDR INFORMATION ww CLAUDIA R 9HEPPARD 1 - SHERHAM, ITA 00068459 01MAN/S3 729.10 O0.009NTRIANGp97M-P 20 1A SP IF ww OUARANTOA INFORMATION JOPP SHER 3 223 6. _ ..i l ww N W: ADD., 9R--V 9HRAMAN, ROY 40043491 07/]0/73 '106,46- O. b0 Q• 615 130, 96RQYL9, TX 76290 lr ww OUARAN7OR INFORMATION ww ROY BH6RMAN MSLOOY MHP 12 DENTON, TX 76901 Unable to locate 810QRLREtlECCA L _ 40011519 03/17/73. _..65,00 _ 0.00 _ 0. 06 65; qO_. AN - Q6 NO 6d/1S/03 167 6 i i • L421 N Unle to 9IMCDAVIDr5R INFORMATION w 400E14606A0331 00/i8DT 48,00 f20.00N LCUST 02 _OV-p', INOar TION esponseocate 1 6 1'l~ ,I aF STANLEY ww GUARANTOR INFORMA w SIMN,BOAN79Y H 6dd65370 01/06/03-44 9OV10- 66, 00 _ b, giS t 34C:7d--gtr Ipu~:l-- , l~ ww OVARANTUR INFORMATION ww 9ARN89T SIMS 37 114 AV9 5 Nt25 bBNTONi 7 `r to D 03)'T X 76201, Unable to 1dCete . Mj SINS, NOAH'L' 020034710 0! /.10/53 2, t; 4d ` R', B6q -70 -1 "917, 117 "91rZA; 911 _ADH 1753 f0-4 Tkb&SR Keyed tl8703/ggaddress NYLLi5 1NOFORMAIION ww 4002g15 STANLEY 04SIMS /17/53' b7; 711__ t61obOREO-B b, O0 _.d6N e1H7d it73""._6._~ _ __._I It _..StpOLTA P 1'M ww GUARANTOR INFORMATION ww b9/AN155 91pOLT 1490 N MILL LSNSSVtLI.R, TK 70067 Unable t0 10care } _ S0A005,DBSRA 0 00063074 Oq/btlStt' J,bd9 0d O 4tl tl Od 3 Otl4 O0 SP tv 1 060 6 I« 900987 _ 9312 ALABAMA OAIN95VILLKI TX 7bA4tl No response ww OUARANTOA tWORMATION ww LARRY . S+Ri4N0UARANTOR5INFORMAT[ON +5w60MARVOt'06/OS/59 650; 0d Otl, 25 -7f, OO 610:2tf~'IO' iP R `'16104/5{1 `'4Ii 6 Mif 47TA SKINNER 6900 90, SY MMONS bBNTDN, TX 76901 No response ilr LLY i •~~(i ~ i7 i;7,p , tt' µ r I a 'i le 01 BLIP 19t)3 WA I TG-0Itr R H1'ORT I ♦ PAprt 31 i PATIENT NAME • I, PAT ID DISCH@ BGG-bAL _ NEW-CHA _.NEW,-AAY..... W-p bAL,.FC_7YP6,CYCLE..,LBT..PMT, _ AGE,.._ FQ_-TYPE ♦ • SMERDON,JESS10A MARIE 10083047 00/04/83 D47,00 3 749.00 0.00 N, 647. 00 gp tp .._g 1• f r* GUARANTOR INFORMATION *M R0008T SMLADON 944 S CHARLES 0440 LGWISVILLE, T% 70067 104 i SMf • H, b&R10 S 00064097 6023/60 409. 25 0, 00 O 00 - -4015,20 Abp ---OF unable- to locate, ♦ GUARANTOR INFORMATION MM CARREN SMITH `gO1 " `b 116 BO SECOND 0ANQ611, T% 76¢66 Moved left no address r 13MMTO, DIAN 00064113 01/19/133 615, Oo 0.00 0. Op 60. 00 BP ER • MHO DBNTDN TX 201 ♦ VARANTOR INFORMATION MM D1AN SMITH ♦ SMITOUARANTDIANNFOHMATION 46026306 05/10/03 -147, 60 p0.00Nb15 - 0.OOdd-- 147.6o-- ADD' fto -b No response.-.... tl SMITH 0607 F1tLpCRBB7 DR. OAAPSVINL, Tk 76050 11¢ d 40D803BO tl4 gM1TH,MAROARL7 L, Unablo.to.locate r • MM GUARANTOR INFORMATION MM MAROARHT.L. OM27N 74 35.. ¢00015FT, WOf0iTH0N1131341TNTbNAOTk 76801 4 180 "_,..G ..~.._.fi SMITH,MARK V 40003bi8 6S2/13185' 3060 -7 0 00 0.-06 Unable-to_}ocate.... _ • MM GUARANTOR INFORMATION MM MARK V SMITH 3B 00 ADD NS dR _ no iJl AT q BOX 164 ROANOKB, TX 762 76¢6¢ 197 6 Unable to locate SMITH, RANDALL b 40009070 03100/83 160. 00 __....0, 00 0, 00.... 150OO SP AIC 176 b.. ` • Mil OUARANTOR INFORMATION MM RANDALL 0 SMITH 16139 MANHATTAN DLN7tlN, TX 76¢01 M;72 responsd 16--. J t/134/813 • _ S6 , -SO BP - 'eR 1 I No t3MITH,A8ANTUR C 00646¢6 5316, 11 0 604 pD SCHMI 44 T2 1 61DBN7tlN, 7k 76¢01 NO response • MM GUARANTOR INFORMATION MM MICHAEL W SMITH BMITH,RIOHARD A P _ 00064614 06/04/8$ -11&30 O, 00 O, pO.. 116. 00 IF Op 3- 12/0¢/88 - 4134 6._.._. ~ • t • MM GUARANTOR INFORMATION MM RICHARD SMITH AT 9LOT 13 004DEN 7RI MHP AROYLOP Yk 76206 OM1TH, SHANNON, b 40001007 4¢/06/83 - ._..-96; 00 3S: Ob 0, SO 63; bC Abb N grgbP49£e__.. _ b y Mw GUARANTOR INFORMATION Mn JERRY SMITH 134 ¢NO PECAN APT Mb BANGER, TX 76$66 Unable SNBLL,ORBGORY,A le to locate ! ♦ Of GUARANTOR INFORM A7[bN 46ORMOCRY007466 43,00 1O,09 OD MASSEY LO 0.T 00 33 4 WYNN3,'0d AOI1 Sit 3__._ lOb b _ MHP DENTON, TX 769201 SPARKMAN,PAULA 1. W29/09 t r OObbr,3W29/09 30,' 15 0•66 . .,---'0 oo-.9;b5S;96....ID .IP...._._analSd /gllP~s~te 4136" 6 ~ • NM GUARANTOR INFORMATION t31A MM PAULA SPARKMAN AT ¢ BOX 163-A PILOT POINT, TX 76¢00 BPBARS,gANDAA K 1R9 6 9 0,1/20/83 54. DO f76. 00 0 00 2:1[h. 00 W ` (tit' No te$porja MM GUARANTOR. INFORMATION JIMMIS BPBARB P.0 BOX 461 SANGOR, 7X 76e66 No. E•.. response I'• SPGLt.S,SbLGMAN D, 40057QA4 06/¢1/03' '1713;10 O: bb -0.66 _f7tl•}0" AbD-'.. SA "d MM OVARANTOR INFORMATION K+~ ~SOLOMAN b, SPELLS YO 6 " 1 ¢04 RUDD6LL N33 DITNTON, 7k 76201 Moved loft no address 6PENt9A,8bWIN J 40014656 04/19/93" 92,1:6 H6: 75 175;Ob..ADD ,A 5 i147i11/83......:;.-44 b.._... Mr GUARANTOR SNFOAHA7ION rr EDWIN J OPBNC94 1681 OAK 0111A DIMON, 'TX' T6¢oj01' BPgNC6R,RbOgR D•` Unablo to locate r 10607407 63701/01 ¢ 7~1b; 00 -1T/l 00 O; Db„'12;+1Q7. Ii0 op IP-`.--11 r MM GUARANTOR INFORMATION MM ROGER D• SPgNCSR 61¢ PURNELL L6WISVILL0, TX 75067 tq9 6. 8PIVEY.OARY A Unable to Iodate - 46 00065661 11/03/01 dg0, pO b. 00 -1e 00 S 665, O0 BP " -tP . " 1 "bb/i7/S3 ibY 6 r l r MM GUARANTOR INFORMATION *0 JAMBS D MOL90D PO fl0X 073 AROYLSi 7k 76¢¢6 ArrangPmQnta not kept t SPOON D2ANB J 27. 00065600 11/i7/g¢ O 44.. 0;00 ._.~10 60 'al§ 96 9P 2P` 5_-'07/lt/85.._. tl1I___ 6.-.:-.:. V ' MM GUARANTOR INFORMATION xM DIANE SPOON 2X02 MHP Lb7 6 AT 4 pBNTON, TX ?6201 No response i / I • ,E UtYK•rl. r ,v r. 7 ~1u(j y f, ,t V~ 'W Wn I TE-0PF REPORT PATIENT NAME PAGE 3Q PAT ID D1ECHO DEG-DAL NEW-CHQNCW-PAY _.W-O DAL PC TYPE. CYCLE LOT, ,PMTAGB_, PQ TYPE_,,. SPRADEARY, GAYLA 00064789 04/90/89 440, 00 - I~ ww GUARANTOR INFORMATION ww QAYLA SPRAUCARY 0 00 -940,00 860004 Sp . TX 3 Ob/03/p3 q0-......6 1620 ENCLAVE PKiJY M9406 HO SUP, TX 77077 SPRABERRYiLVCINDI,L 40005034 02/19/03 76.25 NR.res Onse. 4P 1 ww OUARANTOR INFORMATION ww KAREN SpRABERRY, LYNN 0 40 0 09 76-26 Sp ER O P 1911-_,._.6 " Pr O, BOX 303 TtOOA, TX 76Q71 No response SPOSS910,87EPHANI&M 00064961 12/31/82 1 4d7r40 r to, ww GUARANTOR INFORMATION rw MITCHELL SPROU8910 CHARLOTTE APT 01b DRMTO N, 7X 76001 244 b r SPROLES,TgRESA K ww GUARANTOR INFORMATION J ww UpUtTA HOWARD 0.00 01 - - No response._.. 0tlU*UtT 0031/13i 46145 RY 2 BOX 147000 40 13P ER 4 ARGYLE, TX 76925 213 STABILE,RACHEL 94002095 06/05/63 No response r. ww GUARANTOR INFORMATION ww CHRIS STABILE _-R1r b0 0. 00 _ _.0. 00.. .21~ 00 ,.SP.:.. . 0p. 1906 RMERSON DENTON, 7X 76801 SD 6 - STAdK,JOHNNY DWAYNE NO response 40010450 03/I8183 r 32.60' • ww GUARANTOR tNFORMAT1oN ww 0r00 0.00 JOHNNY DWAYNE STACK 38, 0d OF --ER @ bb/i3/td3 170 .'.b.' PO BOX 204 OHWY 106 PONDER, TX 76249 No response STAFFOR6, JAMBS RAY _ 40045UO 07/21/03 812. 48 rr GUARANTOR INFORMATION ww JAMES RAY STAFPOND 00 2"i- 46 ' _7 _ , YX ADD gq ___.j,_.. 42 _b 4371 lNKER HgU8TON 7X777049 Unable t0 locate r SNMR GUARANTOR Rr 10001163 01/31/83 Ii 199. 74 dd.4 00 BOX 10J OR INFORMATION ww JAMES R. STARNES 1r 9570 73 SP IP " '3 ` 1 196 Vi , i ' ' RT ACORN RANCH DtINTON, TX 761701 STARR, MARISA 00066571 09/99/09 6.606. 65-.., `.0. do F~o. response_. ~A w ww GUARANTOR INFORMATION ww CHARLES STARR Or 00 b,40Ord3 DP " IP 037 6.._ RT 3 SOX 860 pENTONI 7k., 76901 No response, BTENARTiROYOE 400047,90 09/2l /e3 143. 00 410 2tl 0- o0 2341 On ADD . bR "NS rM 121 GUARANTOR INFORMATION ww ROYCE 8TRWART --...6. . RT. 1 BOX 0620 DENTON: TX 76201 Unable to locate ETfkiRE, VyOktE S 40019956 04/00/53 "48,-00 240, bO _ 6'.'00 205. S-' ADD" ._~R Ng ~ Y ww GUARANTOR INFORMATION ww VICKIE 8 STOKES 1040 PARK AVE 203 L$WISVILLE, TX 75067 9011 b STONER; DONN19 L 60067441 0096/03 30. dC .__.__.-dl tlb d, 06-._....65;06' SP ER _ ..141nab1e„to. tpcaSe. _ .215 ,__b._.__ _..n_~ W wN GUARANTOR INFORMATION ww JOHN STONER 635 UNIVERSI7Y'LEWISVILLE, TX 74067 BTRANGR,PRANCES 0 No response . 00067529 O1 /OS/53 JS, b0 0. 06 - 6,66 . J4,00"_ SP UR ww GUARANTOR INFORMATION ww GRANGES B7RAN90 _ ~ RT 1 1 SOJt' 193 AUSREv, T% 76287` ttSb 6" ~"-"I,1 ti'AYL1iR~4A1HY A No response ' •r GVARANTOR INFORMATION ww4dCATHY4A~TAYLOR3 5S' jtl d' Od N d 60'--- SB, TX I 1944 MOOkLIGHT DENTON, TN 74901 TAYLOA,JIMMY D NoVed left no address ww GUARANTOR INFORMATION wr 49260 10001024 J 02/01/93 1, 4116. 40` 49,60 LllOtlr 2tl `SbAr BO- Bp `7?" , 0 ..bd/84/5J lb! , - TAYLOR STAR RT QAINE9V1LLE,'T%76240 TAYLIIR,FHYLLIB A No response r ww GUARANTOR INFORMATION ww~pHYLL150TAYLOR2 4, 4~S,TD d 00 - 4 bd 4 A154 1A ` XA" '._.O 4d+I b 3105 SAO&BRUBH tSENTON, TX 76201 No response 79 6'+ w.Ilw TORRE5,LGTY R. 16007094162/29/PJ' GER, 616.96 _ • Of GUARANTOR INFORMATION ww GILOARDO TORRES 7R. 6 RT 1 box Bob SAN Uiieblk.to Ib/Stl I 76 ~b th 2i6Y1ocate ) TORREB, VERONICA L 00069956;"ld/84/SC 200, 00 6D d0 409; d4' 6A wr GUARANTOR INFORMATION ww GUSTAVO LRRMA 1i9164 {i~ r: ! ~ 1F __4 OAT6f7S3" "•"O1:"._b _.__....J I _ _ _ 524 FT WORTH DR 014 gENTQN, TX' 76201 f .Bo.resPonse J ~ ~ rl I 11 II 0 r 2E r 01 9Ep 19D3 W H I T E 0 P P R D P D It i PAAO 33 r • PATIENT NAMIS PAT ID DISCHO BEO-DAL. NEW-C110 NSW-PAY _-_W-O.OAL..FC_TYPE .CYCLE LBT,PMT AGG_- -_FQ,__TYPE Sp BA TOWNSUNDi MARY C. 40006166 02/22/93 411.50 0.00 _ D.00 4!. 96 ~ i 44 GUARANTOR INFORMATION Of MARY 21.1191 AT 2 009 1161 DENTON, T9 76201 No response 190 6 ~'L• • I ' ON, T% 76001 ~ ww GUARANTOR INFORMATION ww NICK TREVINO 2800 PT WORTH OR 442 DENT ADD IP 3 166 6 Moved left no address 7UCK9RN,0J0PF2RY J. 400/6801 64/04/83 540. 2D 240f 00 0' 00 1i 148. 20 ADD ER 1 149 6.__... • 4w GUARANTOR INFORMATION wr CELHSTA TUCKER PO BOX 1044 OANOER, TX 76266 Unable to locate w UMRH,b0RNICC A 00070797 00/12/82 1, 64 b. 9R - 0.00 -0,00 1,046.92_..0p...17!', ww GUARANTOR INFORMATION xw CHARLES M UMCH 1900 SAM DA9e BLVD R3 DENTON, TX 76201 sS p~pne IF J 3p-,...r30 reo1!/04/83 205 6 UPCHURCH,LINDA 00070900 13120/01. 4, 750, no 0.00 0, 00 4, M. DO w4 GUARANTOR INFORMATION w4 JAMES UPCHUACH AT 1 BOX 79 JUBTIN, T9 76247 No rospogse i VALRNTIN9oYICTOR 0 00011043 07/10/02 001, 60 0.00 0.00 _ 3o1-b0 10 IP Ob3.......6.-.__- • ww GUARANTOR INFORMATION Of DILL VALENTINE 00 BOX 1161 SNYDEA, T% 77049 No response ~ + VALLY400J09R' 06071066 01/14103 90. 75 -6.00 71.76E 10.00 ' BP 0446/83 06- b - - ' ww GUARANTOR INFORMATION 4w GONZUL0 VALLSJO 010 ROSE DENTON, TX 76201 no response' i' ` VANDYKi MICHAEL P .101207d 03/14/53 634, 76_ -O. OD 6-,-06- 7 304d ADD''-1P - 0 fI3/!4%E13 369 4_ b - j w4 GUARANTOR INFORMATION ww MICHAEL P VANDYK 020 PULLTON PENTON, Ti X 76901 Moved left no address VABGU92,MANUBL 00071890 06/16/02 -127.06 O. OD -10,00,- 17 uo - DO--ftD. 3L 02/!6/63_.. 97.._. ti w4 GUARANTOA INFORMATION ww 13AYMUNbO VABGUKZ 1501 MCCORMICK 09NTON, TX 76901 No response w j r V MOGUARANTOR INFORMATION ww00PAUL7VAUGHNO/e3" 83. GD 80X017 WRIGHTOCITY, 6OK0574766 R NO response 2~'4 b VwwLeINFORMATION ww10J04D29 K, V1StldOKY 058 70 AT, 00 0 00 ' CAKAj i0 No response J6"--k- GUARANTOR 4 3 80% 8 NO DECATUR, TX' 762AA -loved loft no address WAbG, K94DRIN 4001140 03/16/03 74. btl 0. 00 'C:00'_-____74'b6_ Abb ""AR '3 - ` 16tl + ww OUA!ANTOR INFORMATION ww GLORIA WADE 920 OCOTT DONTONi TX 76201 b WAON911, BALLIU H 40004506 02/1B/9O 50: 66 0: O0 0. OD . -O6; d0 by kA J Moved deft no address 19 b" ''E 4w GUARANTOR INFORMATION 411 BALLIR WAGNER PO BOX 12e42 PT WORTH, TX 76116 ' M WLLOUARANVI INFORMATION rw400DAVID 4461BL0/10/0AC DOO.'bO 0.00 6:00 66,01,116 ADD 111 A. _._.40.-, _6 E 5010 OCRIPTUR9 NO KNOWN ADDR889 08NTON, TX 76001 y WBOTiCINDY INFORMATION 44400CINDY 103 WH0T1b/03 1bB,60 -'-002 be OAK 0.00 " , YXD Y6 able.t0.,loCete..;..~ 133' 6 291 Unable to locate r .,....{7 . WHIT94w , LAAHY, GUARANTOR J INFORMATION w4 LARRY 40007655 02 WHI/2'!/53 _ ...66},05 d. 00" 0.00_.-.. bk,-3£D`AD0 Cft` NO TB, J AT '1 BOX 0690 09NTON, TX 76901 Un4blo to locate r WHITLOWtUDDOPHINK w4b00JAM&O 14110/06/eR 400.30 217, 40 0, 00 :_.bb0 20 60 - .Ip:: . 0 id/14/65 1'96 .'6 • GUARANTOR WHITLOW 1017 9 OAK bBNTON, TX 76901 No response WILPONO,PORCY CLIFFORD 40025496 06/11/00 01.06 48,00 0 06'___.-T36 O0 ADD -6R 3 W 6111 6 J/: 44 GUARANTOR INFORMATION 44 PERCY CL1FI40RD WILPONG AT 1 BOX 41 APPLE SPRING, TX 70926 Unable to locate a)Y ; 16 W 1 I N X 1 01 SEP 1903 WA I TE -OPF R EP0A T PAGE 34 PATIENT NAME PAT ID DISCHO BEG-DAL NCW-CHO_,. NEW-PAY W-q SAL PC TYPE CYCLE LST.PIIf_ AGE„ F0 TYPO.. t r r ' WILLIAMS,DBRRICA A 00074609 09!18/62 31 134, bb 0100 0•00 O,i34.b5 Sp 0P B 364 6 iI w» OVAAANTOR INFORMATION w« GEONQE WILLIAMS PO BOX 711 ROANOKE, T% ,76262 Moved left no address r WILSON, OSCAR D 40004071 02/18/03 66. 00 300. 00 01.00 374, 06 ADD 9R NB 1'/d 6 4r' NM GUARANTOR INFORMATION rr SELP 700 CORONADO DBNTON, TX 76201 Moved lest no address 110 WINN,aDWARD E 00070400 01/19/83 7Z 60 0100 0.00 7q, 50 Sp 40, 4215, 6 AT 4 N92 OXECUTIVE MHP OENTON, TX 76201 4Y GUARANTOR INFORMATION FRIEDA WINN Y I_ _ -left W 223 b GUARANTOR addres9 . WOODGl1IRAHTOA INFORMATION wMD00ARCHIe WOODS 16069 OUP!/83 2,710"_.40 0 AT . I 00 BOX 0. 91C4 00 2, SAINT 712, J0,40 TX SP . 76210 66 A ~ YVCK,CHAIBTINA 40DOOD79 62/02/93 49,60 y 0,00 0.60 49,00 SP 9A 3 210 6 4r rr GUARANTOR INFORMATION +r• CARL CARSKADSN AT 0 BOX P37 DELSTE AROYLH, T% 762$6 4A able•to 29MOIK,6EVERLV 0 00077167 00/10/82 -608.60 _.0,00 0'00 _ 60d. 60 9P OP _._._li locate. 374 b ~ AT S 060 CAPAIOOAN MHP DGNTON, TX- 76201 w M 04 GUARANTOR INFORMATION 68.26 20, 00 01 00 _ .9626 AT6_. _wk- Resedto pay ! V 1140 W. WALTSRS l.SW1BVILLE, % 74067 I ~ YIROSLSR r►GUARANTORLINFORMATION +~r46PAMELAY 40 ' NMM• W-0 TOTALS MRIVM 63, 152.43 -4)404.00 40 M f _ M' I rt - _ -:w._ . f sD9 tihr.>k, 1 w,eryt VI;1~;, ( Lp iJ 17 1 1 ~4 i a O1 BCP 1903 WH I T E- d N F R E110R T PA0935 k PATIHNT NAMi PAT ID DISCHO _ DEO-UAL NEW-CyQ_ __NEIW-PAV....W-0 BAL. FC PMT__ AGO wwww WRIT-DPP GRAND TOTALS wwww 247,966.83 °361843,03 .24,901,29 - 2711024,29.~1 iI r C 1 i t 1 j i now, R M,ffNpll FLOW MEMORIAL HOSPITAL BALANCE SHEET , MARCH 31, 1983 Current Asset9r 1983 1982 Current Liabilitiesr 1983 1982 - Cash--Operating $ 19,852 $ 228,620 Current Notes Payable $ 4520090 $ 185,496 Interest & Sinking 170 7,608 Accounts payable 7540517 5900433 Reserve Fund 40,855 10,181 Accrued Payroll/Taxes 425,984 378,449 Repair FLM 20,351 1,051• Due Medicare 120,903 1930365 Group Health Insurance 11000 11157 Fees Payable 193,712 193,751 Investments/Board Designated 3091488 521,398 Bond Interest Payable 100061 10 061 Bonds Payable 10,000 _ 651000 Total Cash & Investments $ 391,716 $ 770,015 Total Current Liabilities $1,967,267 $1,6161555 ' Accounts Receivable $3,782;936 $2,6630420 Other Liabilitiesr Lem Allowances 580 653 (224 212) Deferred Income $ 172,543 $ 174,527 Net Patient Receivables W, 0~` ,z 3 ~W Lang Term Notes Payable 319,067 $00j564 Bonds Payable Other, Receivables 27],,901 1840736 420,000 430,OOU Inventories 361,461 265,556 Total Liabilities $2,8780877 $2 721 646 Prepaid Expenses 41,362 93,935 , , Total Current Assets $4,268,723 $3,753,450 Capitalr Property, Plant & Equipments City of Denton $ 3931165 $ 3930165 Land County of Denton 116960871 1,696,871 $ 37,347 $ 371547 Endowment Flow'Estate 2401461 240,461 Building & Improvements 31067,385 3004304630 Fed; Grants,' Hill-Burton 118680910 1,868,90 ftmitur'e & Equipment 4 763 832 4 918 388 federal Grants 256,371 256,3 1 70 B 6"V-jW 04990398-- Pledges and Gifts $42,702 4591380 Gan. Fund Sal,, Beg, of Yr. (291,266) (6860710) " Accumulated Depreciation _(4,14210749) (4,029,933) Current Year 129,647 72 881 Net Property, Plant u#g$$, 470015 $3,4690465 Total Capital ' !11 $4,836,861 $4,501,269 'DOTAL OPMTWG F'IJND $ , 15,738 $7,222,915 Tb'PAL, OPBRATING rwD 7 7 5 738 $7,222,915 ~l pJ ~r Current Ratio 2,29 APR 2 9 198 i .GAYr netaii~,•.~Wk{j.~~jN, ,y~.`~t s WKIM_ II rFr{~i2 1 r1 f'r Page 2 FLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT MARCH 31, 1983 CURRENT MONTH YEAR-TO-DATE PRIOR Actual Budget Actual. Budget Yew Date Adult Patient Days 21769 21945 170168 17,290 17,020 Average Per Day 89.3 9510 94.9 95.0 93.5 Newborn Patient Days 468 434 20204 2,548 21297 Average Per Day 15.1 14.0 12,1 14.0 12.6 dross Patient Revenue/pt. Day $502.32 $415.05 $434.31 $424.17 $377.62 Total Expenea/Patient Day $402.36 $345.33 $366.25 $352.91 $320.18 Month - Charity. Bad Debt Reoo_Very October $ 51,473 $ 96,053 $ 51636 November 127`0181 117,974 4446 December 61,228 106,636 60566 L7anuary 81000 99,706 91934 February 28003 108,131 41092 March 52 295 89 946 12 762 329JOU0 5 61U,445 430436 8 Revenues 4.48 8.38 .068 j i 1 i jw~ I F L O W M E M. 0 R I A L H O S P I T A L Page 3 STATEMENT OF OPERATIONS/MARCH 31, 1983 $ of salaries supplies Total Direct Operating Revenue Revenue & Benefits & Other Expenses Profit (Lass) Daily Hospital Care 6 15,01 1 1 5 ,107 $ 13,621 $ 144,728 $ ,0~ Psychiatric Care 6 770295 36,834 3,596 40,430 36,865 OB/post Partum 3 44,620 18,494 21194 20,688 231932 ICU 2 25,.150 190287 61983 26,270(11120) NurseryAltcu 6 87,235 35,017 5,119 40,136 47,699 Coronary Care Unit 2 33,465 30,643 4,762 35,405 (1,940) Labor & Dolivery/Birthing Center 4 55,098 27,757 71164 34,921 20.,];77 operating& Recovery 5 62,954 23,3,73 16,995 40,168 22)786 E rgency,Room 3 43)981 18,129 27,142 45,271 (10290) Central Supply 9` 127,292 81706 68,493 77,199 50,093 Laboratory/Blood Bank 10 135,058 540689 54,689 80,369 Radiology/Nuclear Medicine 6 86,472 16,185 22,372 380557 47,915 Pharmacy/IV 17 243,304 110296 44,789 56,185 18711,19 Cardiopulmonary 7 97,796 20,400 18,402 38,802 58,994 Anesthesia 3 41,111 15,076 110217 26,293 14,818 Physical Therapy 1 16 300 6 780 1J32. 8 212 80098 Total I~`_ ` xa1;32';~6 :5 41U,984 3O8e970" 727554 i r 4,,`,2....... Deductions of Revenue $ (91,820) $ $ $ $:(911820) ! Charity & Bad Debt (151,546) -w (159$46) Fmployee Health ins, Expense 34,438 34,438 (34,438) Medical Records 607 100943 10663 12,606 (11,999) i Gift Shop/GroWa maintenance 11682 1,646 1,215 2186. (11179) 11 Cafeteria 110514 , 26,397 28;678 55,075 (481561) Plant, 150924 671081 831005 (83,005) Environmental 8ervicas 35,381 8,807 44,188 (44 1' Fiscal Affairs/Data Processing 81008 61068 141076 (1461)) Business Offipa/Credit & Collection 21,811 10;551 32,362 (320362) Personnel 30680 11043 41725 (4,725) Administration 6,731 30395 10,126 (10,126) Quality Control 21969 239 31208 (31200) 1 General & Administrative 510 51,240 51,240 (50,730) Depreciation - 38 259 _ 38 259 38 259) Gain (Loss) From Operation 40070 Non-Operating Revenue 260412 261412 Foundation 3 112 3 112 Total ~ E' r` KimM Dom-" 5D'StitiMWVk'.v^NaA{d.p..rK:w:nVfAa:eva, . .:..a...r..w`.Ir$r.A4•an.ua:r:.lu..isvHAN.+1'd+e.rMr':riti~FM YAI/ld{{YIYS'A<Y I !i tt tC4:Gi+<Ly-FLOW M r M 0 R I A L HOSPITAL Page 4 STATEMEW OF OPERATIONS/ Year-to-date March 31, 1983 8 of Supplies Total Direct Operating Revenue Revenue Salaries & Other nses Profiitt(~ss) Daily Hospital Care M-" MW 1,15 V yg -t, 18 T- , '2 E71, 60 Psychiatric Care 6 437,578 2060992 20,687 227,679 2090899 OD/Post Partum 4 313,785 113,763 141,849 128,612 185,173 ICU 2 162,975 113,401 20,214 1330615 29,360 Nursery/NICU 6 386,075 189,762 37,266 227,028 159j047 Coronary, Care Unit 3 238,022 186,672 26,266 212,938 25,084 Labor & belivery/Birthin Center 3 249,482 155,642 41,819 197,461 52,021 Operating & Recovery 4 2840440 126,060 84,995 2110055 731385 Fzpergency Room 3 223,722 103,111 163,048 266,159 (42,437) Central Supply 8 5990577 46,977 267,526 314,503 285`074 Laboratory/Blood bank 10 767,220 339,296 339,296 4270924 Radiology/Nuclear Medicine 6 4390472 94,666 126,068 220,934 218 538 1 Pharmacy/1v 16 11225,948 70,786 273,760 3940554 H81,394 t. Cardiopulmonary 7 550,113 124,223 106,612 2300835 319,278 Anesthesia 3 2251196 95,123 47,969 1430092 82,104 Totalcal Therapy 1661 ly 84*5 84: 10 467 52,392 32,457 r r r ti' r , r r ~31347f356 Deductions of Revenue (404,394) Charity & Bad, Debt (916,046) 540,4094) EVloy4e Health Ins, Expense (91600 46) ; Medical Records 147,622 147,622 (147,622) Gift Shop/Grounds Maintenance 10 916 690510 151343 81,664 (79,36,9) Cafeteria_ 68,101 158+673 8,745 18 255 (7,3'3 ) Plant ~ 165,508 324,191 • 94,426 3761725 971,151 471,151) Envirorwwtal Services i25 206,011 59,251 2651262 (265462) Fiscal Affaire/Data Processing ' 443 Business Office/Credit & Colle%;tion 133461636 32,98 79199,347 ,279 (791277) 1 h~grsonnel , ti49 65 ,6698 (199 3d7), Administration 16,826 12,145 28,971 (28,971) Qualify Control 38,599 15,399 53,998 (53,598) General & Administrative 150309 3,869 191178 (190178) 11963 298,928 2430925 (243,962) Depreciation «W 227 431 22 27 4 Gain (Lost} From operation $ 1-2VOT ;6,"l , , $ ; Non-4porating Revenue 1610998 (618 Foundation 1722 161 Total S'k'i 3 6,' --44907 A I Page 5 P L O W M E M O R I A L H 0 3 P I T A L SUMMARY OF CASH RBMIPTS AND DISSURSEWTS MARCH 31, 1983 Current Month Year-To-Date Beginning Balance 6, 1 -__z~l-~- w------ --1 Cash Received from: Active Patient Accounts $ 100720461 $ 5,8100365 Bad Debt Accounts 12,762 431436 Cafeteria 12,631 70 988 Appropriations/Donations 61244 205,851 Other 281r886558,667 Total Cash $1,385,984 $ 6 689,307 TOTAL CASH AVAILABLE Cash Disbursements t f payroll $ 492,412 2,9630961 Payroll Taxes 690770 440,812 Patient Refunds 62,940 134,994 Capital Assets 9,797 117,028 Notes Payable 150687 I05,~64 Other 787,3.7_ 7 21905,210 Total Disbursements 903 $ 61667,169 $1 9 " Cash Balance 24,313 Cash Investments 301 r 24,313 683 07 6V, !total Cash r 331t996 i Gross Patient Revenue $ 11390,928 Lean Allowances (111 580) $ 7,454,603 Patient Revenue X9,3.-- Net ~9 Cash Received on Patient Accounts $ 11072,461 $ 5,810,365 Leas: Patient Refunds 62 940 34 994 Net Cash on Patient Accounts , , Cash Received as a 8 of Revenue 7899 81,69 } rt , Page 6 F L O W M E M O R I A L 11 0 S P I T A L AGED ACCOUNTS RECEIVABLE SUMMARY RNW11 31, 1983 Primary Pavor Currant 31-60 61-90 91-120 121-150 150+ Total % of A/R Medicare $ 348,058 $ 19,920 $ 160904 $ 11255 $ 11336 $ 12,424 $ 4590897 13,2% Medicaid 143,438 27,479 10,211 14,527 31104 81696 2070491 5,9% Blue Cross 60,814 52,574 5,142 42 1,346 526 120,444 3,5% Camtercial Ins. 5950058 2370953 97,869 46,078 20,126 14,446 1,011,530 29.0% Self-Pay 295,639 110,536 180,060 1230369 106,187 281,127 11096,918 31,4% Balance After Ins, 2301296 236,947 32,685 27,85520,090 46,932 594,805 17.88 $106731303 $ 745,409 $ 342,871 $ 2134126 $ 152,225 $ 364,151 43,4910085 100.08 In-House 335 j72211 TP'AL A/R i i A/R by 8 47.9% 21,48 9.88 6.1% 4,48 10.4% ' i Days of Revenue: j Accounts Receivable 85 In-House 7 f Total Ir i i i t, h sa!WA. M FLOAT MEMORIAL HOSPITAL AOVD AOCOUNTS PAYABLE Page 7 MARCH 31, 1983 i DEFERRED PAYABLES 0-30 31-60 61 TOTAL Trade Vendorg 286,003 219,910 86,808 592,721 Fees payable 820739 47,884 44,339 174,962 Aocrued Payableg 45,213 45j213 estimated Payablea 116,646 216,646 € i Deferred Audit Fees 18,750 rr......r~.r r_- _ 188 Total 184750 530,60.1, 257,794 131r147 94.8,292 i' 1 t I A I M11 ff`• { Page 8 PLOW MEMORIAL HOSPITAL HOME HEALTH BALANCE SHEET MARCH 31, 1983 ASSE'T'S LIABILITIES Cash $ 21,162 Accounts payable $ Accounts Receivable 96,976 Payable due Flow 2,426 $ 118,138 Accrued Payroll 77 276 Inventory _ 1,844 Total Liabilities $ 9,702 Total Current Assets $ 119,982 EQUIPMENT CAPITAL f Furniture & Equipment $ 10615 Pledges & Gifts $ 115 Less Aco=lated Depreciation (11340 Gen, Fund Sal., Beg. of Yr, 113,815 fi I Retained Earnings Current Yr, (3,381) Net Equipment $ 269 p j Total Capital $ 110,549." j TOTAL OPERATING FUND $ 120251 _ TOTAL OPERATING FUND $ 120,251 j I' WWI J Page 9 F L 0 W M E M O R I A L H O S P I T A L H O M E H E A L T It STATEMENT OF REVMM8 AND EXPENSES MARCH 31, 1983 REVENUES Patient Revenues $ 31,961:. $ 187,170 Deductions of Revenue (31719) -(42 477 Net Revenues $ 28,242 $ 1440693 EXPENSES Payroll & Benefits $ 20,488 $ 125,053 Puro. Service 818 4,377 Supplies 536 81460 Travel 10169 80826 Employee Benefits 226 11089 W Depreciation - 269 Net Expenses $ . 23,237 $ 148,079 Excess of Revenues Over Expenses $ 51405 S (3,381) 3 i i . ( .MrN>AN4.'. W'hKYiV1aMMVtl.n ...a.:...'uaarwtweaW;w'•++nxne,w•~.1MNavr.:sr ✓M0.v.+:u ipgdpgNa lZbp~1g11t~„ i IFkte1'r-ti iw;; Ern--p F; i P L 0 W M E M O R I A L H 0 S P I T A L BAIANCE mm " r FEBRUARY 28, 1983 '..t__ - 1983 1982 1- - 3 1982 2 , Current Assetsr Current Liabilitiesi Cash-Operating $ 70,878 $ 246,743 Current Notes Payable $ 202,090 $ 1490324 Interest & Sinking 170 691 Accounts Payable 970,984 655,534 Reserve Fund 40,330 112 Accrued Payroll/Taxes 406,488 360,1898 ( Repair Fund 20,053 246 Due Medicare 1200903 1930365 Group Health Insurance 11000 41829 Pea Payable 247,837 1960562 Investments/Board Designated 309,988 521,398 Bond Interest Payable 6,707 Bonds Payable ,707 10,000 655,000 TL 'l Cash & Investments $ 441,919 $ 7741019 Total Currant Liabilities $ 119650009 $ 1,6270390 Accounts Receivable $ 3,6760745 $ 2,641,331 Other Liabilities Least Allowances (572_1015) (209 859) Deferred Inoo m $ 199,998 $ 203,615 i Net Patient Receivables TTMZIm $ Long Term Notes Payable 340,711 514,308 Other Receivables Bonds Payable 420,000 430 000 xt her Receivables $ 280,154 $ 225,679 .j~ Pre d E 356,266 264,222 Total Liabilities :psi Expenses 39,659 50,915 $ 20925,718 $ 2,775,313 Capitalr Total Current Assets $4,222,728 $ 3,7951802 City of Denton $ 3931165 $ 393,165 ' Pra rt Plant & County of Denton If Wi.071 f 1,696,871 Land y, Equipment, Endowment Flaw Estate 240,461 240 461 $ 37,547 37,547 Fed, Grants, Hill-Burton 1,868,910 1,866,910 Building & Improvetrsnts 3,0670385 31041,995 Federal Grants 256,371 256,37;, Furniture & Equipment 4 747 915 4 385 310 Pledges and Gifts 542,702 4580680 r~ Gen. Fund Bali, Beg. of Yr. (291,266) (686,776) Acausmalated Current Year 591153 212,844 j Depreciation (41383,490) (31994j809) 4,909) Net Property, Plant Equipment $ 31469,357 $ 31470,043 Total Capital $ 4,7661367 $ 4,440,532 TOTAL OPERATING FUND ~ $ 71692,085 7 215 845 'IbTA[, OPERATING FUNb Current Ratio 2.15 MAC F R~ PAGE 2 FLOW MEMORIAL HOSPITAL 8TATISTICN, STATE- FEBRUARY 28, 1983 CURRENT MONTH YEAR-TO-DATE PRIOR, Actual Budget. Actual Budget Year-•to-date Adult Patient Days 2,974 _-2,660 14,399 14,345 •1mll Average Prx Day 106,2 95.0 95,4 95,0 93.9 Newborn Patient Days 307 392 10736 2,114 11961 Average Per Day 11.0 14.0 11.5 14.0 13.0 Gross Patient Revenue/Pt. Day $ 428.31 $ 459.52 $ 421.12 $ 426.04 $ 372.37 Total Expense/Patient Day $ 337.66 $ 382.32 $ 359.01 $'354.47 $ 316,74 e Month. Charity Bad Debt_ Reaav_,_„• i October $ 510473 $ 96,053 $ 50636 November 127,181 1170974 40446 6,566 6lez28 106,636 Dec6nber January 8,000 99,706 90934 February 29_,9Q3 14e,~31 . ,4c.09? $ 276,785 $ 528,500 $ 30t674 Revenues 4.6% 8.7% .084 ~t9i,C~Kf$Yd.4Pt~,`kSYM1-a, v;~A:-vurn, hi!ti3 G'4. M FLOW MEMORIAL HOSPITAL page3 STATEMENT OF OPERATIONS/FEBRUARY 28, 1983 % of Salaries Supplies Total. Direct Operating Revenue Revenue & Benefits & Other Expenses profit (Loss) Daily Hospital Care 18 $ 22565 123t423 3, 9 137,192 $ 92,773 psychiatric Care 5 63,792 29,926 21789 32,715 31,077 OB/Post Partum 4 51,030 17,321 2,170 19,491 31,539 ICU 3 410275 17,266 2,049 19,314 21,961 Nursery/NICU 5 58,820 26,125 3,983 30,108 28 712 Coronary Care Unit 2 24,760 32,875 41463 37,338 (12,578) Labor & Delivery/Birthing Center 3 379461 22,531 6,000 28,531 81930 Operating & Recovery 4 53,74? 18,458 14,715 33',ll3 20410 Em~~ency Room 3 380704 169185 27,629 43;714 f6,010 C. ,real supply 10 1230667 61678 47,933 54,611 69,056 Laboratory/Blood Bank 9 120,446 579677 575677 62,769 Radiology/Nuclear Medicine 6 100562 14,262 27,770 420032 28,630 Pharmacy//IU 17 212,165 11;559 60,267 71,826 14o;339 Cardiopulmonary 7 93,268 19,089 16,678 356767 57,501 Anesthesia 3 38,715 12;242 7;961 20,203 18,412 Physical Therapy 1 16,619 6 307 1,378 7 685 8 ,1954 3 Total 00 2 , 3 6 1,3 6$-`3$,63$"" ped6itions of Revenue $ (679777 $ - $ - { 5'7.;1 7 III Ohd ty A Bad Debt (164 830 $ $ tX6yoe Health Ins, Expense - 25,651 25,551 (2546#1 Medical Records 876 10;597 129 .101726 (9 851 Gift Shop/Grounds Maintenance 11957 1,154 1;149 2,303 346 f Cafeteria 120247 24,970 26,951 8Q,921 (380674 Plant 14,766 51,512 6 ,278 166,218 Er,w'ronmental Services 31,276 9,867 410143 41,143 F'i al Affairs/Data Processing 7,756 4,878 12,634 , 12,634 Business Ofc./Credit & Collections 20,291 11,541 31,832 31,832 personnel 2,469 879 3,375 31375 Administration 5,934 2005 80339 8,339 Quality Control 25616 487 3,163 3,163 General & Administrative 167 38,484 38,484 (38017 , Depreciation 38 081 38,081 38 081 W) 1'l'I $ 9 5 $ 332, 'k4 Gain Loss) from Operation 730444 NoM4 perating Revenue 33,673 33,673 i Foundation 3 122 3,122 Total; 0, 239, n.l ..-t,...... ..I r ...r v. . /•i :.l.v >..v w-\tii.r. tl ir: Iv . .)iJrIwNY.f w4.v1. .u.Mf1♦ vn4 uiiv~v <I(1WM P'Y1ci'NY~` ippp{M 'j PLOW MEMORIAL HOSPITAL Page4 STATEMENT OF OPERATIONS/YEAR-TO-DATE, FEBRUARY 28, 1983 % of salaries supplies Total Direct Operating Revenue Revenue & Benefits & Other Ex enses P (Loss) Daily Hospital Care '_"T:3"- TT,-H Mo 681;511- V----"n-- Psychiatric Care 6 360,283 170,158 170091 187,249 173,034 OB/Post Partum 4 269,165 95,269 12;656 107,925 161;.2,40 ICU 2 137,825 94,114 13,231 107,346 30,480 Nursery/NICU 6 313,140 154,745 32,147 186,892 126;248 Coronary Care Unit 3 178,8I9 156,029 218003 177,532 11287 Labor & Delivery/Birthing Center 3 1945384 127,886 34,655 162,540 31,1844 Operating & Recovery 4 221,486 1020887 60,000 170;887 500699 Emergency `Room 3 179,741 84,982 135,.907 2200889 (410148) C rat Supply B 4849061 38,271 199,033 2370304 246',757 Lt~ atpr,'y/Blood Bank 10 6310993 284`1607 284,607 3471,386 Radiology/Nuclear Medicine 6 362,831 78,681 103;697 `1821378 170;453 Pharmacy IV 16 982,644 69,390 228,979 288,369 6941'275 Cardiopu monary 7 452,317 103,$23 880210 192,033 2600284 Aneathesi.a 3 184,085 800047 36,762 116,799 67,286 01hysicnl'Therapy 1 68 549 35 145 91 O~ 44,180 2 36 Total b $ ; 67`6 T2r T~ $ , , T~ $ Deduotions.of Revenue (32I,574) t $ $ $ 312,64 Charity A Bad Debts (756,499) i. y68,44 4 Employee Health Ins, Expense 173,429 173,419 17100 Medical Records 21688 56$58 13;699 69 6,7 (66;369 Gift Shop/Grounds Maintenance 99234 _7.,864 71830 15,394 6,1,60 Oafeteria 56,587 132;276 136,829 269,105 212,618 plant 78,602 3090644 388 146 388 146 environmental Services - 170,630 50,444 221,074 €221;074 F° ' 1 Affairs/Data Processing » 38,828 264375 6020 111,838 56 147 166,985 66,203 Bus ness Ofc./Credit & Collections ( Personnel 13,146 11,100 24,246 { 24,246 Administration 31,868 12 003 43,871 43,871 Ouality Control 12,340 3,630 15,970 15;910 General & Administrative 1,453 1340442 134,442 132,ge9 Depreciation 189 172 189 172 18 1 2 (Loss ';T3"1T-$7 7j o $1 Gain ;122°4-44-- 11,776; $ , , ) from Operation (921043 Non'-operating Revenue 1350586 136,686 Foundation 16 610 total 610 F Q PAGE 5 PL0W MrMORIAL HOSPITAL SUMMARY OF CASH RECEIPTS AND DISBURSEWI.;TS FEBRUARY 28, 1983 Current Month Year-To-Date Beginning Balance $ 82,500 $ 2,175 Cash Received fromt Active Patient Accounts $ 903,896 $ 4,737,904 Bad Debt Accounts 40092 30,674 Cafeteria 120272 58,357 Apriations/Donations 199,607 Other 66,054 276,781 Total Cash 986,314 303 323 TOTAL CASH AVAILABLE ,06 ,819 .---5 11323 5,305,498 Cash bisbursermsntsc Payroll $ 459,335 $ 2,471j549 Payroll Taxes 70,209 371,042 Patient Refunds 18,732 72,054 Capital Assets 60624 107 231 Notes Payable 12,697 89,477 Other 424,905 2,117,833 ' Total Disbursement 9921502 5 229 186 Cash Balance J Cash Investments 307 683 307683 Total Cash a8 ,9 38 Gross Patient Revenue $ 11273,791 $ 6,063,676 1 Leger Allowances (78o.4,63) x(391 091 Nat Patient Revenue ,328 Cash Received on patient Accounts 903,896 40737,904 Lew Patient Refunds (18,73~2) 72054) Net Cash on Patient Accounta ,164 Cash Received as a 6 of Revenue 7418 823$ f. ,E X42'tiiki(~$1dy~kGstiJ+i.rt'a;:.i.4d1-. i.MHY 1. .eroi,41:Ir ivr .9. N,1R,.rv...,ni. l N.MIT M'.IkY I r~ PAGE 6 PLOW M r M 0 R I A L HOSPITAL AGED ACCOUNTS RECEIVAI3I8 SUMMARY FEBRUARY 28, 1983 Prima a payor, Current 31-60 61-90 91-120 121-150 150± Total % of A/R Medicare $ 377,367 $ 104,021 $ 16,649 $ 71317 $ 1,322 $ 11,788 $ 5180464 15.2% Medicaid 46,631 31,406 14,585 3,180 11210 7,721 104,733 3.ii 13lue Cross 107,546 18,865 61551 21877 36 564 136,439 4.0% Commercial ins. 539,708 259,320 870560 39,977 61634 12,196 945f395 27.7% Sel -Pay 277,508 226,408 168,795 147,523 97,653 292,202 102100089 35.5% Balance after Ins. 301 000 63000 41 089 27.~4,663~3. 18 290 ,4,,6,1,6_78 49~8.t.320 14,5% a i,'~'~0~"; ( 'l 26 .1 a 2 ,337 12 1 $ 171,1d9 $ 3j 440 13, . E In House 307863 Total A/R $ 31721 tw:_ A/R by % 48.4% 20.68 918% 6.7% 3.6% 10.99 i i Number of Acoountsi f Days of Revenuoi } Accounts Receivable 85 In-House 8 Total i i h r Page 7 FLOW MEMORIAL HOSPITAL HOME HEALTH BALANCE SHEET FEBRUARY 28, 1983 ASSETS LIABILITIES Cash $ 25,671 Accounts Payable $ Accounts Receivable 86,376 Payable due Flow 35118 $112,047 Accrued Payroll 5,498 Inventory 1,844 Total Liabilities $ 6,616 Total Current Assets $113,891 f EQUIPMENT CAPITAL ! Furniture A Equipment $ 11615 Pledges a Gifts $ 115 Less Accumulated Depreciation 1 346 Gen, Fund Bal., Beg, of Yr. 113,815 get Equipment $ 269 Retained Earnings Current Yr. 8 386 > Total Capital $ 1050644 TOTAL' OPERATING FUND 114 160 TOTAL OPERATING FUND ~11.4,16Q s LH Y iAtlltux' 1 Page 8 FLOW MEMORIAL It05PITAL HOME HEALTH STATEMENT OF REVENUES AND EXPENSES FEBRUARY 28, 1983 REVENUES Patient Revenues $ 26,020 $ 155,209 Deductions of Revenue 7 643 38 758 Net Revenues $ 18,377 $ 116,451 EXPENSES Payroll & Benefits $ 195511 $ 104,665 Purc. Service 768 3,559 f Supplies 668 70924 Travel 1,487 70657 Employee Benefits 863 Depreciation _ 269 Net Expenses $ ?21434 124,837 Excess of Revenues Over Expenses $ 4 057 $ 386) { i 1 iJ r f0 00;44 04 APR 1983 CHARITY REPORT PAGE f, (l PATIENT...... .PAT,10.... PT FC, OUARANTOR NAME........... ADDRESS..... CITY........ . ST ZIP; 1S. DYE, AMOUNT,., J ABKINS,PAUL 40011611 QR CC DENTON COUNTY JAIL ON COUNTY AIL'' E NCKlNNBY 87 pBNr~TnnNN 6001.03/16/83 IICNTy { PAXTER,DOLORES SNELL 40009854 ER CC BAXTER,DOLORES SNELL DENTON COUNTY JAIL 33 DENTON TX 76001 03/08/83 -48.00 DENTON,SCOTTY L 00006181 IP CC DENYON,SCOTTY L NT BOX 5807 DENDiONOH COUNTY JT%I, 76203 01106/83 -130.06 J Ii DdWtE8,8DNARD D 00008144 ER CC BtlNLti9,EDNAAD AS REHAB.__ - V rr g76QOi`O6/04/82 46 00 J 9ROWN,RB% R 00009977 IP CC OROWN,REX 2300 pT WORTH DR DEN RED, NO ASS - - RT 1 BOX 36II 9 gENTON YX 76II01 11/14/8II-071240,88 CARE CROSS, LARRY N1 AL 40008179 RR CC DENTON COUNTY JAIL 9. MCKINNEY' DBNOEH~TONkCOUkTY JAIL76201 03/02/83 -79,75 y ` DENHYiKg"7H 40008138 ER CC DENTON COUNTY JAIL DENTON COUNTY JAIL-- _'DENTON 'T%"76701'03/02/83 63.05.._ D6NNYjK9NNKTH 40010043 KA CC i D ON COUNTY 4~pp~~L• I, DENNY,KENNETH' COUNTY _ C 0002844 OP CC DhNNVNKENNETH CA1L 8~`MCNEV BY qENTON '1X 76201 03/04/83 -48,00 ` SUMMIT 4bo DLNCT TOH COUNTY L74201 03/03/83 -86.20 v EkTON _COUNTY: J41 L DENNY,KENNETH C. 40010753 ER CC 09NNY,KENNETH C. ' DENTON CO. JAIL DENTON TX7620103/13/83 " '-40.00 I ~~~~pH~rpp Cc ~~pp~~yy FLOYD,JANET M 00022419 IP CC FLOYO,PAYRICK 0 WINTER HAVEN FARANNDRR& 7R~78004 08/23/82 -407,94 OARIA,BgWAgD Q ANCE AFTER TX MBDI$AID 6001 OQ/2 40006496 ER CC DENTON COUNTY JAIL DENTON DEN - ' J HALL'CONNER 6 10011575 IP CC HALLoCONNER E P 0 BOX 421'M S'L1ND-DENOIONON COUNTY t><~7620[ 03/14/83 -114 85 1783-'° 35!! 16 ._._,.`HAMMONR,RU885LL,L6E 40001166 EA CC HAMMONS,RUSBELL,LEE 2725 CHRIBI LANE 1000 PF. ' C. TX 76201 00/06/83 -38.00 J 1 HORN,PHILAMAE V 00033274 IP CC HORN, ROBERT PO BOX 60023 DRAW" COUNTY TXL7406 04/16782 -5,271 55 ~I "HOWMDiAgTHUR 0' - 00033406 IP CC HOWARD) ARTHUR " 640 RlI08UDLRW V NT E CARE - rryye~ gqeepp67 03717/92 -4, ` 817, 55 J NT AFTER NEOICAID KNOPFEL,JOHN 8, 40008682 OR CC KNOPFEL,JOHN E. DENTON JAIL DENTON T% 76701 03/64/83 -56 00 LEWIS,KENNSTH 40009336 KR CC DENTON COUNTY JAIL DENTON CO JAIL OKNRIVON COUNTY JNL76II01 03/03/83 -14 50 ki~ MANN89iJACX - ,._40006009 99 CC DENTON CO'JAIL - MOKINNEY''8T"` DENTONON.000HTY. L7600f 02/22/93 -1133100 ~ J MCKFLVAiJAM69 00000335 1P CC RAHB4 gN00HIARAHIM 11Et16NORCOUNTY B9LLAN1 O~NON COUNTY L76201 07/19/93 -39,00 ~l ON COUNTY. L t ~p~p YbftOf 01/04/93 -00.11 RAM09Y, MICHAEL 00056509'1P CC 9AM8EY,MICHAEL 909 9 LOOP 288 DKNTON'NCE.AFTER ' 1 R %0+ YNCLOS,PAULA 00056611 IF CC RKYNOLDJ# PAULA {IAfO 8CRIPTUR9 D9NTNNCE AFTEf, 1 IRy61p1 RE L1/24/92 -85, D0 J ..,,...1;, gp~pprp pp It yE. IOOLK, 73N5h1A8 R 00007230 OP C0 RfDDL9, ~t~bMA9 " 913 99LCHE9 OAIN9TIVSLLE TER ~TVR/6240 01/30/83 -f3. 63 R0113IND JEAN 00007707 1P CC ROQUIN84JEAN AT t BOX 06's DENTON " d6N{~ 5 RENAB, R TT I CAID ~~rr66yy~~Of f 1 /04/92 -1191 q0 1 BALANCE AFTE ML~ b A03LE9,ANTON10 00000342 1P CC ROBLESrANTONIO 125 W WALTERS LEWIMI.LK TX 75067 12/27/92 -32.99 TGNfICE AFTER TgIA W{ 33 94 CC RDLLB,WALTj~ 2 8 1.983108 8 RUDDBLL 020 DEN T% 76001 11/21/89 -19,00 b1 L8, IIANIR 9 00009953 ER 00 9098, VERNI9 AT 4' BOX 413 - _ D8N NCE AFTER }~155 0104/10)92 R088~VEg1E J 000592 ~~CE AFTER I~EDICA~ -b!, 00 4s! , 4::y{:,y!:Sh l~ 10:00:56 04 APR 1903 CHARITY REPORT PAON 2 _ r l PATIENT.,., PAT,10 PT PC. GUARANTOR NAME,,,,.... II , . ADORED CITY. , , 6T 11P, . 519. DTtt, AMOUNT.. ' RUNIONS,ELOJE R 00009635 OR CO AUNIONO, ELO115 623 N k AUDDELL. DENTT N r 7bbQQ02'O9/l2/82 -16,00 4' I GLANCE AFTER ICA1U MEb 61ALAIAR,DANIEL 00059899 OR CC DENTON,DEV'CENTEA 909 LOOP 288 DENTON YX 76201 01/¢11613 -16.00 V BCHERLER,SANDRA L 00061044 IP CC 9CHERLER,HAROLD 8 8 POND DEN10N NCE AFTER M~I&ttD TX 76!!01 09/10/82 -14.02 ._8CH8RLERiBANORA L. .00061061 IF CC BCHERLRR~HAAOLD V S"g PdND ___...DE HKRUP.ICY___» NTO~N U-76201 09/27/92-' -374,.97 SCOTT,OLADINE 00061549 IP CC SCOTT#OLADINII 2126 BULIVAN DALLpAB"11TCT TX .16021 01/!12/613 -74,90 J SCVTT, TERRY LEE 10004810 IP CC SCUTT, TERRY LEE P b POX 247 AR01t3WCE AFTER I~I fB~b 02/11/83 -464 93 SEIDLL°i JULIE A 1 AUPTCY._ / ~i 000618!2 1P CC tlE1AL11,JULfE P.0:90X 93694 YWU OTA DENT TX-76204-12/06/02 -42,76 - 0N6LLAt~YMtN4k+,t. AMIIgMrNh } ~ ALANCE AFTER ' O w W00972 IP CC ONELL,MARY 200 E 7HOMP80N ECATVR OTREET'ViRO1F - BALANCE AFTER MEDIJAID L 8 00067 N~p~ F EA MtEyDI gC6AID TUCKOR+ElMiA L 728 IF CC STREET,VtRA1E E 001! 613 R~BAL"ANCE AFTER 21ED1C1fW 01/08/03 -43.50 00069682 IF CC TlLLIO,EMMA 8606 FT, WORTH DR. 056 DENTON TX 76201 00104/99 -107.50 BBApLLANCE AFTER CCpI>266 V . ~I BEULAH M 00070067 IF CC 7U2;KER,OEULAH M 90 PLUM STREET 9ANOER TER I~~pp 1CI7b /17/61¢ -44.70 + UNMATCHEDiCASH- ROFLET"00070896"-IP CC +SHIFLET, DON PI&$bg10-02/01103"-5,b0A oil 1213 TULANE" DENTBR,'~fjE AF ~ r VNMATOHED,CASH NIX,ADELL 00070096 tP CO NIX, ADFLL 500 S, AUODELL, 1146 DENTOR, TX., ***YX 00000 02101/03 -109.00 J VANDERORIF.F, MARY E 00071¢33 IF CC VANDI RORIPP, MARY 2600 NZWLE D4 r't NCE AFTER C YM20L 01 /!4/AO •iM 50 XX 66 WATKINS~AMANDA ' °00072736 fP CC WATKIN9i8RIAN 6 .106' WNCE AFTER EDICAto v f WA KHL, I ANOUS-LN `DANTON _TX"76¢61"02/22/00' ~9y 00--;,-,' , W NONA 00073114 IF CC WEIKEL,BTEPHEN 1$.0. 80% 3026 ROANEE,Ni IOENTCARE CARE YX 76262 07/10/02-14,751, 40 / Np.. . V' E. WILLfAN0,8bVCg A 00074627 9A CC W[LLIAM0,6DYCE 124 AVENUE g APT 119 DIN N YX 76201 12/31/0¢ -35,10 BALANCE AFTER 11EbfCA10' WILBON,IRENE S 00076342 OR QO W1L00Nl1RENg 8 _ AT 7 80%206 AUNARY - YX`76227'01/14/03 _.ie.00 BALANCE AFTER MEDICAID WCpFORD,WILLIAM,ALEN 40006068 OR CC CROWI.BY,MARY,M AT 2 0OX 227 PRt800 YX 75064 02119/03 -10.00 ~p Cp►~ E W~. WDODARDoPENN Y A 00076034 IF OC WOODARD MARCUS ~tX YW 00% 99 LAREAbALiASFrER 7O 01/24103 -10,07 fALLANCE AFT;r. MHMR J WRIOHT, UOOHUA W 00076406 IF CC WRIOHTiANN " 2211W HICKORY 430- 02N ON TX 1W) 04/22/0' _ INDIOENT CARE { REIMBURSEMENT AFTERgC=CNARC]_ BCD TO CHARITY. %Oil 'I w k, 07.26:21 31 HAD 1783 DAD MUT WItITG-OFIT liCPgR7 PAGE 1 - f PATIENT, PAT. 10.... PT FC. DD OUARANTDR-NgMH OUARANTDR-AODR GUAR CITY BY A-TIP DID, DATC CUR, BAL.. ~ f AOODYY,MbN10A A - - -"OOOOIObO DR SP 3 MtlN[CA ADgD77 1456 CRESCENT •l.G{VIBVILLE TX 7606 7 08/09/82 •!O1 SO i ! ' V ! UNABLE TO LOCATE ABUISDAC,KHATTAB 0000100f ON SP 3 KHATTAD A0UI80AE AMERICANA APTS N36 DENTON TX 76201 12/10/92 3f1,00 0 hC7dN,VIfK1 8 00001099 FR Bp 3 VICKI ACTON 3/62 91.75 Lm 00 ADDRESS - 103 CCORANADO N1007 AROYLlS MOVED LEFT TX 76926 NO AQDAE$;S/11/92 393, 00 ADAMB,CATHE INEM 00001119 fip Sp 3 WILLIAM ADAMS AT 6dLOT2145 TLMHP DENTON,. TX 76801 11/10/88 93.75 l MOVED LEFT NO ADDRESS j Irk ADAMS, CORRY R 00001123 IP DAI 3 DDYCS ADAMS 1104 OULLEMEAD DENTON TX 7620E 08/15/62 45,00 .Ap9D1RAN,l.ATEBFA -00001347 5R DP 3 M•A ADEDIRAN 2932 6HAROLgT76 Ap7 7 DENTON OABLE_TO LOCATE TX 7624;1 09/26/61? 25.0 UNABLE TO LOCATE _ AOUILAR,,DAVID_ 00001461 ER 2D 3 DAVID AAOUILAR 314 TEXAS BY __.._._bBNTON T%.76201 06/01/62. 00,40 1r" AHUWAN, MARTHA F 00001537 IP UP 3 ADDAS AHUWAN f0A7 k PRARIE Ml APPOINTMENT NOT KEPT DENTON TX 76001 09/31182 45,65 _.__APPQtt~T11EHT, NQ KEPT. AJAY),WALLACE 00001645 Ep Sp 3 CNRIS AJAVI 1fO AVE E #218 D9NTON 7X 76201 11/09/SP. 6S. 2S ' i4 AL,KHAL1pE:ALIA S MOVED LEFT NO ADDRESS 00001644 IP DP 3 KHALIFS EASA AL 2211 N DELL #111 . DCNTONa_ TX 74901 10/ 9/92 '103, em 00Y611FT NO ADDRESS ALEXANDCR0EUOEN9 00001768 IP 1D 1 04ENE ALEXANDER RT 5 ACORN RANCH #110 DENTON T% 76201 09/05/02. 1,158.40 / A PO►NXlEEN NOT KEPT ALEXANDER, WILLIAM _ 0000!976 HR SP 3 --WILLIAM ALEXANDER-- . - - P s I kw , d. OOX 315 - 11ENTtlN l'TR'96G01 09/09/68 *a. 00 r - ALOHAMDIo.FATItlAH H . UNABLE TO LOCATE r r - HAMgI 3400_JOY00_026 D9NYDN TX 76&01..!0/29/97 - 46,00 0019.09 IP.RAI 3 HAMOAM ALA UNAti.IE TO LOCATE HUSSEIN 2206 9TELLA 42 D9NIDN _ TX 76901 09/04/82 22,50 P ~~•'J AL b1oo HBANRAHIM 0000001925 CA 001933 ER SPI 3 AHUANIALIPOUR 2226 HICKORY Dt{NTON T% 76261 01/10/83 39,40 Ik 0 LOCATE- j ' + ALL$M,JONX(4 A. _ -._.___Q000a170 IP DAI 3 TOMMY ALLEN. 3$OO ATLAS TX 7620,1.09/30/92 641,13•: i NO RESPONSE , ALNAJJAR+FUAD 00002396 5R SP 3 FUAD ALNAJJAR 2320 W PRAR16 APT 205 DSNTONTX 76001 12/ig/92 3$.00 I NOVEO.,LEfi NO ADDRESS } ANDRA9iS}ILRI R -00008536 BR dP 3 LARRY AND$R8 7lb PIELD AAINBBV[LLB 7X 76240 04/30/62 67x25 ANOSABON, 000026tS ER SP 3 GARY ANDBA13ON f A _ 30 DURCH_ . _ COP AEI,.I, MOVED LEFT T% NO 7b0t9 ADDRESS _ ,10/04/07 38,A0 UNABLE TO LOCATE ANDR R J ' I L DE,EMOLIA 00002774 SR OP 3 JACOOD ANDRADE 0206 BTELLA.ST #12 DENTON_ TX 76201 06/29/02 101,60 I. Ef,T_NO ADDRESS ANORFiFIfI,EDWARD C 00002840 EA ADD b EDWARD A160#00 M ~bx 42 TWIN Ldf(E9 Mlle DENTON OPED , TX 00800 09/04%6!!. 74. 00'x•, MOVED LEFT NO ADDRESS AN05L¢QIANOAifR08O 00062866 IP SP I OEOROE ANGEL ALB DR 06„ _ DENTON TX 76201 07/16/90 ,2,07E 65 . Y TROPICANA MOVED LEFT NO ADDRESS ANTHONV,ALL+MN 00002907 SR Bp 3 ALBNN ANTHON OIANNOV 1112- 9AMOTEL #¢30ABNTON _ TX 76261 11/27/82 39,06 ~ NO AESP¢NSE - ARANf pydNE M 00002464 Op SP 3 MARK 'A AgANT -1205 HBNDERBON Nl9 BRfDOtp(1RT T% '6076 66/27/02 DS. 00 - ' NO RESPONSE ARMOTRbN0,PRNNY L 00000137 CR ADD 3 BAMUCL ARMSTRONG 3782 JACKSON 9T IAVINO TX WAR 09/20/02 i'I J 36 00 ARRAMANI,HATUM A 06COM969 99 DP 3 HATLTM ARRAMAHI 2021 W PRAIRIE 0208 OgNTON NO RESPONSE , nc5 T O APD 11/07/02 74, 76 AUATIH,I1bNNA'D 0000b.tiO1 9A 8p 3 DONNA AUSTIN 1400 ODACS ARL1N0 "MOVED LEFT NO ADDRESS TO 'fX 7b020 11/08/E36.. 47, 2 6 ii 10VED LEfT N0 ADDRESS 1 01:26;27 31 MAR 1983 SAD DEnl 6191TE-O": RrPOfIT rnDE 2 • 4 Lk PATIENT,,,,,..,,,. PAT, DD OUAnANTOR-NAMO , OUAnANTOR-ADDR OUAR.CITY DT 0-21P DID. DATE OUR. DAL,. ' 'tike BAD9Ep,pAVLA 1 00003962 OR ID 3 PAULA BABOON -409 E N1LL' DEN7gN _ _ TX 76401 09/10/02 135 7D", , DAILEY) RANDY H 00004093 &A BP 3 RANDY BAILEY 1101 WOODM8R6 LEWIBVIA RESP'W 76067 06/25/82 _3b 00 BAKER,JANICE 00004210 OR Bp 3 MICHAEL OAKEN NO RESPOW AT d BBX 12 gHNTbN T% 76201 12/06/92 41, 75 E BAKER,JANIC[i 0000 4296 OP ADD 3 MICHAEL OAKEN ..Rr_d•'BOX 18 DENTON NO-RESPOI 76201 1t/i7/02 54."66 BAKER,TINA L 60004283 ER BP 3 TINA BAKER . „ UNABLE Tp % TROPICANA MOTEL ,030,4 DGNTON T>~ 76 01 12/93/62 DD 2D ~ fr ~ _ DANDA, ALBORT 00004359 OR OP 3 A MOVED LF T Np 6801. ptlpREq9/R9/6d 30.00 !J 2503 W PRARIR APT 12 DENTON TX 7 J UNABLE To 0 1 BANpAiAL9E<R7 00004366 pp BP 3 ALBERT DANDA - L007 W PRARIE ApT 12 -De MY- Tk 76201 09/01/82 101,20 ' 1IARNOT1, JAMES R UG _.00004655 $R BP 3 RICKY BARNETT ..AT 3 BOX 319F, ppABLE q J LEWISV1Ll T~XO~Db7 OB/17/62 66 00 pA71Y A 00009389 OR BP 3 PATTY BECK 017 ROBE DENTON UNABLE Tikoi$~ DCCK, 1 11/27/82 40.75 lI0_RESPQNSE. ; h?HCI4 PAY1V A .00009397 IP BP 3 PATTY BOOK 617 ROBH TX 76201 11/26/132 449. 30 BCCKi 7HRROA M NO RESPONSE J 00009413 OR BP . 3 THRE6A 0$CK _ 1209 N 10TH.67RD$T .WIChITA_PI NO ALI,,, TX_7.6004_GBIJO/132 36 00_ --RESP NSE? , ~bo f BENN2TT,bRENDA F 40005469 OR BP 3 ROBIN MADGWRLL 3329 W. UNIV90ITY DRNTON :_-.TX 76201 09/,91163 93, 05 4f I-aAny _ E UNABLE,T 6201 013/92/0 --6606676 OR ID J B$N ANY'.OAROLq 00006446 EN DP, 3 OARYLBE7FEfANy77 ~O DOX 109 D~NTGN T_ ~ OfiTH 0 80k 151-. NO RESPONSE D6 OO a~ JUST IN TX 74947 00/0/62 81OLCOIN$SHIA R 00006510 5R 4P 3 DIN$6HIA BIBLE 730 ALEXANDER DENTUN NO RESPOTXE 76201 69/19/82'42,95-, , BIMOIIAMiHANx q 00006643 014 ADD 3 OR. HANK DtNCHAM 126 E, OAK Al D$N70N'--NO.RESPOflrX 76201 11/07/82 39 20 %0 MOVED LEPT NO ADDRESS BIS1400,J1M 0 _ 00006763 OR Bp 3 JIM BISHOP 109 PARKWAY DGNTEIN _ _ TX 76201.1f/16/92-. 116,06_ ' L k"~ NO RESPONSE ALAYLOCKsTGRRtB R 00007466 OP BP 3 MICHAEL BLAYLOCK RT 2 BOX 1017 DENTON TN 76201 11/06182 08 DO 1 MOVED ,LEPT NO ADDRESS BIICANG6RAi 4HRARDO ..00001641 OR DAI 3 6ENARDO OOCANK40A 2622 LOUISB'APT-.37_ DRNTON TX 76201 05/1`19102 '1 , 0ti l... DOtiHMi MIDHSA 00007466 BR OP 3 MI'BHEA BOEHM PO BOX, 1203 , 09NTON.. 7X..76201 06/22/02.. _ 74 60 NO RESPONSE BOGRNRR4MICHAEL 00007674 SP 80 1 MICHAEL BOENNER Pb box 105 PILOT POYATRESPOW 76268 0040/82 0,811.00 BRADFORD, 0917Y a NO RESPONSE . ; 00006493 IP DAI 1 IHi7TY J ORADPORD `RT 3 BOX 1066 ORCAf06- TX 76234 06%06/62 63800 ~ RESPONSE I 9RApYiVAL$pV A 40008699 0R' 6p 3 CECIL BRADY 2600 PT NORTH'NS 580700.. LE TO LOCATE -1 Tx f 62/14/93 70,76 J i OX 357 DONTON NO. RESPONSE 76201 00/31/02 504.71 ' J 11111'._ O BAAG*j RAN0HK6UNNNfiH 6 00008669 Ip BAt 3 WANDA ORA00 AT ~ O N3~ 510750 TX 76201 67/02/6 60600603 OP DAI 3 KRNN&TH BRANCH 220 HANN 2 79 40 BRDNT,DH1Ni-EY J 00605086 1P 2P I LEROY DRENT ft06 K$RLBY BT DSNfON NO RESPONSE TX 76001 00/16/02 1,261,60 001IOD,Bt6VtI 0000961 '99 sp a STOVE NO RESPONSE OROWNiARtiTNA' b _ 00004696 $N Op 3 AROTHA~BRDWN - 2500 90DU1'jigLl. 0140 DRNTON„ T~Ybebl 00/09/00 6166 J i NO pFSPO , f,„ I~DAT WDhTH 500700. _ TS T 16201 002W86 72. 136 _ UNABUt TA LOCATE , , J V S C~ L~ 09:06:34 11 MAR 1985 DAD DEIIT WHITE-Orr REp4RT PAGE 3 4,1 P,ATi[NI.............. PAT.AO,,,, PT rC, E0 GUARANTOR-NAME OUARANTOR-ADDR...... . QUAR,CIfY BT Q-ZIP D1S,DATE CUR. 6AL . DRCNNIND pAM&LA D 00010124 ER SH 3 PAMELA ORONNIND 1580 RUADELL APT 120' tlENTON TX 76201 11/01/92 504. 9D ' UNABLE TO LOCATE ORUCE,KAREN 00010173 OP SP 3 KAREN BRUCE 2001 E PRARIE DENTON TX 76201 11/09/62 .11. 05 ' DUTTZ,CINDV A 00011171 EA SP 3 CINDY DUTTZ AT 2 DOX 927 AUDREY UNABLE T4kOfAI$7 Og/10/02 244,00 CAIN, MAR7fN H _.._.._._.-.00611346 OR 9P 3 RALPH E PAIN 714 ii CON00E85 DGNTON UNABLE PTO~LOCAtE1 10/06/90 39.00 ±Y'' CANALES CYNIHIA...._.._.. 00011569 SP ID 1 RAY CANALE9 9495 LOUISE 017 _ DENTON. T% 76901 09/05/02 11000,70 UNABLE 10 LOCATE CAN7RELL MATTHEW T_ 00011676 ER BP 3 MIKE CANTRELL 9007 7EA8LEV LN 0206 DENTON. TX 76201 10/14/02 39.00 _ -__.IJNA~IL..IO 3.OCA @AR7E11, kARCN - - Ob0190S20 OP SP 1 ALDERT CAR7Kq ' p0 ak icii _ dENTON 7X 74901 07/25/02 669.35 I, NO RESPONSE r 70 V CAWTHON,LEONARO D,00012666 ER GP 3 LEONARD CAWTMON PO SOY 073 LAKE DALLAS- : TX.-75060, 09/00/92 _ 64,90 _ 0 POR OR . NTON_ . N...__RES_ 76001 09/19/SO 30. 00. ' J . OHANDL9R, TAMMYYP ~ - 00019907 ER SP 3 A 8 ..CHANDLER _ _ 91 f BHERMAN..DR D6N70N --UNABLE, ~TQ~,QA 1 11/09/29 ~ 38, Ob ' I. ✓ l SC f _.....CHANULERi7AMMY P000120!5 ER SP 3 A H CHANDLER 211, 9HEHMAN..dRDtINTPIV` MOVED LEt~ ~r"bE4q/39.00 _ 06.00 ' J j CHANDLER TAMMY P 00019023 EA 9P 3 A 5 CHANDLER 911 SHERMAN, DR . D1INTON__'- L411966WEH/14/09 - 1 f- CHRI RV~ ANDi1E - - 00019gb3 ER SP 3 - PAU6INE LIP9COM8 617 CHAM09A6 dANTON HOYED LE N~b IE~~~16180 70. ,9 i If -CLARk,ERIC, D: 00013393 EA SP 3 fiRIC CLARK AT O ROCKY POIN7 MHPA.LJTTLf<-9011 AESPOS 1;060 _Ol/06/93, 20,00 fy1., CLSMONB,AMANDA 00013991 EA SP 3 JOHN CLEMONS MOTEL b, ROOM 29 DE N NTON oTX 76005 10/12/62 70,75 MOTEL 6M NO RESPO _ i _._ONS OLONON6,D9DRA OOOSd034 6 ROM ~ 76901, 13/16/99 99. f0 BA SP 3 JOHN CL ~C11 MtlN9, JOFIN- 00013847 ER SP 3 JOHN, CLEMONS MOTEL b ROOM-09-.-_..:_ OENT.C,N,_,NO AESPOI.76001 10/09/62 109. 75 COLEMAN, MARQARE7 00014597 IP ADD 3 MARGARET COLEMAN PO I1X 2570 DSNTON NO 1 TX- 76201 09/01 /00 110, 90 COMI#JTiLYiANFI_J - 00014879 OP 9P 3 ED.AONO CONNALY AT l 00 5 JBWAR30(tt~ TXnrATO 09/99/60 494. 0- V C~iN,JUANITA L 00015149 IA ADD 3 MARSHALL CORN, _ RT f 130% 40 p „.N K. UNABLE T CLAN, JUANItA L 00015! 96 OP ADD 3 MARSHALL CORN AT S DW 49 0 NEWARK NO AESPO4S176070 09/91/00 53,70 D6'OAT0R10 AESPO - r CATE6 161104 10/01/89 1,990, 76 ' .k1AN1TA L " " 00019809 Eq 9p0 . MARSHALL. 27N CdHN pfd. A OINTM T q~ T t I-~ .mot AROARET OpAWFDIAD 34X 96 PONDER St. LAKE OALLAAO 09/09/60 49,50 CgAWPpRD,,MAA0AR6T A 3 M NO RESPONSE CRAWPORD,MAAOAAET A 00610847 6R ep 3 MARGARET CRANFORD P.D. BOX 66 PONDER 91 LAKE DALLAS TX 75065 09/14/90 100.69 - NO.AESPO TSE 6o01$ei6 ER" 8P- 3 PATRICIA HOLMES Ii 5 PONOER.- OGNTON CAAMlltlgdii79L`HAEL H NO RESPO OR096, CFfEA I L 00016101 ER 9p 3 JIMMY CRtl81B 609 N 6RADAHAW HHXE 761101 09/01190 110. 50 l - ,Rtl98 040$Louisa MI DENTON NO RESP011f;E76901 Ott/05190 1+566, 15 CRCS6,JOANNA L, 00014147 IP ADD I JOANNA LE C N S gNAQL0O LOCATE OVA,PATTI 00016634 EA 9P 3 RONALD CYq 1111 W UNIV96ITY 4206 DENTON TX 76901 09/05%80 96.49 V UNABLE 16 LOCATE I• J •xr;a.hry li ~f 09:P6:43 31 MAR 1,702 DAD DE•D7 WRITC-Orr RGPQR7 PAGE 4 ti PATIENT PAT. 11).... PT FC. DD OVARANTDR-NAMp.., OUARANTOR-ADOR OVAR,CITY ST 0-71P DIS.DATS CUR,BA. ~ - ' DALTON,RICHARD H 00016790 RR DP 3 JIMMY DALTdN 824'ROBfi DBNYDM 7X 7620L-10/11/8 72 . 50- No RESPONSE' DALION, RICHARD H 00016000 90 D1' 3 JIMMY DALTON D24 RODp DCNTON_.. TX 76201 09/21/02 30, 60 NO RESPONSE I~ DALTON,8USANNA OOOL6816 UR OP 3 JIMMY DALTON 824 RODE DONION TX 76901 10/04/02 72.DO._: DALTDN,6USANNA 00016604 RR SP 3 JIMMY DALTDN ©24 RDSC _ DENTDN T% 76201 !2/04/52 b1~00 ' DENTON _ RESPONSE 76201 10/00/62 99,70 J mil DANCER, RONALD L 00016540 OR ADD 3 RONALD DANCER 926 MYRTLE NO RESPONS UNRBJ E~OTOf OC TE ' ' OS 00000 11/07/82 912,00 ,1 216 C CEDAR FRANKLIN KY DANIELB,RAYMONO H 00016900 OR ADD 3 RAYMOND DANIELS tt 00 FT WORTH DR Nod DHNTON NO AESPOHSLOC H2 30.00 t r1 DARRdVAH,CHARLtl7TE 00017007 HR SP 3 AHRALOIN[i HERRING F O DD% 70„ LAKE AAt.LAS TX y9Oba.00/01/ 35 00 52 , 66, 00 r DAUGHURTY,DOROTHY 1 00017170 SR SP 3 EUOSNE DAUGHERTY NO RESPONSE 05/110/ J DAVIS AN01C 00017339 OR SP 13 DARLENE DAVIS 000 WELCH DENTON TX 76201 00/27/02 J _ NO RESPONSE. - bAVf8,JOANN 00017467 OR 8P O JOANN DAMS 704 5 WOOD-.---- DSNTON NO RESpa%76201 11!19/02 38100 - " DAVID LUCILL6_&. 00017041 OR SP 3 LUCILLE DAVIS 84a MADISON. AVENUE _ LEWISVILLNO RESPONSE700b7. 28/328/52 45,00 90 00 1 J 1✓r.' gAVtS,RODHRT F OOOI7590 SR BP 3 RONALD DAVIS. 2920 R MCKtNNEY_.. DENTON_ T% 76201"60/05/82 _ NO RESDOINrSE 0AV18,ROtiURY V V 00017605 GR BP 3 RONALD DAMS 2920 It MCNINNEY DfiN70N TX 76201 10/12/52 77.00 NO RESPONSE DAV1S, ROSH R. , _ ....-.-.00017616 OR ADO 3 RONALD DAVIS 2920, E MCKINNHV DHN1ON:r TX -76001 04114/82- 11333; 2'V NO RESPONSE DAY,YVONNH 00017700 CR 8P 0 RODNEY DAY 106 MANOR 6ANOER 7% 76266 01/00/83 76.10 - / _-NQ RESPONSE-- - ' I DHLARDi3A,JD0H JR 06616028 IF OF I JOSE OR DHLARtlSA 932 S SLM ND- ,DHNTCN TK 76201 09/30/82 1, 121. 00 APPOINTMENT NO KEPT, J 98,10 DHALLA,SAN, 00019390 IF SP 3 SAM DNALLA 900 LONDONDERRY 4k226 DENTON., TX 76201 10/04/02 MWO LEFT NO ADDRESS DOSSEY JIMMY L 00015012 OR SP 3 JIMMY DDSBBY 532 N'CHARLES LEWISVILLE T% 70061.11/17/00 117.20 NO RESP'TX , 1 1 ' DdSS2Y, JIMMY L dbO15OS2O IP SP l <a+ 4Y DO58EY 632 N CHARLHB L6WIt3V1Ll8O RE5,'TK 70067 09/Q1]%02 3, 60$.40 PONSf - R nOWN99 tog . y X 7601 OS/i7/52 e. 18.00 TMINT NOT KEPT APPOIN bOWNSY,MI4DRSD 00015929 Hp ADD 3 MILDROD OGWNIY 120 H OAK DON VON TX 76201 08/1052 80.00 UNABLE TO LOCATE f V00CAN;09-M:Y 00019174 OR SP 3 DHVURL.Y DUNCAN "5 . 219. SLAV OR1Vfi CdIONY TX 70006 SO/1171112 43,05 ROVED LEFT NO ADDRESS 1 ; DUNHAM,EW91LA,A00019907 IF ID I BHOILA DUNHAM AT 4 0O% 160 DSNTON__ ' 76201 07/320/09 60.60 APPOINTK NT NO KEPT ty DY90N,PATSY D 00019646 IP OF I DELANO DYSON 1705 amb DItON KO RES 7K 74261 64/20/52 1,041170 - J PONSf 1. IIIIRON~0609VOLY 80Q19943 lilt SP 3 EUAENfi EI T HDRON 2ilOt1 LDUll4tl It101~ DdNFON 711 763401 lit/36/82 b7, o0 NO RESPON5f EDWARDS 9800 FT WORTH DR 020 DENTON TX 76201 00/20/82 69.9h If NO RESPOTSE EKPO,OKON K QOOOQ06C IP RAI 3' KOKO EKPO 96% 9914 NTOU DENTON NTOU % 76203 09/13102 344,08 J Z Ol7 N WOD1S DR ON 4 1 HLDRUII 11NX Lt1UtN 66020172 fiq SP 3 1HDMAS NUNS APPOIH T P 92 61,dd "t 1' y NO RESPONSE7 l~ ~ft3/1Qi , J , r a 4 nAO V111 WRITE~OrF nVORf PAOf D on:26:do 31 Mna 1903 AgANTOA-ADDA OUAR.CITY 87 4-ZIP 019, DATE CUR. BAL, AT 2 DOk~1147 D6NTON TX 76QOi IOJOQl6Q 72 5PT1 Or7HOMA6 M pA00020506 eq ADD 31 OVAtIANTOR-NAM9 - NO RESPONSE TX 76201 06/Q7/6Q 66 b0 4rl nAW1N,0E0FFR5Y L 00020693 ER SP 3 DILLY ERWIN 046 W MA68EY DENTON NO RESPONSE 60 621.10 ail OnWiN,MAXINE C 00020701 IF OF J MAUAINE KORPOLINSAI 6000 DRYAN PKWY bALLA6 NO RESPOH$E7520b 06/16/ 2 20- 15 AT 2 pOYAL OAK6 I , ERIJSN,A110NAA L 00020719 IP DA1 3 DOODY ERWIN NO RESPONSE JX 76201 N2Q DENTON TX 76001 10/06/62 2,459.70.__;. , J lrlt fCHRONOACH,GERARD R 00021691 IP BP 1 09RARD R FEHRENBACH 2017 W,SYCAMOAE, ySNTDN- NO RESPONSE I J pENNCLLiELHA 1 00021741 OR BP 3 ELMA L RENNeLL R 4C LUd000K NO.AESPOHSEyp43b 12/03!79 940.001 3407 QUAKE 2401 TAk00 RD 4280 F7 NORTH TX 761't3 66/29/61 109.10 J i FINN iJgNFIIFBR A. 00022079 IP Bp 3 91)WARD FINN NO RESPONSE Il FOB[9iKHt8TtNE,.R 4000io00 EA SP 3 milil1Ne Vallee? R 516 WRIGHT 46WISVIL4E T$ 75067 02!45/63 4b 25 W DENTON 'UNABLE %L J 03/!6/62 200.00 J r RT,4 3401.NALTON OR FORD,JORAV W 00022509 IP AAI 3 KENNETH FORD DENTON -APP01NTFtEpT p E%hj11/62 233 75 K 0007itb66 IP BAT 3 DOTTY PtlRTO- 1210 MORBE t ~ ROR~$, EIH7N~6`T7E•~-- ~ _ ~ NO RESPONSE , ~ `y , ~ 'fk 7bi~tl1_07/18/t~32.. _034 bb FOUOT,BRADLEY J 00002806 IF DAI 1 WILLIAM S POU67 3300 RALLMEADOW-M2117. }]ENjGN NO RESPONSE I FRANKS,CHARHAINET 00023160 IP DAI 3 J06 D FRANKS 003 STEVENS 6RIDOSPORT PBINYHX 760 006'0 /iIy/02 311,00 J . Np 75 r? _ t34? APPLeOATE _ LL{W16VIiL~ TX 70tlb7 01763163 1b6 PA(fI T~~L10A L 60023366 OR BP 3 L16A FRENCH . UNABLE jQ LOC TE / SOEi Ml00ON DENTl7N k ,74 Ok b6/Qi_1t12 92, 65 P,ULLgR,..11MMY„ 0, _ OOOR3b40 SP 841 3 JIMMY O FULLER,. NO RESPONSE 7% 7601 08/lt/SQ 616 47 J OAOLIAAI) I'JA00N 00023612 IP ADD i ELWYN GAGLIARDI 2212-19 PT'WORTH DO DSNTON • . _xO.-RESp NSE 66094141 1P SP 1 LUIS OAO61A 0212-PT WOATH DR 066 DONN lX 16201 0004102 1,909 70 J 4 „ NO AESP~NSE OARYiWILLIAM-C-_- ..___:...00024613. IP AAI 3 WILLIAM GARY, 0403 KIN08_l4ANG13_.-. LAItL, DMLHO AESPONSE76056 ,046/10160 ....60 J OASKGY,KIM6ERLY 40001091 OR SP 8 DAVID DURINOHAM, A 019 CARDINAL 4D JS DENTON T% 76201 02105/63 29.00 00424944 Yp SP NO ALE TO.LOCATE OANO t 7576$ 00/0X/90` pad, l0 n~u?RV, YAMM'~N- 3 K~6LEV OI NTRY " AT 5 ROANOKE NO ALfPTO L7bQ0i 00/%3/63 _ A7, f d. J 40003543 ON DP 3 JIMMY A 0006MON 204 PAAIRM 1' J OOt1D0ON, JIMMYA OAAY, D ILLY R 00026591 to DP 1 9 1I,LY A GRAY. Ry 2 BOX 1045 DENTON TX ~4 Ot 00/24/60 , 2)020.00 2421 6TUARf F'F I ata YX 1' 101 6091162 61. 00 "-ORE0N.310CdY J b00St6973 OR ep 3 dtlDDY GREEN UNABLE i0 LOCATE J V ..DENTOW X ,76 OREFN,E6TNER M 00026081 ER BP. .3 TERRY GREEN AT. UNABLE TO. LOCATE 201 0010/03 1134 35, J 1113 9 OAK DENTON TX 76201 07164)02 5,031 01 4,I• OA&ENO,MAAJOgtE T 00046199 OP SP I TRACY GREENE - _ _ _„_NO AESPpNSC.. . npEaOAV PAUL M 00697062 6R AAI 3 PAUL GREGORY -1900 6AM'DA66-APT H2 D9NtbN T% 7406 661112/62 t4, 6A'-** NO NO RESPONSE 011ARA,ANTHONY 00021102 I1R dP 3 ANTHONY OUAGRRA 932 9LM APT WAY DENORADO DP RESPONSE 6901 09/Ri/P2 ills 75 J COL R CO 90119 06/i6/62 16 b0 / `[,I OUNOCAOON,LAURA 00007021 1P,AA1 3 KAI.eN OUNDERSON 6045 ESCA AO _APPOINTH TX ENT NOT 79566 KEP OiT/0 .3/62 A3 3l ~ 4UNNCL9,CALVIN 00027041 1P DAI 3 AODAICK GUNNELS -6616 CHARL69 9EAhROOK NO RESPONSE I 01 ( 04: 26: 57 pS MAR 1993 BAD 31EIII' WRS lE-OFF RGPQRT PAGE b _ PATIENT PAT, 11).... PT FC. DD GUARANTON-NAME....,..,. GUARANTOR-ADDR....... GUAR CITY.,, BT 0-ZIP Ole, DATE CUR.BAL„ OUM16R,REDCCCA J. 00027870 IP OAI a MANK 9 GUNTUR BOX lfS LAKE LANE LAKI 11ALLAB TX 7506e li/13/81 24 70 OWINNUP,RBNRE 40008094 ER WC 3 RENE[ GWINNUp 521 NORTHWOOD APPOINTMENT ( HACKLGR, FAYE LEWIBVILLg TX 75067 1/83 132.45 VIf , 00028027 OP 9P 1 JOHNNY HACKLER P.0. BOX 948 ARGYLE UNABLE TO LOCATE ~ HADbARD,LANAV L._..._ TX 76226 07/18/82 1,611. 10 L ~ 0002B17t1 ER 9p 3 LARRY LAKE DALLAS -NOT. 7/24/82 42,50 j. 00028987 CA 1D 3 JERRY HAGGARD -41B THOMPSON APPOINTMENT 75060 KEPT HALBY,.JERRY 0_.. Y'kALBY NO RESPONSE tY , 339 BURP 8T APT..SP LEWI9VILLQ TX 75067 06/27/82 V HALL, DONNY E 140 75, 60028464 1;R Up 3 DONNY HALL 1305 MILANA WAY CARROLLTtNNO RESPONSE HAMM AN, KDV 76006 07/2i/B17 62, 00fN L 0Do"010 OR OP 3 DORIS HAMMAN -6027 60WLING GREEN ".r HAMp7ON,TAMMIG J_, 000$8910 IP BP 3 RANDY HAMPTON DBNTON TX 76201 08/13/BB 47 f10 AT It BOX 521 NO RESPONSE HANCE,JVOY A 248- DENTpN APPOTNTiHE76261 07/01/82 1,100 7e µ 00088928 IP Bp 3 DpO,HANCE APPOINTMENT 5 BDX 11?A ROANDKE 60612 609/20/82 20945 VE HANCOCK;AMY M _ J IJ 60028906 IP BAI i WILLIAM M HANCOCK PO DD>I 827 NT.NOT FEPT.,; Al VDRD ' TX 76025 Ot!/Ob/89 3, 111 07 J L01 HANCOCK,WILLIAM B., 00029017 OR 10 3, BUSTER HANCOCK BOX 227 WT 1 NOT KEPT ALVpRD APPO J I HANEV,KANDY D 00029046 OR 9P 3 RANDY HANEY 1143 P609LEBROOK L NI9V[LLEPPOfN TX 7X OINTMENT 7 762602e O 6x611S/1/0tS0/02/BB.... DB 10700 00-" I, _.HApdY,BUObNE __.._.:..._0.. b J 'I 0089404 IP tD I' EUGENG HARDY . IIBNTDN' ' i;'ser 90 ' ' PO BOX 1200 k APPOINTMENT N NOT KEPT HARRIBiCHGRYL A,_ 00029001 OP BP 3 ,CHRAYL HARRIS, . _ OY d3ildiAd APPOI ` DO%,466...1.01 LAKEVf! W LAKE, DALLLAB' TX f',S06e4_OE(3f/913 30, 00, u , NANA79,JINMY 00024868 OR OP 3 JIMMY HARRIS 507 RUIN NQ RESPONSE 1r1~ HAAAI9,8HIR1.6V-- `--00030007 SA BP 3 JAMbB HAAAIB DEN7ON TX 76201'07/94/89 164.75 MERT 007 RUTH AP.POINTTX 7 :0, 71 KEPT 61/24/02'- HE1a790N,90NYA NO RESPONSE 103 >ZO b2NTONl° TX HAA 00030197 CSR BP 3 RICKEY HARRISON _ . „-_1008 SOUTH'STH E 6TREET ANO R E$-TX, f' - TX 76¢46 00/21/02 NO A 149 , 96 _W J HANN,PA'tRICIA 00031062 EA 8P 3 ROYC& HEIMAN (15 AANCH,MHP ROANOKE TX 76262 10/06/92 100 00 LOCATE HBt LUMiI MAAfC J 60031138 OR ib 3 HIM HELLUMB :3690 MON1`6LA1R DENTbN 1 NOAAESPYX 7¢74 01 06/69/02 , e1 2e ~ _ HRNDER90N,9NERRY 00031294 ER OP 3 RICKY HENDERUON 246 0TUART EW!I8VILLS TX 70000O67 O1/1!7/Y3 19 7e J 1ANDKDN,LUCILLE E 00031336 BA Bp 3 LUCILLC HENDON J AND J MOTEL 121 LEIJIBVILLBNLE YX LOCATE 07/06/82 ;i2e,'/5 7667 HCONANDELJULI6,TA 0003 1690 1P I1AI 0 ARMANDO NEANANDEL '-6J5 P'AAM9-07... NO RESPONSE HEBTAND,ORLINDA TX 7bs~0f db/iPl/ uIIN'fbN_ _ TX 76871 OS/11502 160 00 „00031898 !p OA1,3 DBLINOA Hf19TAND PD BD% 18 Y1D0A NO RESPONSE ~ V HtCK9, ARCHIB D DtiNTON 02 360 00 00031997 EA BP 3 VELLA HICKS PO flux idea App6iNTH901 NO KEPT " TX 76901 08/07/62 g HIdKO;BL12Ah9YHA- 060:39029 IA D'AI 1 b9NNYHtCKO. CDRONAbp,M1069 D1;~NTON APPQ.[Htf%Ny6901 O6/x6/02 7026, 46 (r"' 6 J HILLrBlMA1,IN K 40004005 COT 0P 3 HFROERT NILE 512 CARDINAL 00-1( DENTON APPOINTMENT NOT KEPT TX Vf 76201 HOLT;CLIkFORD H 00033043 ER 9P 3 CLIFFORD HOLT PO BOX 304 NO ACS LOCATE b2/18/93 43.50 UNABLI TO LOCATE l KB;Lt9A_,_ AUBREV• TN 76227 07/11/02 14A,BC _.._00003167 CA UA1 3 LIRA Htlt)KB B'.0 R'RbX b9 - PONSE WRAT09AP600 YX 74066'0/91/69 i9,Ob ! D NO`RESPONSE r • A., r i` a t' H ( 09:$7:04 Of MAR 1903 IIAD DCSIT WRITE-DPP REPORT PAOE 7 Lr~ P•AT1FN1,,,,,,,, PAY, 1D,,, PT PC. OD GUARANTOR-NAME.....,,,, OVARANTOR-ADDR...,.,, GUAR, CITY.,.,, 9T O~ZIP DIG: DATE CUR, DAL., HUBBARD, JAMES A . _00033537 ER ADD 3 JAME9 HUBBARD 290! NE.,R9TH B7_.. PT WORTH TX 76(01 111%06/92 90 1b NUGHED,ANN L 00034066 ER SP 3 PHILLIP HUGHE8 S19 STANLEYDENTON UNABLE TX 70 LOCATE 76II01 09/19/92 109.45 ~I HULL,WANDA S 00034373 ER CC 3 WANDA HULL PO BOX 453 . RHtlME NO RESPONSE f TX 76079 07/20/82 139.00 LL JACKS& JAMGB D 00038047 ER BP 3 ALTON JACKSON 901 4 CARRBLL_ DENTON-~0"RESPTXS7d201 00160194' 02, y JACKSON JOHN W 00035134 ER SP ,2 JDNN JACKSON 501 NORTH CHURCH 9T NO RESPONSE r PILOT POI NT, 7X.762013 07/31/92 9200 l+ ~r+ JACKS0N,8ANDRA 00039046 AN Sp 2 ERIC MCCLURE NO RESPONSE 104 ROBERTSON 9T DENTON TX-14901 09/111/92 38.00 JACOBBI JEFF _.UNABLE._TO..LOCATE_ 00035337 ER Sp 2 "00NAL0 JACKBOB 409 W ROUND GROVE RD L9W19VILLE TX 78067 Of/46/93 96.00 TO LOCAT JENKIN9,,MARSHA_C,00038659 1P' DA1 2 RODENT W JENKINB 1704 WHITE OAK C7,_.," "DENTON UNABLETX 7620} 04/11/9R 266.65 J 1 JERNIGAN, MARION 00039691 OP ID 2 WILLIAM JERNIOAN921 W OAK AT DENTON NO AESTOXS76Q01, 06/ 9/9II 3200 1J JL41N~bN, 9EN" H _ ._NO. RESPONSE 0063b887 ER SP 2 QWEN JOHNSON 130 VALEp[ELAND'-...... ` SHtRMAN TX 7bO96 0016/92 70,40 t, J0HN9O44,9E901E C 00005968 ER 9P 2 DEN JOHNt1RN..:... RT_1_BOX,320 8P_33A_ NO RESPONSE MIN eAL_ HELL,. TX 7606'1..09/2S/8R J + L NO RESPONSE . !1b 76 W JOHN90N,13INOMEN H 00038973 ER WC 2 BINGMEN JOHNSON AT 1 BOX 320"9P„33A -MINERAL WELLS TX 76067,.0649/09--, J .IIf1,1b Jb{IN9bN, PAMRLA~ '00036076 tlR 1D A RtlV -JOHNSON - - _.O NO RESPONSE, V ` 1227 MCDDNALD DENTN TX 76205 0T%04%9II 34 76 T.HELMA L00006809 ER BP E WILLIE MANUEL 1235 MCDDNALD_. DENT ON APPOINfN~IlK~t~/01/94..,..101, 01,25 ` JOHNSON,VAN C 00036825 AN ID 2 VAN JOHNSON AT 5 SILVER DOME M66 DENTON, _ NO AES"SSbQOS 06/19/94 - 94 00 JDKfiBLbP1N7UADE,OLAWII' 7000lR94 OP SP 2 'OLAWUNMI JDKEOL&INTUAO 606 LEMOW AVG 8440!! bALLd __NO-.RESTOXS75921 02/16/93 60,00 J `r, NMI - UNABLE TO LCOATE JONES, ERICA b 0003b930 ER ID 2 `WILLIE MANUEL 1*35 MCDDNALD DENTON TX 76201 06/16/92 96. 2D J0Nfi8rJASON _ 00036921 1p BA1 1 TOMMY JONES 1 NO RESPONSE J ' , 09 REDWOOD_ DENTON TX 76001 11/05/91_ _,.058 96 I.,1 KARN99,R02IN 00037401 IP SP 2 MICHAEL KARNE9 RT II BOX 310 APPOINTMENT NOT k AUDR9Y TX 76227 06 O6/?4/911 461, 90 kATgJANLtT L 00037572 SP Dp 1 JANET VtATD BOX 203" - APPOINTMENT NOT KEPT Vi" LIYTLC 9LM TX 76069 01/27/93 3440.90 119LL9Y, CA7HY_L 00037697, Ip RAI 1 _ GENE keLLE<Y 1122" JOHNSON PFMTON- NO RE5TX 16201 04/90/84 519 38 (yj K1M,HYEKYUNtl 00039281 IP 9p II OAP KIM 1470 W epRINO VALLEY R1C APPOINTMENT NOT KEPT HARDBON TX 16000 04/06/92 634.0 MORENO,JA(Mtf 00049952 1P bA1 1 JAIME MORENO 214 MOVED LEFT NO ADDRESS W MAGOaY DENTON 1'X 76201 00/01/9II 4t17, NAC9, DARELL L 00049635 tP 9p 1 DAgBLL MACE 11909 PANHANDLe MOVED LEFT NO ADDRESS , TUN, TX 76201 09/02/92 1, 319. 00 NALLOYr9HELLEY P 00049668 10 BP I 814$LLRY NALLEY RI 2 Box 02 l(D RESPONSE AUDREY TX 76II0 09/19/04 669.20 NEA06,D6LINbA D 00049809 OP SP I AR613E NEACg PO W 242 STONOCR6ST JUSTIN NO AESTXNS76447 69/24/04 1.6121 65 NO RESPONSE NEWELLrPAMCLA 9., 00080107 Op 1D 2 JONNY NEWELL 07 POX CIRCLE DENTON NO TN 76201 01/26/02 196.68..... 'I t NICHOL9r JERRY L RESPO SE V + OD050411 RR SP 2 JERRY NICHDL9 1237 DRAIRWOOD LEWISVILLE TX 75067 07/11/92 40.00 . - MOVED LEFT, NO ADDRESS 1 02;27:11 31 MAR lgB3 IIAb DE07 WR1Tfi»tlPP REPORT PAGE 8 PATIENT PAT. 10.... PT PC. Db GUARANTOR-NAME........ GUARANTOR-ADDR...... OUAR.CITY..... ST 0-ZIP DIS,DATE OUR. -DAL, NORMAN,RODIN W 00050765 ER BP 9 RODIN NORMAN 1020 RUDOBLL 0109 DENTON TX 76901 10/19/B2 41.100 NDR7CN,PATRtC1A A 00050064 IP BP I DENNIS NORTON PO D0X 780 PR19CO _MOVED LEFT NO ADDRESS TX 75034 09/07/02 7,605.90 NO RESPONSE NTUDfi,DCDDIE 00050230 ON DAI 2 EMMANUEL NTUDE .-_NT B04 6464 „ DENTON7X 762.01 09/04/62 36.00. < NO RESPONSE ORAKPO,JOY C 00051557 IF JD 1 LAWSON I CRAKPO P 0 BOX 6127 NTBU DENTON TX 76201 08101/82 569.60 f',"~ , ORONA,EDNA C 00031615 BR 8p 2 E, N. CRtlNA NO RESPONSE: 2006 PT WORTH DR 073 DENTON TX 76201 06/10/BO 72,86 09E1,WUBU FRANCIS 00091771 OR 0A1 2 HUBU FRANCIS 08EI NO RESPONSE , p,0 BOX 9371 NTBU t3T/1 TX 76903,0$/20/89 18 .00 `NO RESPONSE ~ PANNELL,DILLV H 00092217 OR EP 2 BILLY PANNELL 508 CARROLL 0254 DENTON TX 76201 09/27/82 59.50 PARKBR,DOMNA K 00052300 ]P AP I G NO RESPONSE i1w ARY LEE PARKER 613 PALLMEADOW APT 1 DENTON TX 76201 IR/23/02 11405.05 W._ E PARMER,,PERRY fi 00062373 OR ID Q p1iRRY,PARIiER NO RESPONSE J , _.R7 2 BOX..309 A_..,...__ Au REY TX 76227 OBY29102 60.73 RESPONSE j PARKER, VICKI L 00009449 OR 8P Q TOMMY PARKER 1915 BERNARD DENTON _ YX 76201 09/02/02 100 50 LI J PARRI8,CATHY A 0tl062.b60 IF OF 2 CATHY A PARRIA 726 OERNARO 97 Mgt! ABNTON NO';RES7O 16201 01/17/01 452 95._ "NO- RESPONSE ,ROtlIE M 00002045 IP OP 1 DAVID OAYNB 2 f'AYNS 592 25 _ ) lJ1 NORTHWEB7 BfiODMD MARIETTA tlH 73 4A 00/l NOUSPONSE- .4 k/0 PEABB,VICKI L 00052951 IP OF 1 VICKI PEAOE 618 W. SYCAMOROAPT I DENTON ' j NO,REJX 76901 04/29/07, 2,067 AO e;1 lJ • F+KfiL,RAY 00003033 IF DAI 2 TERRY PEEL 406 N CHURCH DECATUR ~ TX 76034 00,!06/92 ib9r25 NO RESPONS£ PEPPER,OINI-M 00053014 OR ID D TOM.PEPPER DPX 31 201.SHADY _SHOP LAKS.DALLAO,. 7X 79065 06/16/02 70.00 , NO I y RESPONSE" „ ADD REZ , {}I P9YTCNALCRINA 0 00053330 OR SP 2 BILL19EMCMANIB _-RT02/BOX 1108 „ SANDENT TX 76901 00/04/ $5.00 UNABLETX076CAT 0A/Q4/Bp liZ7.00 I LL - J LCOE V~ PICA20, M1MURRAY fl___._ _,00063918 IF RA1 2 MURRAY,pHILLIPO NO RESPONSE P 0 DOX,07S__l,,,__. _ SANGER _ TX 16266 00/06/80, 96.69 1P9, ' ~ _ _`?10RE5PONSE _ `•i! PIERC OUEL 00054007 OR AP 2 MIOUEL'PICAtO 915 N RUDDELL DENTON TX 76901 09/14/02 131.25 NO RESPONSE ` E,CHAD 00054049 IF BAT Q bARLRN5 PIERCE _301 LOOP 890 0L10 DENTON PO 75201 02/05/02 92q6'-'!- No RESPONSE J PIRSAOLOU,,AMIR T, 00094205 IF ADD 1 NASSER PInVAGLOU.,-_ P,0 DOX,03.NTBU gTAT1 OENTQN TX 76203 06/07/02 1, 116.00 rr PDLLBY,AAVID P . _ ONALE TO LCOATE 00034494 GA 8P 2 DAVID POLLEY P 0 BOX 539 KRUM TX 776(249 09/119/02 55.00 / NO RESPONSE : . • PRA17i0AN1 L 00054759 OR 8P 2 JAMOS PRATT .420 It SOUTH BY 01RARD 11, b2640 07/17/99 366: 00'--' NO RESPONSE P PRICL,KADRV K 00094074 tP ID 2 TIM PRICE 607,0 TA.-l_'_ 445 5D . OATN9$V16 E TX 76St40 tlq/19/02 4 ~ NO RES ONSE , ty, RODBRTS,NICY E 000BR0OS OF AP 2 NICY EVON ROBERTS 000 0 RUDDOLL 0140 DENTON TX 76201 00/09/02 77.00 NO RESPONSE BHAVER,BARDARA J 00062133 OR DP 2 EDOAA 9HAV9A 9425 LOUIDB 013 69NYON TX 00000 08104109 129.40 MOVED LEFT NO ADDRESS J SHELTONiMALENDA J 00062364 ER OP 2 MALBNDA 8HELTON„..,,•.. 930 P95BLEOPOOK LEWIAVILLB. 7E 67 09/O1/0Q 64.08 _ VV BPRAflARY,TONYA 00065755 ER OF, 2 TONYA APNABARY 1809 TYLER DENTON UNAAL k076201EC0120/80 41.50 MOVED LEFT NO.ADDR£$S J iii ~M e M•r I T ..1;.:P:^ar+a d W 09; 27: 17 31 HAR 1903 BAD DE117 WRITE:-OFF REPORT PAGE 9 ' t I• P,ATIENT.:............. PAY. ED, PT FC. DO GUARANTOR-NAME...,...,. OUARANTDA-ADbR....... OUAR.CITY..... ST 0-ZIP DI9,DATE CUR. SAL.. L~ 1 VALOEZ, JUAN 00071027 OR BP 2 JUAN VALDEZ 9 i2 91 110IPT C DDNTON TX 76201 07/25/82 122.25 `f`IIII NO RESPONSE WHITFIELD,WESLEY A 00074021 OR ADD 2 AANDY WHITFIELD ACORN RANCH #201 DENTON TX 76201 09/27/92 43.25 . MOVED LEFT NO AODAESS WILLIAMe,ANNA A....___-...___00074990 OP SP 2 ANNA WILLIAMS _ 1.105 E HICKORY---DENTON, TX 76201 09/22/92 J MOVED LEFT NO ADDRESS 2i. 50_ WILLIW9,CH5LLI 00074633 IP DAI 1 ELIZABETH WILLIAMS PO BOX 121 GAINESVILLE TX 76240.07/25/92 794.19 -1 _.APPOINTMENT NOTkKD/T: ' WILSON,PGAkWE M 00075523 9R 1D 2 PEARLI9 WILSON 200 9 RUDDELL Nag DENTON YX 76201 06/07/92 39.75 NO RESPONSE _oOHYAHATNERBJpA.._ 0 076323 ER 9p 2 P11IL1PgVERTDN, P0.8OX.2Q1LAKE DALLAS T$ 75065.0 20/92 Sr 121.20. --00076141 IP ID I NO RESPONSE 1 WRIGHT 1909 TYL9R DENTON TX,76201 09/01/82 49.00 ! NO RESPONSE. NRIDHT,9HELIA 00076513 IP SP 1 BOYD WRIGHT 207 ELM LEWISVILLE. TX 7601,1 05/16/92 1, 115.95 lti, APPOINTMENT NOT KEPT ' DONALD..-- „000767129 OR "Al 2 DONALD-Y.ECtt_ 609 DRIFTWOOD DENTON 7X,76201 09/14/02 79 14 _ NO RESPONSE YORK,ALAHA 00074779 CA 8P 2 CAROLYN LEE $04 9 RUDODLL APT 56 DENTON TX 76201 03/09/02 53,95 J -ND .RESPONSE . R7'L '6DO76794 OR SP 2 ROBERT YOST 1221'COROELL DENTDN TX 76201 0%11/82 53.00 _ YO9T,ROBE NO RESPONSE YOUNG,MICHAEL 00076919 90 SP 2 MICHAEL YOUNO_ 403, AMARILLO. DENTON TX 76.,'2,01,07/70/92 .__.37190„ NO RESPONSE- YOUNG,VANE99A F 00076968 1P 8P 1 VANS90A YOUNG PO BOX 1264 , DENTON TX 76201 05/06/92 1,279,75 I;_ APPOINTMENT. NOT KEPT j ? 09, 946, 12 J V' '.J L. 1%0 i. w , V r~ FLOW M E M 0 A I AI HOB, P ITAI, rxlmC 5f{EET JANW RY 31, 1983 1983 1982 1983 1982 Current Assetst Current Liahilitiest Cash-Operating $ 64,019 y 155,265 Current Notes Payable $ 202,090 S 124,626 Interest & Sinking 170 691 Accounts Payable 926,544 673,472 r- - Reserve Fund 40,330 112 Accrued Payroll 305,559 253,860 Repair Fund 20,053 246 Payroll Taxes 119,183 1300533 Group Health Insurance 11000 11173 Fees Payable 248,262 190,546 Investments/Board Designated 307,683 396,398 Bond Interest Payable 31354 30354 Bonds Payable 10,000 650000 Zbe Medicare 121,427 193,365 Total Cash & Investments $ 453,255 $ 5531885 Total Current Liabilities $ 11936,419 $ 11634,756 Acounts Receivable $ 31476,336 $ 2,559,265 Other Liabilitiest Lem Allowances (524 415) (215 428) Deferred Income $ 2250076 $ 232,702 Net Patient Receivables Lang Term Notes Payable 349,832 2490319 Ponds Payable 420, 00 430,000 Other Receivables 302,341 2100748 Inventories 3360577 265,271 Total Liabilities $2,931,327 3 20546,777 Prepaid Pxpenses 47,600 49,415 Tota]. Current Assets $ 4,0911699 $ 3t423,156 City of Benton $ 393,165 $ 393,165 CaCity t of Menton 116961971 County 1,6960671 Property, Plant & Cguipmrt Endowment Flow Estate 240,461 240,461 Land 37,547 370547 Fed. Grants, }fill-Burton 1,868;910 1,8680910 Building & Improvements 409021,159 91809,694 Federal CYants 256,371 256,371 0 Furniture & Equipment 2,9 6,651 2 555 787 Pledges and 'Gifts 592,702 454,680 ~i7 (lan, Fund Hai., Beg. of Yr. (293,266) (686,770) Current Year (51,0865 82,942 Accumulated Depreciation (4,350 596 (3,968,777) Net Property, Plant & Equip, $ 314951761 $ 3,434,251 Total Capital _ $ 41656,128 $ 11310,63 TOTAL OPERATING FUND $ 71587,455 $ 6,857,401 TOTAL OPERATING FUND $ 74587,455 S 66,857,407 Current Ratio 2,11 '~/."~4'A.tANU~-x1S/Aekf!#Wr# 1a..i.:.., , , r.. rve. .f qufr. fkfr am a..v .r [ .e. r• c.`''Ip• ".;.¢nn. Yi'1 r,. U.h 4WMit .r:9i Hlu fr.f ltN✓.[NAFb~Y/G71!~+MKIII~ I 1V5!:'1'IY E F L 0 W M E M 0 R I A L H 0 S P I T A L Page 2 STATISTICAL STATEMENT JANUARY 310 1983 CU RRENT M0NT11 YEP:R-T0-DATE P R 1 0 R Actual Budget Actual Budget Year-to-Date Adult Patient Days 2914 2945 11,420 11,450 110237 Average Per Day 94.0 95.0 92.8 95.0 91.4 Aowborn Patient Days 366 420 1424 1708 1582 Average Per Day 11.8 14.0 11.6 14.0 12.9 Gross Patient Revenue/Pr. Day $440.07 $423.32 $419.97 $432.08 $369.21 { Total Expanse/Patient Day $355.92 $349.00 $364672 $357,56 $321.56 Month. Charity. Bad Deter Recovery October $ 51,473 $ 96,053 $ 5;636 November 127,181 117,974 4,446 December 610228 1060636 61566 January 8 000 99,706 9 934 2 , 2 6 z Revenues 5.2% 8.7% .06% E E . i Y Page 3 r L O w M E M O R I A L H 0 S p x T A L 1 STATEMENT OF OPERATIONS/t7ANUARY 31, 1983 of Salaries Supplies Total Direct Operating Revenue Revenue & Benefits & Other E rases Profit (Loss) Daily Hospital Care 3.8 , 55 0525 41774 $ 148 Psychiatric Care 61,517 40,995 693 41,299 688 $ 19829 O~Post Partum 4 55,575 21,006 1,058 22,064 33,511 2 26,400 21,404 673 22,077 41323 Nursery 2 25,795 19,212 31065 22,277 3 ,.518 Neon&tal Nursery 2 31,529 16,176 104 16,274 15250 Coronary Care Unit` y 3 44,670 35,659 20150 37,809 80861 Tabor & Delivery/Birthirrj Center 3 38,211 31,509 2,439 33,948 4';263 Operating & Recovery 4 44,470 23,720 11,740 35,460 M10 ; FMergency Rom 3 37,336 18,620 25,573 440193 (6 857) Central Supply 8 104,793 8,142 32,420 40,562 640231 Laboratoly/Blood Bank 11 140,836 54,129 54,129 860707 Radiology/Nuclear Medicine 6 70,998 3.7,465 16,623 340088 36,910 PharmaoylV 17 221,255 12,650 38,710 510360 169 895 i Cardiopulmonary 8 96,092 22,727 18,250 400977 55,115 Anesthesia 3 420293 21,655 71975 29 630 0 Physical Therapy 1 10 906 7 460 2 198 91658 12,663 1 } 0 1, 6 r9 Orr- 0 ti 599,733 Deductions of Revenue $ (54,060) $ (540060) Charity & Bad Debt (151,870) 870) Employee Health Inn. Expense (151,f $ 20,473 $ 20,973 (20,873} Medical Records 468 $ 11,499 2,870 14,369 (13,941) lift Shop/Grotiunds Maintenance 7.,677 1,349' 124 11473 264 t Cafeteria 120056 28,791 23,386, 520177 (40,12 l) Plant . 16,5].7 65,558 82075 'r Rnviro"ntal Services , 36,785 51128 410913 (41,913) Fiscal Affairs/Data Processing 0 9 121 4 362 13 483 PereBusiness nne1 Office/Credit & Collection 25,095 12,676 37,771 (13,483) (37,771) Administration 20989 11163 41152 (40152) Quality Control 310881 8 210699 3.150 {9,150), General & Administrative 0 0267 _(3 pepreciatidn 998.... 34,359 34,359 (3300361) 37 987 37o987 37987 , Gain (Loss) Prom operation ' , , , , ° Non-Operating Revenue 25,000 55,353; Foundation 3 135 25,000 3135 ; Total c,3 2 80a-- 1~074:L42 83,488 4kJ { t 1 MtiR;'~~'Un V,'ii YtKt.A .fl'. i,:6 ,l irw'., Jgif.-l A: i;i k_vilu+d v,., L4ii-a, 'n+iN:d~wti vn'4on..VNt Ir 3r~~4~1t,~P.D'~{'tk'b~(li..`~` «ratt.tea.N.°..see;.,',syr~t.fl'N.'h-W1a'y,Nd'.R*l3itn3'Y'Ml±S7ri~~iFk~:4~ti49Sh'kf~'dlt7si;l4~Sz[!,~', I~ Y E. Y 1 ' l Page 4` r L 0 W MEMORIAL HOSPITAL STATEMENT Of OPERATIONS WAR-TO-DATE, JANUARY 1983 % of salaries Supplies Total Direct 'Operatirig Revenue Revenue & Benefits & Other E ense$ Profit. Los Daily Hospital Care 17 3=, 69, b7 20t m $o-139 Psychiatric Care 6 . 296,491 1491627 49907 154,534 141,957 OB/Post Partum 5 228,135 83,397 5,037 88,434 129:Y01 ICU 2 96;650 815990 6,041 88,031 81519 Nursery 2 117,070 73,085 18,195 92,291 25,190 Neonatal Nursery, 3 137,250 63,896 11608 66,604 71';746 r Coronary Care Unit 3 154,059 132,008 81096 140;194 131$65 s Labor,& Delivery/Birthing Center 3' 1$60924 1122295 21,713 134,008 22,916 Operating &Recovery 4 1676743 90,062 47;652 137,714 30,029 Emergency Room 3 141,037 73;697 103078 177,175 (36;138) . Central Supply 8 360,93 33,585 149,108 1820693 1779700 Labor6tory/Blood Bank 11 511,547 226,929 226,929 284,618 1 Radiology/Nuclear Medicine 6 2821269 68,137 71,609 140,346 141,923 Phs.rrrgacy/IV 16 770,479 500561 1650983 216,544 5530936 j.' Cardiopulmonary 7 359,Q.49 909463 65,803 156,266 202,783 Anesthesia 3 145,370 71;985 24,612 96,597 48,773 Physical Therapy 1 51 910 30s950 5 545 36V495 A,415 $1,7759495 ~ 946,388 $2,1211883 Total Deductions of Revenue $ (254,796) $ $ $ $ 254+796 Charity&Bad Debt (601,669) 601;6 9 Employee Health Ins. Expense 106,187 106,182 160,1 g7 Medical Records 11813 47,725 10,607 68933 ( 1 Gift Shop/grounds Maintenance 70276 71146 5045 13,091 (5, 16 Cafeteria 440340 114,538 103, 46 218,184 17 "81 -t Plant 68,007 253,962 3210069 32 r819 En ircnme tal services 1480930 31 01 179,93117',9,1 i Fiscal'Affair.s/pats Processing 33153 19,416 521669 (6,69 Busine,$sOfc/Credit &Colleetians 97,712 370441 136;163 (135,1$ Personnel 11,363 91507 20,970 200870 Administration 26,646 8,886 35,532 36,5 2 Quality Control 10,347 21461 129807 12;91 , General A Admi~-istr'ative 1,286 137,648 137,648 136,$bb666 Depreciation - -p- 1ff5111009911 -71661 091 16 001 Gain (Loss) from operation 1165;486 , Non-Operating Revenue 101,919 101010 Foundation 12,461- T1,1824 j686m T41'6" R"86 Total n w. FADE 5 F L 0 W M C M 0 R T A L H 0 S P T T A L ! SUMMARY Or CASH RCCCTPTS AND DTSBURSMMS JANUARY 31, 1983 Current Month Year-To Date Beginning Balance n3;979 $ Molt Cash Received fromi Active Patient Accounts $ 1,046,763 $ 3,833,996 Bad Debt Accounts 9 933 26,581 Cafeteria 12,690 46j085 Appropriations/Donations 820324 199,609 Other 46,827 210L700 Total Cash $ 11198,537 $ 4 317 009 4'I'AL CASH AWLABLFI 5IJ Cash Disbursements t Payroll $ 490,877 $ 2,012,214 , Payroll Taxes 101,432 300,833 Patient Refunds 70729 53,322 Capital Assets 31253 100,607 Notes payable 14,587 761790 Other 522,135 1,692,928 Total Disbursements $ 1 140 013 $ 4 236 684 Cash Balance 92"500 $ $2,500' Cash Inveatments 3 307 683 ! . 't'otal Cash ~r Gross Patient Revenue $ 11280,831 $ 4,785,885 Lem Allowances (61 175) 312 628) Net Patient Revenue lt219 ~4 Cash Received on patient Accounts $ 11046,763 I $ 3,833996 ; bases Patient Refunds) (53022) Net Cash on Patient Accounts 39,034 ~ r , Cash Received as a of Revenue 85.2 8i.4+s I i F ZMWN!IJ 41 .r r• nv.:...... . J Y. 'V. u.1.n.n. M. ~'~1Alt<ht4~W fir.,...:..._. .............._..e r, r „.w.. a.... rx w....u rYiawJ, ' rL04! MR M0 RI AL 1109P I'rAL Page b AG'SD ACCOLNTS RCCSIVABLC SUMMARY JANUARY 310 1983 Primry Payor Current 31-60 61-90 91_-120 121-150 150+ Total of A/R Medicare $ 3570733 $ '90,029 $ 10,724 $ 11601 $ 18 $ 110770 $ 471,875 14,18 Medicaid 500300 26,937 24,892 41247 31877 31919 114,172 3.48 Blue Cross 86,380 16,730 50724 209 841 109,884 3.38 Commercial Ina. 510,150 205,013 88,524 46,227 80155 14,591 872,660 26.2% Self-Pay 382,722 201,444 181,184 123,232 112,956 233,286 11234,824 37,08 Balance after Ins, 222,526 89,123 59,893 37,397, 37,499 86,316 532,754 16.0% . In-House $ 3.1609,811 $ 629,276 $ 370,941 $ 212,913 $ 163,346 $ 349,882 $ 31336,169 100.0% 300,146 Total A/R 3j A/R by % 48.3% 18.9% 11.18 .~9 10.4% Number of Accounts Days of Revenues Accounts Receivable 86 In-House 7 Total ~ 1 1 +X-• n .aMCl ?.Yk •p t FLOW MEMORIAL HOSPITAL HOME HEALTH page7 BALANCE SHEET R JANUARY 31, 1983 ASSETS LIABILITIES Cash $ 23,081,73 Accounts Payable $ 923.05 Accounts Receivable 94971.44 Payable due Flow 3,957.83 118,053.67 Accrued payroll _5,686,80 Inventory _,1,844,32 Total Liabilities $ 100567.68 I Total Current Assets $ 119,897,99 E IrhffiN!' CAPITAL Furniture & Equipwnt $ L, 615.00 Pledge & Gifts $ 115.00 Less Accumulated Depreciation (1,345.80) Gen. Fund Hal., Beg. of Year 1130814.71 Net Equipment $ 269.20 Retained Earnings Current Year (41329.58) Total Capital $ 1090600.13 1 o TOTAL OPERATING FM $ 1204167.19 TOTAL OPEPATING FUND ~ 120,167.81. , 2fi7.81' i E I r Y: baqn F L O W M E M O R I A L li 0 S P I T A L If O M E H E A L T H Page,8 STA'iEM-W OF REVENUES AND EXPMS88 JANUARY 31, 1983 i RLIWUMS s Patient Revenues $ 291804,;)4 $ 129,188.48 j Deductions of Revenue (71627,20) (31,115.16) Net Revenues $ 22,177,04 $ 98,073,32 1 i s EXPENSES E ' t Payroll & FICA $ 21,719,78 $ 85,054,17 1 Purc. Service 817.76 21790.66 j Supplies 7.,560,69 7,256.04 i r Travel 1,290,00 61169.58 ' Employee Benefits 197.48 863.29. i, Depreciation 269,16 Not. Expenses $ 25,585.66 $ 102,402.90 tier f Excess of Revenues over Expenses $ ._{3_,hQ8,62) $ (9 329.58) f 3 l tl jt ~r+ DATE 1/27/03 1 4 : 4 9 : I: L 0 W I(E M 0 R 1 A L H 0 8 P I T A L PAGE i8 J ~L DAD OCnT TRANSFER nLPORT Fag PERIOD 1/01/03 THRU 1131/23 PATIENT NUMDEH r14+e PATIENT NAtAE 04w4 0**4 QQUARANrOR NAVE 4444 DATE DATE ppA gg Op 6ALANCq J PPX NUMBER ADDR, CITY, 8 ZIP ADpA, C1TY,ST, ZIP ADMITTED D18C_HAROED WRTEOFF OP ACCOUNT u r.r r..r rV r.r VUUwu.rrrr rvw rrrr..r .r.rr r.. r.n Vwrr ururrrr r.r r.. rr-------- r..rrrrJ r. rrr.r .VUVr Vr rr..Vw4rrwnr 1 tot 349637 IJ0tlDFII4 JOHN W0ptl DFPI JOHN 9/07/82 8/10/82 1/27/93 795.80 5LIHAARRY HIN90 OLVV T:( 7177% IAL254 ARRY HINES {iLVOTX " 77777 Unable t0 locate, Wp p J 101 410209 WOOBB DELANA /ITp23BDX 198 WILLIAM 7/09/82 7/08/82 1/27/83 1149.90 RT BOX t92 AROYLC TX 76226 AROYLF TX 76926 Arrangements not kept. J lot 34$069 WORRAL STEVEN IJ RRALh STEVEN 7/14/02 7/90/a2 1/27/83 2919.16 1618g I OHWAY 121 oorr pp . . . LEWI8~LLE TX 7SO67 LHWISVILLEE Ntl TX 75067 Arrangements not'kept, J 201 421420 rpYYNN ANNE Tr AT h pWWE~ypyNIJq ~1 7/02/92 1/27/83 4o. to ` ITDOX LM TX 79068 41LOR 202 TkMA87$0G8 No response to collection efforts, Ioti a7niYf 2D 20 Aq RANDY Ago RANDY 6/23/82 6/26/82 1/27/03 1$73,70 Yif 0 JOHNSON OT' 0a ' JOHNSON 8T ~,•,1 V 115NtON Tx 76201 DENfON TX 76201 No response'to Collection efforts. J ' 201 47900IZcg DX A f7b oEOROE yECP. PHOEBE 7/20/92 1/27/93 41,00 rtOY L S TX 74226 "'PO AR0YL1NnX 2r6, , rx 7 Od0 E OAK 61226 No response' to collection efforts, J 201 402149 O41H0 CHARMIKV1 E AIDE; LINDA 7/29/8:, 1/27/93 30, 00 rz#1t~ ; ENTON TX 76P.01 N 0,04 OAK TX 761201 No response to collection`s0orts, ~ , . TOTAL $ . , l All DEBT Nk1Tg-OFF TH19 PERIOD;' 9910, 112 1 t`. I J a , . J . ~ l ' 4 _ , . ......:.n irwwrv~.•ax,vi:deahun4tAt( 4l klf:f , Q! f~ L h 1• U ri 2J t) Q P 1 7 A L pAOE 17 Lr BATE 1127/83 14:49, K L O W IS E M O R J DAD DEBT TRANBFER HLPDRT FOR PERIOD 1101103 tHRU 1/31/83 BALANCE PAT [ tNl IJUMQfiu 4an44 PATIHN7 IIAV~G i -a444n GUARANTOR NAMS *104* AUMIDATI'E7ED. CDATE HAR DA1'fl OF r'«'1 ~ »M~+w » yyADDR! CtTYoST,_ZIP » DIBHAROEU WRITEOFF 00 ACCOUNT Prx Numa R ADDR. CITY. 8T. Ztp » .y 1 DILLY 7/11182 5127183 148.75 W . DILLY ORA J (r RN NTN TX 76801 YOIJNN IN TX .761201 No response. to collection efforts. 70t 824127 gALtRO g 24 Fj DGNTW 7/11/02 1/27/83 38.00 WALLTaggg ApLgY45& tlLEN J 202 297030 l7 HUPPMAN RI T% CHARD 76249 RINK 6 TX ' 76749 No response to c011ection efforts. W41U' 6/00/82 1/27/83 66.00 DU67AN p D % X03 DAVID J 208 76786 Wr fl T% 761247 JV07iN ~T% 76247 No response to collection efforts. J'llJ T1NJ 7/04!02 1/27/03 30.00 p W9l)OTLR ! JAMES CAROLYN 201 423637 8t tH 9T a03 L07H 8T TX 76266 AN0 N TX 76266 No response to collection efforts. 161.80 p8; OANOti WggST JAY 1/28/82 1/.^7/83 N JAY R7. ~IJDDX 1~3 802 394710 R!19Tq BOX 123 DDT T% 76901 No response to Collection efforts. 1J . `r OtilJlgN TX 76.^.01 0 T S/27/83 S0, t0 1. TSIJA W ONOOSt CHARLES 7/11/02 J 201 424374G6aUND0>ti ILOr POINT TX 762b8 PLO T POINT 7% 76298 NO response to collec'Aon efforts, 38,00 ! DILL 6/14182 1/27/89 WW~~{{ ' J pi'ItlutIJIN LA1tC8 0766 41$166 w667 BRAD 201 1266 71J1N OAkB RT 9 TX 76701 No response to collection efforts. j ~,V SWTQIJ rx 76201 DENTt71J 2/27/83 39,00 pERCY WHt{iY PERCY G/2q/82 J 2ot 41g9t1 ItIIT~' p 6 R rX 762201 n0 rbsponse to collection lefforts. j 49 B.OTT DRIVE UBNTOIIEED 8T 87.00 GGTOW TX 76Y0f JAMBS 7107/811^27/03 SL1.gRO tog 42$022 ~j4`9RPRAIRIE JAH89 09 E PRA1RIr TX 76201 No response t0 co110Cttbn efforts. 0•NTON T% 76701 SNTON 1/27/00 48,50 Wt IJ.MB . CAROL 6/09/a;., J CAROL .7006 ~A11t~OLLTON LN II115 TX 70006 No response to collection efforts. 201 413650 910fJb9TN2JLN 4115 V ARIIOI LI 7/08/08 1/227/83 160.20 203 59711 WtL IAMB JAIJICS W L .lAlhq JAMfi4 ig tt1CDONALO DR 1 1 11CDONAID nR 1X 7620, ;10 response to Collection efforts. ` 011 ON Tx 76201 0 NTO) 1173.40 If a I LLIAM9g MARVIN 7/17/87 7/:0!02 027/83 J 202 249027 WILT n1~OY IfARV IN Vi o LOY TX 76201 Arrangements not kept. ~17k0NtQN T% 76201 0 WON b/17/8x 1/87/09 64.00 WS~,L IAMS i WAL" CR Ol 416040 W2ql lnlil~tn PtDR7H pU k511ATX2! 76.05 pdM?oOLD NOW RD NI ' pc11t0u " TX 76201 Arrangements not kept. 4, Dc t ..1 YY~ ~nn1 t' , y DATE 1/27/03 14: 49: r L 0 W 11 E M 0 R 1 A L H 0 8 P I T A C' PAGE tb l J i PAD DRUT TRANfIPCR REPORT FOR Penton 1101183:THRU1131/83 °I J PAiSEflT IIUMOEn r4++IM PATIENT f{A.ryE, AAA► xrAA* OUARA14TOA NAME 'yDATE DATEp tlr BALANCE , PFX NUM9ER AODR, CITY, 9T, ZIP ADDR, CITY,81', YIP ADI11tT D 01SCHAROUD WRI7EOFF OF ACCOUNT r~r ...•.qun... r r~.uwMw., wuruu u.,. rrrrrrrr.-r .~I $60 .f 4 f 207 28126 CIlTONWOATH DR 0i3 Gf i TIl - lJOT1JWORTH OR' NI1J CHAA br CHAT%a87G201 DTTOoNTOIJ TXLEB. 7/26/82 1127/p3 87.25 ~ g1 76201 No response to,dollectlon efforts, J 4 101 451728 ~LppASAM CLA 1911 OpB " 1/327/83 x^47 60 a4 AMUELL BLVD - 5 24 24 AMUELC BLVD Tk 7472D ,RAHH WILLIAM TX rA 70338 Arrangements not 6/04/2 D LL J 4 201 423699 L ~18V ~d DARTXRA 7~0 A Op 1 70 BETTY 7/10/92 1/27/85..- 72 00 L N pN L N l 1 f E 67 L WIGVtLLE ' fx 78067 NO response to co118ction efforts. J ; 201 405779 R ,1P DOU9LA8 TRUMP PATRICIA 5/19/82 1/.97/89 38 00 ORDHAM Ol PORDHAry _ I 9 1 D TX 76201 NrQ14 TX 76201 "Uneble to locate',' b' CLAUDIA TU_ J E 202 4f 918. TU T RR01'4" 40 131 00 ~00 76249 UN~TE TL It RWDtl CLAUDIA 18/82 1 /27/03 0 40 1x " 76349 6/49 No raspOn4e to callebtion Worts. 20l 411181 ALBERT , J 1 NO8 W pp 1~ U llll - EN 6101102 1/97/03 . 18.00 t .1 204 39699 gT Y0LE N917 JeClTX 7'63`01 gBNTQA0l6 DR M217 r CINDY-T 76201 N6/03p92e t0 COllectfon a ffo27/'93 V D~NT01 09 R096LAWN AOBLLAWN 72 00 BIF- 040 Vpp ~ 14 TX 76201 51709NTUN TX 76201 Nd respenso to collection efforts. J i e 201 431 LION N7 MICHAPL ~Sd gULK70N }17 MICHAEL r 7/01/82 1/317/83 46 60. ~ 1 NT I! 1'X 76201 ENi014 TX 76301''° No respdnse t0 o011dction efforts. ''"1 1 20t 4213916 ANggKggU►A►{yR~NNy ANNETIE VAN KppEURL•'fl ANNETTB 7/02/02 1/27/83 78 to LD6SISBVILLE 1321 02307 T% 79067 LLWIBVILLEtQf 02307 Tk 70067' No rASpOASe to coke .rt dtian efforts, J 201 42,1004 pL8 CHRI9TDPNr gAL CHARLOTTE 7/07/82 1/27/83 39.00 1ALTERB W G WALTERB L !I VY LLR TX 79067 L SEVILLE Tx 78067 / ~ No response to collection efforts, 2202 381209 yy,yyCpCp e41l,•R llYOTIC VgpgpNI: A DEBORAH 7/19/02 1/27/83 129 00 OGNTAAADINAL 004 T% 746P.01 DENr 1RDINAL 04 TX 76201 f No respbnse to 661 1ebtl04 efforts. 201 429071 VnhREp JAMES VOLI4t~{ JAMES 7/09/02 1/27/83 48 00 Ingpo phh n40ND8 Lt? Nb8 fv00Q E MONNDE LN 068 LL~WD~3V~LLE Tx 19067 LEWIOV LL6 Tx 73067 No response to 06110etibn efforts, 201 421737 WADE WADE 11 HICKORY 027 MARY 7/03/OR 1/91/03 5179 ,,1{9911` CHAROLETIE APT11Oti DCffTDll TX 76:01 SPA Toll TX 76904 No response to colleCtl0h 9fforts. J 1 l . r J 1 if o:.a-a, i .,.:.:•q; Ylr\>. . irw`N''4k 1.~i s[i, r lyf~'~; 1 w,:~1V::.iaNrt.,~.,kN.Rti,~,+Sw~xwrwrrANW%kYgf/ j 1 7 i. I 1. L DATE 1/27/03 14;49: P L 0 W 11 r M D R I. A L H d 9 P 1 T A L' PAGE 16.,.. IJ " RAD DLUT TRANSFER REPORT PdR P$RtOD 1/01/63 THRU 1131/03 PATIENT IIUMBER 44aws PATIENT HA"X 44FN X*04N OUARANTON NAME **r+ DATE DATE: DATE OP OpDALANCE J D DISCHARGED WN[ 9OpF ACCOUNT f'pN flUI1D&R ADtlR.CITYS«, ZIP AnDR AODq, C CITTYo. OT ZIP ADIIITTE.,~, r r.au.r... J Jrrr .rr..rr..r rrn. uJUY8Tj _r J.._...J J 207 88126 j'DIY13CNO CHARLPS bOJN"ENO CHANLI:6,. 97/26/92 1/27/63 87.26 1. aa125 FT WORTH DR 013 T% 76901 DQNTON WORTH OR 010 T% 76801 o'response to colleotl0n efforts, J AIJTN l01 411720 7RAkTHA11 CLAY T ANIHAM WILLIAM 6/03/62 6/04/92 1/27/03 247.60 yy gg ppq 8 1 29 Af1U$LL DLYU 84 AMUSLL BLVD " `r Mi AR TX 79229 DALLAS TX '709M) Arr6ngoments not kept, E qTrptRhPP NN BARBARA TTRAPPHH l BETTY 7110/02 1/87/83 „ 72.00 20l 423699 - 1r L9104 OVILLE TX 76067` LEWSGVILLE'' TX 70067 No respo se ';1 to collection et forts. ' pq ' 201 409779 1Pr OdU0LA9 T MP PATRICIA t/0/02 1727/03 38.00 T, t0 ,,,T J t 0 NTO ORQHAM TX 76201 NT01jpNpHAM TX 76801 lOCate. „ j e02 415iS2 UT 411 40 CLAUDIA TVTTLI+ CLAUDIA 6/19/02 1/'97/03 131.00 p,0 -90X. 40- , . 11. A 76249 KRul ALD$RT 76845„ 110 re one to Collection o forts 3 SH 00 , 111 D 4 . 201 411161 U;Jpp$qWOOD ALDER! OOp ~ 5JO EAGLE 0837 11 9 4io 0 EA EA0L6 DO 0817 ry J ~ V D914TtltlIN TX 76801 BENT^N Tk 76201 No response to Collection efforts. UR1~gt 6666ppYy Cg 1/87103 7a 00 D 0 204 38609 GCNTdk 08$0.AWN J1iSg%E 76801 gY0D$NTdR09$LAWN CITXY `76801 "NO 6/03/08 respons e to"Collection efforts, 201 485040 NN oYK I1ICHAPL VAN OYK MICHAEL nsh to coilocllon efforts, A 7/01/02 1/27/03 46 to hOJTFVLTON.07 TX 76.01 tl NTOI~LTON #7 TX 7 v~ M~ 6 No respd 701 481396 801 07/02/0:4 1/27/03 7$ 10 , Aft ggK . WN$TIr: VAN K U GWI ~ ANNEtT$ t 8UR wW4N p Y 181 0:1307 p l6 U 121 08307 L 4 aviLLB TX 79067 LLOWI V ELE Tx 79067 No responsc '.,,'col1@cHon efforts, ' CHARLOTTE 7/07/02 1/87/83 39.60 . 'J 201 423004 VNgAgIJg CHRISTOPH~ Vx 2Ld WALT$Re L¢I118VUAILLTER6 S TX 76967 L WifSVILL$ TX 75067. No response to colloatfon efforts, 1 202 301268 ypyp ~#1H Rp HYOTtC Vg NER , DEBORAH 7/19/02 1/27/93 122.00 b OGIITONRDINAL 094 TX 76201 I) ro4RO[NAL 94 TX 76201 No response to collection efforts, J J 80t 482071 ~'o J~11MOEO9 LII 060 TX 79697 t1 02CiV14LED0 LN 110 JAM80 7/06/08 1/27/03 49,00 $ 11 E TX 7067 No response to Collection efforts, 201 4217311 WADE H RY on MARY 7/03/87 1/27/83 at, 76 1311 CHAROLEtir, APT 03 lT i1 HICKORY 027 D 71 Oil Tx 7G.01 D .fl ON TX 76204 No response to collection efforts, , 1 i Y f i@, ut Y.vF ~it`f4R~i! 1C llA3Ga1`a9"`'.1+., ,4.'•_, . +avS,2 -~1 , ty„vdl'h.,M.cdi.a:dR1~AlHxidk,4 A u I yyy I .......~.+r - -.mot. _ '..-----`~-^~1--~--•- I 1 , DATE 1/27/43 14:4; FLOW If EMgR l AL HOSP 1 T AL PAGE 19- DAD DEBT TRANSFER REPORT FOR PERIOD .1/01/83 THRU 1/31/63 ; - PATIENr s1UMB£H n~x►• p/,TIENT It4N,E -w o* an++w PFX BUAAAIITDR NAME «x+4 DATE DA7E ppATTC nF BALANCE J IJUMBtR ADDR, CITY, $T, ZIP ADR, C1TY,9T, ZIP ADMITTED DIDCHAROED WR[TEall OF ACCOUNT 201 419531 %yVERO BARBARA S HERS BARBARA 6/28/09 3/27/93. 22.00 1419 BHOAOWAY I O BtlL[VP,R i DGMTON TX 76201 DENT'S TX 16201 No response t0 cOlieCttOn efforts. J 103 343723 JALK2OOTO14 CHARLAq JH TALKINOTi.N r CHARLES W 710916o- ~ 7/09/e2 1/27/93 119 ORMAN fy 111 vy NI1Ri I %N 1,246. 20 DNIJTDN TX 76201 D6NTON TX 76201 No response to collection efforts, J 201 419770 pTppt4i'.Skt,E1' AHANDA A K6lEY , MILLARD 6/28/82 1/27/93 $6 00 BOOS r NCATH DR 071 a leg LCE C/O D CLARK QQENTON TX 76201 MALAKOFI TX 75149 No response to'COllection efforts, J 101 414441 TAYLOR AL ISA T66TAYLOR . ALISA 6/12/82 6/15/82 t/i27/83 231.65 ` 0L7lenAMBERB T% 76201 UE) C AMBERS Tx 76201' Arrangements not kept, 101 427062 zExAxR r CHARLE'9 TEAR , RUTS 7/19/82 7/31/92 1/21/83 Ste6 60 'I., KqV' 349 ...4315 IJ CLIFF 5 TX 76249 ORANn PRAIRIE TX 79032 Arrangements Ito! kept, J 201 414997 I{IOMA9 DILLY THOMAS JOE 6/13/82 1/27/83 111 '710 LINDEN 1715 LINDEN 38.00 }$6' DIINTON TX 76201 DENTON TX 762DJ Novedl left no address. ' J 202 23!936 R 9 I WILLIAM 6/04/82 1/27/93 2 I? 11000NALD OR,' KAREN TIN MORSE 64.00 DENTON Tr 762J1 DENTOIJ IS No response to collection efforts, J 201 419338 TX 76201 gl{N PPpEIL #123 ' MAE TlIOJIA8 , MAE 6/27/82 1/27/83 43.90 DD14TTO4 TX 71201 DENTONELL N199 TX -.`76$01 No response to Collection'afforts. J 1 407213 TROMP99ON , BANDY THOHPSON , TOM 6/11/82 /27/83 4690 00 RT 1 AOX 103 RRT 1 Box 103 1 1~ cNica a TX' 76030 CH1ca TX 76030 No response to Collection efforts, J 202 427967 1110914714 DR RODERI THORN1ON , ROBERT 7/24/82 1/87/83 129 25 DQ By 010 VICKI DRIVE nK '7311B. DILL CITY OK' 73113 No response to tollection efforts. J 201 42161.0 1801f24 8 tlGl( CLIFF ,RLV ROBERT OnIJ ROBERT 7/03/89 1/27/83 92.50 WN B OAK CLtKF BLVD DALLAS TX 73208 ALLAS TX 75208 No response to tollection efforts, J 201 0.30772 ;01111 B A 362 JACK80;J TO R&9 ELIAZAL 7/28/02 £/27/83 103.95 4 bp AV fpt @Ux 362 fd18RE TX 7b^27 DRtY TX 76226 No response t0 collection efforts. 7 J 201 416490 Onmes RODBRt TORRES ROBERT 6/20/9' 818 N@VADA 1 IS NEVADA 1/27/03 38.00 ~t~IJraw TX 76Pos D~Nrar'+ TX 7e201 No response to collection efforts, J s J JI DAIS 1121103 14:413: P L O W I( f' M p A I A L H 0 8 P 1 Y A L } PAGE 14 J DAD DEBT TRANSFER REPORT FOR PERIOD 1/01/93 TNRV 1/31/83 ~I PATIENT HUMBER ■11i►♦ PATIENT I!A!4E t411M p - J PPX NUMBER w ADDR, CITY, at, lip +naa♦ OUARAUt A NAME •wiM DATJ DATE DAt OF DALANCE ` - , ..ww.. - annR, CI7V,6T, 21P ADMITED. DISCHARGED WAY EOPP OF ACCOUNT \M 4--Yi4 wti N,.M 4 y wYwYyi Y- ti-w---Y-w-Y 201 413062 SA 5104 O tJCcHEK PARK r 11ICHAQI N LLB w._ J DR tt:.65 Rµ UBAN 6/07/&2 1/47/83 LftNIIII118Vgg1LLE Tk 79067 L WISVILLRARK DR N65 T8' 2715067 NO response to collection efforts. 86. 20 209 37b48 ~NOHB9tEH Dn1"rn1683 5 ITH 022 V ~1 b NESTER 6/O1/SP 1/R7JB3 18 00 fJT J TX 76201 l;NYU1•I TX 76201 r 102 314096 8 140hng ` Y No respOnso to collection efforts, J k} AT O , 11iCHA. L. 9ANI)EN9 MICHIAL W 6/07/B2 8 W0 773 TX 76266 SOUPRU X 773 TX 76266 No 6/12ect 1/27/83 75,00 101 422410 CpIIIJEt 1p~ER CAROL response t0 collection efforts, ,J P A IN68VtLLE TX 76240 OAINrBVILLE THOMAS 7/14/82 7/14/92 1/27/83 90.25 SOl 420687 0 I E g TX 76240 Arrangements not kept, J ; ..y CORRAL CITY ' DOIJIJA CQRgAL CITY DONALD 7/30/92 8/03/82 1/27/83 235.62 J SJtN TX 76247 JUSTIN TX 76247 MOVedl left no Address, 201 423061 T JOHN nn 03810 1062 gAtlJLfTbb2 JOHN / ` 1 ; L4KOnALLAB 101 7/09/92 1/27193 329.00 TX 79069 AKE 9AL4AS ik 7bO65 No response to collection efforts. 201 416479 JILVANWDtlD HARINA B LVp JOE 6/18/9R J L1 9 N WOOD t/97/83 TX 76201 IINTOW 39.00 Tk ` 76201 No response to collection efforts, 201 425999 SMITH qL 1VEa ttt 8M TII OLIVER t71 7/17/92 1 g SOUTH RUDDEIL ART 23 044TON TX 76201 AI~NTOOUTH QUDtlELL 023' 1/47183 38.00 202 298434 SN tHgr+8 J09L TT TX 76201 No response to Collections efforts, S411O1JAYN4 BTREFr a19LVEH16 IJAYNti BYRhET , CURLEM 7/03192 !/47/83 116 7$ HH TX 76201 DENTOM TX 76201 201 449787 8 T / No response to collection efforts. pA I1ICNAKL pTAK RR f41CHA6L 7/17/82 J n',t7 ~}VILLp gg07 HARBOR 1/47/83 38.00 f~ LLWIdLLE ~ TX 79067 L6HHWISVILLS 'TX 7!!067 201 366831 P ArJN JAM O8 t( No response tO Collection efforts, J j rr~tY~IIJI,'Q MHP AT 4 LO7 41 PLiiP4 N41 AT 4 JAMES 7/29/82 1127/$13 rX 76201 INTON 1017,00 201 423934 898D PITACH 60 EACH RONk 76x01 NO response t0 CO11e0tI0n efforts, J gg CEfJA BUUttH 7/10/82 SAN06R p 1/27/93 39.00 TX 76266 SANUR Tk 76266 NO response 201 4297139 ttpi~71~ YENNg CHARLOTt TYOIgJ CHARLES 7/29/g2 to edlleCtfon efforts, } `'IL77lNX 2A AK 72173 V}LR!J1AX 2A 1127/03 42 00 AK 72173 No response to collection efforts, r , .If 3 ! i fi ;a L DATE 1/?7/03 14: 48: F L 0 W !i E M 0 R I A L H 0 S P I T A L" PnaE i<^ t J „ - DAD DEPT TRANSFER REPOADDRORCPERI....1ZIP / 1/03 ADMITTED 31/3l /83 PATfENf UUH avava PATICNt f!At1E ♦ baaaa GUARA14TOR NAME ♦aaa PFX NVMOMOE ADnROR, CITY, OT, 21P MITE DATgg DATE pp rrrrrl -.ur 87 '"rrrr "r"°-r"rw°°r°yr - yyr-~ tiTTED DISCHAg0E0 kRtTEOFF' OF A DALANCE -I yruYr r' 4...yrJry CCOUNT 201 430912 RENEAU MISTY RENEAU / 4R3 CAL1E REAL SANDRA 2/29/82 1/27/03 38.00 MSOUITE 923 'CALLS REAL.. - , TX 78149 MESQUITE .4..•. TN 79149 No response to collection efforts, -,I J 202 293039 RHYNt DORIS RHYI:11 V19 V PO DOX 963 MEAGOWVIEW PO 80X 963 MEADOW VILNRIS 7109103 1/77/"3 08 90 - - A10YLC T% 76226 AROYLF TX " 76226 No response to collection efforts," Y~l .J 101 370171 R151 E UILMA R Frh P WILMA 6/23/82 6_/6"6/82 1177183 ?1/16 30 9t1 WOOD 0 9'1 INWRTOHT DENTON TX 76201 _DENTOIJ Tx 76203 No response to collection efforts. 2209 00009 ROCS HOLLY RI000 . JOHN 6/18/82 .1 J r 1 80X 179 E T,1 ROX 179 E' 1/27/83 38 00 rr"ISCO TX 79034 Rta a rx 70024 No rOSpOPSO to cOllection efforts, 202 367102 RO N80!J J po CARL RO ER50N . CARL 7/29/O7' 1177183 43,20 48Cg CHARLOTTE *23 gq Y7°CHARLOTTC #23 nCNTON T% 76203 bE DN TX" 76 01 g8v~~3pbR RB Wwiton efforts, 202 396234 ringggHYS RICHARD ft00ERT a / 912D ONINSULA -P 9MX 403 RICHARD W 6/07/O6" 1/?7183 Q49 00 I pp i LIT LE ELM TX 73068 LtTTLK ELM TX 79060 NO response t0 Coll_ot10n efforts, f 201 414813 ROBBMIHEB OOYCE UTMINg0 . 80YCE 6/13/02 V 1f0 ERNARD 1/27/03 78.20 pp 9E NTON 99kNARp TX 76e ry01 DENTtlN p g 7X ` 76302 No response to collection efforts, 203 77990 90i0EFRA!1C 111KER}SyOSE . MIKE _ 7/11/02 3/27/03 94, $0 [ V GEN7GN TX 76201 tl>`NTONAM~ TX 76201 No response t0 e0118ction efforts, J 261 412189 RUDCER KIMURLY UDDE rV P 0 DO:( 206 pg 0 8tl% 306 0' C' 6/04/82 1/37/03 31. 0'0 ! KRUM 7ti 76349 KRUM . 7X ` 76349 No response to collection efforts, 114, 203 20099 UpgI VIROINtA RUpi VIRGINIA 7103/02 423 SHERATON R0 "'IR" SHERATON RD l/37/O3 18 00 EN ON TX 76201 DENTO31 TX 76201 No response t0 Collection efforts. " J 201 417024 R71KOUSMI III PgANCIS Ru3KOWSKI FRANCIS 6/222/8? 4 40 LAKE AVENUE 03P 4710 LAKE AVENUE N320 3/27/83 69, 20 DALIAS TX 792.1 DALLAS TX 79221 No response to eollecLlon efforts, ,J 400 209 49641 Ei08Uq8g1k~,L LARRY OPELL LARRY 7/11/e3 , GGNTOWIf1E TX 76201 NTORN89 ST TN 76301 NO response to COllectf On efforts. 11 .1, M J V 201 436726 ULARN TRIANOLE 11HYKIE.ft1tH1 OULD N TRIANCI F MHb kI VEM 7/19/82 1/R7/03 38, 00 AROI'LE TX 76?e6 AROYLE TX 76826 NO response to collection efforts. J ~ J I J' i~ f~ ' ~ fir-.. - _ FLOW I1G MD R I AL /H09P 1 T AL PAGE 12 ~r DATE 1/27/03 14: At3; - DAD DEPT TRANSFER REPORT FOR PERIOD 1/01/93 THRU 1/31/83 rr _r r rr r } fl PAl'1LNT IJUMDflII x~+r4 PATIOfJi WAME+~+~ rrxr+ 00ARAN70R NAME •xx• DATE tlAT OppTE OF BALANCE AT NNUM' ADDR. ITY, 81. ZIH r«. «r«, r««AODR.,CITY,BT_r-I--««r«r ADMIYTBD DIRCHAOQED WRITEOFF OF ACCOUNT 201 414706 IATfJct JtlBEPH P ATtlp% 41 JOSEPH 6/13/92 1127183 38 00 J ~02Tno 4 M TX 79460 LITTLF ELM TX 79D68 No raspOnse to C01100 10n efforts. 201 431006 PIERSOON Pq BOX 793f3DERT EV5OgNyK DODOX 75313ROBERT _ 7/31/83 1/27/83 62.79 J LIAKE DALLAS TX 75069 LEKE DALLAS TX 78065 No response to collection efforts. 202 319790 P10 T1 JOHN P OTTt , JOHN 7/10/82 1/27/03 66.50 gA WTONOAN TX 7b201 IENT10 ON*AN TX 6201 No response to C01IOctIon efforts. 201 Aa0208 PC Lf1CCn< 68r TERRY IQLDi.17 K 687 CHERYL 6129182 1/27/03 69 00 J y LA~E DALLAS TX 79060 AKE ALLA9 TX 79065 NO response t0 c011e6t10n efforts, CATHRYN 7/11102 i/a7/03 40.75 t 202 40694 F T~l;R ANHANDL6 CATHRYI! P TT6H : .J f 24 4884801( d TQ 7X 16201 pOfiN1`04 7X 76x01 No response to tolloction efforts, 201 418944 N~RTHO//, fl qRT 141C HATT tJOR7NNppG PT on DANNY 6/06/82 1/27/83 262.70 J ; OA1+tF9V~LLE TX +6240 0AI!lO LL~ TX ` 76340 No response t0 collection efforts. i 1 J 5202 421982 Tg3C p1RM11 ARK PRO ARK 7!07182 1/27/$3 198. 90 A S pp IMM9 TX 76266 No response to collection efforts. V 8 110 R TX 76^x66 PA H t/a7/83 38.00 CLAUdIIlE p H STEVEN 7/27/62 p 201 429712 PUGH `p08 E MAIN 0 SA -MAIN OK 7470t U A111 OK 74701 No response to collection efforts, 4 1ur~AU~ 203 280493 UAR E JUANII'A aUARLPS , JUANITA 6/00/82 1/27/93 134. 8b y p g 1 N g14 CELL 023' J 111 ,h~l1DELL 023 T% 76201 IDI0TIJ TX 76201 No response to collection efforts, t%o Is 0 I CA 7/14/132 tlEt7/93 b4.2tS 205 86546 OUINN 11tCHAri_ g INti DQX 13Sfl TX 75034 NO response to 661laction efforts, 79034 119CC~1 ~V tTt15~C1 00X 131fl 7X $6 202 396609 A`,1~•'T~1011A8 026 JUAN R3At~t 'IMAO 026 ' JUAN 7/!3/82 1/27/83 tl0 J lytCNTO TX 76201 DENT N TX 76201 NO response to collection efforts. SO1 385344 RUTO MICHAEL RgNDY MICHAEL 9/27/82 6/07/82 1/27/03 3811.00 J c ' 4 b /{OLI Y HILL ti 406 IIOLLY Hit.' TX 76201 'NO response t0 tollottlon efforts. ; V OSNTON TXN 76..01 DEENTQN 46 00 7/10/00 201 423749 UlrnvkONAOtl DRiV1 01,410 30% CORONADO DR APT203~%N 76801 NO response to Collection efforts.3 J V 16201 DaNTCN f! r 'en C'JR «R.FSP/.rJr.l {y'ziPl>k..~ 1 t. 2,11, a /83 14:45, FL OW !tE M 0 R I AL H 0 0 P I T A L PAGE 11 ' DAD DEnT TRANSFER REPORT FOR PERIOD 1/01/93 THRU t/31/83 - I PATIENT iJUMDER nrrr♦ PATIENT I!AMEJaM• enaaw GUARANTOR NAME sM►r Dh1E DATE DATE OF DALANC5 P(rX NUMBER ADOR, CITY, 8T, 21P ADDR, CITY,BT, 21P ADMITIED DISCHAROED WRtTEOFF OF ACCID'I 203 263917 O2UN4 111CHAE) 02UNA , MICHAEL 6/25/82 1/27/83 161 45 1021 CARROLL 1021 CARROLL DENTON TX 76201 DENTON TX 76801 No response to collection efforts. 202 262741 PATTURStlN JEREMY PATTLHBON , GARY 6/02/82 l/27/83 93.0) 3 4 N, OffFFADSHAW 324 H BRADSHAW D•NTON TX 76n 201 DENTCN TX 76203 No response to collection efforts. J 202 212829 P`A`TION N JOHNNY PAAyTTON , JOHNNY 6/20/82 1/27/83 , 49 49 L0314 8 1RROLI1N0 RIOOE TX 79067 LHWIEVILL6 RIOCE TX 70067 No response to collection efforts, J 201 419804 PLACI,'J , PAUL PEAC,,C}y , PAUL 6/28/82 1/27/83 75.00 k1o DCNTbWP1TER TX 76201 DENTONpITER TX 76201 No response to collection efforts, 102 2892P PEACH , MARIA EACH , JAMES 6/19/82 6/224/82 1/27/83 1483.60 ' qT 2 GOX 330 a '.V F;128C0 TX 70034 FRI5C00X 33b TX 75034'.. Arrangements not kept, 901 429563 p&pgGARBgppgY , JEAN P77EARSOHHN , MARY 7/26/82 . 1/27/83 38.00 FT0SMIITHONINHIU AR 72404 PTSS11t7H6LER AR 79904 No response to collection efforts, J 201 420174 PEEL , JOHN! PEgL , JOHN 6/29/82 1/27/83 41,10 V pljrSNLOCUBT TX 76201 bENTdIJ LOCUST TX 76201 No response to collection efforts, J c 0 101 429058 spyy14A RUSSE!.1. PENA RAMONA 7/13/82 7/19/02 1/27/03 531.00 IJTONAHE TX 76201 DRNT0144AME 8T TX 765201 No response to collection efforts, J •201 412015 PgqENCaa TT}} r DONALD PENgCggga BETTY 6/04/83 1/27183 64.50 A3 £UI1.J gAYLCN p Tt H J iii V AqL LL TX 76240 0A1k HV L OR L CC TX 76240 No response to collection efforts, J 201 429097 D~NgOtJHNTON ESTAtE13 HPp 7E201 8 A"P~RBrDENTION EgT6A T X~Y76201 NO response to collettion'effOrt g~ 39.40 201 339119 p16ER1ppJA11E LUPE PfRENRAMH LUPE 7/03/02 1/27/83 '30.00 V DENitlIJ TX 76RO1 DENTON TX 76201 No response to collection efforts. J 101 74690 DERRY RICKY PRER~Y RICHARD 6/00/82 6/18/83 1/27/03 500.00 t 1 BOX 06 DOX S6 ARGYLE TX 76226 AROYLE TX 76226 No reapbn"' to Collection efforts. J 1 4172238 f' i 10OX 94 A DELON0 IFp2 TrY DEL, ORES 7/15/82 1/27183 151100 f V Lr W~SVILLE Tk 78067 LEWISVILLE4 A Tk 15067 No response to tollection efforts. J i L J t v Y DATE 1/"27/83 14:49;. F L O W H E M O R I A L H 0 U P I T A L - PAGE 10 - n! DAD DW TRANSFER HLPORT FOR PERIOD 1/Ot/03 THRU 1/31/83 T PATIENT NUMnF.H w444" PATIENT 4,14E 444w Anw4w OUARANTO11 NAME rwww DATE DATE DATTE OF " BALANCE _ PFX NWWR ADDR, ITV, tit, ZIP ADUR, C1TY,8T, ZIP ADMITTED DISCHARGED WR[TEOFF OF ACCOUNT 201 432249 RM C IJKOVICH Jg5Efl1 MILIt940V1CH CANDLE x/02/02 1/27/03 47,00 BOX 21 RT 44 nOX 21 D NTON TX 76901 DENTON T% 76901 Movedt left no address, .,.>1 lot 416290 H4Ll PgQX 89A ALFREu flJLIEPlOX BSA MICHAUL 6/17/02 4/20!62 l/$7/83 1 396.40 DENTON Tx 76201 DENTON TX 76201 No response to collection efforts,, iJ I03 324673 OHOW T I BOX 2069 P DAVID MMOIIK DAVID OR 6/21/bit 6/28/82 1127/03 3494.75 OT p AUDREY Tx 76227 AUnRDOCIx ' 80 TX 76227 Arrangements not kept, l~ ~ 101 38200 MORENO ANTONIO CR MDREtitl ANTONIO OR 3/03/82 3/19/82 1/27/83 4307.10 2 RApILROAD A4E 91 RAILROAD AYE NTat4 TX 76201 DENT014 TX 76201 Arrangements not kept,, 702 431734 Cgg Y.RNNF1H M UNC KENNETH 8/08/02 1/27/03 02.79 VU '90•1 43 1s11~60DT~H 76801 Ay 4 X 43 6HFRWOOD DENTON NMHPtt0 NTgN TX 76201 Iloved1 left no address, ~y 803 219907 ~11NTO 1ONTELLA 'OU #219 ' JAC 7% 745201 DCNTON TELLA #219 JA TX 1~ 76201 _ No response t0 collection efforts, D3 4x.90 )1! 4 ! 101 64491 6100 gRESCENT ~tILDEkIJ (Nb1E1OCt6SHE0CErtT WILDERN 6/26/Oa 6/99/62 1/27/83 972 90 DRNTON Tx , 711201 DENTpr4TW 76201 No response to collection efforts, lOi 369041 N WTO OR a - 390 , LINDA W11111 Ox 390 HAROLD R 7/07/02 7/11/02 1/27/03 603.09 R 3 3g DECATUR TX 76$34 DECATUR T% 76234 No response to Collection efforts, ; fol 419619 NJLpB , JACLYN NILES MARTY 6/06/82 610SIS2 1/97/83 730.79 4 6 qR6HA 49g6 11ARSHA f K LLR 7% 76848 KELLEk : TX 76240 NO response to Collection efforts, 101 410971 ~~A L NOA R In HAROLD 6/05/82 6/06/02 i/2Z/83 699.90 } 3 as 3>3A 8 HQ49S SHOE 0 ntlX 373A ii! 8T VAr.E 7X 79096 8T_VALB TX 79096 No response O collection efforts, 201 418099 'J°;11[TH JOHN N811 1~r JOHN 6/23/82 1/99/83 10,00 " TH NOPR TX 76266 ANOF4A TX 761166 No response to collection efforts, 201 413732 O tVO , JUAN 01~Iva JUAM 6110/OP 119'7/83 #M40 U A t) y/ 2 HETTIE 426 1/6t IIET7tC D NTOM Tx 76201 D WON TX 76201 No response to collection efforts. t 102 199704 ~fjVgqU1pp4gµ 0OURI'VWf 058gUk 1K( OARLANU 6/18/ 0? 6/22/02 1/27/03 228.26 J ~AIttE6VI4LE TX 764149 ,OA1N09VILLE TX 76240 No response t0 Collection efforts. _ J . ul . t y ~:?M? rF*. ur...:n . r,-. , ...A. a,.;. eSY,.• :;e:: , r . n M . n,,,, hum ..can vae Si'f > DATE 1/27/83 14: 44: F L O W It E M O R T A L H D 8 TO I T A L PAGE 9 ~{`•DAD VENT TRANSFER REPORT POR.PERIOD 1/01/83 THRU 1/31/83 J ±i PAtIENt NUMBER PATIENT NAME t444 **M4* OUA 4N!-OR NAME *MM4 BATE OATS DATE OF BALANCE PF% IJUMBER ADDR,.CIT1'r ST, ZIP AVDR, CITY, ST, ZIP ADMITTED DISCHARGED WRITEOFF OF ACCOUNT J •J 101 396416 HUERTA IRMA HUERTA MIOUEL 4/16182 4/27/82 t/27/03 89.31 404 E.MILL 404 E. MILL DECATUR TX' 76234 DECATUR TX 76234 Arrangemonts not kept, 102 69171 JOHNSON EVAN JOHIJSON EVANS 7/26/81 7/27/01 1/27/63 824.79 J 1218 KNIGHT STRL:-T 1219 µµNIDH! STREET DENTON TX. 76201 OENTCII TX 76201 Arrangements not kept.. 202 218479 JOHIJSON UlK1A M ^11060H VER141CE O/06/S2 1/27/03 20.00 J 1` 20 E. HICKORY' iU E HICKOnY DENTON T% 76201 DE V4 TX 76201 no response to C0118Ctlon efforts.. ~ . 201 4303138 J HNSON PATRICIA .,JOHNSON FRANK 81113187 1/27/93 36.00 :E a2 LOUISE APT 46 AT 1 BOX 320 SP 33A .4 DO NTON TX 74-201 MINERAL WELL T% 76067 No response to Collection efforts, 104 164001 ONa. RETHA J(7NES , GEORGE 0/16/02 8121/82 1/27183 2632,20 J bgg RT t BOX 48-8 ~ AUBAF0.5 241 TX 76227 AUBREY TX. 76227 No response to collection efforts. J J 101 4110;!0 EACH DAVID LEACH , SUE 6/02/02 6/07/82 1/27183 4936,05 6314 TON e 8 MILTON L1J1SVtLLE TX 75061 LEWfSVILLE TX 75067 L No response to collection efforts, . c, 201 433417 LGYVA ESPERANCA LLEYVA , ESPLRANOA 8/06/82 1/27/83 49.00 J i 020 RUDDELL 1107 k 4 0 01 EX 11HP p L DENtON T% 761201 DENTOrJ TX 76201 No response to Collection efforts. 1 301713 MALSNE HARION MALONJ- GERALD 9/30/81 1127/83 243.60 J 1 1 1 1 1 18 110R6E i l i a I110R8E v ` DENTON TX 76201 DENTOIJ TX - 76201 No resons8 to collection efforts. q I t l0! 14480 RMAR~IIpJUZf 74 DAIJNY RTR1lbJ0; 74 DANNY 3/06/79 3/10/79 1/27/63 225.00 An7T01'LE TX 76226 AROYLF TX 76226 No. response to collection efforts,,. 102 186874 MATH~-SCN N1'rA MATHtSON RUSSELL 3/21187 3/24/82 1/27/03 1701,20 RT 2 DUX 69 LOT 3 T 2 gO 69 4 'A GYLR TX 76226 AROYLPO TX 76226 Unable to locate. - 1 201 433610 11CpDa XENNE w MCpE~ KENNETH 8106102 1/27/n3 161.48 610 SK114NEA' 6 $ SKINNER DENTON TX 16201 DiNTON T% 76201 No response to collection efforts, -1Ij 101 383036 MCMAHAN OEBORAH MCMAHAM EPFREY p 7/06/87 7/09/82 1/27/83 13.36 J ' l 018 MUCK y ~AIrtE MLLE TX 76240 KF. KI W WA T TX 76240 No response to Collection efforts,,, 4 ^ LA2 CKA TRAIL NORpWX 7/24/61 7/2llec 1/27/63, 101 316069 N RAa QWAYNr MORERg 1^ GL~IJERAL DELIVERY GENERAL DELIVERY 879.55 V RHOME TX 76078 RHONE. TX 76076 - ..Arrangements not kept.. 1- t l' I ALL 1 r r: DATE 1/27/03 14: 41: F L O W 41 E M 0 R I A L H 0 8 e I T A L W PAGE 8 BAD DEBI TRANSFER REPORT POR PERIOD 1/01/03 THHU. 1/31/03 J i~ PATIENT IJUMS~FR **404 DR, EITY at, , o PF% WHO PFX WHO ~ a ~1K ptU~ARANTOR NAME +~*4! DATE DATE ISAJE OF BALANCE ` 2lP _ ADD-, CITY,tlT, ZIP ADMITTED' DlOtHARORD WR TEOFF OF ACCOUNT J 20l 429753 aaqE1•N SUSIE GREEN Y R7..1 SOX 43 , SUSIE 7/27/82 1/27/03 125.75 J tr AUQR6Y TX 76227 DUDREYBtlX 43 TX 76227 No response to Collectfon efforts, J 102 56101 01t3~1 1120FAfRlIHKANSAB DR. JCAN14A pAtFF16V , S8L0 AitANEAB DR, ' MATT 6/20122 1651.39 6/29/82 1/27/83 "J iw OAIJJr_SVILLE TX 76240 INFA ILL , TX 76240 Arrangements not kept, f 101 403849 n OVE , JENN1FBn OROVE LINDAL JA 5/10/8.'. 5l1 i182 1/25/83 277,09 604 Nt TUNE 5y04 fl~PTUNE DCNTtlIJ P T% 76.201. DENTON TX 76201 Arrangements not kept, IOl 308993 HA F DAP F HAgLEg LINDELL 6/2q/82 6/30/82 1177/83 108100 DRTONLAR WAY TX 76201 DEN TO14LARWAY RT 1 TX 76201 No retponSe to ColleCtIon effortS. 101 378307 HANCOCKOX D LINDY HAANCOCKx MIKE 3/29/62 3/31182 1/27/83 7109.40 {r RR OATTtf44lPSBBVILLE T% 76240 OAINFSVILLEO 7X 76240 Arrangements not kept, lot 373761 H81RDCN ANITA qq1 t1CIKtNVIRY 8T 4pt HARDEfJ MCKINNE' ST CHARLES 2/04/82 2106/82 1127/83 464 J 1 , #A I' f,gVI LE . .30 y TX 7 U31 I RMLNSVILLE' TX ' 75031 Arrangements not kept, T 11 427942 O8BU UDDELL AAT 52 CYNTHIA r HApDV PAUL INE 0/01/82 1127/83 J DBNTDN 208 AUAOELL APT 52 83:29 V TX 76201 DENT0I4 TX 76201 HDVedl left no address. 201 410290 HARE WILLIE HARE 9011"Y 120N077ONE TX 76201 SYCAMORE 1003 E tlYCAMORL 5/30/82 1/27/83 67 79 J E V DEIJTOIJ TX 76228 No response to collection efforts, 101 409179 HfR'Ifl9 ADEAIlACp i GARY 5/13/82 9/14/02 1/27/83 AA 217, i19 : S` THACKERVILLE UK 7:3499 HACKERVILLE TX 70499 Arrangements not kept. " f 201 432229 RBtJNILOT 21 DEAN M LINKOVI H CAROLS 0/02/82 1/27!83 47:00 'U t 07GfJ OIJ 4 rX 76201 D NTOIJOT 1 tOl TX 7620I X00111 left,nD address, I 1 290067 g ~ OgpLLOW DENU DROtlN E-I1Arj VON K 5/29/81 6112/81 1197/03 260.00 2 / R LLOW BFIJD DR `J 4 T% ' 76021 SE~FOO TX' 76021 Arrangements net kept, 102 339988 H RBCH HOLLY H1 DrNT SCOTT 7105/82 7/10/82 1/27/83 120H.69 J H Ati in BOX 7l pOX rr1 200 2Nn ST T% 76066 SOUR TX 76266 Arrangements not kept," 102 300566 VIR6CHI , RHONDA PINStH~ SCOTT 9/21/di 9//27/01 1/27/83 250,00 02 LIJI4 V SANOER TX 76266 BANOEN X 71 IX 76266 ArrangementS nDt kept, ~Y ~J o J S ,t r jy44 A1is.:gmLeS4>dfdtri.~ 'dn4ti1}YnY~i". .-.t a DATE 1/27/83 14:41: F L O IJ 11 E M 0 R I A L H 0 8 P 1.T A L PAOE 7 , J BAD OERT TRANSFER REPORT FOR PERIOD 1/01/83 THRU 1/31/03 UI PATIENT IJUMUF.R *414** PATIENT idAME 1+102 a;,%a% GUARANTOR NAME %xA♦ DATE pqTE DATE ppf DALANC -YN I B PFX DUMBER ADDR, CITY, BT, ZIP ADDR. CITY,ST, ZIP ADMITTED DISCHAROED WRITEOF'F OF ACCOUNT y_ . 101 241422 FORD VIVIAN FORA VIVIAN 7129102 7/30/82 1127/93 122 00 ~ 2207 E ALMA 2207 E ALMA 61IERMAN TX 75090 SHERMAN TX 75090 No response to Collection efforts. 101 419697 FRANK SYLVON FRANK SYLVON 6/28/82 6/30/B2 1/27/83 25.00 R18 &WOOD 8T 3113 U WOOD 9T G N7 N 7x 76201 DE TON T% 76201 No response to collection efforts. gAIJK 204 147678 F ALTARHf,U FRANKS, ALTARHEU 5/..8/82 1/27/93 92.00 J RT t NOX 18 P RT i BOX iV P V AUBREY TX 76227 AUDREY TX.. 76227 No response to collection efforts, 10I 397962 FUEtJTE5 PAULA FUEN1t8 , 11ARK 12109/81 12/1x/81 IY27/83 1279.00 ~ 1824 14. ELM 1124. ELM DENTON TX 76201 DNTON TX 76201 Arrangements not kept,. 101 420364 OppIW1:8 , DENNICE 0AIII49 , DENNICE 6/30/92 7/02/82 1/27/83 1167.00 Id13 DRIARWOOD 1213 BRTARWOOD LEWISVILLE TX 79067 LEWISVILLE TX, 75067 Arrangemants not kept, _ WILLIAM 6120/82 7/OtIS9 1/27/83 9201.45 1+J 7 102 400010 2A MMxWORTH OR ' CAROL 0ANDNER FLA AVt DJS FT NTON TX 76201 TAMPA FL 33612 Arrangements not kept. 102 194138 MZA• i R08ALINW, OARZA , ROSALINDA 11/18/81 1l/r8/81 1/27183 110.00 7 4 APOLLV 714 APOLLO DINT ON TX 76201 DENTON TX 76201 Arrangements not,kept, 101: 110840 0296014 PAMELA 0100t~'J GARY 6/06/81 6110/81 1/27/83 140.00 J i LOOP 288 APT IA 3O6CAR11iNAL NF3 , SENTON TX 76201 DENTON TX 76201 Arrangements not kept. i' 101 406397 IIHIC14 VICKI OItl9OtJ FRANK L 8/18/69 5/19/92 1/27/83 92.70 ~ O1 30 R7T 4 BOX 30 ENtO TX 76201 DENTON TX 76201 No response to colleotion-efforts, 1/27/83 40 24 FAI 201 339366 ~~JRpA19LEV BERTH D~NTONIELEY JUAN 1r DrNTON TX 76205 TX 76205 Arra ngement s not, kept , I. 1 390263 GRAHAM , KEN ORAHhM , KEN 6/02/92 1/27/83 ~v 3366.30 I 113 16TH 9T 113 16TH OT TEXAS CITY TX 7/890 TEXAS CITY TX 77890 Arrangements not kept, 202' 391946 G E9N EDWARD pRHCIJ ROBE 5/10/U2 1/27/83 - 76.00 100 11CnONALp 1205 11CDONALD D INT ON TX 76201. DENTON tX 76201 No respunse to Collection efforts, 101 231613 OREFN 11ARY ORRYN OAST014 D 3/02102 3/0x/82 1/27183 926.15 J 9DENTONAVAJO TX 76201 DENTONAVAJO TX 76201 No response to colloCtlon efforts. 1v J a +'?'l w.ayp4- t;~ k ~_y '>V `V 1 p\ IAA A { ~1. A }.~~1~i~ \~1~~~~`. t~~~i~~1~~.~A+ j•~~~~:j4~1~ 4 tA ~ 'tl1R.,. r Cruet C •r.1M11\!. , 1 1 N: .1Che^^w+ 1yy~, 4~,1l1~ 11.A) 11F 11 t~1,.~1,1 1 4 •,~,i,fl~h 4,, ,;5 }p1I V nr , t l',.] 1 • , rih~t~~ 1 ~ 11 1 ~5FK11,1~ ~ ~ ~ Ah4A ~ Vrr~ n14~ lil tnl~lit,~~{I ills` ~4 aUtiJA111 t!i ;,1 ~Y111i1141! It I l4 h lY 1\ oa,'111,Ir,lrl r,liitl ilia 1. 1„•118b ,~i11;fjllirll 4 .,dull 1 Y141h1 1 li „ v' l ybldttf f ~ ? It pH' ~ii{{ I'111f11 I ~1 f t, ~ N ~r~p yl, fl~ ~Ra 1:1 -V J I ttr' i! trll}4 IAt,ll IF 4Gbkl+ if{~ i~~luil3li hi iii{I;i1•}E~,ij ell •I~ COS dp;lrl >Ilt,~~ IlAlll ~j It 11 ~IIN h l'I~ Ir "thl ~I}~ulii~jM1'iltl'~I{111 IIH ~PIl11i I1 ll-~ l :r j{.~ ?rn iii o r IU ~f,Nlll I~q ik l,,ii~l9 Ili Iul~,~l~I,II a+lh~l~, 101 11 D1 J9 II IIIPII~tgll I N 11lF~ly}~l~l I{. ii Iii j 22F i I~I ooll I i~, I~ ~NUr~~V ~~~~IS•~~~11ry~hllMll, IpI~,~P ~ ilk i I ll,l I u~p+Iltq,t l+. LiII iHI~I IIJI l~l l~~li, Y t01 044 IG It N ~ Id INlii 1/ J Nlrr an,t IIW fN~l hl LUIi I i l1:1 Its: IfI iid ,Ih <V ~~n tir IK vr,p+Il AIC IP olml~ li~i Iibll'~lll,rl 1„+;iilllillull pII,!il. 201 41410 of ~NI~I.I, IN.U ( i hfd~J}Ill l n , l <I ~,,,~l~~I/~11Ih l III Ali I 1 ! II.6 i ,i jf r ~ilf .,r ~ ; V I1. rr,n141P~fli.) I# /a~irl IbI IP (ndlrNt; lu E~Ill+flUdl I~lIJI~ f 701 42%94l1 p{~ I/~r)i rlr II Y ri r'r rlii rlclrt' r'n I IIIrl11lllik „ rl I <i, I. ,pl iid ' H~irrfih~f T ! / r>aNhlt lP l~ 1 J !!l~l Ill r ! ,Its 1 ~ 11rHh1~ Ihl , ~ ~iifJlsi7 Iir (Irl Ik'k! liiff kl~r,f i+~. io1 ~;ya~~H r~+~nrM trl+irar ,1. rl,r I ~ti ~.1i ~ J~ ~,a ~ g ~ r~aer/ ~ UUA/ _ ++rdN~l1 llrl~Nl fA ~hMr+) ff~lfl li /brrlN I/rr r1:,,1J~aq (~~f ~l~ v rir tI. f. a N xor ua~r~ri r1 rr,ar? i f 1 +~rrnrr, ~ f ~~3r>ii~rr~ I r,r ► r1 nh r.r r it W Ji /4101( 4 0r M It fl lhnlft lrl~6ji, rrid r 1 i Jl. In( +Erty~f rrjv%r !tkrl, rr l q It 11/)Ir It ln,r/lt -0N+r_b~ ~1,1+)+f7j lrrid ~ li~if~r p,i «,,or~t ~r Ir,4r fl //trfrl Fflkt,.~rYa,r~llra• ld,l ~n'Irr t~ ~i~Ce~l •<,a~,a;.i:; fl'.~rh4y,~.p r„ i . ~ , er If .6 DATE 1/77/83 14:44: FLDW It9 M 0 A t AL H 08P I T A L PAOL 6 ,f { DAD DI t TRANSFER REPORT FOR PERIOD 1/01/83 THRU 1/31/83 PAilEN1 NUMDEN r+aea PATIIENT MAHE 444 k isn*** GUARANTOR NAME *+.R~ DATE DATE OATgg ppF BALANCcE J PFX NUMBER ADDR, CITY, ST, ZIP ADM CITY,ST, ZtP ADMITTED DIBCHAROEO WRIT60 F OF ACCpUNT - - - r J 203 288061 p RTV2SBOd 132 IStBTY RTV2 OX 131 CHARLES 6/30/82 1/27/83 (80.70 ARGYLE. TX 76226 ARM TX 76276 No response to collection efforts.. 201 431449 RU AQMIA227 11ARION LLANOX 227 11ANION 7/31/82 1/27/83 46.00 AAUTUREeeY XY TX 76227 AUSREY TX 76227 No response to collection efforts. 201 325229 DUNH''Mt, IIATTHl-W UUNHAII PRESTON 7/27/92 1/77/83 43.50 4ANv£RI1 tX 76201 CIANOER 204 TX 76266 No response to Collection efforts, V s J 1 325324 DVh LEVADA, DUWE LEVADA 6129182 1/27/83 34.90 301 CORONADO 2013 2616 DENNIS014 ST DENTON Tx 76201 DENTON TX 76201 No response to Collection efforts. .J 4 301481 EDWA.RDS 1 CHARLFB ET WARDS , CHARLE'3 3/02/02 1/27/03 9307 55 923 N EI M RR 3 BOX 494 DENTON TX 76201 ROANOKE TX 76262 ' No response t0 collectionefforts, 201 420371 E IIF.N NARY RJERRY 7/14/02 1/27/83 66.00 RT R BOY 8 TMN CAPRICORN 06 I DENTON TK 76201 gDENTON TX 76201 No response to collection efforts. 1 J 101 419198 ENLO RICHARD 5NLOE RICHARD 6/14/82 6/29/82 1/27/83 549.63 20 IIADDELL P, WApDDELL . L gMC 1IINwY TX 79069 M HINfIEY TX 75069 No response to Collection efforts-, Q ~ 201 424416 R7V NBOX 953 OLEN14 HV2IIlBOX.453 OLBNN 7/11/02 , 1/27/83 86.89 DL~N ON TX` 76201 Dt`,NTONN[[CC TX 76201 No response to collection efforts, -E 8VANO 6112/82 t /2Y = 701 414516 9117CN NULL BLVD T Tk 76201 dENTOC#2ULL BLVD T TX 76201 NO response to collection efforts~3 3070 J , 201 487948 ppANg C1fARLtl1'TL EVAMB CHARLOTTE 7/22/82 1/27/83 59,00 p~ nntlg 17 102 WILLN PpQ SO$ 17 tO2 WILLOW ~l SANQr- - TX 71,266 8ANOF TX - 76266 No response t0 collection efforts, 201 428766 L'V3gqNLL3AA ENOCH VANS HAREN 7/07/87 1/27/03 14.00 DENT TX 76201 gENTl1f1NEY w TX 76201 NO response to Collection efforts. 1 ~ 20l 2Dti007 P2IIgqNiyyIScUUIBE LAPT 6 SARIS gP1g3WLENUISB Aft 6 SADIB 6/I9/82 1 /77/83 96.10 60 2n NiON tx 72201- UHNTON TX 76201 Arrangements not kept. 101 402271 FOREO0X CR BETTY '38Raox CR LARRY 8/07/92 8/09/87 1/27/93 1054.45 J L Ono NfpN TX 76201 DENtON TX -76201 Arrangements not kept.. U mti;w. 1~}•/3~a'~Y.a wureirr, as,-~ a:o~ii?.u'„'.„kY`~1i1"b'r' r1k,~~/+~'Fa of k.4~ a~ . li I . I r I I Y,, } DATE 1/27/03 14:44: P L D W IS E M 0 R I A L H 0 8 P I T A L PAGE b DAD DCn1 TRA149FER R1•PORT FOR PERIOD 1/01/03 THRU 1/31/93 PATIENT NUMOVR *4*4'1 PAIL NT VII 1**4 +**4* GUARANTOR NAME Yr DATLy DATTR DATEy OP --BALANCE`. J pF% NUMBER AnDRI ITYI 8T. ZIP r ADDR` CITY,BT,-ZIP ADMITTED D18CHAROCO WRIT£DFF OF ACCOVNT 4 EUGENE 7/31/02 1127/83 26,00 202 342764 jjLOWITTON YLER ELIDFIJF ltthl"Vi.ER 2 TUN 76201 DENT014 T% 76201 No response to collection efforts. J r 201 424424 COIJNpR DILLIL 24STkHINY,LE DR ARTHUR 7J 11 /82 1/27/H3 40.00 ` 2401 HIIJNLt DR T% 76201 UCN 014 Tx 76201 No response to collection efforts. J f DCNTON I 4 206 17749 CO0kPER JANICF COPgqLH JANSCC 7/07/92 1/27/83 h0. 00 60TON OAR ppTx 76201 DIN70JpA87 GAY. Tx 76RO1 No response to collection efforts. J V 121, 41 I` 4 102 30A.87 RNpA tlL, MARBHAIL TH3% gA5'p'4~E BOX 561 LARRY / 76268 7x 76262 NOoeSpO 5e to collection efffrts~ J 201 411140 QqOk p µ JEFFREY DI, OFIT ' DELLA 6/01/92 t/27/93 89, 25 Lg18}IBVI~LE T% 79067 LEWIb'JILLG T% 75067 NO response t0 collection efforts, J i y lot 430959 CM . IIAYNE Ox I WAYNE Y/30/82 8/10/02 1/27/93 390:50 l 1J P O Dtl:J 490 D Do% 490 PRU,T T% 76249 RUhI TX 76249 NO response to COlleati0n Off*rtel ~ f 4o 6/09/92 1 /?7183 30.00 201 412239 CRIBP DILLY 7 LOT 35 CAPRICORN MHp NO response to collection efforts, , pp 13 Ol 426844 C'R7f0IIpgONp 1tRIJNEIH 76201 RII'C~t LENA 7/18/82 1/27/03 83, 50 2 zO cV AROVLQOk 89 T% 7622'6 No res onse to collection efforts. T% 760011 A OM % 09 p J 160 3g 9ANORA CR09S JIMMY 7!23!92 1127103 21'4.4!1 ! t 69247 IJ. 9RAD9HAU 600 DkkADBHAW f4 fJTnN TX DENTON Tx_ 74201 No response to collection efforts, 1 9 KEN 6/10/8? 1/27/83 38.00 11 201 414037 M) DACtlRN RANCH 07 3ARDARA CCUSHIvIIIN 6 N311 n T% 76201 OKLAHOMA CITY OK 73125 No response to collection efforts. J 201 42,0080 AON>LL NILLIAH bA9 M DALE 7/10/02 1127/83 40,95 MA80EY LOT 46 9 MAE49BY LOT 4b p NS ON 79 7620i I) NTON TX 76205 NO response, to Collection efforts/ J 202 310770 RAAgLLqTf0fffg18D OETTY DALI'ON JIMMY 4/26/82 1!27/83 3q 70 TX 76202 NO response to collection efforts, 06NTU T% 76201 bEN gggg4 1 1RO 120 E 4 ~,F WORT 201 42986e OVtlOOCtinrY 745 ADnY ~0i DAVID 7!16/82 1/27/83 7b.^5 SonIDpORT T% 76026 nRI, rP Tx 76026 60 response to collection efforts,- 4 J 1 hY 610 1 I 1 A DATE 1/27/93 14:44, F L O W Ii E M 0 R I A L H 0 8 P I T A L PAGE ,4~ DAD OEUT TRANSFER REPORT FOR PERIOD 1/01/83 THRU 1/31/83 PATIENT NUMUR v4**i PATIENT HA!iE 4"1k 44*4* OUAgANTOR NAME **'X* RATE PFX NUMB R ADDR,. CITY, 8T, 21P DAT OF - OA AODR, CITY,BT,_-IP AOM-T-- 018OEp WR1~EtlFF OF: ACCOUNT , _ . 4 f 0 . LgTHAM 6680 S LATHAM DAVID 6/04/82 1/27/83 6065 74.00 All 201 412130 ARLRORO MICHARt CARLD010 NO response t0 collection I l &COTBDAI Al - 89297 BCOTSDALE AZ' 89257 efforts, 202 419622 5ARRERA CA9918 1,IRA 14ONROE 7/09/O2 f/27/93 q4. 00 2904 LOU18E 014 8904 LOUISE 0t4 DENTON TX 76201 ENTON TX 'r 7620.1 No response to collection' efforts, 101 393901 CARRO L JEANE1TE C WROL , TERRY 0 6/08/8? 6/12/82 1/27/83 70.00 RT 0'X 120AA POJE TX 76289 'PONDEH~X SQOAA TX 76259 NO response to Collection efforts, t03 1544 t2 RfERq , CHERYL pAnI'EH / LARRY C 6/07/9$ .6/04/82 1/27/83 44.04 i ENiOMOX 3 TLTC ETON BOX 3 TLTC 0 ` TX 76201 ENTON TX 76201 No response to collection efforts. 9 20l 420891 CqC kTlsR JEFFR! Y C RTEH LOU 7/01/82 t/27/93 J LON?CNOX 240 Ap7 V.14 TWIN LAKES 0290 39.00 V TX 76201 DENTOH 7X 76901, No response to collection efforts, , 202 2292t3 CAR AJAL FELIPE CAR AJAL JOE 7. 124/82 1/27/83 44.00 - J i 1 C 1014 MAPLE 8T tIN MAPLE BY DENTON TX T6201 D NTON TX 76201 00 response t0 collection 01Wts, I '2 119024 ylOppkC pHARLpTTC CHpiCE RONALD 7/1'5/82 1/77/83 CI 38 00 / ' C1j8SONILLAOE 9431 apT 01 bppD WILSON STREET r,, TX' 76201 DENTOI4 TX 76201 NO response to collection efforts, - Ftn1 202 93942 C ARK RONtTA CAARY ua J j 10 144 WOOD 102 P, WOOD RONITA 6/06/92 L/27183 38.00 OUNTa TX 76201 LIIWIBVfLtEWOOD TX !5067 LEW18PRIAR140tlD TX 76201 No response to collection efforts. ~ 1 201 418179 B RONALD CfJtlR3D1AR RONALD 6/24/852 1/27/93 39.00 V p 1~ p TX Z0067 no,rBsponse'to collection efforts. + 201 417099 POLUDXLOWEn pp CEOrW 86RIbC8 ptlLfL it F 309RQGDAR B~RIOpYYCE 6/20/82 1/27/83 f9. 00 1 ORR CITY rx 79683 MHP ORg CITY TX' 79693 No response to collection efforts / 201 428664 Cg~OCWOitONADO DR Ap?FPadDN/,lU, ROOAI%X 112 RALPH 7/24/92 1/27/83 38.00 DENT p N / TX 76201 A OYLF YX 76226 ~r Upp ccaa Na response to collectlOA efforts; 204 340091 89471' WORTH DRtJh$K117 all Tf4Nr WORTH DR 8S170LMAN 7/20/02 1127/83 140.75 DENTON TX 76201 DEN ON TX 76201 No response to Collection efforts, 4 S 417799 tlu7pNKOAK 0270 ' BGVEL1'7b201 U0NT0 NIf DETXpL76201 Arrange An8t9 not kept, t/27/03 119.29 w , AWL }NE'~''d~9"7a1a,.r/, ..e1/;i r c'r.,, . .r., .w..r. i.,.~n a, .a .v. ..raaA,l r. •r i' f DATE 1/27/03 14:44; P L O W H 9 M Ott I A L H a R P I T A L PAGE 4 _ U DAD OEuT TRANSFER REPORT FOR PERIOD 1/01/63 THRU 1/31/01 PATIENT 1'lUMnCR 441404 PATIENT I!A!RE 4.«0i 44r4r GUARANTOR NAME **I* DATE DATE OAT OF DALANCE ~ PFX NUMOER ADDR, CITY, ST, ZIP ADDR, CITY,07, ZIP ADMITIeO DISCHARGED WRTTEOFP OF ACCOUNT 201 412130 CAflLRORO 11[CHA41 CARLDOfltl DAVID 6/04/02 1/27/83 74.00 .i, 66(~8 E LATHAM 6/, 90 6 LqTHAM 8GO7SDAi E AZ 89207 8COf8DALL~ AZ' 85287 No response to Collection efforts. 202 419622 £gqRRERA CASSIF L RA HONROE 7/08/PJ 1/27/83 94.00 / 2504 LOUISE 414 ~04 LOUISE 4l4 4 DENTON Tx 76201 BENtfJN TX 76201 NO response t0 Cal )action efforts., 101 393801 itno L. JEANEITE CARROtt. TERRY D 6/08/02 6/(2/82 1/27/83. 70.00 OX 120AA AT 1 BOX 120A~• NI~E 7% 76289 PONOPr TX 76X9 NO rasponse to c0))ection efforts, 103 1D4112 hgAg6AOX 3 TLTC' CHEAYL pjk1cm flox 3 TLTC ' LARRY C 6/07/82 6/09/82 1127/03 404.04 D6NTO TX 76201 ENTON T% 16201 V N0 response to collection efforts, 201 420891 C7pqRjL2OX 290 It JEFFREY cppRYEN LOU 7/01/82 l127/03 ' q 0 TWIN LAKES A2)O 30.00 D N ON TX 76201 D MT014 TX 76201 NO response to Collection efforts, POP 228213 CARVAJAIA PELIPE CARUAJAL JOE 7/24/02 1/27/83 44.00 / 101 MA L9 ST ffOl0 i4APLE BT 4 DENTON TX 7.6201 DIINTON TX 76201 No response to Collection efforts, j r 2 119824 CIIOIC , yAALOTTE CHOICE RONALD 7/t9/82 1/27/83 38.00 } {V 1600 ILLAGE Eh31 F, rT 2041 609 WILEON STREET DftNTON TX 76201 DENT ON Yx 76201 No responso to 011ectfun efforts, It 202 539,12 CLARIl RONITA CLARK RONITA 6/06/02 1/27/83 09.00 1 102 N WOOD 102 14. WOOD KINTON T% 76201 DBNTON7X 76201 No rospOnsa to Collection efforts. ?'1 R 201 416176 CO RONALD i p13 FRIA WOOD RONALD 6/24/82 1/27/83 39.00 1IS 3RtARW00D tltl ` q L W BV11023 CEO..R 8s5p1TX 79067 98a W8V1LL TX 75067 No response t6'C41)eCt10n efforts 201 417089 GlLbfiLOWER A e1LbA LLIFLffil NO cc 6/20/02 1/27/83 18.00 PO E TY T NO X X 75603 mHHP ORE ClIVR BbRINN1Tx• 75693 No response to collection efforts, / 201 420664 OW ORONADO DR /PT PggI~p I 0 N/,11u ppRRACq 112 RALPH 7/24/82 1727/03 30.00 1 r tg, C Q J, R~T FOX !NtON X'17111 AROV1LF _ TX 76226 No response to collection efforts, 202 140041 c LgTpp11 tlfl1~ gg OL TF7 y OLMAN 7/20/02 1/27/03 140 75 C Iq FI WORTH ORVV4 NSlc7 C 1 WORTH OR 4117 O NTON Tx 76201 D NTUNµµ TX 76201 110 response to collection efforts. 1 417790 COLWICK , BEVERLY y02WJANNIE DEVERLY 6/22/82 1/27/:3 119.20 1u07 W OAK 02$0 pp A DGN ON Tx 76201 DENT014 TX 76201 Arrengemants'Not kept, Ir ~ , s S (iej~1~1i` N111'kMr~'niGnld ,d}:F•y.b., , •.v:. . ,u...•.-.. r. o,..., n. h_•,...r»... a+.. r.uVd, W t i 0 .r L DATE 1/27/83 l4; 43r L b IJ It M U A 1 A L H tl 8 P 1 T A L PAOE " PATIENT DAD DEn;' TRANSFER «R6a0R~T FDN pEAiOb PA7% PtENT IWMOEN y♦qr♦ ADDA, CITY, OAMC T , Sr, ♦IIZP 1/01/03 THRU 1/31/$3 (JVJnDER n~f DR, CJTgA NNAMf »,v*• ppTy pp A7E ` ~AbbR[TYr$T, ttP rr__ ADMITTED DIBCHAROEb WRI bATTg ED OF j IIALAN PF' OF ACC86 UNT 202 28571$ ANr}! _ 0 HANN 03 ' TIMDYHY bAO HA ~ ENCH TX 76201 220 DENTON HANN M3 AE14NETH 6/07/0$ 1/27/$3 38.00 _ 00 J . 201 430649 NEWER r% , 74201 , pp8Ep 4pEWEk NO response to Collection affiort2 GNTgryEEO BTREEi ' A TX 76201 1020 fiEO BTRF:~T A 7/29/82 1/27/$3 30 00 loi DENrb~ 275903 pftOCKdIT , BETSY TX 76201 No response to collection efforts. RQOe E 21 DRaCKrTT RONNIE E TX 7622y gg 21 5/04/03 0/06/$1 1/27/88 77 76 203 74448 ROY,FR AU4REYOx TX 7622y qqgg`` JABON LM No response to collection efforts. ` UGNTONUTIJ LOCIL'1' 910 SOUTH BHELIA 7/12/ TX 76;201 r D6NTON LOCUST BS 1/27/83 40 10 201 419061 6RN ONF TX 76201 No response to collection efforts, J H4ERpRENCKEE bEIJA1'rJ: ~pAOgtlCJ$JEROKSE BRENDA 6/2$/B2 TX 49494 HEAPORD efforts. 1/27/03 97.00 i r 202 203962 ppggRpRpq KS 7AHARA TX ` No 'response 'to collection eft`Orts, + bG gp 44 gg 40ti 66 RTd9K40X 66 N ON ' KELLEN 7/04/92 L) i TX 74201 UEWON TX 76201 1/27/03 38 00 1 201 414064 ppppgQppOlltl ppr1p1Vb6 NO response t0 collectIO4 60ons, ~V DEVTON tlEV$LOPtIhMS CEIJfER DAOfJtJ MCIE b/26/$2 . 33113 AV P 83 48 75 1 TX 765201 PLANO T% 4$7310 RpWN , N1$ti NO response to collection efforts, pp 0 ObVfH RUDbI L pROOt Bb RUbbELI 038 NTDN JOSEPH 7/fro/BP r`r DSNTON TX 76201 D>pp 1/27/83 908 00 N p p 'TX 76201; No responso to collection efforts, I 207 346031 [ORiNTtlN pONALD 30 AVE AVC 0 DR .JtJ DONALD r~ TX 76E201 bENTON 30 6/07182 1/27/$3 66.75 201 426199 PRYANT TX 76201< . rr C OOK 343 JhMEB QQRRYAtJT Arrangements not k@ptr IV 9ANCER Atl 00~( 343 JAMS 7/17/$2 VQ7/$8 r~ { 201 449194 14V IJ9 Jk TX 742266 $ANOF'ti Tk 76266 7$• 90 DSNtON DONALD No response to c@llection'affo1/2 It 0 RUb01iLL M127 BUNS JR DQNALO q/22/82 TX 76201 4Np AUDbfiLL 0127 1/27/$8 20.00 201 414$70 CIALVERT 1+NtbtJ TX 76201 ff TbMMY NO response to collection efforts, d0y V LLAOE EA$I Aar 20g CALVEkT TERE$A yy , V bQNfON.; I i D 6/13/$.0 X .16201 pNTON YD 1/27/83 56.50 427435 CANNON TX 76201 01 DAVID Ho response to collection efforts, NTON 4LOUIM: APT 1t V Qg0 Tk 70201 1/27/83 44. No response to,colloetion efforts. 13• ' ' PA ' I DATE 1/27/83 14:43, FLOW 11EMOR IAL H'08P I T A L ' DAD DENT TRANSFER REPORT FOR PERIOD 1/01/83 TH 1/JS/43 J PATIENT NUMDEER 444ea ppgT1EHT I!gME eaa RO reSpOnse to coblectfon of Ort66 PFX NUMDESI AbDR, CITY, ST, ZIP 3444. GUARANTOR NAME r4a4 DATE ATE {{{pI C) BALANCE AbDR, CITY,ST, ZIP ADMITTED DISCHARGED {.AtTEOFF OF ACCOUNT 201 431399 411 BOX B4 RACHEL CtlL'IgQ% 89 DBORA 7/31/82 »1/27/83 38,00 I J tl NTON Tx 76201 RRDTTF.NTOW❑O TX 76ft01 203 298764 8 Cq THRESq BE V NO response to collection' efforts. 1 Q4 N T NTH STntE! +'THREBA 6/10/82 J g WCH hl 771:NTH eT 1/27/83 $0. 20 tv WICHITA PALL Tk 76304 W Cltl) lA FALLS TX W'704 ` 201 418566 JppEN UN JAMES No response to Collection efforts. F91 ` O AHER, T% 76108..... 6129/82 1/27/83 157.00 101 426690 pptieppg3ii CARL DET No response to collection efforts J 'AUI3NE ELMWOgp TX 79609 A2333 ?JE CARL 7/19/02 7/21/02 1/27/83 S1 ELMWbOD 30,00 E 203 390964 BI3 ; t Tx'- 71605 No response to c0116MOn'efforts, i OP p UDbELL 0119 DtIJtiSH1A at Le DINESHIA 7/13/6" ¢ IIIINTOA T% 7620f 7 oU ALEXANDER 1/27/83 38.00 to N D f NTON TX 76COI 201 4n8997 D41)DY HaRLaB qgrtDdy No response to C011ectw efforts, J R 2 DOX 30 LAKE DI!r~RLtlx 76201 bB 2 DOX 30 LAY,E BHOREgAgRLES 9/.^7/82 1/27/83 46.00 gNT9N T NTON Yk 76201. NO re Spunse to collection efforts, 'rl 202 ?93898 gIIggHOP PATRICIA pp pp 2720 CHHBIE LAI+ 2 ROHOCHE0IE LANE SAMUEL 7/30/82 . , J DENTON TX 76ROI D NTON t/27/S3 24 90 r TX 76901 No response to Collection efforts, , 202 098064 B AND TOMMY HOWARD CHARLBME 2 N4 GNI CARROLL DLvu 3633 PITH 7/04/82 1/27/93 67.76 J 1~ Tx- 7b^a01 PT WORTH TX' 76109 NO rOWASO to collection efforts, 201 418491 gg E 8 II a j R~ f 99X 69A k E1 0880X 69A W 6/24/82 1/27/83 48.00 K4r A.OYLE -.TX 76926 A.OYLa T% :762$6 No response to collectlon efforts, 201 429397 60110 HARRY bppx 978 DD , HARRY 1/19/42 CELINA 979 L/27/03 96 19 V Tx 79609 C C L ltlA ;Y% 711009 Arrangements not kept, I?! i 208 17723 BPI, ON LILLLE 170 gg MCKINNEY T% 76201 DB EO pEI++ LILLIE 7/20/62 1 DEN~ON i133N9 E MCIIINNGV 1/s, 95,78 V p NTUN TX 76201 No response to collection effortf ~ 201 413640 k7p2t+1) PAULA Olt~}VA PAULA 6/09/82 f 5 J htw Ag X Qg1 1/27/03 42.96 PILOT 1r TX 76298 PILOT OINf Tx 76258 201 418439 MW YD IfICHAaL tlpy No reSpbnso to Collection efforts, 0 CHARL88 2?l 49048 H BLEB 221 MICHAEL 6/26/02 / gg cc pp t/2>/83 118. 79 IBVILLE TX 79067 LE<WIBV[LLG TX 79067 No response to Collection efforts. rJ 5. f+f . tr... .q r it N.r ,.dU „ ,.u;,1d ANc r. . La("1 I ~~yy c n - „J DATE 1/27183 14:43; FLOW ItFM0R I AL H 0 S P 1 T AL FADE i SAO DFIIT TRANSFER REPORT FOR PERIOD 1/01/93 THOU 1/31/83 VN _ _ _ PATIENT I-0UMBER u<an3 PpATIENT 19/MC 44Aa ppaw4 OUARANI'M NAMC 4a*■ DATE DATE DATE OF BALANCE J PF% NUMDHR AD R, CITY. ST ZIP ^ADDR` CITYVST, ZIP ADMLITEO d18CHAR-Ed WR-TEOFF OF ACCOUNT 6/01/82 6/04/821/27/83 009 87 "A 4' V 102 331314 ADAHa -ANN-- u ADAMS r+ ~,~ANN MARIE--- RT 5 LOT l40 WIN LAKES 11,14P RT 0 LOT 140 TLHHP .76201 No rE4 onse to COllotti00 efforts, ~ J DGNTON TX 76201 MINTON TX P 1 406173 aTlf``Je SOX 321 OARREi.4 ht#lIG3Q% 321 , DARRELL 5/17M 1/87/83 168 40 , AUBRCY 14 TX 76227 AVO8REY TX 762777 No rospanse to collection efforts, 201 418137 AN`AHEKMOT O A^T ll9AHE 116UASTUDENT1IMALT, CENTER 6124/82 !/27/83 56.35 UCNTON, T% 76201 DENTON TX 76201 Arrangements not kept. J 201 41824.1 AT,~Og0V '~,0009RT 1A1fgt60a A005RT 6/24!82 1/27/83 46.25 ` n,167YN4RONV]LLE LAIa 7% 76801 DEMTpWNEONVILLF LAIJI:. TX.. 76201- NO.r0ponse to collection. efforts, 1 V 0 A LLAS TX 77777 ~ MARY 7/pl/82' 1!27/83 17 00 201 427617 AR~iaTRO!JO , KE17H PgqABg~aIIpEULAN ag 6 OEEULAH DALL48 iX 77777 No response to collection efforts, y llt 202 403063 ARMS RONO PEtlOY 71 8RUEO7R011 SAMUEL 7/31/82 t/27/83 02.00 I. a04 7TEXAB TX 7,6201 KENTON CH 43326 NO rOfpOnso to collection Efforts, J 115N'(ON E ERICA ATSHLPY AARON 7/13/82 1/27/83 84,15 202 396861 AYCHLEV 1'11 W OAK 6 THOMAS OANTON T% 76201, DENTON T% 76201 NO response to collection efforts. SHA TX O~ 7y067 IIAM EDWARD 7/28/82 1/27/83 202 424754 L ggA" Vgg9 O V ppILgE ''++DOd fit-INCA o VILI8.E ``4~000 11ANUq Tx 70067 No rosponse to oolleCtfon efforts. 116 50 @I~ i 202 414303 ARN£Tt LlIJOA pAOXl.8772 , IJILL[AM 6121/82 1/27!83 t4 00 r 3 sox 831 9 T~ - pGOgTUR Tx 761!34 @R[CUPOAT TX " 760P6. No respopSo t0 Collection Of forts.,, .Ol 413584 BARYMM DAVID GARY DAVID 6/10/82 1/27/83 8I1 00 it ORNTON ITH LOT MAS 9 M1TH LOT !J$0 J y T2 76201 DF.NTON Y%' 76201 NO rBSp0n68 to COl1eCt10n efforts. n.K 201 407440 DDAORTL~Vg34 PAUL DMal AART0 534 THURMAN 0/21/87 1/'17/83 43.00 P 30 LAKE DALLAS YX 70065 ALLAS TX 73065 HS rosponsa to Collection efforts, J V y~ 201 428016 4pAp1~8 N1~ LWbbD KENT i(A074 IJILLWOOU , K8N7 7/2M1/bit 1/27/83 76.00 WIOISy1LLLE TX 70067 LHWIBVILLE TX 75067 NO response to Collection Offorts. 103 45898 JJARD HENRY 0gg04DePLNCER RD HENRY 7/04M 1/10/82 1/'27/03 91 20 04 SPENCER RD g DBNTON TX 76701 DENTON 7% 76201 No response to collection efforts, ,t "W .a i \N DATE 1/23/03 13: IS: F L.0 W N E M 0 R I A L H C 0 P I T A L PAGE 0 ACCOUNTS RECEIVABLE A04OUNT STATUS REPORT SUMMARY PATIENT CLASS COUNT PATIENT INSUURANCE TOTAL 10 DUG DU DUE OUTPATIENT 1 40.00 .00 40.00 INPATIENT 21 7143.09 .00 7143.09 EMERCENCY 19 1317.24. .00 SL7, 24 / IOTA! ACCOUNTS RECEIVARLF 34 0000.33 00 0000.03 J I **40* TOTAL NUMBER OF ACCOUNTS IN ERROR' rr~ rk♦ ilo l • 1. 1r } fIl YaY} p 1 1 1 4 { i DATE 1/20/83 13,17: F L 0 W It 6 M 0 A I A 1. H 0 8 P I T A L PAGE A ACCOUNTS RECRIVADLE ACCOUNT STATUS REPORT pPAr] LENT !AH Jpp Iry gg pp PRRD r-rpprDMIT A?TTgg po CC gpp +t1N0tRE0T~PI A7y hg.* OUARAHIUROkbDARl3pR•-NP}MI(INE NUMBER N//CC DI9CHAROfi pAT6 MEdICAtD N INS N pADDUEENT.CVRRE~T BALLANCi "1 ' ~r JUSTIN TX 76247 142.00 ~ M 1 pp M (S g 6 pg g W»20fAME 6y09DM DENTIIN 60{S161AMS GTXCE 78193923802 81 li% 6%6D 1ByAb1 1 100.00 Moo : f= b Balance after Medicara and Medlcald, . WRIttDHT JnnSIIVA 41411A Nklpp"I , ANN 3p 8 / /82 150, 00 $19.35 J ~`J 160 ~2 397996a OAR BTNOG TX 722014395 %l7%9 51 l 9 7496 Indlgent care, J V J, ~ J M . 1 I` 1 60 1 yyu y~ { W'~'~Nt`Glj~i•'LLia t Y Y b~p• „pykpr$irF,Ytn wn~A 1. d'r.!••f. ...n ne:.m u ca':.. r. nr v_. i• uawn . +1 zlzlK~((PnYJG.' fY11lKWi u. F~if(f$ . ~R'3'tf~YJ1?.l}A~'.~~t.. ~ '.lsRY t v~..r,.. NF ~r i.f~(.y.t AtlCn•vf ct+. N fHHt' i 4-01;x1 t. ~ C~ •P llf t I, t• A L pAOE 3 DATE 1/28/83 13:11; FL 0W IiE M0R I AL H08P I T ACCOUNTS RECEIVABLE ACCOUNT STATUS REPORT pppppppppp1T1ISiNT N~AJMI R {{JJ gg pp PPR -[ADMIT DATT7E C qA tINDIRECY-PAtMDNq,~ OVARANIpROADDRE88fl--NPHONE NUMBER q/C 016 HAROE DAT9 MEDICAID N INS N PADUE, CURRENT SAL ANC!' ~}p pp g3 g AV 030E 2830029 DBNTCNMPBBE4 01 11TXY 7680126 87 18/2 82 003368303 R'150,00 20 00 20:o8 tJ ppgg p tt Balance after Medicaid, g ' (y, BAltI4O 20834EflT 22t7 OLENgGUpNO RO3sRT 362 1496 at {0%tl1%8 3,500.01. 2086. 3y 2085 Is " (1 M 0T 1 % DCpEN1TtlN TX 769g2701 1}1 11 Hgg b33 9g7qq 4 C B D'~S V 60101 4581~4g DENTONELM9COT1 ATX06 764940/4nt care. at 18% RRR~%8~ 1246E1209A 2:180.00 19,80 213q.80 RJ *102 496174• E„ pp gg gg~{~ 33ggBelance after Medicaid. 4 p g ~ }J9MtT3 342410ARA~ OT3NODROk+ILtMfJB BTXBAfl7b2017365 91 OW312 PENDING 0; 180. 00 40.00 40, S 0 Indigent care, 4. J T H o M pp ~V IMI19 410II11RY dE6~DN a Ap~Y1S BTXDAR7b701 9~ %12 2 ;180.00 10,00 t>a 6/82 E r " Balance after Medicaid. 4, {61 6NYDER 4700681" DENYON CO f11Y JAIL ,IRpXERT7620! 89 %00% 8 0.900,01 1738. L9' S~DD.ID ffo0 6T ON DA LAH B1'RD LINDA Benton Caatnty Ja8111 /gg2 4 900.00 60, 10 44 I qNT q 8008 MHP N3 221 6314 8 I1/1 /B2 810 r@01 43b064~ NEwwlmrl6 TX 78067 Balance after Medicaid, 0. 4 1 11 p gn 66 ``pp J R'300,00 167,40 41b7:40 r , T.OOD9 136E~46 6Af010ERX 1~14EOli/;6 EYXtE 764663606 61 g%4%6 459 fb 42573 qp OR NER KK 9 Balance After 1101lce0 dnd HedlceliGd, 7 TIOREYT PAN G 5 Y101 460230rCE9 a L OE"TONLtlCUiYCEN90N JTX 76001-602Ba1ance after HIdO%%6 and Medicaid. 4L. 19 841,84 N003 0600by OEOT tlMIN00eRDNNt04 BOBBY TX 3. w kN I 2&13095: ISO. SO 7 76201 Balance after 1R/00%6sd 9986 bggaA 1: 90. 18 00 ;:i'•.i ' l~; o$ uu 1, 7 Medicare and Medicaid. i WlI~D1TT $81669 AT I OOX UlkLE17 PAUL 4300194 90 8%(0%00 k 900.00 !42,00. 142,00 J 1 HIII,aurton l ~ I' tt 1 tl~ I 1[ybt.l IL 1 I 5 DATE l123/03 MM R L 0 N 11 E M 0 R I A L H 0 8 P I T A L PAOE 2 f.J4 ACCOUNTS MIdIVA91.E ACCOUNT STATUS WORM Ppp& ENTIIJr1~1E6 q CUAI~ppNIOR NAMME P/pC Agq~gq'I~TnMtT $ATg6 Mg c T e' ~J do "N'S. N0.0 OUARANIOR AODRE88 PHONE NUMBER R/C D18CHAR09 DATE ME!UI CAID M INS M PATIENT CVRRpNT BALAHCS 1 T NG DUE * DENTON 1't 76201 3. 28.00 J 4. oil V 00141ALE 46'SSARAH 50333 RRANEOr..N2Al EX OAAAH ggR 4434 8y ~f1%ttg%gD 1. 900.Ot 62.89 1 DENTON TX 76205 l7/21/82 3; '12:28 J 10 * CC pp * MIA. 4. 0028MAN 472D24LE8SnXES4 Onnn,v,N CHARLE86 3x600 811 18/!7%92 1.900.01 038.14 ft 67 7y ~ * » E A , TX 76838 3; 388, t1 HNgg o g gp q J N g1Texas Rehab, 11/18/1.2 u Jk20RCH 400148» TUYEN DAN®SN1 !9 BCAIPO TX N 76203376 84 423 811 SOl 1;SD0.00 22.50 32': r V Tu E CC T D8 UUL AApp OR 1 Uu Balance after Medicaid, 11 8g2Q !1r 2 420 64MYHIX ZEAL CrXOLY7N 1. 3034 8L W13M 503668145 100.00 22.30 'AA 215 . S 12. r, I! `g ~O g rrBalance after 110dICaId2 88g@g@11692J98439 1p IM*1D9R 47S~2 OENTNAOLEILLPk B TX L 76t~O1831271 84 D%0 %8 M 198:80 109.40 11~Z:48 J K W Balance after fle`dIcaId, 4. I Mi1~DR 21M1191 p304 pUgT[ert~kA1L DAXID 4973 81 6%8qq% Z PSNO[NO 130,00 59.00 € y * * CDLLEVViiLF T 71011 06E900 r6 J V lance after Hedtcaid, J ? PONT 446146E tJ fYHaEIEr JAVME N ~ 8t q1 %8~ 1400.00 86.00 e6 aN1 6 9 1 96 V, * ~b~NT TX 76gotlance after led Ica Id. 4• ' g 1 yy .ie J% PE~D2 4461468 OfJ 1THPEIgr JAVME NONE 84 9 gg/6/1`66/8/p22 18 00 g ggMM s f * * DENTON Yt 76241 618:88 `J pp p 1, IIgg TT gg ggggDalance after Medicaid, 9% 462 22 336SA 15.00 J V R*lOOS 2644C7* N ONOX 11RADO Lots 76Q013622 DE el f?jnpnp g g :98:00 p g T tg Balance after Iladicaid. 4 800,00 145 47 R~1~4p 2480n° l48CAHONTA gADBKOR EaRARY24$DK s : Ito 4940 J' Balance after Modica id. [ J t . k k l DATE 2/23/83 12:50: P L O W 11 E M 0 R I A L H 0 9 P I T A L PAGE «CHARITY CHARGE+OPF LIST ACCOUNTS RECEIVABLE ACCOUNT STATUS REPORT ppgPgATXtEN_T 'l.Mp~E JJ pp pp PApK-tADMIT DATE gg J *SNIfIf~ CT PAT, 0. OVARANIUROp6DRE68R-+MPMONE NUMBER P/C D18CHAROE DATE MEDICAID M INS N PATIENT TOTAL BILL~~rrD pppp HHgggg qq I p DUE CURRENT BALANCE. ,f + A DO`SON 1 428747 C~f1MERCET6.1iIIHNSON 1OPAL 794M 7413 at 7% 11%8 126 .2$ 830 A, a. 1D0. OD 26, 00 22-'l ~!s qq Balance after 11eJ1caid, 7 4, 26, 08 AN001 314A39 pENTONEBLIEIIRE RYX 76D0f7463 Sb 6%7%8 900.01 13,37 y r 4/ /192 222.90 J 13. 37 AR1 R R MOTHY C ARpJI~R IRIMOTHY MHMR, a 800,01 134.48 9 7b Y01 49904» 0AIN98VILLEPTB N77 TX 76SA03734 S4 p%ItD%8.2 J 1► 1~4, 48 0A NfYT L H! p% tlRRI1rTT L H Aft Rehab, g g 4. ~ DO 431674 DENa8A 242W ?X 7612gt 2678 S~ B%D~%BD 33}:100.00 14.00 7Sy ~o N1~ M ~ Balance after Medicare and Medicaid, 4: 14' [4 11L101 430001Y RL0 OUR7CI;I rusE IfIsLPARE gggg at ~~jj/ g/~ 1.30 00 123.00 g Q J M D~NTCN TX 7A2012J71 2 Wi 2 PENDINO 4 4 J; 00 J Balance after Hedicafd, 4. BRACQNEN ppyyNNfHtA p DRACRPN ICYNTHIA~2b 61/0/80 p ,y *l01 3tl9973* dEN ONELCH TX 7 11071 / Cy/8 1,190.00 150.00 ' gg5y Qb Balance after Hddfdaid, g tl nW gER1 4L S~A 0 RANDY bp90943 462-6366 1,190,00 19.OD 100 N14ME HUf APM TX 76 Et q/ / 1!1 yI J 2 0/2D/D1 264746602 1184. f M w RU 249 l 2/8 DD after Hedicald, CARTy q D cAgT' RUSE 6S NE l0f 461954` tlNTOM NORTH ~R TX 76 201E b /pq /gg2 900,01 31.94 N ~y L p BS/82 302.Jp 4 :1! 1 DA101 3gKANDY PPO Bpoxx f0'JA - ,RANDY HIM b BANOEIt TX 76266 2, 130.00 1120, 14 29gD- ~A I J NN CC g Balance after Medicaid, 3. V EN10[SH 46T1 1310 9CR[P1U869M JOHN 900.01 49,23 1 /g t * M HNHR . 1 b/ 61 OALAVt2 1 6A TX 76201 b 133 38, 00 4q.~ J 20 473788 DEIJTON COtlIAVl1 JlA A 11AX IL I 91 tit%D %DD I J Denton county Jaal1, 2' 36. 00 t I [N'4C5 Page 2 FLOW MEMORIAL WSPITAL STATISTICAL STATEMENT July 31, 1983 C U R R E N T M 0 N T H YEAR -TO -GATE PRIOR Actual 9udget Actual Budget Year-to-Date Adult Patient Days 29578 29945 28,612 28 880 27,811 Average Per Day 83.2 9510 94,1 9,0 91.6. Newborn Patient Days 429 430. 3,713 4,256 3 951 Average Per Day 13.80 14,00 12.24 14.00 15,00 Gross Patient Revenue/ $ 506,72 $ 415,04 $460,70 Patient Day $ 456.89 $392,98 Total Expense/Patient nay $ 426.82 $ 345.32 $ 370.92 $ 352,14 $ 334,11 Month Charity Bad Debt Rec~ove_U October $ 611473 $ 96,053 November 127,181 117,974 $ 60636 December 61,228 10b 636 4;446 January 80000 990706 60466 February 28,003 108,131 91934 March 8994b 4;092 620295 Aril 12,762 .42,208 May 9406 36*734 13,696 June 35,112 70,269 ~1111 July 33,718 68,950 21183 $ 433,465 $ 826,907 $ 72;05 % of Revenues 3.3% 6,3~ ~ 17 f I 5 1 r PLOW MEMORIAL HOSPITAL BALANCE SHEET July 31, 1983 1983 1982 1983 1982 Current Assets: u Current Liabilities; Cash-Operating $ 90,609 $ 96,298 Currant Notes Payable $ 420686,,028 745 $ 172596,,765 445 Interest$Inking 202 140481 Accounts Payable Reserve Fund - 41,393 20,412 Accrued Payroll & Taxes 150,903 16700396 Repair fund 20,582 1,847 Due Medicare 219,540 195,787 Group Health Insurance 1,000 10539 Fees Dyable 2,187 5,977 ' Investments/Board Designated 305,464 296,398•: Bond Interest Payable Bonds Payable F Total cash & Investments $ 459,250 430,975 Total Current Liabilities $'1,8901095 $ 1'0503,926 , Accounts Receivable $ 416649154 $ 3 071,391 Other Liabilities: $ 580993 $ 589176 j Less: Allowances (2 046 019 423 682 Deferred Income Net Patient Receivables $ 31659,135 3 2,6479709 Long Term Notes Payable 2650658 478,767 ! Bonds Payable 420,000 430,000 93,251 Other Receivables $J0,914 280,637 Total Liabilities $ 2,634,746 $ 2,474,869 Inventories Prepaid Expenses __,L4 _,-341 69,108 s Capitals 3930165 $ 393,185 Total Current Assets $ 4,784,525 $ 3,521,680 City of Denton $ County of Denton 1,6960871 -3169608n ~ , Plant Equipments _ Endowment Flow Estate 240,461 240,461 Pro party E Land $ 37,547 370547 Fed, Grants, Hill-Burotn 1,868,910 1,866,910 ` I Building & Improvements 3,067,385 $ 31067,385 Federal Grants 256,371 256,371 4 542,71.5. 4,557,178 Pledges and Gifts 661,748 4939748 Furniture b Equipment (291;266) (601,770) ' $ 71647,647 $ 70662,110 CurrentnYearl" Beg. of Yr. ~69 8 8 310_.,167_ Accumulated Depreciatioe 4 372,312 (4,139,998 LL AL 114 4 672 923 k Net Property, Plant & Equip, $ 3,21SA335 $ 3,522,112 Total Capital ti---~---- , $ -8.j 059 $6O $ 7r043}792 TOTAL OPERATING FUND $ 8,455`., 7 043792 TOTAL OPERATING FUND _ - - Current Ratio 2,53 .~i::xYNAfI1 N...IIW I'.W,.1w ••..mxli i t. 5 Page 3 FLOW MEMORIAL HOSPITAL 'f STATEMENT OF OPERATIONS/ July 31, 1983 % of Salaries Supplies Total Direct Operating Revenue Revenue & Benefits & Other Expenses Profit (Loss) Daily Hospital Care 16 $ 201,200 $ 127,891 $ 15,181 $ 143`,072 $ 64,128 Psychiatric Care 5 61,610 370065 30851 400916 20p694 Oa/ Post Partum 3 381195 19,071 29668 210639 11;656 ICU 1 21,600 18,063 20377 200440 1,160 Nursery/NICU 6 749075 35,242 71312 420554 310621 Coronary Care Unit 3 31,909 290856 61287 36,143 19766 Labor & belivery/Birthing Center 6 66,125 25,457 9,617 34,974 31,161 Operating &.Recovery 4 56466 239182 13;727 360909 1,667 Emergency Room 5 61,203 19,023 280009 47,032 14j171 Central Supply 9 112,570 71682 650224 72,906 39664 Laboratory/9lood Bank 12 158,874 670115 670115 91,759 Radiology/Nuclear Medicine 6 80,781 16,245 260110 41,365 39,426 Pharmacy/IV 15 193,816 11,861 33,841 460702 148:114 Cardiopulmonary 6 77,933 19,630 19,700 39,330 38>603 Anesthesia 3 39,047 150898 100394 26,292 12,755 E Physical Therapy 1 21,813 70517 39 43 11_,!61 10,662 -Total 100% $ 1,309,1I7 $ 413,683 $3130847 $ 7270530 $ 581,687 Deductions of Revenue $ (71,792 $ (162,81371'r7y2 Charity & Bad Debt (152,813 Employee Health Ins, Expense $ 49,111 $ 490,111 4911 MAdical Records 625 $ 110062 3,090 14,15213',62 Gift Shop/Grounds Maintenance 10298 2,394 20856 6,260 ($,9962 Cafeteria 100388 27,281 26,668 63,939 43,661 Plant 169394 659101 81,495 - 84496 Environmental Services 35,118 11,708 46;826 46,826 Fiscal Affairs/Data Processing 7,984 3,434 110418 11418 Business Office/Credit &Collect 230207 14,326 37,833 37633 Personnel 39700 3,643 70343 (7;343 Administration 5,619 8;632 141251 (140251 Quality control 30067 360 3,427 (3,427 eneral.& Administrative 396 150017 is 017 14,621 Depreciation 33,.75 33,076 33 016 Gain (Loss) From Operation $ (211,978) $'1360826.; $ 23701001 $ 3729837 $ (684,816 (3,228 Non-Operating Revenue 25,838 25,838 Foundation 3.122 Total $ 5 0, 1,100,367 2 32 !I•dP;>.: 4'¢iW44M.. `riw..d. sL.-: n., u..a . tw <i . nr._...r e.. r... rxws nWe•rswYuUlGViilR,y,4~y , N I FLOW MEMORIAL HOSPITAL Page 4,, STATEMENT OF OPERATIONS/July 1983 Year to bate ' % of Salaries Supplies Total Direct Operating Revenue Revenue & Benefits & Other Expenses Profit...(.Loss Daily Hospital Care "17" 95 $rC 3 X9;964 $`pT;df9';417 $'"`T5T478~~ Psychiatric Care 5 717,752 348,990 32,024 381,014 336,738 OCUPost Partum 4 466,190 186,718 249397 2111115 256;076 2 287,450 1900599 31,286 2210885 65665 Nursery/NICU 5 698,685 3329941 61,453 394;394 304,291 Coronary Care Unit 3 405,389 3n6,935 44,113 361,048 64,341 Labor DellVery/Birthing Center 4 493,247 2549461 72;630 3270191 166,066 Operating & Recovery 4 536,182 2150205 1400800 356,005 1790177 Emergency Room 3 452,086 173,390 274068 4479468 4$628 Central Supply 8 1,088,531 780376 499,991 6780367 510,164 Laboratory/81ood Bank 11 1,403,565 686,599 586,599 8160966 Rapipl'ogy/Nuclear Medicine 6 7660276 1680369 2200461 378,830 381;446 PharNaCyn v 16 20138,235 117,412 4360267 562,679 .10586'1566 Cardiopulmonary 8 100300596 199,282 177,819 3770101 663,495 Anesthesia 3 387,021 144,046 1050367 2490413 ` 137,608 Physical Therapy 1 1~ 57,412 690893 231272 930165 644 247 Total 100% $ 136204,512 5 4,066,180 $ 2,8690601 $ 6,925,681 6,2780831 Deductions of Revenue Charity &,044 Debt $ (772,066) (7724 (1,568,018 '477 4620477 (1 4¢8,087 6mplOyee Health Ins, Expanse $ 462 M Gift edical Records $ 6274 odicShop/Grounds lMa 'ntenence 6,474 $ 1130680 28,714 142'294 g6~8 0 i 16,627 180672 150211 330183 11111 6 " Cafeteria 112,831 264,390 272,197 635;587 42317 6 Plant 153,982 6181221 7220203 r2 3 Environmental services 3429275 99;210 441,486 M*4 6 Fiscal Affairs/Data Processing 79,099 620841 141,940 141,94,0 Business Office/Credit & Collect 2260531 131,667 3580188 358;188 Personnel 299368 220321 51,689 51,689 Administration 59,134 27,902 86,636 86, 36 Quality Control 270367 66001 331368 368 0 03, enerai Administrative 17,660 298,452 298,462 ,792 Depreciation _ 338,208 338,208 1833b 208 $ s -gain (Loss) From Operation $ (21187,891 10314'298 $2,373 21373,012 $ 3,6871310$ (50875 2,01 Non-Operating Revenue 264,104 0 ! Foundation 31,210 _ 31,210 Total $ 11,311,845 $ 60380,478 $ 59513 $ 109612,991 $ 6980854 4 i u4.•11 Vii: A'n ....M V.M4 rtM r•N.H M'• v« {1 ti } n I ~r FLOW MEMORIAL HOSPITAL Page 5 SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS July 31, 1,983 Current Month Year-To-Date Soginoing Balance $ 247,263 $ 29175 ~Cash Recoiv(>d from; Actiyye 4aatient Accounts 51,-60,702. $10)060,674 Ba~ Uo¢t,Accounts 2, $3 720346 Ca fetgrid` Appropriations/Donations ~6~24~ 311,289 Othen 364- 37 Total Cash - _ 723;632 ! TOTAL CASH A"Ai~ADL i ` ' 11 285 973 t Cash pisbupsepeh`E$~s' 1 Payroll $ 648,069 $ 4,936,433 Payroll.rakes ,s 07,774 712,311 Patient'kefunds 180416 248,600 Capita 4ssats Notes Payable 132,295 18,460 179,022 talOther 626 3 $ i 378'855 4,992,699 To' 0 sbursements a0oe lY 2O3 260 Cash 4~ $ t Cash investments Total Cash 3054 4 3 i (Iross Qatient'Revenue $ 306,31a $i3 181,831 Le si 'Allowances OS 8 6) 181 636 Net Papent flevenue $ , Cash Receive on Patient Accounts # 600702 $10 060,674 Less, atient Refunds t 1 lb 24$,600) Net Cas► 4►1 atient Accounts u , t CAO) Received aS a % of Revenue 46,4% 80% ~'j'~^4if.'A`41VM{ ...a.e: ti..: •4M~~N~,:Y.?i,: i-.:!V,L^tG'r-:!"~.S1ti..pYyS=.a:. Y•-.!..wIM•r "`~B?Q l 4' Pag6 6. .•l :his PLOW MEMORIAL HOSPITAL A li AGED ACCOUNTS RECEIVABLE SUMMP,4Y BY DISCHARGE DATE ' duly 31, 193 Primary Payor Current 31.60 61-90 91-120 121-150 1501 Total_ _ % of, A/R Medicare < $ 387,930' $ 106J13 26 691 $ 13,514 $ 4,999 $ 31,433 $ 570,580 13,0% Medicaid 580601 17,619 239362 150740 590406 46,059 2209787 5.0% Blue Cross 63,225 26,670 17,196 1,637 41522 3,705 116,964 2.6% Commercial Ins. 458,411 349,646 141,468 970972 70,552 139,070 10257,119 28,5%; Self Pay 224,731 2600192 194,012 192,875 155,715 1,058,026 2,0860550 4744% Balance after Ins. 2,051 4,608 7,788 120194 126,053 152,694 ,5% 191920898 762,291 407,236 329,526 3070388 11404,346 .40403,684 10060% In House Total A/R 313,592 $'4,7170276 j A/R by 27.1% 17.3% 9.2% 1.5% 7.0% 31.9% Days, of Revenue: Acd0nts Receivable In-House Total 1 i 11 A ••v rt;N\/M1W..+n.x..alNhHWb.NUwnM;'~ r Page 7 `rr} FLOW MEMORIAL. HOSPITAL AGED ACCOUNTS RECEIVABLE SUM14ARY BY PAYMENT DATE July 31 ,1983 Primary PaXor Current _ 31-60~ 61-90 91-120 121-150 1501 Total % of A/R Medicare $ 4260555 $ 87,803 $ 199053 $ 90289 $ 7,243 $ 17,068 $ 6670011 12,7% Medicaid 114,994 21,210 23,899 12,349 40226 419141 217,819 4,9% Blue Cross 669888 24,934 17,422 19676 40649 19611 1160979 2.6% Commercial Ins. 5680431 347,160 1290366 39,593 690888 870018 199419466 27,9% E Self-Pay 613,864 4420653 273,585 129,661 176,429 5230771 201680873 48.5% Balance after Ins, 48,662 309902 111171 15,561 438, 45,646 152,370 3.4% 10839,294 9540662 4749496 208,028 2610773 716,255 414546508 100,0% I In House 2620768 Total A/R 4,717,276 A/R by 41,3% 21.4%. 10,7% 4,7% 6,9% 16,0% Days of Revenue; Accounts Receivable In-House Total i E i S ~MI!i.-+' iv.a ..M.. e.. . . r.: ...i f. I...v ....a. ♦aa.. I.. 11 .wu~n~ .a.. . en N\\ rf i..•. w • WVE M'llyAa..AYa I 'r Page 8 lti FLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE July 31, 1983 Deferred Payable . Current 31-60 60-90 Total Trade Vendors $ 272,093 $ 242,614 ;G $ 614,607 Fees Payable 1029039 520950:: $ 460401 2000390 Accrued Payables 51,942 51,942 Estimated Payablo 120,196 120,196 Deferred Audit Fee $ 19,150 19150 19,150 546,270 295,464 450401 906,285 f 3 i 1 i f j i l •i.. r'i.. rer 11. i, 1w'..v+~ : n.6"MM„h Vrrt.'M YN.i I1fM9 4w. IA'IM14a viW1 p~ ICCI Page FLOW MEMORIAL HOSPITAL HOME HEALTH BALANCE SHEET July 31, 1983 ASSETS LIABILITIES Cash $ 51,337 Accounts Payable Accounts Receivable 70,733 Payable Due Flow 2,969 122,070 Accrued Payroll 4,046 Inventory _____1,844 Total Liabilities 7,004 Total Current Assets $123,914 E UIPMENT CAPITAL Furniture & Equipment 1,616 Pledges A Gifts $ 116 Less Accumulated Depreciation (1,346) Gen. Fund Bal., Beg, of Yr. 113 816 Net Equipment $ 269 Retained Earnings Current Yr. 3,249, Total Capital $ 117,179 TOTAL OPERATING FUND $ 124,183 TOTAL OPERATING FUND L124,183 j l 1 ' ~+,~~hrj~,p l'k.'MpoN ga•Arx4...w_ .r 1,. n • r. n.La dmpy, 14'.tNYrv4rr ri. • v\~1Y•ifµ~L/eC 5 N E a; Page 10 FLOW MEMORIAL HOSPITAL HOME HEALTH STATEMENT OF REVENUES AND EXPENSES July 31, 1983 REVENUES ,Patient Revenues $ 310560 $ 317,160 Deductions of Revenue (8,913) (73 288 Net Revenues $ 230367 $ 2439872 EXPENSES Payroll & FICA $ 19,470 $ 200,474 Purc, Service 1,823 9,22b Supplies, ),657 t 12,898 a Travel 1,774 I4,994 Emyloyee Benefits 2,782 f Depreciation 269 Net Expenses 24 724 $ 2400623 Excess of Revenues Over Expenses $ (1r,367 $ 3,249 I J ' ~s f _ n:' u,.a.r.,u... v..•e.ti :krYw.:lMSk• , ' . iL mi41i#iRldW+tWTl,ilHllt+ityltilgld~ f t N I Ile , ~ a sr f I ~ r f r 7rrii a 09 43:33 29 JUL 1963 CHARITY REPORT PATIE14Y.............. PAT.ID.,.. PT FC. OVARANtOR NA119........... ADDRESS CITY,,.,,...,. ST ZIP,. DIS.DTE. AMOUNT., ALONZO,MARIA 0 10004591 IP MO ALONZO,IIARIA D RT 2 DOX 624 'AT 2 BOX DENTON " .....T1f 76201 07/14/83 »11.70 V I rf OELL,R08EAY E. Ba 10006091 IP MC bELL,RAERT E, 2212nc~ ppla after edi ado ff FT WORTH qR N13 DEN7f1N TX_76ROI 03/13/83 -436, 40 / DABILA,CAPOLtNA I. 40034901 ER 6P CAROLINA DABILA 7 0BOlletNW00Da DENTON ~TX 76201 06/14/83 -61,69 r\ " ....Indigent Caro DAVIS,TERESA F, 40029860 ER MO DAVIS,TERESA F. 400 80, RUpbELL 0118 DENTDN TX 76205 00/2>/03 12.1!0- Balance aftegr Medicade ELMAN,DOROTHY CECILIA 10008014 lP CO ELMAN,DOROTHY CECILIA, 0605 TWITTY THE COL014Y_,___.TX.75054 03/03/83 62.71 ~ W qq 0 g DE t a ce /r FELTMAIJ, EM14A 40024499 ER MO FELYMAN, EMMA ICa CCU(TUNItp ODnt e . 4ReDa-dpD,NTON TX 76201 03/07/83 -11.30 Bntence after Medicade E FRI2Z£L,DUFF 40038937 ER CC OENTON CO JAIL M1ancd Y Sr DENTDN T 041O1 66/V/03 -104,2$ coca ty Jail V 40(8 IP 8P OAIIMON,JAME$ Benton R'! 1 County Jail , OAMON,NA140Y L 00024018 IP $P OANI Pa ent on Account already o Charity all. 00 kt, yt ON. JAMES RT n1 92X 1990 04 Charity tx 7E034 03/oe/8,Y 25.00 ? Paya1ent on Account already on Charity,._ OARRETT,JOHNNY PAUL 40038796 ER 8P OARRETT,JOHNNY PAUL 1910 SCRIPTURE OENTON 71( Y4001 O6/23/AJ _267.49- Deceased No Assets OAR ZA,EP IFAN IA 10018760 1P MC 0ARZA,EPIFA14 IA_ 730 ORVENWOOD DENTON TX„7620( 04719/03 »~2 50 1 J 11 Ba atga after Medicade V OODDHAN,CHARLE9 E 00026081 IP CO OOODMAN,CHARLER Bd)t g4 ERA yI YX 76230 01/20/83 -487.64 , Rehabilitation }I 90K QOpDMAN,CHARLEB E 10009134 Ip CO Ot10DNAfL CHARLES E 6OX 84 ERA YX r/,23ff 03/2e/63-14~3b3,40' ~E 1' Taggs AWb11itatio J OREGN9,MARJORIE T 60026905 OP MD OREEI4E,TRACY Sq LOD 288 NK DENTON 1X 76201 07/09/9; -146 50 10I' HAfiR7L1k0,PA7RICIA Balance After Medicade 00028084 ER 9P HAERTINO,PATRICIA 206 8 OAK DENTDN TX 76201, 10/20/02 -103 75 V y{ _ .,Donton.County jail l HATTENrCAROL b. 00030036 IP Ctl HATTEN,CAROL 7np1O SMITH or DENTDN T1f76001 L2109182 -3i07b,60 HOOUfi,WEILtE 50022631 1p NC HOOUE,NELLIE 22d24eCAgRO~L (SLVD DENTDN Tk.76201 05/$5/83 -26,00 Balance after Medieade HUM THOMAS 8 40017099 ER ADD HUFF, THOMAS 8 RR 4 OREAT BLND KA 67030 04/69/83 -64,60 k JACKSON, ANDERSON 100ai10 1p MC JAC980N, ANDERSON 08N~RACouDa!L Coon V£RY WALC PILOT 007kT TKT7dxrl8 60/62)63 76, 00 { 1r. f M@ ~a g JACO90,NEL13014 40034910 ER CC JACOBS, NELSON II~iA BLft08rJA1Li16M16 W DENTDN TX 76201 06/14/80 -69,00 ; J 4r JOHNOON,LNE 40073061 ER ADD JOHNSON, LEE aad'~PWC AA JaiI DALLAS TX 75221 O5/01/03 .Donlon Qut p1 -49 00 I,r~J I I JUBTICE,DOTTY L 00037432 OP ADD JV9TICE,ERNEOT N41 CfiXfiCUnTfVJE M1HP RT LEWIS3VILLB ~7k 75067 03/2)/82 »132.40 V' n~ oq cp f y KIERTANIM PAUL 9 40033532 ER CC KIERTANI$,PAUL 9 tDGIMU 4pttrii 315 2 DENTON 1X 76201 06/10/93 -56,00 LAWSON,DORWAYNE 40021309 ER 140 OARAETT,ROBBIE 41DeCROp~Tt~B ~O OENYOM TX 76201 06/215/80 -{3,00 V J'I LDFfif,LMELDA SOO33595 TP SP LOPEZ,CAROLINA — . . a1tnnbR~1#ArNWpal~~r~~ B7Ddlcade DI?NfON1X 167(07 Ob!k3/83 -3.432 915 In ment Care V ;MCOUEEN,DOROTHY 50022069 IP MC MCOUEEN,DOROTHY 1. W HICKORY DENTDN TX,76201,OS/"/00f -12 00 Ba oenqce afte@r ped cede iV MILLER,CRIO 00046939 ER M0 MILLER,ARLIN 2 33 AIN08TgN RACE DENTDN TX 76201 01/03/03 -87,20 Balance after .Hedioada,., _ MILLER,SHERRY 0 00047217 IP MO H1L4ER nILLV RT 2 LOT 007 RCCWfi DENTDN Y% 76201 01%30/8D " -is DO 4rl f - 9alence after Hedicade ,,dj r a t s, s I qF 1 1~~, FI<Nn,flr+'K`~h~'li~nr~ RL h 1. 09;43;49 29 JUL 003 CHARITY REPORT PAGE 2 , y PATIEJJT..... . r r PAL tO.... PT rC. OUANA100A NAME.. r r r . ADDRE96.... r . r . r . CITY, r r . 91 YIP.. D19, DYf!. AMDUNY, r r / III MOROAN,ADRIENNE M. 10021093 IP MO MOROAI4,DIA14A 7l5 JACKSON OENTdN "TX 76001 04%27/93 {6,50 , MOAOAN,JOYCE A 00046629 IP DAI MOROAN,f10YCE Ba~ nrOe'A'D&LlWe DENTON -TX 76201 07/74/97 -544, 10 i V + 821 nco after Hedloadgg NEA9dN,NANCY O 00049802 EA CC NFA80N,HELOA 60aapp 1 H FA ILL09LLMEADOW AP 4 DENTON YX 76201 Ol/03/93 •72.00 ~ 1 - - 7 / DDELL N15 DENTON T% 76201 65¢7/83 - 1 1. 00 MC0 DU PENAM, ,CINOY M 08TAN18LA D Indigent RU C re PENAtlOtlM,,AMANDA M.69TAN18LA 0005314002945157 IP RR ISO tl lCaJe M2 C ft d LEWISVILLE !b pp1,,,- T7(730.28 07/19/82 -9,474, t0 I WO a(tgr Medicade ' PRINCE WILLIAM P 00054999 OP 9P PRINCE, WILLIAM PO tl0X 1qY AROYLE TX 76226 12/01/82 -L3,41 J - -Sexos Rehabil l atlon , X11 RANOEL,9AENDA O 40007999 ER ADD RANOEL,DRLNDA O 1360 N BHApV 0AK9 .760 OaVTNLAKE T% 6i' COV01/03 -51.00 J RASOR,LOTTA F 10014196 IP 9P RA9OR,AOBERT 0 e~1t0{ XUgty Jail DENTON „ TX 76201 05/12/0:3 -54.43 j 1r 1 gantal Health kintal D. Retarddllan 3 -77.00 Ii :J REEDY, KELLY 40015077 ER CC DENTtlIJ COUNTS' JAIL tt. MCK Health T ENTON TX 76201 04/0418 1 A /~•r R0919rIl6YTY MARIE 10028004'2P MO Rtl99,DEYTY 11Afl1E pp DOa ~49 DECAYUR T% 76¢"J4 05/¢7/93 +61,00 Dal aaffttggr V f SCOT74AMlLIA 40029613 ER MD WAVINOTON,PATRICE 61ance 9E PAAIRMMggI& dlcade DENTON,. 7X 76201, 05/•26/03 y34,00 Ba ddrIIto 8af er liediesde V 9PANN,TEA69A 0 00065367 IP MO 9PANNtLORENE 1 19 U11h BOWIE TX 76¢30 00/2942 -120.00 !u 4 Mew a ter Hedicads 1r 9PAAY96AKY, 00826 M 40001361 eR 9P appj `yDEARY, ROBIE M 111 c N VMAN 104 T1t 76901 62/06/63 19; 00 ` BTANL;EY, BARBARA L 10070147 1P MO 9TA4aL14Y, BARDAAA L 6 7~3 AL4XgVDPRdl cade DENTON TX 76201, 04/21/93 -67, 50, _ I V 70009964 OP MD 6r j NLEY, KATHOAINE L VAT.'Orl ~Ie.L 442 DENTON TX 76201 05/¢6/03 X96, to Dglance afte .Nodlcade ' THOHA6,9RQTHANTHONY 40037909 ER CC THGMAB DART NTHdNY" - DENTON COUNTY"JAIL 69NTCN""T1060OL 64/24/81 «14.00 Denton ~eenty J ii TRAV1J 19,DONNIE RAY 40041948 6R CC TRAVIB,DONNIE RAY DENTQ, CO, JAIL 315 E DENTON, 7X 76201 0740/91, -56,00 0@ntot~ COIIn Ja11 ♦r IJALTEA9 MARTHA 10027435 ip BP WALTERO,MARTNA 4 M[DDL6 f(D DENTON TX 76¢01 07/07/93 -¢,051,!10 d J l f . - -•--•-_I 1 nt Cgre _ _ ~j Wee 0, dMA J 10010064 IP CO WEflB,DANNY PO f3pff 472 JU8~1M - 711 Y6347 03/06/93 -662,1;4'--'- 'J gent WILL INOHAM,LEVI R 00095168 IP MP WILLIN0HAM,TERE8A I511p2ZTEC THE COL01JEY TX 75006 12/03/82 -89,00 4 WtlAD,AU9AttY N. 10000446 tp MC WORD, AU9R6Y N. . J IltTipe BOXa357 DENTON TX 76¢01 02/04/93 -11.00 _ . Deceased/No Assets_ _ ~r~ W......_._. 710, 03 r kw u j _ , , r: b -OS AvD 1983 _ _ _ fog 1 WA S TE"-OFFr . RFP,D`R 1 ~ PATIENT NAME PAT ID DIBCHO 1120-11AL NEW-CHI NEW-PAY W-0 DAL FC TYPE CYCLE L9T.PMT AGE FG TYnE' 4r ALLEN,9HEARI 0 0000213q 10/IL/92 1,028.45 0,00 -163.32 e65.13 ADD IF N6' 07/25/63 1$7 L r;' *r GUARANTOR INFORMATION r 1 PHILIP 81,1,211` RT n, BOX, 1103.. DI?NTON, TX:„_.76201 r.,.s'sriv , ResppnSe. no ♦,ALL: BUN, AMDER 0 00002246 01/.161`83 57.00 092, Q0 0.00 639.25 ADD ER Ng " 9 • " ' " , *r GUARANTOR INFORMATION. 9*- .MOLLY.ALLI9DW, . „ ..117 2 CAPRICORN Mud N440 DENTON,- TX 76201 - a •I,~ ANDRADErMAR1A T 00002702 05/31/62 2,5911.05 0.00 0.00 x,592 00 ADD t~P R • 1esp~ae ^ 0I/14/83 427 l *r OUARANtOR INFORMATION r* WILMER ANDRADE , 2206 STELLA 11 12 „CENTONI__T%_ 76201, Me, AVtNOER,NANCY J 00003798 12/22/92 611.35 0.00 0.00 611.85 ADD No OP Res e 222 1 M *r OUARWOR INFORMATION EDDIE AVIHO£R R7 3 110X.196 LEWISVI P, TX 75067- Z~o , No Response BIBLE,DIWE3HIA 00006502`011`01/82 342 60 0.00 0.00 34Z60 ADD B 01!30/11,9 977 *r OVARANttlR INFORMATION *k DlNEBHIA BIBLE „724 24 A ItiXANDERµ 0 2MTDN, TX._ 76201 R6Sp0 e • 4 4•DOHOT.WANDA 00007740 09!16/82 1,151.90 0.00 0,00 1is51 90 ADD tP N6 319 1 M OUARANTOR INFORMATION JR JOHN' DOHOT 738,IILMFW000 LEWISVILLE, TX 75067 pp0 Response • RRANCH,KENN£TH S 00008631 01/02/83 41,50 1761 Bb 0 00 218 34 "ADD EIt NB 18 1` 'z '7 r GUARANTOR INFORMATION KENNETH BRANCH 220,HANN N3, DkNTON!„TX „ 76201 W 0ved Left no Addrass r DRIERS, THOMAS R 00009027 0012/83 78.29 11783,80 0100 1 832, 05 ADD ER NO Of/S2/B3 20 1 " 40 GUARANTOR INFORMATION THDMAB BRIERS 1418 KINGSTON L.EWISVILLE, TX 78067 _ '±7 • BROOKB, 6ANORA 00009089 09/27/82 855.30 33100 0.00 ` 808 ,*Q vADD iryengam9$t9 t i~18e/62, 97 „ 1 , Uayyj ' UARANTOR INFtlRMAT10N r* CJRTIS L DROOKB 600, CARVEA WH TEBBQRtl, TX- Y 2 3 O N ! c ~~y@@JJyy~~ ' ,4 7, u Y CITRON RtTA K 10015,169 03/'31/83 609.10 901 ,85 0.00 1,582 q5 ADD lop R;SpVOse 03/31/93 55 3 OUARANTDR INFORMATION *r RICHARD F CITRON 634 UNIVERSITY DBNTON TX 76201 No Response G II 4w COFCR,JBI4NIFER D 00014191 09/04/82 294.40 0.00 0.00 294.40 BP 1P 1 OUARANTOR INPORMPTION DONALD COFEA 331 AT 1 OX IQ 7RE TON, T.K.:00000_ 7 CORN, 9RENDA 0000131 `I2/29/92 990,45 46.75 V ` Y 0.06 1 04 042. @0 ADD ~ ReSpt n e - 50 1__ _ ang D~lt~not y~i GUARANTOR INFORMATION BRENDA CORN 2500 FT WORTH DR Lf'14 OWONN, Kept yep t'°! p rf+, 4r CRIOCR, JEFFREY A 00016006 01/19/83 38.00 .910, 30 0.00 948,00 ADD fr Nq St9 1 ' e* OVARANTDR INFORMATION rM JEFFREY CRID90 370 N MAIN 032 LEWISVILLE, TX .l750e67 • C(JLVER,MANION H 00016386 OB/S3/S2 214,00 0.00 0.00 214,00 ADD £FIb1e WBtOc°te 353 1 4* GUARANTOR INFORMATION *r MAOtON CULVLrR 2000 FIT WORTH DR 90 D[:NlgNi TX 76201 r;} f FRANKLIN,MAROIH M 00023127 09/25/82 437,56 0.00 0.00 437, 56 BA[ [PRB9p09SA fO/17/02 *to ' I- r 0VARANitlR INFORMATION THOMAS FAANKLIIJRT_2 BOX. 1793 PILOT POINT) T Res • OALVAM,Rd8AL1NDA 00023906 01/11/112 1,626 48 0100 0,00 1,b26,45 ID 1P nla 01/211/112 867 1 A *e OUARANTgft INFORMATION ALFONSO OALVAN _ 600 AVE 8 DENTP14 , 7X 76201 r I GEITNER, HARILYf4 00024745 02/19/82 3,464.20 0.00 -10,00 ' 3P439.20 ADD an Nats ~31~°p! ° 63 ~ l+i`, 'k• ih GUARANTOR INFORMATION MARILYN OEITN£R 901 BASSWOOD MANOR LEWfBVILLE, 7k 75067 . r ONANAYAM, KHIREYA 00025044 12/25/92 1, 305 60 375 60 -306.00 630.60 8P rangifentWOW ~ l8 i OVARANIOA INFORMATION ISBAM OHANAIEM _ 2206 8721,1,8 012 DFNTd~N tX' 76201 t Arrangealenls Rot Kept ~~p { ~ , `t , Ir s .174 ( 1`„; h Ag 51 t~'^,l,J ~{.~'F ~1 1 I / y'~ jry~yyY t.. _ .s. W . ~ `~a 7 ~"r . ,?l4°- ;a Ol AUO 1983 N N 1 T E J O F F R ti P O p.r "pAO~ 2 PATIENT NAME PAT tD DISCHA DE0-BAL NEW-C"9 NEW-PAY W-0 BAL PC TYPE CYCLE 'LBT.PMT AGE ~ FOTYPE `f..3 OIAESON, MYRA J 00025064 09/06182 476.10 0.00 -250,00 226, t0 SP IP 1 04/19193 104 1 ~ r }s 1', rr wr GUARANTOR INFORMATION ww MA4K GIASSON .1024.DENTON,11T_._O1?NTON,-,TX- ,1`. 1 )GLORIA. HELEN L 00095536 12/16/01 579.40 0.00 5.00 574, 45 Sp IV "T"02/12/63'. 170 l 'r,•- rr GUARANTOR INFORMATION 4• JOE GLORIA - 3020 MONTCLAIIR.-_,OENTgN, 7% 76201.- -_g. ,__J_-~ + . { - - - ran efents n6t,kept 464 ! f QRAHAM,LAURIE J 00026365 04/04/83 6,539.00 0100 0 00 L 639 D0 to i OUARANTOR INPORMATION rw LAURIE ORAI4AM FO POX 552 SANGER, TX 16226 ti•it+ + Yl l W r 'i ORIFFITH,GENA M 00027300 05/20/82 1+472.90 0.00 -34.00 1,430 Sri SP IPO ""S.se04)08/A3 i15 rr OVARANTOR INFORMATION wr JIMMY W ORIPPITH W. POINT TRAVEL COURT 02671-A 'ST LOVIS, MO 631°t 0.00 830.4t CO Arrange~ents not kept 90 1 HttiMOVARANfR2C1NPORMAT1tlN ww10012847H03120/03 680160 1p49.66D BOX 1013 ROANaKE,-_1_X•- 4 RRefused to Pay HE I MANN, ROYC It DALE 40040511 07/03/03 176.25 0.00 0,00 176,25 SP ER 2 25 1 r rr GUARANTOR INFORMATION wr ROYCE DAI.E HEIMANN PO BOX 1013 RANCH MHP ROANOKE, TX 76263 HEITI,ANTHONY L 00031069 i1/1B/92 696.30 0.00 "'o.00 996.30 ADD 0Ifused~a pay 255 ~'r3J • rr OVARANTOA INFORMATION 4r ANTHONY HEITZ 1451 WH1pPO1WHIL DSNTON, TX 76201 + U ble.to ` ADD ER N9 30 a I ' HOWARD, SHAUWDAA C 00033654 10/05/82 729.35 0.00 0. 00 729, 35 Locate • D 1 a~ L04 GUARANTOA INFORMATION wr VICKI 91111H 2225 BERNARD DENTON, TX 76201 EAL, BERNICE 000,10352 it/iIb,(02 1 1, 632 20 1 , 077. 65 0. 00 21969, 60 ADD Usable t,o Locate y 60 1 n ' wr GUARANTOR INFORMATION DEVICE LEAI.1i _.625_VLAND DENT ONi + MELGNOREB,ORACE 00046230 0003102 1,197.00 0100 0.00 11197.00 so IV 'e"?... 09/00/02 363 rr GUARANTOR INFORMATION rr JUOENTINO 11,ELENDRES C/O INCA METALS P 0 BOX 001 LEWISVILLE76067 unable 0 Locate BP 'ER: 290 1 a 1 MILLeNtORIAN 00046771 10/10182 279.00 0 00 WINDSOR 0. DR 00 - 279. DNNTON, 00 TX 7620 . _ rr GUARANTOR INFORMATION +tr BRIAN MILLER 11A M O L 00047589 03/14/81 20106 0.00 -25.00 255, 00 MCS 10"N" 00/17/0J i60 t r #4GVARANIOAINFORMATION rrCHAALIE CMITCHELL e21 EOOEWOOD DENTON, TX 76201 MORRIS,PAUI.A N 00046892 OS/Ot/01 447,72 0.00 0.00 447.72 -BAI I PRespOs9a $0/21/62 730 l r" 1 rr GUARANTOR INFORMATION rr WILLIAM MORRIS 407 W COLLEOE LEWIBVILLE, TX 76067 14"" 1 is not Kept } NOTYINGHAM,KATHV OOODOV06 11/06/68 757.60 0.00 0,00 707.60 ADD ~ 866 1 rr 9VARANTOR INFORMATION wr KATHY NOTTIIIOHAM _ P 0 POX 046 SCHOOL AD AVBAEY, 1X 76227 PARKER,AMY J 00052256 10/87/82 719,10 0.00 0100 715 f0 SP IP } r• OUARANThR INFORMATION ~.r U. able to Locate u 276 FORMATION rw SHIRLEY JERAELL A1' 1 BOX 54-AO ORAPEVIN67 TX 75061 rr _ PARKER, JIMMY J 00059332 8/07162 270.65 6,00 0.00 270.65 ADD t~RAespo~e 267 1' ~ 201 ww GUARANTOR INFORMATION wr JI1114Y PARKER At $ BOX 405 DE _ Rlsp~nSe + 4 40 OUARANtOR F6LLAM,JEW$LL M Q005305B 11/30/68 702.90 0100 0100 NTON, 768T% 90 75 9F 244 1 ~ I.~ NATION rr BOB PELLAM AT I BOX i82ADAUBREY, TX 76287.Resrn1e.. p POWA0A,DOROTHY ANN 40014261 05/06/83 213.35 t, 507; 60 0.00 1,701.15 SP 73 ! ra QUAAANT A INFORMATION r~ JOHN R. POWAOA 210 MASSEY OCNTON, YX 76201 r, _ _ _ . _ .._____Mo Response ~ A~ '~•J'~ ~ iy„~ , ' % i 1~' A i' 1i 3 i3 n 'til, ~ I I n r., y I.. x„11. GAI w 01 AUO 1983 W R' 1.T E - 0 F F -_.R-E P'.O_R T. PATIENT NAME PAT ID DISC140 U90-DAL NEIJ-CHO NEW-PAY W-D UAL FC TYPE CYCLE LST.PMT AGE FO TYPE it , ROULEO,ANTONIO JOSE 10024990 05/18/83 5,081.05 0.00 0.00 5,081.05 ADD IF NO 74 1 ww OUARANtOR INFORMATION 44 AMTONIO JOSE AOBLP..S. Y,MOTE1. .OENTON,.... TX~7670,1 Unable to Locate 84N,MIOUEU FRANCISCO 00060137 12/27/82 $5.90 170.85 0.00 231.79 SP ER 4 14 1 ww GUARANTOR INFORMATION 4w MIGUEL FRANCISCO BAN 405 SMITH DENTON, T% 76201 No RaIponso 40 SCALZO,MARIA 00060954 12/06/82 2,529.40 0.00 0.00 2,529.40 SP Ip 1 12/17/82 238 1 1►, rw GUARANTOR INFORMATION w4 PHILLIP SCALZO 2$00 FT WORTH DR. 029DENrON,-TX „76201,; _ ' No Resppnse r SHEDDER,CLARENCE E 00062881 11/03/82 223.00 0.00 0.00 223,00 BP OF 3 271 1 ww GUARANTOR INFORMATION ww CLARENCE SPEEDER RT. 2 SOX 346 PILOT PO1Nr, TXV 76258 Aesp nse' SHINS, RUSSELL 00062604 12/19/82 393.00 43.50 0100 23Y.00 Bp 110 1 ww GUARANTOR INFORMATION ww RUSSELL. 12110E .515, RUTH DENTONP, TX 76201 Unable to Locate 0 BIMSFOOROTHY 0 000633622 07/27/82 231.75 0.00 0.00 2^31,75 Sp ER 4 370 1 ww GUARANTOR INFORMATION ww DOROTHY St1SS 1605 WHITE OAK DENTON, TX 76261 C t~ 4P `STACEY,BAMUEL J 00066115 01/26/83 38.00 192.60 0,00 230.65r SP ER.RBS11 nsh ,95 1 , 44 OUARANTOR INFORMATION w4 SAABARA STACEY 702 PAISLEY SY DENTON, TX 76201: 4 • i STARR,RONNIE 00066605 10/01/82 31L67 0100 6.00 311.67 SAI 'N~FRespor~Se 61/11/85 304 f' ' aw GUARANTOR INFORMATION 44 _ RO!lNIE BTARN _ Ri 2 BOX 621C AUDREYr TX 76227 ppoo STEPHEN I3 1 ww ON,KATHELENEB 00066545 01/14/83 966,85 169.95 -773.48 359.32 Sp IP 07/16/S3 GUARANTOR INFORMATION w4 KATHLLENE STEPHE148ON 2702 HINKLE DENTON, TX 76201.4 STINSON, ANGEL M 00067490 07/26/82 205.60 0.00 0.00 905.60 BAI IIOFRA5po 58 08/ M,% 371 1 ww OUARANTOR INFORMATION ww RICKY OT114SO14 P 0 BOX 634 CHM), YX 76030 " o Aetp nse ww 27B.75 0.00 0.00 270. 78 ' aP F 032 THORNTON, JAI419 FORMATION 440006 95 01/03/82 0_1J L _ P._0._ BOX 180 LITTLE 9LM, TX 75068 y. _...______W. I WEOERITERESA A 00073072 10/15/81 2,376.78 0.00 89.00 '2,291,78 SP P~nse 07/19/93 13 t w4 GUARANTOR INFORMATION ww OARALL W90 9A AT 7 SHERWOOD MHP 035 D@NTON 7X-96201' WPEELER,CARRIE 00073619 09/17/82 256,20 0100 0.00 206.20 ADD AigangNBem V'S not'440t a' ~ • 40 GUARANTOR IMPOAMATION ww CARRIE WHEELER 722 181rJ 87 0760 PLANO, TX 75074 1 ~ $ft no Addres s WHITE,MARV fi 00073932 10/29/82 1,991.39 0.00 0.00 11491.35 8p ved L 276„ t OVARANTOA ww INFORMATION ww WILLIAM WHITE RT 8 0266 TWIN LA ~ I•' WRAV, CHAgLfiS R. , JA - 14018711 0.1/ l3/83 . 234.15 ` 1305.00 ` -300.00 _ kfi8 Dt{NTL1N,_Tk :76201 RAY, JA _ 7704 EMDASSY ThRR 239.15 BP 05/09/83 04 171 w" ww ..60MA C ITV, OK 73169 , Jlw GUARANTOR tNFORNATION ww CHAALCS A IJ !Y WRI 0HT,JUUIf H A .000764$2 12//19/82 9,726 30 0,00 9,0617P 664 664.60 Sp 44/ _ P ¢ - 26/83yv ~97 f 40 oGUAAANTdA INFORMATION 07`6122 WROH T 1715 CROIJ Ofi trON, TX 76201 epnI1Rable o Locate ZINN9CKGR,D0AIS E 00077100 14/11/82 200.50 0.00 0.00 200 50 SP E 294 AN GUARANTOR INFORMATION ww GEORGE ZINNhCKER 2627 PRICHARD NC DALLAS, TX ibQ27 _ No Response 444w W-b. TOTAL6 #444 _ 84r. 177' ►D_.9 02q -11,012.50 _tlC i~14: A+i- -a a r'fti Y '.1 r , N Ol AUG 1483 w -R _1, r k ---0 P. p.- PATIENT NAME PAT' 11) DIOOHO UEG-DAL NEW-Clil NEW-PAY W-0 DAL FC TYPE .CYCLE LBT.PMT ACE FO 'TYPO A pfl ANDERBON,L18A 0 00002667 10/23/8, 122, 90 0100 0100 122.90 ADD IP NO `10/95/82 202 it i, wr OUARANTOR INFORMATION ww RANDALL ANDERSON i 11.5_ MARTIN,,LEWJOVILLEi_,T% 75067 ~I ANDERBOIb8V6AN 40008666 03/04/83 164 50 0, 169. 50 ADD ER Otl 0.00 N8 ww GUARANTOR INFORMATION w♦ EUGENE ANDERSON fl No AespOnsO 146 2 1509 6PRINOBROOK DENTON, _T1f , 76801 I r + BAKER,RUDBELL LEE 40004907 03/09/83 125 90 0100 65.50 60.00 ADD Unnaablet to Locate E ww GUARANTOR INFORMATION **,.,RUSSELL LEE DAgER NO 09/08183 its tr ~ _._TAOPIOANA_ MpTEL,Ni14.__O8t{TON~~YX 76@O1' DLACKiptlNALD B 00004924 01/19/83 66 l0 0.00 0,00 66, Noved eft no Address ww GUARANTOR INFORMATION _ww DONALD DLACK_ _ i211 FANNIN, DENTONs_T%.10 _ Bp 76701ER 3 - 144 2, 6tlATHAN,MARY 8 ArI•rangements not Kept 0 00007983 09/18182 152.48 0.00 0.00 152,45 ADD OP N8B ww OVARANTOR INFORMATION ww MARY BOATMAN 109 MASORY.L01" ,08__DENTON, TX 76201 1148 0 BONNEVILLE,CONNIE 40010324 03/11/83 40.00 51 90 0100 - 94,50 ADD No ospoN~ rw ?UARANTOR INFORMATION ww ptlN BONNEVILLE E%ECUfIVE SRI Q 90 MHP X7_ DENTON, TX 76001 • 8000HTON,RICHARD JJ 00007909 01/08/83 127;60 0 00 MGGVVed Lefc no Address W , J1; wr GUARANTOR INFORMATION ww RICHARD DOVOHYON 0.00 127 60 ADD ER N9 ` 209 9 GOX 24 BLIOELL, TX 7626Y • BOWMAN, ANI4A 00008201 06/ 16/82 54. DO 6-00 0100 54= 90 AO0 `VospOn ~ ww OUARANTOR INFORMATION w0 - 00000 .411 • DRI89ON,QAVID A 40030001 05/30116 145,00 0.00 0.00 !45.00 ADD ER NS ww GUARANTOR INFORMATION ww DAVID A DR186ION 11490_HARWIN_qll.,.-HOUSTON, 7%_,77072„ 61 G} 40 90 i ~I~able 0 Locate 412, TO, p 40005407 02/20/83 40. 75 57 10 '0.00 91.06 Sp 2 BrwTOVARANRANTOR INFORMATION ww ART16 t1URftlIJ, p - __LOT 40 FpX CIRCLE ENTDN, Tk ` W . ..BYEq '6201 w rll ► B,DRENDA J 00011/99 01/:4/6.'3 11,00 0.00 A ngemp~~s not kept ■+S GUARANTOR INFORMATION ww BRENDA BYERS 0 00 11 00 ADD CrF N8 184 2 ° W G _ Rti li OREENLAWN._._LANBINO, MI - 48910 i 00011254 04/03/02 182, 10 0.00 0,00 102. 10 ADD Reed Le nO Address • CADE,DORTNIUR INFORMATION ww DOUG CAGE OVARA w■ RT 3 BOX 5 ROANOKE, 331 2 TX 76262 w , CARTER, EVEN W, 40019754 04/19/03 183= 65 0100 0100 183. 61 ADD MgYed leL8no Address i rw GUARANTOR INFORMATION wa BTtiVCN 14, CARTER N3 TERRY BT TAMPA, _Ft. 99999102 2, CLAY1'OR, TIMOTHY OOOt3714 11/30/02 180.35 -0 00 0.00 180:35 ADD U1010 vocate _ . N 5144 2, ww GUARANTOR INFORMATION ww IJALLA".E CLAYTOR 231$ RODINWt)bD DENTON. TX 76201 • COLLIERiDSBRA J 00014664 08/19/02 174.80 0 00 174 80 ADD N~FFe9po " °",111 • ww GVARANTDR INFORMATION ewDEDORAH COLLIER AT 8 TWIN LAKES 089 DENTON, TX 76201 347 fir COLN,JORN R 00014720 10/31/0E 148,00 0-00 0.00 142.00 ADD d -Lefc'`no Address_ GUARANTOR INFORMATION W RY4 q JOHN CtlLW 2604 CbUNTRY LAKE DR CARROLLTON, TX Y$006 _~p. _ _ • ~A~lA CtlTTERILL LORRAINE 00015271 00/29/02 70.50 Locate 0 00 0,00 70,50 ADD V~R , kt! QUAR4N9SIOP9LL9 INFORMATION ww LtlRRAILEyCtlTT11 ERiLt, y . - UrX 7$067 t ' 1709 PEDBLERBACN DR L5WI8VILLE 33Y 8 ✓ 1 i • 0002390b 10/12/62 156, l0 0.00 r20 00 136.10 ADD r~b1e tRoca 04/8'1 t!4 wa GUARANTOR INFORMATION ww JULI U OtlNtALEB '100 D pUnDCI L Nt34 DENTON, TX 7bSI01 0 - A r11 Unable to Locate i i ~s Ol AUG 1983 W R I T E- U F F R l p d R T""'__.__ PAGE D W PATIENT NAME PAT 10 DISCHJ DGO°gAL NEW-CHO NEW-PAY W-0 PAL PC TYPE CYCLE LST,PMT AGE FO' TYPP ~Arl r ORRENFIRLDr RACHEL 00027011 01/16/92 113. 00 0.00 0.00 113,00 ADD OP ND 562 2 +N GUARANTOR INFORMATION wx ROONEY OREENPtELD GENERAL DELIVERY WILLCOXr AZ_ X6643 Unable to Locate iy HEARVEY,PARRY L 00030965 07/31/82 61.75 0100 -41.00 20.75 SP ER 4 OD/06/63 87 2 , x+ GUARANTOR INFORMATION an THERESA CASTEMADA 104,5 kUDDELL_APT, 2 MNTON, TX 76201 Arrangaments not Ke !M HEO0IN9, KE3Tl1 L 00031047 10/10/82 46. 00 0.00 -17.05 29, 75 SP ER 3 00/23/pt 07 70 2 OVARANTOR INFORMATION +a CHARLYE HEOOINS 319 RUTH DTN TX;,-7620I_„ tY i No Response HOWARD,CRA10 A 00033472 10/31 /S2 188.50 0,00 0.00 188150 SP ER 4 274 2 ax OUARANTOR INFORMATION x+ CRAIG HOWARD HT 1 BOX 320 AR3YLE, TX 76226 r JOHNSON,CLIFFORO L 00039899 08/04/62 123,75 0100 0.00 123,75 SP ABSp nse +x GVARANTOR INFORMATION xx CLIFFORD JOHNSON POX 223 PILOT POINT,_TX;,_76258,: 4 362 2 w JORDAN, CLYDE E No Response N• 00037279 11/93/82 129, 00 0.00 0100 129.00 AbD 6R NS 251 2 " xa GUARANTOR INFORMATION x+ CLYDE JORDAN R? ,1 6OX 262C_ DENTON, Tk' 76201 Unable to Locate s, KIRPY,CALEEN 00030711 l0/15/rR 146. 04 0.00 0.00 '346.54 @A1 IP 2 1I/18/8i2 290 2 04 GUARANTOR INFORMATION CAI.EEN KIRPY 315 JA009_ D9NTON0 TX 76201„_ No Response.,., X I l22.00 SP ER A 522" MOODYrE0WAR0 F STAR AT SQ DOX 102-t LOCUST OR.1. q xa OUARANTOA INFORMATION ax EDWARD MOODY r x+ 00048090 OR/25/8n ~ 122, 00 0.00 0.00 ' - 743SY r No Response N1014OLSON,MARSHA K 00050490 11/19/82 40.00 0100 0.00 40.00 8P ER- D 259 2 E GLIARANIOR INFORMATION +w MARSHA NICHOLSON 526 SMITH ST _DENTON, TX 76201 { M S GAVAOE,140WARD 00060097 09/07/02 109.50 0.00 0 00 W 105. SO ADD 7POSpor~ 11/0/87 32@ 2 GUARANTOR INFORMATION +x HOWARD SAVhOQ WESTERN MHP N63 DENTdNr l'X 76701',. - q~Yed LSIt no Address 345', 2 6 SCHWGAT2,PERRY N 00061341 08/21/82 149.79 0,00 0.00 145,75 SP x+ GUARANTOR INFORMATION +x PERRY 0014WERT2 1309 W"OAK DIENTUNi.TX_.76201 J H0 ReSDofSe BHAMJI,@HAgUDUIN 00062059 10/17/82 104 00 0100 0.00 104 00 5P 11 LR _ 3 +x OVARANIOR INFORMATION xx SHASUD61N SHAMJt 9649 E PELKNAp FT WbRTH,. TX 76117 288 2 StLVA, t t t JOEY _ Ho Response 00063091 12/06/82 105.70 0.00 -25,00 80,70 SP ER 1 04111/03 112, 2, ~ a+ GUARANTOR INFORMATION +x JR JOSE SILVA 520 NEPTUNE DENTON, TX 76'.01 Arrangements not Keppt _ SILVAkJOEL 0 00063016 10/30/02 00.00 6.00 0.00 50.00 SC ER 4 11/30/82 275 2 y xa GVARANTOR INFORMATION JOEL SILVA ' 415 N RUDDSLL DENTON, TX 7600 ' 8 1 71MdN0,MEL1SSq T 01/10/03 S5 35 0.00 0.00 06,35 Sp p angem2ents not Kept 203 2 I,i GUARANTOR INFORMATION ++00 if MELISSA OlMMON9_ 1114 OAKWOOD DENTON, TX 76201 SIMPSON, PEARLY 00063339 12/19/82 Z407,70 0, 00 -2, 281. 50 16.20 "Sp ~rd engeentsO+yJOj08e/83'M1 146 2 OVARANTOR INFORMATION x+ ERNEST 9I14P80N P O. BOX 69'J' PILOT POINT. TX 76255_ SLOCPARSARA 00063010 12/07/82 174.95 0.00 0.00 174,95 Sp f~I~AeapofiSe Os/i@103 237: 2 GUARANTOR INFORMATION +a JERRY SLOCUM 10405 SOMfiRTtlle DR OU DALLAS,. TX 75224 ppa 00064303 12/11/82 106.00 0.00 O 00 106-00 Sp tiRkespo 2339 S+ ~T se • OUARANram INFORMATION wx JO SMITH PO DOX 067- FLORENCE, MT Q9833 ,I . I~ _ . _ J.+ . No Response - u,a E Hi PATIENT NAME PAT 10 DISCHO DEG-HAI. NEW-CHO NEW-PAY W-0 BAL FC TYPE CYCLE LST.PMT AGE FOB TYPE A 95 0.00 50._ 27.95 MC8 ER 2 10/06/82 325 2 SxxTOUARANTOROtNFtlRMATfgN WILLIE SMITH/82 4 27.,,,,, FT 1 BOIf_J3A„ Af{OYLE, No Response SPAIN,ORAOS R 00065334 10/04/82 171,25 0.00 0.00 171,25 9P EA 2296 2 ~ dUARANTOR INFORMATION ORADY,BPAIN TD,NI TX.76201 wx _ ._RT4 Bq% 387 BEM No Response r SPRVANC9,OWEN JRE 00065495 01/21/83 84,50 0.00 0 00 84 50 Be OF 3 192 2 + 40 DENTONr TX 76201 L+~' ww GUARANTOR INPORMATION wx OWEN JR SPRUAI4CE 916 RIDGECREOr CR w STACKPOLFx DIANA 00066109 09119/82 141.80 0.00 °10.00 131.80 8AI 1101pea"T -04/14/03 109 2 " 40 xw OVARANTOR INFORMATION xx JIMMIE STACKPULE 10 POX CIRCLE DENTON, TX _ 76201• . Respo se V STANFORD,LDIS INFORMATION wxtl00LOIS STANFORD 66274 09/30/89 149.10 P.D. 801f 2790O DE139,10 SP OP 05/09/83 84 2 41 GUARANTOR NTON,, TX76202 STANLFY,.JOHN C 00066324 10125/82 105.70 0.00 No Response ER N8 780 2 410 ~ 01001 105 .75 ADD ' wx AUARANtOR INFORMATION xw JOHN SIA14LEY AT 3 BOX. 9114 LEWISVILLP, TX 75667 71 Moved Leit no Address r •9TEIN0ACH,JAC08 D 00066761 It/06/82 38.75 0,00 0.00 38.75 SP ER I 248 2 I% GUARANTOR INFORMATION xw KATHY BTEINOAr,,H AT .4 BOX_109_ ROANOAE,_TX•_76262. BTERLINO,MITCHUi L P 00066886 06/12/89 3L 67 0100 0.00 31 67 BAT NOlpesp02e ti/32/81 439 2 xw GUARANTOR INFORMATION wx MIYCHTLL STERl.114b _ _7134 ALLEN DR WIC fYA_PALLB, 7X 76309 , ang pot, Kept .1 146,25 0.00 0.00 146 25 SP w em nts 01/0'I& 645 2 STBWART,VICKIE 00067041 l0/25/r8. ww GUARANTOR INFORMATION xw JAMES STEWART 1613 ROCKY IOINT LEWISVILIE,,. TX 75067 1 1 r SUMNER, JOHN C 00068098 12105182 76.75 0.00 _R6100 50 75 ADD ArERngelEantS 18;/113 8l 2 wM GUARANTOR INFORMATION JOH14 SUMNER 321 WITHERS APT 3 DENTON, TX 76201 148 r We t SUTHHRLAN0,0COTT M 00068155 It/2l/02 45.50 0.00 -15 00 30.50 SP ERS Lo~~t 0925/03 7 7, #x OVARANTOR INFORMATION xw SCOTT SUTHERLAND AT 2, BOX 11,64 DENTON, TX 76901H_~_, Response ~ 6R $ 07/15/83 1y, 2 rt, Y r TEACHOUT,CONNIE E 00068916 09/95/82 121.60 0.00 -05.00 66 60 80 _!*,.GUARANTOR INFORMATION xw CONNIE TGACHOUt 2212 FT WORTH DR #29 OENTON, 1% 76201 TEMPLETON, CAROL J 00066973 12/01/82 07.00 0100 0.00 107, 00 SP li4RR45{IOnae 243 2 w4 OUARANTOR INFORMATION xw TERRY TEMPLETON PO BOX 223•, JUSTIN, YX 76247 t - Unable to Locate 1HOMA8,DOOBY 00069120 02/e5/S2 130,22 0 OD 0.00- 109.22 DAI IP 4 10/14/82 s9a 2„- ww GUARANTOR tNPORMATION xx JAMES ARRINGTON PC BOX 713, PIl OT_POINT, TX 76258 HILLAERT,DONICA 4000603 02/13/83 38,00 ' 0.00 0.00 39 .OD ADD ArHyy•Raangelnery8lnlts not 96pt !6b ? ~ i ww GUARANTOR INFORMATION xx. DCNICA NILLAERT P,_.0 BOX 1303.NtSU_STA ,0914TON_NTSU,„TX ;..;76203W,.,... l ed Let no Address,._. i WILLIAM8r90ITH L 00074690 09/09/02 53.60 0100 0.00 53.66'_9m P 376 2 wx OVARANTOR INFORMATION xw EDITH NILLIAMS 001 THOMAS APT 1 OHNTON, TX 7#201 fable t$ Locate 246 2 • WIBENRR,DETIIE F 00015796 11/28/82 162.00 0.00 0 .00 t62.00 Bp ww GUARANTOR INFORMATION ww EARL WISEN94 1820 N RUDDELL #119. DENTON, TX 76201 WRIOHT, SUSAN L 00016 No Response i 521 10/10/62 77.70 0.00 -26.00 52, 75 SP ER 2 03/21/93 133 2 ' w.. r' X 9 ~ ww GUARANTOR INFORMATION xw SUSAN I4R101iT v 1332 ST RLIN0 LEWISVILLE, TX 067 All Response WTI £ 1, 1, .t t{d•i,%^4 _ , 1. 4 ~i 0 1 AUO 1983 _ W R I T E O F r _R 'S P -O. R T PATICNT NAME PAT ID OIBCM 650-DAL NEW-CH0 NEW-PAY W-0 DAL PC TYPE CYCLE LST.PMT AGE FG TYNE '1r y 1 w YATESI C14ARLEB R. 40016463 0'1/03/63 0,00 4$,00 0100 48,00 SP ER 1 04/06/83 102 2 ' GUARANTOR INFORMATION Kr CHARLES R. YATES RT 4 Box 275 VffkTPNi IX 76201 j J Refused to pay _ W YOUWOICHARMIRWAS 00076844 0111`1183 43 50 0100 0.00 43.50 SP ER 2 202 2 . wa GUARANTOR INFORMATION 4+~ DILLY PITTS PO BOY 1254 DENTONI TX 76201 - No Response W 1ANOTII+ORORGUMN 00077099 10/09/62 197,00 0.00 0100 197.00 SP ER 2 296 2 ' •M GUARANTOR INFORMATION Mw 080ROEAN DAHMH GENERAL. DELIVERY LITTLE_ELMI, 7X-,,;,7e0bS,-- Respo se ,y I 2CNflCRIRtCHARD A 00077120 07/18/82 43.65 128 92 -30.00 164.57 SP ~R ~ 0/10/03 93. GUARANTOR INFORMATION M» RICHARD TENNER AT 1 PILOT POINTS TX No Response- Mrti W-O TOTALS 0444 SI 4,1~. 68 -2; 631 M.52 _...6.047.15 ..._..._..-___..:-r~_... . I .10 r - - - - - - - - E ' 1~ I j 1 016 I I f r . .~..«..w...y- 1.... 41~'w; X711 7 1'r l~/~ ~ . ._~.~._..,_....,.~w+h..1. vc .tj., 1. yl. ,1 1i. ...Y.~.r ~~~I < vi, G J 1, a . or . l.. iiM /1 Nh.1✓fgle,&Jh G..I L.Y. :yYtil 1S 'ltl ~ n r,; of auD 190a - w R i T ti it PATIENT NAME PAT 10 OISCI40 nE0-0AL NEW-CH9 NEW-PAY W-0 DAL FC TYPE CYCLE LST,PMT AGE FO `TYAG ~~i GRAY WILLIAII J 00026724 12/11/80 yr, 24960 0.00 0.00 249,60 9P iP 1 2 ' 963 v4 „ 4 + v wr OUARANTOR INFORMATION rA DOODY CRAY 314 f1,NOdQ__ DENTDN+__tN_ y620I, Missing. Packets.. 'i 'OREF.NErROtlER7 L 00026963 07/11181 144.70 0,04 0.00 144.79 ADO 9R NH 79l 4 ♦ 1' GUARANTOR. INFORMATION r+ ROBERT,0ALENE ,_4306 SAN CARLUS- DALLAS, TX 75026 J4HN9pN+CgRV d 00035807 07/l8 92 103.50 0.00 0100 103.50 ID 4r11 3 379 4' . ! _ _S...NT 51n4..ppACkets_ _ - „ r rr OUARANTUR INFORMATION r1 LASCHUN JOHNSON 920 CROSSTIM 6K D pN+ T% 74701 m Mlsstng_Packets _ JtlI4E8r NORMAN D 00037085 05/19/82 ,203 19 0.00 0100 20115 ADD IP N9 439 4 - „ rP rr GUARANTOR INFORMATION rr' DILLY PYE 7311 STELLA 014D DENTON, TX 76201 N sin AC 131 28 $p g 3 ke03/22/82 573 4 rr A M100GGUARANTQOR INFORMATION rr RICHARD100/DDLET0i4 S .T I BOX . 18 C 0.00 0, RAOSDALC . AUVAO... X - 6227;__. _x MORRI$,ANN 00 51.25 SP g g 4 Packets 291 4 rr GUARANTOR INFORMATION, rr JAIi&9 MORRIS . 81,25 BOX 714 LAKE DALLAS, TX 75045 r MOR4198+JACOUBLINS 00048934 05/26/92 291.15 0.00 0.00 - 291.10 ADD . g'Pir ets .432 4,~, IV ' rr GUARANTOR INFORMATION rr JACKIE_MORRISS 04 tlOL08N TRIANGLE MHP AROYLE+T ing6~9 Miss kets » MULLANE+ GRIN M 00049270 05121 /02 499.00 0 00 _ 0,00 499. S0 SP 1-1!' Y~ ' ry A37 4 rr GUARANTOR INFORMATION ,!111 JOHN D MULI.ANff PO B4:<, I011 LAKE DALLAS, 71t 7l166fl ff sing N ~ NEL9tlNrCHRISTY L 00049165 12/02/62 210,40 D. 00 0.00 210.40 SP M1f~SketS 942 4 rr GUARANTOR INFORMATION rr DILLY WEI.SONP W _ __AT..g. BOX .2.,21..;. AUBRfpYr.. 6927 PHILIPS+WILLIAM j ,)R 14002426 02/02/83 217,50 19.25 -01.50 19.25 CO NPSIng fJCeke~s2it7/83 165 4 IW rr GUARANTOR INPORMATION rr WILLIAM , PHILIPA JR 2260 SOUTHRIDOE--~ NTON T% 74201 r 9PEWCER+OWALO M~ slog 00069532 12/22/8? 46.25 912 90 -99.50 46 125 NC 9p"" ~ a 44/l3/83 95 4 ,1, rr GUARANTOR tNtrORMA710N rr "DONALD SPENCER. 7 BOl(_OlC DfiNTDW, T1f.._ i missIng Packets rrrr W°0 TOTALS **44 _ _ _ w + 2,246,63 , 370. 00 i 4R1A, 39 - g Packets r _ . u._ -.~.•..Nr._._..-.rte.. I r C I1 JfJI j ~ ~ t +r.•- »•~..f.-.,+--nw.w...-- " t T 7' ,/j/ `:1 SL w: '_..A+..aGr.~.7' ,.ii.. `f "f' a. •.«+,r.:.....t......L,...tru......•~ ~L.. Fgb.,t'3~ TK1Rt✓!.6 i y - Yf 0. AV0 1981 E W A I T E M 0F F b R.4 -_...r,,.,_ 1 PATIENT NAM; PAT M 018CHO 8E0-bAL NEW-CNb NEW-PAY W_tl SAL FC TYPE CYCLE LBT,PMT ptlg pp Typg ''Ir M t iFN~♦ WRITE-OFF DRANO TOTAL$ ~ M~ $ e .{64,.936.49 _ 7,427.0814, tlla.Z~ X8,290,02..__._..__-...v___.- V~ • - , to I • 17- a y` I \ ~ I zlnar \ i Jrh 'L k~ Page 1 PLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT NOVEMBER 30, 1984 CURRENT MONTH YEAR-TO-DATE Budget _ Actual_ PriorYear Budget- Actual Prior Year 20656 21340 21605 AdO t Patient Days 6,413 41902 5,336 88.5 78.0 86.8 Average Per Day 88.7 80.4 87,5 427 339 363 Newborn Patient Days 834 764 784 14.2 11.3 12.1 Average Per Day 13.7 1215 12.9 132 155 135 ICU/CCU Patient Days, 277 275 278 i 172 158 178 Operating Room Procedures 346\ 326 372 14,664 8, 63 15,213 Laboratory Tests 291823 210977 30,702 1,993 11894 21400 Respiratory Therapy Treatments 4,061 3,897 4,266 749 726 827 Physical Therapy Treatments 10520. 1,265 1,611 11460 1,`153 11667 Radiologyy.Exams 2,976 2,769 2,935 175795 160203 17,851 Dietary Moals Served 36,267 34,524 36,421 935 19101 945 Emergency Room Visits 1,974 3;065' 21006 ~yov t WRITE-OFFS & RECOVERIES BAD DEBTS MONTH CHARITY COUNTY. PAYMENTS _BAD DEBTS COLLECTCONS October $ 51,624 $ 32,113 $ 122,417 $ 38,147 November 15,494 - 131,427 33_,926_ $ 67,118 $ 32,113 $ 263,844 $ 720073 i i i I s I rLOW MEMORIAL HOSPITAL Page 2 INCOME STATf.mrNT NOVEMBER 30, 1984 Y, CURRENT 140PITI1_ YEAR-TO-DATE Bud e_c~_t__ Actual Prior Year Budget Actual Prior Year $ 1,351,997. PATIENT SERVICE REVENUE: $ 15172,742 $ 1,238,825 Inpatient Revenue $ 25744,984 $ 21515,883 $ 2,474,148 151,766 163,207 155,675 Outpatient Revenue 3135816 _ 326,306 320,663 $ 1,503,763 $ 1,3359949 $ 1,3940500 Total Patient Service Revenue $ 31058;800 $ 2,8421189 $ 21794,811 OEOUCPIONS FROM REVENUE: $ 81,782 $ 100,144 $ 38,632 Contractual AdJustments $ 166319 $ 146,897 $ 92,923 160,903 157,878 136,205 Dad Debts 327,292 334,381 272,318. 78993 75,117 47.402 Other/Charity 160t.679 158 468 91 91.5 Total Deductions from Revenue "3§:?6 rg $ 1,1821085 $ 1,0021810 $ 11172,261 Net Patient Service Revenue $ 2,404,510 $ 2,202,443 $ 213370655 29,134 42;003 21,381 Other Operating Revenue 58,655 960481 39x336 S 1,211,219 $ 11044,813 $ 1,193,642 Total Net Revenue $ 214639165 $ 2,2970924 $ 29376,991 OPERATING EXPENSE: i $ 5541644 $ 537,734 $ 572,812 Salaries & ,Wages $ 1,1266987 $ 111165000 $ 1,162,426 81,467 83,851 52,144 Employee, Benefits 166,328 165,268 141,634 1219280 1690919 121,601 Professional Foes 243,332 309,208 236,$74 .194,312 150,529 162,994 Operating Supplies 3890832 363,692, 339,177 216 172 186 253 166997 Other 438 524 361,728 44 546 ._.fi~7 ,74 Total Oparat i ng Expenses ,t $ 43,344 $ (83,473) $ 117,194 Income (Loss) from Operations $ 99,162 $ ,(7,972) $ 162,134 3,691 _24,476 `1,780 Non-Operating Revenue 71382 49,076 9,563 47,305 58,937) B~ w 121,974 Excess of Revenue Over Expense $ 106,644. 41 104 16212 7 i . W. INtiYfbW9, OliYA1Y~ N Page 4 FLOW MEMORIAL HOSPITAL BALANCE SHEET NOVEMBER 30, 1984 r Assets Liabilities and Fund Balance Current: 1984 1983 Current: 1,984 1983 i Cash & Investmonts $ 3871874 $ 502,135 Current Notes Payable $ 348,500 $ 191,155 Patient Receivables Accounts, Payable 1,862,122 998',091 (Net of Allowances) 31892,510 29760,035 Accrued' Expenses 416,286 554,$64 Other Current Assets 11100,475 1,121,567 Due Government Agencies 48,438 637,190 Total Current Liabilities $ 25665,348 $ 20381,290 Total Current Assets $ 5080,859 $ 41383,737 Long Term Debt 1,389,328 1 427 730 Total Liability $ 49054,674 $ 3,809;020 Property, Plant & Equipment; Fund Balance; Land & Improvements $ 183,242 $ 183,242 Building 2,979,088 2,943,464 Donated Capital $ 49455,779 $ 49455,779 Equipmant 4L982,265 418450990 Pledges & Gifts 666,396 559,003 Fund Balance'09/30/83 (585,947) (1,180,404) $ 0,144,585 $ 7,972,696 Revenue & Expense Summa: 41 104 162 296 Less' Accum, Depr. (4,993,438) 4 540 79) Not p, P A E 3 Total Fund Balance 4 477 332 4 006 674 Total Unrestricted rands $ 81532,006 $ 7,815,694 Total Unrestricted Funds II A22,006 12.181§ 1694 i f R Page FLOW MEMORIAL HOSPITAL SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS NOVEMBER 30,1984 CURRENT MONTH YEAR-TO-DATE Beginning Balance $ 139,200 $ 40,791 i Cash Received from: Active Patient Accounts $ 748j371 $ 11616,921 Bed Debt Accounts 33,926 72,073 Cafeteria 9,868 22)348 Appropriations/Donations 48,585 122,348 Other 29,236 59,431 Total Cash 869,986 1 f 912 TOTAL CASH AVAILABLE S4 110091286 Cash Oisburaemontst Payroll $ 576,977 $ 1,035,321 Payroll Taxes 70,979 142t64d Patient Refunds 71992 80656 Capital Assets 290025 Notes Payable 18,443 66,075 l Other 270,932 588,332 ; Total Disbursements 945 3 3 1 870 049 Cash Balance 63,8 3 ~ 3 Cash investments 324p861 324,861 } Total Cash 388,724 388 2'S t Page 6 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS REC8108LC SUMMARY NOVEMBER 30, 1984 % of r _ Primary Payor Current 31-60 61-90 91-120 _121-150 150 + _ _Total ALR~ Medicare $ 300,277 $ 289,050 $ 204,397 $ 48,067 $ 399116 $ 170,503 $ 1,051,410 20,!~ - Medicaid 16,106 51,700 22,817 16,084 159764 47,983 170,454 33 Blue Cross 1050850 52,535 46,459 49 240,893 3 Commercial Ins. 477,908 399,243 '123,167 604 11000,922 19,tL1 Self-Pay 316,406 321,514 341,719 335,459 327168 1,141,9342,804,100 1 216 547 $ 1,114,042 $ 738,559 $ 420263 382_,048 1 360 320 $ 5,231,779 100,CQ,;# , In-House - 2'A0082 i:. Total Accounts , Receivable 15,4720761 A/A by % 23.3% 21.3 % 14.1 8.0 % 7.3 % 26.0 Days of Revenue; f Accounts Receivable 11319 In-House 5,2 Total 119,1 i Page Y1 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE SUMMARY NOVEMBER 30, 1994 ~ CUYre t 1-6.0 61-90 91-1.20 Total Trade Vendors $ 2290383 $ 286,874 $ 285,795 $ 339,`406 $ 1,141,458 Fees Payable 113,158 70,513 76t856 73,849 334,376 Accrued Payables 62,393 62,393 ,Estimated Payablea 280045 280,945 Audit Fee& 3~2, 950 Total $ 718,829 32950 $ 357,387 $ 362,651 $ 413,255 1,852,1 $ 22 j r _I t P i r i t I t i R page '8 FLOW MEMORIAL HOSPITAL OPERATING INDICATOR REPORT w NOVEMBER 30, 1984 CURRENT MONTH YEAR-TO-DATE 09/30/84 BUDGET ACTUAL VARIANCE BUDGET ACTUAL VARIANCE ACTUAL FACILITY UTILI7.ATION; 1. TOTAL ADULT PATIENT DAYS 2,656 29340 (316) 5,413 4,902 (511) 31,730 2. AVERAGE DAILY CENSUS 88.5 78,0 (10.5) 88.7 80.4 (8,~) 86,9 3. PERCENT OCCUPANCY 56.8% 50.0% (6,8%) $6.9% 51.5% 5,4%) 56.7% 4. ADMISSIONS 530 496 (39 4) 11080 10041 539) 6,353 5. DISCHARGES 531 512 1 10082 11059 23 6,323,. 6. AVERAGE LENGTH OF STAY 5.0 4,6 (;4) 5.0 4,6 _(.4) 5.0 7; MEDICARE R MEDICAID UTILIZATION 30.0% 26.8% 3.2% 30.0% 29.0% 1.0% 3219% 1.0% 32.9% PER ADULT PATIENT DAY; 8, GROSS PATIENT SERVICE REVENUES $ 566,18 $ 570.92 $ 4.74 $ 565408 $ 579.80 $ 14,72 $ 546;05 9. NET OP('ATING REVENUES 466.03 446.50 (9,63) 466;05 Q68,77 13,72 443,11 10, OP50ATINO EXPENSES 439.71 482.16 42.46) 436;7,1 4470.40 ((33.69 437.,95 11, INCOME PROM OPERATIONS 16.32 (35.67) {51.99) 18.32 (1,63) (10.0 5616 WRITE-OFFS AND COLLECTIONS; 12. OROSS'DAYS IN PATIENT A/R 80.0 119.1 (39.1) same 101.7 13. NET,OAYS'IN PATIENT A/R 60.0 86.1 (25,1)) as 71,.8 14. BAD DEBT EXPENSE AS A curNent % OF GROSS PATIENT REVENUE 10.7% 0.9% 1.8% month 18,3% LABOR COST MANAGEMENT: 15. FULL TIME EOUIVALt:NT EMPLOYEES 370.8 373.8 (3,0) 370,8 378,6 (7,7) 384. ,1 16. FTE!S PER ADULT PATIENT DAY 4.19 4,79 (,60) 4.18 4.71 (.53) 4;31 176 PAYROLL AS A % OF TOTAL EXPENSES 47,5% 47.7% .02%) 47.7% 48,4% ,07%) 51 , r, . Wf5154M page 8 PLOW MEMORIAL HOSPITAL OPERATING INDICATOR REPORT SEPTEMBER 30, 1984 CURRENT MONTH YEAR-TO-DATE 09 30 83 BUDGET ACTUAL VARIANCE BUDGET ACTUAL VARIANCE ACTUAL FACILITY MLIZATION; 1, TOTAL ADULT PATIENT DAYS 21850 21670 (180) 2. AVERAGE DAILY CENSUS 34,675 31,730, (20945) 33,510 95.0 89.0 6,0) 95.0 8,1) 3. PERCENT OCCUPANCY 60,9% 86,9 92;Q 4. ADMISSIONS 57.1% ~3,8%) 60.9% $5.7% (5,2%) $9.0% 570 666 (14) 5, DISCHARGES 567 550 17 66064 6353 ol ,917 6,323 594; 69494 6. AVERAGE LENGTH OP'STAY 5,0 4.6 6408 7, MEDICARE & MEDICAID UTILIZATION 30,0% 28.8% 5.0 6,0 5.3 30.0% 32.9 PER ADULT PATIENT DAY; 8. GROSS OPERATI_PATIPIO ENT SERVICE REVENUES REVENUES $ 516,88 $ 524,89 8.01 509,79 $ 545405 $ 35;26 $ 486,93 . NET 467.27 449.36 (17,91) 9 , $ 434.94 443,11 8.45.91 10. OPERATING EXPENSES 438,30 398,24 40.06 407,97 437,95 29, 17 98 3348.91 11. INCOME FROM OPERATIONS 29.97 51,12 22,15 26.98 5,16 ~21,80~ (29588) WRITE-OFFS AND COLLECTIONS; 12. GROSS DAYS INPATIENT A/R 80.0 1017 (21 7 99 2 j 13. NET DAYS IN PATIENT A/R 60,0 71.8 {11,8 Same 14, BAD DEBT EXPENSE AS A 15 $7 6 . % OF GROSS PATIENT REVENUE ,0% 18,3% (3.3%) cvre t 16,JX month LABOR COST MANAGEMENT: 15, FULL TIME EQUIVALENT EMPLOYEES 411-.5 384,1 27,4 16, FTE'S PER ADULT PATIENT DAY 411.6 4,33 4,31 2 402,6 8.9 410.6; 1 4,33 17, PAYROLL AS A % OF TOTAL EXPENSES 5019% 5118% 9%) 6019% 604,63 ,3% (.6%? 514.38 .6% ~at3k1P 1 ~r Page 7 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE SUMMARY SEPTEMBER 30, 1984 Current 31--60 61-90 91.120 Total._ Trade Vendors $ 318,703 $ 278,543 $ 190,960 $ 63,226 $ 851,431 Foes Payable 110,231 58,386 710463 62,837 292,917 Accrued Paya'bles 69,685 695685 Estimated P4yables 213,566 213,566 Audit Pees 28,450 28,46tl Total $ 740,635 1_1361929 - 262,423 lib 062 $ 114562049 } j i utar:.ri 11 I etl'.u MYa1 K Page 6 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS RECEIVABLE SUMMARY SEPTEMBER 30, 1984 % of . Primar-L-Payor Current 31-60 61-90 91-120 121.160 150 + Total Medicare $ 373,240 $ 180,579 $ 76,900 $ 46,838 $ 9,484 $ 155,891 $ 8429932 18,6% Medicaid 279040 31,647 26,190 32,343 3,049 76,706 196,975 - 4,3% Blue Cross 82,442 10,340 .e.- 929782 2,0% Commercial Ins. 506,291 308,384 e..- .e.. 814,675 17.9% Self-Pay-.321,422 321-,102 440,906. 368,005 208,697 963,044 2,623,256 57,3% $ 11310,435 $ _ 852,052 $ 5445076 $ 447 86 221 230 1 195 641 $ 4;570;620 ' 100,0% In-House = - - 2469522 Total Accougs } Receivable „x;4,817,142 A/R by % 28,7 A 18,6 % 11;9 % 9.8 % 4,8 % 26,2 % i Days of Rev6nuel Accounts Receivable In•FlouSe 5.2 - I. Total " 101,7 f I 1 r; Mf~YV I page 6 FLOW MEMORIAL HOSPITAL SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS SEPTEMBER 30, 1984 CURRENT MONTH YEAR-TO-DATE Beginning Balance $ 55935 j $ 11,043 Cash Received from, ; Active Patient Accounts 131 i Bad Debt Accounts $ 820,318 $ 110631332 Cafeteria 10,171 200,641 I Appropriations/Donations 35,198 134,670 Other 31 024 760,989 - 863,258 Total Cash $ 971,782 Total Cash Available 1 3 912790 i Cash Disbursements: Payroll Payroll Taxes $ 471,424 $ 6,03b,568' Patient Refunds 159433 998,891 l Capital Assets 209093 Notes Payable 189217 118,840 15,033 Other 361,736 220,671 6,304,873 Total Disbursements 936 926 1318831042 I Cash Balance Cash Investments $ 320,184 40,791 ; 321,1$4 Total Cash f 361 975 361 975 -r._.~...._._. 4E PLOW MEMORIAL 110SPITAL Page 4 BALANCE SdEET SEPTEMBER 30, 1984 --..-Assets .-Liabilities and Fund Balance Current; 1984 1983. Current; 1984 1983 Cash & Investments $ 358,267 $ 358,778 Current.NotesPayable $ 190,370 $ 208,840 Patient Receivables 3,403,872 2,5740352 Accounts Payable 11456,049 (Net of Allowances) 809,988 Accrued Expenses 455,616 440,876 Other Current Assets 498036, 432,861 Due Government Agencies 54,449 673,411 Total Current Liabilities $ 2,156,381 $ 20132,915 Total Current Assets $ 4,2601176 $ 3,3659991 Long Perm Debt 961,206 8796651 Property, Plant & Equipment; Total Liability $ 3,117,687 $ 8,012,666 Land $ Improvements $ 183,242 $ 161069 Fun6 Balances Building 2t9790088 2,943,464 Equipment 0onages ed & GiCapitalfts $ 4,4:65,779 $ 49465o77'9 . 4,968 993 4 047 089 Pled 82,096 662,0.0.2 Fund Balance 09/36/82 (19180,404) (1779452 $ 8,131,323 $ 7,9520022 Revenue 6 Expense Summary 494,Q5 1 002 962 Less Accumr Depr. 4 921 983) 4 468,0 Net P, P A E , Total, Fund Balance 4 351 928 $ 3,837,377 377 Total Unrestri.cted`Funds $ 7469,515 $ 6,849,943 fotal'Unrestrictad Funds > 7 469 515 6 849 943 1 .r 1 r.. IL'. r. ~Y. i'rv.rLwr a\ ♦..e rr ..yi:«..~~ ..u. 1 l''v A ti FLOW MEMORIAL 1105PITAL Page 3 EXPLANATION OF VARIANCES SEPTEMBER 30, 1984 Variance From Fixed 8udi-~et~~~ Curren on ear- o-6ate TOTAL PATIENT SERVICE REVENUE 71 632) 384j389) 1. Volume Variance ) j Price & Mix Variance $ 21,406 $ 11 501 ,118;$00, Comments, 1) Patient days are 6,3% below budget this month which continues the trend that has left us 8i5% below budget year to date. 2) Actual revenues are 6,9% above budget year to date due to higher formulary increases and new services, TOTAL DEDUCTIONS FROM REVENUE 7o923 692,064) Comments; Higher percentage is still being utilized on bad debts provi- sion than budgeted, Other category reflects improvement due to payment received from the county, s I TOTAL OTHER OPERATING REVENUE 31263 $ 12,~24~ , s Comments; Favorable variance for the month is the result of better bad t debt recoveries which follows the' recent trend, i TOTAL OPERATING EXPENSE j, 118,808 $ 290,01 , Comments; Favorable trend for the :month due to payroll and benefit I expense, end inventory adjustments, ! i TOTAL NON-OPERATING REVENUE %473 $ 320,862 Comments; Budget amounts are reclassified to, deductions from revenue except for the $125,000 from the county. EXCESS OF REVENUE OVER EXPENSE 70,836 443,079) i tr1 I FLOW MEMORIAL HOSPITAL Page 2 INCOME STATEMENT SEPTEMBER 30, 1984 CURRENT MONTH YEAR Budget Actual _ prior- Year PATIENT SERVICE REVENUE: Budnet Actual prior Year $ 1,326,522 $ 11229,989 $ 1,275,607 Inpatient Revenue $ 16,918,264 $ 15,352,393 $ 14,6509062 1461573 171,474 162t756 Outpatient Revenue 1,158,816 .1,940,358 1,696,080 $ 1,473,095 $ 1,4011463 $ 1,4381363 Total Patient Service Revenue $ 179677,140 $ 179292,751 $ 169346,142 DEDUCTIONS FROM REVENUE: $ 105:827 $ 15,249 $ 204,982 Contractual Adjustments $ 132699924 $ 926'1401 $ 1,546,326 123,000 163,484 431,081 Bad Debts 1,476,000 21060,544 2,548,983 ;1 19 297 ether 5 L ` W Total Deductions from Revenue , $ 10231,185 $ 10167,476 $ 722,903 Net Patient Service Revenue $ 14,7749220' $ 139697,767 $ 11,5620760 29,042 32,305 79,682 Other Operating Revenue. 346,504 360,745 286,019 $ 1,260,227 $ 1,1991781 $ 742,585 Total Net Revenue $ 15,122,724 $ 14,0580512 $ 11,857,839 $ 601,325 $ 550,139 OPERATING EXPENSE: $ 540,978 Salaries & Wages $ 7,216,900 $ 6,987,042 $ 6,613,$58 949678 55,915 90,117 Employee aenefits 1,136,136 972,743 991,185 1090531 1810694 126,361 Professional Fees 1,314,444 1,686,475 1,312,179 182,579 669219 112,544 Operating Supplies 2,190,948 _ 20122,914 2,161,079 193 980 X03 124, 197 836 Other 2 327 760 2112L743 2 0 7 4 8 Total Operating Expensos 8 13, 494,91 1 .13 16 Income (Loss) from Operations ---129473, 36,377 Non-Operating Revenue 330,862 305,648 $ _ 78112Q $ _ 1481963 348,874) Excess of Revenue Over Expense 937 536L_194,46 7 1 02j.952 ) r , x r Page 1 FLO14 MEMORIAL HOSPITAL STATISTICAL STATEMENT SEPTEMBER 30, 1984 CURRENT MONTH YEAR-TO-DATE Budget Actual Prior Year Budget_ Actual Prior Year 2,860 2,610 2,697 Adult Patient Days 34,770 31,730 33,570 9510 8910 89.9 Average Per pay 9510 86.9 92.0 390 458 472. Newborn Patient Days 41168 5,140 5068 13,0 15,3 ag-g 15.1 Average Per Day 13,0 14,1 14.0 120 81 .58 ICU,Patiant Days 1,460 1,228 1,107 i 60 31 23 CCU Patient Days 732 364 430 3 219 168 177 OR Procedures 2,616 2,146 j,169 15,060 14,265 150224 Lap Tests 182,'128 182,008 184,215 10920 1,947 1,909 Respiratory Therapy Treatments 22058 27,987 29,941 630 697 1,020 Physical Therapy Treatments 7,768 91177 9,003 1,290 1,621 11354 Radiology Exams 15,652 180673 17,141 18,600 16,888 18,686 Dietary Meals Served 221,680 213,661 223,626 990 10280 10193 Emergency Room Visits 12,012 13,098 12,640, 11RITE•OPFS A RECOVERIES: BAD `DEBTS MONTH CHARITY COUNTY,_PAYMENTS SAD DEBTS COLLE Tl S Oct.-Dec, $ 440,750 $ 52,698 $ 614,540 $ 13,956 Jan.-Mar. 1689080 104,517 795437 240749 Apr.-June 134089 2720808 1,1619609 68,197 July-Sept, 149,694_ 28,481706,102. _ 931739 013 458 504 3 172 588 $ $ 200,641 893 , . I~ k~ V 4 `t ry 14 14,48 04 OCT 1964 CHARITY REPORT PACE 1 PAT~' ID; PT PC.- GUAfIANYOR R.- 10104404 2P CC DARKSRrKEITH MA. f" " AT D 3 E BOX 206A LEWISVIL TX 70016 08/27/84 8-6S7,Rb{ ~ 14 E 10187603 10 CC DARKER,KEITH ALAN AT 3 BOX 308 LEWISVILLE TX 70067 08128/84 -407.20 BARKER, INR f' --•-0AT9WOOb, RO9BIN-M------- 401$7904 ER SP DGNTON, COUNTY JAIL------OtTY-OP"DBNTON - -""DE TON -YX-76201 09/02/84 " 107. OLENN,J1i8gIE 10114478 IP DP QLSNN,JEf391E 1608 VILLAGE EAST N10 DENTON YX 76241 06/28/84 -941.b0 , GUITZKOW,JAMEO 4010632$ FR CC JA1L,I.EWISVILLE COUNTY 111 W, CHURCH 1240 N LEWISVILLE TX 7$067 08/27/04 -99,70 ---HAYEBrROBBRT--"----"-- 10127880 iP SP CHARITY, CtTY-COUNTY"-"""DENTDN'-TX NTON`"'""""TX'76201'08/07/84 ~1770174 HODOES,MICHAEL 40104494 FR CC COUNTY JAIL,DENTON DENTON DENTON YX 76201 OS/20/84 -106.28 HURST,LEWIS 0. 40160947 ER CC JAIL,DENTON COUNTY MCKINNSY ST. DENTON TX 76201 09/10/84 -164,00 ` INQRAMrSYLV1A"'~-"--"-- 401069$2 EA CC COUNTY JAIL, tlENTON'-"--- dENTON DENYON'-"~•'--'^-7X-76201 08/29/84 -86~ OO' JUNESiACTHA 10041942 OP SP JUNES,RCTHA AT 0 BOX 362 AUBREY YX 76207 08/01/94 -386_.0_0 . ~ _ 09/12/04 -.69.60 JONES,RETHA J 4DI61671 ER SP JONES,RETHA J AT 3 SOX 362 AUBREY TX 76297 _ u KIMSLEiKEVIN' 10004176 IP SP -KIMOLErMHLVIN- -"932`S-ELM-ND, "--DENTON'- ~X`76201';02/f0/94'-3rlS0t'4 KIMBLE,KEVIN 10127926 IP CC KIM001,MELVIN AT. 1 SOX 446 PONDER TX 76289 08/30/84 1,103 78 W V KIMDLE,LESLIE S 40140116 RR ADD KIMDLSiL98LIE 6 306A DELAWARE IRVtNQ TX 70062 07/29/04 -107,50 _.____KIM9LEtM9LV1N--'-'40147761 SR-AOD-KIM13LEiMELV1N' ""-006A-DELAWARE IRVINO-- - ~YX-79061--07/28/84 --100:25 V LUCERO,MARYIN 10122013 IP SP LUCERO,MARTIN 424 N RUDDELL DENTON TK 76201 OS/06104 -757 10 MAROVIS,JOHNNY P, 40109788 CA CC JAIL,DENTCN COUNTY MCKINNay ST bENTON YX 76201 09/07/04 -119.00 , °-°MANTIN,DAVID L. - 40160001 CR CC-DENTON COUNTY UAIL,"-- - DENTON,000NTY-ANVX'*"tISNTON --""-YX 76801"0'1/OS/S4""+107PQ0-""" MILLER,ORQO A 40161903 ER CC MILLER,OREG A 709 GLENRHAEA DR LAKE DALLAS YX 70060 09/10/04 -t77,tb MOROAN, MISTY 100$7073 1P CC NtlROAN,QORDON AT l SOX 379 SANDER 1'K 76266 -2214b6:90 OURS.-tX1HN-N.------- --401633tl EA CC- DENTON*COUNTY-UAIL'!- --*DENTON-C %y63lOf"09/19/84"" 107 V REYNOLD6,PAULA 10129069 IP CC RCiYNOLD8,PAULA $66 NDRTHSIDE LEWISVILLE ''TK 76067 09100/04' 1110,36 W RH2NEpMICHAEL ^ _ . 40198902 ER CC . - _ DBNTON,COUNTY JAIL COURTHOUSE ANNEX DENTON YX 76201 09/94/84 -310.20 ~ RH1NL"JCHA9t --'----'----4016#634 ER-00 "'JAILv DENTON-CO. - MCAINNEY ENYOk rX7761I0t"'w07m +101'1 1 +t; SHUFFIELD,SILLY 101[26126 IP CC JAIL,DSNTON COUNTY MCKINNEY 8 02INYC61 d TX 76201 06/21/04 -4,00 t~ - V 8HVPFIELD,9ILLY 40186483 CA CC OfANTON COUNTY JAIL, 001 E MCKINNBY DENTON M7601 01/=84 -0.u40 rSHUFFIBLDr9lLLY W:-- -40180913 OR CC --JA1LrDENTON-COUNTY-""--'rMOKTWCY-STA, T1<ti7 OS/i!6/S4'" • ~ t S A ~~ti . rE.~, 6if0Y' , ' ' fit, y+ w 11. 14:15;$6 04 OCT 1984 CHARITY REPORT PAOE $ I` PATIENT............ PATr IDr PT-FC.--OUARANTOR`NAME...... ADDRE68..... 1.if t7Y ' . `tlYYIPIT DIB DTfl,- t~•. r -SHUFPiSLgr51LLY W;--- 40188087 SR CC S11UFp[SLq,BILLY, W - PO 40%"831 84NOER 7%°76$66°09/O1/tl4"- -29 7 SHUFFIBLO,BILLY W. 40158214 OR CC JAIL,DENTON COUNTY MCKINNEY ST DENTON TX 76201 09/02/94 -56.20 1 _ 9TAANB6,KENNt1TH 40154866 OR CC COUNTY JAIL,DENTON MCKINNEY BENTON TX 761201 06/22/84 -f16 30j 1, ` ---TURNERrCHARLES- - 401896$6 EA CC JAIL, OCNTON'-000NTI'---'-MCKINNEY--S"EBT- "`-'DENTON 1 %`76$01'OY/07/94"`"117 1 WATSON,PAANCES L 40137333 OR SP WATSON,rRANCES L 624 SMITH DENTON TX 76$01 06/26/94 -02.46 I WAY9ON,FAANCES L. 10112175 IP OP WAISON,FRANCE13 L. 624 SMITH BENTON TX 76201 06/16/64 -966 20 { V i~ ----WATSCNrFRANCES L. 40089LSO OR SP WATSON, FRANCES L,-------624 SMITH DENTON""T%-76$01 01/01/04'-"" ~M700 S" WAT90N,FAANCES L. 40138843 ER SP WATSON,FRANCES L. 624 SMIYH DENTON TX 76$01 06/21/64 -49.90 V V WATSON, PRANC98 LAVERN 40189534 OR MC WATSON, EDD1f5 624 SMITH DBNTf1N ,l rrt .,7X 76$01 04/06/64 »127. 40 WEBBtIcORAINB- _.._.-10125618 IP 9P ' Wanoi JERRY TX-7624'1 09/21/64--2.7V5,- 4 WYRICK,CHARLES 40124232 ER OP WYAICK,CHARLES 1100 7TH AVE FORT WORTH TX 76101 05/12194 -76.00 ' i -36, 971. 07 . V ' y Y ' 1 I lY' ~.......u.._~......r_ _......r.-..._,.... rum.-..ra. - ..J._. - - 1 ~ . v 1 1 ,rte li,ti. ' w - - - Y . .iyOrr~;e~E,'~ y1n~1't~, {it~~lJ4 Y~ 4+ .r...~...:.~..' ~ . ri l,,i.~....1~.o ~ , nY•i,, i4. us' ~ , r I 1 ~ 1 01 OCT 1984 ar . 1a}. tS' WR I TE -OPF REP,'0A71 ~~~~'alb 'b PATIEIIT NAME PAi 11) UIEC110 BEG"Bill NEW-CHO NEW-PAY W-0 DAL k PC TYPE CYCLE Le T: PMT AGE •PO TYPO, - a y > f u IIt~~f r i ' 4 1 l . ' ...JAB EBTL.HONICA.._.._._._ --.._)ci12?L71_ic:tl3.LLLL'L.__ 9. 7g. ~rt nn '9.v u tp ' - ti 1 i ~c .1 1 ,>ir ~T,' ti f J -.A~(70 1?1 7~ Anh' YPR s. ~htEli ,119 r' t' ` tiw GUARvJraR , I(IFORi1,411C1'1 i b, riurT 797 S. MU ORCHARD 02078 LEWISVILLE, TX 79967 't;,t r nEUlAficLf~u: LUrsL~r~ - Eri,l , SLtD: .:LClaui=..II.; _00 y r . A r a EAGLE LN zo rj. _..__GB OUhSAIJ iUR~IIdcpNfM4*-ICi IJ M~~LSI aTL3 nOr'_o.A/39 LHARJ6 +n AO ~t4r7% x71 8 FiiIBCOrI IX +79039 N1 j ' r t T. I ! b i ' i UAfi01111 r' nlfer a1L0::::L; II@L111FL4 F Ynt I. wr OUARhIJTOR IIJP0p11hT1aN uw 101lAliltJ A Tl:rJfVSH 2206 W 6TELLA 08 DENTO{'lir ~ 762D1,`»I§., 1, _I I 'I 1}Fr^t Jlgi 1 ~I rr OVARANTOR r~.lsr r ~r BOX 6979 DENTUN NT9Ur TX 71,203 - - , ' V.Sl.AR. f ni , t c n ~ 1 r. • ww OVAAANTOk INFORMATION w. L0u[° I' ARVILAR PODX1135 122In on 1, 40ERNARO111:1 1!11 1 + r.x lt'-~-g^- 'n11511fr 7Jj +76a9 _ r., 5t .S.a I,. 14 r P(.,p 3 1 t", I ~._.41L2pN«G011F'07i.'L-, _ _ _~.AUU7.3 1.>3. 0.2L09, n_OIL.._Y. I1.UU ( ^I 'y4 tYti7urdd If vrr'° 'X` • V ww OUARANT(}R IiJ'"ORf~,41' I UI1 i u 40191 r'ft f l.;t.PAN 2504 LOUT DE 416 Dnil 'TX 7620 rtTI1p._0t)/y..,.C1;3_.___1~, s- n ^n 91 ww OUhRAtJ TUA IIJFC1ItMh1'lUIJ ur iET Affl)J e, n4 IEB^*t---r- ,JSt+Z.- y OOI CAkDIPJAL 'UENTONr4 X S 6201 ' ' t 0 t, 1 r`\ ___._AHIJta-JA11tSi_I1ElJG~.If 1LW1LL__EOle 9.1'L9_D311ll.Bl__-_._-7h_nn-t gti _••a9 ns' atY'n6-il! 'Etf+l 109 tip) wn OUARAIJ rr1R I14F01+M:+TfC1f1 qu YfuRf nl'.I'I 11w 901, CARUIIJAL DVIMN, fX 76201 -~_/ILF.hdLlAC1L~515(:f4L 1~.. .~IULIIil.L49.LG.']L:1._._ -k9~:I0- f1.~Dn 377,. n < A ,ww OUAAAIJTUp INF011MAT IRW •w BHCRYL ALEXANDER No 1503 GOX 793 FAIpCDI'.TX 79n3 ~ (.e 2~' h} I'. r. Ii Al I rL1.1J.ILLIAli.I.' 4U13 :1:11,_.ilGL;.U/114_;102.2`' h h r♦ OVARhNTt1R INr'l}RM4 ! 0~. in 00, . 71h. X16"df .7'a* " p8' "1; d~~i jt4 pA ^ } i~., y 1'ItN ilu.,lnpl 1. rd I1-11 616 RODE DENrON, TX 76201 'I lsllE:11L?.111'1.!:{•:Qfl.fL1.YJ11Jli_._._...__3UL,.cd".'._0LJ_:. L.___SIL.Oo w♦ OUARANTOR INVOr(11AT1011 aw PEJOY L1'NrlL Afl''II4M4 1^8 ❑ 10 n iJ 11A1.A.FLE _ , innDENTONjmss. x no t.7690 „ ------•'T~- n 1~~ + 1' l y , r f n .-._.ARGyFJt. RF.N4 _ Jt '~V • n ) ~ , , 1L 'l:l~, rl,. kf \ _ A1,01013/1.:1/.J!L_~~.37n ~i!f _ ~n5 .'7n •rt nQ'"'' 1 ww OUhAArJTOR INff11JMATIUN •lc(f I" nr AW:r;nLR RT7 BOX 438C VENTON, 'TX `r 76201 W 1 V L' f fJ Jfl l f. l A-~J 7111'LC ^1-Q1Ci'L: It 9 n l_ Q Q¢ w♦ Ol~lIRANTOA INFORMATION wif PATRICIA Arf~TCJ BOX I4 p099TON1 Ci V I Y, 1 1r Iti'~"w NT''" C10- -4 q UE 3l_A7/Dl/.Iil.__.e....275 a l79'.. of nrn ,:1 `.lia'r N+( I " r 1?1 i`jn.,. r'k ! \ L7,46*,ftqUARA14TOR INFORMATION •Ir JUC7INE ARSIATU V 1216 JIM BT 1RV1NOlr TX',79061 ...1t>!. N# INFO(JM AjjGTJ UAMr9 HIM ATHINB 3 GkN7T1NOMAr 4li, O~~~~~~ r A ~ ¢p i r, 1 „ .t e j: ~ I f~r . Tr S r ly T ItY 1 ~ y ter~I ..:.4I1Li3482••.OGL14inay "..$4-.T.S.i.. "t 1 ~''yt.~~' M ww GUARANTOR INPORMATION wq LAXNOR AYALA 2R04 14 ELM DENTON, TXi~ 1201 f "4,'}t \ i''7 a 1,-; t a t , . r ANFa• lier rWn ~:n~ , ~ « QVANAfJll IfJFOk1jATjnIJ wM FREUDIC PASSEk >g~~ E71FRY pk1~~QN~'IT {yq I '1 i 1 v ~Y , ' , 1~ r aSr.; Y~ 1 ~1 ,V T(`~'.'( r~7~ ~1• \I< 1 Ir A.. 'S '.k'ws~r~,•rrt>Jfl hNV~,$l ,I;Y i/' , r ~ ~ ~~a a' ,v f 01 OCT 1904 W R I T E - 0 F F ' ~.iryw w.a y % S r~•; 1. ~..r P!f6 _ R E P 0 R T « 1 PAGE: 2: r PATIENT WALE rni 11) UJ~CIEO DFO-UAL NEW-CHO NEW-PAY W-U DAL 'PC TYPE CYCLE ~LBT,PMT AGE P0! TYPE Yt, 17 n Cf, 6n nnLAa ' r/89 +w 01JAlJANil1R ff!'"uAran`lol q. Ir,l IsnrJ1GN Rr 9 DUX 305A LEWISVILLE, TX 76067 i ~'~itil+, ~ IF v ti oupRaNrpR INroRMnrlorh,a rAMfTA V AOnnv3 RY. 2 Dox gat N:',11AYHiLL"'gyp DENTOtJ r~Ty"76201 r y 1. w };f a +a OUARMlTOR INr'017M4T t rdJ „ .J I L'n?rJ~:: f i -SG OG ^D-tEO-_-""0-On. 1 07 7 - .201 GTELLA 07 DENTON, TX 76203 , q,• r .DELJ..-IlnrrjF' ~42u:.i51:Z-u Il.:..a[J.i OVARANroa INPOPMATInlJ r+ AIMPE R. M.L n97 a~ `'0 HP na ~p~~~" 4 r., n • BI..GIJO«DCIJICt.L.:__-•_ _ 1.~4'1iCif ~L19`.00..1_..2«d0a..89_ RT16 1).'1-_%TU0.~95E7JT040nrel',!-SiRO-ten , IF a•f nti - 1'~1 51 4 , +a OVARAIJrOR INCOr'fV,Ur'Ir 14 f V OD AUORlrYr T% 762e7 lUl OUARpNfOi' INr'7RMn1 1fIN up 11C53ir BLAND fl2 Dk274 O."UOREV. Tx Y, T X 10' 762277t:,t',, I ~ ~ , l•., -DOLD3..RQD.l FL142LJL1~._ ' OUARAff rOk If !'-OP!^,g716f! r+ AnplN L ULYLP3 PC DUX 09O UENTONr pa a ngt!n/~a ,,30,__~r ,r,' i V Tx' 7620E 0I,I13..RUnerJ M• OVARANtOR IA'F'UIlliA l'I011 ~w ROUIN L BOLD!'., PO BOX 898 D-NTONq TV 76201 ~ 4F, h 7 1?.1...__n3S._E 'tJ nn Ap J;a a^ n9/Ia/gg~}90. ' as OUARANTCIH If't-L1PMAi'!(q: Fit Rf1llIN l.. 1301.1)L; PO.fI(JX 695 Dt?N EON, TX .76201 ~ . y -..--UOU)..-OVDS.C7'._.Ll_--.._--lillU:.':33iLfi011L41.:.:~_1:3~1_.Q.G ar :l +M OVARAIJTOR INFOPMATIOF DUt)CVIJ DU 10 3110 ERATfIltiA tina oh nay ~ T 76R014;(r'' , rr,3E~ ' nlJnnFa. ,JF Fr:auy ABAM...~..~.,___60.L'111(14 _12r L1i8~L r ~.t.l~:::ay - n Qn 17 n rn' " 1) OUARANTUP INf'l IUN 44 j 11'nf'/ r,p/,r•I Ct'UCF, r, T pp rn ~I nn/ni. r n e a 1' y 2276 fUCKORY N4'• DENT ON, TX 76201 LCLAI'Li1Jh__--_ (I I , I._- _ .1[ 70 r)- Of) •t ry ■e OVhk AN rOfl IfJ>:-ONMA7 COfJ ew rLAf)rFIIA URUNN Q,~n '+1 $00 11,,CN21E 4W,JSyILLE, T ,'r 7506 + f Q2..dy OUldl /dJTOR IIJf'UR11A 1'![tll ra ,1. dJ 1. Nh YAI'Ir i y 001 SUN VALLEY ~.IJMTON, Tj 76201 "_.._13UI9L'laSTi..GLJtlJi_Ll'J,IN n - / ' OUARANTOR INFORMAI'1OIJ ARCIJIC 0AYNE UUMPA88 1224 N EAtfI:R AXNF,6yI16~p0 Hxunni.Jennv nlllJ•rfTr, ---_dQQ0.75J44.12L~enJ-r _ya.9Jn n nr `~i •.t h v el 3 a► OUARANIOR INPOPMA}lUi r+ MAOY ORIFPITH DURkHAP1' ' 9LM Na"'' •'1•~' r' cs y PSR4TIIA[IJEAPTNI0,3,LITTLE, ~LM TK;~,Z80 6QAt I , ft ~uaalg.,}.~r,-r nlli / nry<"L[rl ~ in .1a n I M• GUARANTOR INFORMATION Nq' 'JAMHB UURrm, PQOX29p RI vp, I' 4 o?9' , t1 " ' L J~ If4 DYRU.DRENhe .J -1Oa[' iYU rt nLjji Ain ••a D-.00- 44 n iJe)1~._" }an'nnJ rjs~%' 1~'3r ` ~h OUARANIOR INF'ORMATIQN +w AI_tf?N IJ, OYRB t ~L{~ n rna/ge:L ~L' ~,,rL 1' V H V 1323 6111•.RMAW Ok jOENT4{Ji "JX13 76201 A0LL,,-=dMY_.0_~.,., 5Z.7n GUARANTOR INFOR{1A1IRN PFIlJ.L1P CAOLL R I dy T,'P Rf E x92 p TONI, , ~i•Z 2q sl', I v , i~~. P, ki,r, , a p r l •i ,1, LO I %o 'I'A =all V - r9.9' i. ray, r r 1 t~,„ •l' ~gp.Nt w f~itN 'r rit"ik'k':I+TS IL'~~`Tr OS OCT 1944 r. rnn R ,r r IR ,a ~r iJ lyf r.,l Y '.:Syt;~4FJ1 '.j W R I T E- 0 F F R P, P, O PATIENT NAME . f 7~r ` ;i• r 'v}e 4 I J, F\. `7C I•• ! ~r u `P 1! I U U I I DEC-DAL I NEW' CHG NUJ-PAY + IJ 0 DAL FC TYPE CYCLE' vLST. PMT AGE Flo I JYYP ULCC 4lll vi ;:LL . r ;I y. j,5 4 by r,~.k s 1 Ib+i: f ALg1dELL ,S.lf&RLE;, ---x121.3 L.,L.ULLOJLL.,.__S}~~0 n On ,n_O ~ tly y ' ;a t ~ K~.. ar GUARAIJTUR II4LIrP~•il h I• 1 • 917 CRU39 TIMIER " DENTON,.TX x76201 I v' I a.,'av, nnll50:A12-_ _ .`1C(li:~.:L:LUaL.IEZ-a-1 1, 4:u1_l : a n~ t n9n r I ~ *n as OUARhNTtlR tJJFOftNA7ltlu }u hA All nWpY r 1371 IRVIfJ fIRIDCEPOF~j' 16/h r`,'rk~i1 ~•4', ~1)Il cnlfeD~L nrrGel a_ _ 26 lu' U5Ld11~4Oa_-~^G 4 11Di OUARAN.f OE2 IrlF(lr~l^'I n l, rn II. MF'CI-_.L 2023W951-11 CI11CA ' `GO, IL '•604Q§, ;IS tF1L..EfLIC_ r r 1 ` -..-1[:QLI.1.uLU1L19LG~1._l.. L~ rr`.pUARANTOR 1NFUrIMArIui4 in ROIIENT CANTRCt_L - 2212 FT WORTH OR" 063 DENjON,11TXJ.!76a ,,,p -J, P _ An Aff/an/Ads f.~ .k ME r♦ OUnRAN TUIt irF'. i'L 'l l'IUI! .a ROMA'_D LCAN CPI ILC RT 1 DUX 91F '!ALLEY VIEW,. TX 76272. 17?.,. r' , V -..~._Cf~q.HAT11L a01o:~.'_Ly..UD, ly/rir _ a Q 1, ._0_pq_.,_ ) ~•I;•, hf1 tr OUARAIJTDR INFORM,ITIUFJ as 100Th CARIt 1591 IIIII' U Rh t r ,,yx.•, + n ,l Ilk 1`Y!$ , 6201 {~,I,. t' ~ I`1 r 1' 'a Ib * I r xx GUARANTOR 114 L1A11-I ION 4r DAJIIIY C ro' OLL 203 CLARK WHITESDORO, : rX 76273 ~ird. f -i,.fl!_11C.CGA_Lilat r r• -r^ ,r., a 1,' r ,ar GUARANTOR INFORMATION r* A MICNI'1 CARfI'R pq pO~ t0 ZTd ~a~T , ~a s 3ayq -0 1 t i , 1 _____LA[iSS:.i:1Vil7LE5_ dD1:i21U1_B:,LLJ.LSL4____.143 IA n nn n nn" " X47 5A9 pltN 2 xA >F , ~ . , , ♦a OUARJdlroft INFORMATION Nr 0144NLE`; r Irk + CARIy flT Q COX 108 AUDREY, TX 76227, I.1 " ~ ° i. I r~UI.7a-lL _..AL1L3~..12f2LL1QLL4-^--Ll ; nn n ar'OUARhf~i A INFORMATION as LOUIS W CHAItAION VL' IIL- V X27 ABH E)JrB,0V Lf r J 9a ' CHALIOL~@aSi7~~UC 1' 3 ,S .,hr 1 YY.MYjp 1 j,'14 f{ j,. ~'.lr A -..-...QOl:l:J4,3,2.~LLILIJ]A_~111_T I I.' r~` 1. { t/ ii 1 r, k aY , J ou/RAwroR INt•tlnMnTlnN xu Un.vc cNnrlGLtR c700 MAIN D ,tl T. AUDREY, TX '76277 r f z t t~AT_321L ,+--_-~gL2:1L,~.1_Q.1r1ClL14 SLi,An ~b _ E 'I 741L L 1 V a , tktl0 IAr FOR>CNFPRNAT101t ay, WATLR ~~4A9_ CM1.g6L12Lad t` w9~11UBTAr10 N20 X14 1~ r1B19I1A LAt1i2 w 'Aa nn y,' I An WN of I If - **.,GUARANTOR INFORMATION xN LARRY ClSeNA 119 RIVEROIDE DENT N,'TJ</17b2 l ~ ' ! ~ t .x.,p I',~}~{ ~ 'ill~t1,~ ~~~f`:~~ ,Jt, ,4 sr 1 t'FN.•. , „ y - 4UlsU.'11,3.-011Lc11L11~_D6 nn r1' 1 t• i ¢ k: tI o nu J !LI'~k . p~`/a ,1'd 1NFpR ATr'~OfJ a CjOBjE..tiIrAHK ,'~I {`T ?r T1gT QfJD T."',r Of r' t ,v Ni r~t~` , ~,l;. ]',i' ,1 , 11 ,t:' ,j,. .T1,M1♦ ,3 p~ r i L CI Ktdaldt hddl A-IfiKtR ' S { I ~ •p a',f~44'1 I M1 • „4' rIn0II.14L1.L.tl2107180 3 'rf 'nti I n' nn y~ M ar•OUARANFOR INrOri14ATIOIJ a~ JIM CLF.NFhtf 1427. NOBLE :DEIJroN IrXft•7~i Q ~'k ( L ~ 7_" LOUD. '.~:1.OGL_LLL a~ 5p 1 D 11o..• r3"1OIJARAN701iINFORMATl6f1 x CL,ir[FICE COLLINS 'S r 1' qi3 KENr' t , rt1i71 '.,11t7~1 n I i,r,fl tl NIi.IlE:11 y1 11 1A All GUARANTOR IhrURMATIUrI ua CL,f-f51JCC COt•LIN9 Y, Ir 713 KE1' LEWIQVI1,4Gf1~T~f.,.?'~SOb7 / °.y --y...LLLLME kartl 1._QI3.__.._l~ rr DUAq/d1TG(i INFORIIAI'IOFI ex KnRI. COLLIW3 .309 T11UI1Agl1~i~^ fig'' ,hf + -yll , x , „ rap L ',t l'1 r{ _ li ` Y r I Ir' .S41r •:F . WrPl }t'.. ~3t'Il~. ra, wrlWllr/' r' . n. L , t '11{{}}TT 01OCT 1904 WR I TE-0FF REPORT, t 4 pPo?N.: ; PATIENT IJAW rAl' lit 01','1 , DUG-DAL NEW-CHG NEW-PAY W-O DAL FC TYPE CYCLE LBT. PMT ACC PO YTYP„ inn nn O ...L,tt ~[19 t 0.b u, iD~ a )4 n7., 12 1. 1 'v _.~.LOLWLCK..TARAN _-1L11 71~L_-:7`[ 1'01 1._73rL114 ;201yIl0_ 95! y ~a of O'JAR AF{1 UD 1'lUi, 1~ 1 'e t. l7LWIC4 LOT 4 TWIN LMi£8 , DENTUN. TX 76201 ° l' v l9 ^ SRI FY. GL 0.1^ L _J 11 Le. C'L"U2 ~1__. ELZ`I non o. r.{1 _....5fl...7,9_ OP w• OUARANrOR INFOPMAT1014 ♦4 JACKIF CUPLLY k20X1046 OErJrglVr TX 7b2o,1 it 7 t 1. `•LQ~.1{ARFJJ kL Tk11..For l~ 4o-Ij 11.u__L)L/D lll_t_,.._%a_.~. .-II-QIlh.- 0 - ']A " 791 on) 1 an :'11Q/1A/gA tr xA GUARANTOR IfVFQkIIATICIN ar TIJrrt r ctrl rIfiL' .229 WAGNI:k CIR THE COLONY, TX 75096 If~ly ' ti t -fitil.EL1tL{,.I]LLGlfi~ --1vJ'id9:i.i.-Gd~LiLB:L1~2.tiYS1Y an fiP Sp, 11 r-14E3 Ili GUARANTOR INFORMATION ea JCANNIF CRAIIFOkD POD911 326 WAi_NUT' ROANCKTX - 16862 1 }y Yi, ; {E t' 1 RR Fa 2- _-.._ll.IXU.I..OANCI~4rtOL-__-_..--_..__q 111'7';hl_il9L~^_.ll:]!L~._~Y' n n i 4. 00 - 9•+ . DffNTOFL TX 76201 t rt► OV.+RMJTUk IrdrU t,i'IJ,. ~ IC'"n t,nN U1.'",I 307 LOOP RBe 4104 R' , l nQ acre ` ww OUARAwon INFORMATION ax 0"rV MIN 707 DA^SIJQOD MANOR LEWI9VILLE,- TX 7$067 '.'J L+'J 'rr If'r r t: 'fir IfTr Il v •r~ Ak6 rQHU -___._..17:.QZ:..1.`.''i..11LlJ.ll3:7.~___E..i. 4Q n_QO,._ n fln-. $7 np Ann MFR uR h^6 ax OVA9AI1TOR 1VOa14TIOU 14 NALLERfl MHP1127 LAKE IIALLAB~ TX 79069 L _U' Ann D..... n- On _ . --I+r--. i4ILL6J7G_~ --~-rq RLGL. n . 1, ~1+ y xw GUARANrOR ms,wMAT KIf I Jnr.- , I?!1n1 t 7 P. O 0OX 964 DEQATI~Ar TX ,'76234 rp- S' :I ,UQ-- -nn 7,- A rA p 79 S70G TEASi.EY LANE, APT. 7A^;Y k. r+ OU/a:A1Jl'rik 11!1: V114Tin1. DErJTON, TX .76209 ,7 7n A nn ^'1 tP FR 4 0h.r^9/94,_,•, t zo. _._za '1.' u.. j 1y nr OUARM1TOR 1W'6r`i1A71r1ANrJ DUIVI:AN '.qOJ 8 DERIJARD JJ119 OEM%' YX 76201 r4 261 CIQ A [IQi. 4..6Q BP IP ~1~ti ".r j J4 •t ~h x•11,v L'1J'e.D DUMLi111 '0407 HAURICE AVE CI.EVBLAND, OH 441,14 r llj':u+' w{ OUARAIVTQL . v r .1 / r9 >aP ~iL 1t1.1.:.L..,_S..:It..L / .r r: AL rry, nCID1iY._5fi n ww OUARANTOR INFORMATIVII .v DUDI'Y CALM W, "P.O, BOX 99 401 OEFrC1IAM LAN DALLAS, TX y;7,E060 It .,+LQOY [BLI ILK!fML0.7 40122229 Old, 1LO,l 5ti Otl G ntl~ _.~QQJ. _.56~IIR...I3A 3? s $ ? FiZ t i- -!n^2 F I~ *4 OUARMMP Ir,r Qr MA1'1u1J 111 FRANA MARtVN EDDY 26P. RIIIGGNAY CIRCLE: LENIMVILLE, TX 78067 V 34.:.1 ilJl... 912 y n nn 7 "{4n It9 ARD IP ^ i1 .~_,.l:t1GLAliO..IItiAILAI...ll.r..-.+____.J.Q1I7L1111-..OSLL'LLC:L.-1._..._ r7. ♦w QUARMJTUR I.NFORMAITON *q' OA141EL L ENJLAW) 2000 FAT WOFIYHI N48 DE„ T N!4 TX ?,-Y620` ;1J1~a' 1'• 3~1 r,t:, ILkt,A~rl1 f ~I~~ i N4>.: ;I1 1r cNnLAtlI1,8HAtlDY n :i1Onnzlln Q9L0ittii._ 3Q A0_. _ r ni GUARANTOR INFORMATION Mx DANIEL L. CIVi L.ANO 2800 PT WORTH DR; 049 DENTONr) TX '76801 ! IL1I 'GLAllis ZAL01jr N 7.IM 1 n. ~p FR 7f) ' T"~' 'CAMOR~' f ~ r X': y,~ )r a~l 1T'1} Ir N INFORMATION r1 6AI-ONE O ENOI.AlID P ,~I~Q , IQ•f h y OUARA T 4" I v ri~ 1 i' 1 ."t vt UP I ;B~Inrs ' ~en nn 1 1 'A, UIZA.MARta • 0351E^,. J1ZL121+t c nnr 441 R x1I OUARhNTOR 1NFOrJMAT1UIJ +1■ CAPI.OS E;I'1tti1ZA I. uieE. JF11 DF.r~rpNJ 1 X Q ' ``IJ~Jb r:' y~ rr Q111:1:1.1Z.Q.2110f11:1.-_..t1Ei:t,-17 1 J 1 flApe f At ?A pw101 ANr~7 NFOrtMATCON rw rOMAg OAPCIA ° PQ Ba ,819' OPI N l,r Mt M2j~`,.'w ~I ly i } ~ y nit r, V.1 tjl' rill r.. ! 01 OCT 1984 W R I TX O F ri. ~ A K d { 4., still PATIENT NAME PAT 11) I?ISiHC 't' m:., Y v~;IR, ~ ~g'yb•,.'~IaC DEC-DAL, NBW GHO NEW PAY W^O DA FC TYPE Y r' F Iri { _ ~~rLAT. PMT AGE ?LPG ';TYP 1 3 . ti, ' ner1J•tA NiCYJACl n 14,,'Wt~ R ' , Y'~ i . k"33~IffJ , " .._JiuL49311._02LS7lli?x._96 !n d`kn`nn Jrl.i , 1'~••, 'r t!! wr GUARANTOR 114F0Pi1/YIpIJ v+ M[rrr,;l„i. U r„11?CIA y r' 4 `I 117430'SARSI2ON'rH0U8TON1 ;.'•}j~f1 .7708y{ t~ 1 ' '1)15.. nnrnn/•i, .,'1 f~ ~ rr' OVARANTOR INFOI?MATIOtJ ww. 5ANTtA0OOMEZD ,~~'~'_~"Q~'^n'^'S { '~4 HALL 8 '7 „ P yi•.r , "liK .,q f pA , Df: 0p1~0 r y m "I -4p13G.Gu)..061d ^`L17A n, ,~"r' " r~l,,{YH fr i ~.J rt l tgg:.l p` w+ GUARANTOR INvORMATIOIJ +r JIIIIJ GUI7IIkI,L 0 nn ~h 'QO ~f 1 tlj,, .y1 f L( 4 / 2721EFJWY 00 116SOVI1E ,THx 72V13 t~1 •w GUARANTO NFOR - L111Z047r ra/ JLS a^s t6 a 7 5i -=h3L{80_ 4 kG R INFORMATION aw ARTIIJR P GPEOORY, ]fi 01 WEST ' V 4 ' ! r 1~ ne WAY' pENiON c~r r , JN. ! fAn rq _20A.40R2b-QZ/A718p ! .7 n wr CUAR AIJ iOR INFORMd T'ION n+ e _ 0 n0 _ n: n4,!'I I a::7 N'.~ i) "Y • lnJ,,.. tr LISA M GRIFFIN 998 DELAIRE LEWISVILLEr1TX197D067 t IN,.. r'i i OUAgAI(TY~gR JNFORMATION aae7L~tIIL--~9{ p~ r NORMA S. HAOY ' ~ 264 q 01KANH'~ LA, pp 4hT , ' n 4 ! C17 .".yr, , ,ri Va/1y 4t O v~ Frr lnl'.v iii rA'. r,,~~y 4 --1DLtA37.03-1.110.41F33....1. ~t~ n~ as nn`~ f:'~Ar ' J!nn ~ ww GUARANTOR INFORMATION] wr KATHY HAISLIP ~ 11L1A r t V 20B OI0901J LN VALLEY'VIEW, FTX M'7.62724 t ~ 1;•m ' L~I.DAGW~. . ~ 11~ arOUA~ ANFOA INFORMATICIN r-r A.01 AIJ.".C.ORPaN HALL.2L0il___....S~DP SOX `J33 'LlI1'ITJ~' . A allk V wa74a'62Sr _L2J22L.OJj ~Ae r r GUARANTOR INr:OPMATlOf1 ar :.RICKY LEG HALL itr r?;: ,,1't 11 b PO W) 229 LANE DALLAS, Tx ' % 76701 r? A+liFlIJ=C Cd n .i ! 1, 41 i i, ` QUARANI'4 INFORMATION 1*' MARK, IJ. HAMMONDr-0D:3"-Dq.,-'~-I-•4 o nLSI1+~ %q3, 932QHIk i BIDE, L T x 7 Q6S'! r r: J t, I a'.1 17'i'Nd'I iffA ~ \F~3 yr ,r: r~ f I"N 4254._p.-/1n/C1A 1-7nA ra GUARANTOR INPORMATIO14 aw +--0 ~n4 - +p.v, r r r ry f ry TERRY 11ARpdWAY .13?7 LATTIMORE DENTON1171('} 476201 1 - 1N AHAiIN ~,gJj,I! ~+~[I ~A1nk ` OUARANTO IFN F ORNAY1011 GINGER tIATS w OHN'-" rr} jj ON6 Ut ungea, r rY NA ti 7 1 1y y,, , t n, h~,F. r Tae rl' - s r t ; k 1 r nOJ.177tt nn/r3'LflA lab,7~ ` ul ww GUARANTOR INFORMATION wr LISA M. HAROROVE - + 190{tWMIPP0RWH1LL11 DENTQ R' T ti t { n ~ r l:r ,~•a!f i~ !,7620 t r~) 'Swyl. , 'r,>, , a;,,y;~ l1flIlY.1,IF.SS~.,lUDY gD3_09411I-LI3 d P°!, ~ y ,'r''~}k • M~ ,4~IA>j~tt'ITtlR' ~NFOR~MA [OiJ r ~LtVW1,6 HPAHNE89 d 1yp 0 C, E i~, { w r T'} ! 7' r t 7 rr OUAgAIJTOR LNPORMA IOIJ rr y T OAY HILLARp ~ 100 PERRY DR ~ SANOERi ~SX ~6 FxI I~ ,~,~5 1 iYq,7~ j V V +ti. 0 ARA~I~Ttl1RltlRtlg7l IJ •rw '¢AACY' EUOENH HAftRJS • # N k 1 aRsti~ AIR ey u kv'i it SGl 'pn i neA._3..IL`SL.1.tl/an 1''; to^.. A .fr t'n F r' R ~i `I' ,'r)~y5 Iti w t w. " wr GUARANTOR INFORMT[rO-q •-w-.a ~U.JL:A.'1C.UK.:2U .-uHIIAGRR3II)1S (1~~_~,~nn qT''9 Mq ' ACORN'RCH Mh1+ DE TO..Nrtr r +(TXR'.S~6Q v f; } fi ,,.'~Y,tr - rr 0U~ RANTOR INFpR I ;OW aw PEOOY JEAN 10gg 18 7° , s u r 1 r r, 4 1}4J1 1 AA~I N10I4",L n 01 OCT 1904 W R V T E- 0 F F R E A d ,i'yti•/,'. r ~~r.. rh•,. 1 PAOR 6,~N '•r A PATIENT NAME" I'nl . f. 1i1. 'I''; DE:G--GA'. NC.W-CHO NEW-PAY ' W-0 VAL 'CPC TYPE rCYCLE LSr. PMT AOE F'OTYPE' l--HAR.7a-CAROLYIJ' oLE _113U'l US~OG/"aCil.Fiy-iJ..81'1_29 _,.n 2-,061] t.-.90 p *4 GUARANTOR ItJFORMATIUN [L nn ,w CAPOL"'N 9u,: WMT 1110 EDIIJGURO LN DENTO1 TX' 26201, t. ' ENronEIIiI_C..NFORMATION ww _lOf:S AP.LNU.r'L.D IJARVFY :GG1 X77 an 7 RTs'• 3 LOT 2S DENTa1J-LSTATE MM GUARANTOR NHP pENTON, " r 6201 y{r• 1i ' a , . unaW£LL...El1O6hlr: .-LB"U1LLS.^...44107..+5~1-,.3At, ya .0._00 O,..flO y1 ~ a~f 78`~`SR~lrr 7P.+. ,3tM'04i29103" •+ti2...~ '.fry +J' aw GUARANTOR INF0011ATIJ11 aw F~,Oib" IVr^IfICLC. 400 CARDINAL NCR DENTON, TX 76201 'i uncunCllJ.J.tS4t1UA-ItDt:L..__- ,nn~t'LL'L:_.14Z1AJ. t;!LJ....r}a;;. GUARANTOR IJJFUIJlIhT1U11 ar LAURA FRANKLIN ' 7403 LARKBPVR STOCKON,Tlg1''.Sgagq7 fV ~j f I Z„ y 14 w" J&V~t~ 1 r fy IJ ~..4JALIKtl1$..IAUESJLA 1aGDdiLS--U.~1/.12[tl~,q Za n•nn nA !SA $A rw OVARAFJTUR IIAFCRMATIO14 .a LORE.TTA HAWKI113 1618 E PRAIRIE DENTON, TX •'76201 , -!IA1,14 1Su1AMLIUA~._,,- entaY,n?~ n,::''ili,l ab_Of) ~~)n n no q w Fri "GUARANTOR INFORMATION rn Lr)nE „ HAWKIVS 1618 E, P~-.---pIpI~.•.,..,r.. Ap peryTON 4TX., 6204 ' 1 _ ue3JKa,neEJn fnu_I:.L1S..~~_.&12i3.16s~L:iA.D3L➢:1_.~126 &n n pq., n`n0 ' 'tit, Fo~'~.an~ F. r~ J{~,t-! _ti al ,3,~1t,g fl,t `J ww GUARANTOR INFORt7A3'IUIJ nu DAIJ!, MICIIIdLLE HAWKS 109 MAMEY DOX SO DENrON, TX 76301 L14, YJ S~SHAW'! _1a11U1L LU1 d F3'1 1Dq no n nn -5n m Sn no sP rR f GUARANTOR-INFORMATIOTI wa LORI i1AYE6 W114 ae ti kTl SX 17A AUOREYi 7k `76~27 F t 'I -i bl i 1 I -WAYS, JAH1tir 1 ry 7a nn 'sa ry~R a 1(>J' 3 I? cry _..1f31._4L~Q~5L10LSi4 Al an fan e•n0 r. rrw GUARANTOR INFORNATION 14 -1A0I[CE t. Hi,vS 9419 PRINCE LAKE DALLAS, TX' 78068 ' , 1DRICY.9.nTAILr 1QfiIL~'iYa_L"C) ],(:ill ~7_riY_ 15 601.79 (l 00 4.i4--l 4 SP IL! J •0 GUARANTOR INf UPMATION ♦w 6TAR F M<. IDPICK6 901 N CRAWPORp OENTON,,''~XI?y 301r- { i? L3 ph rr ~ _h a' vni~'~lrOUARAN TOR l3dFUliMATlCIIi ve DAlip(_N U Ilf7tfi 5' 49,10 VIROIL FY WORTM, TX ,,76 459 r , t 31 J _..1.G1U2ll.0 S1LS2:32J1L._1,_4312..`f, x..40 n nn r. ~ *0 QUARA14TOk' IIJFopf4ATI0N ww MARK A HERMITHR O1'~RR GER D AEIJJyRryP~ J IS R, , '4 LICRJJANI]F 1..CIJR IF7nP3/RR .3DL$26 Z.~IlSL2~LO1_,._~ L't'y 7,y .J AFnn r'Inq•~y~~ w+r GUARANTOR INFORMATION ra CHAISTOPM73 HERNANDEZ 420 PRICE LEWISVFLLE, TK -.75067 iERWANDL.Z._DAlljA 1-2 -3 it. 11 SP- rR I N. ~ 1 M!I 01 ~RAN~yQf1,;NP4AMATION as JOFE 8MMANDRZ QSQ2L'OUIBEk4 5 6 0/ , 0 J 3 r •d 1 j1 , lr ,l, ~r~ ~l 1, i y b Z IF M TI` r `r ' k E Y, ',ri~N J •f i ,r , .i 4 W aEWNN~jv IX.E', Sy3, , TQ 7231L.D 139 67]00 6 , N ww GUARANTOR IfJFORMAI'i07J ww MARIA E. H001MIDCZ 12,16 MCOOIIALD DENTON, TX ee76204 - - .diLSSOfl4 Gl AU11ILy , ~Z A9l.L1L4a 1 ' r ne/ , . Ir is tin „ OR N •t1~' ' T.y3wA+' r t.~. Mtt 0 +kAN J P RI1A RIJ Ao' AVID W #itDSON _T "1" L L 6 1 t ' RI- ;1" iQ Irl I& M' DA r MA UGOB,R110FaY'tr'K t'ndvm'42.03L2 ' /[~e_ x.8651 nn 4, r +r,. T, N. +w OUARA14TOR INFURMAT -ON ww ACIV117 F 111008 RT 1 QOX 1Q1,, KRUM,: `Xk,7(~ 490 s~JO,S ~''.Ir~.,, A'~~~IS , • ,~r , EI M 4 1 ''Ih. • ~bn Rw r. !Jr priatJ. rr NEJIlT3 . _.AL3.11S1Q.'L,4/.EJ'1An -33'L ''.~'i ~~i.;• d t w♦G4ArTC[IyNF~7IJfn~Ia11 wu MARr,u1;RIT♦ FIILGURN Y 3QE' I q IJT C T,., Q L _ _ }T 0}j~l 4e , y dy E } a r, ,y t Idtl jt',i<„1 'r,~e: f r ri 1 , W R 1 T E- 4 F F R E Q R T PAGE 01 OCT 1464 1,rr yt . • p ,1n Ytl - t •t PATIENT NAME PAT 10 UISCFIO [JEC-UAL N:W-CHO NEW-PAY I W U BAL', FC TYPE. CIYCL(: 1.9T PMT' AOE PO TYKII. 1 twt n y p ..1.SGD~.G4L1aLEta •-Ja '!n ' p IAN, PILEMAII Po DOX 924 ROANOKRI 'TX 76262 •,1 k s ,wr °0 'J ,N«+IFMUARA71j OFAf-INFUPI1A7fUN u.+ArrD,, r I1,~:IfnlJ. ur•UUl Vt1TJ„{ ~_AIIL1:.=~.I1LCi~1L1?LIJ.i,.__-.:aL4'' n n0 L93.-.5[a tIa ^«r^oUARA7JTQR INFORMATION HFVIIJ lSE1TH HILEMAN pp BOX 924 yRgAN 56 jp~An_h AOf ~I~M wi fnpl•11g~'T lep'LF'Y4 '1'X!k.. 1'7.`,__^~~`^t l :...1111LAflI1,-J!!HW.~._ ins OUARANTOR INFORMATION ■r Ji'IRI 14IL.LAPD J03WOODROW DENTON, TX 76401 i A MA IA 1:..,R / l i n v pG.1.,1Ll,sZ.-0=1L.LUiLf1,L. 111, 4, }•.16.-63 12r~1BWIt}rVT~,I: `4DEjl 1 i! i• ;F M' ~+t'LOIjARANTOR'INFOR11nTI0w RANDY H[NDMAN 7911 !O£I.AIR 013 r y BA8«P-ATR2Gli... ~-41x131611._0-S/.flZlra _y6..00 'o no 0 .-0II 1 I; t, ~ FF ~•I~T c'I ! t a' f•f !1 OUARANTOR SMFOPHATION *a FATNICN HGU11ti 140 AVE H 0100 DENTONr TX.,I76201 V trlrH U;".,J1"LrrA "''~11L..1w~J4LLIIr O nn IQA_gp,,{n pp A -74H1 ^ «n 011ARANTOR; INPORMATIDIJ It* REBECCA HOCHADEI. N R~' 0 ~t1X l20 AUflREYk S ,J,/~y 1~y27, },N'}t}I )rYY It"!;;+ 1 I q: slay-T Y r.,,;~j / ..,y,,, i" 4•.~1 1J ~'<iti rr (f5 %7 ~1 , r~•. ,r ;,{r ' , 5 nn L• u n Sin . 1 •F..t ' 1' 7n4 'I Jakl9Uii..P4YR1C1LGLUALU--AO1n63si_O3LO Zti4 5" FR OVARAIITOR INFURMATION PATRI01, 001ALU HOCINGHAUB 1109 IJ, CL11 RICE CENTER DENTON, TX 76201 F 1.• ~f'! R%1Zy__+t"L '1'JLUIU :S ~271cULA3.-d . _"_T_-_.. ' 1Yto~; ff q „ E'S'L 'R08E OP.NTON, TXY 2G t , i rr Vi { If 0Q' OUARArITpry' INFORMATlO1J ah HARVEY URANT HOLC071R 6¢0 `Li ai'n W 'Y r« GUARANTOR INFORMATION SHCNI.7AN HOLLAND 1204, IJILSON , OENTON, . TX'', 7,6201 UQL'UftLLE0GAl1_JL1P' an16EL'll 1!'LLd..-~::4-.'L8 / J9""""^^,~PA' ! err ,r i 71 K ` r \ AN it ArSON r« £.RGAR JOHN,, Hp1.L[fIOWORTH 301CCORUNAD4 '020 0 `'IDF!NTPN',; X Zb201, rr • ^ r ,v uen..fiueJ ct^nnvt. y Il J 11 ' ~ppy1 ^7(1 , r« GUARANTOR INFORMATIIIIJ ^n/ 1 I 'rTIOQA.! [0,r. 11 ~jtt1111hi if, A& i: - .1. it ; , IJ ~:.T,br' p _ bail o ~ L1L .I_ T01 HU1.10WIFD P;0. BOX 39' 1,•TXr,,76271 3s'( i~ r ncTiv I -ZLaj:la.11"dL1241 d`^O.15---- .•14-3,1~----=i=i`J..•^ V rR-';tlP_.._„~._TQ3/..(1ZLti9.._` 04,04tARA1►T'OR SNFORMATIOIJ rr• BETTY L. HOOD p l~OX,5Z11,- kS b Ja ~i R% J~N~~RJ,7~f~ 76~6g1fct~Is 1! A. lux 1n,hA f1 AQ'I r. t'!i rl ; f 1 t .1 + ,•0 , V T An 121 nI. Qn ZRA- B7,,,00 rr GUARANTOR INFURMATION RODERT HOOD - IQTIOLDTRIMHP, A A^ I1LiJ1A$. IAO:L`111~:11111~4f114._A,-1;J3,.L1 - , wr 0 }~Rh1+r INPOFIMAT10N rll, MAE HOSKINQ ( ~2d1!} MC ~ Y ' ~T 29,~~a,E 1 ~,ll~ I} ~t~ n~sAi. IF 1,!(:~,tl ~IIA L+~ "k 1 t.n 'pn,«I nNt ! 00961i0Ti.0"tll013LE4 a PIMA rr GUARANTOR INFORMATION *'r CRAIG HOWARD g TI OCO320 F.~ROYL51 P TI ,.,I~~?4cy,.:1!~f~t I" %N, Ian rw Q CIA N N -wLLJ1z; aa~1 z 1. 1 I :rr n 102b F{ RMQtf~(~VL~ l~Ah} 1p me ♦riOI~ARA+1dR' i <t}11MAFI,aN rr,' G~YU$ R,; Htl1JAR4 1 4, r r., r ! I ,1 Y_ ` ,0 Ayll,~ A.f yp" tl h I„r tt v r• s 'J ,jy 'i f Y M~ *0 GUARANTOR INFORMATION JAMf_fl HOWARD 02296 TWIN L6I ZU1.0ENTUNI;;,~K; 7q'd04.i1{f! a61;1,0 rr aJ1~Dt K$} ! 110 J41UL.Fiftfiil I ALI lnC+:f2.:.9_!,_tJ A.I~:QGtLL__l._!Ll" , x.6 rr GUARANTOR J,gFfaRNI~TI,O1J loo CLYDE 14114 NZ IL4 -i- 1t, O~' I I W ~)J i h F 'Rt 1 _ _ y(~ ,ly ~,,,W ,~Y~ ' I ~''''~~r~ir11'•11 11' li/{~ 1~.1.... rlr ~r.r l' Su15 ry~,h'~'~i A 01 OCT 19H4 W R 1 T E- 0 f' F A E P O R T PACE 8 PATIENT WAIIE PAT 11) DISCHO 10-SAL NGW-CMO NEIll U-0 PAL FC TYPE CYCLE LST. PMT ARE FO' TYPE • ~ 1 , r r , f r 1 ~ ;'r 1 ' . 1l r Y ,I , I,.. r Y i~ 1P ❑ i,r~~~ i7h r~i AI yjy tub f Atdd as fL7L3 LLO4 . _.7RQ 303 nh A nn" l yuti_L +r OVARANTort INFORMAL i0/1 4+ Stiff. ON 110114AND 370 MAIN HT 430 LEWISVILLE, TX 75067 nn As11c1n, nn SP Ir Ost33L01~r- ~31i .w' 0 ARANTOR INFORMATION w« JEARY.HOWARD k Ad? MAOSEY BOX84 ,bENTON,';LTXr 7620! ` It T. ~Y1 All Atl1LBTEft N CARL dn1167''nd! Itl/nd :r An, 2b-,, 0_110 n no Al 26 _ Ann ww GUAnAN(iIR INFORMATION J'JAHITA FORNWALT 1001 LINDSEY DENTON, TX 76201 - r. LLY n r Ant Sn'1h6 04121JaAA iUDOA~,n.~4 on -Pinyon a9 no Sp .__Ffi 4 o~L0AL09 is 7&TON' 'Tx 40 OUARANTOq 1NFOftMAT10N ww KELLY JEAN }IOWFIfL 9tllGORONApON1Di6 7b 76201 ~LGUlE_ C., t '"'IndgAbAA ndlf?l Aav 49.., 1P a ~Iy J 1-1 ww JUX,RAN(O1t IltrOftl!.1TI011 rw i_OUIE HVDDGRT P.O. DOX 91 KRUM, TX •76249 •I Huaucv,.1.flI1.L6...D ~.T11 fn:T A31: 7/fIA f S,9~.51:5~m n_T_1 Td nA 15h ,74 fie ,QC...~.,_4IQ7 2 .w OUAA14TOR INFORMAYION w1f LOUIE S. HUDOERT;,. I;PO 110X.31 KRUM,'l'YX.. 76249 tAnnS,116 Alit_qLln fat ±h p on n .,_J" j fle ~P y 0'10_ GUAR6141OR INYOff PIAt'Ip1! ..Ar_1'11J C tIL)ODt.r. JR PO SOX 392 PILOT 1'OIIJ f, TX 762'30 , Sjlf 5f o1 0411 J 1Q1 7n on In no n on 72 to 3P Eft 410'01JARA1JTOk INFORMATIOIJ 44 ANNA L HURHE'.S 404 CAROINALNA}','bENTgN, T% 76201 HEa f"St1SJJ 7u0312_0_=/ 16L8¢ ' d7 An Q OA A nA 1.. 42,00-4P C1P 7 e • ~a w4 OVARAIJIOR t11FORMA1 IUN CAtl111E1.. 1tl1OHE0 1012 R6F.0 DFfJ1ON, TX 76201 ^ 11r~c0,M6lf MUFr A 7nAi„r- nn'l o, n, it wr OUARAtJTOR 114FORMATION ww MARK HUNTER Y BOX 32 7 BANGER, Y% 76266 ~ f•~f~Y, 1'rg old ;r.: , , { ,'•A'. ,'-'f; 1.. `1 ,~',1 ~Q"•,1 4nfcS9ir~4 Or'L,Oh[tlfL ~.91 7y w~44 _~D O~~ 46 Z.b BP__.a -21 7 " Ell A D" +Y 0UAA41Ntl1N If1p0f11,1A11411 FCNII:(.LA U IrCJ)EH 100 0 RVUIELL DLI-ITOM, TX 7620) r t• ft 0. 21 ~ 114 1. 1J.-......ter n -A 9'11 (1} 166.20 9P fP 2 06/04/H4 119 2 7 4♦ OUA ANT OR INFbRMAI' UN w4 AtJ0ER"3bN JACKSON >Pd pOX'I43 PILOT POINT, T% "76738 1jtT dnuteltWk A'All l _ f 7. -0- 0 on n. n6- -''_11y_SIl_ Ftp rR t ref' I•c t4 ++1 OVARA141OR 1f,IO1tMfl1 'w Ef'MITT JACKSON ♦P•0, DUX 143 PILOT POINT, T% 761:36 n y 1 nn 11 N5n 0t/ 1 +1n L ~f >any 1 n>any f n _ a~r,.ti ~h - +9n A0 1 , Ill 15 ar 1J= x '.1''OUARAHTOq INr'OAMAi}Uit ww HAXEI bAKB i1 329 AVE 8 Ovum, •TX" 76.01 1,1,,E ~r.' :h ! n I ' rt Ny 1 L41L 1 ' 9 r P, -A _._04lf4/H4 1h J nA".4 .F7'. Jl1Y J. 1110-C12~1t1LEIlL ;0y-j_ 2~1 ~_RAg.41 IP 00 OVANAf1TOR Ih,O1fMAI IVl2 a+ J:)f(NNY JACIl COX 39,419 N CHUi1CH PILOT POINT, T% 76298 (y (y AiS1DD,'y'i Og e29/na 191 nu n hn n no 191 00 ~,XP FR 1 I i1w, QUARANCOR IIJFtl[j~MATfON ra AURA,JACIt9c7N 813PA1SLEY D IttON, 1%, 7620)','' " f 4 I 1 I r t f ,r f , ~A ww GUARt'l 11:1-011MATION wr LAURA C. JACKSON 813 PAISLHY DEN10N, TX 76201 f~ n 1+ 11 4101tAh3 69/ 91.11.3 n fill) - it p~-._1Z0 t N 4IBTn?, (}ANBAI? ICITV' 'kAy 66109 Ffl~ , ~f `!'1 srr'Jfw`,Sfi ;t . N, .1 c`,pS03 "1't f'iwr,rO~IAgAW10R tNFd[jMA OtJ lUJpCKWO I,~~I~t~ I~y:_°~ , 1 •:r~rr , t , 1 }i11 ......r , f 'i~.~... ;~,rY, , Slr,r ,dF _....5 . . sir ry 1 1 `Ol `QCT _1984 r W A t,T E n' i <N•:; bFF REAOA 7 9 PATIENT NAME PAT' ID b18CH0 Isl r '.v's" , 1 PAO$ 9 tIEO-BAL NEW CHO;1'• It. F h NEW-PAY W-0 BAL PC TYPE CYCLE ts,• .1 ~Y ► :y.F +b v • 4, 1 1~ ? LeT PNT + ; AOE rl FO fVPE+:. 141N.t2Y&l{I2tJ r qdt, , Y JK ~ - P ti r y5 I. s7 I ~ ~1~A ar ~{y~' 1 t1~''t l+a.fy Ew~4 /1 ~pw OUARANrOR IIJFQRIlATIUN wp MYRFION JACKSUN 4.'±i' (t ~IHsl9A~"~'hP t tS+..+.~F; ~I ',qcr,~~~}~ nOK~143 PILQTPOINT{..TK 76238 GUARANTOR IIJF RH Q4•+.,, 7 I. v.tFE, ,'..r~ f r rkk~'r r +Y..' , o , ~,•a S r.'1i q , ri'll(([,; ~t,/r , 11~,a~i11''t9{~ , ~~~1~T.Lt•~"S~' ~~i~~E~l7N~~7K 7620I i s y_1 . tt<.d4.11" 1)A4 q~_~ qy'1 h~i1.r , 1 i.•'.; ./.(1`S ' ww OUARA1JrQR INFORMATIQN ow RICKY, JAFKSON~~::AA".... !/s!~;y ! "i•~,~+3e v;`~+1~ / 143,, P .f',... XLOT AOINrr Il. 74256 QdF'1,S A5 ~ `,I p l 115'` OVaf{NJTOR INPORMAI'll -K lr r •r! 01 A r , KIM JA~IIJD 1:';•11 r.1 i 3460 H k{,M AEIJvirl Ti 76201 14-1 o..a 1 r IE~NtsEr1;,.Q: rl'f~`tf 4-w~ t'Af,. l.... .,y r , P1.1r1' 1 '~e'r° YS a~',lf~ .11, t Ita ar LiCU y i rw OUARAfJiUR IIJPORMATI WI uw 2L' ~d/~otha' 1 Y`~nn .~r4R nrS i '.'•,¢n' n ~lq'o,i 7' 1 ;a•r~f•• . ~,i'~~~` St4 `JY~;,' ~ SHEILA KEIJN160N AT. 4 OUK 9A AUDALVr.,~ . .IAMFq arFVFr t TK 76227• w411 NlA n INPORMAI IPN + 1, ill: LEN N JAMES ! c ? ! 44t31MCADON PARK',CtR NISJn'_.IiEOPOHUr Tf(1'l+76021 l,.a,ls C,. 'r I` Y: IJAYAIF {Ji .'.a . ' • Ant Aq h'.'!. r ww OUARANTUR INFORMATIUIJ_ #w ~yy~b a" nA `4h hn'` - +'1n nn 11 11~ ~ ' r ,••j WAYNE JtFFCOAT FPCOAT ~Fp 1 r •2311 OTELLA;4201 DENTON, TX 76201 r. ~M70VA11ANYOR 1NFL RMPftDIJ 'xrl''.'.CA4VlN ~CLYbE J$NKJNti1 , P 1111 h I n •dR~...l{~~ .S i' r +.ti4r vi• , yid';. i Y~ gtll , , bQglJgT ^ nEN,TDNI+ Tk-1. 7620n 1 ra i r•lt)/p7 n w ?'"i n nf1b6~B4 # 1 /^i~/Ba a Y7n 02 w♦ OUARAfJ rUfJ fNFURMATI CIIJ ww ALUN 0011161 N A n~•.ro hYa f LA I`' 1 ,5 ( ;+,y'~FCI' v 1 ' 7elb 8 PADRE ISLAND DA N130 CbRPUB C+iRl8T1+ TK 78412 I AllyFt rA y + QuARANraA /NFOAMAY~ t y' nAIJNETTJ~ ,~'i r i. nn as Q , 1.; i•Jv. 1Jq K$RDENTONrr TX b.Ttl1 'A,rN:••. I., i''''t' ilr Al "V r 11 -iT-4 t a' ww OVARAllrOlt INFUKMAI'IUI! ,Iw CSZ70.J'_Q~/,1.3/fed tl'_'""'L'g r1n! rti a via in'S1~ '1 `#tl,.';• r J F,. d. LECN+' 0, JOHNSON POIltd ' P. O, b0K 177' PILOT PONT. TX 762y0 11cr 1 11 11 01 v ;>tiYC A Nil I&F l p~f• I'R DE!> CK FREn NNBbNi s '1~ZpA T i r^E!i-+.- t I•" r rl`' " M Yl. r~ir~ r'Iiq C4K ! 8 TaNIIp1T1<':// 6a /01 )+til9 Ir ww OUARANTO(J If¢F'QRf7ATIUlJ *If EONA JOIWBaN R=A9,1! nnY1 dam!-.ADAr aAti'pp 912 HILL, 87 b a e 0 ~S' ENTbNI TX 76$01 r f RANrQR IIJ b 1dlJ war''J E h/a l nb ON .A , , J •.i, ~'1 r 51'' i .r.J ' {''r ~ .I na'T'W~> F~~~'f r S , y~C _.l. k' I Z'!NI 1•''a7 I AI ~ ~ i H -.1~11Y4. c) ,fj~ ~y~I k p pf n~ , I YK> y ao1 f, , 1 ww OUARMJrOfJ tlsF'OfJMATIUfJ ww EOWIN LYNN JQFbJBDN ~ ~I 1119 KEALkY. bENTONr TK 76201 " r pAN Da! INF a 1 HrJ~s+ t Fq nni A ' 4 . ' ~N' a ,+fUbNN9lS fi . ~r;i , sa I ~t YI:, r is i ~N4aN >I Y -j' J;+~~.-'.~ _ih'ir 7. 'lG r~i~Y•)4 p¢ p I .rb ~IY {{x dd; „tI,JM tsn..s {'Irn nA 1rk~.n~~rd!?14h17 w♦ OUARAIJTUA INFOAMA710N ww G@QRJE U JOH i30N. h A. pv o-y , _ { 17 tr~af, nil 1020RGttU DENT ON1 TK 201 I OINP0RMt1T b i ' ;1QfINNa ~Ia J'aN t°-Oa n nfl , r c a' as --PB-- s ti ~L 4 s Q~3Q.v'l pD'I + t (+'CRatl8~111bER8 D zT• f ! " f i l r1 d EhTgNr TK"I~ d BMnr' i, r N 1PV~ I 1' Yi~fk 7?J" + a 76¢01 .i ' f , t 1. M 7 JI. i ~ +b~l u V ;~:.y Ix. ft~(Ir~ s I I A E;ill #rll .~i;~+l~ ~ •~t~ 1 ~1 1 A - M 1 1 ' 01 O C T 1904 W R I T E- 0 F F R E P 0 R T PACT : 10 PATIENT NAME PAT 11) DlSCl10 DEG-BAL NEW-CHO NEW-PAY W-0 UAL rC TYPE CYCLE LST. Pr1T ACE 1.0 TYPE . ,n f ~ ! f~ 1 w ! `I. ,l~l 'r ~/,I,r 1 E f ~LnI2aXI)9iAlI/ne 7nA< lea on la on qn i~a4."9l1. 9f _E@~3.e f i 11Yr Lnl ra' CI9 n1 vti OUA4AtIT011 INrORMATIUN a+ UARRA6A JULES 209 NMA5SCY DENTON, TX 76201 117 --1111 9 35 04Z 2&/Q4 56 nn p Qn Q Op,T 5!,_ n „r0, yARANTOR Ikl•d M 1lUN aA.'TAMt1Y JUNES " s Y29108 SHADY $HdR$,$ CC!RIt{TH,' TX '76205~ IJ a ' J,bn t(r ,zy ~{f y' 1: ~,E ~ i • _ .1' KansA d/2D~Hd ' d7h a t,~.~l.r A7IGN-... r2QCb,5lFRYL JONE0 r~1901n14~ILA ~ OACNE$VILLfE, pTX 76240 OUAgANIOR 110 ORMA 1 C 3 6c " rf , not^'177D 0'1/10/iyA n n__n~•_17 s4._.,I' .._Efi__I~-"`^^_' - y .aa OUAq All rGR JHFORMAI IDIQ r+ MARK JONCB X302 9ACEd RU$H D£I4TOr~, T% 7h~01 i; ~j, F 7,~(•'t~~a.' 1 Apt 71 670 97 f?p Ip A' _ n1/P6/J:1,4_, lly 'J _ a. 1. >D9y7r t _D~Lil S)ftA-S, a-7ti Sp U as OUARANTOR INFORMATION ea DOROTHY J JJN£9 9P9 SCOTT DEU10% TX 76.101 r nvtletl+n l -.~-tAFre1 tnnnn n n"t0^t114 g'o'? 99 -If) no -I 9R a11.nd sf, P I A [ON a+ HARRY JONES, JR 219 A9HSTREET :LEWISVtLLE<, 7% 75967 r: +11 N R INFOnM T ~ OUARA 1p n~,r:a'ttaunv n lnnlyp;lJ,d_rif.L^iLa,1 t.atal..1h .0.~?JL-"L.f353..99~.._.1~.2...e9._fif~.1F' A a3112LL3a 1g a+ OUARAN16P N,FCfWAl IC,': POCiI' J J(i,r;5 3011 )1.1-LUWSTUNE OCN"ON, TX 762k,I , 2 fQQ „ g~r:.i-3L' tCi. ' 7, R1]:Flin,v nOtn 9~~ o'u 1~ttr4 g•, ^ ,n09 ntr S. nUDDo...LX1L' 1 M97 PENTON. TX 76201 T , ar QUARA!lttlR INFORMATION ar VALCNTIIJU PANDA !p t ~ uel 1 v". r ir~na 0.".L2:JLBa tr3g."1,0 ~g~9:t a+ OUA110.1410k INPr)i+11AT1C71 .I4 JJDI 910_LY 9436 9 UELTLIIti£ 030 MESQUITE, TX 75101 ,nnBtrl 1 ]j1 L401 n~>!Ei3 l soe tt 2 6a1.I5 ~n.919 -45 3,oto 22 . SP 1P n___ Otr/"H/.a IR7i_~ rT t M• OVARAilTUR SNFOAMATiUN +M MARK ,g KNIATT' rC/O DUN-TE% 611 FT WORTH f)RDENTOIJ, TX 7612QI V lY w l. 1, p. 46~:. LVV~Y4.- . lob 75 8L! _ <:@_ y ' byl~:~/D4 - M G nnla"ooa e71,p41da' . -tD. ne ~e rr OUARANTOR IN~0144,1rILN as D. L. KROPP I)CA119C RT: LEWISVILLE, T% 79067 rr OUARANTUR fIJPORNAt1UN ra bUVOLA Wr' LAOL NC ' ' 11902 'MERCEDIES DE'NTON, 7%'i 76701 1 i~~Nn '~'fi6k .I4' .ill 4sYA4Q _qR/wJ-A%II~._ 717 l.9 ~.'D nct n nn` `'yg7'~ ADD 1P _Na 199 ~'a:., ' a+ OVARANrOn INS'On11A1'IC I 40 1IM LAHO nT. 2 BOX 9:10 DENT N, TX 76201 "i'.iLfl'1 n tlA_.. n nh ".t6 50 SP CH 3 a a~~ Oki. QUARAMTOR tNFORMAricio rr JOSEPH DEWAYNC LARUE FIT I BOX 75' RRUM, U',•76249 gl]s1 dHONDn 401 .396 tia/iftfll:_ hh.2 y 0 JU a Oo' 61, Y~_ Lt)4 ktr ..NS OVAq AIII100 IHr-Uf1MAl I(II 14 P11014)4 L.411J1-114 Rt R BOX 630 AROYLE, T% 762'Ui w £ _ iR no Q no g) on 64- 80-,ea Eft . r♦ OUARArlTtlA IflrDRHAT cIN +w, MARY;PATRICtA L6.P t0l OOWIE 9T ttQANdfdE+ 1%^ 76262 rlrs InYr .;An+i116tli tl /t~,LJ#4±.-.`eti e_ee 'f4 nri ng.de" hp Pmt ntP1 .tl..,.. w ra OU/,riANfOR Il.rafiMATlCII! as JAMLS EDWARD LEE PO BOX 1167 ROANO9£ T% ,76262 1 _-5-.-~•--..4~ 1 n I nt11SC too ° 9~,2I; M-I t 769.6 9'17 f7 -9•t 69 V,&Qq. 15-Re I aA QVARANtOR fNFb~M T101J +r fBN417A ,I.QI~ISEL6k', 621BERNARD 02 DENTON, y~X, 75x03 .[C "115 3 { {tA{'~1 'j- 1. d c, dt . f1 ~ 1 ''+I ' 7 r' g y,~_ ,d!')tF1.2 1 t 1 ti 01 T 1984 W R I 1 PATIENT fJhME PAT 10 c , . UI,,6H0 D+iO-DAL IJCT E- D F F R E P D R T C,.+++~ ~ R PACE 1l r' lip } 5 S NEW PAY: W0 DAL PC TYPE CYCLH LST. PMT AOE PO . TYPE ~c f at ..Ir,vPJ jv s i 4 ft' 'elm i : J U . K f r 't •1~`{. , t f1 yu) }'h ~,'ylfr ' S 1 i r gr,!rr .,,}r q t r t IBA k l J'.,t Yr r:.~4 , IIrJ;p ~.ii"G•f,~ ~f '~7✓i yr"r tAAg14>J3js39 1{ 1" 'Ja6'adr•`.~rbM+Yy G wr QUARMJTOfl FNFURMATIUIJ rr EUD1l: LEE r pP ,.,tp sN ~~/1f/s+4 'f sh "nl' S., RT,,2 CAINESVILLE, TX 76240 i~!*w' QUARAtJTOR INFOFtMAY] N i RODE 4 PLE ~`i ~4~"~"r ~Q~ d ~Q?„ 4?`3 U • :r P 1 ,if ; f' ~ ~yf'~. 06 11VE $x114 1 1 r_ A ti I > 1 i 'Y i ,r EN ONr4 7R 76201 w l 1 ~ , 1, ~ 4 it t I , ~ t , ~ I1nnn~{Y I 'Yin i 1 t `u~ nDDFlO HY~d1tiA/A R 1'~;a~. 4". °JI~t~ ` hn' ~l!J'':'~h " ,Lt~1 = A[i~ RA ' , 1'R '~_~I' , ~ ~ 1~' ~r 1" ' . ' rr OUhRAfJTOR INr ORMAT101J ww 7 L L1N60N 1012 E HICKOR'. DEtJTON,•T% 76201 AA/A't/Aa _ Ih 1•.' t t a pd ' w OUARANTGR fNFORrf tlb'J w ' KORF;kG, E;; kONO' 0 'V\ '~I ~ r ~ " ,-.~0.3 ~~/Fl4 Sva ~ ir"~6"0 I %pS ST, MQ, UENTONr T%r 76,'x01 ' ; rnr......... A pi t)et1F TU .u, "a01J2DDd_,_____9 nh/tA/13l 4/ nn, /9 AA -MA 4S] ~1+411!T1AQly ?}(1]fy 1~t i n ww OVARAIJTTIR INFORIIATIOtJ ♦w NINA ELIZABETH LYDE RT. 1 bO% 6$7Z SANGER, TX 7620 A Aa_.23L6!L._• ' '161' ~,','~7,C ( nnn1lY n 1nclgns y o7/1R/na a 9sf i •t. MMr.OUARANTDR INFORMATION *Mr DODDViR LY _3-Ir'"T'°+^-'f' 4y"---per-n-d+P•.--.•~ Lt~._.._A Oy f p - r NCH, b G; ( 4 + Ititi >,r , y;ir N+LOOP 2S$7117;r'/I DENT.. Ni'°TX'' 76201 MAP~1l1CAr AMp'I }A _ i•; _r~ „ " n v'..' ~ ',AWU-JIgQAA}14/.11,_„_•,~,~Q$. 7M r~.i'A DA wA AA'.i.i, g~ nr t 7 ++1~,, r •it 4 wr OUARAN fOfi INr'OItf1ATIUN rr 4P FR '.1 ti 1 .i• 10S£ If. MACHVCA 1224 BERNARD Dill T% 76201 09/I /H4 1 ~1•AA31F39, Al/^7~~ tn~~'_na 7' _q`~~n~_:254 ql SP I~-l r A"'/'+n/Lia -r ~ ,,gippp rw,OVARANTOR tNFtlRHe7tON ww'• MA Y IfAODEN v.t, ~r , y . ~ >t800aPTWURTII bR'N9S.';DEIJT01Jr.;TN 76702 'T"` • J 1NA13tY'CATNY A .:J, 1 „„~I 'Ar 'SI r - 11! ~.tfi 'n ,r l ~.."1 ~fk'' 'Y:.; ~.J ~ ~ ' i t e.'(~Cy11L ~4' Q rr OVARANrUFl IN'FDItMAT1UN rw CATHY A. MA INIJRO 0 ~'.14A Ar .It:O~iq{ss A/',"AA• aC:....:£R 4~ , 44' 42~ bEItIJAHD X309 UEIJTDIJ, T% 76201 g n no ~H_ 03 1 i°1Aw'QUARANT13R Ii 10w rli LYNbA'i, LLrOUI"1 ' L4- s 10 Ll " bENTON,! TXr) 7,201 S i Jy;', y 1 1 r t, i r r► GUARANTOR ItWOHMATfUJJ ww KATHLE'E'N D£NIS'1 F. Mr~h1 fi4 r~~~+ 1~. hA AAA d Mgtl,!D43y r` RT I BOX FO-A AVBREY, TX 76227 r' n arAj,OIIARAtIT OR 1Nf RN T1(1rJ wA: l I.pRIDOE N MANHV y00~g S b'NIDN, 1'. ,fr ~~~{1, ,t( 14, , t~','• 4i1 l f.~ ~TX lr } I ?D] 1 t ~ pr_ ' ~ 'Y ~b ~1 all 'V UiLfINr PART]CK Il'•• . °eerlDq~Kl ;~fl/9a/Ar}~y r1'11j AAIk+~ ; +j, 't•. , 7 1,47 •'J•.1 ~q C t '`•+7 N~I~i"~+ i i wr OUARlINION 114r'0RMAT1UJd wr PARTICK H I'IAROHDURN RTI bU% 41 POWER, TX 76299 Yarn I'a 1iANtOR' tNI dRMAYJUIJ 47 RO C14 ; MA Tl ( 1 ~ '07LA of EA IVVA F1' TX' lt30Db11' J~~ 'iJ, sl t~ , I; ' ~ r 1 Y~ a~g1t+~17r1 r gS~~AdYf2/Rb'''+r13a' hA 9Sr` 1!'" lt i Iy t 1 r ww GUARANTOR INFORMATION rw HATTIE MARTIN n AA n n1~ al'4~yly(L7Qd >PR,, h '1 A 1, s 213 AVE 0 019 DENTON, TX ,76201 t5U R NTI~q INF6 I1ATIGIJ wr.s~'.pAANCSt3CD MARt1 &; i' ~ .fl 4,_ ~ { fir" w ~yy•~,r, T y .7 lit 0,4X+r( 1 1Lt)Er Y% q1 y ng/o /N 0 k ! y~ t '7 Db G S , r ,'Y rf Y , 1'! C .I.tlf ^<hi'y .i~ 4 ?r:f t 9 ! /r AF is } y}, I'., II r• QUARAIJrU17 t11FORf1AT1U14 trw REIJJAtt 1N MARTtNH2 2311 STELLA 0217 UENTON, TX 76201 w K¢ 1191FIM QUARANTOR INF0 f~NAT1UJJ 0 NrA ATiNGWf3 M ! i j I n ~n 6 lU, r 'J 1r+ 3• f, f j Q lJ N t 1 p 1 '11514 11NYDt R DEN N DN, T -F^" i R:...76201 r... a ~ i YEf G ' 1 t. . 00 ' , I7L111 PAO~ 1 r2N . I W R I T G- P F F R E ,P O Q .T - - Ol OCT 1984 a PATIEWT IJAMK fAI lli I,I"il,'!!, OF.G-D/+l. WFI4-CI10 K14- PAY W-0 OW PC TYPE CYCLE L8T.PMT AGE ?C 'TYPEktt~l~ .It . i , yt M r l - _-__-9'111d':Lz_i1hL0t7lLS. s[, in n nA n nn '~o[~7's rT ...3.,.,..5Y... Vl1.A ,J n 4UARhROOAtITUP INrtp')^/.111A) n 0.~. 1 '^IVritR,i 2707 FOIJIfR OENTON, T% 76201, o n nn )S 17. . .try ) 'A aY OUht7hIJT OR IA'F'DRt1AT ILIN MCLI FIII` MCAUA - 1:O17,ALIC7i DENTgN1 T%~ ' 7620 rl lY 'tl:c? tiT ~~iza , 4';; Yrr11 a` _ r 1 7A da 'A'AA n,neJ 1'~~~1Q':61HP;I~,i F.k J) • Z. I L.ra :.U ' ..~PICCALLlitS~IlCIn ~.~.-----_AL1341.23..ilGL1LIa ..I U.._ 44s OUAW,111,011 111'0'-1In110l) rat r ~t P.0 DUX f:f0 LAVE DALLAS, T% 7$069 ua ,na nn ~a nn -an4 4414 3._Q r , p Q'. Pq 1, 1134 w« OUARANTOR INFDNMATIUN wa TCN,e MCCLF.NDON WOODOLF.N APTN99 OATHESVILIC, T% 76a4O1 :.f ! dQ.L1.Zt.22..14G1.9L1LA__. 6._DO dap- ' wa'. I ' ' I *4 GVUAnANARANTOR TOR llJriJ1'MhTlOi1 Iinr,+:t t- M!'CC1nMIGK I:1 PALa151110 BANGER TX 76264 7 " ^r q w [a U IA ry'±rS~ ) r/ r ) ai , ) :,4LQliLe~ ''a rp _ 3206 BOB-0°L IJJK DEIJTt~N,•t 76x,44; f + " 7 7 rM GUARANTOR IN°ORMAf1gfJ nw DILt Y IJCXE!.VA J tt r a'Z>ir, PIti t Y;Y ~V « ' n n, : K1. Win):"~ nA..,: : 17a 4•a I Y)dCA l ~_'::11.L0^~O_L.!110L1flA.-.-r.7....nn n nI n w• GUARANTOR IN''UPMAI ION 1, :t]H "rY,r:LVA 320e UO1-0-LIIAl DENVON, T% 76301 s r { , ]S n nD nn 71 " 1'79 '1nO11iu::l.i)4.~221na ~6 •r--G-"r.-......_-_'_.--~~ f "~S~-. i I ♦r OVARh,<TOR INrOPMATION +1« VIM t1CK(!LVA 3206 U DOS LINK AENTONr T% ' 47✓aZ01;- `I. r -ti HEI.YL+ rvMa11 I ?'R1IlI:R26-'la Ann 1 11 n nn' ~6 76'"`'ne "nA 173- •44 OVARAIJTOR I.'.-:v)Mt,1'1014 ,ra tilt. ),;:'~rL'JA 320'6 G013-0-LIIJA DFI4TON, TX 76^01 l:H...~.t111iA 1~ - I '/~-1_-• 1.-:L.~ -n 4:, n n!] 7n «w 0WIANTOR INVE)PHATItti ~f._SP_.~~8. a '1~• ` U,f1MPNfF,R IOU E HALF'' BECATVR, Tx 'i7¢7v44~aW~ d! i U: I i f v Ap,~h7 9"Y'f,, 1n9Ed ~ y 1I , n I ww OUAIIANTOR IllFUfSlArl01+ :,.1:P HT 1 UOX 14D OAINEOVILLE, T% 76:40 00 a 01 OUARANTP IWr'UPMATION ra DANIEL Mf.YCR 3 01 BRIERCLIF•F'~" 7ENTQPJ!' 44X-T1T9E7.Olr n~~,r 4ta ' ! a , 1lIIILtY LiiO? ~R91D'[L~5.496 I1."L- A An'Vd d67FA6 jl' g'lAAhn`JI[fS~1 Nf4'. In?/O~Jid ..~i - H4_~y .~j wr OUARANTUR tfJFONNATIrJfJ Tr'UI',C IlICIIARL. SOS DONNA ST. HURST, TX 1;7605D i'' Q". • 7 V 1 + p31,n r ,1OLL+L'it.1Zf1_fi~~:14_.~1A e an n nq,~..Jt,t3 rs OUARANTQH fNP4RHA1I0W an DOIJO F. MtL.LfR It ty~J'X'8bl'7O9 GC K` p1'✓Y 144 I V+{~ANB'A'~,'~I7tAS,,, 7Cb6B " „ r' f P.'~~ 1 Jfi~Y 4444 Cq ~4\X1'YCr. ya lt. 1. r\ ) 1 tr 15a +J (06LE9_.__..6. a--,.a .J!. l iaa l 94.gq„nn OUARANTOR INFUNMATIUN +a %IGNOA LYNN MILLCR .01 1) CAMCLOT DENTON, TX' 76201 1 r 7 I l / M)( 1 , JI ,1 tf M«`OUARA,4 OR INF'gRMAYiOfJ ns' GIU.Y .1;0 M011OW RT• x BO% ..^.9.!` P[L T 0(! CJ ~,.f, 7ERt1 y,y.,, iYr ~plr,' II :76Y„ d r ° t ,1~ 1 N u1'i'eY QOSt]tI~G..LOLJ_G!'19 we' 7b W, ,.A. An ( + 4~ ' ( +t l 1 M'• OUAPAIJTOR tNF'Ofi11ATlOfJ 4414 CLAY MUt1fO011F:R1• RT 1 SOX 61f VAL4EY'VIEW,,',TK, ^ :76212 '~{9~ LI a h 1 -77 - QGI' cJ r•Y.I 11PJ„•,r„ ai 11.-1]lL1L%-Ela_ 70 ,n r •w OtjARAN7p{~ INaURHA'flOtJ «w cA°f.Y t.YNN MUPGAN i, 1,2,^r,>~ERMA2QIM1E C NI. V` . )i t - ,•i:~f, 11• n T' ddlat 1 ' Yjl i • Si 1 ,M ~'N~•~+~:/~,, Iv~As~A:t,Qlli 1^ r e" Yl r~j~nl:v'~ 1 1 ! r 01 OCT. 1944 W R.►.7 E F F E^p±+V',Rt xS1M'„!ye~r~rSt':l t t4~t Inr,r)ri. r T. f u PATIENT IIAME PAT 11) DIFCHO OEO-DAL NEW-CH0 17EW-PAYE IrIJIO 1tAL~ Cp 4 1~°f ,r ,Q TYf'E CYCLE LQT.PMTr AGE "FO + P K: Tr< 1, 11 jj~'l ! AN AHAHIJ' .3 h(1133I1ri5 nSL.QIlLIl4..:. r r k ,7, p P ,,~~t ~~r OUhRAN7pA INFORMATION a+ 7Y,SI5Y I'F7RCAN APO BOX 91 ROAWOKEr JX 1,,76,762,,+ < t r x ni.5r 4a y 1{ t 5..1.aL:+...w. r~ t2w.lOlJAAANTOA [NFpRHATIdIJ ar.' HAROLD MpAAIO :4{1~7~.# !J VE Oy yl a , A' I,rpy,r , ._.___.1C1 L11,11. I1.LL~fII.FIA- „ y ~r++ OVARhIJ TUR INFORMAt'lOt+ oa M L1.11,11. J IiORRfS 309 RIDGECREBT DENTON,; t'7% 76:01,, ci Nr,'•r -Ir l y a t RFi~JII I IAII'l I?' 927 ^n n M - r -r, ef R4 irr!•0 ARAN OR INFOP1ATf0N T c ^ yI_ WSL1.[AM JOHN 110AAI8 R`17 OFCflEBT".' NT f mrs 414 f]^•P.39 n~/ t M Y ~ a 0/ wr OVhRAFITOR INI'(IRMATIOIJ ua AriAtt 1103LEY 810 LINWOOD $T ".DENTON:'Tyf676Z01'+ „,.yT +,,1,~; +1. 17.1 ' *1;OIfARANTOR INFORMATION +a NAVAL MUFTI , rr , ^ 5 i7 ~ , l,aj i:~y: _ Mllxpuy uI(:nnun t e t ,~.'U,tSZ~C ~`R"r 0 1hP+,s np/I/./r.a In In + a,•.. , 1's OVARANT04 INFORMATIO14 as DAV10 MORPHY 1619 UNDEROWOOD DEN ON,.' T% KV . T :76201 n . r ^ ut 'lr'K .h~?~Lfi'1^ ` vi W OVARAt4Tpfj INFyRNAil01J +n LE4118 A. r{h tRVi , u ,;l>rte r ;7 i.' , 'A h + 9 4 9 CNARLkB NAO I . ,1 x7 7 F~,qt gyp,NAgfl4 ~r ' ' I;n S yti '',{~,n Ur, , tH Gam, r+ OUAAAlITO!< INFORMA'rIOH a♦ DoGN1' nel MV APPLEOROVE; . DALLAB'I%!;TX,1'7SZlZ. v UARAll INFORMAr, 1014 MADLE 14 NASH )Qr ;ORD WSN~IBOR 6RQ% c t 4 ,i i.,,,', ahn9'lI AFI AI [1,Z(t',j A!;' ';1',l ~ ht rf'ycy4gk 1 +~~~r ~I+ y Ill I, ICNAFI n r QW x „1 OVARANTpR LNFCIRI'fATION an PNiLLfB IIEISLI' qOS AI1hRILLp tDENTON+' TX 76ZO1..'y,~ I „f r~ ..h I~r,•ji'}.} ''r • art d"L_Q.'1111l z6 Op Lj n no- %A on on rri 0<;IAAAft~O~ IlJFpIiMATldll +a, 9U4ANrdk 14119014` f}6 R !j ZZS ACID { y ^ ix r ` ~ r 'J I r , iiol~~.f.Sn 'y•'a, t'ky, 11. t ",}ix (g~'. 'JI~~ n Uri . q N• 1ARny'InALa 1062136u,-014 - a t ,a f , : , .,.1 v ww OUARAIITOR INFORMATION +a BUZel NEL60N 45:2 q0X =1'., WORM TX } 4227 - 4GAa >ca~~ a W 49 P ww'QrIIARAt~ pR nJ~'dAr~AT;InH rY.'WILI.IANM NEWt,OM'I,: ' UDA T. ♦~~t 11~ kfY I r,.r r ,1; 1. ,~/r~ I I~I r!•1,~ M 1 I Wy OVARA14TOR INFOPMAT1014 r.0 FAT114A A. NOAH ,DOx,.g318D Ill STAT191l ENI'ON, .620~ x11 , AA(~~y~ ~Q 2. PI) _21L--t-^,l u~tF' 1?'ATr,F, w*`I OUAgA?' i ~flltrr?T1 Or N'» „ Nt?RA '~JOkSWORTHV.• L~ RIQ ^ V ^ q. 0 tl isen¢4!J nil ! ' ,1 dn~ncet;,n7/nupl,r a s. 't a k'~ , I I 'IN r+ OVARAWTOft Mr7OPMATtali rr ELIZABETH 0 UF?fULA 125 HEpITA *.?02,.NZ7R'~> T, 76ZO~rhY!`S~ M! ;a y fV rr4Q4AAAIif INFdRM, T;q'I~ ANN OrMl / 9 ' D 3 1, 4~ 7 i 7 i'~,♦ ! ' ti c~ 4,'. Q~ 1r' 1 h rr I r~; ~ Y1 \ RI' S~ i v ,`I ~t+~. i t..; `r 1 ; 1 ) v'S F '~1R{~~(yl(~yr , • ~ 1 vtV.v r ~YZ f^i, ~j' i i ' 1 .,l,p ',xt+i~gT{NY ~N-l1`~~ ,iAYf ~15.TIllt%1'u°S!r! IrT~'r a t';.;Sp vin{M4v ' 01 OCT 1904 ! W H 1 T' E O F r R E A 4 R, T., yr. All .k ! Zr PATIENT IWO iii 0V^CI+C DEG-RAL' IJEII-CH4 "EW-PAY W-O DAL FC TYPC CYCLE, LIST. PMT AGE PO 'TYP l 11111i''! 11111191 At17_L.__-_._._ _ _ n Y.~' •~;u 1 '`a `'i i. ' p ! 1','`C, iV .-.7 (J,.IG.:.L._t)SLZ.l ma- t In ="Hti a 1'p r'l. y.,. r "M OUARAMTOR IrG 'r laJ 1071! i;l l';I A2+ (In A POD 30: MORTON, IJA 903060362 ' wr OUAllANTC)h [IJFURMATJphI J!IpY PAR1fa -uu 'QQgg ` 11, +k' ,e• a rr f..; 1 "1 MA7 IN;' Liuirvi t.I,Pa' lull 1,4 Bhrane tr a i ,54 I + {fd 7 -~J. L3G=.:j7 GLIO.^..CFi~- an 20 7A nA~' r n nA an A 'ehrl ! J,Iwrk I Will OVARAN IUR [r'r U+M'. 1'Irry! pA„yl r',Ii 609 FAL01KADOW 01 DENTON, T% 76201 y ALL RUgA r. PLl]'!n 1 .l r ««'OUARANTOR INCOrINATIhN as FL.W QAP,LA01) PEI'MFRORAPT, "UR Z QO PT 4•JORTH"DRr'M67 'Q NT JJ Y yJl A c ,,2,;;77 ngi l 71p4 117 7 , n , ` q ~Y , A$0 1 4k~ a• ;':`~5 ! r «o OURAIIrpR IIu'Jr+11ATJC)rl 44 n-~n- ; ti 0 ^ pn l,t 1 ,ti t Z, .y ci 1 PrRC2 627 FRAME DErJTOrJt, T% 76201'.: OVAhaWTOR IPF'OPMATION aaIIIEVIN PIERCE I 126 TAMMY 6AIJ0 } ~ r r s URI X 766bg3474 L 1 r< i ! J'1JJTF2..DE1lnvrr y t' tM!'e:••FF ~„r c c•. el, ~ tI'~''e 2a"' (2 (Ill y• OUA5A1Frok tFJrUr!r~ATJUrI +o C^_Pti 1) rllllldlt 755 7TH ST POMONA, CA 91766 .1,C. ~ { ' U"OPIl /,!1 "11:.1.1 ^grl,. 0-0.') A +F« OARAITTOR Willi M/11017 u« LF:fr PAH PITP[~ r,~. ^ 4 1 300 6 RUDDFLL,"'DE4 0 X g t U`+ 7f GUARANTOR tll'iJ"A11(7rJ „~aBl:_DL.'_rt.,II3.a.tGLE.4 7n _ S.[rl +r+tr, A PLMJ1' 316 rRY #276 C/O DANNY WRIOHT DENTON, 19L_._'' v'• xx 7aa01 ! ram • 1 llfi r~J. ~ OUARAIIrOk INFURMATiQIJ a« (:A!iL PPATT 405E PRAR~ IC p6f`{TOMOt.'J)(QIQt s 7 _111 ;i IF.I rL1V e . ' i Sr I i.1LI1L.fl3L33[£ i' , 111Y, .1 pl J 1A:~6` ! '1 t'f it;el~~r_!7r r 1 Z t, t •TI,t~ 7)': i «V OUARANTOR INr'G!+MATILRJ ay P1'u'r W. PPliOET1 264 OAK { X,' ly',', IgFt! y' ! t t y LEiJI6UILLE, TX 75067 wl li~ ,t ,1 OVAhANTVR lmrUrl ^ v y r*nrr~IJ .J~uv PRUtrr 11 lip BOX 07 ERA, X X6239 F + (L 1. n' l'I'r' u~ A• Lr.,nlnv 7nn~y~n.a AS 112/914 23 v '.i' r `y y Y ~ " r , "Y4~ ~r yF.y': ; < 1rY. , 2 tl ~n , __n n k~5 ^tT~alta'#i'nad 'Ja r1 fi+ OUARANTOR Mr oNMAriori in c ht.10 I,PVI I r, y Pp BOX 51 ERA, TN 76x36 ! ilU3G nano : , ~r'( i, r ONARANTOR I?WPnNArIOl n* J F-RCD RAOU111A P^ r r(2T C{/(Q7 FOR 6TW0 91,1 DE T r'r 762a Pr's S{11nigA9 nn/o'168.A '',S7 A~ r.r+'J.'%n nn':+!.ti,'~,.Zg'`:~rr.t 'k I'I''4.~ ! C/'°U}' aF , b GUARANTOR Illr'pR11A1'rtJll n+l 6TCCe:N D. hr,tIll fl0% 93 :%ARAflt6Br\TX' 760y;i ,,.,e, •«i~"olpha ro9 1ryFyRMATltlyd ,y .R)i1w RAMthEZ Y t' 1 JI s:e 1,ko tKnna9 at~a "fl~~;~'ry ' a('tr ! i+re -BACfIHS7..FeelJngnrr. 7Anlju~/ p. r' I 'xr• ~''I.~Jt'i,' 1,I'1~{ + /5j .L4~ r ' II' GUARAIITOR Ir!FUiMAT101i ,a. JcJ!IfJ RAnjoE'Z 313 THOMAB N25 DEIJTONe 77(+ 76701 `r ,41,+ I Vii „ 4 Ail DUARAN --D111L...17J r ! !.•4t,1,! '11 1 s Ypq tNITOH,M rtdN BILLY FlEr•. D, i I9 ~O9 1 1 lL ' A ~1T~ ,p 1 1.l ,I" 1,,. !i' ' c 1 ; t ~ .r4 , y,• ! C ~ l~l e~' I~ly f ~l. ~y~f 1 f r f 2 I a ls ills MR of OCT 1984 ,t sr IJ R 1 T E- O F F R E P AATICIJT flh+'C Pnl 11'' lit.^CNG DEG DAL IvBW-CHQ NEW-PAY W-O RAL 1'FC T5Pr r E CYCLE L$T PMT AG P1 t (i IJ 1 I Is ' AFYNfII TIAa Y.I.AfYr a~rD.\i'1^,w~ , tS` tf td,~a i « i'. ' °i'' tik .rli:(ly 1_,::. 1LL41+;a 9n nn ,.,i n~ nn Y •k.i! , y, , i . ,n YX. , s r . 13~ lfi,. ~v QUARhIJILIi II+`'GfRlAllr~r: -,o L+,1_FIL PLYNpi.Uc RT 2 DUX 190 AUCREY, n t - a1 TK. Ibe27 - -7tt r w >•±GUARANTOR INrORMATIO--- W .,rte H kL 8 R(CN%H U6,~''""`~"~~ rV n 4-107 iJ JORpR~N -.1Ja 2 w ~vs}~ v '.I y,'• I + l;~ ' V'- I't1,F.M11'~. i , ~EYd Aw WIL -'-=81f CLf.+JCLSAfdr r _.1GfL^t:3Gfina/rn/rta'r aeaat S1k 1 t~_ , is ~r~,.x~ Ih•,rR/4h „t" `.1 Mr OVAIINITOR IN, Of+77h Tlcn: ~r Ina ;.?J 1~ rtr v 1J<.e~:,i L Fir, 11 P,O. BOX 40 VALLEY VIEWr•.TX76272 _11 li I, I **,GUARANTOR INFORMATIOIJ rn GCRI1D R ° n yr. 6n11G1.BI CY I~1.~_..J.. O6 VE E N10 Y `f I f ' j ORIT ~ci~ILiAI~r' s ? ' r;.Y QUARANTUH 1(JFURf,•A7lON ra u9,Q411a/na va nom, DI<d.-: IJl7CL•RTB c,''♦t 6~ % • 600 CHAMBERS DENTON, TX. 76201 f : 4 rrF rtt -ri :I, cc . p r;4;r - •A OUARANTj1R IWORMATTON sr JUr I - ' 1J7 C ROBERTS a321$KYLARK R n, O 0 ~ z d ,nl ' AF V. ,reran - r'13._U1L01L.£1~ I„ d.' _ Irj r FI `j4 1 jf' i~jrrN;:!1?41r rl;.ru y v;~ :,n'ti1k} l~. ^'i, f OVAR hIJTOR IHFDp MATIOEI ar JAIL'(. HODEY nn .f~lY6 r•' i,• n v y 109 63 I/J3 SOUTH Fl0UR0' LO$ ANGELO$, CA 400o~U 14~ 'L.(.r/•:, AY S- I5n rsn n nn .0 nn ,Laa as V Nr QUARAIJ,TOR I0FORIAT10N as EANt1Y KAY R013 R08iNSgIJ 0 - '1jZ40 fJ'.COWAW 096f 'l,E;~JIB 1LLF.iI' TXC •7501`^!'i" f f 11Y..1/i9O11 V •P:':~tIM^~'3" G"f' 71 ti , S _9n114za:+ n+s i -,.,1 ti f►~Y, nr, .,,I'.fS.; + L(1QLL49- gr, OUARAfJTtlR INFORMATION 14ALTER ROOUY ! Iti, k ~ 252 LOUf$E 023 DENTONr TX 76201 r 1,11'* f r•MN,;OVARMJTOR. (IJt'OAMATih(J au 13461) RG'1ERS ~p 6 1107 DARNAkD N~ lti ~p ryrQTq Z~hn+'fi7 620{ r W7, 77P `r''''^~y~ • rte. T-+lD"+9 'A~t ~(!C 1.1'•7{+ e!'Ce/,~I' ~'J I 'n 1 ~1f 1 r 11,5 -...II011n:-,rr r,4/11inu rns an 1L..C1.Ci. Arnnil } 'JFt' N 1 f1 MA OUARAIJTOR 11JrORMAl1[IN r" RUOy PUWG 157 Sh " N'A r}rf'+ Xr'4 1Y'S i 402 CARDINAL 0-3 ^DENTON, rTX ; 7620]' •'•,.OVARANTOR trJFU{PMI rq (i~O LR SALTER ~ n +k~± • r kil 212.WERp Nl I I E T N;; It .h,5+, rl 2Q1 ,pJ, _ w" +!'r Ir ~~?Ij II. « onrns6 IIYIZ/fl.n wn. Frj~ti nk r~Ling~+An~brSnYti`' 00 OUARAIJTOR [IJFORMATIOIJ ♦r MARIA SALIAR 704 JgNQ DEN ; X y' r 1 ~ yT 7g2g1 x .'u a , :l•, • r J A „~y/n 1/r35 c + "."'11 't+'~ ',i~ ' /~I„ 1 't 5, r NN'iG~ppR fj'Offl!tfNFOAMATrJ I{ f1UUFRT-JOB>;PH 8 NGERS,''~'~' ¢ Y~aMI~ d Mri ,y,rII 9 6 E TL Thp'~5067. y nF GUARANTOR INFORMAtIOf4 wp CLYDE SAVAGE q( V )TWIN LAKES #1$iy~;OEiJTO ,r,T 62 tk'+ , ( J~ ' ry " ..1 n ~,1 l'I. i111r )II +'l.. I.• r N•'.AY, ~ G RA14 s' r dlj'I~JRq(tMAT1 IJ vd"Ch'A19jjllk M1Tf1 N n n , V v z, t M dltt/+' il.nns6\rn/Inca p`~Xrtl ii57f!;1rQ l Y 1~ j P'1' n u{ GUARANTOR INf•'dFIMAI'1dIJ su-~__`_~a i. ,J. " 1111.11100 RP((TH BKIMNER• r w 13IF.1?FJIa 65~ UENrON+ tX~r~iiQl,f ~il,+ir1} N 7 / '-V 7 Jlf GUAR lJj1•_l.. ° n' f/...r^ rIP•,, $ tlG ¢F R aT O ♦r .Y f{ 1~ " ti,, +ysA r A M 1 N J,sr~FS 1 ' GTtvf rr6 { p ~ p l t,. • IdG ~ Q1s>~ ,jN~~Y 4.~' ~ryy"yyhh It ~ t 1r 0 ; 1 I} ~i71~~Mv'.~• ~ 1 ItA .1 r +c ( ' , h Y( +1 i 1 r. ✓ _ w ' 'Y✓ttflTlf~M~M~M,Y r/.w.wY w r R /,r + r ' {J i. "C..'S"9f K^ R...»r M►SP,IMY,Ii h T,FiS~~PfN'~'~FlT'(~YMfr Y~ 7~~1'14{~r+ ,i 'I In 1;11'~ymbel-ii, I QI OCT 1994 W R I T C- q P F ! v PATICIJT IJAn;E R.,t P 0 RiY FAr~ F rtt ICJV') [{E'6-Ofd, WEW-CHO NQN-PAY W-p 13AI, PC TYPE CYCLE LOT. PMT ? ~ f'4 ACE APO TYPE„f / 1 tV f 1 ~ a~Y 1 M1. t a+ ry 1, a 4e1 , , u l ¢1„~ 1. 'M1 Ay *4 rl n n h~e 7~ A OUARAl1[UR IIJ~CINM.rT I UiI an Lilt";< ;i 17111E P.0 BOX J34 l^ITTLE ELM,'TX 750b~ r• UVARANT01? INFORMA7 ION 14 Jfd !S . U LflL,SGtiUSL THACitERVILIE~{pK~f 7~gs9 .e tF4~24 v'.,Yfy ~!°I>t~. , 1, h/~ A♦ e raV 1:-q I'll), 50% 1' 9%9. . 47 11~ LSrl 1Sl b+' T',V a~1{7 '}o , tl y,rlf.+ -114. ~ !(jff ! 40.033. 69 116, 411_ 34 NI Z J I ' ,h 1 1 . 19 :MI`nY I'>•t {r ,11 ~ 1 1 ~ ri'. ~ r 1 r y( ~ 'J ~r V L"S'rt4'~'~il'y?7l~AIJ'Ik{ff~IF' r, v~ 1j ~ p', r , ~k 177 I Ta4Y N ~Vl}. P{ f rl 1 ,r ~ ly J _y J_. 1~1I Y3J~G.d~1J01 !!`Kf.:7, fi M1. 1 yr ~l .I .?1 '~'t f'~'. ~ n f 'T,.'~I:r 'i~a FJ7ft: H 1:~1tiL5+ tq.' P.~ I{ 1 y a 'r r I t'r ' ' 7~ a C.( ) ,'h r1 f r 1 ~ 1 1', J ~ 1 1 ry ~.'I r hf JI3''1 ` r'r'V{ 1 • ( p r u .t, t . t' ,1 G r J M1 '~e ~ 1. ` { Y.t ~M1 r l B tiUF t I S 1.1 }1 11 _ , ~f 1 M1 ~ IrA~ 1 t~ 1 Y la i 1~. ~ t'~~,r,v' .'y' t1v r 4 7i1 {0.1~0'f ~M1LT~t t~ r i 01 OCT 1984 W R I T E v,, p oo p F P R E P p g ti,.. pY(.;'3 ,fix:' •+•PAi,~~ l~'YI PATIENT IJAr r_ f. f: ' tl ll - r 1 3EC 'UAL NEW°CiiG IJFIJ-PAY W-0 0(Al. FC TYPE ((;;YCLE LIST, PMT AGE FO '[YPE1~t ~f 3' 1 ,d,•.>+M r I_~~w,f r. N.., X11 lip WRITL- OFF Gr.Ill ld_.•: an+a r J0, 95! 18 Viol 557 12 114 979 47 h W r. 411 40. 6•3O 69 r 114 ! 34 1 t 7 I . q'd - ~i•r~R IY4 1' ~_I'r r t IfHr ~ I' w ~u 4.r~' 1 ;-rt : 7,r L a .~r,, I a {..r E ( ~1 4 Ji + r • f 11~ E r. '.1f +il7 ur3'7~1, rent 4~ ~~~.~~//}~a ! ~r, } r Ill 1 ~ I~ n'y, J 1 t(t ; ~I{/ I J. ~ ' lyi ~r ~-I ~ .i i as u I t I~ f 'ail .rh'k -{ham ' l~ 1 r.' 1 ru ~ t~f t't{"1 .7'M t.1~~i Y~ wl 4' h k .l e1 '.t...l t 1~+ 1 Y 'J, r1>il u 1 r 1 p ~ r r 1 i 'I' f p '.a. ,.1 ../f,^^, 111. ..yf' .a1:r•. 1.f1'~4'{i~'~ll114'; a. ~ J.,. jI ~ r ~~LY41 • 1 ki i~S~i1i ;?1 13 I{✓ _'i 6 j , ~ -vr IW ,~'II , H/~ !Ifi~ '4r Jr 1 7. % , ~ltA { y~r R, n. I 1 Y. . ~:.>~II IjJri/iY~:)t r})~• 'nLY' ;v 1 ,•S ti ~ J ,J ;,1>L,. d;F•~'a a'~`A. r. 1 ~ 1.:1:N rfE h,1#rr1y{ J t ,.4 t, r `r' y.yQ~ `{1 r r JYTT}- , r ,l )l i ) 1 I u Y.Yy~ ~ tJ1,0 a'ta j ,.wl ~w 1~~•.. , f f; ~(Iw 1{t ! 1 Map it 1 ~ i I ~ / ~ f ' °Sk jr 1f bIf(1~!.,~tY f•;f'G:,hV yr 1 r"~: t T d y ! tfi"ZT'' i r *^t r ~ i; •..8 'r 1. j it J;' ' I ~ u (`~.S ~ 'iY n+! . I R u ~ II ~ r I' . µt IL I t .q y _ u + ~ , 1 t~,'{: ~,r: ~t . ,Rti ' ~ ,fi ` Y, Gti vim' ~ •a, M~` ` ;rY'. 'r•R.rL i et. _ 1 r ~q'a Ir 1 1'1t •Ur /rl t i- -l 1•' l + 1(Rt ) kltl4'I'V41 ti I . ' Y,~1l . .a t 11,11 ' ball y,frr t ).A. i ~I i r) µr.1. V ~ i,.f r ,.'q I l•. a :.4 .J ;w...,. J.1 ,Olw~.la l/,w."wAYb}9 iy1~Y.• il.:./~ I , I. N. I ' .^'1 hO1 d ~3; nj'IIYt~I•~ Y:f7i'~i: ,1 T'.'L rr..A1~r•..: .7,14 A ...1.iy111:l J: w.ywy/j4,y,.. Ind r~ 1f,; !)11{ r«• n 1 .i , ,d un r +f r 7M j + i d lip' 14 1 1 ~"Ilry v~-~ IE d I~( II/A I , k rl rl h 1, n{rTSr.~ ".Ir r I r t e I + I ~ ii ~I 5 li tYly r ' 1 r l Ii.Ld ~1 + 4 I f t}^ n j;r 1 . r '1~1f V'' C. ''IdVING~ ♦y 1 r(Ji.►AL~...r1 ill ..I.',~!~~ '~r yr~ 1 I1 yrh r.Q c:. n Ir.. ' + r~ I~r) ~r171 / f~aR ~1r'~I}HIIX~ : fW .I ,h,,i/,N r~ l~) W~~I .~I H ~II .I. tt < 1 i I .r , di w J' , r ~4;yr If! III r• I, ,4l 11'1 c j ~.lII.rW ~I ~yt U~;Mi.tJ SCR' liW?~ gA 44 4-1. 1 1 :~i 1 }I r'~II r•+!'fJN .YID: 'n 1. _T'_'IA '1.6.o Jau r 1 L{ rC ~r, li+~_lyA; 1 i)'yrl+/I r .N f /1 ; . ` I (r '~1 ~ "T^^ . J. e ru 1~~1. I,T~, Irr/`~Altl~ li~l a . I~r( 1 ,f: r I , 4 ~ 3 j1 r .Cl ryt~.',~ . r rl Nf 1 • t , r fiL tl 1 t ' .1 • , ~ s~•~ l 1 .0,1111" 'I '~1 l•4(u•n 4 If w `ul If;. i~':~` 11~ ' i ►f' rb' ; Oil Page 1 FLOW MEMORIAL 8OSPITAL STATISTICAL STATEMENT OCTOBER 31, 1984 YEAR-TO-DATE__.___ Ct1RRr.NT MONTII budget Actual_ Prior _ Year Actual Prior Year 2,757 9,582 2,730 Adult Patient Days 88 .9 82'7 8811 Average Per Day Newborn Patient Days 426 425 421 21 13,7 13.7 13,6 Average Per Day 145 67 71 ICU/CCU Patient Days 174 168 194 Operating Room Procedures 17,978 13,714 15,489 Laboratory Tests Treatments 2,068 2,003 10866 Respiratory Therapy 784 Physical Therapy Treatments 771 569 Radiology Exams 1,516 1,1h 1,368 Dietary Meals Served 18,472 18,3916 1,570 Emergency Room Visits 1,039 1,984 1 1,061 WRITE-OFFS RRE~_ OVERIF. BAD DEBTS r COUNTY PAYMENTS B1~D_DEBTS COLLECTIONS MONTH rVARITY 73,763 $ 122,417 $ 3B,141' October $ 51,624 $ FLOW MEMORIAL HOSPITAL Page 2 INCOME STATEMENT OCTOBER 31, 1984 CURRENT 110MTN YEAR-TO-DATE !ludget _ ` Actual Prior Year Budget Actual Prior Year _ PATIENT SERVICE REVENUE: 1,392,987 $ 1,343,140 $ 1,235,322 Inpatient Revenue _ 162,050 163,100 164,989 Outpatient Revenue $ 1,555,037 1,506,240 $ 1,400,311 Total Patient Service Revenue DEDUCTIONS FROM REVENUE: $ 84,537 $ 61,513 $ 55,609 Contractual Adjustments 166,389 176,502 136,113 Bad Debts 81c686 820368 95,279 Other - 3-T ,61-2 -356',-W 'I Total Deductions from Revenue 4 1,222,425 4 10199,634 $ 1,113,310 Net Patient Service Revenue _ 29,521. 532 7 171955 Other Operating Revenue $ 11251,946 $ 1,253,111 y 11131,265 Total Net Revenue OPERATING EXPENSE: $ 572,343 " 578,266 $ 589,614 Salaries & Wages 839861 71,417 890390 Employee Benefits 1229052 139,289 115,073 Professional Fees 195,520 213,163 176,183 Operating Supplies _ 29622,352 175 475 177,549 Other 1,11128 $y 1,16 0"1z 14809 Total Olerating Expenses `5,131 ;T6T Income (Loss) from Operations 31691 _24,200 56,866 Non-Operating Revenue $ 59,509 4 1001101 40,322 Excess of Revenue Over-Expense FLOW MEMORIAL HOSPITAL Page 4 BALANCE SHEET OCTOBER 31 , 1984 Assets_ Liabilities and Fund Balance Current: 1984 _ 1983 Current; 1984 1983 Cash & Investments $ 464,505 $ 464,547 Current Notes Payable $ 3550371 $ 156;740 Patient Receivables Accounts Payable 1,633,705 1,008,315 (Net of Allowances) 3,692,878 3,828,948 Accrued Expenses 511 475 516,774 Other Current Assets 1,171,440 1,299,346 Due Government Agencies 54,447 150903 Total Current Liabilities $ 21554,998 1,832 732 Total Current Assets ° 5,328,823 $ 5,5920841 Long Term Debt $ 1,462,774 $ 1,2811685 Property, plant f+ Equipment; Total Liability $ 4,017 772 $ 3,114,417 Land & Improvements ; 183,242 $ 162,349 Fund Balance: Building 2,979,088 21943,464 Donated Capital $ 4,4550779 $ 4,455 779 Equipment 4,979,595 4,567,583 Pledges & Gifts 623,746 569 003 Fund Balance 09/30/83 (685 947) 618 105 80141,925 $ 7,673,396 Revenue & Expense Summay 1000101 40 322 Less Accum, Depr, 45959,297) (4,4681611) Net P, P & E $ 3,1 28 $3,20- T,~ff5 Total Fund Balance $ 4,493)679 $ 5,6831209 Total Unrestricted Funds $ 8,511,451 $ 8,797,626 Total Unrestricted Funds $ n,5i1,451 Bj_L9/.L6 page 6 PLOW MEMORIAL HOSPITAL SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS OCTOBER 31, 1984 r CURRENT MON7H _ YEAR-TO-DATE _ Beginning Balance $ 40,791 Cash Received from; Active Patient Accounts 8 868,550 Bad Debt Accounts 38,147 Cafeteria 12,480 Appropriations/Donations 73,763 Other Total Cash 30,195 Total Cash Available 1 023 135 I,063, 26 Cash Disbursements; Payroll $ 458,344 Payroll Taxes 71,661 Patient Refunds 664 Capital Assets 29,025 Notes Payable 47,632 Other 317,400 Total Disbursements 924,726 Cash Balance $ 139,200 Cash Investments - 323_,075 Total Cash $ 462,275 h i Page 6 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS RECEIVABLE SUMMARY OCTOBER 31, 1984 Prilaar Pa or Current 31-60 i ` 61-90 _ 91-120 _ 121-150 150 _Total A/Rf "TedICare $ 291,764 $ 350,618 4 62,396 $ 45,637 $ 35,492 $ 150,383 $ 936 310 18.9% Medicaid 51,390 26,086 16,605 19,572 5,447 42,590 161,690 3.2% Blue Cross 84,659 62,001 49 - 146 709 3.0% Commercial Ins. 5860897 271,549 1,175 859,621 17,3% Self-Pay 323,567 _ 384,011 483,882 364,165 314,487 983,011 2,853i1?3 51.6% $ 1,338,297 $ 1,094,265 $ 564,107 $ 429,374 $ 355,426 $ 1 175 964 $ 4 957 453 100.0% In-House - 236,130 Total Accounts Receivable $ 5 193 583 A/R by % 27,0 22.1 % 11,4 % 8.6 % 7.2 % 23,7 % Days of Revenue; Accounts Receivable 10510 In-House 4.9 Total 109.9 H' 1 Page 7 rLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE SUMMARY OCTOBER 31, 1984 Current _ 31-60 61-90 91-120 Total Trade Vendors $ 286'874 $ 299,058 $ 227,763 $ 165,731 $ 979,426 Fees Payable 104,269 76,856 58,719 71,130 310 974 Accrued Payables 74,491 Estimated Payabies 238,114 - 74 491 Audit Fees -301.700 - 238,114 Total $ 734,448 - 30,700 $ 375,914 $ 286,482 $ 2369861 $ 1 , 633_, 705 i page 8 FLOW MEMORIAL HOSPITAL OPERATING INDICATOR REPORT OCTOBER 31, 1984 CURRENT MONT8- _YEAR-TO-DATE 09/30/84 BUDGET ACTUAL VARIANCE BUDGET ACTUAL VARIANCE ACTUAL FACILITY UTILIZATION: 1, TOTAL ADULT PATIENT DAYS 2,757 2,562 (195) 31,730 2, AVERAGE DAILY CENSUS 88.9 82,7 (6,2) 86.9 3, PERCENT OCCUPANCY 57.OY 53.0% (4, 0%) 55.7% 4. ADMISSIONS 584 545 (39) 6,353 5, DISCHARGES 587 547 (40) 6,323 6, AVERAGE LENGTH OF STAY 4,1 4,5 (.2) 5,0 7, MEDICARE & MEDICAID UTILIZATION 30,07, 31,1% (1,1%) 32.9 PER ADULT PATIENT DAY: 8, GROSS PATIENT SERVICE REVENUES $ 564,03 $ 587,92 $ 23,89 $ 545,05 9, NET OPERATING REVENUES 454,10 489,11 35.01 443.11 10, OPERATING EXPENSES 433,85 459.64 (25,79) 437,95 11, INCOME FROM OPERATIONS 20,25 29,47 9,22 5.16 IIRITE-OFFS AND COLLECTIONS: 12, GRO 9 L1 13. NETTS DAYSYINIPATIENTr1A/R/R 680 0,0 1708,0 (18,0) 101.1 14, BAD DEBT EXPENSE AS A 10,71, 8,15 (2,6%) 18.3% % OF GROSS PATIENT REVENUE 18,3 LABOR COST MANAGEMENT: 15, FULL TIME EQUIVALENT EMPLOYEES 370,8 383.2 (12,4) 384.1 76, FTE'S PER ADULT PATIENT DAY 4,17 4,63 (4.6) 4.31 17, PAYROLL AS A % OF TOTAL EXPENSES 47,9% 49,1% (1,2%) 51.8% - F,C CI+L3_ clll' BT :II' PW C^I1. nt10(rNI' 7 r. 5E - .,tll.. CUUF r11c,,2T r,N!JCY DENTUN ^66 JO t! t:I TY JAIL, DENTUN IX S:t l oa, { IJ, I1 lJ.I.LA It le(1 UEf47 ON TX ,'b 01 01~.^ O1 ';04 IC' ,TC qi2 DENTUN 1Y Ali •,4L.C` ~ .'[01 07/1., d -b IA Iti dENO DENT ON . 4 - TY !tr'.cil 001 1ltI 111. r t L : : L.i;. 414 DENT UN 1Y s i ] 10, 1 -:,"F lL~SitY 1,46'v! 7^%' :4..t A'4F IJ1;JIR LEWISI'll_LE T'.f 7!,067 09/:14/04 00 I , 4 r. \'E(.'' i. ':i',J:Jli lhl lJ CkJR,A1 12.10.1: C.LFWISVIIAA T'( "7 ;i(l A'7 0Ul e7i 114 '•'i4. 61 V i P 1711^ hcL:UJnI_l) DI:NTOIV la 01 Ohl 1J1 •7L Vt I: DENTUN. IX 74,:!01 10/1'J/(J4 °'th. 00 d I ri ";W,fJi f! P,: UENION fx 715:10; 10/1'. ..,1t. V { Ci I A0 DE14ION- .-'---IA 76.101 10/19/04 ~101..-'JI ,,~~w 1, ,,i,lv, 141 C1:, 4t'i7,. I P 1.`Ic1l"y CP NF' r'1"1 I(_I 'Yll,'; rJ ACORN I° 116 UENTON TX 76:!UI O9/:.7/09 °vl 00 w L e.'i, 17 J(.L. i:.'S I&'. PIrfP 14 11-L IACI•: 00 CANT FIOO ARI - 114 9?4417 09/17/0 -'4,11.(10. rt;':p, SARI- PO POA 83G DERR 166. AR- 710111 'lOJOIi IJ'I •06 40 V £t UGd, C'.7 . fIli 4A I'_. IIEIJI ON DENT UN I/62UI 10/01/till °7A 011 Ike &-;I, i17p 1I ( .,nl.. GTCIII ~'.0 11Ct1i1lNI{V 6T. DENTUN .._.TY 7AI!01 09/07/01 -14 00 I,I I,idL ~„,a;F..RI.(i+ i+ 14 1"n.. i;. rPARU( F.. 301 F ISGKIW:Vi?Y IMNIUN-011WO74.. _..,..-I A.../d2U1 1W I"i U4 VO. Ou y I 1r 'AO1 U,CCLII'All+,, , 1 " l..L'i"-,.1,CfIl,Ulgl[tCcmorY JI,IL DENTUN TX 76C!U1 09/21/01 -4UU,Ct'% _ _ !61 Nt+III'~OEN. U1.d 11) P i IF' L PAV 11) P 507 13 `5TH DA%lia Oh 7E(00 10/1.'iL -!)h OC, , f w L, CARilI.',N •I li l+% , 6 J7: ~J Y, OP41 4 - - 315 L. F,~:NINNHY DEENT014 - --'6A 70i!0I- IOJO:0I1 -DQ, 00 V/~ w `r ~M I , M 1 01 NOV 1984 W R I T E- 0 F F R E P O R T PATIENT NAME PAT ID UISCHG BEG--DAL NEW-CHO NEW-PAY W-O SAL FC TYPE CYCLE LOT. PMT PAGE 1 ACE FO TYPE JACKSON. ANDREIJJR. +r GUARANTOR IIJFpRMATIUP! aa40139451 06/21/84 181.29 0.00ANDREW JACKSON, JR. 1829 ROBE EW DOpN, T81 76xpsP_ ER _.4... J { ` 133 JACKBON,CARL L. 40!34231 06/17/84 ww GUARANTOR INFORMATION ww CARL L. JACKSON 124,25 0. 00 0, 00 129.29 dP_. ER.. 4_.._ lI RT 2 CELINA, TX 79009 k37 x JACKSON, GARY DWAYIJE ~ - ww GUARANTOR WAYNEI:ATIpN aa4015.105 08/09/84 0D.10 50, 79 GARY DWAYNE JACKSON DOB 1 43,8._8P._.. ER.. _..3 1973 COLORADO BLVD ND DENTON, TX 76201 80 2 _JACKSON,RICKY 40134678 06/18/84 ww GUARANTOR INFORMATION ww RICKY JACKSON 56.00 OBX1 0.00,-_- S G.Oo 608X143 E WALCOTT PtL56 QTOPO[NT, TXR~76298^ 136. 2... JAJI, TINA C, +w OUAANfOq INFORMATION ww70027ROOM01/2 /84 63.50 0.00 -20.00 43.30 , "Bp. OF 3_- 02/24/64 J 2624 W. OAK N145 DENTONTON TX 76201 .291 2 JAIIEB,DEVERLY JOYCE 40142663 07/t2184 2. wr OUAgANTOR INFORMATION ww BEVERLY JOYCE JAME8106.00 _.,..0.00 O, 00._ 109...00.._. SP Efl_____3_____ J POBOX50411 DENTON, TX ,76206 -110 JAMEB,WILLIAM rw OVARANTOR INFORMATION wa40 00,06/84 169.75 ..36.78 0. 00 .208 . . 30 _ OF WILLIAM JAMES 1420 W MAIN LEWISVILLE, T% 62. __JAMES, WILLIAM MICHAEL 79067 - +r S, WILLIAM MICHRMATION w#40156166 OS/26/84 136. 00_ 0, 00 WILLIAM MICHAEL JAMES BUILDING 170APT0 1--0 LEWISVILLE, 79067 J HN93N,CHARLEO 40130411 06/02/84 O.OD 69, ww OUARANTOR INFORMATION ww CHARLES JOHNSON 69, 10 O.OU OD _ N,TX __86_ ER 2 Ibl 2 I J 2022 WEBTWQ OENTO 7X 76201 JOHNSON, DOUG 40135774 06/21/A4 '_..._I r+ GUARANTOR INFpRMATI0I4 ww DONNY JOHNSON 102,29 0,00 0.00. 102,.29_.SP._._Efl -_i PO BOX 24 JUSTIN, T3 76247 130 -2 JOHNBON,ERVIN 40144247 07/16/84 f ww GUARANTOR INFORMATION ww ERVIN JOHNSON 32'60 0.00 0,00_ _3$,60. 8p.,_..Efl.. _4.__ 149 07/18/84. ! e P,O. Db% 24 JUSTIN TX 76247 JOHNOON,JAC08 A 2___ OUARANTQp INFORMATION ww 0144032 07/S 9/84 149, 00, "..._0,00 0.00 59100., ALLEIJ G JOHNSON 7210 8 PADRE ISLAND DR *11308CDR:,CHRI$TL JOHIJ80N,JAC06 CHARLES TX 784124326 108 GUARANTOR HARLMATIUN ww40133993 06/16/84 706,75 0.00 JACOB CHARLES JOHNSON 1202 W,HICKO0. 106., 130 Q RYO DENTON,7TXv$7620S 4 _ _ J JOHN80N,MICHAEL W.,JA, 40097677 02/03/04 90 ww GUARANTOR INFORMATION ww MICHAEL W, JOHNSON, 8q, 29 0. 00_ 0, 00.._ ___.274 RT 3 SOX 66 DENTON,9TX2S76201 ER _1~ J JOHNSON, PATTY { +r GUARANTOR INFORMATION wr70038419 06/13/04 61.29 0.00 PATTY JOHNSON -49, 00 _ -.12.20 . -SP___.QP_----4-__..08[x9/84_.__----.. yq 4 flT 3 BOX 66 AUBREY, TX 76227 _.._JOHNSON, PATTY. J. - - r+ GUARANTOR INFORMATION wr70MICHAELOW/IJOHNSON 61.35 _-"-0'00 I 91-00 AU___._.._3J ,29__ 8P__ _.OP_~9~9BLB4/_84 _ - _Se.4_----7.`._.__~_~ ~ RT 3 BOX 66 AUOREY, T% '16$x7 JOHNSON,RUTH 40120642 04/x9/64 ~u rr GUARANTOR INFORMATION ww LEE JOHNSON 266. 25 -_0, 00 0.00 266. 29_--BP_- _ ER__. _ 2___._ r 1190 W ELM OTEPHENVILLE, TX 764012467 -147 JOHNSON, TAMMY RENEE rw OUARANTOR INFORMATION ww4QDONNIE 0. DECKER 116, 35 _ 0,.00_. Q 00-_.__ Efi_ -3 - RT. 1 KNOB HILL FR[8C0, 7K 76034___- it OR r .l ' 01 NOV 1904 ' W R I T E- O F F R E P O R T PATIENT IJAME PAGE 2 PAT ID OISCHO DEO-DAL NEW-CIiD NEW-PAY W-0 BAL PC TYPE CYCLE LST.PMT AGE FO TYPE JOHNSON,T014YA R 40146227 07/20/04 96.00 0.00 0.00 ww QUARANrOR INFORMATION LAURA JOHNSON 96, OO..8P___. ER 100. 204 8 RUDDELL.048 OENTON, TX 76205"1~--JOINER,CARRIE 70042106 08/02/64 1°23r 7 xx GUARANTOR INFORMATION CARRIE JOINER ,2v -'96.00... 0..00. ..,67..29-__SP..,. OP_.._-. V SHADY SHORE 0200 M4 LAKE DALLAS, TX 79065 R_ JONES,DETTY 40129709 09/31/84 GUARANTOR 1N1"ORMATION +p DEITY JONES 61. $D 0. 00 0. 00 SP.. ER _1 I235 MCDDIJALD OENTONIJ, TX TX 76201 153 2_ JONES, CLI14 rONA D. 40139349 06/21/84 123,4D 0. 00. .0..00 ER.. _.-q..._-__.__.._ _ GUARANTOR INFORMATION +p DWIGHT JONES 603 LOOP 288 NH-1 DENTON, T% 76201 --132 _ • JONES,DONNIE D. 40135378 06/21/04 +p GUARANTOR INFORMArION +p DONNIE D, JONES 68.00 0,00 0.00 60-00 _95__. ER J P-0, BOX 391 PROSPER, TX Tk 79078 4 --132 2 JONE9,REBECCA LOUISE 40143240 07/14/64 x+ GUARANTOR INFORMATION REBECCA LOUISE JONE914, 75 9.70 0. 00 24. 49__BP_.__£R 1406 AUSTIN DENTON, T% , 76201 "`4' "-07/t6/84 76 _ a JONES,AITA J, 10100923 04/26/04 L 861.09 +x GUARANTOR INFORMATION pw FREDDY H. JONES 380. 134 480 AT 0. 00 -1, 21._ a B0% 2 a4 4 AU AUBREY, T T% 76227 196 2_ JUAREL,R08AR10 40137002 06/25/84 112.10 xp OUARANTOR INFORMATION R09ARI0 JUAREZ 0.00___ ....0.00.__-112..,10.._.91 ~.ER._____1_ J ~ 932 ELM NA DENTON, TX 76201 ---------..120 KAHN,ALEEM 40120636 04/29/84 ww GUARANTOR INFORMATION** SHAFEE KAHN 56.00 0. 0,00.. _.9-BP ___£R___. L _ ~ 703 CO ROELL DENTON, T TX % 76 76a01 - 189. $ - ~ J KANANEN,BRIAN D. 40160673 09/09/B4 xw OUARANTOR INFORMATION wp BRIAN D, KANANEN 139. 00 0. 00 0,00 135, 00 SP _ _ER 9405 LOUISE 4204 DENTON, TX 76201 q.- a__. KANANEN,ORIAN D 40144867 07/19/84 96.00 xx OUARANTOR INFORMATION BRIAN KANANEN. 0 0,00 0.00.. __96_.00_,201_.-_.ER 2509 LOUIS DENTON, T% 76201-- 6201 109._ -_.2... KAY9,LINDA..JO- 40089716 01/02/84 xw GUARANTOR INFORMATION LINDA JO KAYB 100.00 .__.0.00 0. 00....._i08..00_ BP___,ER _ _ AT. 5 BILVERDOME MHI' 427 DENTdN, T% 76201 301 KELLAM,JEffERY D 40091936 01/11/84 70.00 +x GUARANTOR INFORMATION +p FRED MADDOK 00 O. DO _ 70. 00 ADD ER Ng_ J ~ 21 14 LANEY RD D1:NTON, TX % 76206801 - a^92 2._ KELLY,CATHY 40193355 09/17/84 +x GUARANTOR INFORMATION CATHY KELLY SB. 75 - - 0, 00 _ 0. 00 -50..70 _._95_. PO BOX 167 DENTON, TX 76201 76 KERR,RICKY E. 40120867 04129/84 61.20 363.70 +p GUARANTOR INFORMATION wy RICKY E. KERB 0.00 424.90. BP _ ER 2,. / L 2431 DENISON DENTON, TX 76201 169 2_-,- KERRI,BARDARA 40120008 04/26/04 p xx GUARANTOR INFORMATION rp BARBARA KERRI Fd BOX 90522 DEN 96.00 0 00.., 0_00 ._.__TON, TX _TX 7 _76a620-1 ._EA._-_- ISO- 56. 00 4.___.2 _ KI.O,BUN0 40091084 01/08/84 121.50 OUARANrOR INFORMATION xx SUNG KI,0 - P P.0. 00 O. O , -lot .50..... ...9P__.ER._.__-,4_-.d4/26/B4_.. .__._189. 2____. V• P. 0. BOX 9916 DENTON, TX T% %6201 " KINCHELOE,GERRY LEE_ . 40109761 03/21/84 Nis GUARANTOR INFORMATION +w GERRY LEE KINCHELOE AT. 2 BOX 2q _ 0. 00 91.00 0.00 9q 9 91..OQ,85._.._ER_„__3~.03L23/B4____._,~23.._ ARGYLE, TX 762Q6 ~ 01 NOV 1984 W R I T E- 0 F F R E P O R T PACE 3 PATIENT IJAME PAT ID DISCHO BEG-DAL NEW-CHO NErW-"AY W-0 DAL FC TYPE CYCLE LST.PMT AGE FO TYPE KINDSHOVEN,JENNIF'ER 40120131 04/27/04 100.09 0.00 -92,81 47.21 ADD ER. N8 09/21/84 164 2 aw GUARANTOR INFORMATION aw RONBTTE TOkRCS 3400 JOYCE LN DENTOfJ, TX 76201 KING, JOHN 40096471 01/30/84 98,40 0.00 0100 .98.40 8P ER 4 276 2 _ V aw OUARANTOR INFORMATION +r JOHN KING RT2 BOX 43 AUDREY, TX 76227 KINNAMON,SHANF W 70036678 05/21/04 51.79 28.43 0.00 60.18 BP.. OP 3 96 2 xr GUARANTOR INFORMATION as SAM KINNAMON 2137 HONDO DALLAS, TX 79219 KIRKHAM,KIMBERLY 4015073.^ 08/07/04 65.90 .$8.00 0.00... ..93..50....SP ER3___.._._. 80 2. • as GUARANTOR INFORMATION as - KIMBEnI,' KIRKNhM RT1 SX37A LEWIBVILLE, TX 79067 J j KNIOHT,KELLIE M 40107476 03/11/84 96.25 29.00 0.00 87.29...8P.. ER 8.._..... 227 g 1 a« GUARANTOR INFORMATION •w KELLIE M KNIGHT TWIN LAKES MHP 4208 DENTON, TX 76201 I !J KOVACH,STANLEY 10093268 03/20/84 650.69 0.00.. -435.00__215._65_.SP____.IP__. 2. 04/16/84 .199 2. as GUARANTOR INFORMATION wa STANLEY KOVACH 9301 COUNTESS CT LAKE DALLAS, TX 750659783 LAINE,JUANITA P. 40093296 D1/17/64 62,00 0.00 0.00 62.00 _SP ER J 4_ _ 286 2 ww OUARAf1TDR INFORMATION aw ''rITA P. I.AINE RT 2 BOX 141 PILOT POINT, TX 76296 LANDIS, KYLE BLAKE 0 04107/04 129.00 0. 00.,..__ _ 0.00- _129.00 _BP_ - _ER 2_._..._ 207 2---_ f a♦ GUARANTOR INFORMATION BLAKE LANDIB 1029 !J HICKORY DEMON, TX 76201 L I J LANTRIP,MONA L. 40141939 07/09184 142.00 0.00 -20.00 122.00 _8P_ _ER 3 10/11/64 21 2 as GUARANTOR INFORMATION +a MONA L, LANTRIP 2915 SPENCER RD. DBNTON, TX 76201 ti LANZI,CHRISTINE 40135592 06/21/04 96.00 0.00 0.00 96.00_ SP.__ER 4 132 2 U as GUARANTOR INFORMATION wa CHRISTINE LAN2I PO BOX 1101 LAKE DALLAS, TX 79069 LASSITER, JAMES E. 10112019 06118/84 L,240,30 0.00 0.00 1, 240. 308P_ IP 4 135 2 • aw GUARANTOR INFORMATION aw JAMES E. LASSITER 2311 STELLA 023'. DENTON, TX 76201 LAIARO,RDQELIG 10099935 04/22/04 928.63 0.00 . -74.00 _ 854. 60, SP_ _,IP_--_2__-_05/04/84 181 2 • as GUARANTOR INFORMATION as PEDRO LAZARO P.O. RAILROAD 90%441AVE DENTON, TX 76201 LEACH,BECKY L 10108900 OG/02/84 1,178.90 0.00 898,.92 _ . ga_TBP _ IP_..'-.3...... 07/09/84 115 2 J ww CUARANTQR INFORMATION sa BECKY 1_ LEACH 75067 L££,ONE'A 10003160 02/07/84 3,069.69 ••10.00.-2,646.65.._ 413,00_.8p___.lP_..... 2 ar GUARANTOR INFORMATIO14 ra ONEI'A LEE 502 JANNIE DENTON, i% 76201 y LEE,ONETA P 40080319 11/22/03 419,79 0.00 -321.b6' 321 56 __98..19 8P._ ER. 2.-. 06/04/84 190 2 _ pa GUARANTOR INFORMATION ax ONETA P LEE 902 JANNIE DENTON, TX 76201 y ,"FLERi.BEVERLY ANN 40107120 03/10/84 127,DO 0.00 A4_ as OUARANTOR INFORMATION as BEVERLY ANN LEFLER PO BOX 504382 2401 HINKLEODRIVE DENTON,4TX 07620104 '-216 _ y J LEIRDE, MICHEAL 40115669 04/f3/84 189.00 0.00... 0.00 189.00 ..BPER ....3 BOU 2 as GUARANTOR INFORMATION ra M1CH6'AL LEIRDE RT 9 BOX 1 DENTON, TX 76201 ' LEMONPDUMBOR 40120266 05/26/04 104,90 -22,79._ _-60, OD 2P..10___SP EN ..1.__.08/22/84 71_._. as GUARANTOR INFORMATION wa MOSES LEMON P,D, BOX 9805-NT OENTON, TX 76201 , 01 NOV 1984 N R I T E- p F F R E P O R T PATIf.N7 NAME PAGE 4 PAT ID D16CHQ CEO-UAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LST.PMT AGE F'0 TYPE LEMONS, CARLA 40119406 04/24/04 3 as GUARANTOR INFORMATION ar STEVEN 9.75 0.00. 0, GO 39.75 HP.. _ J LEMONS ER RT2 B% 318 GAINESVILLE, TX 76240 4 169 LEWIS,JEFF 40129272 09/29/04 pw GUARANTOR INFORMATION w« CLARENCE LEWIS 0'00 68.00 -58.00. 10. 00__82.. Eh. 1. ._06/06/04 148 U RT 1 BOX 20 C/O DENTON ESTATES MPH DENTON, TX 76201 2. LEYVA, JORGE I. 40129163 05/14/84 05. 00 0.00 20. 00 SP._. ER «w GUARANTOR INFORMATION ww JORGE I, LEYVA -65.00 --.2-.--.07/20/84 ` 2424 W. OAK N206 DENTON, TX 76201 104 2.. - LIGMT, JOE W IOL06342 001Z0184 1, 969.39 --___I • GUARANTOR INFORMATION «r JOE W LIC,Y RT I 0. _ LOT 23 DE001, 365. NTO 0. ENTON T , T% 35__ 7620 201 _.__1P . 4__. 163 2 LINTNER,DEGORAH 10102754 05/09/64 1,199. I as GUARANTOR INFORMATION wa DAN LINYNER 70 394. 25 0- 00 11 553. 95...8P.._..._Ip 2 $/02/84 PO BOX 331 TIOOA, TX 76271 0 - 174 2 LITTLE, JIM L. 70036801 05/23/84 731.69 43.30 0.00 . wr OVARAWTOR INFORMATION ww JIM L. LITTLE -775. 19...8P_.._DP..... _ 4_.__. _ J 2504 CARROLL BLVD. DENTpN, TX 76201 - --157 2.. LITTLE,JUDITH L. 40099149 02/07/04 rr GUARANTOR INFORMATION «w JIM L. LITTLE 101, 00 100, 25 0, 00 201, _..gP__. 6ER. 261 238 2 2504 CARROLL BLVD DENTON, TX 76201 LOCK,MATT 40126062 09/t8/84 137.90 +rr OVARANfOR INFORMATION rr MATT LOCK C/O ROSE LOCK O BOX - 0.00_ _1 _.$2 _,-pR--_q J _ 80X X 73 HALLAf4, NE 60369 66366 _ _..._.._._.165 2_ LOpAN,WILL L. 10099362 03/30/84 «r GUARANTOR INFORMATION r« WILL L. LQOAN 93t.90 0.00 --631. SP,---LP - _.._4_____07107/64 117 _2. J POO OB $73 573 DENTO DEI4TOIJ, TX 76201 ----I LOMAS,MELANIE 40149387 08/03/84 V «w GUARANTOR INFORMATION «r ROSIE P. LOMAS -24'00 222'00 -62.00 .__116 NT _6P,_...ER.- 3_._08/16/64 . ~ 5943 COOL VALLEY BAN ANTONIO, TX 78242 64 2_.. LONO,JIMMY D. 40t66340 09/28/04 j ww OUARANTOR INFORMATION wr JIMMY D. LONG 238'60 0.00. 0.00.__.236. 60.._8P_._...ER.- . 38 2 `NOME DENTON, 'fX 76201 LONQ,MARY FRAZER 10103018 00/27/04 • «r GUARANTOR INFORMATION r« GUY D. LONG 625.8e 307.00 _ -434 40 _ 298,A8._ BT _ _dP__. 3 07109184... 958 N MARKET NEW BRAUNFELS, TX 781305023 LOPEZ,MANUEL 40165862 09/26/84 rw GUARANTOR INFORMATION «w MANUEL LOPEZ 19.90 0.00 0.00 _..SO...BP ER_ - 35 2 -4 1403 TEASLEV LfJ DENTON, TX 7 763OI 01 L000HNEY,LINDA ELLEN 40147142 07/26/84 «w GUARANTOR INFORMATION «r LINDA ELLEN LOUQHNEY65 75 111 1 T5__SP.___ER_.. 10 0.00 bl 1-39 Nf21 I) DENTON TX 76201 40__...2-.--- LVCIER,HELEIJ D. 40129148 05/14/84 «11 GUARANTOR INFORMATION ru HELEN D. LUCIER 59.35 0.00._ -9,35 DO- 00 _BP__..ER_ . 0/84 ~ 1350 APPLEOATE P 0 BOX X 1497 LEWIBVILLE, TX % 75 75067 133 2 KUS,DANNlE J, 40132862 06/12/84 GUARANTOR INFORMATION «w DANNIE J. LVMMUB 123.79 __.._D.OO_._. 0.00_____123..75..BP__.._ER_ I V 1209 LINDSEY ST DENTON, TX 76201 3 L NA,KATHY DEE 40129678 09/31/04 70 0 " r« GUARANTOR INFORMATION KATHY LUNA C/O CLARA48MOTH 10209TH OT 0.00 ~ 4 SANDE ER, T% 76266 _ --152 2 _._LYNCII,KATHY 40125387 09/15/64 70.70. 0,.00 GUARANTOR INFORMATION «w KATHY LYNCH C. DO __...__70._7Q._BP__ %w RT. 1 BOX 2 AUDREY, T% 76227 .___.___._169..__...,2__.______..._ 1'~ ! 01 NOV 1984 WR I TE-0FF REPORT PAGE B PATIENT NAVE PAT LU DISCHO BEG--DAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LOT, PMT AGE FO TYPE .J LYNCH,KATHY 1. 40132870 06/12/B4 234,20 0.00 0.00 234.23 8P. ER 4.. J OUARAWIOR INFORMATION wa KATHY L. LYNCH RT 1, BOX 174-A AUDREY, TX 76227 14I 2 LYNCH, WAYIIE J 40130997 08/00/84 D6.00 72, l3 0.00 ..126. Ia. .SP.. ER 3 80 2 V GUARANTOR INFORMATION! ww WAYNE J LYNCH 101 DIVISION PILOT POINT, TX 76238 LYON AMANDA M. 40123403 03/13/84 140.60 0.00 0.00 140,60 8P ER 3 OUARANTCR INFORMATION DRAG LYON RT. 1 BOX 62DA KRUh', TX 76249 168 2 MAIER,MIKE 40132706 06/11/84 164. 30 0.00 0.00 164.30 "ADD _ ER NS_ . S GUARANTOR INFORMATION as GARY MAIER 316 FRY 0309 DEN'ON, TX 76201 141 .2. MANESS,SHERRY L 70039730 07/04/04 67.23 0.00 0.00 67.25..BP, DP. 2 J GUARANTOR INFORMATION *a JACKIE MANESB 998 BELAIRE 02107 LEWISVILLE, TX 73067 119 2 MANNINO,EDWARD 40116800 04/16/84 76.23 .0,.00 0.00 _.76.23"_.SP J GUARANTOR INFORMATION *a EDWARD MANNING ER 3_..._ ' 198 2_ 1704 HICKORY DENiONJ, TX, 76201 - MANSELL,CHR18T1NA 10107849 03/23/84 B17.40 201,30 0.00 IP. 1 GUARANTOR INFORMATION ww HENRY MANSELL. 227 TWIN LAKES MHP DENTON, TX 76201 1 - 131 2.. V ....._MANUEL,CLARA_ _ 40089161 12/31/83 26.00 _ 0.00 _ . 0.00.. _..26.00__SP._ ER_ 1 GUARANTOR INFORMATION CLARA MANUEL 1244 MCDONALD DENTON, TX 76201 303 2_... V MARBERRY,DEE DEE 10108470 06/02/B4 2,376,03 669.73 0.00 3,046.60_ SP _IP 2._ J 1 GUARANTOR INFORMATION *4 PAUL MARBERRY 893 NICHOLS TRA:LS GLENWOOD ACRES GILMER, TX 73644 147 2 MARSHALL,HATTHEW COLBY 70032113 03/28/64 361.73 0.00 °299.40_ 62.33 _.SP_ OP 1___09/23/(34 _ 37 2 V OUARANTOR INFORMATION a* I.ARRY 0. MARSHALL P.O.BOX 928 PILOT POINT, TX 76238 MARTINEZ,ALICIA F 10077360 03/30/84 014,89 262.00 -809. S9 . 186.96_ SP.. IP 1 .._07/24/&4 100 2 • lY GUARANTOR INFORMATION MICHAEL MARTINEZ P 0 BOX 843 BRIDGEPORT, TX 76026 MARTINEZ,AIIELIA 70040173 07/10/84 187.00 0.00 0.00187. 00__OF. _ ,OP 3 GUARANTOR INFORMATION AMELIA MARTINEZ 370 W. MAIN 023 LEWISVILLE, TX 73067 -113_ 4 E 11ARTINEZ,AMELIA 1 70039032 06/24/84 61.25 0,00 0,00 61,25 _SP. UP_ J GUARANTOR INFORMATION AMELIA I MARTINEZ 1------ -"_-_12B 2 370 W MAIN LEIJIBVlLLE. T% 70067 MART'1NEZ,IDA 40122624 03/06/04 461,83 0.00 0,00 _.__461.85._SP____ER._. 2 GUARANTOR INFORMATION u* GLORIA MARTINEZ C/0 BRASS G GIFTS 1622 W UNIVERSITY DENTON, TX 76201 177__- 2- MARTINEZ, MARY A 40131062 06/03/L4 218.79 0.00 0. 00 210.7S SP... Eft 2 148 2-- *4 J GUARANTOR INFORMATION CARLOS MARTINEZ 1400 ELM DENTON, TX 76201 ~ I _ MASON, DEBBIE 40130312 06/02/84 71.70 0.00 . _0..00_ 91. 73 _BP ER J GUARANTOR INFORMATION DEBBIE MASON R2LOT44 CAPRICORN MHP DENTON, TX 76201 MASQN, EMMA V, 1008645(3 03/07/04 3, 121, 30 -a5. 00 -3, ALLEN D.26 18..04 .8P_ III _4___ 06/30/04 124 2._..._ J GUARANTOR INFORMATION EMMA V. MASON B10 ALLEN ENTON, T% 76201 MASONrJEAN1E 40123963 03/10/64 81.23 _ 0.00 0.00 _ 81.25__ 8P_._ GUARANTOR INFORMATION ww )OJN MASON 2023BELL PCBX1795 D£NTON, TX 76201 165 2_._.._._ r0 1rn , A 01 NOV 1484 WR I TE-0FF REP OR T PAG£6 PATIENT NAME PAT ID DISCHO OEO-DAL NEW-CHO NE14-PAY W-0 DAL PC TYPE CYCLE LST.PMT AGE FO TYPE J MABBAY,KYNNDA K. 10101640 04/20/04 001.90 -97.42_.. -615.26 128.82 _.SP._._IP_ _2_.__06/18/84._.._..136 2. GUARANTOR INFORMATION ww CHARLES MASSAY RT 2 ROYAL OAKS N9 DENTON, TX 76201 _ U MATA, L AIL£EN 40129946 05/30/04 56. 00 0.00... 0.00 .._.56..00._. BP ER 1___.__.. 194 2 ww GUARANTOR INFORMATION AMELIA MARTINEZ 370 MAIN ST 029 LEWISVILLE, TX 75067 MCCALL,JOSEPH W 40130734 06/03/04 104.90 0.00 0.00 104.50 ADD ER NS 190 2 GUARANTOR INFORMATION ww JOE MCCALL P.O. SOX 169 ARGYLE, TX 76226 MCCALL, MAROARET. 40136384 06/23/84 56.00 0.00. 0..00____ 96. 00_ADD ER- _NS___ 130 2 GUARANTOR INFORMATION «w MARGARET MCCALL 513 PAWN CRT LAKE DALLAS, TX 7506D ' MCCARTY,LORRIS EARL 40126179 09/19/64 96.23 0.O 0.00 - - 96.25 SP CR--- 4.-._._._._ 165 2.. 1 GUARANTOR INFORMATION «a LORRIS EARL MCCARTY 1100 E HICKORY DENTON, TX 76201 J _.MCCAULEY,KEYIN 40128852 09128/84 166.50 0.00.... 0.00........166.50.. 8P....._ER.._..~.1__.___.___. _.195 2 «a OUARANTOII INFORMATION w« DONNA MCCAULEY 2210 BERNARD DENTON, TX, 76201 MCCONWELL,KRtBT£N OA5'LE 40121741 09/03!84 96.00 0.00._ 0,00 56.-00 _.SP.._ ER .2 - 181 2 ^ GUARANTOR INFORMATION ww GAYLAND MCCONNELL PO BOX 130 BANGER, TX 76266 J MCIIANIEL,PAIGE 4011BGJB 04/23/94 58.10 __.....0.00. 0.00_.___..58_10.._.SP_.__ER_._ 4__----- _._..192.. GUARANTOR INFORMATION JAMES MCOANIEL RT 2 BOX 341-14 FR18CO, TX 79034 MCDONALD,MARCIA 40134694 06/18/64 106.75 0.00 0.00 106.79 _SP.__ER___ __4____.133 2. ww GUARANTOR INFORMATION MARCIA MCDONALD POBX 193 PONDER, TX 76259 IU MCDONNELL, SONDRA K 40080197 12/27/03 96.50 0.00 - -40. 00 96. 50 __SP. ER__.._. 4..__ 06/21/64 133. 2_ GUARANTOR INFORMATION aw SONDRA K MCDONNELL 1802 GRECNI400D DENTON, TX 76201 MCOEE,CORRIN 10099083 04/19/84 1,643.80 311.5D -90.00 .1,B65,30 128 2 «w GUARANTOR INFORMATION ww CORAIN MCGFE 411 RUTH DENTON, TX 76201 MCGEE, KENNETH W 40140147 07/09/84 202.50 _ 0. OO..._ GUARANTOR INFORMATION w« KENNETH W MCGEE 609 S. BRADSHAW DENTON, TX 76201 MCOUIRE,PATRICIA SUE 40129967 06/01/84 56.00 0.00 _ 0.00 56-00 _SP. 153 2 ; GUARANTOR INFORMATION PATRICIA SUE MCQUIRE 1202 W. HICKORY DENTON, TX 76201 j - J MCLAUGHLIN,JEI4N[FER 40128290 09/26/84 125.50 0.00 -94. SO _ 31, 00.._BP ER 2--_07/12/84 312. 2 GUARANTOR INFORMATION GAIL MCLAUGHLIN PO BOX 272 ARGYLE ARGYLE, TX 76226 _ MCWSLLIAMB,DAVIU CARL 40143208 07/13/84 99.79 0.00 0.00 99.75__SP__. ER.. . _4.._._.07/16/89 10S 2 «w GUARANTOR INFORMATION w4 JACKIE MCWILLIAMS 521 E WINDIIORN28 DENTON, TX 76201 i MCWILLIAMB, ROBERT E. 40153912 00/ 17/84 04.00 192. 29 -00.00 _ 186.25 OR _ ER._.__ 1._.__08/30/84 49_ 2 GUARANTOR INFORMATION ww JACKIE MCWILLIAMB 921 WINDSOR 028 DENTON, TX 76201 " b J MERRI.TT,STEPHEN 40143893 07/15/84 82,29 17.00.... . 0.00... _...49.25__.SP.__.ER.._.._4.___,. 96 8__.____ OUARANTOR INFORMATION HELEN THOMPSON RT 9 BOX 76 SWAMPFOX CAMPGROUND ORNTON, TX 76201 __.MESSER,DANITA 10116184 07/06/84 427.29 14..70 _ 0 OO _ _441 95__ADD _._..114... 2 w; «w GUARANTOR INFORMATION DANtTA MESSER 02 OAKBROOK OR LEWISVILLE, TX 79067 , s •.A 01 NOV 1984 N R I T E- O F F A E P 0 R T PATIENT NAMF. PAGE 7 PAT ID DISCHG DEG-DAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST.PM1' AGE FO TYPE ,J MILLER,DEABY D 40139222 07/02/84 wa GUARANTOR INFORMAI-1014 wa 61, 25 0. 00 0.00 61. 29 8P. cR 2.. 122 J y RANDALL I1Il.LFA 919 MUUNTB DEWTON, TX 7620I 2 ~ 11ILLERiPAUL D 40119190 04/23/04 GUARANTOR 114PORMATION ww PAUL 0 MILLER 132.79 U.00 0.00 132.79.....82. ER 4.. 191 u AT / D0K 916 DENTON, TX 76201 - - - MILLER,14ALTEA G. 40[41988 07/09/84 96.00 GUARANTOR INFORMATION *w WALTER 0. MILLER 0.00 0. 96.00 BP EA 3 9936 BAKER THE E COLONY 56., TX 90040 l14 MMMB,FRANK._ 40123164 09/08/84 96.00 I GUARANTOR INFORMATION wa ELI2AOETH BITCHY 8T 40 0.00 __._143.4Q._._SP ER _.2__.. 1511WESTOAKPI DENTON, TX 76201 194 2 MINTER,DAVID EUGENE 40106169 03/14/84 j *0 GUARANTOR INFORMATION *w DAVID EUGENE MINTER 39 00 24.00 0.00 83.00. BP. ER _ J 614 LONDONDERRY gIO2 DENTON, TX 76201 222 2 MITCHELL,CAROLYN 70040419 07/12/84 I! GUARANTOR INFORMATION *w CAROLYN MITCHELL 630.70 0,00 6 126.14 BP OP 3 08/20/84 73 V 208X10131 1 DEN 56 NTBV, TX 76203 2 MOMTAHEIII,IDEAN 10101368 04/28/84 1,209.99 a* GUARANTOR INFORMATION wp NAS$ER 11011TAHEN7 O. OO -1, 100. 93.._ 103.02 _TON _-7_- 84 33 2 J >v 1706 BUTTERS HILL AR CARROLLLLT4IJ, TX 790075104 75104 . MORENO,RANIRO 40131146 06/09/84 73.00 0.00. 0.00. 73.00_._SP_..,ER. GUARANTOR INFORMATION as RAMIRO MORENO 148 2. J 912RASLROAb DfiNTON, TX 76401 6ORGAN,KIMOERLY L 40127441 09/23/04 144.90 GUARANTOR INFORMATION KIMBERLY L MORGAN 0.00 0.00. 144,.90_.192,__ ER 4.___... 194 8 ~ 2932 8 FEDERAL CHICAGO, IL, IL 00000 - MORLATT,DALE 40123923 09/09/04 237.29 0.00 237. 25 GUARANTOR INFORMATION/ ww DALE MORLATT 0,00 _ DENTON, TX 76201 t- 417 FT WORTH BR DENTON, TX 76201 MORRIS,TERRY WAYNE 40129130 09/14/04 79.00 O 0 GUARANTOR INFORMATION) _3__ 168 8 *w TERRY WAYNE MORRIS .Op 0.00 79,00 8P ER RT. 9 BOX 168A DENTO% TX 76201 MORT0N,M4RK L, 40127474 05/23/84 GUARANTOR INFORMATION ra MARK L. MORTON $9' 09 0. 00 0. 00 99. B3 8P ER. _4_._..._. 1T I BOX 949 PONDER, TX 76299 161 2... MULLEN,ELMER I 10064796 11/16/63 1,796.89 GUARANTOR INFORMATION ELMER I IIULLE14 0.00 - 906. 8' 290..00 67 IF, L__..12/09/83. 286 7 J 4 PO 8dK 143 SANGER, TX 76261. MVN8,STEPHANIE 10129973 08/17/04 071.39 409.89 277. GUARANTOR INFORMATION *w KEN F, MUMS -0..00 1, 24_._87.___12__J V 1, 7900 ROBERTS HOUSTON, , TX 77001 37 NADERI,AAHRAM 40018640 04/19/83 200.29 _ QUARA14TOR INFORMATION a* BAHRAM NADERI 14.90 0.00 294,79 87 ER 3 441 L RT 2 BOX 61,2 0 DENTON, TX 76201 171 NAKAHARA,_YUKt.. 40124947 09/13/84 GUARANTOR INFORMATION aw YUKI NAKAHARA 90, 79 .0- 00 00.__.. _90..70_._ADD.__NA_. J ~ C/O /O M ABAMORt NAKAHARA 1201 AVE A DENTO DENTON, TX X 76201 NANYEB,CARL D 40024077 09/09/60 GUARANTOR INFORMATION CAR[. D NANYES 48,00 30.00 22 0.00.,., 48,00E_8P.__ER ~ _ 943 2 ~ 932 N. CHARLES LEWIBVILLE, TX 79067 NICKERBON,J08H N 40147290 07127/04 GUARANTOR INFORMATION JIMMY N(CKERBON 0.00 _I99.00 x94, 90 104,_50__87 2--,,08/08/84 _ 4 73 2 RT1 OX16L VALLEY VIEW, TX 7627? ii J 01 NOV 1984 WA I TE - QFF R EPORT PAGE8 PATIENT NAME PAT ID DISCHO DEG-DAL NEW-CHO NE14-PAY W-0 DAL PC TYPE CYCLE LST.PMT AGE FO TYPE J NIX,LUCILLE H. 40091779 01/10/84 66.00 0.00 -10.00 56.00SP_...ER. ._.1___.02/20/84.._ 259 2 as GUARANTOR INFORMATION rtw LUCILLE H. NIX 1102 E. 14CKINNEY DENTON, TX 76201 v NIX, STEVEN 40147011 07/28/&4 101.79 0. Do 0.00 101.. 75__SP-.. ER _,.2.._... 94 2 rtrt GUARANTOR 114FORMATION ua STEVEN NIX 2001 TEASLEY 0154 DENTON, TX 76201 NYE,IBAAC 40121998 09/04/84 60,00 0.00 0.00 60. 00 .BP. y ER- - -2.,_ 179 2_. _ J rtx GUARANTOR INFORMATION art DAVID NYE 3400 JOYCE LANE DENTON, TX 76201 ~.OREAR,PAYR[CK.8_ 40150724 08/07/84 56.00 .__..0.000.0056..00_..ADD___ER_----- .NS..----_-___. __..85 __.2_._.._.._.,._.----j • xrt GUARANTOR INFORMATION xw PATRICK 8 OREAR 114AVE E0115 DENTON, TX 76201 - J OREAR, PATRICK S. 40190021 08/04/64 67.60 0.00 - 0.00. _67..60.ADD---ER - NO_ 88 2-- wx GUARANTOR INFORMATION wrt PATRICK S. OREAR 114 AVE E #115 DENTON, u 76201 ~ J OREAR,PATRICK S. 40151441 08/10/84 77.10 0.00 0..00.. 77.10__AUD._._.ER NB.___ BO 2.- GUARANTOR xa GUARANTOR INFORMATION as PATRICK 8. OREAR 114 AVENUE E 4115 DENTON, TX 76201 ORTEZ,JOALDO IU102143 05/02/84 1, 138. 50 0.00 0.00- It 138. 00-_SP-- -IP_.. 3._. 169 2 wa GUARANTOR INFORMATION xx JOSE R ESTRADA 1217 SOUTH MAIN STREET WEATHERFORD, TX 76086 ~ J PARR ISH, LUISA 40126326 05/19/84-. 99.25 0.00 0.00 99_29__$P__, 2.____._._ rtrt GUARANTOR INFORMATION rtx LUIZ GOMEZ 300RUDDELL#94 DENTON, TX 76201 PATTERSON,JOYCE MARIE 40138257 06/28/04 98.75 2.20 0.00... 61.00_.SP_..ER_ 122 2 wx GUARANTOR INFORMATION xx JOYCE MARIE PATTERSON 249CONNER PLAZA LEWISVILLE, TX 79067 V v PE DERSON, JAMES 40130125 06/28/04 56.00 0.00 0.00 96.00 _ADDER._._...NB___.__ .129 2 x4 GUARANTOR INFORMATION 4w JAMES PEDERSON 709 FRAME DENTON, TX 76201 d L PEEVEY, GERALD L. 40157307 00/3D/04 420.65 0.00 0. 00 .420. 65__. SP.-_ _ER_ 2__ 62 2 _ 4x GUARANTOR INFORMATILN xa GERALD L. PEEVEY 901 BERNARD OA13 DENTON, TX 76201 __PENNER,.JESSIE O. 10080109 02/17/84 26, 509.20. __❑76.25-26,.412.70 16._25__S2_ _IP___.._.4._ OB/29/04155.. 2_._._. . ww OUARANTOR INFORMATION ax JESSIE O PENN40 AT 2 BOX 323 PILOT POINT, TX ,t98 PETTUB, DANA 10114294 06/2&/84 1,452,25 30850 04 0. 00 . 5, 310._29-_8P__ IP...._ . 7_.__...___... 76 2 rtw GUARANTOR INFORMATION xx JAMES PETTQI PO BOX 451 DENTON, TX 76201 ~ J PHARISU,STEVEN D 40118079 04/23/84 102.75 0.00_. 0.00.-. 102.15...ADD._..ER -.NB.._ i91 _ 2.._.. Ow GUARANTOR INFORMATION ww RTEVIN D PHARISS 625 FT WORTH OR #18 DENTON, TX 76201 ~ J P IANTT, TAMMY L 40139867 07/04/84 2,00 68,75 0. 00 .70. 75 ADD. ER NB_._ _ 96 2__. xa OUARANTOR INFORMATION 44 TAMMY L PIANTT 3400JOYCE LN#163 DENTON, TX 76201 V PINKERTON,PATT[ 40135691 06/21/84 56.39 0.00 0.00 _ 56.39 8P ER_ 4 532 2-__ rt4 GUARANTOR INFORMATION art PATTI PINAERTON 010 FT WORTH #J DENTON, TX 76201 PIPER,KATRENIA 10109767 06/09/84 5,862.89 74.78_-0,0&3.91___ 863-73.--- ADD IP_____N8__.07/O2/64_ 76._ _.2.._______-,. ~ rtw GUARANTOR INFORMATION ww VIVIAN RUSSELL RT 7, BOX 66 DENTON, TX 76201 L....._PIROMATHA1131RI,MARIT 40134025 06/16/84 61.25 _._..O,OO____-41.29 ___._23_ 2.______ w4 GUARANTOR INFORMATION xw KAJIJARUS PIROMTHAMB[R1 1201 N AUSTIN ST 03 DENTON, TX 76201 ~ 1"' i 01 NUV 1984 W R I T E- O F T' REPOR T PAGE9 J PATIENT NAME PAT ID DISCHO DEG-BAL NEW-CHO NE14-PAY W-0 DAL FC TYPE CYCLE LST.PI1T ACE FO TYPE J PITTMAN, NANCY SUE 40131769 06/08/84 17(.78 xx GUARAurCR INFORMATION xw RON D. PITTMAN 0 25 0, 00 1781 00. .SP_ ER_. 3._ J I09 1/8 CdLLEQE BT. FARMEgSV1LLE, T% 79031 1qa 2. PITTS,CHRISTY 70039290 09/02/84 72.00 0.00 -57,60 14, 40 _SP.__.op xx OUARANTOR INFORMAT(ON ww BOBBY PITTS 3.__-07!16/$4 _ lop 2 V SOX 143 JUSTIN, T% 76247 POMEROY,JESSE 40119398 04/24/84 96.00 0.00 -41.20 14,80 SP ER xx GUARANTOR INFORMATtON xw DEBORAH POMEROY 1. 05/11/114 174 $ 1110 EOAN DEIJfRN, T% 76201 PORTER,ROY_ALV114 40168734 10/06/84 96.00 0.00 -_SP 26 2- 4* GUARANTOR INFORMATION xx ROY ALVIN PORTER RTL OAKDALEO CLEBURNE, TX 76031 ER. PR ICE,FREDDIE R 1 40107450 03/11/84 98.20 0.00 00 25-SP , - J xx GUARANTOR INFORMATIONt wx JOYCE PRICE 0. 98. ER 2_...- 234 2 860 OAKWOOD LE WfBVILLE, T TX % 79067 - PROSE,MICHELLE 40119695 04/29/84 06.00 wx GUARANTOR INFORMATION xw DWAYNE PROSE PC O 0.00 _00 BOX 691 P PIL L0 96.00_-8P. _.ER { J OT POINT,, TX 7629$ 4 - 189 $ PUNCH,LEOIJARD 0,_ 40120902 04/30/84 56.00 O .CD -15.00 ~ _.._r wx GUARANTOR IIIFORMATIO14 xx LEONARD D. PUNCH .00 93 DEN TON, 762PER 1-.. 09/07/84 8 'J Pd BOX 2993 DEidN, TX % 74201 xxxx W-O TOTALS xxxx . 76, 039. 91 -47,593.47 _ 7,824. 09 36,270,09 4 _ 1. J ~ 01 140V 1904 W R I T E - 0 F F R E P 0 R T PAGE 10 v PATIENT NAME PAT ID DISCHG CEO-UAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST.PMT AOE FO TYPE J _ J JARRE:LL,JACK H 40134197 06/16/84 99.00 0.00 0.00 99.00 SP._. ER .........4.._-06/.18/84.... 139 6 ww GUARAITOR INFORMATION aw LOIS JARRELL 1903 N MILL 03413 LEWISVILLE, TX 79067 u OVARLES, LLOYD 40122899 09/07/84 122.45 0.00 -26. 12 96, 33_.ADD. _ ER N8.- 06/08/04...... 196 a• GUARANTOR INFORMATION we LLOYD QUARLES PODX2982 DENTON, TX 76201 , as GUARANTOR INFORMATION LANA L RA.,00N 53d E. MAIN 09 LEWISVILLE, TX 79067 as • RICCABONI, TIMOTHY J. 4019994 0 1 08/24/84 80.00 86.110 0.00 _ . 86.10_ SP. D .ER R 2 N8_08/27/134 44 6 _ bb wa GUARANTOR INFORMATION aw TIMOTHY J, RICCA00NI 3904 NE 22 CT OCALA, FL 32670 RICHARDS,CHASTITY KAY 40129280 09/19/84. 96.00 0.00 0.00- 96.00 8P_ _ER -__3-----.. 169 6 f ww QUARA14TOR INFORMATION ww CHARLES H RICHARDS RT 2 COX 2 DENTON, TX 76201 J ti RIDDLE,C014NIE 10127649 08/29/04 1,124.90 666.39 0.00 1,791.29. SP_.._IP.. 2__... 37 6 wa GUARANTOR INFORMATION aw BILLY RIDDLE 1713 VILLAGE EAST 0102 DENTON, TX 76201 J ROBBINS,E8THER 10123776 08/09/84 929.39 0.00 0.00 929.39 SP- .IP_ - -_3.. 03 6 aw GUARANTOR INFORMATION wn JOHN ROBBINS RT 7, BOX 39 SHRRWOOD MHP DENTON, TX 76201 J ROESSL.R,O£NE 40164360 09/21/04 96.00 0.00 0.00 _ __._96.00-_SP_._._ER__-_2..-.___.._ _.__...39 -6_. as QUiRANTOR INFORMATION as GENE ROESSLER 2103 N ELM DENTON, TX 76201 ~J ROGERS, GARY DON 40128084 09/26/84 29,00 0.00 . 0.00 _ _ 29.00.._SP___ER____I____09/29/84 196 6__ . aw GUARANTOR INFORMATION as GARY DON ROGERS R29X369 PILOT POINT, TX 7628$ V RUSSELL, STEPHANIE A. 4014240$ 07/10/$4 101.79 0.00. 0.00 _ _ .101..79 ...SP - _ ER __.110 6__.- . wr GUARANTOR INFORMATION •w BECKY RUSSELL 2922 LOUISEM34 DENTON, TX 76201 . V BAADEH,KAI1ALELDIN HASAN 40140976 07/06/04 65.50 0.00 0.00_69. 50 -SP_ ER _3.._ _ 11D b AN GUARANTOR INFORMATION wa KAMALELDIN HASAN BAADEH 901 BERNARD 0223 UNIVERSITY CITY APTS DENTON, TX 76201 • V BALIf4A8,8U8fE 40127790 09/24/84 79.30 - 0.00 _._._..0..00-------- 79..90-,ADDEft ------_.,_.._199._.._6 rw GUARANTOR INFORMATION wa THOMAS SALINAS RTl OX 1 KRUMP TX 76249 0.00_. _ 0..00...._ 123.20._AOD .113. b__ SALINAS,.THOMAS 40141463 07/08184 123,24 J ww GUARANTOR INFORMATION aw THOMAS SALINAS 1931 EDWARDS DENTON, TX 76201 - J L SALISBURY,BRENDA 4019362908/18/84 64.10 _.0.00 . . 0.00.___64.-SO 74 .6-_ wr GUARANTOR INFORMATION ww OREf4DA SALISBURY PO BOX 31 ROANOKEs TX 76262 J SAMPSON,11£RRY D 30071140 01/23/84 1,497.26 740.00 x1,$94,03 342..43__8P_. IP _.._3._.._96/16/$9_._..... 130. 6 wa GUARANTOR INFORMATION aM JODY J SAMPSON RT 2 LOT 49 LAKESHORE DENTON, TX 76201 SAVAOE,LARRY 10113296 06/22/84 916.30 0.00._ 0.00__. 916.30 -ADD-. IP___NB 130.6__._._._ wr GUARANTOR INFORMATION aw LARRY SAVAGE 304 W 7TH CLARE, MI 40617 , SCOTT,PONTELLA 40100398 02/11/04 99.09 _ 0 00 0.00__- ._115..09_-SP._..ER _3._.. _ 2616---- _ it ar GUARANTOR INFORMATION rw FONTELLA SCOTT 1019 8 RUDDELL 015 DENTON, TX 76209 V ~ SET SNAP GERALD 4013356006/19/89 79.00 L- L ADD__-_.ER ___NS._.07/30/84 rw OUARANTOR INFORMATIC14 ww LINDA RETINA 704 CODER DENTON, TX 76201 %w 4 01 NOV 1984 W R 1 T E- 0 F F R E P 0 R T PAGE 11 PATIENT NAME PAT ID DISCHO CEO-DAL NEW-CHO NE14-PAY W-0 DAL FC TYPE CYCLE LST.PMT AGE FO TYPE .J SHIELDS,LISA MICHELLE 40155236 08/23/04 56,00 V.00 0.00 96.00. ADD ER NS.. 70 6 wa GUARANTOR INFORMATION wa LISA MICHELLE SHIrLDS 2504 LOUISE DENTON, TX 76201 _ u SICKIN0,SHAWNA 10098523 04/17/84 1, 741. 99 54,205. 57 _ -5. OD 55, 442, 56._SP_ IP . 3.05/16/04 121 6 as OUARAWTOR INFORMATION ar WILLIAM SICKING 935 S.DIXON #408 GAINESVILLE, TX 76240 • SIF I,AHMAD 40133910 06/16/84 42.00 0.00 0.00 42.00 ADD ER _.N8 06/18/84 136 6 as GUARANTOR INFORMATION rw AHMAD SIF! 1901 EDWARD 0100 DENTON~ TX 76201 SLATON,MICHAEL_ 40137010 06/25/84 84.75 0.00 0.00 84,'5 _.ADD....ER_. __148__. _ 128 6 { aw GUARANTOR INFORMATION wa GAIL SLATON 2038 14EOO RD. DENTON, TX 76201 SMITH,CHRISTINA. 40158875 09/04/84 56.00 0.00 0.00 D6..'10.__ADD-__ER _NS 57 6 xx GUARANTOR INPORMATIO14 rw CHRISTINA SMITH 803 ELM STREET #A SANGER, TX 76266 _ SMITH,JUANITA 40151037 08/08/84 63.65 0.00 J 0. 00__.h3.65_.ADD_._Ek.NB_89b__ xw GVARANTOR INFORMATION wa JUANITA SMITH 622 8111TH DENTON, TX 7,6201 I J SMITH,MARY F 10111748 06/17/84 2,727.15 0.00 320.00...2,_407..19 ._ADD IP NS 07/05/84. 119 fi as GUARANTOR INFORMATION ra 14ARY F 8141TH RT 3 BOX 101-0 735 THOMPSON DRIVE SPACE 4 DENTON, TX 76205 l 4 SMITHERB, JOSEPH 40117798 04/20/84 128.00 0.00 0.00_ _ 128.50 ADD.__ER__._. NS 194 aw GUARANTOR INFORMATION xw AI_ICIA SMITHERS 1710 BOLIVAR DENTON, TX 76201 BONDEREGGER,PAVI. EDWARD 40142275 07/10/84 61.75 0.00 0.00 61.75 ADD ER N8 113 6 xx GUARANTOR INFORMATION rw PAUL EDWARD SONDEREGOER 1810 MAPLE DENTON, TX 76201 SPLAWN,CONNIE L, 10106698 05/21/84 928.10 216.50 -0. 00 It 139.60 _ADD _ IT, _ _NS ._00/13/84_ SO 6.. ax GUARANTOR INFORMATION xa GEORGE SPLAWN 510 FT WORTH DR. DENTON, TX 76201 SPLAWN, RANDY 40108219 03/14/04 69.00 0.00 0.00 .69.00- SP SP ER___ _ 2_.__ 231 6 _ ar OUARA14TOA INFORMATIO14 DELMA'J SPLAWN 624 RAILROAD DENTON, TX 76201 ~r SPRAYBERAY CINDY 40127557 05/24/04 156.25 23.50 0.00 179,75 ADD ER_._. NS_ 148 b L wa GUARANTOR INFORMATION aw RICKY SPRAYnFRRY RT2 BOX89-3 ARGYLE, TX 76226 ~ J SPUARIER,AVBREY(SONNY) 40130082 06/04/84 71.00 0,00 -12,96 08.04 ADD ER NS 06/30/84 124 6 aw GUARANTOR INFORMATION wa AUDREY(SONNV) SPURRIER UNITY LODGE DENTON, TX 76201 STALLINGS JA,JAMES C 40108912 03/17/84 136.00 19a.OD 0.00 331, OD SP ER. .3._ 176 6 xx GUARANTOR INFORMATION 44 JAMES STALLINGS SR RT 3 BOX 764 AUBREY, TX 76227 STARNES, VIRGINIA R, 40110330 03/23/04 59.00 0.00 0.00 B9.00 , BP ER 4_ _ 222 6 _ as OVARANTOR INFORMATION a7 VIRGINIA R STARNES RT 3 BOX 402 AUDREY, TX 76227 w ~J STARR,MARISA 10077451 01/09/04 3,037.15 -22.75 0.00_.3,014.40_ SP_._IP__.__ _ _ 290 6____.. xr GUARANTOR INFORMATION rw CHARLES STARR TIT 3 BOX 350 DENTON, TX 76201 STEPHENS,CYNTHIA 40131443 06/06/84 56.00 0.00 0.00 56.00 ADD ER-_._ NS 147 b _ J as GUARANTOR INFORMATION rr CYNT141A STEPHE149 910 LOCUST DENTON, TX 76201 4 STEPHEN'a,ELI ZABETH 40118937 04/23/84 58.10 0.00.._ 0.00 00_10-.ADD._.RR N8 192 6 wx OUARA14TOR INFORMATION xa CYNTHIA 8TFnHENS 709 N CHARLES #135 LEWISVILLE, TX 75067 4 , 1w 1 01 NOV 1984 WR I TE -OFF R EP 0R I PAGE 12 I PATIENT NAME PAT ID DISCHO DEO-DAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST.PMT ACE FC TYPE J IJ STEPHENSOI47 JERRY 40142216 07/10/B4 56. 00 13. 90 0.00 69, 90 ADD _ £R _ NB.. 48 6 as GUARANTOR INFORMATION as ,:RRY STEPHENSON POBX508 ROANOKE, TX 76262 L STEPPS,WALTER 40117913 04/20/84 260.90 0.00 0.00-. 260.90 _ADD ER NS.. V as GUARANTOR INFORMATION as WALTER 81'£PPS 910 W OAK R6 DENTON, TX 76201 193 6 STEVENS,CARL ALVIN 40117475 04118/84 60.89 0.00 0.00 - 60.85- ADD.. ER NS 196 6 as OVARA14TOR INFORMATION as CARL ALVIN STEVENS RT $ DENTON, TX 76201 STEWART, VIRGINIA R 40123572 05/10/84 59. 00 . 0.00 _ 0. 00_..... 59, 00.._. ADD- ..ER _N8_........-.. 174 6 { • as GUARANTOR INFORMATION as VIRGINIA R STEWART 1300 DALLAS DR #1727 DENTON, TX 76201 STIKE,OREO P. 40191993 08/12/81 ' 56,00 0.00 0.00. J as GUARANTOR INFORMATION) as OREO P. STIKE 56.. ER..._ N9 00 6 I ` 50908 90TH AVE. DALLAS, , TX % 70221 STVART,VIROINIA C. 10117851 07/14/84 1,901,93 -22.79 0.00 _1,879 1S__ADD IP NS _ 106 6 J as GUARANTOR INFORMATION as JEFF DECKLY 5201N.CHADDOURNE SAN ANGELO, TX 76903 L SULLENOER,ELTON JOHN 40132797 06/11/84 96.00 0.00 0.00-_..._ 56.00._.-ADD ER_._....NB__ as GUARANTOR INFORMATION as JOHN SULLEIJOER 141 6 L RT 9, BO% 102 DENTON, TX 76201 SULLENGER, MARY LOUISE 40109456 03/ 19/64 97.00 -2.60 -47.40 47, 00 ADO- _ ER___ NS _-04109/64 206 6 J as GUARANTOR INFORMATION as JOHN SULLENGER RT. 9 BOX 102 DENTON, TX 76201 L SULLENGER,.TAMMY BERNICE 4005164108/11/83 95,60 2.49 0.00 _96,.0c?_-ADD_,_-ER......NS._.__ _._.233 .4 as GUARANTOR INFORMATION as JOHN F. SULLEIJO£R RT 5, 102 ACORN RANCH DENTON, TX 76201 J L SVLLIVAN,DAVID 40113938 041?06/64 105.50 0.00 0.00 . . 103.50_ADD ER _ N$___._.__. 207 6 as GUARANTOR INFORMATION as DAVID BULLIVA14 ~ 623 8 RUDDELL D£NTON, TX 76201 TAYLOR,KATHERINE SUSAN 1009467003/28/84 1, 107.99 344.00 0. 00 _.1,.491,95__SP__. Ip.159 6 • ww GUARANTOR INFoRIIATION as TOMMY TAYLOR RT 2, BOX 341-24 FRISCO, TX 75034 V ...TAYLOR, PAVL 40096461 01/30/84 209.00 0.00.- _ 279 • as OUARANTOR INFORMATION as PAUL TAYLOR 4 ~ 801 8i£RRA DENTON, TX 76201 TAYLOR STEVEN V 40/96127 08/26/84 60.20 10.40 0.00 _ J wa GUARANTOR INFORMATION as STEVEN V TAYLOR 78.60_. __ER NB 63 6 RT 4 04% 420 D£NTON, T% 7620 6201 THACKER,TIMMY 40112900 03/31/84 9Z,oO ..0.00 as OVARA14TOR INFORMATION as TIMMY THACKER 0. 00.___..._ 92. 00 __..BP_.._ER.._._._.1__-.._.__ ....____..213 ~ 930 8 KEALV LEWIBVILLELP., TX 75067 0000.~.._. 193. ._..OP_. £R__ .3_.____. 370. 6__.____..._._____..,.i J ~ GUARANTOR * 9 PENNSYLVANIA DENTONNTgN, 1X 76201 as AB,DOROY[NIORMATIOfJ aw40004E95~0MA810/8;, 98 20 l2o. Sb.,OO ADD- . N$___ as 96..00 09 U0 PENNSYLVANIA ' . _._THOMPSON, , JAMES L... 40127045 00/22/84 J OVARA14TOR INFORMATION as THOMPS01% JAMES L. GENERAL DELIVERY LEWI6"ILLE, TX 79067 "'-163 THOMPSON,JAMES L 40146433 07/24/84 6-'.25 0,00 'J as GUARANTOR INFORMATION as JAMES L THOMPSON 0, 00,_ 63,_p9_-ADD _ _.ER____..118___.__... 99 ~ OEN DELVRY L£IJIOVILLEr TX 79067 r~. _THOMPSON,STAN 40194429 08/20/84 56.00 0.00_ _O. 00 ...___96._00__-AOD__ER.____N8_ _ _.._..7Z.----.b aA GUARANTOR INFORMATION as STAN THOKP80N 946 KELLAM TOPEKA- K8 66616 7 01 NOV 19B4 W R I T E- 0 F F R E P 0 R T PAGE 13r PATIENT NAME PAT ID DISCHO BEG-DAL NEW-Cliff NEW-PAY W-11 DAL FC TYPE CYCLE LST.PMT AGE PG TYPE ,J ti J TINNEY,CHARLES W 10069819 12102103 877.75 -1.75 -542,85 333.13 _SP IP 3.._.06/28/84 126 6 GUARANTOR INFORMATION CHANLES W TINNEY 2500 HINKLE DA DENTON, TX 76201 U TORRES,DEBRA 8. 70010445 09/15/83 61,25 40.00 0.00 101.25 SP tip _4_. 359 6. GUARANTOR INFORMATION *a DANIEL TORRES 117 BURL DENTON, TX 76201- s TORREB, FRANCES ANN 40069601 10/1l103 92. 29 0. 00 0.00 92.25 ADD ER Na 394 6 GUARANTOR INFORMATION FRANCES ANN TORRES 1919 MOHIOAN DENTON, TX 76201 TORRES, J08E L _ 40152202 08113184 56.00 0.00 _ 01 OD 56. 00_ SP_ ER 4..__ _ 79 6 . *w GUARANTOR INFORMATION rw JOSE L. TORRES 515 SMITH 06 DENTON, TX 76201 r 1 ~ J TRACY,HITCH 4005509908/22/133 60.25 0100 0.00 60.2$ SP.. ER _I435 6 OUARAN'iOR INFORMATION MITCH TRACY AT 1, BOX 640E SANGER, TX 76266 ~ J TREJO, SILVIA C 40104721 02/28/84 73.30 O' 00 0.00 73. 50 SP.. _ ER 4 246 6- i GUARANTOR INFORMATION SILVIA COWEN 1813 TYLER DENTON, TX 76201 TREVINO,MELISSA 40111015 03/25/84 104.75 96.25. 0.00 __...161..00_.ADD..__ ER.._..NB. 62. 6.. GUARANTOR IN'FORMATIO14 NICK TREVINO 1711 FINA DENTON, TX 76202 TRUITT, SHANTEL D. 40062176 09/15/83. a6.00 24. 00..... 0. 00._...... 80. 00 .SP. - ER .._._4D9. _ .6.._. J GUARANTOR INFORMATION JOHN W. DAVID 1021 E. HICKORY DENTON, TX 76201 J TUCKER, JAMF_8 A. 40069484 09/26/03 99.00 0.00 0.00 ..99..00 SP _ER 3_.__..._ ...400. 6..........__ *w GUARANTOR INFORMATION *w JAMES A. TUCKER 501 LONDONDERRY 837 DENTON, -X 76201 TURNER, TERRY 40146946 07/25/84 249.60 7.00 0.00 256..60__ADD . ER _._.NS.__.. 90 6___. 4 GUARANTOR INPORMATIO14 TERRY TURNER 2300 FT WORTH DENTON, TX 76201 4 ~ S VALDEZ, DEVON 0. 11, 401107,1 B 03/23/84 31.00 0100 0.00 . 31, 00 _ ADD ER NB_. P3/23/84 223 6 GUARANTOR INFORMATION RAYMOND VAI.DEZ AT, 2 027 LAKE SHORE MHP DENTON, TX 76201 VENABLE,IIAAY 40150362 09/02/84 58.25 01 00 0.00_. 08,25 CC____ER_______ 59 6_ • GUARANTOR INFORMATION ww FRIENDS OF THE FAMILY DENTON' DENTON, TX 76201 J WALDEN, JOAilN 70034558 09/26/84 90,00 0,00 01 00..... 90..00_ .ROD dP.... N$ 189 6 ' *r GUARANTOR INFORMATION w* JOANN WALDEN 1406 OAK WOOD DENTON, TX 76201 " J WALDRUM, DENNIS, L 95008694 01/31/B4 66.25 0.00 0.00 66.20 SP OF 275 _ 6 OVARANTOR INFORMATION DENNIS WALDRUM, L. AT 1 BOX 898 AUDREY, TX 76227 ~ !J WALKER, DANNY 40132961 06/12/04 58.90 0-00 0.00 58...90._.ADD, _.ER. 141 6 GUARANTOR INFORMATION *M DANNY WALKER 511 RUDDELL DENTON, TX 76201 WALKER,MELISSA JANE. 95010067 03/31/04 325.00 200.75 0.00.._. 525,75__13P._ *w GUARANTOR INFORMATION LARRY DALE WALKER AT 7 BOX 51-D DENTON, TX 76201 W WALKER, VERNER LAKE 40132204 06/09/84 56.00 0.00 0.00 56..00._. ADD PR._.._._ N8_ 143 .6 GUARANTOR INFORMATION VERNER LAKE WALKER 1104MULDERRY DENTON, TX 76201 WALLACE,CAROL 40122418 05/06/84 144.00 0.00 -113.00 _....31.00__ADD___ ER _..N8..06/06/64 148 6._. GUARANTOR INFORMATION CAROL WALLACE OOODONNIERRAE0219 DENTON, TX 76201 i, 4 .y J 01 NOV 1904 W R I T E- 0 F F R E P O R T PAGE 14 PATIENT NAME PAT ID DISCHO DEG-BAL NF.W-CHG NSW-PAY W-0 DAL FC TYPE CYCLE LST. PMT ACF FO TYPE J WALLACE,JOHN 4UI44715 07/18/04 60.00 fJ rr GUARANTOR INFORMATION rp JEFF WHITECLOUD 0.00 0 60.00 ADD EA NB.. 103 G 2919 LOU[8c #1 DENTON, TX 76201 WALLACE, KENT 11 100779-1 01/12/04 2,246.90 0,.00.. V rr GUARANTOR INFORMATION rr KENT 11 WALLACE 1104 JEFFREY 0. TR 00.. t2,AV1N0, ING 0 _8P_ IP 2 291 4 . T% 75062 WALLACE,WILBER 40109530 03/20/84 56.00 xx GUARANTOR INFORMATIC14 xx WILDER WALLACE O. BOX 994 DENTON, TX 76201 - _.WAAO,AR F-- I0 x GUARANTOR ANTOR INFORMA71014 xp 8P_ IP BARBARA0L/14ARD4 967.90 P.O, BOX 15 LITTLE ELM, 7506$ 3.._._. _.^^>2y 4_.- WARD, BRENDA SUE 401930TO 09/10/84 134.25 0.00 134.20 / OVARA14TOR INFCIRMATIO14 rr BRENDA SUE WARD 0. 00 - ADD ER- _ NO 74 6 1909 NORMAN DEN TON, , TX TX 76201 WARD, GARY D. 40138323 06/29/84 0.00 200.69. j rr GUARANTOR INFORMATION rr GARY D. WARD .__-200.69ADD"_ ER_._..NB.._ ..409 SAINT i1 MOR0RITZ LtJ C/0, WM. BECKMAN PHOENIX, A2 89023 43 6 WARD,JOHN CALVIN 40195679 b0/29/89 J rr GUARANTOR INFORMATION ap JOHN CALVIN WARD 22.35 O.OD 0.00 ON222. , TX ADD. .-ER_._-N$._..___._.. AT 4 Bak 330 D£NTON TX 76201 63 b WARD,LEON BUFORD 40092865 01/16/84 96.00 J xx GUARANTOR INFORMATIC14 xx LEON BUFORD IJARD 0. 00 0. 96. 00_._ $P__.. _ 1! Pa BOX 274 FT. , WORTH HWY. DENTON, TX 76201 - 290......6..._... WARD,LEON BUFORD 40162502 09/16/04 06.70 44 GUARANTOR INFORMATION] ar LEON BUFORD WARD DO 0_._.96._70__$P fR...1"„___ __.._99 6_._ PO Q BOX 274 DENT-ON, TX 76201 - " WEDB,CASEY. 40102089 02/17/84 67.00 90 _ rr GUARANTOR INFORMATION rr CLIFFORD WEBS T 0.00 88X 742._ ER_._ _.3 L R7 4 BOX 311 DENTON, T% 7b201 - 45 b____ WEEEMS,ROSE ANN 40084873 12/12/53 107.50 0.00 0,00 50 . ADD I OVARA14TOR INFORMATION ra ROSE ANN WEEM9 -.-107, _ - £R- - N8._ 323 6 ; • 3000 N BTEMMONB M20 LEWI BVILL LLE, TX 069 WELCHO,MCLISSA 40123069 03/06/84 93.50 0.00 . 0,00 93-50-- En rx GUARANTOR INFORMATION rr BARBARA WELCHO 3311 EAGLE DR, 07 DENTON, TXD 76201 N8 176 _..6.._ WENDT, DRSON D, 40160756 09/09/54 119,50 0.00 0. 00 -__119..90 __ADD_ ER J rr OVARA14TOR INFORMATIO14 ra ORSON D. WENDT NO 92 "6 RT 1, Dtl% 931 LITTLE ELM, T% 78068 WEST,CINDY 40112575 03/31/94 103.50 0.00 0,00 109.80 BP_.__ER. 1 j rr GUARANTOR INFORMATION rr CINDY WEST 305 N LOOP 28B 09 N DENTON, TX 76201 213 6.__. WEST, RAYMOND 0 40103512 D3/03/84 36.00 10, 00 rr GUARANTOR INFORMATION rr RAYMOND 0 WEST RT 1 BOX 722 0AUBREY66TX0 76227 ER NO 2:19 6 _ WESTBROOK,KENNETH 10074474 12126183 959.80 140.75 . J rr OUARANTOR INFORMATION rr KENNY WESTBROQK 0.00 I, 99 8P,_ IP_..__3 1r PO 0tlX I93 SCRUM,, T%X 76247 303..... 6.....__.. WE07ERMAN,WILLIAM H " 40099582 02/09/94 94.50 0.00. ' rr GUARANTOR II4FORMATtO14 ra WILLIAM H WESTERMAN 0,.00_ ..94.90._8X_.. 5 b P. O. BOX 511 LAKE DALLAS, TX 700 9069" 1 86 "J _ WHATLEY, LISA 40144271 07/16/84 146.45 0.00 rr GUARANTOR INFORMATION rr LISA WHATLEY AT 8 ROW E E BOX -115.40 24 DENTONNTON,_.. TX 76201 ADD___BR..__NS-_OS/1B/$4---- - ___.79 @___`__ , Iv ~ p I 01 NOV 1984 WR I TE - OFF R E P 0 R T PAGE 15 r PATIFNT NAME PAT ID DISCHG BEG-UAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST.PMT AGE PO TYPE ,J WHIBNAIIL,MELISA A. 40141479 07/08/84 129.05 0.00 0.00 129.05. ADD ER. _.NB.. 114 6 as GUARANTOR INFORMATIOO as LOLA WHISNANT 305 AVE 0. DENTON, TX 76201 WHITE,RICHARD N 10082766 02/02/84 1,989.05 0.00 0,00 1,989.05 _BP__ IP _4._ xa OQARA14TOR INFORMATIO14 ra E.8. WHITE RT 2 BOX 42 AUDREY, TX 76227 272 6 - - WHITE,TONYA FAY 40116527 04/15/04 111.75 0,00 0.00 111.75 ADD ER N8 199 6 • ax GUARANTOR INFORMATION as TONYA FAT' WHITE 152-AA R7 9 DENTON, T% 76201 WHITLOCK, PHYLLIB A. 40104697 02/20/84 152.65 0.00 0.00 192, 69 8P__. _ ER 4__...._ A l xa GUARANTOR INFORMATION ax PHYLLIS A. WHITLOCK 9068 RUDDELL 0138 DENTON, TX 76201 245 _ b WHITHAN, D'ADRA 10094945 03/28/84 1,124.59 221.50 -756.87 589.22 SP IP 2-__.05/04/84 181 6 J xa GUARANTOR INFORMATIO14 as MELRYN WHITMAN P,O, BOX 1092 RIIANOKE, TX 76262 WHITMAN,D'ADRA TYANN 40107629 03/12/84 122.75 213.90. 0.00._ .336.65 SP._ _ER, 2.___.. _ J xx GUARANTOR INFORMATION xa TED AVERY BRANNUM PO BOX 1092 OAK LANE ROANOKE, TX 76262 185 6 „ WHITIJORTH, DONIAIE 40092256 01/13/84 56.50 0.00 _ 0. 00 - 96 293 6 _ J as OUARANTOR INFORMATION as DONNIE WHITWORTH 00 P._-. ER . .2 609 EMERY DENiON, TX 76201 762tl WILCOX,PEOGY_ 10079671 01/18/84 983.10 0.00_. 810.13._. _142._97__SP_.___1P_____2__.06/05/84_._......__149 i J ax GUARANTOR INFORMATIO14 xa PEGOY WILCOX RT 2 BOX 1163 DENTON, TX 76201 6.- WILEY,BURNETTE ROBINA 10092831 03/17/84 737.20 0,00 0100 737,20 _ADD__ IP._ . NS 227 6. xa GUARANTOR INFORMATION xa BURNETTE ROBI14A I11LEY RT 7 BOX 5,1 MAYHILI. MHP DENTON, TX 76201 WILKERSON,SAMARA JAMEN 40089914 01/03/84 76.00 40,50 0.00 116.50._8P ER. _ 4__. 233 _b V ax GUARANTOR INFORMATION as TAMMIE L. WILKERSON 602 MILL ST, DENTON, T% 76201 WILKINB,CHARLIE D. 40130171 06/02/84 60.75 0.00 0.00 60.75 ADD . ER...._ NS 151 6 xx GUARANTOR INFORMATION as CHARLIE D. WILKINS 600 SKINNER DENTON, TX 76201 - WILLIAMB,CABRIE L 10077097 01/12/84 3,383. 43 960, 28 -3,974. 64 369.07 _ SP 1P__ _ 4__._O4/09/84 147 6 as GUARANTOR INFORMATION as CHARLES WILLIAMB 1200 DALLAS OR #321 DFNTON, TX 76205 V WILLIAMS,PRANK, E 40143372 07/14/84 68.80 0.00 0.00_. 68.80 ADD ER NS _ 108 6_ as GUARANTOR INFORMATION as FRANK WILLIAMS, E III N LAKEVIEW LAKE DALLAS, TX 75076 J WILLIAMB,OLORIA 10068948 11129/83 1,046.40 -10.86 0,00_.1,035..54 .BP - 1_ J GUARANTOR INFORMATION as VENItA WILLIAMS 620 SMITH DENTON, TX 76201 322 b_..._.. WILLIAMB, JAlIFS EDWARD 40119026 04123/84 101.00 0.00 0.00.'- 101.00 _ADD _ ER.... _ N8 .l x~ GUARANTOR INFORMATION aN EDWARD BAIN 192 6._. ~ 1808 BOLIVAR #B DENTON, TX 76201 WILLIAMB, KELLY _40130809 06/03/84 67.00 0. 00 0, 00 67-00, --ADD. - ER- 150___ xa GUARANTOR INFORMATION xx KELLY WILLIAMS 300 MAIN ST #24 LEWISVILLE TX 75067 WILLIAMB,LAURIE 40102741 02/19/84 J 123.00 0.00 0.00... 130.00.. P,P._._.ER._..._..3.._._...,,.. .294. 6_______ ~ xx GUARANTOR INFORMATION ax SHERRY LONOORIE 410 0 8 8 LOCUST DENfON, TX 76201 WILLIAMS,PAMELA K 10086490 02/27/84 821,50 126.50 _ _ 0.00 . ax GUARANTOR INFiIRMATION ax CECIL A. WILLIAMS 945.00._ 4 240. 6.. R'f 2 LOT 99A LAKESHORF ESTATES OEN TON, T% 76201 , .l 01 NOV 1984 WR I TE-•0FF R E P 0 R T PAGE 16 PATIENT 14AIIE PAT ID D1SCHO DEO-DAL NEW-CHG NEW-PAY W-0 BAL FC TYPE CYCLE LST.PMT AGE FG TYPE ✓ y J WILLIAMS,TOMMY T. 40142374 07/11/84 70.35 0.00 0.00 70.35. ADD ER N8 1.13 6 w* GUARANTOR INFORMATION ww TOMMY T. WILLIAMS 716 BAILEY ST DENTON, TX 76:?01 WILLIAMSON, ALICE B, 40492953 01/14/04 58.10 0.00 0.00 98.10 SP _._ER _ 2__._ 291 6 GUARANTOR INFORMATION a* BEVERLY LEFL£R 2401 HINKLE DENTON, TX 76201 WILLIS,TREY 40103012 02/20/U4 136.50 0.00 0.00 136.50 SP ER 3_. _ 294 6 GUARANTOR INFORMATION ar D.E. WILLIS, JR. RT I BOX 1821 FRISCO, TX 79034 WILSON,DONNIE.F. 401622:54 09/14/84 61.00 0.00 0.00__._....61._00__.ADD___.ER._.._ NS_. 40 _ 6 r* GUARANTOR INFORMATION a* BONNIE F. WILSON 316 FRY DENTON, TX 76201 - WILSON, JOR1 40107013 03/09/84 248. 90 0.00 0.00 .._248, 50__.BR.. ER _2-........ 230 6 ~I GUARANTOR INFORMATION *r MARLA T, WILSON 114 AVENUE E #207 DENTON, TX 76201 J WILSON,08GAR BEN 40148942 08/01/84 136.90 0.00. 0.00 _....136.-90BP_.Ep.,_ 2 __.91 6-- GUARANTOR INFORMATION *w OSCAR DEN WILSON 1933 HIGHLAND PARK RD. DENTON, TX 76201 1 WILSON, RODIN LEE 40150971 08/08/84 56.00 61.00 0.00-_ _1t7_00_-ADD--. ER.._ N8 43 6 *w GUARANTOR INFORMATIC14 a* ROBIN LEE WILSON 1110 GREGG DENTON, TX 76201 WINCHEBTER,KEVIN BRUCE 40126732 09/21/84 66.00 0.00.. 0.00 ..___66.00.._ADD_ _..t;R__. N8__ ar GUARANTOR INFORMATIO14 r* KEVIN BRUCE. WINCHESTER 400 COLLEGE 0104 LEWISVILLE, TX 79067 WISE14ERPERIC 40096810 01/31/04 99.00 -7.02 0.00. .__.91._98._6P.___ER...-_4.____.. 359 6 *r GUARANTOR INFORMATION aw EARL WISENEA 610 APOLLO DENTON, TX 76201 __WOOD,JAIIEB. 40101040 02/13/84. 66.79.. 0.00 0.00_.. 66.79.__8P__. ER__. 361.. 6____ OUARA14TOR INFORMATION rw SHARON J WOOD 1903 N MILL 03910 LEWISVILLE, TX 75067 WOODMANCY, LINDA LEE 10056489 12/ 17/83 761.30 296.90 . 0.00 110513. 29 SP__.. IP 2- 48 6, GUARANTOR INFORMATION DWIGHT WOODMANCY P 0 BOX 3193 SAN DIAMS, CA 91773 --WOODS, BOBBY. E 40107975 03/11/84. 97.20._.__ _0.00.__ 0.00_.__ __97.20__SP _.ER_ -_.2--- __-.---234 _ 6_.-- • GUARANTOR INFORMATION BOBBY E 140OD8 1523 HIGHLAND PK RD DENTON, TX 76201 WOODSON, SHEREE, D 40144899 07/18/84 142.85 97.25 - 142. 135 97.29.. SP ER_ 4_._08/01/84 92 6 GUARANTOR INFORMATION rw DONNA WOODBON TWIN LAKES LOT 180 N STUART RD DENTON, TX 76201 1„ J WRIGHT,BILLIE ANN 40128373 05/27/84 56.00 2.00 0.00 _ 58.00 _ADD_ _..ER NS.__ 154 6 r* GUARANTOR INFORMATIC14 rr HARRY WRIGHT 3000 N2 STEMMONS LEWISVILLE, TX 75067 WRIGHT, DOYAL C 40125033 05/ 1'7/84 72.15 0.00 0.00. _...72.15 ADD . ER NS 167 6. GUARANTOR INFORMATION ra DOYAL C WRIGHT 901 BERNARD 217 DENTON, TX 76201 1%0 J WRI0HT,DOYLE 40121261 05/01/14 85.00 0.00 0.00. 85.00 ADD _.ER 183 _ -6-- GUARANTOR INFORMATIO14 rr DOYLE WRIGHT 901 BERNARD DENTON, TX 76201 r V WRI0HT,HELE14 10099794 04/19/84 1,637.89 29.55 -1,336.28. 131.12...ADD_..IP.._...NS.... 05/29/84 48 6.._ ~ GUARANTOR INFORMATION a* HELEN WRIGHT PO BOX 2683 DENTON, TX 76201 rY _-WRIOHT,JERRY.D 40102501 02/19/84 94.00 0.00,.. O..OJ.._- _98.GO__.SP__ ER---.__3__.____-.._____ 255---.b____ *r GUARANTOR INFORMATION r* JEARY D WRIGHT 523 E WINDSOR OR 075 DENTONr TX 76201 r i I i -J 01 NOV 1984 ' WR [ TE - OF F R EPORT PAGE 17 PATIENT NAVE PAT ID DIBCHG DEC-GAL NEW-CHO NEN-PAY W-0 GAL FC TYPE CYCLE LST.PMT AGE PG TYPE ,J J WRIOHI, TOMMY J, , JR. 40102931 02/20/04 61. DO 24.00 0100 8D. 00 _.SP ER_ 3.-_. 290 6 mw OVARA14TOR 1NFOfiMATIGN as TOMMY J, WRIGIIL, JR. 906 MILTON LEWISVILLE, TX 79067 WROE,DAVID 40093924 01/21 /04 58.90 0.00 _ 0.0058.90 _8PER..3.__._. 284 6 w■ GUARANTOR INFORMATION wa DAVID WROE RT 3 BOX 204 AUBREY, TX 76227 i WYNN,THOMAS D 10092371 10/14/03 638.00 186.79 -90,00 774.79 8P IP 1._ 09/03/84 173 6 ww OUARA14TOR INFORMATION ww THOMAS D WYNN PU BOX 461 RHOME, TX 76078 YANCY, GINGER.C 40100190 02/11/84 134. 25 0.00 0.00 134,25 BP.. ER._.._.2.__._. 262 6....._ ww GUARANTOR INPORMATIOII as OIWOER C YANCY RTl BOX 37-M GRAPEVINE, TX 76080 V 1 f YARD. MARVA L. 40111122 03/26/04 66.79 C.00 0.00 66.75 UP ER_ 4 219 6 . mw GUARANTOR INFORMAtIOf4 wa RANDOLPH YARD P 0 BOX 109 DENTON, TX 76201 i ` J YARD,ROSE.MARIE 40109157 03/08/84 902.00 135.79. 0.00 1,037. 79..BP......ER_. 1 6._._. rw GUARANTOR INFORMATION ww RANDY YARD 811 LEHRMAN DENTON, TX ,76201 YOUNG,KEITH 10099610 03/31/84 1, 721.10 0 00 0.00._1,721.10_ADD___.IP__.__.N8 213 6_ J ww GUARANTOR INFORMATION ww SHELI YOUNG 2429 OLD NORTH RD APR 32 DENTON, TX 76201 _ _YOUNO,LOVISE.. 99000702 01/31/84 203.90 -0.00 0.00.. .203.50__8P__,.UP__ 4._____..__ ._379 _ 6_..._. m# GUARANTOR INFORMATION mw LOUISE YOUNG 1406 HALBELL BRIDGEPORT, TX 760263195 YOUNODLOOD,JAMES R 40131391 06/06/04 98.79 0.00 0.00 58.7D AGO ER _NO_._ 147 6 J ww OUARANTOR INFORMATION am JAMES R VOUNOBLOOD 99S BELLAIRE #2307 LEWISVILLE, TX 79067 ZYSKO, SANDRA E 10069916 12/ 13/93 6,942.21 0. 00 -6, 277. 21 _669..00 . SP IP.____ 1..._.03/23/84 223 6 mw GUARANTOR INFORMATION aw MICHAEL J ZYSAO PO BOX 453 SANGER) TX 76266 mwwr W-O TOTALS wwww 53,062.11 -16,679.59. 59,619. 71 96,006.23 !J v ~J • ! J i .1 01 NOV 1984 W R 1 T E- 0 F F R E P 0 R T PAGE 18 J PATIENT NAME PAT ID DISCHO UEO-DAL NEW-CHO NrEW-PAY W-O BAL PC TYPE CYCLE LST.PMT AGE FO TYPE ~ ASANAKA,OLORIA FAY 10100199 001-1/84 1,034,70 1,692.56 -1.007.12 1,720.14 SP 1P .4._-..07/25/84 91 7 J rr GUARANTOR INFORMATION ap JAMES ADANAKA 2500 FREEDOM DENTON, TX 76201 - ABEL,DIANE N, 40135949 06/22/84 81.90 0.00... -56.00 29.50 _.ADD_.. ER NS_..08/13184 00 7 V ww OUARANTOR INFORMATION rw CITY OF LEWISVILLE LE:WISVILLE LEWIBVILLE, TX 79067--- _ ADAMS,MARK T 10083699 02/11/04 2,71B.25 -160.03 -2,281.38 276. b4 SP_ IP _ 4 _ 10/10/84 22 7 e ar GUARANTOR INFORMATION ~a MARK T ADAMS 1708 WAYNE DENTON, TX 76201 ALSEC, URUCE 14 40104994 03/01/84 165, 90 0.00 0.00 169. 90. -ADD ....ER NS ...244. __.7__. rr GUARANTOR INFORMATION rw BRUCE W ALBEE - 9109 9 LOCUST TRAILER D Y-MOTEL DENTON, TX 76201 ALEXANDER, SHAWN E. 40122719 05/07/84 59. 50 -1.76 -36.74 31.00 ADD ER _ J rr GUARA14TOll INFORMA'TIOIJ rr NS 06/06/84 yq$ 7 LARONUh L. TACKETT k132 OOLDEiJ TRIANGLE MHP ARGYLE, TX 76226 ' I ALLEN, DARRY 40149494 08/03/04 77.73 22.10 0.00 99. 89__ADD ER N8._. BS wr GUARANTOR INFORMATION rr BARRY ALLEN 7100 STEMMONS KOA DENTON, TX 76209 ALLEN, MELT SSA ANN 40142747 07/12/04 96. 00 0.00 0..00.. 56. 00- --ADD ER _.NS ar GUARANTOR INFORMATION rw BARDARA 14ELCHFI 109 7_ 629 FT WORTH DR 023 DENTO'•1, TX 76201 ALT,CHARLOTTE 40LO6Oi5 03/04/84 113.75 0.00 _ 0..00 _ _113.75. SP.-__ER_ ww GUARANTOR INFORMATION rw CHARLOTTE ALT --q-----"' ----------241 7._.._-- - 216 DLUEBIRD OENTON, TX 76201 ANDERSON, JOHN 40139941 07/04/64 0.00 56.00 0,00 J ar OUARANTOR INPORMAI ION wr JOHN ANDE490M 10LC CORONADQ DR DENTON, TON __TX 8P_7 ER _____2.___.-.. 96 7___. 76201 __ANSHVTZ,GAIL 70020979 10/17/83 87.90 _ 218.29._ -200.00 _ -105, 75 - XP 79067 r* GUARANTOR INFORMATION ww 14. 7_ GAIL ANSHUTZ 4841 ALTA OAKS LN LEW[SVILLE, T V • ANWAY, ELLEN L. 70030998 03/09/84 643.65 0. 00. 0.00 . 643. 6D - BP_ rr GUARANTOR INFORMATION ww ELLEN L. ANWAY TWIN LAKES MHP #249 DENTON, TX 76201 234 2 ARNOLD, REGINA. LEE_ _ 10090204 10/11/83 880.55 _ 824. 35.__-400. 00__ It 312,__90 _SP.__ JP__. __4-._ .07/31/84 _93_ 7_. wr OUARANTOR INFORMATIC14 ww JIMMY M ARNOLD 022 NORTH LAKE AUBREY, TX 76277 ATHERTON, SHERRY 10110773 06/10/U4 954.55 1, 095. 00 _ 0. 00. 2, 009. 95._ SP.___.IF... rr OVARA14TOR INFORMATION rr LARRY J. ATHERTON 3 127 7._._._ ~ SOX 861 LAKE DALLAS, TX 75069 BABSTRIERI,KATHRYN 40163693 09/18/84 96.00 0.00.., 0.00__ __36-00..SP.___ER__ J ww GUARANTOR INFORMATIOII rw KATHRYN BABSTRIERI - -43_. . 7_.___. 1962 N PROSPECT AVE MILWAUKEE, WI 99999 V DARNER, KATHY 10123404 08/08/84 812.15 730. 45 0. 40 ' 1, 542. 60 IP. wr GUARANTOR INPORMATION rr AMOS BART':g - .._...79 .7... ~ AT 4 BOX 413 LAKE DALLAS, TX 79060 . BAYS,BODBY_J 40122897 05/07/84 63.00 0.00__ __12..60. ADD__.ER__...NB_-_.06/12/-04____.._142. rw OVARA14TOR INFORMATION ww SANDRA ELAINE SAYS 916 LAGUNA DE14TONP TX 76201 - Z--`--'"-- BEROER,DOBBIE HENDRICKS 40155434 09/24/04 126.29 34,50 0.00 _160,75 .__ADD. ER wa GUARANTOR INFORMATION ww CHARLES BEROER 63 7 " __BEARYrJANICE-, 10104628 09/11/84 874.80._-.-763.36 -12. 1900 SAN BASS 0E6D78r96'._AP___-IPOt_.._3_06/29/89 -12,28 ww GUARANTOR INFORMATION ww LEROY BERRY LAKEWOOD EST #159 DENTON, TX 76201 i 01 110V 1984 W R I T E- O F F R E P 0 R T PAGE 19 PATIENT IJAIIE PAT ID DISCHG DEG-UAL NEW-CHO NEW-PAY W-D BAL PC TYPE CYCLE LST.PMT AGE PO TYPE .J J DERRYMAIbCARLA 40192472 00/14/64 96.00 0, 00 0.00 96.00 ADD ER NO 79 7. wa GUARANTOR INFORMATION ap CARLA BERRYMAN 1012 14ORTIIVIE14 DENTON, TX 76201 01 SHOP, INF,F 10060622 10/19/03 124.05 0.00 0.00 124.09 ..ADD.. IF NO 377 7 u wr GUARANTOR INFORMATION) ra DANNY DIOHOP 2503 W. PRAIRIE DENTON, TX 76201 UISHUP,JANfCF. A 40169383 09/24/84 40.40 0.00 0.00 40.40 ADD ER NS 09/29/84 36 7 as GUARA14TOR INFORMATION] aw JERRY DISHOP RT 2 BOX 907D VACATIO14 VILLIAOE MHP DENTON. TX 76201 ~ B*LACK,DAVID ER _4_.... 40 _7__.. GUARANTOR INFORMATION rr40 DAVID 9 0?/13/04 l BLACK 96.00 2405 0.00 LOUISE o08 0 DENTON, 56.00 A 76201 ~ J BLANKENSHIP,EDDIE 40146003 07/22/04 143.00 0.00 0.00 .143.00 BP.. ER 1_. 99 7 as GUARANTOR INFORMATIOI xa EDDIE BLANKENSHIP 2311 STELLA #11' DENTON, TX 76201 `J BOK£R,BETTY 40132631 06/11/84 299.19 327.10 O.OU 082.25_.SP_._..ER. 3 _ 89 7_._ wr GUARANTOR INPORMATIC14 as BETTY DOKER - _ PO BOX 434 RDANOKE, TX 76262 i DRADFORD,MLCHAEL 40133944 06/16/84 263.29. 0.00 0.00.. 263.25 -ADD ER..._.NSB 136 7.. „ ww GUARANTOR INFORMATION ra MICHEAL BRADFORD RT BOX 893 AUBREY, TX 76227 y 1J ___URIDGES,ELIZAOETH.A 40L2624b 09119184 69.60 0.00___._.0.00.__69.60 _BP_. ER__ _.4__.. _..166 7......._ _ __1 rr GUARANTOR INFORMATION wa JAMES RRIDOES PO BOX B27 PILOT POINT, TX 76238 BROWN, SHERYL 40165722 09/29/94 96.00 0.00 0.00 56,.00.__SP_... ER.. _.2 36 7 rr GUARANTOR INFORMATION rw SHERYL UR014N 1115 MOUNT STREET DENTON, TX 76201 BUROE,BETTY M _ 40167132 10/01/84 96.00 0 00 0.00 _ 36.00__OF, ER_ 3.._30 Z_.__.. wr GUARANTOR INFORMATION) rr BETTY M BURGE 5716 KISOR THE COLONY, TX 79056 8UAMAN,ROBERT J 40161648 09/12/84 113.29 0.00 0. 00 113.25_..ADD ER NS_.. 4S 7 { rr GUARANTOR INFORMATION rr ROBERT J BURMAN THE TICKNOR 0718 GREENVILLE, TX 70401 CASTILLE,ANTONIO 4013930206/21/04 107.79 40.60 0.00._.._.148._30__ADD...F_R_.._.NO _._..117 7 rr OVARA14TOR INFORMATION rw ANTONIO CASTILLE L420 MAIN LEWISVILLE, TX 78067 CEROANTZ,AN l GELA 70087498 06!01/84 613.75 31.90. 0..00... .649.39 OP_... .2___..... 148 _ 7 rw GUARANTOR INFORMATION aw ANGELA CEROANTZ 217 N. DENVER DALLAS, TX 79203 ~ I J CHANEY, TIMOTHY L 40147997 07/28/04 79.00 0.00 0.00 79..00.._ADD_ ___ER._._ NS-_ 90... _._7_._...... rr GUARANTOR INFORMATION rr TIMOTHY L CHANEY 912 MCCORMICK DENTON, TX 76201 CHAPMAN, BARDARA A. 10092336 03/22/84 3p 346. 34 0.00 -2, 357. 07 489. 27_. 07/11/84_ t13 - .7_ rw GUARANTOR INFORMATION wy ROBERT E, CHAPMAN PO BOX 797 GAINESVILLE, TX 76240 L ' J __.__.C.HRISTIAN,ARTHVR L.__ 10114791 06/30/84 1,967.20 .__..._0..00._.___0.00_._1,.967.20___BP------- IF _____~Z_ rr GUARANTOR INFORMATION rw ARTHUR L CHRISTIAN 1020 PEAK DENTON, TX 76201 In 4 "J CHRISTIAN,ARTHUR L. 40169607 09/29/04, 59.29 0.00 0.00 ._59.29 ..OF __._ER._____2..___. 39 7._ rr GUARANTOR 114FORMATION4 wa ARTHUR L. CHRISTIAN 1030 8 PEAK DENTON, TX 76201 _CIBNRO,RUDY.. 40138969 07/01/84 114.25 0.00_. 0.00 114.29ADD.._121 ww GUARAIJTOR INFORMATIC14 rw RUDY CISNRO 1430 PARK ROW PLANU, TX 79074 , 01 NOV 1984 WR I TE-0FF R E P 0 R T PACE 20 PATIENT NAME_ PAT ID DISCHO DEC-UAL NEW-CHO NEW-PAY I4-0 DAL FC TYPE CYCLE LST.PMT ACE FO TYPE IF COLLAS,JANIE MARIE 10099889 04/22/04 2,354. 74 0.00 -90.00 2,304.74 _SP IP rr GUARANTOR INFORMATION ax - 4..._.08/13/84 80 7. CEORCC. I_. COLLA5 4430 Cd0[A DR TAMPA, FL 336178206 COLLIN9,DECK1 10114122 06/89/04 228,00 34,10 0.00 U ww GUARANTOR INFORMATION wa CLARENCE COLLINS 462, X0_ 0. _SP.. _.1__. 97 7 v 913 KENT LEWISVILLE, T% 759067 COLLINS,DECKI f L0114221 06/28/04 86110 2,323.e4 0.00 3,k86,94 SP SP l 104 7 GUARANTOR INFORMATION rw CLORENCE COLLA N9 913 KENT LEWISVILLE, TX 79067 • COONROD, BRUCE 40134777 06/10/84 102.79 0.00 -52.75 .50.00__ADD ER NS. 07/28/84 96 _ Z GUARANTOR INFORMATION an BRUCE COONROD RT 4 LOT 91 EXECUTIVE 11HP DENTON, TX 76201 COX, GLEN 40151714 08111/04 81.73 0.00 0100 81.70 -ADD ER NS- 80 7 J wa GUARANTOR INFORMATION aw GLEN COX 1699 PARKWAY DENTON, TX 76201 L 18/84 116.25 203,30 0.00 ..319. 79. ADD ER NS 28 7 CRAIJOUARANTORAINFORMATIOIJ wxMARGARET 03ACRAWFdRD p0 BOX 389 MAYHILL MHP 0E29 DENTON, TX 76201 i ~ DANIELB,CARMEN Y 7003 21/94 90.00 0.00 0.00 ....90.00_ Sp_ OP.. .3___225 7 _ aw GVARAIJTOR INFORMATION wa CARMEN Y DANIELS 318 RUDELL APT 107 DENTON, TX 76201 DANIELS,LEE L 40142919 07/11/84 132.46 28.00 ! GUARANTOR INFORMATION +w LEE L DANIELS 0.00._ 160.46_600 _.ERNB_.__ 96 ....7.. 9 BOX 137 DENTON, T% 76201 L DAVI080IJ, ROBERT 40121071 04/30/84 56.70 56.00 - 0. 00 J aw QUARA14TOR INFORMATION as ROBERT DAVIDSON f1 Bp_.___ 1 _ 9162 7 48 BELLAIR& 02307 LEWISV EWISVILLE, TX TX 79067 ~ DAVIS,DRIDOET 40129819 09/31/84 97.29 0.00 0.00 .97.23 _Se, - ER._ 1__.__ _.193 7 as OUiRANTOR INFORMATION aw BRIDOET DAVIS - ~ blb CHINCHAPEL LEWISVILLE, TX 70067 DAVIS,DENNIS DEVIN 40J21619 05/03/04 56.00 0.00 0.00 56.00_..9P _ER__._2__._._, 182 7. S GUARANTOR INFORMATION +w PATTI A. DAVIS - - RT 3 BOX 94 ROANOKE, T% 76262 DAVIS,DONALD R 40IJ7426 04/JS/84 64.25 29.00 0.00 _ 89.29 .SP._._,J;R......._3_.. 98 7. ~ • +a GUARANTOR INFORMATION as DONALD R DAVIS 1919 SENA DENTON, TX 76201 N.. DAVIS,DOROTHY D 40137606 06/26/94 61.10 .._200008 BERNARD O_ 61. 10 SP- R 1 ...127 Z GUARANTOR INFORMATION aw DOROTHY D DAVIS L DAVIS, KELLY J, 10090900 03/09/84 720,65 0. 00 493 52 2", 13 __SP as GUARANTOR INFORMATION a+ PAUL DAVIS 1P 1_..__06/04/$4190.. ~ 2800 FT WORTH DR. LOT l> BENIGN, TX 76201 ; DELBUDNO, DEBBIE 40120262 05/19/04 146.25 0100 0.00 aw GUARANTOR INFORMATION as DEDDIE DELBUONtl J9 Ibe 7_.____ ~ 4199 B[qD RD MIAMI, FL pL 77777 _.__DHALLA,BEGUM_._... 10099067 04/16/84 394._,0,.00.____ .9,00.._.-.394. 95.._ADD___]~_._.Nfi________. J as GUARANTOR INFORMATION aw DCOUM DHALLA _7___ ~ 11070 BRfOHtgW DR ARLINGTON, T% 76012 DICKERSON,OLORIA 40119479 04/11/84 99,75 0.00 0.00 J wa GUARANTOR INFORMATION ar GLORIA DICKERSON ---.99,78.._.A _ER_.._. H, TX 803 ~ a772 NORTHHAVEN UR Naoa3 FARM MERS BRANCH, TX 75834 , _ DICKINSON,-RACHEL NICOLE 40113920.04/06/84 78.00 _ 0.00 ___2011__....,Z_~__~,__ i aY GUARANTOR INFORMATIC14 ww CHERYL DICKINSON 2206 WELLINGTON DENTON, TX 76201 W • s rA , ' r OI IJOV 1980 IJ R I T E- 0 F F R E P 0 R T PAGE 21 PATIE14T NAME PAT ID DISCHO DEO-DAL NEW-CHO NFW-PAY W-0 DAL FC TYPE CYCLE LST.PMT AGE FG TYPE J DICKII4SDf4,RU08ELl W4YNE,JR 40088938 12/30/83 98,00 0.00 0.00 98,00 SP ER 4.. 309 7 OUARMJTOR INFORMATION #a CHCRYL RENEE DICKINSON 2206 WELLINTON DENTON, TX 76201 DIOOINS,LASHALAEN 40109538 03/03/84 96.00 0.00 0.00 96.00. ADD ER N9 248 7 u a* GUARANTOR INFORMATION w# WILLA DIGGING 3466 SPRINOVALE FARMERS BRANCH, T% 75234 DILLON,RALPH 90127799 09/24/04 59-OD 0,00 0.00 59.00 SP ER 4_._ 199 7 #w OUARANTOR INFORMATION an DANNY DILLON POBX624 PILOT POINT, T% 76298 DISDSWAY,LINDA SUE 10046400 09/13/83 911.29 229.30 -20D.00 936,99 _SP IP _ 4._-._06/20184 134 7 GUARANTOR INFORMATION LINDA SUE DISOSWAY 604 CRESCENT DENTON, T% 76201 - DOTSON,KATHY 10027090 05/22/03 1, 116.90 0.00 -300.00 816-90 -SP J GUARANTOR INPORMATIO14 ROBERT DDTSON .-IP...,..-...4.....-iQ/lY/89 13. 7.. ~ 1419 OAK4JOOD DEMON, TX 76201 DOUGHERTY, SHELLIA 40141909 07/09/84 56.1D 0. 00 0.00 GUARANTOR INFORMATION #w SHELLIA DCUWIP RTY 56,79....BP..__ER_.. 3 _....119 7__._.. RT 2 BOX 631 DEMTON, TX 76201 L DDUOLAS,TIMOTHY 40137729 06/26/84 101,70 0.00 0.00... 101.7O__ADD _ ER-__.NB_ 120 7 J GUARANTOR INFORMATION TIMOTHY DOUGLAS 209 MASSEY 024 WYNNS TRL PK DENTON, TX 76201 J E$iRA, VtNCENF 0. 40128662 05/27/84 27.05 2. 00 _ C.00 GUARANTOR ANTOR INFORMATION ____29..09....ADD ER._.__NS__ 05/29/84 104 7_..___,_ f GU IRENE RODRIOUEZ 2922 LOUISE DENTON, TX 76201 ti EVANS,LYNDA 10099323 04/21/84 2,982.69 0.00 0.00 2,982.65 ADD_._..IP- __N8__ J rw GUARANTOR INFORMATION LYNDA EVAN9 3210 FALL MEADOW 0120 DEN id N, TX 76201 - 191 .FEUERBORN,LEONARD A. 40166103 09/27/84 97,90 0.00 0,00 57.50._ADD OUARANTOA INFORMATION LEONARD A. FEUEROdRN 1224 TENNESS LORANCE, KS 77446 ER 4 FUENTES, ERIC L. 40131942 06/07/84 34,20 0.00 _ 0, 00.__ .34. 20_ ADD _ ER__.__NS _.0b/_!1/84_ 143 GUARANTOR INFORMATION :rw PAULA FUENTES 2522 LOUIeE 022 DENTOtJ, T% 74201 i~• 0**MGUARANTORAINFORMATION 07/18/4 19390 t901 LAKEVIEW OOR 01205 __133_50 ADD . Ell- , -96 TX NS - 4 i 1 0 LTNER, TER88A 10126704 08/27/89 2,894.90 43.00 _ 0.00 2,957.10_00- 1P.- _NS j GUARANTOR INFORMATION TERBEA OILTNER 8 7 992 SOUTH CHARLES 0310 LEWISVILLE, TX 75067 V AOETZ,AREODRY LYNN 40131716 06/08/64 57,40 0.00 0.00- . .97.40 ..ADD-- ER GUARANTOR INFORMATION GREOORY LYNN GOETZ tJS______ 146 ~ 114 DANIELS THE HAVEN$ DBNTOM, T% 76201 ~ _GRAVES,KEVEN D. 40160137 09/09/84 79.00 14. 00 0 00__. 93. LLE .GOD-. 90 GUARANTOR INFORMATION KEVEN D. GRAVES 990 B CHARLES LEW1$VIVILLE, T% 7$067 ~ J GREEN, REBECCA ANN 40199071 09/04/04 64.10 0. GO_ _ __O. 00_..___..64. 10-...BP____ER ~ GUARANTOR INFORMATION RONNIE GREEN - - 308 W000 STREET DENTON, T% 76201 - „ v IJ HAMPTON, WILLIAM DAVID 10112662 06/22/84 1,109.05 0.00 _ 0.OO...S,.109.55_ BP --IP-.--_1 OUAAANTOR INFORMATION SHIRLEY A. HAMPTON 712 PECAN BANDER, T% 76266 4 i HARD IN,.OARY.WAYIJE _ 40140710 07131/84. 110.00 .0.0 .._..0..00 SCO OO.~P..____.ER.__ OUARAMTQR INFORMATION GARY WAYNE HARDIN - - ~ AT. I BOX 219H FR78CO, TX 75034 s , J Ol NOV 1904 W H S T E- O F F R E P O R T PACE Z2 PATIENT NAME PAT ID DISCHO DEG-DAL NEW-CHO NEIJ-PAY 14-0 DAL FC TYPE CYCLE LST.PMT ACE FO TYPE t.i J HARLOS,FRANK WAYNE 40/97422 06/31/04 144.50 0.00 0.00 144.50. SP ER 3 60 7 wr OUARAN'f0R INFDRMATION rr FRANK WAYNE HARLOS 2457 112 LAKEVIEW CIRCLE CORPUS CHRISTI, TX 76410 V HERRERA,RODERTO J.. 40151151 00/09/84 58.79 0.00 0.00 58.75_-ADD _ ER NS- - 84 7 wr GUARANTOR INFORMATION rw ROBERTO J. HERRERA ME27 MAYHILL MHP DENTON, TX 76201 HOOE,STEVENH 401,95681 OB/24/84 91.15 0.00 0.00 91.15 SP_ ER 2_.__ 66 7 rr GUARANTOR L.FORMATIOW as 57EVE14D HOGE PO BON 310 RT 3 EASTVILLE, TX 79056 .._...HOPKINS, LARRY. 40196432 08/27/84 132. 75. 3.60 . ....0. 00 - 136. 35 SP,-..- ER 62 OUARANTOR INFORMATION ww LARRY HOPKINS 333 W VINE ST LEXINOTON KY 40506 J HORTON,JOBHUA A. 40112503 04/01/64 56.00 81,00 0.00 -107.00 -Sip ER 1----- ISB 7-.-___ wr GUARANTOR INFORMATION) aw SHERLEY HORTON 491 FOX AVE. LEWISVILLE, TX 75067 V _ J HOWARD, KENNETH 40149054 08/01/84 96. 90 0.00 0. 00 96..50- -ADD N&.-_ _ 9l 7 wr GUARANTOR INFORMATION) ar ROBERT HOWARD 1407 BERSARD 03 DENTON,.TX 76201 wwww W-O TOTALS wrww 31,848.09 -7,985.26 7,058.60 30,921.43 J 01 NOV 1984 14R 1 TE-0F F REP 0R T PAGE 23 , PATIENT NAVE PAT ID DISCHO DEG-SAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LST.PMT AGE FO TYPE U , arrr WRITE-OFF GRAND TOTALS wwww 160,949,71 -72,294.32 W 74, 502. 36 163,197.75 J J 1 II Y J 4 y y paste 8 FLOW MIMORIAL HOSPITAL OPERATING INDICATOR REPORT AUGUST 31, 1984 CURRENT MONTH YEAR-TO-DATE. 09/30/83 BUDGET ACTUAL VARIANCE BUDGET ACTUAL VARIANCE ACTUAL. FACILITY UTILIZATION: 1. TOTAL ADULT PATIENT DAYS 2,945 2,438 (507) 31,920 29,057 (2,863) 33,570 2. AVERAGE DAILY CENSUS 95.0 78.7 (16.3) 95.0 86.5 (8.5) 92.0 3. PERCENT OCCUPANCY 60.9% 50.4% (10.57,) 60.97 55.4'4 (5.5'x) 59.0% 4. ADMISSIONS 589 545 (44) 6,384 5,797 (587) 6,494 5, DISCHARGES 586 554 (32) 6,351 5,773 (578) 6,508 6. AVERAGE LENGTH OF STAY 5.0 4.3 7) 5,0 5,0 5.3 7. MEDICARE & MEDICAID UTILIZATION 30.0% 30,5X .5%) 30.0'}Z 33.3% (3.3%) 33.8% PER ADULT PATIENT DAY: 8. GROSS PATIENT SERVICE REVENUES $500.20 $598.02 $ 89.82 $507.65 $546.90 $ 39.25 $ 486.93 9. NET OPERATING REVENUES 427.92 474.35 46.43 434.29 442.53 8.24 345.91 10. OPERATING EXPENSES 401.39 496.67 95.28) 407.36 441.60 (34.24) 365.32 11. INCOME FROM OPERATIONS 26.53 (20.94) 47.47) 26.92 .93 (25,99) (29.88) WRITE-OFFS AND COLLECTIONS: 12. GROSS DAYS IN PATIENT A/R 80.0 100.2 20.2) same 99.2 13. DIET DAYS IN PATIENT A/R 60.0 70.2 10.2) (IS 57.5 14. BAD DEBT EXPENSE AS A 15.0% 19.2% ( 4.2%) current 15.0'% % OF GROSS PATIENT REVENUE month LABOR COST MANAGEMEIIT: 15. FULL TIME EQUIVALENT EMPLOYEES 411.5 397.2 14.3 411.5 404.9 6.6 410.6 16. FTE'S PER ADULT PATIENT DAY 4.33 5.05 { .72) 4.33 4.68 IN .35) 4.38 17. PAYROLL. AS A % OF TOTAL EXPENSES 50.914 48.5% 2.4% 50.9'4 50.2% .7% 51.6Z I I 1 Page 7 FLOW 11MORIAL HOSPITAL AGED Pccowas PAYABI C SUMMARY AUGUST 31, 1931 i Current 31.,- 60 61-90 91 - -120 Total Trade Vendors $ 302,945 $ 306,633 $ 153,513 $ 12,26'7 $ 775,318 Fees Payable 92,725 71,463 52,837 217,025 Accrued Payables 61,188 61,188 Estimated Payables 194,312 194,312 Audit Fees 26.200 - - 26,200 p = - - - Total $ X78,096 $ $ 677,370 206,35C $ - -12,267 $ 1,274,043 Page 6 PLOW i!!MORIAL HOSPITAL AGED ACCOUNTS RECEIVABLE SUMMARY AUGUST 31, 1984 Pr_ imary Pa,-or Current 31-60 61-90 ro of 91-120____ ,_121-150_. __._.150 _ Total A/R Medfeare $ 288,206 $ 132,534 $ 99,749 $ 27,557 $ 132,036 $ 26,800 S 706,882 16,9Y, Medicaid 34,304 36,29? 38,022 3,749 12,487 92,012 216,866 5.2' Blue Cross 34,737 24,471 85 _ _ 58,693 1,4'N Commercial Ins. 583,818 2r3,18V, 7,049 793,047 18.9~ Self - Pay 245,059 --.37i2,979 429,057 271,616 27 3,300 - 828~565 2,420,636 57.62 - 1,185,524 1___L74 ,456 $ 567,962 $ 302,982 $ 417, 823 $ 9471377 $ 4,196,124 i00.0t In-House Total Accounts 305 991 Receivable $ 4,502,115 A/R by % 28.2 % 18.5 4 13.5 7.2 % 10.0 ; ~ 226/ Days of Revenue; Accounts Receivable 93.4 In-Ifouse 6.8 Total 100,2 Now page 5 VLOI1 MEMORIAL HOSPITAL SUMMARY Of CASH RECEIPTS AND DISBURSEMENTS AUGUST 31, 1964 CURRENT I10NT11 YLAR- TO- DATE Beginning Balance $ 14,680 $ 11,043 Cash Received from; Active Patient Accounts $ Bad Debt Accounts $ 952,10Gn 11,0II8,201 Cafeteria 180,323 Appropriations/Donations 10'914 124,399 Other 15,686 725,851 822,234 Total Cash 1,011,013 12,941,008 Total Cash Available $ 1,025,693 $ 12,952,051 Cash Disbursements; Payroll $ 450,207 $ 5,575,465 Payroll faxes 56,017 927,473 Patient Refunds 1'1,274 193,760 Capital Assets Notes Payable 32,455 100,623 Other 461,605 205,636 31 37 Total Disbursements 1,019,756 -_.-.5, 94 _12946,116 Cash Balance ,935 Cash Investments $ 3135,935 $ ,060 3153,060 - - - Total Cash 318;995 $ 316 995 FLOW MEMORIAL HOSPITAL Page 4 BAI.AfICL SUFFT AUGUST 31, 1984 Assets - -u abiiities and Fund Balance. Current, 1984 1983 Current; - 1984 - .---1983 Cash & Investments $ 334,094 Current Notes Payable $ 192,293 $ 297,689 Patient Receivables 3,153,389 $ 2,802,640 Accounts Payable (lief or Allowances) 1,274,043 809,40Y Accrued Expenses 439,557 403,771 Other Current Assets _ 446,469 461,287 Due Government Agencies 541,447. 559,487 Total Current II Liabilities $ 1,960,340 $ 2,080,354 Total Current Assets $ 3,933,952 $ 3,732,974 Long Term Debt 1,008,521 704,134 Property, Plant & Equipment; Total Liability $ 2,968,861 $ 2,784,488 Land & Improvements $ 190,356 Fund Oalance; 8ulldin $ 161,469 9 2,971,809 2,943,464 Donated Capital $ 4,455,719 $ 4,455,779 Equipment 4,953,946 4 5,1 Pledges & Gifts 581,596 562,002 Fund Balance 09/30/82 (11180,404) (177,452) $ 8,116,111 $ 7,6501062 Revenue & Expense Summary 345,493 {648,522) Less Accum, Depr, 4,878 ~7..41) (4 406 741 ` - Plet P, P & E3j0 $`3,713 321) Total Fund Balance $ 4,202,461 - $ 4,191,807 Total Unrestricted Funds $ 7,171,322 $ 6,976,295 Total Unrestricted Funds $ 7 ,1.71 322 1_6976,295 Page 3 FLOW WMORIAL HOSPITAL EXPLANATION OF VARIANCES AUGUST 31, 1984 Variance Erom Fixed Budget Current MontI1__ Year-To-Date TOTAL PATIENT SERVICE REVENUE $ 15,129) 312,757) 1. Volume Variance ($-2536f) _T,T55,fl 2, Price & Mix Variance $ 238,472 $ 1,140,645 Comments; 1} Patient days are 17.2''% below budget this month which continues the trend that has left us 9.0% below budget year-to-date. 2) Actual revenues are 7.7Z above budget year-to-date due to higher formulary increases and new services. TOTAL DEDUCTIONS FROM REVENUE $ 124,858 574 917 Comments; Nigher percentage is still being utilized on bad debts provi- sion than budgeted. Other category was very high this month due to no payment being received from the county because of June's advance to help on the Medicare repayment. TOTAL OTHER OPERATING REVENUE $ 3_6_,224 $ 8,978 Comments, Large favorable variance for the month is the result of better J J_ bad debt recoveries which follow the recent trend. TOTAL OPERATING EXPENSE 28,_77_7_) $ 171,_4.6.3 Comments; Professional fees remain high for the month and year-to-date because of extra expenses on CON hearings fees and CT scan fees along with a slight percentage increase in operating supplies expenses. TOTAL NON-OPERATING REVENUE 3,353 $ 193,388 Comments; Budget amounts are reclassed to deductions from revenue except - for the $125,000 from the county. EXCESS OF REVENUE OVER EXPENSE ($_129,177) ($~513,915~ f Page 2 now 11110R1AL HOSPITAL INCOME STATWK.itT '~MI1ST 31, 1984 ----CURRENT NONT11 Y-EAR-TO-DATE Budget Actual Prior Year Budget Actual Prior Year PATIENT SERVICE: REVENUE; $ 1,326,522 $ 1,293,283 1,225,295 Inpatient Revenue $ 14,591,%42 $ 14,122,404 $ 13,374,555 146,573 164,678 170,272 Outpatient Revenue 1,612,303 1,768 L84 533,32i $ 1,473.095 $ 1,457,966 $ 1,395,567 Total Patient Service Revenue $ 16,204,045 $ 15,891,288 $ 14,907,879 DEDUCTIONS FROM REVENUE; $ 105,827 $ 68,819 $ 207,685 Contractual Adjustments $ 11,164,097 ,353,000 $ 1,8913,926 97,060 $ 2,1417,902 123,000 215,696 315,172 Bad Debts 268,913 550,011 608,776 13,083 _ Q2,253 58,371 Other 2 $ _ 2_41,910 $ 366,168 b 581122Q Total Decuctions from Revenue $__2,786,010 3,360,997 $ 4 02 _ $ 112310185 $ 1,091,198 $ 814,339 Flet patient Service Revenue $ 13,418,036 $ 12,534,291 $ 10,339,857 __29,042 266 21,Q32 Other Operating Revenue -__319, b2 32Q,440 275'-391 $ 1,260,227 $ 1,156,464 $ 836,171 Total Net Revenue $ 13,737,497 $ 12,858,731 $ 11,115,254 OPERAT'.NG EXPENSE: $ 601,325 $ 587,603 $ 563,640 Salaries & Wages $ 6,614,575 $ 6,4?6,304 $ 6,132,380 94,678 98,348 82,870 Employee Benefits 1,041,458 7';2,416 901,068 109,537 148,964 120,648 Professional Fees 1,204,907 1,50,779 1,186,418 182,579 199,380 176,132 Operating Supplies 2,008,369 21057,712 1,978,535 193,980 $5 1. 187,010 Other 133,780 2,117,415 1,834,046 $ 11182,099 $ 1,210,876 $ 1,130,300 Total Operating Expenses $ 13,003,089 $ 12,.831 6?6 $ 1?032,44? J $ 78,128 $ (54,412) $ (294,129) Income (Loss) from Operations g, 734,408 $ 27,105 $ (917,193) _ 3,363 18,447 Mon-Operating Revenue _ 125,000 _ 318,388 ___2681671 $~~~T78,12Q $__(51,049) $ (275,682) Excess of Revenue over Expense s £159}4r1£1 a_f 345,493 $.`{64f3,52'L_) _.I / Page 1 FLOW HEM ORIAL HOSPITAL STATISTICAL STATEMENT AUGUST 31 , 19£14 CURRE"IT HONT11 YEAR-10-DATE ~ludget Actual_ Prior Year 8ud~et~ _ _Actual Prior Year /2,945 2,438 2,695 Adult Patient Days 31,920 29,057 30,874 95.0 71,7 86,9 Average Per Day 95,0 86.5 92.2 403 472 472 Newborn Patient Days 4,368 4,696 4,636 13.0 15.2 15.2 Average Per Day 13.0 14.0 13.8 124 115 56 ICU Patient Days 1,340 1,147 1,049 62 13 42 CCU Patient Days 672 323 407 219 216 181 OR Procedures 2,457 2,469 2,418 15,060 21,092 14,450 Lab Tests 167,668 167,743 168,991 1,920 2,134 1,425 Respiratory Therapy Treatments 21,038 23,756 23,432 630 654 961 Physical Therapy Treatments 7,138 8,580 7,983 1,290 1,703 1,361 Radiology Exams 14,362 17,052 15,707 18,600 16,342 17,770 Dietary Meals Served 203,080 196,713 205,719 990 1,189 1,158 Emergency Room Visits 11,022 11,318 11,647 IdRITE-OFFS & RECOVERIES BAD DEBTS _MfMl CHARITY COUNTY PAYMENTS BAD DEBTS COLLECTIONS ; Oct.-Dec. 4 440,750 $ 52,698 $ 514,540 $ 13,956 Jan.-"ar. 168,080 104,517 795,437 24,749 Apr.-June 134,489 272,803 1,157,509 68,197 July 56,654 463,151 21,257 August 54,668 125,540 52,164 J 8~ 436,03 '3,0'J1;,17T S~£10,323 M 10"44:24 <!✓'SFr~ l,pn CNARI1Y RrPf1Rr I'ACC_ 1 v PAT IEIJT.... , , PAT, ti) PT FC. OUANANrOR N411F. ADDRESS. CITY.,... ST ZIP., b(9. DTE. AIIOUNT... ATM INS, KCNNETH IJ, 40194601 LR CC JAIL. DENTON COUNrV Q UE7JTON DEMTOIJ TX 76801 081211$4 -325.00 ALLllAN, 11A iY E 70040400 OP MC ALLMAN, THOMAS A 1419 601'0 DEI.TpN TX 76201 07/13/84 -19,7D ALLMAIJ, MAJJY E. 10103039 If' SP ALLMAN TNOMAS A, _ 1419 BpYD DENTON TX 75201 09/04/84 -322.67 ALLMAN, MAR1' L. 40121170 F.R SP ALLMAN, MARY L. 1419 pOYD DENTON T% 762tl1 05/01/84 -27.07 BELCHER, RUN 40149476 ER CC JAIL, DIiNTON CO ( 0r -IJTON CO JAIL DENTON T% 76201 08/03/84 ~ ~ ••96. 00 110DOUS61', IROLA'it 70043015 OP SP OFFICE, DENTON COUNTY AUDI N/A DEPJTON TX 76201 08/23/84 -34. 00 pRODUES, DOUGLAS O. 4019230;1 ER CC JAIL, DENTON CGUNTI' MCKIIJNEY ST DENTON 7X 76201 00/13/64 -120.00 DURV.HARDT, DAVID ALLEN '10132052 Eli SP BURKHARDT, DAVIT) ALLEN 291400SELAWN DENTOI! TX 76701 06/04/64 -qg BURIU/ARDT, DAVID ALLEN 40132021 ER CC JAIL, DENTON CITY MCKIIJNZY BY DENTON T% 76201 06/lI/64 -98.20 CA5ri Y, KAREN 40140900 ER CC PROIJALTION,I)tNtON COUfJrY 301 E MCIIIN.NCY 0ENTOK ~ 7X 76t0i 0$/01 /6q -71.79 CRUMPECKKR, NORMAN 4015506t ER SP CRUMPECKER, NORMAN 521 W114O5OR 1164 DENTON TX 76201 08/22/64 -132.79 (J DAVIS, JI-HN 4015;1917 ER CC JA fL, bENTON CouN TY MCK[fJNCV' BY DENTON T% 76201 08/18/84 -64,09 DRAPER, ;VLtE 10103224 fP SP DRAPER, CHARLES RT 1, COX 47 COLLIAJSVILLE T% 76233 06/11/84 -1,4 41.79 ffANK IIJS, DAVID WAYIJF 40137712 ER CC JAIL, DENTON COUNTY MCKIIJIJEY 0T, DENTON T% 76201 04/27/64 -70.60 KENT, DAVID 40149445 ER CC 1AIL,DENYON CO DENTON CO JAIL DENTON T% 76^,01 08/03/84 -70100 MCCLURE,ERIC 40149452 ER CC JAIL, DENTON COUNTY - DENTON CO JAIL DENTON T% 76801 08/03/64 -96.00 MOHR, III CNAI_'L 40L49239 1R CC MOHR, MICHAEL 4701 LYp1J5 POMPANO REACH PL 00000 06/03/84 -126.80 11CROAN, 111STY 10057073 IP CC MORGAN, OORDON RT i BOX 379 SANDER TX 76266 -24'920.77 NEAT., INrT F 10122604 fP CC NICHUL.AS, JACKIE P. RT, 2 BOX 014 FklBCD TX 79004 08/09/84 -26$,90 I&IJMAN,CON K 40130874 ER CC NEWMAN,DON K 1419 OAK DENTON T% 74201 06/04/84 -13(l,00 NIC140LAS,JAC97C 1) 10110337 IN CC NICHOLAS, JACKIE D NT 2 BOX 314 PRISCO T% 79034 06700/84 -?'63$.04 NOLCN, IIAVIEE C 70041469 DP BP UPFC,DENTON CT AUDITORS ADDRESS??? DENTON TX 76201 07/26/84 -97,90 OURO, JOHN MICHAEL 40154,773 ER CC JAIL, DENTON CO. 11CK1NNEY DENiOf! 7% 7620( 08/22/94 -36.00 PELZEL,ANGELA 10099009 IP MC PELZEL, ANGELA RT I BOX 114 PILOT POINT 7% 76298 04/03/fl4 -r^^.67.00 PELZEL,ANOELA 10103943 IP MO PELZCL,ANOELA - RY 1 BOX 114 -PfLOT POINT TX 76298 09/26/64 -3,477.00 ' PELZEL, AIJOELA 11 10003?29 IP• SP PELML,ANGELA M RI 1 BOX 114 PILOT' POI1Jt t% %6:98 02/24/84 -2,t62.00 PRUITT,DARY 10121461 IP CC JAIL, COUNTY - MCKINNEY 8T DENTON T% 76201 07/30/84 -000.30 15 r , i f' 10.44:35 07 51iP 19rJ4 AIARITY REPORT PACE 2 R, PAT I E14T, PAIID.... PT Fr, OUAPANtOR IWIC........... ADDRESS.... CITY... • • 3T ZIP. , DIG. DTE. A110UNT... RHIN'E,MICHApL 401095(!1! ER CC DENtON,COU14TY JAIL COURTHOUSE ANNEX DENTON } T% 76201 08/24/84 -56.00 RHINE, II ICHAEL EUGENE 40154627 ER CC JAIL, DENTON COUNTY DENTOtJ - _ DENTOIJ - T% 76201 08/21/84 -61.25 RUSSELL,VUJCENT DEFiNA 40154109 £R CC JATI.,DENTON CDU1ltY 301 E MCKINNEY DENTON " T% 76^,01 08/19/84 -79.x0 SHUF'FIELD, DILLY 10121690 IP CC DENtON,COIJNTY JAIL MCKINNEY ST DENTON TX 76201 00/17/84 -9,983.10 SHUFFTELD,DILLY 10126126 IP CC JAIL,DENTON COUNTY MCKINNEY ST DENTON TX 76201 08/21/84 -1,192.2;; } CHUFF I ELI). D ILLY 40133670 ER CC JAIL, DENTON COUNTY 301 MCKINNEY DENTOIJ ' TX 75201 08/18/84 -07,09 SLATER, TRACY 10126266 IP CC SLATER, TRACY 327 VALLEY PARK DR. GARLAND TX 79C40 08121184 -1,099.50 SLATM TPA*,Y -10153090 ER CC JAIL, DENTON COUNry E MCKINNEY ST. DENTON TX 76PPOI 08/16/04 -90.60 n SLATER, TRACY D. 40193637 ER CC SLATER, TRACY 04 322 322 VALLEY PARK D GARLAND TX 75040 08/10/84 -73.00 D SMTTH,PAULENE 10106021 IP MC 6111 TH. PAULENE 204 W. PAARIE PILOT POINT TX 76298 00/30/84 -371.00 n STARN3,K£NNITH RAY 40139911 ER CC JAIL, DENTON COUTY MC KINNEY ~ bENTOM TX 762.01 07/03/84 -50.25 TAYLOR,14AARY 40149146 ER CC JAIL,DENTON COUNTY 309 MCKINNEY bENTOT! T% 76201 07/20/84 -60.00 7 TAYLOR, PERRY LYIJN 40148371 EA CC JAIL,DENI'ON COUNTY DENTON COUNTY JAIL DENTON TX 76201 07/30/84 -$6.00 TURNEA,CHARLES 10147472 ER CC JAIL,DENTON COUNTY - MCKINNEY - DENTON T% 76201 07/27/04 --179.40 TURV4R, C110LE9 40147704 ER CC JAIL,DENTON COU14TY MCKINNEY DENTON T% 76t?Of 07/7904 -1:,00 UNUER14001),111E FE 10126001 TP SP UNDE'R110111),MARK ANTHONY 304 9 RUDDELL 089 DENTON TX 76201 08/6,10/84 -601.70 UNDERWOOD,NIKKt ANN 10103521 IP SP UNDERWOOD,11ARK ANTHONY 304 S. RUDDELL M89 DENTON - -TX 76201 08/20/84 -849.69 WSLLIANS, IRA JAMES 10103133 IP SP WILLIAMS, IRA JAI11:6 700 SMITH STREET DENTON TX 76$01 05/10/84 -3,010,43, ~ n -04, 668, 18 M r N 1 r F I I 01 SEP W R I T E eA-*~F F rl E P 0 R T rr l: E 1 PATIENI NAME PAT ID D15CHG OEG-UAL MEW-Clio NEU-PAY (4-0 W. fC TYPC CYCLE LST.PHT ACC FG TYPE STEPHENS, CHAD 40119176 04/21/84 61.99 O.OG -$0.G0 11,55 6P CR D Gu/21/flA 72 6 a4 quAnara rqn IIJPUfPMATIUII ap DENNIS STF:I'IiliN5 0921 LA PALOMA DENTON, rX 76:01 SWEATHAN,ANTHONY DUANE 40111403 03/227/04 *a OVARANfOR INFORMATION as ANTHONY DUAIJE SWCATMAN /0 0.00 0.00 56.70 GP Eft A ly7 6 . 0OX 11 GOLDEN TRIANGLE 11H„ AnCYLE, TX 762.',6 TERNE9,14ERRI 6. 40063117 09/10/63 104 60 0.00 -3.66 100.961 9P Ell 2 07i1H4 a♦ OVARANrOR IW OPMATIUIJ as VICTOR TEIOJES PO SOX 1071 LEWISVIL1-E', TX 75067 17I (r u aaaa W-0 TOTALS auaa 222 99 -03. 60 q. 00 169, 17 f y J 01 SEP 1954 WR I TE-0PF R EP 0R T j PAGE P - AT - IENT NAME -PAT ID 01SCH0 DEG-DAL NEW-C142 WN-PAY I4-0 DAL FC TYPE CYi' .LC LST. PMT AGE PG i'fPE lp JOHNSON, JAMES 40131294 06/06/84 59,7$ 56.00 -20.80 94.9$ SP ER I as GUARANTOR INFOnMATION as JAMES JOHP490M 1111 COLLIER 02 DENTON, TX 76201 2 03107;04 1.5 ai W-0 IOTALS aaMa . 139.75 -20.50 06.00 94.99 01 SEP 1984 WR I rE-0FF REPOR T ra,E 3 PATIENT 14AIIE PAT IO DI7Ctl0 _W_ 11 8EC-Ofd_ IJFCHG NEW--PAY I4-0 BAI_ PC TYPE CYCLE LS7. Pt1T i,(;E FO TYPE G4E1J2, GUY 11!O6L13? 11 /17/83 1, 960, 80 -22. 79 -1, 406, 64 G. 7. 41 zip Ip 2--- 06/12104 20 6 - 44 OUAR6NTOR INPCNI'1AT1111J -14 9YI.VANIO Id VAR 2024 N. ELf1 DENTON, TX 76201 ` BALING,KERI JUNE 70031703 03/23/84 622.49 0.00 417.96 Z04, 49 a 44 COARANtOR INFORMATION 44 KERI )IJNC SA1_INO -SP OP----.-2 --07111/84- - 52 6 71 FOX CIRCLE DEfJTONfJ, T TX X 76.',01 SAMPSON, VANH59A 10070170 04/7/04 762 70 239.19 44 OUM4hr4TOR IMr4RMATJON *f LESTER COHNr I.L 9AMPS41i 2105 OAK -PAR A 00 RR q11946. 7%1 1 $9 LEI4t6(A 1 06/00!04 /-,,^f G . VILLE, 7% 75067 SCRU968, HAROLD 401 16790 04/17194 17. 79 - 0. 00 0.00 17:-79 EP- ER - .3 . C 44 OVARANION INFORMAtICN vv HARMI) ECR000S 711 KERLEX DENTON, TX 76201 139 6 SERNA, LUGUSr1N 40118;749 O4/.^.2/94 GUARANTOR IhFURMATIOfJ 44 r' SE RNA 90 0.00 vn AUOUSTIN ERNA RT 1 BOX 174 A 0 AUBR124, EY, 9 TX 5762278 q - 130 E V SHOCAPY,DELORES 40116022 04/13/04 11,1. 7D 0.00 - 0.00 131.79- ACD ER -NS y OVARAN70R IIJFORMATIOH 44 SHARCN SHOCKEY PO 90X 1712 DENTON, TX 76201 139 6 5til1NULER, ROS 114E 700299176 03/01/04 125, 00 0.00 -100.00 44 CVARANTOR INFOPMATTOI7 44 ROSME SMINDLER PO 23,00 BtlX `i0762 DEIJTON, T TX X 7,6201 8111PSON, SANDRA 40119673 04/21,/04 114. 5J - 0. 00 0. 00 114,50- SP CH _._...I__.. _ OUARAN7OR IIJPORIIATIOIJ *4 J. M. 81111190N PO BOX 067 PILOT POINT, TX 76298 126 b r SI. ONE, SrtAIIE 40119141 04123/04 44 OVARANtOR INFORMATION va JCE L SLONE 17,00 h0.0U -17.00 0.00 GP ER 408/18/B4 14 6 <S0, lICCORMICI< CENTON, 7% 76a^O1 S141 TH, CIIRISTOP Hf.R A, 10046060 OO/20/03 B16, GO - -P9.75 -734.05 60.00 SP IP d 08/20/84 C *4 GUARANTOR INFORMA11017 *4 DAVID 11. 5111T11 509 DRIFTWOOD DENTON, T% 76201 12 b - 511Irill J0161 401P5353 01/11/04 36.00 0.00 0 00 96.00 SP- Eli .3 - , 44 OVAR1dJfON RJFORf4ATION 4n JUIJN S111TH 6901 C.AOTPIDOE OLS ODESSA, TX 797629228 109 b SMITH,MATIKA W 40090907 01/07/84 103.70 -7.91- -62.39 - 33. 44 SP ER -4---• ' OUARANMR INFORMATION nv JANICE 0111711 TWIN LAKES 0266 DENTON, TX 76201 06106/&4- g7 b SMITH, MATIKA IJ 40091822 0t/0'7/I14 56 00 O.OD -31.00 29.00 SP 4* OVARANTOR INFONIIATI0r1 44 JANICE Sf11Tll TWIN LAKES 0266 DENTON, TX 76208 4 02/20/69 - 194 6 V SHMA,RONNIE E 10060160 10/22103 2,398, 49 0.00 0.00 2,398.49 BP -IP_.----- 2_.--_..____ of OUARANIOR INFCRMATION va RONNIE E SMITH - --313 - 6 R1 2 COX 430 OEtJ70N, 7% 76201 - ' J SMITH SU8MI D 10076394 01/08/04 2,027.19 -22 73 -1,741.72 262,68 SP *4 OUARAN7OR INFORMATION as SUSAN B Srl1tH RT I BOX 166 C FRISCO, TX 70034P l 04/04/84 - -19V - b V .SMITH,SV3AN D -10077336 03/09/84 1,376.49 1,010,30 -1,933,44 --,.450,-36--SP-- IA ` #a OUARANTOR INFORNAT10ft *0 SUSAN 0 BMITFI RT 1 BOX 166C PR1BCO, TX 75034 ___1,.-._ f SMITHERB,COLE 40112476 03/31/04 62 51, - 0,00 0.00 -624E0 - SP--- V 0UAR6HrCR INWORMAtIOU av COLE SMITHCRB IS16 WAYNE DE14TONo TX 76201 BR 1- 152 6 - I" u SM THERS,CO a#9041RK 7 8M004/00/84 136.25 0.00 0,00 _ 136,25--8P-- OP--_-1_..--. 124 6 41~ NO OVAPAMOR 1NFORMATIOf7 b 1605 LATTIffORC tlENTON, TX 76201 J ✓ ' 01 SEP Y" W R 1 T E' F R E P U H T r" ~;E q I PATIENT NAME PAT SD DISCHO BEG-CAL NEW-CH3 NEW-PAY W-0 DAL FC TYPE CYCLE L67 PMT AOE f~O TYPE ~ J SMITHERS,CURLEN 40107070 03/09/04 67.00 0.00 0.00 67.00 SP ER 2 OVARANFOR INFORMATION *a CVRLEH GMITHERS PO BOY 90£392 DENTON, TX 76201 V 90MERB,KA711Y 40069924 12/14/83 41.79 24.92 -69.67 47,00 SP ER 8 06/09/84 813 6 **•OVARANIOR INFORMATION *w PA1SY SOMfiRS P.O. BOX 90325 SAUCER MHP 0132 DENTON. 1'X 76201 v SORRELL,JEANIE S 10080620 021.0/04 4,262.64 300.79 -I.890. It 673.20 SP IP 4 03/2 (04 137 6 O v *a GUARANTOR INFORMATION x0. GARY W SORRELL RT 6 BOX 104 OAINESVILLH, TX 76240 -SORRELL,MATTHEW.--._. 10089464 03/03/04 080.25 192,50 -649,40 391.35 SP IP 1 04/16/04 127 6 V f v 4w GUARANTOR INFORMATION ww GARY W. SORRELL 1404 COBERSON GAINESVILLE, TX 76240 I` ~ J SOTIK,DIANA MARIE 40113516 04/04)84 96,00 0.00 -44.80 11.20 SP ER 4 09/04104 120 6 xw OUARA14TOR INFORMATION a* MICHEAL SOTIK RT 1 BOX 562 SANGER, TX 76266 SDTO,M;14ERVA A 40107991 03/11/84 99 90 0,00 0,00 57.$0 SP ER 2 173 6 OVARANFOR INFORMATION xw JOSE SOTO 719 'd CRAWFORD DENTON, TX 76201 -8 AHR,M[KE 40115438 04/11/84 30.00 0 ,OC 0.00 30,00 SP ER 2 04/1 ../(14 142 6 OUARAIJTOR INFORMATION ww MIKE EPAIIH RT I BOX 440 STONEY TX 77777 J SPEARS, SfiRAII. S 10072812 12/ 16/83 1,032.00 0, 00 - -830.60 196. 40 5P I P 03/15/04 170 6 ' OVARANTOR INFORMATION xx PHILLIP SPEARS 0167 TWIN LAKES MHP DENTON, TX 76201 v J . -_.9PLAWN, OEOROIA.E .10057431 03/03/84 752.29 - - 181.75 - 0. 00 434. 00 OP [P.. 1 176 E. xx GUARAIJFOR INFORMATION UELMAN H SPLAWN 624 RAILROAD AVE DENTON, TX 76201 v t7 SPLECHTER,JOSEPH HARRY 10049179 09/06/83 3,933.00 ---15 00 -3,886,92 61.08 MC IP 05/07184 117 6 xw GUARANTOR INFORMATION w* JOSEPH HARRY SPLECHtER 310 CARU114AL 07D DENTON. TX 76201 v SPRADAFIY,PATSY 10076982 01/06/84 440,00 0.00 -10.00 430.00 SP IP 1 05/03/84 121 6 OUARANFOR 114FORMATIO14 JERRY SPRADARY P.O.DOX 313 KRUM, TX 76249 v SPRAYOERRY,TOMHY F 40096018 01/29/84 96,00 0.00 - 0.00 96.OU SP ER 4 216 6 w0. OUARANTOR INFORMATION x0. TOMMY F SPRAYOERRY RT2 LOT 17 ROWE DENTON, TX 76201 v SPROLES,PAM J 10084906 02/1:/84-. 842,20 242.39 -788.76 295.79 6P IP - 3 09/2U/U4 4 6 *w OVARAWTOR INFORMATION *s RICKEY SPROLES PO BOX 262 JUSTIN, TX 76247 r SPROLES,RICKSY 40097736 12/25/83 102,7u .36 60 -105.0094.30 SP ER 3 00/27.84 3 6 *x OUARAWFOR INFORMATION xw RICKEY SPROLES POD 262 IJ COLORADO JUSTIN, TX 76247 --....8TARR,CELINDA D. 40076012 It/OS/B3 713. 70 1010 00 0.00 219.70 8P ER 4 169 6 r *r OVARANIOR INFORMATION 0.w BETTY STARR RT 2, BOX 058 AUDREY, TX 76227 ._...,BTARR.MARISA 1007912701/Ib/84_.2,936,I9----11,20-2,679,99 267,40SP IP----4 02117/84- - 169 -6 - rr GUARANTOR 114FORMATIOIJ r* CHARLES STARR RT 3 BOX 350 DENTON, TX 76201 r. STARR, MARTHA. V, 40109179 03/10/04 - 103,90 - ---0.00 -0.00 103 90 SP ER -4 166 6 OVARAIIFOR INFORMATION *w M.Y. STARR RT 3 BOX 350 OENTON, TX 76209 STEPHENS,KIHDCRLYD. 40110507 04/21/04 101.00 0.00 -96,00 49,00 OF CR- - 4 04/25/84 I29 6 OUARANTOR INFORMATION *w KIMBERLYD. STEPHENS PO BOX 40t KRUM. TX 74249 V C 10 n ~rf Ol SEP 1984 WR I TC-0FF R E P 0 R T PACE 5 PATIE14T 14AHE PAT ID DIOCHQ UEO-DAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE L5T.PMT AGE PG TYPE STEVE49, DER14ICE 10069074 11 /29/83 812.73 0.00 -620. 20 192. S3 SP Ip 3 04/$0184 I J y 0UARAWtOR INFORMATIpl1 ar OEOROE STFVCNS AT 7, BOX 740 DENTON, tX 76201 134 6 -+,TSV6f4S,DOUNOLAS 40084469 12/10/83 54.-30 0.00 ---48,00 9. 00 8P ER - I - 08/14/84 - l0 6 *4 GUARANTOR INFORMATION DOUNOLAS STEVENS 1920 6DWARDS MC DENTON, TX 76201 STOCKWELL, BRANDON 10093409 03/24/84 2,549.65 0,00 0.00 2,849,59 Sp IP 4 O OVARAN(OR INFORMATIC14 r* PHILLIP STOCKUELL 1900 14ADALIE OAtNVILLE, TX 76140 194 6 r __.._STOCHWELL, bHERA1 .LYNN-_._ 10094702 12/30/83 2,499,68 389,60- ..-20. 00 .2, 869 28 - 8p Ip GUARANTOR INFORMATION r* PHILLIP N BTOCKWtLL 1500 NATALIE OAINESVILLE, TX 76240 4 03/09/84 176 6 STOKES,EVELYN L 40118374 04'21/04 54.00 112.30 0.00 196,30 SP EP 4 J OUARANIOR tNFORMATION rr EVELYN L '-.rDKES 1619 UND011000 DENTON, TX 76201 106 6 --14TONB,EDWARD 40095754 01/20/04 61,23 - 0.00 - 0,00 - 61.25 SP OVARANIOR INFORMATION rr ED14ARO STONE RT 1 BOX 2 ER - 4 216 b ' 6.AB-1 KRUM, TX 76749 r STRAf40ErpRANCEB 40106486 03/07/94-- 69.30 0.00 0.00 69.30 SP -EA 1 170 6 rr OUARANtOR 114FORMATIO14 DARRELL STRANOE 205A WEDS RD DENTON, TX 76201 $TRU04E,ja- 70024443 l2/12/83 .....887.00 QUARANTOA INFORMATION rr MATTHEW P. STRUDLE J1b P00 - -054. T 0 FT - WORTH RTH OR 60 - 32 DENTON, Sp 0p - -t 07/16/84 47 6 _ , TX 76201 t W HTUSBLERIELD,CHAD 40118150 04/21/54 63.20 - - -0,94 -31.31 31.00 SP ER 3 03/41/84 r* OUARANtOR INPOAMATIO14 MARC 9TUQBLEFIELO 2406 N ELM DENTON, TX 76201 103 6 v f 5**DtlUARANCORC 40106310 IIJFORMATIOt4 RAY 8 03/07/84 97,00 - 0,00 - -30, 00 -67, 00 SP ER - I 04/20/d4 134 6 - TUONICKI 2212-29 FT WORTH DENTON, TX 76205 QUDDAT'H,9COTTHI tCHRLL 4008804412/20/83. --108,50- - ---O.OD-•..- 0. DO- 105.-30--8P -ER -----4 OUAAANTOR INFORMATION LINDA WOOERS 1106 EDINDUAO DENTON, TX 76201 247 6 V _ GULLENOER, SHIRLEY A._-. _4006281,2.09/17/53 56.00 0,00 25..00 .74. 00 8P - - ER 4 - 04109/54 143 6 OVARANtOR 114FORIIATION *r JOHN BULLENOER AT 5 POX 102 ACORN RANCH DENTON, TX 76201 I ~ SULLII4S,CHERYL R - -40104796 02/25/04 66.73 0.00 _20.00 46.73 SP EN 4 - 00/15/84 l09 6 *r OUARANTOA INFORMATIONJ rr CHERYL A SULLINS AT a BOX 299 ARGYLE, TX 76:26 v SULLIVAN, V1R41NIA ANN 100'14282 03/23/84 333.85 0. 00 --0.00 03160 NP . IP- 4 _ 139 6 UARA147pR INFORMATION rr FREDERICK SULLIVAN 1418 ASHLAND DR. CONHOE, TX 94999 1 SURAPONOIHVP?TAWONO 40047412 02/02/94 -99,00 0.00.-_.:_.0,00 . 90.00 SP ER 1. 211 6 QUARANTOR INFORMATION rr HUNTAWONO SURAPONO 1702 CARL RD APT #231 IRVING, TX 760622 V SWGAVAN, CARL - 10095446 04/04/54 - 1,335,90 -0.00--14503, 80 - -U0,00 Sp IP - 2 07/O9/04 04 6 QUARANtOA INFORMATION CARL SWEATMAN 617 NEWTON DENTON, TX 76201 OWSATHANoCARL JU1410A _ 10091676 03/13/84 d, S21, 00 - 0. no "1, 36L 00 --,QO, 00 Sp- lp 4 04/30/134 - 124 6 r #4 AUARA14tOR IMPORM4TIOt4 r* CARL JUNIOR OWQATMAN 617 NLIWTON DENTON, TX 76201 V SWEATMAN CHARLIE 95009460 02/29/0, --78,00 0.00 0.00 78, 00 SP OP_. 4 QUARANTOR INPORMATIO14 CHARLIE SWEATMAN 328 DERNARD DENtON, TX 76201 100 6- w' O1 9£p 1r ~E b ~ W R I T C F R E P O R T PATIENT NAMS PAT ID DISCHO BEG-DAL NEW-CHO NEW-PAY W-0 DAU FC TYPE CYCLE LST,PMT AOLz P'p TYPE r SWEATMAN,JOHNNIS J. 10009382 03/08/83 2,093,90 934.05 -2,940,12 630163 6P RP 4 06/04/04 89 6 rw OUARANTOR INFORMATION JOHNNIE J. SWEATMAN 617 NEWTON DENTON, TX 76201 TAFOLLA,BENNY 10076602 01/09/84 _ 913,79-.-_ 143,75 --x15,00 1,042.50- OP 1P _4 00/14/84 110 6 4 *w OUARANTOR INFORMATION LUIS TAFOLLA 117 8 RUDDELL 022 DENTON, 7% 76201 TAJ, SHIRIN. 40060061 11/11/03 221.00 - 0,00 . -40.00 101-00 OP ER - OUARA14TOR INFORMATION S141RIN TAJ PO BOX 944 DENTON, T% 76401 ' 04/17/64 137 t' TAPIA,VIVIAN—.__.__- _ 1006$680 11/29/03 _493.50 O.00 ~ GUARANTOR INFORMATION r* RAUL 14 TAPIA 203 8 FIRST 8Y 0Or 493, 50 8P - IP---3 276 6 SANGER, 7X 76266 TAPIA,VIVIAN 40126471 05/29/04 98.85 0.00 0,00 90.85 SP ER GUARANTOR INFORMATION • VIVIAN TAPIA 4 101 6 203 FIRST STREET SANCER, TX 76266 TAYLOR,((.LIRA R 40109914 03/t9/94 173.25 - 0.00 0.00 173.29 6P - ER 3 - 03/2O/84 164 6 w* OUARANTOR INFORMATION rr AL16A R TAYLOR 1026 SCOTT DENTON, TX 76201 TAYLOR,CINOY A 40114340 04/07/84 -----56.00 0.00 20,00 - - 36, 00 SP EA 9 / w* GUARANTOR 114FORIIATION CINDY A TAYLOR _ P, O. BOX 364 OEWTON, T% 76201 OS/20/84 19 b i TAYLOR, MISTY.MARIE_ 10069104:11/74/83 869, 20 *r OUARANTOR INFORMATION ww RODERT TAYLOR 42.00-..-737,16-- 179,04 OP IP- _.3-_.00/11/64 liO- -6- 302 W EMBRY DECATUR, TX 76234 3 TAYLOR, PHYLLI! A.. 40074098 10/29/03 _60.80. GUARANTOR INFORMATION *w -.01 00 ._..0. 00 68, 80...BP MR 3 307 6 ? PHYLLI8 A. TAYLOR 3406 SAOEGRUSM DENTON, TX 76201 TEMPLE, ARVID T. 40103566 02/24/04 -56.00 0.00 0. 00 sb 00 MC ER - ` GUARANTOR INFORMATION * ARVID T, TEMPLE 900LONDONDERhyLN,0163 HOLLYHILL APARTMENTS DENTON, TX 76190 201 6 ' TERNED, K9RR1 8 40404564 02/27/04 0. 00 - 91, 50 - 0-00 - 4 OUARANIOR 114PORMATION w* KERRI 8 TERNCS 91.50 6P -4R A 186 6 P-0- BOX 643 FRIENDS 4F FAMILY DENTON OPL T% 76201 TRRN118, VICTOR .8.. 10006429 02/20/04 ..._.649, 95.. 4 0* OUARANTOR INFORMATION rr VICTOR 8. TERNES 0 00_ 649,59. 6P __...3 193 4 P 0 O O tlX 1071 1 LEWI6VILLE, 7k 7906 07 TBRRACG,111AIA11 M -40097446 02/02/94 80, 00 _93. 60• -160.45 • --43, 15 SP - ER 4 06/$5/64- - - 69 6 , *4 OUARANTOR INFORMATION r* JUDITH ANN ALLEN 4009 ATLAb DENTON, TX 76201 TERRYt PREp„JR 70023866 11/30/03. - . 150, 00._. _ 0, 00 -120,00-. 30, 00 SP OP 3 00/04/64_ _ 88 6 / *e OUARANTOR INFORMATION wr PATIENCE TERRY RT 2 BOX 905 DENTgN, 7% 76201 TRARYiFREDRICK tRICKY1rJR, ,4000200 00/12/83 92.23 131:-19 ! *4 GUARANTOR INPORMATIO14 ww PATIENCE' TERRY 173.44-..-•..90.00 -SP-- ER- 4.,. 00/04/54.: 328 6 RT 2, BOX 909 DENTON, TX 76201 rw GUARANTOR 114FORMAT:CN *r ANNRTIE TESTA 825 HIOHLAWO VILLAGE B4, LEW19V1WISVILLE, X fk 75067 - THAO)wo JEREMY _._40076156 01/04194 ---431,70--.-....70-78... x510,36.__ - 192, 09 -SP :IP-_._.- 4 - 08/23/54,.-. 1 *w GUARANTOR INFORMATION r* CHARLEO THACKER 10 _ 6_-,._ LOT 0159 LAKEWOOD EST DENTON, TX 76209 ~------THACK9R,RO91N 10096961.00/25/833,401.54--5, 103 00.-- 214,04 .OP._ Ip.___ ..2 00121/044...- ._..11 6. 40 OUARANTOR INPORMATION w* CHARLES THACKER ~ LAKE11DgD EQTA7E8 k164 DIi1170N, TX 76209 - 4 I f~ I, 01 SEP 1981 WR 1 TE -OFF R L P 0R T PACE 7 v PATIENT NAMV PAT ID DISCHO DEC-DAL NEW-CHO NEW-PAY W-0 DAI. FC TYPE CYCLE LST.PMT ACE PC TYPE / THILLEN, RENEE L, 40119810 04/26/84 - 66. 75 0. 00 - • - - 0. 00 .66.75 8P ER 4 I26 6 rw OUARANrOR INFORMATION 40 RENEE L. THILLEN PO BOX 774 JUSTIN, TX 76247 , V THOMAB,ARZELIA 10097601 04/13/84 2,466,05 -20.50 -2,431.05 - 14,50 SP 1P 4 05/03/84 Ill 6 44-GUARANTOR INFORMATION 44 ARZZLIA THOMAS 61.6 CHAMBER ST. DENTON, TX 76201 J Q THOMAB EARLY 40105173 03/02/04 156,50 69:00 61.20 - 16C 80 SP ER - 4 03/21/84 86 6 4r OUARANrOR INFORMATION wr EARLY THOMAS 500 5 RUDDELL APT 4318,0 DENTON, TX 76201 0 .._._-THOMA91R4CHARO W 40012189-03/19/83-----86,-00- 934,25 --.-360.25- - 6" 00-..SP-_ ER _ ._3 05/.29/84-99 6, 44 GUARANTOR INFORMATION rr RICHARD W THOMAS 1730 E OLTORF 0399 AUSTIN,. TX 78741 r J - - THOMAS#VIVIAN (RHEA) 40119315 04/24/84 113:89- .^06.60 86.65 MC ER- 00/10104 106 6 w4 GUARANTOR 1NFORMATION ww VIVIAN (RHEA) THOMAS 7^a9 E 39TH SAN ANGELO, TX 76901 J THOIVS014o GAL INDA • - 40[10983 03125/84 56,00 0,-00 0.00. 56, 00 8P ._ER 4 189 6 44 OUARANrORINPORMATION r4 MARY THOMPSON PO BOX 465 KRUM, YX 76x49 YHOMPSON, INF MALE : 10098424 06/09/04 49, 091.84 0. 00 - O: 00 491 091. 134 MP -1P 3 82 6 wr GUARANTOR INFORMATION rr KENNETH W. TH011PS014 516 DWIGHT LEWISVILLE, TX 75067 _.----THONPBON,.JENIA M 40117921.04/20/84.._-- 01,55 -.-._-66 OD _ .0. 00 _ . 147: 09 SP ER._---4-- , _ 119 6 4w GUARANTOR INFORMATION rw KENNETH THOMPSON 916 DWIGHT LPWISVILLE, TX 75067 THC1iPBON,J9NIA MARIE - 10001666.04/17/84 1,984,04 0.00 -W.00- 1#904.04 SP IP - - 3 04/25/84 - 129 6 rr GUARANTOR INFORMATION ww 14ENWTH W. THOMPSON $16 DWIGHT LEWISVILLE, TX 75067 r THOMPSONILYNN STACY - 70031670 03/22/84 - 581,40 87.00 --581.40 , 87,00 SP OP 4 OB/9I/04 103 6 4M OUARANTOR INFORMATION 44 T. N. THOMPSON 2121 WOODDROOK DENTON, TX 76201 THOI4PBONb PAT 01/22/e4 - 21168: 65- - 0. 00 -2, 003, 66 - ---165, 00 - SP IF 4 0/11/e4- - 113 6 44 GUARANTOR INFORMATIO14 rr GEORGE THOMPSON BOX 410 KRUM) TX 7624^ _._._7HDHP8ON,-YAM11r- 40085502 32/28/83-- 168. 59...._. -20, 00 -----0,00 SP-- -ER--- 4 I84 6 44 GUARANTOR INFORMATION 44 CHARLES THOMPSON RY 1 BOX 65OX SANGER, TX 76266 -.--THOROUARANYOR INFORMATION 4-4000 DEBRA 172-09/05/83.. -_-88.45.-. --..._.0:00--- -45r96.•._._42r49 - 8P --ER ..'3 10/24/83 31,3 6 I RISON THORMAN 31D BRADLEY DENTON, TX 16901 THURIJERP DARAARA J,--_- 40101980 02/17/84 138. 75 0. 00 0.00 130,70 SP -ER------- 3 - _ 194 - 6 4r OUARANTOR 114FORHGTIOII BARBARA J. THURNER 3412 CARSON FTWORTH? TX 76117 TIDWELL#SHA14MAN. 4009057602/05/84 1G0.00-. _ - 0.-00 - --__0.00- 150:00 -SP BR-- 4 307. _ 6 04 OUARANrOR INFORMATION 4w DONALD TIDWELL 904 SHADY SHORE M19 LAKE DALLAS, TX 75065 J T1CWELL,114LIA - - 10082154-01/29/04 - It 538, 75-------- 0, 00 -1, 488,-75 ----..50, 00 SP - IP ----2 07/18/94 _ .-.-45. it 44 OUARANTOR INFORMATION.-- LESLIE TIDWELL 234 R08EDUO STEVENVILLE, TX 76401 "J -_'-TIGT4E,OANIF6-L•-...~'_ _ -4010294902/20/84--•--60.-75-----14,-00----.-._0,00--_... •74.70-. Sp- 62..._..3_ 190 6 r4 OUARANTOR INFORMATION ww ME'LVIN T1EOE RT 4 BOX 303 DENTON, TX 76201 __.---TIMMONSjKATRI14A L._,._ .10009261 01/20/94 870,00 -..149,93._--696:00., 320.93 BP 1P---- 4 04/03/04 _ -141_ b 44 OUARANrOR INFORMATION w4 2090Y T114MONO 1604 VILLAOE E APT 0701 DENTON, TX 76201 r i A w n, 5 1 v 01 SEP WR I TE/~FF REPORT 1~E6 PATIEIJY NAME PAT IO OlSCHO DEO-tlAL NEW-Clio NEW-PAY W-0 DAI_ FC TYPE CYCLE LST.PMT AGE FO TYPE V TOLLEFSON,WILLIAM P 40107206 03/10/94 -33,10 0.00 0.00 33.10 8P ER 2 03/12/64 173 6 •r OUARANTCR INFORMATlOtJ Mw DEADAH TOLLEFSON OAK POINT MHp N96 LEWI8VILLE, TX 79067 Y „TORRCZ,OUAOALUPE 10075908 03/30/84 6,342,99---- 0.00 0.00 6,348,99 Ep III y MM OVARANIOR INFORMATION rw OUADALUPE TORREZ 2637 SELTLINC COPPELL, TX 79019 I 194 6 TOVAR, OLOR IA V. 10084924 02/21/84 693, 10 - - 109, 60 -100.00 70x. 70 Sp LP 7 Oq/16/84 138 b ' +'M OUARA14TOR INFORMATION r• GLORIA V. TOVAp 416 NETTIE O>:NTON, T% 76201 TERRY E, 40106969 03107/B4 898. 90 0. 00 . _ 0. 00 - 888, 90 Sp ER -1- Y r ♦r GUARANTOR INFORMATION] TERRY E. TRAMMELL P 0 BOX 663 PILOT POINT, TX 76298 177 6 TRAV9LST4AD, YEVELAINE ANTI 10031474 09/01/03 1,214, 10 0313.30 1-1,429, 10 123.30 SP III 2 07Y 6/134 O13 J rM GUARANTOR INFOAMATIO14 rx ERNIE R TRAVEL.9IBAD 103 MANOR BANGER, TX 76266 ( v TRIBDL9,DRIAN E 10082030 02/02/84 1,068,10 - 0.00 -900,98 167,12 Sp lP f 00 OUARANTOR INFORMATION Mr RALPH E. TRIBBLE AT 3 BOX 1217 DECATUR, TX 76234 03/n0/84 169 6 v ,LOW FAYE - .10064089 12/13/03 11125.30 233.50 0. 00 1, 360. 09 Sp Q P 1 ! -TLVARANTOR IIJFORMATIOH rr MICHAEL RAY TRULL 1 - 187 6 912 RAILROAD AVE DENTON, TX 76201 r TURN£R, JENIJIF6q ELAINE 40112923 04/01/e4 X8.40 01 00 _ ...0,00...,...98,40 SP_...ER__,. ~w OVANA14TOA INFORMATION rr JIMMIE D, TURNER -182 6 SOX 104 LAKE HAVEN ESTATES LAKE DALLAS, T% 79069 _UCH6NDU DORIS C IG050907 01/30/84 4,178.-99 6,193, 04 .0.00 10,374,03 0P III 4 GUARANTOR INFORMATION r♦ Ut1UOLA8 AMADI UCHENDU 313 THOMAS N11 DENTON, TX y62:01. 01 /30/84 .,_:.176 6 r UNDERHILL, DOUG - 44100406 02/11/84 _._144,79 - -.19.90 V 0.00 29 629 ER . _ g _ .177 6 Mr GUARANTOR INFORMATION Mw CAROL UNDERHILL RT2 anx 229 ARGYLE, , T TX 762:6 9 UNDERHILL, MARK 99009209 02/18/04 • 42.26 0.00 0.00 . 42, 23 SP -_0P. 3 191 6 OUARANTOR INFORMATION] rr MICKEY UNDERIIILL 600 PEASINO DENTON, TX 76201 r VALOEZ,MAR14 ALBERTU- 40106726 07/08/84 104,79 - - 0.00 0,00 109.79 8P ER 1 • rr OUARANYOR INFORMATIOtJI1I MARIO ALBERTO VALDEZ 9109 LOCUST OENTON, TX 76201 177 6 - r VAUGHAN,DAHD1 D 10004697 02/11/04 _ 999,79 0.00 •.-80.00 919.79 -EP iP J w~ OUARANTOR INFORMATION rw ROGER VAU0IJAN AT 2 BOX 232 SANGER, TX 76:66 a 03/26/84 199 6 tr VEOA,RAYMONDO 40120917 04/30/84 . 194,29 - 0.00 7 OUARANTOk INFORMATION wr RAYMONDO VtOA 0,00 194.29 SP ER 1 _ 172 6 1 r 1003 W. CENTRAL FT. WDk1H, TX 77777 VERDIN,JOSEFINA E 10090686 03/11/04 2,626,79 681,79 -0. 00 3,308,94 8P IP, J MA OUARANfOR INFORMATION yr 2 143 b r ]ODE VEkDIN 1049 RAMEY CIA DENTON, 7X 76201 VE88.CECILE_.....• 40106924-03/04/84- tJ6,90----__0 : 00. rN OUAAANTOR INFORMATION rr JOHN HAMMAN • .--.0 00...•.-..336.90 _.gP.-----7620_. 1..... 176_._.6 _ r i 2027 DUWLING OREEIJ tlENTON, TX 76201 ~ _VIER,BAgNl R._-. "1008b0a~ 02/16/94-576, 19-.--x22,79,. 04 GUARANTOR INFORMATION Mr BILLY VIER »7d. 00 478,40 BP IP 2 -07/86/04 37 6 PO Dnx 149 PILOT POINT, T% 76298 --VINCENT,MANDY GAIL 10047181 00/20/84 0,00•-1,715.30 all iP 4 ,r OUARANTOR IIJFORMATIOW rr TERRY LEE VINCENT AT 3 LOT 44 LEWI8VILLE, TX 79067 144 b r i I b°Fxgm~.ky 1 V 01 SEP 1404 NR I TE -OFF R EPORT Ph,E9 PATIENT NAME PAT 10 DISCHO OEO-Dr,, NEW-CHO IIE14-PAY W-0 DAI. FC TYPE CYCLE LDT.PMT AGE FO TYPE V 1 WILLIAMS, INF 11 10069029 12/07/03 l9, 943r S0 -1,071.06 0.00 14,06k74 SP 1R 1 861 6 ♦w OVARANTOR INFORMATION »~1 VhNITA WILLIAMS 420 SMITH DEIITDN, TX 76201 «w~~ W-0 TOTALS •*0* 141,953. 03 -41, 919. 09 v 15,910.36 115,048.64 4w • v J V J V ~ I V V v • N V J I f' ....:...._.__...+..~._..-~.._.....r-.~..._~_.._._.-.-.__.._~~~....r......~..., ....rte... r._Y, ~.._r. _ ~-,_.~.....__.~a ...-._..W.... it l V J' r r ` t 1 OS SEP Yr f W R I T E ~F F R E P O R T - PATIENT 14AME PAT ID DSSCHO E JO ' DEC-DAL IJEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LOT.P11T A(,E r0 type ALEXANDER,CLEtA M 40127771 09/:9/04 101.70 0.0O0 OUARAIJtOR IIJFORMA110W rw PAUL ALEXANDER R 0. tl0 101.79 ap EN 1 J ww T23 CO 4 Lkmm TX 76209 98 7 ALLARD,JOHN 10104867 00/13/84 479.70 127.75 Oloo 607.0D wr OUX141DR INFORMATION rw ADD tP N9 JOHN ALLARD PO BOX 50161 1 AT RT 1 KRUM KRUM, tX 76:44 106 7 - AROUMANIZ:,ANOELA LORS. 40090060 01/03/84 ww GUARANTOR IWFORM?:TJON ww 153,36 Oloo °_531 00 8 BP ER 4 00/09/84 0 AMELIA MARYAROUMANIZ 9244 PI HOIJTERREY bE1J7011, TX TX %6241 23 7 -._.BAILES,KRI8TI- _ 10075471 01/06/04 3,000,00 • #4 GUARANTOR INFORMATION ww CHAMP POWELL DAILES P 0,00.-2,914,.40 564.107 6266 -4 Ob/11/84 - PO BOk 183 BAiJORR, T8 76766 - 82 7 DAIN,DANNY 40131107 06/09/04 171.29 OVARANtOR INFORMATION wr. bANNv BAIN 0 X3 0,00 1EET 9P ER .00 71. 25 POB9J? LAKELAND BTREE7 LAME DALLAS. TX 75069 87 / - IIALDWIN,TINA ELAINE . 10077220 01/07/04 278 240,65 BP Ip w* OUARAWtOR ,b0 170, b0 ~ INFORMATION ww MIKE TED BALDWIN `300,00 1 O6/02iOq q1 7 AT 6 BOX 305A OAINEBVSLLB', TX 76240 OAMOURO,PAIf _ 40139487 07/02/04 70 ww OUARANtbR INFORMATION ww PAM BAMBURO 01 BERNARD A A-4 -4 113,79 0P ER 2 ~ 99 7 9b1 bE1Jtb1J, tk 76201 8ARK$sL0...__.. 40130973 06/04/84__._-64,00--__-._ ww GUARANTOR INFORMATION ww - ED BARKS 0,00-.-__---0.00.---:.6A.Otl---ADO _.gp NO ~ 1400 1J ELM 06 DHNtON, TX 76201 tl8 - 7 - BARNETT,LARRY .H 40121576 09/02/04 Of OUARANtOR INFORMATION wY LARRY H, DARNETT 3d7 N "71.-00 07 N -.WObDST 1) . 75, 00 gp. ER. _.09/03/84 120 7 E1JtON, 7X 76201 V BANNON, PHYLLIS - _ 10103083 05/04/04 365, 05 0.00 , .0-00 365 SP - 44 GUARANTOR INFORMATION ww PHYLLIS SAWN DALLAS, T. X 69 7520 20_Sp._,.2 r SB44 MARTEL DALLAS, T6 114 7 BATH, CHERYL 40089080 01/02/04 4w OUARANTOR 1NFORMAt1014 ww CHERYL BATH 76. 20.---- 102, 75 . -109.00, . 70, OG , . ER 4 08/07/84 29 7 340 CEDAR CHEST LEW18V1LLE TX 79067 BATES, JOE'_..._. 10095045 03/27/84 _ --300-25 0.00 • 04 OUARANTOR INFORMATION wr JOE BATIS =24. 25 356. OO - Sp Ip . 1 09/09/84 60 7 " AT. 5 BO% 180 HUN7gYILLE, TX 77340 OCALC,LARRY P-._ . 40129512 05/30/04----_-_56.00-_..-_o,00 ww OVARAIJtCA INFORMATION] rw LARRY P SEALS 0, 00' - TX BP ER f 93 T 2900 R08ELAWN DENTDN, 7X 7620f BIARDENoHOTOR4SNFORMpT10N ~~40109703 04/22094 033.75 340.100 3 BO _ 149. 90 0P . OR _ 4 OSY18/04 ' 106 7 ~ DALLAS, T% 762$1 - -BEHL,MICHAEL AR, 40129355 03130/04 _ 152, 70. _ - O'tltl J wr OUARANTOR' 110FORMATIOI4 Of MICHAEL A. DEHL _..0,-00-- -.152,70- BP ...ER 1-- 09 X1/84._ 91 ~ 322 CONORES9 DENTDN, TX 76201 - 7 ____d6f11)I14,UWIiJILLIAII--:~_..-.___40722994 09/07/84~~61.-00--__ • , ww OUARIJJTOR INFORMATION Oil DONALD DENDEL 39, 525 ..,_~20.25--- 75.0O_SP __ER_-__-_2._. 06/111/04.._-- --_73 f 801 W ANDERSON PLAOSTAPF, AN 99999 _.08NBHOLGA,CHARLES _40100174 02/11/04 ww OUARANTOR INFORMATIO14 ww 170.713 - 0.00 -b0, 00- : -110.70 --Sp ER-----2 06/11184- J CHARLES BENS){ETLER 123q AVE A k3 bENTON, TX 76205 82 7 ~ _ 0•TA AOUARANTOR 11JpORMA 10007294 04/27/84:.--1,039,40- 222,64 -1,000,03- --203,21 -SP-_..- TIONJ wr JAIME A DETANCUR 2300 VANDERBILT CT DENTDN, TX 76201 4-.00/29144.--. 99 7 i ' •yA.15 ~N 41tl.~,ti.'.: NR.r ri'a.l M. 1 r 01 SEP 1984 W R 1 T E- O F F R E P 0 R T PAOE I I PATIENT NAVE PAT ID OISCHO DEG-DAL NEW-CHO NEW-PAY 14-0 DAL PC TYPE CYCLE LST,PMT ACE FG TYPE O IOOENB, DOADV 10103299 05/09/64 -1.266.4o O. 00 p. 00 1. 206. 49 SP -.Ip 2 114 7 OUARANTOR INFORMATION rr DOODY BIOOEN$ 211 SMITH BANGER, TX 76266 V V _ ._BISHOP, BODDY.. 401907b3 05/9W84 - .101.00 0.00 - -11,00 - 90.00 8P ER t 08/06/44 26 7 OUARAf1TOR INFORMATION R09C TAYLOR 330$ SAGEBRUSH DEN70N, TX 76201 • BI8LAf1DiSEVERLY - - 40129400 08/01/84 -60.7$ - 0100 - - 0.00 60.75 BP ER 1 91 OUARA141OR INFORMATION] BEVERLY DISLANO 2351 NORTHMILL#22 LEWISVILLE, TX 79067 Y 818LANai BgVGRLY--.-.__. __,.40130122-06101 /84---283-00----4 9:-$D._---- 0, 00 _207, 80 ep._ .trk a 79 , 7 *i GUARANTOR INFORMATION BEVERLY DIBLAND 2051 NORTHMILL022 LEWISVILLE, Tx 75067 v 81SLAND, KAY BEVERLY .,70037577 06/06/84 61,00- - 0. 00 - - 0.00 61. 50 SP OP 2 06106/84 87 7 v* GUARANTOR INFORMATION KAY BEVERLY DIBLAND 2351 N MILL 022 LEWISVILLE, TX 75067 v DLACKv SUNf11 -_.-401289QB 05/28/84------101, 70 0. 00 - 0. DO-101.75 -SP ER 1- - 95 7 - r* GUARANTOR INFORMATION FRANK PATMAN 100 EAGLE 007 OENTON, TX 76201 FARN6WOATH,LARRY S 1010041004/22/04 ---284.50.•..._0.00 .-147.60 136. 90 SP _.-IP-----3 06/02/84 91 7 OVARANTOR INFORMATION *+r L.C, FARNSWORTH 1037 WESTWOOD LEWISVILLE, TX 75067 FQADoMARY-;W__._---_--.-_:.._._..10084604 04/20/84-23x202,79----- 0.OD-22, 168,84- lo=9DSP-- . IP------4--°-08/06/84.....__.26 _ 7 OUARANTOR INFORMATION JOHN FORD 2332 OREEN OAKS bENTON, TX 76201 4 - QAtN9S,KE14NETH R __-7003466504/27/84- 90.80 0 00 0.00 90.20 SP OP 1.... - 126 7 J 1.0 GUARANTOR INFORMATION] DANNY GAINES 817 ANDERSON DENTON, Tx Y6201 0a<»D~VA0NI41E 1IIJFORMA 70029522 02/29/84 355, 00 191, 0f' 0, 00 576.00 SP OP- 4 79- 7- , y TION BONNIE J GIBBS AT #5 BOX 100 H DENTON, TX 76201 01008,0904A KAY 404 11940 03/29/84 61,00 0,00 _ _ _0. 00. _-61, 00 SP- . ER _ 4 . ~ 44 GUARANTOR INFORMATION DEDRA KAY 0[008 19$ > r PO BOX 446 GANGER, Tk 76:66 0011M LORErTA-.._ 70004933 04/06/84 r so OUARANTOA INFORMATION *4 LORETTA GODER 94. Q$ 0,00 »Y9.40 19,83M 8P OF - 2 - 05/14/04 lt0 7 y 620 TEXAS DENTON, Tx 76201 ---OOLDSH1THi CURT[S RAY- - - 40113300 04/Otl/84 -96.50 - 55,11 • -$8.61 --91.00- SP ER 2 05114/84- 06 7 OVAAANTOR INFORMATION CURTIS RAY GOLDSMITH ,7311 STELLA #726 DENTON, TX 76201 OOMGt, LWSA 40128324 05/27/04 60,20 0,00. ----0 40 60. 20 SP ER- _ . 1 96 7 V OVARANTOR INFORMATION *y F4LIPIS GOMEZ 2415 W OAK 023 DSNTON. TX 76201 w GO112AlES,DELOREB P 40115950 04/13/04- 103.-80 0,00 0, 00--- 103.80--8p ER. g.__ _ - 104 y OUARANTOR INFORMATION LOUIS OON2ALEA 106AVE S APTtOI DENTON, TX 76201 w - -OONMEBxFRANK_-- _,._.,._•70034452-05/21/84..•-48,00.-°-----0, 00......__:0, 00---- - 45, 00 - Or— UP_,-_.4..__ r 00 GUARANTOR INFORMATION r* FRANK OONIAL99 1417 6 MCKINNHY DEIVTON,-TX 76201 00NXALEgxJElitRi~MD- •40120925.04/30/84-...__130.-7$-------0.00-. 0.00- 150,-79--SP--ER- _1. GUARANrOR (UPORMATION J6RANIMO GONZALEB 122. 7 w PO BOX 4039 Fr, wBRTlI, rx 76106 0ONXAL118,11ARIA L7,-LOURDES 40137590 04/19/84 _..,.56 00 __.....0,00 ..0 00. 06, 00 SP - en 3 _ 04 7. y OUARANrm INPiRMATIO14 MM MARIA DE LOURDRS GONZALES 313 THOMAS. 021 DENTON, TX 76201 k1rA'% Ol SEP WA I TE^FF REPORT la`~:E 10 PATIENT NAME PAT IO DIBIHQ DEQ-DAI. NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST.PI4T ACE PG TYPE - - OoNIALl1,LUt0 1003/01/04 899,69 - 0.00 X431•72 TX SP IP A - 03/$6/04 199 7 ww OUARAIJtOR INFORMATION wr LUIS O ONZALES 1910 CHOCTAW OENTON, TX 76405 V OOTCHERIMATTHE14 v 40154019 04/06/84 <<^31.49 4 HI D6 46.29 SP ER - 4 09/07/04 117 7 rr OVAAANTOA INFORMATION rw MARTHA OOTCHER 41l4 ETTIE 4EIJTtlN, TX 76701 OOTHARO, SHIRLEY 40118416 04/22/04 96. 00 - 06,00 0.00 132.00 SP ER - 4 Its 7 ~ rr OVARANtOA INFORMATION rr MELVIN OOTHARD P62 RIDGEWAY CIRCLE LEIJISVILLE, TX 79067 v . GRAHAM, MAROAAUT AN44 40119760 04/Q6/04 06, 00 0, 00 - 0.00 - - 96. 00 SP ER 4, l20 7 OUARA14TOR INFORMATION rw MAROARET ANN ORAHAM 820 ROSE DEWON, TX 76201 V ORAM,LAURIE A 40116311 04/14/04 101.00 0.00 O. OD 101.00 tlP ER 3 139 7 *r OUARAI4J4R INFORMATION r■ LUANA VANHORN 064 MAD100N LEWISVILLE, TX 79067 V i 09814 RONALD CHARLES 4011 l 1 ! A 03/476/84 336.50 196.00 0.00 - 03P,30 BP ER . 4 146.. 7 *r QUARANTOR INFORMATION w* RONALD CHARLES GREEN 627 BERNARD DENCON, TX 76201 v -_ORESSETT,KATHY 40190602 04/29/04- 149.30 Bt.00 0.00 ^30.80 SP _.ER I ~ OUARANYOR INPORMATI011 KATHY ORESISETT 43 321 OFAL411EADOW•, ~.02A DEFlTDIL TX 76201 .GRIFFIN, JEFF ' ..:4012720! 09/22/84----.-__06.00--.-----0. .:_._06,00 SP ER q rr GUARANTOR INFORMATION *r fOl 7-- VtClVY OAIPFIN P6 BOX 27 AUDAEY; TN 76427 v .-GAIFFIN,JEFFREY + i ...-40117665 04/l9/04._..__. 90. 00 . 0, 00. 0.00 _ 50.00 - SP EA - 3 _ 134 7 *M OUARANTOR INFORMATION *r JEFFREY GRIFFIN 8232 FISHER DR THE COLONY, TX 94999 v .__..ORINEHAW,TH0MA8 _.-...40090600 02/06/04. . 56,80 0, 00 0. 00 58.00 tlP ER 1 OUARANTOR INFORMATION _ 1308--. ry. THOMAS D. GAINBHAW pT 2 44X 276 hUtlpEY, 7X 762.''.7 V QUNTH£R,JA14ET LYNN • OVARANTOR INPORMATIC14 **40JANET 04~07/04 96.00 0.00 0.00 - 54.00 ADD.-EA NO, 147 7 r, 129E OAK OENTON, TX X 76 76201 QUZZI,MARY • 40091390 11/27/83 9$.60 13.00 - -46,00 3s. 70 SP. ER.."._.4... 12/18/03 294 7 *r QUARANTOR INFORMATION MARY OUZZI 8404 HINKLE ST DENTON, TX 76201 i r HOWARD, SMANIi 40122426 09/06/04 56,00 -84. BO - 0. OO _ 31.20 - SP ER - 2 I *r OUARAIITOA INFORMATION ww MARSHA HOWARD 13X209 ARGYLE, TX 76826 107 7 ,v wrr♦ W-0 TOTAL» rwrr 00, 070, 4q 27,007,66 r .30 9, 727. 63 V , f i i li.Ia?t4YF V 01 5EP 1904 WR I TE -OFF R EP OR T PAGE 13 PATIENT 14ANE PAT lO OISCH0 DEC-RAL NEW-CHO NEW-PAY I4-0 DAL PC TYPE CYCLE _ LST.pHT ACE PO TYPE J Mrr♦ WRITE-OPF DRANO TOTALS rMkr 177,712,42 r -69o297,69 17. 125.66 125 940. 39 tr d V V v I W V r r ; y J 1 r ~J N GROUP HOSPITAL OSEBVI E, INC %OALVIDERREIMBURSEMENT DIVISION April 41 1984 F .K-0, 614 ~s 45-0415 oj? f 1 Mr, Jeffrey R. Hausler, Administrator 19g~ f Flow Memorial Hospital f 1310 Scripture Street Denton, Texas 76201 SUBJECTr DUE DATE FOR MEDICARE COST REPORTSr FISCAL PERIOD 9-30-83 Dear Mr. HaUslerr We have previously advised you that the cost report due date would be postponed until 30 days after certain instruction clarifications were made available to hospitals, These clarifications have been received in Transmittal No, 21 Chapter 12, HIM-I5-11 which is being mailed separately to hospitals on April 5, 1984, We are allowing seven days for mail time and will assume that all hospitals will have received the instruction clarifications by April 12, 1984, Therefore, the due date for the Medicare cost reporting year ended listed above will be May 14, 1984. sincerely, Duncan Kirkpatr ok, Manager payments and Collections Provider Reimbursement Division DKrmlt car Ms. Tarisa whitlow t , s 6 awrx iaaso,aa~•iuaa~ • . y L A P'z GROUP HOSPITAL SERVICE, INC./PROVIDER RElMBURSEMEMT DIVISIOHI V P. 0. BOX 22630310ALLAS, TEXAS 75266 April 4, 1984 / 45-0416 p4 Mr, Jeffrey E, H&U8& r, Administrator i f98q Flow Memorial Hosbital 1310 Scripture Street Denton, Texus 76201 SUBJECTi DUE DATE FOR MEDICARE COST REPORTSi FISCAL PtRI0D 9-30-83 , Dear Mr. Hauslers Ile Dave previously advised you that the cost report due date would be postponed until 30 days after certain instruction olarificatipns were made available to hospitals, These clarifications have been received in Transmittal No, 2, Chapter 12, HIM-15WI2 which is being mailed separately to hospitals on April 51 1984. We are allowing seven days for mail time and will assume that all hospitals will have received the instruction clarifications by April l?., 1984. Therefore, the due date for the Medicare cost ? reportin,1 year ended listed above will be May 14, 1984, Sincerely, I 1tMw+J Duncan Rirkpatt ck. Manager 4f Payments and Collections Provider Reimbursement Division DKsmlt Ccl, M5. 71arisa whitlow i tttu I: SSO.>10•: LW6t I a ~i 01 Dec 496.1 WD 1'f I:-4Fr° pCP I • PATICN'r NAME a 11 T PAGE 1 PAT tD DIDCNO 1 OEO-tlAL NCW-CH(; NEW-PAY W°a DAL f'C TYPE; CYCLE LDT.pl9T qRC F'0 YYPk ,~..~.......r__,.,,••-__---_- i; INORAM,FRANCEfI L. 40162232 09/14/04- 101,29 0.00 0100 101. V) ADD 6R OUARANTOR' NE 11/23 /134 10 $ t tNFORMAffON *Jt--MRRY-•1HORAN kT:• 2-t)0% 34-))ZNTOIjo TX- 7,62M JONES, ORVCF k. 101204133 07/29/64 2, 674. 69 0. 00 3, .96. G,1 ADD IP i; +F+ OUARANTDR-tN ORMATION- -•gRUCE- 4118, 00 4I /JOWD- HT-Z,»OflN 4000_ OGNTON,--T%•--7GR01. Ng. °U a1 I JONES, LORI JO 40164030 04/04/01 127: 29 0: Op b. UO 12'7: 20 ADD ER N8 07 2 .f, -AVARANTOR ENEsORlJAttON+w-1081--40--~13------ IL'PR-WDAK-DENTONr-TX----76201- _ - l„ i„ AITCHENJI,DF:WNSD L. 4016V37 09/7b/O4 61.29 0.00 0.00 61.D9 ADD EH NU I. t QUARANYOR-INPORHAT-tISN-.►~ .DE/JAFiELLr Ki7C►{gJJy~_•~ 1tiUR-NIGNAEL-STr b8NTONr-4X--...16201-_-•_ 74 2 LEWIl1, RO98 L - „I 40;46073 07/21/04 61.19 010011 0, 00 01.1d 6P CR 1 07 j;~-~••"'-~-aM.AUARANTOR-INFORNAT[DN-aFM--••8064 J:-LEWID•-- - /$4/94 ]I30~_$ II 4913-bEL-LAM-N2r,103-LEWIRVILLE, TX--•7 9 0 67----••- LOFT0IUARANTOR -1NK v i 401471:J4 01/26/64 121,10 16.00 0.00 l3'7, lU $P ER I 11:0 d .v~ r w~' ORMATION•+M--•I;URIri•r-LOFXDIJ-- ------»--.._O4t-ROiIERi'E3aN--nENTaN, 1'X• 76x01 +o: LONG, MARK 10063103 02102/04 487.90 119.00 0.00 MI. 70 EP IP I" OVARANTCN• INFORMAT;ON-+*.-.NhRK-LtlNO.----.. BOX-16•WILDW[)DD-,EST-LEW1bV;Li.i, TX ...76067•------ 164 2 Ir•~ MACK;NNON•C1NUY M ; 40199170 04/015/44 96.00 0 9 f16 n _~,r`.... • •~4 GUAR AN Ii r + .00 0,00 b6, b0 Up k ~IIaFORl,AT70N-Nw•-•Ci HJt)Y-•M.--14ACKINNDAJ-._..._.-._.:714 N-ilk AUBHAW--MN ttlIJ,--YX--74:?01 - - I MARIA, NAT1L IA CRIE3TINA 40131699 06/27/04 96.00 0.00 0.00 56. DO Ep Ell 1 I,l .."-OVARANTOR INFUH11ATtON w- AIAT-tbtA-CgdBFtNA MARIA- - Ig00 DALLA9=t7k MtBAQ•-DENTUNr-TX-•-76801-- - _ It 7 2 MEOCAFE, JOYCO ~j• `v + 40122246 00/01/04 l2,^_. b0 0. 110 0.00 IQW, 00 UP EN 1 210 2 BUARANIOH ..t NFONptAT'ION-M•~F_~/dy{1Cj, pIgDGAF'& 1032? • RE60-$F---Ok:NTDNr:TX_ •76 RO 1- , rk„ MEOCAFE,TIFFANY 10104900 06/19/04 96.00 0,00 0.00 96.00 Bp C:P 1•~ #*,OUARANTOH.-INFORMA' P YIt -GORN9IL-MDCAFS- - IQQ4-MCDONALb-•-MNTCN, 1'X 76.'01 I 160 2 ,aI MEOCALFI COLA 10112890 06117/04 47, 302, 79 + •M-GUARANIC)R tNFOR14ATICIN-.IW--{ALA--HQOCALF--• 02IJO 0, OU ! t O '31' 11' v 144 2 ' '~,nr_.._.. xoDQa•i'RIIJITY rIU LG CAf7RCt.i.TCIIJ, ITX 'Ivf.W6 „ MEDLEY, NANL'I 10103630 05/00/04 933060 4J2. i:b 0.00 S, 367, O3 Sp 1P R J4i 2 -4*,OVARANTOR [NpbRI4A7-IOW #M--OARY ft813LkY- 604 1tItlCE'CRL+6T- LE.WI$VILI,Er YX ..77067. n MCEK, PAUL, 10100096 05/14/04 L 296. l0 U. no 0. 00 112'54. 10 Ell u •OUARANTUR-•INFORMATIWJ-tE+t---t,~eRaY-MHGI{ =1• J 19U 8 I r •--FiT :2••DUX--179--•AUOR[iY,-TX-•76'c~21-- MENCHACA,MANCELINO 40130501 0641/04' 101, D0 0.00 0.00 101. 9U SO ER A ~n Lf,O Q r 'AVARANTbR--t NFORNATEUN-rA•-.MARGEL~FNp-MpNO►{~gh••••-•••- --..-J.1.123•CONOREfat9--- lSEHTON, • TN-..76201- II' MILAN,6VDAW ~ _ . _......._......_-_~..._..._.-....~._Y._ 40101639 00/11/04 217, 30 0.110 0.00 a`t7, 00 Ep CR 4 107 2 OUARANTON -;NFORMATION,44• 4AXIgM•} MAr} ~..12,1-7••HARHLCHFAD-I.EWI6ytLLC, Tk /0061 M1LLEq~, BILLY 9 •rJ►•o8{{641rY-6-Mtd $4rt/tl4'' 96.70 0. 00 5.00 101 10 BP ER 3 00/14/64 147 2 E~ •••yr- 127 -TAMMY--TR{:-DANdER, .,'MILLER, JACKSC 0.2 73 07/02/04 027. 09 1112(), Qb 0.00 940. 10 f3p ;P ; 2 10. -AVARANidk•dl(NiMAFtON Mt .HMK;t1 M;I,LFiH r - x205 .4 i ' xU 0000 N:-5;..6TEff1•IUM6-•LgWINVIi.LE,-•-TX -70067. _ ,+I ~'aA~1}Y, 1~'r t v ~ .t,+:~ A . t~l ° . j~JP,, _._4.. w~ i A'I if • 01 000" 1701 II R I P 11-11117 It 1'AICII HI I..i11 Poll 1)) D)I,(IIN) ilt q RAt (till CIIG N1:W-f41Y t1 11 II 1 t l 1 .1 , I-. i :9',i I I X11 « w ~ • 11ILLCR, L6F.' MIN LOLOIU09 06/12/04 Ilm 1. co 397. UO 0.00 1, !"'v l'J 164 ; ;xw OUAR,INIUH INFOkMA71f1N-rx GERkFLL-VAYNE-MILLE%R/-dR°-...-.•.Rr-2F'IMX•17A -,'.VtLY. 1'Y. I 1 1 UO ••470. <'1G Ja9 )I) r'I Ill ~ MILLS,J T 1Og50007 10/10/00 WiQ :0 -moo • xw OUARANIOk INFORMAr 10M xw "".1'f MIt.l.d - Rh 3 DQX-044 W)UREY, IX ' - - + ~r HINU/ AMY Li,W6% 40121691. 013/03/04 99, 00 0. UO 0100 'T7. 00 8P El. ,2J! ~x QUAIIANIOR -INFORMATION *x'. LARRY MINEI -r!49'CONNOR PLAZA hlWl'i •1 • MOLANA/KRIi,lG011EN A 40167GT1 10/01/04 07.,0 0.00 0.00 f.1% tl xr OVAHAN ILItt INFUNI1AI Itill -•-,K.11S MUL IMA--_------_..____. 110 El'LOCU.31 01;(41014. T:( MONROE, BE I'll 10100124 05/31/04 2,401.40 0.110 0. 00 V,1101, 4(1 Fill IP I Ifl,' 2 OUAR11NIOR INFORMATION xM'•RANDALLt1ONRO0---.. t706-N-DUCK OAINE VILI.F., "rX 76~!gq • :I 1' rt a )711 MONVILLF.,CIUEL - 10107146 06/06/04 L171 '7'U 1130.75 0.00 L0:'~: )u • ww OUARtiNlrlk I1,W0klarlrIUN wrt-•UGHWMONVI I:f.F:---•- Itlu DOX -II- 00,11 IN, IA I e).:,') 1%") MOUHE, AIJ0F.'1 OVARANI OR N INFORMAWIN +w 40DRGN140947 13A 07/2 WYNN•-- OU p.00 0 00 ' SQY,QO Ui' tat I 2/04 l0%. - • R0 '1130% ;300°A C?ABIVIL.I..H, rX '/51;7'• •';;1 MURF.'IIF:AI6. Dul.rl, I0I1pU40 0;,/07/04 7 1, 4 0B 0,00 0, 00 1FIE rfi /a ` ww UVARnNIi1N I rIFOHIJA T ION wx- PREDIEf MdRCHFAU--~-~- 5.130% 190. 5/, 4Q ,L 8U NC ~a4n _KF',U I'3 /6C!b~' _ 1 1 ---HT 1 MtJRRI£OH,f'AIRfCK K. 4016(,415 01/130/04 57.40 0.00 0 00 i2 •-J••-. 04 00ARAHIOR INFORMATION -»x-- PATRICK-K. -MUHR9RCN4_°- :?,Il3'W CHAWITTO q.?Q 1041ON, TX 76201 .....~.,.._._..--.4._....._... i • { M05S, DUrllilL- L 100991110 04/17/04 1, 040, . tl5 0. (1O -1, 302. 39 45;3 (.b PiP IF' '1 09• ldlUA IY7 + ' I rx OUARANION or ar..ROk 6131) -IrL1;Al11H, l'X 76+'_34 • MCITEOLARAAlrOR 31J1~dRMA1'1 40131609 06/07/04 56, OU 0 00 0, OD 06. Op EP El? J 1 /A 2 r + OMw+r-• QARY-'MUTEH-dR----••°._.•_--.. f'f1°RdX-5.11 -1.AV,h: DALLAS/ 7X/U0b9 I MOUSOVAUX, 1,kIlIJI:: M. 40131670 06/07/04 IE0. 00 0.110 0.00 120.00 Sr Ell 3 1'/'1 2 _,.^•-"+F* OUARA.NI'OR INFORMArl(IN xx-•-UENNIB-Mr-MUUHSHAUX•.-..---- ._.___./1:1 DAILY DU4TIJr1, 1X 76201 ;1 iJe. MOWDY,OENF+,41 40119630 04/25/04 106.00 0.00 °40,60 $6.40 t3P' ER 1 07/02/84 102 2 rw OUARANI'fIA INFORMATION ww OtiN&•MAIlOY--...__..~-_...._..._ _._._UUX-IX0933-.-DEL RIU/ -TX 70174^20931; ....y...___...._...-_._...__.,r....-...._ 4 • ~ MOl16,RY, ltlll10101 700 05/01/04 06 1. :30 13. 50 • 067. 6O 47. C'U CP II' ) 06/30/114 04 w OVARAN'illk INFUIiNA?IUIV xk- KENNETH Mt)Wh'HY--•- "W614HALRY, u0l4w,-1X 76Ef3U 40 r „ 110YCR8, St-wRYL 70037163 05/A9/04 90.00 0,00 0100 90. 00 IV OP I Jim 2 ` - xw' DUARANION INFORMATION• wx -t1HNRYL--HOYFRA'-- 0039-CHATSWORTH - CAkAWLIJOPIr TX 74007 - l +I,u~ I1URpHY, 11[Ltltir.6 P 40131:100 06/06/04 $6.00 0 00 0. Or) 06. 00 W, EP ? 110 L', u w9F OUAkANIUA 114FOWIA1'10N tFw--M1{.I)RL+U-f'• MURPHY 1614 UNpERNO(IO OFiNT014, TX '7 ;1 Lf) ' MYfiICK, KARFat 40121750 05/03/04 511100 0100 0, Oq 56 OO 8P ER I: n11 'c• OUARAPIIOH INF6RMATION-IFx-••MARTIN-0, MYRICK- -`.3400-JdVCN-LN 11018--5EHTON, TX 76::0EI •t4 NADI.AU,KARI.N SUri 10001570 02/13/04 1, 56+3.90 )t0 -9?Y. 017 930 d6 13)1 if, O4/04/Fl4 16E W ww•OUARANIUR 1NF43RMAI-I6N-xw-- HM711N•Ut114 NAAEAII - FO BOX 517 BAJOCR, 109 /6866 f 01Y)E; .900 WR 1'f C CJrr kePaR r a4e 3 ~ ' PATIENT NAM-: PAT ID bfDC110 DEO-DAL NEW-CHO l4k:W-PAY II•O DAL FC TYPE CYCLE LOT. PMT A4C FO T4'PE; ~ NAEH( t10NNIL n E -RICTCHARHARO0 i%gff Oq 00.75 0.40 0100 91 70 or, L~Ii t 14l i •f' ♦~r•OUARANI'UN' JNFOkHATION-»+•-NABf+•-•--' --^---Hi;-g 2 ---FKIBM -T%--715014 NEAHON, HEL.c,I rt. 40119461 04/25/04 170.70 0.00 115. Dq 89. 9U 6p CH 4 QV MI/84 144 +In ~J "-""--+H-OUARANI"OR-INFOkHATfC)N•yM-HEL:UA-R.--NEAR Ojsl ^---••.•----609-PALI+WADUW,01 --DENtONI, -•r%....76-'UI R I NEELY, PHYLL I H 10100504 04/116/64 b926.34 -30.00 -ICO. 00 1 i 796. 34 8P Ip 4 05/0-I~-/84 ` 2 f j„ •+r• OUARANI'OH -INFORHATI3N-+tM-•pH14:LI9 MIiEL-W------•.----..a:...409-AMARlI:LO-DKNTON.-iX _ -7d80f 2U3 @ . n rl NCLOONI MICIIAEL B. 4012MO 05/02/04 84.00 0'00 -46,00 40. 00 W Eli I. •'"'-'-•'#'++'..QUARANI'I7H-••INFtlHNATtON-•M1!•••-M(QHREL--H.°-Nf;t.$L3N--•---•-•• 6x106-pRfNO~D# jX... 7c.. I UO/,//$1 Iu ENE811ITT1 DWAIN 401106,110 04/62/84, 06. IO 0.00 0.00 """"°^+~OUARANrOkINFaHHATIdM..+~.--DWAINNe6H#fi-T 06. 10 8p Gk 421!2 @ k - A394 BIiENYWOtlt~ STAIR kV #1002 FORT I411R1'HI T%- 761 07 - a{" •',~I NEUMAN, K IM 4tl130''/7S i130170l+0611 06/03/04 I.. 1_- 87, 7S 0. 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(JO 0.00 60.00 6p Eli 1 1116 v +*-OUARANTbk INFORIIATION-JNI-QHARLEH-O+BRYA`r 2g,j1-{~ pRA13iIE-6T -UENFONI TX 46x01 ~u Q=LLrC{IANLOYTD 10101090 04/87/64 1,254.25 Ub.Ob -1.1016.20 iU 04 UP III 1 46/300"134 11,4 i #ii """#y-o0ARANIOR-IWFOkMAfi1ON M.-•/AMrstl-R--4~OE6la- ..101 HEk.41TAW Nil VENTON, TX 76,20 I + ~ D'LOVONLIN, KENNETH W. 4010$110 0640/04 64.25 0.00 0.00 64. 4D EP Cp _.I•**-QUARANTtlH INFORMATION+r---KeNNE1'H•W,--DjLrA)QI41:IN----- 400-CARDINAL 11C-3 - DENYON, --TX 76R0i 4 164 2 DOELLI JAM+ 0 r+ 1' 401100$ 04/01/114 99.00 0, Ub 0. 00 013. 00 bP Eli J 8 r +t+^GUARANTOR- INFORMATION "--•JAHlZS• OD6L4 1141N LAKUS MHO Q68 DEN74N+ IN /6 01 . lS1OU1N+ I JUAN R 40IS690L 06/04/04, 16, 50 0. 00 0.00 14,50 V11, J Eli Ub/4b/74 1713 2 Ot1AkANtOR -INpppi4AT10N LN (il/CNr• .JUAN•fi - -0$23 PRAIRIE • OKNtON, - -76201 TX flt~rGWI'sN61 ELIJAH 401440$$ h0 iJ 1, I. w Qi1ARANif10 (NPOR11Ai1tMN+*-» 9/20/04 104.7t 0, 0100 11U. 2 CH l 1 MOM- N6- a... - ----4301 -0 .OCktONADU• APT- 093410 - UeNI NIONI• TX . %0201 4 !J •WI~'!l 1~i, .r 1. •~1if' } Y . . - n.yi:Y F :,,,'.yin b u. µu. !.\1 a Y 1 01 DEC J904 Wit 1 7 l i O C P l i C f' f) k T F• a . PATICNT NAND PAT 14 010(H0 CEO-VAL NEW-CHO NEW-PAY I4-0 DAL P'C TYI'F: CYCi.E 01f. PIJt rY6C Vc TYPE . ~I I OW5NOs ERNEgT(NE 10077436 01/10/04 3,954.2t LO1 JO -2r 847' 05 48Br 90 SP (P 1 0'1/01/64 IU7 I. - -•.rr OVARANtON- INPOkMAtiON-rr- FANVIT1NR-01411,113- ._.--.2;,,QO WELLINGTON -DENION, -TX 76201 PACHECO, DEI1I.,%H e 40 134507 06/10/04 146.79 200 0.00 146,70 UP Ek 4 169 2 .f) rr GUARANTOR 11JFOHI1hTIUN rr---VENANCIO-PACHCOO- HT 7 BOX--9311--- DENTON,- TX. •-76801----_ ' ACHECO,ROICRTA 11 40121306 00/02/04 61. 90 0 0 0100 b!. 00 UP ER l n 2 1_3 2 8 b PCkOVA ANYTIN INPONHATION ++F--•R00FRTA M PACHECO^-_. 4V4 HO0!LANOtl O~ NTCN1 all. TXNtl-70601 Cry 1- x,14 TX---76201--- PAM ORLO i.I lARI 1:y 40i1D@14 04/10/04 fo,r. 9n 00 yr'QUARANIOR INFOAMAI'IUN rr-•-+IOHN•F'~GiUf TI---•'-- _..._y..____ r. ,to 8-FLM'-0ENt0Nr--TX - M101. , PAIR,PAULA 791134071 04/30/04 67, 60 0. dtl 0.00 62. GO UP OP I 210 ,fir. ' rr OUARANTOH INFORMATIONRONNIE-PAIN— _....x...116 POX-CIRCLE DONTON, -TX•--76?01. PATH, PAi1LA L. 10102440 ' J9/0,",/U4 .339. 70 211. Ud 0.00 41:7. 40 !Jf I}' l t?0;07./131 Ilf7 II --•-•r+• UUARAidi'UH INF'OHMATION rJf- - ROIJNM-W !16 FOX -CIRCLE 1)LHIUFb IX 76,M - - PARKER, JERRY 10106"'? 08/97/G4 5,719.30 1,49 wv O.00 70 OOH 1;J SP IF I 144 c **..GUARANTOR INP'ORt4ATION-rr--•OARY-f1ARKLR-- 3f)17 CAHE05T 11C DEIJTON, -TX 76MI n PI+TOUARANIoN11INFORMAtIUN *4-WILLIAM-AARON0PATTON,-GHO 777d~OILD ONCHA0-00 1 0t)o 8P CH RD 4103itl LEWISVILM TX 47406% -__.._..__.~~IG__ PAYGA, MAN 40f61740 10/07/04 0~. 05 0.00 01 00 02. 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Op or, Clt V. 1110 8 -GUARANTOR--INFORMAT ION-tFJf HECK-PFTERA IfJ9-tl-Fi-BNO UT- MOUNE, OK. 73160 TTV,CAROL 40137007 06/97/04 133.00 0,00 0.00 I'll. 00 UP LIt 1 Ti7p->WFOHMA~ION-•.1+~ Lk1MiD-pARKgA - 308-PONbOH- I)ENION, TX 76801 ;:'70036184 05/15/04. 87.50 onn. $O -10.00 406. 00 UP 01' 3 06/13/134 104 blr4-ps4 FW_ - ~ __._..1p3.0 PONDER —DENTON, TX-- 76201 lLII809 00/14/04 96.00 0.00 0.00 86.00 UP Elf 4 /H f'', 303-PONDER• 80_--01T1470N, 1'X 76POI _ . ,a v .y S • OY•'DL M4 - WR I.TI.. Of P 12CPOR T AOpS • PATIENT NAMC PAT ID DIOCHO BEO-DAL N134-CHO NCW-PAY II-C DA(. FCC TYPE CYCLE LOT. PMT A(JE PO TYPE j Tf'1 PETYYICHRIOTdIB E. 40186408 28/227/04 56.00 0 00 0100 06.00 6P Eli 2 YS a ~RI *k OUARANIGH'INFORMATION *M--C'AROi:CrPE-TTY --10a-"NDERi1C--DENTON,-T)( • 76201 _ e PHILLIPSaSTVIIANII: A 40101971 06/09/04 41.00 0.00 0.00 41.00 EP Eli 0 06111/84 1 /3 Q - • •w*_OUARANIiHf INFORMATION-**- DIANA PHILLIPB------ 111" 1 BDX--149-•AUBREY, TX •76287 0 ~I ° pICItRELL, EI.hER LF.E 40129116 25129/84 56-50 0.00 0.00 $6. SU f3P ER 1 1114 2 -st' OVARAAJI'(1N INFORMATION-*»--ELHFA••GEL-P{CKRNL~ - -610-HILLS IDE-OA:-• L•ITTLH BLMr•'TX ,1 pIT7$I HAROLD l.. 40154767 00/21/U4 56.00 0 UO 1).00 96. OU 9p CR i IUI 2 w+ -OVAN AN1'0ft - I NPORMA7 f ON-Mw-••NHOFck , ~Ii A-P{T{g- -----•-12071^9•-RVDDbE...N06-DkNTONr -.TR_ .76201 0 J , PRICE,CLYIIF A 40127375 05/23/94 96.00 0.00 0.00 96.00 9P EH C Vol 21 ^ - e-OVARANTOR-INPORMATION-**,-MARk{N WIICL +109-CAMPBHLL°DENTON, TX- 76001 - 161 pie PRINCE TERRY L 40126915 03/21/04 100.00 0.00 0.00 00 sp rl~l 1. Ivy w*-OVARAIJfOH INFORMATIONrN-.•CHARLES-fRINI}fi ----------_-.FU DOX-I49--AROYLtr., 76~26 .c PRVITT,CARRIR RUNE 40199494 09/16/04 07.129 0.00 0.00 07. 20 SP Eli 3 07/17/84 1110. 2 ' it I `..**-OVARAN7ON INFORMATION-w»--~J. -RCN116 PRUI-Tf-•~-•-•----° - - kT [-SOX-5411--ARGYLE, 1'X 76224 - - - ~I,4i PAYOR, LAYOf;fIA R 1018E600 09/03/24 L 06:1, 40 -404.05 -611,60 47.70 SP It, 3 0/02 184 43 : 1r • 1i 1111---- +*-OVAHANTOR INF'01,114ATJUN--iNr--RtlCfIY~F~-NRYOR E10B B-00LL•AOE•-IIEOATURI-'fX. -76,734 n. •!.e PUFPIN9ARCEIL JACK 401972167 09/8$/04 226,70 0.00 0.00 226. 1 SP CR 4 191 ' +Iw OUARANTOR INFORMATION•-**-.•dACW-POFFINOAR( ?R----.---..YU BOX S069t-ORNYOFf, ld -76201 e N-O- TO'IAClI-M•u•kfr....._~- ^-4-h SITYPff-__ u " 3, 1136• D9 J6 704. 170 4. , E Jei Vie, 46 sr u~ LIt 1" i V n S~9ry»Oy :J Ol DEC 11104 NIt I'TI, OPP• RGp 0k r i'~„t1`.>. • PAT1CNf NAME PAT III DIUClfa U-0-04L W14-Clio NEW-PAY WU DAL F•; TYFCf CYCLE: 1.!;T.YPII A011 FO TYPE L OWNTHN,JOSHUA 40126902 06/19/04 6I 3J O,00 , o00 6t. ;20 SP 1`k A lop b - rr-QVARANTOR• INFORMATION••**r-BDNVNN-W-•ttUINYLiN----•-- N713VNRtch 85T- AROYLC,-T% 76:::26 REDO, RICKY 40139164 07/01/04 07.00 • 91.00 0.00 178 00 Bf' CH "I !Ul 6 ----rM GUARANTOR INFORMATION +w-fi[OkY RBOU- - ----.1715-OAhIEH BI UUx 96 DEN'tON, VX 76201 _._--._-,___._..t e r RODERT8, JUDY 40140992 07/06/04 135.45 37, 00 U. 00 17L'. 9U 611 EH O 144 6 **-0VARANTOk-INPOHMAT-ltlN-+*--W0Y-Rg0LHT9---- PO-DO% 1314 'DENTUN, TX 16201 .'n I,I• 6CHREIBEfi.ellAftUtl 40141919 07/I0/04 129.29 ;?a. 70 -90.40 L7. 3: ADD IR N5 00/30/84 91 6 ~1e -^-^rn-OUAHAN1,1N-INFORMATION- **-•-f3HARON-80HHI.YURR -w- •^•-091 J^dHAR6dFTE° Ne•^iEIJTON, T% 7640} - r t SCOTT, DAVID L. 40167309 09/00/04 119, 00 0,00 0, 00 119. ADD ER '1" 61~ 6.,. 3u• *4F OVA:RAN1'UR INFORMATION rw DAVID gCRTT- BIL VISTA AVL"-DENlSONt--4-%-70020 II QPAIIJNOUR, i!11HS.ISY C 40197tl26 0171St7/04 621$0 144,50 0.00 P07.00 'Sp CR IIS 117 6 ? OVARANTL1k INFOHNATIOIJ *r--14F.OLEY..U--~3NAlNHUIHi---------bJlb...NNOX---TH6 -Ctli.4NY}_. TX. IY I, SPROLEO, 1'flf aA K 40140002 07/15/04 -57.00 0,00 02. 00 29. OU ADO F:« 1JU 07/87/84 111 6 e ,,•!•---••-rr OVARANTON If-WORHATION•*k-,,UANI'TA.HOWAHD-•--•-.-_.-___.-...__RT.--I-BOX-320-...AROYLE, TX. 76'1.',6 -._.._.._.._.-..w..~._.,.... • 0T8Fa.8,DAR11AlIA MARIE 40193074 OU/16/04 126 30 q, 00 0.00 1@17.90 A00 LN Ito 101 6 (,el.~---_r* OVARANIiIN INITORHAtIUN--rtr-'OLAUUfi-BYNfiLF.'.--- --._.....__..-__.092-d-CHARLEB*3OU..LEWISVILLE, 0 /U067 SUTTON, JOHN 1:. 101'30!380 09/14/04 1, 099. 99 10, 00 0.00 1..^^62. 90 ADD th N8 AD 6 („I'•--^• **-OUARANTUN IN~ORMATdtlN-*+r--JOHN•C..:.tlUFTUN I it flBDRAN- •LEWIRVIL.LE, 'fX 7300' TAPIA,CHRIfITIAN SHAWN 10001949 03/10/03 57,172 99 -0,413.6! 44,060.74 7,660, 9B PW If. '1 10/09/04 Ila 6 40.OVARM4TOk -1NFONilAFJON-+*- hMi'IFIJA-YilpfJfiA•••,•.--_.,-.-....... PU'R0X 631-N1L80HF CIA -%3463 _ - TAR I VCR b 01A, IlOA I EH 1013370069/29/04 3,399.70 0.00 0,00 3,:199,70 ADD iF Na 64 6 r* OUARANTOH -INFORMAT-t UN -F.DRAµ1M-0:--SAMMYE - 14Py-BAOLF,-DR: itiOB DENTEIN, TX 76201 TAVLOR,HARRY L. 40166373 09/121`1/04 96.70 0. OD 0.00 34 70 AOD Ek NS 60 6 ARAN TfiRRY,''UN 11JFORMAYION•a+F--HARHY-1 TAYI:bp -130 lW[NO• DALLAU TX 7021 y~ b 1Ha 6 i._ r.Tr QUERAA,EY CHAN14014 4012990 06/01/04 102.25 0.00 0,00 19,^..20 SP CN *►-OUARANI'Ok IIJPUkMAt'ION-*r- .URADL1:Y-RHANNEIN--T9ARY---••-••----76'U-THOMPBOti.DR.- -LAKIF VALLAS, -TX 79066 - - - TRICE,DOWIA JEA14 10040081 11/14/03 I„134 00 415.60 -1,625.03 140.42 Si' JI' 9 11/15/(94 16 6 OVARANrOR INFORMATION-**-- NE1{4-EVAN3-•TRI0E--- H1. 6.•BU%•442~H -UAINCAVILLK,• TX /6w40._..._....._.__..._. rI" I+ e UPCHURCH,ULIVER 0. 4013VI30 06/11/04 126.00 0.00 0.00 1..6.00 ADD k,l NS 171 6 **-OVARAkTOR T TFUM to*- fJL1Vlr:•Or-UP(IHUHOH .-169•R1N0DWOOD 011`- LAKE ,DALLAS, IA 70t)65 - - - - .~4r I "EIJFORHA NAKFFIBLO,JIiN1 A, 40110963 04/0(/04 07.00 0.00 0.00 0,.00 Bh CR 1 P43 6 OUAp/NUA J90RMAilUN-+rtI-JE'PP°A:•NAK8hI81,1)---._- ......-._,i40UJ0Y0H, LN•Nl"6 DBIdTON, 1`x 7h'!01 WgLCHtL,~L 10066004 1!/16/05 721.69 30,00 -00,00 701.61 ADD Ih N5 042/17/04 I;03 6 Y... OUARANtOR"INPI)RMAfI4N M-9ARBARA-i,f?k.OHEI. f _.6.0_.FT-{JORYN OR A?3 DEiHT4N, Y% 7620j..____ 1 WQOfIJOHNNY 40072076 10/21/40 1y6,50 -14,50 136.00 .^.6.00 SP Elt 4 04/30/04 _ 2L0 6 w, DUARAWT4R 3NFONNATION-*th•-EARIrIiFt;t .-.-...100 q--PARK CT• SAN0ERr TN-.'.76266 rr.a I ! t r,nMn m. w... e.. _ .,M. . ..a _ ♦....i. -..,1.,..• .,,-,env , ........ii , 1./~ I si ~y I I, DEC- 9N4 W,AII T E,'- 0 P P RC P 0 R 7 PAO.. 7 03 p. ~.1''~ 1 {I PATIENY NAME PAT ID4 D1t~dH0 9E0-Ut.,' NEW-CIIO NEli40 W-0 DAL FC TYPE CYCLE L87, PHT r AGE FO TYPE 'e 71`„N n* ~ I1 A..'l &i r a 4A AtNt~LOCk KRf8TOPH& ; 700e~ 4> t 11~ 1 461, Y0 ' 0 CO E 604, 4h 2711, 30 •'iTP OP Z 01 /16/84 300 b' v.' 1 007fRAaT071"rMU t(I a`OrI17A ~it7D1iE'q;" TX 76227-"- e GWCLL1AHti MONTRE 10076408 02/23/84'3391 918. 80.-li 331: 16 Y 0. 00 '28, 087. 69 SP . IP 4 3f! y'6 I • ) "OVARANTOR T7C'WTC1:'[AHF3'-'-"'--`"'-"-'7i20"g 'r'UGtJTOf1~"T1(`76T102- 0pGHF ELIA`nl.'' + `•:40_ 10806A Oq/f~41 4a 4d 28;, bd 80 0 If~ILLIAMg 00 119'05. AA ER 3, 118 6 ' 7 Iju" MM 140 ON, 7E20? u A MLSONI MAUA ICC 11,, 0064541 3., 0, 100:, 44. 1, 820 RO ;l -MAO ' 6, 000 64' 8P tP 2 . 1 t / 14/84 17 ` • ! 6 OA'OVARANTOR "II 4PYRMAI 104; " .'b3tT' 17~77t7NDFiFAD'LFf D7SL 'TX : 70227'• - 'II 1 >It,' Iii ~ ! c tI""~ le •.WOODSI TRACEY R I,i00Y95{H;!1.k!/t13/6 116~f1; 00 9s tO5 19 Al li 3 4b :ri2i 01e~ p4 8P CP. 4 05/19/84, 2;17. . ,.b le 1CZ1Ummmf1TnYAl ION vV""JEFF7' CN-4I92:"'I7 4701"i"'T7C7b261"'""""_'r"" ITIMS ro WOODSON, HELEN 11: 40002690''12/tl3/83 56. 70 0100 -31. 110. 24.80 $P ER 4 03/26184 230 6 i4, 's `-"'-7111-'OUARANTOR`7NPMMAT1d1T 717F" NriCbN M. WUMMON 2C~OllTA1JOOIS -11ENTOIJ, TK 7b:0$ ` - " i•.1 {WRIOHT,PATAICIA JOANN 10111319'09/04/04'r'11i20 20 3N1 46 I0'0~ ti 601 '46', ADD kP NO 89 b ';1 a'i !a tlUARANTOR-1NFfMt1 vN TV FiiMP'LER OY-WRIarm 5dF1'%,"MmC~Ifir it`A7`DE1,11UH,"TX'~`7ba6C 1,1 1!'1. IMAM TAIIIIY 10131183 09/1$M4 2,114.49 259.25 0.00 2p373.74 ADD .1P NS 30 6 „ V' *GUAR/ITJTOR"TNF*MffATTVM stl" IA W MMY ZA7A - 2800'PT-WORTWTR`i24 ^VLWMNi"T1C` 7bUM - ~ a1 + , ! f1 .1 n' 1.~ ' I e 1 1 ~t 7s - 5.1744 95 50,621.93'.. 31 41 1',11 f 41.0 % 34 111' q i' Crl ! '1 : r , ,,r 1 ' t i it u iv;'i . r, 1 :1 1 r1. rl' V1 .I ) 1 Iv`., 1 e 5 .'h i 1 f l; 11 • 'lr 1+ ' ~1' • ° f N ,I 1.1 `1 11t T I I r s ~f I 1' i , 1' •11 1 1 •1 ' '1r' «..»..»l++• ' ~ Y,It I5~ 1~:~ I 1 it Al IS~+IJ II '1, 1 ~~i~ +l J/: 1 -,.w.++ L 1 11 1 L (1 ~7 , I. 1v N 't; IW r 1 ' ;r " a ,1 ! !1 1' 1 •1 ,1 IJQIr `I I 1 t i', 1 1 ~ A Ar 1. 1 1 )1 , 1 ' YaY tl VI! 1,' 7. ~a1 1 ,!1' V '`I r 1.. F'1~1' ~ 1 1 1RW~Fy l~rti ~r ,Y /,~1.1'''1i r+l `~1'/f Ill .•WF 1~, 'IT''t~7i. '4~1'frr17f1'4+~'. .1~}/'r .I`~',•/' r:r:, I: I r r t1 i ' t 11 f A :Utz 51~R~1,~~(1,,\,'l Y---•. sir ~L 7iirr.lSYr'rii.i+r>'~71'XT{A'~Y JL~Aa:WiW..ll:.'i'crl+•:,4.J:.tr.f•Lr'..:...:]ra.a.~:.l/.1~.'.ltt'Yicr~.I...uf • b • r} OI f"OEC• 19F34', °'W ~{t I T E U f F R C P O R? pACt $ ' 1 I - PATIENT NAME PAT IO DItlCHd', - BEd-DAL NOW- CHD N;AI-PAY W-D DAL VC TYVE CYCLE L5r. P11T AGE V, TYPE ` (h ~ t AB'RNATHY,~~ DANA ' S' i 40f36b74' 00/ /8 88'00 d 00 b 00 38 tOG `AbD . ER NO 0b/2A9/04 157 r'~iVR!7RNTLIR`_TI'SF'bRIT7KTTQt7 1ti"~'dANR"74BERFIRTTIY"' TAT `.QNDfhQDERRV CF1"Ntt9 ~DCNTONi TX~'7trT7~t-` . r i r r • -HIMyAR1, QATAR 11 4013529!1 86/$0/dd'. + 96.25 0,'00 76 80; 20, 00 ADD RR M8 09/12/84 111 7 ; , VARRNTgR"ItdFtlRMAT7DN'"KS''""ARFAFtR"RCxHHT~t , 1077' tJ'PR7XtRtff'Nt"'DENT0tti"'T%"7t:70I"' ; n bq, 00 ' 8P CR r' i LD7. 7 j t 'i ,r 11 `AZ AN Sri l Ys~ : + } • 4f~1375b;, /itb/8~`;'T 00„ • 0.00 0 001 • rrA>`rroa=-ii~flfinrr~r~+f~---Rrc : , -arc rro~;'-n`~'2~ ' ~y • + ALbApE,f4AR1A 10125037 08/1V04 @ 7+10 283'60 0 00 0.7n ;A11D IP Nt1 09/15/84 k01 7 , -1, mp AftANTQR'TWfORM`RTTTIN'a OtBV8'CAtb j,t „k 1 i WtJX`"l$f~ 7DTtE1'i`TA fbc2V it t `'A13.8ljtlr JaNIE 4017668 1'/OL/Ate 00 S. 0.00 ' qx b61 00 .'ADb EH Z9 7 • S ; K T)f(`IIVFQIiMAi ION~i17i 1DFiN AGCT$Rtd R7"T ED t1oArMIKI JA Fiber ALLI80N,TASHA R 70050042 10/29/64 A 43,75 " 83 50 0.00 - 97.20 ADD OF NO 22 7 +<'OVARANTOW 1NF'URMATTM-4+r`ZtEITH"A=S0M1t AT 3' WOX"?CJI` BAROER `TX"'7526'6 - ie 'v Jn~ ALRAO(1IErMOHAMMED A.( 40102654''08/14/,84 't'Ob.25 0;;00 -65,80ti; 16.45 ApDt ER•', NO 09/11/84; 61 7 NOUN, IX RRAf<70R`TNPORMA7Yt11C iT7F ~PId1TR fi ACRAO 42"073CRYJ7T7D "'D r. i' ARCHIBALD,LOVISE 40138000 06/28/84 114.30 0,00 0,00 514.35. ADDER NO 156 7 of OIIARANTYIR' TldfORIfi1Tjnr1'a<'M-"thurSL"AjYCHIIiAtp N172 CAMPITB' 0~ii T8 'DCFITDH' TX -mom 9A4t4ELL, JANE 40079092' 11118/09 % 108, 60 O. Co ;.62; 00 ' 46. 52 ADD, ER::' No i2/08/BJ°." a59 7 NTIilT`T?MRRA IUfr`4v--U E`i1T?10"1! LC t 203 HA98TJwol) , ET• vrLtVp lX' 7'J~?S7" i BAILEY, GARY 40152019 08/12/84 ..170.75` 0.00 0.00 170.75',8P 'ER 4 _ 100 7 ; --VW-WA RANIOR 1NFURMA1IUWVW--qAR AILL Rr2RX?I G7iKESHORE DEtdTQF1 7X" T620!«" - f" " u a s. 37' 7,r . dA~I.EYr TAMMY R. 40165947 OB/R5/84 84" 00 77'60 ' 0; 00 033 50 : ADD TV4 0RCd7" D i 1 xx ° 7AMI19 R. 13411T BANUHILLrK914NETH E 40100970 02/20/84 56.00 0.00 6.00 00.00 9p CR 4 /..,3 /8 4 e 7 #tY't1T1RIlANTOR' IIJfOAMA7IClTd`I~#'"I;`IiJDIS'DARTJIttt'L FT: O""'ODX~a77"`CAKL'' VALLAbr T% 79.67 4 ,I'dE~>$LEYiMICHAEL 0 " l' 14114081x'06/26/04 . ;.1957 80 ' 0100 0100 967.80 ADD IP NO 156 7 'I } OVRR7,14TtlR"1NrOMfArION`Ili 7f~CF{1SE~; S 0I'0`FAL'CWAD0W-DC1iTC1N TX 76201 e'` 6 00 0.00 0.00 56.00 ADD ER W8 145 7 , B~LtlTBr 7E aR~>YdpET' 40141624 07/$8/84 ` $6,00, KV~DE NFORMATT[Pub'WX F104NTt UE'C01E " 350'hTAtft N 0 'l'CUTCIVTLLE,'TX'"7ZTOtY OUA - - i , 40161846 09/(9/B4 174.351 +112, 80 0.00 991.60 ADD ER NO 37 7 n> ' 9#JAVISL ~ r Eg1'EAN~R`ATt'1`!'A~""'tff:NTON; "T7(""7G`"07-""•"'"' , WVA.K ANTDR'"7f ACTT Vhg 06/28/84 09.,40* 0.00 0.00 69.40 8P EH 7 1Al 7 t'~•,pAVIDBYr8AN0Y,J01t 40104160, + - gVARRi1fOA TNFOR / 1` ' 2VRA1R1C-'DI'.NT0Nr TX' -761201 J"1'ti ,Y . ~i'a • }7 Ia'i' +'I f , I,1 ! Y i. u~ OtlARANT~ORD'TIVR .'d.~4a~6~11~1106~/~Itl4, A•/h ~Y1v50., 0..0'Do "f1"~'bCb87Yff~/"'OCNTOW0 TXSp CR "'7'6a0I`" 1 160'; ' c' rc dKt~,h I~ANMENSHIPr MELISSA A, 'r 40117764 0"4/1941 v ,T~l6 50 X88, 70 ''157; Qb. ; 116. 55 ADD ER NB ' 08130/84` 90 7 rr RAmIOR -174.m pUA. 74`R TJI'01Jr TA-~7S70I _ ti X;Fk I r O r p +1'i ` R E'p 0 R T AOE q PATIENT NAME CAT SID DIOCHO Ok0-UAL 14 W 41iO WIJ-FAY li-q PAL F. TYPE CYCLE L3T, FMT1 AIDE,, f 0 TYPE BLANKERBHIP OAIUEL 401'$1086 08/087841 56 00 0 00 0.00 SG. 00 RP LR 0 3 114 r 7'. ' ~r 1rs OUARAIJrdR TNFORFlATfrRJ Y« Ul,N7CC DL7INKERBr{1F 171`A-g07f 44f~i( 'DErJYdFJ;"7X 76f;31 ~e e " bL1 T ALfkEU 1.0$18 40135184 06/20784 276.00 -127.00 0.00 149.00 Br' CR 4 l4Y •7 ' rd OUARANrOR Ir:7'dRMAT1QN'~#`"AtiFReO"'LDUI +f{I g r~_-.^~EkECUr7~E fiFEp If f6 DENTON 'T%_-_76?•J1.~_..... e i ',B4L5',0EOR0C P i 401314$5 04/0X/841gy':776" • 0.00 ' Q 00 7d. 75, 9p ER 4 ,f ;d iY dilfiRAFIYtl 174 7 R`TraFdRHArio1J'ftOE~`1lC1~i` '•'`~,2~' A "1,t1Nf1f~T~C3-DE'1V1'ON;"rR"` „ Btl9ANERIHICHAEL 40139752 O6/30/84t lOS OD 9, 45 -20 OD 90:49 ADD ER NO 07/07/84 147' 7 'J1, ,+#'OUARAfJTtlR"TNF01tMATI017 s# MCHAEL AUERNER A88fi:JIA PTLQfPtI1NTr Y3"-~6~58 BOWEN,JtM11Y OALI }ioD~fi4ig'0"$~tQ/,83t l "dab OB 0 00 0 00 1,i0d Ov 8p Ip ' o~ ATJ - 2' ►~+e #Sri1UAIJTOp--TNPOI1 A'I MI j1 't1 j/_ I DT9'E'ABTpdt)IS, 568 ,0 ' BRADDY, MARY L 40101047 04/04/84 62, 45 135. 50 -45. 56 152. 39 '8P ER 4 09/07/64 85 7 IV " " GUARANTOR fW"'MATTtltd'77r""'Hdr'1AA'D'017'hDDV""'-""-"-'--'---RT"fi'Ad1f 8r71rf4RGN"9dlJ~'TSS!"'74728 ►+1 'AR 09A, J071NA 1009960b'04/16/®4r °`rg73, 09 '186, 50 -115,0'0 li 044. 59 gC Ip ~,07/02/84 , 152 7:' ' - Olt avzanTrraa rNanmaxrlrrJ : -~~t~aaad nRE a N I a mnt-7. wrcr;oxJff HFaP° v}#R v TX--yad:r DR13ENO,AWON10 40133282 06/14/84 030.35' 7.00 -0.00 337,85 `Bp ER 3 166 7 n ter-'OU71gANrdR`11JPORMA7TfIN"~17C'-ATJTdFTTr1`r111TH(irtfT"""'""?"""""q$g~M-8y';'-IJpN"•'.TSC-`7624`1`_.""..' "-1 t dRCIJN, SAMUEL WALTER 401 78140 07/21/84' 102; 57d. 92 75: 0, 00'1 lq- SS "ADD $R NO i' 120 7 1 AR71N1'da'T7IFORTA7I'Of7`Y"87SMUL-tiIAT;TER-I717dNN ` -$5^Je'f`IJVCC"F"1S7SLL7{'••T1C;"ftYe , » AIRUCKER, VAC QUWA t.OU 40136715 06/24/84 56.00 0.00 0.00 56, 00 ADD RR ` NO 159 7 j +i #+t OUAITANTOR"tNF4RMATId71'Yx`JACBUET'rVt I--nRUCrtEa- 942'BCH¢RCES'Old8-"LL"i r6V?ME `TX` 70047--` I n ipRUMalELO,'DEBORAH 40147522 07/27184 117,50 0.00 0, 00 '117, 00 ADD FR Ng 124 J, „ `r YS 17UARA77TdR 7Nr PVT-" MP'TCCD"`- 1'Q2 $A7701Ti!"RV" 1JL1QTt117 `TX 7b".Q7" - ''l .'DRYANro KEN14rMl W. 4005290 06/20/84 07.25 $9. 39 0.00. 146. 50 ADD ER NO 101 7 Z W-OUARANTOR IIJFORPDi1"0 RYAryT - 1.23-E""UA1C DSNT W-Tk_ 76201 I OADLLTAMI18TNA H. 1~0U201'1' -RUEBEC 84k 1954. 35 0,00 843. 48 110. 87 ADD ' 1P N8 10/04/94 D fio trAAArJt'Op"INF'dRPlz7rdN7'A'k-•-RII-Atvld"1'ZaEBE`'^-'-^"--""703`110TTt}iJ7fATfi'TR(`C7U'.i`RDE'S~{J1SE7I70TJ;"'T',C"71,20`I'--'. u, OARTERIBRUCE 40153064.08/16/04 164,.00 0 00 0.00 164,00 ADD L'R NO JOB 7 e t Nx DUARAWCA 'IWF'ORMAI UN WIF CC C"ARTER" 9Zdi3 ~BTFY 91 R1~T C IYYI:E-R4CK; AR 7RaO9 . _ y t.CHAVE21L1NOA f0 04044 8T/ d%Bd~'2~f110 16 51, DO' O' do 19, 337. 03 8p Ip 1 106 7 i + ~'•OffARAllTtlp 71J7`IMMA`f'I'OFI"#N"R'•CfI'A -28f1O•"I''Y`I16TlTFT DR-"{156_`.DENYdI''f"-TF"Y6'2`O'l'-"' 1-C01N1P RICH ICHARD + 103.24059 08/13/84 1r8 4t3, 40 187, n5 »300, DO 1.710, bD SP Ip 4-_J-0/30/134 aJ 7 "'`•xlr` RD TN1tRtT a s t A7TIII7"irJF"-D7CI{'"K10RI10W-~ i , 3~0`H4FlDERIfON""VNOEa,"'YX:' 70204- ~dOtlMtI1715ANORA U r 7009@r 06/25/84S x' d6l 5'15, 0 00 0, Od 651,15' ADD Dp N8 156 y tlAll. dUARmrdR"CF1FOdM T-101,11,00 GEARY-GOO ER 611 IBS E '15E~1Tdtr f X "fXQ61 » ifOR060,RANDOLPH J 00014170 61/04/03 1,047'80 74x.45 -t, 098. 24 '24R,01 SP 1P 2 II/Q1/94 10 / 00ARANItlR TNRBHFlATTOFI 71tr "'RANOULPit J CR17UE RY b 1307CT3, "IfENYONI TX"7620I _ 1 '41 tr t/ 1 1~ t,~r ~ 6 Jdg' it i S" ' ,7 ' { pit ~ 1 ! ~ol~' i4i ,I i i ~.r..a.. • _ _ 7 f ' , 1 t 184 1 Ai '.,,i;.,fur~i.,i~j+nl~~t. ~3~1~1.,p _ ' twl' , N~75,Ib~ rkw~c' (t I~~,t. ~~54 •Iid.2i71+..~ i' ~J'. ( '`~,~~.1f 1' ~ 1 ~ ,I~ t WR 1 Tr 0rF REP 0R 7 E yr; PATIENT NANO YA, PAT 1p p1tiC10 DEG -DAL NEW-CIIO > krW PAY W-0 DAI FC TYPE CYCLE l vl, p11T Afl 0 tYpl! • 777-77, µ } ;r 1 1'CEI 2', hACHRL A 101{I61"4 0A/{9G94 4636 60 123 50 / • OUaRAaTOR !TI*FOg1ia11pN'# -RtTDEft1 CRV b. QO 76d IO Ann IP NO 00/20/04 ' S4 y e .-'-"-fir-FlnRE--11EaTCN;-•7N.._y3 02.,.. 51 XULVM JIM IL 40146177.07/23/84 40. 99 49.00 ""'^"4~`OVAAANTOft`fNhCfRMATIiik pT-ITfT 1{--CUL 0.06 139.95 8p LR 1 1,,17 7 9'7i'AF-Nf ; C1SKLr'DaCt7S9 Tfi' 79D'b8 " - L DpW6Y 9TEpHEN t1011t3;07/{g/Bb I 10 7i1JT0 lde4; in O p 0fo0'' 804, td AAp. `rp N ,It : 1~1 • ,a 'DOOOETT,JANICE 40129306 09/84/84 78.'ld 59.60 . 137.70 •ADD EN ND n i, ><#'OUAgafITOA"7TJrOR 0 00 MRTTpa ilf-~J4tJICl"UI7UG>TT. s-t~ ~_mP0 AOX_4g2_"DraT{1M 137.70 QA 8 7 r ,R UOL A8,JA11F8 PAUL r , i; RI 12 , 401f0tX!-'O5%a !4 {tlbr`~ OAH?{TITOR'Tf tl1t1k7sTrON Itlt` Fl CX ! C6. Otl OP Ld d E „ ' , a00 r , y / o e DOIJfJEB, L 18A L. LIB 10090341 04/ 14/04 2+26 60 • ~+~`(iUARANTOR' INFORMATION"illt` ' `tippl g -1T r -R2 7g . -6. 00 1, 197'e5 t`~p lp q i , r o7/2s/e l$9 7 ro r PO l1QX fib' C7TTCE°1`Gr4r"1X` DROCCO, JUAN 90046294 04/O1/H4 1'!O4`d 1 f}UA1!'dl77bI2'f17r0R121iT7QFI l~rtTrkIi3 DRQCCO~"'y 0 DO -49.00 64.^0, !ip ~Op t IS/19/04:'.' 1~ 7,; ~..Y`-."_W~Qx✓rnrr--ltlrvr~;--Tx-~raaa9 ~ WAN n DUIJHANTOn 40134405 06/.17/04 109.75. 0.00 0, 00 100.75 Bp ER 4 K - VQ 130X Q64 gANOER'r"TX`7"6"6 , 166 7 ,t OU iTttl1R'TT Qd1i~lA'11a J't R1 10 u 0 09/og/84' AM,fItN1r 40151 `DUNHArr- 106; 00' t 0,0' n. 00 106, 00 ADp. ER NO . • y'r, - - 59[3 TC`7GVE;_~'17Ea1'QN,6*fY By , ' DVNN,NARY , }r 4"OUARAN{DR 7 40193173 08/16/04 61,00 0.00 0100 61.00 ADD ER N8' a ISFD RAITIIFI YtT RONNTt DUNf1 T629'UNUM4000 "DENTON 105 u' 11115tlk, OARKAR1E FRAlIO1g.t 70034E49 07/03/84' OUARA11tOR TNFDRHA'~ 63.00 0.00 q; 00 ; r 63. On, 'A bin Op J f+8 i lq . y - I OVAaAkTOA' T1Jr0AMAYT aNXE°FRANCTB'[DAfI62fN"~`""'"kT4-11t1X~if'`bR~rJTONi`7?C"7b.Tl?r-"-" . r . u. 8 'I Y `{Oi ~ 1 0Z44 07/01 /84 410.4 + 4` 0 06.70 0.00 46;. . 10 UP Ip 2 no " r7 '1 1> ~ 4` ~I &scantL4A. fp s ~~-~ta2n-cr{Aat urrc-a re DaNraNr T~ 76M 1'LVIA 469 111/14/83'.{ 1,109,33 t 0.00 0100 109.00 BP BR 2 377 bUAAxfDR"fNF0Ttf4ATre ''yT0"ti lR7iATFQaD DCNiON TX""7-i • 1 7/8A•. 1007611t~ O}t , r l8CAM1LLA, YDLANOA r 5 r ` , ~ ,~441, 90 0, r0 00 0 " CRAI+r6 26., 3g Q610 0. 59 8P ip 3 07/09/84 lag _ 7 30 6PI61 e•j• 0. e fX._7ER0t in9• , 0~ 00 0.00 5, 00 BP ER 1 ~ A11 A QN , , ~It Yr1F'fJRFtA7rt7~T 6118820 'r 412 i ,YS.. t OiT "rtL►tTrD}7"rX 7 an'r" - - 7 • ~ -2CaUt1, tl1OY0R 4di 18620 '04/a3/pg fu1tb"al o no o, 00 06.00 ADD EA NO '•e ~Ij,,~(~1 ~ , K? ''°1 1 y,~ ~ 'J' dRV7fR~81"'ir't03'DRNYON."1'3C :'7620.1.._.. ----i~s2 7~...._._......!~ R, .1;•:' ANNBI1~~Mlta; , :4014 30;~0784r,'}'9Y~eo`~;~~ ~ 40-0.'b R - ?O 169. 00 ADD EAR NO 00 7 °t4 P '~aS AStpAAag errroN r1r r~aar- ! 1 10) 8RtAN BCoYT', ' 40159619:09/06/Q4.•• 8940.20 02.88'::. etj ol• ' t OR-7f1F e, 335.09 ADD RR NO ~ l1A'!t{Ci1~ Ql~lyt7f 11QfFiN"'SCOTT"F%,RRt13'.`_'"•.».~.. .~13ts'S7, 64 y t Fox; rx--~6aar----_ Y 1 C,1131/~ It L. y i 01 1DEC ,1984 WrR I7.E-0FF REPORT PAOE'11 • ~'PATiENT IJA14E PAT 10 DISCH0, DEG-DAL NEW-CHO N42W-PAY' W-0 DAL FC TYPE CYCLE LOT, PMT k0E ,FC TYPD st *A88,BTBVE 40136 e'? 06/R4/D4 .94.'75 0 00 a~ i5VA17AF.fU11-rNr'tlfif4ATlQ1TtT~ $1GV~ FA9$`~_ - 0,00 94.75 ADD ER N3 06/27/84 109 7+ ; t'S30-HC'00'RITfC1("`bCF710N,"' 1'!C ~Yb~01~- ; s FICARELLAJ DARRYL L 40167603 10/01/04 6416 '0.00 0100, 64,10 ' ADD ER NB . 11 ;l a~`vUARATJTOfT`ilii~GRFlATTbN pit A7+RRVL C'PTCAA ~~,79'S HGY"I.rt, T~70I IEWTgVCLUC; 1-Y-7SO6- - 60 7 o~ RORDI JAM@9 ' „ a '4614416 0MO;94 r 46. 70, 0 D0 '0. 00 •46.70 ` ADO ER p18 13G 7~ io..,i"75VAtlA1'11~Cft`>-fdF'tllfl~dl'1'',`~7f19`~' S'l7`E""'d1M1#""'DR1.'7OH7C"C71"Y7"0IS`>3tb8" ' u r r FULLDA10H7, JOSHUA ,40140865 07/06%84 , 42. 70 0, 00 0. 00` 42,70 pOp FR its 07/04/84 140 7 si u '"",;Iy+I"OUA>tAl'Il'0R R'F'IJLLT1R111FIT"'"'`""'-`'"-'---`971~W1N080R"l(fit`DErJADD6'201 n WLtARM MARY LOUANN - • '1oo9`SgS3 03/24/84„14430. 00 55. 0S'-1: 140, 40' 340 65 ADD 1P NO 06/02/84 ~ 7 { , ;i i, # Qi1,A1MT~'T "RrWM',TM7 +t-r~E~f1VF7"Ff Q11tlCC",i FT'(dO1iTN~A-'"ifENlrUl71'TX"77>:01"~ - 1 7 7- (io OARRErTIJdYCF,' HAI.I. 10113640 06/29/84 !~qoe, 85 01.00 0.00 908.55 ADD IP _ N8 ' 77`441-dUARAVrOR 10K0RHA'1'iDN'ii 106 7 -CCOYO 7S 'QARAETT l7CI LrP-Y}{E CtlLtlF1Y "'T1f 7"JOBb _ ^x'092"0 i 01ti8O14, CAROL 40123853 00/10/84 10.71 YO 0 00 0100 102, 75. ADD. ER Na ^w43 7 I : #'Dl7ARA'11rtlFt 1T7Ftl1tTfid1 tU dL"'JJ7D~tlir"," qT T2-gL71f-EMif 'RACIf T1( 7~/Ob ;yv I I OOME1, RG1'IJ11L.D0 40138303 09103184 ` 18. ~0 r 0, d0 0.00 19, 90 ADD ER NO 09/09/84 87 7 #~"OUiiRAI4TtJJ7 ` 11JFb17MA1 tOFJ s# -REYNtlLDiS Ddf Ire , 17"LD01~"179r1'"HiU""TJEI'4T014~-"7A""76401 0014ZALKSj Q I CK 1 .40167553 10/'01/814 t " 82, 10,', ADD ' ER F16 _ Co' 7 I otTARANTOft r14FORRATIQR`r1i RAS' Jf7NliiC'Eff ` ~2: O'' o. Do 0.0D rrf» ' " trt•A17sr"-`ra crr- OUTIEtiRI Zr JfICiHUA KEIII{ 40114434 04I09/B4 5600 0.00 24,00 36.00,' ADD ER N8 00/29/84 ""'#741 OVAR'ANrOR 1 86 7 1NF4RtG4TfON i71"6U~ OUT1611RE2 " ",T413'~7'PR trrYEf'B1'-ij7i D~FTphjr TIC Yb"leift "r HAW, JUDY 1010712b 09/23/04 1,722. 70 312 5 0.00 -2, 034, 95 ADD ''1P Nb, ' ' 184 , #i-'017A7iAT41Cffi'7IJFOJi'HXTTON x"t~ CORTI$-HAObR .___`..`."•[020"71iJD6E~:C"ii'.T2f-`rJi=NTOt4`T~""76atlI"~ - ~ 'r' ra HAINES, AMY L 40161986 09/13/84 159, 80 0.00 0.00' 109 $0 ADD ER Fig 77 j 410 # "OUARAiJiOR"1N1*tlRFiATfOFI +7#"AH{`L`HArNEO' "'--KtR'R"(FAi L-,-R11-537' 14TSU'CAll9US DCNTON, TX 76.T0t NARDAWAI'1 MARY V 4013gbbl 09/03/64 74.00 39.00 0.00 log. o0 or eR 3 ~iil7/CRAT4ida-ITJFCRFi7CiTD}7 4k+ TLITA FiOZIAP DtS7 r1lASCEV`ii't QlT-T41r-9C6't1E1faW-Tr r„ ,r ~HARDAIJAYI TCRRY 40148819 07/31/94 07.00 0,00 0.00 59. 00 ADD KR N9 J 122 7 ` As r4,, *6WOVAT1r0R TU rirATTTJARJ•AY, t39 1 5'1if{PDi 0"1304T Y 762UI ` 11~~, 'tla°r4'A ' EV`WY4N _ "I• 144 y MAAp; AT$Vt;IJ LEOIJ .40164'J10' db/20/194, ..'.3d3. 10: $6. 00 0; 00 349. 10 ADD ER N8 q9 y 'I ~i A}TXTTfi1ff fNF'O1TH1iTCGI um HARP ~ Po DQX 309M CELIA 4016379b'04/ta/04' 249.38 I 0 00 0.00 449.35 ADD" ER t4$ 71 7 °J HARR181 5, w-- _ IA1T`l:lEFkti`0id3 AHI:'IN4fON;-r)(- • 1e HGNK1:'(.iYH1111A8 0, dOlfy~i~l9ygy9y A01172b/~i~yAj`+:` ~1.1 Ob 00,oo0y0~~ }111.00 e} ADD RR NB 1204 7 0. },-nrMfil Ull /1 1r1U1'IMOYV~,~-FiCIYnC'1. f'p, yrt„~~MYC "L,54.l.ItC1Or IA 1V44V - yJ `•HINt.SiDON TA y dO14969$ 03%04/4 119 1 0 ff 0 0~0 d, 00 01. ~rI7Np y~ Fr 'o0AliAfiT1J~ fi4 1,'ury ITIIN 0 AilD ER NS 7 , R 9 0 (N"A: LLC~iTI►r'+`TR 76201 . 1 , 1 i Lqa 'r? y01 t1F.C lhlid W R 17 E- O F p n C h q R 7 AOE 1.^. . t] pATlENi IJAIif pAT 1D DIPCHO OEO OA1. NeN-C142' WEN-ppy W-q DAI 1'C TYPS•' <'YCLE l3?. p11T AOE Fo Type .f" cr-v-mrare " 1. ; > 1, 06, 00 39, 096. 54 1' ~y i r I y}~ ,I,i,i a 1• ~ Ifn:, i 11'.4 ~ i. 1t A 1 r 'I I ~ 1 y"1 ' CIS: 1 , _..._..J..._-._.....-»r...........~. to I!I Of Ded t494 « 711011131~ 7,7Ir W R t T e O F F R L P 0 R T ~ ~4A46 13 PATIENT NAHB PAT iD bi6CH0i BEO-BA6 NEW-CHO N64-PAY I4-0 DAL r C T'Ypp CYCLi LOT. p141' AOE PO TYFe 104 1 17'71 053. OEF I '""--"ifi~Y~WpTYi~'=C~F'F"dRd7!JD` ,~1(~`I1/.I 1al - Otr, no 131, aar. a9 G i~• 1 y Ip III ~ _ 1J Ii el ow ' it 10 111 10 i1 14 d 13 t1 , 1wj 2p 11 J 1 I y Ip 1 ,..a` .t 1 A 1 10 1 I d y} PATIlI1T, PAT, Ip,... PT PC OUARAfIIOR rgAt*. , 1F8S .p •,f . CITY, , or YIP.. Dig, 1476. AMC 1„ + 9TALI.I1408, SHEILA M 10108769 IP ep EITAt LILACS, J448 CLAXT11t J RT; 1 BOA 29 ,IWI1kt Y ' ~t i +1 t TN '74Z-7 O41131g1 ?8 3At 90 I '1, i T CCtli BN ECd NA1Fl 9i5n ib[83 71a SP-erlt C1(i.!0, JAly Pit. ' STUSBLEF'1EI D, SARA i 1 1 4017e6E1 FN FP BTUdALKhtFLp,CFC[L `i~7`ITTA9fi`" I'~7`wSQ~ u LEf' _42a 8(1I TM pEMIbN TX 76201 10/89/89 63,20 STUBB 1ELI1, Ol IRA 40187308 EN SP STUORLIll ILI D, SARA - 416 $KITM 0 60EN1DI4 Mot 11/19/84 - 3 -06.00 STl3B6LEh tEI t1, SI,RA F 7005f1329 CP Sp -8filaBL~h~x1.D, 9i~laA'~ ~ I;,~+ ~ 41 f17H `I1 s'.4''~ r 1 BTUBm ELD, SA. RP.N E 40126580 FN SP STUIl9Lah ih1 D, CfC 1L i i - 416 811 TN DEN I ON TX 76201 00/21101 10 TIM WN, MA14KI IN 4017'9145 2N CC DEMON 60VV7Y, X319 3e 210 E hGKIf?NBY CQUfI Y' it ► pEdNON ti ix 76IIOI 11/64/81r -34.00 1 L ' `T€k~F 1 Ir `"-""aoi757i9'~cc 4YCi1Hr1x'",N, €sa r.< Lr LIN '~tzaa r ott JM n'~'b~'a'>i"1i733i~~"'»bX;» • TKAi 4L+,,ItaBENT 40176291 Ea Cc CMUYINI o IrioV PLUM BTMEEI AVBREV TX 762;,7 10/3O/g4 -66.00 ~ n VAMORVEIIi DAVID 40173e43 Ew CC 09111014, 6171' t1 101T0N, Tk 76201 ; pllNION.. tt "yv 7k 76201 !0/22/01 -e4. 00 rl /ON{ \+>./VO/9'~1 fir WORACY`VtRf.ON 401791e EN CC DFlllbll COUyTY, ` ale E~. KIt KIV COU411' DENIOk TX 7420! lilOV/94 11 H re - t , ti1V.+`~~ ,1 Yt'y+ 1~ ,y,a ..r "56.00 1 611+ " 9, 44.07 It ~ Is, If ,1 1 \ 1 I Vol 1 14 t e+enso...n, .w. u.a• . ,,,.,a tFl<.~ KOR:', e: ,,,n... -,.r ,a,..,,e.vau rwvevnxa,u svu-u~CM." .a.ww~llGirisnLWd:JSN.lifiTSl., Y: t/~ • l x `f :7r00;33 OS DEC 1964 CHAR11!' REPORT PAQF 1 ~..1 . • r 1 '~'''t 1"71 x + w '1~~ } + PAT 1E14T.. PAT. 11). PT PC, dVARAt110R t4hlb........... 1E68.. , TV~,~ r L!' 1+51 i yi C1 or 0181 DYE. AHG ~~,1• G 873ND JO C/ fOl~1g46 [P CC CCfI r111J u; J`q~~ DEN10N MC N'IBV <3T w t DENT 1+it 7X 6241 / 7/81 -11839 8 rt 1 C F9 $~hUL A_0.1yg]~7El CC~CHpBr~tPAUL pT i D r n n s CHbS%A,PAVI 40t7240!) EM CC COUPII!',D2NION E. I1CKIf+ME1' UNION TX 76801 W/110.1/8-1 -60.60 i V C ULEYif(f+l'IN 4017d17bf K CC BEf~idt! Qf}UNTY JA1L, DENTOYN COlN21Y !O^I .TX'1620[ 10/i17/B1 -08 7~ f e njr i COOLRyrKK11N 40!76026 EN CQ CO KY V 4 r + t ' S ' f io • _ 9.L_~}IPz It pgNYQt COVNIY JACL '~;'1DIFNI{1N_+' !11: TX '76QbI 10/29/51 I°' e -411.23 a: ,HEIf) I 10143459 IN 9P CORDELI,Hr101 2410 CHARLOTTE 03 DENION TX 76201 11/09/81 -3,977.64 a l fG1f1 ~"V~O[/9 7~Eri CC~C~I~F~H/;+l 7HOYT,B ENTOY COVM! JA1l bEfIION, TX 76Ot 10190181 , -96.00 _ff 11 V ' CORDEIL I r{I 801} a EI 0141711 1 21ltILR _8P E12171ILRR,RON OENEMAL DEI_ IVI RY ARQYI C i +-u ,TX 76206 10/26/91 0 e, ,r FtHOI•ASn;i, ANN 7, !0!28806 1P CC FI ROERSON ANY . Y. 19 OAK SEflu •DENION TX 761201 48/18/81 813.45 i e K flr,H, lh6~FY 0 10t4i083 t> 8P frit~NCH UE8Lg1' p' " ~t lq Wom I&I OLAXA „C ROLL TX 75006 1 8/41 -S , 90 =t 10 ,70 0h1t4110U, ROJE_RT S. -LOjC 2 FOD 1H BP OAf1CHOVr OjENT S, 206 h 1"WN ION Ot 0 r 5 I j) HAMP1(WLHICHAKL R 40176509 Ell CC HhMNT4YiMICR/,KL R DENTON COUNlY JAIL DENION TX 7620t 10/31/81 -58.80 tiJ a. ae HA11P1'0f rROOi!R 11 40iB0969H CC~•-OEIJII! O,' UNTYJhILr 1470`1 '.r ON', `j~61201.11/ •./81 -54, I r 7 I 40173b0i, IirC DE141011, C TTY OF, AgHTONr ' TX 76.201 DEN10N` . , ~r?TK A7tr,T01 t0[~a/81 -101 00 ' J e e Via -JONES, AMY L. 4017/610 EM SP C0U0VEMrNILDRE0 140 W. CUL190L LPWISVILLF TX 73067 t1/04/81 -179.50 V VESSeI10US 10047878 1 AI7D JOI,~ Br THOMAS OEIJEMAL D$i IVksMY COLORAN 0190901 041 /91 -31 . V t4 ' 4A ~Q1326g8 EN hffD J012r8,TMOM'tR f/4 ISAL/D&I mY. in CCL01tAMI BMRIN"•0180901'06/11181 -k+ 40 i 1e JONES, Ti WAS L. 40104811 EN hnD JOt!I S, YHOMAS L. OE14t?MAL DEI IVt MY COLORAOtl 11PR114 CO 98401 03/21/91 -104. 75 4110 Ia 4 _ rr f loll N/.AK`"~ gQ~78~23 ENC ~f~K6~iK V. 72Q, S TAYLOR It UM i 1r °a `;;011IN~ KLI t.1!; T 0~ l'~%91 ~5~ 1 n I 4dti 70 z6_~~ a~N/ y1 ny LL TE 4? ; .Y - ei J 14.0 41 HI,RCMJOHINY 40179774 EM CC Cf1UNIV,DENION aid a N1KIW BV' O+-NION TX 76201it/09/91 -M. 00 i J 1 4) ' 1J 1rHY9rHAR~(R 10142743 I! Sp~I1,TfHyBrMrRK R e U V to TTHli 11AaK ROBEKT. 40176760 EN CC 14hT I HYSr 1UlgK RO d1;. 1e J ~RT DPilrca 1Y''JAIL"a1*DLNION tei1kl Y iX1y61101`1~f1/tl< -11Qir`v'1 M1 T ne V 41 hUHSi M- t4 10143493 IP SP MIMS, URRY ANTHONY RT. 4 EXEr "071 'CORINTH TX 76209 I1/OA/81 -241.20 J ' e MUHSrNICHGI 10140114 fp SP I VH2ik T1sRRY T~ I:GXgIt IPW N 1 ON /d1! i1Q. ti"~'r'F'~ -.L~.1 - ~._.Z4.4jj9.L4.~?I,'~HS, Tr13RY r / - e O'LEARY,HICHARL 40173007 EM CC COUI1!',DENION R NCKU+v 0" ON TJI 76201 10/218/91 -136.80 10Y ea Y 're y. . , 111(.'A, Y f' a ! ' ,J~ S kt" 'i > 1 s HOW 1310 Scripture street MEMORIAL HOSPITAL Denton, TX 78201 (817) 387.5861 ! i a Fiscal Year Ended September 30 of 1901 1982 1983 1984 n Contractual s Adjustment* $ 571,680 $ 552,238 $ 1,546,326 $ 1,026,401 Charity write-off 358,843 449,251 657,733 1,0191028 8ad Debt Write off 752,027 1,1891547 20444,385 21560,181 7 F U , L{ , tt r< Accounts Receivable S 2,517,231 $ 3,536,109 $ 4,196,757 $ 4,941,817 s Accounts Payable 6881720 1,1131018 759,722 11390,662 i County Contribution $ 237,659 $ 300,000 $ 225,000 $ 615,617 * Contractual Adjustments for Medicare and Medicaid i 5 ( w a: L i 1 't:;nYlx` l ~I 0) JAN 1904 W Ft ! 'f F 0 F P R F P O f< T PATIENT HAMS PAT I0 D10010 nE0-UAL NEW-Clio NEW-PAY W-0 SAL PC TYPE CYCLE LST.PMT AGE ADhM9, CH1 i1YL KR18T)N 100P=9 051061d3 935. 30 139. 4(1 ^•7461 V4 32A. 46 6P 111 4 ww GUARANrON INFORMATION ww PATSY AUTII WEIiT 07/dS/99 603 N sO,rH 8T •BAN OCH, "1% 76266 160 1 ~ ADAMS, VALERIE A 00001£'09 12/VD/112 2, 175.26 0,00 -2,176, 72 Balance AfV~ InTupance 10 ROVs DSq~ Baby Not co6VYersd I . 40 ww GUARANTOR INFORMATION we JOHN ADAMS 4qY ti 11 0 93 940 117:0 ROAD LANSING, MI 40910 ` ALDRIDOE,DCURAH ANN 1 0111 4 4 70 09/90/O3 781.70 1;36.69 0.'GU 034~nc~6A}~o,r In Sl enceArrangements not kept 871 1 60 ww GUARANTOR INFdAMA'I'IOM ww pOVLE OGNI? JAhlt 9 11nX 441 . CH1CO4 TX 76030 r Aos nso.._, ALLMAN, TEARSA A. 70017046 09/04/d3 75.75 671: 90 0.00 pl~W.aga j fed- qf* y 411 ww GUARANTOR INFORMATION ww JOHN ALLMAN 1D30 MILL LEWISVILLE, TX 75067 01 1 Moyod it Address ARMBTAONG,PQOOY SUE 10014033 03/."F3/g3 9,130.70 960,1 d -3,411:10 696, !S F 7P 4 09/03/89 121 l 411110 rw GUARANTOR INFORMATION •n SAMUEL11OWA(lD ARMBTRONO 717 0 DETROIT KENTON, OH 99919 DACIIhAN,I.INA,A 00003147 U1/11/63 1,299.90 O, Op 0,00 1,D1 ance 90 AfMs ;Asurance-QNo _Response y Y ww GUARANTOR INFORMATION rw CHHAN L)6A U 8T 390 1 414 NI?TT1E bpNTOM, TX X 76401 • BANDA,ALDERT 100113976 04/14/113 56D.00 0.00 0.00 vli1c27a D ,18d-!}Ved 14 t No Address ww GUARANTOR INFORMATION 041 ALUFRT RAIMA 2900 DERNARO 0CNTON, TX 76901 261 1 BECKBR, CRAIG 8. 40017043 04/10/03 21304. 50 -150. 00 _IL '54y. 60 4919N84P_ ER Q . 015/23/93 177 1 y w* GUARANTOR INFORMATION wr bVbbIE DSCKCR 2608 DRIFTWOOn MEOGUITEe, TX 75100 11LACK,LgNNIE 40D1772D 04/11/03 40,00 343.00 O.OO ROi4"ct10AfUr InpWanca jo Response ww GUARANTOR INFORMATION rw LONNIE SLACK 161) 1 312 0 RUDDELL APT 1NN11e00.0.DRNTON, TX 76801 BLANK, ROBERT GUARANTOR 00007377 07/x7/70 1rg99. lb 0.00 -166. UC SYS33es ns~P IP .'-.3 . -l2/P7/B3 6 1 ww R INFORMATION ww ROBERT BLANK p ilb PRICE OR LEW19V Il:L5, T% 70067 DLANTON,KENNETH DEE,II1 1000031 02/16/03 2,462.10 009.30 -1,962,10 1, Dil~"tP 1P 3 -12/06/83 94 1 40 ww r GUARANTOR INFdRMATION ww 011001M OREFN 610 gIARyET. GAIN`30VSUOtOe~y. /tP40 . 3 09/14193 I11 1` tlL1WtIpY, TgACEV MICHELLE 10000909 041/01V/03 t 500.10 COO QOb. !0 M■ GUARANTOR INFORMATION ww MICHAEL WILSON BOWERY 1207 FAN IN OGNTON, TX 16QOL pRAOV, NANCY No Response 10006430 04/n3/U3 1,913.90 610.40 0. 00 4, 543, 60 9P IP 3 Y 4+ GUARANrija tNFOAMATION 444 ROEERT DRADY PO DOX 52 KRUM, TX 76949 305 t BAiS9N0,AURORA No Response A L0021665 04/97/03 273,'Od 1211,46 -170.'00 414; 45 9P IP 1-- -07/06/83 156 1 tr' r ww GUARANTOR INFORMATION sw VICTOR DRISENO JOB 13 RUDDELL 1313 DENTON, TX 76201 No Response DRITTON,JENNIFER 10014603 03/VO/83 6811.15 In?, no 0.00 751.45 9P IP 4 r GUARANTOR INFORMATION ww MICHAEI. bRITTON 1014 N. CORINTH DENTON, TX 76201 240 t DAOCK,PAMELA 9 No Response ~a 00009365 Ol/16/03 3,511. 35 90B ~Q;44APIL 761,44 8P 1p 3 02/27/B3 169 1 M wM GUARANTOR INFORMATION ww MARVIN f1ppCK PC 9p% !d9 PILOT POINT, 7X.76269 014OWNPANT140NY A. 40010345 0:1/11/03 49.50 170.40 0.00 ayq 90AfSPr InRRrence•3ove7 Left No Address $0 GUARANTOR INFORMATION wF ANTHONY A. CROWN 609 DOARDWALK DENTON, TX 76901 239 1 Il S Moved Left No Address BNOWN,OMER C. 1000330P OR/OD/n3 246.20 0.00 -QD',60 490.60 BP IP 2 04/07/S3 269 t b #0 OUARANran tNFORMATION ws MRS. 0 DROWN RT 4 COX 94F DENTON, TX 76201 ' Balance After Medicare-Moved Left No Address 1. eanwa a.a .rx : a . . , ~IYq' . .t. ..rz4;. ,e ..w.. .K,..s+. v n...,,. .....n . .w' i,/aVNU2i➢.ll.. 1J 1 Ntae~y+7~7'"W,l~lw~' f, CIL, 11, ,11 1 I 1 ~ J 01 JAN 1904 WR 17F 0 F P R kP0R T PAGE2 PATIENT NANR PAT IU D1eC11G nEG-UAL NEW-CHO NEW-PAY W-O DAL PC TYPE CYCLR LBT PMT AGE FO TYPE 4 ~ BROWN, FUNNY ROBE 10000SQ0 00/20/03 875.95 0100 0.00 e73,90 SP IP 3 O:t/28/03 301 1 Nw GUARANTOR INFORMATION ww GORDON DROWN 206 THOMAS GAINEOVIL.LE, TX 76240 BURROUGHS, CLARA 10009/84 03/02/03 080.30 0.00 0.00 S88W,aP IP . 3 004 1 L ww GUARANTOR INFORMATION ww CLARA DURROUDHO 1509 SYNDER n5NTON, TX 76201 J Medicade Denlod-No Response BYROM,DAVID W 40000039 03/01/0:3 .36.99 170.10 0,00 367,70 SP ER 3 - 226 1 rw OVARANIOR INP014MATION ww J. H. BYROM 616 CHIN CHAPEL LEWIBVILI.E, TX 75061 J No Response CAR SKADEN,PHOFBE 1OOL6304 04/04/03 202.60 229.94 0,00 432,64 SP Ills 1 e! L (L *w GUARANTOR INFORMATION ww PHOBUE YaCK At 2 BOX 837 AROYLE, TX 76226 No Response CARRABCO,MANUEL ENRIOU( 10040714 00/18/03 1, 134.440 0. 00 0.00 1, L34, 20 ADD Ip NO 130 1 ww GUARANTOR INFORMATION ww 14ANUEL ENRIOLIE CARRASCO 1008 CUDD,APT015 DRIDOEPORT, TX 76026 No Response CLARK,REOINA PAY IDUIO117 04/12/03 11142.60 510.29 0,00 1,662.79 SP IP 3 138 1 ww GUARANTOR INFORMATION wr RCOINA RAY CLARK 102 0 WOOD DENTON, TX 76201 w Insurance Oenled-No Response COLWICK,ELIZADETHO 00014795 12/.1/03 738.70 34.30 0.00 773.00 SP IP 3 01/76/83 24 1 {y ww GUARANTOR INFORMATION ww ELI2ADETH COLWICH 205 11LUEDIRD DENTONN~,TX 76201 CONLEY,CARLTON R 00014845 09118/02 292.00 0.00 . 0.00 29&WNP IP 3' 10/25/82 470 1 00 Mw GUARANTOR INFORMATION ww CARLTON CONLEY 116 E COLLINS DENTON,'TX 76201 Moved Left No Address CONNOR,DERRELL CARLTON L00199013 04/26/03 3,622:09 0.00 0.00 3,622.05 SP IP 4 250 1 ww GUARANTOR INFORMATION ww DARRELL CARLTON CONNOR PO BOX 9162 DENTON, TX 761301 Moved Left No Address COURTNEY, FtGUARANTORELLY INFORMATION ww 10016902 BRAD02 COURTNEY tl4/04/ 2 04/04/O3 gy3,0926,476:04-26,936.07 412,02 SP IP 1 07/19/83 24 1 ` 161 AV6 A YVCAIPA, CA 92399 + Balance After Insurance-so Response COX,ANOELA 40011OP4 04/11/83 66.25 210, 2D' 0.00 276,50 eP ER 2 121 1 V ww GUARANTOR INFORMATION wa LOTTIE COX 716 VAN R0099TS PL WYOMING, OH 40215 • Ctl%,MARVIN 10003044 02/09/83 806,29 60. 60'.1 1 No Response -394,85 480100 SP ' IP 3- 04/26/83 250 1 wr QUARANTOA INFORMATION ww MARVIN COX 133 YALE 133 'PALE LEWISVILLE, TX 75067 9alance After tnsuranca-No.Response COYLE,DANISL 40062120 00/19/03 87.00 124.05 0,00 911,05 SP ER 4. 121 1 Mw GUARANTOR INFORMATION wr OAN19L OUYLt AT 7 BOX 22 DB:NTON, TX 76201 CROCHET T,QLEN OOOi6097-12/07/02 386 Btl 0:00 No Response -20.00 366.50 MC' "CP 1 '03102/133 005 1- ` wr OUARANTOR INFORMATION wr OLEN CROCHETT 400 RUDDELL 0116 btNTON, TX 76201 Salanoe After Medicare-Arrangements Not Kept OALILI,SHAUOI 00OL6709 01/06/02 109.70 0.00 -00,00 699170 8P IP 1 06/03/83 212 1 aw GUARANTOR INFORMATION ww AKBAR DALILI PO BOX 0070 DENTON, TX 76201 Arrangements 0 Kept DAVIS,EMNIE S 000173911 10/22/02 1,156.65 0.00 0, 00' 1, 156. 65 In, dP 0 ..436 1 ~w GUARANTOR INFORMATION ww EMMIE 8 DAVIS 679 N CHINN CHAPEL LEWISVILLE, TX 79067 Moved Left No Address DEAVEn, HALEY D 00017671 L2/02/0e1 1,302.70 D05,09 -20.00 1P067.79 BP IP 1 07/19/d3 20 1 r ww OUARANTOR INFORMATION ww ROD DEAVER 25 OTMHP AROYLE, TX 76226 # i Arrangements Not Kept ORVORA,RAYMOND 00010320 01/10/03 lie.80 274.05 0100 693.05 SP lP 3 Of/Q$/03 20 1- w■ GUARANTOR INFOIIMATI44 ww JUANITA DEVORA AT 2 DOX 348 PILOT POINT TX 76200 r• No Response 1r ~ 4 Ik, Ilk. s. 1 I ti ~i MI UI JAN 1904 W R I T E -0Fr n EPD R 7 PAGE3 PATIENT NAME PAT 10 DIOCIIG REO-BAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LST.PMT AGE FO TYPE 9(.2Y, PAMELA a , ww GUARANTOR INFORMATION r*QOKCNNpTHUCLZY/O•., 9921 10 0.00 0.00 582,10 ID IP 11/10/up 537 I ~ AT 3 UOX 32 TINDER CREEK OAINESVtLLE, TX 76240 ENQLBR,KARCN H No Res90nse 00020461 11/03/0I 784,24 GUARANTOR 7000 100.00 764,24 SP IP 3 09/16/03 17 1 , INFORMATION w* DUNCAN ENGLUR 612 CRESCENT DENTON, TX 76701 FNLOW,DAROARA ANN No Response 10014020 03/30/03 2, 019, 49 99, D0 -L 889, 86 299.17 SP IP 1 19/28/e3 ww GUARANTOR INFORMATION ww SAMUEL ENLOW 311 OAK SANOER, TX 76866 q 1 EVANS,PATRICIA A, 10012284 03/16/03 031.90 1DO.40 -540.99 406~3eAfgPr In prance9No A07%15/83 170 1 01 i ww GUARANTOR INFORMATION w* MARY L EVANS 1939 MCDONALD DENTON, TX 76201 EYNON,WEIIDY E Balance After Insurance-No RAspoose w 00021147 11=/01 3,079.10 0.00 -48. 00 'I, 031. 18 8p Ip 0 07/20/83 L65 I M rw GUARANTOR INFORMATION *w WENDY EYNON 2116 DARNARD OENTCN, TX 76801 i • FIFLOB,SOODIE 10009254 09/I5/n3 ' No RE13 S 942:70 125, 97 -780" 56 34X. l3 8p [P 2 08/28/83 132 1 GUARANTOR INFORMATION 60081E PIELD9 1687 90071' DGNTON, TX .76201 OngctA EDGAR L Balance After Insurance-No Response 00024091 11/30/09 3D1.65 1,411:61) -349.68 1,4L3r62 ADD IP NS 10/24/83 69 1 ww GUARANTOR INFORMATION *w WALTVn GARCIA Itto MCCORMICK DENTON, TX 76801 Rove 9Bd67eftgp0 AdTP8S5 IGBINEWEKA, PAULINE 0 00034637 01/00/83 1,093.25' 21272.02-1,666,60 2, 4 w* GUARANTOR INFORMATION w* 3 03/04/83 743 t + ANDREW tGD)NEWGKA 2800 W. HICKORY DENTON, YX 76801 Arrangements Not Kept IMPELMANCE,LUCILLE R 00004751 01/10/03 19.65 260.34 -10.00 972.x9 SP . OP C 06/17/89 !g8 I 04 GUARANTOR INFORMATION LUCILLE 1MPEiLMANCE 710 N BOVOLAS CLEOVRNF, TX 76031 JACKSOM,R00ER No Response 4r 10004745 03/09/03 12*J60r l5 0,'00-12, 427, 15 333.00 BP IP "1 04/28/83 840 1 *4 OUARANYOR INFORMATION ROGER JACKSON C/O S SHEDRICK 1253 TENNESSEE ST NEW ORL5ANS, LA 70117 JAIAYER L FATIMA Wang After Medicare-No Response 70000906 04/03/03 560,25 `9.'70 0.00 580.00 BP Gp 2 3RD I r w* GUARANTOR INFORMATION AMID JA7AYBR1 7120 PARK AV8 CARROpLLTON, TX 75006 7.. JENKINS,R019MHARLEY 10003713 02/12/03' 1"`400.15 0,00.' -1329,30 970$290fADD-_AddIPSS -BNB. 07!11/83 174 1 ~ GUARANTOR INFORMATION ROBERT JENKINA7 W 1704 WHITE OAK 1704 WHITE OAK OENTON, TX 76201 JOHNCON, CHARLOTTE 10000960 03/11 /03 1, 057, 05 0. 00 -1 477, 64, , 4119 41 AfUEpr 1nCPranCl2NaVe06/10/93 Addres 200 1 " y ww GUARANTOR INFORMATION 4*' DAVE JOHNSON AT I KNOB HILL PRIEM TX 75034 JOHNSON, GEORGE PHILIP 100605SO 11/14/93 4,093.05 0,'00 »4,334.13 9919.92 Af pr fn=prance4No A12/23/03 9 1 y 00 GUARANTOR INFORMATION GEORGE PHILIP JCLIN80N 1305 SAYN MAWR DENTONr TX 76201 JOHNSON,LOt8 JEANNF 1000715D 02/95/O3 435.60 0:00 0.00 435.60AfOpr InIpranca3Refu03e2d2J/9PDy 006. L y GUARANTOR INFORMATION DARREL JOHNSON 139 VILLAGE MHP LEWISVIppLppLE, fX 75067 JOHNSON, SHERRY Y. 10003697 03/10/03 631.60 277.40 0.00 909 e00RSP -IP 3 '09/1&/83 136 1 r w* GUARF,NYOR INFORMATION A. D, JOHNSON 704 JUPITER DENTQNi TX 76201 I JONE8,26VERLY Medlcade Denied•ggo Response r 10009704 03/06/03 3,165,70 0.00 -2,704,56 461.14 8P IP 3 03/30/83 277 1 4► ww GUARANTOR INPORMATION BILLY JONgn P.O. BOX 304 PONDER, TX 76269 eRTIt,APOLLO Balance After Ins rancWo Response r 00051700 01 /31 /00 730.00 0.00 0 00 730, 00 dP IP 4 335 1 ww GUARANTOR INFORMATION DENNIS STARNES 621 MARCUS LEWISVILLE, TX .75067 Refused to pay u, r r\, \?SR.hsfiMlV7Al4/f~ASF'k~f1~~ C Dl JAN 1984 14R I TD OF P it OPOHT PAGE 4 J (ti PATIENT NAME PAT ID 010C1i0 BEO-BAL NEW-CHO NEW-PAY W-O DAL PC TYPE CYCLE L6T,PMT AGE FG TYPE RUSSELLIEDITH M 00009076 00/In/b2 422.20 233.20 -P,;.26 626.12 10 IP 2 08/22/63 157 1 61 ww OVARANTOR INPORMATION «w HOMER RUSSLLL 1007 DAOSWUOD MANOR LEWISVILLE, TX 79067 ' - No Response WADEIADRtAN CARROL 10014503 04/04/03 31789.25 19,75 -2 544.40 460.60 SP Ip 3 05/01/93 215 l ww GUARANTOR INFORMATION «w CHARLES E. WAnE 630 BEATTIE GAINESVILLE) TX 76240 Arranggements Not Kept WALKER CHARLES WESTLEY 10045363 00/14/03 1,064.46 41036.75 0.00 54401.1 5 MD IP 69 1 ar ww GUARANTOR TNPORMATtON ww VERNIE JEANETTE 8068 AT 7 BOX BIN DENTONI TX 76201 Madlcade Unled•Moved Left No Addr@ss WHYTEIMARY ELIZABETH 40065656 1D/lD/03 202.25 0.00 0.00 202.20 6P ER 17 1 4 ww GUARANTOR INFORMATION rw MARY ELIZABETH WHYTE 160 OAKRIDOE LEWISVILLEI TX 76067 Refused to Pay 3 • weww W-0 TOTALS wwww 001105.67 -701002.31 411309.13 511192.49 • i j i ! J St i 'j 4 , r 14( 1 ff fill 1 'ePhAY.^'t (1 01 JAII 1904 W R I 't E-❑ F V R E P D R T PACE 0..~ r PAT'IENt NAME PAT ID DIOCFIO BEQ-GAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE, LOT.YMT AGE PIP y"CYP~ r ALDERBON,AHANDA 10009496 03/04/03 1,199.70 0.00 -11 Ole, 00 181:70 SP IF 1 04/29/03 747 2 wx GUARANIOR INFORMATION 04 LARRY AIDCROON RT 2 BOX 43 ARGYLC, TX 762,7.6 AN021E, HDNORQUS C, 40016407 04/06/00 73. 90 0.00 -53.50 08bm AW Iwrance&rWAV/Vot'0'121 2 ~ • wx GUARANTOR INFORHATION xx HONOROUS C. ANOZIE P. n. BOX 7402 DENTON NTSU, TX 76203 APPLEOATE, RAY 40013765 03/.6/0'3 115. 79 Q. 00 -40.00 ¢Q~ar>~~ A~t~r I Irenc 4Arr ~g9a3 /a3Not Xep 14 2 y ww GUARANTOR INFORMATION xx RAY APPLEGATE 2217 rY WORTH DR A3N0 RENTO , TX 76201 8 v ARGUITTIBERTHA 70021936 10/29/03 36,85 0.00 0.00 36.25 SP OP 3 67 2 r xr GUARANTOR INFORMATION rx BERTHA AROUITr 114 CAROLINA DRIVE BANGER,' TX 76766 Moved Left No Address ew BARNHILL,KCRRI A 70002314 02/,8/03 120.00 0.00 -75.00 45.00 SP OP 4 ll/15/83 47 2 r wx GUARANTOR INFORMATION xx RANDY DARN!lILL 919 N OAK P 0 DOX99 MUENSTER, TX 76200 Arrangements Not Kept SELVEAL,PAMELA ANN 40061360 09/12/133 56.00 0100 0.00 06,00 SP EA 4 1Y1 2 x* GUARANTOR INFORMATION xw DAVID LEfi RIL.VE'AL 1410 W, OAK M3 DENTON TX 76201 Moved Left No Address BLACK, PAMELA 70000525 04/01/03 00.10 90. 7D 0,00 130.85 8P OP I 16D 2 xr GUARANTOR INFORMATION wx PAMELA BLACK 106 AVE E APT 227 DCNTf7N, TX 7620E No Response DORDEH, R1TA KAY 40014839 03/31/83 46100 0100 0.00 46.00 SP ER 1"' 04/01/93 275 2 M wx GUARANTOR 1N00MATION *x RITA KAY BORDEN 911 GARDENIA 01 AMN Response AMARILLO, TX 74107 ` BOYNTON,DEAU J. 100195D6 04119/03 729.75 -47,50 -970.80 106,45 SP IP 3 00/09/83 81 2 I • xx,OUARANTOR INFORMATION xx VIRGIL OOYNTON RT I BOX 63ON BANGER, TX 76266 Balance After Insurance-No Response BRADSHAW4DOBBY L, 96000204 02/01/03 39.00 0100 0.00 39100 BP OP 3 330 2 wx.OUAAANTOR INFORMATION xw DOODY L. DRADSPAW ' 1,104 N CLEMENTS GNINE SVIL6e, TX 96240 ` Resp DRIETHA(I ALDCRT L.,111 40051815 08/11/03 96.00 0,00 0100 06,00 BP an 4 142 2' i rx GUARANTOR INFORMATtON xw ALBGRT L, DRICTHAURT, 111 1140 FRENCH 8T IRVINO~ TX 7 Obl Moved Left No Address • i BROADUB,D000LAS 0 00009282 09/17/02 53.25 13.'00 0.00 66.25 9P OR 3 06'/@1/83 194 R ' r GUARANTOR INFORMATION rx DOUGLAS BROAaOS 208 RUDDSLL APT 54 NDE TON, TX 16201 o Response BROTHERS, UORCY A 400Jg973 03/79/03 112.0 0100 0.00 112.10 ' ` SP CA 3 284 2 w* GUARANTOR INFORMATION w0 AUDREY BRf1THERR 921 RUTH DENTON, TX 76201 No ResponsA r DROWN, DANNY F.. - 40000709 08/63/03 30.00 10150 0. 00 56.50 8P ER 3 320 2 r* GUARANTOR INFORMATION *w BOB CRISP 1414 NORTH RUUDELL DERNeTON,TX 76701 N DRUCE, OWEN00LYN JEAN 70007364 04/02)83 27. 00 0.00 0.00 87.00 SP OP 4 wx QVARANIOR INFORMATION wx DORIB NELL OROAOUS 208 SOUTH RUDDELL 4014 DGNTON TX 76201 200 2 r " N0 Response 40 BRYANTACHY D 10011591 04/12/03 169.90 45100 -914,20 104.30 SP IP 1 06/17/83 79 2 xx GUARANTOR INFORMATION rw RICKY ONYANt, OR RT 7 BOX 418-D OENTON, TX 762TI Balance After nsurance•No Response 0 BURKHAM, OODDY J. 40013093 03/P.4/03 62.70 0. OD 0.00 62,7B SP CA 4 281 2 *x GUARANTOR INFORMATION xr BOBBY J, nV11KHAM 29 JVPITAR DENTON) TX 76201 Moved Left No Address r CLAYTOR,TIMOTHY J, 40020870 05/94/139 177.00 0100 0100 177,00 SP EA 2 222 2 Ir ■r GUARANTOR INFORMATION xli TIMOTHY J. CLAYTOR 2315 RODINWOOD OCNTON, TX 76201 Insurance Donled•Moveq Loft No Address V e ,._i.L 4 .1a. "'.0 1, wY. w,. ..Pe,t ~s J 01 JAN 1984 WR I Tr -0PF REPORT PAOE6 PATIENT NAME PAT lD d18CH0 D>;0-SRI. IJEW-CHG NEW-PAY W-0 DAL PC TYPE CYCLE LST.PMT AGE FO TYPE to COLE,ANGELA MARIE 40009644 09/06/83 168.00 0100 0100 168.00 SP ER 3 116 2 wr GUARANTOR INFORMATION wr HUSERT C. STOKES 986 Pf WORTH DR. DHNVed, TX L Ho Addre55 0 COLE,EVOENE 40010026 03/31/03 79.25 0.00 0.00 MM79.20 t3P 001E1R l 273 2 4 nw GUARANTOR INFOnMATION ww EUGENE COLT 910 0 LOUSY N9 OEN Moved X 7No~~ Loft ~ 2Address CONATSHO,RICHAnD WADE 40007437 02/27/83 98.50 0.00 0,00 98.80 HP ER 3 307 2 V wr GUARANTOR INFORMATION ww RICHARD WADE CONATSEO AT I BOX 1160 FRISCdr TX 73034 J No Response 1 COOK,PAUL 0 40012205 03/19)O3 55.00 0,00 0.00 118. 00 8P ER 3 286 2 • wr GUARANTOR INFORMATION ww PAUL 0 COOK P.O. BOX 125 FRISCO TX 75034 Moved Left No Address COX, DAVID A 40006942 02/96)03 61. 45 0.00 0.00 61. 45 SP ER 3 306 2 ww GUARANTOR INFORMATION rw DAVID A COX 1111 FANNIN DENTON, 1 76201 No Response CRIBMANrHELEN C 40015976.04/04/03 73.20 0.00 0.00 73.20 SP ER 1 271 2 ww GUARANTOR INFORMATION rr HELEN C. CRISMAN 316 PRY #.-12 DENTON, TX 76201 No Response CULBERTrMICHAEL 8 000160D2 01/10/03 46.35 0.06 0100 46,35 OP ER 8 351 2 w wr GUARANTOR INFORMATION rr TRACY CULDGRT 915 SUMMIT 850 ARLINGTON, TX 76013 'J No Response CURT$INOER,CHRIBTI 00016994 10/10/01 42.00 DO.80 =00:00 63.08 8P an 2' 06122/93 19 2 M • ww GUARANTOR INFORMATION rr CHARLES CURTBINOWER 900 PEOUES 8602 BAN MARCUS, TX 78666 No Response DARROVOH,OLEN D0017090 01/03/03 14.00 0.00 0.00 14,50 8P ER 3 363 2 • rr GUARANTOR INPORI1ATfON wr GLEN OARROUGH 213 AVE 0 818 DENTON, TX. 76201 No Response DAVIS,JEREMY 00017409 06/00/08 242.06 40.00 -65.00 137.56 SP IP ' 3 "10)27/83 66 2 • 9k GUARANTOR INPORMATION rr RICKEY DAVIS 605 N COWON DECATUR, TX 76234 • Balance After Insurance-KcI Left No Address OAVIS rLARRY 0. 40013070 OO/P3/03 123,50 0 ,00 0, 00 125.50 9P ER 3 281 2 , wr GUARANTOR INFORMATION wr LARRY O. DAVIS 9911 WHITEHURBT 8703 DALLAS, TX 70243 No Response DAV19t§ANOY.R. 40006074 02/22/83 41.80 0 60 0,00 41;88 SP ER' 3 312 2 *r GUARANTOR INFORMATION rw SHIPLEY DAVIS 3125 97H ST 06 WICHITA FALL$r Tk 76301 4 No Response DAVIS,VIOLA 0, 40012551 03120/83 69.15 01'00 0.00 69.16 9F ER 3 286 2 *r OUA04NYON INFORMATION rr VIOLA P. DAVIO PO BOX 364 TIOOA, TX. 76271 No Response DICKINSON,RU6AtLL W 00016407 01/21/03 93.70 at. 00 0.00 176.75 9P SIR 3 lq 2 • rr GUARANTOR INFORMATION wr RU96ELL DICKINSON 710 008E BY DENTON, TX 76201 No Response DOAN,DONALD L. 40008302 03/03/03 71.00 0.00 0.00 71.00 SP ER 3 304 9 • rr GUARANTOR INFORMATION wr DONALD L. DOAN 5216 YAOAR VIE COLONY, TX 75056 No Response DODBSr ANGELA D. 40000435 01/03/03 55.50 0. 00 0.00 55.00 SP ER 3` 303 2 " • rw.OVARANTOR INFORMATION rr ROBERT IIAi.L 1706 VILLAGE EAST #901..DENTONr TX 76201 • No Response DOUGHERTYrROSB MARY 70021126 l0/18/03 63.00 0.00 -0100 63,160 SP OF l 74 2 • rr OVARANTDR INFORMATION w* PHILLIP DOUGHERTY PT 2, DOX 119 SPACE 811 AROVLE, TX 56926 J Moved Left No Address DU 9010ihOLI99A B. 40D13443 03/24/03 '57.75 -0.00. -46.20 11.05 SP PR ' 4 05/16/83 230 e) r• GUARANTOR INFORMATION ww JOHN DU DOJS 706 WALTER RO OAINESVILI.Er TX 76240 Balance After Insurance-No Response f lrirrr i rue..;...' 01 JAN 1984 WR t re-OFF • R E:POR 1 PACR7 V PATIENT NAME PAT ID D1OCIIG OEO-BAL NEW-CHO NEW-PAY W-0 DAL FC TYPE CYCLE LOT,PMT A0E FO TYPE r V ~ EARL, FAYE N 00019711 00/12/02 255. 90 0.00 -199, 90 90.00 SP IF 3 07/19/03 167 2 V ww GUARANTOR INFORMATION Ww RONALD EARL AT 6 BOX 205 GAINB'OVILLE. TX 76240 r Arrangements Not Kept E00LESTON,DINAH 8 OOOPOO09 01/13/n3 491.75 0.00 -313.40 178:33 OP OP 0 02/16/83 319 2 V ww OUARANTOR INFORMATION ww DANNY EOGLBSON AT D BOX 68 SILVER 00116 MHP DENTDN, TX 76201 Balance After insurance-Aefused to Pay ELLICTT,STEPHEN A 40034274 06/12/03 52,50 104.99 0.00 187,40 DP HR 2 10 2 V w~ OUARANTOR INFORMATION w~ -WILLIAM A rL.LIOTT 3984 REDSTONE DENTON, TX 76201 No Response EPTINO, TIM M. 70001429 02/16/03 59.40 0.00 0.00 99,40 OP OP 3 02/17/83 310 2 4P ww OUARANTOR INFORMATION wx TIM M. EPTINO 2010 POXCROFT DENTDN, TX 76201 No Response ESCAMILLA,YCLANDA 40009367 03/06/03 39.50 0.00 0.00 39.50 OP ER 3 03108/83 299 2 xM GUARANTOR INFORMATION xw YOLANDA ESCAMILLA R'f 7 BOX 510 DENTDN, TX 76201 r No Response ESTRADA, CLAUDO A 40003063 02/12/03 b3. 25 0100 0100 53.29 OF CA 3 019 2 V wx OUARANTOR INFORMATION xx ARELIB OE CSTRADA 2908 CHARLOTTE 07 DENTDN, TX 76201 Arranggements Not Kept EVANS,PEAALIN6 00081055 01/4+3/03 149,89 0.00 -56.20 89,05 MC ER 3 03/08/83 299 2 V xw OUARANTOR INFORMATION rw PE'AALINE EVANS 525 CHAMBERS DENTDN, TX 76201 r Balance After Medleare•No Response FISCUS,nHETA 0 40002982 02/12/03 40.00 0.00 0,00 40.00 OP EA 2 319 2 y wx OUARANTOR INFORMATION uw SRATT FISCUS 9035 EMNORA HOUSTON, TX 77080 No Response FOLEY, DENISE L 40009003 03105103 43,00 0,00 0100 43 00 ADD ER NO 302 2 r ww OUARANTOR INFORMATION *4 OENINE FOLEY 1503 SUNNY SLOPE DR CARROLTON TX 78007 Moved Left No Address FRANK,MAROIE 00023036 10/09/02 371,00 0.00 -260,00 111.00 SP IP 2 '03110/63 897 7 r ww GUARANTOR INFORMATION ww MARGre FRANK 224 BRYAN DENTONr TX 76201 Balance After insurance-No Response FULLER,CAROLYN RUTH 10010684 04/0t/O3 428,10 00.00 •440.10 15,00 SP IP 4 08/03/03 191 2 r ww GUARANTOR INFORMATION xw CAROLYN RUTH PULLER. 304 8 RUDDELL PHONEIX APT N96 DENTDN TX 76201 1 No Response AALLO,LWER 7 40054771 08/21/03 61,75 0,00 0,00 61.75 OP ER 1 132 2 r wA OUARANTOR INFbnMAT16N wr LOCKER T OALLO 0/0 ANT1A HALLO 2408 ROBINWOOD LN DENTDN, TX 76201 No Response. GREATHOUSE TAACY L 40057093 00/29/03 04.39 0100 0,00 94.45 ADD ER NO 122 2 r/ rx OVARANTOR INFORMATION ww TRACY L OREATHOU8E AT 7 BOX 20 MAYHILL MHO DENTDN, TX 76201 w Moved Left No Address JAMES, J. D. 40010376 04/14/n3 133.00 -13.00 0.00 120.00 OF EA 3 291 2 GUARANTOR INFORMATION xw J. 0, JAMES 2901 W OAK M43 DENTDN, TX Y6201 el✓ Moved Left No Address JAME8,RENUR A 40013047 03/83/03 4S; 00 0.00 0.00 48.00 OP 6R 4 284 2 r ww GUARANTOR INFORMATION 4* RANDY ROCHA 9767 DENTON DR 109 DALLAS, TX 79221 ry ; No Response JwVOUARANTORNfNfORNA7i 00036012 01/04/03 I11.25 0.00 0100 111.29 OF _OP' 1' OAR 2 w y ON xw ANTHONY JONNSCN 209 AVENUE 0 #8 DENTDN, TX 76201 No Response JOHNOON,LEE E. 40011074 00/14/83 210.25 66.90 -160,20. 109,00 Op ER 3 10/31/83 54 2 ww GUARANTOR INFORMATION wr LCE O.,JOHNOON 696 BOARDWALK DENTDN, TX 76201 • No Response JOHNOTON,WILLIAM GLEN 40061580 02/07/03 50,45 0,00 ' -29.79 $8,70 OP 8R _'3" 05/09/03 237 2 r a4 OUARANTOR INFORMATION wr LANA JOHNSTON PO BOX 220 ROANOK4, TX 76262 No Response r ~ • ~ fir. r!J ~ I.. i... . n<r. ,,.r : r.:r 6+-~ rouuwv .-s.e<n b..WN is Nw2t 9 Y~ 00 yl eY 01 JAN 1984 WA I TE -UF1° R E P U R T PAGE8 ~J PATIENT NAME PAT ID DISCHD REO-BAL NEW-CHO NEW-PAY W-0 BAL FC TYPE CYCL9 L.ST,PM1 ARE Fo TYNE w ~J OLIVIENOIRAFAEL 00001000 12/04/02 181,75 0100 0.00 101.73 ADD ER NS 393 2 • ; rr OVARANTOR TNPORMATION al RAFAEL OLIVI£RO 20120 W PRAROe 001 DENTONI TX 76201 ~j No Response-Unable to Locate BTAFFORDIDAVID 4008284412/03/83 67,90 0100 0.00 67,00 SP OR 4' 20 2 • MM OUARANTOR INFORMATION r~ DAVID STAFFORD 2800 PT WORTH DR DENTON# TX 76201 • Moved Left No Address VAN HORNIAMY ANN MARIE 40064?619 10/11/03 103.10 07.90 0100 161.00 SIP ER 4 48 2 • ~r GUARANTOR INFORMATION wk LAWANA VAN HCRN RT 2 SPACE 30 WAKSTON MHP LEWISVILLE, TX 73067 • No Response WILKINSONIFREDDIE_ 40073983 10/29/03 91.80 0.00 0.00 91. Ile eP, ER 3 62 2 • e~ GUARANTOR INFORMATION rM FREDDIE WIL,KINSON 400 BRADSHAW DENTON) TX 76201 ~j i-~ Moved Left No Address WILSONITROY 0 40064610 09/.3/83 79.75 24.00 0.00 103.70 SP ER 2 96 2 • ral GUARANTOR INFORMATION «r BRENDA WILSON DAVIS TA CAT N4 LAKE DALLASI TX 70060 ' Moved Left No Address _ • rre+t W-b TOTALS itrwr 71080.71 -31881.23 • 9"Z 43 41936.89 I • 1 EA ' ~ 1 0 1 ' n 1 4a9/ rytyl`g i 01 JAN 1904 WR I TE-3r F R C P 0 R T PADS9 PATIENT NAME PAT 10 D1800 0110-DAL NEW-CNO NEW-PAY W-0 DAL PC TYPE CYCLE LDT.PMT A05 FO TYPE 1 _ . v , y BARNETT,INF M 00004640 00/04/DO 4j 245.00 0.00 2DO.00 3,910.00 DP IP 3 09/86/93 97 0 V *r GUARANTOR IMFONMATION +1* KENNETH OARNEI'T 3935 WILLOW RUN LEWISVILLE# TX 75067 r Bankruptcy... v M•** W-0 TOTALS MM** 4,$40,00 -M.00 0. UO 3, 9gtl, 00 ~ 4P r r I Iv d M « Y a ! rl w s; ~ w ~ i M to r 00 i fto t 4 Ao: 4 . .a r ,4...py v J'.rkW ..x=0:.ro ,:s... n ,4n.u etrcea. ro I r1 1 1 w r~ 01 JAI! 1404 WR I T E-0FF RF- P 0 A T PAGE 10 PATIENT NAME PAT ID DIBCHO BEO-DAL NEW-CHO NEW-PAY W-0 RAL FC TYPE CYCLE LST.PMT AGE FO TYPE ALLISON, JOYCE 1Ob1223D 03/10103 1,405.05 0.00 -1,338.95 66.50 BP 1P l 04/25/03 251 6 • ww GUARANTOR INFORMATION ww VEBTER AL4ISON RT 0 BOX 66 PILOT POINT, TX 76208 Balance After Insurance-No Response ANTOINB,JUSEPH 40017360 04/10/03 ; 04.25 0.00 0,00 84.25 SP ER 2 264 6 • rw GUARANTOR INFORMATION wr ROTH ANTOINE 715 1/2 ALEXANDER 201 09NTON, TX 76201 r~ No Response ARNOLD,JAME9 40070815 10/16/03 104.75 0100 0.00 104.75 SP ER 1 76 6 • wr GUARANTOR INFORMATION ww JAMES ARNOLD Ilio GREG DENTON, TX 76201 Y Insurance Cenied-Roved Left No Address ATKINS,CANDICE D 10005826 02/17/03 990.30 119.15 490,30 119.15 OF tP " 3 04/04/03 121 6 • ww GUARANTOR INFORMATION rr T H ATKINS 615 CRESCENT DENTONI TX 76201 w Balance After Insurance-Arrangements Not Kept BATEMANrSHERRY E 40014242 041171(33 153,15 0,00 0100 103.46 SP ER 3 26'13 6 • ww GUARANTOR INFORMATION wr BRIAN BATEMAN RT' 2 BOX 32 WILLS POINT, TX 76169 Nn Response BISHOP,J6ARY W. 40013307 04108/03 92.10 67.75 -92.10 67,70 BP ER 1 11/14/B3 48 6 • rr GUARANTOR INFORMATION wr JERRY W. 918HOP 2D04 W UNIVERSITY DENTONI TX 76201 e Balance After Insurance-No Response .r ULEDSgE,NATHAN E 40010798 04/16/63 48.00 0,00 0100 48.00 SP EA a • rr GUARANTOR INFORMATION ww RAY OLEDBOE 120 TONGLEWDOD DOUBLE OAKI,TX 79067 259 6 . ' 90YER, KENNETH J 40002560 02/10/03 126, 37 9. 20 O, Gb 135. Moved 62 aP Left NoEAddress 3 ' 02/17/e3 316 ' 6 ' • ww GUARANTOR INFORMATION • KENNETH J BOYER 2304 PALMER DENTON TX 76201 NO Response RRANDENDURO,DANIELLE LYNN 40055916 b0/26/03 55.40 0.60 -70,40 15,00 SP ER 2 09/t4/83 109 6 ew GUARANTOR INFORMATION wr HELEN BRANDENOURO 710 PONDER BY DENTON, TX 76201 i Balance After Insurance-No Resnnse , fir', 1`j k 8R18ENOrMANUELLA 40D34092 06/12/03 6. 1110 13`(36"'' 0.00 iq,86 8p ER 3 06713/83 146 b ' a • wr GUARANTOR INFORMATION +~r ANTONIO DAIBENO 932 S. ELM DENTONI TX 76201 116 Response el Y ONOCKMAN,JERRY W. 40064046 02/15/03 79,25 10.00 0.00 79.25 BP ER 2 310 6 ww GUARANTOR INFORMATION rw JERRY W. BROCKMAN PO BOX 1055 DFNTONI TX 76201 i., Moved Left No Address BROOKE WILLIAM, 10006718 02/17/03 945.75 f8 SWEET GUM 151.41 SP IP 1 04/25/03 261 b ~ ww GUARANTOR INFORMATION rw WILLIAM BROOKS 711S SWEET QUM DR LEW1WISVILLE, Y$ 75 75pb7 Balance After Insurance-No Response OROU89ANU1 CAJUN R. 40Q6092b 10/00/03 04.65 0.00 0.00 84.65 SP ER 4 03 6 1 GUARANTOR INFORMATION rw CAJUN R, BROUHSAND PO. BOX 92F POOLVILL$, YX 76076 Moved Left No Address BROWN, JAMES 0 00009003 01/06/03 68.75 -0.00 0.00 68,70 SP LR 3 360 6 k 11 rw GUARANTOR INF0411ATION wr CHARLIE BROWN $01 GLORIA COURT PORT NATCHE8 TN 77777 Insurance Denied-No Response BRUCE, KAY R, 40027845 05/17/03 48,00 0. OD 0.00 40.00 SP ER a 220 6 wr GUARANTOR INFORMATION rw KAY R. BRUCE 202 WEBS RD DENTON, TX 76201 Moved Left No Address 1 BUL.TERiJ014N T. 40019071 04/19/03 90.79 0.06 0,00 00.75 SP ER 3 250 6 ' w► GUARANTOR INFORMATION rr NANCY OLIVER 206 LANEY RD DENTON, TX 76201 Moved Left No Address RUSH,CHRISTpPHER A. 100314161 06/10/03 I,B96,90 -49.50 -1, 477. 02 731DS SP IF 2 00/19/83 lag 6 Ba CODVGGtNDEEOM INFORMATION wMA0tl0t976Db2H08105 74, 39 `D~00 [CKE40tl35 AUBT2I6,lOOXance SP 711704 Aeponspona Insurance- After fter a ko 00/0103e • rw GUARANTOR INFORMATION wM GERALD CODY, SR 15452 KENNEBEC BOUTHOATE, M1 45EA - 193 129 6 Balance After Insurance-No Response 1l] i i! { 111 IA, a , t w' 01 JAN 1904 W II I T Et - L1 F It fl E P tl it T PAGE It v PATIENT NAME PAT 10 DISC110 DEG-UAL NEW-CHO NEW-PAY W-O GAL PC TYPE CYCLE 4ST,PMT AGE FO TYPE v V , COLE, ANGOLA M. 40040040 07/OP /03 1411.00 0.00 0.00 1413.00 SP ER 2 179 6 ` rr GUARANTOR INFORMATION rr EVELYN STOKES 992 PT WORTH DR DENTDN, TX 76EO1 Moved Left No Address r COLLEY,DIANE L 40064063 09121/03 70,73 0.00 0100 78,75 or ER 1 fOl b y rr GUARANTOR INFORMATION rr DIANE L COLLEV GENERAL DELIVERY ROCKY POINT, TX 73034 CONNOR, Moved Left No Address v J CHANTHlNI R 40020930 04/24/03 40.00 0.00 0100 46,00 SP ER 4 251 6 y rr GUARANTOR INFORMATION rr 'CHANTHINI q CONNOR BOX 7101 DENTDN, TX 76201 No Response r CORNWALL,LOIS MARY 40015039 04/01/(33 163,30 0.00 -130;130 32.70 SP ER 4 06/09/83 206 6 y rr GUARANTOR INFORMATION rr ROBERT CORNWALL- PO BOX 14 MAVERICK TRAIL LITTLE ELM, TX. 75068 Balance After Insurance-No Response CRAWFORD, MARGARET A, 40006124 02/22/03 38.00 0.00 0100 30.00 Bp ER 3 31P 6 y rr GUARANTOR INFORMATION rr MARGARET A. CRAWFORD TWIN LAKES MHP 238 DENTON, TX 76201 CRUTBLNOER,JIMMV W 00016311 No Response 410 0E/10/03 8t. 25 0.00 0:00 g1. 90 $P " ER 3 336 6 y rr GUARANTOR INFORMATION rr JIMMY CRUTSINOER BOX 721 PILOT POINT, TX 76258 CURNETT, KEVIN 40000377 03/03/03 (34, 00 0.00 0100 84.00 anSCp OenEeNd•NO RNaSponfe V rr GUARANTOR INFORMATION rr JOE OLMSTED 701 HETTIE DENTDN, TX 76201 303 6 No Response DARNALL,SHEILA $ 40003972 02/113/03 40.90 0,b0 0.00 40,90 MC ER 318 b y rr GUARANTOR INFORMATION rr SHEILA S. VARNALC• ell! WINDSOR DENTDN, TX 76201 Applied to Medicare Deductable-No Response e>r DAVIB,ANN61E K 40004376 02/16/03 02,00 0,00 0100 52.00 SP ER 3 3l$ 6 y fb.GVARANTOR INFORMATION rr DARLONE DAV18 800 14ELCH DENTDN, TX' 76201 No Response DAVI9,JOAHUA,0COTT 40005290 02/19/03 74.00 0100 0,00 74.00 9P ER 0 314 6 r rr OUARANTOR INFORMATION rr SEVERELY DAVIS, 8 16 LIVE OAK LANE LAKIY DALLAS, TX 78060 Insurance Oaniod•ND Response DAVIn,MISTY N. 40019622 04/18/03 40.00 0,00 0,00 49,00 OF Ell 3 237 6 r r■ OUARANTOR INFORMATION rr CHARLES DAVIS f004 JOHNSON M1 DENT0% TX 76201 Unable to Locate d ' DAVIB, REID A, 40019572 04/18/03 s; 30.10 0.00 0.00 50,10 OF ER 3 237 6 r rr GUARANTOR INFORMATION rr ANNETTE CRISMAN 1020 FOX AVE 210 LEWI9VILLE, TX 75067 No Response eY DEVEREAUX,MA9LE M. 00010242 01/00/03 1,745,00 0.00 -1,600,00 90.00 8p 1P 3 02/16/93 3110 6 V rr'GUARANTOR INFORMATION rr WILLIAM DaVEREAUX Ill 9 CRAWFORD DENTDN, TX 76202 B DILHORE,RODERT 8 40009391 02/04/03 38,00 0.'00 0,00 3galance After YnSUrenCe•NO Response 00 ER a 390 6 V r! GUARANTOR SNFORMAT'.ON rr NgDERT S. DILMgRE, $R. RT 9 THIN LAKES 0163 DENTDN, TX 76201 ' 4r t DOCKERY,D6891E 10090303 04/C9/a3 3,981.83 Insurance Oenietl•NO,Response rr GUARANTOR INFORMATION rq 098919 DOCKRRY 307 7 K 0 IRKLgNO RKLAND,40 13,40 MC 1P 07/00/83 180 6 I`~ $ANOER, TN 76266 ~ Be anco After Medicare-No Response DOERELINCER,DAWN M:' 60010671 01/22/103 186.00 0'00 0100 196. 0 OF `ER 3 " 044 6 4 4r GUARANTOR INFORMATION rr JACK DORRFLINOEA 1030 MCCOROYCK DENTONr TX 76001 No Response M DRAPPEAUX,THERESA 40009919 03/09/03 74,50 0.00 0.00 74,50 8P ER 3 03/09/93 997 6 0 ri~ GUARANTOR INFORMATION rr DEBBIE DRAPPRAVX RT, 9 BOX 341P FRISCO,-TX 73034 No Response DUNCAN,M P 0001918[! 01/03/ccl 42.70 0.00 0.00 42,73 9P EA 0 363 6 rr GUARANTOR INFORMATION rr H P DUNCAN 3313 KINGFISHER DENTDN, TX 76201 Insurance Denied-No. Response, • 4,. 11P«Ckn<'n'.vrA's A• ^ . . v.<v.._a,r..a.w.u.+.. J3 01 JAN 1904 N R 1 C E- 0 F P R E. P 0 R T PAGE IP Or ~J PATIENT NAME PAT 10 DIOCHO DEO-BAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LST.PMT AOE FO TYPE EARWOOD, MARTEL, L 40007406 02/.~ .7/03 45. 75 40,70 0100 86. 50 SP ER S l0 6 M ►r GUARANTOR INFORMATION rr MARTEL VARWOnD, L 605 N AUSTIN DENTON, TX 76201 V No Response ELDER. MUNSEY R. 10007169 02/ES/03 Z000.40 0.00 -2o466.40 34: 00 MC IP 05/ii/a3 235 6 14 wr GUARANTOR INFORMATION rr MUNSSY R, ELDRR 1212 N CORINTH AT 4 DENTON, TX 76201 r Balance After Modlcare•No Response CNOLAND,UON 00020430 01/30/03 78,00 0.00 0100 78.00 SP ER 4 336 6 y wr GUARANTOR INFORMATION DON ENGLAND PO BOX 270 KnUM, TX 76249 No Response ERLER,13USAN 00090669 10/16/02 60.25 0.00 --45.00 35.25 ID ER 3 06;0:5/83 209 6 w rr GUARANTOR INFORMATION SUSAN ERLER 1912 PAISLEY DENTON, TX 76201 No Response ESCOVEDO,MICHAEL 40004079 02/15/00 49.00 31.80 -19.00 65.80 SP ER 3 04/11/83 17 6 M rr GUARANTOR INFORMATION rr RAY EBCOVEDO $15 SMITH 67 DENTON, TX 7620A 11 No Response EVANS,MAVRICE 40604691 02/18/83 01.70 0. DO 0100 61.70 SP ER 3 317 6 4 rr GUARANTOR INFORMATION rr MAURICE VANS 910 EAGLE 11221 DBNTON, TX 76201 40 " No Response PEIGL, J11MN A 40064396 09/22/U3 (34,00 0.00 0.00 84.00 8P ER 1 99 6 1r GUARANTOR INFORMATION rr JOHN A P'EIOL 611 1-35 #211 DENTON, TX 7b201 40, Moved Left No Address, FERRYMANtJ05Y L. 40007809 02/28/83 136.'35 0.00 48,68 87 67 8P ER 4. -03/01183 276 b 40 Mr GUARANTOR INFORMATION rr JEFF FERRYMAN 8X171 JUSTIN, TX 76247 1 Wince After Insurance-NO Response FLETCHEiRiWAYNE, L 40005134 02/19/03 69.715 0, 00 0.00 68,75 SP ER 4 315 6 I Y„ rr'OVARANTOrt INFORMATION r• WAYNE+ FLETC118R, L 915 SOUTH ELM DENTON, TX 76201 r1 No Response FRAXER,JAMES W 40038020 06/24/83 110175 0,00 0.00 110,75 SP ER 1 190 6 b M► GUARANTOR INFORMATION rr JANBS W FRAZER RT I SOX 3620 DENTON, TX 76201 Rpoveed eeft No Address PUL9RIOHT,ANNEE M 00093949 12101/64 107.10 0100 0.00 107,10 ~p ER 1 396 6 1 r rr GUARANTOR INFORMATION NM ANNIE! FULORtOHT 6AS CHAMBERS OENTON, TX 76201 M j Arrangements Not Kept PULLER,RODNEY 0 00003697 12/02/02 38.00 0.00 20.00 13,00 SP ER 1 OS/00/83 146 6 ' C Y GUARANTOR INFORMATION +r RODNEY FULLER RT 1 ALVOROTON, OH 435081 VP GONIALES,SRNSSTO 10006142 09/30/03 10180.30 0100 0.00 1,180 31 Se IP 3 47 6 0 GUARANTOR INFORMATION r• ERNSSTC GONZALES 900 CLEVELAND DENTON, TX 76201 40 i Moved Left No gddrgss JACOBUS,R011ERT A 40022147 04/20/83 79.75 0.00 0.00 79. TJ SP ER 1 247 6 0 rr GUARANTOR INFORMATION rx ROOKA T A JACOBUS 1000 E:LMWOOD LtWISVILLE, TX 75067 M No ppESppnse JAME9iLES'TER 0 40002214 02/09/03 38.00 0.00 0.00 35.00 SP ER 2 325 6 0 rr GUARANTOR INFORMATION rr LAWRENCE JAMES 716 JANNIE DGNTON, TX p7R6POS Y JODCINURU S 40010969 03/13/63 49.30 iO6; 01% ' - 0.00 1$SkBISesCOnse ER,, 2 136 6 40 r► GUARANTOR INFORMATION r* NURU'S 0099 1401 FORT WORTH DR OENTON, TX 762.01 • ' JOHN90N,LARRY 0 00036991 01/10/03 09.50 0.00 71.60 17W"W" ER 0 02/91/83 314 6' 0 r0 GUARANTOR INFORMATION + LARRY JOHNSON 2100 OUAIL RUN RD DRNTON, tX 76201 1 JOHNSON,MANY A 00036315 01/27/83 460.75 '0.00 368,70 100 00 BP IP 3 07/112/ 163 6 41 rr GUARANTOR INFORMATION CLYDR JOHNSON 2416 ROSELAWN DENTONo ~aence 9 p 16901 InsurasCncq•NNpO, RReefspO 4@ w r i, a , K IxWV: I 01 JAtl I9G4 WR 1 T 1: -0FP R EPOR T PAGE 13 PATIENT NAME PAT 10 DIOCHO DEG-DAL NEW-CIIO NCW-PAY W-0 DAL FC TYPE CYCLE L13T,PMT AGE !:0 T'iPE l 1 . ,y V t.L'ATON,EVELYN J. 40050944 00/17/03 136.75 0.00 -20.00 Il6.75 BP ER 1 09/93/03 10tl 6 r j lx GUARANTOR 1NFDRMATION xk EVELYN J. LEAION 581 WINDSOR DR. N19 DENTON, TX 76POI v. R1TER, INFANT 10053644 tl9/l9/03 ' 136,40 0.00 0.00 1D6n tlB&e J Ip 8 lOd 6 _ xx GUARANTOR INFORMATION SHERRY Rl'1O4 619 PURNELL LEWTSVILLi T% 75067 s 'TURLINGTON, AMY L 00070474 Ot/8O/03 170. 25 300.00 -300,00 170~~'It Den}~d-NO 3espoHo/12m 323 6 y Mx GUARANTOR INFORMATION xx WILLIAM TURLINOTON RT 1 BOX 40C ALVORD, T% 76293 WAKUP I ELD, TERESA 40052763 00/14/03 56.00 0.00 0.00 t)6N$dte9Pnse ER 4 _ GUARANTOR INFORMATION xx TERESA WANI:FIELO 1807 NAVARRO VICTORIA, TX 77901 139 6 { V N ed II~ ft NJ Addresgs WILLIARD,.IAHES E 40073660 IO/37/03 106.25 0.00 0.00 106. ~YJ 6~ R 3 64 6 r xx GUARANTOR INFORMATION xx JAMES E WILLIARD R1' A BOX 946 DENTON, T% 76201 r Roved Left No Address v rxxx W-0 TOTALS xxxx 19,969.92 ^131983.44 639, 70 5,680.48 r r j i V v> I rJ M i w • x uwV~wpy 1 Y 01 JAN 1` 04 W R I 'I r 0 P F R$ P 0 R T PACE 14 PATIENT NAME PAT ID DIOCHO DEG-DAL NEW-CHO NEW-PAY W-0 DAL PC TYPE CYCLE LST.PMT AGE PO TYPE NwNN WRITE-OPF GRAND TOTALS NNNN itt R08.6u 412, 961. bb-9,387,00 65,809,86 r + 4 y. • Ir , ~ j , 1 yj s ;ONO lyRli • ..yak VJ 1 ..i. ~ NiN.. lvnNa. a. V.1~ I.n •aa.+ ..a n.u.eM.... v s I V f4 OD: !iq ;10 LFC 1'!~;I 17woow, r, l'r IPI ' 'fw PhTIRIJI',. I'hlIll...,.I'1I1: q!ih1+/JtIall rJl,ln;„,,,.,,...,, A11111tr83.......... C[TY.......... ST ZIP. W0. DTE. AMOUNT. I 11 . .._..T/ ALIMCU,CLI.;..U 40G'171..4!0 EN VP AI_pACCLELIKEII19IP DO~IIARU nCWTONTK- 76201 07/27/88 104.00 Itk`' Balance After Medicaid • r ; ALIA3KAN1 ONAt3Et1 40! (•:79u F'P ~r A,.IMuNARI OFIASFI4 .1' ELL DHNTOII TX 76E01 07/17/83 -17, 79 Balance After Medicaid V AVITIN, IETA •10077646 CA GFM 41`111, [ETA P.O. ROY 1209 10174 ItA gF.IJT01) TX 76201,11/12/83 -48.00 I Balance After Medicaid . UADB, PAULA 400741 U9 Cit ADD W-M, PAUL 306 WE13TWOOD TERRACE UENTON TIJV TX 76204 10129/03 22,'00 1► Balance Aftor Medicaid 1[i. BELL,PG00Y 11 100503HP III ,P MIA.,IIF:NNEIII, 343 StONCOATE N.14HP LnIJtBVILLE TX 79 67. 09/30/130 ..••706,.01 Balance After Mental Health Mental Retardation RRICE, VIUI_A 4J 10070892 11' SP OR I CE~ VIfILA W 1320 ROBERTSON DEfJTgN T% 76901 92/14/133 ••3, 571. 10 4 Indigent Care Balance After Medicaid BROWN soe os/e3 -84.12 a It 01414, SI IAN NMI ROI.AIJO 400'79764 ER SP IlMNIJ,611ANNUW BOLAND RT 2 DOY 391 Balance After aieald TX 7700344 11/07/03 -82;00 ` DRUVJN,t?Nhll:IJJ It. 40046674 rR 11D nPG;Jr4, SHAIJDN R. RT 2 DOX 331 rRIS= TX 79034 07/25/03 -7.00 + Balance After. Medicaid ER Vp DUCHANAILLOIS BANDY OAKS OROUP HOUE WINTON, TX 7690$ 10/14/83 -13.00 OUCHANA'L 1,018 400'! 1006 Balance After Medicaid CADE,UPHRLIA 100213791 IP Vo WFIEt1,I,ARNY _ 304 0 RVDDELL NR7 DBNTON TX._7640t_,06/O2/83 -79.60 Balance After Medicaid CA110BUN,FRAWK.J11 100679DY 1P tip CIMW11J,PrtAWA JR U1 LORWA BURLIZOON TX 76028 !1/22/83 -tt16.99 _,Order of Protective Custody,., CARTCIJ,JEARETTG E 10019040 IP EP CARTER,JGAIRME E BY I BOX 107 AROYLE TX 74224 '04/22/63 -4,7A4.7a 4w Deceased Left No Assets r , . KRUH TX 76249, f 1 /22/83 -219,30 CARIE9, f109ERT 10067969 Its SP CAftTRR RQkAAT _P O BOX 90 Order of Protective Custody j CA404,TAttHY 10091409 IP 4P CATI.114,TA411i 1224 MCDONALD OFNION 1 04/14/83 -42.00 F11 1 Be1wo After }ledl.caid TX 76x0 CLA6 BLLA dAF 10069801 iP 3P CLhRK,ELIk A. 102 1J WOOD DKNTON TX 74201~11/29/eJs 196.00 r Order of Protective Custody CLAY, BRANDO!J S 10066e39, iP SP CLAY, KAT Y, o FT WQATi1 N22 _DViTf1N T,% 7!1201_1 J/10/63. _ (t 114, 69 H Indigent Care CULLUM, JERrtYE 110089276 I:R CC M..410N CUt-JAIL E HCNIN JCY, OT. DENTON TX 76201 12/13/83 79, 40 i, Denton. COL..Jail . V CULLQfi,JItRRYC 460d6464 BR-C0 CUU.IJI4,J&RNYF "O~iiTON Cp.-,WL" E,HCK 5'6NtdN YK 746201. 18/i4'id -00.79 1 Denton to, Jail f ~I.. gkgFt[IUGH,.t)BNIS 40070800.'D DAVJ0f15HHR C1' Y Y'y625 trTRWORTH ~tlRB6N29Ce A DENTMNdiCaid TX 76201 03/01183 x`00' • I V [ Al F0, . ANE3 T 10007916 rR VP 1 L B9,1anck-After, ~{gdi4ajd._.: l DAV[9, KBI»LY ANNGTrE 100$9786 [p'tP DAVfB KGI LY A* TTe RT Ir BOX 340A_ HCICIVY tx X9994 10/03/03 7 133 Balance After Mental Health Mental Retardation DpN/,4D~t, HEATH4N M n0o972rytl FR „6p OC 1 AI.D$OJi, KAxt(J j~0 S. RUDpELL Oat 17Ce AIIkNTbNdlCaid TM 76261 tie /tti83 11, 00 J V"._ b UJJLF.S'iRRYAJJ DERRELI. 400773>1 RR SP DO1,JI.CY,EVA l.. 40~N yU.gU I6_Nxon gfftrMo + V EORE5it1AlIE4 30007446 IP. OP GUr?69 bAlJ1EL-...'_ i2~' 3HAU1' SHORES a1a D LIKI Mental DALLAS H@e1th TM1Aal 8'"0'2lti4n3 OiL 00 OAINEA,IJILLIC K 4008'1133.6'N,CC OA1(4BR,11II.L_1~_~__..__... O~KT~N_QG_>1Ai1. pRlitaN, 1.X 74t~9.t:;_l~/.Oq/@3 1 ten Co. Jail ` OAP149A,KRIStill 40002760 ER CC DEIITOII COUNTY JAIL DENTON DENTIN TX 76201 l2/03/0J -51,00 entoA.Co, V B9R ~ I P )ix it i. q 14S , 4 I, ,ys oar...,. Lr ATfVJ''y~ i~ L: 111 06 05 Id I)C•c 1'x37 r,115rtItY' Rt'roltl' PAOE R 4 ► Pnrlrrlt ve, GUARANi'OP JJ/d1V. , r ADDRESS. CITY.......... 97 ZIP.. DIS. DTF. AHOVIJt... ' f to 04014EMLA7RFTIA L 400772£4 1--ft 111) 0ARi?ETt,VANKS8A 904 8 R000BLLN190 DIiNTON TX 74201 Il/10/$3 -25.90 y` ~OIBD8,1x,ArI 100039Ctii it, 8P otl+ne, MAN AT ry Balance After Medicaid 2 DOY .,3 AUDREY TX 76297 012/09/83 air 30 J 0ONZALF2,ARNALDO 40000467 FR CC 001,17/11,112,ARNALDO _ DCNTQN.CQ JAIL DENTON TX-76201.11/23/63 ».140.70 V r 0OiJZAt.I?,I1FI1nLDD 40083730 ER CC DTI/, CO,, riilL Denton Co. Jail IiCK1N)JFY DENTON TAI 76201 12/07/83 -56.00 , Jail HARDY, CY141HiA A 40079390 ER 111) HARDY, CYNTHIA A 1204 MCOONALD Denton CODE NTON TX 76201 11/03/83 -24 25 HAYRS,DROOKB 40084931 (:R CC DTI/,,CO JAIL Balance After Medicaid V S MCKINURY..8TRgFT _ Co, ENTON TX_76201..12/,lit/83 _ -01, 00 ` Denton oJail HAYEB,PAVL B 400825;19 1?11 CC DEiJrON COUNTY JAIL DENYQIJ COUNTY JAIL tl6NTON ~ TX 76201 12102/63 »',19,00 H6J.1149. "ODERTA 40076739 CR MC' FM.LIrJ8, RU88RTA - Denton .CO..JAII 1319 "CIOTFN, ROPEAt 96007316 OP £i0 JA I L r DEl.ITON_COVNrY._ tlENTDNNCN 8T nr?NtON Tx 76201 11/06183 » 14. 80 ' Balance After Medicaid ~ rY.~UDIT0i+5, QENTQN TX- 76201 12/01/63 Denton Co. Jail »12ts, o0 JOHNSON, WILLIAM E. A0091468 FR EP JOHNSON, WILL iA14 l: 17022 WESTWOOD DENTON J TX 76201 0e/10/$3 119. 20 WHOLE,KEVIN L4006969.'. FA CAP K1!1eLE IILLVIIJ.. ..::1.-:._x_4:_ R 21x00 PT WORTt1 Dft.._N7 DEI7TON ~ ~ _~~~~'TX76205"10/ll/n3 -56r 00 ~i K,JM11LEJ NSLVIN LYNN 4.0076~i0 F.R_GP K.I1101 C, f((;LVIN_.L,YriN„ _ 2B. 0 p IndsggeM1t CA re 1 Q_ T Wq~7H_DRDRNTqtj.._ V KINOSLEV, LOIS 40098300 FR 11C KIN09L.EY, LOIS V AT I BOX 2088 indigent Care TON TX 79006 09/03/63 16,80 J)/ LVE, DRFNOA 400631LJ3 FR Mt) LEE:, VNF; pA _ V 2900 HihKLE pR 4DFNTgN *x,76801'09/1$/$3 34,00 ! L~iHNAiJ,CAtlilpliJ~,E 40077000 Wt. 110 LEH;44I4,L0f3t Balance After Medicaid ' LEHMAIJ,CATHHRINF E. 40073538 FR 111) DENTON D&VFLCPMPNT CENYER LOaP 26$ DE14TON Tk 76201; 10/27/63 Q9, 00 I y 8elance.After,Medlcafd..,_. LFRi1Ar BUOY J. , JR A006b.yn'7 E!f 60E .E011/11 1809 6614 at D(INTON T 76201 09/'0/03 r1G. 6A ..',{r LYNCHJKAj)IY 40063,119 Fit. CC, JAIL, VENT ON COllrlt'Y Dt TaN Balance After Crippled Childrens _~p44.p0 rr! %0 LYNCH, KAYIIY 1. 4000212$ EA CC LYNCH, KATHY L pFIJipiJ CO JAI Denton Co. Jail L DZ14TON TX 76201 11/30/93 -51,60 1";« LYNCH, LINDA 4007454.1 VR lit) LYNr.H, LINDA _ u00 8 RU6 ---Den ton.CODENtON Tk 76201 10 30/63 31' OO y `j Balance Afte@r Medicaid A, /,tiFLIA CHARLEB._N2Q, i.hTA TIJ(1MA5 40093b1 t FR 8P 11•AtA, AI5FLIA 990 $ CHARLES APT 026 'LFWI6V1LLF Tk 76067 lb/iID/$3 -$4.00 r+ MATA, THOHAB J 400'13900 FA SP HAt f i tr HCDAtlIt,BR100FTTE L. 10053346 lP 111) MCUAOt,DR IBOpTIP l:, qOG 9 RulinLLL NBalance-Afttep-Madlcaid fx 76It0Ii o9/2a6 N9929 HOROAIJ! IfIBTY Balance At or Medicaid 10057073 10 0C HORO J T. 1 POX 379 rrJb ,00kCL?iJ a_... tl NOER TX 76P66 "51r.70f+.Q0..•_ I, 'D N ON HOROAIJ,MIBTY 10070113 1P co 140ROAN,OORDOH In digant:Care-Previou9ly Paid By County RT 1 BOX 379 831,1064 TX 76966 -330 W. 39 1 Indigent, 4pre ' NKAL6r6L12ABF.NJ 400363:17 ER MM NaALE,EI.I%AIIETH 22i24 CARROLL.BLVD D&TON " 7k 76261 06/18(0 158.30 { V Balance After Medicaid :.Ear. 1 3 _ , IR. 1717 „ , _ CI ,I+I l ~ Rrr nrr AA4t-. r t r tl 6q..••.cVNq; u i1 14 Cb: 117 J0 [1f:C I'1f3J CI~'IRI 11' 1tEl'UR1 PROF 3 1.1 • Iy TWIFI)t PAI, III,. P1 PC. OU1,14111fOR NAME........ ADDREBB. CITY.. UT ZIP.. DIS.DIE. AMDUNl., I~ I pOOL~ DAWBARt, rl,1 IRO:!o0 1 4 Ip P w, GP apCILEIt,UILLIAM 408 CARDINAL DEHT01+ TX 76#0! lb/21/U3 -$0.69 r Balance After Rental Health Rental Retardation BARBARA L._. P.p_I3pX 2402 DENTON TX 76201 06/13[03 ^69.75 indigent Care 16 E PYLrS,PHTI.LIP 10070048 1P SO PYLEG,PHILLIP 725 RIDDECREBT LEWISVILLE TX 75067 tW05/83 -357.60 Order of-Protective Cuatody..._ M RIONEY,JIM111t., LEF 10069408 IP BP 1110PH-Y, JIMMIE LEE PO "Box 1315 LAKE EN ALLAS 7i i666 -11 /04183 r314.g0 I~ R091?, BLA!+CA 1 4007939P.. ER MD Indigent prF, RL•ANCA L__ _ 1721. TEASLEY_0246 Car I Balance After Medicaid 'Y 3W.Vls.p8i,0Y L 10017038 +P tiC SELLERS PEOOV 1. 315 WITHERS DENTON IX 76201 09/05/83 -510.30 f Indigent Care._... BHIIkrOol)Y Lt..r 40074627 0R 110 ii11TH,DARbA(3A 106 AVE A\E it DEI4YON T% 76201 10/30/83 ".31.00 I Balance After Medicaid fIpRAREARY,PC81F 100619x!7 IP 11C 5°PAt3GARY, 0001P _ 14 1,7 NORl1AN- VVN1TON Jk..16801_1110.1/03 _.-41_00 r y SPRAY nGRRY,PAT IIG t. Balance After Medicaid 1000309 IP 11; SPVAYRFRRY,FIATTIC L. 1800 nOL1VAR DE14TON TX 76201 09/05/03 -40,00 _ .._._Balante After. Medicaid -~iTEVt48,OFOROE F 10047040 IP GP 3TEV643,0EpR0E E. :501 N. BRLL 0164 DENTON T% 76201 08/22/63 T 50 70 E3TtlTi9, JA1SE8 40003989 ER CC 4AIL.I+L'Hj014 6,.09. _j Dent D U R V W00_ _ T% T8_7690 76287 1_,1.2/Q.4 09/t7/[83m1_ 1.x,___-0039 40 to 3T0Ut,MlCNAEI. 100517.16 IA 11n " p B - 136 9TCUT,MIOHAEL f0US8261 iP -IiO - BTpIJf,MICHAGI. T-~•-~•-_~+OgDXl36 AU 1 A11R Y_,._._.__~% Y62.YLLt1/07/63 1~,O8if 80 • y STOUT MICHAEL 10073526 IP CC STOUT,MIQHAEL Indigent P.O BUR 1ti. GULL IVAN, FAY 100605:!;} IP MC SULLtt'AlbFAY P.O. AV% 151- Indigent ~~~bT`hp11+f TX 76208 10/'20/03 -23,95 iRUffrP, 5HANIF.I. !j 10)76960 ER 110 TRUIFF, OG1rOI1"AH ...-300B40661KL AI'1' p71uQIJf 7x 76201 11%G9i6a _._-l76, 0 40 0 10 lance AtA p ~!edlcaid TRVITt,DEBORAH 10044162 IP SP 1RUITIrtPEOCRAH 300 8 RUDDELL1171 DE To TX 76201 09/07/80-20,.40 ')ANCE,14ARY 9 w 4005673 OP 11C \Ai,CE, tSARV 409 FUl.TC1J MS JT Balance A~ rr dicaid TX 76201 09/30/83 12.00 - Balance ltfl~n kediCaid TX 76901 09/62/03 -444, WALkEfI, Rf,faDY L. 40049314 Eft GP WALKER, RANDY L. RT" 4 9t1% 19 75 ; DB JTpy A87 pNdlCald i 4 _ WALL13R,NATtlER11JE. MU110 10043651 IP 410 WALLER,RATHERINE MUNDEN„ 16021 VILL,AOE.4aM t) IS~NY TX 7620.1,_;09/,11{93 R9;00 Balance AIt6r lt~dicaid 61 WELLB,ANWE n 1004 15130 IP M,: WRLJ.13 AWNIC R 82.4 RIWECREST l}81JTON TX 7620t 07/26/03 -36.60 Balance IkedicHd WILLINOHAH, DARRY WAYf+ 40081051 ER EP WIL01+0HA14, BARRY' IJAYNE --AT 1, BOX 799J 1 0 W 762G6 1'l /26i83 -20.00 p~pf-Oentoe P61 14 pep rWINUtlM,AMANDA MARIE 40049312 F.1t , HO L+II+DpIS,AMANDA MAR1F_..., ,I09 A„RUODDELL Dead NII On D8NYt1~' - Tx 7b 65.07/21/93 -20:00 Balance AS eP dicaid tti' WISRHAIb1.INDA L 40071706 NQ 6P EVRRETr, LOUTt10HER 808 RUDD8LL 160 lr+f TX 76201 10/19/83 11.70 Balance AQ6t' edicald W0006,ANOELA LACHAII 460460A2' FR' MO Hli.6h t1 WCCDB 30l 8 0RAD8HAW tl~+~tI T% 76201 07/do'na 10. 93 V Balance p~ er N~dicaid ylj WRIOIII,AWN MARIE 40071755 BR 11D k>aIOHT,ANN,MARIE_. _2,29.AYg E.8$A,_ b~NtON TX 7¢201,.10/1943. .40.100 i _ . _ Balance After Medicaid rI I