Case Number: 94D 00172
File Date: 12/27/1994
ST OF KS EX REL SRS
Address:
DOB:
Attorney:
GILLIAM, MICHELLE O
Address:
MANHATTAN KS 66502
DOB:
Attorney:
| Receipt Number | Receipt Date | Payor Name | Total Amount |
|---|---|---|---|
| 15163 | 03/27/1995 | GILLIAM/WAMEGO CITY HOSP | 50.75 |
| 15810 | 04/10/1995 | GILLIAM,M/WAMEGO CIT HOSP | 105.53 |
| 16069 | 04/17/1995 | GILLIAM,M/WAM CITY HOSP | 75.32 |
| 16715 | 05/02/1995 | GILLIAM,M/WAM CITY HOSP | 69.79 |
| 17808 | 05/30/1995 | GILLIAM,M/WAM CITY HOSP | 18.68 |
| 18938 | 06/27/1995 | GILLIAM,M/STATE SETOFF | 0.00 |
| 19572 | 07/13/1995 | GILLIAM/WAMEGO CITY HOSP | 53.18 |
| 21120 | 08/28/1995 | GILLIAM,M/WAMEGO CITY HOS | 35.00 |
| 22076 | 09/22/1995 | GILLIAM/WAMEGO CITY HOSP | 35.00 |
| 23000 | 10/20/1995 | GILLIAM,M/WAMEGO CITY HOS | 35.00 |
| 24360 | 12/01/1995 | GILLIAM,M/WAM CITY HOSP | 35.00 |
| 25142 | 12/27/1995 | GILLIAM,M/WAM CITY HOSP | 35.00 |
| 26685 | 02/12/1996 | GILLIAM M/WAMEGO CITY HOS | 17.44 |
| 28168 | 03/25/1996 | GILLIAM,M/WAMEGO CITY HOS | 21.21 |
| 29384 | 04/29/1996 | GILLIAM,M/WAMEGO CIT HOSP | 35.00 |
| 30369 | 05/28/1996 | GILLIAM,M/WAMEGO CITY HOS | 35.00 |
| 30886 | 06/10/1996 | GILLIAM,M/WAMEGO CITY HOS | 30.59 |
| 31335 | 06/24/1996 | GILLIAM,M/WAM CITY HOSP | 4.41 |
| 47065 | 08/11/1997 | GILLIAM,M/FEDERAL SETOFF | 0.00 |
| Description | Transation Date | Amount Paid | Payor |
|---|---|---|---|
| C/S #017454 | 03/27/1995 | 50.75 | GILLIAM/WAMEGO CITY HOSP |
| C/S #017563 | 04/10/1995 | 105.53 | GILLIAM,M/WAMEGO CIT HOSP |
| C/S #017620 | 04/17/1995 | 75.32 | GILLIAM,M/WAM CITY HOSP |
| C/S #107715 | 05/02/1995 | 69.79 | GILLIAM,M/WAM CITY HOSP |
| C/S #017948 | 05/30/1995 | 18.68 | GILLIAM,M/WAM CITY HOSP |
| C/S-(6-11-95)-STATE | 06/27/1995 | 108.15 | GILLIAM,M/STATE SETOFF |
| C/S #018314 | 07/13/1995 | 53.18 | GILLIAM/WAMEGO CITY HOSP |
| C/S #018582 | 08/28/1995 | 35.00 | GILLIAM,M/WAMEGO CITY HOS |
| C/S #018784 | 09/22/1995 | 35.00 | GILLIAM/WAMEGO CITY HOSP |
| C/S #019033 | 10/20/1995 | 35.00 | GILLIAM,M/WAMEGO CITY HOS |
| C/S #019372 | 12/01/1995 | 35.00 | GILLIAM,M/WAM CITY HOSP |
| C/S #019564 | 12/27/1995 | 35.00 | GILLIAM,M/WAM CITY HOSP |
| C/S/ #0L9973 | 02/12/1996 | 17.44 | GILLIAM M/WAMEGO CITY HOS |
| C/S #021744 | 03/25/1996 | 21.21 | GILLIAM,M/WAMEGO CITY HOS |
| C/S #022103 | 04/29/1996 | 35.00 | GILLIAM,M/WAMEGO CIT HOSP |
| C/S #022386 | 05/28/1996 | 35.00 | GILLIAM,M/WAMEGO CITY HOS |
| C/S #022560 | 06/10/1996 | 30.59 | GILLIAM,M/WAMEGO CITY HOS |
| C/S #022680 | 06/24/1996 | 4.41 | GILLIAM,M/WAM CITY HOSP |
| 19970805-FEDERAL STF | 08/11/1997 | 456.00 | GILLIAM,M/FEDERAL SETOFF |