03/29/2007
4:28:32 PM

MD Example PLLC
Statement Detail Report
FROM 02/01/2007 TO 2/28/2007

 

MD Example PLLC / Xeni Financial

Claims Submission:

     

Claim ID

Date

Billed
Amount

Fee
Schedule

Expected
Amount

Loan
Amount

Activity
Amount

Reserve
Amount

MW
Fees

Debits

Credits

Balance

CIGNA

     

38474A

2/16/2007

2,970.00

972.69

972.69

0.00

0.00

0.00

48.63

0.00

0.00

-48.63

 

Sub-Totals:

2,970.00

972.69

972.69

0.00

0.00

0.00

48.63

0.00

0.00

-48.63


Claims Payment:

     

Claim ID

Date

Submission
Date

Billed
Amount

Expected
Amount

Paydown
Amount

Payment
Amount

Reserve
Amount

Int

Debits

Credits

Balance

Blue Cross Blue Shield of TX

     

57915A

2/20/2007

1/12/2007

2,351.00

770.55

0.00

869.12

0.00

0.00

0.00

869.12

869.12

 

Sub-Totals:

2,351.00

770.55

0.00

869.12

0.00

0.00

0.00

869.12

869.12


Interest Paid:

Activity

 

Date

Amount

Loan
Amount

Activity
Amount

 

 

 

Debits

Credits

Balance

Accrued

 

02/03/2007

6.92

2,136.56

6.92

 

 

 

6.92

 

-6.92

Sub-Totals:

6.92

 

6.92

 

 

 

6.92

 

-6.92


Credits/Debits:

     

Transaction Type

Transaction
Date

Transaction
Account

Comments

Transaction
Amount

No Credit or Debit Transactions this period for MD Example PLLC / Xeni Financial


Unrecognized Claim Checks:

     

Claim Id

Check
Number

Post Date

Check Date

Amount

No Unrecognized Claim Checks this period for MD Example PLLC / Xeni Financial

*** End of Report ***