10/24/2007 4:48  Statement Supplement: Payments and Adjustments Page: 1/1
HILLTOP CARDIOLOGY, PLLC From inception to the present
Account: 12896  RONNY JONES Statement Charged Amount: 295.00
Insurance payments and adjustments below are only those applied to the charges displayed on the preceding statement.
Those charges do not include those with zero balances.
Payment Date Payment or Adjustment Source Payment Adjustment Refund Unapplied
01/03/2001 Personal Payment, Cash,      0 5.00      
04/12/2001 Personal Payment, Check,   1035 25.00      
04/25/2001 Personal Payment, Check,   1043 25.00      
10/25/2001 Personal Payment, Check,   1110 35.00      
05/02/2002 Personal Payment, Check,   1207 25.00      
07/05/2002 Personal Payment, Check,   1225 20.00      
12/16/2002 Personal Payment, Check,   1274 35.00      
09/16/2003 Personal Payment, Check,   1353 25.00      
03/03/2004 Personal Payment, Check,   1385 60.00      
02/05/2007 Personal Payment, Check, 1531 30.00      
02/27/2007 Personal Payment, Check, 1543 40.00      
03/14/2007 Personal Payment, Check, 1547 45.00      
03/27/2007 Personal Payment, Check, 1553 40.00      
04/16/2007 Personal Payment, Check, 1560 25.00      
05/16/2007 Personal Payment, Check, 1573 25.00      
06/19/2007 Personal Payment, Check, 1583 25.00      
07/25/2007 Personal Payment, Check, 1588 25.00      
07/27/2007 Personal Payment, Cash 40.00      
08/22/2007 Medcost/Great-West   126.00    
08/27/2007 Medcost/Great-West 38.00 27.00    
08/31/2007 Personal Payment, Check, 1628 68.00      
10/03/2007 Personal Payment, Check, 1637 45.00      
Total, all amounts: 701.00 153.00 .00 .00
Total, Personal Payments 663.00   .00 .00
Total, Insurance Payments: 38.00 153.00    
Total, Adjustments from Practice:   .00