MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

04/18/2010 04/25/2010 135 $ 45.96750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Lopez Fernandez 135-154 A0242

ADDRESSE Amount Enclosed

Maria Lopez Fernandez ____________

1101 Midland AvenueApt 314BRONXVILLENY,10708

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Jack Goldman MD - Adam Goldman MD, 750 McLean Ave Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Lopez Fernandez 135-154 A0242

Account # Statement Date

135 04/18/2010Due Date Amount Due

04/25/2010 $ 45.96Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: GROUP HEALTH, INC (GHI) PPO

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

04/19/2010 04/26/2010 1000057 $ 59.71750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Nidia Cepeda 1000057-175 A0285

ADDRESSE Amount Enclosed

Nidia Cepeda ____________

601 West 189th StreetApt 1CNEW YORKNY,10040

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Jack Goldman MD - Adam Goldman MD, 750 McLean Ave Yonkers NY 10704

Patient Name Invoice # Claim ID

Nidia Cepeda 1000057-175 A0285

Account # Statement Date

1000057 04/19/2010Due Date Amount Due

04/26/2010 $ 59.71Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

04/27/2010 05/04/2010 17211 $ 47.42750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Salazar 17211-246 A1292

ADDRESSE Amount Enclosed

Maria Salazar ____________

645 West 160th StApt 4GNew YorkNY,10032

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Jack Goldman MD - Adam Goldman MD, 750 McLean Ave Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Salazar 17211-246 A1292

Account # Statement Date

17211 04/27/2010Due Date Amount Due

05/04/2010 $ 47.42Our records indicate the following insurance:

Primary Insurance: Health NetSecondary Insurance: MEDICARE

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

04/27/2010 05/04/2010 17211 $ 47.42750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Salazar 17211-247 A0391

ADDRESSE Amount Enclosed

Maria Salazar ____________

645 West 160th StApt 4GNew YorkNY,10032

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Jack Goldman MD - Adam Goldman MD, 750 McLean Ave Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Salazar 17211-247 A0391

Account # Statement Date

17211 04/27/2010Due Date Amount Due

05/04/2010 $ 47.42Our records indicate the following insurance:

Primary Insurance: Health NetSecondary Insurance: MEDICARE

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/06/2010 05/13/2010 1000319 $ 5.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Parra 1000319-317 A1400

ADDRESSE Amount Enclosed

Maria Parra ____________

711 Southern BlvdSuite 1ABRONXNY,10455

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Parra 1000319-317 A1400

Account # Statement Date

1000319 05/06/2010Due Date Amount Due

05/13/2010 $ 5.00Our records indicate the following insurance:

Primary Insurance: Affinity Health PlanSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/06/2010 05/13/2010 1000260 $ 5.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Salce 1000260-320 A2393

ADDRESSE Amount Enclosed

Maria Salce ____________

37 Vermityeaapt 3DNEW YORKNY,10034

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Salce 1000260-320 A2393

Account # Statement Date

1000260 05/06/2010Due Date Amount Due

05/13/2010 $ 5.00Our records indicate the following insurance:

Primary Insurance: Health PlusSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/07/2010 05/14/2010 4054 $ 22.79750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-488 A2062

ADDRESSE Amount Enclosed

Maria Macaluso ____________

644 East 232nd StreetBronxNY,10466

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-488 A2062

Account # Statement Date

4054 05/07/2010Due Date Amount Due

05/14/2010 $ 22.79Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/08/2010 05/15/2010 4054 $ 20.07750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-521 A2234

ADDRESSE Amount Enclosed

Maria Macaluso ____________

644 East 232nd StreetBronxNY,10466

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-521 A2234

Account # Statement Date

4054 05/08/2010Due Date Amount Due

05/15/2010 $ 20.07Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/11/2010 05/18/2010 18308 $ 611.35750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Sosa 18308-582 R0189

ADDRESSE Amount Enclosed

Maria Sosa ____________

636 East 224th StreetApt 2DBronxNY,10466

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Sosa 18308-582 R0189

Account # Statement Date

18308 05/11/2010Due Date Amount Due

05/18/2010 $ 611.35Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/11/2010 05/18/2010 12727 $ 22.87750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Acosta 12727-586 A2374

ADDRESSE Amount Enclosed

Maria Acosta ____________

2955 Frederick Douglas Blvd24KNew YorkNY,10033

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Acosta 12727-586 A2374

Account # Statement Date

12727 05/11/2010Due Date Amount Due

05/18/2010 $ 22.87Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/11/2010 05/18/2010 12727 $ 20.07750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Acosta 12727-587 A2449

ADDRESSE Amount Enclosed

Maria Acosta ____________

2955 Frederick Douglas Blvd24KNew YorkNY,10033

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Acosta 12727-587 A2449

Account # Statement Date

12727 05/11/2010Due Date Amount Due

05/18/2010 $ 20.07Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/11/2010 05/18/2010 4054 $ 79.13750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-605 A2451

ADDRESSE Amount Enclosed

Maria Macaluso ____________

644 East 232nd StreetBronxNY,10466

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-605 A2451

Account # Statement Date

4054 05/11/2010Due Date Amount Due

05/18/2010 $ 79.13Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/11/2010 05/18/2010 22750 $ 76.53750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Capellan 22750-617 A2966

ADDRESSE Amount Enclosed

Maria Capellan ____________

117 Post AvenueApt 3GNew YorkNY,10034

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Capellan 22750-617 A2966

Account # Statement Date

22750 05/11/2010Due Date Amount Due

05/18/2010 $ 76.53Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/11/2010 05/18/2010 20782 $ 2.10750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Fernandes 20782-622 A2221

ADDRESSE Amount Enclosed

Maria Fernandes ____________

139 Westminister DrYonkersNY,10710

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Fernandes 20782-622 A2221

Account # Statement Date

20782 05/11/2010Due Date Amount Due

05/18/2010 $ 2.10Our records indicate the following insurance:

Primary Insurance: United Health CareSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/11/2010 05/18/2010 20782 $ 2.10750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Fernandes 20782-626 A2303

ADDRESSE Amount Enclosed

Maria Fernandes ____________

139 Westminister DrYonkersNY,10710

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Fernandes 20782-626 A2303

Account # Statement Date

20782 05/11/2010Due Date Amount Due

05/18/2010 $ 2.10Our records indicate the following insurance:

Primary Insurance: United Health CareSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/14/2010 05/21/2010 4054 $ 27.61750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-652 A1079

ADDRESSE Amount Enclosed

Maria Macaluso ____________

644 East 232nd StreetBronxNY,10466

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Macaluso 4054-652 A1079

Account # Statement Date

4054 05/14/2010Due Date Amount Due

05/21/2010 $ 27.61Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/14/2010 05/21/2010 1166 $ 15.56750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Broughel 1166-661 A2781

ADDRESSE Amount Enclosed

Maria Broughel ____________

1 Glen AveApt 117GLEN ROCKNJ,07452

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Broughel 1166-661 A2781

Account # Statement Date

1166 05/14/2010Due Date Amount Due

05/21/2010 $ 15.56Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: AARP Health Care Options

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/14/2010 05/21/2010 18656 $ 76.53750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Corniell 18656-689 R0235

ADDRESSE Amount Enclosed

Maria Corniell ____________

1833 Anthony StBronxNY,10457

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Corniell 18656-689 R0235

Account # Statement Date

18656 05/14/2010Due Date Amount Due

05/21/2010 $ 76.53Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/17/2010 05/24/2010 1947 $ 22.11750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Venturini 1947-704 A3085

ADDRESSE Amount Enclosed

Maria Venturini ____________

214 Murray AvenueYonkersNY,10704

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Venturini 1947-704 A3085

Account # Statement Date

1947 05/17/2010Due Date Amount Due

05/24/2010 $ 22.11Our records indicate the following insurance:

Primary Insurance: Empire Blue Cross Blue ShieldSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/17/2010 05/24/2010 135 $ 15.25750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Lopez Fernandez 135-728 A1663

ADDRESSE Amount Enclosed

Maria Lopez Fernandez ____________

1101 Midland AvenueApt 314BRONXVILLENY,10708

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Lopez Fernandez 135-728 A1663

Account # Statement Date

135 05/17/2010Due Date Amount Due

05/24/2010 $ 15.25Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: GROUP HEALTH, INC (GHI) PPO

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/17/2010 05/24/2010 1000205 $ 20.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Pernia 1000205-730 A1039

ADDRESSE Amount Enclosed

Maria Pernia ____________

111 Beacon LaneBRONXNY,10473

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Pernia 1000205-730 A1039

Account # Statement Date

1000205 05/17/2010Due Date Amount Due

05/24/2010 $ 20.00Our records indicate the following insurance:

Primary Insurance: Empire Blue Cross Blue ShieldSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/17/2010 05/24/2010 1000217 $ 5.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Luna 1000217-738 R0141

ADDRESSE Amount Enclosed

Maria Luna ____________

600 West 178 StreetApt 46NEW YORKNY,10033

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Luna 1000217-738 R0141

Account # Statement Date

1000217 05/17/2010Due Date Amount Due

05/24/2010 $ 5.00Our records indicate the following insurance:

Primary Insurance: Neighborhood Health PlansSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/17/2010 05/24/2010 1000217 $ 1.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Luna 1000217-739 R0129

ADDRESSE Amount Enclosed

Maria Luna ____________

600 West 178 StreetApt 46NEW YORKNY,10033

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Luna 1000217-739 R0129

Account # Statement Date

1000217 05/17/2010Due Date Amount Due

05/24/2010 $ 1.00Our records indicate the following insurance:

Primary Insurance: Neighborhood Health PlansSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/17/2010 05/24/2010 1947 $ 15.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Venturini 1947-744 A1615

ADDRESSE Amount Enclosed

Maria Venturini ____________

214 Murray AvenueYonkersNY,10704

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Venturini 1947-744 A1615

Account # Statement Date

1947 05/17/2010Due Date Amount Due

05/24/2010 $ 15.00Our records indicate the following insurance:

Primary Insurance: Empire Blue Cross Blue ShieldSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/20/2010 05/27/2010 12727 $ 9.27750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Acosta 12727-841 A2902

ADDRESSE Amount Enclosed

Maria Acosta ____________

2955 Frederick Douglas Blvd24KNew YorkNY,10033

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Acosta 12727-841 A2902

Account # Statement Date

12727 05/20/2010Due Date Amount Due

05/27/2010 $ 9.27Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

750 Mclean Avenue YONKERS

Patient Name Invoice # Claim ID

1000406-876ADDRESSE Amount Enclosed

____________

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

1000406-876Account # Statement Date

Due Date Amount Due

Our records indicate the following insurance:

Primary Insurance:

Secondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

05/25/2010 06/01/2010 1000016 $ 25.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Abel Santiago 1000016-895 A0773

ADDRESSE Amount Enclosed

Abel Santiago ____________

2353 Crotona AvenueApt 5CBronxNY,10458

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Abel Santiago 1000016-895 A0773

Account # Statement Date

1000016 05/25/2010Due Date Amount Due

06/01/2010 $ 25.00Our records indicate the following insurance:

Primary Insurance: Local 812Secondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/01/2010 06/08/2010 20782 $ 20.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Fernandes 20782-965 A1061

ADDRESSE Amount Enclosed

Maria Fernandes ____________

139 Westminister DrYonkersNY,10710

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Fernandes 20782-965 A1061

Account # Statement Date

20782 06/01/2010Due Date Amount Due

06/08/2010 $ 20.00Our records indicate the following insurance:

Primary Insurance: United Health CareSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/07/2010 06/14/2010 1000260 $ 5.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Salce 1000260-1011 A3600

ADDRESSE Amount Enclosed

Maria Salce ____________

37 Vermityeaapt 3DNEW YORKNY,10034

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Salce 1000260-1011 A3600

Account # Statement Date

1000260 06/07/2010Due Date Amount Due

06/14/2010 $ 5.00Our records indicate the following insurance:

Primary Insurance: Health PlusSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/09/2010 06/16/2010 20566 $ 15.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Jaime 20566-1022 A4064

ADDRESSE Amount Enclosed

Maria Jaime ____________

890 B Union AvenueApt BBronxNY,10459

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Jaime 20566-1022 A4064

Account # Statement Date

20566 06/09/2010Due Date Amount Due

06/16/2010 $ 15.00Our records indicate the following insurance:

Primary Insurance: Montefiore CMOSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/09/2010 06/16/2010 1000681 $ 25.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Roman 1000681-1025 A3441

ADDRESSE Amount Enclosed

Maria Roman ____________

581 West 161 StreetApt #34NEW YORKNY,10032

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Roman 1000681-1025 A3441

Account # Statement Date

1000681 06/09/2010Due Date Amount Due

06/16/2010 $ 25.00Our records indicate the following insurance:

Primary Insurance: HEALTH FIRSTSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/09/2010 06/16/2010 1000508 $ 5.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Torres 1000508-1028 A3171

ADDRESSE Amount Enclosed

Maria Torres ____________

2641 Marion Avenue4EBRONXNY,10458

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Torres 1000508-1028 A3171

Account # Statement Date

1000508 06/09/2010Due Date Amount Due

06/16/2010 $ 5.00Our records indicate the following insurance:

Primary Insurance: Affinity Health PlanSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/15/2010 06/22/2010 1000583 $ 20.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Scarpati 1000583-1047 A3635

ADDRESSE Amount Enclosed

Maria Scarpati ____________

48 North 9th AvenueMOUNT VERNONNY,10550

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Scarpati 1000583-1047 A3635

Account # Statement Date

1000583 06/15/2010Due Date Amount Due

06/22/2010 $ 20.00Our records indicate the following insurance:

Primary Insurance: Empire Blue Cross Blue ShieldSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/21/2010 06/28/2010 1000616 $ 66.60750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Urena 1000616-1089 A3488

ADDRESSE Amount Enclosed

Maria Urena ____________

5 Pinehurst AvenueApt 4BNEW YORKNY,10033

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Urena 1000616-1089 A3488

Account # Statement Date

1000616 06/21/2010Due Date Amount Due

06/28/2010 $ 66.60Our records indicate the following insurance:

Primary Insurance: Health First 65 PlusSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/22/2010 06/29/2010 1000772 $ 20.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Diaz 1000772-1105 A3629

ADDRESSE Amount Enclosed

Maria Diaz ____________

1900 Bermon Avenueapt 4ABRONXNY,10457

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Diaz 1000772-1105 A3629

Account # Statement Date

1000772 06/22/2010Due Date Amount Due

06/29/2010 $ 20.00Our records indicate the following insurance:

Primary Insurance: Oxford Health PlanSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/24/2010 07/01/2010 1000178 $ 15.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Romero 1000178-1139 A0570

ADDRESSE Amount Enclosed

Maria Romero ____________

1042 Southern BlvdApt 3DYONKERSNY,10704

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Romero 1000178-1139 A0570

Account # Statement Date

1000178 06/24/2010Due Date Amount Due

07/01/2010 $ 15.00Our records indicate the following insurance:

Primary Insurance: Empire Blue Cross Blue ShieldSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

06/25/2010 07/02/2010 1000967 $ 40.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Vidal 1000967-1165 A4142

ADDRESSE Amount Enclosed

Maria Vidal ____________

985 Waring AveApt 3ABRONXNY,10469

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Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Vidal 1000967-1165 A4142

Account # Statement Date

1000967 06/25/2010Due Date Amount Due

07/02/2010 $ 40.00Our records indicate the following insurance:

Primary Insurance: EMPIRE BCBSSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

07/20/2010 07/27/2010 1001081 $ 66.60750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Meregildo 1001081-1325 A5171

ADDRESSE Amount Enclosed

Maria Meregildo ____________

760 Grand ConcourseApt 6NYonkersNY,10704

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Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue 914-803-0310 Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Meregildo 1001081-1325 A5171

Account # Statement Date

1001081 07/20/2010Due Date Amount Due

07/27/2010 $ 66.60Our records indicate the following insurance:

Primary Insurance: Health First 65 PlusSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

07/20/2010 07/27/2010 1000967 $ 27.51750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Vidal 1000967-1329 A4974

ADDRESSE Amount Enclosed

Maria Vidal ____________

985 Waring AveApt 3ABRONXNY,10469

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Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue 914-803-0310 Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Vidal 1000967-1329 A4974

Account # Statement Date

1000967 07/20/2010Due Date Amount Due

07/27/2010 $ 27.51Our records indicate the following insurance:

Primary Insurance: EMPIRE BCBSSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

08/05/2010 08/12/2010 1000024 $ 19.32750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Pena 1000024-1415 A5728

ADDRESSE Amount Enclosed

Maria Pena ____________

1920 W. 55 Amstersdam AvenueNEW YORKNY,10032

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Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue 914-803-0310 Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Pena 1000024-1415 A5728

Account # Statement Date

1000024 08/05/2010Due Date Amount Due

08/12/2010 $ 19.32Our records indicate the following insurance:

Primary Insurance: Wellcare of NYSecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

08/05/2010 08/12/2010 1000024 $ 50.11750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Pena 1000024-1416 A5729

ADDRESSE Amount Enclosed

Maria Pena ____________

1920 W. 55 Amstersdam AvenueNEW YORKNY,10032

-----------------------------------------------------------------------------------------------------------------------------------------------------

Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue 914-803-0310 Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Pena 1000024-1416 A5729

Account # Statement Date

1000024 08/05/2010Due Date Amount Due

08/12/2010 $ 50.11Our records indicate the following insurance:

Primary Insurance: Wellcare of NYSecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

08/05/2010 08/12/2010 1000354 $ 30.33750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Marcial 1000354-1425 R0462

ADDRESSE Amount Enclosed

Maria Marcial ____________

2 Sickle StreetNEW YORKNY,10040

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Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue 914-803-0310 Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Marcial 1000354-1425 R0462

Account # Statement Date

1000354 08/05/2010Due Date Amount Due

08/12/2010 $ 30.33Our records indicate the following insurance:

Primary Insurance: Wellcare of NYSecondary Insurance: Medicaid

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

08/06/2010 08/13/2010 1001209 $ 66.60750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Figueroa 1001209-1428 A5669

ADDRESSE Amount Enclosed

Maria Figueroa ____________

550 Cauldwell Ave. # 5HBRONXNY,10455

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Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue 914-803-0310 Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Figueroa 1001209-1428 A5669

Account # Statement Date

1001209 08/06/2010Due Date Amount Due

08/13/2010 $ 66.60Our records indicate the following insurance:

Primary Insurance: HEALTH FIRSTSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

08/10/2010 08/17/2010 23175 $ 5.00750 Mclean Avenue YONKERS

NY 10704

Patient Name Invoice # Claim ID

Maria Arrieta 23175-1445 A5868

ADDRESSE Amount Enclosed

Maria Arrieta ____________

600 West 163 StreetApt 45New YorkNY,10032

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Please return upper portion of statement with payment

Mclean Heights Medical Professionals PC

Dr. Adam Goldman and Dr. Jack Goldman, 750 McLean Avenue 914-803-0310 Yonkers NY 10704

Patient Name Invoice # Claim ID

Maria Arrieta 23175-1445 A5868

Account # Statement Date

23175 08/10/2010Due Date Amount Due

08/17/2010 $ 5.00Our records indicate the following insurance:

Primary Insurance: Affinity Health PlanSecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

12/26/2011 01/25/2012 1000076 $ 570.15750 Mclean Avenue

YONKERS, CO 10704

Patient Name Invoice # Claim ID

Iris German 1000076-1499 A0354

ADDRESSE Amount Enclosed

Iris German ____________

15 Jacobus PlaceBRONX,NY10463

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Please return upper portion of statement with payment

EHI Demo

750 McLean Avenue 914-803-0310

EAST HANOVER, NJ 07936Patient Name Invoice # Claim ID

Iris German 1000076-1499 A0354

Account # Statement Date

1000076 12/26/2011Due Date Amount Due

01/25/2012 $ 570.15Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance:

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

01/04/2012 02/03/2012 11808 $ 480.27750 Mclean Avenue

YONKERS, CO 10704

Patient Name Invoice # Claim ID

Vincent Maselli 11808-1500 A1626

ADDRESSE Amount Enclosed

Vincent Maselli ____________

79 Clarkson RdCarmel,NY10512

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Please return upper portion of statement with payment

EHI Demo

750 McLean Avenue 914-803-0310

EAST HANOVER, NJ 07936Patient Name Invoice # Claim ID

Vincent Maselli 11808-1500 A1626

Account # Statement Date

11808 01/04/2012Due Date Amount Due

02/03/2012 $ 480.27Our records indicate the following insurance:

Primary Insurance: United Health CareSecondary Insurance: Oxford Health Plan

MAKE CHECKS PAYABLE TO & REMIT TO

Mclean Heights Med Prof PC STATEMENT DATE DUE DATE ACCOUNT # AMOUNT DUE

01/04/2012 02/03/2012 1000042 $ 20.00750 Mclean Avenue

YONKERS, CO 10704

Patient Name Invoice # Claim ID

Robert Bernhart 1000042-1501 A0335

ADDRESSE Amount Enclosed

Robert Bernhart ____________

2049 Albany Post RdWALDEN,NY12586

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Please return upper portion of statement with payment

EHI Demo

750 McLean Avenue 914-803-0310

EAST HANOVER, NJ 07936Patient Name Invoice # Claim ID

Robert Bernhart 1000042-1501 A0335

Account # Statement Date

1000042 01/04/2012Due Date Amount Due

02/03/2012 $ 20.00Our records indicate the following insurance:

Primary Insurance: MEDICARESecondary Insurance: United Health Care (Empire Plan)