Billing Contractor Agreement by wdq83439

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									                                                                                                                                                Initial Mailing
                                                                                                                                  Active
                                                                                                                                Completed        Active Activity (Completed
            Cynthia                                                                   Monthly Mailing    Josh     Catch-up      Week of 4/25              5/6/2005)                                   Registration Package
To Do             Done      QTY      Item                                     Sides    March     April   Shows   Info Package   No Activity    Outside     Left Side   Right Side Info Package   Outside     Left Side   Right Side   Total                      Status
Envelopes                  On Hand
                             500     Window Envelope 9X11                                                            100            500                                               250                                             850     Need another 1000
   600                        0      Labels, destination address                                                                                600                                                1000                               1600    What kind of label and how to print
  2500                        0      Big White Envelope 10X13                                                                                   600                                                500                                1100    Cynthia gets a better deal
                              ?      White 9X11                                                                                                                                                    500                                500     Not a problem, Staples
                              ?      Yellow 9X11                                                                                                                                                   500                                500     Not a problem, Staples
Cover Letters
   600                               Letter Head                               1                                                                600                                                                                   600
                             n/a     Cover Letter, Drop-Offs                   1                                                                                                                                                       0
                             n/a     Cover Letter, Registration                1                                                                                                                   500                                500     Should we use letterhead?
                             n/a     Cover Letter, Information                 1                                     100                                                              250                                             350
                             n/a     Cover Letter, Active No Activity                                                               500                                                                                               500
   600                       n/a     Cover Letter, Active Activity                                                                              600                                                                                   600
Custom Forms
                             n/a     Supplier Registration Sheet               1                                  as needed                                                        as needed     as needed                             0      Ready
                             n/a     Contractor Agreement                      1                                                                                                                 as needed                             0      Ready
                             n/a     HIPAA Associate Agreement                 1                                                                                                                 as needed                             0      Ready
                             n/a     D Customer Profile                        1                                                                                                                 as needed                             0      Ready
                             n/a     855C                                                                                                                                                        as needed                             0      Ready
                             n/a     855S                                                                                                                                                        as needed                             0      Ready
                             n/a     NSC Billing Agreement                                                                                                                                       as needed                             0      Ready
                             n/a     EDI Enrollment Form Region A                                                                                                                                as needed                             0      Ready
                             n/a     EDI Enrollment Form Region B, C, D                                                                                                                          as needed                             0      Ready
                             n/a     Assembly instructions                     1                                                                                                                 as needed                             0      Ready
                             n/a     Order form                                1                                  as needed                                                        as needed                 as needed                 0      Ready
Pre-Printed Forms
                              0      855 Instructions                                                                                                                                              500                                500     Ready
                            4000     Ortho Kinetic Review article reprint      4                         1000        100                                                              250          500                                1850    Ready
  3000                        0      SafeStep Folder (1500/1500 with slits)                                                                     600                                                500                                1100    Ready
                  2000      1800     Top Selling Shoe Flyer                    2                         1000        100            500                                               250                      500                    2350    Ready
                 10000      9000     SafeStep Flyer                            1                         1000        100                                                              250                      500                    1850    Ready                                 Copies            Sides
                              0      Condensed Price Sheet                     2                                     100            500                                               250                      500                    1350    Ready                                            800            2
   600                        0      Complete Price Sheet                     10X2                                                                            600                                              500                    1100    Ready                                           1000        17
                  3000       100     Why SafeStep                              1                         1000        100            500                       600                     250                      500                    2950    Ready
                  4000       250     Display Stand flyer (Discontinuing)       1        1000     1000     100        100                                      600                      50                      500                    3350    Ready
                  3000      1800     Promotional Items flyer                   1                          500        100            500                       600                     250                      500                    2450    Ready
                  2000        0      14 Things Article                         2                          500                       500                       600                                              500                    2100    Ready
                              0      21 CMS Standards                          1                                                                                                                               500                    500     Ready                                           1000            1
                              0      Compliant Notice                          1                                                                                                                               500                    500     Ready                                           1000            1
                              0      Complaint Resolution Form                 1                                                                                                                               500                    500     Ready                                           1000            1
                              0      Complaint Log                             1                                                                                                                               500                    500     Ready                                           1000            1
   600                        0      Blank Order Form                          1                                                    500                       600                                                                     1100    Ready                                            600            1
                              0      Fitting Instructions                      2                                                                              600                                              500                    1100    Ready
                              0      Information Collection Form               1                                                                              600                                              500                    1100    Ready                                           1600            1
                              0      Show Registration Sheets                  1                         1000                                                                                                                         1000    Ready                                          Totals
Manufacturer Shoe Sheets                                                                                                                                                                                                                                                                Cynthia 24#     1100
  2000                        0      OrthoFeet                                 2                          500                                                             600                                               500       1600    Ready                                      Lenny 24#      1060
  2000                        0      Apex Aetrex                               2                          500                                                             600                                               500       1600    Ready
  2000                        0      Apex Ariya                                2                          500                                                             600                                               500       1600    Ready
  2000                        0      Apex Ambulator                            2                          500                                                             600                                               500       1600    Ready
  2000                        0      Apex Conform                              2                          500                                                             600                                               500       1600    Ready
  2000                        0      Acor                                      2                          500                                                             600                                               500       1600    Ready
  2000                        0      Pedors                                    2                          500                                                             600                                               500       1600    Ready
  2000                        0      Soft Spots                                2                          500                                                             600                                               500       1600    Ready
  2000                        0      Santuit                                   1                          500                                                             600                                               500       1600    Ready
  2000                        0      Brooks Athletic                           2                          500                                                             600                                               500       1600    Ready
  2000                        0      Brooks Walking                            2                          500                                                             600                                               500       1600    Ready
  2000                        0      Hush Puppies                              2                          500                                                             600                                               500       1600    Ready
  2000                        0      New Balance                               1                          500                                                             600                                               500       1600    Ready
   2000                       0      Custom Insert                             2                          500                                                             600                                               500       1600    Ready
Richie Brace Flyers
  4000                        0      Richie Brace flyer master                 1                                     100                                      600                     250                      500                    1450    Ready
Total Sides    Total Sheets
       1600              800    600
      17000             9000   10200




       1000             1000
       1000             1000
       1000             1000
       1000             1000    600
        600              600    600


       1600             1600
      24800            16000   12000
      0.0444                   532.8 917.922.1081
      0.0427                           203.874.1727 lennylit@aol.com
Richie Brace Manufacturer Flyers - Printed 2000 each, sent 1000 to manufacturer and kept 1000 in SafeStep Office
                  2000                    Allied East                                 1     Same
  2000                                    Allied West                                 1     Same
                  2000                    Eastern Podiatry Lab                        1
                  2000                    Footcare Express                            1
                  2000                    STJ East                                    1     Same
  2000                                    STJ West                                    1     Same
                  2000                    ComfortFit                                  1
                  2000                    Fiber Foot Appliances                       1
                  2000                    KLM                                         1
  2000                                    Burns International                         1
                  2000                    Solo                                        1
  2000                                    Marathon                                    1
Non Richie Brace Sheets
  2000                                    STS                                         1   Gets 2000 of the master ric
  2000                                    Prolab                                      1
  2000                                    K-Fit                                       1
1000 in SafeStep Office
                                  Printed one and not the other




                                  Not Done



                                  Send to Cynthia

                                  Send to Cynthia

 Gets 2000 of the master richie
                                  Send to Cynthia
                                  Send to Cynthia
Registration package gets sent for registration.
Start-up Kit gets sent
              Upon receipt of credit card
              Signed check paying agreement
              Special request (could be any part of or completel)
                                                                                                                      Start-up Kit
                                                                     Registration Package             Catalog
             Item                                           Info Package           Forms       Left Side Right Side      In Box      From Manufacturer
Envelopes
             Window Envelope 9X11                            Pre Printed
             Big White Envelope 10X13                                            Pre Printed
             White 9X11                                                            Stock
             Yellow 9X11                                                           Stock
Cover Letters
             Letter Head
             Cover Letter, Drop-Offs
             Cover Letter, Registration
             Cover Letter, Information
             Cover Letter, Active No Activity
             Cover Letter, Active Activity
Custom Forms
             Supplier Registration Sheet                            Print           Print
             Contractor Agreement                                                   Print
             HIPAA Associate Agreement                                              Print
             D Customer Profile                                                     Print
             855C                                                                   Print
             855S                                                                   Print
             NSC Billing Agreement                                                  Print
             EDI Enrollment Form Region A                                           Print
             EDI Enrollment Form Region B, C, D                                     Print
             Assembly instructions                                                  Print
             Order form                                             Print
Pre-Printed Forms
             855 Instructions                                                        X
             Ortho Kinetic Review article reprint                    x
             SafeStep Folder (1500/1500 with slits)                                               X
             Top Selling Shoe Flyer                                  x
             SafeStep Flyer                                          x
             Condensed Price Sheet                                   x
             Complete Price Sheet                                                                 X
             Why SafeStep                                            x
            Display Stand flyer (Discontinuing)                x                       X
            Promotional Items flyer                            x                       X
            14 Things Article                                                          X
            21 CMS Standards                                                           X
            Compliant Notice                                                           X
            Complaint Resolution Form                                                  X
            Complaint Log                                                              X
            Blank Order Form                                                           X
            Fitting Instructions                                                       X
            Information Collection Form                                                X
            Show Registration Sheets
Manufacturer Shoe Sheets
            OrthoFeet                                                                      X
            Apex Aetrex                                                                    X
            Apex Ariya                                                                     X
            Apex Ambulator                                                                 X
            Apex Conform                                                                   X
            Acor                                                                           X
            Pedors                                                                         X
            Soft Spots                                                                     X
            Santuit                                                                        X
            Brooks Athletic                                                                X
            Brooks Walking                                                                 X
            Hush Puppies                                                                   X
            New Balance                                                                    X
            Custom Insert                                                                  X
Richie Brace Flyers
            Richie Brace flyer master                          x                       X


Samples
Acor        Comfort Street; Walking Shoe; Black (Sample with diabetic insert) - 1203               X
Apex        Ambulator (Sample with diabetic insert and letter) - 1260 - SS1297                     X
OrthoFeet   3 Sample Shoes                                                                     X
OrthoFeet   Molding Foam                                                                       X
OrthoFeet   Stick                                                                              X
Pedors      Sample Shoe                                                                        X
Pedors      Ritz Measuring Stick, Complementary                                                X
Santuit     BrightStep Designer in Black (Sample with diabetic insert) - 100BK                     X
K-Fit       Custom Molded Total Contact Multidensity Inserts (under 200 pounds)                ?   ?
K-Fit       Custom Molded Total Contact Multidensity Inserts (over 200 pounds)                 ?   ?

								
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