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2021-06-23 Meeting MinutesU:V \I.II1l VII(�.AI.AII�.II\I:I,."��1�� ,/ All Agenda Items Properly Numbered Contracts Completed and Signed All 1295's Flagged for Acceptance Z(number of 1295's ) All Documents for Clerk Signature Flagged On this24day of 2021 a complete and accurate packet forZrk of 2021 Commissioners Court Regular Session Day MQnth was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. IC un County Judge/Assistant CO MMI S SI ONERS CO URTCH ECKLI S T/FORM S A oO'�LOCX-----h1 111425 2021 BY UUNiY CLERK CqG ODMCOUNry, TEXAS DEMON COMMISSIONERS MEETING-6/23/2021 Richard H. Meyer County judge David Hall, Commissioner, Precinct l Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Conmmissnoner, Precinct 4 Anna Goodman, County Clerk Catherine Sullivan, Deputy Cleric i"T1bqQ1k(& AWN REGULAR TERM 2021 § JUNE 23, 2021 BE IT REMEMBERED THAT ON JUNE 23, 2021, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. I. Call meeting to order Meeting called to order at 10:00 a.m. by Judge Richard Meyer 2. Invocation Commissioner David Hall 3. Pledges of Allegiance US Flag — Commissioner Gary Reese Texas Flag — Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation 5. Hear report from Memorial Medical Center Jason Anglin, Memorial Medical Center CEO, presented report Page 1 of 5 COMMISSIONERS MEETING — 6/23/2021 6. Approve the minutes of the June 2 and June 9, 2021 meetings RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to authorize the County Judge to sign all documents pertaining to the American Rescue Plan Act Awards, Terms and Conditions. (DH) LA" ESULT: APPROVED[UNANIMOUS] OVER: David Hall, Commissioner Pct 1 ECONDER: Vern Lyssy, Commissioner Pct 2 ES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to authorize the County Treasurer to sign the extension of the Depository Services Contract between Calhoun County and Prosperity Bank for a period of two years. This renewal will run from August 1, 2021 through July 31, 2023. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to approve the cancellation of all Wal-Mart credit cards held by departments and stop the usage of all Wal-Mart cards as soon as possible. Wal-Mart cards/billings are now held by and made payable to Capital One. Wal-Mart cards are not cost effective for the County. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 5 COMMISSIONERS MEETING-6/23/2021 10. Consider and take necessary action on the road closure of the lower part of Haterius Park Lane and only one-way traffic for upper part of Haterius Park Lane in Olivia, Texas between the hours 2:00 pm and 12:00 am on July 4, 2021 for a fireworks display Provided the Bayside Community Church. (JB) Ruben Castillo, Pastor of Bayside Community Church, invited all to come to the fireworks display. RESULT: APPROVED [UNANIMOUS] MOVER: SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Gary Reese, Commissioner Pct 4 Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to authorize Commissioner Behrens to sign a two- year agreement with LaWard Telephone for the Precinct 3 phone system upgrade. (JB) RESULT: APPROVED [UNANIMOUS] MOVER: SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Gary Reese, Commissioner Pct 4 Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to authorize the Calhoun County Sheriff to purchase a 2008 Ford F250 VIN IFT-SX21588EE36183 (a narcotic seized vehicle) from Starr County Motors for $6,774.89. Funds will come from the Narcotic Forfeiture Account. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to declare a 2020 Chevrolet Tahoe (VIN 1GNLCDED6LR282621) as Waste. The insurance company totaled the vehicle after being damaged in an accident. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES. Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 5 COMMISSIONERS MEETING — 6/23/2021 14. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Accept report from the following County Office: i. Tax Assessor -Collector — Mav 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. Consider and take necessary action on any necessary budget adjustments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 5 COMMISSIONERS MEETING — 6/23/2021 17. Approval of bills and payroll. (RM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Payroll RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 10:34 a.m. Page 5 of 5 AGENDA I 110 [ CE OF MEETi1\1G — ()/2_1,/2021 AT FILED � 0CUL___1N JgUN 18 2021 Richard ]H[.1M[eyer C%*',&Eii NPOODOCou n>ty judge Cd Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners'Court of Calhoun County, Texas will meet on Wednesday, Dunne 23, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. [inn Street, Saute 104, Port ]Lavaca, Calhoun County, "Texas. AGENDA The subject matter of such meeting is as follows: 1. Call meeting to order. 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. 5. Hear report from Memorial Medical Center. 6. Approve the minutes of the June 2 and June 9, 2021 meetings. 7. Consider and take necessary action to authorize the County Judge to sign all documents pertaining to the American Rescue Plan Act Awards, Terms and Conditions. (DH) 8. Consider and take necessary action to authorize the County Treasurer to sign the extension of the Depository Services Contract between Calhoun County and Prosperity Bank for a period of two years. This renewal will run from August 1, 2021 through July 31, 2023. (RM) 9. Consider and take necessary action to approve the cancellation of all Wal-Mart credit cards held by departments and stop the usage of all Wal-Mart cards as soon as possible. Wal-Mart cards/billings are now held by and made payable to Capital One. Wal-Mart cards are not cost effective for the County. (RM) Page 1 of 2 NO I ICE OF MEEI ING — 6/23/2021. 10. Consider and take necessary action on the road closure of the lower part of Haterius Park Lane and only one-way traffic for upper part of Haterius Park Lane in Olivia, Texas between the hours 2:00 pm and 12:00 am on July 4, 2021 for a fireworks display provided the Bayside Community Church. (JB) 11. Consider and take necessary action to authorize Commissioner Behrens to sign a two- year agreement with LaWard Telephone for the Precinct 3 phone system upgrade. (JB) 12. Consider and take necessary action to authorize the Calhoun County Sheriff to purchase a 2008 Ford F250 VIN 1FTSX21588EE36183 (a narcotic seized vehicle) from Starr County Motors for $6,774.89. Funds will come from the Narcotic Forfeiture Account. (RM) 13. Consider and take necessary action to declare a 2020 Chevrolet Tahoe (VIN 1GNLCDED6LR282621) as Waste. The insurance company totaled the vehicle after being damaged in an accident. (RM) 14. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (RM) 15. Accept report from the following County Office: i. Tax Assessor -Collector — May 2021 16. Consider and take necessary action on any necessary budget adjustments. (RM) 17. Approval of bills and payroll. (RM) All' - Richard Meyer, County Ju Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's webs ite at www.caIhouncotx are under "Commissioners' Court Agenda" for any official court postings. Page 2 of 2 M!m &tF-A #6 Richard H. Meyer County judge dge David Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 (nary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, June 2, 2021, at 10:00 a.m, in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port ]Lavaca, Calhoun County, Texas. Attached are the true and correct minutes of the above referenced meeting. �-ainoun county, Texas Anna Goodman, County Clerk �-.4Cler_ Page 1 of 1 I• COMMISSIONERS COURT-6/2/2021 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Cary Reese, Commissioner, Precinct 4 Catherine Sullivan, Deputy Clerfld CALHOUN COUNTy COMMISSIONERS, COURT REGULAR TERM 2021 § TUNE 02, 2021 BE IT REMEMBERED THAT ON TUNE 02, 2021, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. I. Call meeting to order Meeting called to order at 10:00 a.m. by Judge Richard Meyer 2. Invocation Commissioner David Hall 3. Pledges of Allegiance US Flag — Commissioner Gary Reese Texas Flag — Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation S. Hear a report from Memorial Medical Center Jason Anglin, Memorial Medical Center CEO, gave report 6. Consider and take necessary action to review and approve the Calhoun County Clerk's Records Archive Plan for 2021-2022. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: SECONDER: Vern Lyssy, Commissioner Pct 2 David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Pagel of5 I• COMMISSIONERS COURT-6/2/2021 7. Consider and take necessary action to approve the Preliminary Plat and the Drainage Plan for Cumpean RV Park. (VL) Victor Fredrickson, VEF Engineering, presented the plat. RESULT: APPROVED[UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to approve the Final Plat of Kellers Landing. (JB) Terry Ruddick, Urban Engineering, presented the final plat. RESULT: APPROVED [UNANIMOUS] MOVER: SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Vern Lyssy, Commissioner Pct 2 Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to authorize Judge Meyer to sign a letter of support for the TCEQ grant application of La Salle Water Control and Improvement District No. 1A ("La Salle') to convert from a water control and improvement district to a municipal utility district. The Court recognizes that this action is part of La Salle preparation for the potential consolidation with Port O'Connor Improvement District. The Court is of the opinion that such a consolidation will benefit Calhoun County and the residents of both districts. (GR) Sandra Witte explained the benefit of converting to a municipal utility district. RESULT: APPROVED [UNANIMOUS] MOVER: SECONDER: David Hall, Commissioner Pct 1 Vern Lyssy, Commissioner AYES: Pet 2 Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 5 COMMISSIONERS COURT — 6/2/2021 10. Consider and take necessary action to authorize Commissioner Reese to submit a grant application to the Texas General Land Office under its CEPRA Grant Program for Phase 2 of the Boggy Bayou Nature Park Shoreline Protection Project. GOMESA funding will be used as matching grant funds. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to authorize Commissioner Reese to contract with Kathy Smartt Grants for $500, to be paid with GOMESA funds, to prepare a grant application under the Texas General Land OfFce's CEPRA Grant Program for Phase 2 of the Boggy Bayou Nature Park Shoreline Protection Project. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner PcL 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to authorize the County Judge to submit a commitment letter to the Texas General Land Office, which states that $154,000 in County GOMESA funding will be used as the match for Phase 2 of the Boggy Bayou Nature Park Shoreline Protection Project. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to acknowledge an increase in the sheriffs Forfeited Property Fund for 2020 as follows; (RM) a. 2860-001-45060 — Forfeitures Revenue - $2,950.00 b. 2860-999-63920 — Miscellaneous - $2,350.00 c. 2860-999-60580 — Buy Money - $600.00 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 5 [ COMMISSIONERS COURT-6/2/2021 14. Consider and take necessary action to declare the attached list of equipment from the County Clerk's Office as Surplus/Salvage. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hail, Lyssy, Behrens, Reese 15. Accept reports from the following County Offices: i. County Auditor — April 2021 ii. County Treasurer — March 2021 M. County Treasurer — Investment Report for Quarter Ending March 31, 2021 iv. County Treasurer — Quarterly Statement of Balances for Quarter Ending March 31, 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. Consider and take necessary action on any necessary budget adjustments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 5 I COMMISSIONERS COURT-6/2/2021 17. Approval of bills and payroll. (RM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vem Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vem Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 10:33 a.m. Page 5 of 5 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern LYssY, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, June 9,2021, at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca Calhoun County, Texas. Attached are the true and correct minutes of the above referenced meeting. Richard Meyer, COU'Ytf Judge Calhoun County, Texas Anna Goodman, County Clerk D4epuCIe4r Page 1 of 1 COMMISSIONERS COURT-6/9/2021 ➢ icha>rd H. Meyer County judge David MR, Commissioner, Precinct l Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Catherine Sullivan, Deputy Clerk REGULAR TERM 2021 § _ JUNE 09, 2021 BE IT REMEMBERED THAT ON JUNE 09, 2021, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. 1. Call meeting to order Meeting called to order at 10:00 a.m. by Judge Richard Meyer 2. Invocation Commissioner David Hall 3. Pledges of Allegiance US Flag — Commissioner Gary Reese Texas Flag — Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation Commissioner Lyssy reminded everyone of the benefit for the SMVFD on June 12, 2021 5. Approve the minutes of the May 12, May 19 (rescheduled to May 26) and May 26, 2021 meetings. RESULT. APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 1 of 4 COMMISSIONERS COURT— 6/9/2021 6. Consider and take necessary action on the First Amendment to the PPIII Tax Abatement Agreement between Calhoun County and Formosa Plastics Corporation, Texas dated December 30, 2019 and effective January 1, 2020. (RM) Motion made to move the effective date to January 1, 2022. RESULT: APPROVED [UNANIMOUS] MOVER: Judge Meyer, County Judge SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to approve the Final Plat for Drifters RV Park (formerly known as Smalley RV Park). (VL) Jake Helfer, Elite Engineering, presented the final plat. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese S. Consider and take necessary action to approve the attached charges for CCEMS's Rural CE Program and associated classes. (RM) Lori McDowell, CCEMS, presented charges. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to accept an anonymous donation of $100.00 to the Sheriff's office to be deposited into the Motivation account. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 4 COMMISSIONERS COURT-6/9/2021 10. Accept reports from the following County Offices: i. County Clerk — May 2021 ii. Floodplain Administration — May 2021 iii. Justice of the Peace, Precinct 1— May 2021 iv. Justice of the Peace, Precinct 2 — May 2021 v. Justice of the Peace, Precinct 4 — May 2021 A. Justice of the Peace, Precinct 5 — May 2021 vii. Sheriffs Office — May 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action on any necessary budget adjustments. (RM) RESULT: APPROVED [UNANIMOUS] . MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Approval of bills and payroll. (RM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 4 COMMISSIONERS COURT — 6/9/2021 Payroll RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 10:33 a.m. Page 4 of 4 OMB Approved No. 1505-0271 Expiration Date: 11/30/2021 Recipient name and address: Calhoun County 211 S. Ann Port Lavaca, Texas 77979 U.S. DEPARTMENT OF THE TREASURY CORONAVIRUS STATE FISCAL RECOVERY FUND DUNS Number: 087309324 Taxpayer Identification Number: 746001923 Assistance Listing Number and Title: 21.027 Sections 602(b)(2) and 603(b) of the Social Security Act (the Act) as added by section 9901 of the American Rescue Plan Act, Pub. L. No. 117-2 (March 11, 2021) authorizes the Department of the Treasury (Treasury) to make payments to certain recipients from the Coronavirus State Fiscal Recovery Fund and the Coronavirus Local Fiscal Recovery Fund. Recipients hereby agrees, as a condition to receiving such payment from Treasury, agrees to the terms attached hereto. Recipient: Authorized Representative Signature (above) Authorized Representative Name: Authorized Representative Title: Date Signed: U.S. Department of the Treasury: Authorized Representative Signature (above) Authorized Representative Name: Authorized Representative Title: Date Signed: Richard Meyer PAPERWORK REDUCTION ACT NOTICE The information collected will be used for the U.S. Government to process requests for support. The estimated burden associated. with this collection of ito the Office, of nformation is 15 minutes per response. Comments concercy andning the accuracy of this burden estimate and suggestions for reducing this burden should be directed ent of the form to this address. assigned agencyama not conduct oz sponger, and and a person is sot regm'ted, 1500 eto raypond to $ collection of information D. unless0t displays ONOT send the control number assigned by OMB. U.S. DEPARTMENT OF THE TREASURY CORONAVIRUS STATE FISCAL RECOVERY FUND AWARDTERMS AND CONDITIONS I seofFmd a. Recipient understands and agrees that the funds disbursed under this award may only be used in compliance with sections 602(c) and 603(c) of the Social Security Act (the Act) and Treasury's regulations implementing that section and guidance. b. Recipient will determine prior to engaging in any project using this assistance that it has the institutional managerial, and financial capability to ensure proper planning, management, and completion of such project. Lot of Perform nr The period of performance for this award begins on the date hereof and ends on December 31, 2026, As set forth s Treasury's implementing regulations, Recipient may use award funds to cover eligible costs incurred durin that begins on March 3, 2021 and ends on December 31, 2024. g the period "Vad M Recipient agrees to comply with any reporting obligations established by Treasury, as it relates to this award. LMaint_ enauQg of and Ar a. Recipient shall maintain records and financial documents sufficient to evidence compliance with sections 602(c) and 603(c), Treasury's regulations implementing those sections, and guidance regarding the eligible uses of funds. b. The Treasury Office of Inspector General and the Government AccountabiliTy Office, or their authorized representatives, shall have the right of access to records (electronic and otherwise) o Recipient in order o conduct audits or other investigations. c. Records shall be maintained by Recipient for a period of five (5) years after all funds have been expended or returned to Treasury, whichever is later. 5. Pre award Coal$ Pre -award costs, as defined in 2 C.F.R. § 200.458, may not be paid with fending from this award. -®dministrative (o Recipient may use fiords provided under this award to cover both direct and indirect costs. 7Cost SbadM Cost sharing or matching funds are not required to be provided by Recipient. 8- ('onflict¢ of Int r .�3,z Recipient understands and agrees it must maintain a conflict of interest policy consistent with 2 C.F.R. § 200.318(c) and that such conflict of interest policy is applicable to each activity subrecipients must disclose in writing to TreasuryPP affecting the awarded funds in accordance with C.F.R. pass -through 0entity, ceded under this award. Recipient and as appropriate, any potential conflict of interest 2-compliance with Aonlicahle I aw and k a. Recipient agrees to comply with the requirements of sections 602 and 603 of the Act, regulations adopted by Treasury Pursuant to sections 602(f) and 603(f) of the Act, and guidance issued by Treasury agrees to comply with all other applicable federal statutes, regulations, and executive orders, and Recipient shall provide for such compliance by other parties in any agreements it enters into with, parties relating this award.foregoing.the Recipient also b. Federal regulations applicable to this award include, without limitation, the following: i. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 C.F.R, Part 200, other than such provisions as Treasury may determine are inapplicable to this Award and subject to such exceptions as maybe otherwise provided by Treasury. Subpart F -Audit Requirements of the Uniform Guidance, implementing the Single Audit Act, shall apply to this award. ii. Universal Identifier and System for Award Management (SAM), 2 C.F.R. Part 25, pursuant to which the award term set forth in Appendix A to 2 C.F.R. Part 25 is hereby incorporated by reference. Reporting Subaward and Executive Compensation Information, 2 C.F.R. Part 170, pursuant to which the award term set forth in Appendix A to 2 C.F.R. Part 170 is hereby incorporated by reference. iv. OMB Guidelines to Agencies on art Debarment and Suspension (Nonprocurement), 2 C.F. Pa 180, including the requirement to include a term or condition in all lower tier covered transactions (contracK It ts and subcontracts described in 2 C.F.R. Part 180, subpart B) that the award is 9.subject o 2 C.F.R. Part 180 and Treasury's implementing regulation at 31 C.F.R. Part I` v. Recipient Integrity and Performance Matters, pursuant to which the award term set forth in 2 C.F.R. Part 200, Appendix X11 to Part 200 is hereby incorporated by reference. vi. Governrmentwide Requirements for Drug_Free Workplace, 31 C.F.R. Part 20. vii N ew Restrtcttons on Lobbying, 31 C.F.R. Part 21. viii. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42 U.S.C. §§ 4601-4655) and implementing regulations. ix. Generally applicable federal environmental laws and regulations. c. Statutes and regulations prohibiting discrimination applicable to this award, include, without limitation, the following; i. Title VI of the Civil Rights Act of 1964 142 U ii. iv V. C.F.R. Part 22, which prohibit discrimination n the basis 0of race, 0d et color, or national origin under programs or activities receiving federal financial assistance; Treasury's implementing under Pr regulations at 3 P The Fair Housing ActTitle discrimination in bons" VIR of the Civil Rights Act of 1968 (42 U.S.C. §§ 360I et segin, sex, familial9 .), which prohibits ing on the basis of race, color, religion, national on status, or disability; Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794 which prohibits discrimination n the basis of disability under any program or activity receiving federal financial assistance; The Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101 et seq.), and Tres regulations at 31 C.F.R. Part 23, which prohibit discrimination on the et se of age in programs receiving federal financial assistance; and Treasury's implementing g P grams or activities Title 1I of the Americans with Disabilities Act of 1990, as amended (42 U.S.C. § § 12101 et se . discrimination on the basis of disability under programs, activities, and services provided or made available by state and local governments or instrumentalities or agencies thereto. q )' which prohibits IQ* 0 Remedial a 'ion PP Tree the event of Recipient's noncompliance with sections 602 and 603 of the Act, other applicable laws Treasury's implementing regulations, guidance, or any reporting or other programTreasury conditions on the receipt of a subsequent tranche of future award fiords, if anrr take other avaailable remedies as set forth in 2 C.F.R. § 200.339. in the cse of a violation of sections 602(c) or 603(c) of the Act regarding the use of funds, Prmay evious additional onal shall be subject to recoupment as provided in sections 602(e) and 603(e) of the Act. payments I II I. Ha�AC Recipient agrees to comply, as applicable, with requirements of the Hatch Act (5 U.S.C. §§ 1501-1508 and 7324-7328), which limit certain political activities of State or local government employees whose connection with an activity financed in whole or in part by this federal assistance. Principal employment is in 191 False. Recipient understands that making false statements or claims in connection with this award is a violation of federal law and may result in criminal, civil, or administrative sanctions, including fines, imprisonment, civil damages and Penalties, debarment from participating in federal awards or contracts, and/or any other remedy available bylaw. 13 Publications,)[wsu Any publications produced with funds from this award must display the followin language: being] [was] supported, in whole or r part, by federal award number [enter project F Department of the Treasury." g gaage. "This project he AIN] awarded to Calhoun County by the U.S. .14 D&S t7wed the Feat L -- rnmenr a• Any funds paid to Recipient (1) in excess of the amount to which Recipient is finally determined to be authorized to retain under the terns of this award; (2) that are determined by the Treasury Office of Inspector General to have been misused; or (3) that are determined by Treasury to be subject to a repayment obligation pursuant to sections 60(e) and 603(e) of the Act and have not been repaid by Recipient shall constitute a debt to the federal government. 2 b. Any debts determined to be owed the federal government must be paid promptly by Recipient. A debt is delinquent if it has not been paid by the date specified in Treasury's initial written demand for a have been made or if the Recipient knowingly or improperly retains funds that are a debt as defined in paragraph 14(a). Tress Payment, unless other satisfactory arrangements Treasury will take any actions available to it to collect such a debt. a. The United States expressly disclaims any and all responsibility or liability to Recipient or third persons for the actions of Recipient or third persons resulting in death, bodily injury, property damages, or any other losses resulting in any way from the performance of this award or any other losses resulting in any way from the performance of this award or any contract, or subcontract under this award. b. The acceptance of this award by Recipient does not in any way establish an agency relationship between the United States and Recipient. a. In accordance with 41 U.S.C. § 4712, Recipient may not discharge, demote, or otherwise discriminate against an employee in reprisal for disclosing to any of the list of persons or entities provided below, information that the employee reasonably believes is evidence of gross mismanagement of a federal contract or grant, a gross waste of federal funds, an abuse of authority relating to a federal contract or grant, a substantial and specific danger to public health or safety, or a violation of law, rule, or regulation related to a federal contract (including the competition for or negotiation of a contract) or grant. b. The list of persons and entities referenced in the paragraph above includes the following: i. A member of Congress or a representative of a committee of Congress; ii. An Inspector General; iii. The Government Accountability office; iv. A Treasury employee responsible for contract or grant oversight or management; v. An authorized official of the Department of Justice or other law enforcement agency; vi. A court or grand jury; or vii. A management official or other employee of Recipient, contractor, or subcontractor who has the responsibility to investigate, discover, or address misconduct. c. Recipient shall inform its employees in writing of the rights and remedies provided under this section, in the predominant native language of the workforce. h ild encourage eat Belt trae o he rT r e pursuant to Executive Order 13043, 62 FR 19217 (Apr. 18, 1997). Recipient should encourage its contractors operating cto adopt and enforce on-the-job seat belt policies and programs for their employees when ompany-owned, rented or personally owned vehicles. 18. Reducinn Text ' acagjgg �xn iie nr`ln� pursuant to Executive Order 13513, 74 FR 51225 (Oct. 6, 2009), Recipient should encourage its employees, subrecipients, and contractors to adopt and enforce policies that ban text messaging while driving, and Recipient should establish workplace safety policies to decrease accidents caused by distracted drivers. OMB Approved No. 1505-0271 Expiration Date: 11/30/2021 ASSURANCE OF COMPLIANCE WITH CIVIL RIGHTS REQUIREMENTS ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 As a condition of receipt of federal financial assistance from the Department of the Treasury, the Calhoun County (hereinafter referred to as "the Recipient") provides the assurances stated herein. The federal financial assistance may include federal grants, loans and contracts to provide assistance to the recipient's beneficiaries, the use or rent of Federal land or property at below market value, Federal training, a loan of Federal personnel, subsidies, and other arrangements with the intention of providing assistance. Federal financial assistance does not encompass contracts of guarantee or insurance, regulated programs, licenses, procurement contracts by the Federal government at market value, or programs that provide direct benefits. This assurance applies to all federal financial assistance from or funds made available through the Department of the Treasury, including any assistance that the Recipient may request in the future. The Civil Rights Restoration Act of 1987 provides that the provisions of this assurance apply to all of the recipient's programs, services and activities, so long as any portion of the recipient's program(s) is federally assisted in the manner proscribed above. 1. Recipient ensures its current and future compliance with Title VI of the Civil Rights Act of 1964, as amended, which prohibits exclusion from participation, denial of the benefits of, or subjection to discrimination under programs and activities receiving federal funds, of any person in the United States on the ground of race, color, or national origin (42 U.S.C. § 2000d et seq.), as implemented by the Department of the Treasury Title VI regulations at 31 CFR Part 22 and other pertinent executive orders such as Executive Order 13166; directives; circulars; policies; memoranda and/or guidance documents. 2. Recipient acknowledges that Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency," seeks to improve access to federally assisted programs and activities for individuals who, because of national origin, have Limited English proficiency (LEP). Recipient understands that denying a person access to its programs, services, and activities because of LEP is a form of national origin discrimination prohibited under Title VI of the Civil Rights Act of 1964 and the Department of the Treasury's implementing regulations. Accordingly, Recipient shall initiate reasonable steps, or comply with the Department of the Treasury's directives, to ensure that LEP persons have meaningful access to its programs, services, and activities. Recipient understands and agrees that meaningful access may entail providing language assistance services, including oral interpretation and written translation where necessary, to ensure effective communication in the Recipient's programs, services, and activities. 3. Recipient agrees to consider the need for language services for LEP persons during development of applicable budgets and when conducting programs, services and activities. As a resource, the Department of the Treasury has published its LEP guidance at 70 FR 6067. For more information on LEP, please visit hup•//vn=. , 4. Recipient acknowledges and agrees that compliance with this assurance constitutes a condition of continued receipt of federal financial assistance and is binding upon Recipient and Recipient's successors, transferees and assignees for the period in which such assistance is provided. 5. Recipient acknowledges and agrees that it must require any sub -grantees, contractors, subcontractors, successors, transferees, and assignees to comply with assurances 1-4 above, and agrees to incorporate the following language in every contract or agreement subject to Title VI and its regulations between the Recipient and the Recipient's sub -grantees, contractors, subcontractors, successors, transferees, and assignees: The sub -grantee, contractor, subcontractor, successor, transferee, and assignee shall comply with Title VI of the Civil Rights Act of 1964, which prohibits recipients offederal financial assistance from excluding from a program or activity, denying benefits of, or otherwise discriminating against a person on the basis of race, color, or national origin (42 U.S.C. § 2000d et seq.), as implemented by the Department of the Treasury's Title VI regulations, 31 CFR Part 22, which are herein incorporated by reference and made a part of this contract (or agreement). Title V! also includes protection to persons with "Limited English Proficiency" in any program or activity receiving federal financial assistance, 42 U.S.C. § 2000d et seq., as implemented by the Department of the Treasury's Title VI regulations, 31 CFR Part 22, and herein incorporated by reference and made a part of this contract or agreement. 6. Recipient understands and agrees that if any real property or structure is provided or improved with the aid of federal financial assistance by the Department of the Treasury, this assurance obligates the Recipient, or in the case of a subsequent transfer, the transferee, for the period during which the real property or structure is used for a purpose for which the federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is provided, this assurance obligates the Recipient for the period during which it retains ownership or possession of the property; 7. Recipient shall cooperate in any enforcement or compliance review activities by the Department of the Treasury of the aforementioned obligations. Enforcement may include investigation, arbitration, mediation, litigation, and monitoring of any settlement agreements that may result from these actions. That is, the Recipient shall comply with information requests, on -site compliance reviews, and reporting requirements. 8. Recipient shall maintain a complaint log and inform the Department of the Treasury of any complaints of discrimination on the grounds of race, color, or national origin, and limited English proficiency covered by Title VI of the Civil Rights Act of 1964 and implementing regulations and provide, upon request, a list of all such reviews or proceedings based on the complaint, pending or completed, including outcome. Recipient also must inform the Department of the Treasury if Recipient has received no complaints under Title VI.. 9. Recipient must provide documentation of an administrative agency's or court's findings of non-compliance of Title VI and efforts to address the non-compliance, including any voluntary compliance or other agreements between the Recipient and the administrative agency that made the finding. If the Recipient settles a case or matter alleging such discrimination, the Recipient must provide documentation of the settlement. If Recipient has not been the subject of any court or administrative agency finding of discrimination, please so state. 10. If the Recipient makes sub -awards to other agencies or other entities, the Recipient is responsible for ensuring that sub -recipients also comply with Title VI and other applicable authorities covered in this document State agencies that make sub -awards must have in place standard grant assurances and review procedures to demonstrate that that they are effectively monitoring the civil rights compliance of sub -recipients. The United States of America has the right to seek judicial enforcement of the terms of this assurances document and nothing in this document alters or limits the federal enforcement measures that the United States may take in order to address violations of this document or applicable federal law. Under penalty of perjury, the undersigned official(s) certifies that he/she has read and understood its obligations as herein described, that any information submitted in conjunction with this assurance document is accurate and complete, and that the Recipient is in compliance with the aforementioned nondiscrimination requirements. ¢1 svn- `get Reci i nt<' Striature of Authorized O tci : Date PAPERWORK REDUCTION ACT NOTICE The information collected will be used for the U.S. Government to process requests for support. The estimated burden associated with this collection of information is 15 minutes per response. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Office of Privacy, Transparency and Records, Department of the Treasury, 1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send the form to this address. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid control number assigned by OMB. Mae Belie Cassel From: rhonda kokena <rhonda.kokena@calhouncotx.org> Sent: Thursday, June 17, 2021 2:40 PM To: Mae Belle Cassel Subject: AGENDA ITME / JUNE 23 Attachments: Bank Extension 8-1 to 7-31-2023.pdf Importance: High Good Afternoon - Would you be so kind as to place the following on the agenda for the 23'"� To Approve and Accept the extension on the Depository Services Contract between Calhoun County and Prosperity Bank for a period of two-year basis and allow County Treasurer to sign. Contract will run from August 1, 2021 through July 31, 2023. I have attached a copy of the extension letter for the agenda. Thank you. COLC 'T�'�E's , ER C"2 Ct.; -A '! X I Calhoun County Texas i CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f 1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2021-771696 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Prosperity Bank Houston, TX United States Date Filed: 06/28/2021 2 Name of governmental entity or state agency that is a party tot the contract for which the form is being filed. County of Calhoun Date Acknowledged: 07/22/2021 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. RFP# 1923 Depository Bank Services Effective 8.1.2021 Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary Prosperity Bancshares, Inc. Houston, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is and my date of birth is My address is ' (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the _day of , 20_ (month) (year) Signature of authorized agent of contracting business entity (Declarant) V.....; v1 1 e ffd98 Forms provided by Texas Ethics Commission www.emlcs.state.tx.us -•-•- -- CERTIFICATE OF INTERESTED PARTIES FORM 1295 I Complete Nos, 1.4 and 6 it there are Interested parties. Complete Nos, 1, 2, 3, 5, and 6 if there are no Interested ;andcountry OFFICE USE ONLY 1 Name of business entity filing form, and the city, statof the business anti s lace CERTIFICATION OF FILINGof business. ty' p Certificate Number.Prosperity Bank 2021-cafe NuHouston, TX United States96 2 Name o governments entity or state agency t at s a Date Filed: a contract iorwhich t e orm s OB/28/2021 being filed. t County of Calhoun Date Acknowledged: 3 Provide the identification number used by the governmerdal entity or state agency to track or identify the conhact, and provide a description of the services, goods, or other property to be provided under the contract. RFP# 1923 Depository Bank Services Effective 6.1.2021 4 Name of Interested Party City, State, Count Nature of interest y ry (Place of business) (check applicable) Prosperity Bancshares, Inc, Controlling Intermediary ' Houston, TX United States X, ;i 5 Check only if there is NO Interested Party. 6 UNSWORN DECLARATION L: My name is John Zacek_ and my date of birth IS _ My address is I declare under penalty of perjury that the foregoing isl true and correct, - Executed in Victoria Court t Texas ry, s ate or on the 281hday of June 20 21 (month) (year) signs ure of au ant of contracting business entity rms provfded by Texas Ethics Commission (oeclerent) www.ethlcssta[e.tx.us Version V1.1.Ceffd98a #9 Mae Bella Cassel From: rhonda kokena <rhonda.kokena@calhouncotx.org> Sent: Thursday, June 17, 2021 3:35 PM To: Mae Belle Cassel Subject: AGENDA ITEM / JUNE 23 Importance: High Per our conversation, please place the following on the next agenda: To discuss and approve the cancellation of any Wal-Mart credit cards held by departments and stop the usage of all cards as soon as possible. Wal-Mart cards/billings are now held by and made payable to Capital One. Wal-Mart cards are not costs affective for the County. Thank you. I>or; Lnvncn, F1,Kn_s <:a= Calhoun County Texas 1 #10 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 —Office (361) 893-5346 — Fax (361) 893-5309 Email: ioel.behrens(a)calhouncotx.org Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for June 23, 2021. • Please Consider and Take Necessary Action on road closure of the lower part of Haterius Park Lane and only one way traffic for upper part of Haterius Park Lane in Olivia, TX. Between the hours of 2:00pm — 12:00pm on July 4, 2021 for fireworks display provided by Bayside Community Church. Sincerely, A/ _ r Joel Behrens Commissioner Pct. 3 #11 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172^Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309 Email: ioel.behrens(dcalhouncomom Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for June 23, 2021. • Please Consider and Take Necessary Action on Commissioner Behrens to sign two year agreement with La Ward Telephone for Pct. 3 phone system upgrade. Sincerely, Joel Behrens Commissioner Pct. 3 WN LA WARD DATE 6/2/2021 12991 State Hwy 172, PO Box 246 QUOTE # 20210602 La Ward, Texas 77970 CUSTOMER ID 101016 361-872-2211 or 361-872-2501 fax VALID UNTIL 7/2/2021 www.laward.net Prepared by: Dee Darilek deeCillaward.ora Calhoun County Precinct #3 Attn: Lynette Adame 24627 State Hwy 172 Port Lavaca, TX 77979 361-893-5346 DESCRIPTION UNIT PRICE • • LWT TEO UC System (Per Extension) 2 year agreement Monthly Lease Option: TEO UC System per Extension 30.00 3 90.00 Unlimited Local Ft Domestic Toll per Extension 15.00 3 45.00 Additional One-time Fees: Model IP 9104 Phone with DC adapter 238.39 3 $ 715.17 Installation Labor ($50/per technician) 50.00 2 100.00 POE Injector 20.00 1 20.00 Ethernet Adapter 39.00 1 39.00 $ 874.17 Included Features with each Extension: PC Softphone Mobile App Phones come with a one year warranty. 1. Proposal valid for 30 days from "quote Date" above 2. Unlimited Local & Domestic Long Distance calling to Continental US 3. Alaska & Hawaii are "offshore domestic' & incur additional LD as well as International Calling Rates will generally vary between $.11 - S3.00/per minute (rate list ovoilable upon request) 4. All taxes, fees, and surcharges are in addition to the quote provided 5. Please fax or mail the signed price quote to the address above Acceptance (sign below): Date: Name: you have any questions about this price quote, please contact Dee Darilek, 361-872.2211, dee@laward.org Thank You For Your Business! CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos. 1- a and 6 if there are interested parries. OFFICE USE ONLY Complete Nos.1. 2, 3. 5. and 6 if there are no interested parties. CERTIFICATION OF FILW G Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2021-766466 La Ward Telephone Exchange, Inc. La Ward, TX United States Date Filed: 06/15/2021 2 Name of governmental entity or state agency that is a parry tot the contract for which the tam is being filed. Calhoun County Pct 3 Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the conuact, and provide a description of the services, goods, or other property to be provided under the contract TEO Phone System Voip phone service to the Calhoun County Pct 3 offices 4 Name of Interested Pa Party City, State, Court Ty try (place of business) Nature of Interest (check applicable) Controlling Intermediary 6 Check only it there is NO Interested Party. X 6 UNSWORN DECLARATION My name s� Q .� d{� �`{� .and my date of birth is My address is r (street) {city) (state) (rap code) (country) I declare under penalty of perjurythat the foregoing is true and correct. ,. Executed in County, State of —"� G!� (&t, on the Aday of Z M . 20 ,. (mpnth) (year) Signature of authorized agent of contracting business entity (Dadaranq Forms provided by Texas Ethics Commission wvwv.ethics.state.tx.us Version V1.1.ceffd98a CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2021-766466 La Ward Telephone Exchange, Inc. La Ward, TX United States Date Filed: 06/15/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Pct 3 Date Acknowledged: 06/25/2021 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. TEO Phone System Voip phone service to the Calhoun County Pct 3 offices 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is and my date of birth is My address is , (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the _day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.ceffd98a # 12 06-17-'21 08:55 FROM- CALHOUN CO SHERIFF 361-553-4668 T-234 P0001/0001 F-864 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553.4668 MEMO TO: RICHARD MEYER, COUNTY JUDGE SUBJECT: PURCHASE VEMCLE DATE: JUNE 23, 2021 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR JUNE 23, 2021 w Consider and take necessary action for Calhoun County Sheriff's Office to purchase a 2008 Ford F250 VIN 1FTSX21588EE36183(narcotic seized vehicle) from Starr County Motors for $6774.89 . Monies will come from Narcotic Forfeiture Account. Vehicle will be placed in Sheriff's Office fleet with insurance. Attached is all the documention. Sincerely, A Bobbie Vickery Calhoun County Sheriff 06-17-'21 14:16 FROM- CALHOUN CO SHERIFF 361-553-4668 T-236 P0006/0008 F-868 Cause No.2020-CV-4020-DC THE STATE OF TEXAS § IN THE DISTRICT COURT V. § 24Tn JUDICIAL DISTRICT 2008 FORD F2509 SUPERDUTY § TRUCK, VIN# IFTSX21588EE36183, § DEFENDANT § OF CALHOUN COUNTY, TEXAS AGREED FINAL JUDGMENT OF FORFEITURE On this day, the above styled and numbered cause was considered. Plaintiff, the State of Texas appeared through her Assistant District Attorney. The Respondent, MANUEL TREVINO, did not appear. The Court finds that the 2008 Ford F250, Super Duty Truck, VIN# IFTSX21588EE36183 was seized on May 29, 2020 in conjunction with the arrest of Neville McCorkel for the felony offense of Possession of Marijuana. The Respondent Neville McCorkel has defaulted and a Default Judgment in this case has been rendered against him. The Respondent Manuel Trevino has been served with process and said return has been on file with the Clerk of the Court for 10 days, excluding the date of judgment. The Respondent Manuel Trevino, is the registered lienholder on the 2008 Ford F250, Super Duty Truck, VIN# 1FTSX21588EE36183 and the parties have negotiated a settlement of this case and agreed to the forfeiture of the property seized. Manuel Trevino, the Respondent, has agreed to release the lien upon payment by the Calhoun County Sheriffs Office of $6,774.89 (the amount remaining on the lien). The Court finds that in the interest of justice this settlement should be approved. The Court, having read the pleadings and papers on file, having heard any evidence presented by the Plaintiff, and arguments of Counsel, finds that the 2008 Ford F250, Super Duty Truck, 06-17-'21 14:16 FROM- CALHOUN CO SHERIFF 361-553-4668 T-236 P0007/0008 F-868 VIN# IFTSX21588EE36183 is contraband as defined by Chapter 59, Code of Criminal Procedure. Therefore, the Court finds that this property is subject to forfeiture. It is, therefore, ORDERED, ADJUDGED, and DECREED by this Court that any and all interest of Respondent MANUEL TREVINO in and to the 2008 Ford F250, Super Duty Truck, VIN# 1FTSX21588EE36183, is hereby forfeited, to the State of Texas, as provided in Chapter 59 of the Texas Code of Criminal Procedure in accordance with its Local Agreement with the Calhoun County Sheriffs Office. It is further ORDERED, ADJUDGED and DECREED that all costs of this lawsuit are assessed against the party incurring same. All other relief not expressly granted herein is denied. SIGNED this day of 2021. JUDGE PRESIDING APPROVED AND ENTRY REQUESTED: c ASSISTANT DISTRICT ATTORNEY Calhoun County, Texas APPROVED: Manuel Trevino Starr County Motor 1429 E. Grant St. Roma, Texas 78584 06-17-'21 14:16 FROM- CALHOUN CO SHERIFF 361-553-4668 T-236 P0008/0008 F-868 DATE RECEIVEI) FROM OFOR RENT 415 11 r+� r '' ".:r:;,t�/`'; ";.: D.OL FOR .•S' `•:, ACCOUNT' 0•.• . '.,::..;..•,.1''.'.,. PAYMENT MONEY FROM BAL. DU@ V?©'" ORDER1. I all (�DVAEDIT 06-17-'21 14.14 FROM- CALHOUN CO SHERIFF 361-553-4668 T-236 P0001/0008 F-868 I r Upon sale of this vehicle, the purchaser must apply fora new title within 30 days unless the vehicle is purchased by a dealer. Until a new title is issued, the vehicle record will continue to reflect the owners jne listed on the current title. SEE BACK OF TAB FOR ADDITIONAL INFORMATION. l C? 1 0114196-01S427 4 STARR COUNTY MOTORS 1 '-PO BOX 1384 8 co ROMA, TX 78584-1384 DETACH 1 1)MV VE ICLfID2NGPIdRONNUM9EN, E "'�F,,TSX215,88EE36183. 20 '..�;"[ 1, (•... =' i MOOEtlpie .' IN TO.ryS'`Y✓E16NT! 'I 11Ni'' rigs. igsElkrNk dl�dSr�� M ILL NEVIIfiIfIIAND,T MClCOR1C ,.�':1'94.?,QOIJNTY •ROAD 647a 'Y'.:. �.� . � SILNA.'TURE OF OWNENON PGENTI a i firr�'�53��•. pg• ID: .',✓ . nrLRTiacuME6 0 •0 BOX WI 4 t t ROMA TX 8 y �y P. 5�, Ord Wd IA DATE OF LIEN I I NDLENHOWEH tie✓ •� `ill. �I`Iq.� {;{��li �`.:'t�I�l :6'A.,;P;R .c"i'�'. , .', ,,•ii t 1J i � lftSl"I%P8 f UI '•`�'11iR�� t' , 'r RIGNTS•'OF GVRV.IVOR'S •'HIP ACRE •ENT' I. WE, THE MARRI9Q,P.E,A9ONS WNOEE SIGNAnIII0 WPM HEREIN, HERESY, ,. "AGREE TNRT;,TH€ pwNERSNIQ,OP•TNE VEHICLE, ON RMED ON:TNG 'MATIFICAI OF TITLE GHALL FROM THIS DAY FORWARD EE HELD,4100 AND.IN THE EVENT OE DEATH OF ANY OPME, URSQNS'NAMED IN 1HE • A�+NEfiAENt.11/EOWNEAENIPOFTNE VENICIEBNALLVF,BLINTN„E BURYIVURiSr. ' 15223.,79 AVMORIEED AGSM ''• z I'iE nAlk IN1611t1hn All �Ii� s AvmoRlzeoAGENT 11, r ` SRDLIENHELEAGEO ` i MiHONIZ OAGENT.,,' • ,r SIGNATURE DATE'': 06-17-'21 14:14 FROM- CALHOUN CO SHERIFF 361-553-4668 T-236 P0002/0008 F-868 AvYERS ORDER. 00Et2/2D� STpCK.fJ^ 9:0.282' ESLIER fNEOWA'f1OJr: QEIiLERiS5LLE1tfNE4FiIN7tTI0N: INS VILLE 13RANRT MCrCORM '194• COUNTY ROAD 6478 dAYTON; TX 77M 0011k : 'CHAMBERS NONE; CELL: WOF.dc: busrATEtoM09878053 arAfe:TX eXP.eATE: 6121122 S.T%ll2j ' 66614i lUib`f.ORS ��g �� G�NT �� R0114A, TX78584 s� �ac� .7•rP•ij�!a`Sap�a�a ' a.pa'.:, 05I21170 VEtdcLE INPoRMATION: ... .. .. .YEAR: 200$ coLg(tf: WNITE VIN:� 1FTS1f2t588EE36483 SToCtS: 14282 "KE: FORD COL"OR 2: STILE:. b`WREfvr.p-ITY Gyi; B MODEL'. F260 leocir'; 4DR 11tILEAo):1 EXEMPT TRANS: AUTO II -IN INFORMATION: YEARa 604OR: a(at<a: NleeaoE: 'ETT6 Nl [t, .. .. .... . VEKICLr::ptaCA: 1U:999:: Q .IVfAy MooEt,: F10b': >gaLquce owEoro: :Seje's 1.'ax: t){f,`I.•'E;T�,. Titlb F4e;M00LircnsgYRaai$fr Milo lchFe@.(Sate): 7'•5D.:(SfQliijfiL %,5„0 '1'S'.t'ia BALANCE OWED: $ 0-60 ROAR Tllvt6 H: ALLOWANCE: $0.00 oiIOTE'GBT:' f7P�palilf!$'QIyICEr:OtC? r',33.75„ ZmA Witte D'ealees Inventory Tait cheirse;i- Intfsnsitpd' fo to) rijburse,'the dealer for ad valaretM'taYes' on, its. motor ,uahicl6 inventt6 ti6 charge, which is paid by life dealer t0 the count, aisesaGr- CIP1400 is not a tax Ulfhosed: qtt a cqA <p16er 6y : he. r�ovetnmenti. and is not required to be Charged by k(le.,dpaler to the consumer. 'pealerstitveRfony°Fex": 4 fzk - - Rnyoff.sih Tie e.ItY. . Nib *'A documentary fee Is nos an ptflicial lee, A documentary flee" is not _. TequfYed by iAW,, bpi rn'pp be Mrg'eti'to quya',r%'f6F handling dcct+mept; .velsting to The sate, A du+httnentar')r {eo may rla"eXEeetI a reasova'6N amount agreed to by the parties. T6ie notice is.'rcttuirad bylaw. Un honprario de documvitaoion ne as ton tiopprario oriclai• tin fioYtorano de' decunrenlacfdn no as redderS'do p6r is 14., pefe p0ade stirdorooda, al colrprSdOT COlno gaStos d'e nienOlo(j(si. 't14fiurd6`fitg'$;1:efaafpnaddis con una vsnta. Un honorario de 4acumetitacion no.. puede' excedde uns 'cantided raionable, cotdada_ pales.prides„Et1tA:nktlflGaei6SieSrepuettdaor hit . .Dpepmentaly Fee". QB.DU YOTAL opt, i f,77'4.80 :. TRADE-inALLOWANGE NIA DEPOSIT NiA klF�t4 "nLyi bER INfoHMATtaN .........:.. '. COMPANY: STARR C'OUFI:FYMoToRls CACaH ooVVN,pAYMN7 S,DDU.tl� STREET: PO B0%.19A4 CITY.5TATe,29P: ROMA, TX 78584 TOTAI,'CRED.IT 5,00a.ga INSU - t! r'N: COMPANY: AGENT: PHONE: P.OLICVa: O cash Ed Flnares HALARCE nUE. .0,774,09 KNoted. please sae your ht9tallinerit ides, eprflad for Infmmoaan alj'saf finance itfatgq ii:iuraTeG.$itd ta+maorpdy,rent(a(heHhah rPnlri. WARRANTY OISOLAIMER; unf6bs Seller provid"Awr➢tten watranly, or cntef: ihtua Aeii t tionlrae(wi(hfp'S.tl"days from the r{aie oY.thiscontract, this vehlNe is being sold "As is . WITH AM FAULTS" and Sellai makes no wBrraAtles, eilprass or idtjolledr on th'd Vehicler an5(dierd'witl be no implied warranties df merchanjohility or of Ntriess 116VA partfcblar puippse.This.didda0ddrdodd taffect any wammvi by dIta Yshiple inamifacbjr&. Sellerrlatth$raasdmeS.noraath.,oriZys anyoiherpbrson.Wasgumeforitanyliibl6ryircop tUontViihthesaieoflhflVBhlCieaadtheteJateQpmducts anhSanrices. rnNTRACTUAL DISCLOSURe STATEMENVAUSED VEtt(CLES ONLY), The IntarmAtion ypa sae an the window form far this Vehicle is part of this contract. lirtorinaDpn on the wlpdow,'form overrides any pontrary provisions in the eontraet of eals,.5'pantsa Trsnsiation: Gul9 paracompraddms de vehfeulas usedos. La Infotinahtdn que ve'sn'el formulaHp dq la Ven[anihii pbra a"xte vehicu) Fomra parta Bel presents contracp. La informaclon del tormtrlado data rehlandla deja sin dfactd t6da,dispdsiiieh do contrarfp,coetaplda'04 dtpentratb. de Yenta. Buyer hereby declares that helshe is of legal 'age io transact businass and that no unfair inducement has been .made by Seller. This agreement and the related documents that Buyer signs contemporaneously with this agreement, including any retail installment contract, contain the entire agreement between Guyer and Seller end cancels and superae h s any prior agreement including oral agreements relating to the s o mot V hicle. Any change to this agreement mus a in **rifting list must sign it. 1(F 5l12120 X±�r" — 5112120 X_ Acce b uthodZed Represenlaeve of Seller Dele Buyer Date Co -Buyer Date G3Qx-e0re4. 04110 02019 Fan, Cornpuling, tnc. 06-17-'21 14:15 FROM- CALHOUN CO SHERIFF 361-553-4668 T-236 P0003/0008 F-868 .QWR TWO: S/12120 ROTOR VEHICLE RPTA TA -N ,WNT CONTRACT. F2.TXA[C-SA IL IS. � LIL NAVILLE BRA10-11' MCCORKFL STARR COUNTY MOTORS 1-40, UNTYROAD 6476 14;29 t (31XIA " 7N. all ST YTON, TX 77535 ROMA, T97A 04 Phow, phor&. -96&944=5844 TIM Buyer is referred The S;:Ileels nalcrrmd (oas'wO or";u;.01rhj-. aminiamay be firatrakfamedby theaeller. ORWAI - ZE 76 PAY: The credit pdVe is obdWit below ad -the "Total Sialits f1rice.'Thit Mash Price is Also shown below: By sighing this otIctirstir, you challse to purcliO4 thovefilicne on draciltsicewding Who terms ofthIS contract You i3gineW Oyths The Amount FiAandgd Fine ficaCbe. irchaptissin this conWct lime togree to mslte'payrqeerds� according -to the Ps)jm6n1 66hedula fiti rill, ceiithmt. If more than one pentbri signs as & buyer. Ydu agree t.6 keep all the pnornl5es:in this agreement even if haLva IfiGnIvoly Inspected, accepted. end appravao the vefildc in all Wspacts. ni� irok WHICH PkikCHASEM, Uniesg the follawinc. box is chlickedi, you are kipyinj tho volhW"rimarily for peracimil,-16millr, of housA614 use. It checked, this tremiducholl (ea commerord ve6jcfje msts)Iment sple and djjapt6t 303 of lhiI Tens FrIPORW R006 applies to this corterabi, VEflICLs I . Stocit Ne. .1 Year I Mike. FLV Wir, ca 11 ant WNilm Member r �ffNc� Ob�eroonwAtce L io�8;2 I 2608 FOk2 FW . F.actury-efreitIrExtouthee' 'firgade-lin(s):.Year . Maki —Mbd I ._ V(NLicense No. Yes�r_ Moke_ Model—__ VIN License. No ANNUAL PERCENTAGE RATE y.diriy ram. FINANCE CHARGE Tht.00118f Vinalftil Me Moll Ail Qq91104, Amount Finititidd Thaikinewil. (Civellgrorlbadto irmlor tyraur�iuiff, Tout of payments The emo,nQowQII Wvb &W afteryou hjvA�nadd Oil pay! * nano; Totaysgife Piled The tourissit afy6bz purchase on qed4:IqiIUjtriq dawnDjacastoFyouededii psynientr9f 5 SAW,% s__L',�774-89 0.00 gb g, 0.00. S 6774.89 s— 6.774-89 YgptI'4jtneM64fi.dUIaVylI.. u Won j QfdF:P-y'A o' Annumt ofIlilionahris when P'tbuk"t. A4134. 13 000.00 MQNtHI;Y 0elgiln n1jig 40ne 12, 202a $974.80 J61Y 12 '* ?021 Or as rollowa: ' Lers, Charge! lFwa do not recaft your entire.paymunt vAbIn 15doys after Itts due (10 days Ilyou are buying E haevy camihercial vehWid), y6u will pay 6 tole thorgle of 6% of theschedulad payment prepayment: If you reffall a any part of the cleirt that you dWq early, you will nothave to pay a penalty- Addesceriall Information: You Will War to this 600unkimt for iv)(401rallOn about nonpayment, defaui% security Interests, any required repaYrient in full before the . soedulecil date and ant fisfaids. Any change to ral changes to this contract are anlarteable. ierSignak N/A doNtitilvidlk W.Afimmd NOTICE TO THE BUYER — DO NOT SIGN THIS. CONTRACT EJEFORE YOU READ IT OR IF IT CONTAINS ANY BLANK SPACES YOU ARE ENTITLED TO A COPY OF THE QbNTJkAdT. YOU SIGN, UNDER THE LAW, YOU HAVE THE RIGHT To PAY OFF IN ADVANCE ALL THAT YOU OWE A -NO UNDER CERTAIN CONDITIONS MAY SAVE A POkTk)N OF THE FINANCE CHARGE, YOU VALL KEEP THIS CONTRACT TO PROTECT YOUR LEGAL RIGHTS. This contract has 4 pages. Be sure to review all 4 pages of this contract before signing below. BUYER'S ACKNOWLEDGEMENT OF CONTRACT RECEIPT: YOU AGREE TO THE TERMS OF THIS CONTRACT ACKNOWLEDGE RECEIPT OF A COMPLETED COPY OF IT. YOU CONFIRM THAT BEFORE YOU SLGNED THIS CONTRACT. WE RAVE IT TO YOU, AW-iOU WERE FREE TO TAKE IT AND REVIEW IT. Buyer X Z( _ 21�ge D-tc—L/1-212620 cc -Buyer X NIA Buyers and OtheYownaft - A buyer is a portion who is TC*poriisibio fiorpaying the entire debt. An "other owner' is a person whose name It on the title to the vehicle but does not have to pay the debt. The other owner agrees to the security interest in the vehicle given to us in this ciontroel, Other Omer Geller Sign -- Date 511212020 _Printed YRIS CONTRACT 19 NOT VALID UNTIL YOU AND WE SIGN IT. Tllle_4:�o ( __ Page 1 of 4 (of document 735055) FZTX-RIGSA 04118 True Daily Earnings - Sales Tax Advanced 0 2010 Fraser Computing, Inc. 06-17-'21 14:16 FROM- CALHOUN CO SHERIFF 361-553-4668 T-236 P0004/0008 F-868 A Papa: 1 T1Jnq9AMXM MX*STQ$:Y P,i�ntcd; 6102/20 ao. 9.1;9 by: 61"A cousir b=083 stock #: 1042 iwxLr* Baa.=. bp*gm=; 08 WPD Faso I - - * I - a p p r, T 19 D T a Tmakisacus OW- I ENIWozpa PICH-us, I Mftk MBEIMST *" bA = wo ==XFT Dks=PTlw —��w ---- �--- aw-mm �4�, I 4AWCE gua NOYn MPMEW "OffiEt' i TMdSACTM REM.M.ft ---- - — ---- ------ — — -- ajj$/ZD 0/12129 Xr 11010 m zdbn PAysaht; 5,000400 5,000.0b 511CY20 &f12i.20 L= 1. 02 CA Cash 8.20,00 820.00 Total V&y Qts Ifecetwa: 4'es0.0,0 s"ka-do 0.00 0.00 0-00 0.00 0.00 Contract Mancag 6,954,4B .x&2: "Total byreht. Roaaivsd° are totals of actual MiV received, it does not include Feen B d. Por ivm Charges, as Prito Off, n #13 06-17-'21 10:33 FROM- CALHOUN CO SHERIFF 361-553-4668 T-235 P0001/0003 F-866 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 PAX NUMBER (361) 553-4668 MEMO TO: RICHARD MEYER, COUNTY JUDGE SUBJECT: VEHICLES FOR WASTE DATE: JUNE 23, 2021 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR JUNE 23, 2021 r Consider and take necessary action to declare as waste the Calhoun County Sheriff's Office vehicle listed below due to it being totaled by insurance after the accident. 2020 C14EV TAHOE 1GNLCDED6LR282621 Sincerely, Bobbie Vickery Calhoun County Sheriff 06-17-'21 10:33 FROM- CALHOUN CO SHERIFF 361-553-4668 T-235 P0002/0003 F-866 Date:s/29/2021 Property Condition: Total Len Assignment Number 975-305-0020 Office: PDAVictorls, TX #875 PO Box 3894 Victoria TX Phone: 361-582-4732 Fax: 361-582-0044 Vahicle/Owner information: Insured: CALHOUN COUNTY Claimant: CALHOUN COUNTY Vehicle: 2020 Chevrolet TAhoe VIN #: 1GNLCDEC6LR282621 Loss Recap Estimated Amount of Open Damages: 0.00 Estimated Salvage Value: 0.00 Repair Facility Estimate Amount: 0.00 Agreed Scope of Damage: No IMWYIPYI Bettermeni Days to Repair:0 Applicable: Appearance Allowance: No Reason: Interior: Good Paint: Good Regiu Engine: 5.3 Inter Mlleage: 15319 Salval 202 S Tire Information: Stock Site: 265/65r/17 Salyaj Type: radials f. P¢eP&¢tY, 0'd 111ie e.;,q P_{iIS ERG.': Condition Report Loss Recap for Total loss Assignment Received: 5/27/2021 Date'of, L:osri" Date of First Contact: 5/28/2021 H' 'Date of) rispaetion: Vkiihfi :.g.' Inspection Lbcatlohl } 202 S ANN STREET PORT LAVA8k TX 77979i'+ None Specified Recommendation: Total Loss Primary Damage: Front.6enter ad: Yes Tread Depth(In 32nd's): LF:6 RF:6 ,'''-':...... :.':' LR:4 RR:4 Spere:0 r Claim #: APD20210216-1 Policy #: N/A :^('':�'01M Method: Quotes Bop kValue: $43.237.50 if Market Survey: $0.00 lines 1 & 2: $43,237.50 ..;,.',Toia(,Adjustments: $0.00 S ".'11 uggested ACV: $43,23750 Rate: 0.000) $0.00 _ Grand Total: £43,237-Lo f Remarks Open Items This vehicle is a Tota)Toss'':!' l '' Very heavy damage. to front of Vehlcls Frame Is damaged bayph'd'repair and would 'peedto'be replaced. There Is a verygood yyW ."bllityof enginscomppnent dareage. There will boa lot 'of.bldden damage ow'ar'so 1 used the m ieage of (15319) given to me by shedffs tbil change XQ parts of same year available (2020) go i wrote estimate )aria. a NADA sheet for you review. Direction to Pay: No Drivable: Yes Special Equipment: Approx Cast of Special Equipment: 0.00 06-17-'21 10:34 FROM- CALHOUN CO SHERIFF 361-553-4668 T-235 P0003/0003 F-866 could not find any comparible sales for this unit since it Is a 2020 Model have attached a comparable of an LS model which was the closest match rat it is higher that NADA. Since this is a 2020 Model 1 feel that the NADA average between NADA Retail and NADA Clean trade of $43237.00 is fair. have attached 3 salvage bids for Your review rho values on this report do not reflect any police equipment mounted on nside of vehicle. t appears all equipment could and should, be removed and transferred to another unit LKQ parts could not be located at this time. Searched vendors as listed In ,open, This appraisal has been written for visible damage only. The hood would not open at the time of inspection. Possible hidden dame to the inner structure and engine components. Possible hidden damage to the undercarriage and suspension. Please review and let me know if you have any questions or need anything also on this file. #14 Calhoun County, Texas SURPLUS/SALVAGE DECLARATION REQUEST FORM Department Name: Memorial Medical Center Storage Units - County Auction June 2021 Requested By: Jason Anglin, CEO Inventory Reason for Surplus/Salvage Number Description Serial No. Declaration 10rown Recliner No longer used J Black Rolling Office chairs No longm used t Red Rolling Grill Glair No longer used Pilo or Metal Shelving No Langer UsedfRroxen 1 eo. of Red Senders No longer used t Gray Refriigeralor No lunge, used Red IV Poses No longer used wfioelchel, Feel No Longer UseNEroken wooden Table 110longer used Metal Rack No longer useo 2 Maelchahs No longer Uaedl(3raken s i i 1 f{ f t 'c 4 k l k� v s k k4V Y'�ys n 4 a Sa' �n� 6 yea ■ fY Y � '� _-..._.._�-�+w'^ i s � , t� � yt ' � i _ ,... �_ � .� � _. x, ,._ ; . � � .�._. �� 4 ar � � ., ,�» _ .. . � _ i i N Px �1. c G 1 iA..c 4 x, L�:e Vdi 1'f G� h i` L 'yv5 4S�4 r� . , k 4 � f a Ali l Y k1 Y ,� �. �?� y. 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TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL ANDELECTRONICBANK PAYMENTS $ 887,696.48 , TOTAL TRANSFERS BETWEEN FUNDS $ 1,761,841.88 TOTAL NURSINGHOME UPL EXPENSES $, 936,805.17 TOTAL INTER -GOVERNMENT TRANSFERS $ 760,604.40 V GRAND TOTAL DISBURSEMENTS APPROVED'June 23, 2021 $ 4 336,00693. ✓ MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---June 23, 2021 PAYABLES AND PAYROLL 6/17/2021 Weekly Payables 436,710.90 6/17/2021 MASA-Insurance 1,734.00 6/17/2021 Nava Biomedical -Supplies 4,748.01 6/17/2021 Citibank Credit Card -see attached 1,471.80 6/21/2021 Beyer Mechanical -Trailer mounted AC 41,868.74 6/21/2021 McKesson-3408 Prescription Expense 8,598.46 6/2112021 Amedsource Bergen-340B Prescription Expense 505.25 6/21/2021 Payroll Liabilities -Payroll Taxes 94,160.12 6121/2021 Payroll 297,514.94 Prosperity Electronic Bank Payments 6/18/2021 Credit Card & Lease Fees 120.80 6/1476118/21 Pay Plus -Patient Claims Processing Fee 262.46 TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS': $ 887,06,48 TRANSFERS BETWEEN FUNDS-MMC 6/21/2021 Transfer from Money Market Account to MMC Operating 1,500,000.00 TRANSFER BETWEEN FUNDS TO NURSING HOMES 6/17/2021 MMC Operating to Golden Creek Healthcare -correction of NH insurance payment deposited into MMC Operating 52,801.12 6/1712021 MMC Operating to Gulf Pointe Plaza -correction of NH insurance payment deposited Into MMC Operating 28,485.13 6/1712021 MMC Operating to Tuscany Village -correction of NH insurance payment deposited into MMC Operating 12,374.D8 6/17/2021 MMC Operating to Bethany Senior Living- correction of NH insurance payment deposited into MMC Operating 36,599.23 MEDICARE ADVANCE PAYMENT RECOUP-ACH TRANSFERS 6/21/2021 Ashford to Bethany Senior Living -correction. of Ashford medicare recoup taken from Bethany Senior Living in error 15,046.61 6/2112021 Broadmoor to Bethany Senior Living -correction of Broadmoor medicare recoup taken from Bethany Senior Living in error 15,046.67 6121/2021 Crescent to Bethany Senior Living -correction of Crescent medicare recoup taken from Bethany Senior Living in error 16,046.67 6/21/2021 Fort Bend to Bethany Senior Living -correction of Fart Bend medicare recoup taken from BethanySenior Living in error 16,046.67 6/2V2021 Solera to Bethany Senior Living -correction of Solera medicare recoup taken from Bethany Senior Living to error 16,046.67 6/21/2021 Golden Creek to Bethany Senior Living -correction of Golden Creek medicare recoup taken from Bethany Senior Living in error 15,046.67 6/21/2021 Tuscany Village to Bethany Senior Living -correction of Golden Creek medicare recoup taken from Bethany Senior Living in error 15,046.67 6/21/2021 MMC Operating to Bethany Senior Living -correction of MMC medicare recoup taken from Bethany Senior Living in error 15,046.67 6/21/2021 MMC Operating to Bethany Senior Living -correction of MMC medicare recoup taken from Bethany Senior Living in error 8,684.80 6/21/2021 Ashford to MMC Operating -correction of Ashford medicare recoup taken from MMC Operating 227.13 6/2112021 Broadmoor to MMC Operalinginrrecdon of Broadmoor medicare recoup taken from MMC Operating 227.13 6/21/2021 Fort Bend to MMC Operating -correction of Fort Bend medicare recoup taken from MMC Operating 227.13 8/21/2021 Tuscany Village to MMC Operating -correction of Tuscany Village medicare recoup taken from MMC Operating 227.13 6121/2021 Golden Creek to MMC Operating -correction of Golden Creek medicare recoup taken from MMC Operating 227.13 6/21/2021 Solera to MMC Operating -correction of Solera medicare recoup taken from MMC Operating 1,161.38 6/2112021 Crescent to MMC Operating -correction of Crescent medicare recoup taken from MMC Operating 227.13 TOTAL TRANSFERS BETWEEN FUNDS $-1,761,841 BBi ,v NURSING HOME UPL EXPENSES 6121/2021 Nursing Home UPL-Cantex Transfer 6/21/2021 Nursing Home UPL-Nexion Transfer 6/21/2021 Nursing Home UPL-HMG Transfer 6/21/2021 Nursing Home UPL-Tuscany Transfer 6/21/2021 Nursing Home UPL-HSL Transfer QIPPIRECOUP CHECKS TO MMC 612212021 Ashford 6/22/2021 Broadmoor 6/22/2021 Crescent 6/2212021 Fort Bend 6/22/2021 Solera TOTAL NURSING ROMEUPL EXPENSES INTER -GOVERNMENT TRANSFERS 6/2112021 IGT DSH to be paid July 02, 2021 6/21/2021 IGT DSRIP Waiver to be paid July 08, 2021 TOTAL INTER=GOVERNMENTTRANSFERS 452,649.91 66,362.81 28,040.53 33,476.93 307,726.08 19,106.93 7,913.86 6,373.57 7,722.55 7,493.00 936,866 ,7 155,555.25 $95,049.15 $ 760,604.40 GRAND TOTAL'bISSURSEMENTS APPROVED June 23, 2021$, 4,336,006>93 If 6/17/2021 tmp_cw5report5706522081193599033.htm1 06/17/2021 MEMORIAL MEDICAL CENTER 1 13:0311 NI AP Open Invoice List '1 'J�}7 7 1 invoice.template 0 - Due Dates Through: 07/0712021 ap_open Vendor# Vendor Name Class Pay Code -'i1283 -- ACE HARDWARE 15521✓ Invoice# Comment Tran Dt InvOt Due Dt Check Dt Pay Gross Discount No -Pay Net 154693 ✓ 06/16/2021 06107/2D21 07/02/2021 18.36 0.00 0.00 / 18.36 rr SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11283 ACE HARDWARE 1E 18.36 0,00 0.00 18.36 Vendor# Vendor Name Class Pay Code 10619 ADAM BESIO,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 061521 06/15/2021 06/15/2021 05/15/2021 89.99 0.01) 0.00 69.99 REIMBURSE PURCH EXCHANGE It• Vatlitn✓-f VOW Vendor Totals: Number Name Gross Discount No -Pay Net 10619 ADAM BESIO 69.99 0100 0.00 59,99 Vendor# Vendor Name Class Pay Code A1705 ALIMED INC. M Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net RPSV03592606/16/2021 05/25/2021 06/09/2021 308,26 0.0D 0.00 308.26r/ 0I SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net At 705 ALIMED INC. 308.26 0.00 0.00 308.26 Vendor& Vendor Name Class Pay Code A1360 AMERISOURCEBERGEN DRUG CC W 4/' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 3057972411 106/15/2021 06/08/2021 06/14/2021 20.800.00 0.00 0.00 20,800.00 r✓ .INVENTORY (40) Ve ICIUN (A1 710.00 t4j% 3058142355L06/15/2021 06/09/2021 06/15/2021 342.08 0.00 0.00 342.08,✓ INVENTORY Vendor Totals: Number Name Gross Discount. No -Pay Net A1360 AMERISOURCEBEF 21.142.08 0.00 D.00 21,142.08 Ventlor# Vendor Name Class Pay Code 12282 ASCEND NATIONAL LLC-YtftVL FLV (tAlli'xo t m. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 27106 12/31/2018 12/29/2016 01/18/2019 2,9" 0.00 0,00 2,9,d.66 SURGERY STAFFING Vendor Totals: Number Name Gross Discount No -Pay et 12252 ASCEND NATIONAL 2,9616 0.00 0.00 2,9�66 Vendor# Vendor Name Class Pay Code A0400 AUREUS RADIOLOGY LLC v/ Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 2223423 ✓ 06/1512021 05/24/2021 05/24/2021 2,680.00 0.00 0.00 2,680.00 ✓ LAB STAFFING 2223697t/ 06/15/2021 05/24/2021 05/24/2021 2,680.00 0.00 0.00 2,680.00 ✓ LAB STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net A0400 AUREUS RADIOLO( 5,360.00 0.00 0.00 5,360.00 Ventlor# Vendor Name Class Pay Code B1220 BECKMAN COULTER INC ✓ M _ Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 109084543,466M5/2021 05/24/2021 06/18/2021 133.29 0100 0.00 133.29 SUPPLIES ✓ Vendor Totals: Number Name Gross Discount No -Pay Net B1220 BECKMAN COULTE 133.29 0.00 0.00 133.29 Vendor# Vendor Name Class Pay Code 10599 f BKD, LLP V Invoice# Com ent Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8K01409608/16/2021 05/25/2021 06/19/2021 46,800.00 0.00 0.00 46,800.00,-' file:lf/C:/Users/mmckissecWcpsl/memmed.cpsinel.com/u88150/data_5/imp_ew5report5706522081193599033.html 1111 6/17/2021 tmp_pw5repart5706522081193599033.htm1 PRELIM FINAL AUDIT FOI2131/20 Vendor Totals: Number Name Gross Discount No -Pay Net 10599 BKD, LLP 46.800.00 0.00 0.00 46,800.00 / Vendor# Vendor Name. Class Pay Code J 81800 BRIGGS HEALTHCARE M Invoice# Comment Tran Of Inv Dt Due Of 13351921 Check Ot Pay Gross Discount No -Pay Net 06/16/2021 0526/2021 06/25/2021 84.50 0.00 0.00 84.50 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Not 81800 BRIGGS HEALTHCP- 84.50 0.00 0.00 84.50 Vendor# Vendor Name Class Pay Code 13968 BROOKHOLLOW Invoice# C%mment Tran Or Inv Of Due Of Check Of Pay Gross Discount No -Pay Net 82467360 ✓06/162021 01/18/2021 008/2021 174.00 0.00 0.00 174,00 SYMPATHY CARDS Vendor Totals: Number Name Gross Discount No -Pay Net 13968 BROOKHOLLOW 174.00 0.00 0.00 174.00 Vendor# Vendor Name Class Pay Code 11224 CABLES AND SENSORSV/ Invoice# Comment Tran Dt Inv Dt Due Ot Check Of Pay Gross Discount No -Pay Net 112810✓ 06/16/2OP1 06/01/2021 07/01/2021 324.00 0.00 0.00 324.00✓ SUPPLIES 112806✓ 06/162021 06/01/2021 07/01/2021 232.00 0.00 0.00 232.00 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11224 CABLES AND SENS 556.00 0.00 0.00 556.00 Vendors Vendor Name ClasJs Pay code 11295 CALHOUN COUNTY INDIGENT AC( ✓ Invoice# Comment Tran Of Inv Of Due DI Check Dt Pay Gross Discount No -Pay Net 061121 06/16/2021 06111/2021 06/1112021 70.00 0.00 0.00 70.00 TRANSFER Vendor Totals: Number Name Gross Discount No -Pay Net 11295 CALHOUN COUNTY 70.00 0.00 0.00 70.00 Vendor# Vendor Name Class Pay Code C1325 CARDINAL HEALTH 414, INC. W lnvcice# Comment Tran Of Inv Of Due Dt Check Of Pay Gross Discount No -Pay Net 8002537174d6/15/2021 05115/2021 OGM9/2021 188.99 0.00 0.00 188.99 ✓ SUPPLIES Vendor Totals: Number Name Grass Discount No -Pay Net C1325 CARDINALHEALTH 188.99 0.00 0.00 188.99 Vendor# Vendor Name class Pay Code 13000 CLEARFLY Invoice# Comment Tran Of Inv Of Due Dt Check Of Pay Gross Discount No -Pay Net INV354496 ✓O6/16/2021 06/01/2021 06/15/2021 1,116.30 0.00 0.00 1.116.30 PHONES Vendor Totals: Number Name Gross Discount No -Pay Net 13000 CLEARFLY 1,116.30 0.00 0.00 11116.30 Vendor# Vendor Name Class Pay Code 10212 CLINICAL PATHOLOGY LABS ✓ ICP Invoice# Jpamment Tran Of Inv Of Due Of Check Dt Pay Gross Discount No -Pay Net P021040 ✓ 06/152021 04/30/2021 04/30/2021 -104.00 0.00 0.00 •104.00r/ / CREDIT 2021050 ✓ O6/15/2021 05/31/2021 05/31/2021 17.002.75 0.00 0.00 17,002.75 LAB SERVICES v' 17905-2021001 /15/2021 05/31/2021 05/31/2021 168.52 0.00 0.00 188.52 LAB SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 10212 CLINICAL PATHOLC 17,067.27 0.00 0.00 17,067,27 Vendor# Vendor Name Class Pay Code 13964 DALLAS FRANKLIN Invoice# Comment Tran Of Inv Of Due Of Check Of Pay Gross Discount No -Pay Net file:///C:/Users/mmekissecklepsilmemmed.cpsinet.com/u88l50/data 5/(mp_cw5mport5706522081193699033.html 2M1 v 6/17/2021 tmp_ow5report5706522081193599033.htm1 061021 06/10/2021 06/10/2021 07/07/2021 1,178.12 0.00 0100 1,178.121% REIMBURSE DEPENDANT BCBS Vandor Totals: Number Name Gross Discount No -Pay Net 13964 DALLAS FRANKLIN 1,178.12 0.00 0.00 1,178,12 Vendor# Vendor Name Class Pay Code D1193 DEPUY SYNTHES SALES, INC../ M Invoice# Co%%meet Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 23151330RM176/16/2021 09/21/2020 10/16/2020 9,135.80 0.00 0.00 / 9.135.80 // SUPPLIES 23244067RI�6/16/2021 10/16/2020 11/10/2020 536.60 0.00 0.00 536.60 ✓� / SUPPLIES 23257983RI 166/16/2021 10/21/2020 11/15/2020 35.20 0.00 0.00 35.20 ✓� aV3113ILI SUPPLIES -694649229E106/16/2021 11/13/2020 12/08/2020 2,838.20 0.00 0.00 2,838.20✓ 234OV443ILI SUPPLIES 4N-7[0 95S906/16/2021 12/09/2020 01/03/2021 84,80 0.00 0.00 84.80 4/ 2w 1;L101 P-i SUPPLIES '59426610SO06/16/2021 01111/2021 OPJ05/2021 91.80 0.00 0.00 91.80 ✓' a3�j1l 34V_I SUPPLIES 595'78eOnS'06/16/2021 02/16/2021 03/13/2021 2,601.40 0.00 0.00 2,601.40 y' 95"9kfo4V_1 SUPPLIES 595995749406/16/2021 02/16/2021 03/13/2021 303.00 0.00 0.00 303.00✓ SUPPLIES 23882327RIt96/16/2021 04/09/2021 05/0412021 4,985.00 0.00 0100 4,986.00,✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net D1193 DEPUY SYNTHESS 20.611.80 0.00 0.00 20,611.80 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 6460640 ✓ 06/16/2021 06/07/2021 07/02/2021 28.62 0.00 0.00 28.62 ✓ SUPPLIES 6454471 ✓ O6/16/2021 06/07/2021 07/02/2021 2.75 0.00 0.00 2.76 ✓ SUPPLIES 6465391 06/16/2021 06/10/2021 07/05/2021 39.51 0.00 0.00 39.51 ✓� SUPPLIES 6466050 ✓ 06/16/2021 06/10/2021 07/05/2021 74.40 0.00 0.00 74.40v� SUPPLIES 6465390 ✓ 06/16/2021 06/10/2021 07/05/2021 144.01 0.00 0.00 144.01 ✓` SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SC 289.29 0.00 0.00 289.29 Vendor# Vendor Name Class Pay Code 11011 DIAMOND HEALTHCARE CORP,/ Invoice# Comment Tran Dt Inv Dt Due Dr IN20064655r,06/16/2021 Check Ot Pay Gross Discount No -Pay Net 06/01/2021 06/26/2021 31,144.58 0.00 0.00 31,144.58 BEV HEALTH IN20054656%04/16/2021 06/0V2021 OW26/2021 4/1 19.166.67 0.00 0.00 19,166.67 ✓ CPR SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 11011 DIAMOND HEALTH( 5D,311.25 0.00 0.00 50,311.25 Vendor# Vendor Name Class Pay Code 12788 DUDE SOLUTIONS, INC ✓/ Invoice# Comment Tran Dt Inv Ot Due DI INV91907 /06117/2021 Check Dt Pay Gross Discount No -Pay Net 06/01/2021 07/01/2021 4,597.75 0.00 0.00 4,597.75 ✓''� WORXHUB Vendor Totals: Number Name Gross Discount No -Pay Net 12788 DUDE SOLUTIONS, 4.597.75 0.00 0.00 4,597.75 Vendor# Vendor Name Class Pay Code 11046 E.MDS, INC , / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net file:///C:/Users/mmckisseck/cpsi/memmed.opsinat.com/u8Bl50/data_5/tmp_cw5report5706522081193599033.html 3111 Y t 6/17/2021 tmp_cw5repart5706522081193599033.html 447219 V1 06/16/2021 06/09/2021 06/09/2021 4,500.00 0100 0.00 4,500.00 ADVANCED WORKFLO FUNCTION Vendor Totals: Number Name Gross Discount No -Pay Net 11046 E-MDS, INC 4,500.00 0.00 0.00 4,500.00 Vendor# Vendor Name Class Pay Code E0500 / EAGLE FIRE & SAFETY INC ./ M Invoice# C mment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 82378 /(06/15/2021 03/11/2021 03/11/2021 280.00 0.00 0.00 280.00 VENT HOOD CLEANING Vendor Totals: Number Name Gross Discount No -Pay Net E0500 EAGLE FIRE & SAFI 280.00 0.00 0.00 280.00 Vendor# Vendor Name Clas} Pay Code 11284 EMERGENCY STAFFING SOLUTIO ,./ Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 40328 „% 06/15/2021 06/15/2021 06/15/2021 40,062,50 0.00 0.00 40,062.50 ER STAFFING tl'l5th) Vendor Totals: Number Name Gross Discount No -Pay Net 11284 EMERGENCYSTAF 40,062.50 0.00 0.00 40,062,50 Vendor# Vendor Name _ Class Pay Code 13872 ETHOS MEDICAL STAFFING ✓ / Invoice# Comment Tran D1 Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 26366 V1 06/10/2021 06/04/2021 07/04/2021 2,943.20 0.00 0.00 2,943.20 NURSESTAFFING Vendor Totals: Number Name Gross Discount No Pay Net 13872 ETHOS MEDICAL S 2,943.20 0.00 0.00 2,943.20 Vendor# Vendor Name Class Pay Code 13804 EVERGREEN MEDICAL SERVICES Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net EMSIN0001206/16/2021 04/15/2021 04/15/2021 1,000.00 0.00 0.00 1,000,00 f 31 WENT EVAL Vendor Totals: Number Name Gross Discount No -Pay Net 13804 EVERGREEN MEDII 11000.00 0.00 0.00 1,000.00 Vendor# Vendor Name Class Pay Code S0501 EVOQUA WATER TECHNOLOGIES / Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Grass Discount No -Pay Net 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SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net S0501 EVOQUA WATER TI 1,815,00 0,00 0.00 1.815.00 Vendor# Vendor Name class Pay Code F1300 FIRESTONE OF PORT LAVACA ,/W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0073932 ✓ 06/16/2021 06/08/2021 06/08/2021 797.90 0.00 0.00 797.90 BATTERY, ALTERNATER, BELT �r Vendor Totals: Number Name - Gross Discount No -Pay Net F1300 FIRESTONE OF POI 797.90 0.00 0.00 797.90 Vendor# Vendor Name Class Pay Code 11183 FRONTIER 11/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Nei 060221 06/17/2021 06/02/2D21 06/28/2021 1,177.66 0.00 0.00 1,177.66 V- PHONES 28155203381222165 Vendor Totals: Number Name Gross Discount No -Pay Nei 11183 FRONTIER 1,177.66 0.00 0.00 1,177.66 Vendor# Vendor Name Class Pay Code 11149 GARDNER & WHITE, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 070121 05/31/2021 07/01/2021 07/01/2021 4,792.84 0.00 0.00 4.792.84 1-' INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 11149 GARDNER & WHITE 4,792.84 0.00 0.00 4,792.84 Vendor# Vendor Name Class Pay Code file:/I/C:/Users/mmokissack/cpsi/memmed.cP$inet.comlu8B150/date 5/tmp_gw5report57C6522081193599033.html 4111 11 611712021 tmp_cw5report5706522081193599033.html 12404 GE PRECISION HEALTHCARE, LLC Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 6001809168@75/31/2021 03/18/2021 07/01/2021 -21.50 0.00 0.00 -21.50 111� // CREDIT 6001809161i08/31/2021 03/18/2021 07/01/2021 -601.06 0.00 0.00 -601.96 // CREDIT 6001861313108/16/2021 06/01/2021 07/01/2021 868.16 0.00 0.00 868.16 � MAINTCONTRACT 6001661102t0616/2021 06/01/2021 07/01/2021 3,588.58 0.00 0.00 / 3,588.58 yr MAINT CONTRACT ..// 60018W861041/16/2021 06/01/2021 07/01/2021 672.33 0.00 0,00 572.33 yi // MAINTCONTRACT 6001861154,46/16/2021 06/01/2021 07/01/2021 51665,83 0.00 0.00 5,665.83 V" MAINTCONTRACT ��!! 6001861040106/16/2021 06/01/2021 07/01/2021 680.00 0.00 0.00 / 680A0 y MAINT CONTRACT Vendor Totals: Number Name Gross Discount No -Pay Net 12404 GE PRECISION HEf 10,751.44 0.00 0.00 10,751.44 Vendor# Vendor Name Class Pay Code 13960 GOODS & SERVICES MANAGEMEt Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 3403826191/o�06/10/2021 06104/2021 07/04/2021 329.59 0.00 0.00 329.59 �!'J /,! 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Vendor Totals: Number Name Gross Discount No -Pay Net M2621 MMC AUXILIARY GI 124.68 0100 0.00 124.68 Vendor# Vendor Name class Pay Code IW16 MORRIS & DICKSON CO, LLC invoice# Comment Tran Of Inv Of Due Of Check Dt Pay Gross Discount No -Pay Net 69544781% 06/15/2021 06/01/2021 06/11/2021 253.37 0.00 0.00 253.37 INVENTORY 6956013,% 06/15/2021 06/01/2021 06/11/2021 22.35 0.00 0.00 22.35 INVENTORY 6956012✓ 06/1512021 06/01/2021 06/11/2021 101,49 0.00 0.00 101.490; INVENTORY / 6956011 1/ oe/15/2o2i 06/011P021 00/11/2021 9159 0.00 0.00 9.59 INVENTORY CM56370 V0611612021 06/04/2021 06/14/2021 .4,825.63 0.00 0,00 -4,825.53 file:///C:/Userslmmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5706522081193599033.html 6/11 i M1 8/17/2021 tmp_cwSreport5706522081193599033.htmI / CREDIT CM56369 ✓ 06/15/2021 06/04/2021 06/14/2021 INVENTORY •965.00 0.00 0.00 -965.00 f CM56371 V O6/1512021 06/04/2021 06114/202, CREDIT -86.56 0.00 0.00 -86.56 6969833 /O6/15/2021 06/00/2021 06/16/2021 INVENTORY 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06/78/2021 / CREDIT -11.65 0.00 0.00-11.65 ✓ 881 OA ✓ O6/15/2021 06/08/2021 06/18/2021 CREDIT •5.00 0.00 0.00 -5.00 ✓'� / 8811 d 0611CV2021 06/08/2021 06/18/2021 / CREDIT -4.99 0.00 0.00 -4.99 6980912 ✓ 06/15/2021 06/06/2021 06/18/2021 $2,83 0.00 0.00 umINVENTORum f 6980913 ✓ 06/16/2021 06/08/2021 06/18/2021 INVENTORY 695.12 0.00 0.00 595.12 /- ,/ 6985788 06/15/2021 06/09/2021 06/19/2021 INVENTORY 212,75 0.00 0.00 212,75 6983746 ✓ 06/15/2021 O6/09/2021 06/19/2021 INVENTORY 733.98 0.00 0.00 733.98 ✓ 6984339 06/15/2021 06/09/2021 06/19/2027 INVENTORY 83.81 0.00 0.00 83.61 ✓ 6984338 �r06/75/2021 O6/09/2021 06/19/2021 INVENTORY 90.38 0.00 0.00 90.38 6984336 ✓106/15/2021 06/09/2021 06,19/202, INVENTORY 52,33 0.00 0.00 52.33 6984337 ✓ 06/15/2021 06/09/2021 08/19/2027 / INVENTORY 751.43 0.00 0.00 751.43 6985787 ✓06/15/2021 06/09/2021 06/19/2021 INVENTORY 601.42 0.00 0.00 601.42 CM57141 /6/15/2021 06/09/2021 06/19/2021 CREDIT -23.30 0.00 0.00 -23.30 6983912,// 06/15/2021 06/09/2021 08/19/2027 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Class Pay Code 11165 PARA V,. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8701 ✓ 06/16/2021 06/01/2021 07/01/2021 3,084.00 0.00 0.00 3,084.00 REVENUE INTERGRITY PROGRAN Vendor Totals: Number Name Gross Discount No -Pay Net 11155 PARA 3,084.00 0.00 0.00 3.084.00 Vendor# Vendor Name Class Pay Code P2100 PORT LAVACA WAVE W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 043021 06/15/2021 04/30/2021 05/25/2021 356.00 0.00 0.00 356.00 y/ NEWSAD 053121 06/15/2021 05/31/2021 06/25/2021 350.00 0.00 0.00 356A0 f NEWS AD Vendor Totals: Number Name Grass Discount No -Pay Net P2100 PORT LAVACA WA\ 712.00 0.00 O.OD 712.00 Vendor# Vendor Name Class Pay Code 12480 PRO ENERGY PARTNERS LP / Invoice# C merit Tran Dt Inv Dt Due Ot Check Ot Pay Gross Discount No -Pay Net 21050600 76/15/2021 05/31/2021 06/15t2021 3,423.70 0.00 0.00 3,423.70 ✓r. 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Gross Discount No -Pay Net 13616 TRIOSE, INC 1,622.73 0.00 0.00 1,622.73 Vendor# Vendor Name Class Pay Code U1054 UNIFIRST HOLDINGS v%� W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8400366430�08/2021 06/07/2021 07/02/2021 45.15 0,00 0.00 45.15 LAUNDRY 8400366454 MI8/2021 06/07/2021 07/02/2021 1,584,73 0.00 0100 1,684.73 LAUNDRY � 8400366431 ,D6/08/2021 06/07/2021 07/0212021 45.16 0.00 0.00 45.16 LAUNDRY 8400366185 Pet 6/2021 06/03/2021 06/28/2021 100.04 0.00 0.00 100.04 LAUNDRY 8400366833 &6/16/2021 06/10/2021 07105/2021 189.49 0.00 0100 189.49 LAUNDRY 8400366887 00�16/2021 06/10/9021 07/05/2021 102.82 0.00 0.00 102,82 LAUNDRY Vendor Totals: Number Name Gross Discount No -Pay Net U1054 UNIFIRSTHOLDINC 2,067.39 O.00 0.00 2,067.39 Vendor# Vendor Name Class Pay Code U1200 UNITED AD LABEL CO INC ✓ M Invoice# Comment Tran Dt Inv Dt .Due Dt Check Dt Pay Gross Discount No -Pay Net 788924401 06/16/2021 04/20/2021 05/15/2021 143.62 0.00 0.00 143.62 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net U1200 UNITED AD LABEL t 143.62 0.00 0100 143.62 Vendor# Vendor Name Class Pay Code V1058 VICTORIA ANESTHESIOLOGY V1W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 043021 06/15/2021 04130/2021 04/30/2021 46.367.05 0.00 0.00 46,367.05 / ANESTHESIA v Vendor totals: Number Name Gross Discount No -Pay Net V1058 VICTORIA ANESTHI 46.367.05 Mo 0.00 46,367.05 Vendor# Vendor Name Class Pay code 12548 WAGEWORKS, INC �/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 0521DR467706/1512021 06/01/2021 06/01/2021 215.52 0.00 0.00 215.52 y/ COBRA Vendor Totals: Number Name Gross Discount No -Pay Net 12548 WAGEWORKS, INC 215.52. 0.00 0.00 215.52 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC Invoice# Cam em Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9110994530 /10/2021 OW0812021 07/03/2021 285.18 0.00 0.00 285.18 ✓ SUPPLIES 9110990426 OB/16/2021 05/28/2021 06/22/2021 240.50 0.00 0,00 240.50 SUPPLIES �,- Vendor Totals: Number Name Gross Discount No -Pay Net 11110 WERFEN USA LLC 526.68 0.00 0.00 525.68 �5�, Grand Totals: rr' y� Gross ^^^^^^r z� No -Pay Net 441.411.56 0M 441,411 Sa J N 17 28111 P5 lwv&c�&i file;a/C:/Userslmmckissack/cpsi/memmed.cpsinet.comlu8B150ldata_5/tmp_cw5report5706522081193599033,html 11/11 6/1812021 OPEN INVOICE MASA.html 0611812021 MEMORIAL MEDICAL CENTER 10:43 AP Open Invoice Ust Dates Through: Vendor# Vendor Name Class / 11612 MASH GLOBAL BUILDING ✓ Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay 98686OMKMI0611712021 07/0112021 07/01 /2021 INSURNACE Vendor Totals: Number Name Grass 11612 MASA GLOBAL BUII 1,734.00 Report Summary Grand Totals: Gross Discount 1,734.00 0.00 jUN 17 2121 4Ft22�.�� 11E4T.4.S 0 ap open invoice.template Pay Code Gross Discount No -Pay Net 1.734.00 0.00 0.00 1.734.00 ✓ Discount NO -Pay Net 0.00 0.00 1,734.00 No -Pay Net 0.00 1,734.00 file:!/IC:lUsersledca.pere7JAppDatelLocallMicrosoNWindms/INetCachelContent.OutlooklOXVHORZSfOPEN INVOICE MASA.html 1/1 A 6/18/2021 OPEN INVOICE NOVA BIOMEDICAL.html MEMORIAL MEDICAL CENTER 06/18/2021 AP Open Invoice List 10:45 Due Dates Through: 07/0812021 Vendor# Vendor Name Class 10866 NOVABIOMEDICAL Invoice# Cpmment Tran Dt Inv Dt Due Dt Check Dt Pay 90864633 J 06/17/2021 06/0112021 07/01/2021 SUPPLIES Vendor Totals: Number Name Gross 10868 NOVA BIOMEDICAL 4,748.01 Repot. Summary Grand Totals: Gross Discount 4,748.01 0.00 0 ap open_invoice.template Pay Code Gross Discount ND -Pay Net 4,748.01 0.00 0.00 4,748.01 Discount No -Pay Net 0.00 0.00 4,748.01 No -Pay Net 0.00 4,748.01 file:lllCaUsers/erica.perez/AppDatalLocal/Microsoft/lNlndowstiNetCachalContenLOutlooklOXVHOR25!OPEN INVOICE NOVA BIOMEDICAL.html i11 a CITIBANK CORPORATE CARD Account Statement CG4mo4eal CaNAecoum JASOIIWANGLIN 1"1'• m Account Inquiries: f/ I' pl Toll Frec: 1•(800)-24a•4553 \�• 9 II lm mati.nel: 1-(904)A z 54-7314 Account Number: XXXX-XXXX-XXX) TDDITTv: 1-(8T7)•505•T276 Summary of Account Activity Uo'a Tmta0IA Iwuy $1.471.8 Send Notice of Billing Errors and Customer Service Inquiries to: CITIBANK, NA., PO BOX 6125, SIOUX FALLS SO $7117-6125 Not an invoice. For your records only. credil Limit $20,000 cash A.tlranee Um8 $0 SlatementClosing Dale 00312021 Days in Billing Padad 31 Transactions ..................." NOTICE MEMO ITEMS) LISTED BELOW """""""'•"" U51G4 05*3 5261 655M021123980008505419 1 DANIEL INDUSTRIES POWE PORT LAVACA TX 77979 USA ✓11282 • M12 05111 Me 55429501131852749652996 2 AHIMA 8003iS435 IL 60601 USA '/19S00 '. 74955299 05/19 05118 7399 $5125031138700919559954 3 DIGICERT INC 80170196" UT 84043 USA \� OS127 05125 5062 55 nlf1146200873100083 4 TEXASHOSPITALASSOC 5124651000 TX 78701 USA X .WW CR',. 819 05131 05130 $942 554M86111E0200370601800 5 Ame4an.com'2XBLK4NF1 Anan.comlbilWA, WIN USA 113.99 11242756274MIO 06103 08/02 T499 56429501153713799174120 6 E82021REGIONALEMER U0141372M CA 94103 USA 15.00 l OM 06/02 8398 SS429501153852917614219 7 APIC 2024542641 VA 22202 USA �0500 \/ W61421 // 0aW 06/02 M99 82305091153000014721199 8 TSICP.ORG BLANCO TX 78606 USA •/710000 O61G3 %*2 8699 823(5091153000014791490 9 TSICP.ORG BLANCO TX 76606 USA �/ 'Red """""""""" TOTAL AMOUNT OF MEMO ITEM(S)S1,471.80 u5 4 i N v„ NOTICE SEE REVERSE SIDE FOR IMPORTANT INFORMATION Page l of ........... ..... ... ......-_...................... .._ __.. .._.._.. .._.__..................T............................... CobCITIBANK N.k PO BOX 6125 SIOUX FALLS SO 57117.6125 JASON W ANGLIN CALHOUN COUNTY STE A 202 S ANN ST FORT LAVACA TX 77979-4204 Account Number XXXX-XXXX-XXX Statement Closing Date June 03, 2021 00006934502 Not an Invoke. For your records only. • Raped vlooPor Smofancam/mmmlale/y^ qd NMmandeNmamopene+ory my. Paymem9:'rau may mare a WYmenaM your Wavdany bdhamm madunl onlNv v;Mm.aeY%.CdIlut.CdF.,&no%I.pMM.mbe,m,REaanlhe lmnal Udn9Cou".9m.Pa.. 0. Vm1.." mg.mbaWMM MM. me CWAnamd, Me aalenrnlm Mpata lamaramlen Cd Comdram Cod. m im, pa'Ymem finale onabled W alMola¢m. m 11i9 by mail, ploate allwl aMaicnlnmif lima Plaxvme your aaamt number on the hunt d the peak • Credll Repols: Tile flank or Mean %eumm, idam'don I. amR bumme. Late Fw unm9y bffim aadmM. Pedant to— N tend do Company anak b payment W%mvnts. nasatl WymenN.aalher MITMIMon" Avalon, may bareheaded in Io.liCaMMgey bdan4S lfweleranmyoul maw "race,Nprapeffahn dldYr ydderand repot pmceaahp local, by 60 em. 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Catalog Number Description Unit Cast Unit WAS, Extended Cost g x �z5�rn�r LG�LLj'L '7 r1 G1.� (L 5 :T� C v b — t N A - Gr2�t r-f' fbr c: het - ail �4 cf' C)C GnOV �Zy�� f 1.n I g 9 j�c��,/'bn�' I `i l/(t�i�lfl�7., ty)-C�',�'•��`Yf.D�...t'"i_p._i 10 �j Est. Freight Est. Total Cost TOTAL COST l,TfITCC- Contact: Date: Dept, Director Quoted By: Dir. Nursing Buyer. E.T.A. Dir. Clinical Services CFO T MEMORIAL MEDICAL pCENTER PURCHASE ORDER Bill To: 815 N. VIRGINIA ST PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX: (361) 5552-0312 Vendor Name: CAI Jaay jc-- Vendor Address: Vendor Phone #: Vendor Fax #: Ship To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361) 552-6713 F4kX: p (361) 552-0312(( Date: +iD 1 P.O. # Account # Initiated B Fetal n YWI Date Required Expense4 Department Deliver To Una No. Qty. Catalog Number Description Unit Cost Unit Extended Meal. 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N N N N N N N N N N N N N O O O O O D O 0 0 0 0 0 0 N N N N N N ry N ry N N N N c g C N 6 O o E M a !R 2 V c 2 C !p Transaction Summary Transaction Complete Texas Health and Human Services Commission Memorial Medical Center Operating County C L .4 2o3t0(:)t-0 Page No: t of i Run Date: wtwsov Run Time:13:14:43 Jason Anglin From: HHSC PFD DSH Payments <DSHPayments@hhs.texas.gov> Sent: Friday, June 18, 2021 11:06 AM To: ShanePlymell@shannonhealth.org; sparrish@ych.us; nwheeler@ych.us; Divya.Matai@nwths.com; Alita.Risinger@BSWHealth.org; gquillin@parmermedicalcenter.com; rodney@preferredmanagementcorp.com,, duane.woods@cmcvtx.org; czafereo@cmcvtx.org; pstrauss@cmcvtx.org; Jason Anglin; Roshanda S. Thomas; jeffrey.dane@umchealthsystem.com; terry.mckenzie@umchealthsystem.com; terrell.thrasher@umchealthsystem.com; Lhardin@seymourtexas.net; afutch@seymourtexas.net; Lsmaistna@seymourtexas.net; kogann@grmedcenter.com;jwalker@henddckhealth.org; aeurek@hendrickhealth.org; JoAnn Greenway; robert.fdes@childrens.com; adriana.martinez2@childrens.com; aalexander@cuerohospital.org; ssutton@cuerohospital.org; Jaime.Mitchell@TitusRegional.com; Chris.Torres@TitusRegional;com; rkorkmas@ppgh.com; apuckett@ppgh.com; scoleman@ppgh.com; wwhiddon@ppgh.com; michaelnunez@umcelpaso.org; rshah@umcelpaso.com; Iflores@umcelpaso.com; Whitney.Wilde@BSWHealth.org; wwgage@texaschildrens.org; nnlim@texaschildrens.org; sjsmallb@texaschildrens.org; maleo@texaschildrens.org; Melonie.Pipes@gracehealthsystem.com; miwiliiams@lmchospital.com, (price@lmchospital.com,, mo@starcoimpex.com; ashley.underwood@adventhealth.com; Trey.Wicke@BSWHealth.org; dmak@ecmh.org; mlongoria@ecmh.org; mbergstrom@primehealthcare.com; ejimenez@primehealthcare.com; cxhandle@baptisthealthsystem.com, S.Turley@dhr-rgv.com; R.Haddad@dhr-rgv.com; j.navarro@dhr-rgv.com; R.Peralez@dhr-rgv.com; Rogelio_Reyes@chs.net; zachary_ervin@chs.net; donaid.mcdaniel@parisrmc.com; Lhacker@lubbockheart.com; Macruz@lubbockheart.com, bfoley@lubbockheart.com; morta@lubbockheart.com; jason.millerl@steward.org; Dan.Rich@BSWHealth.org; mark.meyer@utsouthwestern.edu; sara.cowan@utsouthwestern.edu; sharon.corum@uhsinc.com, RGray@Culbersonhospital.arg; steve.bishop@smmctx.org; barry.harding@smmctx.org; tammy.hartfield@smmctx.org; mark.kimball@smmctx.org; Kevin.Markham@uhsinc.com; pburke@scmc.us; christy@preferredmanagementcorp.com; jamesjenkins@steward.org; ty.culver@uhsinc.com; Bryan.Nichols@BSWHealth.org;jsmith@medicalartshospital.org; creeves@medicalartshospital.org; (stokes@medicalartshospital.org; phil.sosa@uhsinc.com; Erich_Wallschlaeger@cedarparkregional.com; Derrick.Ourts@uhsinc.com; mitchellmulvehill@texashealth.org Cc: Brown,Adam (HHSC); Okoniewski,Amanda (HHSC); Kaminsky,Kathryn (HHSC); Guzman,Kenneth (HHSC); Regmi,Asha (HHSC) Subject: REVISED DSH 2O21 Final IGT Notification 5 of 7 Attachments: TexNet User Guide.pdf; 2021 Final DSH Payment Calculation-PMTS-6.18.21.xlsx [WARNING -Remote attachments, VERIFY SENDER] CAUTION: This email originated from outside of the organization: Do not click links or open attachments unless you DSH Providers, Please see attached for a revised Final Disproportionate Share Hospital (DSH) 2021 calculation. This updated calculation was necessary as HHSC identified the inclusion of dual eligible days within the Total Medicaid Hospital Days in the non -state tab. HHSC has removed dual eligible days from the Total Medicaid Hospital Days. HHSC also identified the exclusion of year-to-date (YTD) advance intergovernmental transfer (IGT) refunds. HHSC has adjusted the YTD Advance DSH IGT payments to reflect refunds. We've adjusted the federal allocation amount based on the enhanced federal medical assistance percentage (FMAP). Finally, a few other changes were made for individual hospitals. Providers that have already entered their TexNet submission should cancel their TexNet and reenter the revised amount. The TexNet User Guide is attached for assistance on how to cancel a TexNet. HHSC apologizes for any inconvenience. Thank you, HHSC Provider Finance Payments (Formerly Rate Analysis) Texas Health and Human Services Commission P.O. Box 149030, Mail Code 1344 Winters Building 701 W 51st Street Austin, TX 78751 F TEXAS Health and Human Services DSH Participants: Attached is the finalized 2021 Final Disproportionate Share Hospital (DSH) Payment Calculation Workbook. Payment calculations are based upon a total DSH allotment that includes increased federal funds resulting from changes to DSH allotments based upon Sec. 9879 of ARPA. HHSC has been in communication With CMS about how the U.S. Secretary of Health and Human Services will implement provision Sec. 9879, but no formal guidance has been issued at this time. CMS confirmed today that formal guidance is still weeks or months from being disseminated. However, they have given every indication that they expect the federal allotment amounts to increase to implement the statutory provision. Based upon these conversations, and the statutory language in Sec.9819, HHSC is increasing payments to an amount "equal to the total DSH payments that the State could have made for such fiscal year without such increase to the Federal medical assistance percentage." Should CMS' formal guidance when disseminated deviate from this approach, HHSC will work with providers to adjust payments for DSH 2O21 in accordance with the final CMS guidance at that time. The DSH payments and intergovernmental transfer (IGT) amounts are based on the calculations in the Model Scenario Analysis (see tabs labeled " Non -State" and "State" for non -state-owned and state-owned hospitals respectively). To ensure that all government entities receive this notification, HHSC strongly encourages providers to send this information to any government entity who is IGT'ing on their behalf. Below are the pertinent dates associated with the DSH Pass 1 and Pass 2 payment: • July 1, 2021 Last date to schedule transfer in TexNet • July 2, 2021 Pass 1 and Pass 2 IGT Settlement Date • July 13, 2021 State Owned Hospitals submit Journal Entry • July 30, 2021 Latest DSH Pass 1 and Pass 2 Payment Date **Late IGTs will not be accepted. Pass 3 payment amounts cannot be calculated until HHSC is in receipt of the IGT for the Pass i and Pass 2 Payments. Please ensure you select the DSH bucket in TexNet when you enter your IGT. It is imperative that you send a screen shot/PDF copy of the confirmation/trace sheet from TexNet or an email with the confirmation number, settlement date and IGT amount if the TexNet is submitted over the phone, to DSHPavments(a@hhs.texas.eov, Additional information regarding the TexNet process can be found at this link. State owned hospitals must send a copy of their Journal Entry to DSHPavments@hhs.texas.aov. HHSC will not send confirmation emails confirming receipt of Trace Sheets. Please set your email settings to request a delivery receipt, if a confirmation is needed. Please include two contacts and their phone numbers and email addresses, should HHSC have any questions regarding the TexNet received. If you have questions regarding the DSH payment process, please send an email to DSHPavments@hhs.texas eov Thank you, HHSC Provider Finance Payments (Formerly Rate Analysis) Texas Health and Human Services Commission P.O. Box 149030, Mall Code 1344 Winters Building 701 W 51st Street Austin, TX 78751 TEXAS I+' d Health and Human t' Services Transaction Summary Transaction Complete Texas Health and Human Services Commission Memorial Medical Center Operating County �L 4�-210 31oo3D Page No: i o1 i Run Date: 61IM021 Run Time: mm as all a�� '8a8 8$s8� $$8$$$$ wNNNr�NNNN $s$a$$$�sa$ssssa$ ry�t��s.mmaa',p�a$ms�s �NNwyNv1 N. w`� �N nN N N N N $'e.$$$$$$BS;.$$88$$ F o� S 5 ��6o�Z4�rz yO P G p o O V V f O3'LL5E�8 s"�i p;3j�^ssplaaaa as"s"a�a�Ka� �o �a a estersd asiz sd ds sd a n i i x x x z x s x e: sere: ceca Cc: Brown,Adam (HHSC) <Adam.Brown04@hhs.texas.gov>; Chang,Sylvia (HHSC) <sylvia.chang@hhs.texas.gov>; Corzine,Ketha (HHSC) <Ketha.Corzine@hhs.texas.gov>; Jenkins,Brooke (HHSC) <Brookeienkins0l@hhs.texas.gov>; Okoniewski,Amanda (HHSC) <Amanda.Okoniewski0l@hhs.texas.gov>; HHSC Texas Healthcare Transformation and Quality Improvement Program<TXHealthcareTransformation@hhsc.state.tx.us>; Wade,Tonika (HHSC) <Tonika.W ade@hhs.texas.gov> Subject: July 2021 DSRIP DYIO R11GT Notification - RHP 17 -1 of 2 Anchors/Government Entities/Providers: Please carefully review this message in its entirety making note of the information Provided which pertains to the DYgO Delivery System Reform Incentive Payments (DSRIP) Attached are the following files: DSRIP Notification- DYIO Round 1 July 2021 Affiliation Summary and DY10 Round 1 July 2021 IGT Summary workbooks. These workbooks include DY10 DSRIP payments, DY9 Carryforward Reporting, and DY8 Carryforward Reporting. The DYIO Round 1 July 2021 Affiliation Summary workbook has separate tabs for each Regional Healthcare Partnership (RHP) and contains the Intergovernmental Transfer (IGT) needed, by affiliation, for DY10 Round 1 DSRIP payments, DY9 Carry Forward, and DY8 Carryforward. The DY10 Round 1 July 2021 IGT Summary workbook has separate tabs for each RHP and contains the total IGT needed by each IGT Entity for the DYIO Round I DSRIP payments, DY9 Carryforward Reporting, and DY8 Carryforward Reporting. Providers can determine their estimated payment amount by dividing Column N of the DYIO Round 1 July 2021 Affiliation Summary by the state share of the current FMAP. The current FMAP is 68.010/a/31.99%. The Transformation Waiver Team will email the Anchors information to share with providers regarding how much will be paid by Category and measure on Friday, June 18, 2021. Health and Human Services Commission (HHSC) Provider Finance Department is unable to answer questions regarding this Information. Please send any questions regarding this information to TXHealthcareTransformationrlo hhsc state tx us HHSC requires that the appropriate TexNet bucket is used for DSRIP Reporting IGTs. The DSRIP Reporting IGT should be placed in DSRIP. IGT Entities may choose to IGT less than the required amount for DSRIP Reporting payments; however, all affiliated providers and metrics will be paid proportionately. IGT may not be directed towards specific providers, Categories, or metrics. A screen shot/.pdf of the confirmation/trace sheet or email of the confirmation number if the TexNet is submitted over the phone is required and must be emailed to PFD DSRIP Payments d)hhsc.stateAx.uS. We are requesting that all government entities enter their IGT transactions into TexNet no later than July Sth with a Settlement Date of July 6th. No IGT's submitted after July Sth will be accepted. HHSC Accounting will request the Comptroller to issue payments according to the following estimated schedule: Monday, July 05, 2021 Last date for Public entities to enter TexNet and submit Trace Sheet Tuesday, July 06, 2021 TexNet Sweeps (Settlement date of funds) Tuesday, July 20, 2021 Payment issue date for Transferring Hospitals "Big 6" Friday, July 30, 2021 Payment issue date for Non -Transferring Hospitals Information regarding TexNet Connect can be found at https:Ilcomi3troller.texas.gov/programs/systems/docs/96-1193.odf Thank you, HHSC Provider Finance Payments Texas Health and Human Services Commission P.O. Box 149030, Mail Code H-400 Brown-Heatly Building 4900 N. 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PyA- ctgj a-6cL ,VV.. __ jv+ kkiv L t y,�-J',,`�� 060321C O6/1512021 06/03120211107/08/2021 113,05 0 00.00 113,05✓ TRANSFER II 060321A O6/1512021 00/03/2021 07/08/2021 806.77 0.00 0.00 806.77 TRANSFER tl q 060321 B O6115/2021 06/0312021 07/08/2021 761.09 0.00 0.00 761.09 ✓ TRANSFER k II 060921 06/16/2021 06/09/2021 07/08/2021 47,309.16 0.00 0.00 V 47,309.16 TRANSFER 11 11 Vendor Totals: Number Name Gross Discount No -Pay Net 11836 GOLDENCREEK HE 52.801.12 0.00 0.00 52,801.12 Grand Totals: Gross Discount No -Pay Net 52,801.12 0.00 0,00 52,801.12 file:///C:/Users/mmckissack/cpsi/mommed.cpsinat.comfu88l6O/data_5/tmp_cw5reporl1499820979994632041.html ill 6/17/2021 _ tmp_cw$report5783844296916456758.html _ MEMORIAL MEDICAL CENTER 13t'O6/r j t 'i AP Open Invoice List 0 Dates Through: ap_open_invoice.template '—'%L�ntloi#`"`.:::^";i!%'aa�,,:i::;✓ Vendor Name Class Pay Code 12696 GULF POINTE PLAZA Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 060121A 06/15/2021 06/01/2021 07/08/2021 849.53 00..00 0.00 849.53 1% TRANSFER W R io Lty{► u- mKI rl�xy�(.� J' ""``77�� LL..�� i4b WKL(- Upth)' 060221 06/15/2021 06/02/2021 07/08/2021 4,488.00 O.00AI. 0.00 4,468.00�/ TRANSFER 6ik 11 060221A 06/15/2021 0810212021` 07/08/2021 15,153.01 0.00 0.00 15,153.011/ TRANSFER 11 060321E 06/15/2021 06/03/2021 07/08/2021 262.98 0.00 0.00 / 262.96 TRANSFER U 11 060321A 06/15/2021 06/03/2021 07/08/2021 4,080.00 0.00 0.00 4,080.00 TRANSFER 1t )I 0603210 W15/2021 06/03/2021 07/08/2021 3,460.26 0.00 0.00 3,460.26 TRANSFER 1` i, f' 061021 06/16/2021 06/10/2021 07/08/2021 191.37 0.00 0.00 191.37 TRANSFER Vendor Totals: Number Name Gross Discount No -Pay Net 12696 GULF POINTE PLA2 28,485.13 0.00 0.00 28,485.13 Grand Totals: Gross Discount No -Pay Net 28,485.13 0.00 0.00 28.485.13 MaIrm JUN 17 21211 4M. _t,.k8 file:WC:/Users/mmckisseek/cpsi/memmed.cpsinet.com/u881501data_5/tmp_cw5report5783844296916456758.html 111 6/17/2Q21t _ _ imp_ cw5report7226741883776275731.html O6/17/20211i '1 t MEMORIAL MEDICAL CENTER " t ` i elf I 0 13 07 AP Open Invoice List ., Dates Through: ap_open_invoice.template V11d1,.,,It endor# r} �_, I,,,, r, '" Vendor Name / Class Pay Code 13004 TUSCANY VILLAGE ✓ Invoice# Comment Tran Dt Inv DI Due Dt Check Ot Pay Gross Discount No -Pay Net 060121A 06/15/2021 06101/2021 07/08/2021 129.16 0`.00 0.00 129.16 TRANSFER tJA IrtXnlXV_ Pwy`- jt,psi'iLd IN'11 V _ V&V&. OGYM.TY 060321A 06115l2021 06/03/2021 07l08/2021 2,987.02 0.00 0.00 2,987.02 v/ TRANSFER It Ii 060421 06/15/2021 06/04/2021 07/08/2021 6,544.79 0.00 0.00 6,544.79 TRANSFER t1 14 060421A 06/15/2021 06/04/2021 07/08/2021 11560.86 0.00 0.00 1,560.86 TRANSFER It 1t 060421C 06/16/2021 06/0412021 07/08/2021 1,152.25 0.00 0.00 1,152.25 TRANSFER 11 11 Vendor Totals: Number Name Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 12,374.08 0.00 0.00 12,374.08 Grand Totals: Gross Discount No -Pay Net 12,374.08 0.00 0.00 12,374.06 ACIMM TV ,jUN 17 2121 *1tJwW". AS file:/I/C:lUsers/mmckissacklcpsi/memmed.cpsinet.comlu88150ldata_5/tmp_cw5report7226741883776275731.html 1/1 6117/2021 tmp_cw5report4693243080726686969.html O6/17/2021 MEMORIAL MEDICAL CENTER 0 13j 1a 4i1$ h i 2021 AP O en Invoice List p Dates Through: ap_open_involce.template ,yendorf, Vendor Name Class Pay Code r'{''f2`792 `6i'.S71�ip 11;+t:.U: BETHANY SENIOR LIVING Invoice# Comment Tran Ot Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 060121 06/15/2021 06/01/2021 07/08/2021 803.1$ 0.00 0,00 803.13 TRANSFER NF! 1Y4iblYly yl[L-� UCNVMI (' V 060121A 06/15/2021 06/01/2021 07/08/2021 V 371.00 0= 0.00 371.00 TRANSFER It It 060321 06/1$/2021 06/03/2021 07/08/2021 5.665.00 0.00 0.00 5.565.00 TRANSFER 01 11 060321A 06/15/2021 06/03/2021 07/08/2021 9,148.94 0.00 0,00 9,148.94,x TRANSFER it 11 060421 06/15/2021 06/04/2021 07/08/2021 613.63 0.0011 0.00 613.63 TRANSFER 11 060821 06/16/2021 06/08/2021 07/08/2021 33.64 0.00 0.00 33.64 r/ TRANSFER it I 061021 06/16/2021 06/10/2021 07/08/2021 20,063.89 0.00 0.00 20,063.89 TRANSFER 'I 11 Vendor Totals: Number Name Gross Discount No -Pay Net 12792 BETHANY SENIOR 1 36,599.23 0.00 0.00 36.599.23 Report F.uemar}. 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I tnn.b^]ui i 1r...hNn OVp/Camel a9P/Canp1 apt/dmp3 Oyu al+n NNpOMpN - s,]wa 3,1dR6 - ;411.% - E4IL50 • 30,164.W 341N.W - 9,7J1A3 ],]114E - 154M 364.31 94166.9E - '"La /.asat yti6li ;WLI/ ],113A6 5,936.W 5,Mnw - 4,,70.W 9.M.W - 9.365.W DAMN - DAMN f y5,634d I'm W 6,WIA0 ai - 91I0.31 Mail E, - 1,390.10 33,mllfid1.]6 - 7I,4141.16 91 iH f1 11%w. 4MSSf )Ilµf ZOOM lfll I73753,I5 MCPopiION aPv/CN N T..rrNNa,rl oMrlumW ar!/f9mpa am/tempt 3ua.N ann xnvonTMx LS3160 - 7,42440 4330,66 I3.353.90 - MUM - 433s.W M.067]5 - 1.881.W (MAXI, 40,$ i Al ]LW ir]]SST 9,95101 ,{,5wA1 - 9.aE01 LINW I,MRw T•1694] 7,IM42 MICUM - E.3MM 353.W - 352,00 l.8%50 - 3,695.50 11]A97.J9 ]9.]l0.11 (9W10 tli]S 196151 35A] R]]xs] 79.3a.F NM<PORTON aeP/cwnN TnmlmQuJ jIy]154-p aeP/WrrN aPP/CemP1 aP1/Umll bWl< aPPTI MH IORTON ]],43950 R4I8.93 NAWSS 11.90.90 - 9.Sfm S91E.3E I.WL" ]•S S.M 7.71JAS I".m 5.763M 5.J81.a QCf0.55 .609HYI I" 59133I l.ON31 ]335.)4 ).J]259 33 M6A5 MMCKMION aFP/ mN T �n1 N�rLus ]3yrJl1 aW/UmN aW/[drrpl aPP/bmpl {IyN ar9n NH pA]ION NAwW ' 11.153N - 1;153d - 92750 91730 - 1I.9".WN.W - - 5,915M MOM MOM - I9.09LW Li;45).61 , MYW 147M Owls S.3MAX LOOM Lp9Al TIMM 054,19 lam LIM 5.6w39 - 9.0839 3A0,w - 3.MW I.MAq 1.N1A0 - l,4wA0 1,no.R - I,RO15 1,481.33 - 1,NIA3 9.15]A9 - 9.i3.40 12[9M - 1,149,64 I,Owso - 2NOW i 133.15].n I9?9x.n✓ s,]3RM LON.ss 14ss.s3 1.I34W ISIA%al TWM N4330.63 6]L563J]3 3).19i.31 SAIL. 15957.15 35W µWsl Ill. 51.16 612112021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number I Name Groups Add Group Account Type Search Ali DDA Data reported as of Jun 21. 2021 10 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $5,896.381.97 $6,340,428.81 $6.895,381.97 $5,266,193.32 '4551 CAL CO INDIGENT S5,711A4 $5,711.84 $5.711.84 $5.965.89 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $82,692.20 $82.692.20 S82,692.20 $6.615.59 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $535.31 $535.31 $535,31 S535.31 2014 '4357 MEMORIAL MEDICAL S2,238,780.52 S2.317,280.84 $2.238,780.52 $2.058.870,32 CENTER -OPERATING -4373 MEMORIAL MEDICAL CENTER -PRIVATE S430.98 5430.98 S430,98 S430.98 WAIVER CLEARING '4361 MEMORIAL MEDICAL S190.829.12 •/ S194,550.06 S190,829.12 $164,512.89 CENTER INH ASHFORD -4403 MEMORIAL MEDICAL CENTERINH S200,585.42 S207,237.15 $200,585.42 S91,118.23 BROADMOOR. '4411 MEMORIAL MEDICAL $93,669.45 595.704.99 $93.669A5 $66,812.50 CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $57.450.64 ,i S60143.68 S57,450.64 S50,389.63 CENTER INH FORT BEND '4438 MEMORIAL I SOLERA AT MEDICAL CENTER! SOLE $137.534.79 ,/ $141,75745 $137.534.79 S93,311.63 WEST HOUSTON .2998 MIMIC -MONEY MARKET S2,606,587.00 $2,606,587.00 S2,606,56Z00 S2.606,587.00 FUND '5506 MMC-NH BETHANY S178,896.18 $368,897.52 $178,896.18 S74,681,61 SENIOR LIVING '5441 MIMIC -NH GULF POINTE PLAZA. S872262 $116,172,98 S8.722.62 S156.57 MEDICAREIMEDICAID •5433 MIMIC •NH GULF POINTE PLAZA - PRIVATE PAY $19,596,82 S22,331.99 $19,596.82 Si9,596.82 '3407 MIMIC -NH TUSCANY VILLAGE $73,359.08 S120,394.82 $73.359.08 $24,608.35 hitps;/Iprosperity.olbanking.comlonlineMessenger 111 Memorial Medical Center Nursing Home UPL Weekly Nexion Transfer Prosperity Accounts 6/14/2021 Prwl.w Acaunt BaNNnL Parts., Toda9'a 1111reir, Amount to Ne Trandened to NureMt Nur31n Xame Number Ba2ante TiaMeneut /TmMer4e ea one Balance Nome 1 202,187.111 200,13139 60,636.63 - - 821012.29 65,36181 Banke.1-1. 82,692.20 Variance leave In BPlana 100A0 Whaidledln{fordiateR uw Betooty 1p.'"''�� / 21)13 WI niften{lar Mediate Withholders raA �SrUZ711✓ Pandln{Checkfor Mediarewnhholdln{ 1373.]e✓ Pendln{Check for Mediarawlthholdln{ ` 3]5.w ✓ PeNEIn6Cheekf0! Mediare withholding �{y S]1.90 ✓ E APNILINTENEII .. MAYINTEBEST 36S1 e/ TUNE INTENESE /bluse0elana/TraMer Alnt 653W.a1 ✓ Nate drily balanm afover$6,088wi1/Dr tramfamda D1a nuMna ha.. Nate 2: Each amor t baa a bare balan c of $IW Mar MMC d1laaard to open 4coun t Apomaed: 2aan An{IIn,CEo 8/102022 .."REnem N 21 2t�1 r:TNN WaeklyTranlxrawM UPLTt n fcc kmmarytm23VundxN UPL]rmefN wmmam6.21.21.xls, mmc--- 5 q5 wPV(Gny61t NN a 51f4JO M1a10enln NOV(fompl w1j, m01 wwi(amn �Ou wvvtl P00.110N .( ... OUt NE(IOXXfPL1N114010(NLPi(11 $66 M Sl (/56/1011 RY5/ Sf10.LT(MLO 9PMt56164555976917 9 6560W y16/lml trpom 71,071.61 14.016611 9W.111.69 ✓ 80.06.61 6/21/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/Name Groups Account Type AOn Group DOA Data reported ae of Jun 21 20,11 10 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 1s $5,895,381.97 $6,340,428.81 55,895,381.97 55,266,193.32 -4551 CAL CO INDIGENT $5.711.84 $5,711,84 $5,711.84 $5.965.89 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $82.692.20 / $82,692.20 $82.692.20 S6.615.59 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES $535.31 5535.31 5535.31 $535.31 2014 '4357 MEMORIALMEDICAL 52,238,780.52 52,317,280.84 52,236,780.52 $2,058.870.32 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE 5430.98 $430.98 $430.98 5430.98 WAIVER CLEARING '4381 MEMORIAL MEDICAL CENTER/NH ASHFORD 5190,829.12 5194,550.06 3190,829.12 5164,512.89 '4403 MEMORIAL MEDICAL CENTER /NhI $200,585.42 5207,237.15 5200,58542 S91,118.23 BROADMOOR '4411 MEMORIAL MEDICAL CENTER/NH CRESCENT $93,66945 $95,704,99 $93,669.45 568.812.50 '4446 MEMORIAL MEDICAL CENTER I NH FORT BEND 557,450.64 960,143.68 $57.450.64 $50.309.63 '443 MEMORIAL MEDICAL CENTER !$OLERA AT 5137.534.79 5141,757.45 5137,534.79 $93.311.6.4 WEST HOUSTON '2998 MIMIC -MONEY MARKET FUND 52,606,587.00 S2.606,587.00 S2,606.587.00 $2.606.587.00 'S506 MMC-NH BETHANY SENIOR LIVING 5178.696.18 5368,897.52 5178.896, 18 574,681.fi1 '5441 MMC -NH GULF POINTE PLAZA- 58,722.62 5116,172.98 $9.722.62 $156.57 MEDICARE/MEDICAID '5433 MIMIC -NH GULF POINTE PLAZA - PRIVATE PAY 519,596.82 $22,331.99 $19,596.82 S19,596.82 '3407 MMC-NH TUSCANY VILLAGE $73,359.08 S120.394A2 $73.359 OB 52.4,608.35 htipsa/prosper(ty.olba nking.comlonlineMeasenger 1J1 Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 6/19/1022 ..I— An, .wtMBe R[mum ammnly frandln9 halulen.dm renln xam. Numb, MI.na innalenOm Tnnalervin &.0—d ie4 Ue Innln Rdmu xuMn Nmme 5,10).)S I6.a99.1(I - 19.5%"a'i 39A)0.61 BrAwlance 14596.. , Man. la—enSannu mr. "RIt IN]RNBST ".a6 ✓' .Ylew[. ST 4a9 ✓ leaf INTIRIST Rdlu3taalanra/Trxtl.rAma t9.0%N a/ aredwa Amounuoae &I... Sorm. Fends, TnnAemdte NUM Name Xumba 6elann FnmlenOn .}nmlervin hatlea d Oe of Trader,'f ae I.4Nn[e NUMn Nnne _ — - 9}.I09.36 91,952A9 r/ B.f66df 415.6] 11,566.05 sunksaW. B.>1261 e/ Vatlmn Nore: P�ly6omn[6ajova$fi,WRMNMNmuferr[d(alhen Unp Rwn NartI:FMI a[mm[1of abmeatls[[a/$IW NttMM[depwilMmoy[n unount. haves. Bal.nm Rare NRILIN Rf6T ]6.]6 ✓' MFYINRR95T net ./ ]UN11x TREST / atllurt Btlm[.RoarwarrRmt 466Rof ✓ TmOLTMN56fR3 afar 2.8f Ogv.w-j mued: IwnNpIM, KO 6/la/10i1 N 2 1 21L1 10 _.LAOwwas rum.eed, ]ramNnWx un rmrM3ummaryUW tUune\Xx wl La[ela 3ummary414]41u MMCPOATON g1PP/COmo& NH „4 f1PnlN1-0nt TronAel-In OIPP(CAMPl QPP/COmPt WPP/Comp9 up. OIPPT POATON 6A51102I HUMANACHPDISOHCCWMPM56269824 DC 1536 4.022.40 - 4.022.40 6/14/2021 NDCSWEEPfACH291 2IM246665P39WEEPFA - 2,93068 7,970.62 6/14/2021 HUMANA CNA 0150 HCWWPMS 624982 1202N1269 4.695.95 - 1,695.95 6/1412021 HNB-ECHOACH MFAECH0PIn9V.jOM n3 Um p02 16A89.10 16899W WON t OIPP/Cem NH .. ". 10IHtlM-0Yt 11.0.1.1 0IPP/COm91 OPPIUMOZ OIPP/COm03 WM OIpT P0N31ON 6/16/2D21 WMf OUTHM61EAWCES,0C 91,952]9 6/18/2021 N"O, 8}fifi.06 8.566.M 9L952.09 ' 9 56L05 1' 056E05 91. 79 2'..... BAS5 M 6/21/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number / Name Groups Add Group Account Type iDDA Data reponed as of Jun 21. 2021 i 0 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $5,895,381.97 $6,340,428.81 $5,895,381.97 $5,266,193.32 '4551 CAL CO INDIGENT 55.711.84 55,711.84 $5,711.84 $5.965.89 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $82,692.20 $82,692.20 $82,692.20 $6,615.59 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $535.31 $535.31 5535.31 $535.31 2014 '4357 MEMORIAL MEDICAL 52238,780.52 $2.317,280.84 $2,238,780.52 $2,058,870.32 CENTER• OPERATING -4373 MEMORIAL MEDICAL CENTER - PRIVATE $A3098 5430.98 5430.98 S430.98 WAIVER CLEARING -4381 MEMORIAL MEDICAL $190,629,12 S194,550.06 5190,829.12 $164.512.89 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH 5200,585.42 5207,237.15 $200,585.42 S91,118.23 BROADMOOR '4411 MEMORIAL MEDICAL $93,669.45 $95,704.99 $93,669.45 568,812.50 CENTER/NH CRESCENT *4446 MEMORIAL MEDICAL $57.450.64 560.143.68 557,450.64 $50.389.63 CENTER/NH FORT BEND '4438 MEMORIAL L CENEERISOLERA ERA ATAT 5137.534.79 5141,757.45 $137,534.79 $93.311.63 WEST HOUSTON 2998 MMC -MONEY MARKET 52,606,587.00 52,606,587.00 $2.606,587.00 52.606,587,00 FUND '5506 MMC-NH BETHANY 5178,896.18 5368,697.52 5178,896.18 574,681.61 SENIOR LIVING '5441 MMC-NH GULF POINTE PLAZA- 58,722.62 $116,172,98 $8,722.62 5156.57 MEDICARElMEDICAID 'S431 MMC-NH GULF POINTE $19,596.82, $22,331.99 $19.596.82 519,596.82 PLAZA - PRIVATE PAY '3407 MMC-NH TUSCANY 573.359.08 5120,394.82 $73.359.08 $24.608.35 VILLAGE hltps://prosperity.olbanking.com/onllneMessonger r 1l1 Memorial Medial Center Nursing Home UPL Weekly Tuscany Transfer Prosperity Amounts 611412p21 Pm . antrum lue. 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Runin -'- xx6.Wo.x6 xox,a6191 aep60.>3 ✓ - TB,lSpoa 33.06.93! 9an1 &Yn[! 13,35AOB VaNb! lem In &lan[e WncldldNIarMldiva Mvp letWa Wle"Waryhrfor OaUxnY /lWW/ \\\\ M.e—awlt Pandir, Chao for ModinnAthNd n{ 0>S.x9f PandlulQPd for Bladean.11M x,ph9l f MadlunwllMtldiM landlryU in ➢1fi xpE.w ,/ RIG PMERIGPOYPPPRILmPP PYMT xE,m9.E5 a// blurs Ylanonnmin.M1 3I,d16.91 v/ No LNhM1vlvn[nv/ovnSSpItl H110elma/medty lhenurunpM1ane roved: L ILA Nole]: fvdattawll huaebm6Plannv/$IWMvt MMC✓romllNlPopen anawt IamnagpMlEO enenpn J M / 1 2121 CAMMNMMI�t MMCPORTION QIPP/Comp6 6/I6/2021 WIRE OUT 11NeAe ENTERPRISES, IlC Tro0sfer-0Pt Tn0$er•In QIPP/Comp1 QIPP/Cemp2 giPP/Camp3 &bpsa gIPPTI NH PORTION 6/18/2021 Deposit 203,461.91 - 6/18/2021 M PLAN AOMINIST HCCWMPMT 179113000023030 43,030.73 - 43,030.73 5,72000 5,720.00 Z03,861.91 48750.73 - - 48,75O.73 , , 6/21/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number I Name Groups Add Group Account Type (ODA Data reported as, of Jun 21. 2021 10 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts; 15 $5,896,381.97 $6,340,428.81 55,895,381.97 $5,266,193.32 '4551 CAL CO INDIGENT $5,711.84 $5,711.84 $5.711.84 $5,965.89 HEALTHCARE '4454 MEMORIAL MEDICAL 1 NH GOLDEN CREEK $82.692.20 S82,692.20 $82,692.20 $6,615.59 HEALTHCARE 3 MEMORIAL MEDICAL CENTER - CLINIC SERIES 553531 5535.31 $535.31 5535.31 2014 '4357 MEMORIAL MEDICAL $2238,780.52 $2.317,280,84 $2,238,780.52 $2,058,870.32 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $430.98 5430.98 $430,98 S430.98 WAIVER CLEARING '4381 MEMORIAL MEDICAL 5190.629.12 5194,550.06 5190,829.12 $164,512-89 CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH S200,585.42 5207,237.15 5200,585.42 591,118.23 BROADMOOR '4411 MEMORIAL MEDICAL 593,669A5 $95,704.99 $93,669.45 568.812.50 CENTER INH CRESCENT `4446 MEMORIALMEDICAL 557.450.64 $60.143.68 $57,450.64 550.389.63 CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER /SOLERA AT $137,534.79 $141,757.45 5137,534.79 593.311.63 WEST HOUSTON '2998 MMC -MONEY MARKET $2.606.587.00 $2.606,587.00 $2,606,587.00 $2606,587.00 FUND '5506 MMC-NH BETHANY SENIOR LIVING 5178,896.18 $368,897,52 5178,896.18 574,681.61 'S441 MMC -NH GULF POINTE PLAZA- $8 722 62 5116,172.98 $8.722.62 $156.57 MEDICARE)MEDICAID '5433 MMC-NH GULF POINTE PLAZA - PRIVATE PAY $19,596.82 $22,331.99 $19.596.82 519,596.82 '3407 MMC •NH TUSCANY VILLAGE 573.359.08 ✓ S120,394.82 $73,359.08 $2d,508.35 hltps;//prosparity.clCe nking.comlonllneMessenger 1!1 Memorial Medical Center Nursing Home UPL Weekly HSLTransfer Prosperity Accounts 6/14/2021 rnarou. P-11, Amwm In ee Neew[ blmmne Meawrc r..ml.Nwn Nunin Mame Humb,r N4rxe T,nA nOut Anmlenln C611eane Re Toa..N 1nn1 b4ntt Xunln Ilene . e .nf:.: .3 TY 2)9.919.ai ]t3.310.1B ])LeBB.92 YQLUU2— VB,ro6.le }�J,pt2{'p DOW hnu o� di Odin'. knvmn NLnee loom Penam3fty 3]9,053a6 1// "Jlfi. ✓� BREW MRYIXRREVT ".It 0.15 IYMBINIFR2lT aary,IBalanafrnmftr nt aI Mom mrybalanras/avnSt,aaowAtherromfineermhenuo Mnrtx:NMv[rounrhomGntebulen[e oft)Porhor MMcaeWmeemmen o�unr. loan M3un,[Bo �If c/lagozl : ,-. 1 2 2 2021 'u- " _ w mg I:wx we,W rnmrn.\xx wlrnnea fumm,rvUwNoa\nx uvkn,mhrlumnm3sl.b,b 6/14/2021 Depealt 6/14/2D23 Depp It 6/15/2021 Oeposit 6/15/2021 O."lil 6/16/2021 WIREOUTBETHPNY SENIOR LIVING, LTD 6/16/QW1 HEALTH HUMAN SVC HCCLIIMPMT 17460034113016 2 6/17/2021 Dep0sit 6117/20R NOVITAS SO WTION HCCWMPMT 67"81420000162 6/18/M21 DeP436 6/19/2021 HEALTH HUMAN SVC HCCIAIMPMT 174600M1130162 MMCPORTION OIPP/6pmp4 Tranafer-0ot Tronsfer-IrIpIPP/Compl QIPP/Comp2 QIPP/Cemp3 f3apse QIPPTI NH PORTION - 6,213.W 6,211.60 - 44,322.71 44.327.71 • 1,507.25 - 1,507.25 - 2,514.52 - 2,514.52 273,370.16 - - 9.472.50 - 9,47250 • 2,375A0 - 2,375.10 - 8,041.67 - 8,041.67 - 200,997.38 - 1W.897.38 - 3,317.19 3,317.19 273370.16 178,566.92 / 178,666.92 6/21/2021 Quick View Select Quick View Accounts Account Numbed Name Account Type Search All DDA Account Number Current Balance Number of Accounts: 15 $5,895,381.97 '4561 CAL CO INDIGENT 55.711.54 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $g2,69220 HEALTHCARE '4365 MEMORIAL MEDICAL $535.31 CENTER - CLINIC SERIES 2014 '4357 MEMORIALMEDICAL 52,238,780.52 CENTER - OPERATING •4373 MEMORIAL MEDICAL CENTER - PRIVATE 5430.98 WAIVER CLEARING '4381 MEMORIAL MEDICAL 5190,829.12 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL 5200,585.42 CENTER/NH 13ROADMOOR '4411 MEMORIAL MEDICAL $93,669.45 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $57.450.64 CENTER INH FORT BEND '4438 MEMORIAL MEDICAL CENTER I SOLERA A7 $137,534.79 WEST HOUSTON '2998 MMC-MONEY MARKET $2,606.587.00 FUND '5506 MMC -NH BETHANY 5178,896.18 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA. 58,722.62 MEOICAREIMEDICAID '5433 MNIC -NH GULF POINTE $19,596.82 PLAZA - PRIVATE PAY '3407 MMC •NH TUSCANY $73.359.08 VILLAGE hops:/Iprosperity.olbanking.comlonlineMessenger Treasury Center Select Group Groups Atld Group Data reported as of Jun 21, 2021 10 Available Balance Collected Balance Prior Day Balance $6,340,428.81 $5,895,381.97 $5,260.193.32 55,711.84 $5,711.84 55.965.89 582,692.20 $82,692,20 $6,615.59 $535.31 $535.31 S535.31 $2.317,280.84 S2,238.780.52 $2,058.670.32 $430.98 5430.98 5430.98 5194,550.06 $190,829.12 5164,512.89 5207,237.15 5200,585.42 591,118.23 $95.704.99 $93,669.45 568.812.50 580.143.68 $57.450.64 $50.389.63 $141,757,45 $137,534.79 593,311.63 52,606,587.00 $2,606,567.00 $2.606.587.00 5368,897.52 $178.896.18 $74.681.61 S116.172.98 58,722,62 5156.57 $22,331.99 519,596,82 S19,596.82 9120.394.82 $73.359,08 524,608.35 r 111 i , I 101."NOMA !` U' YsC Al_ f� i -f F.R. MEMORIAL MEDICAL CENTER ,lp., R,;.ri li,,irak 06/22/21 /A100UNT $19,106.93 []IIt11Fe5i i..dtil: Mall Chrck to vendor j iR&rw,1 in Deps I �I cy l I.1l1IViBE R: 10255040 ------------- ------- ---- --- — ----------- ---- ---- - --- MEMORIAL MEDICAL CENTER ODIF Requnsled: 06122/21 AM,�OLJNT $7,913.86 JUN 2 2 As Fop. Acc-11 . USE ()Hp( AFL C_iI2CI: Recon i Check Lo Depr r-IUMBER! 10255040 N/lINK_)RIAL PAE-_I'll...r.. L. CPNIFITF.R MEMORIAL MEDICAL CENTER at-. Request<:d: 06/22/21 �OR ACCT. U C oelt.'t JUNpI +� �? �? E IlmpresC i-.asii y ( 21L1 l Sit i 1E" is IMaii Chirci: to Vendor /ANl0UNT $6,373.57 C1,11 fdIIN B[P' 10255040 MOLINA QIPP PAYMENT — CVi,SUh.A' Mayra Martinez r - -------- --- ---- . ...... Nil jr- M C.) R iA L "VI LE D D.,"F;Nl-F FE. R U MEMORIAL MEDICAL CENTER 01,1111, E]A/P 1-hecK JVJ N 2 2 2921 DM ai.lCheck io Vendor i AM0',ff%7 $7,722.55 (VI. NUIVBFI.?: 10255040 100: MOLINA QIPP PAYMENT &Its- Mayra Martinez jHC! LV: Rl �j 9v r, A Y MEMORIAL MEDICAL CENTER 06/22/21 T $7,493.00 po:i ,cc,. UsE cjra), jimprestCash 2 2 2121 _jA/P Che.d.; gay CMoil Cherk, to Vendor al Rerul n C11_k io Detlr HUNABEQ: 10255040 ----- --------- E'XPL-ANAY 10 N: MOLINA QIPP PAYMENT — 'So)fv�...- Mayra Martinez June 23, 2021 2021 APPROVAL LIST - 2021 BUDGET COMMISSIONERS COURT MEETING OF BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE FICA MEDICARE FWH PAYROLL FOR 6/25/21 06/23/21 29 $326,683.30 P/R $ 606.22 P/R $ 141.78 P/R $ 826.00 TOTAL VENDOR DISBURSEMENTS: $ 328,257.30 P/R $ 326,463.14 TOTAL PAYROLL AMOUNT: $ 326,463.14 TOTAL AMOUNT FOR APPROVAL: $ 654,720.44 00 �C �[ O � z ym ym P z z m m W O O ro J o ' o A j O b O n la yy >z y > cii �� > C7 r Xh m i m �� A A y ph � �� N cc °c c �C) chi y O O O y N m N m m U q U U U A A N N N N N a NG. 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