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2021-09-22 Meeting MinutesCOMMISSIONERS' COURT-9/22/2021 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 ]Karla Perez, Deputy Clerk REGULAR TERM 2021 § SEPTEMBER 22, 2021 BE IT REMEMBERED THAT ON SEPTEMBER 22, 2021, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. The subject matter of such meeting is as follows: 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 — Gary Reese Texas Flag — Vern Lyssy 4. General Discussion of Public Matters and Public Participation. Introduced Kaddie Smith as new clerk. 5. Approve the minutes of the August 18, 2021, August 25, 2021, September 1, 2021 and September 8, 2021 meetings. Page 1 of 11 COMMISSIONERS' COURT — 9/22/2021 6. Consider and take necessary action to appoint Precinct 1 Justice of the Peace, Judge Hope Kurtz, as Judge Pro Tern to complete the unexpired term of retiring Precinct 2 Justice of the Peace, Judge Calvin Anderle, beginning October 1, 2021. (RM) Page 2 of 11 COMMISSIONERS' COURT — 9/22/2021 Consider and take necessary action to approve the contract between Calhoun County and Kraftsman LP for the Infrastructure at Little Chocolate Bayou County Park — Playground Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. E-1 and authorize the County Judge to sign the contract and all necessary documents. (DH) Page 3 of 11 COMMISSIONERS' COURT — 9/22/2021 8. Consider and take necessary action to renew a contract with AARC Environmental, Inc. for Spill Prevention, Control and Countermeasures (SPCC) Planning for Calhoun County Airport and authorize the County Judge to sign all necessary documents. (VL) Page 4 of 11 COMMISSIONERS' COURT — 9/22/2021 9. Consider and take necessary action to authorize Precinct 3 Commissioner Joel Behrens to propose the purchase of Calhoun County Property ID# 24170 (James A. Wisdom Estate) located in Olivia, Texas in the amount of $51,600. This property is appraised for $136,180 by the Calhoun County Appraisal District. (JB) Page 5 of 11 COMMISSIONERS' COURT — 9/22/2021 10. Consider and take necessary action to accept payment from the General Land Office in the amount of $1,000.00 for Bilge Reclamation Facilities in Seadrift, Texas and place the funds in Precinct 4 R & B account 570-53510. (GR) Page 6 of 11 COMMISSIONERS' COURT-9/22/2021 11. Consider and take necessary action to accept checks from the City of Seadrift in the amount of $46,433.55 and $58,255.56 for reclaiming, compacting, and seal coating streets and place the funds added to Precinct 4 R & B account 570-53510. (GR) Page 7 of 11 COMMISSIONERS' COURT — 9/22/2021 12. Consider and take necessary action on the second insurance proceeds check from TAC in the amount of $4,679.42 for damages during the Winter Storm the week of February 15, 2021 and disburse $39,676.70 ($40,617.58 minus the deductible portion of $940.88) for MMC's part of the claim. (RM) Page 8 of 11 COMMISSIONERS' COURT — 9/22/2021 13. Accept report from the following County Office: I. Tax Assessor -Collector — August 2021 Page 9 of 11 I COMMISSIONERS' COURT — 9/22/2021 14. Consider and take necessary action on any necessary budget adjustments. (RM) Page 10 of 11 I COMMISSIONERS' COURT — 9/22/2021 15. Approval of bills and payroll. (RM) Page 11 of 11 All Agenda Items Properly Numbered ✓Contracts Completed and Signed II 1295's Flagged for Acceptance (number of 1295's ) ✓AII Documents for Clerk Signature Flagged On this �ay of 2021 a complete and accurate packet for !�Of 2021 Commissioners Court Regular Session Day Mlonth was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. CM � Calhoun County Judge/Assistant FILED ATZ,i,V-2-0'CLCCL-T--M SEP 2 2 2021 COUNTY CLERK AL8RUfd COUNTY, TEXAS BY:_LL _ n COMMISSIONERSCOURTCHECKLI ST/FORMS I NorICEOFIMIILErIIVG-9;1);J021 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 will meet on Wednesday, September 22, 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. AGENDA The subject matter of such meeting is as follows: � OFILED AT�_'CLOCK A M 1. Call meeting to order. SpENP 13 2021 Z. Invocation. EPK CALGO �N ONNTY FI S COUN Y ®Yt- ✓d 3. Pledges of Allegiance.QLRUIY 4. General Discussion of Public Matters and Public Participation. 5. Approve the minutes of the August 18, 2021, August 25, 2021, September 1, 2021 and September 8, 2021 meetings. 6. Consider and take necessary action to appoint Precinct 1 Justice of the Peace, Judge Hope Kurtz, as Judge Pro Tem to complete the unexpired term of retiring Precinct 2 Justice of the Peace, Judge Calvin Anderle, beginning October 1, 2021. (RM) 7. Consider and take necessary action to approve the contract between Calhoun County and Kraftsman LP for the Infrastructure at Little Chocolate Bayou County Park — Playground Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. E-1 and authorize the County Judge to sign the contract and all necessary documents. (DH) 8. Consider and take necessary action to renew a contract with AARC Environmental, Inc. for Spill Prevention, Control and Countermeasures (SPCC) Planning for Calhoun County Airport and authorize the County Judge to sign all necessary documents. (VL) Page 1 of 2 I NO I K E or MBE I IN(i 9. Consider and take necessary action to authorize Precinct 3 Commissioner Joel Behrens to propose the purchase of Calhoun County Property ID# 24170 (James A. Wisdom Estate) located in Olivia, Texas in the amount of $51,600. This property is appraised for $136,180 by the Calhoun County Appraisal District. (JB) 10. Consider and take necessary action to accept payment from the General Land Office in the amount of $1,000.00 for Bilge Reclamation Facilities in Seadrift, Texas and place the funds in Precinct 4 R & B account 570-53510. (GR) 11. Consider and take necessary action to accept checks from the City of Seadrift in the amount of $46,433.55 and $58,255.56 for reclaiming, compacting, and seal coating streets and place the funds added to Precinct 4 R & B account 570-53510. (GR) 12. Consider and take necessary action on the second insurance proceeds check from TAC in the amount of $4,679.42 for damages during the Winter Storm the week of February 15, 2021 and disburse $39,676.70 ($40,617.58 minus the deductible portion of $940.88) for MMC's part of the claim. (RM) 13. Accept report from the following County Office: L Tax Assessor -Collector —August 2021 14. Consider and take necessary action on any necessary budget adjustments. (RM) 15. Approval of bills and payroll. (RM) 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 a I I 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 website at www.calhouncotx.org under "Commissioners' Court Agenda' for any official court postings. Page 2 of 2 Rl()TILI OI MEI I61('-')/ )i'Ol] Richard lH . Meyer County judge David 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, September 22, 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. AGENDA The subject matter of such meeting is as follows: FILED AT%_7 O'CLOCK A M 1. Call meeting to order. (LM SEP 1.7 2021 2. Invocation. JH ANNAM. o0 MAN COUNTY PKC L CUN NTY,TEMS SY�- 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. inirodvch n of Kaolclie bmi+h as new Clerk 5. Approve the minutes of the August 18, 2021, August 25, 2021, September 1, 2021 and September 8, 2021 meetings. VL ID R 6. Consider and take necessary action to appoint Precinct 1 Justice of the Peace, Judge Hope Kurtz, as Judge Pro Tern to complete the unexpired term of retiring Precinct 2 Justice of the Peace, Judge Calvin Anderle, beginning October 1, 2021. (RM) PASS 7. Consider and take necessary action to approve the contract between Calhoun County and Kraftsman LP for the Infrastructure at Little Chocolate Bayou County Park — Playground Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. E 1 and authorize theCaSdnhty�cgy to sign the contract and all necessary documents. (DH) Sco+i DNIGtz Sarah signed dacs. 8. Consider and take necessary action to renew a contract with AARC Environmental, Inc. for Spill Prevention, Control and Countermeasures (SPCC) Planning for Calhoun County Airport and authorize the County Judge to sign all necessary documents. (VL) VL/DH Page 1 of 2 I i"IUIII l r 1 iJIEI N( '';'u7_1 9. Consider and take necessary action to authorize Precinct 3 Commissioner Joel Behrens to propose the purchase of Calhoun County Property ID# 24170 (James A. Wisdom Estate) located in Olivia, Texas in the amount of $51,600. This property is appraised for $136,180 by the Calhoun County Appraisal District. (JB) V L./I)I't 10. Consider and take necessary action to accept payment from the General Land Office in the amount of $1,000.00 for Bilge Reclamation Facilities in Seadrift, Texas and place the funds in Precinct 4 R & B account 570-53510. (GR) GR r j g 11. Consider and take necessary action to accept checks from the City of Seadrift in the amount of $46,433.55 and $58,255.56 for reclaiming, compacting, and seal coating streets and place the funds added to Precinct 4 R & B account 570-53510. (GR) G IZ./is 12. Consider and take necessary action on the second insurance proceeds check from TAC in the amount of $4,679.42 for damages during the Winter Storm the week of February 15, 2021 and disburse $39,676.70 ($40,617.58 minus the deductible portion of $940.88) for MMC's part of the claim. (RM) ONIVL. R05hanAa `Nmas 13. Accept report from the following County Office: V L / G iz i. Tax Assessor -Collector — August 2021 14. Consider and take necessary action on any necessary budget adjustments. (RM) 6AYZIL'L 15. Approval of bills and payroll. (RM) Image�Nea re M� D H/V (pun DIAIvt, Richard Meyer, County Jucol Calhoun County, Texas Rai 10, ►� 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 website at www.calhouncotx.org under "Commissioners' Court Agenda' for any official court postings. Page 2 of 2 COMMISSIONERS' COURT-9/22/2021 Richard H. Meyer County judge David Hall, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Deese, Commissioner, Precinct 4 Karla Perez, Deputy Clerk REGULAR TERM 2021 § SEPTEMBER 22, 2021 BE IT REMEMBERED THAT ON SEPTEMBER 22, 2021, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. The subject matter of such meeting is as follows: 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 — Gary Reese Texas Flag — Vern Lyssy 4. General Discussion of Public Matters and Public Participation. Introduced Kaddie Smith as new clerk. 5. Approve the minutes of the August 18, 2021, August 25, 2021, September 1, 2021 and September 8, 2021 meetings. Page 1 of 4 COMMISSIONERS' COURT — 9/22/2021 6. Consider and take necessary action to appoint Precinct 1 Justice of the Peace, Judge Hope Kurtz, as Judge Pro Tern to complete the unexpired term of retiring Precinct 2 Justice of the Peace, Judge Calvin Anderle, beginning October 1, 2021. (RM) Consider and take necessary action to approve the contract between Calhoun County and Kraftsman LP for the Infrastructure at Little Chocolate Bayou County Park — Playground Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. E-1 and authorize the County Judge to sign the contract and all necessary documents. (DH) 8. Consider and take necessary action to renew a contract with AARC Environmental, Inc. for Spill Prevention, Control and Countermeasures (SPCC) Planning for Calhoun County Airport and authorize the County Judge to sign all necessary documents. (VL) 9. Consider and take necessary action to authorize Precinct 3 Commissioner Joel Behrens to propose the purchase of Calhoun County Property ID# 24170 (James A. Wisdom Estate) located in Olivia, Texas in the amount of $51,600. This property is appraised for $136,180 by the Calhoun County Appraisal District. (JB) Page 2 of 4 COMMISSIONERS' COURT — 9/22/2021 10. Consider and take necessary action to accept payment from the General Land Office in the amount of $1,000.00 for Bilge Reclamation Facilities in Seadrift, Texas and place the funds in Precinct 4 R & B account 570-53510. (GR) 11. Consider and take necessary action to accept checks from the City of Seadrift in the amount of $46,433.55 and $58,255.56 for reclaiming, compacting, and seal coating streets and place the funds added to Precinct 4 R & B account 570-53510. (GR) 12. Consider and take necessary action on the second insurance proceeds check from TAC in the amount of $4,679.42 for damages during the Winter Storm the week of February 15, 2021 and disburse $39,676.70 ($40,617.58 minus the deductible portion of $940.88) for MMC's part of the claim. (RM) 13. Accept report from the following County Office: I. Tax Assessor -Collector —August 2021 14. Consider and take necessary action on any necessary budget adjustments. (RM) Page 3 of 4 COMMISSIONERS' COURT-9/22/2021 15. Approval of bills and payroll. (RM) Adjourned: 10:16 a.m. Page 4 of 4 AGENDA Richard H. Meyer County judge David ]Full, Commissioner, Precinct I Vern 1Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, September 22, 2021 at 10:00 a.m. in the Commissioners' Courtroorn in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. The subject matter of such meeting is as follows: AT$;570FILED M [`r5% Call meeting to order. SEP 1..7 2021 L. Invocation. pNNAM.goODMAN OOUNtt tFRKG OOUN Ny. S ,,// SYt I J/ 1�5 tr'Pledges of Allegiance. 44. General Discussion of Public Matters and Public Participation. Approve the minutes of the August 18, 2021, August 25, 2021, September 1, 2021 and September 8, 2021 meetings. "Consider and take necessary action to appoint Precinct 1 Justice of the Peace, Judge Hope Kurtz, as Judge Pro Tern to complete the unexpired term of retiring Precinct 2 Justice of the Peace, Judge Calvin Anderle, beginning October 1, 2021. (RM) Consider and take necessary action to approve the contract between Calhoun County and Kraftsman LP for the Infrastructure at Little Chocolate Bayou County Park — Playground Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. E-1 and authorize the County Judge to sign the contract and all necessary documents. (DH) Consider and take necessary action to renew a contract with AARC Environmental, Inc. for Spill Prevention, Control and Countermeasures (SPCC) Planning for Calhoun County Airport and authorize the County Judge to sign all necessary documents. (VL) Page 1 of 2 t Consider and take necessary action to authorize Precinct 3 Commissioner Joel Behrens to propose the purchase of Calhoun County Property ID# 24170 (James A. Wisdom Estate) located in Olivia, Texas in the amount of $51,600. This property is appraised for $136,180 by the Calhoun County Appraisal District. (JB) Y0. -Consider and take necessary action to accept payment from the General Land Office in the amount of $1,000.00 for Bilge Reclamation Facilities in Seadrift, Texas and place the funds in Precinct 4 R & B account 570-53510. (GR) 11.Consider and take necessary action to accept checks from the City of Seadrift in the amount of $46,433.55 and $58,255.56 for reclaiming, compacting, and seal coating �/ streets and place the funds added to Precinct 4 R & B account 570-53510. (GR) 12. Consider and take necessary action on the second insurance proceeds check from TAC in the amount of $4,679.42 for damages during the Winter Storm the week of February 15, 2021 and disburse $39,676.70 ($40,617.58 minus the deductible portion of $940.88) for MMC's part of the claim. (RM) i3. Accept report from the following County Office: I.Tax Assessor -Collector —August 2021 74. Consider and take necessary action on any necessary budget adjustments. (RM) T5. Approval of bills and payroll. (RM) 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 website at www.calhouncotx.org under "Commissioners' Court Agenda" for any official court postings. Page 2 of 2 #5 Richard H.10 Byer County judge David Hall, Commissioner, Precinct ll Vern ]Lyssy, Commissioner, Precinct B Joel Behrens, Commissioner, Precinct 3 Mary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, August 18, 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, Co to Judge Calhoun County, Texas Anna Goodman, County Clerk 'i L. _ P/. 4&. Deputy Page 1 of 1 COMISSIONERSCOURT-8/18/2021 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1= ABSENT Vern ]Lyssy, Commissioner, Precinct 2 e ABSENT Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Catherine Sullivan, Deputy Clerk REGULAR TERM 2021 § AUGUST 18, 2021P BE IT REMEMBERED THAT ON AUGUST 18, 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 Joel Behrens 3. Pledges of Allegiance. US Flag — Commissioner Gary Reese Texas Flag — Commissioner Gary Reese 4. General Discussion of Public Matters and Public Participation. N/A 5. Approve the minutes of the August 4, 2021 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Behrens, Reese Page 1 of 3 CO M ISSI O N ERS COURT — 8/18/2021 6. Consider and take necessary action to authorize the Commissioners' Court to sign the Order of Election for the November 2021 Constitutional Amendment Election. (RM) Amy Ochoa, Elections Admin. Assist., presented the Order of Election. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Behrens, Reese 7. Consider and take necessary action to approve an agreement with G & W Engineers for the design and engineering of the roof and HVAC system at Memorial Medical Center. Pass 8. Consider and take necessary action to approve a 1-year maintenance agreement with CFI Mechanical for the Adult Detention Center chiller. (RM) Everett Wood, Maint. Sup., spoke on this matter. RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Behrens, Reese 9. Accept reports from the following County Office: i. County Clerk — July 2021 ii. Justice of the Peace, Precinct 3 — July 2021 iii. Justice of the Peace, Precinct 5 — July 2021 iv. Treasurer — February 2021, Revised v. Treasurer — June 2021 vi. Treasurer — Investment Report, Quarter Ending June 30, 2021 vii. Treasurer — Quarterly Statement of Balances, June 30, 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Behrens, Reese Page 2 of 3 COMISSION ERS COURT — 8/18/2021 10. 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 4 AYES: Judge Meyer, Commissioner Behrens, Reese 11. Approval of bills and payroll. (RM) MMC RESULT: APPROVED[UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Behrens, Reese Payroll RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Behrens, Reese Adjourned: 10:08 a.m. Page 3 of 3 Richard ]H . Meyer County judge David Hall, Commissioner, Precinct l 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, August 25, 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, Cout Judge Calhoun County, Texas Anna Goodman, County Clerk J,R ep - lerk / Page 1 of 1 COMMISSIONERS COURT-8/25/2021 Richard H. Meyer County judge ge David 1h14 Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 REGULAR TERM 2021 § AUGUST 25, 2021 BE IT REMEMBERED THAT ON AUGUST 25, 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. N/A 5. Approve the minutes of the June 23, 2021 Workshop and August 11, 2021 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 1 of 7 COMMISSIONERS COURT-8/25/2021 6. Consider and take necessary action to propose a new tax rate for 2021. (RM) Tax rate .6101 approved (For 2022 Budget) 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 set the date, time and location for the Public Hearing to adopt the 2021 proposed tax rate. (RM) Date approved 09-08-2021 @ 10:00 a.m. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to set the date, time and location for the Public Hearing to adopt the 2022 Calhoun County Budget. (RM) Date approved 09-08-2021 @ 10:00 a.m. 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 issuance of a county credit card to County Judge at Law Alex Hernandez with a $5,000 limit. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 7 COMMISSIONERS COURT-8/25/2021 10. Consider and take necessary action to amend the 2021 Salary Order. (RM) County Treasurer amendments RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese EMS stipend per employee for Out of County Transport 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 the Independent Audit Report for the year ended December 31, 2020 by Armstrong, Vaughan and Associates, P.C., Certified Public Accountants. (RM) Debra Fraser gave report of audit. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to approve the FY 2022 SAVNS Grant Contract and authorize the County Judge to sign. (SAVNS = Statewide Automated Victim Notification Service) (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 7 COMMISSIONERS COURT — 8/25/2021 13. Consider and take necessary action to acknowledge overpayment on FEMA DR-4332 Hurricane Harvey and authorize a refund to the Texas Division of Emergency Management as follows: (RIM) a. PW 3889 Debris - $342.44 RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action to approve adding to the selection of donation options on a Juror Payment Receipt the right to donate to Calhoun County's local Veteran's office. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action to reject all bids received on June 24, 2021 for the Infrastructure at Little Chocolate Bayou County Park Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. E-1 and rebid the project at a future date with changes from the original scope. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. Consider and take necessary action to accept and approve the renewal for 2022 Post-65 Group Retiree Healthcare Program administered by Texas Association HEBP County Choice Silver Retiree plan with Humana and authorize the County Treasurer to sign. This silver choice plan is of no costs to the County. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 7 COMMISSIONERS COURT — 8/25/2021 17. Consider and take necessary action to approve a $34.90 charge for sidewalk chalk paid from the County Clerk's Department and donated to the Calhoun County Library. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 18. Consider and take necessary action on a Contract Agreement with Matagorda Bay Mitigation Trust for Contract No. 017: Green Lake Park Development; contract period from September 1, 2021 until March 31, 2022 for Preliminary Planning Phase; and authorize the County Judge to sign all documentation. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 19. Consider and take necessary action to participate in a grant application with West Side Calhoun County Navigation District for a Texas Department of Transportation Maritime Division Rider 37 Grant for road upgrades to Dierlam and Harbor Roads in Precinct 4 and authorize the County Judge to sign a letter of support for this grant. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 20. Consider and take necessary action to authorize Commissioner Behrens to settle with TAC to pick up the 2018 Dodge Ram Quad Cab, VIN # 1C6RR6FG9JS324695, Asset No. 23-0258, damaged in a July 14, 2021 accident and appraised as a total loss. (JB) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5 of 7 COMMISSIONERS COURT-8/25/2021 21. Consider and take necessary action to declare all items not sold in the online auction as Waste. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 22. Consider and take necessary action to declare the following inventory from Precinct 4 Road & Bridge as Surplus/Salvage and remove from inventory and authorize salvaged inventory to be utilized as trade-in for new equipment. (GR) a. 24-0422 Bomag Compactor b. 24-0451 Compactor — Dynapac CA 150D VSD RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 23. Accept reports from the following County Office: I. Justice of the Peace, Precinct 4 — July 2021 ii. Tax Assessor -Collector — July 2021 RESULT, APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 24. 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 6 of 7 COMMISSIONERS COURT-8/25/2021 25. Approval of bills and payroll. (RM) ZY I UT L�] RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Indigent 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 Adjourned: 10:56 a.m. Page 7 of 7 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern 1Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Commissioners'Court Co� � y � Count of Calhoun County, Texas met on Wednesday, September 1, 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. r R chard Meyer, Cokn jy Judge Calhoun County, Texas Anna Goodman, County Clerk Page 1 of 1 COMMISSIONERS COURT-9/1/2021 Richard ]H . Meyer County judge David ]['fall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 ]noel Behrens, Commissioner, Precinct 3 Crary Reese, Commissioner, Precinct 4 Catherine Sullivan, Deputy Clerk REGULAR TERM 2021 § SEPTEMBER 01, 2021 BE IT REMEMBERED THAT ON SEPTEMBER 01, 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. if US Flag — Commissioner Gary Reese Texas Flag — Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. N/A 5. Hear report from Memorial Medical Center. i Jason Anglin, Memorial Medical Center CEO, gave monthly report. 6. Recognize Calhoun County EMS for their contribution to saving lives in our community with the American Heart Association Mission Lifeline Award. Page 1 of 5 I COMMISSIONERS COURT-9/1/2021 7. Public Hearing regarding amending the 2021 Calhoun County budget. (RM) Commenced: 10:15 a.m. Candice Villarreal, Auditor's Office, presented the amendments. Closed: 10:23 a.m. 8. Consider and take necessary action to amend the 2021 Calhoun County Budget. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action on an Order from the District Judges setting salaries of the County Auditor and Assistants for fiscal year 2022 and approving the number of assistants for the Auditor's office for fiscal year 2022. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to approve an agreement with G & W Engineers for the design and engineering of the roof and HVAC system at Memorial Medical Center. 11. Consider and take necessary action to accept an anonymous donation in the amount of $300.00 to the Sheriff's Office to be deposited into the Motivation account. (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 COURT-9/1/2021 12. Consider and take necessary action to approve a request from the Sheriffs Office to use Jail Telephone Commissioned Funds to purchase a Clorox 360 Disinfecting Machine in the amount of $3,672.00. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to approve Addendum No. 1 to the Specifications and Invitation to Bid Packet, Bid Number 2021.05 for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action to approve the FY 2022 SAVNS Grant Contract and authorize the County Judge to sign. (SAVNS = Statewide Automated Victim Notification Service) (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action to approve the Infrastructure Development Plan for Highway 172 RV Park (Glenn Cullins). (JB) Rose Marshall requested the court table the item pending further investigation. Matter to be tabled at this time. Page 3 of 5 COMMISSIONERS COURT-9/1/2021 16. Public Hearing on a Petition to Vacate a part of Outlot 2 in Outblock 24 of the Port O'Connor Townsite situated in the Santiago Gonzales Survey, Abstract No. 19, Calhoun County, Texas as recorded in Volume 2, Page 001 of the Calhoun County Deed Records. (GR) Commenced. 10:36 a.m. Henry Danysh (G&W Engineering) presented the Petition. Closed: 10:38 a.m. 17. Consider and take necessary action to approve the Preliminary Plat of the Casarez Subdivision (a replat of part of Outlot 2 in Outblock 24 of the Port O'Connor Townsite). (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 18. Public Hearing on a Petition to Vacate Outlots 1 and 4 in Outblock 11 of the Port O'Connor Townsite situated in the Santiago Gonzales Survey, Abstract No. 19, Calhoun County, Texas as recorded in Volume 2, Page 001 of the Calhoun County Deed Records. (GR) Commenced: 10:34 a.m. Closed: 10:40 a.m. 19. Consider and take necessary action to approve the Preliminary Plat of the Jameson Subdivision (a replat of part of Outlots 1 and 4 in Outblock 11 of the Port O'Connor Townsite). (GR) 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 COURT-9/1/2021 20. Accept reports from the following County Offices: i. County Auditor — July 2021 ii. Justice of the Peace, Precinct 3 — July 2021, Revised iii. Treasurer —June 2021, Revised iv. Treasurer — Investment Report, Quarter Ending June 30, 2021, Revised v. Treasurer — Quarterly Statement of Balances, June 30, 2021, Revised RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 21. Consider and take necessary action on any necessary budget adjustments. (RIM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 22. 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 Payroll RESULT: APPROVED[UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hail, Lyssy, Behrens, Reese Adjourned: 10:45 a.m. Page 5 of 5 Richard H. Meyer County judge David Hall, Commissioner, Precinct I 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, September 8,2021, 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. Ifichard Meyer, Cot(rO§ Judge Calhoun County, Texas Anna Goodman, County Clerk -KaAA, VOA27 Neputy Clerk Page I of 1 COMMISSIONERS COURT-9/8/2021 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 Catherine Sullivan, Deputy Clerk REGULAR TERM 2021 £ SEPTEMBER08, 2021 BE IT REMEMBERED THAT ON SEPTEMBER 08, 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. N/A 5. Public Hearing on the Proposed 2022 Calhoun County budget. Commenced: 10:01 a.m. Closed: 10:03 a.m. Page 1 of 6 COMMISSIONERS COURT-9/8/2021 6. Consider and take necessary action on an Order to Adopt the 2022 Calhoun County Budget. (RM) RESULT: APPROVED[UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Public Hearing regarding the proposed 2021 tax rate. Commenced: 10:05 a.m. Closed: 10:10 a.m. 8. Consider and take necessary action on an Order to Adopt the 2021 Tax Rates. (RM) Debt Service Tax Rate of $0.321 per $100 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Maintenance and Operations Tax Rate of $0.5780 per $100 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner PcL 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Total Tax Rate Tax Rate $.6101 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 6 COMMISSIONERS COURT-9/8/2021 9. Consider and take necessary action to designate the Bauer Community Center as an additional site for Calhoun County Court at Law # 1 on September 27, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to authorize a loan in the amount of $36,000 from the General Fund to the King Fisher Beach Park Capital Project Fund. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to approve an agreement with G & W Engineers for the design and engineering of the roof and HVAC system at Memorial Medical Center. ( Motion made for Engineering Services Only and pending approval from Sara Rodriguez, County Attorney. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action on Orders from the District Judges setting the salary of the Official Court Reporter for the 24"', 135m, 26r and 377'h Judicial Districts for fiscal year 2022. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 6 COMMISSIONERS COURT-9/8/2021 13. Consider and take necessary action to accept insurance proceeds from TAC in the amount of $27,043.25 for a vehicle that was considered a total loss after an accident on 7/14/21. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall; Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action regarding a Texas Department of Transportation Grant for Routine Airport Maintenance Program (TxDOT Project No. M2213PRLA) and authorize all appropriate signatures. (VL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action to approve the Infrastructure Development Plan for Highway 172 RV Park (Glenn Cullins). (JB) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. Consider and take necessary action to declare the attached list of items 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 Hall, Lyssy, Behrens, Reese 17. Consider and take necessary action to declare the attached list of items from the County Clerk's Office as Waste. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 6 COMMISSIONERS COURT-9/8/2021 18. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Waste. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 19. Accept reports from the following County Offices: I. District Clerk — August 2021 ii. Flood Plain Administration — August 2021 iii. Justice of the Peace, Precinct # 1 — August 2021 iv. Justice of the Peace, Precinct # 2 — August 2021 v. Sheriff's Office — August 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 20. 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 21. 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 Page 5 of 6 COMMISSIONERS COURT —9/S/2021 County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 10:46 a.m. Page 6 of 6 #6 Consider and take necessary action to approve the contract between Calhoun County and Kraftsman LP for the Infrastructure at Little Chocolate Bayou County Park — Playground Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. E-1 and authorize the County Judge to sign the contract and all necessary documents. (DH) DOCUMENT NO.00500 AGREEMENT BETWEEN OWNER AND CONTRACTOR THIS AGREEMENT is dated as of the 14th day of July in the year 2021, by and between CALHOUN COUNTY (hereinafter called OWNER) and KRAFTSMAN LP (hereinafter called CONTRACTOR). OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows; .01 THE WORK: CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK - PLAYGROUND IMPROVEMENTS CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-082 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1. .02 ENGINEER: The Project has been designed by G & W Engineers, Inc., 205 West Live Oak, Port Lavaca, Texas, 77979, who is hereinafter called ENGINEER and who will assume all duties and responsibilities and will have the rights and authority assigned to ENGINEER in the Contract Documents in connection with completion of the Work in accordance with the Contract Documents. .03 CONTRACT TIMES; a. Calendar Days The Work shall be complete and ready for final payment in accordance with Paragraph 14,07 of the General Conditions within 120 Calendar Days after the date when the Contract Times commence to run. b. Rain Days CONTRACTOR may be allowed an adjustment to the CONTRACT Times for "rain days", which are defined as follows. Any day(s) in which rainfall occurs prior to 12:00 p.m. (noon), of such quantity that, in the opinion of OWNER's representative, would prevent a safe working environment for CONTRACTOR at the construction site, 00500-1 AGREEMENT BETWEEN OWNER AND CONTRACTOR LCB Pad Playground I l"Mycmenls - GLO Contlsd No. 20-00-064-C182 Fit. No. 5310.01 k 2. Any day(s) following the above described "rain day(s)" in which the condition of the construction site, in the opinion of OWNER's representative, is not conducive to providing CONTRACTOR with a safe working environment at the site. OWNER shall only consider an adjustment in Contract Times if CONTRACTOR submits a written request for "rain days" to OWNER's representative for review, by 10:00 a.m. on the Monday following the week in which the day(s) occurred. Failure to submit such a written request shall be a representation by CONTRACTOR that additional days are not warranted. OWNER's representative shall review all requests when submitted and will have final on site determination for "rain days". Disagreements between CONTRACTOR and OWNER's representative shall be submitted to OWNER. C. Liquidated Damages OWNER and CONTRACTOR recognize that time is of the essence in this Agreement and that OWNER will suffer financial loss if the Work is not substantially complete within the time specified in paragraph .03.a above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. They also recognize the delays, expense and difficulties involved in proving in a legal proceeding the actual loss suffered by OWNER if the Work is not substantially complete on time. Accordingly, instead of requiring any such proof, OWNER and CONTRACTOR agree that, as liquidated damages for delay (but not as a penalty), CONTRACTOR shall pay OWNER FIVE HUNDRED DOLLARS ($500.00) for each day that expires afler the time specified in paragraph .03.a. CONTRACTOR hereby agrees that said sum per day is a fair estimate of the pecuniary damages which will be sustained by OWNER in the event that the Work is not complete within the agreed time, or within extensions of time properly granted in accordance with the Contract Documents. Said sum shall be considered as liquidated damages only and not a penalty, said damage being caused by loss of timely use of the Work other injury difficult to quantify. For purposes of applying this liquidated damages clause, the CONTRACTOR agrees to waive as against the OWNER any defense to enforcement of said clause based on any of the following claims: (1) that the clause is a penalty; (2) that the daily amount stated in the clause is not a reasonable estimate and approximation as of the time of contracting of OWNER's actual damages; (3) that the damages caused to OWNER by reason of delay were not difficult to estimate at the time of contracting. 00500-2 AGREEMENT BETWEEN OWNER AND CONTRACTOR LCB 1'mk Pluyamued Im rovememe - (i1.0 Commel No. 20.065-064-C182 File No. 5310.011e .04 CONTRACT PRICE: OWNER shall pay CONTRACTOR for performance of the Work in accordance with the Contact Documents in current funds as per CONTRACTOR's proposal which forms a part of this contract. In no event shall the amounts payable pursuant to this Contract exceed $189,080.00, being the TOTAL BASE BID plus the amount of any duly authorized change orders or contract amendments executed by OWNER. .05 PAYMENT PROCEDURE: CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the General Conditions unless otherwise amended by the Contract Documents. Applications for Payment shall also include all required documentation indicated in Division 1 - General Requirements, Section 01025 of these Specifications. ENGINEER shall process Applications as provided in the General Conditions. a. Progress Payments OWNER shall make progress payments on account of the Contract Price on the basis of CONTRACTOR's Applications for Payment as recommended by ENGINEER and as provided below. All progress payments will be on the basis of the progress of the Work measured by the schedule of values provided for in Article 2 of the General Conditions. 1. Progress payments will be in an amount equal to the percentage indicated below, but, in each case, less the aggregate of payments previously made and less such amounts as ENGINEER shall determine, or OWNER may withhold in accordance with Paragraph 14.02.13.5 of the General Conditions. A. 90% of the Work completed (with the balance being retainage) B. 90% (with the balance being retainage) of materials and equipment not incorporated in the Work (but delivered, suitably stored and accompanied by documentation satisfactory to OWNER as provided in Paragraph 14.02.A.1 of the General Conditions). 2. Request for Payments All requests for payments shall be divided into materials costs and labor/equipment costs. All requests for material payment shall be accompanied by CONTRACTOR's paid invoice for the material in accordance with Article 14.02.A.1 of the General Conditions, 00500-3 AGREEMENT BETWEEN OWNER AND CONTRACTOR LCB Park I Mi mund l no.c 1 - OLO Conlmd N.. 20-065-064-C182 Filc No. 531o.011e b. Final Payment Upon final completion and acceptance of the Work in accordance with Paragraph 14.07 of the General Conditions, OWNER shall pay the remainder of the Contract Price as recommended by ENGINEER as provided in said paragraph. .06 CONTRACTOR's REPRESENTATIONS: In order to induce OWNER to enter into this Agreement, CONTRACTOR makes the following representations: a. CONTRACTOR has examined and carefully studied the Contract Documents (including the Addenda listed in paragraph 7 herein) and the other related data identified in the Bidding Documents including "technical data." b. CONTRACTOR has visited the site and become familiar with and is satisfied as to the general, local and site conditions that may affect cost, progress, performance or furnishing of the Work. C. CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws and Regulations that may affect cost, progress, performance and furnishing of the Work. d. CONTRACTOR has carefully studied all reports of explorations and tests of subsurface conditions at or contiguous to the site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the site (except Underground Facilities) which have been identified in the Supplementary Conditions as provided in Paragraph 4.02.A of the General Conditions. CONTRACTOR accepts the determination set forth in the Supplementary Conditions to the extent of the "technical data" contained in such reports and drawings upon which CONTRACTOR is entitled to rely as provided in Paragraph 4,02.A of the General Conditions. CONTRACTOR acknowledges that such reports and drawings are not Contract Documents and may not be complete for CONTRACTOR's purposes. CONTRACTOR acknowledges that OWNER and ENGINEER do not assume responsibility for the accuracy or completeness of information and data shown or indicated in the Contract Documents with respect to Underground Facilities at or contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes responsibility for having done so) all such additional supplementary examinations, investigations, explorations, tests, studies and data concerning conditions (surface, subsurface and underground facilities) at or contiguous to the site or otherwise which may affect cost, progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences and procedures of construction to be employed by CONTRACTOR and safety precautions and programs incident thereto. CONTRACTOR does not consider that any additional examinations, investigations, explorations, tests, studies or data are necessary for the performance and furnishing of the Work at the Contract Price, within the Contract Times and in accordance with the other terms and conditions of the Contract Documents. 00500-4 AGREEMENT BETWEEN OWNER AND CONTRACTOR. I.CB Park PIMMod 110MV01019 -OLO Cmumel No, 20-065-064-CI82 He No. 5310.01 le e. CONTRACTOR is aware of the general nature of the Work to be performed by OWNER and others at the site that relates to the Work as indicated in the Contract Documents. f. CONTRACTOR has correlated the information known to CONTRACTOR, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. g. CONTRACTOR has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that CONTRACTOR has discovered in the Contract Documents and the written resolution thereof by ENGINEER is acceptable to CONTRACTOR, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing of the Work. .07 CONTRACT DOCUMENTS: The Contract Documents which comprise the entire Agreement between OWNER and CONTRACTOR are attached to this Agreement, made a part hereof and consists of the following: a. This Agreement. b. Exhibits to this Agreement. C. Calhoun County — GLO Contract No. 20-065-064-C182: Required Contract Provisions; General Affirmations and Nonexclusive List of Applicable Laws; Rules and Regulations; and Section 3 Clause d. CONTRACTOR's Proposal. e. Performance, Payment and other Bonds. f. Notice of Award. g. Notice to Proceed, h. General Conditions. i. Calhoun County, Texas General Conditions. j. Supplementary Conditions, k. Technical Specifications. 00500-5 AGREEMENT BETWEEN OWNER AND CONTRACTOR LCB Park Playground Imornvemenls - 610 Contract No. 20-066-D64d162 File No. 5320.011e Drawings numbered & titled for the different areas of work as indicated below: INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK - PLAYGROUND IMPROVEMENTS CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND MICE CONTRACT NO.20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORT{ ORDER NO. E-1. SHEET NO. DATE DESCRIPTION C1.0 06/08/21 COVER SHEET C2.0 03/22/21 GENERAL NOTES C3.1 06/08/21 PLAYGROUND PLAN C4.1 03/22/21 STANDARD DETAILS in. Addendum numbers One (1) to One (1) inclusive n. The following of which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto: All Written Amendments and other documents amending, modifying or supplementing the Contract Documents pursuant to Paragraph 3.04 of the General Conditions. There are no Contract Documents other than those listed above in this Article 7. The Contract Documents may only be altered, amended or repealed in accordance with the appropriate provisions of Article 3 of the General Conditions. .08 AUSCI LLANEOUS: a. Terns used in this Agreement which are defined in Article 1 of the General Conditions will have the meanings indicated in the General Conditions. b. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and, specifically but without limitation, moneys that may become due and moneys that are due may not be assigned without such consent(except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. C. OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and legal representatives to the other party hereto, its partners, successors, assigns and legal representatives in respect to all covenants, agreements and obligations contained in the Contract Documents. 00500-6 AGREEMENT BETWEEN OWNER AND CONTRACTOR LCB Park Pln round Imurovemenis - GLO Contract No. 20-005.064-C182 File No. 5310.011e d. Any provision or pail of the Contract Documents held to be void or unenforceable under any Law or Regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the Contract Documents shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. IN WITNESS WHEREOF, the parties hereto have signed this Agreement in triplicate. One counterpart each has been delivered to OWNER, CONTRACTOR and ENGINEER. All portions of the Contract Documents have been signed or identified by OWNER and CONTRACTOR or by ENGINEER on their behalf. OWNER: C OUN COUNTY BY:Ih , ard H. Meyer, Coun dge ATTEST: ADDRESS: 211 S. Ann, Suite 301 Port Lavaca, Texas 77979 CONTRACTOR- KRAF�SMAN LP BY: F -bp-Ei- Korev-Soderberg, COO ATTEST: ADDRESS: 19535 Haude Rd Spring, Texas 77388 PHONE: (361) 553-4600 PHONE: (281) 353-9599 FAX: (361) 553-4444 FAX: N/A END OF DOCUMENT 00500-7 LCS Park Plavzrountl Improvements -GLO Contract No. 20-065-064-C182 File No. 5310.011e Kraftsman LP (Legal Fimr Name) PROPOSAL , hereinafter called "BIDDER", is submitting this Proposal for Furnishing and Performing the Work specified herein as the INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK — PLAYGROUND IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-CiS2 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1. This PROPOSAL is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". 1. Terms used in this PROPOSAL are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER hi the form included in the Contract Documents to fiunish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Working Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: 1-060821 Date Received: 23-2021 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 Addendum No. 1 — Playground Lnprovomcnts d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. C. BIDDER has correlated the information known to BIDDER, information and observations obtained From visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firn or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firn or corporation to refrain fiom bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.033 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Addendum No. 1 — Playground Lnprovemmrrs BASE BID BID BID DESCRIPTION OF ITEM WITH ITEM QTY, UNIT PRICE WRITTEN IN WORDS AMOUNT 1. I LS Furnishing Mobilization and Insurance as per plans and Note: specifications for a lump sum price of Price includes Payment and Seventeen Thousand Dollars Performance Bond and zero Cents. $ 17,000.00 2. 1 LS Furnishing equipment, materials and labor for the installation of the CDBG temporary and a permanent acknowledgement sign as per page 02845-1 of the specifications for a lump sum price of Five Thousand Five Hundred Dollars and Zero Cents. s 5,500.00 3. 1 LS One (1) Centerpiece Play Structure meeting the following requirements: age group 5-12, ADA inclusive, minimum capacity of 80, approximate use zone of 45' x 45' and be made of materials and stainless -steel fasteners suitable for coastal environments, including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Seventy One Thousand Dollars and Zero Cents. $ 71,000.00 4. 1 LS Four (4) total bench seat with back rest/ support including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Four Thousand Eight Hundred Ten Dollars and Zero Cents. S 4,8W.00 00300-3 Addendum No. I —Playground Improvements BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT 5. 1 LS Four (4) total park trash receptacle including labor, equipment and materials complete in place as per plans and specifications for a lump sum price of Four Thousand Six Hundred Twenty Dollars and zero Cents. $ 4,620.00 6. 1 LS Earthwork required to ensure stable base below playground zone including, stripping top layer organic material, subgrade preparation and excavation or imported fill to meet required slopes and elevations as necessary to ensure ADA compliancy including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of 7. 1 LS ote: rice is for ADA ompliant per STM 1292 - noineered Wood Fourteen Thousand Dollars and zero Cents. $ 14.000.00 ADA minimum and ADA inclusive playground surfacing with adequate curbing/containment structures as required to support the designated playground area including required ADA inclusive surfacing for ADA inclusive centerpiece play structure for a total of 7,600 SF of both ADA compliant and ADA inclusive surfacing, including labor, equipment and material for a complete installation as per plans and specifications for a lump sum price of Twenty Three Thousand Dollars and zero Cents. $ 23,000.00 00300-4 Addendum No. 1 — Ploygmund Improvemonls BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS LS Four (4) inch thick steel reinforced with perimeter grade beams as required, 4,000 psi concrete pedestrian walkway approximately 2,300 SF including labor, equipment and materials for a complete installation as per the plans and specifications for a lump sum price of 9. 1 LS Note: Price includes supply and install of sodding. AMOUNT Forty Six Thousand Seven Hundred Fifty Dollars and Zero Cents. $ 46,750.00 Furnishing labor for the installation of approximately 2,400 SF of Flortam species sodding around the perimeter sidewalk filled areas that are disturbed as per plans and specifications, for a lump sum price of Two Thousand Four Hundred Dollars and Zero Cents. $ 2,400,00 TOTAL BASE BID AMOUNT, for INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK — PLAYGROUND IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1, being Items 1 thm 9 above is: One Hundred Eighty Nine Thousand Eighty Zero DOLLARS CENTS. CALANDAR DAYS 189.080.00 120 AWARD OF CONTRACT SHALL BE BASED ON THE "BASE BID" WITH CONSIDERATION OF THE OWNER'S OPTIONS 00300-5 Addendum No. I — Playground Improvemems OWNER'S OPTIONS BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT Four (4) 01. 1 LS THree43-) Bay Powder Coated Steel Swing Set with Swings designed-with—fitture—shad"tended, Two (2) being Standard Belt Seats, two (2) being Bucket Seats, one (1) Note, ADA compliant Swing and One ADA compliant wheel Owner Option 11 is for integrated shade for This chair accessible swing which shall include ADA inclusive structure but must be surfacing materials required and a deduction for the purchased with Owner standard ADA surfacing not required due to the increase in Option 1 if desired ADA inclusive surfacing for the wheel chair swing section including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Twenty Nine Thousand Dollars and Zero Cent 02. t LS One (1) ADA Germpliam Zip Line between 75' to 100' in length including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Twenty Seven Thousand Five Hundred Dollars and Zero Cent 03. 1 LS des ADA Pomed in Place sive surfacing materials fired and a deduction for tandard ADA Engineered J Fiber surfacing not fired due to the Increase in PIP inclusive surfacing for DA Monkey Bar section One (1) ADA Compliant powder coated steel monkey bar horizontal ladder play equipment suitable for wheel chair accessibility including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Eighteen Thousand Dollars and Zero $ 29,000.00 27,500.00 $ 18,000.00 00300-6 Addendum No. I — Playground Improvements BID BID ITEM QTY. UNIT 04. 1 LS de: ructure Is recycled uprights it powder coaled steel to itch play structure. Owner )tion B (Mushroom eppers) must be �rchased to functionally link Buse Bid Item 3 (Play DESCRIPTION OF ITEM WITH PRICE WRITTEN IN WORDS One (1) standard height powder coated steel monkey bar play equipment including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of AMOUNT Three Thousand One Hundred Sixty Dollars and Zero Cents. $ 3,160.00 05. 1 . LS One (1) ADA Compliant wheel chair accessible merry-go- round which shall include ADA inclusive surfacing materials required and a deduction for the standard ADA surfacing not required due to the increase in ADA inclusive surfacing for the merry-go-round including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Thirty Four Thousand Dollars and Zero Cents. 06. 1 LS One (1) Motion Spring Rider for Ages 2 to 5 (theme to be determined) including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Two Thousand Seven Hundred Dollars and Zero Cents. 07. 1 LS One (1) Motion Spring Rider for Ages 4—te-2-(theme to be determined) including labor, equipment and materials for a complete installation as per plans and specifications for a Nola: lump sum price of Spring Riders, per AS'm and CPSC Guidelines, are not recommended for ages I to 2. Spring rider proposed Two Thousand Seven Hundred Dollars are for ages 2 to 5 Zero and Cents. $ 34,000.00 2,700.00 $ 2,700.00 00300-7 Addendum No. 1— Playground Improvements BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS 08. 1 LS Nate: This (tern is recruited to functionally link Owner Option Item 4 There (3) total Rubber Mushrooms including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of U1308r111aLd Two Thousand Six Hundred Aollars and Zero Cents. $ 2,600.00 09. 1 LS One (1) in -ground mounted drum/bongo kit for musical play including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Two Thousand Four Hundred Dollars and Zero Cents. $ 2,400.00 010. 1 LS One (1) climb and play wall/tunnel including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Ol 1. 1 LS Note: This unit is an integrated shade and can only be purchased at time of original installation of four tiny swing in Owner Option 1 Five Thousand five Hundred Dollars and Zero Cents. Four Bay Sun Shade Canopy for Three -Bay Swing Set in Base Bid including labor, equipment and materials for a complete installation for a lump sum price of Seventeen Thousand Nine Hundred Dollars and Zero Cents, 00300-8 51600.00 17.900.00 Addendum No. I —Playground Improvements BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT 012. 1 LS Sun Shade Canopy for One Bay Tire Swing Set in Base Bid including labor, equipment and materials for a complete Note: installation for a lump sum price of We have included in our four bay swing with integrated shade an ADA Inclusive NO BID Team Swing Dollars and Cents 013. 1 LS Triangle Sail Shade Canopy (40'x40'x4O') Structure including labor, equipment and materials for a complete installation for a lump sum price of Fifty Thousand and Zero 014, 1 LS Hopscotch play at the proposed sidewalk including labor, equipment and materials for a complete installation for a lump sum price of One Thousand Dollars and Zero Cents. 015. 1 LS Themed Steppers (5 EA) Play including labor, equipment and materials for a complete installation for a lump sum price of Two Thousand Nine Hundred Dollars and Zero Cents per-eubtelarxi 016, 1 LS One Single Bay Swing Set Structure including Tire Swing "°1ef designed with future shade intended, including labor, We have included In our lour ui ment and materials for a complete installation for a a q P P bay swing configuration an lump sum price of ADA Inclusive Team Swing in place of a lire swing NO BID Dollars and Cents per ubicyaM. $ NO BID $ 50,000.00 $ 1,000.00 $ 2,900.00 $ NO BID Addendum No. 1 —Playground Improvements -t•-i-i-1-•I••i•-1-•i-H--H--I•++-pill! --rr;-F-'rI r,--r-r,- I ++!-F•i- H 1 r1-rrT,-I-F-h•F•F•h+;-F•1-hi••I••F•t•-f•-i••I-I-F+•FH+1 •H-+ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to rum. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. 7. The following documents are attached to and made a condition of this BID: DOCUMENT NO. 00411- REQUIRED BID SUBMITTAL INSTRUCTIONS 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this 23rd day of June 2021. Authorized Signature: Name: Kris Soderberg Title: Vice President c-`�Attesting Signature:�Q/I/LA-� Name: Legal Firm Name: Kraftsman Business Address: 19535 Haude Rd Phone Number: 281-353-9599 Facsimile Number: �P��" E-Mail Address (optional): info@kraftsmanplay.com State of Incorporation, if applicable: �iL 5 State Contractor License No.: END OF DOCUMENT 00300-10 Addendum NO, I—Playgmund Improvements Sond No. 4448796 PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS that: Krattsman, LP (Name of Contractor or Company) 19535 Naude Road, Spring, Texas 77388 (Address) hereinafter called Principal, and SureTec Insurance Company (Name of Surety Company) 9737 Great Mills Trail. Suite 320 Austin Texas 79759 (Address) hereinafter called Surety, are held and firmly bound unto CALHOUN COUNTY. TEXAS (Name of Grant Recipient) 211 S. Ann Suite 301 Port Lavaca Texas 77979 (Grant Recipient's Address) hereinafter called OWNER, in the penal sum of $ One Hundred Eighty Nine Thousand Eighty Dollars and zero cents Dollars ($ 189.ogo.00-------------------------) in lawful money of the United States, for the payment of which sum well and truly to be made we bind ourselves, successors, and assigns, Jointly and severally, firmly in these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER dated the 14th day of July, 2021 a copy of which is hereto attached and made a part hereof for the construction of: INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK - PLAYGROUND IWROVEMENTS CALHOUN COUNTY, TEXAS —TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C1S2 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO, E-1. 00610-1 NOW THEREFORE, if the Principal shall well, truly and faithfully perform its duties in all the undertakings, covenants, terms, conditions, and agreements of said contract during the original term thereof, and any extensions thereof which may be granted by the OWNER, with or without notice to the Surety and during the one year guaranty period, and if he shall satisfy all claims and demands incurred under such contract, and shall fully indemnify and save harmless the OWNER from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the OWNER all outlay and expense which the OWNER may incur in making good any default, then this obligation shall be void, otherwise to remain in full force and effect. PROVIDED FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the SPECIFICATIONS. PROVIDED, FURTHER, that no final settlement between the OWNER and the Principal shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied, IN WITNESS WHEREOF, this instrument is executed in wo to counterparts, each one of which shall be deemed an original, this the 29th day of July, 2021 ATTEST: KI'altsmal LP (Princ'pa (Principal Secretary) Z'C (SEAL) L / 19535 Haude Road (Witness as to Principal) (Address) 19535 Haude Road Spring, Texas 77388 (Address) Spring, Texas 77388 ATTEST: SmeTec Insurance. Company (Surety) By 1 ,k �.-1,t Ate- -—(\3fi,)\ (Witness as to Surety) , Randic Lom, Assistant (Attorney In Fact), Alicia Cantavella 9737 Great Hills Trail, Suite 320, Austin, Texas 78759 9737 Gmal Hills Trail, Suite 320, Austin, Texas 78759 (Address) (Address) NOTE: Date of BOND must not be prior to date of Contract. If PRINCIPALICONTRACTOR is Partnership, all partners should execute BOND, "Power -of attorney for person signing for Surety Company must be attached to bond 00610-2 Bond No. 4448796 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS that: Kraflsman. LP (Name of Contractor or Company) 19535 Haude Road Spring 'rxa 77488 (Address) a Partnership , hereinafter called Principal, (Corporation / Partnership) and SureTec Insurance Company (Name of Surety Company) hereinafter called Surety, are held and firmly bound unto CALHOUN COUNTY, TEXAS (Name of Recipient) 211 S. Ann Suite 301 Port Lavaca, Texas 77979 (Recipient's Address) hereinafter called OWNER, in the penal sum of $ one Hundred riahty Nine Thousand Eighty Dollars and zero Cants Dollars, $ 189,080.00------------------ in lawful money of the United States, for this payment of which sum well and truly to be made, we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents. THE CONFIDENTIALITY OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER, dated the 14th day of Inly, 2021 , a copy of which is hereto attached and made a part hereof for the construction of: INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK - PLAYGROUND IMPROVEMENTS CALHOUN COUNTY, TEXAS —TEXAS GENERAL LAND OFFICE CONTRACT NO, 20.065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1. (Project Name) NOW, THEREFORE, if the Principal shall promptly make payment to all persons, firms, SUB- CONTRACTORS, and corporations furnishing materials for or performing labor in the prosecution of the WORK provided for in such contract, and any authorized extension or modification thereof, including all amounts due for materials, lubricants, oil, gasoline, coal and coke, repairs on machinery, equipment and tools, consumed or used in connection with the construction of such WORK, and all insurance premiums on said WORK, and for all labor, performed in such WORK whether by SUB -CONTRACTOR or otherwise, then this obligation shall be void; otherwise to remain in full force and effect. 00620-1 PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in anyway affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the SPECIFICATIONS. PROVIDED, FURTHER, that no final settlement between the OWNER and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS WHEREOF, this instrument is executed in two (2) counter -parts, each on of (Number) which shall be deemed an original, this the 29t1r day of l ly 2021 ATTEST: By (s) (Principal Secretary) C ✓L (SEAL) 19535 Maude Road Sri ine, Texas 77388 Spring. Texas 77388 (Address) ATTEST: SureTec Insurance Company By (Witness as to Surety Randie Loin, Assistant (Att6mey in Fact) , Alicia Cantavella 9737 Great Hills Trail Suite 320, Austin, Texas 78759 9737 Great Hills Trail, Suite 320, Austin Texas 78759 (Address) (Address) NOTE: Date of BOND must not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND, 'Power -of attorney for person signing for Surety Company must be attached to bond 00620-2 4221073 S-un eTec Insurance Company LIMITED POWER Or ATTORNEY iincuv 111 Dien by These Presents, That SURFTFC INSURANCE COMPANY (the ,Companyl'), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint Jeffrey L. Brady, Dennis M. Descant, Jr., Cheryl A. Sanders, Alicia Cantavella its (rue and lawful Attorney -in -fact, with full power and authority hereby confened in its (lame, place and stead, to execute, acknowledge and deliver any and all bonus, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for, providing the bold penalty floes not exceed Fifty Million and 00/100 Dollars ($50,000,000.00) and to bind the Company thereby as fully and to the scone extent as if such bond were signed by the President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney -in -Pact may do in the premises. Said appointment is niatle under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved. that the President. ally VICc-President, any Assistant Vice-president, any `ieCltlary of ally Assistant Secretary shall be and Is hereby vested with full power and authority to appoint any one or more suitable persons as Atttaney(s)-in-Fact to represent and act for and oilbellatfof the Company s lbjecl In the rot lowing provisions: Attorm)-in-Fact rally be given full powerand authority for and in the name of and of behalf of the Company, to execute, acknoteledge and deliver, an), and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and :ally such instruments so exezded by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Bo it Re.1'olved,, that the signalore of any authorized officer and seal of the Company herciofare or hereafter affixed to any power of aulonoy or any cenificate relating thereto by facsimile, and any power ofa(torney or certificate bearing facsimile sigataure 01 lilesialile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is aaached. (Adopted al a meeling hakt on 20" it/ 1999) In fPihtevs hMeereof, SURETEC INSURANCE. COMPANY has caused these presents to be signed by its President, and its corporate seal to be hereto affixed this nl, day of m,iy . A.D. 2021 . SURETCC INSURANCE COMPANY f -yr9r Michael C.ICeuntg,President $Iille tlfTnxas ss: ' County of Harris *....., On Illis 7a, day, of may A.D. 2021 before me personally came Miclutel C. Reimig, to inc known, who, being by ale duly sworn, did depose anti say, that he resides in Houston,' Texas, (list he is President of SURF rEC INSURANCE COMPANY, the company desenbed in and which executed the above instrument; that he knows the seal orsaid Contpaay; that the seal affixed to said instrument is such curpuraie seal; that it was sal affixed by order of the Board of Directors ol'said Company; and that he signet) his name thereto by like order. lAr•.ltASFIF" u {r,,tq Vulir, ip0 AR t1 ;'1` r1x"rt It trls•rr:(sr t( Tanya Sneed, Nolati•y Public My commission expires March 30, 2023 I, M. Brent Beaty, Assistant Scerclary of SURE. 1'GC INS( RANCE COMPANY, do hereby artily ttal the above and foregoing is a true and correct cop)' of a Power of Attorney, executed by said Co Infinity, which is still it full force and effect; and liatherniore, the resolutions of the Board of Directors, set oaI in the Power or Attorney are in fuI I force and effect. Given under nay hand and the sent of said Company at Houston, Texas this (lily of July/T _ 2021 A.D. -1�ct It Bea y, Assistan Seniry Any insbvntant Issued In excess of cite penalty stated above is totally void and without any validity. 4221073 For verification of the authority of this power you may call (713) 812.0800 any business day between 8:30 am and 6:00 pm CST, Su,uireTec �Ir suirance Company IMPORTANT NOTICE Statutory Complaint Notice/Filing of Claims To obtain information or make a complaint: You may call the Surety's toll free telephone number for information or to make a complaint or file a claim at: 1-866-732-0099. You may also write to the Surety at: SUreTeC Insurance Company 9737 Great Hills Trail, Suite 320 Austin, TX 78759 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at 1-800-252- 3439. You may write the Texas Department of Insurance at: PO Box 149104 Austin, TX 78714-9'104 Faxft: 512-490-1007 Web: httn://unmw.tdi.texas.gov Email: ConswmerProtection@tdi.texas.gov PREMIUM OR CLAIMS DISPUTES: Should you have a dispute concerning your premium or about a claim, you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. Nm' Ride, V2019 A� ®® CERTIFICATE OF LIABILITY INSURANCE DATE13/2D21YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(tes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER Brady, Chapman, Holland & Associates 10055 West Gulf Bank Houston TX 77040 CONTACT NAME: PHONE FAX c o • 713-688-1500 AID, No: EODAIe ; ecerts@bch-insurance.com INSURERSAFFORDING COVERAGE NAIC Ii INSURER A: Oklahoma Surety Co. - 23426 INSURED Kraftsman, LP Kraftsman Commercial Playgrounds INSURERS: Texas Mutual Insurance CO 22945 WsuRaac: Navigators Specially Ins. Co. (Am WINS) 36056 _ INSURER D: Mid -Continent Casualty Co. 23418 and Water Parks 19535 Haude Road Spring TX 77388 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1696928832 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF ADD SUER POUCYNUMSER POLICY EFF MMIOD/YYYY1 POLICY EXP (MMIDDNYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY OOGLOO1048525 10/11/2020 10/11/2021 EACH OCCURRENCE 31,000,000­5ANKGE CLAIMS -MADE FxI OCCUR TO -RENTED PREMISES Me occurrenoet _ $100,000 X MEO EXP (Any one person) $ L00o BI&PD Dad PERSONAL& ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JEp7 LOG PRODUCTS-COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILELIABILITY 06CA002839526 10/11/2020 10/11/2021 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Par poison) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS 1X BODILYBODILY INJURY (Per accitlenl) $ X PROPERTYDAMAGE Peraccidenl $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY C UMBRELLA LIAR X OCCUR H020EXC7843781C 10/11/2020 10/11/2021 EACH OCCURRENCE $6,000,000 X AGGREGATE $5,000,000 EXCESS LIAR CLAIMS -MADE DEB I X I RETENTION$ n $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBEREXCLUOE09 NIA 0010060303 1011IJ2020 10/11/2021 X I PER OTH. STATUTE ER E.L. EACH ACCIDENT $1,00Q000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 D Ranted &Leased 04CIM000016334 10111/2020 10/11/2021 $30gDD0 Per Item Equipment $3001000 Per Loss Deductibles $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required). The General Liability policy includes additional insured and primary non-contributory perform ML1357(04113) in favor of Certificate Holder. The General Liability policy Includes blanket waiver of subrogation perform ML1080(07/11), as required by written contract. The Automobile policy includes blanket additional Insured perform MA2004(11/00), and blanket waiver of subrogation perform MA2003(03/10), as required by written contract. The Workers Compensation policy includes blanket waiver of subrogation per form WC420304B(06/14), as required by written contract. Additional Insureds: Calhoun County and G&W Engineers, Calhoun County 211 S. Ann, Suite 301 Port Lavaca TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Policy No. 06-GL-001048525 OKLAHOMA SURETY COMPANY ML 13 57 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CALHOUN COUNTY 1. WHO IS AN INSURED (Section III is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability caused, in whole or in part, by your performance of "your work" for that insured. However: A. The insurance afforded to such additional insured only applies to the extent permitted by law; and B. If coverage provided to the additional insured is required by written "insured contract", the insurance afforded to such additional insured will not be broader than that which you are required by the written "Insured contract" to provide for such additional insured. 2. With respect to 1. above the following additional provisions apply: 4. Other Insurance The insurance afforded by this Coverage Part is primary insurance and we will not seek contribution from any other insurance available to the insured unless the other insurance is provided by a contractor other than the above named additional insured. We shall be considered as excess insurance of any other insurance provided by a contractor other than the above named additional insured. This amendment applies only when you have agreed by written "insured contract" to designate the person or organization listed above as an additional insured subject to all provisions and limitations of this policy. All other conditions remain unchanged. ML 13 57 04 13 Includes copyrighted material of Insurance Services Office, Page 1 of 1 Inc., with its permission MI 90 00 08 99 A \ OKLAHOMA SURETY COMPANY 1437 S. BOULDER SUITE 200 TULSA OK 74119 GENERAL LIABILITY GENERAL CHANGE ENDORSEMENT Policy No. 06-GL-001048526 Named Insured and Mailing Address Agency and Mailing Address KRAFTSMAN, L.P. BRADY CHAPMAN HOLLAND & ASSOC 42-0220 SEE NAMED INSURED ENDORSEMENT 10055 WEST GULF BANK 19535 HAUDE ROAD HOUSTON TX 77040 SPRING TX 77388 .POLICY PERIOD: From 10/11/2020 to 1011112021 at 12:01 A.M. Standard Time at your mailing address shown above. Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements, or declarations of the undermentioned Policy other than as stated below. NO: 020 EFFECTIVE 08/17/2021 THIS POLICY IS AMENDED AS SHOWN Adding Additional Insured, under form S ML 1367, In favor of: Name of Person or Organization - G&W ENGINEERS Pro-Rata:.150685 NO CHANGE IN PREMIUM: FORMS AND ENDORSEMENTS APPLYING TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THIS TIME: ML1357(04113) Countersigned at: HOUSTON TX Date: 09/02/2021 By Authorized Representative MI 90 00 08 99 Page 1 of 1 No. 06-GL-001048525 PREMIUM Location Classification TEXAS Waiver Of Subrogation -See Form ML 1080 Flat Charge (Fully Earned) Additional Insured - See Form ML 1357 Per Each (Fully Earned) Additional Insured -See Form ML 1215 Per Each (Fully Earned) Manufacturers Representatives Machinery or Equipment - installation, servicing or repair NOC continued on next page Minimum Premiums Policy Writing $500 All Other $631 PR/CO $665 OKLAHOMA SURETY COMPANY ML 15 08 04 97 COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS Code No. Premium Basis Rate Advance Premium AIArea gcosl Pr/Co All Other PdCo All Other P)Paymli U)Perunll Sxmss Sales T)See Dem M)Ad.mians 900459 T) 500.000 500. 900465 T) 9,800. 900464 T) 3,700. 45993 8) 12,000,000 .809 .295 9,708. 3,540. 97223 P) 550,000 17.214 13.569 9,468. 7,463. Extension of Declarations — Total Advanced Premium $ 26,894. $ 50,367. ML 15 08 04 97 Includes copyrighted material of Insurance Services Office, Inc., with PAGE 001 its permission OKLAHOMA SURETY COMPANY ML 15 08 04 97 COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS Policy No 06-GL-001048525 PREMIUM Location Code No. Premium Basis Rate Advance Premium Classification A)Area gcasl Pr/Co All Other Pr/Co All Other TEXAS Contractors - subcontracted work - 91581 in connection with construction, reconstruction, erection or repair - Not buildings NOC Contractors - Executive Supervisors or 91580 Executive Superintendents Products -completed operations are subject to General Aggregate Limit Designated Project - See ML 1097 900454 Flat Charge (Fully Earned) P)Payrall UIPer Unll 5)Gross Sales T)See Desc. M)AEmieslans C) 2,250,000 P) T) 610,000 3.430 3.430 7,718. 7,718. Incl. 28.108 Incl. 17,146. 500.000 Extension of Declarations —Total Advanced Premium ML 15 08 04 97 Includes copyrighted material of Insurance Services Office, Inc., with its permission 500. PAGE 002 Policy No. 06-GL-001048525 OKLAHOMA SURETY COMPANY ML 15 09 04 97 COMMERCIAL GENERAL LIABILITY LOCATION SCHEDULE LOCATION OF PREMISES Location of All Premises You Own, Rent or Occupy: Loc: 001 19536 HAUDE RD. SPRING TX 77388 Loc: 002 122 APRIL BREEZE MONTGOMERY TX 77356 ML 15 09 04 97 Includes copyrighted material of Insurance Services Office, Page 1 of 1 Inc., with its permission MI 90 09 1197 OKLAHOMA SURETY COMPANY 1437 S. BOULDER SUITE 200 TULSA OK 74119 SUPPLEMENTARY DECLARATIONS FOR NAMED INSURED Policy No. 06-GL-001048626 THE NAMED INSURED FOR THIS POLICY IS: KRAFTSMAN, L.P. KPPE,LLC KRAFTSMAN EQUIPMENT, L.P. KRAFTSMAN, L.P. DBA KRAFTSMAN COMMERCIAL PLAYGROUNDS & WATER PARKS PLAYKRAFT, INC. DBA KRAFTSMAN PLAYGROUND & PARK EQUIPMENT MM REAL ESTATE INVESTMENT, LLC MM HAUDE RD. PROPERTY, LP MM CYPRESSWOOD PROPERTY, LP MM REAL PROPERTY HOLDING, LP KRAFTSMAN 401(K) AND PROFIT SHARING PLAN MI 90 09 1197 Includes copyrighted material of Insurance Services Office, Page 1 of 1 Inc., with its permission Policy No. 06-GL-001048525 OKLAHOMA SURETY COMPANY MIL 13 57 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: G&W ENGINEERS 1. WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability caused, in whole or in part, by your performance of "your work" for that insured. However: A. The insurance afforded to such additional insured only applies to the extent permitted by law; and B. If coverage provided to the additional insured is required by written "insured contract", the insurance afforded to such additional insured will not be broader than that which you are required by the written "insured contract" to provide for such additional insured. 2. With respect to 1. above the following additional provisions apply: 4. Other Insurance The insurance afforded by this Coverage Part is primary insurance and we will not seek contribution from any other insurance available to the insured unless the other insurance is provided by a contractor other than the above named additional insured. We shall be considered as excess insurance of any other insurance provided by a contractor other than the above named additional insured. This amendment applies only when you have agreed by written "insured contract" to designate the person or organization listed above as an additional insured subject to all provisions and limitations of this policy. All other conditions remain unchanged. MIL 13 57 0413 Includes copyrighted material of Insurance Services Office, Page 1 of 1 Inc., with its permission Vern Ly Calhoun County Commissioner, Precinct #2 5812 FM 1090. Port Lavaca, TX 77979 September 10, 2021 Honorable Robert Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer (361) 552-9656 Fax (361) 553-6664 Please place the following item on the next Commissioners' Court Agenda • Discuss and take necessary action to renew a contract with AARC Environmental, Inc. for Spill Prevention, Control and Countermeasures (SPCC) Planning for the airport, and allow Judge Meyer to sign all necessary documents. Sinc 7 rely' � 41� Vern Lyssy VL/Ij EXHIBIT A SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 Tier II Report File Tier II Report under Superfund Amendment and Reauthorization Act (SARA), Title III, Sections 311 & 312 Costfor I" chemical: ..................................................................................................... $1,500.00 Cost for each additional chemical*: .................................................................................. $350.00 *Number of Chemicals to be determined by AARC based on information provided by client ***The terms of -this agreement arefound-in-the-Master Service Agreement which has been previously signed* Calhoun County Airport AARC Environmental, Inc. By: By: Name: Judge Richard Meyer Date Name: Guillermo Barthel Date Title: Calhoun County Judge Title: Project Coordinator 2000 W Sam Houston Parkway S. Suite 850, Houston, TX 77042 (713) 974-2272 // FAX: (713) 339-2272 EXHIBIT B SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 PAYMENT STRUCTURE Due each January 1, 2022-2026 for 2021-2025 Reporting year ..................................... $1,500.00 Balance due upon completion of Tier II Report(s)........................................................... $350.00 per chemical ***The terms- of this agreement are found intheMaster Service Agreementwhichhas beenpreviously signed" Calhoun County Airport AARC Environmental, Inc. By: By: Name: Judge Richard Meyer Date Name: Guillermo Barthel Date Title: Calhoun County Judge Title: Project Coordinator 2000 W Sam Houston Parkway S. Suite 850, Houston, TX 77042 (713) 974-2272 H FAX: (713) 339-2272 EXHIBIT A SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 Tier II Report File Tier II Report under Superfund Amendment and Reauthorization Act (SARA), Title III, Sections 311 & 312 Costfor Ia chemical: ..................................................................................................... $1,500.00 Cost for each additional chemical*: .................................................................................. $350.00 *Number of Chemicals to be determined by AARC based on information provided by client **The terms of this agreement are found in the Master Service Agreementwhichhas been previously signed*** Gateway Flight Center, LLC By: Name: Judge Richard Meyer Date Title: Calhoun County Judge AARC Environmental, Inc. By: Name: Guillermo Barthel Date Title: Project Coordinator I. 2000 W Sam Houston Parkway S. Suite 850, Houston, TX 77042 (713) 974-2272 H FAX: (713) 339-2272 EXHIBIT A SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 Texas Pollution Discharge Elimination System (TPDES) TPDES General Industrial Storm Water Permit • Prepare Site Map of facility according to the permit • Prepare Notice of Intent for the Permit. (Permit Fee to be paid by the client) • Prepare Storm Water Pollution Prevention Plan (SWPPP) per TPDES Permit requirements • Assist with implementation of Pollution Prevention Plan Cost per facility for TPDES renewal: .................................................... Annual Storm Water Pollution Prevention Training • Records generated for your files • Video and interactive slide presentation • Reviews and handouts provided • Meeting State and Federal Regulations ...$4,675.00 Costper 25 employees on-line session: ............................................................................................................ $650.00 Cost per in person training session: .................................................................................................................. $950.00 Quarterly Inspections • Conduct inspections to document implementation of plan Cost per inspection: ............... Annual Review of Plan ................................................................... $ 5 5 0.0 0 • Update plan to take into consideration major changes to operation Costper year: ................................................................................................................................................... $550.00 Sampling Services • Storm water sample analysis (*Samples to be • Provide sampling kit collected onsite by trainedfacility representative. • Provide FEDEX or similar pick-up service AARC will not be responsible for obtaining water . Sample analysis report and review samples.) • Discharge Monitoring Report (DMR) to EPA Cost annually per outfall for Texas Effluent Limitations (TEL) sampling: ...................................................... $585.00* Arsenic, Barium, Cadmium, Chromium, Copper, Lead, Manganese, Mercury, Nickel, Selenium, Silver, and Zinc. Cost bi-annually per outfall for Benchmark Monitoring: $TBD by Sic Code* *This amount will be invoiced on the speck date on Exhibit B regardless if and when monitoring occurs at the site. The associated discharge monitoring reports (DMRs) will be prepared and submitted regardless of whether or not monitoring has occurred. The DMR preparation and submittal costs are included in the amount invoiced to you. Also, a $25 additional charge will be incurred if a sample kit that has previously been supplied, but not usedfor AARC samples, needs to be replaced. ***The terms of this agreement are found in the Master Service Agreement which has been previously signed*** Gateway Flight Center, LLC, By: Name: Judge Richard Meyer Date Title: Calhoun County Judge AARC Environmental, Inc. By: Name: Guillermo Barthel Date Title: Project Coordinator l 2000 W Sam Houston Parkway S, Suite 850 Houston, TX 77042 (713) 974-2272 // FAX: (713) 339-2272 EXHIBIT B PAYMENT STRUCTURE Facility: 4876 FM 3084, Port Lavaca, Tx 77979 TPDES General Industrial Storm Water Permit Renewal Due Herewith (First %a Permit Cost) ....................................... Due Upon Delivery (Second %z Permit Cost) ........................... Annual Storm Water Pollution Prevention Training Due per session on January 1, 2023-2026 for Storm Water Training ......... Quarterly Inspection ........................................... $2,375.00 ........................................... $2,300.00 ............................... $650.00 Due upon completion of 1st quarter inspection (Jan -Mar. 2023-2026)............................................................$550.00 Due upon completion of 21d quarter inspection (April -June 2023-2026).......................... ............................... $550.00 Due upon completion of 4" quarter inspection (Oct -Dec 2023-2026)...........................................................$550.00 Annual Review of Plan Due upon completion of Annual Review (July -September 2023-2026)...........................................................$550.00 Sampling Services Texas Effluent Limitation Due per outfall on January 1, 2023-2026 for TEL analytical monitoring.........................................................$585.00 Benchmark Due per outfall on January 1 and July 1, 2023-2026 for Benchmark analytical monitoring............................$TBD ***The terms of this agreement are found in the Master Service Agreement which has been previously signed *** Ga ay light Center, LLC. AARC Environmental, Inc. 1 By:—ZZ-LoZ) By: 'Name: Judge Richa(LI.4yer Date Name: Guillermo Barthel Date Title: Calhoun County Judge Title: Project Coordinator Am 2000 W Sam Houston Parkway S, Suite 850 Houston, TX 77042 (713) 974-2272 // FAX: (713) 339-2272 EXHIBIT A SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 Texas Pollution Discharge Elimination System (TPDES) TPDES General Industrial Storm Water Permit • Prepare Site Map of facility according to the permit • Prepare Notice of Intent for the Permit. (Permit Fee to be paid by the client) • Prepare Storm Water Pollution Prevention Plan (SWPPP) per TPDES Permit requirements • Assist with implementation of Pollution Prevention Plan Cost per facility for TPDES renewal: Annual Storm Water Pollution Prevention Training • Records generated for your files • Video and interactive slide presentation Reviews and handouts provided • Meeting State and Federal Regulations Cost per 25 employees on-line session:..... Cost per in person training session:........... Quarterly Inspections .............................................................................. $4,6 75.00 • Conduct inspections to document implementation of plan Cost per inspection:......... Annual Review of Plan • Update plan to take into consideration major changes to operation Cost per year: Sampling Services • Storm water sample analysis (*Samples to be collected onsite by trained facility representative. AARC will not be responsible for obtaining water samples.) ..................................................... $ 6 5 0.0 0 ..................................................... $950.00 ...................... $ 5 5 0.0 0 ........................ $550.00 • Provide sampling kit • Provide FEDEX or similar pick-up service • Sample analysis report and review • Discharge Monitoring Report (DMR) to EPA Cost annually per outfall for Texas Effluent Limitations (TEL) sampling: ...................................................... $585.00* Arsenic, Barium, Cadmium, Chromium, Copper, Lead, Manganese, Mercury, Nickel, Selenium, Silver, and Zinc. Cost bi-annually per outfall for Benchmark Monitoring: ............................................................ $TBD by Sic Code* *This amount will be invoiced on the specific date on Exhibit B regardless {land when monitoring occurs at the site. The associated discharge monitoring reports (DMRs) will be preparedand submitted regardless of whether or not monitoring has occurred. The DMR preparation and submittal costs are included in the amount invoiced to you. Also, a $25 additional charge will be incurred tfa sample kit that has previously been supplied, but not used for AARC samples, needs to be replaced. ***The terms of this agreement are found in the Master Service Agreement which has been previously signed*** Calhoun County Airport By: Name: Judge Richard Meyer Date Title: Calhoun County Judge AARC Environmental, Inc. By: Name: Guillermo Barthel Date Title: Project Coordinator > 2000 W Sam Houston Parkway S, Suite 850 Houston, TX 77042 (713) 974-2272 // FAX: (713) 339-2272 EXHIBIT B PAYMENT STRUCTURE Facility: 4876 FM 3084, Port Lavaca, Tx 77979 TPDES General Industrial Storm Water Permit Renewal Due Herewith (First %, Permit Cost).............................................................................................................$2,375.00 Due Upon Delivery (Second %z Permit Cost).................................................................................................$2,300.00 Annual Storm Water Pollution Prevention Training Due per session on January 1, 2023-2026 for Storm Water Training...............................................................$650.00 Quarterly Inspection Due upon completion of V quarter inspection (Jan -Mar. 2023-2026)............................................................$550.00 Due upon completion of 2nd quarter inspection (April -June 2023-2026).........................................................$550.00 Due upon completion of 41' quarter inspection (Oct -Dec 2023-2026)...........................................................$550.00 Annual Review of Plan Due upon completion of Annual Review (July -September 2023-2026)...........................................................$550.00 Sampling Services Texas Effluent Limitation Due per outfall on January 1, 2023-2026 for TEL analytical monitoring.........................................................$585.00 Benchmark Due per outfall on January I and July 1, 2023-2026 for Benchmark analytical monitoring............................$TBD M ***The terms of this agreement are found in the Master Service Agreement which has been previously signed*** Calhoun County Airport Name: Judge Richard Meyer Title: Calhoun County Judge AARC Environmental, Inc. RA Date Name: Guillermo Barthel Date Title: Project Coordinator 2000 W Sam Houston Parkway S, Suite 850 Houston, TX 77042 (713) 974-2272 // FAX: (713) 339-2272 EXHIBIT B SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 PAYMENT STRUCTURE Due each January 1, 2022-2026 for 2021-2025 Reporting year ..................................... $1,500.00 Balance due upon completion of Tier II Report(s)........................................................... $350.00 per chemical 4*77te terms of this agreement are found inthe -Master Service Agreement which has been previously signed'**, Gateway Flight Center, LLC By: Name: Judge Richard Meyer Date Title: Calhoun County Judge AARC Environmental, Inc. By: Name: Guillermo Barthel Date Title: Project Coordinator MW 2000 W Sam Houston Parkway S. Suite 850, Houston, TX 77042 (713) 974-2272 // FAX: (713) 339-2272 EXHIBIT B PAYMENT STRUCTURE Facility: 4876 FM 3084, Port Lavaca, Tx 77979 TPDES General Industrial Storm Water Permit Renewal DueHerewith (First''/2 Permit Cost).............................................................................................................$2,375.00 Due Upon Delivery (Second %a Permit Cost) ............ .......................................................... ........................... $2,300.00 Annual Storm Water Pollution Prevention Training Due per session on January I, 2023-2026 for Storm Water Training...............................................................$650.00 Quarterly Inspection Due upon completion of I" quarter inspection (Jan -Mar. 2023-2026)-..................... ................... .................. $550.00 Due upon completion of 2"d quarter inspection (April -June 2023-2026).........................................................$550.00 Due upon completion of 0quarter inspection (Oct -Dec 2023-2026).............................. ............................. $550.00 Annual Review of Plan Due upon completion of Annual Review (July -September 2023-2026).... .................... ................................... $550,00 Sampling Services Texas Effluent Limitation Due per outfall on January 1, 2023-2026 for TEL analytical monitoring ................................................. ........ $585.00 Benchmark Due per outfall on January I and July 1, 2023-2026 for Benchmark analytical monitoring............................$TBD ""77re terns of dds agrcearent are found in the Masser Service Agreenennvldch has been previously signet.'" Gate a Flight Center, LLC, AARC Environmental, Inc. t Name: Judge Richard M yet Dore Name: Guillermo Barthel here Title: Calhoun County J ge Title: Project Coordinator 2000 W Sam Houston Parkway S, Suite 850 Houston, TX 77042 (713) 974-2272 // FAX: (713) 339-2272 EXHIBIT A SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 Tier II Report File Tier II Report under Superfund Amendment and Reauthorization Act (SARA), Title III, Sections 311 & 312 Cost for 1"chemical:.............. ......................................... ............... $1,500.00 Cost for each additional chemical*: 'Number of Chemicals to be determined by AARC based on inrormation provided by client *@rennawf (h%s ngrremrntnrejfrtnrcl•ttFtNtr'�7dsfM' SenWce',JgrHrnFwiiMh�Ins-d�rrhiiVJHnttrh,rl,4ner�'�`+ Ih n County Airport AARC Environmental, Inc. I z9���� By: Name: Ju ge Ri card eyer Date Name: Guillermo Barthel Date Title: Calhoun Corn Judge Title: Project Coordinator MW 2000 W Sam Houston Parkway S. Suite 850, Houston, TX 77042 (713) 974-2272 // FAX: (713) 339.2272 EXHIBIT B SERVICE ORDER Facility: 4876 FM 3084, Port Lavaca, Tx 77979 PAYMENT STRUCTURE Due each January 1, 2022-2026 for2021-2025 Reporting year ........................ ............. .$1,500.00 Balance due upon completion of Tier 11 Report(s)........................................................... $350.00 per chemical Cut oun unty Airport AARC Environmental, Inc. By: z7-2o7� By; ame: Judge Richard e er Da Name; Guillermo Barthel Date Title: Calhoun Coui t udge Title: Project Coordinator 2000 W Sam Houston Parkway S. Suite 850, Houston, TX 77042 (713) 974.2272 H FAX: (713) 339-2272 CERTIFICATE OF INTERESTED PARTIES FORM 1295 i ati Conepkm Nos. I - a and 6 if there p kstareslad pieties. OFFICE USE ONLY Complete Nos. 1, 2, 3. S. and 0It there arc no Interested Mies. CERTIFICATION OF FILING 1 Nam* of business entity Ming 0orm, and the city, state sand country at the business 4001y's place Ce"Hicato. Number: of business. 2021-002881 AARC Environmental, Inc. Houston, TX United States Date Flied: 0911612021 Name o governmental entry or staterAaency t at s aparty to the .contract rm is being filed. Calhoun County Date.AcknovMdged: 3 Provide the Identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of Will services, goods, or other property to be provided under the contract. 09/16/2021 Environmental compliance services 4 Name of interested Party City, State, Country (place of business) Nature of interest (check applicable). Controlling ' Intermedia AARC Environmental, Inc. Houston, TX United States X 5 Check only if there is NO interested Party. ❑ 6 UNSWORN DECLARATION Mynameis AIO@$o Cca"4V , and my date of birth is My address is , .. NO uS'COw %X % iO ti Z. ,. U:5 (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in. lidrrt.5 - County, State of,on the ./G day Of rvter 20?r. (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc J 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 i4calliouncotx.org 9 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 September 22, 2021. • Please Consider and Take Necessary Action on Precinct 3 Commissioner Behrens to propose purchase of Calhoun County Property ID # 24170 (James A. Wisdom Estate) located in Olivia, TX. In the amount of $51,600, property is appraised for $136,180 by Calhoun County Appraisal District. Sincerely, Joel Behrens Commissioner Pct. 3 9116121. 12:57 PM Calhoun CAD Map Search Fmq u n is CCL]nty Road 3Gq E mos:l f:�'.c. Si i0f. :n httpsJ/propaccess.trueautomabon.com/mapSearcW?cid=83&p=24170 w 9115/21, 12:55 PM Calhoun CAD - Property Details or ...:. __., ,�._• ems: 2021 Account Property ID: Geographic ID: Type: Property Use Code: Property Use Description: Location Address: Neighborhood: Neighborhood CD: Owner Name: Mailing Address: 24170 S0505-OCOAO-0001-00 Real 60 CR 318 PORT LAVACA, TX 77979 EMMETT COLE AREA 2150 WISDOM JAMES A (ESTATE) 34 PARRISH RD PORT LAVACA, TX 77979-6050 (+) Improvement Homesite Value: + (+) Improvement Non-Homesite Value: + (+) Land Homesite Value: + (+) Land Non-Homesite Value: + (+) Agricultural Market Valuation: + (+) Timber Market Valuation: + (_) Market Value: _ (—) Ag or Timber Use Value Reduction: — Legal Description: RICHTER SWENSON, BLOCK A, LOT 1, 1.0 AC Zoning: Agent Code: Mapsoo: 2150 Map ID: SOSOS-OOOAO-0001-00 Owner ID: ID4035 % Ownership: 100.0000000000% Exemptions: $124,180 $0 $12,000 $0 Ag/ Timber Use Value $0 $0 $0 $0 $136,180 $0 (=) Appraised Value: _ $136,180 (—) HS Cap: — $0 (_) Assessed Value: _ $136,180 Owner: WISDOM JAMES A(ESTATE) % Ownership: 100.0000000000% Total Value: $136,180 Entity Description Tax Rate Appraised Value CAD CALHOUN COUNTY APPRAISAL DISTRICT 0.000000 $136,180 FML FARM TO MARKET& LATERAL ROAD 0.000000 $136,180 GOS CALHOUN COUNTY 0.587200 $136,180 GWD CALHOUN COUNTY GROUNDWATER CONSERVATION DISTRICT 0.008280 $136,180 NV6 CALHOUN PORT AUTHORITY 0.000900 $136,180 Sol CALHOUN COUNTY ISD 1.096300 $136,180 Total Tax Rate: 1.692680 Taxable Value Estimated Tax $136,180 $0.00 $136,180 $0.00 $136,180 $799.65 $136,180 $11.28 $236,180 $1.23 _ $136,180 $1,492.94 Taxes w/Current Exemptions: $2,305.10 Taxes w/o Exemptions: $2,305.10 https://pmpa=ess.trueautomation.com/clientdb/Property.aspx?cid=83&pmp_id=24170&year-2021 114 9/15/21, 12:55 PM Calhoun CAD - Properly Details Improvement RESIDENTIAL State Al Living 1960.0 sgft Value: $124,180 #1: Code: Area: Type Description Claass Exterior Wall Beale SQFT MA MAIN RSB08 BRV 1995 1960.0 AG ATTACHED GARAGE RSB08 1995 506.0 OF OPEN PORCH RSB08 1995 60.0 ST STORAGE RSF04 1996 360.0 # Type Description Acres Sqft Eff From Eff Depth Market Value Prod. Value 1 RL RESIDENTIALLOT 1.0000 43560.00 142.80 305.00 $12,000 $0 Year Improvements Land Market AS Valuation Appraised HIS Cap Assessed 2022 N/A N/A N/A N/A N/A N/A 2021 $124,180 $12,000 0 136,180 $0 $136,180 2020 $121,060 $10,000 0 131,050 $0 $131,060 2019 $121,060 $10,000 0 131,060 $0 $131,060 2018 $121,060 $10,000 0 131,060 $0 $131,060 2017 $133.240 $10,000 0 143,240 $0 $143,240 -' 2016 $133,240 $10,000 0 143,240 $0 $143,240 2015 $133,240 $5,000 0 138,240 $0 $138,240 2014 $134,740 $5,000 0 139,740 $0 $139,740 2013 $136,250 $5,000 0 141,250 $0 $141,250 2012 $136,250 $5,000 0 141,250 $0 $141,250 2011 $136,250 $51000 0 141,250 $0 $141,250 2010 $139,260 $5,000 0 144,260 $6,683 $137,577 2009 $120,070 $5,000 0 125,070 $0 $125,070 2008 $120,070 $5,000 0 125,070 $0 $125,070 # Deed Date Type Description Grantor Grantee Volume Page Deed Number 1 5/16/2015 PROS PROBATE WISDOM WISDOM 2016-PR-14 I JAMESA JAMESA (ESTATE) (ESTATE) . 2 5/3/2010 HA HEIRSHIP AFFIDAVIT WISDOM JO WISDOM 129843 ANN JOANN (ESTATE) 3 1/1/1971 D DEED WISDOM D268 178 JAMES A Property Tax Information a of 09/15/2021 Amount Due 1fPa1d on: 7. Year Taxing Jurisdiction Taxable Base Value Base Tax Taxes Paid Discount Base penalty Attorney Amount Tax Due & Fees Due Interest 2020 CALHOUN COUNTY $131,060 $769.59 $0.00 $769.59 $153.91 $184.70 2020 CALHOUN PORT AUTHORITY $132,060 $1.18 $0.00 $1.18 $0.23 $0.28 2020 CALHOUN COUNTY ISD $132,060 $1526.71 $0.00 $1526.71 $305.34 $366A1 2020 CALHOUN COUNTY GROUNDWATER CONSERVATION DISTRICT $131,060 $10.85 $0.00 $10.85 $2.17 $2.60 2020 TOTAL: $2308433 $0.00 $2308.33 $461.65 $553.99 2019 CALHOUN COUNTY $131,060 $730.26 $0.00 $730.26 $233.68 $192.79 2019 CALHOUN COUNTY GROUNDWATER CONSERVATION DISTRICT $131,060 $12.45 $0.00 $12.45 $3.98 $3.29 2019 CALHOUN PORT AUTHORITY $131,060 $1,31 $0.00 $1.31 $0.42 $0.35 2019 CALHOUN COUNTY ISO $131,060 $1564.33 $0.00 $1564.33 $500.58 $412.98 $1108.20 $1.69 $2198.46 $15.62 $3323.97 $1156.73 $19.72 $2.08 $2477.89 https://propaccess.trueautomadon.corn/clientdb/Propertyaspx?cid=83&prop id=24170&year-2021 214 9/16/21, 12:55 PM Calhoun CAD - Property Details 2019 TOTAL: $2308.35 $0.00 $2308.35 $738.66 $609A3 $3656A2 2018 CALHOUN COUNTY $131,060 $642.19 $0.00 $642.19 $282S7 $184.95 $1109.71 2018 CALHOUN PORT AUTHORITY $131,060 $1.31 $0.00 $1.31 $0.58 $0.38 $2.27 2018 CALHOUN COUNTY ISO $131,060 $1695.40 $0.00 $1695.40 $745.98 $488.28 $2929.66 2018 CALHOUN COUNTY GROUNDWATER CONSERVATION DISTRICT $131,060 $12.84 $0.00 $12.94 $5.65 $3.70 $22.19 2018 TOTAL: $2351.74 $0.00 $2351.74 $1034.78 $677.31 $4063.93 2017 CALHOUN COUNTY $143,240 $701.88 $694.86 $0.00 $0.00 $0.00 $0.00 2017 CALHOUN PORT AUTHORITY $143,240 $1A3 $1.42 $0.00 $0.00 $0.00 $0.00 2017 CALHOUN COUNTY ISO $143,240 $1852.95 $1852.95 $0.00 $0.00 $0.00 $0.00 1 2017 CALHOUN COUNTY GROUNDWATER CONSERVATION DISTRICT $143,240 $14.32 $14.32 $0.00 $0.00 $0.00 $0.00 2017 TOTAL: $2570.58 $2563.35 $0.00 $0.00 $0.00 $0.00 2016 CALHOUN COUNTY $143,240 $701.87 $701.87 $0.00 $0.00 $0.00 $0.00 2016 CALHOUN PORTAUTHORITY $143,240 $1.43 $1.43 $0.00 $0.00 $0.00 $0.00 2016 CALHOUN COUNTYISD $143,240 $1852.95 $1852.95 $0.00 $0.00 $D.00 $0.00 2016 CALHOUN COUNTY GROUNDWATER CONSERVATION DISTRICT $143,240 $14.32 $14.32 $0.00 $0.00 $0.00 $0.00 2016 TOTAL' $2570.57 $2570.57 $0.00 $0.00 $0.00 $0.00 201S CALHOUN COUNTY $46,592 $176.67 $174.91 $0.00 $0.00 $0.00 $0.00 2015 CALHOUN PORT AUTHORITY $46,592 $1.16 $1.15 $0.00 50.00 $0.00 $0.00 2015 CALHOUN COUNTY ISO $65,592 $494.6S $494.65 $0.00 $0.00 $0.00 $0.00 2015 CALHOUN COUNTY GROUNDWATER CONSERVATION DISTRICT $46,592 $4.66 $4.66 $0.00 $0.00 $0.00 $0.00 2015 TOTAL: $677.14 $675.37 $0.00 $0.00 $0.00 $0.00 WISDOM JAMES A(ESTATE) TOTAL: $22786.71 $5809.49 $6968.42 $2235.09 $1840.71 $11044.22 2011 CALHOUN COUNTY $49,000 $176.67 $174.91 $0.00 $0.00 $0.00 $0.00 2011 CALHOUN PORT AUTHORITY $49,000 $1.76 $1.74 $0.00 $0.00 $0.00 $0.00 2011 CALHOUN COUNTY ISD $78,000 $624.01 $624.01 $0.00 $0.00 $0.00 $0.00 2011 TOTAL: $802.44 $800.66 $0.00 $0.00 $0.00 $0.00 2010 CALHOUN COUNTY $44,725 $176.67 $176.67 $0.00 $0.00 $0.00 $0.00 2010 CALHOUN PORT AUTHORITY $44,725 $1.74 $1.74 $0.00 $0.00 $0.00 $0.00 2010 CALHOUN COUNTY ISD $73,725 $524.01 $624.01 $0.00 $0.00 $0.00 $0.00 2010 TOTAL $802.42 $802.42 $0.00 $0.00 $0.00 $0.00 2009 CALHOUN COUNTY $36,056 $176.67 $176.67 $0.00 $0.00 $0.00 $0.00 2009 CALHOUN PORT AUTHORITY $36,056 $1.41 $1.42 $0.00 $0.00 $0.00 $0.00 2009 CALHOUN COUNTY ISD $65,056 $624.01 $624.01 $0.00 $0.00 $0.00 $0.00 2009 TOTAL: $802.09 $802.09 $0.00 $0.00 $0.00 $0.00 2008 CALHOUN COUNTY $36,056 $176.67 $174.90 $0.00 $0.00 $0.00 $0.00 2008 CALHOUN PORT AUTHORITY $36,056 $1.41 $1.40 $0.00 $0.00 $0.00 2008 CALHOUN COUNTY ISD $75,056 _ $624.02 _ $624.01 _$0.00 $0.00 $0.00 $0.00 _ $0.00 . 20M TOTAL: $802.09 $800.31 $0.00 $0.00 $0.00 $0.00 2007 CALHOUN COUNT $36,056 $176.67 $174.90 $0.00 $0.00 $0.00 $0.00 2007 CALHOUN PORT AUTHORITY $36,056 $1.41 $1.40 $0.00 $0.00 $0.00 $0.00 i 2007 CALHOUN COUNTY ISD $75,056 $624.01 $624.01 $0.00 $0.00 $0.00 $0.00 2007 TOTAL: $802.09 $800.31 $0.00 $0.00 $0.00 $0.00 2006 CALHOUN COUNTY $28,125 $137.81 $137.81 $0.00 $0.00 $0.00 $0.00 2006 CALHOUN PORT AUTHORITY $28,125 $1.15 $1.15 $0.00 $0.00 $0.00 $0.00 , 2006 CALHOUN COUNTY ISD $67,225 $806.53 $806.53 $0.00 $0.00 $0.00 $0.00 2006 TOTAL $945.49 $945.49 $0.00 $0.00 $0.00 $0.00 2005 CALHOUN COUNTY $17,894 $93.23 $93.23 $0.00 $mo10 $0.00 $0.00 2005 CALHOUN PORT AUTHORITY $17,894 $0.77 $0.77 $0.00 $0.00 $0.00 $0.00 2005 CALHOUN COUNTY ISD $56,894 $806.53 $806.53 $0.00 $0.00 $0.00 $0.00 .; 2005 TOTAL: $900.53 $900.53 $0.00 $0.00 $0.00 $0.00 2004 CALHOUN COUNTY $17,894 $93.23 $93.23 $0.00 $0.00 $0.00 $0.00 2004 CALHOUN PORT AUTHORITY $17,894 $0.82 $0.82 $0.00 $0.00 $0.00 $0.00 2004 CALHOUN COUNTY ISD $56,894 $806.58 $806.53 $0.00 $0.00 $0.00 $0.00 -, 2004 TOTAL: $900.58 $900.58 $0.00 50.00 $0.00 $0.00, 2003 CALHOUN COUNTY $81,894 $426.67 $426.67 $0.00 $0.00 $0.00 $0.00 2003 CALHOUN PORT AUTHORITY $81,894 $3.85 $3.85 $0.00 $0.00 $0.00 $0.00 2003 CALHOUN COUNTY ISD $66,894 $914.31 $914.31 $0.00 $0.00 $0.00 $0.00 2003 TOTAL' $1344.83 $1344.83 $0.00 $0.00 $0.00 $0.00 2002 CALHOUN COUNTY $68,562 $290.98 $290.99 $0.00 50.00 $0.00 $0.00 2002 CALHOUN PORT AUTHORITY $68,562 $3.22 $3,22 $0.00 $0.00 $0.00 $0.00 , https7/propaccess.trueautomation.00mlclientdb/Property.aspx?cid=83&prop_id=24170&year-2021 3/4 9/15/21, 12:55 PM Calhoun CAD - Property Details 2DO2 CALHOUN COUNTY ISO $53,562 $700.48 $700.48 $0.00 $0.00 $0.00 $0.00 2002 TOTAL: $994.63 $994.68 $0.00 $0.00 $0.00 $0.00 2001 CALHOUN COUNTY $68,562 $257.11 $254.54 $0.00 $0.00 $0.00 - $0.00 2D01 CALHOUN PORT AUTHORITY $68,562 $3.22 $3.19 $0.00 $0.00 $0.00 $0.00 2001 CALHOUN COUNTY ISO $53,562 $70D.48 $700.48 $0.00 $0.00 $0.00 $0.00 2001 TOTAL: $960.81 $95&21 $0.00 $0.00 $am $0.00 2014 CALHOUN COUNTY $47,792 $176.67 $176.67 $0.00 $0.00 $0.00 $0.00 2014 CALHOUN PORT AUTHORITY $47,792 $1.43 $1.43 $0.00 $0.00 $0.00 $0.00 2014 CALHOUN COUNTY ISO $76,792 $624.01 $624.01 $0.00 $0.00 $0.00 $0.00 2014 TOTAL: $802.11 $802.11 $0.00 $0.00 $0.00 $0.00 2013 CALHOUN COUNTY $49,000 $176.67 $176.67 $0.00 $0.00 $om $0.00 2013 CALHOUN PORT AUTHORITY $49,000 $1.52 $1.52 $0.DO $0.00 $0.00 $0.00 2013 CALHOUN COUNTY ISO $78,000 $624.01 $624.01 $0.00 $0.00 $0.00 $0.00 2013 TOTAL: $802.20 $802.20 $0.00 $0.00 $0.00 $0.00 2012 CALHOUN COUNTY $49,000 $176.67 $174.90 $0.00 $0.00 $0.00 $0.00 2012 CALHOUN PORT AUTHORITY $49,000 $1.57 $1.55 $0.D0 $0.00 $0.00 $0.00 2012 CALHOUN COUNTY ISD $78,000 $624.01 $624.01 $CAD $0.00 $0.00 $0.00 . 2012 TOTAL: 002.25 $800.46 $0.00 $0.00 $0.00 s0.00 WISDOM JAMES A TOTAL: $12464.61 $12454.88 $0.00 $0.00 $0.00 $0.00; GRAND TOTAL (ALL OWNERS): $2525L32 $18264.37 $6968.42 $2235.09 $1840.71 $11044.22 NOTE: Penalty & Imumenatt*ues every month on the unpaid tax and madded to the balance. Attorney fees may alw inorea a your tax liability 0not paid by Jury L Ifyou plan to submit payment on a future date, make sure you enter the data and RECALCULATE to obtain the eomeRwtal amount due. n'?SE ,.c 55:-45'au httpsJ/propaccess.trueautoma0on.rnm/clientdb/Property.aspx?cid=83&prop_id=2A170&year-2021 414 #10 Gary D. Reese County Commissioner County of Calhoun Precinct 4 September 13, 2021 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 Commissioners' Court Agenda for September 22, 2021. • Consider and take necessary action to accept payment from General Land Office in the amount of $1000 for Bilge Reclamation Facilities in Seadrift, Texas and place funds in Precinct 4 R&B account 570-53510. Sincerely, n �) Gary D. Reese GDR/at P.O. Box 177 - Seadrift, Texas 77983 - email: gary.rees mcelhouncotx.ore (361) 785-3141 Fax (361) 785-5602 THE STATE OF TEXAS PAYMENT INFORMATION INVOICENUMBER INVOICE DATE INVOICE DESCRIPTION DOCUMENT INVOICE AMOUNT 2021 ISSUE DATE: 09/08/2021 09/07/2021 BILGE FACILITY SEADRIFT PAYEE NUMBER: 1XXXXX19239 MAIL CODE: 025 PAYEE NAME:. COUNTY OF CALHOUN PRECINCT 4 — NON-NEGOTIABLE — 9PE82541 11000.00 WARRANT TOTAL: $1,000.00 WARRANT NUMBER: 143975729 For questions about this payment or to sign up for Direct Deposit, please contact your paying agency. GENERAL LAND OFFICE 512-463-3883 WOULD YOU LIKE TO VIEW: - Your state payment history and download it? - The invoice number and description information for a payment? The phone number and contact information of the paying agency? You can view all of this and more on the Search State Payments Issued website. Go to COMPTROLLER.TEXAS.GOV, and click on 'State Payments Issued., For short how-to videos on using the Search State Payments Issued website, click on the 'About' tab, then 'Video Library' under 'News and Media.' Also consider enrolling in direct deposit. It's easy, fast and secure. Contact the paying agency named on this payment stub to sign up today. Printed by Texas Comptroller of Public Accounts (512) 936.8138 or www.TexasPayeeResources.org TEXAS COMPTROLLER OF PUBLIC ACCOUNTS Q S SEPTEMBER 09, 2021 090821 1XXKXX19239 025 0 305 9PES2541 PAYING AGENCY 512-463-3883 GENERAL LAND OFFICE Pay ONE THOUSAND DOLLARS AND 00/100 To COUNTY OF CALHOUN PRECINCT 4 PO BOX 177 SEADRIFT, TX 77983-0177 VOID AFTER 08/31/2024 Oelmhheeb Il diixtxlny TREASURY WARRANT N:;. 143975729 $ 1,000.00 f Glenn Heger Comptroller of Public Account #11 Gary D. Reese County Commissioner County of Calhoun Precinct 4 September 16, 2021 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 Commissioners' Court Agenda for September 22, 2021. • Consider and take necessary action to accept checks from City of Seadrift in the amount of $46,433.65 and, $58,255.66 for reclaiming, compacting, and seal coating streets and have funds added to Precinct 4 R&B account 570-53510. Sincerely, �-,©Q^, Gary D. Reese GDR/at P.O. Box 177 -- Seadrift. Texas 77983 -- email: aarY.reese(a.calhouncotx ore - (361) 785-3141 - Fax (361) 785-5602 FIRST NA:m%xALBANK In JAvaca CITY OF SEADRIFT PMa 7PbItrtU. T..n GEM RA.t FUM) en Jnbpvdlnaw.� p 0 BOX Ise 88-2316/1131 :QW] (LXAS ?7983 91812021 PAY TO THE Calhoun County Pct. #4 $ **46,433.56 ORDER OF Forty -Six Thousand Four Hundred Thirty -Three and DOLLARS P Calhoun County Pct. #4 P.O. Box 177 VOID AFTER 90 D Seadrift, Texas 77983 MEMO RECLAIM, COMPACT, AND SEAL COAT STREETS 0 L' Is 111.1111 4 FIRS-r Nxrjor,�m BANK CITY OF SEADRIFT NB1P.0 , 11"rtlAmlca - U. Q rmx hbpoftim.... :,�,X 15 88-2316/1131 9/14/2021 fr PAY TO THE Calhoun County Pct. #4 ORDER OF "58,255.56 Fifty -Eight Thousand Two Hundred Fifty -Five and DOLLARS Calhoun County Pct. #4 VOID AFT�9�AY_S____) P.O. Box 177 Seadrift, Texas 77983 4) a*11U)JA �_� MEMO RECLAIM, COMPACT AND SEAL COAT STREETS 0011 IS 5 IIP , WAO At 11 D HATUSE #12 Mae Belle Cassel From: candice.villarreal@calhouncotx.org (candice villarreal) <cand ice.vi Ila rreal @cal houncotx.org> Sent: Friday, September 10, 2021 1:35 PM To: maebelle.cassel@calhouncotx.org; Richard H. Meyer; David Hall; vern lyssy; joel.behrens@calhouncotx.org; Gary Reese Subject: Agenda Item - Insurance Proceeds - Winter Storm Attachments: Ins Proceeds - Winter Storm - 2.pdf; Calhoun County Winter Storm Claim PR20219650-1 (489 KB) MaeBelle, Please add the following to the next available Commissioners Court agenda. • Consider and take necessary action on second insurance proceeds check from TAC in the amount of $4,679.42 for damages during the Winter Storm the week of February 15, 2021 and disburse $39,676.70 ($40,617.58 minus the deductible portion of $940.88) for MMC's part of the claim. Thank you, Candice viCCarreal 1�AssistantAuditor Ca6houn County Auditors Office 202 S. Ann Street, Suite B (Port Lavaca, 7X 77979 ('hone (361)5534612 Calhoun County Texas Mae Belle Cassel From: BrettA@county.org Sent: Thursday, August 26, 2021 2:19 PM To: Candice villarreal Cc: cindy.mueller@calhouncotx.org; Brett Anderson Subject: Calhoun County Winter Storm Claim PR20219650-1 Attachments: Calhoun Final Report 8-18-21-11560-43352572.PDF the sender and know the content is safe. Hi Candice, Do not or open I hope you are having a great week so far. Please see the adjuster's report for your records. It looks like they are only waiting on repair invoices to the HVAC at the hospital. However, the estimate and numbers below take into account the recommended initial total from the HVAC inspector we sent out. A small payment is due at this time as outlined below. Please let me know if you have any questions. Replacement Cost Value $125,980.97 Less Depreciation -$ 18,801.55 Actual Cash Value $107,179.42 Less Deductible -$ 2,500.00 Less Advance Payment -$100,000.00 Total $ 4,679.42 Thank you, rip/ Brett Anderson r5 y.A Property Program Supervisor Risk Management Services `^ Texas Association of Counties 1210 San Antonio St/Austin, TX 78701 of w FAX:512.615-8942 t= o u N OFFICE: 800-456-5974 DIRECT: 512-615-8921 Check out our Online Property and Liability Claims Reporting portal at: https://www.county.0rg/Risk-Management/""File-a-Claim TAC Way Fundamental #16. KEEP THINGS FUN. Remember that the world has bigger problems than the daily challenges that make up our work. Don't take yourself too seriously. Joy and laughter bring us closer together and make us look forward to coming to work each day. Laugh every day — be part of creating a happy environment. 0 w� �U OO og oz U6� O� Z 6Q NQ� XN_ F� o' 0 0 y N a N O y NV N n m r N o N N �Qi o y � Y U N O. #13 SUMMARY TAX ASSESSOR -COLLECTORS MONTHLY REPORT AUGUST 2021 COLLECTIONS DISBURSEMENTS Title Certificate Fees 494 $ 6,662.00 Title Fees Paid TXDOT $ 4,082.00 Title Fees Paid County Treasurer Salary Fund $ 2,470.00 Motor Vehicle Registration Collections $ 138,145.39 Disabled Person Fees $ 40.00 Postage $ Global Additonal Collections $ 0.83 Paid TXDOT $ 112,421.50 Paid TXDOT SP $ 19,233.95 Paid County Treasurer $ - Paid County Treasurer Salary Fund $ 4,800.65 DMV CCARDTRNSFEE $ 1,729.39 $ - GL Additonal Collections $ 0.83 $ - GLOBAL (IBC) Credit/Debit Card Fee's $ 1,409.83 GLOBAL Fees In Excess of Collections $ 320.39 MERCH SERVICES STATEMENT $ - Additional Postage -Vehicle Registration $ 7.95 Paid County Treasurer -Additional Postage $ 7.95 Motor Vehicle Sales & Use Tax Collections $ 566,709.99 Paid State Treasurer $ 566,709.99 Special Road/Bridge Fees Collected $ 19,160.00 Paid County Treasurer- RIB Fees $ 19,160.00 Texas Parks & Wildlife Collections $ 3,888.00 TPW GLOBAL CC TRANSACTION FEES $ 173.88 GLOBAL ADDITIONAL COLLECTIONS $ - Paid Texas Parks & Wildlife $ 3,499.20 Paid County Treasurer Salary Fund $ 388.80 P&W CCARDTRNSFEE $ 173.88 GLOBAL Additonal Collections $ - GLOBAL (IBC) Credit/Debit Card Fee's $ 125.01 GLOBAL In Excess/Shortage of Collections $ 48.87 Boat/Motor Sales & Use Tax Collections $ 38,108.41 Paid State Treasurer $ 36,202.99 Paid County Treasurer, Salary Fund $ 1,90SA2 TABC 5%CO COMMS FOR MONTH OF $ - TABC 5% CO COMMS FOR MONTH OFJULY 2021 $ 12.00 Paid County Treasurer, Salary Fund $ 12.00 County Beer & Wine Collections $ 965.00 Paid County Treasurer, County Beer & Wine $ 916.75 Paid County Treasurer, Salary Fund $ 48.25 INTEREST EARNED ON OFFICE ACCOUNT $ 21.29 Paid County Treasurer, Nay. East. $ 0.01 Paid County Treasurer, all other districts $ 21.28 INTEREST EARNED ON PARKS AND WILDLIFE ACCOUNT $ 3.87 Paid County Treasurer, Interest on P&W Ace $ 3.87 INTEREST EARNED ON REFUND ACCOUNT $ 0.06 Paid County Treasurer, Interest on Refund Ace $ 0.06 Business Personal Property - Misc. Fees $ 240.00 Paid County Treasurer $ 240.00 Excess Funds $ 402.06 Paid County Treasurer $ 402.06 Overpayments $ 6.92 Current Tax Collections $ 47,561.77 Penalty and Interest - Current Roll $ 9,231.39 Discount for early payment of taxes $ _ Delinquent Tax Collections $ 24,134.59 Penalty & Interest - Delinquent Roll $ 9,997.63 Collections for Delinquent Tax Attorney $ 17,360.43 Advance - FM & L Taxes $ 5.38 Advance - County AdValorem Taxes $ 88,984.04 Paid County Treasurer- Nev. East $ 116.34 Paid County Treasurer- all other Districts $ 1,826.54 Paid County Treasurer - Delinq Tax Atty. Fee $ 17,360.43 Payment in Lieu of Taxes $ _ Paid County Treasurer - Navig. East $ _ Paid County Treasurer- All other Districts $ _ Special Farmers Fees Collected $ 80.00 Paid State Treasurer, Farmers Fees $ 80.00 Hot Check Collection Charges $ _ Paid County Treasurers, Hot Check Charge $ _ Overage on Collection/Assessing Fees $ Paid County Treasurer, overage refunded $ _ Escheats $ _ Paid County Treasurer -escheats $ _ TOTAL COLLECTIONS $ 882,803.46 TOTAL DISBURSEMENTS $ 882,803.46 TOTAL OF ABOVE RECEIPTS PAID TO STATE AND COUNTY $ 882,803.46 KERRIBOY Tax Assessor -Collector I RICHARD EYER County Judge #14 m a Ch I� e III o c z A m c c z m A O a r V = It O �zz �A000 i z z A y 0 0 3 3 ca N 0 z m N 0 0 c 1 O a r z O A� z 119 C O 0 0 0 O O O A O a r 0 0 M A O sEa W m O m ou o 3 4 3 Z m 4 z Z z m' z m z OE m DE g m a: b C �� 3 a m A z=_ #15 September 22, 2021 2021 APPROVAL LIST - 2021 BUDGET COMMISSIONERS COURT MEETING OF BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE FICA MEDICARE FWH NATIONWIDE RETIREMENT SOLUTIONS OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT TMPA - UNITED WAY OF CALHOUN COUNTY CAHOUN COUNTY GENERAL FUND CITIBANK ROBERTS ROBERTS ODEFEY WITTE 09/22/21 19 $476,253.01 P/R $ 54,674.82 P/R $ 12,787.00 P/R $ 36,891.36 P/R $ 4,867.50 P/R $ 1,516.15 P/R $ 328.00 P/R $ 10.00 A/P $ 17,430.70 A/P $ 23,698.18 A/P $ 287.25 TOTAL VENDOR DISBURSEMENTS: 628,743.97 $ CALHOUN COUNTY OPERATING ACCOUNT - TRANSFER FUNDS FOR AP/PR CALHOUN COUNTY INDIGENT HEALTH CARE TOTAL INVESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: A/P $ 3,000,000.00 `� k A/P $ 35,682.41 $ 3,035,682.41 I TOTAL AMOUNT FOR APPROVAL: $ 3,664,426.38 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT,APP.ROVAL LIST FOR ---'September 22, 2621 INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES Community Pathology Association Deter Healthcare System HEB Pharmacy (Medimpact) Pharmacy Reimbursement MMCenter (In -patient $25,653.501 Out -patient $4,635.541 ER $621.76) Singleton Associates, PA Victoria Anesthesiology Assoc SUBTOTAL Memorial Medical Center (Indigent Healthcare Payroll and Expenses) Co -pays adjustments for August 2021 Reimbursement from Medicaid by:CT 50.79 135.25 48.57 30,910.80 149.16 332.08 31,626.66 4,166.67 Subtotal 35,793.32 0+0.0'0) 0.00 COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY UNIT PRICE TOTAL PRICE 1000-800-98722-999 Transfer to pay bills for Indigent Health Care $35,683.32 approved by Commissioners Court on 09/22/,2021 1000-001-46010 August 31, 2021 Interest ($0,91) O a $35,682.41 COU8TY AUD R < APPROVAL OR* t THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY THIS OBLIGATION. I CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME IN GOOD CO ION AND REQUEST THE COUNTY TREASURER TO PAY THE ABO LIGATION. BY: 9/22/2021 Q p r m = fm IL Q. U G LLJ a Q U DEPARTMENT HEAD DATE ©IHS Source Totals Report Issued 09/03/21 Calhoun Indigent Health Care Batch Dates 08/31/2021 through 09/01/2021 For Source Group Indigent Health Care For Vendor. All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 3,799.00 199.95 01-2 Physician Services -Anesthesia 1,326.00 332.08 02 Prescription Drugs 48.57 48.57- 05 Lab/X-Ray 11,719.15 135.25 13 Mmc - Inpatient Hospital 71,611.19 25,653.50 14 Mmc - Hospital Outpatient 14,377.02 4,635.54 - 15 Mmc - Er Bills 1,943.00 621.76 i Expenditures 104,875.61 31,678.33 Reimb/Adjustments -51.68 -51.68 Grand Total 104,823.93 31,626.65- EXPENSES 4,166.67 35,793.32 COPAYS <110.00> TOTAL 35,683.32 , APPROVED ON CEP 10 2021A BY lid CALHOUN COUNTY AUDITOR QHs Source Totals Report Issued 09/03/21 Calhoun Indigent Health Care Batch Dates 02/01/2021 through 09/01/2021 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 19,960.00 1,906.81 01-2 Physician Services -Anesthesia 2,496.00 694.25 02 Prescription Drugs 800.26 800.26 05 Lab/X-Ray 11,719.15 135.25 08 Rural Health Clinics 4,282.00 4,082.13 13 Mmc - Inpatient Hospital 71,611.19 25,653.50 14 Mmc - Hospital Outpatient 93,023.09 29,927.14 15 Mmc - Er Bills 23,754.00 7,601.28 Expenditures 227,919.10 70,974.03 Reimb/Adjustments -273.41 -273.41 Grand Total 227,646.69 70,700.62 EXPENSES 33,333.36 104,033.98 COPAYS <620.00> TOTAL 103,413.98 Calhoun County Indigent Care Patient Caseload 2021 Approved Denied Removed Active Pending January 2 0 0 11 5 February 0 0 0 11 7 March 1 1 2 10 5 April 2 0 0 12 6 May 0 0 1 11 9 June 0 0 1 11 9 July 0 0 1 10 4 August 0 0 2 8 5 September October November December YTD Monthly Avg 1 0 1 11 6 December 2020 Active 9 Number of Charity patients 197 Number of Charity patients below 100% FPL 71 Calhoun County Pharmacy Assistance Patient Caseload 2019 Approved Refills Removed Active Value January 7 0 0 7 $8,589.00 February 4 0 0 11 $10,869.00 March 2 6 1 12 $14,515.00 April 2 2 0 14 $14,719.00 May 1 3 0 15 $14,765.00 June 3 5 0 18 $22,563.00 July 2 4 0 17 $22,897.00 August 1 2 0 18 $22,546.00 September October November December YTD PATIENT SAVINGS $131,463.00 Monthly Avg 3 3 0 14 $16,432.88 0 December 2020 Active 87 50240.000 08/04/21 50240.000 08/06/21 50240.000 08/19/21 50240.000 08/20/21 50240.000 08/25/21 50240.000 08/26/21 50240.000 00/30/21 50240.000 08/31/21 :.g M*t 50240.000 COOBY2 INDIGENT DOWN 10.00 10.00 00/00/00 MR 2 10.00 10.00 00/00/00 PM 2 10.00 10.00 00/00/00 PLB 2 30.00 30.00 00/00/00 PLB 2 10.00 10.00 00/00/00 FIB 2 10.00 10.00 00/00/00 PLB 2 20.00 20.00 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 110.00 0 g WW°J r 4 ;PROSPERITY BANK 411w Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13424 8/31/2021 "4551 Page 1 of 2 [STATEMENT SUMMARY Public Fund Cantractual Ckgw Int Account No x--4551 08/01/2021 BeginningBalance 3 Deposits/Other Credits + $10,749.15' 5 Checks/Other Debits - $10,760.65 08/31/2021 Ending Balance 31 Days in Statement Period $5,423.33 Total Enclosures 7 r •r r r Date Description Amount O8/05/2021 Deposit $10,698.24 j",n ?k O8/27/2021 Deposit $50.00 ro pay --�a 08/31 /2021 Accr Earning Pymt Added to Account $0.97 Check Number Date Amount Check Number Date Amount Check Number Date Amount 12471 08-09 $4,166.67 12473 08-09 $6,252.97 12475 08.11 $146.18 12472 08.09 $168,37 12474 08.12 $26.46 rDAILY ENDING Date Balance Date Balance Date Balance 08-01 $5,434.83 08-11 $5,398.88 08-31 $5,423.33 08-05 $16,133.07 08-12 $5,372.42 08-09 $5,545.06 08-27 $5,422.42 Interest Paid This Period Interest Paid YTD MEMBER FDIC o F G HN O6R Below is an itemization of the Earnings paid this period. " $0.91 Annual Percentage Yield Earned $16.85 Days in Earnings Period Earnings Balance 0.16 % 31 $6,789.00 NYSE Symbol "PB" p�. K MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---September 22, 2021 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLE$, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 707,639.23 !i TOTAL TRANSFERS BETWEEN FUNDS $ 25i048.94 TOTAL NURSING HOME UPL EXPENSES $ 1,791,690.28 TOTAL INTER -GOVERNMENT TRANSFERS $ IGRANDj TOTAL DISBURSEMENTS APPROVED September 22, 2Q21 $ 2,624,278A6` `� MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---September 22 2021 PAYABLES AND PAYROLL 9/1612021 Weekly Payables 688,481.85 9/16/2021 Azalea Health -Processing and Support Fee 550.00 9116/2021 Fusion Cloud Services, LLC-Phone 1,181.13 9/16/2021 Patient Refunds 457.77 9/16/2021 Citibank Credit Card -see attached 556.08 9/2012021 McKesson-340B Prescription Expense 12,955.71 9120/2021 Amedsource Bergen-3406 Prescription Expense 377.54 9/1612021 Payroll Liabilities for supplemental payroll -Payroll Taxes 97.32 9/1612021 Supplemental Payroll 345.54 Prosperity Electronic Bank Payments 9/2012021 Sales Tax for Augusl2021 1,459.84 911312021 Cleargage-Patient Financing Service 67.40 9113-9/17121 Pay Plus -Patient Claims Processing Fee 394.85 9/17/2021 ExpertPay- child support 614.20 TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 707,639.23 TRANSFER BETWEEN FUNDS TO NURSING HOMES 9/16/2021 MMC Operating to Solera-correction of NH insurance payment deposited into MMC Operating in error 3,420.00 9116/2021 MMC Operating to Golden Creek -correction of NH insurance payment deposited into MMC Operating in error 3,694.90 9/16/2021 MMC Operating to Tuscany Village -correction of NH insurance payment deposited into MMC Operating in error 1,812.54 9/16/2021 MMC Operating to Bethany -correction of NH insurance payment deposited into MMC Operating in error 1.217.06 MEDICARE ADVANCE PAYMENT RECOUP 9/2012021 Broadmoor to MMC Operating -correction of Broadmoor medicare recoup taken from MMC Operating 1.370.34 9/20/2021 Broadmoor to Bethany -correction of Broadmoor medical recoup taken from Bethany 512.97 912012021 Broadmoor to Tuscany Village -correction of Broadmoor medical recoup taken from Tuscany Village 466.36 9/20/2021 Crescent to MMC Operating -correction of Crescent medicare recoup taken from MMC Operating 1,370.34 9/20/2021 Crescent to Tuscany Village -correction of Crecent medicare recoup taken from Tuscany Village 466.36 9/2012021 Crescent to Bethany -correction of Crecent medicare recoup taken from Bethany 512.97 9/20/2021 Fort Bend to MMC Operating -correction of Fart Bend medicare recoup taken from MMC Operating 1,370.34 9/20/2021 Fort Bend to Tuscany Village -correction of Fort Bend medicare recoup taken from Tuscany Village 47.50 9/20/2021 Solera to MMC Operating -correction of Solera medicare recoup taken from MMC Operating 1,370.34 9/20/2021 Solera to Bethany -correction of Solera medicare recoup taken from Bethany 512.97 9/20/2021 Solera to Tuscany Village -correction of Solera medicare recoup taken from Tuscany Village 466.36 9/20/2021 Golden Creek to MMC Operating -correction of Golden Creek recoup taken from MMC Operating 1,370,34 9/20/2021 Golden Creek to Tuscany Village -correction of Golden Creek medicare recoup taken from Tuscany Village 466.36 9/20/2021 Golden Creek to Bethany -correction of Golden Creek medicare recoup taken from Bethany 512A7 9/20/2021 Tuscany to MMC Operating -correction of Tuscany medicare recoup taken from MMC Operating 3,574.95 920/2021 Tuscany to Bethany -correction of Tuscany medicare recoup taken from Bethany 512.97 TOTAL TRANOFERS BETWEEN FUNDS $' 25,04894 l NURSING HOME UPL EXPENSES 9/20/2021 Nursing Home UPL-Cantex Transfer 1,224,600.64 9/20/2021 Nursing Home UPL-Nexlon Transfer 285,683.11 9/20/2021 Nursing Home UPL-HMG Transfer 34,178.08 9/2012021 Nursing Home UPL-Tuscany Transfer 50,037.72 9/2012021 Nursing Home UPL-HSL Transfer 197,190.73 TOTAL NURSING HOME UPL EXPENSES $ 1,791,69028_ TOTAL INTER=GOVERNMENT TRANSFERS $ GRAND TOTAL DISBURSEMENTS APPROVED September 22, 2021 $ 2,624,278 A5 ,9/16/21, 1{,44?M tmp_cwbreport7256912091011677174.htMI 09/16/202.4.. , MEMORIAL MEDICAL CENTER 13:44 ,," AP Open Invoice List .. L�1[.i Due Dates Through: 09/30/2021 Ven11o'r#�=�- _-. ::.� �,,;- Vendor Name Class 10995 ABILITY NETWORK (SHIFTHOUND ' Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross 21M0133312106/1512021 09/07/2021 09/07/2021 616.28 SCHEDULING SERVICES Vendor Totals: Number Name Gross Discount 1099E ABILITY NETWORK 616.28 0.00 Vendor# Vendor Name Class 11283 ACE HARDWARE 15521 V' Invoice# ,Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross 156251 ✓ 08/31/2021 08/03/2021 09/30/2021 7.35 SUPPLIES 16662808/31/2021 08/13/2021 09/30/2021 35.99 SUPPLIES 156907r/ 08/31/2021 08/23/2021 09/30/2021 9.99 SUPPLIES 156917 „i 08/31/2021 08/23/2021 09/3012021 9.99 SUPPLIES Vendor Totals: Number Name Gross DlscounL 112B3 ACE HARDWARE 1; 63.32 0.00 Vendor# Vendor Name Class 10950 ACUTE CARE INC w' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross INV323 v' 08/31/2021 08/20/2021 08131/2021 1,400,00 RFID FEE INV377 Yf 09/15/2021 09/20/2021 09/30/2021 1,400.00 RFID FEE Vendor Totals: Number Name Gross Discount 10950 ACUTE CARE INC 2,800.00 0.00 Vendor# Vendor Name Class R1200 ADTCOMMERCIAL V/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 141230307'r`08/31/2021 08/03/2021 09/30/2021 49.18 FIRE MONITORING Vendor Totals: Number Name Gross Discount R1200 AOTCOMMERCIAL 49.18 0.00 Vendor# Vendor Name Class A1580 AIRGAS USA, LLC-CENTRAL DIV M s/ Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross 91164602774131/2021 08/12/2021 09/30/2021 308.31 OXYGEN 9116803961,08/31/2021 08/24/2021 09/30/2021 121.24 OXYGEN Vendor Totals: Number Name Gross Discount A1680 AIRGAS USA, LLC - 429.55 0.00 Vendor# Vendor Name Class 10958 ALLYSON SWOPE v,- Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross 091621 09/16/2021 09/16/2021 09/16/2021 261.00 CONTACT EMPLOYEE 091621A 09/16/2021 09/16/2021 09/16/2021 3,903.75 CONTRACT EMPLOYEE Vendor Totals: Number Name Gross Discount 10958 ALLYSON SWOPE 4,164.75 0.00 Vendor# Vendor Name Class A2150 ANNOUNCEMENTS PLUS TOO AG, W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross file:l//C:/Users/mmckissacklepsl/memmed.cpsinet.com/u8815D/data 5ltmp_cw5report7256912091011677174.html 0 ap_open_invoice.template Pay Code Discount No -Pay Net 0.00 0.00 516,28 No -Pay Net 0.00 616.28 Pay Code Discount No -Pay Net 0.00 0.00 7.35 v` 0.00 0.00 35.99 0% 0.00 0.00 9.99 0„ 0.00 0.00 9.99 yr' No -Pay Net 0,00 63.32 Pay Code Discount No -Pay Not 0.00 0.00 1,400.00 r/ 0.00 0.00 1,400.00 No -Pay Net 0.00 2,800.00 Pay Code Discount No -Pay Net 0.00 0.00 49.18 ,. No -Pay Net 0.00 49,18 Pay Code Discount No -Pay Net 0.00 0.00 308.31 0.00 0.00 121.24 a - No -Pay Net 0.00 429.55 Pay Code Discount No -Pay Net 0.00 0.00 261.00 ,. 0.00 0.00 3,903.75 i, - No -Pay Net 0.00 4,164.75 Pay Code Discount No -Pay Net 1119 ,9116/21, �:44 PM tmp_cw6mport7256912091011677174.html , 625 t. 08/31/2021 08/26/2021 09/30/2021 15.00 0.00 0.00 15.00 v` PRINTING GIVING TREE LEAF 627 .-1 08/31/2021 08/26/2021 09/30/2021 169.00 0.00 0.00 169.00 .' DOOR STICKERS Vendor Totals: Number Name Gross Discount No -Pay Net A2150 ANNOUNCEMENTS 184.00 0.00 0.00 184.00 Vendor# Vendor Name Class Pay Code A0400 AUREUS RADIOLOGY LLC ,/ Invoice# Comment Tran Ot Inv Dt Due Or Check Dt Pay Gross Discount No -Pay Net 2218206 v" 08/31/2021 05/17/2021 06/16/2021 2.680.00 0.00 0.00 2.680.00 r,- - LAB STAFFING 2245737 V" 08/31/2021 OW112021 07/21/2021 2,680.00 0.00 0.00 2,680.00 -- LA13 STAFFING 2251296 �/08/31/2021 06/28/2021 07/28/2021 2,680.00 0.00 0.00 2,680.00 .. LAB STAFFING 2251856 i,/08/31/2021 06/28/2021 07/28/2021 2,208.00 0.00 0.00 2,208.00 „- LAB STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net A0400. AUREUS RADIOLOI 10,248,00 0.00 0.00 10,248.00 Vendor# Vendor Name Class Pay Code 81150 BAXTER HEALTHCARE 4r' w Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 71693117 , 08/31/2021 08/09/2021 09/30/2021 -234.86 0.00 0.00 -234.86 CREDIT 71a18930,/68/31/2021 08/20/2021 09/14/2021 469.71 0.00 0.00 469.71 b' FILTERS 71844436 r,:'08/31/2021 08/21/2021 09/30/2021 629,50 0.00 0.00 629.50 . LEASE 71844530,/O8/31/2021 08l2312021 09/30/2021 2,367.50 0.00 0.00 2,367.50 EASE 71841137 ,'�08/31/2021 08/23/2021 09/30/2021 943,86 0.00 0.00 943.86 v SUPPLIES 71862793 r/68/31/2o2i 08/25/2021 09/30/2021 136.22 0.00 0.00 136.22 SUPPLIES- 71863588.%'08/31/2021 08/26/2021 09/30/2021 1,107,98 0100 0.00 1,107.98 SUPPLIES 12330489 y/68/3112021 08/28/2021 09/30/2021 7,14 0.00 0.00 7.14 LATE FEE 71520425 09/15/2021 07/27/2021 08/21/2021 280.16 0.00 0.00 280.16 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 81150 BAXTER HEALTHC/ 5,707.21 0.00 0.00 5,707.21 Vendor# Vendor Name Class Pay Code M2485 BAYER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 6009423644,08/31/2021 08/24/2021 09/30/2021 1,783.20 0100 0.00 1,783.20 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2485 BAYER HEALTHCAI 1,783.20 0.00 0.00 1,783.20 Vendor# Vendor Name Class Pay Cade 81220 BECKMAN COULTER INC yr' M Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 109265808v'08/31/2021 08/31/2021 09/25/2021 134.17 0.00 0,00 134.17 SHIPPING 109267211..08/31/2021 08/31/2021 09/30/2021 626.25 0.00 0.00 626.25 SUPPLIES 109269973 .0�/09/2021 09/01/2021 09/26/2021 413.57 0.00 0.00 413.57 SUPPLIES I OP267845 v,09/09/2021 09/01/2021 09/26/2021 181.13 0.00 0.00 181.13 SUPPLIES 109269909 09/0912021 09/01/2021 09/26/2021 887.81 0.00 0.00 887.61 file:///C:/Users/mmckissack/cpsilmemmed.cpsinet.com/u88l50/data 5/Imp_cw5report7256912091011677174.html 2/19 �9116/21, 1n44 PM imp_ew5report7256912091011677174.html SUPPLIES 109267808„/09/09/2021 09/01/2021 09/30/2021 159,46 0.00 0.00 159,46(! SUPPLIES 7301137 ✓ 09/09/2021 09/01/2021 09/30/2021 8,010.78 0.00 0.00 8,010.78 SUPPLIES 109268478 ✓09/09/2021 09/01/2021 09/30/2021 176.12 0.00 0.00 176.12 SHIPPING 109269985 V6109/2021 09/01/2021 09/30/2021 1,018.22 0.00 0.00 1.018.22 SUPPLIES it 5446044 ,09/09/2021 09/05/2021 09/30/2021 6,249.42 0.00 0.00 6.249.42 «' MAWT CONTRACT 109269998 V611612021 09/01/2021 09/26/2021 51.18 0.00 0100 51.18 ' SUPPLIES a Vendor Totals: Number Name Gross Discount No -Pay Net 81220 BECKMAN COULTE 17,908.11 0.00 0.00 17,908.11 Vendor# Vendor Name Class Pay Code B1320 BEEKLEY CORPORATION M Invoice# Com��ffant Tran Dt Inv Dt Due Of Check Of Pay Gross Discount No -Pay Net INV1461976 QB%3112021 08/25/2021 09130/2021 212.95 0.00 0.00 212.95 y. SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 81320 BEEKLEYCORPOR 212.95 0.00 0.00 212.95 Vendor# Vendor Name Class Pay Code D1040 C R BARD, INC - Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No•Pay Net 82989827,/ 08/31/2021 08/24/2021 09/30/2021 147.68 0.00 0,00 147.68 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net D 1040 C R BARD, INC 147.68 0.00 0.00 147.68 Vendor# Vendor Name Class Pay Code C1048 CALHOUN COUNTY / W Invoice# Comment Tran Dt Inv Dt Due Of Check Dt Pay Gross. Discount No -Pay Net 082421 08/31/2021 08/24/2021 09/30/2021 42.05 0.00 0.00 42.05 FUEL Vendor Totals: Number Name Grass Discount No -Pay, Net C1048 CALHOUN COUNTY 42.05 0.00 0.00 42.05 Vendor# Vendor Name Class Pay Code 11295 CALHOUN COUNTY INDIGENT AC( Invoice# Comment Tran Of Inv Dt Due Dt Chkk Dt Pay Gross Discount No -Pay Net 091521 09/15/2021 09/16/2021 09/15/2021 110.00 0.00 0.00 110,00 INDIGENT CO PAYS Vendor Totals: Number Name Gross Discount No -Pay Net 11295 CALHOUN COUNTY 110.00 0.00 0.00 110.00 Vendor# Vendor Name Class Pay Code 01325 CARDINAL HEALTH 414. INC. v' W Invoice# Comment Tran Dt Inv Of Due Dt Check Of Pay Gross Discount No -Pay Net 8002615925108/3112021 08/14/2021 09/30/2021 229.16 0.00 0.00 229.16 ,. SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C1325 CARDINAL HEALTH 229.16 0.00 0.00 229.16 Vendor# Vendor Name Class Pay Code 13992 CARIANT HEALTH PARTNERS krJ Invoice# Comment Tran Dt Inv Dt Due Of Check Of Pay Gross Discount No -Pay Net 127681 y' 09/03/2021 09/01/2021 09/30/2021 1.980,00 0.00 0.00 1.980.00 MED BURG STAFFING ' 127682 v'� 09/03/2021 09/01/2021 09/30/2021 3.461.25 0.00 0.00 3.461.25 MED SURG STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net 13992 CARIANT HEALTH 5,441.25 0.00 0.00 5,441.25 Vendor# Vendor Name Class Pay Code C1992 CDW GOVERNMENT, INC. M f1e:01C:/Users/mmckissecklcpsl/memmed.cpsinet,comlu88150/data 5/tmp_cw5report7256912091011677174.html 3119 19116/21, 1n44 PM tmp_cw5report7256912091011677174.html Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net H972936 v/08/31/2021 08106/2021 09/30/2021 84,99 0.00 0.00 84A9 WEBCAM v" K026759 s%'68/3112021 08/30/2021 05/30/2021 528.70 0.00 0.00 528.70 MONITOR Vendor Totals: Number Name Grass Discount No -Pay Net 01992 CDW GOVERNMEN 613.69 0.00 0.00 613.69 Vendor# Vendor Name Class Pay Code 14084 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 090821 08/31/2021 09/08/2021 09/30/2021 30.00 0.00 0.00 30.00 t`f PATIENT REFUND Vendor Totals: Number Name Gross Discount No -Pay Net 14084 30,00 0.00 0.00 30.00 Vendor# Vendor Name Class Pay Cade 12768 CHEMAQUA ' „ Invoice# Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 7468678 v'-08/31/2021 08/10/2021 09/30/2021 518.75 0.00 0.00 518.75 WATER TREATMENT Vendor Totals: Number Name Gross Discount No -Pay Net 12768 CHEMAQUA 518.75 0.00 0.00 518.75 Vendor# Vendor Name Class Pay Code 10105 CHRIS KOVAREK 11 Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 53 �, 09/09/2021 09/02/2021 09/30/2021 80.00 0.00 0.00 80.00 SWING BED Vendor Totals: Number Name Gross Discount No -Pay Net 10105 CHRIS KOVAREK 80.00 0.00 0.00 80.00 Ventlor# Vendor Name Class Pay Code C1600 CITIZENS MEDICAL CENTER �. - W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 082021 08/31/2021 08/20/2021 09/30/2021 50.00 0.00 0.00 - 50.00 10 BLS CARDS t-- Vendor Totals: Number Name Gross Discount No -Pay Net C1600 CITIZENS MEDICAL 50.00 0.00 0.00 50.00 Vendor# Vendor Name Class Pay Code 13000 CLEARFLY Invoice# Comment Tran Dt Inv Dt Due D1 Check Dt Pay Gross Discount No -Pay Net INV372427,,,08/01/2021 09/01/2021 09/30/2021 1,246.50 0.00 0.00 1,246.50 PHONES Vendor Totals: Number Name Gross Discount No -Pay Net 13000 CLEARFLY 1,246.50 0.00 0.00 1,246.50 Vendor# Vendor Name Class Pay Code 10212 CLINICAL PATHOLOGY LABS ' ICP Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1765620210108/31/2021 08/31/2021 08/31/2021 13.234.25 0.00 0.00 13,234.25 LAB SERVICESa'"' Vendor Totals: Number Name Gross Discount No -Pay Net 10212 CLINICAL PATHOLC 13,234.25 0,00 0.00 13 234.25 Vendor# Vendor Name Class Pay Code C1166 COASTAL OFFICE SOLUTONS k.-1W Invoice# Corpment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net OE324251 vb813012021 08/27/2021 09/30/2021 150.00 0.00 0.00 150.00 SUPPLIES OECT1808608%31/2021 08/27/2021 09/30/2021 62.50 0.00 0.00 BUSSINES CARDS 62.50 Vendor Totals: Number Name Gross Discount No -Pay Net C1166 COASTAL OFFICE E 212.50 0.00 0.00 212.60 Ventlor# Vendor Name Class Pay Code 11030 COMBINED INSURANCE V Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net file:///C:/Users/mmokissack/cpsi/memmed.cpsinet.comtu881501data_5/tmp_cw5report7256912091011677174.html 4119 „9116/21, 1,�44 PM tmp_cw5report7255912091011677174.hunt 090121 09/14/2021 09/01/2021 09/30/2021 854.92 0.00 0,00 854.92 INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 11030 COMBINED INSURP 864.92 0.00 0.00 854.92 Vendor# Vendor Name Class Pay Code 13572 COMMUNITY INFUSION SOLUTION ,; -' Invoice# Comment Tran Ot Inv Dt Due Dt Check Ot Pay Gross Discount No•Pay Net IC20210843 09/15/2021 09/04/2021 09/14/2021 14,993.18 0.00 0.00 14,993,18 OP INFUSION CENTER Vendor Totals: Number Name Gross Discount ND -Pay Net 13572 COMMUNITY INFUE 14,993.18 0.00 0.00 14,993.18 Vendor# Vendor Name Class Pay Code 14080 CORROHEALTH, INC. Invoice# pommant Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 48036 08/31/2021 08/04/2021 09/03/2021 2,242.00 0.00 0.00 2,242.00 ,/ v� PURCHASED SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 14080 CORROHEALTH, IN 2,242.00 0.00 0.00 2.242.00 Vendor# Vendor Name Class Pay Code 11368 CYRACOM LLC v,- Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 139643 08/31/2021 08/81/2021 09/30/2021 - 545,13 0.00 0.00 545.13 INTERPERTATION u Vendor Totals: Number Name Gross Discount No -Pay Net 11368 CYRACOM LLC 545,13 0.00 0.00 545.13 Ventlor# Vendor Name Class Pay Code 1036E DEWITT POTH & SON Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Grass Discount No -Pay Net 6539510, 08/31/2021 08/23/2021 09/17/2021 44.59 0.00 0.00 44.59 w F SUPPLIES 6540210 08/31/2021 08/24/2021 09/30/2021 40.65 0.00 0.00 40.65 SUPPLIES 6540330 ; `'08/3112021 08/24/2021 09/30/2021 376.28 0.00 0.00 376.28 ` SUPPLIES 6543320 v' 08/31 /2021 08/26/2021 09/30/2021 185.60 0.00 0.00 185.60 V, SUPPLIES 6545660 v�08/3112021 08/31/2021 09/30/2021 126.76 0.00 0.00 126,76 SUPPLIES 65456701/ 08/31/2021 08/31/2021 09/30/2021 114.60 0.00 0,00 114.60 SUPPLIES 6547710v, 09/01/2021 09/01/2021 09/30/2021 99.55 0.00 0.00 99.55 sue' SUPPLIES 6549460✓ 09/01/2021 09/02/2021 09/27/2021 12.01 0.00 0.00 12.01 SUPPLIES 654954501/09/01/2021 09/02/2021 09/30/2021 29.15 0.00 0.00 29.15 SUPPLIES 6549510 ✓` 09/01/2021 09/03/2021 09/30/2021 111.13 0.00 0.00 111.13 u- SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Not 10368 DEWITT POTH & SC 1,140.32 0.00 0.00 1.140.32 Ventlor# Vendor Name Class Pay Code 11011 DIAMOND HEALTHCARE CORP Nam' Invoice# Comment Tran Dt Inv Ot Due Ot Check Dt Pay Gross Discount No -Pay Net IN20054887 r09116f2021 0910V2021 09/26/2021 2,500.00 0.00 0.00 2,500.00 INPATIENT ASSESSMENT Vendor Totals: Number Name Gross Discount No -Pay Net 11011 DIAMOND HEALTH( 2,500.00 0.00 0.00 2,500,00 Vendor# Vendor Name Class Pay Code 10789 DISCOVERY MEDICAL NETWORK, Invoice# Comment Tran Ot Inv Dt Due Dt Check Ot Pay Gross Discount ND -Pay Net MMC083121 OB/31/2021 08/3112021 09/30/2021 110,205,28 0.00 0,00 110,205.28 81e:///C:/Users/mmcklsseck/cpsi/memmed.cpsinet.com/u8B150/data_5/imp_,cw5report7256912091011677174.html 5/19 9f16/21, 1:44 PM tmp_cw5repon7256912091011677174.htm1 n PRO FEES fVtr3 1(1-3 1 , _ , k MMC091521 09/15/2021 09/15/2021 09/15/2021 137,150.04 0.00 0.00 137,150.04 ��- PROFEES epi- Vendor Totals: Number Name Gross Discount No -Pay Net 10789 DISCOVERY MEDIC 247.355.32 0.00 0.00 247.355.32 Vendor# Vendor Name Class Pay Code 11291 DOWELL PEST CONTROL 1% Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 20984,.E 08/31/2021 05/31/2021 00/25/2021 260.00 0.00 0.00 260.00Ii' PEST CONTROL 21019 1/' 06/31/2021 06/30/2021 09/30/2021 505.00 0.00 0.00 505.00 PEST CONTROL 21020 4i 08/31/2021 08/30/2021 09/30/2021 260.00 0.00 0.00 260.00 PEST CONTROL FW4321 y/ 08/31/2021 07/31/2021 09/30/2021 105.00 0.00 0.00 105.00 PEST CONTROL FW4290 ,,�" 08/31/P021 07/31/2021 09/30/2021 160.00 0.00 0.00 160.00 1� PEST CONTROL FW4280 ✓ 08/31/2021 07/31/2021 09/30/2021 505.00 0.00 0.00 505.00 PEST CONTROL FW4661 IX 08/31/2021 08/31/2021 09/30/2021 160.00 0.00 0.00 160.00 v� PEST CONTROL FW4781., 08/31/2021 08/31/2021 09/30/2021 505.00 0.00 0.00 505.00" PEST CONTROL Vendor Totals: Number Name Gross Discount No -Pay Net 11291 DOWELLPESTCOI' 2,460.00 0.00 0.00 2,460.00 Vendor# Vendor Name Class Pay Code D1710 DOWNTOWN CLEANERS ,/ W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay I Gross Discount No -Pay 083121 08/31/2021 08/31/2021 09/30/2021 368.10 0.00 0.00 LAUNDRY Vendor Totals: Number Name Gross Discount D1710 DOWNTOWN CLEAT 368A0 0.00 Vendor# Vendor Name Class 12040 DRIESSEN WATER INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross 14302703 09/15/2021 08/31/2021 09/22/2021 31.60 SUPPLIES Vendor Totals: Number Name Gross Discount 12040 DRIESSEN WATER 31.50 0.00 Vendor# Vendor Name Class 12044 DRIESSEN WATER INC. (CULLIGAI Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 1430270308:08/31 /2021 08/31 /2021 09/30/2021 31.50 SUPPLIES Vendor Totals: Number Name Gross Discount 12044 DRIESSEN WATER 31.50 0.00 Vendor# Vendor Name Class 11284 EMERGENCY STAFFING SOLUTIO Net 368.10 No -Pay Net 0.00 368.10 Pay Code Discount No -Pay Net 0.00 0.00 31.50 No -Pay Net 0.00 31.50 Pay Code Discount No -Pay Net 0.00 0.00 31.50 No -Pay Net 0.00 31.50 Pay Code Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 40548 v'� 08/31/2021 08/31/2021 09/30/2021 11800.00 0= 0.00 11800.00 ODUTAYO COBER BUNNELL-VW_k�.n'\ LLV'1Vs,e-,„- 40567✓ 09/15/2021 09/15/2021 09/25/2021 40,062,50 0.00 0.00 40,062.50 STAFFING (4'1`Sttt,) Vendor Totals: Number Name Gross Discount No -Pay Not 11284 EMERGENCY STAF 41,862.50 0.00 0.00 41,862.50 Vendor# Vendor Name Class Pay Code 10042 ERBE USA INC SURGICAL SYSTEQ 1. I/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 697969 V 08/31/2021 08/24/2021 09/30/2021 139.50 0.00 0.00 139,50 ,fr SUPPLIES file:/I/C:lUserslmmcklssack/cpsilmemmed.cpsinet.cam/u88150/data_5/tmp_cw5report7256912091011677174.html 6119 9/16121, 1.44 PM imp _cwSrepor17256912091011677174.htmI , u Vendor Totals: Number Name Grass Discount No -Pay Net 10042 ERBE USA INC SUF 139.50 0.00 0.00 139.50 Vendor# Vendor Name Class Pay Code 13872 ETHOS MEDICAL STAFFING t/ Invoice# Comment Tran DI Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 27628 v' 08/31/2021 08/13/2021 09/30/2021 2,896.00 0.00 0.00 2,896.00 ICU STAFFING 27738 08/31/2021 08/20/2021 09/30/2021 2,919.20 0.00 0.00 2.919.20 ICU STAFFING 27856 09/16/2021 06/2712021 09/26/2021 2,927.20 0.00 0.00 2,927.20 STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net 13872 ETHOS MEDICAL 5 8,742.40 0.00 0.00 8,742.40 Vendor# Vendor Name Class Pay Code S0501 EVOOUA WATER TECHNOLOGIES v=, Invoice# Comment Tran DI Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 905045604 v,08/3112021 08/31/2021 09/30/2021 20.00 0.00 0.00 20.013 _ MAIT CONTRACT Vendor Totals: Number Name Gross Discount No -Pay Net S0501 EVOOUA WATER TI 20,00 0.00 0.00 20.00 Vendor# Vendor Name Class r Pay Code F1403 FISHER & PAYKEL HEALTHCARE M d/ Invoice# Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 91301034 0%08131/2021 08/31/2021 09/30/2021 660.38 0.00 0.00 660.38,-- SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net F1403 FISHER & PAYKEL 1 660.38 0.00 0.00 660.38 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE ,'� M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8133044 �!" 08/31/2021 08/10/2021 09/04/2021 438,00 0.00 0.00 438.00 "- SUPPLIES 8862202 ,r`08/31/2021 08/i2/2021 09/06/2021 142.56 0.00 0.00 142.56 -' SUPPLIES 8862203'/ 08/31/2021 08/12/2021 09/06/2021 1,158.08 0.00 0.00 1,158.08 y' SUPPLIES 92113526 ,./-08/3112021 08/16/2021 09/10/2021 1,044,44 0.00 0.00 1,044.44 v SUPPLIES 9216525 ,.' 08/31/2021 08/16/2021 09/10/2021 548,59 0.00 0.00 548,59 SUPPLIES 9377197,.E 08/31/2021 08/17/2021 09/11/2021 54.60. 0.00 0.00 54.60 SUPPLIES 9664364 v/08/31/2021 08/191PO21 09/1$/2021 228.85 0.00 0.00 228,86 i SUPPLIES 9664363 ii/ 08/31/2021 08/19/2021 09/13/2021 67.86 0.00 0.00 67.86 SUPPLIES 9783954✓ 08/31/2021 08/20/2021 09/30/2021 123.44 0.00 0.00 123.44 ✓' SUPPLIES 0030391✓� 08/31/2021 08/24/2021 09/18/2021 413.90 OAO 0.00 413.90 SUPPLIES 0173745✓� 08/31/2021 OBY2512021 09/19/2021 37.38 0.00 0.00 37.36 i-'- SUPPLIES 0173739 ,'` 08/31/2021 08/25/2021 09/30/2021 239.32 WIG 0.00 239.32 .. SUPPLIES 0322948,i''08/31/2021 08/26/2021 09/20/2021 1,212.00 0.00 0.00 1,212.00 SUPPLIES 0322944 f OBY31/2021 0826/2021 09/30/2021 01000.00 0.00 0.00 6,000.00 ,r SUPPLIES 0322936 V/ 08/31/2021 08/26/2021 09/30/2021 1,343.46 0.00 0.00 1,343.46 SUPPLIES i 0447192 " 08/31/2021 08/27/2021 09/21/2021 404.00 0.00 0.00 404.00 v' file:/1/C:lUserslmmcklssack/cpsi7memmed.cpsinet.com/u8815O/data_5/tmp_cw5report7256912091011677174.htm1 7119 9116121. 1:44 PM n tmp_cw5report7256912091011677174.html SUPPLIES f- 0570230 V' 08/31/2021 08/30/2021 09/24/2021 197.80 0.00 0.00 197.80 SUPPLIES 0570229 08/30/2021 09/24/2021 1,207,53 0.00 0.00 1.207.53 nA8131/2021 r,,-- SUPPLIES 0697007 � OW3112021 08/3112021 09/25/2021 1,267,50 0.00 0.00 1,287.50 SUPPLIES 0570227,,11• 08/31/2021 08/3112021 09/25/2021 7.23 0100 0.00 7,23 �- SUPPLIES 0697006 ✓ 08/31/2021 08/31/2021 09/25/2021 189.04 0,00 0.00 189,04 SUPPLEIS Vendor Totals: Number Name Gross Discount No -Pity Net F1400 FISHER HEALTHCA 16,346.58 0.00 0.00 16,345.58 Vendor# Vendor Name Class Pay Code 11183 FRONTIER .,-' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 082321 08/31/2021 013/2312021 09/30/2021 14.39 0.00 0.00 14.39 PHONES ACCT 3615620254052518 Vendor Totals: Number Name Gross Discount No -Pay Net 11183 FRONTIER 14.39 0.00 0.00 14.39 Vendor# Vendor Name Class. Pay Code 13960 G & S MANAGEMENT GROUP LLC Y` Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 340382483. 68/3112021 05/13/2021 09/30/2021 2,166.90 0.00 0.00 2,166.90 .✓- TRASH SERVICE/CONTAINER 340382486t,08/3112021 05/13/2021 09/30/2021 345.52 0.00 0,00 345.52 TRASH SERVICE 3403B328T 09/02/2021 09/30/2021 332.42 0.00 0.00 332.42 ,6W0912021 TRASH SERVICES Vendor Totals: Number Name Grass Discount No -Pay Net 13960 G & S MANAGEMEh 2,844.84 0.00 0.00 2,844,84 Vendor# Vendor Name Class Pay Code 10901 GENESIS DIAGNOSTICS ri Invoice# Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 52492 j 08/31/2021 08/30/2021 09/30/2021 122.46 0.00 0.00 122,46 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay 10901 GENESIS DIAGNOS 122.46 0.00 0.00 Vendor# Vendor Name Class Pay Code C1470 GI SUPPLY M Invoice# Comment Tran Dt Inv Dt Due DI Check D1 Pay Gross Discount No -Pay 755255 v 08/31/2021 08/24/2021 09/30/2021 380.00 0,00 0.00 SUPPLIES Vendor Totals: Number Name Gross Discount C1470 GI SUPPLY 380.00 0,00 Vendor# Vendor Name Class W1300 GRANGER,/ M Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross 9013326890„ 08/31/2021 O8/05/2021 09/30/2021 205.44 SUPPLIES 9036671478.08/31/2021 O8/2712021 09/30/2021 43.80 SUPPLIES 903924531248/31/2021 08/31/2021 09/30/2021 237.52 SUPPLIES Vendor Totals: Number Name Gross Discoun, W1300 GRAINGER 486.76 0.00 Vendor# Vendor Name Class 01210 GULF COAST PAPER COMPANY " M Net 122.46 Net 380.00 ' No -Pay Net 0.00 380.00 Pay Code Discount No -Pay Net 0.00 0.00 205.44 f 0.00 0.00 43.80,j 0.00 D.00 237.52 4/ No -Pay Not 0.00 486,76 Pay Code Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2091066,'� 08/31/2021 08/24/2021 09/23/2021 794.36 0,00 0.00 794.36 SUPPLIES Ole:///C:/Users/mmckissack/cpsi/memmed.cpsinel.com/u88150ldata_5/Imp_ cw5report7256912091011677174.html 8119 9/16/21, 1:44 PM tmp_ow5report7256912091011677174,html 2095008 t/08/31/2021 08/31/2021 09/30/2021 172,24 0.00 0.00 172.24 SUPPLIES 2095013 �,-'08/31/2021 08/31/2021 09/30/2021 482.44 0,00 0.00 482.44 ✓ SUPPLIES 2096216 ,j 08/31/2021 08/31/2021 09/30/2021 129.59 0.00 0.00 129,59 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPE 1,578,63 0.00 0.00 1,578,63 Vendor# Vendor Name Class Pay Code 12380 HEALTH SOLUTIONS DIETETICS , Invoice# Comment Tran Dt Inv Ot Due Ot Check Dt Pay Gross Discount No -Pay Net 083121 08/31/2021 08/31/2021 09/30/2021 3,000.00 0.00 0.00 3,000,00 DIETITIAN �,."•" Vendor Totals: Number Name Gross Discount No -Pay Net 12380 HEALTH SOLUTION 3,000.00 0.00 0.00 3,000.00 Vendor# Vendor Name Class Pay Code 10804 HEALTHCARE CODING & CONSUL v` Invoice# Comment Tran Dt Inv Dt Due Ot Check DI Pay Gross Discount No -Pay Net 11351 t% 09/15/2021 08/31/2021 09/30/2021 450.75 0.00 0.00 45015 CODING SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 10804 HEALTHCARE COD 450.75 0.00 0.00 450.75 Ventlor# Vendor Name Class Pay Code H0416 HOLOGIC INC ✓" Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 9828054 ✓"08/31/2021 08/26/2021 09/30/2021 1,243.01 0.00 0.00 1,243.01 SUPPLIES Vendor Totals; Number Name Gross Discount No -Pay Net H0416 HOLOGIC INC 1,243,01 0.00 0.00 1,248.01 Ventlor# Vendor Name Class Pay Code 10922 HUNTER PHARMACY SERVICES v," Invoice# . Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 4554 v/ 08/31/2021 08/31/2021 09/30/2021 14,923.09 0.00 0.00 14,923.09 Vendor Totals: Number Name Gross Discount No -Pay Net 10922 HUNTER PHARMAC 14,923,09 0.00 0.00 14,923.09 Vendor# Vendor Name Class Pay Code 12596 INDEED, INC. v' Invoice# Comment Tran Ot Inv Dt Due 01 Check Dt Pay Gross Discount No -Pay Net 48456887 ✓ 08/31/2021 OB/31/2021 09/30/2021 202.15 0.00 0100 202.15 JOB LISTING Vendor Totals; Number Name Gross Discount No -Pay Net 12596 INDEED, INC. 202.15 0= 0,00 202.15 Vendor# Vendor Name Class Pay Code 11200 IRON MOUNTAIN r/ Invoice# Comment Tran Dt Inv Dt Due Dt OX13C465 "08131/2021 Check Dt Pay Gross Discount No -Pay Net 08/31/2021 09/30/2021 617.56 0.00 0.00 617.56e, SHRED SERVICE Vendor Totals: Number Name Gross Discount No -Pay Net 11200 'IRON MOUNTAIN 617.56 0.00 0.00 617.56 Vendor# Vendor Name Class Pay Code 11285 ITA RESOURCES INC Y-' Invoice# CO'Mment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net MMC92021VO9106/2021 09/06/2021 09/26/2021 30,375,25 0.00 0.00 30,375.25 H• PESP SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 11285 ITA RESOURCES tN 30.375.25 0.00 0.00 30.375.25 Vendor# Vendor Name Class Pay Code 11108 ITERSOURCE CORPORATION Invoice# Comment Tran Dt Inv Dt Due Dt Check Or Pay Gross Discount No -Pay Net 711389 tj09/15/2021 09/01/2021 09/01/2021 250.00 0.00 0.00 250.00 fie:/I/C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cwbreporL7256912091011677174,html 9/19 Ott 6/21, �:44 PM Imp-cw5report7256912091011677174.htm1 SUPPORTSVSTEM Vendor Totals: Number Name Gross Discount No -Pay Net 11108 ITERSOURCE CORI 250.00 0.00 0.00 250.00 Vendor# Vendor Name Class Pay Code 10834 JACKSON & CARTER, PLLC ,, Invoice# , Comment Tran Ot Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 2900 ✓ 09/06/2021 09/06/2021 09/30/2D21 885,00 0.00 0.00 885.00 4 , LEGAL Vendor Totals: Number Name Gross Discount No -Pay Net 10834 JACKSON & CARTE 885.00 0.00 0.00 885.00 Ventlor# Vendor Name Class , Pay Code L0700 LABCORP OF AMERICA HOLDING; M v Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 70596863 08/31/2021 08/28/2021 09/22/2021 15.50 0.00 0.00 15.50 SUPPLEIS Vendor Totals: Number Name Gross Discount No -Pay Net L0700 LABCORP OF AMEF 15.60 0.00 0.00 16.50 Vendor# Vendor Name Class Pay Code 11600 LEGAL SHIELD ✓ Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 091521 09/14/2021 09/15/2021 09/15/2021 541.35 0.00 0.00 $41.35 v' PAYROLL DED Vendor Totals: Number Name Gross Discount No -Pay Net 11600 LEGAL SHIELD 541,35 0.00 0.00 541.35 Vendor# Vendor Name Class Pay Code 12628 LEGATO / Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net C1981 -� 08/31/2021 06/30/2021 09/30/2021 1,206.25 0.00 0.00 1,206.25.' C2010 +'' 08/31/2021 07/31/2021 09/30/2021 564.89 0.00 0.00 564.89 Vendor Totals: Number Name Gross Discount No -Pay Net 12628 LEGATO 1.771.14 0.00 0.00 1,771.14 Vendor# Vendor Name Class Pay Code 10972 M G TRUST �/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 082721 08/31/2021 08/27/2021 09/30/2021 790.86 0.00 0.00 790.86 PAYROLL DED 090921 09/1412021 09/09/2021 09109/2021 790.86 0.00 0.00 790.66 PAYROLL DEDUCTIONS Vendor Totals: Number Name Gross Discount No -Pay Net 10972 M G TRUST 1,581.72 0.00 0.00 1,681.72 Vendor# Vendor Name Class Pay Code 11203 MEDI-DOSE, INC . Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0820956 ✓ 08/31/2021 08/26/2.021 09/30/2021 102.55 0.00 0.00 102.55 4. SUPPLIES Vendor Totals: Number Name Grass Discount No -Pay Net 11203 MEDI-DOSE, INC 102.55 0.00 0.00 102.55 Vendor# Vendor Name Class Pay Coda 11141 MEDICAL DATA SYSTEMS, INC. Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 163330 08/31/2021 08/31/2021 09/25/2021 2,067.26 0.00 0.00 2,06726 COLLECTIONS 163328 v' 08/31/2021 08/31/2021 09/30/2021 3,463.29 0.00 0.00 3,463.29 COLLECTIONS 163329 „/' 08/31/2021 08/31/2021 09/30/2021 4,699.19 0.00 0.00 4,699.19 COLLECTIONS Vendor Totals: Number Name Gross Discount No -Pay Net 11141 MEDICAL DATA SYf 10,229,74 0.00 0.00 10,229.74 Vendor# Vendor Name Class Pay Code file:///C:tUsers/mmckissack/cpsi/memrned.cpsinet.com/u88l5O/data_5/tmp_Gw5report7256912091011677174.html 10119 ,9116/21, 1,:44 PM tmp_cw5repon7256912091011677174.html 10613 MEDIMPACT HEALTHCARE SYS, It A/P Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 090921 09/15/2021 09/09/2021 O9/O9/2021 61.66 0.00 0.00 61.5E INDIGENT Vendor Totals: Number Name Gross Discount No -Pay Net 10613 MEDIMPACT HEALI - 61.5E 0.00 0.00 61.56 Vender# Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC ✓- M Invoice# ,I Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 195928930 08/31/2021 07/20/2021 09/30/2021 110.43 0.00 0.00 110.43 ' SUPPLIES 1962D04531s08/31/2021 08/10/2021 09/04/2021 144.44 0.00 0.00 144.44 ✓ SUPPLIES 1962283862,9A1/2021 08/12J2021 09/06/2021 15,058.76 0.00 0.00 15.058.76 SUPPLIES 1963175554,108/3l/2021 08/19/2021 09/30/2021 85.06 0.00 0.00 65.06 SUPPLIES 1963175555.98/31/2021 08/19/2021 09/30/2021 22.33 0.00 0.00 22.33 /- SUPPLIES �f 1963175552 98/31/2021 08/1912021 09/30/2021 10.90 0.00 0.00 10.90 SUPPLIES v' 1963175550 0131/2021 08/19/2021 09/30/2021 12.98 0.00 0.00 12.98 V SUPPLIES 1963057676J,08/31/2021 08/19/2021 09/30/2021 110.43 0.00 0.00 110A3 SUPPLIES 1963175551 ,08131/2021 08/1912021 09/30/2021 48.58 0.00 0.00 48.58 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTR 15,683.91 0.00 0.00 15,583.91 Vendor# Vendor Name Class Pay Code 10963 MEMORIAL MEDICAL CLINIC Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 082721 00/31/2021 08/27/2021 09/30/2021 84.00 0.00 0.00 B4.00 PAYROLL DED 090921 09/14/2021 09/09/2021 09/09/2021 295.2E 0.00 0.00 295.26 PAYROLL DEDUCTIONS Vendor Totals: Number Name Gross Discount No -Pay Net 10963 MEMORIAL MEDICF 379.26 0.00 0.00 379.26 Vendor# Vendor Name Class Pay Code 10904 MERCK SHARP & DOHME CORP ,. / Invoice# Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 7015532896 08/31/2021 08/05/2021 09/30/2021 4,642.68 0.00 0.00 4,642.68 INVENTORY Vendor Totals: Number Name Gross Discount No -Pay Net 10904 MERCK SHARP & D 4,642.68 0.00 0.00 4,642.68 Vendor# Vendor Name Class Pay Code 10791 MINDRAY DS USA, INC, i, Invoice# Comment Tran Dt Inv DI Due Ot Check Ot Pay Gross Discount No -Pay Net 0600874629,08131/2021 08/09/2021 09/30/2021 52.26 0.00 0.00 52.26 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10791 MINDRAY DS USA, 52.26 0.00 0.00 52.2E Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LI-C Invoice#Comment Tran Dt Inv Dt Due Ot Check Ot Pay Gross Discount No -Pay Net 0890 V/ 08/31/2021 08/30/2021 09/09/2021 -73.40 0.00 0.00 -73.40 CREDIT 0891 08/31/2021 08130/2021 09/09/2021 -271.53 0,00 0.00 -271.53 ✓ ` i' CREDIT 7279297 '.,'/ 08/31/2021 08/31/2021 09/10/2021 353.95 0.00 0.00 353.95 INVENTORY file:///C:/Userslmmekissecktcpsitmommed.cpsinet.comlu88l5O/data_51tmp_cw5report7256912091 Oi 1677174,htmi 11/19 19116/21, 1:44 PM tmp_cw5report7256912091011677174.htm1 7289609 '68/31/2021 08/31/2021 09/10/2021 1.900.56 0.00 0.00 1,900.56 INVENTORY 7279298 „,/08/31/2021 08/31/2021 00/10/2021 47.29 0.00 0.00 47,29 INVENTORY 1661 % 08/31/2021 08/31/2021 0911 OM21 .0.94 0,00 0.00 -0.94 ��- CREDIT 1994 ,/ 08/31/2021 08/31/2021 09/10/2021 -0.06 0.00 0.00 -0.05 ,ram CREDIT 7279302 ,' 08/31/2021 08/31/2021 09/10/2021 1,934.91 0.00 0100 1,934.91 INVENTORY 1650 08/31/2021 08/31/2021 09/10/2021 -0.82 Mo 0.00 -0.82 v/_ CREDIT 1659 .%F 08/31/2021 08/31/2021 09/10/2021 -4.99 0.00 0.00 -4.99 CREDIT 1993./ 08/31/2021 08/31/2021 09/10/2021 -0.02 0.00 0.00 -0.02 CREDIT 1995 08/31/2021 08131/2021 09/l0/2021 -4.99 0.00 0.00 -4.99 CREDIT 7284458 ,i" 09/09/2021 09/01/2021 09/11/2021 770.22 0.00 0.00 770.22 ` INVENTORY 7284459 , 109/09/2021 09/01/2021 09/11/2021 19.36 0.00 0.00 19,36 V' U INVENTORY 7284457 %0910912021 09101/2021 09/11/2021 777.62 0.00 0.00 777.62r,, INVENTORY 7289611 09/09/2021 09/02/2021 09/12/2021 2,192.04 0.00 0.00 2,192.04 INVENTORY 7289610 ,V/09/09/2021 09/02/2021 09/12/2021 28.97 0.00 0.00 28.97 it INVENTORY 7293648 i% 09/09/2021 09/08/2021 09/16/2021 503.68 0.00 0.00 503.68 INVENTORY 7293647 09/06/2021 09/16/2021 462.66 0.00 0.00 462.66 i v/09/09/2021 INVENTORY 7293649 ,/ 09/09/2021 09/06/2021 09/161PO21 413.86 0.00 0.00 413.86 INVENTORY 7301204 ,/09/09/2021 09/07/2021 09/17/2021 711.16 0.00 0.00 711.16 INVENTORY 7301205 ti' 09/09/2021 09/07/2021 09/17/2021 243.14 0.00 0.00 243.14 INVENTORY 7298959 ✓ 09/09/2021 09/07/2021 09/17/2021 8,464.52 0.00 0.00 8,464.52 X INVENTORY 7301203 ,,� 09/09/2021 09/07/2021 09/17/2021 5,856.83 0.00 0.00 5,856.83 y, INVENTORY 7298968 rj'09/0912021 09/07/2021 09/17/2021 3,942.95 0.00 0.00 3,942.95 INVENTORY 7305902 ✓� 09/15/2021 09/08/2021 09/18/2021 56,49 0.00 0.00 56.49 INVENTORY 7304885,j 09/15/2021 09/08/2021 09/18/2021 10.57 0.00 0.00 10.57 ar'" INVENTORY 7307111 v/ 09/1512021 09/08/2021 09/18/2021 33.54 0.00 0.00 33.54 INVENTORY 7304886 „j '09fl5/2021 09/0812021 09/18/2021 42.70 0.00 0.00 42.70 , INVENTORY 7305903 v`/ 00/15/2021 09/08/2021 09/18/2021 297.36 0.00 0.00 297.36 INVENTORY 7305904 /� 09/15/2021 09/08/2021 09/18/2021 216.27 0.00 0.00 215.27 INVENTORY 7311305 09/15/2021 09/09/2021 09/19/2021 390.77 0,00 0.00 390.77 ✓' INVENTORY 7311303✓ 09/15/2021 09/09/2021 09/19/2021 1.45 0.00 0.00 1.45L-,' INVENTORY 7311304JO911512021 09/09/2021 09/19/2021 326.82 0.00 0.00 326.82 file:!//C:/Users/mmckissack/cpsilmemmed.cpsinet.com/u88150/data_5/tmp_cw5report7256912091011677174.html 12/19 19116121. 1,:44 PM tmp_cw5repor17256912091011677174. html INVENTORY / �/ 7308036 09/15/2021 09/09/2021 09/19/2021 10.71 0.00 0.00 10.71 .� INVENTORY 7317323 <r'09/15/2021 09/12/2021 09/22/2021 1.625.63 0.00 0.00 1,625.63 j INVENTORY 7317322 �/69/15/2021 09/12/2021 09/22/2021 317.66 0,00 0.00 317.66 INVENTORY 7317324 J09/15/2021 09/12/2021 09/22/2021 39.39 0.00 0.00 39.39 INVENTORY 7317321 ; ' 09/15/2021 09/12/2021 09/22/2021 64.19 0.00 0.00 64.19 INVENTORY 7322608 ;()6/1512021 09/13/2021 09/23/2021 315,37 0.00 0.00 315.37 ✓"- INVENTORY 7319025 ✓' 09/15/2021 09/13/2021 09/23/2021 47,29 0.00 0.00 47.29 INVENTORY "' 7322607 ,/09/15/2021 09/13/2021 09/23/2021 11.82 0.00 0.00 11.82 7319024 / 09/15/2021 09/13/2021 09/23/2021 162.79 0.00 0.00 102.79 INVENTORY 1; 7$27318 V69/15/2021 09/14/2021 09/24/2021 372,34 0100 0.00 372,34 INVENTORY 7327319 , '09/15/2021 69/14/2021 09/24/2021 1,196.24 0.00 0.00 11196,24 INVENTORY 7327320 ; �09/15/2021 09/14/2021 09/24/2021 489,61 0.00 0.00 489.61 INVENTORY Vendor Totals: Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSOI 34,294,99 0.00 0.00 34,294.99 Vendor# Vendor Name Class Pay Code M2659 MXR IMAGING, INC", M Invoice# Comment Tran Dt Inv Dt Due Of Check Dt Pay Gross Discount No -Pay Net 880800643 y08/3112021 08/25/2021 09/24/2021 1.146.55 0.00 0,00 1,146.55 ✓` SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2659 MXR IMAGING, INC 1,146.56 0.00 0.00 1,146.55 Vendor# Vendor Name Class Pay Code 13548 NACOGDOCHES TRANSCRIPTION Invoice# Comment Tran Dt Inv Of Due Dt Check Dt Pay Gross Discount No -Pay Net 7467 09/16/2021 09/14/2021 09/14/2021 505.68 0.00 0.00 505.68 TRANSCRIPTION -1- k Vendor Totals: Number Name Gross Discount No -Pay Net 13548 NACOGDOCHES TF 505.68 0100 0.00 $05.68 Vendor# Vendor Name Class Pay Code 12388 NATIONAL FARM LIFE INSURANCE Invoice# Comment Tran Dt Inv Dt Due Ot Check DI Pay Gross Discount No -Pay Net 3495573 '// 08131/2021 08/31/2021 09/30/2021 3,478.60 0.00 0.00 3,478.60 INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 12388 NATIONAL FARM LI 3,478.60 0.00 0.00 3,478.60 Vendor# Vendor Name Class Pay Cade 01500 OLYMPUS AMERICA INC M Invoice# Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Not 31263327 �07131/2021 07/23/2021 09/30/2021 P qOQ 0.00 0.00 , 0,60 31304467 „10813112021 07/28/2021 08/22/2021 111.63 0.00 0.00 111.63 SUPPLIES �,,-•' 31263327A,/09/16/2021 07/20/2021 08/14/2021 99.21 0.00 0.00 99.21 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 015DO OLYMPUS AMERIC, 210.84 0.00 0,00 210,84 Vendor# Vendor Name - Class Pay Cade 01416 ORTHO CLINICAL DIAGNOSTICS file:/1/C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report7256912091011677174.html 13119 19116121, 1:44 PM tmp_ew5repor17256912091011677174.htm1 Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 185202764410831/2021 08/16/2021 09/15/2021 759.03 0.00 0.00 759.03 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 01416 ORTHO CLINICAL D 759.03 0.00 0.00 759.03 Vendor# Vendor Name Class Pay Code 11069 PABLO GARZA Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 091421 09/15/2021 09/14/2021 W/14/2021 2.145.00 0.00 0.00 2,145.00 CONTRACT EMPLOYEE f o r E 1° 11 3 -� Vendor Totals: Number Name Gross Discount No -Pay Net 11069 PABLO GARZA 2,145.00 0.00 0.00 2,145.00 Vendor# Vendor Name Class Pay Code P0706 PALACIOS BEACON W Invoice* Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 33058307 .68/31/2021 08/27/2021 09/30/2021 167.50. 0.00 0.00 197.50 AD Vendor Totals: Number Name Gross Discount No -Pay Net P0706 PALACIOS BEACON 187.50 0.00 0.00 197.50 Ventlor# Vendor Name Class Pay Coda 10152 PARTSSOURCE, LLC U Invoice# Comment Tran Di Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 03621620 106/31/2021 10/16/2020 09/30/2021 386.67 0.00 0.00 386.67 CENTRIFUGE REPAIR 03764177 ,/08/31/2021 03f10/2021 09/30/2021 179.64 0.00 0.00 179.64 �.. PARTS FOR PREVENTIVE MAINT 03763907,/ 08/31/2021 03/10/2021 09/30/2021 17.10 0.00 0,00 17.10 PARTS FOR PREVENTIVE MAINT 03554474 '168/31/2021 08/07/2021 09/3012021 60.39 0.00 0.00 60.39 SUPPLIES 03974141 .-,08/31/2021 08/16/2021 09/30/2021 101.01 0.00 0.00 101.01 SUPPLIES 03981699 v68/31/2021 08/18/2021 09/30/2021 883.68 0.00 0.00 883,68 4r., SUPPLIES 03985060 / 08/31/2021 08/20/2021 09/30/2021 294.33 0.00 0.00 294.33 SUPPLIES 03990383v-08/31/2021 08/24/2021 09/30/2021 524.20 0.00 0.00 524,20 SUPPLIES 03623281v'08/3112021 10/19/2021 09/30/2021 214.29 0.00 0.00 214.29 CENTRIFUDE REPAIR Vendor Totals: Number Name Gross Discount No -Pay Net 10152 PARTSSOURCE, LL 2,661.31 0.00 0.00 2.661.31 Ventlor# Vendor Name Class Pay Code P1800 PITNEY BOWES INC r. 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' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Nei IN0004899390813112021 07/31/2021 09/30/2021 2,523.79 0.00 0.00 2,523.79 PT SURVEY file:///C:/Userslmmckissack/cpsi/mommed.cpsinet.comtu88l50/data 5/tmp_cw5repart7256912091011677174.html 14119 19/16/21, JA4 P10 imp_cw5repor17 256912091011677174.html IN0004939508/31/2021 08/03/2021 09/30/2021 2,523.79 0.00 0.00 2,523.79 PT SURVEY Vendor Totals: Number Name Gross Discount No -Pay Net 11932 PRESS GANEY AS£ �.� 5,047.58 0.00 0.00 5,047.58 Vendor# Vendor Name Class Pay Code 12480 PRO ENERGY PARTNERS LP � ,. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 21080600 ,/69/15/2021 08/31/2021 09/15/2021 31060,36 0.00 0.00 3,060.36 GAS Vendor Totals: Number Name Gross Discount No -Pay Net 12480 PRO ENERGY PAR- 31060.36 0.00 0.00 31060,36 Vendor# Vendor Name . Class Pay Code 10896 OIAGEN INC v Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 997977157 V1)8/31/2021 08/24/2021 09/30/2021 1,627.69 0.00 0.00 1,627.69 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10895 OIAGEN INC 1,627.69 0.00 0.00 1,627.69 Vendor# Vendor Name Class Pay Code 13940 RN NETWORK,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 3990932RI„A9/15/2021 091131P021 09/13/2021 2,793.00 0.00 0.00 2,793.00 ICU STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net 13940 RN NETWORK 2,793,00 0.00 0.00 2,793.00 Vendor# Vendor Name Class Pay Code G0425 ROBERTS, ODEFEY, WITTE & WAL W. ,,,' Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 81 _ 09/03/2021 09/03/2021 09/30/2021 2,818.76 0.00 0.00 2,818.76 LEGAL 107 09/03/2021 09/03/2021 09/30/2021 481,25 0.00 0.00 481.25 LEGAL 183 09/03/2021 09/03/2021 09/30/2021 11,869.00 0100 0.00 11,809.00 LEGAL Vendor Totals: Number Name Gross Discount No -Pay Net G0425 ROBERTS, ODEFEI 15,169.00 0.00 0.00 15,169,00 Vendor# Vendor Name Class Pay Code 81800 SHERWIN WILLIAMS W Invoics# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 16636 � 08/31/2021 08/18/2021 09/30/2021 71.29 0.00 0.00 71.29 L..% SUPPLIES 18556 ,f 08/31/2021 08/25/2021 09/30/2021 97.90 0.00 0.00 97.90 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 81800 SHERWIN WILLIAM: 169.19 0.00 0.00 169.19 Vendortt Vendor Name Class Pay Code 10936 SIEMENS FINANCIAL SERVICES �' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net -401-20032 08/31/2021 08/16/2021 09/30/2021 2,193.83 0.00 0.00 2,193.83 !tl.i ON !Ci4 MAINTCONTRACT 5638210005k08131/2021 08/30/2021 09/30/2021 1,333.33 0.00 0.00 1,333.33 ✓ - 'zi,LI LEASE Vendor Totals: Number Name Gross Discount No -Pay Net 10936 SIEMENS FINANCIA 3,5?7,16 0100 0.00 3,527.16 Vendor# Vendor Name Class Pay Code 10699 SIGN AD, LTD. N Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 264852 +' 08/31/2021 08/16/2021 08/26/2021 672.00 0.00 0.00 672.00,,E AD 265642 .�� 09/01/2021 09/01/2021 09/30/2021 400.00 0.00 a00 400.00 AD ,- file://IC:/Users/mmckissack/cpsi/memmed.cpsinet.comtu88150/data_5/imp_cw5report7256912091011677174.html 15/19 9116/21, 1:44 PM tmp_cw5report7255912091011677174.html Vendor Totals: Number Name Gross Discount No -Pay Net 10699 SIGN AD, LTD. 1,072.00 0.00 0.00 1,072.00 Vendor# Vendor Name Class Pay Code 10195 SINGLETON ASSOCIATES PA y/ICP Invoice# ,Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 90-20 w:' 08/31/2021 07/01/2019 09/80/2021 908.77 0.00 0.00 908.77 CONTRACT BILLING 90-30 f' 08/31/2021 01/08/2020 09/30/2021 1,313.37 0.00 0.00 1,313.37 CONTRACT BILLING 105-2 vj' 06/31/2021 09/29/2020 09/30/2021 95.77 0.00 0.00 95.77 CONTRACT BILLING 105.3 -; ' 08/31/2021 12/16/2020 09/30/2021 440.15 0.00 0.00 440.15 CONTRACT BILLING 105-1A .,/ 08/31/2021 12/16/2020 09/30/2021 107.10 0.00 0.00 107.1CI CONTRACT BILLING 105.4 `�' 08/31/2021 01/18/2021 09/30/2021 10.51 0.00 0.00 10.61 i CONTRACT BILLING 105-5 • 08/31/2021 01/21/2021 09/30/2021 1, 164.85 0.00 0.00 1.164.85 . CONTRACT BILLING 105.6 08/31/2021 03/03/2021 09/30/2021 887.24 0.00 0.00 887.24 4;,.. i CONTRACT BILLING 105-8 08/31/2021 04/30/2021 09/30/2021 1.180.47 0.00 0.00 1,180.47 CONTRACT BILLING 90-32 „' 09/16/2021 04/01/2020 09/30/2021 1,031.35 0.00 0.00 1,031.35 CONTRACT BILLING Vendor Totals: Number Name Gross Discount No -Pay Not 10195 SINGLETON ASSOC 7,139,58 0.00 0.00 7,139.58 Vendor# Vendor Name Class Pay Code S2353 SMITHS MEDICAL ASD INC / Invoice# Comment Tran Dt Inv Dt Due Check Dt Pay Gross Discount No -Pay Net 16373194 ;0813112021 08/26/2021 09/14/2021 331.94 0.00 0,00 331,94 v SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net S2353 SMITHS MEDICAL.0 331,94 0.00 0.00 331,94 Vendor# Vendor Name class Pay Code 11296 SOUTH TEXAS BLOOD & TISSUE C ,� Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net CM5292- 08/31/2021 08/31/2021 09/30/2021 -2,370,00 0.00 0.00 -2.370,00 M CREDIT 107016945 . 08/31/2021 08/31/2021 09/30/2021 7.080,00 0.00 0.00 7.080.00 .! BLOOD Vendor Totals: Number Name Gross Discount No -Pay Net 11296 SOUTH TEXAS BLO 4,710.00 0.00 0.00 4,710.00 Vendor# Vendor Name Class Pay Code C1010 SPARKLIGHT W Invoice# Comment Tran DI Inv 61 Due Dt Check Dt Pay Gross Discount No -Pay Net 082021 08/31/2021 08/20/2021 09/30/2021 9854 0.00 0.00 98.54 CABLE i V Vendor Totals: Number Name Gross Discount No -Pay Net C1010 SPARKLIGHT 98.54 0.00 0.00 98.54 Vendor# Vendor Name class Pay Code S2694 STANFORD VACUUM SERVICE y' M Invoice# ,Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay .Net 287943✓ 08/31/2021 08/17/2021 09/30/2021 385.00 0.00 a00 385.00 PUMP GREASE TRAP Vendor Totals: Number Name Gross Discount No -Pay Net S2694 STANFORD VACUU 385.00 0.00 0.00 385.00 Vendor# Vendor Name Class Pay Code 12476 SUN LIFE FINANCIAL "I Invoice# Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount NaPay Net 082421 08/31/2021 08/24/2021 09/30/2021 8,225.49 0.00 0.00 8,225.49„_ file:///C:/Users/mmckissack/opsi/mommed.cpsinet.comtu88150/data_5/tmp_cwBreport7256912091011677174.html 16/19 9116/21, 1A4 PM Imp_cw5mpon7256912091011677174.html PAYROLLDED Vendor Totals: Number Name Gross Discount No -Pay Net 12476 SUN LIFE FINANCIP 8,225.49 0.00 0.00 8,225.49 Vendor# Vendor Name Class Pay Code T2539 T-SYSTEM, INC v', W Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net -401-70016 08/31/2021 08/27/2021 09/30/2021 431.42 0.00 0.00 431,42 w,--- uS,S4 ERX LICENSE 48411 �08/31/2021 08/31/2021 09/30/2021 51699.00 0.00 0.00 5.699.00 v; TRACKING HOSTING STAT Vendor Totals: Number Name Gross Discount No -Pay Net T2539 T-SYSTEM, INC 6,130.42 0.00 0.00 6,130,42 Ventlor# Vendor Name Class Pay Code 12704 TEXAS BURNER & BOILER SERVIC Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 213442 �,! 08/31/2021 08/19/2021 09/30/2021 758.00 0.00 0.00 758.00 REPLASE LOW GAS PRESSURE S' ` Vendor Totals: Number Name Gross Discount No -Pay Net 12704 TEXAS BURNER & 1 758.00 0.00 0.00 758.00 Vendor# Vendor Name Class ^ Pay Code 10766 TEXAS HOSPITAL ASSOCIATION ,% Invoice# Comment Tran DI Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 0900133696W8/31/2021 08/03/2021 09130/2021 7,006.38 0.00 0.00 7,006.38 ✓ MEMBERSHIP DUES Vendor Totals: Number Name Gross Discount No -Pay Net 10765 TEXAS HOSPITAL 7,006.38 0.00 0.00 7,006.38 Vendor# Vendor Name Class Pay Code 13880 TEXAS SELECT STAFFING =' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0018039510109/1512021 09/09/2021 09/09/2021 3.089.75 0.00 0.00 3,069.75 " 7h'11q STAFFING f Vendor Totals: Number Name Grass Discount No -Pay Net 13880 TEXAS SELECT STr 3,089.75 0.00 0.00 3.089.75 Vendor# Vendor Name Class Pay Code 11039 THE BRATTON FIRM Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0910216 '� 09/16/2021 09/10/2021 09/10/2021 101.17 0.00 0.00 101,17u,,-' HOSPITAL LIEN REIMBURSMENT 091021 09/16/2021 09/10/2021 09/10/2021 656.06 0.00 0.00 656.00 HOSPITAL LIEN REIMBURSMENT 091021A 09/16/2021 09/10/2021 09/10/2021 222.28 0.00 0.00 222,28 HOSPITAL LIEN REIMBURSMENT Vendor Totais: Number Name Gross Discount No -Pay Net 11039 THE BRATTON FIRP 979.51 0.00 0.00 979.51 Vendor# Vendor Name Class Pay Code T0801 TLC STAFFING W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 27708 �� 08/31/2021 08/30P2021 09/30/2021 1,908,05 0.00 0.00 1,908.05 v STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net T0801 TLC STAFFING 1,908.05 0.00 0.00 1.908.05 Vendor# Vendor Name Class Pay Code 13224 TORCH :r' Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Not 090121 09/14/2021 09/01/2021 09/01/2021 9,375.00 0.00 0.00 9,375.00 CFO RECRUITING Vendor Totals: Number Gross Discount No -Pay Net /Name 13224 TORCH tJ^ 9,375.00 0.00 0.00 9,375.00 Vendor# Vendor Name Class Pay Code 13616 TRIOSE, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net file:!!/C:/Users/mrnckissacklcpsilmemmed.cpsinel.com/u88150/data 51tmp_cw5report72569 12091011677174.html 17119 9/16121,.1:44 PM tmp_ew5report7256912091011677174,html TRIO92305 v09/15/2021 09/10/2021 09/25/2021 1,797.54 0.00 0.00 1,79T54 FREIGHT MANAGEMENT Vendor Totals: Number Name Gross Discount No -Pay Net 13616 TRIOSE, INC 1,797.54 0.00. 0.00 1.797.54 Vendor# Vendor Name Class Pay code 11001 ULINE ~ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 137338297 08%31/2021 08/12/2021 09/30/2021 715.81 0.00 0.00 715.81 WIRE SHELVING Vendor Totals: Number Name Gross Discount No -Pay Net 11001 ULINE 715.81 0.00 0.00 715.81 Vendor# Vendor Name Class Pay Code U1054 UNIFIRST HOLDINGS W Invoice# Comment Tran DI Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 8400375383 99%16/2021 09/02/2021 09/27/2021 41.07 0.00 0.00 _ 41.07 LAUNDRY 8400375385:09//16/2021 O9/02/2021 09/27/2021 121.55 0.00 0.00 121.55,!" 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Vendor Totals: Number Name Gross Discount No -Pay Net U1200 UNITED AD LABEL 1 292.91 0.00 0.00 292.91 Vendor# Vendor Name Class Pay Code V1058 VICTORIA ANESTHESIOLOGY W Invoice# Comment Tran Ot Inv Or Due Dt r Check Dt Pay Gross Discount No -Pay Net 083121 08/31/2021 08/31/2021 08/31/2021 43.315.01 0.00 0,00 43,315,01 ANESTHSIA Vendor Totals: Number Name Gross Discount No -Pay Net V1058 VICTORIA ANESTHI 43,315.01 0.00 0.00 43.315.01 Vendor# Vendor Name Glass Pay Code V1471 VICTORIA RADIOWORKS, LTD AV Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 21080204 ,/08/31/2021 08/31/2021 09/30/2021 280.00 0.00 0.00 280.00 AD 21080207, 06/81/2021 OBY31/2021 09/30/2021 40.00 0.00 0.00 40.00 „-' r AD 21080205.,E 08/31/2021 08/31/2021 09/30/2021 280.00 0.00 0.00 280.00 AD ✓ Vendor Totals: Number Name Gross Discount No -Pay Net V1471 VICTORIA RADIOWi 600.00 0.00 0.00 600.00 Vendor# Vendor Name Class Pay Code 13808 VITA PERSONA LLC✓' tile:///C:/Users/mmckisseek/cpsi/mammed.cpainet.com/u88l50/data_5/Imp_cw5report7256912091011677174.htmt 18119 9116121. 1:44 PM tmp_cw5mporl7256912091011677174.html Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net VP2021200409/61/2021 06/24/2021 09/01/2021 2,398.60 0.00 0.00 2,398.50,,E INVENTORY Vendor Totals: Number Name Gross Discount No -Pay Net 13808 VITA PERSONA LLC 2,398.50 0.00 0.00 2,398.50 Vendor# Vendor Name Class Pay Code 12548 WAGEWORKS, INC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0821DR467798/31/2021 08/31/2021 09/30/2021 155.52 0.00 0.00 155.52 COBRA 0321DR4677.p8/31/2021 08/31/2021 09/30/2021 155.52 0.00 0.00 155.52 ✓� COBRA 083121 08/31/2021 08/31/2021 09/30/2021 28.53 0.00 0.00 2B.53 ADMIN FEES 0421DR677908131/2021 08/31/2021 09/30/2021 155.62 0,00 0.00 155.52 COBRA Vendor Totals: Number Name Gross Discount No -Pay Net 12548 WAGEWORKS, INC 495.09 0.00 0.00 495.09 Vendor# Vendor Name Class Pay Code 10793 WAGEWORKS, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 082721 08/31/2021 08/27/2021 09/30/2021 3,352.29 0.00 0.00 $,35229 , PAYROLL DED 090921 09/14/2021 09/09/2021 09/09/2021 3,382.29 0.00 0.00 3,3B2.29 --` PAYROLL DEDUCTIONS Vendor Totals: Number Name Gross Discount No -Pay Net 10793 WAGEWORKS, INC. 6,734.58 0.00 0.00 0,734.58 Vendor# Vendor Name Class Pay Code 10943 WALLER,LANSDEN, DORTCH 8 DP �' Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 10823029 .108130/2021 09/08/2021 09/08/2021 428.00 0.00 0.00 428.00 LEGAL FEES 10819255 j 09/15/2021 08/09/2021 08/09/2021 321,00 0.00 0.00 321.00' : LEGAL Vendor Totals: Number Name Gross Discount No -Pay Net 10943 WALLER,LANSDEN, 749.00 0.00 0.00 749.00 Vendor# Vendor Name Class Pay Code W1040 WATERMARK GRAPHICS INC _,/M Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 133237 OW31/2021 07/09/2021 09/30/2021 273.10 0.00 0.00 273.10 I SHIRT ORDER FOR MMC CLINIC E ✓ Vendor Totals: Number Name Gross Discount No -Pay Net W1040 WATERMARK GRAF 273.10 0.00 0.00 273.10 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC Invoice# Comment Tran Ot Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 9111010000 005/2021 07115/2021 08/09/2021 1,571.67 0.00 0.00 1,571.67 LEASE Vendor Totals: Number Name Gross Discount No -Pay Not 11110 WERFEN USA LLC 1,571.67 0.00 0.00 1,57147 Grand Totals: Gross Discount No -Pay Net 688,481.85 0.00 0.00 688,481.85 filar!/1C:lUsers/mmekissacklcpsllmemmed.cpsinal.com/u88l50/data 5/tmp_cw6report7256912091011677174.htmi 19119 9116121. 3:44 PM 0911612021 15:44 Vendor# 14088 tmp,_cw5repott7551580515696634995.html MEMORIAL MEDICAL CENTER 0 AP Open Invoice List ap_open_invoice.template Dates Through: Vendor Name Class Pay Cade ' AZALEA HEALTH Invoice# Comment Tmn Ot Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 57484 09/16/2021 09/03/2021 - 09/0312021 550.00 0.00 0.00 550.00 PROCESSING AND SUPPORT FEE V Vendor Totals: Number Name Gross Discount No -Pay Net 14088 AZALEAHEALTH 550.00 0.00 0,00 550.00 RepOl k $nnlnlary Grand Totals: Gross Discount No -Pay Net 550.00 0.00 0.00 550.00 file:MC:IUserslmmckissacldopsilmemmed.cpslnet.com/ue8150ldata_5ltmp_cw5repon7551580515696634995,html 111 9/17121. 12:31 PM tmp_cw5repon5446101663372652466.htm1 09/17/2021 MEMORIAL MEDICAL CENTER 12:31 AP Open Invoice List Dates Through: Vendors Vendor Name Class 12636 FUSION CLOUD SERVICES, LLC Invoices Comment Tran DI Inv D1 Due DI Check Dt Pay 28278469 09/17/2021 08/16/2021 09/15/2021 PHONES Vendor Totals: Number Name Gross 12636 FUSION CLOUD SE 1.181.13 Repnrt 6ununm'y Grand Totals: Grass Discount 1,181.13 0.00 0 ap_open_involce.template Pay Code Gross Discount No•Pay Net 1.101.13 0.00 0.00 1,181.13 Discount No -Pay Net 0.00 0.00 11181.13 No•Pay Net 0.00 1,181.13 file:ll/C:IUsamlmmckissacklepsilmemmed.cpsinet.com/u6111501data_5ltmp_cw5report5446101663372652466.htm1 1/1 RUN DATE: 09/16/21 MEMORIAL MEDICAL CENTER PAGE 1 TIME: 14;00 EDIT LIST FOR PATIENT REFUNDS ARID=0001 APCDEDIT PATIENT PAY PAT NUMBER PAYEE NAME DATE AMOUNT CODE TYPE DESCRIPTION --------------------------------------------------------------------------'/------------------- 091521 457.77 2 ARID=0001 TOTAL 457.77 ---------------------------------------------------""-------"'------ TOTAL 457.77 GL NUM F CITIBANK CORPORATE CAR® Account Statement cemMedcalmA4count JASONI'/ANOLIN Account Inquiries: Q1' Tall Free: 1.(800)•248-4553 t International: 1-(9W)A54.7314 Account Number: XXXX-XXXX-XXXX-6997 TDD(TrY: 1•(877)•505-7276 Summary of Account Activity Not an invoice. For your records only, Tatar Aclivily S556.08 Credit Limil S20,O0o Send Notice of Billing Errors and Customer Service Inquiries to: CITIBANK.N.A., PO BOX 6125. SIOUX FALLS SD 571176125 Cash Advance Umil 5o Statement Closing Date 1100312021 Days in Billing Period 31 Transactions •"•^•""'•'••'••.. NOTICE MEMO ITEM($) LISTED BELOW " ... '...... -" 08106 08105 6942 55432861217200651479820 1 AMLJMMp US•2P7GJSKV1 Amm.camAdllWA 98109 USA y^'43.95 '- 111-672976942354 08r10 08109 6942 54432861221200790s25071 2 AMEN MMp US Anam.comINIMA 28109 USA vh1.00 OR 1124740939-21828 OW13 08112 5942 55310201224083333438272 3 AN0NMKTPUS'2O1A78ENI ANIZKOOABILLWA 98109 USA "'409 �. 111-7911090.71994 / MIS 08/18 5942 SM32861230200354407178 4 AMZNMIdp US'20SCS8D51 Amzn.cowbIIIWA 98109 USA ✓v65.29 1114389965-37978 MIS 08118 6942 5M328GI230200376129073 5 AMZNMMp US'2095GWO2 Amm.coMhSIWA 98109 USA 111-0283849.44834 ��Affl OW20 08/19 Me 0513437123260003SMSM5 6 NPDSNPOB.HRSA.GOV 800.767673E VA 22033 USA f2.00 '. NTIO90213 r• 08I20 09n0 6999 654329612322007962538S5 7 AMA•CREOENTIHLING 600621-8=IL Swill USA 'hypo MM 08121 5942 55432B61233200057634255 8 Amamn.cam'2D3E66SK0 Arnm.camll iIANA 0109 USA 89 111.1747799-11114 ✓ W31 08130 829905436841242300232162835 9 FSP-EMR SAFETY HEALT 972.235SMOTX 75243 USA M31 0=0 8299 05436841242300232162919 10 FSP2MRSAFETY&HEALT 972-235833OTX 75243 USA OWI ONO 8299 O&IM1141242300232163099 11 FSP•EMR SAFETY&HEALT 912.235.8330TX 75243 USA „6Q00 W 09102 09101 -9399 55488721245091271004689 12 TXOPS CRIME REC$ S124242936 TX 78752 USA '2196 v' OGM M 01 Me 051343712456DO030405418 13 NPDS NPOS.HRSA.GOV 800.7676732 VA 22033 USA '�- N78254848 ✓+3.00 11 arun, nAm, AOGn Sidi•1AL19dF9nMO]dAAil1F fA 6m.Y.opnpmmmw. AMl-NJHAC II ^MR1Y IISL JA lll NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION a �� . SIIOUX FALLS SD 57117.6125 Page 1 of 4 JASON W ANGLIN CALHOUN COUNTY 202 S ANN ST PORT LAVACA TX 77979-4204 Account Number XXXX-XXXX-XXXX-6997 Statement Closing Date September 03, 2021 09006934902 Notaninvoice. For your records only. ,s N78283385 Page 3 of 4 MEMORIAL MEDICAL CENTER PURCHASE (ORDER Bill To: 815 N. VIRG1MA ST. Ship To: 815 N. VIRGRHA ST, PORT LAVACA, TX 77974 PORT LAVACA, TX 77979 PHONE: (361) 552-6713 PHONE: (361) 552-6713 FAX: (361) 5�5,2tp-0312 FA/X:: /�(36 ) 552-0312 Vendor Name: �jY/�tN.VN✓Y—' Date: 'u�`V ��a Vendor Address: Vendor Phone #: Vendor Fax #: P.O. # Account # . Initiated Bv: Date Required Expense# Department Deliver To Form # 9401 Line Qty. Catalog Number Description No. Unit Cost Unit Extended Mess. cost ( 3 -���t rVl 1 UY 5 6 — pz —.,' S Ca. t)®, �utlr(� Ps C X's g _ I's &0. tan 9_ �X9) Est. Freight ' — Est. Total Cost ~ �% t �yTOTAL COST Contact: Data Dept, Direct( Quoted By: Dir. Numing Buyer. E.T.A. Dir. Clinical Administrator MEMORIAL, MEDICAL CENTER. PURCHASE ORDER Bill To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX: (361) 5522--0312 ^^ � Vendor Name: �1 1 bfz k— Vendor Address: Ship To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361)552-6713 FAX: (361) 552-0312 Date: P.O. # Vendor Phone #: Account # Vendor Fax M Initiated D Date Required Qty. Expcmcw Department Deliver To We Description Unit Cost Unit Extended No. 2 4 , Mens. Cost t 6 0,;, LI - 0 I I a.na z MA &7,44i� - � . 0-0O } f/ t , N Ppe2- I dew a,®� a �'u� flVthld'6:TVL— iioi)�cticrkl {ilLboS }y l s 's v u4 - n`t — (kc+tt d, 07 Vic 10 1A tj I61VI 30 ++ - S!,<. 7 r�(lpuINL— fbaVyi(Ait) (Aoll -Ni J'Aotkanhl 9 (�cnla3o,1 1�,li1� �•pl,o�rtra.r�.t f`>Ldlt io �--STF Est. Freight Est. Total Cost �i /��Ls /I . 11 .� L� i _I►11 �LI Contact: Quoted By: Buyer: Date: E.T.A. Dept. Director_ Din Nursing Dir. Clinical Services TOTAL COST )5(1. 0 Administrator MSKESSON STATEMENT As of: 0911712021 twos=,r: aoso DC: ens MEMORIAL MEDICAL CENTM AMT DUE REMITTED VIA ACH DEBIT Territory: AP Statement for intonation only 815 N VIRGINIA STREET Costs. 632636 PDRT LAVACA T% 77979 Date: 09/18/2021 Page: 002 To ons re proper eretlb to your account, detwis and Mum this stub with your mmOtance As of: 09/17/2021 sage; 002 Mail to: Comp: 8000 AMT DUE REMITTED VIA ACH OMIT Statement for information only Cusl: 632536 PLEASE CHECK ANY Date: 09/18/2021 ITEMS NOT PAID (�) 9111ng atlonnt Account MpIa�sPaS Due Number � omen Cash Amount P Amount P RacaWable ]ale Date Number Rafemnce Description Discount (gross) F (not) F Number 3F Column legend: P = Pest Due Item, F = Fulum Due Item, blank = Currant Due Item 'DTAL• National Acct 602536 MEMORIAL MEDICAL Cf31TLTi Subtotals: 13,220.10 USD 'Kure Due: 0.00 Due It Pald On Time: 1t Paid By 0912112021, USD 12.955.71 inert Due: 0.00 Pay This Amount: 12,955.71 USD Disc and It Wald late: 264.39 ast PaYmerd 2.451.97 If Paitl Aker 09/21/2021, Due If Pahl late: 18/07/2017 Pay this Amount: 13.220.10 USD USD 13.220.10 For AR Inquiries please contact 800-867-0333 EVISKE'rJSON As of 09/17/2021 Page: 001 To seems Paper cso0 to yoor STATEMENT eccamt, 0elach 6m1 Mum this cwnvmr. eesv sl with pour ramlttance DC: 8115 As of: 09/17/2021 Page: 001 MED Rr15 ANT DUE WEMORIA' MEDICAL VICMEMORIAL MEDICAL CE4TFA Statement KA LISIX 15 815 N VIaGINIp ST PORT L4VACA TX 77979 REMITTED VIA ACH DEBIT for inlormaron only Territory: 400 CUMamer. 258342 Dale: 09/18/2021 Mall to: Comp: BOoo AMT DUE REMITTED VIA ACH DEBT Slatemenl for Information only Cum: 256342 PLEASE CHECK ANY Date: 09/18/2021 TEAS NOT PAID (�) filling )ate Due Dale Receivablg"atlanal Account WS8536 Number foference Descriptor, Cosh Olscount Aerosol P (Toss) F Amount (net) P F Rem lvabo Number )melame/ Number 256342 WALMART 1090/MEd MED MS 19/13/2021 09/21/2021 7293508262 15224280 1151nvoice 25.62 1.281.16 1,255.54.E 72935082B2 19/13/2021 09/21/2021 7293500263 15244403 11slrtcdce 0.74 37.06 36.32✓ 7293608263 19/13/2021 09/21/2021 7293508264 15244403 1151nvome 9.70 484.93 475.23 ✓ 7293508264 19/13/2021 09/21/2021 7293608265 15286660 115lnvoice 10.19 509.63 499A4 ✓ 7293508265 IW13/2021 09/21/2021 7293508266 0912211534-00 1151nvolce 0.74 37.06 30.32 ,✓ 7293506266 19113/2021 09/21/2021 7293508267 153450D8 II Sinvmce 5.10 254.82 249.72 ✓ 7293508267 1W13/2021 09/21/2021 7293508268 153450DO IISlnvolce 0.01 0.63 0.62 ,✓ 7293508268 -9113/2021 OW2112021 7293682924 0910210846 1951nvolce IAA 70.21 68.81 ✓ 7293682924 19/14/2021 09/21/2021 7293832616 15361600 115lnveice 1.77 88.36 86.59 ✓ 7293832618 -9/1412021 09/21/2021 7293832619 15399539 1151nuoice 8.49 424.39 415.90 ✓ 7293832610 1W14/2021 09/21/2021 7293832620 15399539 1151nvoice 19.85 992.69 972.84,% 7293832620 19114/2021 09/21/2021 7293976770 0913211004 1151nvmice 2.31 115.39 113.08 1/ 7293976776 19/15/2021 09/21/2021 7294110605 15439604 1151nvoice 4.32 215.98 211.66 ✓ 72941TO605 19/15/2021 09/21/2021 7294110606 15476974 1151nvmlce 16.98 648.94 831,96✓ 7294110606 19/15/2021 09/21/2021 7294260118 0914210837 1951nvaice 39.74 1,987.17 1,947.43 '� 7294260118 19/16/2021 09/21/2021 7294385495 15500474 115lnvolcs 7,75 387.42 379.67✓' 7294385495 19/16/2021 09/21/2021 7294385496 15539325 1151nvolcs 9.42 470.96 '461.54.✓ 7294385496 19/16/2021 09/21/2021 7294540403 09t5210549 115lnvoice 2,53 126.73 124.20 •1 7294540403 19/17/2021 09/21/2021 7294649872 15563424 1151nvoice 5.70 284.87 279.17 ✓ 7294649872 19/IU2021 09/21/2021 7294649874 15503424 1151nvoice 3.47 173.45 169.98 -1 7294649874 19/17/2021 09/21/2021 7294649876 15603664 1151nvoire 1.91 95.66 93.74 ✓ 7294649876 19/17/2021 09/21/2021 7294649877 15613280 1151nvmice 1.91 05.05 93.74/ 7294649677 19/17/2021 09/21/202/ 7294778630 0916210716 1951nvolce 6.45 322.47 316.02.' 7299]78830 19/17/2021 09/21/2021 7294778631 0916210737 1151nvoice 7.36 368.11 360.75 / 7294]]6691 For AR Inquiries please contact 800-867-0333 MWESSON STATEMENT camemr. Boos WALMARr 1098/MEA MED PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CENTER Statement for information only VICKY KAUSE( 815 N VIRGINIA ST POST LAVACA T% 77979 tote" Date As of: 09/17/2021 Page: 002 To ensrae proper credit to your amount, tlemoth and return this stub with your mmmmnm DC: 8115 As at 09/17/2021 Page: 002 Mail to: Camp: eD00 Territory: 400 AMT DUE flEr11TT® VIA ACH 0®R Statement for information only Customer: 256342 Data: 09/10/2021 Cult 256342 PLEASE CHECK ANY Date: 09/18/2021 ITEMS NOT PAID (+) Cash Amount P Amount P Receivable Description Dlsount (gram) F (net) F Nrmber T column Will P = Past Due Item, F = Future Due Item, blank = Curren Due Item 'OTAL Customer Number 256342 WALMART 1098/MEa MED PHS Sublolole: 9,573.73 USE) 'alum Due: 0.00 If Pak By 09/2112021, kart Due: 0.00 Pay This Amount: 9,480.27 USD Ast Payment 9.207.30 If Paid After 0912112021, 19/13/2021 Pay this Amount: 9,673.73 USD For AR Inquiries please contact 800-867-0333 Due It Paid On Time: USD 9,480.27 Was lost If paid late: 93.46 Due 11 Paid W. USO 8,6]3.]3 MSKES'JON As of: 09117/2021 Page: 001 To ensure proper cre6K to your STATEMENT account, BHeeh aM haum this wm: emo Mub with your remklarwe OC: 8115 As c1: 09/1712021 Page: 001 FC AMT DUE HQAITTED VIA ACH DEBIT Territory: 400 Mail to: Comp: 8000 ME ORI MEDICA490/ML R AL MEDICAL Ca4TFA CENTER Statement for inloanation only AMT DUE RWITTED VIA ACH DEBIT VICKY KAU$EK Customer: 464450 Statement Ion alormati n only 815 IN 815 N IA ST Data: 09/18/2021 AVACVIRGI PORT tAVACA TX 77979 Cust: 464450 PLEASE CHECK ANY Data: 09/18/2021 ITEMS NOT PAID (✓) 129 Due )ate Date neceivablrtianal Account 45r36 Number nalmoce Cash Descriplian Discount Amount P (gross) F Amount P Heeeivable (rout) F Number :udamer Number 464450 H® MY FC 490/MEM MC PHS P911612021 09/21/2021 7294380462 55x621048 1151nvoice 48.49 2,424.64 2,376.05,/ 1294380462 19/16MO21 09/21/2021 7294380467 6Sx621278 1151nvalae 0.12 6.01 5.89�/ 72993B0981 19/17/2021 09/21/2021 7294613764 55x626414 1151ntolca 8.07 403.27 395.20 ✓ 7294613]69 1F column legend: P e And Due Item, F = Fulum Due Item, blank = Current Due Item 'OTAL Customer Number 464450 HEM MY FC 490/MEM MC MS SaMmals: 2.833.82 USD :aura Due: 0.00 Due It Paid On Tim: If BY 2021, DID 2,777.14 2m Due: 0.00 Payy This Amount: 2,777.14 USO Dina lost H pad late: 56.68 m Paymme 9,207.30 11 MW After 0912112021, Due It Paid Late: 19/13/2021 Pay this Amount: 2,833.82 USD USD 2,833.82 aql". For AR Inquiries please contact 800-867-0333 4 For AR Inquiries please contact 800-867-0333 4 MWESSON STATEMENT s�ma�v: sms CVS PNCY 7475IMEM MC pHs AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CMTM Statement for information only VICKY KADSSK 815 N VIRGINIA 5T ART IAVACA TX 77979 Ylling Due Reeeivabl0'to allonel Amount MIPS )ate Date Number Reference As of: 09/17/2021 1 Page: 001 To ensure Proper credit to your account, dataM and Mm uthis stub with your containers OC: 8115 As of: 09/17/2021 Page: 001 Mail to: Camp: 8000 Territory: 400 AMT DUE ASIMITTED VIA ACH D®IT Customer: 835438 Statement for information only Date: 09/18/2021 Oust: 835430 PLEASE CHECK ANY Date: 09/18/2021 ITEMS NOT PAIID Cash Amounl P AmouM P Resolvable Description Discount (gram) F (net) F Number )ustomer Number 835438 CVS PHCY 74751MEM MC pHs t9/16/2021 09/21/2021 7204554479 1355777 115lnvoice 14.25 712.55 698.30 1/ 7294554479 O W column legend: P - Past Due Item, F - Future Due Item, blank - Current Due Item -6TZ Customer Number 835438 CVS PHCY 7475/MBA MC pHs Subtotals 712.55 USD 'inure Due: 0.00 Due It Paid On Time: If Pald 8y 09/212021, use 698.30,a% 4st Due: 0.00 Pay This Amount: 698.30 USD Dice loaf H paid late: 14.25 ast Payment 9.207.30 N Paid After 092112021, Oue II Paid We: -911312021 pay this Amount: 712.55 USD use 712.55 For AR Inquiries please contact 800-867-0333 STATEMENT Statement Number: 61641181 1 011 AmensourceBergen- Date: 09-17-2021 AMERISOURCEBERGEN DRUG CORP WALGREENS a12494 340E 12727 W AIRPORT BLVD. MEMORIAL MEDICAL CENTER 1001352841037028186 SUGAR LAND TX 77478-6101 1302 N VIRGINIA ST PORT rAVACA U 77979.2509 Sal -Fri Due in 7 days DEA: RA0289276 866-451-9655 AMERISOURCESERGEN P.O. Box 905223 Not Yet Due: 0.00 CHARLOTTE NC 28290.5223 Current 377.54 Past Due: 0.00 Total Due: 377.54 Account Boleros; 377.54 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 69-15-2021 09-24-2021 3057694087 162841 lawice 154.12 0.00 154.121 09-15-2021 09.24.2D21 M67694088 162842 Invoice 0.09 0 DO 0.091j 09-15.2021 OB-24-2021 3067694099 162843 laud. 0.09 0.00 0.099 09-15.2021 09-242021 3067694780 162844 Iavaice 9.06 0.00 9.06-: 09-16.2021 09-24-2021 3067832813 162854 Invoice 214.18 0.00 214.18 , Current 1-15 Days 16-30 Days 31-60 Days 61-90 Days 91-120 Days Over 120 Days 377.54 0.00 0.00 0.00 0.00 0.00 0,00 Reminders Thank You for Your Payment Date Amount Due Date Amount 09.17-2021 (343.58) 09-242021 377.St TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) "ENTER 9-DIGIT TAXPAYER IDENTIFICATION NUMBER" "ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE it SIGN" FTIF FEDERAL TAX DEPOSIT ENTER 1" Ell ENTER 2-DIGIT TAX FILING YEAR" "ENTER 2-DIGIT TAX FILING ENDING MONTH" 1ST QTR - 03 (MARCH) - Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) -July, Aug, Sept 4TH QTR -12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" "6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER #fin# ENTER: 1� -� 21 �- 09 $ 97.32 1 $ 54.56 $ 12.76 $ 30.00 CHECK 5 CALLED IN BY: CALLED IN DATE: CALLED IN TIME: 1j F:WP•Payroll FileslPsyroll Taxes12 VW19 R2 MMC TAX DEPOSIT WORKSHEET 09.9.21.xis 9/1612021 v m: m a/ ^ � e ........ —.... : + MEEKRUI e«. , Pace , _! * ; A , : Pay Par!" m- u m. �. — Grand Tornist m;-- t Gross: «_ r.Inks �: ,: Q . , » Iredil -- __: 94AE Her: : ar cvArAmt _at : I ------------------------------------- .......... . 1�,, e, 4 � MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT -- September 13 , 2021- September 19, 2021 Date Bank Description 9/13/2021 PAY PLUS ACHTRAN5452579291101000694105076 9/13/2021 CLEARGAGE LLC CLEARGAGE, 7HSTY27XL14XOMF 242 9/14/2021 PAY PLUS ACHTRAN5452579291101000695048338 9/14/2021 MCKESSON DRUG AUTO ACH ACH04728795 910000133 9/15/2021 PAY PLUS ACHTRANS 452579291101000595945492 9/15/2021 TEXAS COUNTY DRS RECEIVABLE 0419 21000027387 9/16/2021 PAY PLUS ACHTRANS 452579291101000696940460 9/17/2021 PAY PLUS ACHTRANS 452579291101DO0697798196 9/17/2021 EXPERTPAY EXPERTPAY 74600341191000012508059 9/17/2021 AMERISOURCE BERG PAYMENTS 0100007768 210000E 9/17/2021 MEMORIAL MEDICAL PAYROLL 746003411113122650 9/17/2021 IRS USATAXPYMT 220166030885990 6103601000472 Jason Anglin, CEO Memorial Medical Center PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT -- ESTIMATED ACHS Date Description 9/20/2021 ACH Payment WEBFILE TAX PYMT DO Jason Anglin, CEO Memorial Medical Center MIMIC Notes -3rd Party Payer Fee - Patient Financing Service - 3rd Party Payer Fee -340B Drug Program Expense -3rd Party Payer Fee - Retirement Funding -3rd Party Payer Fee - 3rd Party Payer Fee -Child Support Payment -Payroll Ending -3408 Drug Program Expense Payroll - Payroll Taxes September 20, 2021 h N17'1muk uy l5 m! 1c 'eA-p.1,FvwJ 1. 0q'aN I G- MMC Notes -Sales Tax September 20, 2021 ( ytl-b,q Amount 67-4 CA EUY5jt cL 6 9207.3 a{ by t „ 134,67' 14262227, In'4$ 614-L,., 124,44? t 343.58 322452.04f- 106133.59.+ 6 1 - 4 u - 581,835.23 6 1 4 - .- I Amount 1A59.84. '.:. 1,459.84 LI•UU '. QQ Confirmation: You Have Filed Successfully Sales and Use Tax Taxpayer ID: User ID: Reference Numbs, Date and Time of Filing: 09/1512021, 09:26:54 AM PAYMENT SUMMARY Electronic Check State Amount; $1,105.94 Local Amount: $353.90 Amount to Pay: $1,459.84 Electronic Check: S1,459.84 Period Ending 08/31/2021(2108) Taxpayer Name: MEMORIAL MEDICAL CENTER Taxpayer Address: 815 N VIRGINIA ST PORT LAVACA , TX 77979-3025 IP Address Payment Reference Numbs Trace Number Entered By: Sarah Henderson Email Address: Telephone Number: (361) 552.0342 Type of Bank Account: Checking Accountholder Name: Bank Routing Number Bank Account Number Payment Effective Date: 09/20/2021 CREDIT SUMMARY Credits Taken Are you taking credit to reduce taxes due on this return? No Licensed Customs Broker Exported Sales Did you refund sales tax for this fling period on items exported outside the United States based on a Texas Licenced Customs No Broker Export Certifications? LOCATION SUMMARY Lo<e Total Texas Taxable Sales Taxable Subject to State Subjectta State Tax Due Local Tax Rate Local Tax Due sales Purchases Tax (Rate.0625) Local Tax 00004 17784 17784 0 17784 1111.5 17784 0.02 355.G8 SubTotal 17784 17794 0 17784 1111.5 17784 355.68 Total Tax for Locations $1,467.18 Total Tax Due: 81,467,18 Timely Filing Discount: -87,34 Balance Due: $1,459.84 Pending Payments. -$0.00 Total Amount Due and Payable: $1,459.84 ( State amount due is $1,105.94) ( Local amount due is S353.90 ) 9/16/21, 2:06 PM tmp_cw5report3294206206648316972.html 09/16/2021 MEMORIAL MEDICAL CENTER 14:05 AP Open Invoice List 0 Dates Through; ap_open_invoice.template Vendor# Vendor Name Class Pay Code 11828 SOLERA WEST HOUSTON Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 083121A 08/31/2021 08/31/2021 10/01/2021 3,420.00 0.00 0.00 3,420.00 TRANSFER V4f I(uxJV1ftU_ c(poSi-64 ihfD fN.A-L 0VCj,&4ih Vendor Totals: Number Name Gross Discount J No -Pay Net 11828 SOLERA WEST HOt 3,420.00 0.00 0.00 3,420.00 ,;cl-nr ,.�nncarg Grand Totals: Gross Discount No -Pay Net 3,420.00 0.00 0.00 3,420.00 .. �.. it ._.. .. file:///C:/Userslmmckissack/cpsilmemmed.cpsinet.com/u86150/data_5/tmp_cw5repoh3294208206648316972.html 1/1 9/16121, 2:04 PM tmp_cw5report5742840757990120983.html MEMORIAL MEDICAL CENTER 09116/2021 0 14:04 AP Open Invoice List ap_open_invoice.tamplate Dates Through: Vendor# Vendor Name Class Pay Code 13004 TUSCANY VILLAGE . Invoice# Comment Tran Dl Inv Dt Due Dt Check Dt Pay Gross Discount No•Pay Net 090721 09/15/2021 09/07/2021 10/O1/2021 1,812.54 0.00 0.00 1,812.54 MEDICARE REPAYMENT SWINGBI Vendor Totals: Number Name Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 1,812.54 0.00 0.00 1,812.54 `ep,: SU':,noi•, Grand Totals: Gross Discount No -Pay Net 1,812.54 0.00 0.00 1,812.54 file:/RC:IUserslmmckissack/cpsilmemmed.cpsinet.com/u8B150/data_5/lmp_cw$report5742840757990120983.html ill 9116/21, 2:04 PM tmp_cw5report4913786334812291983.himl MEMORIAL MEDICAL CENTER 09/76/2021 AP Open Invoice List 14:04 Dates Through: Vendor# Vendor Name Class 11836 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Ot Inv Ot . Due Ot Check Dt Pay 090721 09/15/2021 09/01/2021 10/01 /2021 MEDICARE REPAYMENT SWINGBI , Vendor Totals: Number Name Gross 11836 GOLDENCREEK HE 3,694.90 i tnp>url Si�cron,y Grand Totals: Gross Discount 3.694.90 0.00 0 ap_open_I nvolce.template Pay Code Gross Discount No -Pay Net 3,694..90 0.00 0.00 3,694.90 Discount No -Pay Net 0.00 0.00 3,694.90 No -Pay Net 0.00 3,694.90 file:U/C:/Users/mmckissecktcpsi/memmed.cpsinet.coMu88159/data_5/tmp_cwSmport49137B6334812291983.himl 111. 9116/21, 2:05 PM tmp_cw5report3582159849940641618.html 09/1612021 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 14:05 ap_open_involce.template Dates Through: Vendor# Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 083121A 08/31/2021 08/31/2021 10/01/2021 1,217.06 0.00 0.00 1,217.06 TRANSFER Wji%MVv1-R1L P✓PA{dLp0Ej1i ej in`h Y4\11i.L OpcM.-11 Vendor Totals: Number Name Gross Discount No -Pay Net 12792 BETHANY SENIOR 1 1.217.06 0.00 0.00 1,21T06 Report SUM.11,11y Grand Totals: Gross Discount No -Pay Net 1.217.06 0.00 0.00 1,217.06 :i7r1;;r file:l/1C:1Users/mmckisseck/cpailmemmed,cpsinet.com/u88l50/data_5/tmp_cw5report3582159849940641618.html 1/1 Request for Transfer of Funds rransler a: OaG flepues4tl Payel Requatetlh, IE Requatofione mail pls P -Ayber number plrtnnormunry wit, alermem@inm unlava FeteN R OI paleaf SeMte RE AM vm pl VavmeN pal Pavmene TftrnM! 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T.9 AllbnnwlW lnhr MyaFlafve4hl 3!W!E OROADMOOR At CREEk510E aMwn an IX168 I0.CM38JSSAy1[ 61RE N/A N/A B/I6/2021 EFT R/A N/A onwoll EFL 1,963.1E EFTW55089 NOOACW016869 836E ORWOMOOR AT CREMIDE N/A N/A _ 8/IMMI EFT 1.35431 EFIGM 515 NOAROWO26869 SE,31 ORWOMOORATCREERSIDE N/A N/A 9/32/2021 EFT 3.30312 EFTG4 M2 NOMOW]EW69 95.16 310 nMODRAT(REMME N/A N/A B/IB/M (FT 5 1.47556 EFTMM (VWROGW26969 6335 BR0AOMOORATCREEMEDE N/A N/A vb=.21 Efi 5 638.99 EFT6059578 N.EREW]W69 26.53 ROMI.00R At EREERSIRF WA N/A R/39/Ml EFT $ 39.Op EFT6061.0 NOAfl00N26869 ]62 DROADMOORATCREERSIOf b/A N/A p/19/E021 EFT $ E99.i2 EFMOG170 NOARWN26869 3.19E BROA0M00NAT CREEMIOE NM R/A 8/33/2021 EFT $ 3,159 E8 EROB709 NOARWW26869 89]B BRCIAMOCAMMEMIDE WA WA BJ2312021 EFT 5 3.190.19 efi6069680 NOAMiJ2W49 13361 BRMOMOORATCREERSIDE II/A WA B/2q/20,, FFT 5 127.83 EF16MI201 NMRL lsfi09 5.31 RRMOMOOR M CREERSUE WA N/A R/IS/INl [{T 5 M10.63 fF1W69101 N 0(EXT26069 11320 ORMDM00RAT(REERSIpF WA WA W25120E FrT 5 9,II3.9] EFT6069125 NDAAORGUNS09 332.53 tlKWOMDOR AT CREERSIM 8126 2021 [FT $ 431.8E EFT60R959 NOAROD0026B69 12.96 ORMOMOOR AT CREERSIOf N/F R/A 8/2612021 EFT $ 1,022.AO EFi6GN935 NOAR000026869 1 42.51 BR0ADMOOR AT CREER510E WA IIA B/3W3021 [FT $ S,393W ERW7I140 NOAA0 26969 1 223.85 BROAOMDOR AT CREEMIOE TOTAL 32.95R56 To6l filllE ou[hy MOmoFial McGIGICeNen DaG RlFelve 9 2 3031 APPFmed 6Y Cteveryyr AaG_.REl ec 92E 20I Fro N llitY immeM . StA fC! Te FaGllty: MM(nn2 Amount: I.3I03[ Request for Transfer of Funds rmnElm N: ..I. Mqun@d 9/17/2021 .,u mfmuRE RequeetN by IAEUM 6[IBWN- BUSINESS Uff ICE MANAGED 0.equeetoM1emall iAo�tlen'alir`ylmn �� Pequestvls phone number 361-SS1L500 msm[IaemuMY CA... faelliµ Bmb, S.,., VWnB and WB SEPIYeya bm mmondvxa.mm [OENwery.M Wlm patkMName V W Gate ul EervRe RE VIRW rummpaymeM qee E py'i n� Claim Numhef gNmneNN. [mee uLnEE4jQjYnG.N p_,LpURf[Nunt H/A N/A 9/1WZ@E EFT [R601E99 CVUAPLYp@I:B69 S1E.97 i OMGPE(PEfY.510E-AVXILNflY AWANCEWAN[F PMe 11 be Nlled aut MBmmial Metllul QntOt: eh ale Pere 9 )] i0 1 A,,.Yed bY. C nenecr Bate.l n.MFee 9µn:3ow Fom Ea[BLr: W., r itp Hotln MpUmunL 5129 osieoh anslenw,•• m EWlity: i.uPMNry. une Request for Transfer of Funds )rinser a: mupegvevetl s.y.0 I." MEXIURE PequegeO bl: PPCMARENN flequestoi[—i' weAldnyrnenr Requeelole "I",number )13-01063w .11W. ar.-, e6 .m wi, NSC/rXY VIWGF v.xa�rcw� P I O3hnl6em4e pF I Oateo(pavmen[ rve.nrva...�. (M A e�rmeue jbmmen (jle6Humher (HMHumber Munan.eaee. rme, weedln a,rvnm Nl �a)6a4 Nodea 9,I3.Z3 EA 6 alaez EFi4 6 Oue Tusany tram Braadmaor 9].xl fA $ m 65 [FT4GpG9G5 WOVM/CVOpPb 2069 /CVOpp00O3x6P69 3 2zo Oue iusunYlrom BroMmaor iMPF a64.36 96fi 36 - Tobe llletl curb Medmdial Metliul Center. Odra Oxl Pppmved by: [[Isupryel m[e ohramler: rl1 Rl � n frcmFitlllty. WndEmaor io radPry: wmv pmovne a oamounrore. pmm AnrNv: rnF.nnrv: amnvm: i I'm e Xr::.. C_F; Request for Transfer of Funds rmmrerv: mate Remelled 9p012M Pavel .n.EHM b, Ad-1-5HAn, Inummubhenull number elrOM1pnane npmbm minNamrcvumr Famliv b: ulerrnem Wnimnmllrvacxmni n_MJAM� mERvHLAxa59c9En. pales Tweoftement F. Memeleek gvment SMw owEkitIYp•9efB/I6/20)1 •wennrtbb4rrr n NndSffuAJj ip]968 FFT6055921 NDARWNE955] n489 MECRESENT 8/10/2021 EFT 1.903.12 ER6055989 CVDAKEW01955] 8162 IIIECRESENI tl 1]/M2E EW 135431 EFT605]614 CVDARD]Ig1955J 56.31 CHEERfSENT 81IM021 EFi L3036U lr 6wslw NDAR21W01959 95.I6 NIECRESSN2 r &./ almo21 EfT 5 1,4T556 EFT059608 CVDAR=ft955] 61.35 THE CRES1.1 q/19/M2t In 5 63R99 EFT60595TR C.rmnmb01915) z6.5] INECIIESENiWI9/20d1 EIT $ 39.W EFTH52T40 N.AW00195s2 1.62 THE CRES2NT q/I9Rm2l Ell 5 899.11 EFT.1103 NDAPCU N551 3]A1 THE CRESCNT 822U3021 Fit $ 2,1594R EFT6065]09 NMPCIM19551 M.]8 INECPESENT R/23/20z1 EFI 5 3.190.]9 r,Hl680 CVDAR000919552 In,62 IIIECRESENI B/E4/SOlI Fit $ I2293 EFTM7287 NDAPWW1955] 531 THE CRESENT WP N/A B/25/M21 EFT 5 2.» 683 E216069201 (VOPRM 1959 THFCAESEHi N/A N/A 8/SSlM21 FFt 5 8.117.93 FFi6069I)5 CVOAPDO'A1955T THEM., N/P N/A tl/26/2021 fFi 5 431e4 EiiCA]0959 NWR0N019557 INECPESENT N/A N/A B26/Epil fR $ 1.@3.40 FFI60]0935 NpMCW019551 THECPEWNt N/A NIA e/30/ID21 FFl 5 5,383.92 EF36014540 CVMR00001955] 1HECR15EW J223AS I be Memorial Metllul hnler: 0n e. eaencerac 9/zz zOZI �4 ¢sMMC n.1.31 =!r. Aw _: Request for Transfer of Funds nanire: a: oamp0queind s.y.zl payu M[WCPRE Requeiladby: HA[HEIPAEN/SAS Requestasenoll -:N !L6'1'vPrnu RequestoripMne number nvnlns3m OUNEarCounly DWOPIA fMlllly TU5C RWNAGE mllereneu 0 nme6pylaver_nJ __ -, wm,me mMv_.,m_=3 PoHe,RName pR0 4aleelvMee pE Oalmmmw TyppelMmen[ I(Y.&[m � flg(p Numhe Mlm Humbee p[elmnxtlM ry:nE, 4lmiuM VTNxum aalyg Newnan 9.1i 31 FR 5 918.e6 F{IfL06N0 W[I/NOAPbb]1965] S alee4 Due lm[anY l,nm Cres[ent 9].]I FR 5 e].SO FirE600965 WD/NOARW003955] 5 050 Due imnnylum Ues[enl TO]AE a4Q34 <66.36 Tobefilledoulb Memonal Medl[al Cemn: epmwd 91 d 1 ApP,ovud br C o nulaamlu: nt2 zozs inmeadl'nr cm[em T. Tanrir muanv ammnl! c4c.]4 nm r,m,Froners: Dan of....W - immHalllq. A .u.!y: Pmaunf. Request for Transfer of Funds rraa:T[rx: oate IUHMI.ud 9/ty/20,2I 1-m MEDICARE Requeeledby: TATUMGGRDON BUSINESS OFFICE MANAGER Requestoh mtil ly_mdmi m��liY_ RequeNOYpAone number 361-5540500 p6vinarmunry Calhoun HdCM Delnsry Senior Uvi, wmpgmemarrnoupmml,11. pmNa WNalwaw" h. TLpv_eryrvCDinmrnmlNva[ayon� m.,nmmrpeNwyaEnn' patleM Name REQIRIIED pamaFS Dd,, RE I p llgmalpamient TweeHRIDAD nt AR En PRTRR t Q... SWI, 1 NARDI- a.l...C11 19vSf'9lU.gVNA. X/A WA 9pOVID EET IT WITI, CVDFRWIID19557 5E297 THE CRESENM1PU111LLARY AWANCE PMT TOTAL Sli.9T To be plied om by M M—m. Medial Cemer: Oa1a Re[e 9 TTp]( Ppprwed by: CCIevMFM Date Pl FF[ility:tlift, 7zgmv From AD'.,cRIM:.0 iatlllry: HAD'., Ampunl: 549T DM. i1-fi ei1 r m Fadne Amount: Request for Transfer of Funds Tpml[, Y: oa[e Requ.s.d Payer Requested by: Requ[ibr'mmall Reque[[oh phone number Binrinurcamm, Fa[Ili[y Pa[bm Nyne Y B Coleol5ervke flustmende.ms "mooffavment PdMen[ 1 Nnd[I.Is {unJ9E (p_Tpygly[gl Nees ( N/A WA and/2031 FFT 1,0796B EF]E055921 NMBOSp019556 AE. 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TOTA( 329EB96 __ 1.3]O.N .. To fie filled oath MI-611 Medilll Onsee: ogle Pea oed: 9 20 20 Ano,na'eB h9: Dam FVT Milane: e,E.n9:.l2-2 20P2I1 Y TOslle! Amount: llr: IMTeMS[Lomit, 1.31034.' 1 AIM: Request for Transfer of Funds hamfer p: D.M llepueelM 917.21 Payea MEOIWE Red uvledb, MCHELAREH.WS emMl :p:t+] us [nrP�nef 71 - meeeeue:bff nenora pnone number ]13-0]0-53pp DM[1[l Ov Caue, 8... .aiW N5GHYVItmaf ((lerenvn:®mmeeo ne[Cmm[no b Muni IpPjEnulwl Typa of Parma t L nt qeh Xu rope) Ci0 m Xumber gXXnnaaFPL.11 ryPlc Su:ge2-la FUMe ag YOY �.aS44Yp5 a them D" 9].]t FFi 5 "so Ef ensw65 WO/NURD0.VE9556 5 so eaey from FORTDENO - iDTgl If 50 C],5p MPmoXaI Medim CCenNr.ce =CenNr.ledadt ed: 9 202rd bE': CCIWaMevlRnrfer �2 p1ciell: crt Bend:: luiWnY iJ.yJ' M1emXe aa:a Pl:alft: J:nW ..T AL�._•. , Request for Transfer of Funds ir4Mere. Inks Hayvenen �r Iteyuutedby. Re -= 0 Pepuetb,'v Obane numM1n vhtk ...... 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[ E Aa_nL_ riILWC6( Eb,Emnga nMM.[nme (yMeylm Lent°NI Ionru be fec H/A N/A 9/IWM EFT ifi609LL99 NMROWT8110 SUED Salad War Nomton-MXItWRYA NCE FIAT TOTAL 5119i Tahe Olkdagiu Memmlal ..deem... 1: WmR ed APPLaved W.CC er¢n6M Olte allLir f: 91P ]Oil .E."'t", nSoera T. oel nv Ammn Amunt 51).9T Farm FmlitY: m FadlltY: _.. AmOunf. reamier R: Request for Transfer of Funds oa<e PegppXptl payer PeNuefeep by PA[IIfLRX[N)SAS PegvesMlsemaA usAa3•YwII�r.LSSar_m IlepuaMlphpne numbfr 733]]0A3M Olserl[LpICOuney BPAEDPX. Fxiliry IUSGHY VIIUOE patlenl Namn RE UIR (ROWRE rvbe ED)wHalpaeme,rt Treeufparnn (X Efi 1 Pa'men! gpe4NumFe. Balm Xumher Mna. bY0 NMes aM1e4npn 91i.0L 9. ].SI EET fFl 5 ae 5 so FFl00063a0 EETWB0945 WO/EVDeRWWt01]U WO/[VMPWN'IRa]0 5 eo S aa].Sp DueimunYi.om Sopm L1e iu%any bom 5oera p6636 ip be filleE oul by Memmrhl Metliml 4n4e Dah pp 9 SO NIEt :1pPepveU bu: t evenP.ry wreorin, rem xz Eo]t r fadury: F.di ft : sple a m imam llm°ue! a46. DatroTYM.r4m as hmnsbr. 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TDTAL 3E.950.56 GpIOFN CAEEN Tebefilledwt Memofial Mael[il Cenle[: Da1P e 9 E0 1 Applpeee by L[leue e [ Di4011rsnge[: 9}E JOE From FaNllty: -a G.yy .t TO Pa011[y: [M1n!( AMOUnt. 1,3]0.9d r1� 09' ham3m A: Request for Transfer of Funds mte Requeeted 93In Poyer MEMCARE Requmted br MCIIECARENN S Requnlofs _ �iLII3ggEaee riei RequeetoYs phopho ne wmhei I13-]]0.63M OIa1NRe/Cauply GRAZORIA Ndli, T9SCANY NFWGE 1 n nm[dm olben/a co" PMIena Menu pE EIIfl pateol$rvlx NIpFO Oate Mpdvmen] ivceal Varmenl (M�e EFl1 ry�p� 3__ vim- GehMumM/ paMNumle/ ANlen neelM-fMe tl- IVM/41d NM/la3 nyWpe¢ 9.13.E1 9.i33 Ffi FFT 5 <sene 5 2m [RE9063C0 EET6G00945 WO/(vOARWW)9340 WG/(VOAR9pM)95i0 S ee 5 w Oue lusunH/om4dtlen UeeR Oue[uxa, ltam G.Wtl Crcek mTN 466.36 fo he fdNd uulb M .,W Medical@nl, Yateflace I93 E A,,-.d 6Y+ Cfleveu0e/ gale of tnmlei. 9 ]1 10]1 imm Ea,lt: Go en C/eek TO Fa n, U, Amnvnt 466.36 i' nl¢WaeL Nalea.lnnifB/: T*Fa Efl R foouok[ AmOvnl: Request for Transfer of Funds nanne�u. pae Requeslea 911712021 Paye[ MEDICARE A,.ottahy: TATUM GORDON- OUSINESS OFFICE MANAGER RequeRhe"n A pa,Jllhn[hmlmny+lwygnm gfpM1One nue[ RumI.r uasvnRm AM. o. Counly Uhoun iaalNr eemany..I., Im, SYlgena«®mm[nmN.rv,ca manmeerommmnma..ca com ME .NMRLINEN �RF�RJ pEeei4nYe qQ 1 paleaf Pe M Mani Pevme CM1e Pamrtnl [he[Y umha[ tl.Im Numbe[ A[1lmmNet.mm[ N ryne.uaFuee. FN ^ N/A NIA 9/Ib/2021 EFT EBb ID, UOM000019510 92.9] GOIVf. CREEA&AI N A.1l. v ADVANCE PMI roraE s{29} mhe nieaave avMemarol meaty cameo pale Reserve }} 2021 APPmwa W. pare ai[2mle��}Ip{ ipm htiliry: Gn tlen CrcA lO Fatlllty; ny AnwunC SILY} _ _ nem F%16W P� From Faellily: TA Facility. Ampunl M. Rpquesu6 Payel Pequ<rtetl Ey: RepuesearS emaJ RepuestoYl phone numker plsxlttprfoun[y WIRY S�y.Y➢Rnfi9n m •ifdmn oUPlt�ra4a>_}ll raexm x.m. 8 N/A WA WA N/A N/A X/A N/A 4.re ersawre RE I EO 1/1/2021 al Ps P. 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M ITIIN MMS PMXIOMMAWtONX1N 9/N/NJI M%i',Up ZCHOC.WAUMT IIMMNs) IILOLtl 9/N/ldl NOVUMSOIUNONXCMIMPMt N631061M11]e 9/IU3021 --ZH P SUC XCCLMIUNNT 311111110111PV 91 4/2Nl NOVISASSOIUNONXCLMIMPMi6)bb1061M."y 9165/1G]1 oePgn 9/l6/N1{ WINOUI HUMAN NSVC 1NdNLfIASANJ1 9/l4/N11 HWTH XUMANSVC."Lom"Or"'0.6J133MR 9/li/IOJI UNLfOMMUNITY P{X((WIMPMI IJ6M3J1191M00 'N'Tw Pate NN PDXTOx ;tl6,M ......It ASK* GGUa1 W3. b,ld."ts Sb1101 G;Ms4 53)S0 6Md 1,NLso 36.520.95 d99d 1.163.9 1,163.J6 1,155.96 PAI1431.51 AM.e91.13. i , 4ppA9]N MMCPoRTIOx W in"Nen1" Qlpp/(Pmp] OIPP/[nmpt plPpffcmq 6Yme QIPPT MAIN. XHPOA9bX ' I.SN.M 1.6W.W 7,517.45 1,SIfa0 ' IA3710 1.10,10 I1l641] I6.160,1I ' IAWiO 1.771,10 1'227." 3,egap "A"Jo - / 3,E31b 3.1R59 14.565.9E/ , IA30.M - 115.W4.65 p11 S.. ,ON. - W 6A3p.E0 ill'. 11,33F40 - I6,3N" ' 19,N0.0 39,NO.ti 3N.N6.N r p3,34 MMCpOR ON QIPP/<Pmp9 jR}n I�Ip OVp/(OmPI Qlpp/(pnpl Q1111 14 BMPe all, xn5.n W 11 IAR". N.aNm 16.99G13 - , ' S95.M 585M IM,NS SI IM,US.SI - I ' l.iI SA91.13 AS SAe).N - 38.91 30A1 SµWJI ✓ NI9NS .f MMCMPTON OMp/GmW nj�i Eel i nn dn,lp NPP/4m11 Mpv/4mpl WPPlump, kwm WIN 51 "PORTION - ISN.d I,519w ' N,ISBo) S.0N01 ;N4.A9 3.-01A,49 - 3.1Au0 1}2AR - 1.49L10 3.451A0 I.NSM I,I15.M UI,11194 - II),13)90 ' S,SN.91 - 31961IR 2,941-9) 1AM816 - i3,9Nfifi )3.94A65 I"... }9]}I19M in . sly GO NNIOMIMN S.naal 3,IN 11 e.wQM ll.bzz.GA MMCPoIRIIW QIPp/[01ryM tng5u _� Ie3nalenln / p QIOP Cem 1 QIpP(Glmpl NPP/yg 1 Gla M PI XXpOpTOH ' 3.p63d 9A45.M 95913 959d3. ' ll].M 1.d161 9120/2021 Quick View Select Quick View Accounts Account Number / Name Account Type Treasury Center Select Group Groups Adr1 GroUP My Groups as o1 Sup 20, 202 ', Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $6,779.004.68 $7,220.874.67 $6,779,004.68 $6,763,632.03 '4551 CAL CO INDIGENT S16,152.00 $16.152.00 $16,1511.00 S5,423.33 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK 5295.257.56 5295,257.56 S295,257.56 $295,257.56 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $535.78 S535.78 $535.78 $535.78 2014 '4357 MEMORIAL MEDICAL S3,481,723.29 S3,839.650.25 $3,481,723.29 $3,808.257.35 CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE 5431.36 $431.38 $431.36 5431,36 WAIVER CLEARING '4381 MEMORIAL MEDICAL S470.882.82 S483,992.01 S470,882.82 $395,561.93 CENTER I NH ASHFORD ✓ '4403 MEMOCENTERRIAL NH MEDICAL S210,313.44 S210,313.44 S210,313A4 S169,6w57 BROADMOOR '4411 MEMORIALMEDICAL S138.976.56 f S144,212.71 $138,976.56 $133,135.82 CENTER I NH CRESCENT '4446 i MEMORIAL MEDICAL S302.258.72 S313,807.58 $302,258.72 $189,787486 CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER / SOLERA AT S142,020,04 v S166,900.92 S142.020.04 $141.215,67 WEST HOUSTON '2998 MMC-MONEY MARKET $1,108.404.74 $1.108.494.74 S1.108.404.74 $1.108,404.74 FUND '5506 MMC-NH BETHANY SENIOR LIVING $198,611.76 S206,705.63 S19B,611.76 S186.176.54 '5441 MMC -NH GULF POINTE PLAZA. $29129 66 S29.129.66 $29.129.66 $28.180.70 MEDICARE/MEDICAID 'S433 MMC-NH GULF POINTE PLAZA- PRIVATE PAY 5321,943.17 S325,175.89 S321,943.17 S250,118A7 '3407 MMC •NH TUSCANY VILLAGE $62,363,78 $80,205.14 $62.363.78 $51 454.35 htlps://prosperily.oloanking,comlanline Messenger 1/1 Memorial Medical Center Nursing Home UPI Weekly Nel{ion Transfer Prosperity Accounts 9/20/2021 Au.PPnt Nurm. He.. Number GPlddn:Cunds Prevlau, RelinntnB Balance innder-0u ",1i66$ Matt OnMba@non a(over 55,0E-0wrll be bam/rrred ro bhe nuningbame. Note 2: Each ucmuar not abuse bobnre a/5100 that MMC depaaaed as open account Pending Tbdays BebinninE Amount to U Trwtlrwpd. NuralnE Hn BPPaN9 Balance Home 20 - 295,251.56 28SAS3.11 Bank B{lance 195,25156 vanm{e teave.n Bolenee 100.00 PendlnR ck-Medicare repayment owed to MMC 2,08803 Medicare repayment owed la Bethany 512.97✓/ Medicate sepavmeetowed to Tusrony 41,36 J/ Medicare repayment awed to MMOUNIC t.. so IUEYINTEREST 2648 ✓i AUGINTERM 3022 {/ SEP INTEREST Mivat aalmfeAnndvrAmt iB5.683.11 ,� d. J... MPlln, 1E0 9/SOl10ii I Nm Weelly iumlenWll avl iron.... 6—.112NAwel—b.Ahn W'I rramin Lmmarv<ta tl.lw QNrYilhwk ' "WIN, IIM IPpn511gC RID 91NIi iQW5551)69il v "'Won pR/IPAM1S nPSi B[N S[WI f i9611555PR9131 111111.1 1YY1/I MX111 MI 65CO SIIM[ 5 G169111S1i691i 9 911L3011 .Crn[n:: M[Ni StRYICU MM39.16916R 9111/3031 WP[ It NUA1PM SIC N[CIAIMPM11116COPU P111 91 91I6)IMIOIWI MPC PCYI I U•I.11. nEP10M 11W.PP.t,I NCREEP 9114i ]0]1 NI atJN IN MAX JI'C IIIY�PMMJS Ii14D]li]IJ0111 MMCP00.JIUN [ypp/Ce t NN inntln�jii Tgntlu�n CUM."NPP/[wnpl Npp/Gmpl Nvv 11 PO0.➢691 O1 69J JO � fU 601. P) 6ElCP 6.IOIM 6.1W M11 I,t3969 IE39 G1 1,J1916 11 )I. Glnioe cJ,naw 69i91191 )11 J9)11 MI J5)11 69A 9J 11 361.DJI J9 Jn.pJJ,IJ • 92012021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number I Name Groups Account Type Aad Gnnil: P.av ;;rmiPS Senrcn All DDA Data mlmneu :,... nl S.,u 20 3t- •. Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $6,779,004.68 $7,220.874.67 56,779,004-68 $6,763,632.03 '4551 CAL CO INDIGENT 516.152.00 516,15200 516.152,00 55.423.33 HEALTHCARE '4a54 MEMORIAL MEDICAL' $295.257.56 5295.257.56 5295.257,56 52952575,3 NH GOLDEN CREEK HEALTHCARE '4365 MEMORIAL MEDICAL 5535 72 5535.78 S535 78 S53E 78 CENTER - CLINIC SERIES 2014 4357 MEI<1ORIAL MEDICAL SS 4F 1.713, 19 53.639,650 25 53.481 723.29 53 809.257.35 CENTER - OPERATING '4:373 MEMORIAL MEDICAL $431, 36 3431,3E 5431.36 5431 .36 CENTER -PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL 5410,88282 $483992.11 54711,662.82 5395.561 �!3 CENTER.: NH ASHFORD '4403 MEMORIAL MEDICAL 5210,313.44 5210,313.44 520.313,44 S169.588:37 CENTER INH BROADMOOR '4411 MEMORIAL MEDICAL 5138.97656 5144.212.71 5138,97656 S133 135 82 CENTER i NH CRESCENT '4446 MEMORIAL MEDICAL 5302.258.72 5313.607.58 5302258.72 5189.787.86 CENTER : NH FORT BEND '4438 MEMORIAL MEDICAL 5142,020.04 $166,900.92 $142.0204 S1,1Y1,215 c7 CENTER! SOLERA AT WEST HOUSTON '2998 MhIC•MONEY MARKET 51. 108.4047' 51,108,104.74 S1108 J0474 j1, 108.40474 FU14D 3506 MMC-NHBETHANY $198.611 Jc 520670563 S196,61176 S186,17854 SENIOR LIVING '5441 MMC -NH GULF POINTE $29,12966 S29129$6 529,'29.68 S28,180711 PLAZA- MEDICAREIMEDiCAID '5433 MINK -NH GULF POINT_ $321,9431T 5325,175.89 $321.9.13,17 $250,118.47 PLAZA - PRIVATE PAY '3a07 MMC •NH TUSCANY S62,3637@ 580.205 14 S62.36378 S51A54 35 VILLAGE hltps:r/prosperity.aibanking,comronlineMessenger r 1 Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 9/20/2021 Pr.YIOY Re.., Beeinnln0 nxn3n x W.., O,Nna. y'uit V' H(i4,Ym*hlt, E93.92060 INWxua A¢eum eaHnMne HYNNeH HwnM. B,an[e Guke fiYeyjrgMklFnpluedlyy_ ..: la ts}>s xoN: Eahoiw"rho%0 4IXp4-111 OeIMIh.1 otbnumngfi4u Note}; Facdar[eunlbaao0oN6oionce n/$109[FarMMCdepgdedry Pom o¢ount. mxx w[[spn..�t[[alpruvnwn�NaYmmwnonueofrme[gxx Uru¢nn[summ.ry 9.xo.a..D. P.name Amennunen 'TNmfenln fY[tle ed De eJ6 iranaterredao id..NO .1Babn Nunln Xame ' .21.9411, -511}439 - Bant eabnN 3Lp[yxl Gi varxnN In.ein W.— IMM Ec"CARt PAYMFNT5TDN0lD 3tR,W9.33 ,/% luty"ITIM 9T uxi .GIMERF9T /, 934 f A I 3TP R Pdlu¢&lann/nanao, ml _ 5.1)0.39 /' rnnafenlnJ pa tlea PendlnH <mRe innvf[(urenrtd[o pe att[ Tql SDe n Balrn[e Nwln Home 39.:3956 29.DWA9 O.MWN39,C0))9 nN E9.I1966 Vm-r. [rNn[e leave in Ralarce xC0.W 3YlYIN19.1st AUq IMRFR BA} f MP WREST Adlun Oalenn/rrgtlo Pml 19.WE,}9 [/` T4TAlTRAN5PF0[ / Pp)aiP�d: Icon Mflln. LEO 9(l0/}9i1 9{l3/3031 NNE ECHO HCCUIMPMT Tt6003011 Up000E69500 V23120I3 PUS ECHO HCCWMpMT 746W3411 N00002695W 9/33/2021 NNE 6010 NKUIMPMi )IOOp343194pp00369500 9/13/3021 HER ECHO HKUIMPMT 246W34114400002695M 9/13/2021 NNE ECN0HCCWMPMT)46003411440WU2695W 9/13/2021 NNE - ECHO NCC HMPM])46003411 AV0002,950E 9/14/2021 HAI ECHO NCCSAIMPMT]46W3411440000EOS]39 9/14/E021 HER LCHOHCCUIMPMT74WO3411440000105319 9/14/2021 HNE. ECHO HCWIMPMT 74GN3411440009205739 9J1412021 HUMANA INS CO NCCUIMPMT 82195283000561473 9/14/2011 AETNA HOO HCCUMPMT 1922093E90 d310020W62, 9/15tN022 NNE ECHO NCCUIMPMT 1411330440N0135869 9/15/3021 NNE- ECHO NCCUIMPMT 74001.11440000235869 910IM21 NNE - ECHO HCCUIMPMT 7460034114Q0,,235,69 9/19/Sp31 HUMANA CHA OISS HCCUIMPMT 6149824200001373 9/16/2021 WIRE OUT HMO SERVICK LIC 9/17/30E1 NNE' ECHO HCCUIMPMT 746 W341144ON0289939 9/17/2021 NICE (CVO MC[UIMPMI )46W3alI g4W0Y289919 901/3021 NNE -ECHO NCCUIMPMT 14603411440000289939 9/17/20E1 HNB- ECHO HCCUIMPMT 246W34LI 440000289939 MMCPORNON Trana6tr.0ul TranHery In yPP Com l ONP/Cpmp16 NH J P CIIeP/<4mp1 O1PP/C0m 3 "PT, PORTION 3099,96.96 25p8 ' 15,66 189.96 25.09 15,68 118.31 is OP 15.6E Ile 38 2311 - 15.69 113.61 1351 M I 111.61 806.33 688.26 1.800.00 80631 301.38 91800.00 23.52 303,38 2,027.91 23.51 1.5.392 2.027.91 11,314.89 1$63.98 67137 51.53173 67157 4.351,14 51.331.13 I9,369.96 4.151.64 15.269.96 I34210.89 81.229.46 / 81119.46 611E) nN'Pbii1- IsY � d 1 _ TquNI-ChA 9JI412021 W PS LOEFIC WNIR NCCUIMPMr212236)93) 2100 9/15/2021 OapoaN 9/16/2021 WIRE OUT HMO SERVICES, LUC 14,045.88 9/1){2021 HEALTH HUMAN SIC NCCUIMPMT 1246R341290132 MMCPORTION 4.30 UPPICNAM& NN Lan 3,OIPP/Camel OI OIP//C0mp3 Pp/CemP3 L p OAP II PORTION 18,0245,3 lE,@4334AI 94896 948.96 28 W) ]9 15.21 1 110,i3).ls 110,21).25 9/2012021 Quick View Select Quick View Accounts Account Number Name Account Type Search All LODA Account Number Current Balance Number of Accounts: 15 $6,779.004.68 '4551 CAL CO INDIGENT $16,152.00 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK 5295,257.56 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES 5535.78 2014 '4357 MEMORIAL MEDICAL S3.461,723,29 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.36 WAIVER CLEARING '4381 MEMORIAL MEDICAL S470,882.82 CENTER I NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH 5210,313.44 BROADMOOR '4411 MEMORIAL MEDICAL S138,976.56 CENTER! NH CRESCENT '444 MEMORIAL MEDICAL S302.258.72 CENTER INH FORT BEND '4438 MEMORIAL MEDICAL CENTER / SOLERA AT $142,020.04 WEST HOUSTON '2998 MMC -MONEY MARKET S1. 108.404.74 FUND '5506 MMC -NH BETHANY 5198,611 76 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA - S29,129.66 �! MEDICARE/MEDICAID '6433 MMC -NH GULF POINTE 5321,943.17 f PLAZA - PRIVATE PAY '3407 MMC-NH TUSCANY S62,363.78 VILLAGE hops:!/pr06perity.olbanking.c0m/onllneMessenger Treasury Center Select Group Groups l+dd Group My Groups 001a reported as of SNP 20 2021 9 Available Balance Collected Balance Prior Day Balance $7,220,874.67 $6,779,004.68 $6,763,632.03 $16.152.00 S16,152.00 $5.423.33 S295,257.56 S295,257.56 $295,257.56 S535,78 5535.78 $535.78 S3,639,650,25 S3,481,723.29 $3,808,257.35 S431,36 S431.36 S431.36 S483.992.01 S470,882.82 $395,561.93 S210,313,44 S210,313.44 $169,688.57 S144,212.71 S138.976.56 S133.135.82 $313.807.58 S302,25B.72 $189.787,86 $166,900.92 S142,020.04 $141.215.67 $1,108,404.74 Si, 108.404.74 S1.108,404,74 $206,705,63 $198,611.76 5186,178.54 S29.129.66 $29,129.66 S28.180.70 $325.175.89 $321.943,17 $250,118.47 $80.205.14 S62.363.78 S51 354,35 r i/1 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity Accounts 9/20/2021 rreawm t<mvnt Berinnine Nurllne Name numger bl<n<e !W'ZWSrdXettMPi *''.'_�: '<rr:':r'A 19q,g23q� Nalr:os"Iseon[eao(cvrr55.MV mIIhr NgmjeneEbrhenuumgAanr. rveo-E se<A4mavnrstet0 Ealr edusul a(SIW mal MMc drpweM m cpm attoum. Penahp leea[lu bn4blana usnan<e leave In blast! Ma O'..e0a9mem.d to mmc MMI<aremp.vm.m eWeeteetlNAxv Maaitarempaymen<owetlln MMNNIC Adjust Nahnnrtram I<r Rmr ...All As er Trrmfused As ragoe 9,13a.[a 5IL9I 3,9Ia95 sawLlz ./ TienStirVlllaaa c „� c 'c, : . ' W1412021 NOVITASSOLUTION HCCIAIMPMT6762D1420M153 9/15/2021 Oep.it 9/16/ZD21 WIPE OUT UNSAP ENTERPRISES, LLC 9/17/2021 RS PIAN AOMINIST HCCIAIMPW 1J9 211MZaS91 MMC PORTION giPP/Wmp4 Tm. e,-OU Tra er-In OIPP/Comps gIPP/Comp2 OIPP/Camp3 ®.IU. glPp Tl NH PORTION 9,219AS 33,996.73 3,,219A6 134,194.14 33,996.J3 - 10,909A3 10.909.43 9/20I2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number I Name Groups Account Type Add Group My Groups (DDA Data reported as of Sell 20, 2L21 v Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $6,779,004.68 $7,220.874.67 S6,779,004.68 S6,763,632.03 '4551 CAL CO INDIGENT $16,152A0 $16,152.00 $16,152.00 $5.423.33 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $295.257.56 $295,257.56 $295.257.56 $295.257,56 HEALTHCARE '4355 MEMORIAL MEDICAL CENTER -CLINIC SERIES $535.78 $535.78 S535.78 S535.78 2014 '4357 MEMORIAL MEDICAL S3.461.723.29 $3,839,6%25 $3,481.723.29 $3,808,257.35 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE S431.36 S431.36 $431.36 S431.36 WAIVER CLEARING '4381 MEMORIAL MEDICAL S470,882.82 S483.902.01 S470,B82.82 $395.561 93 CENTER! NH ASHFORD '4403 MEMORIAL MEDICAL CENTERINH $210.313.44 S210,313,44 S210,313.44 S169,688.57 BROADMOOR '4411 MEMORIAL MEDICAL S138,978.56 S144,212.71 S138,976.56 S133.135A2 CENTER INH CRESCENT '4446 MEMORIAL MEDICAL S302,258.72 S313.807.58 $302.258.72 SIB9787.86 CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER /SOLERA AT S142,020.04 $166,900.92 S142.020.04 $141,215.67 WEST HOUSTON '2998 MMC -MONEY MARKET S1.108,404.74 $1,108,404.74 51,108,404.74 $1.108,404.74 FUND '5506 MMC -NH BETHANY $198.611.76 S206705.63 S198,611.76 S186,178.54 SENIOR LIVING '5441 MMC-NH GULF POINTS PLAZA- $29,129.66 $29,129,66 S29, 129.66 S28,180.70 MEDICARE!MEDICAIO '5433 MMC -NH GULF POINTE S321,943.17 $325.175.89 S321,943.17 $250,118.47 PLAZA - PRIVATE PAY '3407 � MMC -NH TUSCANY VILLAGE S62,363.78 $80,205.14 $62.363.78 $51 A 54.35 Mips:/Iprosperity. of banking.crom/onl IneMessenger 1l1 t s a Memorial Medical Center Nursing Home UPL Weekly HSLTranster Prosperity Accounts 9/20/2021 v(w Raaum Berrnnlq N un MXome Nume•• 6).BRi13 Bilka!111$eP�ifrToR' <, Not. POyho)ancn o/ovac$9.WOxvll he (mm/ertdla (MnwvnP Fome. Nn(tS,Ftl(An[[oun(ho[n6oi<WlOrlc<nJ $IOP fhaIMMC depoYtP6lo apM o([Wnl. Pen®ry / Medlnn hamle[.In Cfi Clea[ed Reoavmen] gmauMaom Tnnaletted In ]WwYBeairnln)BJmae NuninR Name 1911,611M $7r190.73 &nk Balance 198.611]6 J ...,e lewem Bala nce ]%rp Taemnaca cs. lar deonall eo.r {lls.MV ^y IUtY INTEREST ]S.Si ERE6] /�� ]].6) ✓ spho Sm INTFR651 ACImL Bahixe/fnMlo Fmt l9).19Sb P m[tl: lafenGn)Iin. CfO 9/ln/IO)1 f �XM KeeLly Ttn llNsWNY9l RtnMII SWnMNUoi111M11mh!(\NN NLlnnaltl Sun mtN 910.S1.aNa MMCPORTION OIPP/[4mp4 Tmnsf,,OVt Transfer -In I QIPP/ComPl OIPP/COmp2 GIPP/Cemp3 l5lapse OIPPi2 NN PORTION 22,905.70 - 22.905.20 57,462.OB S7,462.05 2,04,312 - 7,044.92 2,884.46 - 2,884.45 04,254.85 - 94,234,05 82.483.40 _ 9/13/2021 Deposit 9/13/2021 Deposit 9/24/2021 Deposit 9/14/2021 ACCENTCARE INC PAYAMES9990007660 230000170 9/25/2022 Deposit 9/16/2021 WIRE OUT RETHANy SENIOR LIVING, LTD 9/16/2021 Deposit - 22$.50 - 225.50 9/17/2021 NOVITASWLUTIONNCCLAIMPMT67649142WOO1B3 - 10,779.02 - 10,970.02 9/17/2021 NOVICE OF SOUTH Payments NF 119122690022873 1,6i5.20 1.655.20 82,4B3.40 /19t,190.2 / 197.M.75 9/20/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number! Name Groups Account Type Add Group My Groups �DDA - - Data repotted as of Sep 20. 2021 9 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $6,779,004.68 57,220,874.67 56,779,004.68 56,763,632.03 '4551 CAL CO INDIGENT $16,152,00 $16,152.00 $16,152.00 S5A23.33 HEALTHCARE '4454 MEMORIAL MEDICAL I NH GOLDEN CREEK 5295,257.56 5295,257.56 5295,257.56 5295,257.56 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $535.78 5535.78 5535.78 $535.78 2014 •4357 MEMORIAL MEDICAL 53,481,723.29 53,839,650.25 $3,481,723.29 33,808,257.35 CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER • PRIVATE $431.36 5431.36 $431.36 5431.36 WAIVER CLEARING '4381 MEMORIAL MEDICAL 5470,882A2 5483.992.01 $470.882.82 $395,561.93 CENTER! NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH 5210,313.44 $210.31344 $210.313.44 5169,688.57 BROADMOOR '4411 MEMORIAL MEDICAL $138.976.55 S144,212.71 5138,976.56 $133.135.82 CENTER I NH CRESCENT '4446 MEMORIAL MEDICAL 5302.258.72 $313.807.58 5302.258.72 5189,787.86 CENTER i NH FORT BEND '4438 MEMORIAL MEDICAL CENTER /SOLERA AT 5142,020.04 5166,900.92 5142.020.0.1 $141 215,67 WEST HOUSTON '2998 MMC-MONEYMARKET $1,108,404.74 $1,108,404.74 $1.108,404.74 S1.108A04.74 FUND 'S50fi i' MMC-NH BETHANY 5196,611.76 J 5206,705.63 5198,611.76 $186,178.54 SENIOR LIVING '5441 MMC-NH GULF POINTE PLAZA - $29,129.66 $29.129.66 S29129.66 528.180,70 MEDICAREiMEDICAID •5433 MMC •NH GULF POINTE $321,943.17 5325,175.89 $321 943.17 $250,118.47 PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY $62.363.78 $80,205.14 562,363.78 551,454.35 VILLAGE https:llprosperity.olbanking.comlonlinaMessenger tt1 P aC mp3 0 C To D Z �C ] o y y m �i n Nm Nm m r N O � O N n �s ms c `aw "Ccn y c o 0 o -zi Vl N > one chi s p r C y y m � my a m Z O t0/i VOi VOi A N N N N O A W O � O O N N n 6 2 n n n n n n n n n n n 20 0 as in 0 K zz n� n n O O O O O m A n O n n Nm%r 8 0 'o 'o o o 'o a 5 s > n m m n a n n n n n n K n n n n n z m m a a K a a a K K o 0 0 0 pp C OO A A W A pN pJ �C �O J N U U P �> $`a_ -n _n aKO Qam ZK �m �N,a o3 3 °'K �"3 §+K 3 GOC z;; ♦�C nO NC Nn .Q a a ya Cp a ja a ui N GiN CV-q irZ-q -i Hw �nw o,o oT° z� Z,� So $° -na v m y J IJ N W O J W W �O W IJ J J O �O U W N Ca A T O O Co3 c 8o 3� yc 2 (� y { o �U o op O G 9 O K7 m s W O O O O uAi N N b b w q Nq q Cam" a �K cmi a a a m A P W O 22 O W N N W N U N N 3 o POC S O DO tAtx�7 (n aN C rn :Vl mmO mA 0 Co �O �O �O Z zz zzy -t Z o -i a n ,nyn tm"oDQ-1W �oanoXo AC O �Z�Omm3� C o00 O P W � O N J N I O� O O �D T yNi � •O O � N ? 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