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2021-10-20 cc meeting minutesNOTICE OF MEETING — 10/20/2021 Richard H. Meyer County fudge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 (ABSENT) Gary Reese, Commissioner, Precinct 4 Kaddie Smith, Deputy Clerk NOTICE OF MEETING The Com missioners' Court of Calhoun County, Texas will meet on Wednesday, October 20, 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: I. Call meeting to order. Meeting called to order at 10:00 a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag — Joel Behrens Texas Flag — Vern Lyssy 4. General Discussion of Public Matters and Public Participation. Galen Johnson, Olivia -Port Alto Volunteer Fire Department spoke on receiving a grant for 50,000.00 to go toward a new grass truck. 10:01-10:05 5. Approve the minutes of the October 6, 2021 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 1 of 7 NOTICE OF MEETING — 10/20/2021 6. Consider and take necessary action to grant bereavement leave to Ron Langford for the month of November. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: David Hall, Commissioner, Pct1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Public Hearing on a Petition to Vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of the Calhoun County Plat Records. (DH) Commenced: 10:07 a.m. Closed: 10:08 a.m. Henry Danysh spoke. 8. Consider and take necessary action on a Petition to Vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of the Calhoun County Plat Records. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 9. Consider and take necessary action to approve the Preliminary Plat of the Graham Subdivision (a replat of Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach). (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 10. Consider and take necessary action to approve the Final Plat of the McPeters Subdivision (a replat of 8.12 acres being part of Lot 2, Block 150 of the Alamo Beach Subdivision). (DH) Henry Danysh spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 2 of 7 NOTICE OF MEETING — 10/20/2021 11. Consider and take necessary action to approve the Preliminary Plat for the Desilos RV Park. (VL) Judge Richard Meyer moves to table this item for next week. 12. Consider and take necessary action to approve the Preliminary Plat of the Saltwater Haven No. 2, Port O'Connor, Texas. (GR) Henry Danysh spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 13. Consider and take necessary action on Abila MIP Fund Accounting quote for one additional user license and authorize the County Auditor to accept and sign the quote. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 14. Consider and take necessary action on the first insurance proceeds check from TAC in the amount of $11,325.40 ($61,325.40 — deductible of $50,000) for damages caused by Hurricane Nicholas on September 13, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 15. Consider and take necessary action to approve Addendum Number 1 to the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 3 of 7 • NOTICE OF MEETING — 10/20/2021 16. Consider and take necessary action to award the bid for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two-year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearly for one year terms upon Commissioners Court approval. (RM) PASS 17. Consider and take necessary action to accept a donation of $1,000.00 from the Inteplast Group Corporation in Memory of Dean Wade Harley to be used to benefit CCEMS in their mission of caring for the many people of Calhoun County. (RM) Dustin Jenkins spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 18. Consider and take necessary action to accept a donation of $50.00 from Lambert and Helen Wang in Memory of Dean Wade Harley to be used to benefit CCEMS in their mission of caring for the many people of Calhoun County. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 19. Consider and take necessary action to accept the attached list of donations for September 2021 to the Calhoun County Public Library. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 20. Consider and take necessary action to declare the attached list of items from the Calhoun County Public Library for September 2021 as Surplus/Salvage. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 4 of 7 NOTICE OF MEETING — 10/20/2021 21. Consider and take necessary action to declare the attached list of items from the Calhoun County Public Library for September 2021 as Waste. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 22. Consider and take necessary action on a request by Calhoun County EMS Director to transfer the Seadrift VFD 1999 Chevrolet 3500 Ambulance Chassis and Module to CCEMS and the CCEMS 2004 Chevrolet Suburban to Seadrift VFD as indicated on the attached Transfer Form. (RM) Dustin Jenkins spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 23. Consider and take necessary action on a request by Calhoun County EMS Director to transfer five (5) C3 Handheld Ultrasound Scanners to MMC as indicated on the attached Transfer form to be utilized by MMC ER, MMC Clinic and the MMC Hospitalist on duty. (RM) Dustin Jenkins spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 24. Consider and take necessary action to declare the attached list of items from Calhoun County EMS as Waste. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 5 of 7 • NOTICE OF MEETING — 10/20/2021 25. Accept reports from the following County Offices: i. County Clerk — September 2021 ii. District Clerk — September 2021 iii. Justice of the Peace, Precinct 3 — September 2021 iv. Justice of the Peace, Precinct 4 — September 2021 v. Justice of the Peace, Precinct 5 — September 2021 vi. Sheriff's Office — September 2021 vii. Tax Assessor -Collector — September 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 26. Consider and take necessary action on any necessary budget adjustments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 27. Approval of bills and payroll. (RM) Image and Healthcare RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 6 of 7 • NOTICE OF MEETING — 10/20/2021 Adjourned: 10:34 a.m. Richard Meyer, County Judge 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 ora under "Commissioners' Court Agenda" for any official court postings. Page 7 of 7 NOTICE OF MEETING — 10/20/2021 ]L ich2rd H. Meyer County judge David Mall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 'Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Com missioners' Court of Calhoun County, Texas will meet on Wednesday, October 20, 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 FILED The subject matter of such meeting is as follows: nTq_�tBO'CLOCK a M 1. Call meeting to order. klou OCT IS 2021 NNA M. 2. Invocation. COU JERK CALHOUR OUNty TEXAS U S IeX (� gw 3. Pledges of Allegiance. J� I V L 4. �r I Disc s "on of Public Matters an Public Participation. o:o `-IQnJOh6� N- �6tfUO��11r�jr�ss-havtfil � . 5. Ap�rove the minutes of the October 6, 2021 meeting. �D1� IJ� 6. Consider and take of action to grant bereavement leave to Ron Langford for the month of November. (RM) \ /nn�1� 7. Public Hearing on a Petition to Vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as WV in V,Qlume Page 126 of the Calhoun County Plat Records. (DH) (U:O1 �U I� � UWV c�b�ed, (D Ug B. Consider and take necessary action on a Petition to Vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of the Calhoun County Plat Records. (DH) DWI V L _ n np(OV�A — 9. Consider and take necessary action to approve the Preliminary Plat of the Graham Subdivision (a replat of Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach). (DH) -1 + P Page 1 of 3 NOTICE OF MEETING - 10/20/2021 10. Consider and take necessary action to approve the Final Plat of the McPeters Subdivision (a replat of 8.12 acres being part of Lot , Block 150 of the Alamo Beach Subdivision). (DH) ��Ri WgSh N IVY 11. Consider and take necessary� action to approve the Preliminary Plat for the Desilos RV Park. (VL) _ I bt SAK ( I V VU� U V'C{/I` 12. Consider and take necessary action to approve the Prelimina PI t of the Saltwater Haven No. 2, Port O'Connor, Texas. (GR) ftyj UnVn P /- �� m �n AuAa�- IDIt 13. on er and take necessary, action on Abila MIP Fund Accounting quote for one additional user license and authorize the County Auditor to accept and sign the quote. (RM) o r'I I b* 14. Consider and take necessary action on the first insurance proceeds check from TAC in the amount of $11,325.40 ($61,325.40 - deductible of $50,000) for damages caused by Hurricane Nicholas on September 13, 2021. (RM) 11 U I�J1 15. Consider and take necessary action to approve Addendum Number 1 to the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 fpr tthee ppEdbeginning January 1, 2022 and ending December 31, 2022. (RM) �s\JV� 16. Consider and take necessary action to award the bid for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two-year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearlyiww terms upon Commissioners Court approval. (RM) _ po(�S —. 17. Consider and take necessary action to accept a donation of $1,000.00 from the Inteplast Group Corporation in Memory of Dean Wade Harley to be used to benefit CCL M$ in their mission of caring for the many people of Calhoun County. (RM) V I ff 18. Consider and take necessaryction to accept a donation of $50.00 from Lambert and Helen Wang in Memory of Dean Wade Harley to be used to benefit CCEMS in their mission of caring for ��the ,,��many pseople of Calhoun County. (RM) V LI � � 19. Consider and take rt�cessaryraction to accept the attached list of donations for September 2021 to the Calhoun County Public Library. (RM) U 'N 6 20. Consider and take necessary action to declare the attached list of items from the Calhoun County Public Library for September 2021 as Surplus/Salvage. (RM) y J kt 1 21. Consider and take necessary action to declare the attached list of items from the Calhoun County Public Library for September 2021 as Waste. (RM) b 1 I \ 16 22. Consider and take necessary action on a request by Calhoun County EMS Director to transfer the Seadrift VFD 1999 Chevrolet 3500 Ambulance Chassis and Module to CCEMS and the CCEMS 2004 Chevrolet Suburban to Seadrift VFD as indicated on the attached Transfer Form. (RM) � � `(1 ,Q Page 2 of 3 NOTICE OF MEETING — 10/20/2021. 23. Consider and take necessary action on a request by Calhoun County EMS Director to transfer five (5) C3 Handheld Ultrasound Scanners to MMC as indicated on the attached Transfer form to be utilized by MMC ER, MMC Clinic and �the �MMC Flospitalist on duty. (RM) 24. Consider and take necessary action to declare the attached list of items from Calhoun County EMS as Waste. (RM) � W I `� 25. Accept reports from the following County Offices: I. County Clerk — September 2021 ii. District Clerk — September 2021 \ fLl \iii. Justice of the Peace, Precinct 3 — September 2021 V VV iv. Justice of the Peace, Precinct 4 — September 2021 v. Justice of the Peace, Precinct 5 — September 2021 vi. Sheriff's Office —September 2021 vii. Tax Assessor -Collector — September 2021 26. Considier nd take necessary action on any necessary budget adjustments. (RM) 27. Appoval o li s and payrrolll. (RM) MC11 Richard Meyer, County d CMN bA1 : DCalhoun 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.calhcuncotx.org under "Commissioners' Court Agenda" for any official court postings. - V Page 3 of 3 Calhoun County Commissioners Court Public Participation Form NOTE: This Public Participation Form must be presented to the County Clerk or Deputy Clerk prior to the time the agenda item (or items) you wish to address are discussed before the Court. Instructions: Fill out all appropriate blanks. Please print or write legibly. (J NAME: A Z. Ely ,TO HZVS 9/V ADDRESS: TELEPHONE: PLACE OF EMPLOYMENT: L `y //, /� h �— 7 &59 1/ /C—/, 9 EMPLOYMENT TELEPHONE: Do you represent any particular group or organization? YE NO (Circle one) If you do represent a group or organization, please provide the name, address and telephone number of the group or organization: � � r - 1?;2-O�03�<57 Whicc agenda item (or items) do you wish to address? cl-� FIE-5- In general, are you for or against the agenda item (or items)? I hereby swear that any statement 1 make will be the truth and nothing but the truth to the best of my knowledge and ability. Signature: October 20, 2021 2021 APPROVAL LIST-2021 BUDGET COURT MEETING OF BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE FICA MEDICARE FWH AFLAC NATIONWIDE RETIREMENT SOLUTIONS OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT PRINCIPAL FINANCIAL GROUP RELIANCE STANDARD LIFE CITIBANK PAYROLL FOR 10/12/21 SUPPLEMENTAL PAYROLL FOR 10/15/21 CALHOUN COUNTY INDIGENT HEALTH CARE 10/20/21 25 $215,817.71 P/R $ 12,881.54 P/R $ 54,763.20 P/R $ 38,731.77 P/R $ 2,742.01 P/R $ 4,660.00 P/R $ 1,516.15 P/R $ 1,584.28 P/R $ 5,077.60 AT $ 17,195.19 TOTAL VENDOR DISBURSEMENTS: $ 354,969.45 P/R $ 110.82 P/R $ 326,784.40 TOTAL PAYROLL AMOUNT: $ 326,895.22 A/P $ 7,358.85 TOTAL INVESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: $ 7,358.85 TOTAL AMOUNT FOR APPROVAL: $ 689,223.52 All Agenda Items Properly Numbered Contracts Completed and Signed All 1295's Flagged for Acceptance (number of 1295's —�) AL All Documents for Clerk Signature Flagged On this day of Q� 2021 a complete and accurate packet for ZqW1,of 2021 Commissioners Court Regular Session Day Month was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Calhoun County Judge/Assistant COMMISSIONERSCOURTCHECKLIST/FORMS AGENDA NOIIr,E OF IV! EETIvIG— 1.0/2U/202] Rich2rd H. Meyer County judge David dull, Commissioner, Precinct I 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, October 20, 2021 at 10:00 a.m. in the Com missioners' Courtroom in the County Courthouse at 211 S. Linn Street, Suite 104, Port Lavaca, Calhoun County, 'Texas. AGENDA The subject matter of such meeting is as follows: Ai`1�ociocK a M !. Call meeting to order. OCT 19 2021 G. Invocation. ANNA14,0000MAN COUN LENK CAUiOUN COUNTY, TEMS � 13' Pledges of Allegiance. /General Discussion of Public Matters and Public Participation. prove the minutes of the October 6, 2021 meeting. 6. Consider and take necessary action to grant bereavement leave to Ron Langford for the month of November. (RM) VVC ;7 Public Hearing on a Petition to Vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of the Calhoun County L/n6'Q Plat Records. (DH) 08� Consider and take necessary action on a Petition to Vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of / the Calhoun County Plat Records. (DH) '9. Consider and take necessary action to approve the Preliminary Plat of the Graham Subdivision (a replat of Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach). (DH) Page 1. of 3 NO I(l- OF IMF-EI IN - 1.000120)1 10 Consider and take necessary action to approve the Final Plat of the McPeters Subdivision (a replat of 8.12 acres being part of Lot 2, Block 150 of the Alamo Beach Subdivision). (DH) 111. consider and take necessary action to approve the Preliminary Plat for the Desilos RV Park. (VL) 7 Consider and take necessary action to approve the Preliminary Plat of the Saltwater ,Haven No. 2, Port O'Connor, Texas. (GR) 33. Consider and take necessary action on Abila MIP Fund Accounting quote for one additional user license and authorize the County Auditor to accept and sign the quote. �(RM) kg. Consider and take necessary action on the first insurance proceeds check from TAC in the amount of $11,325.40 ($61,325.40 — deductible of $50,000) for damages caused by ��Hurricane Nicholas on September 13, 2021. (RM) i5. Consider and take necessary action to approve Addendum Number I to the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning Jan ary 1, 2022 and ending December 31, 2022. (RM) �� bl�� C^ 1� Consider and take necessary action to award the bid for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two-year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearly for one year `� terms upon Commissioners Court approval. (RM) '17. Consider and take necessary action to accept a donation of $1,000.00 from the Inteplast Group Corporation in Memory of Dean Wade Harley to be used to benefit CCEMS in their ission of caring for the many people of Calhoun County. (RM) 18. Consider and take necessary action to accept a donation of $50.00 from Lambert and Helen Wang in Memory of Dean Wade Harley to be used to benefit CCEMS in their mission of caring for the many people of Calhoun County. (RM) Z9.,Consider and take necessary action to accept the attached list of donations for September 2021 to the Calhoun County Public Library. (RM) Consider and take necessary action to declare the attached list of items from the Calhoun County Public Library for September 2021 as Surplus/Salvage. (RM) 621. Consider and take necessary action to declare the attached list of items from the ,/Calhoun County Public Library for September 2021 as Waste. (RM) 22. Consider and take necessary action on a request by Calhoun County EMS Director to transfer the Seadrift VFD 1999 Chevrolet 3500 Ambulance Chassis and Module to CCEMS and the CCEMS 2004 Chevrolet Suburban to Seadrift VFD as indicated on the attached Transfer Form. (RM) Page 2 of 3 NOTI(IF OF MEETING — 10/20/2027. 3 Consider and take necessary action on a request by Calhoun County EMS Director to transfer five (5) C3 Handheld Ultrasound Scanners to MMC as indicated on the attached Transfer form to be utilized by MMC ER, MMC Clinic and the MMC Hospitalist on duty. �(RM) `-4. Consider and take necessary action to declare the attached list of items from Calhoun County EMS as Waste. (RM) t5-.`AAccept reports from the following County Offices: `r�County Clerk — September 2021 `ifs District Clerk — September 2021 4 r Justice of the Peace, Precinct 3 — September 2021 Iv' Justice of the Peace, Precinct 4 — September 2021 V' Justice of the Peace, Precinct 5 — September 2021 5r Sheriff's Office — September 2021 ViiTax Assessor -Collector — September 2021 46- Consider and take necessary action 27. Approval of bills and payroll. (RM) on any necessary budget adjustments. (RM) Richard Meyer, County Judg Calhoun County, Texas A copy of this Notice has been placed an 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 ore under "Commissioners' Court Agenda' for any official court postings. Page 3 of 3 #5 NOTICE OF MEETING — 10/20/2021 Richard ]E . Meyer County judge David Hall, Commissioner, Precinct h Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 (ABSENT) Gary Reese, Commissioner, Precinct 4 Kaddne Smith, Deputy Clerk NOTICE OF MEETING The Commissioners' Court off Calhoun County, Texas will meet on Wednesday, October 20, 2021 at 10:00 a.m. in the Commissionners' Courtrooms 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: 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 — Joel Behrens Texas Flag — Vern Lyssy 4. General Discussion of Public Matters and Public Participation. Galen Johnson, Olivia -Port Alto Volunteer Fire Department spoke on receiving a grant for 50,000.00 to go toward a new grass truck. 10:01-10:05 5. Approve the minutes of the October 6, 2021 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 1 of 23 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, October 6, 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 Richard Meyer, C ty Judge Calhoun County, Texas Anna Goodman, County Clerk m1all r9i Page 1 of 1 NOTICE OF MEETING-10/6/2021 Richard Fl. Meyer County judge David 1H[all1, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Geary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will] meet on Wednesday, October 6, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Aran Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: 1. Cali meeting to order. Meeting called to order at 9:59 a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag — Gary Reese Texas Flag — David Hall 4. General Discussion of Public Matters and Public Participation. Brandon Gilbrenth, resident of Tap Road spoke on a matter of the public abusing the road. Commissioner David Hall has been in contact and is aware of all matters. 10:01-10:04 5. Approve the minutes of the September 29, 2021 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Gary Reese, Commissioner, Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 1 of 4 NOTICE OF MEETING— 10/6/2021 6. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one year periods if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (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. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2022.02 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Vern Lyssy, Commissioner, Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions, Bid Number 2022.03 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 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 9. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Inmate Food Services, for the Calhoun County Adult Detention Center, Bid Number 2022.04 for the period beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: Gary Reese, Commissioner, Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 4 NOTICE OF MEETING-10/6/2021 10. Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Point Comfort Volunteer Fire Department. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: David Hall, Commissioner, Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Six Mile Volunteer Fire Department. (RM) 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 to approve the FY2022 Texas Indigent Defense Commission Formula Grant Request for Application resolution and authorize the County Judge to apply online. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner, Pct 4 SECONDER: Joel Behrens, Commissioner, Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as National 4-H Week in Calhoun County. (RM) 4H Teacher Emily D.eForest introduced students. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Vern Lyssy, Commissioner, Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as Texas Extension Education Association Week in Calhoun County. (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 3 of 4 NOTICE OF MEETING—10/6/2021 15. Accept report from the following County Office: I. County Treasurer — 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 16. Consider and take necessary action on any necessary budget adjustments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner, Pct. 4 SECONDER: Joel Behrens, Commissioner, Pct. 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 17. 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 Adjourned 10:34 a.m. Page 4 of 4 #6 NOTICE OF MEETING — 10/20/2021 6. Consider and take necessary action to grant bereavement leave to Ron Langford for the month of November. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: David Hall, Commissioner, Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 2 of 23 NOTICE OF MEETING— 10/20/2021 7. Public Hearing on a Petition to Vacate Lots 4 and 5 in First Addition to Magnolia Beach, situated in the Jose 236, Calhoun County, Texas as recorded in Volume Z Plat Records. (DH) Commenced: 10:07 a.m. Closed: 10:08 a.m. Henry Danysh spoke. Block 3 of the Tilke and Crocker Maria Mancha Survey, Abstract No. Page 126 of the Calhoun County Page 3 of 23 PUBLIC HARING - 1012012021 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 ,noel Behrens, Commissioner, Precinct 3 (wary Reese, Commissioner, Precinct 4 NOTICE OF PUBLIC HEARING The Commissioners, Court of Calhoun County, Texas will meet on Wednesday, October 20, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse, 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that Calhoun County Commissioners' Court will hold a Public Hearing in the Commissioners' Courtroom, 211 S. Ann Street, Suite 104, in Port Lavaca, Texas, at 10:00 a.m, on a Petition to vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 1.26 of the Calhoun County Plat Records. (DH) Richard Meyer, County 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 meetingtime. For your convenience, you may visit the county's website at www.czlhouncotx or Linder "Commissioners'Court Agenda" for any official court postings. Q.. Uqq,, FILED AT i`OICLOCK—fk—M OCT 1 2021 ANNAM000DMAN ,0 TY CLERKREOU(NI C�O/UUNNT�Y%TIEXAS BY Page 1. of I 1-01'S 4 (5 IN BLOCK 3 OF SH! TILKC AN I) CROCKC"R RkST AM I ION M MAGNOLIA 131ACH sm.JAII21) IN IIiF ,k7,;f;i MARIA MANC:HA SUM/LY, A13STkACT NO. 236, CALHOUN COUNTY, R:XAS A83 HFCr)RDI- L) IN 'MI_IIR41= Z, PAR 126 OF MIL: GAI_.hIOIJN C;OIJN Il' 1='LAT I:C-:COL;D��. S fAT OI' TEXA, COON "I Y OP: CAL.HOUN KNOW AI.L. KAM I sY fI II >I PhL:r,L iV 13: That the undersignecl, being the designated agent of the owrior of the Inopcliy described <a,, Lots 4. d 5 in Block 3 of the Tilke and C roc{<cr Fkat Addition to hilaagnolia i3ench i9:Lu:ated in the Joe Maria Mancha Sufvey, Abstract No. 236, Calhoun County, Texas as rocorded in VOlunle X, Pago 126 of the Calhoun Couniy Plat Records, do hore:by petition the Caliaoun Couni.y Coir'Ualissioners Courl to vaCato said Lots 4 & 0 in Block 3 of the 'I"ilke and Crorkc-ar Fiat Addition to Magnolia Beach in accordance with Sections 206 and 201 of the Subdivision heagul:��tions and Reuroational Vehicle: Park Regulations Adopted by Calhoun (,utility Cornnnissionors Court on November 29, 2004 and Amended on December '13, 2t)07. Property owners: I rina Kaye Graham Located at 189 and 191 L)lackburrl Street, Port Lavacn, Texas t he property is proposed to he rupWRed in accurd,:ance with ca plot suhnurted to tbca C 11mun County (:orn nlissionors Court, The petition will he considered by the Calhoun County Conlmissionors Court on October 20, 2021 ,:at 10:00 rain. y 0 FILED SEP 21 2021 COUN'N'ffy CLENKNCA�tOUNa C�OUNTY,'rEXAS Nyl,. _ I')esijnritaldf\gent: � I IM�nryFA (>any>b IZ.P.[ `i 1.,08�3 - Cr V\4l.nguaoors" Inc. Tl3Pl.,S Firm No. 10022 100 7.05 W. Lives 0stk Port Lavaca, IX 771U79 (361) 6)52 4500 m 0 uo NOTICE OF MEETING — 10/20/2021 8. Consider and take necessary action on a Petition to Vacate Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of the Calhoun County Plat Records. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 4 of 23 Mae Belle Cassel From: Sent: To: Subject: Attachments: Sent from David's Whone Begin forwarded message: David.Hall@calhouncotx.org (David Hall) <David.Hall@calhouncotx.org> Thursday, October 14, 2021 10:00 AM Mae Belle Cassel Fwd: corrected agenda items for October 20, 2021 10149-001 PRELIMINARY PLAT.pdf, Untitled attachment 00028.pdf; 8911-001 FINAL PLAT.pdf From: hdanysh@gwengineers.com Date: October 14, 2021 at 9:52:32 AM CDT To: David Hall <david.hall@calhouncotx.org> Cc: gking@gwengineers.com Subject: corrected agenda items for October 20, 2021 CAUTION: This email originatedfrom outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Please see corrected date and additional item: Commissioner Hall, Please place the following Item on the agenda for October 20 2021: 1) Public hearing on Petition to Vacate Lots 4 & 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of the Calhoun County Plat Records 2) Consider and take necessary action to Vacate Lots 4 & 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach, situated in the Jose Maria Mancha Survey, Abstract No. 236, Calhoun County, Texas as recorded in Volume Z, Page 126 of the Calhoun County Plat Records 3) Consider and take necessary action to Approve the Preliminary Plat of the Graham Subdivision (a replat of Lots 4 & 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach) t 4) Consider and take necessary action to Approve the Final Plat of the McPeters Subdivision (a replat of 8.12 acres being part of Lot 2, Block 150 of the Alamo Beach Subdivision) Thank you HENRY A. DANYSH Registered Professional Land Surveyor State of Texas No. 5088 G & W ENGINEERS, INC 205 W. Liveoak Street Port Lavaca, Texas 77979 Office: 361-552-4509 Cell: 361-920-4524 Calhoun County Texas t ETIT1Q;t TCp 0lAC AT't LC:iRS 4. & 5 IN 131 0CI< 3 0FP THE TILKG ANC) GROC KLR F 1I�ST AD1)ITI0N TO MAGN0LIA Rl�ACiPi, "WRATED IN THE 10,Sr MARIA MANCHA St,IR\lI-Y, ABSTRACT NCY 236, GAI_I-10UN COUNTY, VE:XAS AS RECORDED IN VOI-AJIVIF J, PAGF '120) 01�- 'HIP C:ALNC3UN COUNTY PLAT 1NLCORDS. SSA EP' 01 'RT XA COUN I Y OF CAL.1-10UN KNOW ALL MIEN 13Y THF. Sl i PRL 3[:NTt3: That the undersigned, being the designated agent of the owner of they property de,sciibod as Lots 4 & 5 in Block 3 of the Tilko and Crocker First Addition to Magnolia Beach, situsrted in thc, ,Jose Maria Mancha SLnvey, Abstract No, 23M CaMOLM County, Toxas as roombe d in Volume X, Page 126 of the Calhoun County Plat Records, do hereby petition the. Calhoun County Cornrnissioners Court to vacate. said Lots /1 d; 5 ire Block 3 of The. TiIV:F: and Crocker First Addition to Magnolia Beach in accordance with Sections, 20(3 and 207 of the Subdivision Regulations and Recreational Vehicle Park Regulations Adopted by Calhoun County ConTrnissioners Court on November 29, 2004 and Amended on [jecombor '13, 2007. Property owners: Idea Kaye. Grahain Localod at 100 and 101 BWcWnan Streast, Port Lavaca, Texas The, preapeNy is Larnposed to be rop acted in accordance with a PWI: submitted to ttua Calhoun County C;orninissionearsCourt. The petition will be. considered by the Calhoun County Comrnisojoners Court on Octobor 20, 2021 at 10:00 a.m. SEP 21 20'1.1 COUNTY CLEVAQal BR COUNTY, TEXAS DesignWe;d A eat: Henry Danysh, R.P. -.13. 5088 G !?, V( Engineers, Inc. T13P1-S I"kin No. 10022100 205 W. Live Gak Port Lavaca, I-X 77979 (361)552---4509 #9 NOTICE OF MEETING — 10/20/2021 9. Consider and take necessary action to approve the Preliminary Plat of the Graham Subdivision (a replat of Lots 4 and 5 in Block 3 of the Tilke and Crocker First Addition to Magnolia Beach). (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 5 of 23 i ,s�aaow�. ;� 33 5�' e9 � 1 al • 3Zaw.ux L�pn G � OO UYI s6 6 r O o0� cc re 0 • ° i'R 1 MS, PRV� x t GJ gyp O c M.SS,fi1.4'LS Z C Y� y o r E�� O D ¢ 1P M,ro.w.Us m r 1 Hgn f n9H M1 "9B F m Byl Z a �i N Y3 Cg u .p0,0 O m �� z Q ® aS� w ®@® €p H m x '3E t" W m n € H t., 1rc1 a w n 4 gg �m 7 O N'H �9^m+3M ^m{ S a $ "s O M ~ �Wy 'RR 4�y Q� � 2 E 33ppP AA .i Rillgal€AR N0,S d t= € 3 WP -55 Rj !_ E 4LiR I g 0 I rnmtn.. C [+C y yy O Or � 4 q2 Ohm y A EE 9g y tic aiy¢ m rn SIR IR 4 Y€ Y & Io- TO ;R 9 p g n e;�•,;,:.� _ �o G 1, W ENGINEERS, INC. _ LANNING • • ENGINEERING • SURVEYING • Pm n OZ o O o 205 W. WE OAK STREET. PORT LFVRCB, ]ERRS 77979 Ip D P b o p O d $ :. 5URTBPLFl 10022100 PRELIMINARY PLAT (351) 552-4509. PORT LAVACA (979) 323-]1C0: BAT CITY .. > 'm ere ."-Cze (6") vstlntll land 6M-M 6ec) 11Vld AHVNIWIl3PJd o p BG6GG StlX3l 'VDVAtll 180d MUM Xtl0 Mil 'M 502 z i y i • 'JNINNVId • 3NIA3A8l15 • 'JNItl33NI0N3 • Z w w fm as G 2 w IIL Ey ? pY5 d a � _ � ti ppa UO tias kF] �pC fg8 KB Sgtl� w agx§ E3 4'sF€4 3y i4 ��aE �/ FWz d i Y aY a b ^d Y�� Yqq a j9s €6gggg `Q�gc' U n C PY11 p II`a g9al5 Vl .. i��%%F g9 yp6�y®�, y� d y 4° [@= y� j� W w z F # b d C G tl fi� E � b E� $ B N G� b G �FxU W W w a E- o U efi 0.I Iwi 'a F a� x a o a^ SZ W co a s a .oa w z SlT W .ro•" a co 0. G Z 4Y9'55 a G m .s LO a h s o " F': oZO p= a 9 n � MT�p2E iSjREESi- U, 4 a P # 10 NOTICE OF MEETING— 10/20/2021 10. Consider and take necessary action to approve the Final Plat of the McPeters Subdivision (a replat of 8.12 acres being part of Lot 2, Block 150 of the Alamo Beach Subdivision). (DH) Henry Danysh spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 6 of 23 xuo ere mu-m (us) r.Vl laoa aoss-zss (sc) I 1Vld WNll ao122001 !'ON M.. s]a91 Z o= 0 0 GLUL SVX31 'Y3VArl 1Wd'133&S Xtl0 W1'M s02 111 " • 9NINNVId • D tIA NOs • 'JN IN33N19N3 • _ - OKI `SHaHNIDNa AM D8 0 oig�¢!�Ft' FF ip% Fx L' gg 1ly 3 ub 33F 3aa 3 uYYS �y tl O [m>eYa 71 53T52'2Tf 415111' 3 d� � EtlR y 1V1 U z r wok E Egy1b 13 5 pq `g pp F pg � F 9g U Z>a h Bg a�]T92'3)'E O � \ U� •g fi U a aa %bra 5. Z N W s 3F 'U�sS.I aMLiiiZ�'w]N e � K g O9LZ 'ON OVON 13N8Vw-01—Vg8V3 i s ay�y 9� h Rom � aA %% fl #11 NOTICE OF MEETING — 10/20/2021 11. Consider and take necessary action to approve the Preliminary Plat for the Desilos RV Park.(VL) Judge Richard Meyer moves to table this item for next week. Page 7 of 23 #12 NOTICE OF MEETING — 10/20/2021 12. Consider and take necessary action to approve the Preliminary Plat of the Saltwater Haven No. 2, Port O'Connor, Texas. (GR) Henry Danysh spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 8 of 23 Gary D. Reese County Commissioner County of Calhoun Precinct 4 October 14, 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 October 20, 2021. • Consider and take necessary action to Approve the Preliminary Plat of the Saltwater Haven No. 2, Port O'Connor, Texas. Sincerely,` 1✓ Gary D. Reese GDR/at P.O. Box 177 — Seadrift. Texas 77983 — email: earv.reese a) calhmmcolx.ora — (361) 785-3141 — Fax (361) 785.5602 jAli 3" 4 �ng 9 F l $ p g €x F s � si oo'az C. y Hill20 p'g 4 LPY FR C,r 4 Piz z 3n �A�SF F Fi� � �7 g gg @ pia Ea s4� �v nq a F8 �a 9 {dY aa F aO+ NR o"ydi€'' se _ G & W ENGINEERS, INC. ^ $ m • ENGINEERING • SURVEYING • PLANNING p o -205 W. pbE OAK . Pg;i . TEXAS 77979 IOPLS nNMNO.: 10022100 m l7! p o b PRELIMINARY PLAT (oep 5sz-a5o9: Pc9i txvxce (9v9) 5z5-]lo0: ear crtv BOGGY BAYOU °oa= o - A m PV tla 'a 's CIO i r ---------- - / / a m ------- s 1 ris a 00 a z e ms ? Y -------------- ------- —__- It -I __u_S ____/ m H a amm .xx cMAw5-- ' --r—------- - C p ---------- i s m s flE 5 m ^' ------ ------------- raWowco L.L I—-,, :< u 5 $ N J- _- ----- - - - _� al ------------ ------------------ jo Ns I —- n, o, reg , ------------------ 0 ------------------ 5 r_________ ___________,_____ __ ___________ ,�i .E ,r F35��-°''�• €I e©o ----------------- ___________ _ _ --__J L __ _ __ mxc melrn.L _� ¢ q - N NIS s Hr _____ 4 — ---------------------------------------- -------------------------------------- — — - - --- -- -- - 0 5m c 'VISION mA G & W ENGINEERS, INC. m p =pogr mum • ENGINEERING • SURVEYING • PLANNING :Opp • a o 205 W. LI4E OAK S1HEEi, Pgii LAV2OA. TEXAS ]]W9 'V O n n :. ', NO.: PRELIMINARY PLAT 979)G0230 (asq esz-uos: roxi uvncA (s]sI �z3am¢ env crzr PORT AVA #13 NOTICE OF MEETING — 10/20/2021 13. Consider and take necessary action on Abila MIP Fund Accounting quote for one additional user license and authorize the County Auditor to accept and sign the quote. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 9 of 23 Mae Belle Cassel From: cindy.mueller@calhouncotx.org (cindy mueller) <cindy.mueller@calhouncotx.org> Sent: Wednesday, October 6, 2021 2:04 PM To: Mae Belle Cassel Cc: Richard Meyer; David Hall; vern lyssy, Joel Behrens; Gary Reese; vanessa.verrier@communitybrands.com Subject: Agenda Item Request Attachments: 1295 Community Brands 2021.09.30 redacted.pdf, 09.01.21 - Calhoun Co TX 12845 - MIP FA single user add.pdf Please place the following item on the agenda for October 20, 2021: • Consider and take necessary on Abila MIP Fund Accounting quote for one additional user license and authorize County Auditor to accept and sign the quote. Cindy Mueller County Auditor Calhoun County 202 S. Ann, Suite B Port Lavaca, TX 77979 V: 361.553.4610 F: 361.553.4614 Cindv.mueller(a calhouncotx.ore Calhoun County Texas 10800 Pecan Park Blvd #400 Austin, TX 78750 Vanessa Vender vanessa.verrier@communitybrands.com Ship To Cindy Mueller Calhoun County, Texas 202 South Ann Street, Ste B Port Lavaca, TX 77979-4204 United States Agreement Term: 9/1/2021 - 12/14/2021 MIP FA Additional Users - 1-User Perpetual Additional Users - 1-User Perpetual - M&S Signature: / • t q _ Name (Print): _�—•lr�,On✓. LLgJ�p/��Y Questions? Call +1.800.811.0961 Quote #: Q-196978-1 Expires On: 10/31/2021 Customer #: 12845 Bill To Calhoun County, Texas 202 South Ann Street, Ste B Port Lavaca, TX 77979-4204 United Slates Page 1 of 1 $2,695.00 1 $2.695.00 $674.00 1 $194.35 MIP FA Total: $2,889.35 Effective Date: d U _ AO _c 1 Title: p yi 6 f 14c r- Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1. 2. s, 5, and 6 itthere are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2021-807059 Community Brands Austin, TX United States Date Fled: 09/28/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed.. Calhoun County, Texas Date Acknowledged: g Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract Sep-21 One perpetual MIP user 1 software user license for MIP fund accounting 4 Name of interested Party City, State, Country (place of business) Nature of interest (check applicable) Gontrolffng7 intermediary 5 Check only If there is NO Interested Party. X Iaj 6 UNSWORN DECLARATION My name is Vanessa verri er and my date of birth is 10800 Pecan Pk Blvd, Ste 400 Austin TX 78750 USA My address is , (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct . Williamson TX 30 Sept. 21 Executed in County, State of on the __._day of,--- 20____ , / (month) (year) �c uauv i r441 u Signature of audibrized agent of contracting business entity (Declarant) #14 NOTICE OF MEETING — 10/20/2021 14. Consider and take necessary action on the first insurance proceeds check from TAC in the amount of $11,325.40 ($61,325.40 — deductible of $50,000) for damages caused by Hurricane Nicholas on September 13, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 10 of 23 Mae Belle Cassel From: candice.villarreal@calhouncotx.org (candice villarreal) <candice.villarreal@calhouncotx.org> Sent: Friday, October 8, 2021 2:41 PM To: maebelle.cassel@calhouncotx.org; Richard H. Meyer; David Hall; vern lyssy; joel.behrens@calhouncotx.org; Gary Reese Subject: Agenda Item - Hurricane Nicholas Insurance Proceeds Attachments: TAC Proceeds - Hurricane Nicholas 100521.pdf MaeBelle, Please add the following to the October 20th agenda. • Consider and take necessary action on the first insurance proceeds check from TAC in the amount of $11,325.40 ($61,325.40 — deductible of $50,000) for damages caused by Hurricane Nicholas on September 13, 2021. Thank you, Candice Villarreaf 1st Assistant Auditor Calhoun County Auditors Offue 202 S. Ann Street, Suite B Port Lavaca, qX 77979 Phone (361)553-4612 Calhoun County Texas TEXAS ASSOCIATION OF COUNTIES RISK MANAGEMENT POOL -CLAIMS 53539 $-50000.00 T _ 53539 paso�' ,. TEXAS COUNTIES FROSTBANK - MANAGI MENTP06 RISK MRNAGEMEN'k.PObL-CLAIMS aoam4o '- - 1210 k p AUSTISTINTONIO7TREET- N,JX 79701 'I CyOp12se9 1512f 4]&e]53 x DATE AMOUNT.-E 10/5/2021 $ 11,325,40 PAN ELEVEN THOUSAND THREE HUNDRED TWENTY-FIVE AND 40/100 DOLLARS F „2 TO T. HE ORDER Calhoun County „I / VOID AFTER 1800 DAYS / _ /}' /,(�;_// ~i 202 S Ann St Ste B �7J .(NW[.>,- Port Lavaca, TX 770794204 II'053539". #15 NOTICE OF MEETING— 10/20/2021 15. Consider and take necessary action to approve Addendum Number 1 to the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 11 of 23 October 14, 2021 To: Judge Meyer From: The office of the County Auditor Please place the following item on the Commissioners Court Agenda for October 20, 2021: Consider and take necessary action to approve Addendum Number 1 to the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022. CALHOUN COUNTY, TEXAS ADDENDUM NO. 1 to the INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL Bid Number: 2022.01 Bid Term: January 1, 2022 thru December 31, 2022 With the option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County Page 1 of 3 Clarification and revisions to the original Invitation to Bid Specifications, Invitation to Bid Form and Cover Page for Method or Source Document have been deemed necessary. Once approved by Commissioners Court, Addendum No. 1 shall automatically become part of the Invitation to Bid for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 and shall supersede any previous specification(s) and/or provision(s) in conflict with this Addendum No. 1. If discrepancies and/or inconsistencies exist between these specified revisions and the original Invitation to Bid Specifications, Invitation to Bid Form and Cover Page for Method or Source Document, said Addendum No. 1 shall govern. By submitting a bid, respondents shall be deemed to have received Addendum No. 1 and to have incorporated Addendum No. 1 into their bids. Requested information and/or questions to Bid Number 2022.01, Annual Supply Contract for Delivered Fuel: 1. Provide a copy of a current invoice with backup provided by the County's current supplier: See Attachment A 2. What is the requested benchmark? Please see page 3 of the Specifications See Attachment B The SPECIFICATIONS were amended: REMOVE: Entire Original Specifications (page 1— 8) REPLACE: With the Amended Specifications (page 1-8) • The information in Red is what changed from the Original Specifications 3. Due to #2 changing the Specifications, the INVITATION TO BID FORM was amended to reflect the changes in the words "plus or minus" to "Mark -Up" See Attachment C The INVITATION TO BID FORM was amended: REMOVE: Entire Original Invitation to Bid Form (page 1— 7) REPLACE: With the Amended Invitation to Bid Form (page 1-7) • The information in Red is what changed from the Original Invitation to Bid Form Page 2 of 3 4. Due to #2 amending the Specifications and Invitation to Bid Form, the COVER PAGE for the "METHOD OR SOURCE DOCUMENT" was amended to reflect the changes in the words "Plus or Minus" to "Mark -Up" See Attachment D The COVER PAGE for THE METHOD OR SOURCE DOCUMENT was amended: REMOVE: Original Cover Page for the Method or Source Document REPLACE: With the Amended Cover Page for the Method or Source Document • The Information in Red is what changed from the Original Cover Page for the Method or Source Document Page 3 of 3 ATTACHMENT A Copy of Current Invoice with Backup provided by the County's current supplier Copy of Invoice and Backup for Diesel (Clear) & Gasoline (Unleaded) Copy of Invoice and Backup for Diesel (Dyed) Invoice V 11Y11Y Distributing P.O. BOX 1247 ^ 4102 HWY. 59 N VICTORIA, TEXAS 77902-1247 (361) 575.1981 (800) 831-1981 FAX (361) 576-2602 www.newdistributing.com Bill To: i Calhoun County Precincl4 104 E Dallas St Seadrift, TX 77983 (� Invoice No: 19899- 08 Invoice Date: Thu 08/26/2021 y Delivery Date: Thu 08/26/2021 Ship To: ID: _— Pot 4-S Barn #2 448 Harbor Road Seadrift, TX 77983 Account ID: � Order No: DT-26586-2108 Reference No.: 337223 P.O. No: Salesperson: Thank you for your business Customer Copy Description BOL No Units YnItPrice Total Diesel ULSD Clear 645399 2,012.00 11 2,356700 1,/ 4,741.68 Federal Diesel Oil Spill Tax ( 0.002140) 0.002140v� 4.31 Federal Diesel Tax (0.000000) 0.000000 0.00 Federal Lust Fund ( 0.001000) 0.001000 ji 2.01 State Diesel Tax (0.200000) 0,200000 / 402.40 Texas Load Fee( 0.001200) - , 0.001200 j 2.41 Product Total 2.561040 $5,152.81 / V/ 87 Conv w110% Ethanol (Lo RVP) 645399 1,000.00 v 2.413800 L. 2,413.80 Federal Gas Oil Spill Tax (0.001930) 0.0019301,% 1.93 Federal Gasoline Tax (0.000000) 0.000000 0.00 Federal Lust Fund ( 0.001000 ) 0.001000.", 1.00 - State Gasoline Tax ( 0.200000) 0.200000 t- 200.00 Texas Load Fee ( 0.001200) 0.001200 1.20 Product Total 2,617930 $2,617.93 V Invoice Total $7,770•74 ,/ 7,770.74 INKw Cris #190MA, P.O. BOX 1247 ° 4102 HWY. 59 N VICTORIA, TEXAS 77902-1247 www.newdistributing.com (361) 575-1981 (800) 831-1981 FAX (361) 575-2602 DATE ACCOUNT/�Q. SOLD TO \.,, .f /1 UEL IVERY No. 1 TERMS: ❑ C.O.D. ❑ NET 10 DAYS ❑ NET 30 DAYS CUSTOMER P. O, 10,'— DELIVERED TO 1 I DELIVERED BY 4ISLI C ) I. o- I•`'r'.Nd4�'C3B�11=d��'Y PACI(AGIES IiAZARDOUSMATERIAI. DESCRIPTION ORIGIN MANIFEST QUANTITY NO. KIND ---BULK -__ � _ --Or DER GASOLINE, IjUNLL•AUED 3, PGII OCTANE-- ( )� L� 1�{Z}2) V '` BULK UN 1LIN GASOLINE, 89 —NUM UNLEADED 3, PG It OCTANE PLUS BULK UN 1203, GASOLINE, 93 PER _ PG OCTANE UNLEADED BULK A1993, DIESELFUEL 3, _ S% ULSD _ PG III BIO DYED BULK NA 1093, DIES EL FUEL 3, PO III 6% ULTRA•LOW SULFWIDIESEL G1 V(I1� J l -V c7ilJ Ch UN 1223, KEROSENE, BULK 3, PG III KEROSENE NA 1268, NAPTHA, 3, PG III SOLVENT METHANOL NA I233. GIII MEfHANOL nFFORMt1LNI'f-:I7 GASOLINE MAY ----CONTAIN UP>_TO100%EI'I1AN01. PRICE.: TAX PLAICE __......._.__� ExClud"" Including AMOUNT Tax Stalo Foci. Tax _F. SALE: All past due accounts are subject to the ❑ EXEMPT ❑ RESALE ❑ FARM USE: lesser of 1 Y:%per month or maximum lawful rate, computed ------------ from the due date. - -- .. rr TEf1MS1F Np CONDITIONS AC -PTEU 6y: If)—'-- C.9-tf.,��f )C_ _aiwL2 f � CHECT<EU&RECEIVED INVOICE WILL. FOLLOW SUBJECT TO CORRECTION OF CLERICAL ERRORS 6/26/2021 CIISixafted OPIS City Rack Report for .i5 j..I,ICI'I'ir.; �;r� '(f.. .I. JII i.:.. 'i' >. VICTORIA/PLACEDOr TX 2021-08-26 10:00:23 EDT **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS CBOB ETHANOL(IOX) PRICES** 7.8 RVP Move Terms Unl Move Mid Move Pre Move Date Tinte Valero b 1-10 228.38 + 4.85 244.46 + 4.85 277.83 + 4.86 08/25 18:00 76-Mot b 125-3 230.72 + 9.41 245.91 + 9.41 279.04 + 9.42 08/25 18:08 Shell -Mot b 125-3 230.82 + 9.42 249.04 + 9.41 283.47 + 9.41 09/25 18:00 Citgo b 1.10 231.25 + 8.21 246.91 i 8.21 279.23 + 8.21 08/25 18:00 PSX b 1-10 231.44 + 7.00 248.44 + 7.00 281.44 + 7.00 08/25 18:00 Citgo u 1-10 233.38 + 9.01 248.54 + 9.01 280.86 + 9.01 08/25 18:00 XOM b 125-3 234.75 +11.53 251.97 +11.53 285.39 ill.54 08/25 19:00 Cenex b 1-10 234.80 + 9.12 -- -- -- -• -- -- -- -- 08/25 18:00 LOW RACK 228.38 244.46 277.83 HIGH RACK 234.80 251.97 2BS.39 RACK AVG 231.94 247.90 281.15 OPIS GULF COAST DELIVERED SPOT (SRI) FOR VICTORIA/PLAC 223.11 -- -- 230.87 BRD LOW RACK 228.38 244.46 277.83 BRD HIGH RACK 234.80 251.97 285.39 BRD RACK AVG 231.74 247.70 281.20 LED L041 RACK 233.38 248.54 280.86 UDD HIGH RACK 233.3E 248.54 280.86 UBD RACK AVG 233.38 248.54 280.86 CONT AVG-08/26 231.94 247.90 281.15 CONT LOW-08/26 228.38 244.46 277.83 CONT HIGH-08/26 234.80 251.97 285.39 VICTORIA, TX LOW RETAIL 248.60 AVG RETAIL 266.15 LOW RETAIL EX -TAX 209.84 AVG RETAIL EX -TAX 227.39 VICTORIA/PLACEDO, TX 2021-08-26 10:00:23 EDT **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS ULTRA LOW SULFUR LED DISTILLATE PRICES** Move Terms No.2 Move No.1 Move Pre Move Date Time Valero b 1-10 225.83 + 5.24 -- -- -- •• -- -- -- •- 08/25 18:00 PSX b 1-10 225.93 + 5.75 -- -- -- -- -- -- -• -- 08/25 18:00 Cenex b 1.10 225.94 + 3.57 -- -- -- -- -- -• -- -- 08125 18:00 Motive b 125-3 226.63 + 5.77 -- -- -- -- -- -- -- -- 08/25 18:60 Citgo b 1.10 226.67 + 5.84 -- -- -- -- -- -- -- -- 08/25 18:00 Citgo u 1-10 226.67 + 5.84 -- -- -- -- -- -- -- -- 08/25 18:00 76-Mot b 125-3 226.79 + 5.78 -- -- -- -• -- -- •- -- 08/25 18:00 Shell -Mot b 125-3 226.84 + 5.78 -- -- -- -- - -- -- -- 08/25 18:00 LOW RACK 225.83 -- -- -- -- HIGH RACK 226.84 •- -- -- -- RACK AVG 226.41 -- -- -- -- OPIS GULF COAST DELIVERED SPOT (SRI) FOB VICTORIA/PLAC 211.33 - -- -- -- BRD LOW RACK 225.83 -- -- -- -- BRD HIGH RACK 226.84 -- -- -- -- BRD RACK AVG 226.38 -- -- -' UBD LOW RACK 226.67 -- -- -- -- UBD HIGH RACK 226.67 -- -- -- -- UBD RACK AVG 226.67 -- -- -- -- CONT AVG-08/26 226.41 -- -- -- -- CONT LOW-08/26 225.83 •- -- -- -- CONT HIGH-08/26 226.84 -- -- -- -- RUpslAvebracks.opisnet.cmnf V2 6/26/2021 Customized OPTS City Rack Report for VICTORIA/PLACEDO, TX 2021-08.26 10:00:23 EDT **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS ULTRA L014 SULFUR RED DYE LED DISTILLATE PRICES** N0.2 N0.1 Pre Move Terms RD Move RD Move RD Move Date Time Cenex b 1.10 226.34 + 3.57 -- -- -- -- •- -- -- -- 08/25 18:00 PSX b 1-10 226.94 + 5.75 -- -- -- -- -- -- -- -- 08/25 18:00 Citgo b 1-10 227.07 + 5.84 -- -- -- -- -- -- -- -- 08/25 18:00 Citgo u 1-10 227.07 + 5.84 -- •- -- -- -- -- -- -- 08125 18:00 LOW RACK 226.34 -- -- -- -- HIGH RACK 227,07 -- -- -- ^' RACK AVG 226.8E -- -- -- -- OPIS GULF COAST DELIVERED SPOT (SRI) FOB VICTORIA/PLAC 211.68 -- -- -- -- BRD L014 RACK 226.34 -- -- -- -- BRO HIGH RACK 227.07 -- -- -- -- BRD RACK AVG 226.78 -- -- -- -- UBD LOW RACK 227.07 -- -- -- -- UBD HIGH RACK 227.07 -- -- •- -- UBD RACK AVG 227.07 -- -- -- -- CONT AVG-08/26 226.86 -- -- •- -- CONT LOW-08/26 226.34 -- -- -- -- CONT HIGH-08126 227.07 -- -- -- -- VICTORIA/PLACEDO, TX **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS WHOLESALE 85 SME 8IODIESEL ULS2 UL52D Move Terms LED LED Date Time XOM b 125-3 225.50 -- -• 08/25 19t00 Valero to 1-10 225.83 -- -- 08/25 18:00 PSX b 1-10 225.93 -- -- 08/25 18:00 motiva b 125.3 226.63 -- -- 08/25 18:00 Citgo b 1-10 226.67 227.07 08/25 18:00 Citgo D 1-10 226.67 227.07 08/25 18:00 76-Mot b 125-3 226,79 -- -- 08/25 18:00 Shell -Mot b 125-3 226.84 -- -- 08/25 18:00 LOW RACK 225.50 227.07 NIGH RACK 226.84 227.07 RACK AVG 226.36 227.07 BRD LOW RACK 225.50 227.07 BRD HIGH RACK 226.84 227.07 BRD RACK AVG 226,31 227.07 UBD L014 RACK 226.67 227.07 UBD HIGH RACK 226.67 227.07 UBD RACK AVG 226.67 227.07 CONT AVG-08/26 226.36 227.07 CONT LOW-08/26 225.50 227.07 CONT HIGH-08/26 226.84 227.07 Copyright, Oil Price Information Service 2021-08-26 10:00:23 EDT PRICES** https://viebracks.oplsnet.ccmt 2/2 Invoice !<VI P.O. BOX 1247 0 4102 HWY.. 59 N VICTORIA, TEXAS 77902-1247 (361) 575-1981 (800) 831-1981 FAX (361) 575.2602 www.newdistributing.com Bill To: Calhoun County EMS Station 705 Henry Barbe—r WAy--- Port Lavaca, TX 77979 Order No: DT-26495-2108 Salesperson: Thank you for your business Description BOL No Diesel ULSD Dyed 645286 Federal Diesel Oil Spill Tax ( 0.002140 ) Federal Lust Fund ( 0.001000 ) Texas Load Fee (0.001200 ) Invoice Total Invoice No:19845-2108 V Invoice Date: Wed 08/25/2021 Delivery Date: Wed 08/26/2021 Account ID: Ship To ID: -_ EMS Central Station Generator 705 Henry Barber Way Port Lavaca, TX 77979 Reference No.: 337217 P.O. No: Units Unit Prige 80,00 2.432250 0.002140 0.001000 0.001200 Product Total 2.436690 Customer Copy 194.58V 0.17 0.08 v 0.10 v $194.93 194.93 New Dist P.O. BOX 1247 - 4102 HWY. 59 N VICTORIA, TEXAS 77902-1247 www.newdistributing.corn (361) 575-1981 (800) 831-198-1 FAX (361) 575-2602 DATE DELIVERY TICKET No TERMS: ❑ C.O.D. ❑ MET 10 DAYS ❑ NET 30 DAYS ACCOUNT a— CUSTOMER P O. PI10 SOLD T0� iGK 0)22'? C Q ' DELIVERED TO ADDRESS DELIVERED BY U (f J EmFpwn'`r- 9c'P c w,!r-.lrAc-P !.l-i;3t90-4..24-9300 PACKAGES HAZARDOUS MATERIAL ORIGIN MANIFEST' — QUANTITY PRICE Exoludin 9 TAX PRICE Including J A6:IOUNT NO. I<IpID DESCRIPTION NUMBER lax State Fed. �( e BULK UN 1203, GASODNE, 87 OCTANEUNLEADED 3, PG 11 BULK UN 1203, GASOLINE , 89 UNLEADED 3, PG 11 OCTANE PLUS UN 1203. 93 SUPER BULK GASOLINE, 3, PG 11 OCTANE UNLEADED BULK NA 1903, DIESEL FUEL 3, 5°/ ULSD DYED PG III NA 1993, 5% ULTRA-LOVI BULK DIESEL FUEL 3, PO III BID SULFUR DIESEL UN 1223, KEROSENE, 3, PG III KEROSENE NA 1266, NAPTHA, SOLVENT 3, PG III NA 1230, METHANOL fAETF1ANOL 3, PG III ]H1S VOOLICT IS DYED DIESEL F NUN TAX ABLE USE: ONLY JEL ENALTY F R 1AXA BLE USE FF HIGHWAY NO LEGAL OR MOTOR VEHI LE USE REFORMULATED GASOLINE MAY 'CO TAIN UP TO 10% ETHANOL Sales Ta:: CONDITION OF SALE: All past due accounts are suhlect to the ❑ EXEMPT ❑ RESALE ❑ FARM USE I a :, �.1® lesser of 1 '/z% per month or maximum lawful rate, computed from the due date. •o TERMS AND CONniTlnNc nrnFPTFn BY: INVOICE WILL FOLLOW SUBJECTCORRECTION ){ _ OF CLERICAL ERRORS CHEGICEU & HtCaIVtU uu 8/25/2021 Customized OPTS City Rack Report for (Cm. Tb. iikiiH VICTORIA/PLACEDO, TX 2021-08-25 10:00:18 EDT **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS CEDE ETHANOL(10%) PRICES** 7.8 RVP Move Terms Unl Move Mid Move Pre Move Date Time 76-Mot b 125-3 221.32 + 3.90 236,50 + 3.90 270.42 + 3.90 08/24 18:00 Shell -Mot b 125-3 221.40 + 3.90 239.63 + 3.90 274.06 + 3.90 08/24 18:00 Citgo b 1-10 223.04 + 4.70 238.70 + 4.70 271.02 + 4.70 09/24 18:00 XOM b 125-3 223.22 + 1.44 240.44 + 1.44 273.85 + 1.43 08/24 19:00 Valero b 1-10 223.53 + 5.60 239.61 + 5.29 272.97 + 5.28 08/24 18:00 Citgo u 1-10 224.37 + 3.75 239.53 + 3,76 271.85 + 3.76 08/24 19:00 PSX b 1-10 224.44 + 4.30 241.44 + 4.30 274.44 + 4.30 08/24 18:00 Cenex b 1-10 225.68 + 3.67 - -- -- 08/24 18:00 LOW RACK 221.31 236.50 -- -_ 270.42 HIGH RACK 225.68 241.44 274.44 RACK AVG 223.37 239,41 272.66 OPIS GULF COAST DELIVERED SPOT (SRI) FOB VICTORIA/PLAC 213.56 -- -- 223.46 BRD LOW RACK 221.31 236.50 270.42 BRD HIGH RACK 225.68 241.44 274.44 BAD RACK AVG 223.23 239.39 272.79 UBD LOW RACK 224.37 239.53 271.85 UBD HIGH RACK 224.37 239.53 271.85 UBD RACK AVG 224.37 239.53 271.85 CONT AVG-08/25 223.37 239.41 272.66 CONT LOW-08/25 221.31 236.50 270.42 CONT HIGH-08/25 225.68 241.44 274.44 VICTORIA, TX LOW RETAIL 249.07 AVG RETAIL 266.56 LOW RETAIL EX -TAX 210.30 AVG RETAIL EX -TAX 227.80 VICTORIA/PLACEDO, TX 2021-68-25 10:00:28 EDT **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS ULTRA LOW SULFUR LED DISTILLATE PRICES** Terms No.2 Move Move No.1 Move Pre Move Date Time PSX b 1-10 220.18 + 6.00 -- -- -- -- -- -_ - 08/24 18:00 Valero b 1-10 220.59 + 5,76 __ __ __ __ _ _ 08j24 18:00 Citgo b 1-10 220.83 + 6,06 __ __ 08/24 18;00 Citgo u 1-10 220.83 + 6.08 __ __ __ 08/24 18:00 Motiva b 125-3 220.86 + 5.77 -- -- -- __ _ _ -_ 08/24 18:00 Cenex b 1-10 220.89 + 3.29 -- -- -- -_ _ 08/24 18:00 76-Mot b 125-3 221.01 + 5.77 -- -_ __ __ __ __ _ 08/24 18:00 Shell -Mot b 125-3 221.06 + 5,77 __ __ __ __ __ __ 08/24 28:00 LOW RACK 220.18 HIGH RACK 221.06 RACK AVG 220.78 OPIS GULF COAST DELIVERED SPOT (SRI) FOB VICTORIA/PLAC 205.63 BRD LOW RACK 220.18 BRD HIGH RACK 221.06 BRD RACK AVG 220.77 UBD LOW RACK 220.83 UBD HIGH RACK 220.83 UBD RACK AVG 220.83 CONT AVG-08/25 220.78 CONT LOW-08/25 220.18 CONT HIGH-08/25 221.06_- https:/fwebracks.opisnetcorr. 112 8/25/2021 Customized OPIS City Rack Report VICTORIA/PLACEDO, TX 2021-OB-25 10:00:28 EDT **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS ULTRA LOW SULFUR RED DYE LED DISTILLATE PRICES** No.2 No.1 Pre Move Terms RD Move RD Move RD Move Date Time PSX b 1-10 221.19 + 6.00 -- -- -- -- -- -- -- -- 08/24 18:00 Citgo b 1-10 221.23 + 6.06 -- -- -- -- -- -- -- -- 08/24 18:00 Citgo u 1-10 221.23 + 6.08 -- -- -- -- -- -- -- -- 08/24 18:00 Cenex b 1-10 222.29 + 3.29 -- -- -- -- -- -- -- -- 08/24 19:00 LOW RACK 221.19 -- -- -- -- HIGH RACK 221.29 -- -- -- -- RACK AVG 221.24 -- -- -- -- OPIS GULF COAST DELIVERED SPOT (SRI) FOB VICTORIA/PLAC 205.98 -- -- -- -- BRD LOW RACK 221.19 -- -- -- -- BRD HIGH RACK 221.29 -- -- -- -- BRD RACK AVG 221.24 -- -- -- -- UBD LOW RACK 221.23 -- -- -- -- UBD HIGH RACK 221.23 -- -- -- -- UBD RACK AVG 221.23 -- -- -- -- CONT AVG-08/25 221.24 -- -- -- -- CONT LOW-08/25 221.19 -- -- -- -- CONT HIGH-08/25 221.29 -- -- -- -- VICTORIA/PLACEDO, TX 2021-08-25 10:09:18 EDT **OPIS CONTRACT BENCHMARK FILE** **OPIS GROSS WHOLESALE ES SME BIODIE5EL PRICES** ULS2 UL52D Move Terms LED LED Date Time XOM b 125-3 219.65 -- -- 08/24 19:00 PSX b 1-10 220.18 -- -- 08/24 18:00 Valero b 1-10 220.59 -- -- 08124 18:00 Citgo b 1-10 220.83 221.23 08124 18:00 Citgo u 1-10 220.83 221.23 00/24 1B:00 Motive b 125-3 220.86 -- -- 08/24 18:00 76-Mot b 125-3 221.01 -- -- 09/24 18:00 Shell -Mat b 125-3 221.07 -- -- 09/24 18:00 LOW RACK 219.65 221.23 HIGH RACK 221.07 221.23 RACK AVG 220.63 221.23 BRD LOW RACK 219.65 221.23 BRD HIGH RACK 221.07 221.23 BRO RACK AVG 220.60 222.23 UBD LOW RACK 220.83 221.23 UBD HIGH RACK 220.83 221.23 UBD RACK AVG 220.83 221.23 CONT AVG-08/25 220.63 221.23 CONT LOW-08/25 219.65 221.23 CONT HIGH-08/25 221.07 221.23 Copyright, oil Price Information Service hltps:l/webracks.oplsnet.conV 212 ATTACHMENT B Amended Specifications All changes are in Red SPECIFICATIONS FOR ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL BID NUMBER 2022.01 Amended with Addendum No. 1 BY ORDER OF the Commissioners Court of Calhoun County, Texas, sealed bids will be received for the Annual Supply Contract for Delivered Fuel as needed by the Road and Bridge Precincts, other Calhoun County Departments, and the Calhoun County Hospital and Clinic (Memorial Medical Center & Memorial Medical Clinic), (all hereinafter called Calhoun County) for fuel tanks and/or generator fuel tanks. See Contact and Billing Information and Location of Fuel Tanks and Generator Fuel Tanks for complete information for each Calhoun County delivery location. INVITATION TO BID PACKET The complete Invitation to Bid Packet may be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. The complete Invitation to Bid Packet must be used in preparing the bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3`d Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.01 ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL If the SEALED BID is sent by UPS, FedEx, or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.01 ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 A late delivery with an early postmark will not suffice. Page 1 of 8 Calhoun County is not responsible for the delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid due date and time. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the bid is received and the time the bid will be opened. No bids will be accepted after the due date and time has been reached. Calhoun County accepts no financial responsibility for any cost incurred by the bidder in the course of responding to these specifications. Faxed or emailed bids shall not be accepted. BID TERM The bid shall be in effect for a period of one (1) year beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County. BID INFORMATION/REQUIREMENTS To submit a valid bid, read the entire Invitation to Bid Packet for all required information that must be included and all required forms (see page 7) that must be returned and/or filled out, signed and dated and returned. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a bid. If you will not be submitting a bid, we would appreciate your indicating on your "NO BID" response any requirements of this bid request which may have influenced your decision to "NO BID." Calhoun County is not responsible for errors if the Bid Forms are handwritten. It is recommended that all information submitted by the vendor on the Bid Forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. All bidders shall provide the Brand Name for each type of fuel to be used throughout the bid period in the space provided on the Invitation to Bid Forms. Unleaded Gasoline must be free from water and suspended matter and octane of 87 and octane of 93 non -Ethanol. Diesel Fuel must be free from water and suspended matter. The bidder who is awarded the bid shall supply Calhoun County with a 1,000-gallon skid fuel tank and Pump with meter at no additional charges. The movable skid fuel tank should be double wall or a single wall tank and secondary containment that satisfies TCEQ requirements. Delivery (free of delivery charges by the awarded bidder) of the empty skid fuel tank will be to the Calhoun County Recycle Center, 900 Landfill Road, Port Lavaca. The skid fuel tank, when needed, will be moved by Page 2 of 8 Calhoun County to close proximity of the Calhoun County Courthouse, 211 S. Ann St., Port Lavaca and fuel will be delivered to this location. +., ?d) 94 RQ@d LOW SUI fU. Dyed Piesel. This paragraph deleted from Specifications All bidders are required to bid a plus OF rwiRUS MARK-UP per gallon for each fuel type and location. Unless noted under Other Fees not included in Mark -UP the e4►s-emm4ws Mark -Up per gallon shall include any and all delivery charges and other fees that will be billed in addition to the Lowest Rack Price and Texas State Excise Tax that is listed. THE RI ' IS OR A411119 MARK-UP AND OTHER FEES, IF ANY OTHER FEES ARE LISTED, PER GALLON WILL REMAIN CONSTANT THROUGHOUT THE TERM OF THE CONTRACT. All bidders shall provide with their bid a copy of the Method or Source Document used for plus OF rAinis; Mark -Up per gallon throughout the bid period. The bid shall be for the lowest available branded daily rack prices. Calhoun County is aware that the Rack Price may vary throughout the term of the contract. Bidders shall note on the bid sheet the method or source that will be used throughout the term of the contract to determine the lowest Rack Price and shall provide a sample copy of any documentation available with their bid. In addition, the bidder shall supply documentation of corresponding lowest rack price with each invoice. Awarded bidder will be required to furnish acceptable evidence to substantiate the rack price charge with each billing and bill of lading from pickup location. Calhoun County is EXEMPT from all Federal Excise Taxes and Sales Tax (county, city and state sales tax). Calhoun County is subject to Texas State Excise Tax on gasoline and clear diesel. The bidder must state on the Invitation to Bid Form all Other Fees that are not included in the plus OF rr+i+u+s Mark -Up per gallon. Only Other Fees listed on the Invitation to bid form or separate page that is signed and dated by an authorized representative and returned by the bidder with their bid and awarded as such to the successful bidder will be allowed to be included on the invoice when the awarded bidder submits the invoice for payment. If bidder does not list any Other Fees, then the invoice shall only include the Lowest Rack PriceplasOF MORas plus the Mark -Up per gallon bid amount and Texas State Excise Tax when applicable. Bid price shall include all transportation costs to the designated delivery locations. Bidder must list on the Invitation to Bid Form any delivery charges or fees for after hours, weekends and/or holidays. If these charges or fees are not listed, no other delivery charges or fees can be included on the invoice. All charges must be included in thews Mark -Up per gallon or clearly stated on Bid Form. Additional charges listed separately, if any, will increase the amount of the bid. Page 3 of 8 Any exceptions and/or variations from the specifications in this bid document must be indicated on the bid form or on a separate attachment to the bid and labeled as such. Exceptions taken and/or variations made to the specifications and listed on the bidder's bid or separate attachment may void the bid. The request for a bid on delivered fuel does not guarantee that Calhoun County will purchase this product during the bid period. Calhoun County does not guarantee to purchase any minimum or maximum quantities. Fuel will only be ordered as needed. Calhoun County has the right to reject, at any time, any fuel that is undesirable. Calhoun County legally accepts delivery of fuel after it is unloaded and approved by Commissioners and or an employee of other Calhoun County Departments. Loaded weight of truck, trailer and fuel cannot exceed legal state and county weight limits on road and bridges that approach designated delivery sites. Bidder shall check with Precinct Commissioner for such limits. All fuel ordered will be delivered to the delivery site designated and within 24 hours from time of order. In the event a contracted bidder is unable to deliver the fuel ordered within 24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the said fuel from the bidder which submitted the next lowest bid that met bid specifications and/or requirements and can deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or other charges when cancelling an order. Awarded bidder shall be required to notify Calhoun County in the event of unforeseen delay arising in the delivery of an order. In the event an order will not arrive at the Calhoun County delivery location at the designated time, Calhoun County shall have the right to cancel and/or refuse acceptance of the order. Calhoun County shall not be assessed any penalties, fees and/or other costs due to this cancellation and/or refusal. If awarded bidder cannot supply a product, a written statement from the bidder indicating the reason, must be sent to the County department and Calhoun County reserves the right to spot purchase the product. Calhoun County and/or the awarded bidder have the right to cancel the delivery of fuel at any time due to weather and/or road conditions. No penalties, fees and/or other charges will be billed to Calhoun County if the delivery of fuel is cancelled by Calhoun County and/or the awarded bidder due to weather and/or road conditions. Calhoun County reserves the right to refuse any order delivered for not being in compliance with the specifications, general conditions and/or the "Hazardous Communications Act", commonly known as the "Texas Right to Know Act". No penalties, fees and/or other charges will be billed to Calhoun County in the event an order is refused due to non-compliance of the specifications, general conditions and/or State and Federal Regulations. The bidder, at the bidder's cost, shall immediately remove the fuel from the Calhoun County location that are deemed unsatisfactory, and are not in compliance with the specifications, general conditions Page 4 of 8 and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other charges shall be billed to Calhoun County for the removal of the fuel from the Calhoun County location. Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified by State and Federal Regulations. Calhoun County reserves the right to conduct random sampling of pre -qualified products for testing and to perform random audits of test reports. Calhoun County representatives may sample products from the manufacturing plant, terminal, shipping container and any other source they deem necessary to insure reliability of the products. If testing will be performed through a third party, the bidder will be required to allow the third -party access to the facilities in order to acquire samples for testing. Regardless of results of any product(s) test required by Calhoun County, all costs incurred for such tests shall be paid for by the bidder. The award of a bid will be voided if specifications, general conditions and/or instructions within this Invitation to Bid Packet are not followed. The bid would then be awarded to the bidder which submitted the next lowest bid that met specifications and all requirements of the Invitation to Bid Packet. Invoices shall not include other charges, including freight, handling charges or special delivery charges, when invoiced unless these charges were noted on the bid form or separate attachment and awarded as such. Invoices to Calhoun County must be billed to Calhoun County with reference to the Commissioner and Precinct or other Calhoun County Department that is being invoiced. (See Contact and Billing Information and Location of Fuel Tanks and Generator Fuel Tanks) Invoices must list separately the Texas State Excise Tax and/or Other Fees if any Other Fees were awarded. Invoices must not include any Federal Excise Taxes or Sales Tax (county, city or state sales tax). Each invoice must include the delivery ticket that was signed by a Calhoun County employee at the time of delivery. Each invoice must include a copy of the source document used to calculate the base price of the fuel purchased, with such base price highlighted or clearly marked. The successful bidder shall use the same source document throughout the term of the awarded bid (example: weekly OPIS Price Index; rack pricing from the same company, etc.). It is understood that Calhoun County Commissioners Court reserves the right to accept or reject any and/or all bids for any/or all fuel and/or services covered in this bid request and to waive informalities or defects in bids or to accept such bids as it shall deem most advantageous and to be in the best interest of Calhoun County. Calhoun County will evaluate and award bid based on lowest and best bid meeting specifications and all requirements of the Invitation to Bid Packet. "Lowest and best' means a bid or offer providing the best value considering associated direct and indirect costs, including transport, other fees, Page 5 of 8 maintenance, reliability, life cycle, warranties and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options bid as it deems to be in the best interest of Calhoun County. Although the cost of fuel to be provided is an essential part of the bid, Calhoun County is not obligated to award a bid (contract) on the sole basis of cost but will award to the bidder considered to be the best value to the County. The bid award shall be based on, but not necessarily limited to, the following factors: • °+u-vF Minus Mark -Up per gallon • Other Fees, if any, not included in Plus 9F minus Mark -Up per gallon • Special needs and requirements of Calhoun County • Delivery • Compliance in returning and/or including all required forms • Results of testing samples (if required by Calhoun County) • Calhoun County's experience with products bid • Bidder's past performance record with Calhoun County If bids are awarded, award information will be emailed and/or mailed to all bidders that submitted a bid regardless if the bidder was awarded a bid or not. Calhoun County Commissioners Court and the County Auditor's office work diligently to get this information to the bidders as soon as possible. To obtain results, or if you have any questions, please contact Peggy Hall, Calhoun County Assistant Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4610, peggy.hall@calhouncotx.org. As time permits, bid awards will be posted on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results, Results 2022. Once bids are awarded by Calhoun County Commissioners Court, this bid packet in its entirety will be the working contract between Calhoun County and the successful bidder for the period designated. Calhoun County or the bidder may cancel this bid (contract) at any time for any reason, provided a written notice is given. Should there be a change in ownership or management, the bid (contract) shall be cancelled unless a mutual agreement is reached with the new owner or manager to continue the bid (contract) with its present provisions and prices. Bidder understands that Calhoun County is a government entity subject to Texas State and Federal Public Information Statutes. Bidder hereby waives any obligation to the release to the public of any documents submitted in accordance with the bid. No person has the authority to verbally alter these specifications or any information within the Invitation to Bid Packet. Any changes will be made in writing (Addendum approved by Calhoun County Commissioners Court) and mailed and/or emailed to each bidder that received a bid packet. All disputes or protests will be held in Calhoun County, Texas. Page 6 of 8 INSURANCE REQUIREMENTS The awarded bidder must furnish, at their own expense, certificates of insurance or other acceptable evidence from a reputable insurance company or companies acceptable to Calhoun County, licensed to write insurance in the State of Texas showing the contractor and/or bidder is covered by insurance within the minimum limits of liability listed in the General Conditions that are included in this Invitation to Bid Packet. REQUIRED INFORMATION/FORMS TO BE RETURNED WITH INVITIATION TO BID • Invitation to Bid Form (page 1-7) • Method or Source Document that will be used for Mark -Up throughout the bid period • Affidavit • Bidder and Order Information Form • Certificate of Interested Parties, Form 1295 — Must return when submitting your bid • Certificate of Current Liability Insurance — Return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you carry at least the minimum required coverage. Once the bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured. • Conflict of Interest Questionnaire, Form CIQ — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certificate Regarding Debarment & Suspension and Other Responsibility Matters ■ Certification Regarding Lobbying • Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date • House Bill 89 Verification • Residence Certification • W-9 RENEWAL The awarded bid (contract) shall be for a period of one (1) year with an option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County. Intentionally Left Blank Page 7 of 8 ADDITIONAL INFORMATION All fuel tanks and/or generator fuel tanks currently being used by Calhoun County are owned by Calhoun County. All fuel tanks and generator fuel tanks are above ground. Calhoun County is not currently an OPIS subscriber. Average size of delivery for the Calhoun County Precincts: Precinct 1: About 1000-1500 gallons each of unleaded & diesel Precinct 2: About 800-900 gallons of unleaded & 2000-3000 gallons diesel Precinct 3: About 700-800 gallons unleaded & 300-400 gallons diesel Precinct 4-P: About 500 gallons unleaded & 400-500 gallons diesel Precinct 4-S: 104 E Dallas —About 1200-1500 gallons unleaded & 900-1000 diesel; 448 Harbor Road —About 800-1000 gallons diesel Do Calhoun County Precincts typically order both products at one time? Precinct 1: Yes Precinct 2: No (due to the extra 3,000-gallon tank for diesel) Precinct 3: Yes Precinct 4-P: Sometimes (try our best, but not always possible) Precinct 4-S: Sometimes (try our best, but not always possible) How often are orders placed? Precinct 1: About 4 times a year depending on work being done Precinct 2: About every 6 weeks for unleaded and every 31d order for diesel (about 4 times a year) Precinct 3: About 5 times a year Precinct 4-P: About every 2 to 3 months for unleaded and diesel Precinct 4-S: 104 E Dallas —About every month for unleaded and quarterly for diesel; 448 Harbor Road —About every 2 months for diesel Generators: As needed depending on necessity of use of generator All Calhoun County Precincts and other Calhoun County Departments order at a different time including 4-P (Port O'Connor) and 4-S (Seadrift). All Calhoun County Precincts and other Calhoun County Departments handle their own fuel orders; therefore, invoices are billed to each separately. (See Contact and Billing Information and Location of Fuel Tanks and Generator Fuel Tanks) Page 8 of 8 ATTACHMENT C Amended Invitation to Bid Form All changes are in Red CALHOUN COUNTY, TEXAS INVITATION TO BID FORM AMENDED WITH ADDENDUM NO. 1 Annual Supply Contract for Delivered Fuel Bid Number: 2022.01 January 1, 2022 thru December 31, 2022 With an option for renewal for an additional three - one (1) year periods, if aggreeable with both the successful bidder and Calhoun County BIDDER'S NAME AND ADDRESS: • Please type or print in ink. If handwritten, must be legible. • White out is not acceptable. • This is a bid form only and does not represent an order for a purchase by Calhoun County. • Acceptance of the successful bid shall obligate the bidder to provide up to the amount bid at the bid terms and conditions stated herein. Acceptance of the successful bid shall only obligate Calhoun County to purchase some of the items from that bidder. Calhoun County reserves the right to require any successful bidder to enter a separate written contract containing the terms herein and other reasonable conditions. The Invitation to Bid packet, in its entirety, will be the binding contract between Calhoun County and the successful bidder. • SEE SPECIFICATIONS FOR DELIVERED FUEL AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS • Estimated quantities are not guaranteed for the year. Amounts will vary by need. • ALL Transportation Costs and Other Fees must be included in the bad p1bis eF menus mark-up per gallon or clearly stated on the bid • Delivery in 24 hours from receipt of order. • Calhoun County is Exempt from all Federal Excise Taxes and Sales Tax (county, city and state sales tax). • Calhoun County is Not Exempt from: Texas State Excise Tax on Gasoline and Clear Diesel • ALL OTHER FEES NOT INCLUDED IN o"'6 T COTTMINUS THE MARK-UP PER GALLON MUST BE LISTED AND CLEARLY STATED ON THE INVITATION TO BID FORM. If extra space is needed to list Other Fees, attach a separate page stating the fee and amount of the fee. This separate page must be signed and dated by an authorized respresentative. Make note of this separate page under the Other Fees column. Only Fees listed onthebid returned by the bidder and awarded as such to the successful bidder will be allowed to be included on the invoice when the awarded bidder submits the invoice for payment. List Method or Source that will be used throughout the bid period and provide a copy: Page 1 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued HkUpMaTexas Per State Fuel Type I Gallon lExciseTax Precinct 1 Gasoline Fuel Tank(s) Location: Unleaded 305 Henry Barber Way 87 Octane $ $0.20 Port Lavaca TX 77979 Brand Name: Gasoline Unleaded 93 Octane $ Non -Ethanol $0.20 Brand Name: Diesel Low Sulfur (Clear Diesel) $ $0.20 Brand Name: Precinct 2 Gasoline Fuel Tank(s) Location: Unleaded 5812 FM 1090 87 Octane $ $0.20 Port Lavaca TX 77979 1 Brand Name Diesel Low Sulfur (Clear Diesel) $ $0.20 Brand Name: OTHER FEES NOT INCLUDED IN PW&OR-MMUS THE MARK-UP PER GALLON If No Charge OR Not Applicable, Texas Mark NA - List Any Other Environmental Feels) AND Fee Per Delivery OSLTF— (seeieaas Petroleum Amount of LUST Federal Oil ProductsoeliveryFee Feels) FEE Spill Fee schedulefors,ow Gallons U:ARer Hours Call Out or more) service Fee ;s than 2,500 lions the Fee is i00 Gallons but Is than 5,000 lions the Fee is ;s than 2,500 lions the Fee is i00 Gallons but ;s than 5,000 lions the Fee is is than 2,500 lions the Fee is D Gallons but than 5,000 ins the Fee is Less than 2,500 Gallons the Fee is D Gallons but than 5,000 Ins the Fee is than 2,500 Ins the Fee is D Gallons but than 5,000 Ins the Fee is Page 2 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN 12161:16 OR MINUS THE MARK-UP PER GALLON If No Charge OR Not Applicable, Mark NA PIUS F Texas List Any Other Minus- Environmental Fees) AND Mark-U P Texas OSLTF- Fee Per Delivery (See Texas Petroleum. Amount of Per State LUST Federal Oil Products Delivery Fee Fee(s) Schedule for 5,000 Gallons Ex: After Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or more) Service Fee Precinct 3 Gasoline Less than 2,500 Gallons the Fee is Fuel Tank(s) Location: Unleaded $ 24627 State Hwy 172 87 Octane $ $0.20 2,500 Gallons but Port Lavaca TX 77979 Brand Name: Less than 5,000 (Precinct 3 is in Olivia) Gallons the Fee is $ Gasoline Less than 2,500 Unleaded Gallons the Fee is 93 Octane $ $0.20 $ 2,500 Gallons but Non -Ethanol Less than 5,000 Brand Name: Gallons the Fee is Diesel Less than 2,500 Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Precinct 4 Gasoline Less than 2,500 (Port O'Connor) Unleaded Gallons the Fee is $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 93 Trevor Street Brand Name: Less than 5,000 (Off of Hwy 185) Gallons the Fee is Port O'Connor TX 77982 $ Diesel Less than 2,500 Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Page 3 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN PLUS OR MINUS THE MARK-UP PER GALLON If No Charge OR Not Applicable, Mark NA Plan OF Texas List Any Other Minus Environmental Fees) AND Mark -Up Texas OSLTF- Fee Per Delivery (5ee7exas Petroleum Amount of Per State LUST Federal Oil Products Delivery Fee Fee(s) schedule for 5,000 Gallons Ex: Aker Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or more) service Fee Precinct 4 Gasoline Less than 2,500 Gallons the Fee is (Seadrift) Unleaded $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 104 E Dallas Brand Name: Less than 5,000 Seadrift TX 77983 Gallons the Fee is Gasoline Less than 2,500 Unleaded Gallons the Fee is $ 93 Octane $ $0.20 2,500 Gallons but Non -Ethanol Less than 5,000 Brand Name: Gallons the Fee is Diesel Less than 2,500 Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Precinct 4 Gasoline Less than 2,500 Gallons the Fee is (Seadrift) Unleaded $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 448 Harbor Road Brand Name: Less than 5,000 Seadrift TX 77983 Gallons the Fee is Diesel Less than 2,500 Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Page 4 of 7 Invitation to Bid Form - AnnualSupply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN PLUS MINUS THE MARK-UP PER GALLON If No Charge OR Not Applicable, Mark NA Plus OF Texas List Any Other Minute Environmental Fees) AND Mark -Up Texas OSLTF- Fee Per Delivery (See Texas Petroleum Amount of Per State LUST Federal Oil Iduct,leriveryFee Fee(s) Schedule for 5,000 Gallons a: After Hours Call Out Department fuel Type Gallon Excise Tax FEE spill Fee or more) Service Fee Skid Fuel Tank Skid Location for fuel Diesel Less than 2,500 Gallons the Fee is Delivery: Low Sulfur $ Within Close Proximity (Clear Diesel) $ $0.20 2,500 Gallons but to the Calhoun County Brand Name: Less than 5,000 Courthouse Gallons the Fee is 211 S Ann Street $ Port Lavaca TX 77979 Generator - Calhoun County Diesel Less then Gallons theeFee Fee is Courthouse Low Sulfur $ Generator Fuel Tank (Red Diesel) $ NA 2,500 Gallons but Location for Fuel Brand Name: Less than 5,000 Delivery: Gallons the Fee is 211 S Ann Street $ Port Lavaca TX 77979 Generator - Calhoun County Less than 2,500 Adult Detention Diesel Gallons the Fee is Low Sulfur $ Center (JAIL) $ NA 2,500 Gallons but (Red Diesel) Generator Fuel Tank Brand Name: Less than 5,000 Location for Fuel Gallons the Fee is Delivery: $ 302 W Live Oak Port Lavaca TX 77979 Page 5 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN ^r 1:16 OR MINUS THE MARK-UP PER GALLON If No Charge OR Not Applicable, Mark NA PIUS OF Texas List Any Other Minus Environmental Fee(s) AND Mark-UpTexas OSLTF- Fee Per Delivery (see Texas Petroleum Amount of Per State LUST Federal Oil Products UeNeryFee Fees) Department Fuel Type Gallon Excise Tax FEE Spill Fee Schedule for 5,000 Gallons or more) E.: After Hours Call Out. Service Fee Generator - EMS Central Station Less than 2,500 (Emergency Diesel Gallons the Fee is Low Sulfur $ Management (Red Diesel) $ NA 2,500 Gallons but Services) Brand Name: Less than 5,000 Generator Fuel Tank Gallons the Fee is Location for Fuel $ Delivery: 705 Henry Barber Way Port Lavaca TX 77979 Generator - EMS South Station Less than 2,500 (Emergency Diesel Gallons the Fee is Management Low Sulfur $ (Red Diesel) $ NA 2,500 Gallons but Services) Brand Name: Less than 5,000 Generator Fuel Tank Gallons the Fee is Location for Fuel 5 Delivery: 6084 State Hwy 185 E Seadrift TX 77983 Page 6 of 7 Invitation to Bid Form -Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN SUS THE MARK-UP PER GALLON If No Charge OR Not Applicable, Mark NA Plus BF Texas List Any Other MitIUS Environmental Fees)AND Mark-U P Texas OSLTF- Fee Per Delivery (See Texas Petroleum Amount of Per State LUST Federal Oil Products Delivery Fee Fee(s) Schedule for 5,000 Gallons Ex: Aker Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or more) Service Fee Generators - Memorial Less than 2,500 Medical Center Diesel Gallons the Fee is Low Sulfur $ (Hospital) (Red Diesel) $ NA 2,500 Gallons but Generators Fuel Tank grand Name: Less than 5,000 Location for Fuel Gallons the Fee is Delivery: $ 815 N Virginia Street Port Lavaca TX 77979 Generator - Memorial Diesel Less than 2,500 Gallons the Fee is Medical Clinic Low Sulfur $ Generator Fuel Tank (Red Diesel) $ NA 2,500 Gallons but Location for Fuel Brand Name: Less than 5,000 Delivery: Gallons the Fee is 1016 N Virginia Street $ Port Lavaca TX 77979 The undersigned affirms that they are duly authorized to execute this bid and that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder, that the contents of this bid as to prices, terms or conditions of said bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee, or agent of Calhoun County in connection with this bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands and has followed all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date: Authorized Signature & Title: Printed Name & Title of Authorized Signature: Phone Number: REMARKS: Email: Page 7 of 7 ATTACHMENT D Amended Cover Page for Method or Source Document All changes are in Red METHOD OR SOURCE DOCUMENT (FOR PL&LS OR ^"' MARK-UP PER GALLON) AMENDED WITH ADDENDUM NO. 1 • Return a copy of the Method or Source Document that will be used for the Rk+s er Men-; Mark -Up per Gallon throughout the bid period #16 NOTICE OF MEETING- 10/20/2021 16. Consider and take necessary action to award the bid for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two-year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearly for one year terms upon Commissioners Court approval. (RM) lj-Rs' Page 12 of 23 #17 NOTICE OF MEETING — 10/20/2021 17. Consider and take necessary action to accept a donation of $1,000.00 from the Inteplast Group Corporation in Memory of Dean Wade Harley to be used to benefit CCEMS in their mission of caring for the many people of Calhoun County. (RM) Dustin Jenkins spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 13 of 23 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Wednesday, October 13, 2021 1:50 PM To: Mae Belle Cassel Cc: Donna Hall; Lori McDowell Subject: Fwd: Acceptance of Donation Attachments: Inteplast_Donation_letter_for_Dean_Harley.pdf Mae Belle, Please add the following to the next Commissioners Court agenda. To accept a donation of $1000.00 from the Inteplast Group Corporation in memory of Dean Wade Harley. We at Calhoun County EMS want to thank the Inteplast Group for their generosity. This gracious gift will go far in benefiting CCEMS in our mission of caring for this community. Thank you, J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustinjenkins@calhouncotx.org (361)571-0014 Calhoun County Texas Dean W. Harley Brenda Wilson / Inteplast Lolita Human f Wed 929/2021 1:46 PM To: Brenda Wilson / Inteplast Lolita Human Resources Inteplast Lolita Colleagues, <bwilson@inteplast.com> We are saddened to inform you that, our colleague of 2. lyears, Dean W. Harley passed away Monday, September 27, 2021. Dean's was the wave you received each day as he greeted you in hi's Tpacity as Security Guard. He was originally hired into IBS in 1998 andtransferred the Security Department in 2011. His addition to Security was so important because of his experience with emergency services. Dei was quick to grab his gear and attend to any colleagues on the Lolita site that needed his expertise. For this we are forever grateful. , A memorial service will be held at Richardson Funeral H 1 PM the same day. The family requests that those wisl to: Calhoun County EMS Calhoun County Hu 705 Henry Barber Way or P.O. Box 1505 Port Lavaca, TX 77979 Port Lavaca, TX 77E The Lolita plant site will recognize Dean's 20 plus years Best regards, Brenda Brenda R. Wilson Senior Director of Human Resources and Inteplast Group 101 Inteplast Blvd, Lolita, TX 77971 p:361-874-3138 c:361-920-0424 bwilsQD@ nteplast com wwwInteplast com F INTEPLASTGitoui, This communication is solely for use by the intender or copyrighted under applicable law. If you are not t copying or distribution of this communication, in wY communication does not constitute a contract offer, communication also does not constitute consent to or for transfers of data to third parties. e, 123Newlin, Port Lavaca on Wednesday, October 6 at 2 PM. Visitation is at to remember Dean with a memorial please consider donations in his name Society with a tree planting service at a later date, ecipient and may contain information that is privileged, confidential intended recipient, you are hereby formally notified that any use, e or in part, is strictly prohibited. Unless explicitly stated, this contract amendment, or an acceptance of a contract offer. This e use of sender's contact information for direct marketing purposes #18 NOTICE OF MEETING — 10/20/2021 18. Consider and take necessary action to accept a donation of $50.00 from Lambert and Helen Wang in Memory of Dean Wade Harley to be used to benefit CCEMS in their mission of caring for the many people of Calhoun County. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 14 of 23 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Friday, October 8, 2021 11:42 AM To: Mae Belle Cassel Cc: Donna Hall; Lori McDowell Subject: Acceptance of Donation Attachments: Inteplast_Donation letter_for_Dean_Harley.pdf Mae Belle, Please add this to the next Commissioners Court agenda. To accept a donation of $50.00 from Lambert and Helen Wang in memory of Dean Wade Harley. We all here at Calhoun County EMS want to thank Lambert and Helen Wang for their generosity. This gift will be used for the care of our community and will go to benefit many people in Calhoun County. Thank you, J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org (361)571-0014 Calhoun County Texas Dean W. Harley Brenda Wilson / Inteplast Lolita Human I Wed 9/29/2021 146 PM To: Brenda Wilson / Inteplast Lolita Human Resources Inteplast Lolita Colleagues, <bwilson@inteplast.com> We are saddened to inform you that, our colleague of 2 years, Dean W. Harley passed away Monday, September 27, 2021, Dean's was the wave you received each day as he greeted you in his ,.capacity as Security Guard. He was originally hired into IBS in 1998 and transferred the Security Department in 2011. His addition to Security was so important because of his experience with emergency services. De a was quick to grab his gear and attend to any colleagues on the Lolita site that needed his expertise. For this we are forever grateful A memorial service will be held at Richardson Funeral 1 PM the same day. The family requests that those w to: Calhoun County EMS Calhoun County 705 Henry Barber Way or P.O. Box 1505 Port Lavaca, TX 77979 Port Lavaca, TX The Lolita plant site will recognize Dean's 20 plus years Best regards, Brenda Brenda R. Wilson Senior Director of Human Resources and Inteplast Group 101 Inteplast Blvd, Lolita, TX 77971 p:361-874-3138 c:361-920-0424 bwilson@inteRk com www.inteplast.com 60 INTEPLASTGKOl1P This cormunication is solely for use by the intender or copyrighted under applicable law. If you are not i copying or distribution of this communication, in wf communication does not constitute a contract offer, communication also does not constitute consent to or for transfers of data to third parties. 123 Newlin, Port Lavaca on Wednesday, October 6 at 2 PM. Visitation is at to remember Dean with a memorial please consider donations in his name Society oyment with a tree planting service at a later date. ecipient and may contain information that is privileged, confidential intended recipient, you are hereby formally notified that any use, e or in part, is strictly prohibited. Unless explicitly stated, this contract amendment, or an acceptance of a contract offer. This use of sender's contact information for direct marketing purposes #19 NOTICE OF MEETING— 10/20/2021 19. Consider and take necessary action to accept the attached list of donations for September 2021 to the Calhoun County Public Library. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 15 of 23 94L bmkmz- Calhoun County Public Library w", cclibrary org 200 W. Mahan I Port Lavaca, TX 77979 Ph: 361.552.7323 Fax: 361.552.5218 Report September 2021 The following materials have been donated to the Calhoun County Public Library System during the month of august 2021 Books 1 1 1 1 1 15 Paperbacks 3 27 DVD 3 2 Others 10 boxes of colored legal files folders 6 boxes of Penda flex legal hanging folders 6 black 11x17 fastener folders 2 boxes of manila file pockets 12 boxes of letter hanging folders 6 boxes of legal hanging folders 1— Four adjustable shelf bookcase 3 — Four drawer vertical filing cabinets 1450 piece bag of candy 155 piece ba of cand Donor Linda Kolar Linda Ward Lavern Henley Fred Thomas AbeBooks Unknown Donor Charles Willoughby Unknown Donor Carla Whitwell Bill White Donor g y — -- NoemiCru2 4 boxes of toothpicks 2 —85 piece bag of candy Arnold Ecle United Way of Calhoun County $100 donated to the Port O'Connor Library from Dorothy Reuhman $100 donated to the Port O'Connor Library from Kay Middleton djL Calhoun County Public Library wZc ibrary org 200 W. Mahan I Port Lavaca, TX 77979 Ph: 361.552,7323 Fax: 361.552.5218 Others Donor $20.80 to Calhoun County Public Library from Ellie Garcia $.25 to Seadrift Branch Library for overage when audited $.30 to Port O'Connor Branch Library for overage when audited $20 in Memory of Charlotte Fitzgerald to Port O'Connor Library from Sandra Pustka $20 in Memory of Charlotte Fitzgerald to Port O'Connor Library from Jeanette S. Henke $4.20 to Seadrift Branch Library from donation bucket $7.65 to Port O'Connor Branch Library from donation bucket # zo NOTICE OF MEETING— 10/20/2021 20. Consider and take necessary action to declare the attached list of items from the Calhoun County Public Library for September 2021 as Surplus/Salvage. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 16 of 23 OIAL Calhoun County Public Library www.anbrary.arg 200 W. Mahan i Port Lavaca, TX 77979 Ph: 361.552.7323 Fax: 361,552.5218 Report September 2021 I would like the following to be declared Surplus/Salvage 19 Books 5 Pbks 5 DVD 2 Audio Bks # 21 NOTICE OF MEETING— 10/20/2021 21. Consider and take necessary action to declare the attached list of items from the Calhoun County Public Library for September 2021 as Waste. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 17 of 23 A. Calhoun County Public Library w cclibrary -arg 200 W. Mahan I Port Lavaca, TX 77979 Ph: 361.552.7323 Fax: 361.552.5218 Report September 2021 I would like the following items to be declared waste 10 Pbks # 22 NOTICE OF MEETING — 10/20/2021 22. Consider and take necessary action on a request by Calhoun County EMS Director to transfer the Seadrift VFD 1999 Chevrolet 3500 Ambulance Chassis and Module to CCEMS and the CCEMS 2004 Chevrolet Suburban to Seadrift VFD as indicated on the attached Transfer Form. (RM) Dustin Jenkins spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 18 of 23 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Friday, October 8, 2021 11:50 AM To: Mae Belle Cassel Cc: Gary Reese; Lori McDowell; Donna Hall Subject: Asset Transfers (Chevy Suburban & Ambulance swap) Attachments: Dept_Xfers_CCEMS_SeadriftAmb_Suburban_Ambulance_2021.pdf Mae Belle, Please place the following item on the agenda for the next available Commissioners Court: Consider and take necessary action on request by Calhoun County EMS Director to transfer the Seadrift VFD 1999 Chevy 3500 Ambulance Chassis & Module to CCEMS and the CCEMS 2004 Chevy Suburban to Seadrift VFD as indicated on transfer form. Respectfully, J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org (361) 571-0014 Calhoun County Texas Inventory Number Calljoun County, Texas DEPARTMENTAL INVENTORY TRANSFER REQUEST FORM By: J. Dustin Jenkins Serial No. From/To 541-0167 2004 Chevy Suburban 111GNECIU16,11785181 From 345/CCEMS to 340/SeadriftAmb 523-0054 11999 Chevy 3500 Ambulance Chassis 1GBKC343OXF079895 From 340/Seadrift Amb to 345/CCEMS 523-0056 1 Ambulance Module 1GBKC34]OXF079895 From 340/Seadrift Amb to 345/CCEMS # 23 NOTICE OF MEETING — 10/20/2021 23. Consider and take necessary action on a request by Calhoun County EMS Director to transfer five (5) C3 Handheld Ultrasound Scanners to MMC as indicated on the attached Transfer form to be utilized by MMC ER, MMC Clinic and the MMC Hospitalist on duty. (RM) Dustin Jenkins spoke on this. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 19 of 23 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Monday, October 11, 2021 12:43 PM To: Mae Belle Cassel Cc: Donna Hall; Lori McDowell; kdaniel@mmcportlavaca.com; EClevenger@mmcportlavaca.com Subject: Departmental Inventory Transfer: C3 BW Ultrasound Scanners From CCEMS to MMC Mae Belle, Please place the following on the next Commissioners Court Agenda: Consider and take necessary action on request by Calhoun County EMS Director to transfer 5-C3 Handheld Ultrasound Scanners to MMC as indicated on transfer form to be utilized by MMC ER, MMC Clinic & the MMC Hospitalist on duty. Very Respectfully, J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org (361)571-0014 Calhoun County Texas Calhoun County, Texas DEPARTMENTAL INVENTORY TRANSFER REQUEST FORM Requested By: J. Dustin Jenkins, Director of EMS Inventory Number Description Serial No. Transfer From/To Department 541-0387 C3 BW Scanner Handheld 52713 P-C345-K-1904-A0191 From CCEMS To MMC 541-0344 C3 BW Scanner Handheld P-C345-K-1811-A0387 From CCEMS To MMC 541-0345 C3 BW Scanner Handheld P-C345-K-1811-A0381 From CCEMS To MMC 541-0346 C3 BW Scanner Handheld P-C345-K-1811-A0386 From CCEMS To MMC 541-0347 C3 BW Scanner Handheld P-C345-K-1811-A0372 From CCEMS To MMC # 24 NOTICE OF MEETING — 10/20/2021 24. Consider and take necessary action to declare the attached list of items from Calhoun County EMS as Waste. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 20 of 23 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins)<Dustin.Jenkins@calhouncotx.org> Sent: Monday, October 11, 2021 12:54 PM To: Mae Belle Cassel Cc: Donna Hall; Lori McDowell Subject: Waste Declaration- Multiple Items Attachments: Waste Declaration Request Form -Multiple Items_2021_10_11.pdf Mae Belle, Attached you will find a Waste Declaration Request, to go on the next available Commissioners Court Agenda, for multiple items (including 2 couches, 1 ambulance AC Unit, 6 office chairs, 10 CPR mannequins) that are no longer salvageable as indicated on the attached Waste Declaration form. Very Respectfully, J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org (361) 571-0014 Calhoun County Texas Ca oun County, Texas WASTE DEC RATION REQUEST FORM Department Nao)e: EMS Requested By: 11 1J. Dustin Jenkins, Director of EMS Inventory Number Description Serial No. RP_asnn fnr Wasfa naclarnfinn =l-- - MilMil -_� Ml Mll 1.r<l # 25 NOTICE OF MEETING — 10/20/2021 25. Accept reports from the following County Offices: i. County Clerk — September 2021 ii. District Clerk — September 2021 iii. Justice of the Peace, Precinct 3 — September 2021 iv. Justice of the Peace, Precinct 4 — September 2021 v. Justice of the Peace, Precinct 5 — September 2021 vi. Sheriff's Office — September 2021 vii. Tax Assessor -Collector — September 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 21 of 23 CALHOUN COUNTY CLERK MONTHLY REPORT RECAPITUATION iEPTEMBER 2021 OPTICAL. PUBLIC. DEBC GLCDDE MIL CRIMINAL REWRD6 PROBATE..: TOTAL DISTRICTATTORNEY FEES 100044020 $ 168.02 $ 168.02 BEER LICENSE 100042030 $ 10.00 $ 10.00 COUNTY CLERK FEES 1000L4030 $ 753.00 $ 334.93 $ 13,147.75 $ 333.00 $ 14,568.68 APPEAL FROM JP COURTS 100044030 $ - $ - COUNTY COURT ATLAW 8IJURY FEE 100044140 $ - JURY FEE 100044140 $ 80.00 $ - $ 80.00 ELECTRONIC FILING FEES FOR EFILINGS 100044058 $ - $ - $ - IS - $ - JUDGE'S EDUCATION FEE 1000L4160 $ - $ - $ - $ 30.00 $ 30.00 JUDGE'S ORDER/SIGNATURE 1000L4180 $ 32.00 $ $ - $ 42.00 $ 74.00 SHERI FF'S FEES 100044190 $ 75.00 $ 141.85 $ - $ 200.00 $ 416.85 VISUAL RECORDER FEE 100044250 $ 18.01 $ 18.01 TIME PAYMENT FEE - COUNTY -'NEW2020"" 100044332 $ 30.00 $ 30.00 COURT REFPORTER FEE 1000A4270 $ 105.00 $ - $ - $ 90.00 $ 195.00 RESTITUTION DUE TO OTHERS 100049020 $ - ATTORNEY FEB -COURT APPOINTED 100049030 $ - $ - APPELLATE FUND (TGC)FEE 2620A4030 $ 40.00 $ 30.00 $ 70.00 TECHNOLOGY FUND 2663-0 030 $ 33.49 $ 33.49 COURTHOUSE SECURITY FEE 267044030 $ 40.00 $ 82.96 $ 531.00 $ 30.00 $ 683.96 COURT INITIATED GUARDIANSHI P FEE 2672L4030 $ 120.00 $ 120.00 COURT RECORD PRESERVATION FUND 2673d4030 $ 80.00 $ - $ 60.00 $ 140.00 COURT REPORTER SERVICE FUND"NEW2020" 2674 030 $ 24.79 $ 24.79 RECORDS ARCHIVE FEE 267544030 $ 5.000.00 $ 5.000.00 COUNTYSPECIALTYCOURT ""NEW2020"" 2676 030 $ 165.26 IS 165.26 COUNNIURYFUND "NEW2020" 2679+14030 $ 8.26 $ 8.26 DRUG& ALCOHOL COURT PROGRAM 269844U30-005 $ 1.99 IS 1.99 JUVENILE CASE MANAGER FUND 2699L4033 $ - $ - FAMILY PROTECTION FUND 170644030 IS 60.00 $ 60.00 JUVENILE CRIME& DELINQUENCY FUND 2715-0 030 $0.00 $ - PRE-TRIAL DIVERSON AGREEMENT 2729L4034 $ 600.00 $ 600.00 LAW UBARY FEE 2731L4030 IS 245.00 $ 210.00 $ 455.00 RECORDS MANAGEMENT FEE -COUNTYCLERKK 273844380 $ 0.28 $ 5,030.00 $ 5,030.28 RECORDS MANGEMENT FEE - COUNTY 2739L4030 $ 35.00 $ 209.06 $ 30.00 $ 274.06 FINES -COUNTY COURT 274045NO IS 2,975.92 $ 2,975.92 BOND FORFEITURE 27404505D $ - $ - STATE POLICE OFFICER FEES - STATE (DPS)(30%) 7020-20740 IS 1.55 $ 1.55 CONSOLIDATED COURT COSTS -COUNTY 7070-20610 IS 0.09 $ 0.09 CONSOLIDATED COURT COSTS - STATE 7070-2074D $ 0.83 IS 0.83 CONSOLIDATEDCOURTCOSTS-COUNTY -'NEW2020'- 7072-20610 $ 88.45 $ 88.45 CONSOLIDATED COURTCOSTS-STATE "NEW2020" 7072-20740 $ 796.02 $ 796.02 JUDICIAL AND COURT PERSONNEL THAI NO NG-ST(100%) 7502-20740 $ 40.00 $ - $ 30.00 $ 70.00 DRUG& ALCOHOL COURT PROGRAM -COUNTY 7390-20610 $ 0.40 $ 0.40 DRUG& ALCOHOL COURT PROGRAM -STATE 7390-20740 $ 1.59 $ 1.59 STATE ELECTRONIC FILING FEE - CIVIL 7403-22887 $ 210.00 $ - $ 180.00 $ 390.00 STATE ELECTRONIC FILING FEE CRIMINAL 7403-22990 $ 0.55 IS 0.55 EMS TRAUMA - COUNTY (10%) 7405-20610 $ 365.81 $ 365.81 EMSTRAUMA-STATE(90%) 74G5-20740 $ 40.65 $ 40.65 CIVIL INDIGENT FEE -COUNTY 7480-20610 $ 4.00 $ 3.00 $ 7.00 CIVIL INDIGENT FEE -STATE 7480-20740 $ 76.00 $ 57.00 $ 133DO JUDICIAL FUND COURT COSTS 7495-20740 $ 1.65 $ 1.65 JUDICIAL SALARY FUND -COUNTY (10%) 7505-20610 $ 0.01 $ 0.01 JUDICIAL SALARY FUND - STATE (90%) 7505-20740 $ 0.06 $ 0.06 JUDICIAL SALARY FUND (CIVIL&PROBATE) -STATE 7505-2G740-005 $ 294.00 $ 252.00 $ 546.00 TRAFFIC LOCAL(ADMINISTRATIVE FEES) 7538-22884,100044359 $ 9.00 $ 9.00 COURTCOST APPEAL OF TRAFFIC REG OP APPEAL) 7538-22885 $ - BIRTH - STATE 7855-20780 $ 81.00 $ 81.00 INFORMAL MARRIAGES - STATE 7855-20782 $ 12.50 $ 12.50 JU DICIAL FEE 7855-20786 $ 280.00 $ - $ 240.00 IS 520.00 FORMAL MARRIAGES - STATE 7855-20788 $ 210.00 $ 210.00 NONDISCLOSURE FEE - STATE 7855-20790 $ 28.00 $ - $ - $ 28.00 TCLEOSE COURT COST-COUNTY(10%) 7856-20610 $ 0.00 $ 0.00 TCLEOSE COURT COST - STATE (90%) 7856-207Q $ 0.01 $ 0.01 JURY REIMBURSEMENT FEE -COUNTY (10% 7857-20610 $ 0.00 $ 0.00 JURY REIMBURSEMENT FEE STATE (90%) 7857-20740 $ 0.04 $ 0.04 STATE TRAFFIC FI NE - COUNTY (5%) 7860-20610 $ 3.00 $ 3.00 STATE TRAFFIC H NE - STATE (95%) 7860-20740 $ 57.00 $ 57.00 STATETRAFFICFINE-COINTY(4S) 91112019 7860.20610 $ 2.00 $ 2.00 STATE TRAFFIC FINE- STATE(95%) 91112019 7860-20740 $ 48.00 $ 48.00 INDIGENT DEFENSE FEE -CRIMINAL -COUNJ 7865-20610 $ ODO $ 0.00 INDIGENT DEFENSE FEE -CRIMINAL -STATE (90%) 7865-20740 $ 0.02 $ 0.02 TIMEPAYMENT-COUNTY(50%) 7950-20610 $ - $ - TIMEPAYMENT - STATE (50%) 7950-20740 $ - $ - BAILIUMPINGANDFAILURETOAPPEAR- COUNTY 7970-20610 $ - BAILJUMPINGANDFAILURETOAPPEAR -STATE 7970-20740 $ - DUE PORT LAVACAPD 9990-99991 $ 0.46 $ 0.46 DUESEADRIFTPD 9990-99992 $ - $ DUE TO POI NT COMFORT PD 9990-99993 $ - $ - DUETOTEXASPARKS&WILDLIFE 999099994 $ - $ - DUE TOTEXAS PARKS& WILDLIFE WATER SAFETY 999099995 $ - DUETOTABC 9990-99996 IS - DUETOATTORNEYADLITEMS 9990-99997 $ - DUETOOPERATING/NSFCHARGES/OUETOOTHERS 7120-20759 $ IS IS 39.00 1 $ 1,500.00 1$ 1,539.00 $ 2,477.00 IS 6,212.00 $ 24,061.25 $ 3,437.00 $ 36,187.25 TOTAL FUNDS COLLECTED $ 36,187.25 (0.00) FUNDS HELD IN ESCROW: $ - AMOUNT DUE TO TREASURER(2DWS): Es 34,647.79. TOTAL RECEIPTS: 1$ 36,187,25. AMOUNT DUE TO OTHERS (LESS SF'S)u $ 1,539.46 I OF 2 U:A0 REFORTSIMOMHLYW DITOR AND TREASURER REP0RTS120210JDJDl TREASURER REPORTS.Au 1J"M021 CALHOUN COUNTY CLERK MONTHLY REPORT RECAPITUATION 3EPTEMBER 2021 CASH ON HAND, REGISTRY OF COURT FUNDS IPROSPERITI�_ BEGINNING BOOK BALANCE 81 $ 115.306.74 FUND RECEIVED $ 1,000.00 "BALANCE OF CASH BONDS" $ 73,262.00 DISBURSEMENTS $ 19.950.00 _ __ _ ENDING BOOK BALANCE 9/30/2021 $ 96,356.74 "OTHER REGISTRY REMS" $ 16,042.24 "IBC CASH BOND CHECKS— $ 7,052.50 BANK RECONCILIATION REGISTRY OF COURT FUNDS ENDING BANK BALANCE 9/301ZD21 $ 112,951.74 "TOTAL REGISTRY FUNDS" $ 96,356.74 OUTSTANDING DEPOSITS" $ - OUTSTANDING CHECKS" $ 1fi,595.00 Ra..clt d: $ - RECONCILED BANK BALANCE 9/30/2D21 $ 96,31174 "check cleared twice- bank to refund" CERTIFICATES OF DEPOSITS HELD IN TRUST - PROSPERITY BANK ' CD'S ': Date Issued ( Balance - -PurchaseslS Wlthdmwals ' Balance' -: 81312021 - - Interest 0913021 1044D 1/24/2018 $ $ $ 10441 1/24/2018 $ 10,286.14 $ 10,286.14 10442 1/24/2018 $ 1,276.19 $ 1,276.19 10443 1/26/2018 $ 1,276.19 $ 1,276.19 10444 1/25/2018 $ 9,637AI $ 9,637.41 10445 1/25/2018 $ 9,637AI $ 0.45 $ 9,637.86 10446 1/26/2018 $ 9,637A1 $ 0.45 $ 9,637.86 10449 6/9/1955 $ 20,356.08 $ 20,356.08 10414 3/2/2018 $ 3,594.35 $ 3,594.35 10455 3/2/2018 $ 3,594.35 $ 3,594.35 10486 8/26/2020 $ 5,920.06 $ $ 5,920.08 TOTALS: $ 75,215.59 $ 0.90 $ $ 75,216.49 047712a, � /�UoomaA-- -Z/ 2 OF TRE45URER REPORTWO2100021.TREASURER REPORTS.Am 10/1D2021 Treasurer Receipt Nos. F2021SEP007,019, 028,039 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/1/2021 COURT NAME: DISTRICT CLERK MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2021 ACCOUNT NUMBER ACCOUNT NAME DEBIT CREDIT 1000-001-44190 SHERIFF'S SERVICE FEES $1,567.27 1000-00144140 JURY FEES $80.00 1000-001-44045 RESTITUTION FEE $0.00 1000-001-44020 DISTRICT ATTORNEY FEES $0.00 1000-001-49010 REBATES -PREVIOUS EXPENSE $6.50 1000-001-49030 REBATES-ATTORNEY'S FEES $21.57 1000-00144058 DISTRICT CLERK ELECTRONIC FILING FEES $0.00 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEES $0.00 1000-001-43049 STATE REIMB- TITLE IV-D COURT COSTS $0.00 DISTRICT CLERK FEES CERTIFIED COPIES $59.00 CRIMINAL COURT $31.99 CIVIL COURT $1,847.85 STENOGRAPHER $195.00 CIV FEES DIFF $0.00 1000-001-44050 DISTRICT CLERK FEES $2,133.84 1000-999-20771 FAMILY VIOLENCE FINE $0.00 1000-999-10010 CASH - AVAILABLE $3,809.18 2706-001-44055 FAMILY PROTECTION FEE $30.00 2706-999-10010 CASH - AVAILABLE $30.00 2740-00145055 FINES - DISTRICT COURT $39.53 2740-999-10010 CASH - AVAILABLE $39.53 2620-00144055 APPELLATE JUDICIAL SYSTEM $65.00 2620-999-10010 CASH - AVAILABLE $65.00 2670-00144055 COURTHOUSE SECURITY $98.96 2670-999-10010 CASH - AVAILABLE $98.96 2673-00144055 CRT RECS PRESERVATION FUND- CO $180.00 2673-999-10010 CASH - AVAILABLE $180.00 2739-00144055 RECORD MGMT/PRSV FUND - COUNTY $48.00 2739-999-10010 CASH - AVAILABLE $48.00 2737-00144055 RECORD MGMT/PRSV FUND -DIST CLRK $177.00 2737-999-10010 CASH - AVAILABLE $177.00 2731-00144055 LAW LIBRARY $455.00 2731-999-10010 CASH - AVAILABLE $455.00 2663-00144050 CO & DIST CRT TECHNOLOGY FUND $3.19 2663-999-10010 CASH = AVAILABL $3.19 7040-999-20740 BREATH ALCOHOL TESTING - STATE $0.00 7040-999-10010 CASH - AVAILABLE $0.00 2667-00144055 CO CHILD ABUSE PREVENTION FUND $0.16 2667-999-10010 CASH - AVAILABLE $0.16 7502-999-20740 JUDICIAL & COURT PERSONNEL TRAINING FUND -STATE $90.00 7502-999-10010 CASH-AVAILABE $90.00 7383-999-20610 DNA TESTING FEE - County $0.06 7383-999-20740 DNA TESTING FEE - STATE $0.55 7383-999-10010 CASH - AVAILABLE $0.61 7405-999-20610 EMS TRAUMA FUND - COUNTY $0.05 7405-999-20740 EMS TRAUMA FUND - STATE $0.46 7405-999-10010 CASH - AVAILABLE $0.51 7070-999-20610 CONSOL. COURT COSTS - COUNTY $0.31 7070-999-20740 CONSOL. COURT COSTS - STATE $2.81 7070-999-10010 CASH - AVAILABLE $3.12 7072-999-20610 STATE CONSOL. COURT COSTS- COUNTY $0.00 7072-999-20740 STATE CONSOL. COURT COSTS- STATE $0.00 7072-999-10010 CASH -AVAILABLE $0.00 2698-001-44030-010 DRUG CRT PROG FEE - COUNTY (PROGRAM) $14.12 2698-999-10010-010 CASH - AVAILABLE $14.12 7390-999-20610-999 DRUG COURT PROG FEE - COUNTY (SVC FEE) $2.82 7390-999-20740-999 DRUG COURT PROG FEE - STATE $11.30 7390-999-10010-999 CASH -AVAILABLE $14.12 7865-999-20610-999 CRIM - SUPP OF IND LEGAL SVCS - COUNTY $0.02 7865-999-20740-999 CRIM - SUPP OF IND LEGAL SVCS - STATE $0.18 7865-999-10010-999 CASH - AVAILABLE $0.20 7950-999-20610 TIME PAYMENT - COUNTY $5.16 7950-999-20740 TIME PAYMENT - STATE $5.15 7950-999-10010 CASH - AVAILABLE $10.31 7505-999-20610 JUDICIAL SUPPORT-CRIM - COUNTY $0.09 7505-999-20740 JUDICIAL SUPPORT -GRIM - STATE $0.50 7505-999-10010 CASH - AVAILABLE $0.59 7505-999-20740-010 JUDICIAL SALARIES -CIVIL - STATE(42) $756.00 7505-999-10010-010 CASH AVAILABLE $756.00 2740-001-45050 BOND FORFEITURES $0.00 2740-999-10010 CASH -AVAILABLE $0.00 2729-001-44034 PRE-TRIAL DIVERSION FUND $0.00 2729-999-10010 CASH -AVAILABLE $0.00 7857-999-20610 JURY REIMBURSEMENT FUND- COUNTY $0.04 7857-999-20740 JURY REIMBURSEMENT FUND- STATE $0.35 7857-999-10010 CASH - AVAILABLE $0.39 7860-999-20610 STATE TRAFFIC FINE- COUNTY $0.00 7860-999-20740 STATE TRAFFIC FINE- STATE $0.00 7860-999-10010 CASH - AVAILABLE $0.00 7403-999-22888 DIST CRT - ELECTRONIC FILING FEE - CIVIL $570.00 7403-999-22991 DIST CRT - ELECTRONIC FILING FEE - CRIMINAL $3.96 CASH - AVAILABLE $573.96 1-44050 DISTRICT CLERK FEES $0.00 9-10010 CASH - AVAILABLE $0.00 1-44055 RECORD MGMT/PRSV FUND - COUNTY $0.00 9-10010 CASH - AVAILABLE $0.00 1-44050 COUNTY JURY FUND $0.00 9-10010 CASH - AVAILABLE $0.00 1-44055 COURTHOUSE SECURITY $0.00 9-10010 CASH - AVAILABLE $0.00 1-44050 CO & DIST CRT TECHNOLOGY FUND $0.00 9-10010 CASH - AVAILABLE $0.00 1-44050 COUNTY SPECIALTY COURT FUND $0.00 a-1 nnl n CASH - AVAILABLE $0.00 TOTAL: 7855-999-20784-010 DIST CRT - DIVORCE & FAMILY LAW - STATE $147.75 7855-999-20657-010 DIST CRT - DIVORCE & FAMILY LAW - COUNTY $2.26 7855-999-20792-010 DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - STATE $97.00 7855-999-20658-010 DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - COUNTY $3.00 7855-999-20740-010 DIST CRT - OTHER CIVIL PROCEEDINGS - STATE $826.50 7855-999-20610-010 DIST CRT - OTHER CIVIL PROCEEDINGS - COUNTY $43.50 7855-999-20790-010 DUE TO STATE - NONDISCLOSURE FEE $0.00 7855-999-10010-010 CASH - AVAILABLE $1,120.00 TOTAL (Distrib Req to Oper Acct) $7,489.95 $7,489.96 DUE TO OTHERS (Distrib Req(s) attached) ATTORNEY GENERAL (RESTITUTION) 0.00 OUT -OF -COUNTY SERVICE FEES 550.00 REFUND OF OVERPAYMENTS 0.00 DUE TO OTHERS 0.00 TOTAL DUE TO OTHERS $550.00 REPORT TOTAL - ALL FUNDS 8,039.95 PLUS AMT OF RETURNED CKS 0.00 LESS: TOTAL TREASURER'S RECEIPTS (8,039.95) Revised 01/31/20 OVER / (SHORT) $0.00 DISTRICT COURT SEPTEMBER STATE COURT COSTS REPORT 2021 SEPTEMBER SECTION I: REPORT FOR OFFENSES COMMITTED COLLECTED COUNTY STATE 01/1/20 - Present - - 01/01/04-12/31/19 .$2.,75: 0.28 2.47 09/01/01 - 12/31/03 i 0.02 0.19 09101/99 - 08/31/01 0.02 0.14 09/01/97 - 08/31 /99 - - 09/01/95-08/31/97- noinvos-nRisvos DNA TESTING FEES 0.61 0,06 0.55 EMS TRAUMA FUND 0.51 0.05 0.46 JUV. PROB. DIVERSION FEES JURY REIMBURSEMENT FEE $0.39 0.04 0.35 INDIGENT DEFENSE FUND $0.20 0.02 $0.18 STATE TRAFFIC FEES $0.00 - $0.00 DRUG CRT PROG FEE $28.24 $16.94 11.30 SECTION II: AS APPLICABLE STATE POLICE OFFICER FEES FAILURE TO APPEARIPAY FEES - - JUD. FUND-CONST. CO. CRT. _ JUD. FUND -STATUTORY CO. CRT. MOTOR CARRIER WEIGHT VIOLATIONS TIME PAYMENT FEE $10.31 5.16 5.15 DRIVING RECORD FEE JUDICIAL SUPPORT FEES $0.59 0.09 0.50 ELECTRONIC FILING FEE -CR $3.96 $3.96 TOTAL STATE COURT COSTS $47.93 $ 22.68 $ 25.25 CIVIL FEES REPORT BIRTH CERTIFICATE FEES MARRIAGE LICENSE FEES DECL. OF INFORMAL MARRIAGE ELECTRONIC FILING FEE - CV NONDISCLOSURE FEES 0 JUROR DONATIONS JUSTICE CRT. INDIG FILLING FEES STAT PROB CRT INDIG FILING FEES STAT PROB CRT JUDIC FILING FEES STAT CNTY CRT INDIG FILING FEES STAT CNTY CRT JUDIC FILING FEES STAT CNTY CRT -JUDICIAL SUPPORT CONST CNTY CRT INDIG FILING FEES CNST CNTY CRT JUDIC FILING FEES .............................. DIST CRT DIV & FAMILY LAW DIST CRT OTHER THAN DIV/FAM LAW ; ,6 DIST CRT OTHER CIVIL FILINGS FAMILY PROTECTION FEE JUDICIAL SUPPORT FEE JUDICIAL & COURT PERSONNEL TRANING FEE. -:34 TOTAL CIVIL FEES REPORT SEPTEMBER COLLECTED COUNTY STATE $570.00 $570.00 $0.00 $0.00 $150.00 2.25 147.75 $100.00 3.00 97.00 $870.00 43.50 826.50 $756.00 $756.00 $90.00 - $90.00 $ 2,536.00 $ 48.75 $ 2,487.25 TOTAL BOTH REPORTS $ 2,583.93 $ 71.43 $ 2,512.50 CALHOUN DISTRIBUTION COUNTY REQUEST 201 West Austin DR# 420 A 44470 PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: Anna Kabela Address: Title: District Clerk City: State: Zip: Phone: ACCOUNT NUMOER DESCRIPTION AMOUNT 7340.999-20759-999 District Clerk Monthly Collections - Distribution $7,489.95 SEPTEMBER 2021 V# 967 TOTAL 7,489.95 ZO 7i of Official ( I Date ENTER COURT NAME JUSTICE OF PEACE N0.9 ENTER MONTH OF REPORT SEPTE SEP - MBER 12021 ENTER YEAR OF REPORT CODE AMOUNT CASH BONDS REVISED 01/30/20 . ADMINISTRATION FEE-ADMF BREATH ALCOHOL TESTING - BAT CONSOLIDATED COURT COSTS -CCC 361.82 STATE CONSOLIDATED COURT COST-2020 970.00 LOCAL CONSOLIDATED. COURT COST-2620 224.00 COURTHOUSE SECURITY -CHS 36.19 - CJP CIVIL JUST DATA REPOS FEE CJDR/MVF 0.48 CORRECTIONAL MANAGEMENT INSTITUTE -CMI OR CHILD. SAFETY - CS CHILD SEATBELT FEE - CSBF CRIME VICTIMS COMPENSATION :-OVID DPSC/FAILURE TO APPEAR OMNI DPSC 4.63 ADMINISTRATION FEE FTA/FTPt(aka OMNI)-. 2020 30.00 ELECTRONIC FILING FEE 90.00 FUGITIVE APPREHENSION - FA GENERAL REVENUE .-GR CRIM- IND LEGAL SVCSISUPPORT -OF 18.09 JUVENILE: CRIME & DELINQUENCY JCD JUVENILE CASE MANAGER FUND JCMF 60.00 JUSTICE COURT: PERSONNEL TRAINING JCPT JUROR: SERVICE FEE -JSF 36.18 LOCAL ARREST FEES LAF 61.95 LEMI LEDA LEOC OCL PARKS& WILDLIFE ARREST FEES PWAF 10.00 STATE ARREST FEES SAF 53.27 'SCHOOL GROSSINGICHILD SAFETY FEE SCF SUBTITLE C-SUED 1D5.04 STATE TRAFFIC FINES -'.EST 9.119-STF 556.02 TABC ARREST FEES - TAF TECHNOLOGY FUND YF 36.19 C'TRAFFIC =TFC 10.50 LOCAL TRAFFIC FINE-2020 33.36 TIME PAYMENT -TIME TIME PAYMENT REIMBURSEMENT FEE. 2020 83.17 TRUANCY PREWDIVERSION FUND 18.09 LOCAL& STATE WARRANT FEES -WRNT 7.72 COLLECTION SERVICE. FEE-MVBA-CSRV 984.60 DEFENSIVE DRIVING COURSE - DOC DEFERRED FEE - OFF 126.00 DRIVING EXAM FEE- PROVDL FILING FEE T-FFEE&CVFF 225.00 FILING FEE SMALL. CLAIMS - FFSC COPIES/CERTIFED COPIES CC INDIGENT FEE ,CIFF or INDF 54.00 JUDGE PAY RAISE FEE JPAV 54.28 SERVICE FEE SFEE 150.00 OUT -OF -COUNTY SERVICE FEE `. EXPUNGEMENT FEE � EXPG - EXPIRED RENEWAL EXPR ABSTRACT OF JUDGEMENT AOJ ALL WRITS -WOP/WOE 150.00 DPS FTA FINE DPSF LOCAL FINES FINE 3,066.52 LICENSE & WEIGHT FEES LWF PARKS & WILDLIFE FINES PWF 119.00 SEATBELT/UNRESTRAINED CHILD FINE SEAT V-JUDICIAL& COURT PERSONNEL TRAININGJCPT 46.00 OVERPAYMENT ($10&:OVER) -.OVER 287.50 OVERPAYMENT (LESS THAN $10) -OVER RESTITUTION -REST PARKS & WILDLIFE -WATER SAFETY FINES WSF WCR TOTAL ACTUAL MONEY RECEIVED. $8.068.80' TYPE: AMOUNT TOTAL WARRANT FEES 7.72 ENTER LOCAL WARRANT FEESRECORD ON TOTALPAGEOF HILL COUNTRYSORWARE MO. REPORT STATE: WARRANT FEES.. $7.72:'. RECORDON TOTAL PAGE OF HILL COUNTRY SOF6NAREMO. REPORT DUE TO OTHERS. AMOUNT.: DUE TO CCISO-50% of Fine on JV cases 0.00 PLEASE INCLUDE DR REQUESTING DISBURSEMENT DUE TO DA RESTITUTION FUND 0:00_PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT REFUND OF OVERPAYMENTS 287.50 PLEASE INCLUDE O.k, REQUESTING DISBURSEMENT OUT -OF -COUNTY SERVICE FEE 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT CASH BONDS 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT (IF REQUIRED) TOTAL DUE TO OTHERS $287.60: TREASURERS RECEIPTS FOR MONTH. AMOUNT'' CASH,_ CHECKS, M.O.s&CREDIT CARDS -__- $8,06888.60.80: Calculate from ACTUAL Treasurofs Recelpls TOTALTREAS.RECEIPTS $60. MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/412021 COURT NAME: JUSTICE OF PEACE NO. 3 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2021 ACCOUNTNUMBER ACCOUNTNAME AMOUNT CR 1000-001-45013 FINES 3,084.37 CR 1000-001-44190 SHERIFF'S FEES 118.74 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 0.00 CHILD SAFETY 0.00 TRAFFIC 43.86 ADMINISTRATIVE FEE 156.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44363 TOTAL ADMINISTRATIVE FEES 199.86 CR 1000-001-44010 CONSTABLE FEES -SERVICE 300.00 CR 1000-001-44063 JP FILING FEES 225.00 CR 1000-001-44090 COPIES / CERTIFIED COPIES 0.00 CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 83.17 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 984.60 TOTAL FINES, ADMIN. FEES & DUE TO STATE $4,995.74 CR 2670-001-44063 COURTHOUSE SECURITY FUND $105.54 CR 2720-001-44063 JUSTICE COURT SECURITY FUND $9.05 CR 2719-001-44063 JUSTICE COURT TECHNOLOGY FUND $100.19 CR 2699-001-44063 JUVENILE CASE MANAGER FUND $60.00 CR 2730-001-44063 LOCAL TRUANCY & PREVENTION DIVERSION FUN $80.00 CR 2669-001-44063 COUNTYJURYFUND $1.60 STATE ARREST FEES DPS FEES 12.20 P&W FEES 2.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 14.20 CR 7070-999-20610 CCC-GENERAL FUND 36.18 CR 7070-999-20740 CCC-STATE 325.64 DR 7070-999-10010 361.82 CR 7072-999-20610 STATE CCC- GENERAL FUND 97.00 CR 7072-999-20740 STATE CCC- STATE 873.00 CR 7860-999-20610 STF/SUBC-GENERAL FUND 5.25 CR 7860-999-20740 STF/SUBC-STATE 99.79 DR 7860-999-10010 105.04 CR 7860-999-20610 STF- EST 9/1/19-GENERAL FUND 22.24 CR 7860-999-20740 STF- EST 9/1/19- STATE 533.78 556.02 CR 7950-999-20610 TP-GENERAL FUND 0.00 CR 7950-999-20740 TP-STATE 0.00 DR 7950-999-10010 0.00 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 2.70 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 51.30 DR 7480-999-10010 54.00 Page 1 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/4/2021 COURT NAME: JUSTICE OF PEACE NO.3 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2021 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 1.81 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 16.28 DR 7865-999-10010 18.09 CR 7970-999-20610 TUFTA-GENERAL FUND 1.54 CR 7970-999-20740 TL/FTA-STATE 3.09 DR 7970-999-10010 4.63 CR 7505-999-20610 JPAY-GENERALFUND 5.43 CR 7505-999-20740 JPAY-STATE 48.85 DR 7505-999-10010 54.28 CR 7857-999-20610 JURY REIMB. FUND-GEN. FUND 3.62 CR 7857-999-20740 JURY REIMB. FUND -STATE 32.56 150 DR 7857-999-10010 36.18 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.05 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.43 DR 7856-999-10010 0.48 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND -STATE 45.00 DR 7502-999-10010 45.00 7998-999-20701 JUVENILE CASE MANAGER FUND 9.05 CR 7998-999-20740 TRUANCY PREVENT/DIVERSION FUND- STATE 9.05 DR 7998-999-10010 18.09 CR 7403-999-22889 ELECTRONIC FILING FEE 90.00 DR 7403-999-10010 90.00 TOTAL (Distrib Req to OperAcct) $7,679.95 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY 0.00 DA - RESTITUTION 0.00 REFUND OF OVERP 287.50 OUT -OF -COUNTY SI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE 101.15 WATER SAFETY FIN 0.00 TOTAL DUE TO OTHERS $388.65 TOTAL COLLECTED -ALL FUNDS $8,068.60 LESS: TOTAL TREASUER'S RECEIPTS $8,068.60 REVISED 01/30/20 OVER/(SHORT) $0.00 I Page 2 of 2 10-11-21;10:14 ;From:Calhoun County JP4 To:5534444 ;3617852179 # 1/ 4 FAX COVER SHEET OCTOBER 11, 2021 FROM: JUSTICE COURT_PCT. 4. CALHOUN COUNTY 103 W. Dallas Street P.O. Box 520 Seadrift, Texas 77983 PHONE: 361-785-7082 FAX: 361-785-2179 TO: County Judge Office Ref: Money Distribution Report FAX: 361-553-4444 NOTE: The SEPTEMBER 2021 report is attached. Please give me a call if you have any questions. PAGES TO FOLLOW: _4_ INCLUDING THIS COVER PAGE Thank you, Judge 'Wesley J. Hunt 10-11-21;10:14 ;From:Calhoun County JP4 To:5534444 ;3617852179 4 2/ 4 V MONEY RECEP ej DOTHERS:-:j U,Grlup - lio% or ping, DDARE$TIT,VF,l NFL Mi6FOOERP&MOENT F;COUNTYSERVICE F To AMOUNT 0:00 mm UO WENT 1:11 "IIIEWCLUUCDA.PEQUMTkNOCISBUNsMENT 000 0 ftwcvcLum DMIGUMwavlalumumm L—Lj.oDIPLfASffINQVD9 D.UETOOTH RECEIPTS W-1 11,6liculaofMMACTUALTmaeoWoRmolpto 10-11-21;10:14 ;From:Calhoun County JP4 To:5534444 ;3617852179 # 3/ 4 MONTHLY REPORT OF COLLECTIONS AND DISTRISUTIONS 10/6/2021 COURT NAME: JUSTICE OF PEACE NO, 4 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2021 ACCOUNTNUMBER ACCOUNTNAME AMOUNT OR 100D-001-45014 FINES 911.65 CR 1000-001.44190 SHERIFF'S FEES 197.00 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 10.00 CHILD SAFETY 3.00 TRAFFIC 15.00 ADMINISTRATIVE FEES 62.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 OR 1000-001-44364 TOTAL ADMINISTRATIVE FEES 90.00 OR 1000-001-44010 CONSTABLE FEES -SERVICE 75.00 OR 1000-001-44064 JP FILING FEES 100.00 OR 1000-001-44090 COPIES / CERTIFIED COPIES 0.00 OR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00 OR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 0.00 OR 1000.001 44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 OR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 OR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 OR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0100 OR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 OR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 335.10 TOTAL FINES, ADMIN. FEES & DUE TO STATE $1,708,65 OR 2670-001-44064 COURTHOUSE SECURITY FUND $33.70 OR 2720-001-44084 JUSTICE COURT SECURITY FUND $4.59 OR 2719-001-44054 JUSTICE COURT TECHNOLOGY FUND $40.00 OR 2699-001-44004 JUVENILE CASE MANAGER FUND $5.00 OR 2730-001-44064 LOCAL TRUANCY PREVENTION Ili DIVERSION FUND $20.00 OR 2669-001.44004 COUNTY JURY FUND $0.40 STATEARRESTFEES DPS FEES 2.00 P&W FEES 1.00 TABC FEES 0.00 OR 7020-999-20740 TOTAL STATE ARREST FEES 3.00 CR 7070-999-20610 CCC-GENERAL FUND 24.03 OR 7070-999-20740 CCC•STATE 216 27 OR 7070.999.10010 240.30 OR 7072-999-20610 STATE CCC- GENERAL FUND 24.80 OR 7072-999-20740 STATE CCC- STATE 223.20 DR 7072-999.10010 248.00 CR 7860,999-20610 STF/SUBC-GENERAL FUND 3.00 OR 7860.999 20740 STF/SUBC-STATE 57.00 DR 7860-999.100/0 60.00 OR 7860-999-20610 STF- EST 9/1119- GENERAL FUND 6.00 OR 7860-999-20740 STF- EST 9/1/19- STATE 144.00 OR 7880.999.10010 150.00 OR 7950-999.20610 TP-GENERAL FUND 50.00 OR 7950-999.20740 TPSTATE 50.00 DR 7950-999.10010 700.00 Page 1 of 2 10-11-21;10:14 ;From:Calhoun County JP4 To:5534444 ;3617852179 # 4/ 4 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/6/2021 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2021 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 1.20 CR 7480-99940740 CIVIL INDIGENT LEGAL -STATE 22.80 DR 7480-999-10010 24.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 1.00 CR 7865-999.20740 CRIM-SUPP OF IND LEG SVCS-STATE 9.00 DR,7865-999-10010 10.00 CR 7970-989.20610 TUFTA-GENERAL FUND 20.00 CR 7970-999.20740 TUFTA•STATE 40.00 OR 7970-999-10010 60.00 CR 760MBS-20610 JPAY -GENERAL FUND 2.40 CR 7505-999-20740 JPAY-STATE 2160 OR 7505-999.10010 24.00 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 2.00 CR 7857-999-20740 JURY REIMB. FUND- STATE 18.00 OR 7857-999-10010 20.00 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.00 CR 785r-999.20740 CIVIL JUSTICE DATA REPOS: STATE 0.00 DR 7856-999-10010 0.0o CR 7502-999-20740 JUO/CRT PERSONNEL TRAINING FUND- STATE 20.00 OR 7502-999.10010 20.00 7998-999-20701 JUVENILE CASE MANAGER FUND 4.00 CR 7998.899.20740 TRUANCY PREV/DIV FUND - STATE 4.00 DR 7998-999A0010 8.00 CR 7403-999.22889 ELECTRONIC FILING FEE 40.00 DR 7403.999.10010 40.00 TOTAL (DisNib Req to Oper Accf) $2,818.95 OVE TO OTHERS (Distrib Req AtichcO CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENTS 0.00 OUT -OF -COUNTY SERVICE FE 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 79.90 WATER SAFETY FINES 000 TOTAL DUE TO OTHERS $79.00 TOTAL COLLECTED -ALL FUNDS $2,898.85 LESS; TOTAL TREASUFR'S RECEIPTS $2,898.86 REVISED 01/29/20 i OVER/(SHORT) $0.00 Page 2 of 2 10-06-21;17:13 ;From:Calhoun County Pct. 5 To:5534444 ;3619832461 # 1/ 9 FAX COVER SHEET JUDGE NANCY POMYKAL P 0 BOX 454 PORT O' CONNOR, TX.77982 (361)983-2351 -TELEPHONE (361)983-2461 - FAX COUNTY OF CALHOUN JUSTICE COURT PCT. 5 DATE OCTOBER 6 2021 TO: CALHOUN COUNTY DISTRICT CLERK ATT: ANNA KABELA FAX NUMBER(S) 361-553-4637 PAGES: 9 Including this cover SUBJECT: SEPTEMBER 2021 — MONEY DISTRIBUTION REPORT NOTE: Hi Anna. I am faxing my SEPTEMBER. 2021 Money Distribution Report Please let me know if you have any questions. Have a great week! Thanks. P THE CONTENTS OF THIS FAX MESSAGE ARE INTENDED SOLELY FOR THE ADDRESSEE(S) named In this message. This communication is intended to be and to remain confidential and may be subject to applicable attorney/client and/or work product privileges. If you are not the intended recipient of this message, or if this message has been addressed to you in error, please immediately alert the sender by fax and then destroy this message and its attachments. Do not deliver, distribute or copy this message and/or any attachments and if you are not the intended recipient, do not disclose the contents or take any action in reliance upon the information contained in this communication or any attachments. 10-06-21;17:13 ;From:Calhoun County Pct. 5 To:5534444 ;3619832461 # 2/ 9 Money Distribution Report CALNODDI JYS eEBTZMBkR a0R1 REYOAT Receipt CxaOa/DeSeaOant Ceflea\Ameaate 377403 2020-0184 09-01- Total 2021 CCC 62.00 LAP 5.00 WENT SO.00 LCCC 14.00 FINE 264.00 DONALDSON, KAITLYN TUSTINE CSRV 119.50 513.50 377403 2021-0259 09-02-2023 LTFC ..••,. xi.,.,.:>3 kA sr...,;gt3?ee 4sTt s�,i S.!€nAi€x .<o.UM;.€r s{ v:'z', 1 93 9TFl 32.07 DFF 66.00 ° STRATMANN0 Ca2h �)ra� s Q �'tx eMCS a' '�w�, IFk4 s4 ">s,ns C�. wce s i'vg F v t sxss .e s v x r e x 7u;zefdslz<ns.:ExxtKosk6`",at*'3saa. .&ah3'S4 sls is ^. ni5:#J;�§,r£., BAY#s 41�nt42ex0Si6xa cdks3gFzY ie ey}v`di,Fz. 377405 2020-0221 09-02-2021 CSRV a5,00 ' HARRINGTON, ANDREW 25,00 __.._ .. ....._., xa-mv-rrarrvz.n is atk.ita:0'z,rs.z4.s'...o-.35iRtlt lC,.?maik'd.isn rN.tr; StE:ist tr int 4:w sir:'( 407 2021-0309-DC 09-07-2021 IFEE 6 00 FILI 25.00 JpTF 5.00 EFF 10.00 JPHORGAN CRASS SANK, N.A. 46.00 Company Chock 9-05-2021 CCC 6y,,. .,'""n w.a ,5.-O"ar. LCCC i•b#i:`fi'v:A io', 1ai t:',r.",'iin i3�3.€isi',+u�Gn 'i r,t rce�vuirh;r �ty�Yr' "; 377409 i02YATTD 0 .00 LAF 5.00 LCCC 19.00 LTFC 3.00 STPl 50.00 144.00 WOODALLr-WYATT DALE DOC 10.00 377411 2020-0299 09-IS SEARCY, SHANNON ELIZABETH CSRV 111.00 401.09 377413 1904.0216 -,..... .rr CCvn.e.:. 09.35-2021 JSF 9.00 CCC 40.00 CH8 STZ2NOR6, RAYMOND CODY TF 4.0D JCSF 1 3.00 LAP 3.00 WRNT 50.00 474.50 .00 JPAY 9.00 IDF a nn .Tore 2.00 MVF 0.10 377415 2021-0315 09- CDC' 62,00 LAP VASOUEZ,-DANIEL SENJAMIN DSFF L46.00 377417 2022.03 CHAVEZ, ISREAL 377419 2021-9264 DEAN, KERRI LYNN 377421 2021-0311 SERKOVSZY, DAVID PAUL Personal Check 5.00 LCCC 14,00 LTFC STri 50.00 280.00 .,,.�. ..,.. +.ce LCCC e.64--._........ ......-..,..,,:,,....:.,,.�,:::r, 50.00 ....LCCC ^14,0..,, e.,e.,.ussver,ur.4.n.dto:,•�J:41�It`:P.ia.Q<:�F.'..'f.V', 09-29-2021 STF1 50.00 LAP 5.00 0 FINE 66.00 LTFC 3.09 So. oO nccc I1.00 LTFC 3.00 DSFF 146.00 SO.00 STF3 50.00 290.00 10-04-2021 Page 1 10-06-21;17:13 ;From;Calhoun County Pot. 5 To:5534444 ;3619832461 # 3/ 9 Nosey Distribution Report Reeeiat ceCALRODN OPS DIIPTRNDER 2D21 REPORT Wa/Daleadent Cedee\ueeualo _ Total 397423 2011-0310 09-29-2021 CCC 92.00 LAP 5.00 LCCC 14.00 LTPC 3.00 5TF1 50.00 144.00 WETZ1Gr NONICA MEE DDC 101D0 Credit Card .0-04-2021 Page 2 10-06-21;17:13 ;From:Calhoun County Pct. 5 To:5534444 ;3619832461 # 4/ 9 Money Distribution Repose JALEDDN JP5 $HPTSE038R 202Y REPORT Type Cede Description Count Retained Di burs d M y T tal T The following totals represent - Cash and Cheek, Collected BOND APD APPEAL BOND 1 COST CCC CONSOLIDATED COURT COSTS 7 250.00 0.00 250.Oo COST CCC CONSOLIDATED COURT COSTS 38.65 347.89 786.59 COST CMS COURTHOUSE SECURITY 0 0 0.00 0.00 0.00 COST IDF INDIGENT DEFENSE POIND 0.00 0.00 0�00 COST JCSF JUSTICE COURT SECURITY FUND o 0 o.oD 0.00 0.00 COST OPAY JUDGE PAY RAISE FEE 0.00 0.00 0.00 COST JSF JUROR SERVICE FUND 0 0.00 0.00 0.00 COST LAF SHERIFF'S FEE 0 0.00 0.00 0 .0 0 COST LCCC LOCAL0.0CONSOLIDATED COURT COST (EFF. I.J.11 7 1.18 0 0.00 3 .0 COST MVF MOVING VIOLATION FEE 7 0.00 $7,28 COST OMNC UPS OMNI FEE - COUNTY 0 0.00 0.00 0.00 COST OMNO DPS OMNI FEE • DPS D 0.00 0.00 D.00 COST OMNO DPS OMNI PEH - OMNISASE D 0.00 0.00 0.00 COST OMNR OMNI REIMBURSEMENT FEE (EFF. 1.1.201 0 0 0.00 0.00 0.00 COST PWAF TEXAS PARKS & WILDLIFE 0.00 0.00 6.60 COST TP TECHNOLOGY FUND 0 0.00 0.00 0.00 COST TPDF TRUANCY PRSVENTION & DIVERSION FUND 0 0.00 0100 0.00 COST WRNT WAFIWC FEE 0 0.00 0.00 0,00 FREE CSRV COLLECTION BSRVICSS FEE 1 50.00 0.00 50.00 FEES DDC DRIVER SAFETY COURSE - 2020 1 1 S50.50 0.00 1000 FEES OFF DEFERRED FEE 10.00 10.00 0.00 10.00 20.00 FEES EPP ELECTRONIC FILING FEE 1 9.00 0.00 PEES FILL FILING FEE 1 10.00 10.00 10.00 FEES IFEE INDIGENT FEE 1 25.00 5.30 0.00 0.00 FEES JCMF JUVENILE CASE MANAGER FEE 1 6.00 6.00 FEES JPTP JUDICIAL & COURT PERSONNEL TRNG PEE 0 0.30 D.Do -CV FINE DEFP DEFERRED FINE 0.00 5.00 5.00 FINE FINE FTNE 1 146.00 246.00 0.00 19G.00 146.00 FINE LTPC LOCAL TRAFFIC FINS (EFF, 9.1.19) 3 0.00 0.00 FINE PWF PARKS & WILDLIFE FINE 5 16.00 3.93 16.00 FINE STF1 STATE TRAFFIC FINE (EFF. 9,1.19) 0 0.00 D.00 0.00 5 220.00 232.07 Money Totals 10 1,262.12 S91.38 1,853.50 The following totals represent - Transfers Collected BOND APE APPEAL BOND 0 COST CCC CONSOLIDATED COURT COSTS 0.00 0.00 0.000 COST CCC CONSOLIDATED COURT COSTS D.00 0.00 0.00 COST CHS COURTHOUSE SECURITY 0 D.00 0.00 0100 COST IDF INDIGENT DEFENSE FUND D 0.00 0.00 0.00 COST JCSF JUSTICE COURI SECURITY FUND 0 0,00 0.00 0,00 COST JPAY JUDGE PAY FEE 0 0,00 0,00 0.00 COST JSP JUROR SERVICEICEFUND OND 0 0.00 0.90 0.00 COST LAP SHERIFFS FEE 0 0.00 0.00 0.00 COST LCCC LOCAL CONSOLIDATED COURT COST (EFF, I,1, 0 0.00 0.00 0.00 COST MVF MOVING VIOLATION FEE 0 0.00 0.00 0.00 COST OMNC DPS OMNI FEE - COUNTY 0 0.00 0.00 0.00 COST OMND DPS OMNI FES - OpS 0 0.00 0.00 0.06 :UST OMNO DPS OMNI GEE OMNIEASE 0 0.00 0.00 0.00 COST OMNR OMNI: REIMBURSEMENT FEE (EFF. 1.1.20) 0 0,00 0.00 0.00 :DST PWAF TEXAS PARKS & WILDLIFE 0 0'DO 0. 00 0.00 CO5T TF TECHNOLOGY FUND 0 0.00 0.00 0.00 :AST TPDF TRUANCY PREVENTION & DIVERSION FUND 0 0 0.00 0.00 0.00 1DRT WANT WARRANT FEE 0.00 0.00 0.66 FEES CSRV COLLECTION SERVICES PEE 0 0.00 0.00 0.00 ?EES DDC DRIVER SAFETY COURSE • 2020 0 0.00 0.00 0.00 FEES OFF DEFERRED FEE 0 0.00 0.00 0.000 ?EES EFF ELECTRONIC FILINU FEE 0,00 0.00 0.00 ?Egg FILI FILING FEE 0 0.00 O.DD 0.00 ?EFS TFEE INDIGENT FEE 0 0.00 0.00 0.00 ?EES JCMF JUVENILE CAGE MANAGER D 0.00 0.00 0.00 TES JPTP JUDICO:Ai. & COURT PERSONNNEEL TRNG FEE -CV M 0 0.00 000 . 0.00 TINE DEFF DEFERRSO FINE 0 9.00 0.00 0.00 'INS FINE PINE O 0.00 0.00 0.00 +INE LTFC LOCAL TRAFFIC FINE (EFF. 9.1.19) 0 0.00 0.00 0.000 'INE PWF FORKS &WILDLIFE FINE 0.00 0.00 0.00 0 0.00 0.00 0.00 .0-04-2021 Pegs 9 10-06-21;17:13 ;From:Calhoun County Pct. 5 To:5534444 ;3619832461 # 5/ 9 Nanny Distribution Report CALHOUN JPS DEPTEN02S, 2021 REPORT Type Code Description Count Retained Disbursed No ey-T t 1 FINE STPS STATE TRAFFIC FINE (C•FF. 9.1,10) 0 ;.Do 0.00 0.00 Transfer Totals 0 0.00 0.00 0.00 The following totals represent - Jail Credit and Community Service BOND APB APPEAL BOND 0 0.00 0.00 0.00 COST CCC CONSOLIDATED COURT COSTS 0 0.00 0.00 0.00 COST COO CONSOLIDATED COURT COSTS 3 12.00 100.00 120.00 COST CHS COURTHOUSE SECURITY 3 9.00 0.00 9.00 COST IDF INDIGENT DEFENSE FUND 3 9.60 5,40 6.00 COST JCSF JUSTICE COURT SECURITY FUND 3 3.00 0.00 3.00 COST JPAY JUDGE PAY RAISE FEE 3 1.80 16.20 18.00 COST JSF JUROR SERVICE FUND 3 1.20 10.80 12.00 COST LAP SHERIPPIS FEE 2 10.60 0.00 10.00 COST LCCC LOCAL CONSOLIDATED COURT COST (EFF. 1.1. 0 0.00 0.00 0.00 COST MVP MOVING VIOLATION FEE 2 0.02 0.18 0.20 COST OMNC DR$ OMNI PEE - COUNTY D 0.00 0.00 9.00 COST OMNO DPS OMNI FEE - DPS 0 0.00 0.00 0.00 COST ONNO DPS OMNI FEE - OMNIBASE 0 0.00 0.00 0.00 COST OMNR OMNI REIMBURSEMENT FEE (EFF. 1.1.20) 0 0.00 0.00 0.00 COST PWAF TEXAS PARES & WILDLIFE 0 0.00 0.00 0.60 COST TF TECHNOLOGY FUND 3 12.00 0.00 12.00 COST TPDF TRUANCY PREVENTION & DIVERSION FUND 2 0.00 4.00 4.00 COST WANT WARRANT FEE 3 150,00 0.00 159.90 FEES CSRV COLLECTION SERVICES PEE 3 331.50 0.00 331.50 FEES DOC DRIVER SAFETY COURSE - 2020 D 0.00 0.00 0.00 FEES OFF DEFERRED FEE D 0.00 0.00 0.00 FEES EFF ELECTRONIC FILING FEE D 0.00 0.00 0.00 FEES FILL FILING PEE D 0.00 0.00 0.00 PEES IRUE INDIGENT PEE 0 0.00 0.00 0.00 FEES JCMF JUVENILE CASE MANAGER FEE 3 15.00 0.00 15.99 FEES JPTF JUDICIAL & COURT PERSONNEL TRNG PEE -CV 0 0.00 0.00 0.00 FINE DEPP DEFERRED FINE 0 0.00 0.00 0.00 FINE FINE FINE 3 745.80 0.00 745.80 FINE LTFC LOCAL TRAFFIC FINE (EFF. 9.1.19) 0 0.00 0.00 6.00 FINE PWF PARKS & WILDLIFE FINE 0 0.00 0.00 0.00 FINE STF1 STATE TRAFFIC FINE (SFP. 9.1.19) 0 0.00 0.00 0.00 Credit Totals 3 1,291.92 144.58 2,436.50 The Yellowing totals represent - Credit Card Payments SOND APB APPEAL BOND 0 0.90 0.00 0.00 COST CCC CONSOLIDATED COURT COSTS 7 43.40 390.60 434.00 COST CCC CONSOLIDATED COURT COSTS 1 4.00 36.00 40.00 COST CHS COURTHOU9S 9E001rY 1 3.00 0.00 3.00 COST IDF TNOICENT DEFENSE FUND 1 0.20 1.80 2.00 COST JOSP JUSTICE COURT SECURITY FUND 1 1.00 0.00 1.00 COST JPAY JUDGE PAY RAISE FEE 1 0.60 5.40 6.00 COST JSF JUROR SERVICE r(m 1 0.40 3.60 4.00 COST LAP SHERIFF'S FEE 7 33.00 0.00 35.00 COST LCCC LOCAL CONSOLIDATED COURT COST (EFP. 1.1. 7 90.00 0.00 98.00 COST 31VF MOVING VIOLATION PEE 0 0.00 0.00 0.00 COST OWC DPS OMNI FEE - COUNTY 1 4.00 0.00 4.00 COST ONND DPS OMNI FEE - DPS 1 0.00 20.00 20.00 COST OMNO DPS OMNI FEE - OMNIBASE 1 0.00 6.90 6.00 COST OMNR OMNI REIMBURSEMENT FEE (EFP. 1. 1. 20) 1 10.00 0.00 10.00 COST PWAF TEXAS PARKS & WILDLIFE 1 4.00 1.00 5.00 COST TF TECHNOLOGY FUND 1 4.00 0.00 4.00 COST TPDF TRUANCY PREVENTION & DIVERSION FUND 1 COST WRNT WARRANT' FEE 2 . 309.99 .00 0 0.00 2.00 0.0 PEES CSRV COLLECTION SERVICES PEE 5 336.50 0.00 33 336.50 FEES DOC DRIVER SAFETY COURSE - 2020 2 20.00 0.00 29.90 FEES DPP DEFERRED FEE a 0.00 0.00 0.00 FEES EFF ELECTRONIC FILING PEE 0 0.00 0.00 0.00 FEES FILI FILING FEE 0 0.00 0.00 9.90 FEES IFEE INDIGENT FEE 0 0.00 0.00 0.06 FEES JCMF JUVENILE CASE MANAGER FEE 1 5.00 0.00 FEES JPTF JUDICIAL & COURT PERSONNEL TRNG FES-CV 0 0.00 0.00 5.00 0.00 FINE DEPP DEFERRED FINE 3 318.00 0.00 310.00 LO-04-2021 Page 4 10-06-21;17:13 ;From;Calhoun County Pot. 5 To:5534444 ;3619832461 # 6/ 9 Money Distribution Report CALNOON JFS SEPTEMBER 2022 REPORT lype Code Description Count Retained Diobureed Momey-Totals FINE FINE FINE 2 325.00 0.00 325.00 FINE LTFC LOCAL TRAFFIC FINE (EPP. 9.1.19) G 18.00 0.00 18.00 FINE PWF FARES & WILDLIFE FINE 1 30.22 171.28 201.50 FINE STPI STATE TRAFFIC FINE (EFF. 9.1.19) 6 12.00 280.00 300.00 Credit Card rotale 10 1,372.32 925.6E 21299.00 The following tetale represent - Combined Money BOND APB APPEAL BOND 1 250.00 0.00 250.00 COST COO CONSOLIDATED COURT COSTS 14 82,05 735.49 820.54 COST COO CONSOLIDATED COURT COSTS 1 4.00 39.00 40.00 COST CHS COURTHOUSE SECURITY 1 3.00 0.00 3.00 COST IDF INDIUSNT DEFENSE FUND 1 0.20 1.00 2.00 COST CORP JUSTICE COURT SECURITY FOND 1 1.00 0.00 1.00 COST JPAY JUDGE PAY RAISE FEE 1 0.60 5.40 6.00 COST JSF JUROR SERVICE FUND 1 0.40 3.60 4.00 COST LAP SBRRIFF'B FEE 14 $6.10 0.00 66.18 COST LCCC LOCAL CONSOLIDATED COURT COST (EPP. 1.2. 14 185.28 0.00 105.28 COST MVP MOVING VIOLATION FEE 0 0.00 0.00 0.00 COST OMNC PPS OMNI FEE - COUNTY 1 d.OD 0.00 4.00 COST ONND UPS OMNI FBE - DPS 1 0.00 26.66 20.00 COST OMNO DPS OMNI FEE - OMNIBASE 1 0.09 6.00 6,00 COST OMNR OMNI REIMBURSEMENT FEE (EFF. 1.1.20) 1 10.00 O.DO 10.00 COST PWAP TEXAS PARKS & NILDLIFE 1 4100 1.00 5.99 COST TF TECHNOLOGY FUND 1 4.00 0.00 4.00 COST TPDF TRUANCY PREVENTION & DIVERSION FUND 1 0.00 2.00 2.00 COST WF= WARRANT FEE 3 130.00 0.00 15D.00 FEES CSRV COLLECTION SERVICES FOR 6 453.00 0.06 455.00 FEES DEC DRIVER SAFETY COURSE - 2020 3 30.00 0.00 10.00 FES$ OFF DEFERRED FEE 1 66.00 0.00 66.00 FEES EPP ELECTRONIC PILING FEE I D.00 IO,OO 10.00 FEES FILL FILING FEE 1 25.00 0.00 25.00 FEES IFEE INOIOSNT FEE I 0.30 5.70 9.00 FEES JCMF JUVENILE CASE MANAGER FEE 1 5.00 0.00 3.00 FEES JPTF JUDICIAL & COURT PERSONNEL TRNG FEE -CV 1 0.00 9.00 5.00 FINE OEPF DEFERRED FINE 4 464.00 O.OD 494.00 FINE FINE FINE 5 741.00 0.00 741.00 FINE LTFC LOCAL TRAFFIC PINE (EFF, 9.L 19) 11 31.93 O.OD 31.90 FINE PWF PARKS & WILDLIFE FINE 1 30.22 171.28 201.SO FINE STP1 STATE TRAFFIC FINE (SFr. 9.1.19) 11 21.28 510.79 532.07 Money TOta14 20 2,634.44 11517.09 41161.50 The follewimE totals represent - Combined Money &Ad Credits BOND APR APPEAL BOND 1 250.00 0.00 250.00 COST COO CONSOLIDATED COURT COSTS 14 82,05 738.49 820.54 COST COO CONSOLIDATED COURT COSTS 4 16.00 144.00 160.00 COST ONE COURTHOUSE S$CVRiTY 4 12.00 0.00 12.00 COST IDF INDIGENT DEFENSE FUND 4 0.80 7.20 8.00 COST JCSF JUSTICE COURT SECURITY FUND 4 4.00 0.00 4.00 COST SPAY JUDGE PAY RAISE PRE 4 2.40 21.60 24.OD COST JSF JUROR SERVICE FOND 4 L.60 14.40 16.00 COST LAP SHERIFF'S FEE 16 76.18 0.00 76.19 COST LCCC LOCAL CONSOLIDATED COURT COST (EPP. 1.1. 14 185.28 0.00 129.28 COST MVF MOVING VIOLATION PEE 2 0.02 0118 0.2D COST OMNC DPS OMNI PRE - COUNTY 1 4.00 0,00 4.00 COST ONND DPS OMNI PIE - DPS 1 0.00 20.00 20.00 COST ONNO DPS OMNI FEE - OMNTBASE 1 0.00 6.00 6.00 'OST OMNR OMNI REIMBURSEMENT FEE (EPP. 1.1,201 1 10.00 :UST PWAP TEXAS PARRS & WILDLIFE 1 4.90 0.00 1.00 10.00 5.00 :OST TP TECHNOLOGY POND 4 16.00 0.00 16.00 'DST TPDF TRUANCY PREVENTION & DIVERSION FUND 3 0.00 0100 6.00 :CST WENT WARRANT PSI; 6 200.00 0.00 300.00 ?EBS CSRV COLLECTION SERVICES FEE 9 796.50 0.00 706.50 ?RES DDC DRIVER SAFETY COURSE - 2020 3 30.00 0.00 30.00 FEES OFF DEFERRED FEE 1 96.06 aA6 66.00 ?EBB EPP ELECTRONIC FILING PER 1 0.00 10.00 10.00 ?EBS FILI FRINC FEE 1 25.00 0.00 25,00 PEES IFEE INDIGENT FEE 1 0.30 5.70 6,00 10-04-2021 -- Page 5 10-06-21;17:13 ;From:Calhoun County Pct. 5 To:5534444 ;3619832461 # 7/ 9 Money Distribution RaPpre CALEOUN JP5 EEPTEMeER 2021 REPORT Type Cede Description Count Retained Disbursed money -Totals_ PEES JCMP JUVENILE CASE MANAGER FEE FEES JPTF JUDICIAL 6 COURT PERSONNEL TRNO FEE -CV FINE DOFF DEPERRED PINE FINE FINE PINE FINE LTFC LOCAL. 'TRAFFIC FINE (OFF. 9.1.19) FINE PWP PARES 4 WILDLIFE FINE FINE STPS STATE TRAFFIC PINS (EFF. 9.1, 191 4 1 4 P 11 1 11 Mao 0.00 464.00 1.406.80 21.93 30.22 21.2E 0.00 5.00 0.00 0.00 0.00 171.28 510.79 20.00 ... 5.00 464.00 1,486.66 31.93 201.30 532.07 Report Totals 23 3,926.36 1,661.64 5.588.00 10.04-2021 Page 6 10-06-21;17:13 ;From:Calhoun County Pot, 5 To:5534444 ;3619832461 # 8/ 9 money Distribution Report Date 0040-0000 Payment Type Cash & Cheeks Collected Jail Credits & Comm service Credit Cards & Transfers Total of all Collections Pinta 0.00 0.00 0.00 0.00 Court Costo 0.00 0.00 0.00 0.00 CMUCIM 725 Bees 0.00 0.00 0.00 0.00 SEPTE"sm 2021 REPORT Rondo Restitution 0.00 0.00 0.00 O,OD 0.00 0.00 0.00 0.00 Other 0.00 0.00 0.00 6.00 Total 0.D0 0.00 0.00 0.00 09-01-1991 Cash 6 Checks Collected Jail Credits & Comm service Credit Cards & Trahoiara Total of all Collections 0.00 0.00 0.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 01-01-2004 Cash & Checks Collected Jail credits & Comm Service Credit Cards & Transfers Total of all Collections 9.90 745.80 201,50 .447.30 0.00 344.20 147.00 491.29 0.00 346.30 111.50 458.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 DAD 0.00 0.00 0.00 0.00 0.00 1,436.50 460.00 1,896.50 01-01.2020 Cash & Checks Collected Jail Credits & Comm service Credit Cards & Transfers Total of all Collections 009.00 0.00 961.00 1,799.00 $55.00 0.00 627.00 1,182.00 24D.50 0.00 250,00 490.50 250.00 DAD 0.00 250.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11853.50 9.00 1,836.06 3,691.50 TOTAyS Cash & Checks Collected Tail Credits & Comm Service Credit Cards & Transfero Total of all Cellectiom0 608.00 746.80 1,462.50 21716.30 555.00 344.20 774.00 1,673.20 240.50 149.90 361.50 940.50 250,00 0.00 0.00 250.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11853.50 1,436.SD 20298.00 3,SD6,00 .0-04-2021 Page 7 10-06-21;17:13 ;From:Calhoun County Pct. 5 To:5534444 ;3619832461 # 9/ 9 Money Distribution Report CALROON JP5 SEPTEMBER 2021 REPORT Description Count 0o11eeted RoCaiDed Disbursed State of Texas Quarterly Reporting Totals State, Comptroller Coat and FOOD Roport section I: Report for Offences Committed 01-01-20 Forward 14 820.5d 02.05 738.49 01.01-04 - 12-31.19 1 40.00 4.00 36.00 09.01-91 - 12-31.03 0 0.00 0.00 9.00 Rail Bond Fee 0 0.00 0.00 0100 DNA Testing Fee - Juvenile 0 0.00 0.00 0.00 ENS Trauma Fund (EMS) 0 0.00 0.00 0.00 Juvenile Probation Diversion Fees 0 0.00 0.00 State Traffic Fine (off. 09-01-19) 11 532.07 21.28 0.00 State Traffic Fine (prier og-03.10) 0 510.79 Intoxicated Driver Pine 0 0.00 0.00 0.00 Prior Mandatory Costs (JRF,IDF,JS) 3 0.00 22.00 0.00 1.20 0.00 Moving Violation Fees 0 10.80 0.00 0.00 0.00 DNA Testing Fee - Convictions o 0.00 0.00 0.00 DNA Testing Fee - Comm $up" 0 0.00 0.00 Truancy Prevention and Diversion Fund 0 0.00 0.00 0.00 Failure to Appear/Pay Fees 1 0.00 Time Payment Pace 0 20.00 0.00 20.00 Judicial Fund - Count County Court 0 0.00 O.OD 0.00 Judicial Fund - Statutory County Court 0 0.00 D.00 0.00 0.00 0.00 0.00 Section Ji: As Applicable Peace Officer Foss 1 5.00 4.00 1.00 Motor Carrier weight Violations 0 0.00 Driving Record Fee 0 0.00 0.00 Report Sub Total 31 0.00 D.00 0.00 1,420.61 112.53 1,317.00 State Comptroller civil Fees Report CV; Birth Certificate Fees 0 0.00 0.00 CF: Marriage License Pees 0 0.00 CF: Declaration of Informal Marriage 0 0.00 6.00 O.DO 0.00 CF: Fondinelasure Fees 0 0.00 D.00 CF: Juror Donations 0 0.00 0.00 0.00 CF: Justice Court Indig Filing Fees 1 0.00 G.OQ 0.00 0.00 CF: Stat Prob Court Indig Filing Fees 0 0.00 0.30 5.70 CF: Stat Prot Court Judic Filing Peas 0 0.00 D.DO CF: Stat Cnty Court Indig Filing Fees 0 0.00 0.00 0.00 0.00 CF: Star CPty Court Judic Filing Fees 0 0.00 O.DO CFr Coat Cnty court Indig Filing peen 0 0.00 0.66 0.00 CF, Cast Cnty Court Judie Filing Pass 0 0.00 0.00 0.00 CF: Diet Court Divorce a Family LAW 0 0.00 0.00 0.00 CP: Diet Court Other Divorce/Family Law 0 D.00 9.09 0.00 CP. Diet Court Indig Legal Services 0 0.00 0.00 O.DO CF; Judicial Support Fos 0 D.00 0.00 0.00 CF: Judicial 4 Court Para, TrAining Fee D 0.00 O.Oa 9.00 Report Sub Total 1 D.00 0.00 6.60 9.00 0.30 5.70 Total Due Per This Pariod 32 1,435.61 112.03 1,322,7g rHE STATE OF TEXAS Before me, the undersigned authority, this day county of Calhoun County personally appeared Nancy Pomykal, Jvptiea Of the Pease, Precinct NO 5, Calhoun County, Texas, who being duly sworn, deposes And says that the above and foregoing report is true and correct. titneas my hand this �4 / day of ��r� A.D. Tice the Peace, Pr tint No ' COunty, TAXa SHERIFF'S OFFICE MONTHLY REPORT SEPT. 2029 BAIL BOND FEE $ 630.00 CIVIL FEE $ 265.75 JP#1 $ 3,353.90 JP#2 $ 1,853.88 JP#3 $ 440.00 JP#4 $ 245.00 JP#5 $ 416.00 PL MUN. $ - COUNTY COURT $ SEADRIFT MUN. $ 520.00 PC MUN. $ 2,216.50 OTHER $ 10,143.00 PROPERTY SALES $ - DISTRICT $ - CASH BOND $ - TOTAL: $ 20,084.03 SUMMARY TAX ASSESSOR -COLLECTORS MONTHLY REPORT SEPTEMBER 2021 COLLECTIONS DISBURSEMENTS Title Certificate Fees 635 $ 8,385.00 Title Fees Paid TXDOT $ 6,210.00 Title Fees Paid County Treasurer Salary Fund $ 3,176.00 Motor Vehicle Registration Collections $ 171,084.84 Disabled Person Fees $ 50.00 Postage $ - Global Additonal Collections $ 1.80 Paid TXDOT $ 139,066.62 Paid TXDOT SP $ 23,416.01 Paid County Treasurer $ - Paid County Treasurer Salary Fund $ 6,387.36 DMV CCARDTRNSFEE $ 2,265.86 $ - GLAdditonalCollections $ 1.80 $ - -- - GLOBAL (IBC) Credit/Debit Card Fee's $ 1,429.38 GLOBAL Fees In Excess of Collections $ 838.28 MERCH SERVICES STATEMENT $ Additional Postage -Vehicle Registration $ - Paid County Treasurer - Additional Postage $ - Motor Vehicle Bales & Use Tax Collections $ 618,615.71 Paid State Treasurer $ 618,615.71 Special Road/Bridge Fees Collected $ 23,610.00 Paid County Treasurer -R/B Fees $ 23,610.00 Texas Parks &Wildlife Collections $ 4,721.00 TPW GLOBAL CC TRANSACTION FEES $ 91.44 GLOBAL ADDITIONAL COLLECTIONS $ - Paid Texas Parks & Wildlife $ 4,248.90 Paid County Treasurer Salary Fund $ 472.10 P&W CCARDTRNSFEE $ 91." GLOBAL Addilonal Collections $ - GLOBAL (IBC) Credit/Debit Card Fee's $ 83.91 GLOBAL In Excess/Shortage of Collections $ 7.53 Boat/Motor Sales & Use Tax Collections $ 45,036.66 Paid State Treasurer $ 42,784.83 Paid County Treasurer, Salary Fund $ 2,261.83 TABC 5%CO COMMS FOR MONTH OF $ - TABC 5 % CO COMMS FOR MONTH OF $ - Paid County Treasurer, Salary Fund $ - County Beer & Wine Collections $ 930.00 Paid County Treasurer, County Beer & Wine $ 883.50 Paid County Treasurer, Salary Fund $ 46.50 INTEREST EARNED ON OFFICE ACCOUNT $ 19.67 Paid County Treasurer, Nev. East $ - Paid County Treasurer, all other districts $ 19.67 INTEREST EARNED ON PARKS AND WILDLIFE ACCOUNT $ 2.32 Paid County Treasurer, Interest on P&W Acc $ 2.32 INTEREST EARNED ON REFUND ACCOUNT $ 0.06 Paid County Treasurer, Interest on Refund Ace $ 0.05 Business Personal Property - Misc. Fees $ 12.70 Paid County Treasurer $ 12.70 Excess Funds $ - Paid County Treasurer $ _ Overpayments $ 0.45 Current Tax Collections $ 7,062.69 Penalty and Interest - Current Roll $ 2,220.75 Discount for early payment of taxes $ _ Delinquent Tax Collections $ 4,947.88 Penalty & Interest - Delinquent Roll $ 2,766.92 Collections for Delinquent Tax Attorney $ 4,072.99 Advance - FM & L Taxes $ - Advance - County AdValorem Taxes $ 16,683.25 Paid County Treasurer - Nev. East $ 25.86 Paid County Treasurer - all other Districts $ 389.58 Paid County Treasurer - Delinq Tax Ahy. Fee $ 4,072.99 Payment in Lieu of Taxes $ _ Paid County Treasurer - Navig. East $ _ Paid County Treasurer- All other Districts $ _ Special Farmers Fees Collected $ 45.00 Paid State Treasurer, Farmers Fees $ 45.00 Hot Check Collection Charges $ _ Paid County Treasurers, Hot Check Charge $ _ Overage on CollectionlAssessing Fees $ _ Paid County Treasurer, overage refunded $ _ Escheats $ _ Paid County Treasurer -escheats $ TOTAL COLLECTIONS $ 893,677.87 TOTAL DISBURSEMENTS $ 893,677.87 TOTAL OFF A/BBOOVE RECEIPTS PAID TO STATE AND COUNTY $ 893,677.87 / LCl}%i.C/ � KERRI BO D Tax Assessor -Collector r RICH Dfi MEYER CoLWdy Judge # 26 NOTICE OF MEETING— 10/20/2021 26. Consider and take necessary action on any necessary budget adjustments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 22 of 23 m) 2 § § § m m; � = e m ■ § B �; » E ° ■ ■ »; �) • ■ �. ■� mc K e- z 2 ■� k= mCp m k. z) 0m0 ; § z; k= m0` mM� § § ok ; §: Z) ( ; ■: ■ B) % �_: m �, » ■ z§ , ; % o. : @§ 2 �em2 2 ® m §& § *zzz� § § ) 3 §/// ' § c): X §§>> ` 2: § §�--§ § X; ) ) ) � ) � ) § § v� - , m � ■: mj ■§ s; m= « o m: z§ z; �_ ■ �: z ; z: o| /q§ .o: C,: A§§ B § m k z k ) ME m , m= RE § li m )PE m o §| § ») & . ■§ o ■_ z % p » ■ z. § § m§ § ; o§ M) k 9 k §§§ mm■ § § ■ w§ � .B� �)BBIF § ■ 2| z �\ z � s; ■ §( z § a) ■ �) c= C= § Z= ■ § §) a .4§ 2 � §k § § ) z 2 ) �b- § / § § � ) ) !§ B � m( k • & 00= o A§ z § ( ■ ■| m ■ z| o » -lE m 0 § Z� § Mj --n ■ 2 k » §) Z= § ]| § @ mk e ■ Z§ m o ■ m§ ■) � § ■ z 2 k m m �_ C mm y m= o c5 z s !7 0 0 c z { a x 0 O r r 0 t> 0 M 0 a r 0 z n D Z 'nI Eu M 0 o m: 3 3 a? m ^� z m z Z zE a Cl a o: c oz: z N m C ♦: m 0 m p nC r: mm: 0 0 0 a 0 0 0 C z Z m= �= o T a re �= 3 i Z 3= m C ♦= rn y z � z a-rn • .4 n m = o dc m M z o= v v z= z_ c c = c k § ■ I ■ % 2§ z m) m �\ m x ■§ _ ■ ° z| \§ �/ ■ ` �| � ■§ (A§ § §) F) ■ $ m § M) e§ ■ • , m= �° �) o § § �Z § ) � � ( $ § m ■ M: m ■ z ■ § ■ -0i »� . m �: 2 ) §: ■ z; k_ k » ; ■ �: z: ■ k »: ■ rn M: § §: § @ �: |° ■ � o ■ ■ 2� ■: 2r .4 § |) §°§ z � & % \ m :a W,on W N � 0 o N c O D D r 0 m �zo O O my A j A z m c m A m z N� mCO m w 000 A000 z z z 8 A O O11 OOO 0r O O O a 0 c z w v m mu a m z 4 w A tll m r m n 1 0 z Cl) 0 a r 0 N O 0 1 w m D m m j v O m m m z 0 0 zz m N 000 cA) 00 p0p z z z z a 3 v=. z m: c m 2� z a 4 zi l: z ZE m 3€ r mi i m 3 z d! m m X O a m m z y CAA O O N N o G) 0 c v z C7 Z n m m mZ N0 O 3 Z�7 z Zz y 1 ti m o i y T a n v N o z C <o Pp o0 O Z 0M O m N z K n A D m w] Z G) m m D Z 000 zz m m m m m z 3 m 0 a r N m m cn D r r m� e D O z zea li m m=_ O O m m �_ m Q m- v z z z° a= 0 m_ m m= 0 3 Gi m n A Z_ z 3=_ H r= a y= c mME o y= (§ � S °■ 2. §; 6 ■ � § , I § ■ ■ M: ■ • § ■ ; _ ■ X ■ ■ @ m: �: »� ■: z; ■ �: § § a; ■ § m' �) a m P! 2 % ' § , o & ' % § k § § § }�§ m�§ # I ■ it a. 2 § m - § m ■ M. �! _ ■ § �| ° ; 3 x M, - / ■ §( § §) • M. ■ 2 ■: m a) z: ■ % . § m; ; ■ o) :� ■ C. ■ ■: 'E g n! , ■ m: ;o ;/ ■: ■ % _ , k k : k A m A � $ "n : \ : v § 2 ;§§ sm■ §/ (( M(§ \ @ in 1�m m� 0 600 ()) 0 „ \ § § 2 § ) ) k 0 2 k q q 2 In § m m ME m k\ J M) ■ ° z) k § k) § §§ U § ,§1 ■ z , § § §q§% § _ § m ■ m) \ �= o ■ % �) 2 ) �) k ■ $ z| o » .4E m ; ■ z| A z m■In E ■ r_7 WE ° ■ � �) § �( ■ � § m x ca ■ 2 B � m m m m N in m A W O W m W (O N m 00000� cOKW- C F C Z N m p m p r Z m rn m G) D m m --0 -4c_�I z N � U z 0 T m e z z z z z 00000 G) G) G) 0 G) zzzzz z z z z z m N A N N O EA O O O O O O O O e T N V fA O E9 EA EA 0 0 0 0 0 IN W A N N 0 0 0 0 0 0 0 0 0 0 z Z m 0 44 9= m t 3= m Z= ,oz, z ME m o=_ m �_ o a c _ m A CIE o m= M L)1 a Z Z_ A n= _ y A m m z m m 0 D r �MMIF- J M [fi O N O tp W m O o 0 i11 m m o 0 ga oe m � m N c m o Z = m o m L �A 0 o mo m m 3 a'' m T �I m m 310 1 °z, 1 a'' z m G m m Z C m A m m o r o � m m Pm � O Z a It a � z v n m G) m n r c v ±§§ ±k§ k k � \ it s #000 s #±#«§ �■�« \§�■ _ « »\\)�� _ # k § ;2§ e&■ §§§ A k It $§ $§ U . ® . m . ® - 7 - § . - m % § % , § $ k \ \ k § m ) 0 ) 0 ■ m § Cl) § � k a � B ■ � ■ § -0 lmw1�mw §§ [woo\ INN lm�Qmm B z ■ �= o A§ z § ( I i ■| m ■ z| o » -lE m § z §j § @ § 1 §) o � @ k\ ME o ■\ w §; k B �( , m n. #) 2 § k � ) a s | R k 2 k § � $ 0000000000 0000000000 77\\{\\\\z ,§ § 0±00000«0 )\£@f«fm\� $ e }\)\\)\\\ &k! B k k °■ G k .J1 � z w $ k k B § W z \_I @ ) 8 § � c k O m: m: a€ PO: .4: 3: Fit z: z€ a: z€ o; o m=. mo a€ 70 E 1: 3: m: z; .41 1 m Z a m m m m Z 1 r 9 0 m 0 cn T D Ar T m m11 z O O zz Q IF0 1 0 T z itm; a 3 a: m Po: 1 Z 3: m: m Z` w = N z a 3: It w m { in =i m � o m: z m: m A m m o A { C z a C 0 a m m m n r C v 2 k § ■■ Mir B @ ME k § B �• v § )PE/ § ) ME k ■ ME » qE o § Zj § z §) ; § § z| \ § M( 0 ` �m E m • m § m) 2 0 2 �) § c \ z 2 j \ �0 d # 27 NOTICE OF MEETING— 10/20/2021 27. Approval of bills and payroll. (RM) Image and Healthcare RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Adjourned: 10:34 a.m. Richard Meyer, County Judge 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. 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Crowley D.O. HEB Pharmacy (Medimpact) Pharmacy Reimbursement MMCenter (In -patient $01out-Patient $1,297.60/ ER $420.48) Memorial Medical Clinic MMC Professional Fees. Port Lavaca Clinic Associates Singleton Associates, PA Victoria Anesthesiology Assoc SUBTOTAL Memorial Medical Center (indigent Healthcare Payroll and Expenses) Co -pays adjustments for September 2021 Reimbursement from Medicaid by:DC 201.28 69.96 1,718.00 815.81 95.43 103.63 106.39 152.54 3,263.04 4,166.67 Subtotal 7,429.71 (70:00} 0.00 M 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 $7,359.71 approved by Commissioners :Court on'.10/2 0/2021 1000-001-46010 September 30, 2UI Interest ($0.86) $7,358.85 COUNTY AUDITOR APPROVAL ONLY 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 N AND REQUEST THE COUNTY TREASURER TO PAY THE ASO GATION. f BY: —� 10/18/2021 ffi C14 N 0 7 A 0 t— DEPARTMENT HEAD DATE m ©IHS Source Totals Report Issued 10/11/21 Calhoun Indigent Health Care Batch Dates 09/30/2021 through 10/01/2021 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 3,639.00 403.10 01-2 Physician Services -Anesthesia 546.00 152.54 02 Prescription Drugs 69.96 69.96 08 Rural Health Clinics 937.00 919.44 14 Mmc-Hospital Outpatient 4,056.00 1,297.60 15 Mmc - Er Bills 1,314.00 420.48 Expenditures 10,623.60 3,325.76 Reimb/Adjustments -62.64 -62.64 Grand Total 10,660.96 3,263.12 EXPENSES 4,166.67 7,429.79 COPAYS <70.00> TOTAL 7,369.79 Ld�IZ,tz:' APMtOVED ON OCT 1 8 2021 Sy COUNTY AUDITOR CALHOUN COUNTY, TEXAS ©IHS Source Totals Report Issued 10/11/21 Calhoun Indigent Health Care Batch Dates 02/01/2021 through 10/01/2021 For Source Group Indigent Health Care For Vendor. All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 23,599.00 2,309.91 01-2 Physician Services -Anesthesia 3,042.00 746.79 02 Prescription Drugs 870.22 870.22 05 Lab/X-Ray 11,719.15 135.25 08 Rural Health Clinics 6,219.00 5,001.57 13 Mmc - Inpatient Hospital 71,611.19 25,663.50 14 Mmc-Hospital Outpatient 97,078.09 31,224.74 15 Mmc - Er Bills 25,068.00 8,021.76 Expenditures 238,542.70 74,299.79 Reimb/Adjustments -336.05 -336.05 Grand Total 238,206.65 73,963.74 EXPENSES 37,500.03 111,463.77 COPAYS <690.00> TOTAL 110,773.77 Calhoun County Indigent Care Patient Caseload 2021 V 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 0 0 0 6 6 October November December YTD Monthly Avg 1 0 1 10 6 December 2020 Active 9 Number of Charity patients 200 Number of Charity patients below 50% FPL 75 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 0 4 0 18 $24,250.00 October November December YTD PATIENT SAVINGS $155,713.00 Monthly Avg 2 3 0 14 $17,301.44 0 December 2020 Active 87 MEMORIAL MEICICA LHECK REQUEST P CALHOUN COUNTY INDIGENT ACCOUNT A Y E F. AMOUNT $70.00 Date Requested: 10/12/21 OCT F 4- 2021 Gar G/L NUN(: FOR ACCT. USE ONLY Imprest Cash []A/P Check Mail Check to Vendor ❑ Return Check to Dept 50240000 EXPLANATION: TO TRANSFER INDIGENT CO -PAYS FROM OPERATING ACCOUNT TO THE INDIGENT REQUESTED BY: MAYRA MARTINEZ AUTHORIZED BY: RUN DATE: 10/07/21 MEMORIAL MEDICAL CENTER PAGE 129 TIME: 10:15 RECEIPTS FROM 09/01/21 TO 09/30/21 RCMREP G/L RECEIPT PAY CASH RECEIPT DISC COLL GL CASH NUMBER DATE NUMBER TYPE PAYER AMOUNT AMOUNT NUMBER NAME DATE INIT CODE ACCOUNT .................................... 50200.000. 09/30/21 602712 IN --...... ------------------------------------------------------------------- THL -GBRP CLAIMS 8.32- 0.32- -------------------- 00/00/00 FAG 2 50200.000 09/30/21 602714 IN TML -GBRP CLAIMS 68.85- 68.85- 00/00/00 FAG 2 50200.000 09/30/21 602716 IN THL -GBRP CLAIMS 73.22- 73.22- 00/00/00 FAG 2 50200.000 09/30/21 602726 IN GOLDEN RULE 26.62- 26.62- 00/00/00 FAG 2 50200.000 09/30/21 602788 IN AETNA 0 S HEALTHCAR 816.15- 816.15- 00/00/00 FAG 2 50200.000 09/30/21 602796 IN TRIWFST VA CCU CLAI 18665.61- 18685.61- 00/00/00 FAG 2 50200.000 09/02/21 599323 IN CIGNA HEALTHCARE 70.83- 70.83- 00/00/00 RAH 2 50200.000 09/02/21 5993B3 IN PAN AMERICAN LIFE 87.20- 87.20- 00/00/00 RAH 2 50200.000 09/02/21 599385 IN PAN AMERICAN LIFE 53,00- 53.00- 00/00/00 FAH 2 50200.000 09/08/21 600262 IN ADMINISTRATIVE CONC 153,07- 153.07- 00/00/00 RAH 2 50200.000 09/15/21 600868 IN MIMTTAN LIFE INSU 73.40- 73.40- 00/00/00 FAH 2 50200.000 09/15/21 600876 IN BOONG 49.80- 49.80- - 00/00/00 FAH 2 50200.000 09/15/21 600878 IN MOLINA HEALTHCARE 464B.50- 4648.50- 00/00/00 FAH 2 50200.000 09/16/21 600983 IN HUMANA 4242.00- 4242.00- 00/00/00 FAH 2 50200.000 09/21/21 601332 IN CHAMP VA 13438.43- 13438.43- 00/00/00 MRP 2 50200.000 09/23/21 601640 IN WPS MN3 VAPC3 882.69- 882.69- 00/00/00 MRP 2 50200,000 09/29/21 602088 IN ENTRUST 12219.46- 12219.46- 00/00/00 MRP 2 50200.000 09/29/21 602162 IN WPS MVH VACCN 417.56- 417.56- 00/00/00 NRP 2 50200.000 09/30/21 602333 IN CONT LIFE INSURANCE 4012.49- 4012.49- 00100/00 MRP 2 50200,000 09/30/21 603088 IN MIKE HOOKS LLC 1309.00- 1389.00- 00/00/00 MRP 2 50200.000 09/01/21 5991% IN CIGNA HEALTHCARE 78.11- 78.11- 00/00/00 RC 2 50200.000 09/01/21 599183 IN CIGNA HEALTHCARE 44.73- 44.73- 00/00/00 RC 2 50200.000 09/01/21 599248 IN CIGNA HEALTHCARE 162.85- 162.85- 00/00/00 RC 2 50200.000 09/03/21 599602 IN CIGNA HEALTHCARE 95.44- 95.44- 00/00/00 RC 2 50200.000 09/15/21 600764 IN RESERVE NATIONAL IN .00 .00 OD/00/00 RC 2 50200.000 09/15/21 600830 IN CIGNA HEALTHCARE .00 .00 00/00/00 RC 2 50200.000 09/20/21 601221 IN ORR 165.57- 165.57- 00/00/00 RC 2 50200.000 09/22/21 601515 IN CIGNA HEALTHCARE 240.75- 240.75- 00/00/00 RC 2 50200.000 09/22/21 601521 IN CIGNA HEALTHCARE 79.82- 79.82- 00/00/00 RC 2 50200.000 09/27/21 601907 IN NEDI-SHARE 78.00- 78.00- 00/00/00 RC 2 50200.000 09/29/21 602107 IN CIGNA HEALTHCARE 133.53- 133.53- 00/00/00 RC 2 50200.000 09/29/21 602109 IN CIGNA HEALTHCARE 113.85- 113.85- 00/00/00 RC 2 50200.000 09/30/21 602696 IN ARM V 8 11RALTHCAR 126.82- 126.82- 00/00/00 RC 2 50200.000 09/30/21 602798 IN ALL SAVERS ALTERNAT 3.74- 3.74- 00/00/00 RC 2 50200.000 09/30/21 602007 IN CIGNA HEALTHCARE 75.54- 75.54- 00/00/00 RC 2 50200.000 09/30/21 602910 IN CIGNA HEALTHCARE 141.67- 141.67- 00/00/00 RC 2 50200,000 09/30/21 602893 IN CIGNA HEALTHCARE 102,72- 102.72- 00/00/00 RC 2 50200.000 09/30/21 603152 IN CIGNA HEALTHCARE 68.05- 68.05- 00/00/00 RC 2 50200.000 09/30/21 603157 IN CIGNA HEALTHCARE 439.45- 439.45- 00/00/00 RC 2 50200.000 09/30/21- 603159 IN CIGNA HEALTHCARE 84.96- 84,96- 00/00/00 RC 2 50200.000 09/30/21 603161 IN CIGNA HEALTHCARE 130.11- 130.11- 00/00/00 RC 2 50200.000 09/30/21 603165 IN CIGNA HEALTHCARE 70.83- 70.83- 00/00/00 RC 2 **TOTAL** 50200,000 COMMERCIAL INS. -ADJ -120599.27 50240.000 09/21/21 601141 CA 10.00 10.00 00/00/00 KAM 2 50240.000 09/08/21 600243 VI 20.00 20.00 00/00/00 PLB. 2 50240.000 09/09/21 600115 CA 10.00 10.00 OD/00/00 PLB 2 50240.000 09/13/21 600438 CA 10.00 10.00 00/00/00 PLB 2 50240.000 09/11/21 600960 VI 183.69 183.69 00/00/00 PLB 2 50240.000 09/17/21 600961 MC 42.81 42.81 00/00/00 PLB 2 50240.000 09/20/21 601171 CA 10.00 10.00 00/00/00 PLB 2 50240.000 09/20/21 601205 CA 10.00- 10.00- 00/00/00 PLB 2 50240.000 09/21/21 601206 CA 10.00 10.00 00/00/00 PLB 2 RUN DATE: 10/01/21 MEMORIAL MEDICAL CENTER PAGE 130 TIME: 10:15 RECEIPTS FROM 09/01/21 TO 09/30/21 RCMREP G/L RECEIPT PAY CASH RECEIPT DISC COLL GI. CASH NUMBER DATE NUMBER TYPE PAYER AMOUNT AMOUNT NUMBER NAME DATE INIT CODE ACCOUNT -------------------------------------------------------- 50240.000 09/24/21 602505 VI ------------------ 183.69- -------------------------------------------------------- 183.69- 00/00/00 PLB 2 50240.000 09/24/21 602SOS MC 42.81- 42.81- 00/00/00 PLD 2 50240.000 09/29/21 601924 CA 10.00 10.00 00/00/00 PLB 2 **TOTAL** 50240.000 COUNTY INDIGENT COPAYS 70.00 50420.000 09/22/21 601334 CK STANFILL BARBARA 100.00 100.00 00/00/00 PLB 2 50420.000 09/22/21 601335 CK MC VOLUNTEERS 200.00 200.00 00/00/00 PLB 2 **TOTAL** 50420.000 GIVING TREE DONATION -OTHER REV 300.00 50510.000 09/14/21 600585 CA CAFE 394.46 384.46 00/00/00 BAR 2 50510.00D 09/14/21 600586 VI CAFE 247.87 247.87 00/00/00 RAH 2 50510.000 09/14/21 600587 KC CAFE 20.41 20.41 00/00/00 KAN 2 50510.000 09/14/21 600588 AS CAFE 4.06 4.06 00/00/00 KAN 2 50510.000 09/14/21 6ODS89 VI CURBSIDE 57.57 57.57 00/00/00 KAN 2 50510.000 09/14/21 600591 CA CAPE 384.46- 384.46- 00/00/00 KAM 2 50510.000 09/14/21 600594 CA CAFE 384.55 304.55 00/00/00 KAM 2 50510.000 09/14/21 60CS97 CK CAFE 4.09 4.09 00100/00 KAM 2 50510,000 09/14/21 60CS90 CA CAFE 384.55- 384.55- 00/00/00 KAM 2 50510.000 09/14/21 600599 CA CAFE 380.46 380.46 00/00/00 KAN 2 50510.000 09/14/21 600620 CA CAFE 380.46- 380.46- 00/00/00 KAN 2 50510.000 09/14/21 600622 CA CAFE 288.11 288.71 00/00/00 KAH 2 50510.000 09/14/21 600658 CA CAPE 288.71- 288.71- 00/00/00 KAN 2 50510.000 09/14/21 600660 CA CAFE 196.96 196.96 00/00/00 KAH 2 50510.000 09/01/21 598953 VI CAFE 269.72 269.72 00/00/00 PLB 2 50510.000 09/01/21 598954 MC CAFE 53.17 53.17 00/00/00 PLB 2 50510.000 09/01/21 598955 AS CAFE 12.79 12.79 00/00/00 PLB 2 50510.ODO 09/01/21 598956 VI CURBSIDE 54.81 54.81 00/DO/00 PLB 2 50510.000 09/01/21 598957 MC CURBSIDE 19.77 19.77 00/00/00 PLB 2 50510.000 09/01/21 59895E BE CURBSIDE 9.41 9.41 00/00/00 PLB 2 50510.000 09/01/21 598959 CA CAFE 215.25 215.25 00/00/00 PLB 2 50510.000 09/02/21 599187 VI CAFE 330.41 330.41 00/00/00 PLB 2 50510.000 09/02/21 599188 MC CAFE 125.23 125.23 00/00/00 PLB 2 50510.000 09/02/21 593189 AE CAFE 9.03 9.03 00/00/00 PLE 2 50510.000 09/02/21 599190 VI CURUSIDS 78.32 78.32 00/00/00 PLB 2 50510.000 09/02/21 599191 MC CURBSIDE 24.43 24.43 00/00/00 PLB 2 50510.000 09/02/21 599192 ON CURBSIDE 9.41 9.41 00/00/00 PLB 2 50510.000 09/02/21 599193 CA CAFE 17B.29 178.29 00/00/00 PLB 2 50510.000 09/03/21 599433 VI CAPE 303.04 303.04 00/00/00 PLB 2 50510.000 09/03/21 599434 MC CAFE 26.01 26.01 00/00/00 PLB 2 50510,000 09/03/21 599435 AS CAFE 8.39 0.39 00/00/00 PLB 2 $0510.000 03/03/21 599436 VI CURBSIDE 18.64 18.64 00/00/00 PLB 2 50510.000 09/03/21 599437 MC CURBSIDE 14.48 14.48 00/00/00 PLB 2 50510.000 09/03/21 599438 CA CAFE 151.30 151.30 00/00/00 PLB 2 50510.000 09/07/21 599662 VI CAFE 298.41 298.41 00/00/00 PLB 2 50510.000 09/07/21 599663 NO CAFE 63.93 63.93 _ 00/00/00 PLB 2 50510.000 09/07/21 599664 VI CURBSIDE 121.96 121.96 00/00/00 PLB 2 50510.000 09/07/21 599665 NO CURBSIDE 22.69 22.69 00/00/00 PLB 2 50510.000 09/07/21 599666 DS CURBSIDE 36.55 36.55 00/00/00 PLB 2 50510.000 09/07/21 599667 CA CAFE 293.53 293.53 00/00/00 PLB 2 50510.ODO 09/07/21 599684 VI CAFE 92.98 92.98 00/00/00 PLB 2 50510.000 09/07/21 599685 NC CAFE 19.54 19.54 00/00/00 PLB 2 50510.000 09/07/21 599686 AS CAFE 8.39 8.39 00/00/00 PLE 2 orm"WIVAN W, s 4 W z- 815 N. Virginia St. Port Lavaca, Texas 77979 (361) 552-6713 Date: 10/12/2021 Invoice # 361 For: Sep-21 Bill To: Calhoun County a: *p�$CRIp7`tON ;^ 11NICiiJ1�11"" Funds to cover Indigent program operating expenses. Jason Angli CEO $ 4,166.67 Total $ 4,166.67 q;. • APPROVED ON OCT i 8 70�St By COUNTY AUDIT01', Ca"OUN COUNTY, TE/J PROSPERITY • a • •R Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13311 9/30/2021 Page 1 of 2 09/01/2021 Beginning Balance $5,423.33 3 Deposits/Other Credits + $10,839.53 7 Checks/Other Debits - $10,781.09 09/30/2021 Ending Balance 30 Days in Statement Period $5,481.77 Total Enclosures 9 Date Description Amount JJ 09/17/2021 Deposit $10,728.67- 09/24/2021 Deposit $110.O0ALJ ` 09/30/2021 Accr Earning Pymt Added to Account $0.86 $ Check Number Date Amount Check Number Date Amount Check Number Date Amount 12476 09-20 $4,166.67 12479 09.28 $1,310.62 12482 09.24 $148.62 12477 09.20 $103.53 12480 09.28 $368.48 12478 09.20 $4,579.54 12481 09.23 $103.63 Date Balance Date Balance Date Balance 'o 09.01 $5,423.33 09.23 $7,198.63 09.30 $5,481.77 N 09-17 $16,152.00 09-24 $7,160.01 09.20 $7,302.26 09-28 $5,480.91 o� _� •• Below is an itemization of the Earnings paid this period. `• Interest Paid This Period $0.86 Annual Percentage Yield Earned 0.15 % Interest Paid YTD $17.71 Days in Earnings Period 30 Earnings Balance $6,980.58 MEMBER FDIC NYSE Symbol "PB" LGN�j October 20, 2021 2021 APPROVAL LIST - 2021 BUDGET COMMISSIONERS COURT MEETING OF BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE FICA MEDICARE FWH AFLAC NATIONWIDE RETIREMENT SOLUTIONS OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT PRINCIPAL FINANCIAL GROUP RELIANCE STANDARD LIFE CITIBANK PAYROLL FOR 10/12/21 SUPPLEMENTAL PAYROLL FOR 10/15/21 CALHOUN COUNTY INDIGENT HEALTH CARE 10/20/21 25 $215,817.71 P/R $ 12,881.54 P/R $ 54,763.20 P/R $ 38,731.77 P/R $ 2,742.01 P/R $ 4,660.00 P/R $ 1,516.15 P/R $ 1,584.28 P/R $ 5,077.60 A/P $ 17,195.19 TOTAL VENDOR DISBURSEMENTS: $ 354,969.45 ✓ P/R $ 110.82 4 P/R $ 326,784.40 TOTAL PAYROLL AMOUNT: $ 326,895.22 ✓ f A/P $ 7,358.85 ' TOTAL INVESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: $ 7,358.85 ' E TOTAL AMOUNT FOR APPROVAL: $ 689,223.52 � I MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---October 20, 2021 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 558,6177.25 TOTAL TRANSFERS BETWEEN FUNDS $ 100,637.04 TOTAL NURSING HOME UPL EXPENSES $ 915,864'10 TOTAL INTER -GOVERNMENT TRANSFERS $ 43,837.00 / GRAND TOTAL DISBURSEMENTS APPROVED October 20i 2021 $ 1,619,00.39' 1 '/ MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---October 20, 2021 PAYABLES AND PAYROLL 10/14/2021 Weekly Payables 491,681.72 10/18/2021 Spectrum Health Partners -cost associated for interm CFO per contact 45,000.00 10/14/2021 Citibank Credit Card -see attached 381.00 10/1812021 McKesson-340B Prescription Expense 5,348.30 10/16/2021 McKesson-340B Prescription Expense 9,102.08 1011812021 Amerisource Bergen-340B Prescription Expense 1,080.13 10/18/2021 Amerisource Bergen-34013 Prescription Expense 322.61 Prosperity Electronic Bank Payments 10112/2021 Credit Card & Lease Fees 4,635.05 10/13/2021 Cleargage-Patient Financing Service 72.40 10/8-10/15/21 Pay Plus-Patlent Claims Processing Fee 439.76 10/12/2021 ExpertPay- child support 614.20 TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 558,677.25, TRANSFER BETWEEN FUNDS TO NURSING HOMES 10/14/2021 MMC Operating to Ashford -NH portion of QIPP deposited into MMC Operating 4,205.38 10/1412021 MMC Operating to Solera-correction of NH Insurance payment deposited into MMC Operating in error and NH portion of QIPP 15,980.26 10/14/2021 MMC Operating to Fort bend -NH portion of QIPP deposited into MMC Operating 1,688.89 10/14/2021 MMC Operating to Broadmoor-NH portion 6f QIPP deposited into MMC Operating 1,722.72 10/14/2021 MMC Operating to Crescent -correction of NH insurance payment deposited into MMC Operating in error 1,384-93 10/1412021 MMC Operating to Golden Creek -correction of NH insurance payment deposited into MMC Operating in error and NH portion of QIPP 6,467.44 10/14/2021 MMC Operating to Gulf Pointe Plaza -correction of NH insurance payment deposited into MMC Operating and NH portion of QIPP 35.460.66 10/14/2021 MMC Operating to Tuscany Village -correction of MMC medicare recoup taken from Tuscany and NH portion of QIPP 8,921.14 10114/2021 MMC Operating to Bethany -correction of NH Insurance payment deposited into MMC Operating in error and NH portion of QIPP 21,571.32 MEDICARE ADVANCE PAYMENT RECOUP 10118/2021 Broadmoor to MMC Operating -correction of Broadmoor medicare recoup taken from MMC Operating 646.66 10/1812021 Crescent to MMC Operating -correction of Crescent medicare recoup taken from MMC Operating 646.86 10/18/2021 Solera to MMC Operating -correction of Solaro medicare recoup taken from MMC Operating 646.86 10/18/2021 Golden Creek to MMC Operating -correction of Golden Creek recoup taken from MMC Operating 545.86 1011812021 Tuscany to MMC Operating -correction of Tuscany medicare recoup taken from MMC Operating 645.86 TOTAL TRANSFERS BETWEEN FUNDS $ 100,637Oz1 NURSING HOME UPL EXPENSES 10/1812021 Nursing Home UPL-Centex Transfer 298,729.55 10/18/2021 Nursing Home UPL-Nexion Transfer 170,638.83 10/1812021 Nursing Home UPL-HMG Transfer 39,76T59 10/1812021 Nursing Home UPL-Tuscany Transfer 103,546.46 10M8/2021 Nursing Home UPL-HSL Transfer 303,182.67 TOTAL NURSING HOME LPL EXPENSES $ 915,864:1,0 INTER -GOVERNMENT TRANSFERS 44,487.00 IGT 2022 OSH Advance 2 Payment to be paid 11/03f2021 43,837.00 TOTAL INTER -GOVERNMENT TRANSFERS $ 43,837.00' GRAND TOTAL DISBURSEMENTS APPROVED October 20, 2021 $ 1,619,01&Ag Page 1 of 13 '6' i� MEMORIAL MEDICAL CENTER 10%14/2021 - AP Open Invoice List 0 -10:34 Crd.tou;l:_bn,ei.pAL�l4,r Due Dates Through: 10127/2021 ap_open_i nvoice.template Vendor# Vendor Name Class Pay Code A1680 AIRGAS USA, LLC - CENTRAL DIV M Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 9117452094 09130/20 09129/20 10/24/20 2,766.42 0.00 0.00 2,766.42 9118072666 10108/20A9/28/2010/23/20. 308.31 0.00 0.00 308.31 y% �. OXYGEN 9118190127e/'� 10/12/2010101/2010/26/20 197.48 0.00 0.00 197.48 OXYGEN 9117947805 '// 10/14/20 09/22/20 10/17/20 104.02 0.00 0.00 104.02 OXYGEN Vendor Totals Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC -CENTRAL DIV 3,376.23 0.00 0.00 3,376.23 Vendor# Vendor Name Class Pay Code 10958 ALLYSON. SWOPE ✓ Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 101121 10/12/2010/1112010/11/20. 3.264.75 0.00 0.00 3,26475 v` CONTRACT EMPLOYEE Vendor Totale Number Name Gross Discount No -Pay Net 10958 ALLYSON SWOPE 3,284.75 0.00 0.00 3,264.75 Vendor# Vendor Name Class Pay Code i A0400 AUREUS RADIOLOGY LLC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2327856 r/' 09/30/20 09/27/2010/27/20 2.956.38 0.00 0.00 2,956,38 6 j LAB STAFFING 2328231 .% 09/30/2009/2712010/27120. 2,428.75 0.00 0.00 2,428.7E LAB STAFFING 2328123 09/30120 09/27/20 10/27120 2,604.75 0.00 0.00 2.604,75 f/ LAB STAFFING Vendor TotalE Number Name Gross Discount No -Pay Net A0400 AUREUS RADIOLOGY LLC 7,989.88 0.00 0.00 7,989.88 Ventlor# Vendor Name Class Pay Cade 80436 BARD ACCESS N', Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 46463474 ✓/1011112009129/2010/11120. 31.50 0.00 0.00 31.50 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 80436 BARD ACCESS 31.50 0.00 0.00 31.50 Vendor#Vendor Name Class Pay Code B1266 BECKMAN COULTER CAPITAL ti W Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 109350627. / 10112/20 10111/20 10120/20 633.60 0.00 0.00 833.60 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net B1266 BECKMAN COULTER CAPITAL 833.60 0.00 0.00 833.60 Vendor# Vendor Name Class Pay Code B1220 BECKMAN COULTER INC M Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net file:!//C:/Users/eheiman/cpsi/menuned.cpsinet.com/u98547/data_5/tmp_cw5report2738... 10/ 14/2021 Page 2 of 13 109328355 ✓ 09/30/2009/29/2010124/20 1,751.06 0.00 0.00 1,751.06 SUPPLIES 544722G 00/30/20 09/30/2010/25/20 3,507.27 0.00 0.00 3,507,27 r/ SUPPLIES 109331508 10/01/20 10/01/20 10/26120 2,743.40 0.00 0.00 2,743.40 SUPPLIES 7302855 10/05/20 10/01/20 10/26/20 7,275.02 0.00 0.00 7,275.02 v� w METER BILLING Vendor TotalE Number Name Gross Discount No -Pay Net B1220 BECKMAN COULTER INC 15,276.75 0.00 0.00 15,276.75 Vendor# Vendor Name Class Pay Code 12600 BIOFIRE DIAGNOSTICS LLC ✓" Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Grass Discount No -Pay Net 1 1280137525 ✓ 09/29/20 09/22/20 10/22/20 7,740.00 0.00 0.00 7,740.00,- SUPPLIES Vendor Totak Number Name Gross Discount No -Pay Net 12600 SIOFIRE DIAGNOSTICS LLC 7,740.00 0.00 0.00 7,740.00 Vendor# Vendor Name Class Pay Code 10599 BKO, LLP ..' Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net BKO1449711 v/ 10/14/20 08/26/20 09/20/20 9,568.(10 0,00 0.00 9,568.00 AUDIT 2020 Vendor Total: Number Name Gross Discount No -Pay Net 10599 BKD, LLP 9,568,00 0.00 0.00 9,568.00 Vendor# Vendor Name Class Pay Code 12324 BLUE CROSS BLUE SHIELD ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check O Pay Gross Discount No -Pay Net 081821A 10/12/20 08/18/20 09101120 1,381.49 0.00 0.00 1,381.49 COBRAINSURANCE Vendor Totale Number Name Gross Discount No -Pay Net 12324 BLUE CROSS BLUE SHIELD 1,381.49 0X0 0.00 1,381.49 Vendor# Vendor Name Class Pay Code B1650 BOSART LOCK & KEY INC rr M Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 122694 �% 10/11 /20 08/25/20 09124/20 419.85 0.00 0.00 419.85 r t3) ELu4VAA Vendor Totals Number Name Gross Discount No -Pay Net B1650 BOSART LOCK & KEY INC 419.85 0.00 0.00 419,85 Vendor# Vendor Name Class Pay Code B1680 BOUND TREE MEDICAL, LLC r,% M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 84207222 ✓' 09/29/20 09/14/2010/11/20. 150.79 0.00 0.00 150.79 SUPPLIES 4 Vendor Total; Number Name Gross Discount No -Pay Net B1680 BOUND TREE MEDICAL, LLC 150.79 0.00 0.00 150.79 Vendor# Vendor Name Class Pay Code 12740 BUILDING KID STEPS i Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net AUG20210 10/12120. 08131/2008131120. 411.00 0.00 0.00 411.00 SPEECH THERAPY SEPT2021 10112120 09/17/20 09/17/20 1,000.00 0.00 0.00 1,000.00 file:///C:/Users/eheimanlepsi/memmed.cpsinet.com/u98547/data_5/tmp_cw5report2738... 10/ 14/2021 Page 3 of 13 SPEECH THERAPY SEPT2021A 10/12/20 09/17/20 09/17/20 1,261.00 0.00 0.00 1,261.00 SPEECH THERAPY SEPT2021C 10/12/20 09/17/20 09/30/20 260.00 0.00 0.00 250.00 SPEECH THERAPY SEPT20218 10/12/20 09/17/20 09/30/20 1,026.00 O.OD 0.00 11026.00 SPEECH THERAPY Vendor Totals Number Name Gross Discount No -Pay Net 12740 BUILDING KID STEPS 3,948.00 0.00 0.00 3,948.00 Vendor# Vendor Name Class Pay Code 11295 CALHOUN COUNTY INDIGENT ACCOUN Invoice# Comment Tran Ot Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 101221 10/14/20 10/12/20 10/12/20 70.00 0100 0.00 70.00 INDIGENT CO PAYS Vendor Totals Number Name Gross Discount No -Pay Net 11295 CALHOUN COUNTY INDIGENT ACCOUN 70.00 0.00 0.00 70.00 Vendor# Vendor Name Class Pay Code 13992 CARIANT HEALTH PARTNERS y/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 128184 v "- 09/29/20 09/22/20 10/21/20 3,900.00 0.00 0.00 3,900.00 MED BURG STAFFING Vendor Totals Number Name Gross Discount No -Pay Net 13992 CARIANT HEALTH PARTNERS 31900.00 0.00 0.00 3,900.00 Vendor# Vendor Name Class Pay Code 13028 CAVALLO ENERGY TEXAS LLC „' Invoice# Comment Tran DI Inv DI Due Dt Check D Pay Gross Discount No -Pay Net 212640015926614 ✓ 09/30/20 09/20/20 10122/20. 8.29 0.00 0.00 8.29 V ENERGY BILL ACCT 167662 Vendor Total: Number Name Gross Discount No -Pay Net 13028 CAVALLO ENERGY TEXAS LLC 8.29 0.00 0.00 8.29 Vendor# Vendor Name Class Pay Code 01992 CDW GOVERNMENT, INC.,/ M Invoice# Comment Tran Dt Inv D1 Due Dt Check D Pay Gross Discount No -Pay Net / L229521 Y 09/80/2009/24/2010/24/20 280.79 0.00 0.00 280.79 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMENT, INC. 280.79 0.00 0.00 280.79 Vendor# Vendor Name Class Pay Code C1730 CITY OF PORT LAVACA ,i' W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 091321A 10/11/2009/1312010105/20. 25.68 0.00 0.00 25.68 4, 091321 10/11/20 10105/20 10118/20 3,104.35 0.00 0.00 3,104.35 WATER ACCOUNT 12132000 101121 10/ii/2010/05/2010/18120 64.13 0.00 0.00 64.13 v' WATER ACCOUNT 12126002 Vendor Totals Number Name Gross Discount No -Pay Net C1730 CITY OF PORT LAVACA 3,194.16 0.00 0.00 3,194.16 Vendor# Vendor Name Class Pay Code 13572 COMMUNITY INFUSION SOLUTIONS. Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net file:///C:/Users/eheiman/epsilmemmed.cpsinet.cornlu98547/data_5/tmp_cw5report2738... 10/ 14/2021 Page 4 of 13 IC20211015 1/ 10/08/20 10/06/20 10116l20 1&267.55 0.00 0.00 12,267.55 OP INFUSION CENTER Vendor Totals Number Name Gross Discount No -Pay Net 13572 COMMUNITY INFUSION SOLUTIONS 12,267.55 0.00 0.00 12,267.55 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON - Invoice# Comment Tram Dt Inv Dt Due Dt Check Dr Pay Gross Discount No -Pay Net 657706.0 , / 09/30/20 09/27/20 10/22/20 5.40 0.00 0.00 5.40 SUPPLIES 657791.0,, 09/3012009/28/2010/23/20. 45.99 0.00 0.00 45.99 SUPPLIES 657907-0 09130/20. 09/29/2010/24/20 19.56 0.00 0.00 19.56 SUPPLIES 6545901 10/01/20 09/01/20 09/30/20 38.04 0.00 0.00 38.04 ✓- SUPPLIES 6545902 ✓ 10/11/20 09/08/20 10/03/20 21.68 0.00 0.00 21.68 !: SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10368 DEWITT POTH &. SON 130.67 0.00 0.00 130,67 Vendor# Vendor Name Class Pay Code 11011 DIAMOND HEALTHCARE CORP Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net IN20054944 ✓'- 10/08120. 10/0112010126/20 2,500.00 0.00 0.00 2,500.00 INPATIENT ASSESSMENT IN20054932 10/08/2010/0112010/26/20 31.144.58 0.00 0.00 31,144.58 INPATIENT ASSESSMENT IN20054933 �/ 10/08/2010/0112010126/20 19,166.67 0.00 0.00 19,166.67 CPR Vendor Totals Number Name Gross Discount No -Pay Net 11011 DIAMOND HEALTHCARE CORP 52,811.25 0.00 0.00 52,011.25 Vendor# Vendor Name Class Pay Code 10789 DISCOVERY MEDICAL NETWORK INC Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net MMC093021, / 10/12/20 09/30120 10116/20 204,661.08 0.00 0.00 204,651.08 PROFEES:.p}. 14'hu!-Z01,1 Vendor Totals Number Name Gross Discount No -Pay Net 10789 DISCOVERY MEDICAL NETWORK INC 204,661,08 (1.00 0.00 204,661.08 Vendor# Vendor Name Class Pay Code 11291 DOWELL PEST CONTROL r/ Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 21374 ✓ 10/08/20. 09/3012010/25120. 160.00 0.00 0.00 160.00 v' PEST CONTROL Vendor Totals Number Name Gross Discount No -Pay Net 11291 DOWELL PEST CONTROL 160.00 0.00 0.00 160.00 Vendor# Vendor Name Class Pay Code 11284 EMERGENCY STAFFING SOLUTIONS Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 40644 ,/ 10/11/20 10/15/20 10/25/20 40,062.50 0.00 0.00 40,062.50 PRO FEES E/R t 1-15411) Vendor Totals Number Name Gross Discount No -Pay Net 11284 EMERGENCY STAFFING SOLUTIONS 40,062.50 0.00 0.00 40,062,50 file:///C:/Users/eheiman/cpsilmemmed.cpsinet.cowlu985471data_51tmp_cw5report2738... 10/ 14/2021 Page 5 of 13 Vendor# Vendor Name Class Pay Code 14136 EPI-EDWARD PLUMBING s% Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 64276 ✓� 10/11/20. 10/07/20 10/11/20 329.00 0.00 0.00 329.00 ANNUAL BAC FLO TEST 64277 10/11120 10/07/20 10/11/20. 662.00 0.00 0.00 662.00 ANNUAL GAS TEST Vendor Totals Number Name Gross Discount No -Pay Net 14136 EPI-EDWARD PLUMBING 991,00 0.00 0.00 991.00 Vendor# Vendor Name Class Pay Code 10689 FASTHEALTH CORPORATION Invoice# Comment Tran Dt Inv Dt Due DI Check D Pay Gross Discount No -Pay Net 10A21mmC „/ 10/08/20, 10/01/2010/16/20 495.00 0.00 0.00 495.00 MONTHLY INVOICE Vendor Totals Number Name Gross Discount No -Pay Net 10689 FASTHEALTH CORPORATION 495.00 0.00 0.00 495.00 Vendor# Vendor Name Class Pay Cade F1100 FEDERAL EXPRESS CORP. ,f W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 751685977 f 10/08/20 09/30/20 10/25/20 43.45 0.00 0.00 43.45�, SHIPPING Vendor Total. -Number Name Gross Discount No -Pay Net F1100 FEDERAL EXPRESS CORP. 43.45 0.00 0.00 43.45 Vendor# Vendor Name Class Pay Code 14092 FIRST CONNECT CENTER LLC / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2873 09/29/20 09/23/20 10/23/20 4,697.50 0.00 0.00 4,597,50 ts; IVIED BURG STAFFING Vendor Totals Number Name Gross Discount No -Pay Net 14092 FIRST CONNECT CENTER LLC 4,597.50 0.00 0.00 4,597.50 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE ,% M Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross Discount No -Pay Net 4037436 �/ 09/29/20 09/27/20 10(22/20 13.05 0.00 0.00 13.05 SUPPLIES 4037429 V 09/29/20 09/27/20 10/22/20 21.28 0.00 0.00 21.28 ✓" SUPPLIES 5637029 ✓ 09/29/20 09/29/90 10/24/20 117.59 0.00 0.00 117.59 SUPPLIES 4037438 .� 09/30/2009127/20 10/22/20 144.21 0.00 0.00 144.21 SUPPLIES 1819443 ,/ 10101/20 09/13/20 10/08/20 28.30 0.00 0.00 28.30 SUPPLIES vr� 1427264 J 10/01/20 09129/2010124/20 312.94 0.00 0.00 312.94 M/ SUPPLIES A637031 10112/20 10/24/20 09/29/20 438.00 0.00 0.00 438.00 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 1,075.37 0.00 0.00 1,075,37 Vendor# Vendor Name Class Pay Code 13980 GBS ADMINISTRATORS, INC file:///C:/Users/eheiman/cpsi/memmed.cpsinet.com/u98547/data_5/tmp_cw5report2738... 10/14/2021 Page 6 of 13 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 481006025EPT 10/1412009/01/2010/01/20. 1,767.11 INSURANCE Vendor Totals Number Name Gross 13580 GRS ADMINISTRATORS, INC 1,767,11 Vendor# Vendor Name Class Pay Code 12948 GREAT AMERICAN FINANCIAL SVCS Invoice# Comment Tran Dt Inv Dt Due Ot Check O pay Gross 30034009 ✓ 10112/20 09/06/20 09/30/20 10,02aA- COPIER LEASE Vendor Totals Number Name Gross 12948 GREAT AMERICAN FINANCIAL SVCS 10,028.68 Vendor# Vendor Name Class Pay Code G1210 GULF COAST PAPER COMPANY ,% M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 21076061/ 09/30/20 09121120 10/21/20 1,049.44 SUPPLIES 2108150 i 09/30/2009121/2010/21/20 140.91 v SUPPLIES Vendor Totals Number Name Gross G1210 GULF COAST PAPER COMPANY 1,190.35 Vendor# Vendor Name Class Pay Code 11552 HEALTHCARE FINANCIAL SERVICES ✓ Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross 100496409 ,/� 10/12/20 07/28/20 09/01/20 4,610.52 Vendor Totals Number Name Gross 11552 HEALTHCARE FINANCIAL SERVICES 4,610.62 Vendor# Vendor Name Class Pay Code 10923 HELMER SCIENTIFIC ✓ Invoice# Comment Tran Dt Inv Dt Due DI: Check D Pay Gross 0000393291 „/ 10111/2009/22/2010/11/20 5,246.08 SUPPLIES Vendor Totals Number Name Grass 10923 HELMER SCIENTIFIC 5,245.08 Vendor# Vendor Name Class Pay Code 10922 HUNTER PHARMACY SERVICES j Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 4597 V 10/11/20 09/30/20 10/20120. 14.682.21 PHARMACIST Vendor Totals Number Name Gross 10922 HUNTER PHARMACY SERVICES 14,682.21 Vendor# Vendor Name Class Pay Code D1710 KEEP-U-NEATCLEANERS f` w Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 101121 - 10/11/20 10108120 10/18/20 74.20 Discount No -Pay Net 0.00 0.00 1,767.11 Discount No -Pay Net 0.00 0.00 1,767.11 Discount No -Pay 0.00 0.00 Discount No -Pay 0.00 0.00 Net 10,02aA8 Discount No -Pay Net 0.00 0.00 1,049.44 0.00 0.00 140.91 t- Discount No -Pay Net 0.00 0.00 1,190.35 Discount No -Pay Net 0.00 0.00 4,610.52 Discount No -Pay Net 0.00 0.00 4,610.52 Discount No -Pay Net 0.00 0.00 5,245.08 Discount No -Pay Net 0.00 0.00 5,245.08 Discount No -Pay Net 0.00 0.00 14,682.21 ,.. Discount No -Pay Net 0.00 0.00 14,682.21 Discount No -Pay Net 0.00 0.00 74.20 LAUNDRY Vendor Totals Number Name Gross Discount No -Pay Net D1710 KEEP-U-NEAT CLEANERS 74.20 0.00 0.00 74.20 Vendor# Vendor Name Class Pay Code 11796 LUBY'S FUDDRUCKERS RESTAURANTS ,J file:///C:/Usersteheirnan/epsi/memmed.cpsinet.corn/u98547/data_5/tmp_cw5report273 8... 10/I4/2021 Page 7 of 13 Invoice# Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross Discount No -Pay Net 24165200139 ✓ 10111/2010/06/2010/06/20 346.68 0.00 0.00 346.68 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11796 LUBY'S FUDDRUCKERS RESTAURANTS 346.68 0.00 0.00 346.68 Ventlor# Vendor Name Class Pay Code 10972 M G TRUST ✓ Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 100721 10105/20. 10108/2010/08/20 790,86 0.00 0.00 790.86 PAYROLL DEDUCTIONS Vendor Totals Number Name Gross Discount No -Pay Net 10972 M G TRUST 790.86 0.00 0.00 790.86 Vendor# Vendor Name Class Pay Cade. J1350 M.C. 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JOHNSON COMPANY INC 187.96 0.00 0.00 187.96 Vendor# Vendor Name Class Pay Code M2827 MEDIVATORS M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 91074249 ✓ 10/01/20. 10105/2010111/20 400.00 0.00 0.00 400.00 SUPPLIES Vendor Total,, Number Name Gross Discount No -Pay Net M2827 MEDIVATORS 400.00 0.00 0.00 400.00 Vendor# Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC ,i M Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net ✓/ 1968143330 09/29/20. 09129/2010/24/20 294.28 0.00 0.00 294.28 SUPPLIES , 1968143336 ✓� 09/29/20 09/29/20 10/24/20 287.27 0.00 0.00 287.27 SUPPLIES 1967901076 ✓- 09/30/20. 09/2812010/23/20 2,044.40 0.00 0.00 2,044.40 v/r SUPPLIES 1967901078 09130/20. 09/2812010123/20 1,180.09 0.00 0.00 1,180.091�% SUPPLIES 193814330kz 09130/2009129/2010124/20 46.16 0.00 0.00 46.16 SUPPLIES 1968143312 d,/' 09/30/20 09129/20 10124/20 42.61 0.00 0.00 42.81 SUPPLIES 1968143311v,/ 09/3012009/29/2010/24/20 98.76 0.00 0.00 96.76 ,✓- SUPPLIES 1968143313 ✓ 09/30/20 09/29/20 10/24/20 525.41 0.00 0.00 525.41 SUPPLIES 1968143308 / 09/30/20 09/29/20 10/24/20 35.24 0.00 0.00 35.24 yr SUPPLIES 1968143310 09/30/20 09/29/20 10/24/20 35.24 0.00 0.00 35.24 SUj?PLIES 1968143317 °/ 09/30/20 09/29/20 10/24/20 24.75 0.00 0.00 24.75 J SUPPLIES file:///C:/Users/eheiman/cpsi/memmed.cpsinet.com/u985471data_51tmp_cw5report2738... 10/ 14/2021 Page 8 of 13 1968143315 ✓ 09/30/20 09/29/20 10/24/20 525.41 0.00 0.00 525.41 ✓ SUPPLIES 1968143316 ✓ 09/30/20 09/29/20 10/24/20 24.99 0.00 0.00 24.99 F. SUPPLIES 1968143309y' 09/30/20. 09/29/2010/24/20. 17.62 0.00 0.00 17.62 SUPPLIES 1968143307 ,j- 09/30/20 09/29/20 10/24/20 35.24 0.00 0.00 35.24 SUPPLIES 1702603445,, - 09/30/20 09/30/20 10125120 313.89 0.00 0.00 313.89 INTEREST 1968589042 ✓ 10/01/20 10102/20 10/27/20 767.34 0.00 0.00 767.34 vim` SUPPLIES 1968589044 10101/20 10/02/20 10/27/20 148.36 0.00 0.00 148,38 ✓-' SUPPLIES 1968644632 y' 10/06/20 10/02/20 10/2712D 815.95 0.00 0.00 615.05 ��.-- SUPPLIES 1968644633 „/ 10/11/20. 10/02/2010/27/20 439.23 0.00 0.00 439.23 V SUPPLIES 1968589043 ✓ 10/11/20 10/02120 10/27120 148.36 0.00 0.00 148.36 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 7,848.80 0.00 0.00 7,848.80 Vendor# Vendor Name Class Pay Code 10825 MEMORIAL MEDICAL CLINIC ICP Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 100721 10/07/20 10/07/20 i0/07/20 110,00 0.00 0.00 110.00 PAYROLLDEDUCTS Vendor Totals Number Name Gross Discount No -Pay Net 10825 MEMORIAL MEDICAL CLINIC 110.00 0.00 0.00 110.00 Vendor#Vendor Name Class Pay Code M2621 MMC AUXILIARY GIFT SHOP v' w Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 100821 10/08120 10/08/20 10/21/20 334.80 0.00 0.00 334.80 PAYROLL DED Vendor Totals Number Name Gross Discount No -Pay Net M2621 MMC AUXILIARY GIFT SHOP 334.80 0.00 0.00 334.80 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC % Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 7407851 ✓ 10/06/20 10/06/20 10/16/2D 310.65 0.00 0.00 310.65 INVENTORY 7409140 ✓ 10/06/20 10/06/20 10/16/20 4.472.78 0.00 0.00 4,472.78 .INVENTORY.. 7398732✓ 10/07/2010/04/2010/21/20. 9.60 0.00 0.00 9.60 INVENTORY 7403888✓ 10/07/2010/05/2010121/20 361.20 0.00 0.00 361.20 INVENTORY 7403887v/ 10/07120 10/05/20 10/21120 26.08 0.00 0.00 26.08 INVENTORY 7403889 10/07/20 10/05/20 10/21/20 28.93 0.00 0.00 28-93 J INVENTORY file:/NC:/Users/eheiman/cpsi(memmed.cpsinet.com/u98547/data_5/tmp_cw5report273 8... 10/ 14/2021 Page 9 of 13 7402026 v 10/07/20 10/05/20 10/21/20 206.51 0.00 0.00 205.51 W,!' INVENTORY 7403084 10/07/20 10/05/20 10/21/20 725.26 0.00 0.00 725.26 >^ INVENTORY 7407850 10/11/20. 10/0612010116120 81,27 0.00 0.00 61.27 ,� INVENTORY 7407594 /10/11/201010612010/16/20. 3,123.73 0.00 0.00 3,123.73 INVENTORY Vendor Totals Number Name Gross Discount No -Pay Net 10535 MORRIS & DICKSON CO, LLC 9,326.01 0.00 0.00 9,326.01 Vendor# Vendor Name Class Pay Code M2659 MXR IMAGING, INC M Invoice# Comment Tran Dt Inv Dt Due Dt CheckDPay Gross Discount No -Pay Net 8800810329 :. 10/11/20 09/20/20 10/20/20. 680.04 0.00 0.00 680.04 kj � TABLE SKIRT Vendor Totals Number Name Gross Discount No -Pay Net M2659 MXR IMAGING, INC 680.04 0.00 0.00 680.04 Vendor# Vendor Name Class Pay Code 11472 OCCUPRO LLC +' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 22973 10/08/20. 10/01/2010/07/20. 487.47 0.00 0,00 487.47 , y PROVIDER/MONTHLY SUPPOI Vendor Total, Number Name Gross Discount No -Pay Net 11472 OCCUPRO LLC 487.47 0.00 0.00 487.47 Vendor# Vendor Name Class Pay Code 01500 OLYMPUS AMERICA INC ,/ M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net i 31501247 J 10/01/2009/09/2010/04/20. 419.84 0.00 0.00 419.84 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 01500 OLYMPUS AMERICA INC 419.84 0.00 0.00 419.84 Vendor# Vendor Name Class Pay Code 11069 PABLO GARZA ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 101121 10/12/20 10/11/20 10/11/20 2,616.25 0.00 0.00 2,616,25 CONTRACT EMPLOYEE Vendor Total: Number Name Gross Discount No -Pay Net 11069 PABLO GARZA 2,616.25 0.00 0.00 2,616.25 Vendor# Vendor Name Class Pay Code 13988 PAYCHEX, ADVANCE FBO Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 006844 v'. 10/07/20 10/06/20 10/21/20 3,725.00 0.00 0.00 3,725.00 MED SURG STAFFING Vendor Totals Number Name Gross Discount No -Pay Net 13988 PAYCHEX, ADVANCE FBO 3.725.00 0.00 0.00 3,725.00 Vendor# Vendor Name Class Pay Code P1800 PITNEY BOWES INC W Invoice# Comment Tran Dt Inv of Due Dt Check D Pay Gross Discount No -Pay Net 1019092144 ✓ 09130/20. 09/2612010126120 207.00 0.00 0.00 207.00 POSTAGE Vendor Totals Number Name Grass Discount No -Pay Net file:///C:lUsers/eheiinan/cpsi/memmed.cpsinct.com/u98547/data_5/tmp_cw5report273 8... 10/ 14/2021 P1800 PITNEY BOWES INC 207.00 Vendor# Vendor Name Class Pay Code P2200 POWER HARDWARE .�• W Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross A76657 �.' 10/08/20 09/02/20 09/12/20 16.97 SUPPLIES A76494 = 10/08/20 09/02/20 09/12/20 4.99 Page 10 of 13 0.00 0.00 207.00 Discount No -Pay Net 0.00 0.00 16.97, 0.00 SUPPLIES Vendor Totals Number Name Grass Discount P2200 POWER HARDWARE 21.96 0.00 Vendor# Vendor Name Class Pay Code S1001 SANOR PASTEUR INC .' W Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount 916812639 09/30/20 09/30/20 10/21/20 -1,2;5.10 0.00 CREDIT MEMO Vendor Totals Number Name Gross Discount S1001 SANOFI PASTEUR INC -1.26 10 0.00 Vendor# Vendor Name Class Pay Code 11556 SHELLY MCAFEE ./• Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount 101121 10/11/20 10/06120 10/06/20 33.04 0.00 MILEAGE K4 Q Vendor Totals Number Name Gross Discount 11556 SHELLYMCAFEE 33.04 0.00 Vendor# Vendor Name Class Pay Code 81800 SHERWIN WILLIAMS .! W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount 25965 10/08/20.09/09/20 09/24/20. 47,82 0.00 T.RP5940 y% 10/08/20 09/09/20 09/24/20 25.81 PAIN Vendor Totals Number Name Gross S1800 SHERWIN WILLIAMS 73,63 Vendor# Vendor Name Class Pay Code 10936 SIEMENS FINANCIAL SERVICES Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 5638210006546.4. 10/12/20 09/29/20 10/24/20 1,333.33 LEASE Vendor Total: Number Name Gross 10936 SIEMENS FINANCIAL SERVICES 1,333.33 Vendor# Vendor Name Class Pay Code S2353 SMITHSMEDICALASOINC ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross 16404988 ./ 09/29/2009/23/2010/23/20 1,078.29 SUPPLIES Vendor Totals Number Name Gross $2353 SMITHS MEDICAL ASD INC 1,078.29 Vendor# Vendor Name Class Pay Code 11296 SOUTH TEXAS BLOOD & TISSUE CEN Involce# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 107017619 .�• 09/30/20 09/30/20 10/25/20 5,581.00 HE 0.00 4.99 -� No -Pay Net 0.00 21.96 No -Pay Net 0.00 •1,260 No -Pay Net 0.00 .1,210 No -Pay Net 0.00 33.04 No -Pay Net 0.00 33.04 No -Pay Net 0.00 47.82 �,- 0.00 25.81 Discount No -Pay Net 0.00 0.00 73,63 Discount No -Pay Net 0.00 0.00 1,333.83 Discount No -Pay Net 0.00 0.00 1,333.33 Discount No -Pay Net 0.00 0.00 1,076.29 ✓" Discount No -Pay Net 0.00 0.00 1,078.29 Discount No -Pay Net 0.00 0.00 5,581,00 file:///C:/Users/eheiman/cpsi/memmed.cpsinet.com/u98547/data_5/tmp_cw5report2738... 10/14/2021 Page 11 of 13 CM5491 1// 09/30/20. 09/3012010/25/20 -1,185.00 0.00 0.00 -1,185.00 CREDIT MEMO Vendor Totals Number Name Gross Discount No -Pay Net 11296 SOUTH TEXAS BLOOD & TISSUE CEN 4,396.00 0.00 0.00 4.396.00 Vendor# Vendor Name Class Pay Code C1010 SPARKLIGHT W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 0914A 10/11/2010/0812010/08/20 2,258.00 0.00 0.00 2,258.00 091421 10/11/20 10/08/20 10/11/20 101.70 0.00 0.00 101.70 f CABLE ACCOUNT 118134105 Vendor Total=, Number Name Gross Discount No -Pay Net C1010 SPARKLIGHT 2,359.70 0.00 0.00 2,359,70 Vendor# Vendor Name Class Pay Code 10094 ST DAVIDS HEALTHCARE '✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net MMC202108 V 10/08/20 10/07/2010/07/20 745.00 0.00 0.00 745.00- CONNECTIVITY FEE Vendor Totals Number Name Gross Discount No -Pay Net 10094 ST DAVIDS HEALTHCARE 745.00 0.00 0.00 745.00 Vendor# Vendor Name Class Pay Code 14100 STAFFING FIRST ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Not 2109123✓ 10/07120. 10105/2010121120 4.693.75 0.00 0.00 4,59375 v" OB NURSE STAFFING Vendor Totals Number Name Gross Discount No -Pay Net 14100 STAFFING FIRST 4,593.75 0.00 0.00 4,593,75 Vendor# Vendor Name Class Pay Code S2694 STANFORD VACUUM SERVICE ,/ M invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 648054 J' 10/08/20 10/08/20 10121/20 385.00 0.00 0.00 385.00 GREASETRAP Vendor Totals Number Name Gross Discount No -Pay Net $2694 STANFORD VACUUM SERVICE 385.00 0.00 0.00 385.00 Vendor# Vendor Name Class Pay Code T2539 T-SYSTEM, INC ,% W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 49049 l ,.' 09/30I20 09/27120 10/27/20 431.42 0.00 0.00 431,42 TRACKING/HOSTING/STAT Vendor Totals Number Name Gross Discount No -Pay Net T2539 T-SYSTEM, INC 431.42 0.00 0.00 431.42 Vendor# Vendor Name Class I Pay Cade T2204 TEXAS MUTUAL INSURANCE CO ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 1003099252 v' 10/11/20 10/01120 10/23120 4,644.00 0.00 0.00 4,644.00 WORKERS COMP Vendor Totals Number Name Gross Discount No -Pay Net T2204 TEXAS MUTUAL INSURANCE 00 4,644.00 0.00 0.00 4,644.00 Vendor# Vendor Name Class Pay Code 13680 TEXAS SELECT STAFFING ✓ file:!//C:/Users/eheiman/cpsUmemmed.cpsinet.comlu98547/data 5/tmp_cw5report2738... 10/14/2021 Page 12 of 13 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 001623451079IN y' 10107120 10/08/20 10108/20 9,072,05 0.00 0.00 9,072.05 L MED SURG TRAVEL NURSING Vendor Totals Number Name Gross Discount No -Pay Net 13880 TEXAS SELECT STAFFING 9,072.05 0.00 0.00 9,072.05 Vendor# Vendor Name Class Pay Code S1801 TRACI SHEFCIK ,f` W Invoice# Comment Tran Dt Inv or Due Ot Check D Pay Gross Discount No -Pay Net 101121 10/11120 10/11/20 10111/20 120.00 0100 0.00 129.00 RN/APRN RENEWAL . Vendor Totals Number Name Gross Discount No -Pay Net S1801 TRACI SHEFCIK 129.00 0.00 0.00 129.00 Vendor# Vendor Name Class Pay Code T3130 TRI-ANIM HEALTH SERVICES INC �' M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 84741564 „% 09/29/20 09/27/20 1012PJ20 287.31 0.00 0.00 287.31 ✓ ' SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net T3130 TRI-ANIM HEALTH SERVICES INC 287.31 0.00 0.00 287.31 Vendor# Vendor Name Class Pay Code 13616 TRIOSE, INC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check O Pay Gross Discount No -Pay Net TRI093715 �/ 10/12120. 10/07/2010/22/20 619.39 0.00 0.00 619.39 -", FREIGHT MANAGEMENT Vendor Totals Number Name Gross Discount No -Pay Net 13616 TRIOSE, INC 619.39 0100 0.00 619.39 Vendor# Vendor Name Class Pay Code U1054 UNIFIRST HOLDINGS ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 8400378113✓ 09/30/20,09/27/2010/22/20 317.02 0.00 0.00 317,02 ..' S211yLAUNDRY 8400377M 09/30/20 09/27/20 10/22/20 45.15 0.00 0100 45.15,j" %t), 3eUNDRY 8400375,92 09/30/20 09/27/20 10/22/20 47.47 0.00 0.00 47.47 , , 4 LAUNDRY 8400377815 t/ 09/30/20 09/27/20 10/22/20. 2,230.21 0.00 0.00 2,230.21 ,. ,.•" LAUNDRY 8400378112 ` 09/30/2O 09/27/2010/22/20 169.39 0.00 0.00 169.39 LAUNDRY $400378111 v, 09/30120 09/30120 10/25/20 191.74 0.00 0.00 191.74 LAUNDRY 8400378129✓l 09/30/2009/3012010/25/20 1,566.08 0.00 0.00 1,566.08 u' LAUNDRY 8400378108 ,./ 09/30120. 09/30/2010/25/20 38.75 0.00 0.00 38.75= LAUNDRY 8400378123✓/ 09/30/20 09/30/20 10125/20 79.43 0.00 0.00 79.43 ✓ LAUNDRY 8400378110 f 09/30/20 09/30/20 10/25120 137.13 D.00 0.00 137.13 LAUNDRY 8400378142-' 09/30/20 09/30/20 10125/20 122.73 0,00 0.00 122.73 LAUNDRY file:///C:/Users/eheiman/cpsl/memmed. cpsinet.com/u98547/data_5/tmp_cw5report273 8... 10/14/2021 840378621 10/07/20 09/30/20 10/26/20 199.32 0.00 0.00 LAUNDRY 8400378620 `f 10/07120 09130/20 10/25120 179.77 0.00 0.00 LAUNDRY i 8400378618 , 10/07/20 09/30/20 10/25/20 137.13 0.00 0.00 LAUNDRY Vendor Total:Number Name Gross Discount No -Pay U1054 UNIFIRST HOLDINGS 5,461.32 0.00 0.00 Vendor# Vendor Name Class Pay Code U1056 UNIFORM ADVANTAGE W Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay SIV11468957 I/ 10/14/2010/12/2010127120 108,96 0.00 0.00 UNIFORMS FOR JENISE SVET SIV11468946 -/ 10114120,10/12120 10127/20. 117.96 0.00 0.00 UNIFORMS FOR BRITTANY N/ SIV11468971 Y'� 10/14/20 10/12120 10/27120 77.91 0.00 0.00 UNIFORMS FOR MARIA LONG SIV11468964 ,,, / 10/14/20 10/12/20 10/27/20 21.98 0.00 0.00 UNIFORMS FOR RAMONA PEF Vendor Totals Number Name Gross Discount No -Pay U1056 UNIFORM ADVANTAGE 326.81 0.00 0.00 Vendor# Vendor Name Class Pay Code 12208 WAGEWORKS Invoice# Comment Tran Dt Inv or Due Dt Check or Pay Gross Discount No -Pay 100321 10/08/20 10/08/20 10/08/20 3,327.29 0.00 0.00 ADMIN COMPLIANCE FEE Vendor Totals Number Name Gross Discount No -Pay 12208 WAGEWORKS 3,327.29 0.00 0.00 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC V, s Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pa 9111045695 09/30/20 09/28/20 10/23/20 8,555.12 0.00 0.00 SUPPLIES Vendor Totals Number Name Gross Discount No -Pa 11110 WERFEN USA LLC 8,555.12 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 490,416,62 0.00 0.00 n; rr>arra arr OCT I a tuz'1 Page 13 of 13 199.32 179.77 137.13 Net 5,461,32 Net 108.96 ' 117.96 77.91 21,98 �- Net 326.81 Net 3.327.29 Net 3,327,29 y Net y Net 8,555,12 Net 490.416.62 4 I,ali5.10 L+g1,461.?z, file:!/IC:/Users/eheiman/epsi/memmed.cpsinet.com/u98547/data_5/tmp_pw5report273 8... 10/14/2021 MEMORIAL MEDICAL CENTER 10/1812021 0 AP Open Invoice List 10:37 ap_open Dates Through: _invoice.tempiate Vendor# Vendor Name Class Pay Code 14148 SPECTRUM HEALTH PARTNERS, LLC Invoice# Comment Tran Ot Inv DI Due Dt Check 0 Pay Gross Discount No�Pay PET MMC21 10/18120 10/18/20 10/18/20 25,00D.00 0.00 0.00 AGENCY STAFFING --P-0-4L url aU.dvLk4-VV (0/4r L+-jLy jn,4 rtw L.W NOV06 MMC21 10118/2010/18/2010/18120 20,000.00 0.00 0.00 AGENCY STAFFING — 10111-- III 41? 6 ptr WN1Y _& 41' AW+IA6 ,4 121jLun.L Vendor Total; Number Name ik}VLL L,fbp Gross Discount No -Pay 14148 SPECTRUM HEALTH PARTNERS. LLC 45,000.00 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 45,000.00 0.00 0.00 OCT 2U21 rO,SWq AwAtwav- Page 1 of 1 Net 25,000.00 20,000.00 Net 45,000.00 Net 45.000.00 file:/(/C:/Usersleheimantcpsilmemmed.cpsinet.comlu98547/data 51tmp_cw5report9208... 10/18/2021 CITIBANK CORPORATE CARD Account Statement Comma JASCNWMGUN JASONYlMIGUN _ � 'I m Account Inquiries: Toll Free: 1-(WW-240.4553 —'--1 l/ fMernalional: 1{904)-954.7314 Account Number: XXXX-XXXX-XXX7 TOD7ITV: 1g877}5D5-7276 I of Account Send Notice of Billing Errors and Customer Service Inquiries to: CITIBANK. N.A„ PO BOX 6125, SIOUX FALLS SD 57117AS125 Transactions Not an invoke. For your records only. Credit Limit $20,000 Cash Adverme Umn $0 Statement Closing Date 10103/2021 Days In Billing Period 30 Data Date MCC Ralorence Number DescriptioNLowOon AJnoum •'••••"•"""'••'"" NOTICE MEMO ITEMS) LISTED BELOW'*'* ........ ....... 09110 C9109 8299 $545702125328E664200539 1 HEALTHSTREAM E4EARNIN BOG5210574 TN 37203 USA psoa OW13 09110 820 05436841253300244503528 2 FSP'EMR SAFETY& HEALT 972-235 oTN 75243 USA V 48.00 calls 09110 82M 054368412533M244503601 3 FSP'EMRSAFETY&HEALT S72-2354MOTX _ 75243 USA v124AD W116 09115 9399 051343712S9600639486115 4 NPMNPDB.HRS&GOV 800.767i6732VA 22033 USA 22M ✓ C9116 09(15 9399 061343712ESSD0035486297 5 M78497929 NPDBNPDB.HRSA.GOV 800-7674732 VA 2200 USA .: 52M l% 1,178498181 09116 09MB ease 55432$612592M115221047 8 AMA-CREDENTl4UNG BOD621.83351L 60611 USA // •,4.w 0921 0920 9399 05134371264600034949801 7 NPDB NPDB.HRSAGOV 800-7G74732VA 22M3 USA 12AD M78572559 0922 0921 9399 0513437126SODD033188US 8 NPDB NPDS.HRSAGOV 800.767.6732 VA 22033 USA 2.011- N78G09908 now 0921 9329 091343712S.5600D33188418 9 NPDB NPDB.HRSAGOV 800.787 M VA 22033 USA -290 M76610M 0922 0921 9399 0513437126550033188582 10 NPDB NPDB.HRSAGOV 800.7674732 VA U033 USA ; 2M NT6610107 M22 0921 93M G51343712GS6M033188665 11 NPOS NP00.HRSA.GOV 600-767.6732 VA 22033 USA ;280'l' 1,178610199 0922 0921 9399 05134371265600033188749 12 NPOS NPDB.HRSAG0V 00467.6=VA 22033 USA ''2A0'�- 1475610399 0923 0922 9399 0513437126NM033057646 13 NPOBNPOB.HRSAGOV 800.767.6732 VA 22033 USA .3.00 `r N78618470 0923 0922 9399 14 NPDB NPOB.HRSAGOV 800-767-6732 VA 22033 USA zoo FOR IMPORTANT INFORMATION CITIBANK N.A. �� Ba SIIOUXX FALLS SD 57117-6125 JASON W ANGLIN CALHOUN COUNTY STE A 202 S ANN ST PORT LAVACA TX 77979A204 Page i of 4 Account Number Xl)=-XXXX-XXX Statement Closing Date October 03, 2021 C,"-.LTICU"'COUI'My SAS; nor, Not an invoice. OCT - 7 2021 For rUr records Only. CODOL934502 Account: )=-)=X-XXXX Transactions (con't) OS130 0929 9399 85134371273W0035928829 15 NPOa NPM.HRSAGOV 8000.76746732 VA 22033 USA 2A0 / N78760541 09130 0920 5999 55432651273200132785281 16 AMA'CREOENTIALING 8006214i33511 60611 USA 44.W "" TOTAL AMOUNT OF MEMO ITEM($): $381.00 Page 3 of 4 • Rep2olmlar9taten CeNfmmNhblY: QrleWfhonCLnosare ape ovary my, mainstream esstreenyb. QropNMnCP letter offer MQtelteppohmonloe numbarspe[i`ed Cn Mclmnl of Lmd. • ClMlt Roper e: Pit, BanF may mpn Account Inhibilkn W GNII tau bous. Lalo payment., moved Mwi at Other delays on the NCpJat may lee mneQN. yourcrodamem. •who,, one, ,MeUne:Ian GnN.tt X89an Mahe m9CIe4X ime(a rANanof KWxMmay a used fo Cased ad. 11maS obtain Is Ibo tmdmam am[ant War (and GIGMIdtt tan Gorge al eny tine. The Staff n[h Qrtlha.efe CrNN Ilse land PayMeme: YN may (sake a preset b yNr WefMVAIYbWNwM saount plMe .Of, CNI'loo't.%ease net. that semi mTa Ml.nad. 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VIRGINIA ST PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX: (361) 552-0312 Vendor Name: �%(�'✓1_7�3'C Vendor Address: Vendor Phone #: Vendor Fax #: Ship To: 815 N. VIRGINIA ST, PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX: (361) 552-0312 Date: (1)1 jI � / -,;� o P.O. # Account# Initiated B m Date Required ExpenseN Department DelivcrTo ro9v4u1 Line No. Qty. Catalog Number Description Unit Cost Unil Mess. Extended Cost •J 7 PAL-Gy ��r� 1)0 v v Z ;JL 10 Am A Gow Contact: Quoted By: Buyer. Est. Freight Est. Tota ' ost TOTAL COST Date: E.T.A. IS CGUtd' Dept. Director_ Dir. Nursing _ Dir. Clinical Services Administrator MEMORIAL MEDICAL CENTER. PURCHASE ORDER Bill To: 815 N. VIRGINIA ST. Ship To: 815 N. VIRGINIA ST, PORT LAVACA, TX 77979 PORT LAVACA, TX 77979 PHONE: (361) 552-6713 PHONE: (361) 552-6713 FAX: (361) 5522-0312 FAX: r (361))552-0312 Vendor Name: 0. co—i�_ (: yyl((L Date: Vendor Address: Vendor Phone #: Vendor Fax #: P.O. # Account# Initiated Date Required Expensep Department DdiverTo rorm p vqut L - CXv. I Catalog Number N Description Unit Cost Unit Extended Meas, Cost } � r i i[d U ,_' t .. „(j� 3 a s �! U U C) - Iq I/ i.0 C) 6 'L UU, 7 z bU ��TT�� n!,0C). 9 I Yt it 4 10 _.. VvYI-0 -! �lf✓rf lritk'fiL'IS' i( /�r L)C) r-Ywr-4iK-4' \1Jyn/bt row/15v Est. Freight Eft. Total Cost TOTAL COST L' NOTES: G��i%s' rrr��Smt`s GaG� Gam} 2 Contact: Quoted By: Buy": Dalc: Dept, Direct Dir. Nursing E.T.A. i I Dir. Clinical Services Administrator Grand Totals: Gross 4,205.38 Ai°i!']i0VW w OCT 1 F 2021 cam AWWM CALWOSkN _Qf)W,;k , TWKA9 10%1 Q/,?,0,21 MEMORIAL MEDICAL CENTER 08:36 AP Open Invoice List • Dates Through: Vendorlf �' Vendor Name Class 11816_... „-�• ASHFORD GARDENS .InvoicefP'- Oomment Tran Dt Inv Dt Due Dt 10621 10/07/2021 10/07/2021 11/04/2021 UHC AUGUST QIPP PAYMENT Vendor Totals: Number Name 11816 ASHFORD GARDEN 4,205.38 Discount 0.00 Check Dt Pay Gross 0 ap_open_invoice.tempiate Pay Code Gross Discount No -Pay Net 4,205.38 0.00 0.00 4,205.38 Discount No -Pay Net 0.00 0.00 4,205.38 No -Pay. Net 0.00 4,205.38 MEMORIAL MEDICAL CENTER 10/1412021: 0 AP Open Invoice List 08:,38.F, ap_open_invoice.template Dates Through: 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 100621 10/08/2021 10/06/2021 11/04/2021 1.688.76 0.00 0.00 1,688.76 UHC AUGUST OIPP PAYMENT 100421 10/14/2021 10/04/2021 10/28/2021 3465.00 0.00 'M1It. TRANSFER OI IYtLVtJAKLY NtKhkg1"6v( Vt,_1Y 100521 10/14/2021 10/05/2021 10/28/2021 5,800.00 0.00 TRANSFER tl 1% 100621A 10/14/2021 10/06/2021 10/28/2021 7,026.50 0.00 TRANSFER it t Vendor Totals: Number Name Gross Discount 11828 SOLERA WEST HOl 15,980.26 0.00 naporl Sun'. W ry Grand Totals: Gross Discount No -Pay 15,980.26. 0.00 0.00 aI OCT 14 2M CY4T, w 0.8gf.`L61Q9? 0.00 3,465.00 .—'- 0.00 3,800.00 0.00 7,026.50 to No -Pay Net 0.00 15.980.26 Net 15,980.26 �- MEMORIAL MEDICAL CENTER 10/14/2021 -- - AP Open Invoice List 08:37 ',-j p"< 1i �y.' Dates Through: VendgrN Vendor Name Classi FORTBEND HEALTHCARE CENTEI Invoice# Comment Tmn Dt Inv Dt Due Dt Check Dt Pay 100621 10/08/2021 10/06/2021 11/04/2021 UHC AUGUST QIPP PAYMENT Vendor Totals: Number Name Gross 11820 FORTBEND HEALTI 1,686.89 Grand Totals: Gross Discount 1,688.89 0.00 APO.A0V W aw OCT 14 2021 0ob'W11BY AW_fti9 _1& CALx2ta'�etti mhn>y�,'T5, 'r .`X'AS 0 ap_open_i nvoice.template Pay Cade Gross Discount No -Pay Net 1,688.89 0.00 0.00 1,688.89 Discount No -Pay Net 0.00 0.00 1,688.89 No -Pay Net 0.00 1,688.89 10/14%2i'721 �y %LL�f MEMORIAL MEDICAL CENTER 08:38 AP Open Invoice List r _ „ Dates Through: Vendor# Vendor Name Classy 11832 BROADMOOR AT CREEKSIDE PAF ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 100621 10/07/2021 10/07/2021 11/04/2021 UHC AUGUST OIPP PAYMENT Vendor Totals: Number Name Gross 11832 BROADMOOR AT C 1,722.72 Grand Totals: Grass Discount 1,722.72 0.00 APIWWW A4K OCT 9 h 2021 CAOWIM AM74131Z CAL',iArM&S 8016,\ %, TEXAS 0 ap_open_invoice.template Pay Code Gross Discount No -Pay Net 1,722.72 0.00 0.00 1,722.72 .% Discount No -Pay Net 0.00 0.00 1,722.72 No -Pay Net 0.00 1,722.72 MEMORIAL MEDICAL CENTER 10/14/2021 Ej" T � ;, �� AP Open Invoice List 08:37 's it �'? Dates Through: Vendpr#.. Vendor Name / Class 11824 -"�' THE CRESCENT ^� Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 100621 10/08/2021 10/00/2021 11/04/2021 UHC AUGUST OIPP PAYMENT Vendor Totals: Number Name Gross 11824 THE CRESCENT 1,384.93 Grand Totals: Gross Discount 1,384.93 0.00 ppy')Ik1'0'�ID �I OCT 14 2021 ®"&NV?y k 0 ap_open_invoice.template Pay Code Gross Discount No -Pay Net 1,384.93 0.00 0.00 1.384.93 ..i' Discount No -Pay Net 0.00 0.00 1,384.93 No -Pay Net 0.00 1,384.93 j � ' ", ' MEMORIAL MEDICAL CENTER 10/14/2021 0 AP Open Invoice List 10:41 ap_open_invoice.template Due Dates Through: 11104/2021 Vendor# Vendor Name Class Pay Code % 11836 GOLDENCREEK HEALTHCARE V/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay 100621 10108120. 10/05/20 11/04/20 2,876.24 0.00 0.00 UHC AUGUST OIPP PAYMENT 100121 10/14/2010/0112010/28/20. 2,619.80 0.00 0.00 TRANSFER 0 }i i11St1yI,,wu- p�luk dlu tj js &d j Y 4-,t AAA- �0 100521 10/14/20. 10/05/20 11/04120. 332.04 0.00 TRANSFER tL it 1006218 10/14/20 10/12/20 11/04/20. 639.36 0.00 0.00 TRANSFER t' 0 Vendor Total; Number Name Gross Discount No -Pay 11836 GOLDENCREEK HEALTHCARE 6,467.44 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 6,467,44 0.00 0.00 r® OCT j ji Buz i c:WaW,0.k.L.�lta,0Tt Page 1 of 1 Net 2,876.24 ✓�� 2,619.80 332.04 639.36 Net 6,467.44 Net 6,467.44 file:///C:/Users/eheiman/epsi/memmed.cpsinet.corn/u98547/data_5/tmp_cw5report3166... 10/14/2021 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code GULF POINTE PLAZA Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 100621 10/08/2021 10/06/2021 11/04/2021 1,700.30 0.00 0.00 1,700.30 v UHC AUGUST OIPP PAYMENT 100121 10/14/2021 10/01/2021 10/28/2021 6,120.00 0.00 0.00 6,120.00 TRANSFER Nk 1Y dvi"Ru- depo6 i4r.A IVFir VV NtkL OkC#_I 100121A 10/14/2021 10/01/2021 10/28/2021 `✓� 508.96 0.0 0.00 508.96 TRANSFER it I+ 100421 10/14/2021 10/04/2021 10/28/2021 465.54 0.00 0.00 465.54 TRANSFER Li tl 100421A 10/14/2021 10/04/2021 10/28/2021 3,264,00 0.00 0.00 3,264.00 TRANSFER It 1I 100521A 10/14/2021 10/05/2021 10/28/2021 14.910.64 0.00 0.00 14,910.54 ✓ TRANSFER tr /t 100521 10/14/2021 10/05/2021 10/28/2021 6,968.54 0.00 0.00 6,968.54 TRANSFER I+ ) I 100621A 10/14/2021 10/06/2021 10/28/2021 1,522.78 0.00 0.00 1,522.78 TRANSFER � If Vendor Totals: Number Name Gross Discount No -Pay Net 12696 GULF POINTE PLA2 35,460.66 0.00 0.00 05,460,66 Grand Totals: Gross Discount No -Pay Net 35,460.66 0.00 0.00 35.460.66 APyDO V W WT OCT i h 2021 a;sru GALw15'Q€6 SNrZY;�".'S.'. s 7fAE1 MEMORIAL MEDICAL CENTER 210'L 0 AP Open Invoice List 08 38 ap_open_invcice.lemplate ,�,� <pn^;3 .o.0 Dates Through: Vendor# Vendor Name Class Pay Code 13004 TUSCANY VILLAGE / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 100621 10/08/2021 10/06/2021 11/04/2021 1,695.79 0.00 0.00 1,695.7,9 UHC AUGUST OIPP PAYMENT 100521A 10/14/2021 10/05/2021rr,,II 10/28/2021 3,073.00 0.00 0.00 3,073,00 ANSFER h�t^� C 1dv-t'�ta R10105/2021,v 101 L 1A�855: 0KI- 100521 10/14/2021 8/ 021V� 2 0. 01 0.00 855.02 i,/ TRANSFER 11, I t 1006213 10/14/2021 10/06/2021 10/28/2021 1,491.42 0.00 0.00 1,491,42 TRANSFER I' ci 100621A 10/14/2021 10/06/2021 10/28/2021 1,805.91 0.00 0.00 1,805.91 TRANSFER Vendor Totals: Number Name Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 8,921.14 0.00 0.00 8,921.14 Grand Totals: Gross- Discount Na-Pay Net 8,921.14 0.00 0.00 8,921.14 AA1°71cD w 4PI OCT 14 2021 i MEMORIAL MEDICAL CENTER 10/14/2021in'P P 1, 11 0 AP Open Invoice List - `�" 08:39 ap_open_invoice.template Dates Through: rr;[ Vendor#� "' ` �`.7:; Vendo[Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 100121A 10/14/2021 10/05/202111/04/2021 9,583.52 0.00 0.00 9,683.52 rA,V �I TRANSFER I� ins0tur>.ti P�JK'{ &pyt+r irj, BALL 0VCUJV 100421A 10/14/2021 10/05/2021 11/04/2021 2,956.79 O o.00 0.00 2,956.79 f% TRANSFER It it 100521 10/14/2021 10/05/2021 11/04/2021 7,596.12 0.00 0.00 7,596.12 TRANSFER it t1 4- 100121 10/14/2021 10/05/2021 11/04/2021 1,434.89 0.00 0.00 1,434.89 TRANSFER It yi Vendor Totals: Number Name Grass Discount No -Pay Net 12792 BETHANY SENIOR 1 21,571.32 0.00 0.00 21,571.32 Grand Totals: Gross Discount No -Pay Net 21,571.32 0.00 0.00 21,571.32 'ar? ym SIX OCT 1 k 2021 c(I)WI W AVONROU Facility ID Facility Name Total UHC Deposits 4811 Ashford 53,487.60 105818 Broadmoor 22,098.02 105314 Crescent 17,739.24 4628 Fort Bend 21,591.04 105006 Solera 21,050.09 102540 Golden Creek 36,646.69 100806 Gulf Pointe 21,669.81 103462 Tuscany 54,410.03 Bethany Total UHC Desosit 248,692.52 NINIC PORTION QIPP/Comp1 QIPP/Comp 2 QIPP/Comp3 0jPP/Comp4& Lapse QIPP TI NH PORTION 45,076.85 8,410.75 49,282.22 4,205.38 18,652.57 3,445.45 20,375.30 1,722.72 14,969.39 2,769.85 16,354.31 1,384.93 18,213.26 3,377.79 19,902.15 1,688.89 17,672.56 3,377.53 19,361.33 1,688.76 30,894.21 5,752.48 33,770.45 2,876,24 18,269.21 3,400.60 19,969.51 1,700.30 51,018.46 3,391.57 52,714.24 1,695.79 214,766.51 33,925.01 231,729.51 16,9fi3.01 53,487.69 22,098.02 17,739.24 21,591.04 21,050.09 36,646.59 21,669.81 54,410.03 248,692.52 MSKES$ON STATEMENT As of: 10/16/2021 Page: 002 To aware prWr Credit to your account, detach and Mum this co=prn: GOO stub with your mergence DC: 8115 A. o1: 10/15/2021 Page: 002 MEMORIAL MEDICAL CMTFTR ANT DUE REAITTEO VIA ACH DEBIT Territory: Mail to: Comp: 8000 AP Statement for information only AMT DUE REMITTED VIA ACH DEBIT 815 N IA STREET Statement for Information only FORT LAVACVACA TX ]]9]9 Customer: 632536 Date: 10/18/2021 Cast: 632536 PLEASE CHECK ANY Date: 10/16/2021 IFUMS NOT PAID (1) filling Oue )ate Data gatlOnal Aoeount 6 Rer:Nvable Ur�25fT Number ENlarenw Cash OeacHptlon Discount Amount P F Amount P Receivable F Number (gross) (net) W column legand: P = Pest Due Item, F = Future Due Item, blank c Current Due Item -OTAL National AW 632536 MEr10RIAL MEDICAL CENTER Sumotais 6.457.41 USD vAum Due: 0.00 It Paid By 1011912021, cast Due: 0.00 Pay This Amount 5.348.30 USD ast Payment 2.451.97 If Paid After 10119/2021, -810712017 Pay this Amount: 6,457.41 USD /JAL: z�"i&i.bb ti l ilyy � SU02`IU I "?Mk)vw 4074 DCT ID 2021 CWW.'W AtRf el CALNi rnCOMIIW,v.ExAs For AR Inquiries please contact 800-867-0333 Due If Paid On Time: USD 5,348.30� Oise and If paid late: oa.11 Due If Paid late: USD 5 45].41 MSKESSON STATEMENT HEB PHCY 0434/ME4 MED PHS AMT DUE REMITTED VIA ACH OBIT MEMORIAL MEDICAL CENTER Statement for information only VICKY KAUSEK 815 N VIRGINIA ST PORT LAVACA TX 77979 AS of: 10/15/2021 Page: 001 To ensure Proper credit to your account, detach and return this stub With your remblanon DC: 8115 As of: 10/15/2021 Page: 001 Mail to: Comp: 8000 Territory; 400 AMT DUE REMITTED VIA ACH OMIT Statement for information only Customer: 190813 Date: 10/16/2021 Cust: 190813 PLEASE CHECK ANY Date: 10/16/2021 ITEMS NOT PAID (r) filing Due Receivas,fl xxatlonal AvermentMPG 6 Cash Amount P Amount P Resolvablelul I )ate Data Number Helerenou Description Discount (gross) F (net) F Number :ustomHr Number 190813 — H® PHCY 0434/ME4 MED FIRS — ---- 0/13/2021 10/19/2021 7299692184 2017036941 1151nvoice 4.59 229.67 225.081/ 7299691184 0/15/2021 10/19/2021 7300267933 2017037176 1151nvoice 0.38 19.08 18.70 ✓ 7300267933 0/15/2021 10/19/2021 7300267934 2017037176 1151nvoice 2.23 111.34 109.11 ✓ 7300267934 IF column legend: P = Past Oue Item, F = Future Due Item, blank = Current Due Item 'DTpI: Customer Number 190315 H® PHCY 0494/MBA MED PHS Subtotals: 360.09 USD !Mo. Due: 0.00 Oue It Paid On Time: If Paid By 1011912021, USD 352.89v$ +ast Due: 0.00 Pay This Amount: 352.89 USD Disc lost it paid late: .20 .stPayment 9,102.08 It Pattl Aftert19/2021, Due II Paltl late: 011 0/11/2021 Pay this Amount: 360.09 USO USD 360.09 AP2alOi'QT1 4HQ OCT 10 2021 conrNw AB(474Km CAL "''tMV uEB\'T.', 2EXAg For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As at: 10/15/2021 Page: 001 To ensure proper crowd to your amount, tlatach add return this Ca.,� esoo DC: 8115 stub with your As 4b 10/1512021 remRlanm Page: 001 WALMART 109SIMEM MED HIS MEMORIAL MEDICAL CENTER VICKV KAUSEC AMT DUE REMITTED VIA ACH DEBIT Statement for Information only Territory: 400 Customer: 258342 Mail to: Comp: 8000 ANT DUE REMITTED VIA ACH DEBIT Statement for information only 815 N VIRGINIA ST Date: 10/16/2021 PORT IAVACA TX 77979 Cult: 256342 PLEASE CHECK ANY Date: 10/16/2D21 R S NOT PAID (v) 911ing Due )ate Date t4atlonal Account peo 6 Number l N Reference Number Ralerence Description Cash Discount - Amount P ' - (gross) F Amo(net) P (net) F Number Numfm 7ustomer Number 256342 WALMART 1088/MEM MED PHS 0/09/2021 10/19/2021 7299208944 1008210731 1151nvoice 3.91 195.70 191.79✓ 7299208944 0/11/2021 10/19/2021 7299158644 16B74722 1151nvoice 0A9 a09✓ 7299150644 0/11/2021 10/19/2021 7299322362 1008210736 1951nvoloe 0.03 1.48 1.45 1 7299322362 0/12/2021 10/19/2021 7299622498 1011210943 1151nvoice 0.01 0.63 0.62" 7299622496 0/13/2021 10/19/2021 7299699698 17104937 1151nvoice 13.49 674.54 661.05 ✓ 7299699698 0/13/2021 10/19/2021 7299699699 17104937 1151nvoice 2.27 113.66 111.39'e 7299699699 0/13/2021 10/19/2021 7299063274 1012210758 1951nvoice 8.48 423.86 415.38 ,/ 7299863274 0/1312021 10/19/2021 7299863275 1012210847 1151nvoice 4.05 202.67 198.82 ,�' 7299863275 0/1412021 10/19/2021 7300001709 17170164 1151molce 0.70 34.97 34.27 ✓`. 7300001709 0/14/2021 10/19/2021 7300001714 17211295 1151nveled 0.16 0.16 ✓ 7300001714 0/1412021 10/19/2021 7300001716 17211295 1151nvaice 0.01 0.63 0.52 ,j 7300001716 0/14/2021 10/1912021 7300DO1717 17218395 1151nv0ice 0.01 D32 0.31 �� 7300001717 OY1412021 10/19/2021 7300139606 l013210748 1951nvoice 1.07 53.55 52.48 7300139606 0/14/2021 10/19/2021 7300139607 1013210833 1151nvoico 1.08 94.07 92.19 ,/ 7300139607 0/16/2021 10/19/2021 7300269333 17236634 1151nvoice 5.38 268.98 263.60 ✓ 7300269333 0715/2021 10/19/2021 7300269334 17236624 11 Slovoice 0.01 0.63 0.621% 7300269334 0/15/2021 10/19/2021 7300269335 17278507 1151mmice 0.01 0.63 0.62 ✓ 7300269335 0/15/2021 10/19/2021 7300426442 1014210758 195mvome 15.57 776.29 762.72 J 7300426442 OF column legend: P = Past Due Item, F = Future Due Item, blank = Current Due Item 'OTAL• Customer Number 258342 WALMART 109E/MEM MED PHS SUMotalc 2,044.86 USD -inure Due: mat Due: 0.00 0.00 If Paid By 1011912021, Pay This Amount. 2.787.98 USD Due If Paid On Time: USD 2.787.98 Dino lost It paid late: 56.86 net Payment 9.102.08 0111/202, AP?Wym It 1I After 1011912021, Pay this Amount: 2.844.86 USD Due I1 Paid tale: USD 2,844.86 4r0 OCT ill 2921 CmrypiyYA2RMiO9 For AR Inquiries please Contact 800-867-0333 CA'a' tWti r`.'OSVY'l','P' MSKESSON STATEMENT amnesty: eaoo HES My FC 490/MEr1 MC PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CENTER Statement for Inermation only VICKY KAUSE( 815 N VIRGINIA ST PORT LAVACA TX 77979 As of: 10/15/2021 Page: 001 To ensure Prefer credit to Your aumtes, detach aM return this stub wfth your mmiNanea DC: 8116 As of: 10/15/2021 Page: 001 Mall to: Come: 8000 Territory: 400 AMT DUE REMITTED VIA ACH DEBIT Statement for information only Customer. 464450 Date: 10/16/2021 Clean 464450 PLEASE CHECK ANY Dale: 10/16/2021 ITEMS NOT PAID (1) filling Due Recaivablpanarral Account MOPE Xate Date Number Reference Description :ustomer Number 464450 HED PHY PC 49D/MEM MC PHS 0/12/2021 10/19/2021 7299459312 55X607364 1151nvoine 0/12/2021 10/10/2021 7299459314 55x667447 IISinvolce 0/12/2021 10/19/2021 7299459315 55467572 115lnvoice OMW2021 10/19/2021 7299459316 55x667573 1151nvoee OM5/2021 10/19/2021 7300235024 55x677153 1151nvelco 0/15/2021 10/19/2021 7300236026 55x677204 1151nvoice T column legantl: P = Past Due Item, F = Future Due Item, blank = Current Due Item -OTAL Cublomer Number 484450 HEl MY FC TWIMIRA MC PHS Sum mis: 'Aure Due: 0,00 It Paid By 10119/2021, last Due: 0.00 Pay This Amount: ssl Payment 9,102.08 It Paid After 1011912021, Oil IM021 Pay this Amount: Arr•aonm •N OCT f U mi (]ONDI,�y Aaawma, O'LnI1W Gevxv', 9SiiAn coat Discount 4,81 17.20 1.00 0.09 5.32 0.06 1.424.99 USO Amount P Amount P Resolvable (grws) F (met) P Number 240.61 235.80 ✓ 7299459312 860d2 842.92t/ 7299459314 50.22 49.22✓. 7299459315 474 4.55 ✓ _ 7299459316 260.14 260.82 ✓ 7300235024 3.16 / 3.10 J 7300235026 Due It Paid On Time: USD 1,396.51✓� 1,396.51 USD Disc lost if paid late: 2848 Due If Paid Late: 1.424.99 USD USD 1.424.99 For AR Inquiries please contact 800-867-0333 MWESSON STATEMENT AA of„°/,5,2D2, Page, °°' To ensue proper our nsu eca inarelcahadift Mum this tlwM datum e rrPan: suss Arab with your remRtera e DC: 8115 As of: 10/15/2021 001 ge: CVS PHCY 7475/MEM MC PHS AMT DUE REMITTED VIA ACH DEBIT Territory: 400 Mall tc: 128000 MEMORIAL MEDICAL CEJTEA Statement for information only AMT DUE SEMITT® VIA ACH DEBIT VICKY KAUSE( Customer: 835938 Statement for information only 815 N VIRGINIA ST Date: 10/16/2021 POET LAVACA TX 77979 Cust: 835438 PLEASE CHECK ANY Date: 10/1612021 ITEMS NOT PAID (.d) tilling Due Numberbl� atonal Account 8 Amount P Amount P f@ceivable ]afa Date Number Heferenee Descdprl0n Olscouni flefer1 Olm 19rase) F (ntl) F Number _ — _ _ :ustcmer Number 835438 CVS PKCY 7475/MEN MC PHS 0/14/2021 10/19/2021 7300173562 1397653 1151nvolce 16.65 827.47 810.92 d/" 7300173562 O W column legend: P = Past Due Item, F = Future Due Item, blank = Current Due Item __.__._—_._.__—_._.____._..._--_..—.._"— _._.__—_. �.._..__..___.....____... 'OTAL Customer Number 835938 CVS PHCV 74]6/MBA MC PHS —..—.— _ Subtotals: 827.47 USD 'Mum Due. 0.00 Due If Paid On Time: 0 Patel By 10119/2021, USD 810.92 + st Due: 0.00 Pay This Amount: 810.92 USD Disc lost If paid Late: /) 16.55 IY�•.• ast Payment 9,102.06 If Peld Aker 10119/2021, Due If Paltl late: 0/11/2021 Pay this Amount: 827.47 USD USO 827A7 APPWVM ON OCT 18 2021 cWz:4�ae�:ru For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 10/08/2021 u�v�v: asoo DC: 8115 MEIAORIAL MEDICAL CENTER AMT DUE REMITTED VIA ACH DEBIT Termory: AP Statement for Information only 815 N VIRGINIA STREET Customer: 632636 PORT LAVACA T% 77979 Date: 10/0912021 Page: 002 To ensure proper credh to your account, detach and Mum this stub whh your Mathews A. of: 10/00/2021 Page: 002 Mall to: Camp: 8000 AMT DUE REAITTED VIA ACH DEBIT Statement for information only cum: 632536 PLEASE CHECK ANY Date: 10/09/2021 ITE2r1S NOT PAID (v) ational Account 6 t— ylling Due Rrcelvablrr�95t1 Cash Amount P Amount P Receivable )eta Date Number Reference Description Discount (gross) F (net) F Number IF column legend: P = Part Due Item, F = Forum Due Item, blank = Current Due Item 'OTAL• National Feet 632536 MEMORIAL MEDICAL CENTER Subtotals: 9,287.83 USD vture Due: 0.00 If Paid By 10/1212021, Net Due: 0.00 Pay This Amount: 9,102.08 USD act Payment 2.451.97 It Paid After 1011212021, i8/0712017 Pay thle Amount: 9.287.83 USD 0•L. '14. 6U , 4 b'f•>) [JO• 4 ArtWYM RPI OCT 19 2021 Ca) ''WAM'WOu cALNIIIA �o1sc.^�r,TEXA4 For AR Inquiries please contact 800-867-0333 Due If Paid On Time: USD Ulsc lost If pals late: 9,102.08 185.75 Due If Paid We: USD 9.287.83 m=RCJDVIY STATEMENT Agof: 1010812021 Company: 8000 DC: 8115 HEB PHCY 0434/MEM MED pHs AMT DUE REMITTED VIA ACH DEBIT Territory: 400 MEMOPoAL MEDICAL CENTER Statement for information only VIC" KALISR( Customer. 190813 815 N VIRGINIA ST Onto: 10/09/2021 FORT LAVACA T% 77979 Page: 001 To mosum proper creek to your account, detach and Mum this stub with your mordancy, As of: 10/0W2021 Page: 001 Mall to: Comp: 8000 AMT DUE HE4ITTED VIA ACH DEBIT Statement for Infoonallon only Cash 190813 PFEASE CHECK ANY Date: 1010912021 ITEMS NOT PAID (0) Cling Due HecelvabllNatlonai Account MY, — Cam Amount P Amount P Receivable F])ate Date Number Mference Description Discount (grass) F (net) F Number )unomer Number 190813 HEB PHCY 0434/MEM MED PHS 0/06/2021 10/12/2021 7298322844 2017036598 1151nvolce 1.62 76.12 74.60�' 7298322844 O IF column legend: P ao Pan Due Rem, F = Future Due Item, blank aa Curren Due Item 'OTAL Customer Number 190813 H® PHCY 04341MEld MED PHB suMotals: 76.12 USD 'pure Due: 0.00 Due It Paid On Time: If Paid By 10/12/2D21, USO 74.60 rad Due: 0.00 Pay This Amount: 74.60 USD Dlac lest It Paid late: IjIYlf9r__ 1.52 AM Payment 9.404.01 If Paid After 10/12/2021, Due If Paid late: 0/04/2021 Pay this Amount: 76.12 USD USD 76.12 Al OOT 41N OCT i 8 2021 CALna311 g�i9ARQ� Wj` m . �ecAs For AR Inquiries please contact 800-867-0333 MWESSON STATEMENT cann•ny: 8000 CVS PHCY 7006/MEMOWA MS AMT DUE RFMITTm VIA ACH DEBIT MEMORIAL MEDICAL CENTER Statement lad Inlormalion only VICKY KALISEK 816 N VIRGINIA PORT LAVACA T% 77979 As of: 10/08/2021 Pegs: 001 To ensure proper credit to your account, detach and Mum this stub with your remittance DC: 8115 As of: 1010812021 Pe9e: 001 Mall fee Comp: 6000 Territory: 400 AMT DUE REMITTED VIA ACH DEBITCustomer. 262262 Statement forr Information only Date: 10/09/2021 Cum: 262252 PLEASE CHECK ANY Col. 10/09/2021 ITEMS NOT PAID (r) 911mg Due Rac.Webk'mlonal Account MPG Caeh Amount P Amount P Reeeleable lets Data Number Reference Description Discount (gross) F (net) F Number :ustomer Number 262262 CVS PHCY 7006/MEMORIA PHS 0/07/2021 10/12/2021 7298604012 1307100 1151rwe1ce 9.54 476.91 467.37 7296604012 O IF column legend: P . Peg Due Item, F = Future Duo Item, blank = Current Due Item 'OTAL Customer Number 262262 CVS PHCY 7006/MfMORIA PHS Subtotals: 476.91 USD :inure Due: 0.00 Due If Paid On Time: It Mid By 10/1212021, USD 467.37.�{, Mg Due: 0.00 Pay This Amount: 487.37 USD Disc lost If paw late: I10y` 9.64 ag Payment 9,404.61 It Paw After 10/1212021, Due If Paw late: 010412021 Pay this Amount: 476.91 USD USD 476.91 AT?AOYYp1D ON OCT 18 2021 Ca �,AMWM CALNc M' 10t1NW,'PSXA9 For AR Inquiries please contact 800-867-0333 STATEMENT oompw, 6aoo HIB PHY rC 490/MEM MC PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CMTER Statement for Information only VICKY KAUSEK 815 N VIRGINIA ST PORE LAVACA TX 77979 As of; 1010812021 Page: 001 To ensure proper men to your acaamh detach and Mum this stub with your remittance DC: 8116 As of: 10/08/2021 Page: OD1 Mall to: Camp: 8000 Territory: 400 AMT DUE REMITI'M VIA ACH 9H81T Customer 464450 Statement for Intonation only Date: 1010912021 Cust: 464450 PLEASE CHECK ANY Date: 10/09/2021 ITEMS NOT PAID (�( alarm ACCminl 6 plling Due Numberhl Cash Amount P Amount P Number late Data Number Palmer" Description Discount (groaet F (nap F Number :umomer Number 464450 H® PHY 1C 490IMEM MC PHIS 0/08/2021 10/12/2021 7298843733 55x6643]] 1151nvoioe 13.80 690.13 676.33 / 7291843738 0/0012021 10/12/2021 7298843737 66xB64640 1151nvoice (1 0.33 0.32 v 7296843737 0/08/2021 10/12/2021 7298843738 55x664697 1151mmice 0.26 12.93 12.67✓' 7298843738 W column legend: P = Pool, Due Item, F = Future Due Item, blank = Current Due Item 'OTAL• CUM.Mor Number 464450 HEM PHY PC 490IMEM MC PH6 Subtotals: 703.39 USD ''uture Due; 0.00 Due It Mid On Time: If Paid By 1011212021, USD 689.32 lye rest Dua: 0.00 Pay This Amount: 689.32 USD DIN lost if paid late: 1`oly` 4.0] Payment 9,404.61 If After 10/12/2021, Due If Poltl late: 01 /04/2021 Ihle Amount: My this 703.39 USD USD 703.39 APCTY071D �(4 OCT 14 2021 c®�:44y ATAP.e&O$ For AR Inquiries please contact 800-867-0333 MSKESSONSTATEMENT As of! 10/0812021 Page: 001 To ensure proper cretl„ to your accoum, detach and Mum this canoes: Me stub with your remittance VC: 8115 As of: 10/08/2021 Page: 001 CVS PHCY 747SIMEM MC FHS Mail to: Comp: 8000 MIRAORIAL MEDICAL CENTER AMT DUE REMITTED VIA ACH DEBIT Territory: 400 Statement for information only qMT DUE RB41Ti® VIA ACH DEBIT R ITTE VIA VICKY KALISIX N IA ST Cusmmm: 835438 Statement only I'O AVACVIRGI PORT LAVgCA TX 7]B]9 Date: 10/09/2021 Oust: 835438 I (EASE CHECK ANY Date: 1010912021 ITE7AS NOT PAID (�) NIIis Due atlonal Account 6 Receivabl WJtR Cash Amount P Amount P Receivable 1are9 Data Number Reference Description Discount (grass) F (net) F Number :ustomer Number 835438 CVS PHCY 7475/MW MC PHS 0/07/2021 10/12/2021 7298784472 1387664 1151mmice rF column legend: P = Past Due Item, F = Future Due Item, blank = Current Due Item 'OTAL' Customer Number 835438 CVS PHCY 747S/MEN1 MC PHS Subtotals: 'vtum Due: 0.00 If Paid By 1U/12/2021, 'ast Due: 0.00 Pay This Amount: ast Payment 9,404.61 If Pe1tl After 1011212021, 0/04/9021 Pay this Amount: AreLryj3D M OCT 10 2021 G®AC4?gMiOHi CAtYuS'INdl\ 4.71 235.35 230.64 ✓/ 7298784472 O 235,35 USD Due If Net On Time: USD 230.64 ✓� 230.64 USD Disc lost It poi„ late: 4.71 Due If Mid Late: 235.35 USD USD 235.35 4> For AR Inquiries please contact 800-867-0333 MSKESSON As of: 1010012021 Page: 001 To wart 9 proper crook to your STATEMENT account, detach and Mum this company: anon DC: 8115 stub with your As of: 10/08/2021 remittance Nga: 001 WALMART 1096/MEM MOD PHS AMT DUE REMITTED VIA ACH OMIT Territory: 400 Mall to Camp: 8000 MEMORIAL MEDICAL CB4TEA VICKY KALISE( 815 N VIRGINIA ST Statement for information only Customer: Date: 256342 10/09/2021 AMT DUE REMITTED VIA ACH DEBIT Statement for Information only MRT IAVACA TX 77979 Cust; 256342 PLEASE CHECK ANY Data: 10/09/2021 ITEr1S NOT PAID (e) filling Due Re4elvablretlmw Account WASyi6 Cash Amount P Amount P Receivable late Date Number Reference Description Discount (grass) F (not) F Number :ustomer Number 256342 WALMART 10981MEy1 MED PHS 0/02/2021 10/12/2021 7297820305 1001210833 1151nvoius 0.97 48.37 47.40 ✓ 7297820305 0/04/2021 10/12/2021 7297769942 46449104 1151nvolce 15.59 779.59 764,00, 7297709942 0/04/2021 10/12/2021 7297769944 16469858 115lnvoloe 0.70 34.97 34.27✓ 7297769944 0/04/2021 0104MO21 10/12/2021 10/12/2021 7297769945 7297931696 16513993 1001210730 1151nvoice 1951nvoice 4.73 236.69 0.03 231,96 °' 0.03 ✓ 729T769945 7297931698 0/05/2021 10/12/2021 7298082463 16695283 1151nvcice 6.55 327.49 320.94✓ 7298082463 0/05/2021 10/12/2021 7298082464 18635624 1151nvolce 7.80 393.19 385.33 7298062464 0/06/2021 10/12/2021 7298OH2465 1664667B 115Involce 2.18 109.16 106.96- 7298062465 010SP2021 10/12/2021 7208248076 1004211004 115mvolce 18.12 906.06 887.96 ✓ 7298248076 W08/2021 10/12/2021 729BB49509 16679275 1151nvolce 16.28 814.04 797.76✓ 7298349509 0/06/2021 10/12/2021 7298349611 16679276 1151nvolca 0.04 1.90 1.06✓ 7298349511 0/06/2021 10/12/2021 7298349512 16718586 1151nvoice 1.96 97.96 96.00 ✓ 7298349512 0/08/2021 10/12/2021 7296500674 10062/071B 1951nvolce 16.32 815.95 799.63 ✓ 7298500674 0/06/2021 10/12/2021 7298500677 1005210624 11510voice 4.47 223.54 219.07r' 7298600677 0/07/2021 10/12/2021 7298620032 16783317 1151nv01ce 8.74 436.78 428.04 ✓ 7298620032 0/07/2021 0/08/2021 10/12/2021 10/12/2021 7298782701 7298869918 1006210837 16807754 1151nvoice 115lnvoice 7.86 2.18 393.19 109.19 385.33 ✓ 107.01 ✓ 7290782701 7298869918 0/08/2021 10/12/2021 7298B69919 16807764 115Involce 26.22 1,411,03 1,382.81 ✓ 7298869919 0/08/2021 10/12/2021 7299007312 1007210829 1961nvolue 10.3D 51BA5 509.06 ✓ ,r 7299007312 0/08/2021 10112MO21 7299007313 1007210934 115lnvcice 2.75 137,46 134.71 / 7299007313 For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of 10/08/2021 Page: 001 To eneum proper Credit to your account, detach and mum able a,,,emy: moo stub with your rebalance DC: elt5 As of; 10/06/2021 Nige001 WALMARr 10981MW MED PHS AMT DUE REMITTED VIA ACH DEBIT Territory: 400 Mall to: Comp: s000 MEMORIAL MEDICAL CENTER Statement Jar Information only AMT DUE REMITTED VIA ACH DEBIT VICKY KALISE( Cuatomer. 256342 Statement for intonation only 815 N VIRGINIA ST Date: 10/09/2021 POFfr LAVACA TX 77979 Cue: 256342 PLEASE CHECK ANY Date: 10/09/2021 ITEMS NOT PAID (1) IF column legend: P = Pawl Due Item, �e11o1�61fYlEcBWli I6eSR�36 blank = Current Due Item i 'OTAL• Customer Number 256342 WALMARr 109E/MEM MED PHS Subtotals: 7.796.06 USD Mum Due: 0.00 Due If Paid On Time: If Paid By 1011212021, USD 7,640.I5,.//� hurt 0. 0.00 Pay We Amount: 7,640.15 USD Disc lost it paid late: 155.91 AM payment 9,404.61 If Polo After 1011212021. (`]LI' Due It paid Late: 0/04/2021 Pay this Amount: 7.796.06 USD USD 7,796.08 APeR )YLD 401 OCT 14 2021 CAL:St5071 SLiN.1^t°P. TP:KA,R For AR Inquiries please contact 800-867-0333 t or t STATEMENT Statement Number: 61760076 AmerisourceBer'gen` Date: 10-08-2021 AMERISOURCEBERGEN DRUG CORP WALGREENS H12494 340E m01352841037W"a6 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER SUGAR LAND IX 77478-6101 1302 N VIRGINIA ST • PORT LAVACA TX 7797E-2509 sat - Fri Due In 7 days DEA: RA0289276 866-451-9655 AMERISOURCEBERGEN P.O. Box 905223 CHARLOTTE NC 23290-5223 Not Yet Due: 0.00 Curet: 1.080.13 Past Due: 0A0 Total Due: 1,080.13 Aunt Balance: 1,080.13 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 10-04.2021 10.15-2021 W69537283 163036 Invoice 15.32 0.00 15.32 10-04-2021 10-15.2021 3069537284 163037 Invalce Won 0.00 16.05 10.04.2021 10-15.2021 3069537265 163038 Invalce 0.09 OM 0.09 10-04-2021 10-15-2021 W69637286 163040 Invoice 33.85 0.00 33.85 10.04-2021 10-15-2021 3069563397 163087 Invoice 345.48 O.OD 345.48 1045-2021 10-15-2021 3069691503 163093 Invoice 27.11 0.00 27.11 10-06-2021 10.15-2021 3069826831 163100 Invoice 38.42 0.00 36.42 10-D7-2021 1045.2021 3CO9088855 5213882777 Imoice 26.52 0.00 2652 10.08-2D21 W-15-2021 3070098993 163115 Invoice 577.19 0.00 577.19 10.08-2021 10.15-2021 3070098994 163116 Invalce 0.09 0.00 0.09 Current 1.16 Days 16-30 Days 31-60 Days 61-90 Days 91.120 Days Over 120 Days 1,080.13 0.00 0.00 0.00 0.00 0.00 0.00 Thank You for Your Payment Reminders Date Amount Due Date Amount 10-08-2021 (889.53) 10-15-2021 _- 1,000.13 s.-a60c:a Total Due: 1,0 0.13 et4 OCT 16 2021 50023q C*%m0V AMWOR CALMIM ZOVI\^t'l','1 XW' I STATEMENT Statement Number: 61807838 Amensou(CeBePgew Date: 10-15-2021 1 or AMERISOURCEBERGEN DRUG CORP WALGREENS 012494 340B 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER 7747t46101 1302 N VIRGINIA ST PORT LAVACA TX 77979-2509 F1001352641101370281WSUGARLANDTX DEA: RA0289276 866-451-9655 AMERISOURCEBERGEN P.O. Box 905223 Not Yet Due: am GHAftLOTTE NC 20290sv223 Cunene: 28].61 7EI Peel Due: coo Total Due: 267.81 A000unl Balance: 267BI Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Recelved Balancei Data Date Number Number Type Amount 10-11-2021 10-22.2021 3070234763 163124 Invoice 24.61 0.00 24.61 1411-2021 10-22-2021 3070234764 163126 Invoice 96.57 0.00 96.57 10-11-2021 1422.2021 3070234765 163127 Imcice 0.09 0.00 0.09 1D-11-2021 10-22-2024 3070266252 163173 Invoice 76.62 0.00 76.62 10.13.2021 10-22-2021 3070536658 163186 Inwice 19.75 0.00 1976 10-14-2021 10-22.2021 3070671106 163193 Ireoice 15.34 0,00 15.34 10,45.2021 10-22-2021 3070810411 163203 Invoice 34.39 0.00 34.39 10.15-2021 10.223021 U2791170 163093 Invoice (6.W) 0.00 (6.33) 10-15.2021 1042-2021 342791171 163093 Invoice 6.57 0.00 6.57 Current 1.15 Days 16-30 Days 31-60 Days 61.90 Days 91.120 Days Over 120 Days 267.61 0.00 0.00 0.00 9.00 0.00 0.00I Thank You for Your Payment Date Amount 1015-2021 (1,0B0.13) n em.3veo e1v ON 16 2021 65002t11 CO3- y AM-*wm C 43d_d1'1': df:S3af,?3'n^AS Reminders Due Date Amount 10-224D21 267.61 Total Due: 267.61 IN STATEMENT statement Number. 61740975 AmerisourceBergem Date: 10-01-2021 1 or 1 AMERISOURCEBERGEN DRUG CORP US SIOSERVICES CARROLLTON MOB - 501 PATRIOT PARKWAY 5025 PLANO PARKWAY SUITE 100 TX 762a241336 CARROLLTON TX 75010 FllD270691101862;8707:ROANOKE ue In 7 d DEA: RA0316958 8fi8-451-9655 AMERISOURCEBERGEN P.O. Box 970740 Not Yet Due: 0.00 DALLAS TX 75397-9740 Cunent: 55.00 Peet Due: 0.00 Total Due: 55.00 Acwunt Balance! 55.00 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Receivad Balance Date Date Number Number Type Amount 09-27-2021 10.00-2021 342571093 Invoice 55.00 0.00 MAD Current 1.16 Days 1 16.30 Days 31-60 Days 61-90 pays 91-120 Days I Over 120 Daya 55.00 0.00 0.00 0.00 0.00 0.00 0.00 Reminders Due Date Amount 10.00-2021 55,00 Total Due: 55.00 AP3AOYW dN OCT 10 2021 CO1,.,?T AE WOR CAi,FiCrdPt 92tl;',"i','fA"Iv1B Ply) via 2`44 - 3'l•zb ' MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNTOctobera, 2021-October 15, 2021 1U`d0 Dose Qank Deacriptio MM[N t Amount L 1 7 4 10/0/2021 STATECOMPTRLRTEI452579291101OO 00P8190002 10/8/2021 PAY PWSACHTBAN545252929110100D691899028 Payment lame 43394.ODj' 3rdB ny, Favor Payor Fee -@,53f)r 1/1212021 AMERISDURCEBERG Dru 340E Drug Program Expense 889.M G' G C S DISCO NT 390MANS )M6610D02 10/12/2021 TSYS/TRANSFIRSTOISCOUNT393009825899466110 Credit CAN Processing Fee 10/12/2021 TSYS/TRANSFIRST DISCOUNT42390WIBM9761M . Credit Card Processing Fee 595.23 556.35 l�yalltl 10/12/2021 TSYS/TRANSFIRST DISCOUNT 41NO23918376110 - Credit Card Processing Fee jC)� �l T 10/12/2021 TSYS/TPANSFIRST DISCOUNT 413998013918316110 - Credit Card Processing Fee 111.34 111.34 TSYS/TRANSFUSM DISCOUNT 4139900I3324196110 Credit Card Pm<casing Poe 214311 Jib' 10/22/2021 10/12/2021 TSY5/TMNSFIRST DISCOUNT 413990025323856110 - Credit Card Pmressln8 fee 554,03 1 1 y(1 .. 10/12/2021 TSYS/TRANSFIRST DISCOUNT 40993023MOl 6110 - Credit Card Processing Fee 54.03 10112INRl TSYPLUSACHTRADISCOUNT -Credit Card Fee 5 `z '� 1 4 9 10/12/2031 PAY PW3N NS 579291998013324016130 Bid Payor Fee Air Fee anal,2.08 DRUG AUICACH ACH0I600189IO299 10/12/2021 MCKESSEXPEAT0N OXPERTRE10.000341126361891000D142 -3ild Drug Preaym E%-Pose 9104-'D-lif L)54 30/32/2021 EAY Payment -Payroll Ending .619,67,.E y!1 - 11; 's J PLUS 10/13IM21 PAY PLUS ACHTRANS 4525T9291101000693852254 ACHTRRTPAV1579291101000693852254 add iffySupPI -3rdrim'.yorfee 2591- 10/13/2021 PAY PLUS 29110100U693150444 - 3rd Pady Payor Fee ;72AO J 1 I ' > t ' GAGELEEACHTEANS CUAR525T9 10/14/2021 CLEPAY 4525799110100SN4954062 -Patient Financing ]2]0 10/15/2021 PAY PLUS ACHTRAN5452579291 PLUS ACEITRAMS ymFServiw -35d Party Payor Fee g0.54 L.n--:' E LI rJ li �. C - 9291 IOIMB5946676 r 10/15/2021 PAY PLUS ACHTMN5452MNTS01 10/15/2021 - 3rd Party Payor Fee rla ycl i-�/A� AMERISOURCE CM77682106 260i100602 0419 3400 Dreg Program Expans0 08-0,54 1080.16** Vr'1 NTY DR$ RECEIVABLE 10/IS/2021 TEXAS COUNTYICARECEIVLLL7460021000025246 21 Retirement Funding stN- 61It LI 10/15/2021 MEMORIALXPYMT2W168892DS650061036000279 -Payroll 306230.SU4 302710,50 (i 14 ' 10/IS/2021IRS USATA%PYMT 22016009IDfi65026303fi03002t29 .Payroll Tacos 96W5.104 e; I C14�Ly�S�- �,. rz 4u 1 - OdPber 1-2021 r Jason Anglin, CEO 3�'3Wl�'T"6 be. 10,1", 4 i )' 1 F, 7 • '/ b " q Memorial Metli[al Cent F- j04fj-914uI IOdh21 U. 4 " b V'. PROSPERITTBANK �'•r`T-�'',A Y R-FIPpwJ. m.FH'zf co 61bLO ' ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT - ESTIMATED ACHS + n1. UR'.vT--LI Cc. Date Diniabitlon Notes Amount � . -/ µ ... L 11/312023 20225eTddnmtl Payment 93,832.00 43,837.O0 October 19, 2021 lason Anglin, CEO Memorial MedicalCenter OCT +q 2021 I;3EfYN''i 1lA.k3UV. C Ai.ni,ld,%tdle,�t5'.'eRX.11; Transaction Summary Transaction Complete Trace # Texas Health and Human Services Commission Memorial Medical Center Operating County Payment Total 1 $43.837.00 Bank Routing and Account Number Settlement Date 11/312021 DSH Amount $43,837.00 Entered By Marley Moehri Page No:1 of 1 Run Date: 10rl812021 Run Time: mao:oa Transaction Summary Trace Ni.lmber: _ ) has freer, deleted successfully. Texas Health and Human Services Commission Memorial Medical Center Operating County Payment Total Bank Routing and Account Number Settlement Date 11/3/2021 DSH Amount $43,394.00 Entered By Marley Moehri Page No: 1 of 1 Run Date: 1811812021 Run Time:ll:sa:01 Proposed Method for State -Owned Hospitals Non -State Owned Urban 5 Public Hospital class 1 3 Nan -State Owned Urban 15-6 Non -State Owned All Other Won-arareuwneo Icuss Texas Health and Human Services Commission April 27, 2015 351,410 983,267 834,825 1,188,235 1.186,236 71,405 400,143 132.831 204,238 204.236 1,560.964 7,687,053 1,991,520 3,552,484 3,621.431 Texas Health and Human Services Commission April 27, 2015 42,231,541 42,231,541 1.858,053,277 490,386,887 1.264,100,626 1,856,053,277 7,271,064 7,271.064 240.286,813 53,079,519 167,948,223 - 240,286,813 128,927,745 128,927,745 2,780,883,109 534,350,953 888,695,985 69,543,620 2.717,339,490 iaa Texas Health and Human Services Commission April 27, 2015 42,231,541 - 1,813,821,737 845,009 43,076.549 21,216,808 7,271.064 - 233,015,748 108,655 7,379,620 3,634,738 126,767,306 2.160,439 2,590,572,183 1,206,875 127,974,181 4,923,500 Texas Health and Human Services Commission April 27, 2015 IMD CHECK $5,974,756 58,108,559 122,401,916 122,401,916 - 1,733.651,361 71,223 122,473.139 - - 11,014,358 11,014,358 - 229,272,455 9,419 11,023,777 132,897,681 132,710.855 186,826 2,584,628,634 106.184 132,817.039 (61,653) 58,108,569 266,313,955 266,127,129 180,826 4,547,552,450 186.826 266,313,956 (61,653) Y a $0 $132,743 $132,7431 $0 1 $2,304,682 $95 $132,838 $0 Texas Health and Human Services Commission April 27, 2015 23,504 32,097 79,380,968 1,733,580,138 43,092,172 3,108 - 3,637.846 229.263.036 7,385,931 2,943 - 4,864,791 2,584,522,451 127,962,248 29,555 32.097 87,883,605 4.547,355,624 178,430,350 b I hEW r.. N $2,304,788 $89,002 $31 $0.00 - $43,837 Texas Health and Human Services Commission April 27, 2015 u 00i 122,473,139 79,380,966 11,023,777 3,637,846 132,817,039 4,864,791 268,313,965 Texas Health and Human Services Commission April 27, 2015 To: tracy.betts@hcmhosp.com; bfkalmus@mdanderson.org; jsharp@mchd.net dsmith@columbusch.com; cmh.sbamett@cogdellhospital.com; ujohnson@jpshealth.org; carta.davila@mhshealth.com; afutch@seymourtexas.net; radha.savitala@crmc.health; dgarcia@echd,com; kwalsh@wiseheaRhsystem.com; sherrie@wshd-txcom; tlancaster@freestonemc.com; veronica.kimbro@electrahospital.com; anna.smith@hmh.cc; jstanley@comanchecmc.com; jaertker@ecmh.org; r.haddad@dhr-rgv.corn; jared.brown@smmcbr.org; Rob.tyler@signaturehc.com; ereimer@grmedcenter.com; halvarado@lambhc.org; dhaehn@ccmhospital.com, claudia.falcon@vvrmc.org; jmenking@hillcountrymemorial.org; Elia.Stokes@cookchildrens.org; thorton@lavacamedcen.com; ssutton@cuerohospital.org; mchong@dimmitregional.com; cwhite@fishercountyhospital.com; klahey@bkd.com; ss siegert@olneyhh.com; sabrina.hiett@stonewallhospital.org; talford@sweenyhospital.org; te.contreras@umhtx.org; mruff@wghospital,com; apuckett@ppgh,com; mbermea@lchdhealthcare.org; TPfahning@permianregional.com: CRodriguez20@primehealthcare.com; Iflores@umcelpaso.org; pgonzales@ansongh.com; kparker@rankincountyhospital.org; ryan@ahcv.com; terrell.thrasher@umchealthsystem.com; nnlim@texaschildrens.org; germis@stlukeshealth.org; mklock@matagordaregional.org; lauram@bmhd.org; tfhastings@starcarelubbock.org; Marley Moehrig; tammyz@jchd.org; bbrewer@fallshospital.com; beverly.montez@okmh.org; shawton.hankins@hcahealthcare.com; laurend@dhcg.com; kvoss@throckmortonhosp(tal.com, ncooke@martinch.org; rol7Bs82@yahoo.com; heather.corder@emhd.org; christophecfrierson@strategicbh.com; Susan.Hodgesl @BSWHealth.org; nicoleplain@texashealth.org; jaclynn.harrison@christushealth.org; Neil.Graff@ardenthealth.com, tricia.sanford@tsrh.org; miwilliams@lmchospital.com; Margaret Haak-Muse; j�acob@utmb.edu; aimeeplowman@mhd.com; mwallace@sunhouston.com; denise.green@redriverhospital.com; mance.fine@childrens.com; kevin.mulvany@myfrh.com; frey@gl-law.com; Steve.Broman@HCAhealthcare.com; melissa.wheeler@cedarcresthospital.com; jgulihur@rchd.care; jsmith@medicalartshospital.org; diana.strupp@tenethealth.com; scarruth@obmc.org; brichards@oceanshealthcare.com; megan@pm-hs.com; rmdowles@utmb.edu; cclark@hilirh,com; cochua-faustino@houstonmethodist.org; elviah@mangoldmemorial.org; bfoley@lubbockheart.com; matthew.herbst@memorialhermann.org; Wanda.pierce@memorlalhermann.org; tony.coronado@memorialhermann.org; a.zinni@crockettmedicalcenter.com; Keri Disney -Story; sara.cowan@utsouthwestern.edu; stephanie.swanson@utsouthwestern.edu; martinez@gl-law.com; capeto@gl-law.com; dolveral@covhs.org; laura.case@cchdonline.com; vreasoner@gracehealthsystem.com; sparde@bkd.com; paslin@chambershealth.org; julieh@rpmh.net; Isurvant@st- joseph.org; carmen.campos@riovistabh.com; priscitla.saiz@conchoch.com; bertodatto@gl-law.com; brian.schrayer@ardenthealth.com; Shari.Collier@stdavids.com; Julie.T.Page@uth.tmc.edu; laura.williams@adventhealth.com; kara.cox@coryellhealth.org; kaylac@brownfield-rmc.org; flodone@ttuhsc.edu Cc: HHSC PFD DSH Payments, Brown,Adam (HHSC); Okoniewski,Amanda (HHSC); Kaminsky;Kathryn (HHSC); Guzman,Kenneth (HHSC); HHSC PFD Uncompensated Care Tools; Wotfe,Megan (HHSC); Michalik,Ed W (HHSC); Grady,Victoria C (HHSC); Cantu,Rene (HHSC); Regmi,Asha (HHSC); Heinemann,David (HHSC); Dovalina,Jose (HHSC); Heinemann,David (HHSC); Jacques,Robert (HHSC) Subject: REVISED DSH 2O22 Advance 2 Notification 1 of 3 Attachments: 2022 DSH Advanced Payment 2 CalculationJRDRevisedl01821.xisx; TexNet User Guide.pdf WARNING -Remote attachments, VERIFY SENDER- C., Ifi=ON: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. DSH Providers: Please see attached for a revised Advance 2 Disproportionate Share Hospital (DSH) 2022 calculation file. This updated calculation is to account for a provider opting out of this advance payment. Providers that have already entered their TexNet submission should cancel their TexNet and reenter the revised amount. The TexNet User Guide is attached for assistance on how to cancel a TexNet. HHSC apologizes for any inconvenience. Please let us know if you have any questions. Thank you, HHSC Provider Finance Payments (Formerly Rate Analysis) Texas Health and Human Services Commission Attention: Provider Finance Department North Austin Complex 4601 Guadalupe St Austin, TX 78751 Mail Code H-400 P.O. Box 149030 Austin, Texas 78714-9030 TEXAS `+rr=�t�. r♦;�.�itti arrcJ 4u.r:,v, yL :rryi(Q'. DSH Providers: Attached is the FFY 2022 DSH Advance 2 Payment Calculation that details how HHSC calculated the advance payment/IGT amounts, and related IGT Notification spreadsheets. Payment amounts/transfer amounts for state hospitals can be found in column V of the "State" tab and the corresponding IGT amounts in column W of the same tab. Payment amounts for non -state hospitals can be found in column AW of the "Non -State" tab and the corresponding IGT amounts in column AX of the same tab. To ensure that all government entities receive this notification, HHSC strongly encourages providers to send this to any government entity who is IGT'ing on their behalf. Please also note that the current 2022 DSH Advance 2 Payment calculation continues to use the state payment cap calculated in the 2021 applications. Accordingly, it is up to each provider to determine if it should opt out of the advance payment due to the concern that their 2022 state payment cap cannot support it. Providers who have a state payment cap that cannot support the DSH advance payments they receive will be at risk for recoupment when the final 2022 DSH payments are calculated in May of 2022. The following information pertains to 2022 Second DSH advance payment. All payment dates are calendar year 2021. I. Key Dates October 18, 2021 HHSC notifies of payment intergovernmental transfer (IOT) amounts November 2, 2021 Last date to transfer funds into TexNet November 3. 2021 lcXNet settlement date November 12, 2021 Pay the transferring hospitals (Urban public hospital -Class one) November 15, 2021 State Owned Hospitals submit Journal Entry November 19, 2021 State Owned Hospitals paid November 30, 2021 Pay remaining DSH hospitals 11. November 2021 Advance DSH payment Which hospitals will receive an advance DSH payment in November? Hospitals that received a 2021 DSH payment are eligible to receive a 2022 Advance DSH payment (subject to the availability of the non-federal share of the payment amount). Since this payment will be made before HHSC has determined qualification for 2022 DSH, a hospital may opt out of the November payment by sending a written request to 11SHPat tnetlis_ rih%._<;;asao_ by October 30, 2021. Hospitals should opt out of the October payment if: 1. The hospital is concerned it will not qualify for 2022 DSH; or 2. The hospital is concerned that it will be overpaid for 2022 DSH based on YTD advance payments and the costs calculated in the providers' 2022 DSH/UC Application. Does a hospital need to do anything to receive the October payment? All public hospitals will be required to transfer funds to HHSC in order to receive a program year 2022 DSH payment. Urban public hospitals are required to transfer 100 percent of the non-federal share of their Pass One and Pass Two 2022 DSH payments and non -urban public hospitals are required to transfer 100 percent of the non-federal share of their Pass One and Pass Two 2022 DSH payments. Urban public hospitals class one and class two (see below), (i.e,, those owned by a governmental entity that has historically funded DSH payments) do not need to do anything prior to transferring funds into TexNet. Urban public hospital - class one is a hospital that is operated by or under a lease contract with one of the following entities: the Dallas County Hospital District, the El Paso County Hospital District, the Harris County Hospital District, the Tarrant County Hospital District, or the University Health System of Bexar County. Urban public hospital - class two is a hospital that is operated by or under a lease contract with one of the following entities: the Ector County Hospital District, the Lubbock County Hospital District, and the Nueces County Hospital District. Non -urban public hospitals may need to take certain steps. A non -urban public hospital is: 1. Any hospital anywhere in the state that is owned and operated by a non -state governmental entity (other than one of the entities described above); or 2. A privately -operated hospital operating under a lease from a governmental entity in which the hospital and governmental entity are both located in the same county with 500,000 or fewer persons, based on the most recent decennial census, where the privately -operated hospital and governmental entity have both signed an attestation that they wish the hospital to be treated as a public hospital for all purposes for 2022 DSH and 2022 UC waiver payments. If you are a privately owned hospital who has submitted an attestation to be treated as a public hospital for prior DSH payments, HHSC will continue to treat your facility as a public hospital for the purpose of DSH and UC payments. Privately -operated hospitals in this category are `rural public -financed hospitals" and are eligible, along with rural public hospitals, for Pass Three DSH payments. All non -urban public hospitals should ensure that the governmental entity that owns the hospital is aware of its obligation and prepared to transfer funds for the November payment. Any governmental entity that has not previously transferred funds through the TexNet System for an HHSC Payment (i.e., Uncompensated Care, DSH, and DSRIP) must enroll with TexNet to submit funds for this payment. The TexNet Enrollment form can be accessed at ht=.; Private hospitals (i.e., privately -operated hospitals that do not lease from a governmental entity and hospitals described in item (2) above that do not submit an attestation form) do not need to do anything to receive the November DSH payment. How will payment and IGT amounts be calculated? To calculate the November payment amounts and distribute 20% of the 2022 DSH funds, HHSC well use the methodology described in 1 Tex. Admin. Code § 355.8065 for interim DSH payments, but will use hospitals, 2022 interim hospital -specific limits, Medicaid days, and low-income days. Ill. Remaining 2022 DSH funds Which hospitals will receive subsequent DSH pay ruts? HHSC is distributing 2022 DSH funds over four payments. Only hospitals that received a 2021 DSH payment and submitted a 2022 DSH/UC Application will be eligible for advance DSH payments. Due to the timing, HHSC has not verified that providers who are included in the first 2022 DSH advance payment calculation have requested a 2022 application. If a provider slated to receive a 2022 DSH advance payment knows they are not going to request a 2022 application, they should opt out of receiving this payment. All hospitals that meet the DSH qualification criteria based on data in the 2022 DSH/UC application will be eligible to receive DSH payments that occur after the applications are processed (subject to the availability of the non-federal share of the payment amount), including hospitals that did not participate in 2021 DSH. How will payment and IGT amounts be calculated? Using information from each qualifying hospital's 2022 DSH/UC application, HHSC will use the methodology described in the DSH rule to calculate a 2022 DSH payment amount. For each hospital that received one or more advance payments, HHSC will reduce the 2022 DSH payment amount by the sum of such payments. HHSC will then determine IGT obligations. If a hospital received an advance payment and later submitted a rural public -financed hospital attestation form, HHSC will increase the IGT obligation for the governmental entity that owns the hospital by an amount equal to half of the non-federal share of any 2022 advance payments. Wilt there be a Pass 3? Once the final 2022 DSH payment amounts are calculated, HHSC will determine if any 2022 DSH allocation funds remain to be distributed through Pass 3. If such funds are available for distribution, HHSC will work with rural public hospitals and rural public -financed hospitals that have submitted the above -referenced attestation to determine Pass 3 payments and required transfers. Pass 3 payment amounts are not calculated for advance payments. What if a hospital receives advance pavments but does not qualify for 2022 DSH? HHSC will recoup the entire amount of all advance payments made to any hospital that does not qualify for 2022 DSH. What if a hospital's advance payments exceed its 2022 DS14 navment amount? HHSC will recoup the amount of any advance payments that exceed the 2022 DSH payment amount calculated using the information in the application. Any hospital concerned about potential recoupment should opt out of receiving advance payments, as described in Section Il above. For additional information, please contact t 11± asp _ ** Note that if you have not already enrolled in TexNet Connect for HHSC Rate Analysis you will need to do so immediately. Information pertaining to enrollment can be found at: _ r_ Please ensure you select the DSH bucket in TexNet when you enter your IGT. It is imperative that you send a screen shot/PDF copy of the confirmation/trace sheet from TexNet or an email with the confirmation number and IGT amount if the TexNet is submitted over the phone, to Please include two contacts with their phone numbers and email addresses, should HHSC have any questions regarding the TexNet received. HHSC will not confirm receipt of emails Please set your email settings to request a delivery receipt, if a confirmation is needed. Please let us know if you have any questions. Thank you, HHSC Provider Finance Payments (Formerly Rate Analysis) Texas Health and Human Services Commission Attention; Provider Finance Department North Austin Complex 4601 Guadalupe St Austin, TX 78751 Mail Code H-400 P.O. Box 149030 Austin, Texas 78714-9030 tv TEXAS t, Health and Human ` ; Services Request for Transfer of Funds nanslerp: Oete Requeste6 Payer Requested by: RegYena,arell gequeswls pgr.a nnmher oh..nrmnnn Facility ,..I.e—,.P l xrarouP:eut Pl.W P—.. POP W wxpna d.. rneren�cr6amn nmararara. eal9mmm Wllara[x ru P.MetN. R 16EQ] O.ee nE4rvlm RE EIIREO W@Ol PdrrMnt Treeofyavme tl E P nt LMrY NurM¢r M..NYmher Mlenn..e.a. Enter l��mr-rar Eeaml. W233E5 NNes EIS: M_p_op N/A N/A 9/3OM EFT 4913W EFT65Mim CVOPRMO96669 BWROMOOPATLPFERIOE N/A N/A 10N/1021 EFT 8.31BA6 EH6113934 UMPM16869 19400 BROACMOt1RATME8510E N/A N/A 10/e12W1 [FT Mris EFib5151PP NWRWW16069 1901 BROAOM00RATEREWIVE TOTAL fi59161 6e4Bb MleBput Memarltl Medkal hntm .ahe OaleP ]0 1< 3011 ApprwM by; Mays MarlRrea T. O 'M 1 1 - kY di fBRO�WIu]:jFl%I II' r I: Amaun12O 6g4.P6 Oate YllnnS(er: mm Jra, To E. ATgYel:nI: . y 4N OCT i B 2021 4'(6lSydy AL@L0.ryQ Request for Transfer of Funds rraaarer p: Oxa Requ..d 10/18/3021 Payer Requatlea by: Ad,W.a51.koe Requetlo't email Requee.rphone number Olserlte er CaunN FulllN MMcMic FOB ir't Ski niS1�VL•. nneae xam. pneprsema E IRE o1 Pe Tme Wveam mAeu YEYmF9[ how a L paRM Rellen nnelMFnNr Nam unr FMeem IO YOY Raen vx33.R5 N/A / N/A 9 H 3@I EFEM0M OSa NOARM019SS] THEMEANT N/A N/A 10p/3021 iEffn EFr &278.60 8.399.ah EFffillSM 394.N THE MESFNT N/A N/A 10/B/E031 IF 393.55 FFT6115399 MARW001955] N0AR0]001955] 19.01 THE MFSfNT TOW1 13j91M WO Ta h<011etl oW Memotlal MCElul Lenten App ett AOproveaby: CaR ln[euemer mrt oimn. 1y n Po Facli I. CTMcV. To Feellity: MMCYNIC Amount 1TcROY35i �i OCT 1 L 2U11 cdv�A CAEHOIN RobWqv.� Request for Transfer of Funds rM�ner p: mte wegeeme Aayo R.wve.Eed eN Pe9ue.mra<men ne9uea3or. vnone number omdeaameary Faallry Mkol Name ft UI FO Oattel4Mee RF 1 E TweeEParmen Ate— permene N Xu A.waameee 1,0r.:v.4.W bmM anm a WA N/A 9/24/2021 EFT a,913W ERGIMM WW:ROOWIGI)0 233,65 SOLEMWESTIIOUSTON N/A N/A IOJ71WZ1 EFT 81218,M E96113984 W0MWW18170 39Q00 WLEM WEST HOUSTON N/A N/A 10/P/3011 EFL 399.55 FFTG 115)Hw CVMPOWJIwI)0 19A1 3OIEMWESTNOUSTON roWl U,591.b1 WG.86 lobe plledautC Memodel MedkalEmha: ata ee ] 1 EO2l Appmved 6y: Ma aMa:iMet tool Vansln: 1 30 3021 Tofazlllry: MM LHI T.F.1",iry: MMCCLINIC AmaunN 6e6 P6 tew f,rtantlxoemak Fmm Fatlllry: ON TO FaNllty: Amounl: OC1 14 LULI ca3sVM Amw: . (:ALM9RD3 C(•3BSw' , +8X Request for Transfer of Funds nan:fer R, 00[e Req:Rsree Payer Requested by RequeROYs6Ml1 Requutefi OxPne numE[r Gabor or Coonty Miiliry M.- ylayC..oL:, ylkm x.M f YI 0 OateWxMtt 0 YI FO I LOWFEM PGmnmo Pavmpm [Mv0_ CEFT6Number EM13930 GAG unWer NOp0pW019590 gmn.mm.a.mxr IunlsFlw Nord.Nl xoK[ GOLDEN CREEK 53305 9/E9/EGE1 EFT <,913Lp WA NIA A NIA 101E/E0E1 EFT B,39956 EFT6113904 NOARM 39E 00 GOLDEN CREEK NIA NIA 10/B/2021 EfT 399.55 fFT6115E00 OE9MO N0nPM00E9590 19.01 GOLDEN CREEK TOTAL 13591.61 Gi06 TO be nlled outby Memarlal Medlol Center: Go. 0.e[e e 1 liImOL p9Pmved by: tenet Date.11.o f.1; E1 fmm h[Inry: GOLDEN CREEK To F.Ell MMC CLINIC Amount b0 irom FsiillRoo- Do iN of n gmoun4 cow.-oiA".'B — CALROVNVneSPM,TPB' AS Request for Transfer of Funds Tansierp: OEte Requatgtl ]0/10/30E3 P[Yer RequHicd bg Adll.lil SXhat Regveltghemel RegueltaRO1lone number OIEtXnerC.unN PoLllby MMCllpl[ F.nM[x. IR m pebnrservl[e E N0.Ep pel al noe nr P.rment CM1 [ E Peet' nl�ne GFtSIMILe[ Im Hu b [ dnMn..e.e.ux. mnea.I n.Pone.m XetIE yM1Owno N/F N/A 9 9/M/3O31 EFT 4,913.6O EITISM)3e NDARWCp0]9 333.00 AUYVIWGE N/A NA 1o>SO3] E17 0,33OA6 ERGiisms S NOARM0039OO 394.E0 TU N/A N/p ID83O31 EFT 39A5O fR61152O0 NpppWp0039O5 19.01 TUSaNYVIWGE iUSGNY VIWGE ipiA[ 13,69t.61 W6.86 To be filled Oxlb Memodel MedleelLMlep pe • . M 3031 APPmved by CxlllnC rvel:gr pale oFaciehlity. 30 3 1 From lift, N: manv. Te ...t:: MME.,INIC Amounp 06.06 ATi aiN ocT 18 202i Mernarial Medical Center Nursing Home UPL Weekly Centex Transfer Prosperity Accounts 10/18/2011 4[miR OW,, WI.,— xM p.rvYep aa.,.— Mvvmwbinn,3nrndln Nunky YnlMx.m. x.mb.. 9m,v mnnw.ar nmwxnM .o. Ix a.I.n[. Ikilljy/d 6bLNkt n,W;.11 .4).49)55 151.49485 ✓ ]59,9996; ✓,", 155,199.41 bnkblanu I55.999.01 Varlan[e Leweln0tlen[e 104.00 ORIN]FPEfi OFCIHRPFSr AEIun RalanuRnntlu Rm: / 155,099.41 y BIOIdIMter >;.14)Je �/);,44].30 �4,33940 24,439.40 23,692.54 Bankaffin[e )4.439A0 lewein eaonw iW.a0 MEDVARCPEPAYMEN37OMMCYNIC 646.86✓ OCTINRRFn NOVINEER53r O[CINBFflfSr AtliuR Oalan[e/runr]er Aml Sa,6p254 �/ Q'Isco N 3n,]b.00�/I6,])135 41,19f.5] v ✓ 45,759.04 45,032.16 bnk Mbn[e 1 45,759.04I Var4n[a 4welnblan[e One. MF01[ARFRFPAVMFXTTOMMWNIC ` / "&as ✓ eeceemERl1T NOVINRRFn 41nxnRin Ad,11 blrnttRunder Pml 4s,612.10 ✓ Fdn Bond• 14,9)).39✓ 12,86675 e/9,305.0 j ✓ 11.495.64 11,195,64 bnkbbn[e 11,495.64 Vatlanu 1w..ma.Llx. 100.00 n MRM , NOVINTFRE4T OFCINTFRM AElnfl bhnce/Tnmly Rm: 11,39sA Sme7RRTWN614WIN: 34,3294a T/34.229A8 y63.3]6.64 ✓ Bank Ralantt 0,47444 63,416.64 62,729,79 Vu1MGe Iewelnblantt loom MFOICAREREFAYMMTTOMMWNIC 646.99 p� OCT 1 u 2o21 ORINTFAF9T C(iYvNZY Awmwh .a ObCIN)ERCn WTAETRANVin 290.729.55 A monad: ` � rornumbpM1wne. lasso Rn(Iry CFO 10/1R/E021 NC arpFreO ra pen x[wnl. 1{Xx WerIN nw dMV1X UP1Tnnxx5Ymm4ryUV31\OgebnINNVPilrvnvfn5umm,ry 19.1611.Nv 116fpHU�IMi ]d6/3Wl UXC COMMUNIry PI NUNIM9M])YA01}119t0]W 10/t/IW I UNf COMMVNIp II N[EMIMPMC]NAON119IIXM Ida/SOIL CIO NA MCC WIMOMl13xK3611991MN1i11]UO IdwSUI EF tUM Lo/upeu 4 usfi 1011E/]Oxl MANIH HT ll/)Oxl HEALTH GICMHUMAN U AN SV C HCICMLUIMM PxMfIWTAO]A4d]WI AmNIVN,THI LAIMPM,IUAIII.W Ai1i9]t. UNI2121l HNIII NUMMNSWI1MTIll m/u/foh Am4efmvp5LAINNAp111.l5IVA1IMNG 1011]/1011 .5 1HICIMM11,226,55,N1 )013II0il UMCM.MUNM1lLHCNIMPMTI034U91M 0IA IOWplS YHCURA...pK.CMIMPMI].HNSW191M95 N3d 1 t ?-, 10/I2/3011 CAN, INUMOSl CAM. INWOUNI CAW 1WRIP-31 C. u6 1,1111011 CRISIS fWRIPARS C. IN,1NSSUOII.UP 10/11/1011 "116 IN 112011 N"NOUT AUN. OWN CANC NMRIS NI 101/1/1021 MI. 1Of 212;1 XGIIN HUMAN ON IICCNIMPMT LIKML313Cb1 f0/31/loE1 HUMANA INS CO NCCWMPMT 390161 1OOD3695246 INAVI011 URIC COMMUHpY 1L NCCNIMPM!)KOSI41I91WLU IN" 011 XCAITN NUM,SNWCHUWMN PMIlNIMOMI SO, ROSS/ C.Ibfi SCISSIONS C9133 IO(IINPSI .,?I ,,WINS C.111 1-112,1021 CRISIS 10/3L2011 CNI1! l0/11/]2 CAR ld l]/]011 C[119 1d1111021 Cepm SdIL1011IMNN6NXMN]il)!1 MNI PMM p1lN 45 tdli0011 XOVRAS SOIVxON NCLWMPMi 6)1315 ASMN103 IdU/]0]I UIR [OMMUMMRNUNLNPMt ]46MIlll 9lC0?) IdUP011 [0156NN HCCWMPMt M6N3f119IDW0 1044/1021 NW NWITAS SOIVpWNOXSNttW MPMi 616)]I41W W l)1 Y Idllll@l IX160 1011E/SWl CNI61 ldl!/5011 [Fl6l IWSS/Sal tti61 IWINSaI MNP Svpp4mpnU NC[NIMPMl A60a11I ll43N 101101 UNCCOMMUNIttRHCCNIMPMT]KWNL1910a9 S01IO2US02I VH[COMMVNIry RRICCUIMPMi]KW3d11910a0 Idepan un4ex..xnwxaumP4ri4w.lnuN]14 'VISIN31 CARS.NHUAUNSV[HCMIMPMt l]a6W141UW]2 Id11/1011 CFI16] 10/11/2CN171 IO/II/l021al CFIli3 =Nutt I] 1.1170 la aPolS CMtle INII/1021 GMilt WIWI al CMI,9 I0/1I/2at CM168 10/31/Sal WIMON WHSCHUL INGflFC1N)FMlll l0/1)/1al NM&tMVP1MCHUNMMPM111615T1A11lllfL 10/LAUCCI NOVIlp5501UxOXNCMIMP6tt K6110MCN1la ID MUUNU% UNC fOMMUN1ry P3 XCMIMPM 6W341112 9M l(RUNH011 URCCOMMNnIe N[CWMPMPART74 II4NJO 101411021 HUMANA MU NIh MNCCNMMPMr)4KONII91at0 I0114/}O!1 MUMdNA INS CO NGMIMPMr39W61MWaN4f6 TOTAM ISOnpenlHN bin\ Cewmme Io-Naumv mua Llu .9. 3 MMC NONnox dpP/comes n ,J Leo ippp dPP/famP1 dIP/rtmpi dIp/fvmpi A4pn dIP 11 NN PoRSIOH M., ]W W IA3LO.W Sd.iW.CO ]fie 11,41985 . 403.09 - KS.W LOSo si S,oltlsz iASIA'S - d.3a,ll 6.1"3a 68Ku 1.341,95 1,301.91 2. 1 \.1514 r L,KSM3 LILISR3 L.S l.., - ISA36 H.",1 - 5I,369.P - 33r3C9.P aA91.59. 1 151.dSU5 r! Ls1A9<JS MMC PORTION app/Cw N 3 nrSySgrOm TnnN`I^ dPP/CAMPI Olpp/caroi CUPP/C4mp3 64pu WIN NN POpxOX 5969 11.3". - Nov. 9A]A3 9.971.49 ]ISSN L941.]9 ,N).10 d3,5]OS] Ld8400 - SARUM ILIUI39 - 11.)1].19 6,330 Ca 6,334M NAGAII 1,106.IS l A,O4]J0 50.339.M-.� 1C 339b MARCPOFNON T_MPJyry91 }ppR(Vjp dPP(dmpl aPP/Cant, OIPP/Camp] A4pe d11i1 NN POMIOX - SA34N 9,00.30 l3] M48A :ox.]e Y].03 9,91)A9 . L4IS.OA 1 ARTA. I.Ad].IO , A.K169 4.863 IS SAW.m 3AMUA - Ir}36.19 La.." 4,16'. 4,151.92 ID,167.I6 19,161.11 - MIIIA5 4.911.85 i6.1]1!f 4I,1W.}1 e 41 19.1 MMC OARION COPP/cmlW T-UM-0, $9P141IN a99/temp, WHRU.mp} dPP/Camp} 44". aPo 11 NN mum 15.11 11,071.15 1,699.M ]8.9] 11A52.00 AT51.00 2SSRS4 - lwa l LNOK 234961 4,sKAS %usm ✓ 9]Bsm MMC POflTIOh avv/dmp rm4,� T^", .,.4 aPv(cPmP9 deP/camvx a9v/cemPl u,o,l avvn xxv.alax 10.660a IO,KUW 655553 4555a 6].]9 14l]3a6 101.)6 N]A1 9.91. 5.0 L51591.16 Lu]]0 11111.32 ,LAM LO13 6]16 19,699.16 - 5.665.59 2.04162 ] 11pW - 1166559 - S3,00 i;"I, - 5:SW.]9 112.11 - 5,55019 MI]9N 63.316G a.I16.N 312,81155 189.)L.b - I19.I66}p 10/18/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/Name Groups Adn Group Account Type IDDA Data reported as of Oct 18. 202' Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7,017,511.30 $7,185,792.37 S7,017,511.30 $6,346,797.9 '4551 CAL CO INDIGENT S5.370A6 S5,370.86 $5.370-86 $5.370.E HEALTHCARE •4454 MEMORIAL MEDICAL I $171,385.69 $171,385.69 S171.385.69 S16S,466.E NH GOLDEN CREEK HEALTHCARE AM MEMORIAL MEDICAL $535.85 S535.85 $535.85 5535.E CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL S4,481,046.86 $4,610,066.44 54,481,046,86 53,848,446.E CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE S431.41 S431.41 5431.41 S431.4 WAIVER CLEARING '4 81 / MEMORIAL MEDICAL $155,999.41 ✓ 5155,999.41 5155,999.41 S155,999.4 CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $24,439.40 $28,651.40 S24,439.40 S24,439.4 BROADMOOR '4411 MEMORIAL MEDICAL $46,759.04 ` $53,336.24 $45,759.04 545,759.( CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $11,495.64 ✓� $11,616.96 $11.495.64 $11.495.E CENTER INH FORT BEND •4438 MEMORIAL MEDICAL CENTER I SOLERA AT $63.476.64 ,/ $87.125.04 S63,476.64 563,476-E WEST HOUSTON '2998 MMC-MONEY MARKET S1,108.632.49 S1,108.632.49 S1,108,632.49 $1,108.632.4 FUND '5506 MMC •NH BETHANY $303.282.67 S303,282.67 3303,282.67 S292,798.4 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- $27,183.65 $27.183.65 $27.183.65 S26.203.E MEDICAREIMEDICAID '5433 MMC-NH GULF POINTE S514,179.37 $517,881.94 $514,179,37 S503,319.E PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY $104,292.32 $104,292.32 S104,292.32 $94A22.' VILLAGE r https://prosperity.olbanking.comlonlineMessenger Ili Memorial Medical Center Nursing Home UPL Weekly Nexion Transfer Prosperity Accounts 10/19/2021 Prerfdm A.c.unt BeRlnnlnR b: N.ro:O.ty baPnus.0.1 SS,OMwlllbe tnm/.rredm the nursmp O.mn N.[[is E.[A ..ream her 9 bmeba.n[f.fS10O xbP[MMC deP.tir[d r..Penattoun[. A]P.wvw vN OAT 18 2021 C (RISDAW AEU 1:\nN w<egrrnmr<nlnn uPRrmdersmnmdn\x.xpamberinN uv[rumry summrry m.19.x1..In Vending ilnI It. B. Tranderred 1. N.rtl.R - 171,30.69 / WnEgdl.nce ]11,3gS.fi9 ✓ VdfinCO leav<in B3lan[e ID0.0) MEDIWE REPAYMENT TO MM NNIC "us ✓ O INTEREST NOY INTEREST DECINTEREST Adluet aahnm/r..tfer Amt 13O;63B." A.P[oved; Id:enA.en�, ao 3D/xg/zon 1➢/811021 NFLl1N NUMpN SVC NCC41MPMT ll4W]341I30112 10/1l/3011 C9134 10/»/l0u CKvs 1WIl/i011 CK»3 la»/10RI . 0 10/un021 IX»6 10/13/l0ll CK133 ly»/0» [K»I l0/:V;02l WIRE OIIT NFYWN Nf+I]H p10010EN [PE EK IWIL203i ml9 111 ]WILI031 Nwil IWI]/]Wl 11YSRR 1IRSi RKCOSSLMTH3694SIIWSS]]9 IW»/1011 GCW1NCREEKNfRETMEK 0EP 131013191MW1110 10/U/fOli TSYSRRRN1fIRSi OK<OSttM15411015IIS.Mla TSYSRNPNSIWT UMEAIM+5d91015691 115 IW13/loll 6GIUEN IIRST B.CosNCOfP Ill0I56910%J01569 ]0/»/IDi1 TSl]RRRNSFlMT BKfO511M15<36H355N)19119 I011411021 T" LWIlC BXCOSMT036USS91691i99 10/»/1111 TS»RNpNSfINST BIICO s11MT H36Hss56)69V9 W/ISR021 » S ETYNSf WSIRO31N1iSU41960169129 l0/13R031 AtlI5f R1LM ENl SE RVICF El055»4199601691Wi mmcn"ON NPP([gnp+Ll NN 711011Se4W RLpI(L[jg WPP/CmmPI ryIP/CwnPl plpP/Camel +pu ryPPt1 POPfiON - 521.M 511.79 .712 3.9A 9.9 i].d9 . 1,501.36 - 1. an W 19.8».95 136.A30.35 - t]6,8]O SS 9,]W,16 9170.16 d,M.W 1,772.0 215.91 )8S.9B lAV.91 � 1,+tL9) Sd9B,W - ylyA O,l 1.)663) 1,168.3] ],16931 ),169.R 9]Ap W ..W gIW 193.W I..6)0W ].6300) 61,93I W • »f 1�U5.69r l>LIP5.69 10/1812021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number I Name Grou s Account Type Atld Group Search F All [DIDA7 Data reported as of Oct 18, 202- Account Number Current Balance Available Balance Collected Balance Prior Day Belanc Number of Accounts: 15 $7,017,511.30 $7,185,792.37 $7,017,511.30 $6,346,797.9 •4551 CAL CO INDIGENT 55.370.86 $5.370.86 $5,370.86 $5,370,E HEALTHCARE '4454 MEMORIAL MEDICAL 1 NH GOLDEN CREEK $171.385.69 i� 5171,385.69 $171,385,69 5165,466.E HEALTHCARE '4365 MEMORIAL MEDICAL $535.85 5535.65 5535.85 5535.E CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL 54,481,046.86 54,610,066.44 54,481,046.86 53,848,446.E CENTER -OPERATING '4373 MEMORIAL MEDICAL $431 Al 5431.41 $431.41 S431A CENTER - PRIVATE WAIVER CLEARING -4381 MEMORIAL MEDICAL 5155,999.41 5155,999.41 5155,999.41 S155.999A CENTER I NH ASHFORD •4403 MEMORIAL MEDICAL CENTERINH $24,439.40 528,651.40 $24.439.40 524,439A BROADMOOR '4411 MEMORIAL MEDICAL $45,759.04 553,336.24 $45.759.04 545.759.0 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $11.495.64 $11.616.96 511,495.64 $11,495.E CENTER I NH FORT BEND *4436 MEMORIAL MEDICAL CENTER I SOLERA AT 563,476.64 $87,125,04 $63,475.04 563,476.E WEST HOUSTON '2998 MMC-MONEY MARKET 51,108,632.49 $1,108,632.49 51,108,632.49 $1,108,632.4 FUND •5506 MMC -NH BETHANY $303,282.67 5303,282.67 $303,282.67 5292,7984 SENIOR LIVING 'S441 MMC-NH GULF POINTE PLAZA- $27JW8 65 527,183.65 $27,183.65 $26.203.E MEDICAREIMEDICAID '5433 MMC-NH GULF POINTE $514.179.37 $517,861.94 S514,179.37 5503.319.E PLAZA -PRIVATE PAY '3407 MMC-NH TUSCANY $104,292.32 5104,292,32 5104,292.32 594,422 VILLAGE hllps•J/prosperity.olbanking.comlonlineMessenger 1l1 Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 10/18/2021 P6Nbm gmeumme< K<Yum B.Emnfn. oendNO rr+v1<rte— xan'yxem< number Ba1an« rnmsv'oxt g9.58&0ln CEme.,.a Be uYN r<a+ +Be Mnln xuni OUH0v1MB NYi•PlfyihPiY '. .. W3.5[<.Of V3].9<1 ]<<./ 39,SBi05 I,31 3 31<,1393r ]y603.96 Bmt Bllan[e Lervemeab:n[ 1B9,BB FtlIOfLVM 9gTMEXrS TONOIO 501.395.0 IXTIN]EREsr DECHITERES PEFmiE6FiT FdfYO Ba+ve(Tnnder Yn[ U,5t3.9< ✓ M1wkuu imovm m0+ k.M BallnniOl P..dit TnvGmatO xuxwx<me m'.w, Bxann rmNle,.w[ A..I.rm ctsM.rea 0e o+¢+ rum +Re innm Balnrce xu,nn xe fiYlfiblhtf Bhu Mdia10/h4dpW -. 3]5.<5 3R<5 ]],083.65 j ]],1BJOS /1i,083AS< Bank a.,.... 31,103bf ✓ W,Nnro Nux: Mrrb.bn,n.1.is,= N.Nae 1.111.rle m lAmmnM h—n< NY,e3:Ea,hO„Ow,hu,ubal<balenat.1sim 1h01 MMe Pepol4,dlo op --, Ai?AOYM ON OCT ,I a zone CO'WW AYrL"i.F4Y1 CAI 1 \MN WeelN nandtnVlM V){➢m)IpSvmmery\1USMYeleher\bI VYLn+nJn3umm.ry30.10.31..W Le+vein Balance 10a. =eATREST NWINIf.R[ST eECINRRFST Rdjux BaYn[e/TravlerYnr 2]p13.55 J rY.w laongn3an,¢x 1oN/zan 10/8/2021 HNB-ECHO HCCIIMPMT 74003411440 O02NI27 10/9/2021 HNB - ECHO HCCWMPM124MI11144000021B32) 10112i20ll CNloll 10/12/2Wl IX10ID 10JI212021 WIRE OUT HMO SERVICES, IIC 10/12/ID21 HNB-ECHO HCCUIMPMT 746W3411 MOOCOMV35 10/171104 HNB- ECHO HCCUMPMT M6003411440=U1795 10111/2031 HNB-ECHO HCCUIMPMT 34603411440000P1735 IOIIV2021 HNB- ECHO HUWMPMT 24MM 11440 O241735 10112/2G11 HNB - ECHO HCCUIMPMT 746003411440000M035 10/12/2021 HN8• ECH0 HCCUIMPMT 74WW412440000241135 10/1312021 HAS - ECHO HCCUIMPMT 74GW3411440000M2118 10/13/2021 NNB - ECHO HCCUIMPM1346003411"NO0202118 1011312021 NNB-ECHO HCCUIMPMT 71WU341144000D102219 ID/14120U HNB-ECHO HCCUIMPMT 246003411440000254810 10/14/2021 HNB- ECHO HUUIMPMT)45MU4114400002U830 10/14/2021 HUMANA CHA 015E NCCUIMPM16249024]000O1M0 10/15/2021 NNO-EUO HCCUIMPMT 246W3411440000206938 10/15/2021 HNB- ECHO HCCIIMPMT 246W34114400 M939 10/15/2021 HUMANA CHA OOB HCCUIMPMT 624982 4200W19M 1Bp2/z6n cnW3 10/25IM21 HORIDI 10/15/31131 NOflI01AN 13A NCCUIMPMi6)SE93430W0]9340>E MMCPORTION OIPP/NmP4& NH TMnA8H001 Tun�r�n CVPNU.Pl m./C.wP OIPP/COmP3 b 44 G1PPT1 PORTION 4.994.14 4,9P4.14 9,6m.xx - 9.607.23 60.22 28,94).29 13,932.13 - 21.9i - 7194 1,805.93 - 1.805.91 54.69 $4.99 5.16132 - 5,364Bi 1,206.SC - 1,204.54 16.32 16.22 1,32636 - 4326.06 10369 - 102.69 Ip02.13 - LOU1.13 10.46 - 36046 353.82 - 253.81 2,905.25 - 2.W5.75 238.13 - 138,73 942,92 - W2.92 9,]]8.19 - 9,726.19 3L947.34 39.131.05 39583 03 MMCPORTiON 01PP/Comp46 NN Tnntltl-Out TMnAnnln I OIPP/OAmpt OIIPP/Comp; OIPPJCpmP3 MOae OIPP➢ I PORTION 26AA 26,103.65 9W.00 2410255 98000 26AA 23,083.65 3T 083 fi3 3L974.19 65.666.70 66666]0 10/18/2021 Quick View Select Quick View Accounts Account Number / Name Account Type v Search All DDA Treasury Center Select Group Groups Add Graup Data reported as of Oct 18, 202' Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7,017,511.30 $7,185,792.37 S7,017,511.30 $6,346,797.9 '4551 CAL CO INDIGENT S5.370.86 $5,370.86 $5,370.86 55,370.E HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $171,385.69 S171,386.69 S171,385.69 5165,466.E HEALTHCARE '4365 MEMORIAL MEDICAL $535.86 S535.85 $535.85 S535.E CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL S4,481,046.86 S4,610,066.44 S4,481,046.86 S3,848,446.E CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431,41 S431.41 S431 41 S431.4 WAIVER CLEARING '4381 MEMORIAL MEDICAL $155.999.41 S155,999.41 S155,999.41 S155,999.4 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH S24,439.40 $28,651.40 S24,439.40 S24,439.4 BROADMOOR '4411 MEMORIAL MEDICAL S45.759.04 $53,336.24 $45,759.04 S45,759,C CENTER/NH CRESCENT -4446 MEMORIAL MEDICAL $11 A95.64 $11.616.96 $11.495.64 511,495.E CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER/SCLERA AT $63.476.64 S87,125.04 $63,476.64 $63,476.E WEST HOUSTON •2998 MMC-MONEY MARKET S1,108.632.49 S1,108,632.49 S1,108,632.49 $1,108.632.4 FUND '5506 MMC -NH BETHANY S303,282.67 S303.282.67 S303,282.67 S292,798A SENIOR LIVING 441 PLMA7MJAC -NH GULF POINTE $27.183.65 / $27,183.65 S27,183.65 526,203.E MEDICAREIMEDICAID '5433 MMC -NH GULF POINTE $514,179,37 ✓ 5517,681.90. $514,179.37 S503,319.: PLAZA -PRIVATE PAY '3407 MMC -NH TUSCANY $104.292.32 5104,292.32 $104,292.32 S94,422' VILLAGE httpsa/prosperity.olbanking.comloniineMessenger tli Memorial Medical [enter Nursing Home UPL Weekly Tuscany Transfer Prosperity Amounts 10/19/2021 PoMc. pRount Lellnnln{ ..e.n Ioho..10 11 A. d1be I.Ijerred to he.—, n.me. Nate L fo,4.1-11 Amx 6-6af fee 0sleeMafopmo[[cum. OCT t d Lori rarusarx.a�1[lY•zc cae:Ear,: ra;mT3�t:,t;::c:; Amount to Be WAnebn[e 3Be,H3R a� Vapa.[ laavtin Bdan[e 1B]YII MEDIWE R[PAYMENTTO MM Well "1.6✓ Adlun BabnnJnan[fer Aml ]p].6p5I5. A ,-,d I low", \'�""— lYll9/1031 LmnM111M1 me MMC PORTION gIPP/ComP4 01 TransFer-0ut Tnns/er.ln 41PP%C4mp1 gIPP/Comp2 gIPP/[4mp3 8lapse QIPP❑ NH PORTION 10/8/2021 KS PIAN ADMINIST HCCIAIMPMT 179111=20203 - 16,735.00 - 16,735.00 10/12/2021 moss 29,489.19 - 10/12/2021 CKI060 510.00 - 10/12/2021 CK1066 202.78 - 1011212021 CKlom 447.42 - 10/12/2021 CK1067 9,977.49 10/12/2021 CK1D63 2,425.04 10/12/2021 CKID61 1,447.10 - - 10YI212021 0eposlt - 67,339.95 - 67,339.95 10/12/2021 O4posit - 5,691." 51691.04 10/12/1021 Deposit 10,315.44 - 30,325.44 10/15/2021 KS PIAN ADMINIST HCCIAIMPMT 17911100N26000 9.870.00 9,870,00 44A99.00 109,942.43 / - 1014143 10118/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number I Name Groups Ann Grnup Account Type _ r 5earch All [DDA Data reported as of Oct 18. 202' Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7,017,511.30 $7,185,792.37 $7,017,511.30 $6,348,797.9 '4551 CAL CO INDIGENT $5,370.86 $5,370.86 $5.370,86 $5.370.E HEALTHCARE '4454 MEMORIAL MEDICAL NH GOLDEN CREEK 5171385.69 $171,385.69 5171,385.69 5165,466,E HEALTHCARE •4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $535.85 5535.85 5535,85 $535.E 2014 -4357 MEMORIAL MEDICAL $4,481,046.86 $4,610.066.44 54,481,046.86 53,848,446.E CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE 5431.41 $431 Al 5431.41 5431.4 WAIVER CLEARING '4381 MEMORIAL MEDICAL S155,999.41 5155,999.41 S155.999.41 S155.999.4 CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTERINH $24,439.40 528,651.40 524,439.40 $24.439.4 BROADMOOR '4411 MEMORIAL MEDICAL $45.759.04 $53,336.24 545,759.04 $45,759.0 CENTER INH CRESCENT •4446 MEMORIAL MEDICAL 511,495.64 $11,616.96 $11.495.64 $11,495.E CENTER INH FORT BEND •4438 MEMORIAL MEDICAL CENTER I SOLERA AT $63,476.64 $87,125.04 563,476.64 $63,476.E WEST HOUSTON '2998 MMC-MONEY MARKET 51,108,632.49 $1.108,632.49 $1,108,632.49 $1,108,632.4 FUND '5506 MMC-NH BETHANY $301282.67 5303,282.67 $303.282.67 S292,798A SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA - $27,183.65 $27.183.65 $27.183.65 $26.203.E MEDICAREIMEDICAID 'S433 MMC-NH GULF POINTE $514,179.37 5517,881.94 5514,179.37 5503.319.: PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY - 5104,292.32 �� $104.292.32 5104,292.32 $94,422,2 VILLAGE htlps://prosperity.olbanking,comlonlineMessenger 1l1 Memorial Medlcal Center NurSing Home VPL Weekly HSLTransfer Prosperity Accounts 10/18/2021 0-1-1 yendlry lmnunttu Ba M unt &&,On Median Ynmhmtlt0 NVM1In pOme NumMr Babm! lnna4equl rtnnrlrnln C1a[leand qe ent TWa aBe Innln Ba4ve Nvnln Mem! BMYAYSInI✓IMIt ... ]9.96i 11 Y9,]ai.R IDldB16] ✓ 303RBl.bl 303,19i6> &nY Oalann 303,10}6l ✓ VirllnN leave In Barill<! IWW OCr IxTFpFSf xOVIxr OfCIHioro,ENEST _ Rdjwepalen[e/lrmdxt 1 343.b1d] j �k Nau: onHbWonmo/orns;OW nvlfbe4nmhrrdmebenurunBxeme. Mpr red'. A.1\ Hale 3: Earb oe[W ft[n bmeMronien/5100rbn MMC M110, CEO 10/L(1@I r:Wx WOW TtmtlpntxH YR Uemftf FummM1011\OtlDhe H Nl Nr Ver summery m.lesl.ma 10/8/2021 HOSPICE OF SOUTH Payments NF 113122650022502 10/12/2021 CIf1007 10112/2021 WIRE OUT BETHANY SENIOR LIVING, LTD 1011111031 Deport 1011212921 DePOsit 10/12/2022 D. 011t 10/12/2021 OePp0l l0/12/2@1 Oepes4 30/12/2021 U."ot 10/1212021 HEALTH HUMAN SVC NCCNIMPMT 174GW341130162 10/19/2021 Deposit 10/14/2021 NOVITAS SOLUTION HCCLAIMPMT 676401420000171 LOAD/= D.NIt 10/15/Z021 Oepmait 10/15/2021 HOSPICE OF SOUTH Payments NF 113122650073896 10/15/2021 HEALTH HUMAN SVC HCCLAIMPMT 174600341130162 MMC PORTION OIPP/COmP4 Transfer-Ou[ seF- QIPP/COmpA CIPP/CpmpE OIPP/C9mp9 &lapin QIPPTI NHPORTION ].580.59 - I.SBB.59 79,645.10 , 7.989.17 - 7,363.17 52,368.16 - 51.368.16 909.55 - 909.53 48,59SOB - 48,593.06 16],6]6.46 - 267,676.45 7,235.50 - 7,235.50 1,920,10 1,970.10 5,750.50 - 51750.59 243.34 - 243.34 1,180.0 - 11330.00 3.4L6.00 3,416.00 1.495.76 - 1,495.76 4.192.50 - 4,192.50 79R63,12 309,i0L6)./ 303.I82.61 10/18/2021 Quick View Select Quick View Accounts Account Number I Name Account Type Searrh F All Treasury Center Select Group Groups Add Group Data as of Oct 18. 202' Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts; 15 $7,017,511.30 $7,185,792.37 47,017,511.30 $6,346,797.9 '4551 CAL CO INDIGENT 55.370.86 $5.370.86 $5,370.86 85,370.E HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $171.385.69 S171,385.69 5171.385.69 $165.466.E HEALTHCARE '4365 MEMORIAL MEDICAL $535.85 5535.85 $535.85 5535.E CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL $4,481,046.86 54,61Q066.44 54,481,046.86 $3,848,446.0 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.41 5431.41 $431.41 $431.4 WAIVER CLEARING '4381 MEMORIAL MEDICAL $155.999A1 5155.999.41 S155,999.41 S155,999.4 CENTER INH ASHFORD '4403 MEMORIAL MEDICAL $24.439.40 $28,651.40 524,439A0 $24.439.4 CENTERINH BROADMOOR '4411 MEMORIAL MEDICAL 545,7%04 553.336.24 $45,769,04 $45,759.0 CENTERINH CRESCENT '4446 MEMORIAL MEDICAL 511,495.64 511,616.96 511,495.64 $11,495,E CENTER INH FORT BEND '4438 MEMORIAL MEDICAL CENTER I SOLERA AT $63,476.64 $87,125,04 $63,476.64 563,476.E WEST HOUSTON '2998 MMC-MONEY MARKET 51,108,632.49 51,108,W2A9 51,108,632.49 51,108,632.4 FUND '5506 MMC •NH BETHANY 5303,282.67 $303,282.67 S303,282.67 $292,798.4 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA - $27,183.65 $27,183.65 527,163.65 526,203.E MEDICAREIMEDICAID '5433 MMC •NH GULF POINTE 5514,179.37 5517,881,94 5514,179.37 $503,319,E PLAZA -PRIVATE PAY '3407 MMC -NH TUSCANY $104.292.32 5104,292.32 S104.292.32 594,422.E VILLAGE hitpstllprosperity.olbanking.comlonlineMessenger 111