2022-04-27 Final PacketNOTICE OF MEETING-4/27/2022
Richard H. Meyer
County judge
David Hall, Commissioner, Precinct 1
Vern Lyssy, Commissioner, Precinct 2
Joel Behrens, Commissioner, Precinct 3
('vary Meese, Commissioner, Precinct 4
Kadldlc Smith, Deputy Clerk
NOTICE OF MEETING
The Commissioners'Court of Calhoun County, Texas will meet on Wednesday,
April 27, 2022 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:
1. Call meeting to order.
Meeting called to order at 10:00a.m. by Judge Richard Meyer
2. Invocation.
Commissioner David Hall
3. Pledges of Allegiance.
US Flag- Commissioner Gary Reese
Texas Flag- Commissioner Vern Lyssy
4. General Discussion of Public Matters and Public Participation.
N/A
5. Hear report from Memorial Medical Center.
Roshanda Thomas gave the report
6. Consider and take necessary action to approve an Order Prohibiting Outdoor Burning.
(RHM)
Pass
Page 1 of 4
NOTICE OF MEETING-4/27/2022
7. Consider and take necessary action to authorize the Professional Services Work
Authorization Number 4 for the GBRA Green Lake Control Structure Re-establishment
Permitting Scope of Work. (RHM)
RESULT:
APPROVED[UNANIMOUS]
MOVER:
Gary Reese, Commissioner Pct 4
SECONDER:
Joel Behrens, Commissioner Pct 3
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
8. Consider and take necessary action to approve the engineering change order (Work
Order No. C-2) for Rebid — Magnolia Beach Fire Station Project for Calhoun County,
Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
County 2020 CDBG-DR Contract Work Order No. C-1. (DH)
RESULT:
APPROVED[UNANIMOUS]
MOVER:
David Hall, Commissioner Pct 1
SECONDER:
Vern Lyssy, Commissioner Pct 2
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
9. Consider and take necessary action to approve the engineering change order (Work
Order No. E-2) for Rebid — Little Chocolate Bayou County Park for Calhoun County,
Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
County 2020 CDBG-DR Contract Work Order No. E-1. (DH)
RESULT:
APPROVED[UNANIMOUS]
MOVER:
David Hall, Commissioner Pct 1
SECONDER:
Vern Lyssy, Commissioner Pct2
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
10. Consider and take necessary action to change the name of Huleo Road to Whitaker
Road in Precinct 4. (GDR)
RESULT:
APPROVED[UNANIMOUS]
MOVER:
Gary Reese, Commissioner Pct 4
SECONDER:
Joel Behrens, Commissioner Pct 3
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
11. Consider and take necessary action to approve the Preliminary Plat of Serendipity
Subdivision. (GDR)
Terry Ruddick explained prelim plat.
RESULT:
APPROVED[UNANIMOUS]
MOVER:
Gary Reese, Commissioner Pct4
SECONDER:
David Hall, Commissioner Pct 1
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 2 of 4
NOTICE OF MEETING-4/27/2022
12. Consider and take necessary action to approve the Final Plat of Lot 1R, Block 154
Resubdivision No. 1. (GDR)
Terry Ruddick explained final plat.
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 accept an anonymous donation of $75.00 to the
Sheriff's Office to be deposited into the Motivation Account (2697-001-49082-679).
'
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 declare the attached list of Portable Radios from
the Emergency Management Department as Surplus/Salvage. (RHM)
Pass
15. Consider and take necessary action to declare the attached list of miscellaneous
equipment from the Emergency Management Department as Surplus/Salvage. (RHM)
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. (RHM)
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-4/27/2022
17. Approval of bills and payroll. (RHM)
MMC
RESULT:
APPROVED[UNANIMOUS]
MOVER:
David Hall, Commissioner Pct I
SECONDER:
Gary Reese, Commissioner Pct 4
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
County Bills
RESULT:
APPROVED [UNANIMOUS]
MOVER:
David Hall, Commissioner PcL 1
SECONDER:
Gary Reese, Commissioner Pct 4
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Adjourned:10:25a.m.
Page 4 of 4
(/ All Agenda Items Properly Numbered
�/ Contracts Completed and Signed
AAII 1295's Flagged for Acceptance
(number of 1295's )
ikAll Documents for Clerk Signature Flagged
Onthis&goayof 2022 a complete and accurate packet
for2q4Cof 2022 Commissioners Court Regular Session
Day M Ynth
was delivered from the Calhoun County Judge's office to the Calhoun County
Clerk's Office.
Calhoun County Judge/Assistant
COMMISSI ONERSCOURTCHECKLIST/FORMS
AGENDA
Jll' i ��I IViI I hkk "O'-'
Richard H. Meyer
County judge
David Ball, Commissioner, Precinct 1
Vern Lyssy, Commissioner, Precinct 2
Joel Behrens, Commissioner, Precinct 3
Gary Reese, Commissioner, Precinct 4
NOTICE OF MEETING
The Commissioners' Court of Calhoun County, Texas will meet on Wednesday,
April 27, 2022 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: AT I FILED �/
/J 9 o'CLOCK�. _L!_V,
`f. Call meeting to order. APR 2 2 2022
N.G 530 OP9P,N
el�ir BY CL GAL Jl�N COUNTY, TE-M
',/S Pledges of Allegiance.
4. General Discussion of Public Matters and Public Participation.
.Hear report from Memorial Medical Center.
[6 Consider and take necessary action to approve an Order Prohibiting Outdoor Burning.
RHM)
Consider and take necessary action to authorize the Professional Services Work
Authorization Number 4 for the GBRA Green Lake Control Structure Re-establishment
Permitting Scope of Work. (RHM)
eo'Consider and take necessary action to approve the engineering change order (Work
Order No. C-2) for Rebid — Magnolia Beach Fire Station Project for Calhoun County,
Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
/County 2020 CDBG-DR Contract Work Order No. C-1. (DH)
kl Consider and take necessary action to approve the engineering change order (Work
Order No. E-2) for Rebid — Little Chocolate Bayou County Park for Calhoun County,
Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
County 2020 CDBG-DR Contract Work Order No. C-9. (DH)
F-1
Page 1 of 2
0. Consider and take necessary action to change the name of Huleo Road to Whitaker
Road in Precinct 4. (GDR)
r1. Consider and take necessary action to approve the Preliminary Plat of Serendipity
Subdivision. (GDR)
`i2. Consider and take necessary action to approve the Final Plat of Lot 1R, Block 154
Resubdivision No. 1. (GDR)
i-3 Consider and take necessary action to accept an anonymous donation of $75.00 to the
Sheriffs Office to be deposited into the Motivation Account (2697-001-49082-679).
(RHM)
41.0ac-onsider and take necessary action to declare the attached list of Portable Radios from
,the Emergency Management Department as Surplus/Salvage. (RHM)
t5. Consider and take necessary action to declare the attached list of miscellaneous
Zusider
ipment from the Emergency Management Department as Surplus/Salvage. (RHM)
6and take necessary action on any necessary budget adjustments. (RHM)
T%. Approval of bills and payroll. (RHM)
Richard H. Meyer, Cour
Calhoun County, Texas
A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street,
Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for
at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at
www.calhouncotx.org under "Commissioners' Court Agenda" for any official court postings.
Page 2 of 2
NOTICE OF MEETING-4/27/2022
Rich2rd ]H . MeyeT
County judge
David Hall, Commissioner, Precinct 1
Vern ]Lyssy, Commissioner, Precinct 2
Joel Behrens, Commissioner, Precinct 3
Gary ]Reese, Commissioner, Precinct 4
Kaddie Smith, Deputy Clerk
NOTICE OF MEETING
The Commissioners'Court of Calhoun County, Texas will meet on Wednesday,
April 27, 2022 at 10:00 a.m. in the Commissioners'Courtroom in the County Courthouse at
211 S. Ann Street, mite 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 10:00a.m. by Judge Richard Meyer
2. Invocation.
Commissioner David Hall
3. Pledges of Allegiance.
US Flag- Commissioner Gary Reese
Texas Flag- Commissioner Vern Lyssy
4. General Discussion of Public Matters and Public Participation.
N/A
5. Hear report from Memorial Medical Center.
Roshanda Thomas gave the report
Page 1 of 13
#5
NOTICE OF MEETING — 4/27/2022
6. Consider and take necessary action to approve an Order Prohibiting Outdoor Burning.
(RHM)
Pass
Page 2 of 13
#6
BURN BAN ORDER — 4/27/2022
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
WHEREAS, on the 27th day of April, 2022, the Commissioners' Court finds that
circumstances present in all unincorporated areas of the County create a public safety hazard that
would be exacerbated by outdoor burning.
IT IS HEREBY ORDERED by the Commissioners' Court of Calhoun County that all
outdoor burning is prohibited in the unincorporated area of the County for 90 days from the date
of adoption of this Order. The County Judge may rescind this Order upon a determination that
the circumstances that required the Order no longer exist
Household Trash may be burned in a closed or screened container.
This Order is adopted pursuant to Local Government Code §352.081, and other applicable
statutes. This Order does not prohibit outdoor burning activities related to public health and
safety that are authorized by the Texas Commission on Environmental Quality for: (1)
firefighter training: (2) public utility, natural gas pipeline or mining operations; (3) planting or
harvesting of agricultural crops; or, (4) burns that are conducted by a prescribed burn manager
certified under Section 153.048, Natural Resources Code, and meet the standards of Section
153.047, Natural Resources Code.
In accordance with Local Government Code §352.081(h), a violation of this Order is a
Class C misdemeanor, punishable by a fine not to exceed $500.00.
ADOPTED this 27th day of April, 2022 by a vote of ayes and
nays.
Richard H. Meyer
Calhoun County Judge
ATTEST:
Anna Goodman, County Clerk
Deputy
Page 1 of 1
NOTICE OF MEETING — 4/27/2022
7. Consider and take necessary action to authorize the Professional Services Work
Authorization Number 4 for the GBRA Green Lake Control Structure Re-establishment
Permitting Scope of Work. (RHM)
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 13
Mae Belle Cassel
From: Richard.Meyer@calhouncotx.org (Richard Meyer) <Richard.Meyer@calhouncotx.org>
Sent: Monday, April 18, 2022 8:35 AM
To: Mae Belle Cassel
Subject: FW: Green Lake - Permitting work
Attachments: 2022-04-14 Work Authorization No.4 - Green Lake.pdf
From: bperkins@gbra.org (R. Brian Perkins, P.E.) <bperkins@gbra.org>
Sent: Thursday, April 14, 2022 10:08 AM
To: Gary.Reese@calhouncotx.org; richard.meyer@calhouncotx.org
Subject: RE: Green Lake - Permitting work
CAUTION: 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.
Commissioner Reese and Judge Meyer,
Attached is the duly executed Work Authorization for the environmental work related to Green Lake. I believe the next
step is for you to consider this at Commissioner's Court.
Thank you,
Brian
R. Brian Perkins, P.E.
Deputy Executive Manager of Engineering
O (830) 560-3983
//''''�� C (512) 589-8244
LJB GUADALUPE-BLANCO RIVER AUTHORITY
933 E. Court St.
Seguin, TX 78155
From: R. Brian Perkins, P.E.
Sent: Tuesday, March 29, 2022 8:40 AM
To: Gary.Reese(@caIhouncotx.org; richard.meverC@calhouncotx.org
Subject: Green Lake - Permitting work
Good morning Commissioner Reese and Judge Meyer,
This morning, I received the next Work Authorization from Arcadis for the Green Lake work. There has been some back
and forth on this, and GBRA is now satisfied with the scope and fee for this work. Please see attached. Arcadis has
signed it and we are about to route it around for signatures on our end. However, I wanted to give you an opportunity to
review.
1
Per our agreement, I believe that once we've executed this Work Authorization, the County will need to consider it
before Commissioner's Court and authorize it. At that point, we can give Notice To Proceed.
If you'd like to discuss, please let me know.
Thanks,
Brian
R. Brian Perkins, P.E.
Deputy Executive Manager of Engineering
O (830) 560-3983
C (512) 589-8244
GUADALUPE-BLANCO RIVER AUTHORITY
933 E. Court St.
Seguin, TX 78155
Calhoun County Texas
PROFESSIONAL SERVICES WORK AUTHORIZATION
Work Authorization: 4
GUADALUPE-BLANCO RIVER AUTHORITY
GREEN LAKE CONTROL STRUCTURE RE-ESTABLISHMENT PERMITTING
SCOPE OF WORK
March 24, 2022
GENERAL OVERVIEW
The Guadalupe -Blanco River Authority (GBRA) engaged Arcadia U.S., Inc. (Arcadia) in the
Engineering Master Services Agreement on June 18, 2018. GBRA has requested that Arcadis
provide this scope of work and fee proposal for permitting of the Green Lake control structure re-
establishment in Calhoun County, Texas. The project team for this task consists of Arcadis and
its subconsuftant(s): HDR Engineering, Inc. (HDR).
The overall goal of this project is to re-establish the Green Lake control structure. The existing
Green Lake control structure is non -operational. As a result, erosive overflows from Green Lake
are causing cuts to form along the north levee of the GBRA diversion canal segment paralleling
State Highway 35 (SH35), resulting in a loss of wetland habitat due to erosion. These cuts have
allowed undesirable boat access to Green Lake from the diversion canal, further increasing
habitat impacts. Furthermore, these cuts may adversely affect water supply operations for the
diversion canal through hydraulic connection to Green Lake at lower than desired water surface
elevations, causing water loss frorr the diversion canal to Green Lake during water deliveries.
In an effort to address the above problems, GBRA and Calhoun County seek to re-establish the
Green Lake control structure. The primary objectives of this project are to provide controlled
outlets for Green Lake to convey overflows, eliminate direct boat access between Green Lake
and the diversion canal, and separate the two water bodies hydraulically during water supply
deliveries, thereby allowing GBRA to operate the diversion canal at a higher water surface
elevation than Green Lake without water loss (as It has historically). GBRA and Calhoun County
also desire the improvements to be simple to construct and to provide reliable and improved long-
term maintenance access.
The following scope of services outlines anticipated pre -application tasks required to permit the
preferred alternative, currently identified as the Goff Bayou alternative control structure location
and associated levee maintenance and access road (temporary and permanent) improvements,
as described in the Feasibility Study Report dated February 10, 2022. In order to understand the
potential Impacts to waters of the U.S. and demonstrate that the preferred alternative is the Least
Environmentally Damaging Practicable Alternative (LEDPA) to the U.S. Army Corps of Engineers,
environmental field work is proposed for a study area including three potentially practicable
alternatives and associated maintenance activities which may be connected actions for which
Independent utility has not been confirmed to date, as described in the Feasibility Study Report
and depicted in Figures 1 and 2.
Page 1 of 6
2022-03-24
Figure 1 — Green Lake Control Structure Location Alternatives
Figure 2 — Green Lake Potential Levee Maintenance
SCOPE OF SERVICES
TASK 100 - PROJECT MANAGEMENT AND ADMINISTRATION
Project management activities are to manage communication and coordination between the
project team and GBRA, internal project team management, and quality assurance and control.
Monthly project update conference calls will be conducted between the GBRA and Arcadis team
to discuss ongoing tasks, data needs, technical considerations, and schedule and budget.
Page 2 of 6
2022-03-24
Arcadia will also conduct project management and administration activities for the project
including planning work activities, maintaining the project schedule and budget, invoicing, and
coordination with GBRA. The duration of this permitting phase is assumed to be six (6) months.
The Arcadis Project Manager will manage communication and coordination with GBRA and
Calhoun County.
Task 100 Deliverables
• Monthly project progress conference calls.
• Meeting agenda(s) and minute(s), as needed.
• Monthly electronic invoices including an activity report for the period.
TASK 200 — FIELD DELINEATION OF WATERS OF THE U.S.
A field delineation will be performed by HDR to collect sub -meter GPS data on potential waters
of the U.S., including wetlands, along the project alternatives, as depicted In Figures 1 and 2,
and as described below:
• The delineation would occur In an approximately 50-foot buffer around the alternative
locations preliminary layout and access roads from the feasibility report, as well as the
levee maintenance locations, and occur in one mobilization over four days with access
coordinated by GBRA and Calhoun County. The delineation at 'dy area consists of
approximately 51 acres including the following locations:
o Goff Bayou structure site and access road (approximat ly 14 acres)
o North canal levee access, Hog Bayou, and previous str cture site (approximately
16 acres)
o South canal levee maintenance area (approximately 21 acres)
• Delineation will be in accordance with the USACE 1987 Wetland Delineation Manual and
the 2010 Atlantic and Gulf Coastal Plain Regional Supplement as well as the USACE
Galveston District guidance applicable at the time of the work.
• A general habitat evaluation for federally listed threatened and endangered species
would occur at the same time as the delineation field work, with a focus on marsh habitat
identification that may be considered suitable for Eastern black rail by federal agencies.
Presence/absence surveys for threatened and endangered species as well as
freshwater mussel surveys are not Included in this scope but could be performed as
supplemental services authorized by GBRA.
Task 200 Deliverables
• Delineation data will be provided as an ArcGIS file in Texas State Plan Coordinate Zone
(4204). NAD 83.
• A delineation report to include methods, summaries, quantitative results, data forms, and
exhibits Illustrating the delineated boundaries of waters, including wetlands, and
Page 3 of 6
2022-03-24
uplands. A draft report will be provided in this phase. The report can be finalized in a
future phase as a stand-alone report for inclusion in a future permit application package.
TASK 300 — UPDATED ENVIRONMENTAL PERMITTING EVALUATION
Environmental scientists and project engineers will review each Green Lake control structure
alternative to evaluate potential impacts to waters of the U.S. and potential permitting
requirements based on the field data collected from Task 200 and the preliminary layouts in the
feasibility report. We anticipate the meeting with GBRA/County will be virtual.
The anticipated tasks to conduct the updated permitting evaluation include:
• Update HDR's existing GIS database for resources of concern, including the following:
o Potential waters of the U.S., including wetlands.
o Vegetation communities.
o State and federal threatened & endangered species.
• Define limits of previous soil disturbance and approximate time of construction for existing
structures, levees, and access roads to the extent practicable using Task 200 data and
publicly available historic aerial photographs and maps. Project engineers will provide
input on extent of levee maintenance work needed for the Hog Bayou and previous control
structure locations to be feasible and fully operational.
• Perform an impact assessment of the three conceptual options for the project from the
feasibility report to evaluate the alternatives from the USACE standpoint of the potential
to be the LEDPA. The assessment will Include a matrix for inclusion in a 404 permit
application or pre -construction notification package.
• Coordinate with project design engineers to further define purpose and need, practicability
of alternatives, and avoidance and minimization measures that can be taken for each
alternative.
• Identify potential permit requirements (Nationwide Permit, Regional General Permit, or
Standard Permit).
• Prepare a draft Technical Memo to summarize the permit evaluation findings.
• Respond to one round of question and comments from GBRA/County to the technical
memorandum reviewed in a virtual meeting.
• Update the draft Technical Memo to address comments and submit a final Technical
Memo.
Task 300 Deliverables
The updated environmental permitting evaluation will be summarized in a Technical
Memorandum and provided electronically. Draft and final Technical Memorandum will be
provided.
Page 4 of 6
2022-03-24
TASK 400 — PRE -APPLICATION AGENCY COORDINATION
We will prepare for, coordinate, and participate in a pre -application meeting with regulatory
agencies, such as a joint evaluation meeting (JEM) with the USACE Galveston District, commonly
attended by Texas Commission on Environmental Quality (TCEQ), Texas Parks & Wildlife
Department (TPWD), U.S. Fish and Wildlife Service (USFWS), and National Marine Fisheries
Service (NMFS). The JEM may occurvirtually or in person depending on agency health and safety
protocols in place at the time, and would allow project information to be presented to the agencies
to get preliminary feedback, and present the preferred alternative as the LEDPA, for USACE
comment. Up to three HDR permitting specialists/engineers as well as one Arcadia engineer
would participate in the meeting to represent GBRA and Calhoun County. Agency feedback would
be documented in meeting minutes.
Task 400 Deliverables
• Agency meeting minutes provided electronically.
• Recommendation regarding scope of work for Final Design & Permitting Phase efforts.
OWNER TO PROVIDE
This scope of work is based under the assumptions that GBRA (and/or Calhoun County) will
provide the following:
GBRA to coordinate with Calhoun Coun for property access coordination for the field
delineation.
GBRA to provide boat for south levee access during field delineation.
Review of permitting information and feedback as necessary. Up to 3-week review time is
assumed for GBRA and Calhoun County concurrent review on technical memorandum.
FEE PROPOSAL
This work will be performed on personnel time at the hourly rates agreed upon via email on
February 18, 2022, plus actual expenses. The estimated fee for each task as described in this
scope of services is included in the table in the following page and is based on a 6-month period
of performance. A breakdown of the hours for each team member is also attached at the end of
this scope of services.
Note, Section 404 permit application development, mitigation planning, and coordination support
are planned to be included in a future final design phase following the outcome of the pre -
application coordination with USACE. Additionally, cultural resource surveys, required species -
specific protected species surveys, any state permitting such as aquatic resource relocation
plans, sand and gravel permitting, and agency consultation support for National Historic
Preservation Act (NHPA) Section 106 and ESA Section 7 will be conducted in future work
authorizations. Thus, none of these services are included in the fee proposal.
Page 5 of 6
2022-03-24
Task
Description
Arcadis Total
HDRTotal
Total
Project Cost
100
Project Management and
$8,900
$8,280
$17,180
Administration
200
Field Delineation of Waters of the
$3,190
$37,015
$40,205
U.S. and Report
300
Updated Environmental Permitting
$4,070
$20,620
$24,690
Evaluation
400
Pre -Application Meeting and
$7,675
$14,500
$22,175
Coordination
TOTAL FEE
$23,835
$80,41S
$104,250
PROJECT SCHEDULE
The field delineation (Task 200) is proposed to occur within 3 weeks on notice to proceed,
depending on access, weather, and water levels. The permitting schedule is highly dependent on
the findings of the tasks described herein and agency feedback. To the extent possible, Task 300
will be completed within two months of the completion of Task 200, and Task 400 will be
completed within two months of the Task 300 completion, pending agency response.
Arcadia U.S., Inc. (Engineer) IGuadalupe-Blanco River Authority
Charles Schoening DarreliNic o
Principal -in -Charge Senior Deputy General Manager
Date: March 28, 2022 Date: 13 12Z
Page 6 of 6
2022-03-24
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NOTICE OF MEETING-4/27/2022
8. Consider and take necessary action to approve the engineering change order (Work
Order No. C-2) for Rebid — Magnolia Beach Fire Station Project for Calhoun County,
Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
County 2020 CDBG-DR Contract Work Order No. C-1. (DH)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
David Hall, Commissioner Pct 1
SECONDER:
Vern Lyssy, Commissioner Pct 2
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 4 of 13
u 0
uo
Mae Belle Cassel
From: david.hall@calhouncotx.org (David Hall) <david.hall@calhouncotx.org>
Sent: Monday, April 18, 2022 9:54 AM
To: MaeBelle.Cassel@calhouncotx.org
Cc: 'peggy hall'
Subject: FW: Engineering Change Orders for Court Agenda
Attachments: WO# C-2 - MB Fire Station G&W Change Order 041822.pdf, WO# E-2 - LCB G&W
Change Order 041822.pdf
From: smason@gwengineers.com (Scott Mason) [mailto:smason@gwengineers.com]
Sent: Monday, April 18, 2022 9:47 AM
To:'David Hall' <david.hall@calhouncotx.org>
Cc:'Katy Sellers' <katy@ksbr-llc.com>
Subject: Engineering Change Orders for Court Agenda
the sender and know the content is safe.
David,
Do not click links or open attachments unless
Just wanted to start an email to get on the agenda for next week for the change orders so we can go out for bid on the
park and the fire station.
Peggy said you need an agenda item for where money is coming from or add it to the agenda item(s).
Consider and take necessary action to approve the engineering change order (Work Order No.
C-2) for Rebid - Magnolia Beach Fire Station Project for Calhoun County, Texas under Texas
General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract
Work Order No. C-1. (DH)
Consider and take necessary action to approve the engineering change order (Work Order No.
E-2) for Rebid - Infrastructure Improvements at Little Chocolate Bayou County Park for Calhoun
County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
County 2020 CDBG-DR Contract Work Order No. E-1. (DH)
Thanks,
Scott P. Mason, P.E.
Lead Project Engineer
G&W Engineers, Inc.
1
205 W. Live Oak
Port Lavaca, Texas 77979
P: (361) 552-4509
F: (361) 552-4987
smason@gwengineers.com
Calhoun County Texas
Magnolia Beach Fire Station Project
Work Order No. C-2
Pursuant to the Contract (Contract) between the County of Calhoun (County) and G & W
Engineers, Inc. (Provider) for professional engineering services, as authorized under the County-
GLO Contract No. 20-065-064-C182, Provider is authorized to perform the services described
below, subject to the Scope of Services; Tasks / Deliverables / Timefiames / Special Conditions;
Benclunarks / Budget; and any other conditions of this Work Order. This Work Order modifies
and amends the Contract, all provisions of which not specifically amended herein shall remain in
full force and effect.
This project will improve the infrastructure and amenities at Little Chocolate Bayou County Park
in connection with the Performance Statement stated in Attachment A of the County-GLO
Contract. The project will include modifications to the original bid package as performed under
Work Order No. C-2, which is required as a result of additional floodproofrng measures required
by the GLO for the facility location being in a 500 — year floodplain.
R"IDEOWKIDUSIM
Provider shall perform modifications to the bid documents, including the construction plans which
will reduce the scope of the project in a full faith effort to receive bids within the project budget.
Provider then will update the bid package and re -advertise the bids for the project. At which time
bids are opened and received and a recommendation for award is made by provider the original
Work Order Scope and Engineering Budget shall resume.
Task 1— Revise Construction Plans & Preparation of Bid Documents and Advertise BMW.
Provider will aid County with soliciting a construction contractor and perform other necessary pre -
construction activities. Provider will provide the following services:
a. Revise Construction Plans as recommended and discussed based upon bids received.
b. Prepare a bid advertisement, advertise the bid, and distribute bid documents to prospective
bidders.
c. Participate in a pre -bid meeting in Calhoun County to meet with potential bidders to discuss
project details, answer questions, and review or clarify the scope of construction work.
d. Assemble and submit to County a written document containing an attendees list and the
pre -bid meeting minutes, listing questions and answers for distribution to all interested
parties.
e. Prepare addendum(s) to the Project Manual (Bid Package), if needed.
Pagel of 3
Deliverables:
For each deliverable, digital copies are to be sent to County and the Grant Administrator.
1. Written summary of the pre -bid meeting (submitted within three (3) business days of
meeting).
2. Addendum to the bid documents, if needed (submitted within five (5) business days of the
last day to submit comments/questions).
3. Bid Advertisement(s)
Timeline: Completed within (8) weeks.
Task 2 —Bid Proposals and Selection of Contractors.
Provider will assist County in the review of submitted proposals for conformance with project
requirements. Provider will summarize cost proposals in tabulated format for comparison. Provider
will assist County in reviewing bidder qualifications and assist with contract negotiations.
Deliverables:
1. Bid Tabulation Summary.
2. Recommendation of Award.
3. Notice to Proceed (to be provided to the selected contractor within two (2) business days
of Calhoun County Commissioners Court approval of the contractor).
Timeline: Complete Recommendation for Award for presentation to County and digital copies of
each deliverable are to be sent to County and the Grant Administrator within two (2) weeks of bid
closing.
Provider shall submit invoices to the Grant Administrator at the completion of each Benchmark,
in accordance with the Project Budget/Payment Schedule provided below. Requests for payment
must be supported by documentation as required under the Contract, such as invoices, receipts,
statements, stubs, tickets, time sheets, and any other documentation that, in the judgment of the
Grant Administrator, provides full substantiation of reimbursable costs incurred.
All invoices, reimbursement documents, and deliverables submitted must prominently display
"Magnolia Beach Fire Station Project"and "Work Order No. C-2." Failure to include this
identification may significantly delay payment under this Work Order.
Page 2 of 3
PROJECT BUDGET/PAYMENT SCHEDULE
Total compensation due to Provider for services provided or performed pursuant to this Work
Order shall not exceed Thirty Thousand Dollars ($30,000.00). Invoices shall be paid in
accordance with the Project Budget below:
Benchmarks/Deliverables i Amount Paid Per Benchmark
Benchmark 1- Revise Construction Plans & Bid Does $30,000.00
Total Budget for This Work Order $30,000.00
Termination or Interruption of Work: County reserves the right to halt or defer all or any
portion of the work included in the Scope of Services of this Work Order any time during the
performance period. If such an event occurs, the Parties agree that the schedule and budget may
require renegotiation.
Amendments to Work Order: Material changes to this Work Order may only be made by written
agreement of both Parties.
All Parties to the Contract executed this Work Order, to be effective as of the date signed by the
last party.
CO OFCALHOUN
Richard H. Meyer
Calhoun County Judge
Date of execution: 4r-z rzaz:
G & W ENGINEERING, INC.
w--
Brian P. Novian
President
Date of execution: - i -�-7o zr
Page 3 of 3
NOTICE OF MEETING-4/27/2022
9. Consider and take necessary action to approve the engineering change order (Work
Order No. E-2) for Rebid — Little Chocolate Bayou County Park for Calhoun County,
Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
County 2020 CDBG-DR Contract Work Order No. E-1. (DH)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
David Hall, Commissioner Pct 1
SECONDER:
Vern Lyssy, Commissioner Pct 2
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 5 of 13
#9
Mae Belle Cassel
From: david.hall@calhouncotx.org (David Hall) <david.hall@calhouncotx.org>
Sent: Monday, April 18, 2022 9:54 AM
To: MaeBelle.Cassel@calhouncotx.org
Cc: 'Peggy hall'
Subject: FW: Engineering Change Orders for Court Agenda
Attachments: WO# C-2 - MB Fire Station G&W Change Order 041822.pdf WO# E-2 - LCB G&W
Change Order 041822.pdf
From: smason@gwengineers.com (Scott Mason) [mailto:smason@gwengineers.comj
Sent: Monday, April 18, 2022 9:47 AM
To:'David Hall' <david.hall@calhouncotx.org>
Cc: 'Katy Sellers' <katy@ksbr-Ilc.com>
Subject: Engineering Change Orders for Court Agenda
111rlsl7
David,
of the organizatioi
or(
is unless
Just wanted to start an email to get on the agenda for next week for the change orders so we can go out for bid on the
park and the fire station.
Peggy said you need an agenda item for where money is coming from or add it to the agenda item(s).
Consider and take necessary action to approve the engineering change order (Work Order No.
C-2) for Rebid - Magnolia Beach Fire Station Project for Calhoun County, Texas under Texas
General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract
Work Order No. C-1. (DH)
Consider and take necessary action to approve the engineering change order (Work Order No.
E-2) for Rebid - Infrastructure Improvements at Little Chocolate Bayou County Park for Calhoun
County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun
County 2020 CDBG-DR Contract Work Order No. E-1. (DH)
Thanks,
Scott P. Mason, P.E.
Lead Project Engineer
G&W Engineers, Inc.
1
205 W. Live Oak
Port Lavaca, Texas 77979
P: (361) 552-4509
F: (361) 552-4987
smasonCoDgwengineers.com
Calhoun County Texas
Infrastructure at Little Chocolate Bayou County Park
Work Order No. E-2
Pursuant to the Contract (Contract) between the County of Calhoun (County) and G & W
Engineers, Inc. (Provider) for professional engineering services, as authorized under the County-
GLO Contract No. 20-065-064-C182, Provider is authorized to perform the services described
below, subject to the Scope of Services; Tasks / Deliverables / Timeframes / Special Conditions;
Benchmarks / Budget; and any other conditions of this Work Order. This Work Order modifies
and amends the Contract, all provisions of which not specifically amended herein shall remain in
full force and effect.
toss 1 _s►
This project will improve the infrastructure and amenities at Little Chocolate Bayou County Park
in connection with the Performance Statement stated in Attachment A of the County-GLO
Contract. The project will include modifications to the original bid package as performed under
Work Order No. E-2, which is required as a result of the bids that were received and the project
being over budget due to the pandemic and higher cost associated with materials.
Provider shall perform modifications to the bid documents, including the construction plans which
will reduce the scope of the project in a full faith effort to receive bids within the project budget.
Provider then will update the bid package and re -advertise the bids for the project. At which time
bids are opened and received and a recommendation for award is made by provider the original
Work Order Scope and Engineering Budget shall resume.
113,YMMA 1 Billt n i►
Task 1—Revise Construction Plans & Prenaratlon of Bid Documents and Advertise Bid(s).
Provider will aid County with soliciting a construction contractor and perform other necessary pre -
construction activities. Provider will provide the following services:
a. Revise Construction Plans as recommended and discussed based upon bids received.
b. Prepare a bid advertisement, advertise the bid, and distribute bid documents to prospective
bidders.
c. Participate in a pre -bid meeting in Calhoun County to meet with potential bidders to discuss
project details, answer questions, and review or clarify the scope of construction work.
d. Assemble and submit to County a written document containing an attendees list and the
pre -bid meeting minutes, listing questions and answers for distribution to all interested
parties.
e. Prepare addendum(s) to the Project Manual (Bid Package), if needed.
Page 1 of 3
Deliverables:
For each deliverable, digital copies are to be sent to County and the Grant Administrator.
1. Written summary of the pre -bid meeting (submitted within three (3) business days of
meeting).
2. Addendum to the bid documents, if needed (submitted within five (5) business days of the
last day to submit comments/questions).
3. Bid Advertisement(s)
Timeline: Completed within (6) weeks.
Task 2 — Bid Proposals and Selection of Contractors.
Provider will assist County in the review of submitted proposals for conformance with project
requirements. Provider will summarize cost proposals in tabulated format for comparison. Provider
will assist County in reviewing bidder qualifications and assist with contract negotiations.
Deliverables:
1. Bid Tabulation Summary.
2. Recommendation of Award.
3. Notice to Proceed (to be provided to the selected contractor within two (2) business days
of Calhoun County Commissioners Court approval of the contractor).
Timeline: Complete Recommendation for Award for presentation to County and digital copies of
each deliverable are to be sent to County and the Grant Administrator within two (2) weeks of bid
closing.
Provider shall submit invoices to the Grant Administrator at the completion of each Benchmark,
in accordance with the Project Budget/Payment Schedule provided below. Requests for payment
must be supported by documentation as required under the Contract, such as invoices, receipts,
statements, stubs, tickets, time sheets, and any other documentation that, in the judgment of the
Grant Administrator, provides full substantiation of reimbursable costs incurred.
All invoices, reimbursement documents, and deliverables submitted must prominently display
"Infrastructure at Little Chocolate Bayou County Park" and "Work Order No. E-2." Failure to
include this identification may significantly delay payment under this Work Order.
Page 2 of 3
k
Total compensation due to Provider for services provided or performed pursuant to this Work
Order shall not exceed Twenty-five Thousand Dollars ($25,000.00). Invoices shall be paid in
accordance with the Project Budget below:
Benchmarks/Deliverables Amount Paid Per Benchmark
Benchmark 1 Revise Construction Plans & Bid Does $25,000.00
j otal Budget for This Work Order $25,000.00
Termination or Interruption of Work: County reserves the right to halt or defer all or any
portion of the work included in the Scope of Services of this Work Order any time during the
performance period. If such an event occurs, the Parties agree that the schedule and budget may
require renegotiation.
Amendments to Work Order: Material changes to this Work Order may only be made by written
agreement of both Parties.
All Parties to the Contract executed this Work Order, to be effective as of the date signed by the
last party.
CO OF CALH�O%UN
Richard H. Meyer
Calhoun County Judge
Date of execution: y Z? 2 oz L
G & W ENGINEERING, INC.
9= 2-1
Brian P. Novian
President �
Date of execution: ` 11 v Wzz
Page 3 of 3
NOTICE OF MEETING-4/27/2022
10. Consider and take necessary action to change the name of Huleo Road to Whitaker
Road in Precinct 4. (GDR)
RESULT:
APPROVED[UNANIMOUS]
MOVER:
Gary Reese, Commissioner Pct 4
SECONDER:
Joel Behrens, Commissioner Pct 3
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 6of13
#10
Gary D. Reese
County Commissioner
County of Calhoun
Precinct 4
April 19, 2022
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 April 27, 2022.
Consider and take necessary action to change the name of Huleo Road to Whitaker
Road in Precinct 4.
Sincerely,
I 'A 0
Gary D. Reese
CDR/at
P.O. Box 177 — Seadri0, Texas 77983 —email: earv.reese a calhouncotx.ora — (361) 785-3141 — Fax (361) 785-5602
NOTICE OF MEETING-4/27/2022
11. Consider and take necessary action to approve the Preliminary Plat of Serendipity
Subdivision. (GDR)
Terry Ruddick explained prelim plat.
RESULT: APPROVED [UNANIMOUS]
MOVER: Gary Reese, Commissioner Pct 4
SECONDER: David Hall, Commissioner Pct 1
AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 7 of 13
#11
Gary D. Reese
County Commissioner
County of Calhoun
Precinct 4
April 19, 2022
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 April 27, 2022.
• Consider and take necessary action to approve the Preliminary Plat of Serendipity
Subdivision.
I
cerely,
Gary D. Reese
GDR/at
P.O. Box 177 — Seadrift. Texas 77983 — email: Rarv.reese d calhouncom.ore — (361) 785-3141 — Fax (361) 785.5602
8
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NOTICE OF MEETING — 4/27/2022
12. Consider and take necessary action to approve the Final Plat of Lot iR, Block 154
Resubdivision No. 1. (GDR)
Terry Ruddick explained final plat.
RESULT: APPROVED[UNANIMOUS]
MOVER: Gary Reese, Commissioner Pct 4
SECONDER: Joel Behrens, Commissioner Pct 3
AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 8 of 13
#12
Gary D. Reese
County Commissioner
County of Calhoun
Precinct 4
April 20, 2022
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 April 27, 2022.
• Consider and take necessary action to approve the Final Plat of Lot 1R, Block 154
Resubdivision No. 1.
Sincerely,
A
�0
Gary D. Reese
GDR/at
P.O. Box 177 — Seadrifl, Texas 77983 — email: eary reccea�calho�acot� n� — (361) 785.3141 — Fax (361) 785-5602
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NOTICE OF MEETING-4/27/2022
13. Consider and take necessary action to accept an anonymous donation of $75.00 to the
Sheriffs Office to be deposited into the Motivation Account (2697-001-49082-679).
(RHM)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
David Hall, Commissioner Pct 1
SECONDER:
Vern Lyssy, Commissioner Pct 2
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 9 of 13
#13
CALHOUN COUNTY9 TEXAS
COUNTY SHERIFF'S OFFICE
211 SOUTH ANN STREET
PORT LAVACA, TEXAS 77979
PHONE NUMBER (361) 5534646
FAX NUMBER (361) 5534668
MEMO TO: RICHARD MEYER, COUNTY JUDGE
SUBJECT: ACCEPT DONATION TO SHERIFF'S OFFICE
DATE: APRIL 27, 2022
Please place the following item(s) on the Commissioner's Court agenda for the date(s)
indicated:
AGENDA FOR APRIL27, 2022
* Consider and take necessary action to accept anonymous donation to the
Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the
amount of $75.00
Sincerely,
Wim
Bobbie Vickery
Calhoun County Sheriff
n
e
2315 ..,
t'
✓ `/ r
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FOR
A
NOTICE OF MEETING-4/27/2022
14. Consider and take necessary action to declare the attached list of Portable Radios from
the Emergency Management Department as Surplus/Salvage. (RHM)
Pass
Page 10 of 13
#14
Calhoun County, Texas
SURPLUS/SALVAGE DECLARATION REQUEST FORM
Department Name: lEmergency Management
Requested By: LaDonna Thigpen on 4-27-22
Inventory
Number Description
Reason for Surplus/Salvage
Serial Nn_
406-0156
406-0157
406-0168
541-0222
541-0223
XTS 1500 Portable Radios
XTS 1500 Portable Radios
XTS 1500 Portable Radios
XTS 1500 Portable Radios
XTS 1500 Portable Radios
XTS 1500 Portable Radios
XTS 1500 Portable Radios
XTS 1500 Portable Radios
XTS 1500 Portable Radios
687CPX1253
687CPX1254
687TGWE707
687CLT0197
687CLT0198
687TGWE708
687TGWE709
687TGWE710
687TGWE721
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
Traded in for new on 2021 APR Radio Project
NOTICE OF MEETING-4/27/2022
15. Consider and take necessary action to declare the attached list of miscellaneous
equipment from the Emergency Management Department as Surplus/Salvage. (RHM)
RESULT:
APPROVED[UNANIMOUS]
MOVER:
Vern Lyssy, Commissioner Pct 2
SECONDER:
David Hall, Commissioner Pct 1
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 11 of 13
#15
Calhoun County, Texas
SURPLUS/SALVAGE DECLARATION REQUEST FORM
Department Name: lEmergency Management
Requested By: LaDonna Thigpen
Inventory Reason for Surplus/Salvage
Number Description Serial No. Declaration
The following are not on inventory
Sony Digital Mavica Camera
MVC-FD90 SN171125
No longer used.
Sony Cyber Shot SDC-HX20V
Camera P-80808637
No longer used
Kodak Easy Share DX6490 Cam
KCTCT43034238
No longer used.
Sony Digital Handycam
DCR-TRV240 404850
No longer used.
Kodak Rapid Battery Charger
K5000
No longer used.
Kroy Duratype Label Maker
D064080
No longer used.
240 SE w/4 cartridges
NOTICE OF MEETING — 4/27/2022
16. Consider and take necessary action on any necessary budget adjustments. (RHM)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
Gary Reese, Commissioner Pct 4
SECONDER:
Joel Behrens, Commissioner Pct 3
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 12 of 13
#16
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NOTICE OF MEETING-4/27/2022
17. Approval of bills and payroll. (RHM)
MMC
RESULT:
APPROVED [UNANIMOUS]
MOVER:
David Hall, Commissioner PcL 1
SECONDER:
Gary Reese, Commissioner Pct 4
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
County Bills
RESULT: APPROVED [UNANIMOUS]
MOVER: David Hall, Commissioner Pct 1
SECONDER: Gary Reese, Commissioner Pct 4
AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Adjourned:10:25a.m.
Page 13 of 13
# 17
April 27, 2022 2022 APPROVAL LIST - 2022 BUDGET
COMMISSIONERS COURT MEETING OF
04/27/22
BALANCE BROUGHT FORWARD FROM
APPROVAL LIST REPORT PAGE 20
$182,647.58
AT&T MOBILITY
EMS MARCH 2O22 CELL PHONE SERVICE
A/P
$
418.96
CAP PROD CHOCOLATE BAYOU PARR &
G&W
MAGNOLIA BEACH FIRE STATION
A/P
$
50,000.00
PITNEY BOWES
SO POSTAGE
A/P
$
1,000.00
TOTAL
VENDOR DISBURSEMENTS:
S
234,066.54
PAYROLL FOR April 29, 20202
P/R
S
371,532,461--
TOTAL PAYROLL AMOUNT:
S
371,532,46'V"
TOTAL INVESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: $
TOTAL AMOUNT FOR APPROVAL: S 605,599.00
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR ---April 27 2022
TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES
TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 1,086,356A6
TOTAL TRANSFERS BETWEEN FUNDS $ 90,276.10
TOTAL NURSING HOME UPI, EXPENSES $ 833,07269
TOTAL INTER•GOVERNMENT TRANSFERS $ 04,439.64
GRAND TOTAL DISBURSEMENTS APPROVED April 27, 2022 $ 2,074,143.881"
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR ---April 27 2022
PAYABLES AND PAYROLL
4/21/2022 Weekly Payables
4/21/2022 Citibank Credit Card -see attached
4/25/2022 McKesson-340B Prescription Expense
4/26/2022 Ameriscurce Bergen-3406 Prescription Expense
4/25I2022 Payroll Liabilities -Payroll Taxes
4/25/2022 Payroll
Electronic Bank Payments
TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES
4/21/2022 MMC Operating to Solera-correction of NH insurance payment deposited into
MMC Operating
4/21/2022 MMC Operating to Golden Creek -correction of NH insurance payment
deposited into MMC Operating in error
4/21/2022 MMC Operating to Gulf Pointe Plaza -correction of NH insurance payment
deposited into MMC Operating
4/2l/2022 MMC Operating to Tuscany Village -correction of NH Insurance payment
deposited into MMC Operating
4/21/2022 MMC Operating to Bethany -correction of NH insurance payment deposited
into MMC Operating in error
TOTAL TRANSFERS BETIIVEEN FUNDS
NURSING HOME UPL EXPENSES
4/25/2022 Nursing Home UPL-Cantex Transfer
4/25/2022 Nursing Home UPL-Nexion Transfer
4/25/2022 Nursing Home UPL-Tuscany Transfer
4/25/2022 Nursing Home UPL-HSL Transfer
TOTAL,NURSING 4DME.UPL EXPENSES'
553,996.42
2,992.82
6,396.20
629.49
129,263.56
392,689.06
387.90
$ 1,086,;355A6.
7,481.39
10,688.78
3,153.20
3,009.25
65,943.48
$ 90r276.10'
428,253.42
110,812.66
84,999.01
209,007.60
INTER -GOVERNMENT TRANSFERS
5/6/2022 IGT CHRIP PGY1 to be paid on May 06, 2022 64,439.64
TOTAL INTER -GOVERNMENT TRANSFERS' $ 64,439.64 ,
GRAND TOTAL DISBURSLMENTS.APPROVEDrA ril'27,:2022 $ 2,0741;4,188
Page 1 of 12
RECEIVED BY WE
COUNTY AUDITOR ON
MR110122022 MEMORIAL MEDICAL CENTER
11:27 AP Open Invoice List
CA� anN COUNTY,
Vendor EX*Name Due Dates Through: 05/12/2022
Class Pay Code
10995 ABILITY NETWORK(SHIFTHOUND) �/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
22MOD49740 ✓ 04/12/20 04/06/20 06108/20 647.28
SCHEDULING SERVICES
Vendor Totals Number Name Gross
10995 ABILITY NETWORK (SHIFTHOUND) 647.28
Vendor# Vendor Name Class Pay Code
10950 ACUTE CARE INC
0
ap_open_invoice.template
Discount
No -Pay
Net
0100
0.00
647.28
Discount
No -Pay
Net
0.00
0.00
647,28
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
INV687 ✓ 04/20/20 0420/20 05/20/20
1,400.00
0.00
0.00
RFID FEE
Vendor Totals Number Name
Gross
Discount
No -Pay
10950 ACUTE.CARE INC -
1,400,00
0.00
0.00
Vendor# Vendor Name Class
Pay Code
12900 AMANDA GRIGGS /
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
041322 04/20/20 04/13/20 04/25/20
76.00
0.00
0,00
TREIM-n(CUpA-1'tD"I"ritlyRyIq
fdRti_r.M-Vtr`jU&t
Vendor Totals Number Name
Gross
Discount
No -Pay
12900 AMANDA GRIGGS
76.00
0.00
0.00
Vendor# Vendor Name
Pay Code
/Class
A2150 ANNOUNCEMENTS PLUS TOO AGAIN t/ W
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Grass
Discount
No -Pay
705 i j 04/12/20 04/29/20 05/09/20
10.00
0.00
0.00
PRINTING
Vendor Totals Number Name Gross
A2150 ANNOUNCEMENTS PLUS TOO AGAIN 10.00
Vendor# Vendor Name Class Pay Code
A2218 AQUA BEVERAGE COMPANY,"
M
Invoice# / Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
192256 ✓'' 04/2020 04/02/20 04/27/20 64.10
WATER
Vendor Totals Number Name Gross
A2218 AQUA BEVERAGE COMPANY 64.10
Vendor# Vendor Name Class Pay Code
A0400 AUREUS RADIOLOGY LLC bl
Invoice# _Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross
2556145✓ 04/20/20 04/11/20 05/11/20 2,412.00
,TRAVEL LAB STAFFING (3Ia5-3)dT I.%1�}{1lW llit'1'a
2656054 ✓ 04120120 04/11120 05111/20 2,680.00
TRAVEL LAB STAFFING P I AS -3 Ia 1 da� S'1'71 w1+.y
2557941 �i 04/20/20 04/1112005111120 2,760.00
TRAVEL LAB STAFFING L3Id5-3I31)6L7-) (1h4 VMv -
2556112 f 04/20/20. 04/11/20 05/11/20 2,760.00
TRAVEL LAB STAFFING 13�'i7Jr-'7j )'3IOda) SI4�M1IMAi,(n,_-.
Vendor Totals Number Name Gross
A0400 AUREUS RADIOLOGY LLC 10,612.00
Net
1.400.00 V �
Not
1,400.00
Net
75.00
Net
75.00
Net
10.00
Discount
No -Pay
Net
0.00
0.00
10.00
Discount
No -Pay
Net
0.00
0.00
64.10
Discount
No -Pay
Net
0.00
0.00
64,10
Discount
No -Pay
Net
0.00
0.00
2,412.00
0.00
0.00
2,680.00 ✓-
0100
0.00
2,760.00 ✓'
0.00
0100
2,760.00✓
Discount
No -Pay
Net
0100
0100
10,612.00
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Page 2 of 12
Vendor# Vendor Name Class Pay Code
B1150 BAXTER HEALTHCARE „'� w
Invoice# Comment Tran Dt Inv Ot Due Dt Check D' Pay Gross
Discount
No -Pay
Net
74449431 yid 04/12/20 03/24/20 04/18/20
330.64
0.00
0,00
330.64 f ,.
SUPPLIES
74520493
04/12/2003/30/2004/24/20.
461,35
0.00
0.00
461.35 ri
SUPPLIES
7454$365 ,// 04/20/20 04/01/20 04/26/20
140.31
0.00
0.00
140.31 1/!
§UPPLIE5
✓
74550664 04/20/20 04/01/20 04/26/20
110.91
0.00
0.00
110.91
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
Bi150 BAXTER HEALTHCARE
1,043.21
0.00
0.00
1,043.21
Vendor# Vendor Name Class Pay Code
B1220 BECKMAN COULTER INC ✓ M
Invoice# Clmment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
109810971 ✓ 04/20/20 04/06/20 05/01/20
455.52
0.00
0.00
455.52
SUPPLIES
109817544 / 04/20/20 04/11/20 05106/20
748.65
0.00
0.00
74&65
,SUPPLIES
5456162✓ 04120/20 04/43/20 05/08120
5,016.58
0.00
0.00
5,016.58
MAINT/LEASE
109825807 / 04/20/20 04/13/20 05/08/20
1,438.84
0.00
0.00
1.438,84 yJ`
SU PLIES
I D9828031 04/20/20 04/15/20 05/10/20
308.58
0.00
0.00
308.58
SUPPLIES
U
109827940 ,/ 04120/20 04/15/20 05/10/20
1.288.45
0.00
0,00
1,288.45
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
B1220 BECKMAN COULTER INC
9,256,62
0.00
0.00
9,256.82
Vendor# Vendor Name Class Pay Code
12324 BLUE CROSS BLUE SHIELD ✓-
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass
Discount
No -Pay
Net
041522A 04/20/20 04/15/20 05101/20
1,616.83
0.00
0.00
1,516.83
COBRA MAY 22
041522 04120/20, 04115/2005101120
214,483.59
0.00
0,00
214,483.59
PAYROLL DEDUCT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
12324 BLUE CROSS BLUE SHIELD
2113,000.42
0.00
0.00
216,000.42
Vendor# Vendor Name Class Pay Code
B1680 BOUND TREE MEDICAL, LLC a% M
Invoice# Comment Tran Of Inv Ot Due Dt Check 0Pay Gross
Discount
No -Pay
Net
84483150 ✓ 04120120 04/12120 04/12120
296.82
0.00
0.00
296,82 ✓"
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
B1680 BOUND TREE MEDICAL, LLC
296.82
0.00
0.00
296.82
Vendor# Vendor Name Class Pay Code
13992 CARIANT HEALTH PARTNERS „%-i
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
1112 04/2012004/06/2/004/06/20
2,520.00
0.00
0.00
2,520.00 j
TRAVEL NURSE STAFFING ( 3IaN_ 77111)?0-) FU(bt1.L)
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Page 3 of 12
1364 04/20120.04/13120 04/13/20
2,520,00
0.00
0.00
2,520,00
TRAVEL NURSE STAFFING ( 41" 4Ih122)I YW&
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
13902 CARIANT HEALTH PARTNERS
5,040.00
0.00
0.00
5,040.00
Vendor# Vendor Name Class Pay Code
13336 COCA COLA SOUTHWEST BEVERAGES
V/
Invoice# Comment Tran Dt Inv of Due of Check D Pay Gross
Discount
No -Pay
Net
24165200735 b'' 04/21/20 04/06/20 05100120
-250.00
0100
0.00
-250.00
CREDIT
24165200734 �. '� 04/21/20 04/06/20 05/06/20
576.00
0.00
0.00
576.00
DRINKS
Vendor Total$ Number Name
Gross
Discount
No -Pay
Net
13336 COCA COLA SOUTHWEST BEVERAGES
326.00
0.00
0.00
326=
Ventlor# Vendor Name Class Pay Code
14404 CON -METAL CONCRETE, LLC ,/
Invoice# Comment TranDt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
042022 04/21 /20 04/20/20 W20/20
281.22
0.00
0.00
281.22 V /
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
14404 CON -METAL CONCRETE, LLC
281.22
0.00
0.00
281.22
Vendor# Vendor Name Class Pay Code
C2157 COOPER SURGICAL INC ,/� M
Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
6193137 y/ 04/20/20 04/06/20 04/20/20
715.22
0.00
0.00
715.22
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
C2157 COOPER SURGICAL INC
715.22
0.00
0.00
715.22
Vendor# Vendor Name Class Pay Code
14400 CULINARY CONCESSIONS LLC ✓-
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
INV00005559 r - 0412012003/31/20
31,636.07
0.00
0.00
31,636.07
FOOD, SUPPLIES, CONTRACT
f
INV00005559 04/21120 03/31120 04/30/20
31,636.07
0.00
0.00
31,636.07
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
14400 CULINARY CONCESSIONS LLC
63,272.14
0.00
0:00
63,272.14
Vendor# Vendor Name Class Pay Code
10509 DA&E ,:
Invoice# ✓ Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross
Discount
No -Pay
Net
17675 04/21/2004/08/2004/08/20
1,540.00
0.00
0.00
1,540.00
CAH MEDICAREREIMBURSEM
Vendor Total: Number Name
Gross
Discount
No -Pay
Net
10509 DA&E
1,540.00
0.00
0.00
1.540.00
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
41124 04/20/20 04/15/20 04/25/20
40,062.50
0.00
0.00
40,062.50
TRAVEL NURSE STAFFING (1-151k)
Vendor Total, Number Name
Gross
Discount.
No -Pay
Net
11264 EMERGENCY STAFFING SOLUTIONS
40.062.50
0.00
0.00
40,062.50
Vendor# Vendor Name Class Pay Code
file:/NC:/Users/Itrevinolepsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report287377... 4/21 /2022
Page 4 of 12
`/
T0383 ERIN CLEVENGER W
Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay
Gross
Discount
No -Pay
Net
041422 04/20/20'0`4/14/20 04/25/20
30.42
0.00
OW
30.42 V /
TRAVEL Mj4WMA Or.IVNtIwN1 &vmkrUUF- 11111-L,
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
T0383 ERIN CLEVENGER
30.42
0.00
0.00
30.42
Vendor# Vendor Name Class Pay Code
13872 ETHOS MEDICAL STAFFING
Invoice# Comment Tran Dt Inv Di Due Dt Check D Pay
Gross
Discount
No -Pay
Net
/
27509,/ 04/20/20 08/06/20 08/06/20
2.767.92
0.00
0.00
2,767.92 ,.
ICU NURSE STAFFING (1,8,3-'I(e ila.�-� tbWAKtL
,
27991 ✓ 0412O 20. 09103/20 0 10/03/
2,865.20
0.00
0,00
2,865.20
C'�
ICUSTAFFING L��aa _g�otg�al I l6tKli.-
VA4.
,
28098 04/20120 09/10/20 10/1010
2,715.48
0.00
0.00
2,715.48y,/
1 `
ICU STAFFING ( {t I �q I - o) I4I 21 6j/AWL7 L-
.
28219 04/20120 09/17/20 10/17120
2,780.30
0.00
0.00
2,780.30
ICU STAFFING (q jq, qj I t l Xt� fh(A((olk'
28336 04/20/20 09/24/20 10/24/20.
2,752.72
0.00
0.00
2,752.72
ICUSTAFFING �FIIaJ�i, el'CA14ak-
VendorTotal:Number Name i
Gross
Discount
No -Pay
Net
13872 ETHOS MEDICAL STAFFING
13,881.62
0.00
0.00
13,881.62
Vendor# Vendor Name Class Pay Code
C2510 EVIDENT M
Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay
Gross
Discount
No -Pay
Net
T2204081378 04/2012004/08120'05/03/20
33,757.89
0.00
0.00
33,757.89 r'+'
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
C251D EVIDENT
33,757.89
0.00
0.00
33,757.89
Vendor# Vendor Name Class Pay Code
F1400 FISHER HEALTHCARE f� M
Invoice# Comment Tran DI Inv Dt Due Dt Cheek D Pay
Gross
Discount
No -Pay
Net
1353840 f 04/12/90 03/31/20 04/25/20
147.90
0.00
0.00
147.90
SUPPLIES
1450095 ✓ 04/20/20 03/22/20 04/16/20
317.96
0.00
0.00
_
317.96
SUPPLIES
1406255 �%� 04/20/20 04/01/20 04/26/20
906.06
0.00
0.00
906.06✓
SUPPLIES
.
1450094 ,.�/ 04/20/20 04/04120 04/29/20
637.37
0.00
0.00
637.37 �!
SUPPLIES
1497016 +/04/20/20 04/05/20 04/30/20
23.26
0.00
0.00
23.26
SUPPLIES
1596949 V/04/20/20 04/07/20 05/02/20
604.48
0.00
0.00
604.48
SUPPLIES
1596947,,,- 04/20/20 04107/20 05102/20
1,587,56
0.00
0.00
1.587.5611
SUPPLIES
1690941 04/20/20 04/11/20 05/05/20
22.83
0.00
0.00
22.83
UPPLIEB
1740715 04/20/20 04/12/20 05/07/20
89,51
0=
0.00
89.51 ✓f
/SUPPLIES
1740716 04/20/20 04/12/20 05/07/20
✓
161.50
0.00
0.00
161.50
SUPPLIES
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Page 5 of 12
Vendor Totals Number Name
Gross
F1400 FISHER HEALTHCARE
4,498.43
Vendor# Vendor Name Class Pay Code
13960 G & S MANAGEMENT GROUP LLC
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass
340384915 "� 04/20/20 04/12/20 04/22/20
371.15
TRASH SERVICE
340384914 / 04120/2004/1 PJ2004/22/20
1,392.76
TRASH SERVICE
340384948 x
1/' 04/20/20 04/13/20 04/23/20
260,55
TRASH SERVICE
Vendor Totals Number Name
Gross
13960 G & S MANAGEMENT GROUP LLC
2,024.46
Vendor# Vendor Name Class Pay Code
12404 GE PRECISION HEALTHCARE, LLC ✓
Invoice# Comment Tran Dt Inv Dt Due 01 Check D Pay Gross
6002095435 ✓' 04/20/2004101/2005/01/20
86.67
IMAGING CONTR
6002095632 „/� 04/20/20 04/01/20 05/01/20
868.16
IMAGING CONTR
6002095385 Li 04/20/20 04/01/20 05/01/20
680.00
IMAGING CONTR
60D2095434. 04/20/20 04101/20 05/01/20
8,588,58
IMAGING CONTR
6002095457,/ 04/20/20 04/01/20 05/01/20
5,665,83
MAINT CONTRACT APR 2022
Vendor Totals Number Name
Gross
12404 GE PRECISION HEALTHCARE,LLC
10,889.24
Vendor# Vendor Name Class Pay Code
G1001 GETINGE USA ✓
Invoice# Comment Tran Dt Inv Ot Due Dt Check Pay Gross
6991859593 :' 04/20/20 03/29/20 04/29/20
39,94
SUPPLIES
Vendor Total, Number Name
Gross
G1001 GETINGE USA
39.94
Vendor# Vendor Name Class Pay Code
W1300 GRAINGER w% M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
9269580594 �% 04/20/20 04/05/20 04/30/20
247.90
SUPPLIES
Vendor Totals Number Name
Gross
W1300 GRAINGER
247.90
Vendor# Vendor Name Class Pay Code
G1210 GULF COAST PAPER COMPANY ' M
Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross
2213413 ✓ 04/12/20 04/05/20 05/O5/20
856.28
Discount No -Pay
0.00 0.00
Discount No -Pay
Oleo 0.00
0.00 0.00
0,00 0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
0.00 0,00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
oleo oleo
Discount No -Pay
0.00 0.00
SUPPLIES
Vendor Totals Number Name Gross Discount Nu -Pay
G1210 GULF COAST PAPER COMPANY 856.28 0.00 0.00
Vendor# Vendor Name Class Pay Code
H1399 HILL -ROM COMPANY, INC M
Net
4,498.43
Net
371.15
1,392,76
260.55
Net
2.024,413
Net
86,67 ,
868.16
680.00
3,588.58
5.666.83
Not
10,889,24
Net
39.94 ✓
Net
39.94
Net
247.90
Net
247.90
Net
856.28
Net
856.28
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Page 6 of 12
Invoice# Comment Tran Dt Inv Dt Due Dt Check O Pay Gross Discount No -Pay
2531730 .- 04/20/20 05/31/20 06/30/20 252.00 0.00 0.00
SUPPLIES
2547675 ,i 04/20/20 06/30/20 07/30/20
Net
252.00
126.00 0.00 0.00 126.00 W
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
H1399 HILL -ROM COMPANY, INC
378.00
0.00
0.00
378.00
Vendor# Vendor Name Class
Pay Code
14316 JUNXION MED STAFFING ,/
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
MMCWE040222 ,/' 04120/20 04108120 04/23/20
9,145.00
0.00
0.00
9,145.00 ✓f
TRAVEL NURSE STAFFING (S)U-+-}fldlti�
�'t 44`t.4
.
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
14316 JUNXION MED STAFFING
9,145.00
0.00
0.00
9,145.00
Vendor# Vendor Name Class
Pay Code
14396 KING RANCH TURFGRASS. L,P. .y`
Invoice# Comment Tran Dt Inv of Due Dt
Check D- Pay Gross
Discount
No -Pay
Net
01510 04/20/20 04/20/20 04/20/20
620.00
0.00
0.00
620.00
AMERISHADE GRASS
V
.
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
14396 KING RANCH TURFGRASS, L.P. 620.00
0.00
0.00
620.00
Vendor# Vendor Name Class
Pay Code
L0700 LABCORP OF AMERICA HOLDINGS � M
Invoice# Comment Tran Dt Inv Dt Due Dt
CheckDPay Gross
Discount
No -Pay
Net
/
7264580, / 04/20/20 04/02/20 04/270
15.00
0.00
0.00
15.00 ✓
LAB SERVICES
/
72469693 ,,.; 04/20/20 04/02/20 04/27/20
36.29
0.00
0.00
36.29 f
LAB SERVICES
72607987A✓f 04121/20 (14102120 04/27/20
79.25
0.00
0.00
79.25
LAB SERVICES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
L0700 LABCORP OF AMERICA HOLDINGS 130.54
0.00
0.00
130.54
Vendor# Vendor Name Class
Pay Code
11796 LUDY'S FUDDRUCKERS RESTAURANTS
Invoice# Com/mQnt Tran Dt Inv Dt Due on
Check D Pay Grass
Discount
No -Pay
Net
INV00005456 ✓ 04/20/20 02/28120 03115120
26,193.96
0.00
0.00
26,193.96 ✓
FOOD, SUPPLIES, CONTRACT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11796 LUBY'S FUDDRUCKERS RESTAURANTS 25,193.96
0.00
0.00
26,193.96
Vendor# Vendor Name Class
Pay Code
J1350 M.C. JOHNSON COMPANY INC ✓ M
Invoice# /Comment Tran Dt Inv or Due or
Check D Pay Gross
Discount
No -Pay
Net
00390347 ✓ 04/20/20 04/08/20 04/20/20
95.33
0.00
0.00
95.33 ✓
SUPPLIES
Vendor Total: Number Name
Gross
Discount
No•Pay
Net
J1350 M.C. JOHNSON COMPANY INC
95.33
0.00
0.00
95.33
Vendor#Vendor Name Class
Pay Code
M2178 MCKESSON MEDICAL SURGICAL INC `//'
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D' Pay Gross
Discount
No -Pay
Net
19275008 / 04/13/20 04/12/20 04/27/20
83.84
0.00
0,00
83.84
SUPPLIES
file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report287377... 4/21 /2022
Page 7 of 12
19275021 v i 04/13/20 04/12/20 04/27/20
418.69
0.00
0.00
418.69
SUPPLIES
Y
Vendor Total: Number Name
Gross
Discount
No -Pay
Net
M2178 MCKESSON MEDICAL SURGICAL INC 502.53
0.00
0.00
502.53
Vendor# Vendor Name Class
Pay Code
M2280 MEAD JOHNSON NUTRITION ✓
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
993369801 y/ 04/12/2004104/2004/12/20
216.00
0.00
0.00
216.00
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
M2280 MEAD JOHNSON NUTRITION
216,00
0.00
0.00
216.00
Vendor# Vendor Name Class
Pay Code
11612 MEDICAL AIR SERVICES ASSOC. ✓'r
Invoice# ,Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
1233766✓/ 04120120 04/15120 04130/20
1,588.00
0.00
0.00
1,588.00 v/
MAY 22 INSURANCE
.
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11612 MEDICAL AIR SERVICES ASSOC. 1,588.00
0.00
0.00
1,588.00
Vendor# Vendor Name Class
Pay Cade
M2470 MEDLINE INDUSTRIES INC M
. Invoice# Comment Tran Dt Inv Dt Due Ot
Check D Pay Gross
Discount
No -Pay
Net
2204966109 y// 04/12/20 04102120 04127120
2,546.99
0,00
0.00
2,546.99 V/
SUPPLIES
2204956105 ✓ 04112/20 04/02/20 04/27/20
340,80
0.00
0.00
340.80. f
SUPPLIES
2205124371 04/12/2004/04/2004129/20
26A6
0.00
0.00
26,16
SUPPLIES
2205124372 04/1212004/04/2004/29/20
1,291.14
0.00
0.00
1,291.14,/`
SUPPLIES
2205124368 , / 04/12/20 04/04/20 04/29/20
12.22
0.00
0.00
12,22
SUPPLIES
2205124370 f 04/12/20 04/04/20 04/29/20
707.19
0.00
0.00
707.19 ./
SUPPLIES
2205124367 �' 04/12/20 04/04/20 04/29/20
114.02
0.00
0.00
114.02 .!
SUPPLIES
2204956108 �' 04/12/20 04/12/20 05/07/20
29.40
0.00
0.00
29.40
r
2204756525 W% 04/20/20 04101/20 04/26/20
31,27
0.00
0.00
31.27
SUjPPLIES
�,.--
2205327982 v' 04/20/20 04/05/20 04/30/20
45.80
0.00
0.00
45.80
SUPPLIES
2205327981 Jam. 04/20/20 04/05/20 04/30/20
75.00
0.00
0.00
75.00
SUPPLIES
2205327979 �% 04/20/20 04/05/20 04/30/20
4,27
0.00
0.00
4.27
SUPPLIES
2205327980 ✓/04/20/20 04/O5/20 04/30/20
0.66
0.00
0.00
0.66 ✓
SUPPLIES
2205648494 yr' 04/20/20 04/06/20 05/01 /20
746.82
0.00
0.00
746.82 �..�
SUPPLIES
2205548493 s� 04/20/20 04/06/20 05101 /20
185.96
0.00
0.00
185.96 f
SUPPLIES
file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report287377... 4/21 /2022
Page 8 of 12
2205548495 ✓- 04/20/20 04/06120 05101/20
334.04
0.00
0.00
334.04 u,�
SUPPLIES
2205645385 V / 04/20120 04/06/20 06/01/20
-20.65
0.00
0.00
-20.65
CREDIT
Vendor Totals Number Name
Grass
Discount
No -Pay
Net
M2470 MEDLINE INDUSTRIES INC
6,471.09
0.00
0.00
6,471.09
Vendor# Vendor Name
Class
Pay Code
10536 MORRIS & DICKSON CO,
LLC „%
Invoice# Comment
Tran or Inv Dt Due Dt
Check D Pay Gross
8096334 �`
04/20/2004/13/20 D4/23/20
18.87
INVENTORY
8097723 1 j
04/20/20 04/13/20 04/23/20
38.68
INVENTORY
8095335 .l
04/20/20 04/13/20 04/23120
267.13
INVENTORY
8100777✓ ,.
04(20/20 04/14/20 04/24/20
210.30
INVENTORY
6822 1/
04/20/20 04/14/20 04/24/20
-32.35
Discount
No -Pay
Net
0.00
0.00
18.87 �.
0.00
0.00
38.68 ✓�
0,00
0.00
267.13
0.00
0.00
210.30 v
0.00 0.00
CREDIT
8098104 �f` 04/20120 0014120 04/24/20 6,533.69
0.00
,INVENTORY
8097921 04/20/20 04/14/20 04/24120 3.997.18
0.00
INVENTORY
8098580 f 04120/20 04/14/20 04/24/20 2,561,60
0.00
INVENTORY
6669 Z 04120/20 04/14/20 04/24/20-123.51
0.00
CREDIT
/
8100776 „/ 04/20/20 04/14/20 04/24/20 31.05
0.00
INVENTORY
Vendor Totals Number Name Gross
Discount
10636 MORRIS & DICKSON CO, LLC 12,502.64
0.00
Vendor# Vendor Name Class Pay Code
14124 MSH HEALTH SERVICES LLC _/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross
Discount
MM00061 ✓/04/20/20 04/04/20 04/19/20 6,463,75
0.00
TRAVEL NURSE STAFFING tala5-31bil Pfi) wVt�tW1x--
MMC0063 ✓ 04/2012004/11/2004126/20'J 5,425.00
0.00
TRAVEL NURSE. STAFFING (411- 4 ll fy) (h0llVtk jlL P--
MMC0064`,/ 04/20/2004/11/2004/26/20 2,960.00
0.00
T',iAVEL NURSE STAFFING (,141111' '\
MMC0065 ✓ 04120/2004/18/20051/03/20 \ 2,940.00
��'
0.00
NURSE STAFFING L 41 Y - 41 2�! past `-'
/TRAVEL
MMC0066 04/20/20 04/18/20 05/03/20 5,463.75
✓
0.00
TRAVEL NURSE STAFFING tli%- 41Iglr3-)
MM00062 ✓/ 04/21/20 04/06/20 04/21/20 2.940.00
0.00
TRAVEL NURSE STAFFING ('171 j - $l3il yy� Dµ,r-
VendorTotalsNumber Name Gross
Discount
14124 MSH HEALTH SERVICES LLC 26,192.50
0.00
Vendor# Vendor Name Class Pay Code
M2659 MXR IMAGING, INC ✓�- M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
0.00
0.00
0.00
0.00
D.00
No -Pay
0.00
-32.35 j
5,533.69,,-
3,997.18 ✓.
2,561.60
-123.51
31.05 V/J
Net
12,502.64
No -Pay Net
0.00 5,463.75
0.00 5,425.00 ✓�
0.00 2,960,00
0.00 2,940.00 ✓
0.00 5,463,75 W/
0.00 2.940.00 1/f
No -Pay Net
0.00 25,192.50
No -Pay Net
file:///C:/CJsers/itrevino/cpsihnenimed.cpsiiiet.com/u88125/data_5/tmp_cw5report287377... 4/21 /2022
Page 9 of 12
8600661862 V' 04/20/20 09/03/20 10/03/20 916.51
0.00
0.00
916.51 ✓
SUPPLIES
8800888896'/ 04/20/2004/11/2005/11/20 1,00a.34
0.00
0.00
1,008.34 f'
SUPPLIES
Vendor Total -Number Name Gross
Discount
No -Pay
Net
M2659 MXR IMAGING, INC 1,924.85
0.00
0.00
1,924,85
Vendor# Vendor Name Class Pay Code
12388 NATIONAL FARM LIFE INSURANCE Y%
Invoice# fCommenl Tran Ot Inv Dt Due Dt Cheek D Pay Gross
Discount
No -Pay
Net
3666605 ✓ 04120/20 04/11120 05/01/20 4,001.31
0.00
0,00
4,001.31
PAYROLL DEDUCT
Vendor TotalE Number Name Gross
Discount
No -Pay
Net
12388 NATIONAL FARM LIFE INSURANCE 4,001.31
0.00
0.00
4,001.31
Vendor# Vendor Name / Class Pay Code
12316 NCS PEARSON, INC, I/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
/
17865B46 v' 04120/2004/01/2004/01/20 250.00
0,00
0.00
250.00 Wig
SUPPLIES
Vendor Totals Number Name Gross
Discount
No -Pay
Net
12316 NCS PEARSON, INC. 250.00
0.00
0.00
250.00
Vendor# Vendor Name Class Pay Code
11472 OCCUPRO LLC 11/
Invoice# Comment Tran DI Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
25607 v/ 04/12/20 04/07/20 05/07/20 48T47
0.00
0.00
487A7
MTHLY PROVIDER LICENSE
Vendor Totals Number Name. Gross
Discount
No -Pay
Net
11472 OCCUPRO LLC 487.47
0.00
0.00
487.47
Vendor# Vendor Name Class Pay Code
14252 OLOOP TECHNOLOGY SOLUTIONS
Invoice# Comment Tran Dt Inv Dt Due Dt Check 0-Pay Gross
Discount
No -Pay
Net
INVAJONES0020 ✓ 04120/2004/05/2004/05/20 6,184.75
0.00
0.00
6,184.75 '
TRAVEL NURSE STAFFING ju'a
INVAJONES0019 VX 04120/20 04105/20 05105/20 6,184.75
0.00
0.00
,
6,184.76
TRAVEL NURSE STAFFING jla5' 5131 ) TZ'J {<LS
Vendor Totals Number Name Gross
Discount
No -Pay
Net
14252 OLOOP TECHNOLOGY SOLUTIONS 12,369.50
0.00
0.00
12,369.50
Vendor# Vendor Name Class Pay Code
01500 OLYMPUS AMERICA INC r,/� M
Invoice# Comment Tran Dt Inv Dt Due DI Check D Pay Gross
Discount
Nu -Pay
Net
32481747 / 04121120 04/07/20 05102/20 1,137.51
0.00
0.00
1,137.51 ✓�
LEASE
Vendor Total, Number Name Gross
Discount
No -Pay
Net
01500 OLYMPUS AMERICA INC 1,137,51
0.00
0.00
1.137.51
Vendor# Vendor Name class Pay Cade
01416 ORTHO CLINICAL DIAGNOSTICS /
Invoice# Comment Tran Dt Inv Dt Due Dt Check D. Pay Gross
Discount
No -Pay
Net
18123391611 f 114,20/20,13/28/2004/27/20 752.16
UPPLIES
0.00
0.00
752.16
Vendor Total[ Number Name Gross
Discount
No -Pay
Net
01416 ORTHO CLINICAL DIAGNOSTICS 752.16
0.00
0.00
752.16
Vendor# Vendor Name Class Pay Code
file:///C: /Userslitrevino/cpsilmemmed. cpsinet.com/u8 8 l 25/data_5/tmp_cw5report2873 77... 4/21 /2022
Page 10 of 12
10152 PARTSSOURCE, LLC ✓/
Invaice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
4300806 ��! 04/20/20 04/04/20 05/04/20 89,38
Discount No -Pay Net
0.00 0,00 89.38 L,%
04300265 04/20/20 04/04/20 05/04/20
48.65
0.00
0.00
48.65
✓'
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10152 PARTSSOURCE,. LLC
138.03
0.00
0.00
138.03
Vendor# Vendor Name Class
Pay Code
/
11080 RADSOURCE ,J
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
SC32090522r/ 04/20/20. 04/1212005/07/20
1,791.67
0.00
0.00
1,791.67 1/
SERVICE AGREEMENT
SC13756 a/' 04/21/2003/22/2004/16/20
1,791.67
0.00
0.00
1,791.67
CONTRACT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11080 RADSOURCE
3,583.34
0.00
0.00
3,583.34
Ventlor# Vendor Name Class
Pay Cade
12436 SHANNA O'DONNELL, FNP
Invoice# Comment Tran Dt Inv Dt Due Ot
Check D Pay Gross
Discount
No -Pay
Net
2161637 0412012004/19/2004/25/20
1,299,00
0.00
0100
1,299.00
IJp1110(k OWa lluu+r7<4 (?Vvrtxi IlnetUL#_e (Lkvat(OS Ip6lucim
aad-*u ,)
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
12436 SHANNA O'DONNELL, FNP
1,299.00
0.00
0.00
1,299.00
Vendor# Vendor Name Class
Pay Code
10936 SIEMENS FINANCIAL SERVICES ✓
Invoice# Commen Tran Dt Inv Ot Due Dt
Check D Pay Gross
Discount
No -Pay
Net
56382200030297 04/20Y2O 04/02/20 04/22/20
4,038.24
0,00
0.00
4,038.24 L!
LEASE
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10936 SIEMENS FINANCIAL SERVICES 4,038.24
0.00
0100
4,038.24
Vendor# Vendor Name Class
Pay Cade
11296 SOUTH TEXAS BLOOD & TISSUE CEN
Invoice# C/omment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
107021879 04/20/20 04/15/20 05/10/20
✓
4,094.00
0.00
0.00
4,094.00 j
BLOOD
CM6782 y/ 0020/2004/1512005110/20
-1,896.00
0.00
0.00
•1,896.00
CREDIT
Vendor Totats Number Name
Gross
Discount
No -Pay
Net
11296 SOUTH TEXAS BLOOD & TISSUE CEN 2,198.00
0100
0.00
2,198.00
Vendor# Vendor Name Class
Pay Cade
13528 STRYKER FLEX FINANCIAL ./
Invoice# , Comment Tran Ot Inv Dt Due Dt
Check DPay Gross
Discount
No -Pay
Net
246940 04121/2004/12/2005/1 PJ20
1,294.26
0.00
0,00
1,294.26 ✓`
LEASE
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
13528 STRYKER FLEX FINANCIAL
1,294.26
0.00
0.00
1,294,26
Vendor# Vendor Name Class
Pay Code
12476 SUN LIFE FINANCIAL
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
010121 04/20/200U01/2D 02/01/20
2,484.03
0.00
0.00
2,484.03
file:///C:[Userslltrevinolepsilmemmed.cpsinet.com/ti88125/data_5/tmp_cw5report287377... 4/21 /2022
Page I of 12
PAYROLL DEDUCT
Vendor TotalE Number Name
Gross
Discount
No -Pay
Net
12476 SUN LIFE FINANCIAL
2,484.03
0.00
0.00
2,484.03
Vendor# Vendor Name Class Pay Code
I
10758 TEXAS SELECT STAFFING, LLC ✓�
Invoice# Comment Tran DI Inv Dt Due Ot Check D- Pay Gross
Discount
No -Pay
Net
001962951079IN ✓ 04/20/20 03/30120 03/31/20
4,042.50
0.00
0.00
4,042,50
pIlq-'b)all Aa)%'j,
0019695510791N �.�� 04120/20
4,042.50
0.00
0.00
4,042,50
(;)Aq-3'31j??_) jibLhK.L.
�f
/
18995CM✓ 04/21/20 03109/20 03/10120
-4,115.10
0100
0.00
.4,116.10 r�
CREDIT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10758 TEXAS SELECT STAFFING, LLC
3,969.90
0.00
0.00
3.969.90
Vendor# Vendor Name Class Pay Code
14224 THE TACT CORPORATION OF NYC / '
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
9266704313/ 04/20/2004/01/2005/01/20
6,228.00
0.00
0.00
6.228.00 L'
TRAVEL NURSE STAFFING(3INkijLz)
reg1e,
/
9266704456 ,/ 04120/20 04/06/20 05/08120
6,228.00
0.00
0.00
6,228.00 �..%
TRAVEL NURSE STAFFING (g)p�) �) �) 4%}
to 11..
9266704588 04/20/20 04115/20 05/01 /20
6,228.00
0.00
0.00
6,228.00 ✓/
✓
TRAVEL NURSE STAFFING 41111
C'Qq le.
Vendor TotalE Number Name
Gross
Discount
No -Pay
Net
14224 THE TACT CORPORATION OF NYC
18,684,00
0.00
0.00
18,684.00
Vendor# Vendor Name Class. Pay Code
14372 TRIAGE, LLC , /
Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross
Discount
No -Pay
Net
INVI796403400 ,/ 04/20/2003129/2004/15/20
4,212.00
0.00
0.00
4,212.00 Z'
STAFFING 13�I-31111z�) shams
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
14372 TRIAGE, LLC
4,212.00
0.00
0.00
4,212.00
Vendor# Vendor Name Class Pay Cade
T3334 TRINITY PHYSICS CONSULTING LLC J/ W
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
035367 ✓ 04/12/20 04/06/20 05/06/20
660.00
0.00
0.00
660.00
PORTABLE EVALUATION
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
T3334 TRINITY PHYSICS CONSULTING LLC
660.00
0.00
0.00
660.00
Vendor# Vendor Name Class Pay Code
14208 TRUSTED HEALTH, INC i,//
Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross
Discount
No -Pay
Net
INV9308 r,/' 04/2D/20 04/02/20 05/02M
9.970.00
0.00
0.00
9,970.00
TRAVEL NURSE STAFFING
INV9309 V/ 04/20/20 04/09/20 05/09/20
5,657.50
0.00
0.00
5,657.50
TRAVEL NURSE STAFFING
Vendor TotalE Number Name
Gross
Discount
No -Pay
Net
14208 TRUSTED HEALTH, INC
15,627.50
0.00
0.00
16,627.60
Vendor# Vendor Name Class Pay Code
U1064 UNIFIRST HOLDINGS INC
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
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Page 12 of 12
8400392193 L/
04/12/20 04/11/20 W06/20
2,346.77
0.00
0.00
LAUNDRY
8400392168 ✓
04/12/20 04/11/20 05/06/20
45.15
0.00
0.00
LAUNDRY
8400392169 �/
04/12/20 04/11/20 05/06/20
56.82
0.00
0.00
LAUNDRY
84OD392467 �/
04/20/20 04/14/20 05/09/20
198.59
0.00
0.00
LAUNDRY
8400392511 ✓%
04/20/20 04/14/20 05/09120
1,614.52
0.00
0.00
LAUNDRY
8400392488 ✓'
04120/20 04/14/20 05109120
163.74
0.00
0.00
LAUNDRY
8400392489 /
✓LAUNDRY
04/20/20 04/14/20 05/09/20
193.01
0.00
0.00
8400392486 v/�
04/20120. 04/14/20 05/09/20
42.82
0.00
0.00
LAUNDRY
840031124110
04/20/20. 04/14/20 06/09/20
199.32
0.00
0.00
L AUNDRY
8400392526✓
04/20/20 04/14/20 05/09/20
103.78
0.00
0.00
LAUNDRY
8400392503 ✓
04/20/20 04/14/20 05/09/20
80.90
0.00
0.00
LAUNDRY
Vendor Total: Number Name
Gross
Discount
No -Pay
U1064 UNIFIRST
HOLDINGS INC
5,045.42
0.00
0.00
Vendor# Vendor Name
Class Pay Code
11110 WERFEN USA LLC
Invoice# Comment
Tran Dt Inv Dt Due Dt Check D Pay
Gross
Discount
No -Pay
9111145138 /
04/20/20 04115120 05/10/20
1,571.67
0.00
0.00
CONTRACT
Vendor Total: Number Name
Gross
Discount
No -Pay
11110 WERFEN USA LLC
1,571.67
0.00
0.00
Report Summary
Grand Totals:
Gross Discount
No -Pay
585.632.49 0.00
0.00
APR 21 2022
G= �i pns
5135, 0, ° 49
31,656°U'r
2,346.77
45.15
56.82 v
19B.59 v'�
1.614.52 ,r/
163.74 -1-1
193.01
42.82 ✓
199.32 ✓
103,78
80.90
Net
5,045.42
Net
1,671.67
Net
1,571.67
Net
685,632.49
131, h34 U7}
file:///C;/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report287377,.. 4/21 /2022
flUCEIHAIc COUNTY +.I'IITi UK CORPORATE CAR®
APR 21 2022
Account Statement
Ceea0001 Card Axoant
ROSHANDA S THOMAS
® Account Inquiries:
CAI.I-10Uh1 + r) I�lt Fl AS Toll Free; 1-(800)-246AS 3
International: 1-(904).954.7314 Account Number: XXXX-XXXX-XXXX
TDDnTY: 1-(877)-505.7276
Send Notice of Billing Errors and Customer Service Inquiries to:
CITIBANK, N.A., PO BOX 6125, SIOUX FALLS SO 57117.6125
Transactions
Uaen Havance Limn
$U
Statement Closing Date
04103/2022
Days in Billing Period
31
Post
Data
Trans
Oat.
MCC
Reference Number
oeacriptionfLocatlon
Amount
""""""""""'
NOTICE MEMO ITEM(S) LISTED BELOW ""••'•"......•••.
03108
03/(117
6943
82711162067000001092234
1
SPECIALISTID.COM MIAMI FL
33155
USA
a/247.23
03l10
03/09
9399
05134372069600033111192
2
CMS MEDICARE APPLIC FE 410-786-1663 MD
21244
USA
��31.00 iJ
15370723363465171
03/11
03110
9399
05134372070600033867071
3
CMS MEDICARE APPL(C FE 410-786.1663 MD
21244
USA
✓631.00
11524508587929939
03118
03116
W40
52704872076722481376234
4
HYATT REGENCY SAN ANTO 8885874589 TX
78205
USA
Y 883.59 '—
41705940
CHECK IN: 0311W022
03/29
03/28
8299
$6436872088130882727696
5
EIMEVIOENCE IN MOTION 502-4427697 KY
40223
USA
V&.00 47
437942
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
s®UL1a CITIBANK N.A.
CII T6r PO BOX 6125
SIOUX FALLS SO 57117-6125
ROSHANDA 5 THOMAS
202 S ANN ST
PORT LAVACA TX 77979.4204
Page / of 2
ipi Hr-)Vaj Up
APR 21 2022
6Y COUNti Y AUDITC)a
CAI}ipUN COUNTY, TEYAS
Account Number XXXX-XXXX-XXXX
Statement Closing Date April 03, 2022
Not an invoke.
For your records only.
00007905040
• RePmt a lost Or Stale"Cord lmmedyi Ourtelephme linmme Op.o CVory day,
24 hauM o day. Call lh¢Cusmmer Servoe te,epbono numberspaested on the ifteri
the 91Omme if to report a 10.1 or I toMn CM Corporate Cold.
• Cardholder Crndlf Llno, Each Cardholder has on rdNMWal Crudlt Lino(n parson of
which may be used to, Cash Advances), which Is the maximum amount that the
Cardhmat can charge at cosy fate. The site Ot each Camhom.1c Crack Line (and
Cash Limit. N any), Is detalmined by the Company end la o Fast]. of in, lots,
Company Cradle Lino.
• To rareese or Sealboale o cam,mmy or Cmdho/dor Credit Lino. The Company
may oquast Changes to ends lines by connecting Cm Corporate card Customer
Sm0CQg Our telephone lima an Open every day, 24 hours a day at the telephone
number spaciled on Postal the mamment.
Additional Camookfame: The Company may request applications fro additional
Cardhaldem byountading Ctl Corpora le Card Sem,'ce. Ouralephone inm era open
ovary day, 24 hours a day at the telephone number sarrested on the front mi the
etammenl Limit ante Cie Cmpoole Card per Cmdheltlm.
01d R-Werr 6Online Tool; You can newly manage gout C10 Corporate Card online
using the CMManagcr online lool. CtiManager enables you to manage bu•inea6
expenses from anywhere Around the globe from yourcomputor or mobile twice; you
can view emlmm nt. online as well as conall, account balances. To QgWto, for
ChiManagar, gleam lag on to wwwqXI m" in and slick an the 'Self
mg um min for CemholderY IIM. From there, f o, the prompts to establish your
account
• Payme0m: YOU may make A Payment to your UUMIdUally, billed Cad account COCA
Were CIIiManagee Pieces nma that came argxnuadons do not Inma Me Oftwimager
0"Iro payment mature enabled Car Cardh0ldess, It paying by mall, plomo aiow
$U ickntmatIngtimo, ROOM writ year account number on the front of the check,
For centrally billed aocounto, please an sure to send an Company check as payment
lot all Ceramicist balances. It we receive your maXed payment In proper farm at our
prncrosrg 4011y W 6:00 p.m. Eastern Time, a wXl be credited as of that day.
Payment. Can also be made by elegronm fund transfer, wife transfer. ACH lrandar,
direct Cobs, and Other mathods, Call The number on the front of this statement for
worm c.
• Camp.py, RmPstami/on: By as payment of any amounts charged m the Aemuig,me
Company: (I) ratites the original Application low the Account and the authorih of all
parsons at the a., of their signing such Application, and (if wuthmime me Continued
tea of the Account under the terms of The Corporate Card Agreement by all
Cardholders to Wham Castle am bound.
$Nets# rformaflm m 0mh Advances: Cmdhoidan may got a Cash Advance at
aw r 160,00 locations worldwtde.
• The Cardholdmfa Cash Ativonce Limit is a pad of the Cardholder's Total
Credit Line. It la not an Wedbnd the of Cant.
• For Caoh Advmnccs from ATM,, a .epa.m Pmeanal Idoirthosten
Nestor (PIN) Is focused for aocurXy, purposes.
Delinquency Fee: My Amount will be delinquent unless the Bank ocabm the
amount shown an the bIDkg statement es the balance dus, less any disputed
charge, by the payment raw dam. The Bank will show any unpaid pmian M Ina
balance due as a paatdue balance an subsequent Calling statements. it any ponbaof
the past due Infante apponn on bro commOCUMO 1,111aq statements (approximately
56-60 days after rho billing cycle date), I agree to pay a deiinquenay foe moody
based on a percmmge ortW minim past due balance untllmy payment m neeNed by
the Bank. A late foe may alma bo imposed mmihly uniP payment for m0 past due
balance Is receertd by the Bank
• In Case of Ermra or Qd"cns About your Sig: you am res;a0male for Initiating •
In the Coke, taus, phrase explain in dotail0 a dispute ad INC reaults al Ind
Me dispute resduuon pr... go g year Aeeount statemmtlialeehagas Chat you bell&.
Btlompt of resales It with the mmcWnt The letter must include the ameanl
Olt unauthorized, incorrect, ice MO,CWndim that has not bean mooned, or (or
returned merehandma.You should also litam the P.mee X your Amount Statement
InV.NBd, and must be signed by Iho IndlVldual Cardhoder, We will
0-111"ou of the raeulla at ACT efforts,
Inconeetly lots a coeds as a charge or N a credit, for which you have been Issued a •
It you returned mcrch.ra ice and ocehad a credit slip which has not yet
coda slip. Is not shown. To begin the dispute nealueon process, ise
been pasted, pmmOelt. 30 days tram the data ft . issued. It It has net
dtimanaaer eanvloafn.
Wan posted to the Aceeml by than, fomerd a copy of the Cmditalipto us
• YOU may also dispute a transaction by writing m M. you may was to us on a
at the liNh9dopme add.. spealmol on the front of the elatemenl.AINm,
seperote sheet at the address upeaMet on the front of this dotemont es soon m
with the copy Of the Credit slip plesa0 Include a letter (signed by the
tntlNklual CemholdeQ smd0g that mats Was not omtmtl. Ir a Credit slip
possible, Please newly m no later than 60 days after me data of Oe bill On watch the
error Of problem pnld letter please
p ppoa us the o:
Woe not Issued, pro.. rdgWat da. bran the melahanL II the mmekaal
account n
• the name and amount number. For centrally billed Company Acrounts,
cam d Company fiam.
The Company name antl Imospocal account number,
refuses, pleamwebe m us and explain the detaPs.
On nonANpumd..tars or any leaser ah¢wn by (0, Bank cat to be In
osoc
• The dollar the AfmWMnter
of Imp Plat CIA
• theo ut antl molar" Iln omen I1.Ne error; N more Inlormo110n
error, the Bank may charge the Company or Cardholdef the fee smound
In me Corporate Card Agreement for each copy dl any document the
Is needs
Is n0¢tlM about an Xam, ateasa deaerlhe x 1e ue.
A
Company or Cmdhokvr aqumts, such ao duplicate period[. sraarm,ft
..
Bank rinds you amponscle
=a unsuccessful In
coming we quality of
;old, We may be able
Page 2 of 2
mcall .
MEMORIAL MEDICAL CENTER
PURCHASE ORDER
Bill To: 815 N. VIRGINIA ST.
PORT LAVACA, TX 77979
PHONE: (361) 552-6713
FAX: (361) 552C41 0�312�,_ 1'
Vendor Name: 1 i b`Vhk
Vendor Address:
Vendor Phone #:
Vendor Fax #:
Ship To: 815 N. VIRGINIA ST.
PORT LAVACA, TX 77979
PHONE: (361) 552-6713
FAX: (361)5552-0312
Date: 1 5-/ Pa-
P.O. #
Account #
. Initiated
Form # 9401
Date Required Expense# Depa[tment Deliver To
Line Qty. Catalog Number
No,
Descripfiort
Unit Cost
Unit
Meas.
Extended
Cost
t o. t
ales I D. —-7
-3
z
2472'3
s
Ui1 +
yl
(o,��•f7
631
e A/tcl it c
(Y�tvl
4 883. 59 .E
b00.00
5
G S dul��cA
(03 .
6
-(eke -a C GS. oltl ics
g
II� m i �J C64 c
<< �y�
�r N
n+n°0
iI.(tr
YIS-i�'+-�-slit,
A� j��pI�OAM� / 1•��,
10
I V, 44fI1 0
W4,
Nr11'FS• Est. Freight Est. Total Cost TOTAL COST % jj 1. 01 '
Contact:
Quoted By:
Buyer.
Date:
E.T.A.
Dept. Director
Dir. Nursing
Dir. Clinical Services
MSKESSON
STATEMENT
As nt: 04/22/2022
Page: 002
TO swum Proper cre nt to your
accourd, detseh and return this
m=wn: e000
stub with yow mmi tence
DC: 6115
MEMORIAL MEDICAL CENTFA
As of: 04/22/2022 Page: 002
Man tw Own: 8000
AMT DUE REMITTED VIA ACH DEBIT
Territory:
815 N VIF13INIA STREET
statement for Information only
ANT DUE AWITT® VIA ACH DEBIT
PORT LAVACA TX ]]B]8
Cuslomen 632536
Statement for Information only
Date; 04/23/2022
Oust: 632536 PLEASE CHECK ANY
Ost. 04/23/2022 ITEMS NOT PAID (r)
l
Account Wipe
Date" e
D
�MNw
NumberReference Description OluouM
Amount P
(grew) F
Amwmt P Resolvable
(wt) F Number
PF column legend: P = Pan Ow Item, F = Future Due Item, blank = Curren Due Item
TOTAU Nnlonal Add 832536 MWOMAL MEDICAL CENTER
Subtnele:
6.526.70 USE)
Future Due:
0.00
Pen Ow:
If Paid By 04126/2022,
Ow n PaM On Time:
USD 6.396.20
0.00 Pay This Amount:
6,396.20
LED
Dix log P Palo and;
Leg 2,451,9]
11 Paid After 09/26/20R2,
30.56
Dw II Paid Late:
08/O]12017
/201]
Pay thle Amount:
6.526.76
LED
LED 6,626.76
44.66
5. 195''8:5
280.60
1
875. 11
6,39.6. 2u
,:
AMOVEDON
APR 25 2022
f3Y COUNTY AUDITOR
CALHOUN COUNTY, T W8
For AR Inquiries please contact 800-867-0333
MSKESSON
STATEMENT
As d: 04/22/2022
Paget Lot To whom,proper dead to year
aaoum, tlalwh and mt.this
c pmr: soon
mwHub with your mittee
DC: 8115
CVS PHS
Ao of: 04/22/2022 Page: 001
Mall I. Camp: 6000
MEMO�CYRIAL MEDICAL
IAL MEDICAL CH4TFA
CENTER
AMT DUE REMITTED VIA ACH DEBIT
Territory: 400
VICKY KALISIX
Statement for Information only
AMT DUE F@AITTm VIA ACH DEBIT
615 N
$15 N IA
Customer 262252
Statement for Mhurallon only
AVACVIRGI
FONT IAVgCA TX ]]9]9
Date: 04/23/2022
Cud: 202262 PLEASE CHECK ANY
Dale: 04/23/2022 ITEPAS NOT PAID (�)
Date Due NRemmemumner"Peouna: Acceun[ iyTa Cash Amount P AmeaM P geplvabk 1 Data Date Number Referowe Description Discount (groea) F Portl to Number
Codomer Number 262252 CVS PHCY 7006/MFMORIA PHS 04/20/2022 04/26/2022 7337364172 1659127 11SInvolee 0.91 45.57 44.66 /✓ 7337364172 O
PF oolmnn legentl: P = Pod Due Item, F = FWma Dun Item, blank = Current Due Item
TOTAL' Customer Number 262252 CVS PHCV 7006/MEhl MS
Summalc 45.67 USD
Rauh Bud
0.00
Due If Pald On Time:
If Paltl By 0412612022,
USD
44.66
Pent Dun:
0.00 Pay This Amount:
44.66 USD Din feet 6 Pala lets:
✓
laH Payment
8,901,37 If Paid Attu 0412612022,
Oee If Paid late:
0.91
09/18/2022
Pay this Amount:
45.57 USD USD
45.57
► { , `L--L-�
For AR Inquiries please contact 800-867-0333
MWESSON
smear: emo
WALMARI' 1098/MEM MEO PHS
MEMORIAL MEDICAL CENTER
VICKY HALLOW
815 N VIRCINIA ST
POW LAVACA TX 77979
STATEMENTAs
of: 0412=022
Pager Out To ewuro proper creditto your
account. Mach arld return this
90 With your remlbance,
Dc: ells
As or: 04/22/2022 Pape: 001
ALIT DUE Hall VIA ACH p®1T
Tamory: 400 l
Mall to: Comp: 3000
Statement tar infowellon only
AMT DUE REMITTEDVIA ACH DEER
Cumamen 256942
Statementfor Intonation only
Date: 04/23/2022
CM: 256342 PLEASE CHECK ANY
Data: 04/23/2022 ITEMS NOT PAID (0)
Date Dot Number
Account bTJfy96 Cnh (gam) F A P Retthabk Dale Data Number Reference Oeurlptkn Discount M F Number
Customer Number 256342
WALMARR 1098/M@6 MEU MS
OV18/2022
04/28/2022
7336836713
30484732
1161nvaice
2.31
115.38
04/18/2022
04/26/9022
7336836714
3D518196
1151nvoice
2.81
140.53
113.07✓
'�
7336836713
04118/2022
04/26/2022
733683671E
30568328
1151nvolce
5.80
289.91
137.72
7336836714
04/18/2022
04/26/2022
7337047083
0415220813
1951mmice
0.05
2.53
284.11✓
2.48✓
733683671E
04119/2022
04/2MO=
7337132361
30802600
115invoke
16.90
848.78
891.00✓
7337047083
04/19/2022
04/26/2022
7337132302
30802600
1151nvoico
7,89
394.50
7337132351
04/19/9022
04/26/2022
7337282043
0418221016
1151nvol"
2.62
128.70
386.61/
7337132362
04/20/2022
04/26/2022
7337384260
30874525
1151nvolce
8.46
422.89
123.26✓
7337202043
04/20/2022
04/26/2022
7337384251
30232699
1151nvolce
414IA3✓
7337384250
04/21/2022
04/26/2022
7337622972
30989763
1151nvoice
0.01
0.16
0.16,/
7337394251
04/21/2022
1141265!022
7337622973
31051596
1154w.en,
0.33
0.32✓
7337622972
04/21/2022
04/26/2022
7337774383
0420220835
1151nvolce
25.98
0.16
0,16,/
7337622973
04/22/2022
W26/2022
73379t9239
31108147
1151nvmce
1.298.97
1.272.99 ✓
7337774333
04/22/2022
04/26/2022
7337919240
311692224
1151nvolue
8.50
22.77
424.88
1,138.69
416.38
7337919939
04/22/2022
04/26/2022
7337919241
31169224
1151mvoke
0.01
0.32
1, 116.92 ✓
7337919240
04/2W2022
04/96/2022
7337919242
31185206
115Invoice
1.11
55.32
0,31 ✓
64.21 ✓
7337918241
04MW2022
04/26/2022
7338067523
0421220848
1951nvalce
0.80
73379192242
42.76
41,90
7338067523
PF column e9enm P = Not Ow Item, F = Future Ow Item, blank :
Current Due Item
TOTAL• Customer Number 256342 WALMART 1098/MQA MED PH9
Subtotals:
6,301.99
USD
Mum Due:
0.00
/,1�
�l V
- pus N laid
On Tlme:
Pact Due,
11 Paid By 09/2BMe022,
USD
5.105,83
0.00
Pay This Amount:
6,195.63
USD
Disc had N
Paid We:
Lain Payment
8,901.37
11 PoW Ater 041a6/2022,
Dw II Paid
06A6
lab:
01/19/2022
Pay this Amount:
5,301.89
USD
USD
5.301.89
APPAWDON
APR 25 2022
For AR Inquiries please contact 800-867-0333 9Y000NWAUMOR
CALHOUN COUNTY. TEXAS
MSKESSON
STATEMENT
As W: 04/22/2022
Paga: 001 To ensure prefer foods to your
acceum, de rch and mtum this
0 Prl:eODD
stub with your mm„tenou
DC: 8/15
As of: 04/22/2022 Page: 001
HIM My FC 490/MBA MC PHS
AMT DUE REMITTED VIA ACH OMIT
Temrary: 400
Mau to: Comp: 8000
MEMORIAL MEDICAL CENTER
KAUSEX
Statement for Inionnallon only
AMT DUE REMITTED VIA ACH DEBITVICKY
815 N VIRGIAVAC IA ST
Cualomm: 484460
Statement for Information only
WRT IAVACA T% 77979
Dale: 04/23/2022
Cush 464460 PLEASE CHECK ANY
Data: 04/23/2022 ITEMS NOT PAID (1)
011ng D. Number Retueram DRaealvabIl"Homal Auoum 196 CashAmounl P Amount P Ilauivabb
Date Datescription Discount (grow) F (net) F Number
Customor Number 464460 HIE MY FC 490IMFM MC ME
04/19/2022 04/26/2022
04/19/2022
7337110721
55x451609 1151nvole.
5.09 254.26
249.17 ✓ 7337110721
04/26/2022
7337110722
5SX451012 1151nvoice
0.30 14.05
14.55 ✓ 7337110722
04/19/2029 04/2612022
7337110723
55x451770 1151nva(ce
0.34 17.22
16.88 ✓ 7337110723
PF ouNmn legend: P = Peet
Due Drum, F = R4um Due
Item, Manic a Cement Due Item
TOTAL Cumomvr Number 984950 H® PHY FC 990/MfE MC PHa
Subtolah: 296.33
USD
Future Due:
0.00
Duo If Pea On Tlma:
11 Paid By 0412612022,
USE) 200.60
Put Due:
0.00
Pay This Amount;
280.60 LED
Dleo loaf K pald late:
Lest
6,901.37
N Attar O4@e/2022,
5.73
Due If Paltl Cato:
04/1B/2022
/2022
y this
Pay Chic Amoum:
288.33 USD
U30 268.33
lNPp MON
APR 25 2022
BYCOUWYAU01TOR
CALHOUN COUMY, TOM
For AR Inquiries please contact 800-867-0333
MSKESSON
STATEMENT
Cr.,': aaoo
CVS PHCY 7475IMM MC NO
ANT DUE REMITTED VIA ACH DEBIT
MENIMAL MEDICAL CENTER
Statement for information only
VICKY KALISSK
815 N VIRGINIA ST
PORT IAVACA TX 77979
As at: 04/22/2022
Pown 001 To resume Proper emit to your
account, tlesch and mtu n this
Mob with your romlttesa
DC: 8115
As at: 04/22/2022 Page: 001
Territory: 400
Mall to: Comp: 8D00
ANT DUE IRT® VIA ACH DEBIT
CustomerCuCustomer835438
3tetemant tar far Information only
Data: 04/23/2022
Cum: 035438 PLEASE CHECK ANY
Drum 04/23/9099 ITEMS NOT PAID (s)
BI01ep Due PawWa6l�etiwei Account �98 Cent Amount P Amount P BSNvabb
Data Date Number Rdemnce Description Obscure (grow) F (trot) F Nmnber
Customer Number 836430 CVS PNCY 7475/MS7A MC WE
04/20/2022 04/98/2D22 7337655845 1659575 1151nvoice 17.86 892.97 875.11 ✓ 7337566845
PF wtu leaned: P e Pest Due Item, F . Fulum Due Item, blank a Correct Due Item
TOTAL Cudomar Number 835438 CVS PNCY 7475/MW MC WE
SuMMaN: 892.97 USD
FIAure Due: 0.00 Due If Paid On Time:
It Past By 0412612022, Uso 875.11
Pad Due: 0.00 Pay This Amount: 875.11 USD Dis loot 8 paltl late:
7AS
bm P2022M 0,901.37 If y this
Amft. unt: 2042, Due If Pont taus:
04/18/2022 Pay ihle Amount: 892.97 USD U30 882.87
APPROVEDON
APR 25 2922
BYCOUNiYAL)WOR
CALHOUN COUNTY, TM8
For AR Inquiries please contact 800-867-0333
AmerisourceBe en' STATEMENT Statement Number: 62896331
r9 Date: 04-22-2022
1 of 1
AMERISOURCEBERGEN DRUG CORP
WALGREENSe12494340B
1001362841=028180
1270 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER
SUGAR LANDTX 7747MI01
1302 N VIRGINIA ST
PORT LAVACATX 77979.2608
DEA: RA0289276
Set-FOOteln7daya
868461-9656
AMERISOURCEBERGEN
P.O. BOX 905223
NC 2029D5223
Not Yet DowCHARLOTTE
00
. 000
Cunene:
82.49
Peel Due:
0.00
Total Due:
629.49
Ac.9 Balance:
629AO
Account Activity
Document Due
Reference
Purchase Order
Document
Original Last Receipt Amount Received
Balance
Date Date
Number
Number
Type
Amount
04-18.2022 0429.2022
$089958879
165550
Invoice
2.45
0.0
2.45
W-0&2022 04-29-2022
3089059010
106561
Invoice
0.29
0.00
0.29
04-16-2022 0429-2022
W90000966
185599
Invoice
40.85
0.00
40.88
ON0-2022 04.29-2022
3090000989
165600
Invoice
10.48
0.00
10.4E
0419-2022 0F29-202
309012180E
IM607
Involm
208.09
0.00
208.09
(W21-2022 042041)22
309W13441
165622
Invoice
6,1.62
0.00
W.62 ,
(W22-2022 We-=
30SM7639
loom
Invoice
302.42
0.00
3MA2'
04-2D2022 04.294022
3090657980
165633
Invoice
0.09
0.00
0.09
Current
1-16 Days
16-30 Days
31-60 Days
6140 Days
81-120 Days
over 120 Days
82B.4B
0.00
0.00
0.00
0.00
0.00
0.00
Thank You for Your Payment
Reminders
Date
Amount
Due Date
/ L // 1
iI
Amount
04-22-2022
(208999)
04-29-2022
�I f
Total Due:
V
620.49
629.49 `
APPROWDON
APR 25 2022
BY COUNiYAUDROR
CALNOUN COUNTY
TOLL FEE PHONE NUMBER: 1-800-SSS-3453
(EFTPS TUTORIAL SYSTEM: 1.800-572-8683)
F7"ENTER 9-DIGITTAXPAYER IDENTIFICATION NUMBER"
"ENTER YOUR 4-DIGIT PIN"
[7"MAKE A PAYMENT, PRESS 1"
"ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN"
E"IF FEDERAL TAX DEPOSIT ENTER 1"
"ENTER 2-DIGIT TAX FILING YEAR"
"ENTER 2-DIGITTAX FILING ENDING MONTH"
15T QTR - 03 (MARCH) - Jan, Feb, Mar
2ND QTR - 06 (JUNE) - Apr, May, June
3RD QTR - 09 (SEPTEMBER) - July, Aug, Sept
4TH QTR -12 (DECEMBER) -Oct, Nov, Dec
El "ENTER AMOUNT OF TAX DEPOSIT- FOLLOWED BY # SIGN"
"1 TO CONFIRM"
"ENTER W/CENTS AMOUNT OF SOCIAL SECURITY"
"ENTER W/CENTS AMOUNT OF MEDICARE"
"ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING"
E_T6-DIGIT SETTLEMENT DATE"
"1 TO CONFIRM"
ACKNOWLEDGEMENT NUMBER
#qx# ENTER:
0
$
129,263.56
1
$
64,311,42
$
15,040.48
$
49,911.66
CHECK:
C�
CALLED IN BY:
CALLED IN DATE:
CALLED IN TIME:
FAAP•Payroll Files\Payroll Tazes12022VQ R1 MMC TAX DEPOSIT WORKSHEET 4.25.22.xis 412512022
PSi...:AL F:E7iC:.:._ 7.•E4
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-- -----------------------------------------------------
................ a 7'i L'1 L e r _:.__...-__.-.
ass cc Tascx
...............................................................
74522.!5 A: J;.NC A"krzs E:3ESI -r5.53
332i2.i5 Cn _ 5 C;%E ' :AE3-C ...:i
'OiL2. CSi_D S^5.'. CLIEliC CG363tI
:'..:... CEP•_: _-_ _: '
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65.51 FT- L ..._. .? TES
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° -
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22 Credit 7•: xk�:' .2exclie. Tem Total: •275
.................................................................
v
941 RECITAX DEPOSIT FOR MMC PAYROLL
PAY PERIOD: BEGIN
PAY PERIOD: END
PAY DATE:
GROSS PAY:
DEDUCTIONS:
A/R
ADVANC
BOOTS
SUNLIFE CRITICAL ILLNESS
SUNLIFE ACCIDENT
SUNLIFE VISION
SUNLIFE SHORT TERM DIS
BCBS VISION
CAFE-D
CAFE-H
CAFES
CANCER
CHILD
CLINIC
COMBIN
CREDUN
DENTAL
DEP-LF
SUNLIFE TERM LIFE
SUNLIFE HOSP INDEM
FED TAX
FICA-M
FICA-0
FIRST C
FLEX S
FLX-FE
GIFT S
GRP-IN
GTL
HOSP-1
LEGAL
OTHER
NATIONAL FARM LIFE
MEO SURCHARGE
PR FIN
RELAY
REPAY
STONEDF
STONE
STONE 2
STUDEN
TSA-R
UWIHOS
TOTAL DEDUCTIONS
NET PAY:
TOTAL CAFE 125 PLAN:
TAXABLE PAY:
$
519,753.86
$ 619.753.85
"CALCULATED"
Fmm MMC Rasa
Difference
FICA - MED(ER)
,s.. 5
7,536A3
FICA - MED(EE)
,.m S
7,536.43
S 7.520.24
$ 16.19
FICA -SOC SEC(ER)
a1w S
32,22474
FICA -SOC SEC(EE)
4mw $
32,224,74
S 32,155.71
$ 69.03
FED WITHHOLDING
$
49,911.66
S 49.911.66
TAXDEPOSM
S
128434.00 3
129,26355
FICA -MEDICARE
2M $
15.072.86
515,040.48
FICA - SOCIAL SECURITY
•24tl It
54.449.48
$64,311.42 PREPARED BY:
FED WITHHOLDING
5
49.911.66
$49,911.66 PREPARED DATE:
TOTAL TAX:
$
129,434.00
$129,263.58 $ 170.44
REVISED 3r782014
TOTALS
$ 518,640.59
(49.681
(54.741
(1.010.44)
609.70
49, 911.66
7.520.24
32.155.71
5 16.304.93
5 125,951.53
S 392.689.06
Exempt Anal:
Employees over FICA -SS Cap:
S -
S
Paycode S -Employee Relmb.:
TOTAL: $
Caillin Clevenger
4/252022
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MEMORIAL MEDICAL CENTER
PROSPERITY BANK
ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT--- April 18, 2022 - April 24, 2022
Date
B100
MM[ Notes
CP51
Ame
Puy
4/18/2022 PAY 1921002
6111 111
.3rd Party Payer Fee
60,Zg1:'g
G
4/18/2022 TEXAS COUNTY DRSRECEIVA8LE 041923000021569
TEXAS CSACHTBR$ RECEIVABLE 402156
- R¢tiremen[Funding
158038.5
6II 2�
6 0 0
4/19/2022 PAY PLUS ACHTRANS452579291101000697745464
-3rd Party Payer Fee
°58.29za
SR • 29 =
4/19/2022 MCKESSON DRUG AUTO ACH ACH04990704910000140
- 340B Drug Program Expense
�k9,01.e
<i 5P. y
4/20/2022 WEBFILE TAX PYMT DO 9021056311M 21000029424
-Sales Tax
1,347.1491-
4/20/2022 PAY PLUS ACHTRAN5452579291101000698844880
- 3rd Party Payer Fee
252 Sty
U ' � I
4/21/2022 PAY PLUS ACHTMN54525]9291101000699fi03502
3rd Party Payor Fee
O;gj'
j 6 I�ti
4/22/2022 PAY PLUS ACHTRANS 4525792911010011690513625
- 3rd Party Payer Fee
IN
4/22/2022 AMERISOURCE BERG PAYMENTS 01000U77682100002
- 3408 Drug Program Expense
2,069.99*
4 4U .., ;
170,744.98 17
* '( C Lt S 6
April 25, 2022
:6,
L' - � ' " %
Anthony Richardson
8+901
/ -
Memorial Medical Center
7r p"v&APROSPERITY
BANK
G,069:.';
-
ELECTRONICTRANSFERS FOR OPERATING ACCOUNT -ESTIMATED
ACHS"II�y°''-
. 2�g klovoYLA 0 4•Ub•2t[t-
' 98'7 • 90 ;
Date Rewrote.
MMC NOW
Amount
5/6/2022 IGT
CHIRP IGT
MA39.64
38 / " 9 U +
J8'i-4ll -
11
0 • O U x
nn
1 � 4
64A39.69
�J�'
April 25, 2022
Anthony Richer son v
Memorial Medical Center
�R..•.',xl rgr e .
APR 25 2022
CALHOUN COUNTY,'if�7M
Transaction Summary
Transaction Complete
Trace 4-:(
Texas Health and Human Services Commission
Memorial Medical Center Operating County
Payment Total
$64.439.64
Bank Routing and Account Number
Settlement Date
5/6/2022
CHIRP Amount
$64,439.64
Entered By
Marley Moehri
Page No:1 or i
Run Date: 4/2112022
Run Time: 11:5s:59
Marley ODonnell
From:
Luba Kubinski <luba@ahcvcom>
Sent:
Wednesday, April 20, 2022 5:18 PM
To:
jaclynn.harrison@christushealth.org; kristina.alldredge@christushealth.org;
joel.vigil@christushealth.org; chris.nicosia@hcahealthcare.com; Steve King;
Eric.Hamon@dchstx.org; Mike_Healey@chs.net; eric_,graves@chs.net;
michael tea@chs.net; czafereo@cmcvtx.org; pstrauss@cmcvtx.org;
Duane.Woods@cmcvtx.org; Roshanda 5, Thomas; Anthony Richardson; Marley
ODonnell; David Lee; sparker@rcmhospital.org; jmoehler@rcmhospital.org; Jonny F.
Hipp (NCHD; Belinda Chism (NCHD); Jared A. Konczal (konczal@gl-law.com); Lance
Ramsey
Cc:
Colt Sullivan; David Elliot; Robin Daniel; Justin Flores
Subject:
PGY1 Final CHIRP IGT- Nueces SDA
Attachments:
CHIRP PGY1 Final Recommended Allocation.pdf
organization. Do not eliek,links or open attachments unless you
Good afternoon,
It's that time again! Based on HHSC's notification email below, the PGY1 Final CHIRP IGT
submission deadline is Thursday, May 51h, and the Nueces SDA will need to identify $37,763,348.44
in available funding. To ensure 100% funding of the SDA prior to the May 5'h deadline, we are
requesting confirmation of the amounts and funding sources within the attached 'CHIRP PGY1 Final
Recommended Allocation' by the deadlines listed below.
PRIVATE HOSPITALS - Please confine the non-ftaderal share allocation attributable to your
facility and tht Intended funding source by Tuesday, April 26th. If you believe any of the
information provided in the attached summary is incorrect, please let us know immediately.
PUBLIC HOSPITALS- Please provide a copy of the TexNet sent to HHSC by Friday, April 29th
to those copied on this email. If you expect the amount will be different than the amount noted
within the attached Allocation Summary, please let us know as soon as possible.
Thank you for your part in ensuring that your facility, and the other hospitals in the SDA continue to
receive the maximum payments from CHIRP. If you have any questions or concerns, please don't
hesitate to reach out!
Best regards,
Luba Kubinski
Financial Analyst
AHCV -Adelanto HealthCare Ventures L.L.C.
401 W. 15th Street, Suite 840
Austin, TX 78701
Direct: 512-508-9545
https:gahcv.com/
From: Texas Health and Human Services Commission <txhhs@oublic.eovdeliverv.com>
Sent: Monday, April 4, 2a22 2:54 PM
Subject: Comprehensive Hospital Increase Reimbursement Program (CHIRP) IGT Notification —Settlement Deadline
Extended
•.. This email is from an external address. If it looks like it is from an AHCV employee, please forward as attachment to
t ITSu000rtOAHCV.com as it is likely a harmful email. "'
TEXAS
Health and Human Services
Comprehensive Hospital Increase
Reimbursement Program (CHIRP) IGT
Notification - Settlement Deadline
Extended
The original settlement date for CHIRP was set to be April 16th,
2022 (21 days following receipt of federal approval from CMS).
The settlement date has been extended from Monday, April 18,
2022, to Friday, May 6, 2022.
HHSC received federal approval from the Centers for Medicare and
Medicaid Services (CMS) to move forward with the Comprehensive
Hospital Increase Reimbursement Program (CHIRP) on March 25, 2022.
The purpose of the Comprehensive Hospital Increase Reimbursement
Program (CHIRP) is to provide increased Medicaid payments to
hospitals for inpatient and outpatient services provided to persons with
Medicaid enrolled in STAR and STAR+PLUS. Texas Medicaid managed
care organizations receive additional funding through their monthly
capitation rate from HHSC and are directed to increase payment rates
for participating hospitals.
This is a follow-up notification to the Intergovernmental Transfer (IGT)
suggestions for the 2nd Half of Year 1 (SFY 2022) sent via email to
participating providers on November 4, 2021, which noted that IGTs
would be due 21 days following receipt of federal approval from the
Centers for Medicare and Medicaid Services.
The original settlement date for this program was set to be April 16m,
2022 (21 days following receipt of federal approval from CMS). The
settlement date for this program has been extended from
Monday, April 18, 2022, to Friday, May 6, 2022.
The calculations for IGT amounts by provider can be found on the
Provider Finance CHIRP website under "Suggested IGT Transfer
Amounts per provider". Suggested IGT amounts are listed in cells
ATS:AT422 on tab CHIRP Payment Calc of the posted file.
Please transfer funds through TexNet following these instructions, and
email a screen shot or PDF of the confirmation/trace sheet to
HHSCPFDCHIRPPavments(o)hhs texas ctov.
Please email any questions regarding this change or the calculation in
general to PFD Hosoitalsahhsc.state. tx.us.
You have subscribed to get updates about Texas Health and Human Services (HHS). For more information about HHS, please visit our
website.
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CHIRP SFY2022 Payment Calculation
State snare
CHIRP PGY1 Final WORKING DRAFT
Recommended IGT Allocation SUBJECT TO CHANGE
Nueces SDA
Nueces Courdy
LPPF
121776403
1689641680
Christus S ohn Hos Sal Co us Christi
4,752,904.59
Nunes County
LPPF
020873601
1608810573
Co us hristl
Medieal
Center
6,768,092.14
Nunes Coun
LPPF
132812205
154 286172
Driscoll Chiklrens Hospital
21,759,338:07
Nunes Coun
LPPF
094222903
100388SU41
lChnstus3 ohn Hospital Alice
365,612.05
Nueces County
LPPF
1 020811801
1 1447228747
lChristus5 ohn Hospital Beeville
327,906.35
Nueces county
LPPF
43 1356606
1 1093783391
lChfistus S ohn Hospital Kleberg
32g754.77
Nunes LPPF Total
$ 34,294,607.07
GreggCounty
LPPF
094118962
1 1851343909
jDatar Hospital Neat"
2,594,620.93
TM99 LPPF Total
$ 2 594 820.93
Self -Funded
137907508
1124062162
Cidnns Medical Center
742,138.88
Self -Funded
137908111
I 1889630865
imentonal Medical Center
64 439:84-
Sett -Funded
138412710
1699772541
Kamea Coun Hoe Ital District
27,017.92
Self•Funded
020881801
1842240188
Refu io Cou Memorial Hospital iMl District
40.523.10
Self•Fundetl Total
$ 874,119.54
ueces UIJA I tual.'
37;78 i .. "
Confidential
For Discussion Purposes Only 4/20/2022
Page I of 1
€0EIVEU BY THE
UN Y AUDITOR ON
APR A/WOU MEMORIAL MEDICAL CENTER
11:45
AP Open Invoice List 0
WirlwJtilwW111.TY;,TEXAt3 Dates Through: ap_open involce.tem�late
Vendont Vendor Name Class Pay Code
11828 SOLERA WEST HOUSTON
Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay
041522 04/20/20 04/15/20 05/13/20 7,481.39 0.00 0.00
TRANSFER N�1115U YaYl(e P�KA Aeptif,14.d ittim IY.1HL optw+yll
Vendor Total: Number Name Gross Discount No -Pay
11828 SOLERA WEST HOUSTON 7,481.39 0.00 0.00
Report Summary
Grand Totals: Gross Discount No -Pay
7,481.39 0.00 0.00
APR 21 2022
ALCONONYDIACUCUS
Net
7,481.39
Net
7,481.39
Net
7,481,39
file:///C:/Users/itrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report550837... 4/21/2022
Page 1 of 1
RECEIVED BYTHE
COUNTY AUDROR ON
AM21IF
MEMORIAL MEDICAL CENTER
0
G 1 2022
AP Open Invoice List
11:44
ap_open_invoice.template
Dates Through:
CALHWPld'ADVhftrrTW" Class Pay Code
11836 GOLDENCREEK
HEALTHCARE
Invoice#
Comment Tran Dt Inv Dt Due Dt Check D Pay
Gross
Discount
No -Pay,
Net
041122
04/20/20 04/11/20 05/13/20
3,552.31
0.0y0
0.00
/
3,552.31 ✓
TRANSFER NO 1ftVjKtL p K4 dgxti17{, trk IttIt M1uovt ,T no
041122A
04/20/2004/11120 5/13/20
5,302.28
0.00
0.00
5,302.28 .�
TRANSFER It
11
041122E
04/20/20 04/11120 05/13/20
157.93
0.00
0.00
157.93 �
TRANSFER It
11
041322
04/20/20 04/13/20 06/13/20
133,67
0.00
0.00
133.67
TRANSFER tt
II
,
041522
04/20/20 04/15/20 06/13/20
302.69
0.00
0.00
302.69
TRANSFER tt
of
041522A
04/20120041M5/2005/13/20
1,239.90
0.00
0.00
1,239.90
TRANSFER
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11836 GOLDENCREEK HEALTHCARE
10,688.78
0.00
0.00
10,688.78
Report Summary
-
Grand Totals:
Gross Discount
No -Pay
Net
10,688.78 0.00
0.00
10,688.78
APPROVEDON
APR 21 2022
BY COUNTY AUDITOR
CALHOUN COUNTY, TEXAS
file:///C:/Users/Itrevino/epsi/memmed.cpsinet,com/u88125/data_5/tmp_cw5report295607... 4/21 /2022
Page I of 1
RECEIVED BY
MEMORIAL MEDICAL CENTER
rrAPry2fgg
0
2022
AP Open Invoice List
11:4$
ap_open invoice.lemplate
Dates Through:
C"9w&wwyr,ww
Class Pay Code
12095 GULF POINTE PLAZA
Invoice# Comment Tran Dt Inv Dt
Due Dt Check DPay Gross
Discount
No -Pay
Net -
041322 04/20/20 04/13/20
05/13/20 3,153.20
0.00
0.00
/
3,153,20 ✓
TRANSFER NH insurance
PIKI dquiI�J. Ih-1` mw-(- Out,
'
Vendor TotalE Number Name
Gross
Discount
No -Pay
Net
12695 GULF POINTE PLAZA
3.153.20
0.00
0.00
3,153,20
Report Summary
Grand Totals: Gross
Discount
No -Pay
Net
3,15320
0.00
0.00
3,153.20
APR 21 2022
UDrTG
CALHCOUN OUNTTY,, 7E%AS
file:///C:/Usersllt evino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report205515... 4/21/2022
Page 1 of I
RECEIVED BY THE
COUNTY AUDITOR ON
APR 21 2022
04/21/2022
MEMORIAL MEDICAL CENTER
CAWOU16&UNTY,TlEXAS
AP Open Invoice List
0
ap_apen_invoice.template
Dates Through:
Vendor#Vendor Name
Class Pay Code
13004 TUSCANY VILLAGE
Invoice# Comment
Tran Dt Inv Dt Due Dt Check D Pay
Gross
Discount
No -Pay
041122
0,,4/II20/2004/11/2005113/20
2,124.57
0.00
0.00
TRANSFER
t,
IVft IftK►UL V601 i�y,Lpll6t,4
[K-h RKL UjA*V,
041222
04/20/20 04/12/20 05/13/20
569.66
0.00
0
TRANSFER
tt
1`
041322
04/20/20 04/13/20 05/13/20
315.00
0.00
0.00
TRANSFER
Vendor Totals Number Name
Gross
Discount
No -Pay
13004 TUSCANY VILLAGE
3,009.25
0.00
0.00
Report Summary
Grand Totals:
Gross Discount
No -Pay
3,009.25 0.00
0.00
AmF vm o1
APR 2 12022
ACALYFi�U'-�N I�iIYa§
Net
2,124.57 Z
569.68
$15.00
Net
3.009.25
Net
3.009.25
file:///C:/Userslltrevino/cpsilniemmed. cpsinet.com/u88125/data_5/tmp_cw5report291170... 4/21 /2022
Page I of 1
TOR ON
,Comp
0 2 2022
MEMORIAL MEDICAL CENTER
APR/
�./2 AP Open Invoice List
C,ALA� A° COUP'
0
ap_open_Invoice.template
Dates Through:
Vendor# Vendor Name Class Pay Code
12792 BETHANY SENIOR LIVING
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
041122 04/20/20 04/11/20 05113/20 21,084.22
0.00
0.00
/
21,084.22
TRANSFER NII iftaNt, Mki krwf4l ''10 MYN(.
optrx�,
041222 04/2Qt20 04/12/20 05/13/20 42.396.88
0.00
0.00
42,396.88
TRANSFER It
I)
041322 04/20/20 04/13/20 05/13/20 2,462,38
0.00
0.00
2.462.38
TRANSFER k
it
Vendor Totals Number Name Gross
Discount
No -Pay
Net
12792 BETHANY SENIOR LIVING 65,943.48
0.00
0.00
65,943.48
Report Summary
Grand Totals: Gross Discount
No -Pay
Net
65,943.48 0.00
0.00
65,943.48
APR 21 2022
BY COUNTY AUDITOR
CALHOUN COUNTY, TEXAS
tile:!//C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report432917... 4/21/2022
Memorial Medical Center
Nursing Nome UPI.
Weekly Cortex Transfer
Prosperity Accounts
4/25/2022
.ununt
xumY.
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APPROVEDON
APR 2 5 2022
MNIMER5T
10o"NEREST BY COUNTY AUDFFOR
MMIMIFREST CALHOUN COUNTY, TEXAS
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TOTALS "VASSM 418,15L86
AEON AS
4/25/2022 Treasury Center
Quick View
Select Quick View Accounts Select Group
Account Number f Name Groups
Account Type Add Group
r
[DDA
Data reported as of Apr 25, 202;
Account Number Current
Balance
Available Balance
Collected Balance
Prior Day Balanc
Number of Accounts: 15
$8,210,347.92
$8,602,461,95
$8,210,347.92
$7,903,162.3
'4551
CAL CO INDIGENT
$52,612.57
552,612.57
$52,612.57
$52.612.t
HEALTHCARE
-4454
MEMORIAL MEDICAL
NH GOLDEN CREEKEK
$110,912.66
$113,350.40
$110.912.66
$2,832.2
HEALTHCARE
'4365
MEMORIAL MEDICAL
CENTER - CLINIC SERIES
S536.26
$536.26
$536.26
S536,5
2014
'4357
MEMORIAL MEDICAL
S6,210,091.14
S6,345,719.46
S6,210,091.14
S6,059,891.2
CENTER - OPERATING
'4373
MEMORIAL MEDICAL
CENTER - PRIVATE
$431.71
S431.71
$431.71
$431.7
WAIVER CLEARING
'4381
MEMORIAL MEDICAL
$22,462.01
J
$88.269.43
$22,462.01
$38.977.7
CENTER I NH ASHFORD
Am
MEMORIAL CENTER NH MEDICAL
$121.105.66
,�
S142,666.60
S121,105.66
S75,164.2
BROADMOOR
'4411
MEMORIALMEDICAL
$146,559.37
✓
S175,722.27
S146,569.37
S150,132.c_
CENTER/NH CRESCENT
'4446
MEMORIAL MEDICAL
$39,947.49
✓
$43,258.16
$39,947.49
S13,960.e
CENTER / NH FORT BEND
'4438
MEMORIAL MEDICAL
CENTER / SOLERA AT
$98.678.89
✓
S139,345,47
$98,678.89
$134,547E
WEST HOUSTON
'2998
MMC-MONEY MARKET
$1,110,015.19
$1,110,015.19
S1,110,015.19
S1,110,015A
FUND
'5506
MMC-NH BETHANY
$209,107.60
S209,107.60
S209,107.60
5198.899.E
SENIOR LIVING
'5441
MMC •NH GULF POINTE
S1,654.98
$95,057.00
S1,654.98
51,654.E
PLAZA -
MEDICAREIMEDICAID
'5433
MMC -NH GULF POINTE
51,13138
$1,270.82
$1.133.38
$2,617.1
PLAZA - PRIVATE PAY
•3407
MMC-NH TUSCANY
S85,099.01
$85,099.01
S85.099.01
S60,787.E
VILLAGE
r
htlps:/lprosperity.olbenking.comlonlineMessenger
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Memorial Medical Center
Nursing Home UPI.
Weekly Nexion Transfer
Prosperity Accounts
4/25/2022
P.W.vF
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Si621.56
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APR 2 5 2022
BY COUNTY AUDTFOR
CAL HOUN COUNTY, TEXAS
n\xx weekMnamtm\xx unumd.r mmma�yµax3W ngxx uPE uMner wmmama.ss.n.ara
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110,913.66
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SWISS 110.1UN Mom"
4/25/2022
Treasury Center
Quick View
Select Quick View Accounts
Account Number/Name
Select Group
Groups
Account Type
Add Group
t�-,
Data reported as of Apr 25 202:
Account Number Current Balance
Available Balance
Collected Balance
Prior Day Balane
Number of Accounts: 15
$8,210,347.92
$8,602,461.95
$8,210,347.92
$7,903,162.2
'4551
CAL CO INDIGENT
$52,612.57
$52.612.57
$52,612.57
$52,612.°
HEALTHCARE
'4454
MEMORIAL MEDICAL f
NH GOLDEN CREEK
5110.912.66 x/
$113,360.40
5110,912.66
52,8325
HEALTHCARE
'4365
MEMORIAL MEDICAL
CENTER -CLINIC SERIES
$536.26
5536.26
$536.26
$535.2
2014
'4357
MEMORIAL MEDICAL
56,210,091.14
56,345,719.46
$6,210,091.14
S6,059,891.2
CENTER• OPERATING
'4373
MEMORIAL MEDICAL
CENTER -PRIVATE
$431 71
5431.71
5431.71
5431.7
WAIVER CLEARING
'4381
MEMORIAL MEDICAL
$22,462.01
$88,269.43
522,462,01
$38.977.7
CENTER/NH ASHFORD
'4403
MEMORIAL MEDICAL
CENTER/NH
$121.105.66
$142,666.60
5121,105.66
$75,164.2
BROADMOOR
'4411
MEMORIAL MEDICAL
$146.559.37
5175,722.27
$146,559.37
5150.132.E
CENTER! NH CRESCENT
'4446
MEMORIAL MEDICAL
$39.947.49
$43,258.16
$39,947.49
513,960.E
CENTER l NH FORT BEND
'4438
MEMORIAL MEDICAL
CENTER I SOLERA AT
$98,678.89
5139,345A7
598,678.89
$134,647.E
WEST HOUSTON ,
'2998
MMC-MONEY MARKET
$1,110.015.19
51,110,015.19
$1,110,015.19
$1,110.015.1
FUND
'S506
MMC •NH BETHANY
$209.10T60
$209,107.60
5209,107.60
5198,899.E
SENIOR LIVING
'S441
MMC -NH GULF POINTE
PLAZA -
$1.654.98
595,057,00
$1.654.98
$1,854 c
MEDICARE/MEDICAID
'5433
MMC NH GULF POINTE
S1.133.38
$1.270.82
$1,133.38
$2.617.3
PLAZA -PRIVATE PAY
'3407
MMC -NH TUSCANY
$85,099.01
$85.099.01
_ $85.099.01
$60,787.E
VILLAGE
hltps:tiprosperity.olbanking,comlonlineMessenger
111
Memorial Meolwl [enter
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4/25/2022
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Quick View
Select Quick View Accounts
AccounLNumber t Name
Account Type
Treasury Center
Select Group
Groups
Atltl Group
Account Number
Current Balance
Available Balance
Collected Balance
Prior Day Selene
Number of Accounts; 15
$8,210,347.92
$8,602,461.95
$8,210,347.92
$7,903,162.2
*4551
CAL CO INDIGENT
HEALTHCARE
$52,612,57
552,612.57
$52,612,57
$52,612.1
*4454
MEMORIAL MEDICAL /
NH GOLDEN CREEK
$110,912.66
$113,350.40
$110.912.66
$2,832.2
HEALTHCARE
'4365
MEMORIAL MEDICAL
CENTER - CLINIC SERIES
$636.26
$536.26
$536.26
$535.2
2014
'4357
MEMORIAL MEDICAL
CENTER -OPERATING
56,210,091A4
56,345,719.46
$6.210,091.14
56,059,891.:
•4373
MEMORIAL MEDICAL
CENTER - PRIVATE
$431 71
$431.71
$431.71
5431.7
WAIVER CLEARING
'4381
MEMORIAL MEDICAL
CENTER/NH ASHFORD
522,462.01
$88.269.43
$22.462.01
S38,977.7
'4403
MEMORIAL MEDICAL
CENTER/NH
$121,105.66
$142,666,60
5121,105.56
575.164.2
BROADMOOR
'4411
MEMORIAL MEDICAL
CENTER/NH CRESCENT
$146,559.37
5175,722,27
5146,559.37
$150,132 c
'4446
MEMORIAL MEDICAL
CENTER NH FORT BEND
$39,947.49
$43,258.16
$39,947.49
513,960.E
'4438
MEMORIAL MEDICAL
CENTER ISOLERA AT
598.678.89
5139345A7
598.678.89
5134,647.E
WEST HOUSTON
'2998
MMC-MONEY MARKET
FUND
$1,110,015.19
51,110,015.19
$1,110.015.19
51,110,015.1
'S506
MMC -NH BETHANY
SENIOR LIVING
5209.107,60
5209,107.60
S209.107.60
$198,899.E
44
MMC -NH GULF POINTE
PLAZA-
/
$1,654,98 ,/
595.057.00
$1,664.98
$1,654.E
MEDICARE/MEDICAID
'S433
MMC-NH GULF POINTE
$1,133.38 ,�
$1,270.82
$1,133.38
$2,617.9
PLAZA - PRIVATE PAY
'3407
MMC -NH TUSCANY
$115,099.01
585,099.01
$85,099.01
560,787.E
VILLAGE
https;liprosperity.olbanking.com/onlineMessenger
111
Memorial Medical Center
Nursing Home JPL
Weekly Tuscany Transfer
Prosperity Accounts
4/25/2022
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CALHOUN COUNTY. TEXAS
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4/20/2022 NOWTAS SOLUTION HCCLUMPMT 676201420000166
4/21/2022 CK1097
4/21/2022 HNB-ECHO HCCIAIMPMT 746003411440000287611
4/21/2022 NOWTAS SOLUTION HCCLAIMPMT 676201420DO0171
4/22/2022 CK1099
4/22/2022 Molina KC of TX HCCLAIMPMT PNIZ757179944200
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-
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34,545.58
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4125/2022
Quick View
Select Quick View Accounts
Account Number / Name
Account Type
Searrh All
DDA
Account Number Currant Balance
Number of Accounts: 15
$8,210,347.92
5 1
CAL CO INDIGENT
$52,612.57
HEALTHCARE
'4454
MEMORIAL MEDICAL 1
$110.912.66
NH GOLDEN CREEK
HEALTHCARE
,4365
MEMORIAL MEDICAL
CENTER - CLINIC SERIES
$536.26
2014
'4357
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S6,210,091.14
CENTER -OPERATING
'4373
MEMORIAL MEDICAL
CENTER - PRIVATE
y431.71
WAIVER CLEARING
381
MEMORIAL MEDICAL
$22,462.01
CENTER/NH A5HFORD
403
MEMORIAL MEDICAL
$121.105.66
CENTER/NH
BROADMOOR
'4411
MEMORIAL MEDICAL
$146,569.37
CENTER/NH CRESCENT
'4446
MEMORIAL MEDICAL
$39.947.49
CENTER/NH FORT BEND
-4438
MEMORIAL MEDICAL
$98,678.89
CENTER I SOLERA AT
WEST HOUSTON
'2998
MMC-MONEY MARKET
$1,110.015.19
FUND
'5506
MMC -NH BETHANY
S209,107.60
SENIOR LIVING
•5441
MMC -NH GULF POINTE
$1,654,98
PLAZA-
MEDICAREIMEDICAID
'5433
MMC -NH GULF POINTE
S1,133.38
PLAZA -PRIVATE PAY
'3407
MMC -NH TUSCANY
$85,099.01
VILLAGE
https://prosperity.olbanking.com/onlineMesseagef
Treasury Center
Select Group
Groups
Atld Group
Data reported as of Apr 25, 202:
Available Balance Collected Balance Prior Day Balanc
$8,602.461.95 $8,210,347.92 $7,903,162,3
$52.612.57 $52,612.57 $52,612.E
S113,350.40
$110,912.66
S2,832.1'
$536.26
$536.26
S536.2
$6,345,719.46
$6,210.091.14
S6.059,891.2
S431.71
S431.71
S431,7
$88.269.43
$22,462.01
$38,977.7
S142,666.60
S121,105.66
$75,164.e
6175.722.27
8146,559.37
S150.132.E
$43,258.16
$39.947.49
S13,9601
S139.345.47
S98,678.89
8134,647.E
S1,110.015.19
$1,110,015.19
S1,110.015.1
$209,107,60
S209,107.60
5198,899.E
$95,057.00
$1.654.98
$1,654.S
$1,270.82
S1,133.38
S2,617.;
$85,099.01
$85,099.01
560.787.E
i/1
Memorial Medial Center
Nursing Home UPL
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e/25/2022
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Select Quick View Accounts
Account Number I Name
Account Type
Treasury Center
Select Group
Grou s
Atltl Graup
Account Number
Current Balance
Available Balance
Collected Balance
Prior Day Balanc
Number of Accounts: 75
$8,210,347.92
$8,602,461.95
$8,210,347.92
$7,903,162 1
•4551
CAL CO INDIGENT
HEALTHCARE
$52.612.57
$52,512,57
$52.612.57
$52,612.E
'4454
MEMORIAL MEDICAL!
NH GOLDEN CREEK
$110.912.6fi
$113,350,40
$110,912.66
52,832.Z
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,4365
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$536.26
5536.26
553626
.
5536.<'
2014
,4357
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CENTER -OPERATING
$6,210,091.14
56,345,719.46
$6.210.091.14
$6,059,891.2
'4373
MEMORIAL MEDICAL
CENTER - PRIVATE
$q31 71
5431.71
.
543171
$4317
WAIVER CLEARING
,4381
MEMORIAL MEDICAL
CENTER! NH ASHFORD
$22,462.01
$58,269.43
$22,462.01
$38.977.7
•4403
MEMORIAL MEDICAL
CENTER/NH
$121,105.66
$142,666.60
$121,105.66
$75,164.2
BROADMOOR
'4411
MEMORIAL MEDICAL
CENTER/NH CRESCENT
$146,559.37
5175,722.27
$146,559.37
5150,132.E
'4446
MEMORIAL MEDICAL
CENTER/NH FORT BEND
$39.947,49
$43,258.16
$39,947.49
513,960.E
'4 38
MEMORIAL MEDICAL
CENTER / SOLERA AT
$98.678.69
5139,345.47
$98.678.89
5134,647.;
WEST HOUSTON
'2998
MMC-MONEY MARKET
FUND
$1,110,015.19
$1,110,015.19
51,110,015.19
51,110,015.1
'5506
MMC -NH BETHANY
SENIOR LIVING
$209.107.60 ✓
9209.107.60
5209,107.60
5198,899.F
'5441
MMC -NH GULF POINTE
PLAZA-
51,654.98
$95,057.00
51.654.98
$1,654,E
MEDICARE/MEDICAID
'5433
MMC-NH GULF POINTE
PLAZA 'PRIVATE PAY
51,133.38
$1,270.82
$1.133.38
$2,617.3
'3407
MMC •NH TUSCANY
VILLAGE
$85.099.01
$85,099.01
$85,099.01
580,787.E
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