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2022-05-25 Final PacketDill All Agenda Items Properly Numbered Contracts Completed and Signed All 1295's Flagged for Acceptance )'All (number of 1295's ) Documents for Clerk Signature Flagged On this 4ay of 2022 a complete and accurate packet for 257cof 2022 Commissioners Court Regular Session Day Month was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. -rwu4z� Calhoun County Judge/Assistant COMMISSI ONERSCOURTCHECKLIST/FORMS AGENDA G1O 1 lCF OF MLF IlNG - ')/2 5/2022 Richard H. Meyer County judge David Hall, Commissioner, Precinct I Vern gyssy, 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, May 25, 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 FILED W O'GLOGK M Call meeting to order. MAY 2 0 2022 42-zInvocation. o T Y Go tw D edges of Allegiance. B 4. General Discussion of Public Matters and Public Participation. Hear reports from the Agri Life Extension Office: Coastal and Marine K4-H and Youth Development Family and Community Health `6. Consider and take necessary action to adopt a policy for Qualified Educational Assistance. (RHM) `7. Consider and take necessary action to authorize Commissioner David Hall to sign a Victoria Electric Cooperative, Inc. Electrical Service Agreement for Chocolate Bayou Boat c� Ramp for new service. (DEH) 8. Consider and take necessary action to accept a donation to Calhoun County Precinct 1 in e amount of $500.00 to be placed into line item 53992. (DEH) Goa Public Hearing concerning a Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas, Page 1 of 2 NQTI(!_ OF MI i IIrJC, `>j�5/Z012 IConsider and take necessary action on a Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. (GDR) 11. Consider and take necessary action to approve the Final Plat of Serendipity Subdivision. (GDR) K. Consider and take necessary action to have funds of $1,906.24 from the City of Seadrift be placed in Precinct 4 R & B account 570-53210. Funds were accepted by Commissioners' Court on May 18, 2022. (GDR) 4: Consider and take necessary action to accept and approve the agreement with Valley View Consultants, LLC and authorize the County Treasurer to sign. Said Agreement will remain in effect until June 30, 2024. (RHM) W4. Consider and take necessary action to authorize the indemnification of the previous Museum Director against personal liability for the loss of county funds in the amount of $171.77 during the period of January 1, 2015 to March 31, 2022. The loss was incurred by the previous officer in their performance of their official duties; however, the loss was not the result of the officer's negligence or criminal action per Local Government Code ,�157.903. (RHM) '15. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (RHM) Y6. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Waste. (RHM) i7"Xccept Monthly Report from the following County Office: 1`—County Clerk — April 2022 fi!District Clerk — April 2022 i8. Consider and take necessary action on any necessary budget adjustments. (RHM) 19. Approval of bills and payroll. (RHM) Richard H. Meyer, County Jub6e 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-5/25/2022 Rioin2rd H. Meyer County judge David Hall, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Sara Rodriguez, County Attorney Karla Perez, Deputy Clerk NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, May 25, 2022 at 10.00 a.m. in the Commissioners' Courtrooms in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting was called to order at 10:00 a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag — Commissioner Vern Lyssy Texas Flag — Commissioner Gary Reese 4. General Discussion of Public Matters and Public Participation. Bobbie Vickery requested prayers for Uvalde. 5. Hear reports from the AgriLife Extension Office: I. Coastal and Marine ii. 4-H and Youth Development iii. Family and Community Health R3 Shepley, Emily, and Karen Lyssy with the AgriLife Extension Office and Amy with CCISD gave updates on past events including crab trap cleanup, adopt -a - beach cleanup, earth day, partnership with the Formosa Tejano Wetlands and CCISD, livestock shows, and community outreach. Page 1 of 4 NOTICE OF MEETING-5/25/2022 6. Consider and take necessary action to adopt a policy for Qualified Educational Assistance. (RHM) Clarri Atkinson explained the current policy and requested a few errors be changed before approval. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to authorize Commissioner David Hall to sign a Victoria Electric Cooperative, Inc. Electrical Service Agreement for Chocolate Bayou Boat Ramp for new service. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to accept a donation to Calhoun County Precinct 1 in the amount of $500.00 to be placed into line item 53992. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Public Hearing concerning a Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. Closed regular meeting at 10:48 am Terri Ruddick with Urban Engineering explained the petition to vacate and plans for the Serendipity Plat. Opened regular meeting at 10:50 10. Consider and take necessary action on a Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. (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 2 of 4 NOTICE OF MEETING — 5/25/2022 11. Consider and take necessary action to approve the Final Plat of Serendipity Subdivision. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to have funds of $1,906.24 from the City of Seadrift be placed in Precinct 4 R & B account 570-53210. Funds were accepted by Commissioners' Court on May 18, 2022. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to accept and approve the agreement with Valley View Consultants, LLC and authorize the County Treasurer to sign. Said Agreement will remain in effect until June 30, 2024. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action to authorize the indemnification of the previous Museum Director against personal liability for the loss of county funds in the amount of $171.77 during the period of January 1, 2015 to March 31, 2022. The loss was incurred by the previous officer in their performance of their official duties; however, the loss was not the result of the officer's negligence or criminal action per Local Government Code 157.903. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (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—5/25/2022 16. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Waste. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 17. Accept Monthly Report from the following County Office: I. County Clerk — April 2022 ii. District Clerk — April 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 18. 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 19. Approval of bills and payroll. (RHM) INDIGENT RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese COUNTY RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese ADJOURNED AT 10:58 AM. Page 4 of 4 #5 NOTICE OF MEETING — 5/25/2022 Rich2rd H. beget County judge David ]Ball, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 GarryReese, Commissioner, Precinct 4 Sara Rodriguez, County Attorney Karla Perez, ][Deputy Clerk NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, May 25, 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 was called to order at 10:00 a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag — Commissioner Vern Lyssy Texas Flag — Commissioner Gary Reese 4. General Discussion of Public Matters and Public Participation. Bobbie Vickery requested prayers for Uvalde. 5. Hear reports from the AgriLife Extension Office: i. Coastal and Marine ii. 4-H and Youth Development III. Family and Community Health 117 Shellley, Emily, and Karen Lyssy with the AgriLife Extension Office and Amy with CCISD gave updates on past events including crab trap cleanup, adopt -a - beach cleanup, earth day, partnership with the Formosa Tejano Wetlands and CCISD, livestock shows, and community outreach. Page 1 of 15 Coastal and Marine EXTENSION ACTIVITY REPORT TO COUNTY COMMISSIONERS COURT April 2022 Miles traveled: County Vehicle 282 Personal Vehicle 0 Selected major activities since last report 4/4 — All Around 4-H Club Sportfishing Tournament and Project Talk 4/5 — Meet with Journalists to tour Oyster Demonstration Farm in Palacios 4/7 — Get YMCA Garden Beds Ready 4/9 —Magnolia Beach Adopt -a -Beach 4/12-4/14 — CCISD 9t" grade program at Formosa Wetlands 4/18 — 4-H Sportfishing Club Kayak Fishing Trip to Boggy 4/19 — CCISD Wetlands Trip Cleanup, OLG Boat Building Project 4/20 — Calhoun County TAMU Scholarship Interviews 4/21 — OLG Boat Project, Lavaca Bay Foundation Meeting 4/22 — Lighthouse Beach Cleanup with VISD 4" grade classes 4/25 — Lockhart HS, GBRA, TPWD, AWR Program 4/26 — Texas Sea Grant Coastal Monitors Meeting 4/28 — Meeting with TMN about Irrigation System in Garden at Office Direct Contacts by: Office: 14 E-mail/Letters: 164 Instagram Posts/Followers: 9/281 Site:6 Newsletters: 0 Phone/Texts:131 Volunteers:0 Major events for next month— Mav 2022 5/3-5/5 — annual leave 5110 — OLG Boats, CHS Scholarship Day Presentations 5111 —Marine Advisory Committee Meeting 5/14 — TMN talk 5/19 — AgriLife Meeting Cuero 5/20 — POC Elementary Kayak Trip Name Calhoun County Coastal and Marine Agent April 2022 Title Date (Month -Year) Texas A&M AgriLife Extension - The Texas A&M University System - College Station, Texas 4-H and Youth Development EXTENSION ACTIVITY REPORT TO COUNTY CON April 2022 Miles traveled: County Vehicle 192; Personal Vehicle 0 Selected maior activities since last report April 1 — Welcome to the Real -World program at OLG Seadrift School Egg to Chick Planning Meeting April 4 — Seadrift School Egg to Chick — Set Incubators Welcome to the Real -World program at OLG April 5 — CCF Steer Tag In April 6 — Seadrift School Egg to Chick — Set Eggs Welcome to the Real -World program at OLG April 7 — Serve as Judge for Victoria 4-H Scholarship interviews April 8-9 — District 11 4-H Spring Spectacular April 11 — Seadrift School Egg to Chick lesson April 12-14 — CCISD Formosa/Tejano Wetlands Field Trip (91 Grade) April 12 — Livestock Judging Practice April 13 — Plant vegetables at YMCA April 18 — 4-H Sportfishing — Fishing Trip April 20 — Seadrift School Egg to Chick lesson April 24 — CCF Swine Clinic I April 25 — Aransas Wildlife Refuge Kayaking program County 4-H Council Meeting 4-H PALA Meeting April 26 — Seadrift School Egg to Chick lesson April 27-28 — Job Fair for Schools in Golden Crescent COURT Direct Contacts by: Office: 7 E-mail: 203 Facebook Posts/Followers: 20 posts/519 followers Site: 2 Newsletters: 1 Instagram Posts/Followers: 4 posts/195 followers Phone/Texts: 27 4-H Enrollment: 185 youth; 23 adult volunteers Maior events for next month — Mav 2022 May 3 — PLC Virtual Meeting May 7 — CCF Poultry Clinic I May 9 — Meeting with Chuck Naiser in Rockport May 10 — CHS Scholarship Day May 13 — Ag in the Classroom May 16 — County 4-H Council Meeting May 19-20 — AgriLife Spring Faculty Meeting in Victoria May 24 — Assist Calhoun YMCA with Youth Fun Day May 31 — District 11 4-H Horse Show Calhoun CEA — 4-H and Youth Development April 2022 Texas A&M AgriLife Extension • The Texas A&M University System - College Station, Texas Family and Community Health EXTENSION ACTIVITY REPORT TO COUNTY COMMISSIONERS COURT April 2022 Miles traveled: 558 County Vehicle 52 Personal Vehicle Selected major activities since last report ➢ Meetings 4, 7, 11, & 21 with TEEA, CalCoISD SHAC, OLG Board, Volunteer Steering Committee, & Sr. Citizen Board ➢ April 1, 4, 6-8, 11,13-15, 18, 20-22, 25, 27-29 — Strong People Strong Bodies Classes 24-week series ➢ April 12, 19 & 26 Be Well Live Well Programs at the Sr. Citizen's Center and Library 10:00 & noon ➢ April 4, 11, 18 & 25 Walk Across Texas Continues with OLG and Calhoun County ➢ April Cooking Well with Diabetes virtually ➢ April 8 & 9 Spring Spectacular 4-H District Competition in Victoria ➢ April 13 District 11 TEAFCS meeting in Karnes County ➢ April 14 Working at Wetlands with Emilee & RJ ➢ April 21 County Fair Judging in Wharton County ➢ April 22 Planning Meeting for Healthy South Texas Youth Ambassadors here in Calhoun County ➢ April 26 Early Childhood Educator Training ➢ April 27 & 28 Job Fair in Victoria Direct Contacts by: Office:15 E-mail/Letters:310 Facebook Page Post 37 Site:S Newsletters: 0 Followers 555 Phone/Texts: 89 Volunteers: 8 Facebook profile 964 friends Major events for next month — May 2022 ➢ Meetings 9, 19,23 & 24 with OLG Board, Sr. Citizen Board, Volunteer Steering Committee & United Way Board ➢ May 2, 4-6, 9, 11-13, 16, 18-20, 23, 25-27, & 30 — Strong People Strong Bodies Classes 24-week series ➢ May 2, 9, 16, & 23 A Fresh Start to a Healthier You at the Pregnancy Help Center ➢ May 3, 17 & 31 Be Well Live Well Programs at the Sr. Citizen's Center and Library 10:00 & noon ➢ May 4 Teaching Nutrition Program in Victoria at Faith Academy ➢ May 8 Walk Across Texas Ends Calhoun County — Reports Due OLG and County ➢ May 10 Age My Way Conference at VFW Hall ➢ May 12 Welcome to the Real World in Jackson County ➢ May 13 Ag in the Classroom — MyPlate with Emilee and 3rd Graders in the County ➢ May 19 Regional Program Planning Meeting with all Agents in District ➢ May 24 Meeting Dr. Rick Avery in Corpus Christi, our new Director ➢ May 24 Early Childhood Educator Training ➢ May 25 Commissioner's Court Interpretation with all Extension Agents ➢ May 30 Memorial Day - County Holiday - My Birthday- Thanks for the day off Karen P. Lyssy Calhoun Name County CEA — Family and Community Health April 2022 Title Date (Month -Year) Texas A&M AgriLife Extension • Texas A&M University System • College Station, Texas I i r.. C T I 4 0 > T I ' I 0 of - a ,n N rl a w T w -1 rl 00 N 00 N n M co N 00 N 00 V1 0o N co m to V1 00 ° w i v'z3 r-I s c I d v c Z-M:a ! ale z z WI`I�N iceO 'h U °xja G G a w Q `o R C O G 7 C G V U 55 GG u° abt;L) z u c g .., c ? 1 1 m f a L U m U m m v �o U C U� K m Y oD OC C K Y m 2 s� 3 1 1 m ? d' \ m N �! y00; '^ c p l 1 1 1 d 1 u LL ° C S LL. LL N Vl Y N N N C •� 1 1 N E V .� Vi Vi = u m C m i :: �. m Z C ° u d = V o tll > I c oc om y m c an 0 ami d w E d m= m af0i co v I g U U m 0.o.m33�33 VI V) !! LL m m m LL Ma °c v a °c m oco m o F o o m o m tto � LL O O O O O U } C ..I N N N N N N N .N N N N N N N N N N N N N N N N N N N N N N N N N N O O O O O O O O O O N m n n \ N \ M \ M \ \ V1 \ W \ 01 \ e-1 \ C41 \ V1 N G 'd'aaaad'v`vva 0\0 0\0 O\1 °\f a aavaa a �'�; #6 NOTICE OF MEETING — 5/25/2022 6. Consider and take necessary action to adopt a policy for Qualified Educational Assistance. (RHM) Clarri Atkinson explained the current policy and requested a few errors be changed before approval. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 15 CALHOUN COUNTY QUALIFIED EDUCATIONAL ASSISTANCE PLAN TUITION ASSISTANCE POLICY Approved by Commissioners Court , 2022 To encourage personal and professional development that improve skills, knowledge, understanding and abilities to increase productivity, the County of Calhoun has established a Qualified Educational Assistance Plan for full-time employees. (IRS Publication 5137, Fringe Benefit Guide for Federal State and Local Governments, IRC Section 127) The Qualified Educational Assistance Plan offered by the Countyto full-time employees is offered for only tuition and out of county fees under two programs, Payment upon Enrollment or Reimbursement. The employee AN/only choose either, Payment upon Enrollment or Reimbursement. The option the employee chooses in the beginning will remain the same throughout the lifetime maximum amount that has been set by Commissioners Court. (Example: If the employee chooses Payment upon Enrollment for tuition assistance for the fall semester, the employee may not choose Reimbursement for the spring semester). Under the Qualified Educational Assistance Plan, the County has set a cap of $5,250 tuition assistance per year (January 1 thru December 31) per full-time employee. The County has set a maximum lifetime tuition assistance at $10,500 per full-time employee. The availability of tuition assistance is subject to Commissioners Court approved funding in each individual department. Funding will be established annually as part of the budget process based upon anticipated participation and available funding. Each County department will be responsible for determining if funds are available in their department. If funds are not available within the department's budget, the department may request funds during annual budget workshops. To be eligible for consideration of tuition assistance, an individual must be a full-time employee that has completed a minimum of twelve months of service with the County and be in good standing with the County prior to the request for tuition assistance. In cases where an employee is currently under a designated performance improvement plan for a disciplinary matter or for performance improvement issues, the employee will not be eligible for tuition assistance while on the plan. To retain eligibility fortuition assistance, an employee must remain as an active full- time employee in good standing from the time the request is submitted to the time a course or certification program is completed and, if available, applyfor FAFSA, grants, scholarships or other financial assistance. The employee must take all courses and certification programs for which tuition assistance is received on the employee's own time. The employee will not be paid by the County for any time needed during work hours for any class or certification program. (Example: Time needed to study, complete assignments, testing, attend classes or labs, etc.) If a class or certification program is only available during an employee's normal work hours, the employee must request Page 1 of 9 a flexible schedule from the employee's department head (elected or appointed official). With prior approval from the employee's department head (elected or appointed official), the employee must use vacation leave, comp time, or leave without pay in order to attend or fulfill any responsibility for the class or certification program. When there is a conflict between classes or certification programs and the employee's job responsibilities, the job responsibility must come first. A course or certification program must be offered by accredited colleges, universities, business institutes or trade schools and must: 1. Relate to current position or prospective (new) job duties; 2. Be required by a an accredited college, university, business institute or trade school which is related to a County career field; 3. Benefit Calhoun County by increasing employee skills, knowledge, understanding and abilities needed to increase productivity and achieve County goals and objectives; 4. Be approved by the employee's department head (elected or appointed official); 5. Be recorded (detailed with amounts and receipts) and kept up to date by the employee's department head (elected or appointed official); and 6. Be on file in the Human Resources Department. All required forms must be obtained from the Human Resources Director. Forms from the employee's department will not suffice for the requirements of the Qualified Educational Assistance Plan, Tuition Assistance Policy. A course or certification program will be defined as a class of instruction taught at or by an accredited college, university, business institute or trade school that meets on a regular basis over an extended period of time. Online courses from an accredited college, university, business institute or trade school are eligible for tuition assistance. Non-credit courses or courses containing the same or similar information as received in previous courses (repeat courses) are not eligible for tuition assistance. Tuition assistance will be paid upon enrollment or reimbursed only once for each approved course or certification program. The County will not pay or reimburse for courses or certification programs for which tuition assistance has already been paid or reimbursed. Should a question arise about the administration of this policy or whether a course or certification program meets the requirements of this policy, the employee must contact the Human Resources Director. Seminars, conferences, continuing education, and any license or certification that is required by the County or by law, for the employee to maintain in order to keep their present job, salary or status will be covered by funds within each department and not by the Qualified Educational Assistance Plan. The County will provide assistance for only the cost of Tuition and Out of County fees, if any, not to exceed the yearly and maximum amounts per employee set by Commissioners Court. Tuition Page 2 of 9 and Out of County fees, if any, will be paid upon enrollment to the college, university, business institute or trade school or reimbursed to the employee only after the employee has submitted all of the required documentation. Other fees and expenses are excluded from Tuition Assistance. These fees include but are not limited to, the following:; - - - --. • Tools or Supplies that the employee may keep after a course is completed; • Education involving sports, games or hobbies; • Meals, Lodging, transportation (fuel, mileage or any travel expenses); Books; • E-Book Course fees; • Materials; • Supplies; • Elective fees; • Exam, Testing and/or Certification fees • Installment fees; • Late fees; • Service fees; • Return check fee; • Deposits; • Orientation fees; • Application, Entrance and/or Registration fees for admittance and/or graduation; • Change of class or certification program fees; • Identification cards; • Uniform fees; • Health and/or Liability insurance fees; • Fees for copies of official transcripts and/or certificates; • Parking fees From the total cost of tuition and out of county fees, if any, the County will pay the difference between the amount approved by the County and the amount of financial assistance, which has been or will be received, from any source, but no more than the maximum amount allowed by the County (yearly or lifetime). If other financial assistance received by the employee is more than the amount approved by the County, no payment upon enrollment or reimbursement will be made by the County. If financial assistance is received after the County has made a payment upon enrollment or reimbursement, the employee must immediately notify and reimburse the County the amount received (up to the amount of the County's payment or reimbursement) from other financial assistance. Employees who fail to report and reimburse the County for any other financial assistance and amounts received will he "Able a... the .,...,.., Of '"^ ,,...:Fe payfflent WpeR the empleyee, will no longer be eligible for tuition assistance from the County and will face legal Page 3 of 9 consequences from the County up to and including termination. The employee agrees that any funds due to the County will be deducted from the employee's payroll check(s). The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. If the employee fails to voluntarily reimburse the County, the County will seek any legal options the County may have, up to and including termination. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. If an employee resigns or is terminated, except for a reduction in force, prior to the completion of a course or certification program and the required years of service, the employee agrees to immediately reimburse the County for any tuition assistance paid on the employee's behalf or any reimbursement the employee received. The employee agrees that any funds due to the County will be deducted from the employee's final payroll check that is due to the employee at the time of the employee's resignation or termination. The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. Ifthe amount owed to the County is not paid immediately, the County will seek any legal options the County may have, up to and including termination. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. If an employee is injured on the job or while on military active duty and has to involuntarily leave employment (including a disability retirement with TCDRS due to injury or illness) before course or certification program completion and required years of service, a waiver would be given for any tuition assistance the employee would otherwise be obligated to reimburse to the County. Intentionally Left Blank Page 4 of 9 OPTION 1 — PAYMENT UPON ENROLLMENT PAYMENT UPON ENROLLMENT PROCEDURES Pages 1— 4 must also be followed Within twenty days prior to the beginning date of any course or certification program for which the employee seeks the payment upon enrollment option, the employee must submit to the Human Resources Director the following: 1) Proof of enrollment (schedule or other document showing enrollment status); 2) Written approval (signed and dated) from the employee's department head (elected or appointed official); 3) Payment Upon Enrollment Request Form (obtained from the Human Resources Director); 4) Promissory Note/Employment Agreement (obtained from the Human Resources Director). A separate Promissory Note/Employment Agreement is required for each class or certification program for which the employee applies for payment upon enrollment; 5) Written explanation of how the course, courses or certification program is related to the employee's field of employment or the County's needs. The written explanation must be approved, signed and dated by the employee's department head (elected or appointed official); 6) A detailed (itemized) invoice/statement from the college, university, business institute or trade school that lists the detailed (itemized) costs, including fees (See Other Fees, page 3), for the course, courses, or certification program by semester, quarter or year for which the employee must pay out-of-pocket (not covered by Grants, Scholarships, Veterans Program, GI Bill, other subsidies, or other financial assistance). Other financial assistance received must be disclosed and listed; Payment upon enrollment will be paid only once for each approved course or certification program. The County will not pay for courses or certification programs for which payment upon enrollment has already been received; 7) The County will only consider the Option for Payment upon Enrollment if the employee completes and submits all of the above requirements and any other documentation that is requested by the County. The County will pay directly to the college, university, business institute or trade school for an employee's approved tuition and out of county fees, if any, with an annual cap of $5,250 and a lifetime maximum amount of $10,500; 8) The Human Resources Director will calculate the amount of payment upon enrollment, create a purchase order, attach all of the required documentation received, and return to the employee's department to submit for approval to be paid directly to the college, university, business institute or trade school. Failure to submit required documentation by the published deadline dates will disqualify the employee for payment upon enrollment for that approved period. Page 5 of 9 9) The County's Qualified Educational Assistance Plan, Tuition Assistance Policy and the Promissory Note/Employment Agreement set forth the terms and conditions of the agreement between the employee and the County. The employee shall agree to pay the County for all costs paid by the County, including the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount owed to the County, if: a) The employee fails to complete the course, courses or certification program during the semester, quarter or year for which payment upon enrollment is made by the County; b) The employee fails to submit upon completion of the course, courses or certification program the original official grade slips and transcripts; c) The employee does not provide proof (official transcript) of achieving a grade of A, B, C or P (Pass) for each course; d) The employee does not provide the final original detailed (itemized) invoice/statement from the college, university, business institute or trade school that lists the detailed (itemized) costs, including any fees (see Other Fees, page 3), for the course, courses or certification program and the detailed (itemized) payments made by the employee, the County and other financial assistance sources. Other financial assistance received must be disclosed and listed; e) The employee does not provide a copy of the up to date detailed (itemized) record of tuition assistance that has been paid on behalf of the employee (kept by the employee's department head (elected or appointed official)); f) The employee does not remain employed with the County based on the following schedule (time will run concurrent): Amount Received Years of Service Required Repayment Liability Within a Calendar Year After Completion of a Course for Early Termination $1- $2,000 2 100% $2,001- $4,000 3 100% $4,000 - $5,250 4 100% The employee must pay the County for all tuition assistance paid on the employee's behalf if the employee leaves the County prior to fulfilling the required years of service; and 10) The employee agrees that any repayment due to the County will be deducted from the employee's payroll check(s) and/or the County will seek other legal options the County may have, up to and including termination. The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. Page 6 of 9 OPTION 2 — REIMBURSEMENT REIMBURSEMENT PROCEDURES Pages 1— 4 must also be followed 1) The employee will pay all costs. Within twenty (20) days after the completion of any course or certification program, the employee must submit the following to the employee's department head (elected or appointed official) for approval before submittingto the Human Resources Director: a) Reimbursement Request Form (obtained from the Human Resources Director); b) A copy of the Promissory Note/Employment Agreement (obtained from the Human Resources Director). A separate Promissory Note/Employment Agreement is required for each course or certification program for which reimbursement is requested; c) A copy of the signed approval from the department head (elected or appointed official); d) Proof (official transcript) of a grade of A, B, C or P (Pass) for each course. Grades below C or P (Pass) will not be reimbursed; e) Proof of payment (front and back of cancelled check, copy of other method of payment, etc.); f) Original detailed (itemized) invoice/statement from the college, university, business institute or trade school that lists the detail (itemized) costs, including any fees (See Other Fees, page 3), that were paid for each course or certification program and the detailed (itemized) payments made bythe employee and/or other financial assistance sources. Other financial assistance received must be disclosed and listed; g) An explanation of how the completed course, courses or certification program is related to the employee's field of employment or the County's business needs; and h) A copy of the up to date detailed (itemized) record of tuition assistance that has been reimbursed to the employee (kept by the employee's department head (elected or appointed official)); The Human Resources Director will calculate the amount of reimbursement, create a purchase order, attach all of the required documentation received, and return to the employee's department to submit for approval to be reimbursed. Failure to submit required documentation by the published deadline dates will disqualify the employee for reimbursement for that approved period. 2) The County will reimburse an employee for tuition and out of county fees, if any, for each successfully completed class or certification program if submission of all required documentation is met, with an annual cap of $5,250 and a lifetime maximum amount of $10,500; Page 7 of 9 3) Reimbursement will be paid only once for each approved course or certification program. The County will not reimburse tuition and out of county fees, if any, for courses or certification programs for which reimbursement has already been received; 4) Reimbursement will be provided if an employee achieves a grade of A, B, C or P (Pass). Original official grade slips and transcripts are the only acceptable documentation; 5) No reimbursement to the employee will be made until the employee has furnished satisfactory evidence of having completed a course or certification program by the published deadline; 6) Employees requesting reimbursement will be agreeing to the terms based on the following schedule (time will run concurrent): Amount Received Years of Service Required Repayment Liability Within a Calendar Year After Completion of a Course for Early Termination $1- $2,000 2 100% $2,001- $4,000 3 100% $4,000 - $5,250 4 100% The employee must pay the County for all tuition assistance reimbursed to the employee if the employee leaves the County prior to fulfilling the required years of service; and 7) The employee agrees that any repayment due to the County will be deducted from the employee's payroll check(s) and/or the County will seek other legal options the County may have up to and including termination. The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. Page 8 of 9 EMPLOYEE ACKNOWLEDGEMENT I have received a copy of the Calhoun County Qualified Educational Assistance Plan, Tuition Assistance Policy that outlines my obligations as a County employee. I understand that I am responsible for reading and familiarizing myself with the information, policies, requirements and procedures of the plan. If I need clarification on any of the information in this plan, I will contact the Human Resources Director. This form must be included with the employee's completed Request Form for either Payment Upon Enrollment or Reimbursement. I have read and understand the Qualified Educational Assistance Plan, Tuition Assistance Policy and I agree to abide by and adhere to these policies, requirements and procedures. Signature of Employee Printed Name of Employee Date Signed Signed acknowledgement must be on file in the Human Resources Department before any payment upon enrollment or reimbursement will be considered. A copy must also be attached to the Request Form when Payment upon Enrollment or Reimbursement is requested. Received by the Human Resources Director: Date Signature of the Human Resources Director Page 9 of 9 CALHOUN COUNTY QUALIFIED EDUCATIONAL ASSISTANCE PLAN TUITION ASSISTANCE POLICY Approved by Commissioners Court 2022 To encourage personal and professional development that improve skills, knowledge, understanding and abilities to increase productivity, the County of Calhoun has established a Qualified Educational Assistance Plan for full-time employees. (IRS Publication 5137, Fringe Benefit Guide for Federal State and Local Governments, IRC Section 127) The Qualified Educational Assistance Plan offered by the Countyto full-time employees is offered for only tuition and out of county fees under two programs, Payment upon Enrollment or Reimbursement. The employee may only' choose either, Payment upon Enrollment or Reimbursement. The option the employee chooses in the beginning will remain the same throughout the lifetime maximum amount that has been set by Commissioners Court. (Example: If the employee chooses Payment upon Enrollment for tuition assistance for the fall semester, the employee may not choose Reimbursement for the spring semester). Under the Qualified Educational Assistance Plan, the County 1 as seta cap olTj $5,250 tuition assistance per year (January 1 thru December 31) per full-time employee,. The County has set a maximum lifetime tuition assistance at $10,500 per full-time employee. r-_ - The availability of tuition assistance is subject to Commissioners Court approved funding in each individual department. Funding will be established annually as part of the budget process based upon anticipated participation and available funding. Each County department will be responsible for determining if funds are available in their department. If funds are not available within the department's budget, the department may request funds during annual budget workshops. To be eligible for consideration of tuition assistance, an individual must be a full-time employee that has completed a minimum of twelve months of service with the County and be in good standing with the County prior to the request for tuition assistance. In cases where an employee is currently under a designated performance improvement plan for a disciplinary matter or for performance improvement issues, the employee will not be eligible for tuition assistance while on the plan. To retain eligibility for tuition assistance, an employee must remain as an active full- time employee in good standing from the time the F requesi, is submitted to the time a course rj e tificationprogram his completed and, if available, applyfor FAFSA, grants, scholarships or other financial assistance. The employee must take all courses and certification programsjfor which tuition assistance is received on the employee's own time. The employee will not be paid by the County for any time needed during work hours for any class or certification program. (Example Time needed t - -- study, complete assignments,_ testing, attend classes or labs, etc.) If a class or certification] programis only available during an employee's normal work hours, the employee must request Page 1 of 9 a flexible schedule from the employee's department head (elected or appointed official). With prior approval from the employee's department head (elected or appointed official), the employee musti use vacation leave, comp time, or leave without pay in Prder to attend or fulfill 6nyresponsibility forthe class or certification program. When there is a conflict between classes or certification programs and the employee's job responsibilities, the job responsibility must come first. A course or'certrfication program ',must be offered by accredited colleges, universities, business institutes or trade schools and must: 1. Relate to current position or prospective (new) job duties; 2. Be required by a an accredited college, university, business institute or trade school which is related to a County career field; 3. Benefit Calhoun County by increasing employee skills, knowledge, understanding and abilities needed to increase productivity and achieve County goals and objectives; 4. Be approved by the employee's department head (elected or appointed official); 5. Be recorded (detailed with amounts and receipts) and kept up to date by the employee's department head (elected or appointed official); and 6. Be on file in the Human Resources Department. All required forms must be obtained from the Human Resources Director. Forms from the employee's department will not suffice for the requirements of the Qualified Educational Assistance Plan, jTu lc6 Assistance Policy. A course or certification programs will be defined as a class of instruction taught at or by an accredited college, university, business institute or trade school that meets on a regular basis over an extended period of time. Online courses from an accredited college, university, business institute or trade school are eligible for tuition assistance. Non-credit courses or courses containing the same or similar information as received in previous courses (repeat courses) are not eligible for tuition assistance. Tuition assistance will be paid upon enrollment or reimbursed only once for each approved course or certification program, The County will not pay or reimburse for courses or certification, programsl, for which tuition assistance has already been paid or reimbursed. Should a question arise about the administration of this policy or whether a course or, certification program meets the requirements of this policy,! the employee must contact the Human Resources Director. Seminars, conferences, continuing education, and any license or certification that is required by the County or by law, for the employee to mamtainin order, to keep their present job, salary or status will be covered by funds within each department and not by the Qualified Educational Assistance Plan. The County will provide assistance for only the cost of Tuition and Out of County fees, if any, not to exceed the yearly and maximum amounts per employee set by Commissioners Court. Tuition Page 2 of 9 and Out of County fees, if any, will be paid upon enrollment to the college, university, business institute or trade school or reimbursed to the employee only after the employee has submitted all of the required documentation. Other fees and expenses are excluded from Tuition Assistance. These fees include, but are not limited to, the following: • Tools or Supplies that the employee may keep after a course is completed; • Education involving sports, games or hobbies; • Meals, Lodging, transportation (fuel, mileage or any travel expenses); • Books; • E-Book Course fees; • Materials; • Supplies; • Elective fees; • Exam, Testing and/or Certification fees • Installment fees; • Late fees; • Service fees; • Return check fee; • Deposits; • Orientation fees; • Application, Entrance and/or Registration fees for admittance and/or graduation; • Change of class or certification program fees; • Identification cards; • Uniform fees; • Health and/or Liability insurance fees; • Fees for copies of official transcripts and/or certificates; • Parking fees From the total cost of tuition and out of county fees, if any the County will pay the difference between the amount approved by the County and the amount of financial assistance, which has been or will be received, from any source, but no more than the maximum amount allowed by the County (yearly or lifetime). If other financial assistance received by the employee is more than the amount approved by the County, no payment upon enrollment or reimbursement will be made by the County. If financial assistance is received after the County has made a payment upon enrollment or reimbursement, the employee �rtus immediately notify and reimburse the County the amount received (up to the amount of the County's payment or reimbursement) from other financial assistance. Employees who fail to report and reimburse the County for any other financial assistance and amounts received +H+44 el will no longer be eligible for tuition assistance from the County an ill face lege Page 3 of 9 consequences from the County up to and including termination,. The employee agrees that any funds due to the County will be deducted from the employee's payroll check(s). The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. If the employee fails to voluntarily reimburse the County, the County will seek any Fal options the County may have, up to and including termination. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. If an employee resigns or is terminated, except for a reduction in force, prior to the completion, of a course or certification program and the required years of service, the employee agrees to immediately reimburse the County for any tuition assistance paid on the employee's behalf on y reimbursement the employee received. The employee agrees that any funds due to the County will be deducted from the employee's final payroll check that is due to the employee at the time of the employee's resignation or termination. The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. If the amount owed to the County is not paid immediately, the County will seek any legal options the County may have, up to and including termination. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. If an employee is injured on the job or while on military active duty and has to involuntarily leave employment (including a disability retirement with TCDRS due to injury or illness) before course .orcertification program completion and required years of service, a waiver would be given for any tuition assistance the employee would otherwise be obligated to reimburse to the County. Intentionally Left Blank Page 4 of 9 OPTION 1 - PAYMENT UPON ENROLLMENT PAYMENT UPON ENROLLMENT PROCEDURES Pages 1-4 must also be followed Within twenty days prior to the beginning date of any course or certification progra m for which the employee seeks the payment upon enrollment option, the employee must submit to the Human Resources Director the following: 1) Proof of enrollment (schedule or other document showing enrollment status); 2) Written approval (signed and dated) from the employee's department head (elected or appointed official); 3) Payment Upon Enrollment Request Forml (obtained from the Human Resources Director); 4) Promissory Note/Employment Agreement (obtained from the Human Resources Director). A separate Promissory Note/Employment Agreement 3 required for each class or'certification program for which the employee applies for payment upon enrollment; 5) Written explanation of how the course, courses or certification program is related to the -- — employee's field of employment or the County's needs. The written explanation must be approved, signed and dated by the employee's department head (elected or appointed official); 6) A detailed (itemized) invoice/statement from the college, university, business institute or trade school that lists the detailed (itemized) costs, including 'fees- (See Other Fees, page 3), ] for the course, courses, or certification program� semester, quarter or year for which the employee must pay out-of-pocket (not covered by Grants, Scholarships, Veterans Program, GI Bill, other subsidies, or other financial assistance). Other financial assistance received must; be disclosed and listed;; Payment upon enrollment will pay aid only once for each approved, course or certificatiorr', p p Y 'pro____, ram The Count will not a for courses or certification ro rams for which payment upon enrollment has already been received; 7) The County will only consider the Option for Payment upon Enrollment if the employee completes and submits all of the above requirements and any other documentation that is requested by the County. The County will pay directly to the college, university, business institute or trade school for an employee's approved tuition and out of county fees, if any, with an annuafl cap of $5,250 and a lifetime maximum amount of $10,500; 8) The Human Resources Director will calculate the amount of payment upon enrollment, create a purchase order, attach all of the required documentation received, and return to the employee's department to submit for approval to be paid directly to the college, university, business institute or trade school. Failure to submit required documentation by the published deadline dates will disqualify the employee for payment upon enrollment, for that approved period. Page 5 of 9 9) The County's Qualified Educational Assistance Plan, Tuition Assistance Policy's and the Promissory Note/Employment Agreement set forth the terms and conditions of the agreement between the employee and the County. The employee shall agree to pay the County for all costs paid by the County, including the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount owed to the County, if: a) The employee fails to complete the course, courses or certification programl during the semester, quarter or year for which payment upon enrollment' is made by the County; b) The employee fails to submit upon completion of the course, courses 6� certification program the original official grade slips and transcripts; c) The employee does not provide proof (official transcript) of achieving a grade of A, B, C or P (Pass) for each course; d) The employee does not provide the final original detailed (itemized) invoicevstatementI from the college, university, business institute or trade school that lists the detailed (itemized) costs, including any fees (see Other Fees, page 3), for the course, courses ;or certification program] and the detailed (itemized) payments made by the employee, the County and other financial assistance sources. Other financial assistance received must be disclosed and listed,; e) The employee does not provide a copy of the up to date detailed (itemized) record of tuition assistance that has been paid on behalf of the employee (kept by the employee's department head (elected or appointed official)); f) The employee does not remain employed with the County based on the following schedule (time will run concurrent): Amount Received Years of Service Required Repayment Liability Within a Calendar Year After Completion of a Course for Early Termination $1- $2,000 2 100% $2,001- $4,000 3 100% $4,000 - $5,250 4 100% The employee must pay the County for all tuition assistance paid on the employee's behalf if the employee leaves the County prior to fulfilling the required years of service; and 10) The employee agrees that any repayment due to the County will be deducted from the employee's payroll check(s) and/or the County will seek other legal options the County may have, up to and including termination. The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. Page 6 of 9 OPTION 2 — REIMBURSEMENT REIMBURSEMENT PROCEDURES Pages 1— 4 must also be followed 1) The employee will pay all costs. Within twenty (20) days after the completion of any course mortification program, the employee must submit the following to the employee's department head (elected or appointed official) for approval before submitting to the Human Resources Director: a) Reimbursement Request Form (obtained from the Human Resources Director); b) A copy of the Promissory Note/Employment Agreement (obtained from the Human Resources Director). Aseparate Promissory Note/Employment Agreement is required for each course or certification program -for which'' reimbursement is requested; c) A copy of the signed approval from the department head (elected or appointed official); d) Proof (official transcript) of a grade of A, B, C or P (Pass) for each course. Grades below C or P (Pass) will not be reimbursed; P e) Proof of payment (front and back of cancelled check, copy of other method of payment, etc.); f) Original detailed (itemized) invoice/statement from the college, university, business institute or trade school that lists], g any the detail (itemized) costs including fees See - Other Fees, page 3), that were paid for each course[or certification programand the - detailed (itemized) payments made bythe employee and/or other financial assistance sources. Other financial assistance received must be disclosed and listed; g) An explanation of how the completed course, courses or certification program is,, related to the employee's field of employment or the County's business needs; and h) A copy of the up to date detailed (itemized) record of tuition assistance that has been reimbursed to the employee (kept by the employee's department head (elected or appointed official)); The Human Resources Director will calculate the amount of reimbursement, create a purchase order, attach all of the required documentation received, and return to the employee's department to submit for approval to be reimbursed. Failure to submit required documentation by the published deadline dates will disqualify the employee for reimbursement for that approved period. 2) The County will reimburse an employee for tuition and out of county fees, if any, for each successfully completed class or certification' program if submission of all required documentation is met, with an annuall cap of $5,250 and a lifetime maximum amount of $10,500; Page 7 of 9 3) ;Reimburseme wiIf be paid only once for each approved course or certification prog ar rn The County will not grog as]for which eimbursemen� hasalready beenfrrecei ed;Y for courses 'or certification 4) Reimbursemehf will be provided if an employee achieves a grade of A, B, C or P (Pass). Original official grade slips and transcripts are the only acceptable documentanta n 5) No reimbursement to the employee will be made until the employee has furnished satisfactory evidence of having completed a course or certification program by the published deadline; 6) Employees requesting reimbursement will be agreeing to the terms based on the following schedule (time will run current): Amount Received Within a Calendar Year $1- $2,000 $2,001- $4,000 $4,000 - $5,250 Years of Service Required Repayment Liability After Completion of a Course for Early Termination 2 100% 4 100% 100% . r The employee must pay the County for all tuition assistancei reimbursed to the employee if the employee leaves the County prior to fulfilling the required years of service; and 7) The employee agrees that any repayment due to the County will be deducted from the employee's payroll check(s) and/or the County will seek other legal options the County may have up to and including termination. The employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County, the employee will pay the balance owed to the County by cash or money order immediately. The employee agrees to pay all of the County's attorney and legal fees if the County is forced to incur any such expenses to collect the amount due to the County. Page 8 of 9 EMPLOYEE ACKNOWLEDGEMENT have received a copy of the Calhoun County Qualified Educational Assistance Plan Tuiti' As Polio that outlines my obligations as a County employee. I understand that I am responsible for reading and familiarizing myself with the information, policies, �equirements and procedures of the plan. If I need clarification on any of the information in this plan. l will contact the Human Resources Director, This form must be included with the employee's completed Request Form for either Payment Upon Enrollment or Reimbursement. I have read and understand the Qualified Educational Assistance Plan, Tuition Assistance Policy, and I agree to abide by and adhere to these policiesFrequirements and procedures. s. Signature of Employee Printed Name of Employee Date Signed Signed acknowledgement must be on file in the Human Resources Department before any payment upon enrollment or reimbursement will be considered. A copy must also be attached to the Request Form when Payment upon Enrollment or Reimbursement is requested. Received by the Human Resources Director: Date Signature of the Human Resources Director Page 9 of 9 Calhoun County Educational Assistance Plan Reimbursement Request Form Calhoun County offers an Educational Assistance Plan to its full-time employees per the terms found in the Calhoun County Personnel Policies (Qualified Educational Assistance Plan, Tuition Assistance Policy). The employee who voluntarily and on their own time, pursues education courses or certification programs!, must notify and receive approval in writing from their department head (elected or appointed official) as well as approval from the Human Resources Director. Employee must submit, within twenty (20) days after the completion of any course or certification program, for which the employee seeks the Reimbursement option, all of the documentation that is required before Reimbursement will be considered. (See attached Qualified Educational Assistance Plan, Page 7, Option 2 — Reimbursement, Reimbursement Procedures). Approved Tuition and Out of County Fees, up to a maximum of $5,250 per year (January 1— December 31) will be reimbursed to the employee once all of the required documentation has been submitted and approved by the Human Resources Director, the employee's department head, the County Auditor and Commissioners Court. (Lifetime maximum amount of $10,500 per employee) I, (print name), request approval for the Educational Assistance Plan, Payment Upon Enrollment, forthe following course(s) 'or certfcation progr m; Name of College, University, Business Institute or Trade School: Course(s) or Certification Program,: Dates of Attendance: Beginning and ending Cost (per attached receipts): for NO, explain reason: :)u receivine financia or financial assistance? YES NO list each one and the amount of each one that you are other financial sources? _YES NOi Employee's Signature Date Dept. Head's Signature (Elected/Appointed Official) Date ------------------------------------------------------------------------------------------------------------------------------------------------ Reviewed and Approved by Calhoun County Human Resources Director HR Director's Signature Date Calhoun County Human Resources Educational Assistance Plan, Reimbursement Request Form - 2022 Calhoun County Educational Assistance Plan Payment Upon Enrollment Request Form Calhoun County offers an Educational Assistance Plan to its full-time employees per the terms found in the Calhoun County Personnel Policies (Qualified Educational Assistance Plan, Tuition Assistance Policy). The employee who voluntarily and on their own time, pursues education courses or certification programs! must notify and receive approval in writing from their department head (elected or appointed official) as well as approval from the Human Resources Director. Employee must submit, within twenty (20) days prior to the beginning date of any course or certification program;, for which the employee seeks the Payment Upon Enrollment option, all of the documentation that is required before Payment Upon Enrollment will be considered. (See attached Qualified Educational Assistance Plan, Page 5, Option 1- Payment Upon Enrollment, Payment Upon Enrollment Procedures). Approved Tuition and Out of County Fees, up to a maximum of $5,250 per year (January 1- December 31) will be paid directly to the college, university, business institute or trade school. Payment Upon Enrollment will not be paid until all of the required documentation has been submitted and approved by the Human Resources Director, the employee's department head, the County Auditor and Commissioners Court. (Lifetime maximum amount of $10,500 per employee) I, . (print name), request approval for the Educational Assistance Plan, Payment Upon Enrollment, for the following course(s) or certification program]: Name of College, University, Business Institute or Trade School: Courses)', Certification Program Dates of Attendance: Beginning _ Cost (per attached receipts): ending id you apply for Grants, Scholarships, or otherfinanaal assistance? YES _NOj f NO, explain reason A you receiving financial assistance through Grants, Scholarships or other financial sources? YES NOj - if yes, list each one and the amount of each one that you are receiving_ Employee's Signature Date Dept. Head's Signature (Elected/Appointed official) Date Reviewed and Approved by Calhoun County Human Resources Director HR Director's Signature Date Calhoun County Human Resources Educational Assistance Plan, Payment Upon Enrollment Request Form - 2022 CALHOUN COUNTY, TEXAS PROMISSORY NOTE For Tuition Assistance This Promissory Note (hereinafter called "Note") is Texas(hereinafter called "County"), having its principal Lavaca, Texas 77979 and having their principal address at: and is an employee in the County Department of: by and between the County of Calhoun, address at 202. South Ann St, Suite 301, Port (hereinafter called "Employee"), The Note, which consists of (1) This Note and (2) the County's Qualified Educational Assistance Plan, Tuition Assistance Policy, which shall become a condition of Employee's employment, is for tuition assistance, (Payment Upon Enrollment or Reimbursement) at a total amount of $ (Year Amount) for year ( Semester and Fiscal Year). Tuition assistance in the amount of $ approved by the County and paid on Employee's behalf to or reimbursed to Employee for tuition paid by Employee Name of College, University, Business Institute or Trade School at was for the following courses or certification program: Name of College, University, Business Institute or Trade School For value received, I, , of I , , and inconsideration $ tuition assistance received from the County in the form of payment upon enrollment or reimbursement, I agree agrees to remain a full-time employee in good standing with the County for years from the date of payment or reimbursement, guaranteeing employment thru In the event Employee does not does not fulfill their required employment years and does not abide by and adhere to the policies, requirements and procedures set forth in the County's Qualified Educational Assistance Plan, Tuition Assistance Policy, which is part of this Note, Employee agrees to repay the County 100% of the tuition assistance that was paid on behalf of Employee or reimbursed to Employee in the sum of $ in full immediately. As such, and for value received, I, on or before the expiration of days from the date of this note, promise to pay , or order, at (county auditor's office), the sum of spelled out dollar amount of note ($_ by the date of maturity or the date on which employee is no longer employed by the County, whichever occurs first. Employee agrees that any funds due to the County will be deducted from Employee's payroll check. Employee agrees that if sufficient funds are not available to satisfy any tuition assistance owed to the County and Employee fails to voluntarily reimburse the County immediately by cash or money order, the County will seek any legal remedies available at law. Page 1 of 3 e� In the event Employee defaults in the payment of any obligation due under this notes. then, at the option of the County and without notice, this note, together with the accrued interest and all other loan charges, shall become immediately due and payable. In the event the indebtedness evidenced by this note is collected by or through an attorney, the County shall be entitled to recover reasonable attorney fees to the extent permitted by applicable law. This note shall be governed by and construed in accordance with the laws of the State of Texas. In witness to this Note, the parties execute their acceptance of its terms and the terms set forth in the County's Qualified Educational Assistance Plan, Tuition Assistance Policy by affixing their signature below in the presence of a notary: Signature of Employee Printed Name of Employee and Last 4 digits of SSN Date Signature of Department Head Date Printed Name of Department Head SWORN TO AND SUBSCRIBED BEFORE ME by the above Employee, who, on oath, states that Employee agrees to the above statements and understands and agrees to abide by and adhere to the policies, requirements and procedures for the tuition assistance Employee received set forth in the Qualified Educational Plan, Tuition Assistance Policy, which is part of this Note. The foregoing instrument was acknowledged before me this day of 120 by Name of Employee Stamp / Seal Notary Public State of My Commission Expires Page 2 of 3 I Original must be attached to each request for Payment Upon Enrollment or Reimbursement and be on file in the office of the Human Resources. Received in the office of the Human Resources: Date Signature of the Human Resources Director Page 3 of 3 NOTICE OF MEETING — 5/25/2022 Consider and take necessary action to authorize Commissioner David Hall to sign a Victoria Electric Cooperative, Inc. Electrical Service Agreement for Chocolate Bayou Boat Ramp for new service. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 15 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax(361)553-8734 Please place the following item on the Commissioners' Court Agenda for May 25th, 2022. Consider and take necessary action to approve Commissioner David Hall to sign Victoria Electric Cooperative, INC. Electrical Service Agreement for Chocolate Bayou Boat Ramp for new service Sincer , Da E. Hall DEH/apt Angela Torres From: cclark@victoriaelectric.coop (Cindy Clark) <cclark@victoriaelectric.coop> Sent: Tuesday, May 17, 2022 3:33 PM To: ANGELA.TORRES@CALHOUNCOTX.ORG Subject: Chocolate Bayou Service Agreement, Acct 981270-025 Attachments: Ca ICo Pctl .pdf Follow Up Flag: Follow up Flag Status: Flagged 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. Please sign the second page at the bottom for the account for the new meter at Chocolate Bayou. The account number for this will be 981270-025. Per Mike, the service man who met with you, we had to create a different account due the location for the new meter being set up. You can send it back to me once signed. It is our understanding that there will also be another Yard Light set up at the pole near the meter there, for which there will be a different service order created/sent out on this account number. Thank you for your assistance in this. Best regards, Cindy CCark, NsR III Victoria Electric Cooperative 5502 US Hwy 59 N Victoria, TX 77905 (361) 573-2428, ext 2119 vicwria Eiecmcooper cative ._, ** ll7i(7Rdi'JiR7j 361.582.5550 "VEC Mission Statement To exceedour Member's expectations ofproviding safe, reCiable, affordabCe electricity andcontinue to improve the quality of Cfe of each. member through CoyaCempCoyees, with a focus on service and community. CONFIDENTIALITY NOTICE: This email transmission is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510 et seq., and the information contained in this message and documents accompanying same are legally privileged and confidential VICTORIA ELECTRIC COOPERATIVE, INC. ELECTRIC SERVICE AGREEMENT Member Name m/id Mailing Address: Member's Stems: �/ 4Lurcen ](nn�nu,U—YDOz='C)9✓GJy ( ) Corporation C ( ,0l lf\t5=•)do 1=A,J ( )Individual r�G'� J hY1� %• ( ) Partnership r7 `7197CI ) Other_ Account No. ggw.?m —03 5 Type of Service: Service Location: y C Member's Equipment: Frequency: 60 Cycle / Sec with Delivery Voltage: Reasonable variation ( ) Primary Volts ( )Single Phase ( )220/480 Volts ( ) Three Phase ( ) 120 / 240 Volts ( ) Other With reasonable variation Date Service Available Expiration Date Maximum Electrical Load The undersigned (hereinafter called the "Member'l hereby makes application and agrees to purchase electric service from VICTORIA ELECTRIC COOPERATIVE, INC. (hereinafter called "Cooperafive") upon the following terms and conditions: 1. Service Cooperative agrees to use reasonable diligence to provide electric utility service (including but not limited to the supply of electric energy) to Member's Service Location at a particular point where electric energy first leaves the line on equipment owned by Cooperative and enters Member's service entrance conductors. When electric energy becomes available Member will purchase all electric energy required to be used at the Service Location from the Cooperative and use such electric energy exclusively for the operation of Member's equipment. The Cooperative may limit the amount of electric energy to be furnished as indicated above and in the Service Rules and Regulations of the Cooperative. Member understands that the voltage and frequency of electric energy provided may vary within the standards set forth in the Cooperative's Service Rules and Regulations. Nothing contained herein shall prohibit Member from using electric energy generated by renewable energy sources (e.g.: solar) in Members wholly -generating facilities. 2. Payment, Member agrees to pay for electric service in accordance with Cooperative's standard tariff schedules in effect for like conditions of service to the class of service furnished hereunder. If any tariff or rate is changed by the Cooperative, or by order or consent of any regulatory authority having a jurisdiction thereof whether or not at the request of the Cooperative, such changed tariff, rate / or redefined class of service shall be applicable to service provided hereunder from and after the effective date of such change. Periodically, Cooperative will render to Member a statement of services rendered. Member agrees to pay the total amount shown on such statement within fifteen (15) days from its date. Payment shall be made to Cooperative at its office in Victoria, Texas. 3. Additional Terms. The electric service contracted for herein is to be provided and taken in accordance with the provisions of this agreement for electric service, and Cooperative's service rules, regulations and tariffs, including arty and all amendments that may hereafter be approved or ordered by any regulatory authority having jurisdiction. SAID SERVICE REGULATIONS AND TARIFFS ARE A PART OF THIS AGREEMENT TO THE SAME EXTENT AS IF FULLY SET OUT HEREIN AND ARE ON FILE AND AVAILABLE AT UTILITY'S OFFICES IN VICTORIA, TEXAS. 4. Easements and Rights of Access. Customer agrees to grant or to secure for Cooperative, at Member's expense, and rights of way on property owned or controlled by Member and to provide suitable space on such premises for installation of facilities where such rights of way and space are necessary to provide electric service to Member. Cooperative's representatives, employees, and assigns are hereby granted rights of ingress and egress of Customer's premises at all reasonable times for the purpose of inspection of facilities, providing service, and in order to carry out the provisions hereof. I oft VICTORIA ELECTRIC COOPERATIVE, INC. /Member Name and Mailing Address: Por_. Lg vg Account No. ELECTRIC SERVICE AGREEMENT Member's Status: ( ) Corporation ( ) Individual ( ) Partnership//� (xj Other 1»DV! Type of Service: Service Location: vr--Ce, oai- tM a yu,.to vozl, L Frequency: 60 Cycle / Sec Reasonable variation (Single Phase ( ) Three Phase Member's Equipment: Delivery Voltage: ( ) Primary Volts ( ) 2201480 Volts ( ) 120 / 240 Volts ( ) Other With reasonable variation Date Service Available Expiration Date Maximum Electrical Load The undersigned (hereinafter called the "Member") hereby makes application and agrees to purchase electric service from VICTORIA ELECTRIC COOPERATIVE, INC. (hereinafter called "Cooperative") upon the following terms and conditions: 1. Service. Cooperative agrees to use reasonable diligence to provide electric utility service (including but not limited to the supply of electric energy) to Member's Service Location at a particular point where electric energy first leaves the line on equipment owned by Cooperative and enters Member's service entrance conductors. When electric energy becomes available Member will purchase all electric energy required to be used at the Service Location from the Cooperative and use such electric energy exclusively for the operation of Member's equipment. The Cooperative may limit the amount of electric energy to be famished as indicated above and in the Service Rules and Regulations of the Cooperative. Member understands that the voltage and frequency of electric energy provided may vary within the standards set forth in the Cooperative's Service Rules and Regulations. Nothing contained herein shall prohibit Member from using electric energy generated by renewable energy sources (e.g.. solar) in Member's wholly -generating facilities. 2. Payment. Member agrees to pay for electric service in accordance with Cooperative's standard tariff schedules in effect for like conditions of service to the class of service furnished hereunder. If any tariff or rate is changed by the Cooperative, or by order or consent of any regulatory authority having a jurisdiction thereof whether or not at the request of the Cooperative, such changed tariff, rate / or redefined class of service shall be applicable to service provided hereunder from and after the effective date of such change. Periodically, Cooperative will render to Member a statement of services S. Continuity of Service. Cooperative shall use reasonable diligence to provide constant and uninterrupted electric power, however, if electric power of service should fail or be interrupted, or become defective, or be reduced through act of God, governmental authority, action of the elements, public enemy, accident, strikes, labor trouble, maintenance, repair or upgrading work, or any cause beyond the reasonable control of Cooperative, Cooperative shall not be liable under the provisions of this agreement. 6. Tem. The acceptance of this instrument by the Cooperative shall constitute an agreement between the Member and the Cooperative. The contract for electric service shall continue in force for an initial term of %,.nyears, from the date service is made available by the Cooperative to the Member. After the initial term, this agreement may be terminated by either parry giving notice. The initial monthly billing period shall start when Member begins using electric power and energy, or thirty (30) days after service described herein is made available to the Member, whichever is earlier. 7. Breech / Discontinuance of Service. Notwithstanding any other provisions of this agreement, Cooperative may discontinue service if Member has breached any portion of this agreement by failure to make timely payment or otherwise, and Cooperative has given Member notice in accordance with the Service Rules and Regulations of the Cooperative regarding Discontinuance of Service as they may be hereafter amended by order or consent of any Regulatory Authority havingjurisdiction. 8. Notice. All notices required to be given under the terms and provisions of this agreement may be given by mailing such notice to the other party by United States mail addressed to such other party as indicated above. The notice shall bear the date of its mailing, and shall be effective on and after such date. 9. Effective Date / Modification. Notwithstanding anything contained herein, this agreement shall not become effective and is not binding until executed by the Utility and Customer. No modification or alteration hereof shall be binding on either party unless reduced to writing and signed by the parties hereto. 10. Waiver. No waiver, expressed or implied, to any breach of any one or more of the covenants or agreements hereof shall be deemed to be a waiver of any subsequent breach. 11. Member's Installation. Member warrants that his or her installation at the Service Location (including all conductors, switches, equipment, wiring, and protective devices of any kind of character) is constructed in accordance with the National Electric Safety Code of the American Standards Association as well as applicable laws or ordinances, and that Member's installation will be maintained in such a manner as to conform to such standards. 12. Entire Agreement / Law Governing. This agreement constitutes the entire agreement between the parties and supersedes all prior agreements between Customer and Utility for the service herein described, and Utility, its agents and employees have made no representations, promises, or made any inducements, written or verbal, which are not contained herein. Customer agrees that it is not relying on any statements not herein obtained. This agreement shall be construed and governed in accordance with the'laws of the State of Texas. 13. Assignment. This agreement shall not be assigned by Customer except in accordance with the Articles, By-laws, and rules and regulations of Cooperative. This agreement shall inure to the benefit of Cooperative's assigns. 14. Meter Tampering. In the event utility reasonable determines that its meter or equipment has been tampered with or bypassed the Cooperative may disconnect service and / or estimate electric energy consumed. Member agrees to pay such statement or statements reflecting the highest estimated usage of electricity by Member for the longest period time such tampering or bypassing may have continued plus all labor, material and equipment necessary to repair or replace damaged facilities. 15. Minimum Monthly Charge. The minimum charge for each billing period (approximating 30 days) shall be (1) the demand charge or (2) $-7—A-D , whichever is greater.. 16. Contributions in Aid of Construction. Member shall make a contribution in aid of construction to Cooperative in the amount of VICTORIA ELECTRIC COOPERATIVE, INC. MEMBER Byt__! Vl .( 1%dlA n\ 52-ZC' By 5 -2 -2-2-- Manager oYluthorized Employee 5-1 Property 0 � pC - Date By Tenant Date This institution is an equal opportunity provider and employer. 2 of 2 5. Continuity of Service. Cooperative shall use reasonable diligence to provide constant and uninterrupted electric power, however, if electric power of service should fail or be interrupted, or become defective, or be reduced through act of God, governmental authority, action of the elements, public enemy, accident, strikes, labor trouble, maintenance, repair or upgrading work, or any cause beyond the reasonable control of Cooperative, Cooperative shall not be liable under the provisions of this agreement. 6. Term. The acceptance of this instrument by the Cooperative shall constitute an agreement tween the Member and the Cooperative. The contract for electric service shall continue in force for an initial term of i years, from the date service is made available by the Cooperative to the Member. After the initial term, this agreement may be terminated by either party giving notice. The initial monthly billing period shall start when Member begins using electric power and energy, or thirty (30) days after service described herein is made available to the Member, whichever is earlier. 7. Breach / Discontinuance of Service. Notwithstanding any other provisions of this agreement, Cooperative may discontinue service if Member has breached any portion of this agreement by failure to make timely payment or otherwise, and Cooperative has given Member notice in accordance with the Service Rules and Regulations of the Cooperative regarding Discontinuance of Service as they may be hereafter amended by order or consent of any Regulatory Authority having jurisdiction. 8. Notice. All notices required to be given under the terms and provisions of this agreement may be given by mailing such notice to the other party by United States mail addressed to such other party as indicated above. The notice shall bear the date of its mailing, and shall be effective on and after such date. 9. Effective Date / Modification. Notwithstanding anything contained herein, this agreement shall not become effective and is not binding until executed by the Utility and Customer. No modification or alteration hereof shall be binding on either party unless reduced to writing and signed by the parties hereto. 10. Waiver. No waiver, expressed or implied, to any breach of any one or more of the covenants or agreements hereof shall be deemed to be a waiver of any subsequent breach. 11. Member's Installation. Member warrants that his or her installation at the Service Location (including all conductors, switches, equipment, wiring, and protective devices of any kind of character) is constructed in accordance with the National Electric Safety Code of the American Standards Association as well as applicable laws or ordinances, and that Member's installation will be maintained in such a manner as to conform to such standards. 12. Entire Agreement / Law Governing. This agreement constitutes the entire agreement between the parties and supersedes all prior agreements between Customer and Utility for the service herein described, and Utility, its agents and employees have made no representations, promises, or made any inducements, written or verbal, which are not contained herein. Customer agrees that it is not retying on any statements not herein obtained. This agreement shall be construed and governed in accordance with the •laws of the State of Texas. 13. Assignment. This agreement shall not be assigned by Customer except in accordance with the Articles, By-laws, and rules and regulations of Cooperative. This agreement shall inure to the benefit of Cooperative's assigns. 14. Meter Tampering. In the event utility reasonable determines thafits meter or equipment has been tampered with or bypassed the Cooperative may disconnect service and / or estimate electric energy consumed. Member agrees to pay such statement or statements reflecting the highest estimated usage of electricity by Member for the longest period time such tampering or bypassing may have continued plus all labor, material and equipment necessary to repair or replace damaged facilities. 15. Minimum Monthly Charge. The minimum charge for each billing period (approximating 30 days) shall be (1) the demand charge or (2) $'T/,5 D whichever is greater.. 16. Contributions in Aid of Construction. Member shall make a contribution in aid of construction to Cooperative in the amount of $ -iS h VICTORIA ELECTRIC COOPERATIVE, INC. MEMBER NOTICE OF MEETING — 5/25/2022 8. Consider and take necessary action to accept a donation to Calhoun County Precinct 1 in the amount of $500.00 to be placed into line item 53992. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 15 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax (361)553-8734 Please place the following item on the Commissioners' Court Agenda for May 25th, 2022. • Consider and take necessary action to approve Commissioner David Hall to accept donation in the amount of $500.00 and to be placed into line item 53992 Sincer , D a 4E. Hall DEH/apt TERESA MALINEK PO BOX 32 PORT LAVACA, TX 77979 w ffi, dcr of 1317 882316/1131 9t CHECK AMMQN dollars la an«a F FmsrN Pno ALBANK N$ P.O. Drawer 7, Port Lavaca, Texas 77079 - .w/(wAwf bPodt fo'S wn„�o can. ssnmensuase #9 NOTICE OF MEETING — 5/25/2022 9. Public Hearing concerning a Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. Closed regular meeting at 10:48 am Terri Ruddick with Urban Engineering explained the petition to vacate and plans for the Serendipity Plat. Opened regular meeting at 10:50 Page 5 of 15 PUuI l( fiEAf;INI is?' /20) Richard lH[.1 ever County judge David Hall, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF PUBLIC HEARING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, May 25, 2022 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse, 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. 1. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Court will hold a Public Hearing in the Commissioners' Courtroom, 211 S. Ann Street, Suite 104, in Port Lavaca, Texas, on May 18, 2022 at 10:00 a.m. regarding a Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. This notice is in accordance with Section 111.007 and Section 111.0075 of the Texas Local Government code. MAY 2 0 2022 Richard H. Meyer, CountyQlikfge a Calhoun County, Texas BY: 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 1 of 1 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May 17, 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 May 25, 2022. • Public Hearing concerning Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. Sincerely, I 1 0 Q,, Gary D. Reese GDR/at P.O. Box 177 - Seadrift. Texas 77983 - email: aan-.reese(akalhouncotx ore - (361) 785-3141 - Fax (361) 785-5602 #10 NOTICE OF MEETING-5/25/2022 10. Consider and take necessary action on a Petition to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlets as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. (GDR) LT:APPROVED[UNANIMOUS] R: Gary Reese, Commissioner Pct 4 NDER: F Joel Behrens, Commissioner Pct 3 : Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 15 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May 17, 2022 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 M` W111k VI11 : 4YW9, Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for May 25, 2022. • Consider and take necessary action to Vacate a portion of Outlots 3 and 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas. Sincerely, Gary D. Reese \\\\\ GDR/at P.O. Box 177 — Seadrift. Texas 77983 — email: earv.reese%?cnlhouncoex.org — (361) 785-3141 — Fax (361) 785-5602 • • U81 Land Surveying+Aerial Imaging Sleca1991 PETITION TO VACATE A Portion of Outlots 3 & 4, Outblock 3 Port O'Connor Townsite Outlots THE STATE OF TEXAS} THE COUNTY OF CALHOUN) KNOW ALL MEN BY THESE PRESENTS: That the undersigned being the designated agent of the owners of the property described as a portion of Outlots 3 & 4, Outblock 3, Port O'Connor Townsite Outlots as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas do hereby petition the Calhoun County Commissioner's Court to Vacate said tract of land, in accordance with Sections 206 and 207 of the Subdivision Regulations and Recreational Vehicle Park Regulations Adopted by Calhoun County Commissioner's Court on November 29, 2004 and amended on December 13, 2007. The property is proposed to be re -platted in accordance with a plat submitted to the Calhoun County Commissioner's Court. The petition will be considered by the Calhoun County Commissioner's Court on May 25, 2022 at 10:00 am. 2004 N. Commerce Victoria, TX 77901 361-578-9837 S24981 Victoria San Antonio Cuero 2004 N. Commerce Victoria, TX 77901 12861 Silicon Drive San Antonio, TX 78249 104 E. French Street Cuero, TX 77954 urbansurveying,ccm 361-578-9837 210-267-8654 361-277-9081 Firm N: 10021100 Firm It: 10193843 Firm H: 10021101 ,),�,.r�ii i�If1?\��4�iii(liI ill `';11�; ,�yr. `��x�. +.f� � 7S'®�• ,t� �•: #11 NOTICE OF MEETING — 5/25/2022 11. Consider and take necessary action to approve the Final Plat of Serendipity Subdivision. (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 7 of 15 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May 17, 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 May 25, 2022. Consider and take necessary action to approve Final Plat of Serendipity Subdivision. Sincerely, Gary D. Reese \ GDR/at P.O. Box 177 — Seadrift. Texas 77983 —email: earv.reese ai calhouncoix.ore — (361) 785-3141 —Fax (361) 785-5602 ........ .. ....` 7-7' E �w TH_ urea survgnn9a Pea I amu .�,: Imo LECEno . V SURVEYORS CERTIFICPTE n wnrc rveirw� iry n r �an.wa wn ry dew s � e° FINAL PLAT SERENDIPITY SUBDIVISION oaf aE .E:. woEe A�oao: r... �o�.rv+fna Eo m sneEri va 1 CALHOUN COUNTY PPPRAISAL OIStRICT i`x��;unrl�wiS �1 rwc�l�,'I oa�ecnwn.a�urmmKwce PoaracoxxoR IMPROVEMENT DISTRICT (f COUNTY CLERKS' CERTIFICATE I (f FLOOOPNIN AOMINISTRANR lI OALHOUN OOUNTY E I I-1 ` ,ME_ UN OI6TRICT_ OWNER'S CERTIFICATE .66* Ei t xuc.l.. Po•,o�sis/ataz co7�ceui �uTDm Aa,iea[ataa o FINAL PLAT LF us'M,;aaE SERENDIPITY SUBDIVISION ) #12 NOTICE OF MEETING — 5/25/2022 12. Consider and take necessary action to have funds of $1,906.24 from the City of Seadrift be placed in Precinct 4 R & B account 570-53210. Funds were accepted by Commissioners' Court on May 18, 2022. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 15 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May 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 May 18, 2022. • Consider and take necessary action to have funds of $1,906.24 from City of Seadrift be placed in Precinct 4 R&B account 570-53210. Funds accepted by Commissioners' Court May 18, 2022. Sincerely, S� �J Gary D. Reese CDR/at P.O. Box 177 -Seadrift. Texas 77983 -email: �.reese i calhmmcoh.orei calhmmcolc.ore - (361) 785-3141 -Fax (361) 785-5602 #13 NOTICE OF MEETING-5/25/2022 13. Consider and take necessary action to accept and approve the agreement with Valley View Consultants, LLC and authorize the County Treasurer to sign. Said Agreement will remain in effect until June 30, 2024. (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 9 of 15 Mae Belle Cassel From: rhonda.kokena@calhouncotx.org (rhonda kokena) <rhonda.kokena@calhouncotx.org> Sent: Thursday, May 19, 2022 3:03 PM To: MaeBelle.Cassel@calhouncotx.org Subject: AGENDA 5.25.22 Attachments: IA Agreement 2022 04 27 Calhoun County.doc Importance: High Afternoon MaeBelle — Please put the attached Agreement renewal on next week's agenda with the following verbage: To Accept and Approved the agreement with Valley View Consultants, LLC and authorize the County Treasurer to sign. Said Agreement will remain in effect until June 30, 2024. Thank you so much. 2hovAcf S. ICo{zeo 61 Oal,houw Co TrenSurer 202 S..4ww street, .Suite A port LIWROG1, Texas 77_97J 361-553-462� Calhoun County Texas t AGREEMENT BY AND BETWEEN CALHOUN COUNTY, TEXAS AND VALLEY VIEW CONSULTING, L.L.C. It is understood and agreed that Calhoun County (the Investor) will have money available for investment (the Investable Funds) and Valley View Consulting, L.L.C. (the Advisor) has been requested to provide professional services to the Investor with respect to the Investable Funds. This agreement (the Agreement) constitutes the understanding of the parties with regard to the subject matter hereof. 1. This Agreement shall apply to any and all Investable Funds of the Investor from time to time during the period in which this Agreement shall be effective. 2. The Advisor agrees to provide its professional services to direct and coordinate all programs of investing as may be considered and authorized by the Investor. 3. The Advisor agrees to perform the following duties, when requested: a. Assist the Investor in developing cash flow projections, b. Suggest appropriate investment strategies to achieve the Investor's objectives, c. Advise the Investor on market conditions, general information and economic data, d. Analyze risk/return relationships between various investment alternatives, e. Attend occasional meetings as requested by the Investor, Assist in the selection, purchase, and sale of investments. The Advisor shall not have discretionary investment authority over the Investable Funds and the Investor shall make all decisions regarding purchase and sale of investments. All funds shall be invested consistent with the Texas Public Funds Investment Act, Chapter 2256 Government Code and the Investor's Investment Policy. The eligible investments are listed in the Investor's Investment Policy, g. Advise on the investment of bond funds as to provide the best possible rate of return to the Investor in a manner which is consistent with the proceedings of the Investor authorizing the investment of the bond funds or applicable federal rules and regulations, h. Assist the Investor in creating investment reports in compliance with State legislation and the Investor's Investment Policy, i. Assist the Investor in creating monthly portfolio accounting reports, and j. Assist the Investor in selecting a primary depository services financial institution. 4. The Investor agrees to: a. Compensate the Advisor for any and all services rendered and expenses incurred as set forth in Appendix A attached hereto, b. Provide the Advisor with the schedule of estimated cash flow requirements related to the Investable Funds, and will promptly notify the Advisor as to any changes in such estimated cash flow projections, c. Allow the Advisor to rely upon all information regarding schedules, investment policies and strategies, restrictions, or other information regarding the Investable Funds as provided to it by the Investor and that the Advisor shall have no responsibility to verify, through audit or investigation, the accuracy or completeness of such information, d. Recognize that there is no assurance that recommended investments will be available or that such will be able to be purchased or sold at the price recommended by the Advisor, and e. Not require the Advisor to place any order on behalf of the Investor that is inconsistent with any recommendation given by the Advisor or the policies and regulations pertaining to the Investor. 5. In providing the investment services in this Agreement, it is agreed that the Advisor shall have no liability or responsibility for any loss or penalty resulting from any investment made or not made in accordance with the provisions of this Agreement, except that the Advisor shall be liable for its own gross negligence or willful misconduct; nor shall the Advisor be responsible for any loss incurred by reason of any act or omission of any broker, selected with reasonable care by the Advisor and approved by the Investor, or of the Investor's custodian. Furthermore, the Advisor shall not be liable for any investment made which causes the interest on the Investor's obligations to become included in the gross income of the owners thereof. 6. The fee due to the Advisor in providing services pursuant to this Agreement shall be calculated in accordance with Appendix A attached hereto, and shall become due and payable as specified. Any and all expenses for which the Advisor is entitled to reimbursement in accordance with Appendix A attached hereto shall become due and payable at the end of each calendar quarter in which such expenses are incurred. 7. This Agreement shall remain in effect until June 30, 2024, with the option of the Investor to extend this Agreement in additional one and two-year increments. Provided, however, the Investor or Advisor may terminate this Agreement upon thirty (30) days written notice to the other party. In the event of such termination, it is understood and agreed that only the amounts due to the Advisor for services provided and expenses incurred to and including the date of termination will be due and payable. No penalty will be assessed for termination of this Agreement. In the event this Agreement is terminated, all investments and/or funds held by the Advisor shall be returned to the Investor as soon as practicable. In addition, the 2. parties hereto agree that upon termination of this Agreement the Advisor shall have no continuing obligation to the Investor regarding the investment of funds or performing any other services contemplated herein. 8. The Advisor reserves the right to offer and perform these and other services for various other clients. The Investor agrees that the Advisor may give advice and take action with respect to any of its other clients, which may differ from advice given to the Investor. The Investor agrees to coordinate with and avoid undue demands upon the Advisor to prevent conflicts with the performance of the Advisor towards its other clients. 9. The Advisor shall not assign this Agreement without the express written consent of the Investor. 10. The Advisor verifies it does not boycott Israel and commits it will not boycott Israel in the future. 11. This Agreement shall be interpreted under the laws of the State of Texas. Calhoun County will be the venue for any lawsuit arising out of this Agreement. 12. Notices to the Investor and the Advisor shall be sent to the addresses set forth below: Investor: Calhoun County Attn: Rhonda Kokena, Treasurer 202 South Ann Street, Annex If Suite A Port Lavaca, TX 77979 Phone 361.553.4619 Advisor: Valley View Consulting, L.L.C. Attn: Richard Long, Manager 2428 Carters Mill Road Huddleston, VA 24104 Phone 540.297.3419 13. By initialing the appropriate line, Investor acknowledges that: 1) Investor was provided a written copy of Form ADV Part 2 not less than 48 hours prior to entering into this written contract, or 2) Investor received a written copy of Form ADV Part 2 at the time of entering into this contract and has the right to terminate this contract without penalty within five business days after entering into this contract. 3) X Investor is renewing an expiring contract and has received in the past, and offered annually, a written copy of Form ADV Part 2. When accepted by the Investor, it, together with Appendix A attached hereto, will constitute the entire Agreement between the Investor and Advisor for the purposes and the consideration herein specified. 3. Respectfully submitted, l e Richard G. Long, Jr. Manager, Valley View Consulting, L.L.C. This agreement is hereby agreed to an ,O-i5x'ecuted oA behalf of CalhqutyCounty, County Date: 5--Z�IkoopC H EVOOLVII-XV1 FEE SCHEDULE AND EXPENSE ITEMS In consideration for the services rendered by Advisor in connection with the investment of the Investable Funds for the Investor, it is understood and agreed that said fee shall be prorated and due and payable at the end of each investment quarter. The annual fee will not exceed: Average Quarter End Book Value Annual Fee First $20 million 0.070% (7 basis points) Second $20 million 0.055% (5.5 basis points) Balances over $40 million 0.045% (4.5 basis points) Should the Investor issue debt and select a bond proceeds investment strategy that incorporates a flexible repurchase agreement or other structured investment, fees will be determined by any applicable I.R.S. guidelines and industry standards. Said fee includes all costs of services related to this Agreement, and all travel and business expenses related to attending regularly scheduled meetings. With pre -trip Investor approval, the Advisor may also request reimbursement for special meeting or event travel and business expenses. The obligation of the Advisor to pay expenses shall not include any costs incident to litigation, mandamus action, test case or other similar legal actions. Any other fees retained by the Advisor shall be disclosed to the Investor. 5. APPENDIX A FEE SCHEDULE AND EXPENSE ITEMS In consideration for the services rendered by Advisor in connection with the investment of the Investable Funds for the Investor, it is understood and agreed that said fee shall be prorated and due and payable at the end of each investment quarter. The annual fee will not exceed: Average Quarter End Book Value Annual Fee First $20 million 0.070% (7 basis points) Second $20 million 0.055% (5.5 basis points) Balances over $40 million 0.045% (4.5 basis points) Should the Investor issue debt and select a bond proceeds investment strategy that incorporates a flexible repurchase agreement or other structured investment, fees will be determined by any applicable I.R.S. guidelines and industry standards. Said fee includes all costs of services related to this Agreement, and all travel and business expenses related to attending regularly scheduled meetings. With pre -trip Investor approval, the Advisor may also request reimbursement for special meeting or event travel and business expenses. The obligation of the Advisor to pay expenses shall not include any costs incident to litigation, mandamus action, test case or other similar legal actions. Any other fees retained by the Advisor shall be disclosed to the Investor. a #14 NOTICE OF MEETING — 5/25/2022 14. Consider and take necessary action to authorize the indemnification of the previous Museum Director against personal liability for the loss of county funds in the amount of $171.77 during the period of January 1, 2015 to March 31, 2022. The loss was incurred by the previous officer in their performance of their official duties; however, the loss was not the result of the officer's negligence or criminal action per Local Government Code 157.903. (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 10 of 15 Mae Belle Cassel From: Erica.Perez@calhouncotx.org (Erica Perez) <Erica.Perez@calhouncotx.org> Sent: Tuesday, May 17, 2022 1:11 PM To: Mae Belle Cassel Cc: Vicki.Cox@calhouncotx.org Subject: Commissioner's Court Agenda Item -Museum Attachments: Museum Shortage Log.pdf Mae Belle, Please add the following agenda item for the next available Commissioner's Court: • Consider and take necessary action to authorize the indemnification of the previous Museum Director against personal liability for the loss of county funds in the amount of $171.77 during the period of January 01, 2015 to March 31, 2022. The loss was incurred by the previous officer in their performance of their official duties, however the loss was not the result of the officer's negligence or criminal action per Local Government Code 157.903. Best regards, Erica Perez Assistant Auditor Calhoun County Auditors Office 202 S. Ann, Suite B Port Lavaca, TX 77979 Phone: 361. 553.4463 Calhoun County Texas Museum Inuentory 5hortaee Description Quantity Price Total Price Proffessor Noggin Freshwater 1 $ 9.99 $ 9.99 Images of Calhoun County 2 $ 21.99 $ 43.98 Assorted Pins 1 $ 2.50 $ 2.50 First Polish Americans 1 $ 19.95 $ 19.95 Arrowhead 1 $ 0.45 $ 0.45 Postcards 4 $ 1.00 $ 4.00 In Search of La Salle (DVD) 1 $ 15.99 $ 15.99 Arrowheads 14 $ 0.45 $ 6.30 I Camp Indianola 1 $ 12.95 $ 12.95 Postcard 2 $ 1.00 $ 2.00 Images of Calhoun County 2 $ 21.99 $ 43.98 Erasers 2 $ 1.00 $ 2.00 Erasers 2 $ 0.35 $ 0.701 1 $ 3.00 $ 3.00 2 $ 1.99 $ 3.98 total shortage: $ 171.77 1 #15 i NOTICE OF MEETING — 5/25/2022 15. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (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 11 of 15 Calhoun County, Texas Surplus/Salvage Declaration Request Form Department Name: Memorial Medical Center Storage Units — County Auction - May 2022 Requested By: Roshanda Thomas, Interim CEO INV # DESCRIPTION SERIAL It REASON FOR SURPLUS/SALVAGE 1 Blue Phlebotomy Chair No Longer Used Framed Wall Art No Longer Used 1 Information Sign No Longer Used 1 Tan Mail Box Shelf No Longer Used 2 Gray Bulletin Boards No Longer Used 1 Wooden Bookcase I No Longer Used 1 Blue Fabric Office Chair No Longer Used YVAKye No Loh e4- S #16 NOTICE OF MEETING — 5/25/2022 16. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Waste. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 12 of 15 Calhoun County, Texas Waste Declaration Request Form Department Name: Memorial Medical Center Storage Units — May 2022 page 1 Requested By: Roshanda Thomas, Interim CEO -'-c (2Z INV # DESCRIPTION SERIAL # REASON FOR WASTE 2 Monitors Broken 1 VHS Player Broken 1 Incubator Broken 1 Slide Dryer Broken 1 Battery Back-up Broken 1 Desk Top Computer Broken 4 Printers Broken 1 Tan Fabric Chair Stained Multiple Privacy Curtains Stained 1 Black Office Chair Broken 1 Red Office Chair Stained 1 Tan / Black Office Chair Broken 1 Gray Desk Broken 1 Hospital Bed Broken / No Parts Available 1 Black Office Chair Broken 1 Shredder Broken 3 Gray Vital Monitors Broken 2 Anesthesia Machines No Longer Used/No Parts Avail 4 Blue Vital Monitors No Longer Used/No Parts Avail 1 Gray Monitor No Longer Used/No Parts Avail 1 Surgery Table No Longer Used/No Parts Avail 1 RAP-1 No Longer Used/No Parts Avail 4 Surgical Scopes No Longer Used/No Parts Avail 1 Blue Office Chair Broken #17 NOTICE OF MEETING — 5/25/2022 17. Accept Monthly Report from the following County Office: I. County Clerk — April 2022 ii. District Clerk — April 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 13 of 15 CALHOUN COUNTY CLERK MONTHLY REPORT RECAPITUATION APRIL 2022 OFFICIAL PUBLIC DESC GLCODE CIVIL/FAMILY .CRIMINAL RECORDS PROBATE .TOTAL. DISTRICT ATTORNEY FEES 1000-44020 $ 692.60 $ 692.60 BEER LICENSE 1000-42010 $ 5.00 $ 5.00 COUNTY CLERK FEES 1000-44030 $ 210.00 $ 1,385.20 $ 12,552.00 $ 432.00 $ 14,579.20 APPEALFROM JP COURTS 1000-44030 $ - $ - COUNTYCOURTATIAW#1JURY FEE 1000-44140 $ - JURY FEE 1000-44140 $ 40.00 $ - $ 40.00 ELECTRONIC FILING FEES FOR E-FILINGS 1000-44058 $ - $ - $ - $ - $ - JUDGE'SEDUCATIONFEE 1000-44160 $ - $ - $ - $ 30.00 $ 30.00 JUDGE'S ORDER/SIGNATURE 1000-49180 $ 10.00 $ - $ - IS 58.00 $ 68.00 SHERIFF'S FEES 1000-49190 $ 225.00 $ 966.58 $ - $ 175.00 $ 1,366.58 VISUAL RECORDER FEE 1OW-44250 $ 266.61 $ 266.61 TIME PAYMENTFEE. COUNTY•'NEW2020" 100044332 $ 365.38 $ 365.38 COURT REFPORTER FEE IOW-44270 $ 50.00 $ - $ - $ 150.00 $ 200.00 RESTITUTION DUE TO OTHERS LOW 49020 $ - ATTORNEY FEES -COURTAPPOINTED 1000-49030 $ - $ - APPELIATEFUND(TGC)FEE 2620-44030 $ 10.00 $ 30.00 $ 40.00 COURTFACILITYFEE FUND 2648-44030 $ 40.00 $ - $ - $ 120.00 $ 160.00 TECHNOLOGY FUND 2663-44030 $ 138.52 $ 138.52 COUNTYJURYFUND *'NEW2020" 2669-44030 $ 20.00 $ 34.63 $ $ 60.00 $ 114.63 COURTHOUSE SECURITY FEE 2670-44030 $ 40.00 $ 346.30 $ 550.00 $ 120.00 $ 1,056.30 COURT INITIATED GUARDIANSHI P FEE 2672-44030 $ 180.00 $ 180.00 COURT RECORD PRESERVATION FUND 2673-44030 $ - $ - $ - $ - COURTREPORTERSERVICE FUND "NEW 2020•• 267444030 $ 103.89 $ 103.89 RECORDS ARCHIVE FEE 2675-44030 $ 5,280.00 $ 5,280.00 COUNTYSPECIALTYCOURT •'NEW2020" 2676-44030 $ 69180 $ 692.60 COUNTYDISPUTERESOLUTION FUND 267744030 $ 30.00 $ - $ - $ 90.00 $ 120.00 DRUG&ALCOHOL COURT PROGRAM 2698-44030-005 $ - $ - ILIVEN ILECASE MANAGER FUND 2699-44033 $ - $ - FAMILY PROTECTION FUND 2706-44030 $ - $ - JUVENILE CRIME & DELINQUENCY FUND 2715-44030 $0.00 $ - LANGUAGEACCESSFUND 27254403D $ 6.00 $ - $ - $ 18.00 $ 24.00 PRE-TRIAL DIVERSION AGREEMENT 2729-44034 $ 100.00 $ 100.00 LAW LIBARY FEE 2731-44030 $ 70.00 $ 210.00 $ 280.00 RECORDS MANAGEMENT FEE -COUNTY CLERKK 2738-44380 $ - $ 5,300.00 $ 5.300.00 RECORDS MANG EVENT FEE - COUNTY 2739-44030 $ 80.00 $ 865.75 $ 90.00 $ 1,035.75 FINES - COUNTY COO RT 2740-45040 $ 12,748.42 $ 12,748.42 BOND FORFEITURE 2740-45050 $ - $ - STATE POLICE OFFICER FEES - STATE (DPS)(20%) 7020-20740 $ 4.78 $ 4.78 CONSOLIDATED COURT COSTS -COUNTY 7070-20610 $ - $ - CONSOLIDATED COURT COSTS- STATE 7070-20740 $ $ - CONSOLIDATED COURT COSTS -COUNTY •-NEW20207072-20610 $ 484.78 $ 464.76 CONSOLIDATED COURT COSTS -STATE •-NEW2020"'7072-20740 $ 4,182.85 $ 4,182.85 JUDICIAL AND COURT PER50NNELTRAINING-ST(100%7502-20740 $ - $ - $ - $ - DRUG& ALCOHOL COURT PROGRAM - COUNTY 7390-20610 $ - $ - DRUG &ALCOHOL COURT PROGRAM -STATE 7390-20740 $ - $ - STATEELECTRONICFILINGFEE -CIVIL 7403-22887 $ - $ - $ - $ - STATE ELECTRONIC FILING FEE CRIMINAL 7403-22990 $ - $ - EMS TRAUMA - COUNTY (10%) 7405-20610 $ 1,202.92 $ 1.20Z92 EMS TRAUMA - STATE (90%) 7405-20740 $ 133.66 $ 133.66 CIVIL INDIGENT FEE -COUNTY 7480-20610 $ - $ - $ - CIVILINDIGENTFEE -STATE 7480-20740 $ - $ - $ - JUDICIALFUNDCOURT COSTS 7495-20740 $ - $ - JUOICIALSALARY FUND -COO NTY(10%) 7505-20610 $ - $ - JUDICIALSALARY FUND- STATE )90%) 7505-20740 $ - $ - JUDICIAL SALARY FUND (CIVIL & PROBATE) -STATE 7505-20740-005 $ - $ - $ - TRAFFICLOCAL (ADMIN ISTRATIVE FEES) 7538-22884,1000-44359 $ 9.57 $ 9.57 -COURT COST APPEAL OF TRAFFI C REG UP APPEAL) 7538-22885 $ - BIRTH - STATE 7855-20780 $ 81.00 $ 81.00 INFORMAL MARRIAGES - STATE 7855-20782 $ - $ - JUDICIALFEE 7855-20786 $ - IS - $ - $ - FORMAL MARRIAGES- STATE 7855-20788 $ 120.00 $ 120.00 NONDISCLOSURE FEE -STATE 7855-20790 $ - $ - $ - $ - $ - TCLEOSECOURT COST - COUNTY )10%) 7856-20610 $ - $ - TCLEOSECOURT COST - STATE (90%) 7856-20740 $ - $ - JURYREIMBURSEMENT FEE -COUNTY (10% 7857-20610 $ - $ - JURY REIMBURSEMENT FEE -STATE (90%) 7857-20740 $ - $ - CONSOLIDATED CRT COSTS - STATE [PA FAM, CV) S9417859-20740 $ $ - $ STATE TRAFFIC FI NE - COO NTY IS%) 7860-20610 $ - $ - STATE TRAFFICFINE- STATE (95%) 7960-20740 $ - $ - STATE TRAFFIC FINE . COUNTY (4%) 91112019 7860.20610 $ 6.38 $ 6.38 STATE TRAFFIC FINE .5TATE(96%)91112019 7860.20740 $ 163.06 $ 153.05 1 OF 2 5118 022 CALHOUN COUNTY CLERK MONTHLY REPORT RECAPITUATION APRIL 2022 OFFICIAL PUBLIC DESC GLOODE. CML/FAMILY CRIMINAL 'RECORDS" .PROBATE :TOTAL INDIGENT DEFENSE FEE -CRIMINAL - COUNTY (10%) 7865-20610 $ - $ - INDIGENT DEFENSE FEE -CRIMINAL - STATE (90%) 7865-20740 $ - $ - TIME PAYMENT - COUNTY (50%) 7950-20610 $ - $ - TIME PAYMENT -STATE(50%) 7950-20740 $ - $ - BAIL JUMPING AND FAILURE TOAPPEAR -COUNTY 7970-20610 $ - BAIL JUMPING AND FAILURE TOAPPEAR -STATE 7970-20740 $ - DUE PORT LAVACAPD 9990-99991 $ 62.56 $ 62.56 DUE SEADRIFT PD 9990-99992 $ - $ - DUE TOPOINT COMFORT PID 9990-99993. $ $ - DUE TOTEXASPARKS & WILDLIFE . 9990-99994. $ -. $. DUE TO TEXAS PARKS& WILDLIFE WATER SAFETY 9990-99995 $ - DUETOTABC 9990-99996 $. - DUE TOATTORNEY ADLDEMS 9990-99997 $ - DUE TOOPERATING/NSF CHARGES/DUE TO OTHERS 7120-20759 $ $ $ 426.00) $ 500.00 $ 74.00 $ 831.00 $ 24,927.00 $ 23,462.00 $ 2,263.00 $ 51,483.00 TOTAL FUNDS COLLECTED $ 51,483.00 - FUNDS HELD INESCROW. $ - AMOUNT DUE TO TREASURER(20RB): $ 51,346:44 TOTAL RECEIPTS: $.'51,483.00 AMOUNT DUE TO OTHERS (LESS SFS): $ 136.56 REGISTRY_ DEPOSITS, CASH BONDS, AND CERTIFICATES OF OEPOSrr CASH ON HAND, REGISTRY OF COURT FUNDS IPROSPERITYI BEGINNING BOOK BALANCE _3/31/2M$ 78,425.62 FUND RECEIVED $ 1,000.00 -BALANCE OF CASH BONDS" $ 50,223.50 DISBURSEMENTS $ 9,406.00 ENDING BOOK BALANCE _4/30/2M $ 70,019.62 "OTHER REGISTRY ITEMS-' $ 13,196.12 **IBC CASH BOND CHECKS- $ 6,150.00 BANK RECONCILIATION REGISTRY OF COURT FUNDS ENDING BANK BALANCE 4/3C/2022 $ 84,439.62 -TOTAL REGISTRY FUNDS" $ 69,569.62 OUTSTANDING DEPOSITS" $ - OUTSTANDING CHECKS- $ '14,420.'0' Recoaclled: $ 450.00 RECONCILED BANK BALANCE 4/30/2022 $ 70,01162 "May Transaction" CERTIFICATES OF DEPOSITS HELD IN TRUST - PROSPERITY BANK 'CdS - Date Issued ,:Balance Punchasoal IfIffithdirawale Balance- - 31312022 Interest 04130122- 10440 1/24/2018 $ $ $ 10441 1/24/2018 $ 10.288.74 $ 1.27 $ 10,290.01 10442 1/24/2018 $ 1,276.51 $ 0.16 $ 1,276.67 10443 1/25/2018 $ 1,276.51 $ 0.16 $ 1,276.67 10444 1/25/2018 $ 9,639.83 $ 1.19 $ 9,641.02 10445 1/25/2018 $ 9,639.83 $ 1.19 $ 9,641.02 10446 1/25/2018 $ 9,639.83 $ 1.19 $ 9.641.02 10449 6/9/1955 $ 20,361.22 $ 20,361.22 10454 312/2018 $ 3,595.25 $ 3,595.25 10455 3/2/2018 $ 3.595.69 $ 3,595.69 10486 8/26/2020 $ 5,922.013 $ 5,922.00 10495 12/22/2021 $ 34,142.07 $ 34,142.07 10496 12/2212021 $ 34,142.06 $ 34,142.06 TOTALS: $ 143,519.54 $ 5.16 $ $ 143,524.70 �If— I/s"+// 5/19/2022 Submnted by: Anna M Goodman, County CICB Data 1 RicAard Meyer, Calhoun County Judge Data 2 OF REPORTS2022043022 TREASURER REPORTS 511 e2D22 *Treasurer Receipt Numbers: F2022APR004, 008,024,038 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 5/3/2022 ACCOUNT NUMBER COURT NAME: DISTRICT CLERK MONTH OF REPORT: APRIL YEAR OF REPORT: 2022 ACCOUNT NAME DEBIT CREDI' 1000-00144190 SHERIFF'S SERVICE FEES $1,311.07 1000-00144140 JURY FEES $250.00 1000-00144045 - RESTITUTION FEE $0.00 1000-00144020 DISTRICT ATTORNEY FEES $0.00 1000-00149010 REBATES -PREVIOUS EXPENSE $4.61 1000-00149030 REBATES-ATTORNEY'S FEES $1,946.20 1000-00144058 DISTRICT CLERK ELECTRONIC FILING FEES $0.00 1000-00144322 TIME PAYMENT REIMBURSEMENT FEES $142.88 1000-00143049 STATE REIMB- TITLE IV-D COURT COSTS $0.00 DISTRICT CLERK FEES CERTIFIED COPIES $224.00 CRIMINAL COURT $172.75 CIVIL COURT $1,953.92 STENOGRAPHER $551.11 CIV FEES DIFF $0.00 1000-00144050 DISTRICT CLERK FEES $2,901.78 1000-999-20771 FAMILY VIOLENCE FINE $0.00 1000-999-10010 CASH - AVAILABLE $6,556.54 2706-00144055 FAMILY PROTECTION FEE $0.00 2706-999-10010 CASH - AVAILABLE $0.00 2740-00145055 FINES - DISTRICT COURT $1,761.93 2740-999-10010 CASH - AVAILABLE $1,761.93 2620-00144055 APPELLATE JUDICIAL SYSTEM $110.37 2620-999-10010 CASH - AVAILABLE $110.37 2648-00144055 COURT FACILITY FEE FUND $440.00 2648-999-10010 CASH - AVAILABLE $440.00 2670-00144055 COURTHOUSE SECURITY $476.94 2670-999-10010 CASH - AVAILABLE $476.94 2673-00144055 CRT RECS PRESERVATION FUND- CO $680.74 2673-999-10010 CASH - AVAILABLE $680.74 2725-00144055 LANGUAGE ACCESS FUND $66.00 2725-999-10010 CASH - AVAILABLE $66.00 2739-00144055 RECORD MGMT/PRSV FUND - COUNTY $102.64 2739-999-10010 CASH - AVAILABLE $102.64 2737-00144055 RECORD MGMT/PRSV FUND -DIST CLRK $36.18 2737-999-10010 CASH - AVAILABLE $36.18 2731-00144055 LAW LIBRARY $772.59 2731-999-10010 CASH - AVAILABLE $772.59 2663-00144050 CO & DIST CRT TECHNOLOGY FUND $17.31 2663-999-10010 CASH - AVAILABL $17.31 7040-999-20740 BREATH ALCOHOL TESTING - STATE $0.00 7040-999-10010 CASH - AVAILABLE $0.00 2667-00144055 CO CHILD ABUSE PREVENTION FUND $0.71 2667-999-10010 CASH - AVAILABLE $0.71 7502-999-20740 JUDICIAL & COURT PERSONNEL TRAINING FUND -STATE $10.04 7502-999-10010 CASH-AVAILABE $10.04 7383-999-20610 DNA TESTING FEE - County $5.32 7383-999-20740 DNA TESTING FEE - STATE $47.89 7383-999-10010 CASH - AVAILABLE $53.21 7405-999-20610 EMS TRAUMA FUND - COUNTY $34.55 7405-999-20740 EMS TRAUMA FUND - STATE $310.97 7405-999-10010 CASH - AVAILABLE $345.52 7070-999-20610 CONSOL. COURT COSTS - COUNTY $57.70 7070-999-20740 CONSOL. COURT COSTS - STATE $519.31 7070-999-10010 CASH - AVAILABLE $577.01 7072-999-20610 STATE CONSOL. COURT COSTS- COUNTY $181.17 7072-999-20740 STATE CONSOL. COURT COSTS- STATE $1,630.51 7072-999-10010 CASH- AVAILABLE $1,811.68 2698-001-44030-010 DRUG CRT PROG FEE - COUNTY (PROGRAM) $94.22 2698-999-10010-010 CASH -AVAILABLE $94.22 7390-999-20610-999 DRUG COURT PROG FEE - COUNTY (SVC FEE) $18.84 7390-999-20740-999 DRUG COURT PROG FEE - STATE $75.37 7390-999-10010-999 CASH -AVAILABLE $94.21 7865-999-20610-999 CRIM - SUPP OF IND LEGAL SVCS - COUNTY $0.78 7865-999-20740-999 CRIM - SUPP OF IND LEGAL SVCS - STATE $7.06 7865-999-10010-999 CASH - AVAILABLE $7.84 7950-999-20610 TIME PAYMENT - COUNTY $38.81 7950-999-20740 TIME PAYMENT - STATE $38.81 7950-999-10010 CASH - AVAILABLE $77.62 7505-999-20610 JUDICIAL SUPPORT-CRIM - COUNTY $3.84 7505-999-20740 JUDICIAL SUPPORT -GRIM - STATE $21.75 7505-999-10010 CASH - AVAILABLE $25.59 7505-999-20740-010 JUDICIAL SALARIES -CIVIL - STATE(42) $87.11 7505-999-10010-010 CASH AVAILABLE $87.11 2740-001-45050 BOND FORFEITURES $0.00 2740-999-10010 CASH - AVAILABLE $0.00 2729-001-44034 PRE-TRIAL DIVERSION FUND $0.00 2729-999-10010 CASH - AVAILABLE $0.00 7857-999-20610 JURY REIMBURSEMENT FUND- COUNTY $1.77 7857-999-20740 JURY REIMBURSEMENT FUND- STATE $15.94 7857-999-10010 CASH - AVAILABLE $17.71 7860-999-20610 STATE TRAFFIC FINE- COUNTY $0.00 7860-999-20740 STATE TRAFFIC FINE- STATE $0.00 7860-999-10010 CASH - AVAILABLE $0.00 7403-999-22888 DIST CRT - ELECTRONIC FILING FEE - CIVIL $60.00 7403-999-22991 DIST CRT - ELECTRONIC FILING FEE - CRIMINAL $21.59 CASH - AVAILABLE $81.59 LOCAL CONSOL. COURT COST 1-44050 DISTRICT CLERK FEES $391.74 9-10010 CASH - AVAILABLE $391.74 144055 RECORD MGMT/PRSV FUND - COUNTY $244.84 9-10010 CASH - AVAILABLE $244.84 144050 COUNTY JURY FUND $9.79 9-10010 CASH - AVAILABLE $9.79 144055 COURTHOUSE SECURITY $97.94 9-10010 CASH - AVAILABLE $97.94 144050 CO & DIST CRT TECHNOLOGY FUND $39.17 9-10010 CASH - AVAILABLE $39.17 144050 COUNTY SPECIALTY COURT FUND $244.84 9-10010 CASH - AVAILABLE $244.84 7855-999-20784-010 DIST CRT - DIVORCE & FAMILY LAW - STATE $0.02 7855-999-20657-010 DIST CRT - DIVORCE & FAMILY LAW - COUNTY $0.00 7855-999-20792-010 DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - STATE $0.00 7855-999-20658-010 DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - COUNTY $0.00 7855-999-20740-010 DIST CRT - OTHER CIVIL PROCEEDINGS - STATE $66.50 7855-999-20610-010 DIST CRT - OTHER CIVIL PROCEEDINGS - COUNTY $3.50 7855-999-20790-010 DUE TO STATE - NONDISCLOSURE FEE $0.00 7855-999-10010-010 CASH - AVAILABLE $70.02 2677-999-20740-999 COUNTY DISPUTE RESOLUTION FUND $330.00 2677-999-10010-999 CASH - AVAILABLE $330.00 7858-999-20740-999 DIST CLK - DUE TO STATE CONSOLIDATED FEE 2022 $374.00 7858-999-10010-999 CASH AVAILABLE $374.00 TOTAL (Distrib Req to Oper Acct) $17,135.96 $16,107.64 DUE TO OTHERS (Distrib Req(s) attached) ATTORNEY GENERAL (RESTITUTION) 0.00 OUT -OF -COUNTY SERVICE FEES 925.00 REFUND OF OVERPAYMENTS 0.00 DUE TO OTHERS 0.00 TOTAL DUE TO OTHERS $925.00 REPORT TOTAL - ALL FUNDS 17,032.64 PLUS AMT OF RETURNED CKS 0.00 LESS: TOTAL TREASURER'S RECEIPTS (17,032.64) Revised 01/31/20 OVER / (SHORT) $0.00 DISTRICT COURT STATE COURT COSTS REPORT SECTION I: REPORT FOR OFFENSES COMMITTED 01/1/20 - Present 01/01/04 - 12/31/19 09101/99 - 08/31/01 09/01/97-08/31/99 09/01 /95 - 08/31 /97 09/01/91-08/31/95 COLLECTED '. $525.471tl. rill ids o. r 1,t4.- APRIL COUNTY 181.17 52.55 - 5.15 - APRIL 2022 STATE 1,630.51 472.92 - 46.39 - TOTALS 2388.69 238.87 1 2,149.82 BAIL BONDS FEES DNA TESTING FEES 53.21 5.32 47.89 EMS TRAUMA FUND 345.52 34.55 310.97 JUV. PROB. DIVERSION FEES JURY REIMBURSEMENT FEE $17.71 1.77 15.94 INDIGENT DEFENSE FUND $7.84 0.78 $7.06 STATE TRAFFIC FEES $0.00 - $0.00 DRUG CRT PROG FEE $188.43 $113.06 75.37 SECTION II: AS APPLICABLE STATE POLICE OFFICER FEES FAILURE TO APPEAR/PAY FEES - - JUD. FUND-CONST. CO. CRT. .. JUD. FUND -STATUTORY CO. CRT. MOTOR CARRIER WEIGHT VIOLATIONS TIME PAYMENT FEE $77.62 38.81 38.81 DRIVING RECORD FEE JUDICIAL SUPPORT FEES $25.59 3.84 21.75 ELECTRONIC FILING FEE -CR $21.59 $21.59 TOTAL STATE COURT COSTS $3,126.20 $ 437.01 $ 2,689.20 CIVIL FEES REPORT APRIL COLLECTED COUNTY STATE BIRTH CERTIFICATE FEES MARRIAGE LICENSE FEES DECL. OF INFORMAL MARRIAGE ELECTRONIC FILING FEE - CV $60.00 $60.00 NONDISCLOSURE FEES - '0 $0.00 $0.00 JUROR DONATIONS JUSTICE CRT. INDIG FILLING FEES STAT PROB CRT INDIG FILING FEES STAT PROS CRT JUDIC FILING FEES STAT CNTY CRT INDIG FILING FEES STAT CNTY CRT JUDIC FILING FEES STAT CNTY CRT -JUDICIAL SUPPORT CONST CNTY CRT INDIG FILING FEES CNST CNTY CRT JUDIC FILING FEES DIST CRT DIV & FAMILY LAW 0':. $0.02 - 0.02 DIST CRT OTHER THAN DIV/FAM LAW 0'. $0.00 - - DIST CRT OTHER CIVIL FILINGS T. $70.00 3.50 66.50 FAMILY PROTECTION FEE JUDICIAL SUPPORT FEE 3 $87.11 $87.11 JUDICIAL & COURT PERSONNEL TRANING FEF 5 $10.04 - $10.04 2022 STATE CONSOLIDATED FEE 4 $374.00 $374.00 COUNTY DISPUTE RESOLUTION FUND 330.00 330.00 TOTAL CIVIL FEES REPORT $ 931.17 $ 3.50 $ 927.67 TOTAL BOTH REPORTS $ 4,057.37 $ 440.51 $ 3,616.87 CALHOUN DISTRIBUTION COUNTY REQUEST 201 West Austin DR# 420 A 44685 PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: Anna Rabela Address: Title: District clerk City: State: Zip: Phone: ACCOUNT NUMBER DESCRIPTION AMOUNT 7340-999-20759.999 District Clerk Monthly Collections - Distribution $16,107.64 APRIL 2022 V# 967 TOTALI 16,107.64 of Official ( % Date #18 NOTICE OF MEETING — 5/25/2022 18. 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 14 of 15 :z :§ :CL :§ k k « § B} §/\ \C4 k - _ kZ a ■� ■ \� U) _ (§ § 16 0 J 0 0 K w J Z 0 � I W p W Z S a y V [n MM R f 10 7 Z i a W o 0 o c f»e, v3c iLr frWe i� ;d 'W o 0 o c O I f z z Nl 00 H Z Z Z e O rnw y , �5rnrn o z e2 v W Y J � w W p = a Q = Q O U) Z N OM W z 02 W JU W CW w O G Q ` O O O M c a v N 0 i w J F 0 z 0 0 U J w IFLIW O `m Z a a 2 €A 'zz :F 9z 3W e'L E� L EW :o 2 J uj Z 0 uj °z LL F z 0 a 6 N N o C m 6 000 N 16 O - OWiD N N N = N W N N w rn gg _km _ r 000 0 o00 0 -T. Z 6 N N = O !I E9 f9 f9 = `z fA cN N = ``O 0 _Z =r =Z -z W 000 0 =W lu _a =� e _ =W W W OW 0 0 0 =0 a W 0 0 Q 0 =G V W W W lq_ F = gh bbO F d m U =Z s - w = o > =t1 e o = s o w �x W a1 _-L KKW w - cai -W c�KUZ a _ W zzy2j W =V F zz2 v o z f =Q z e g W rn rn¢ z 0. L ¢ = y m� uj 'O a � z �I w =W w w w 5v 3 ' _� uj a z -? _mFL Q C7w =' W x m Z =11! p i s = F a W z Q w d =_Q Z 0> _-Z y w� =Z N J w z =Z W U =Z W a= =� a _5W wi =Z LLJ W �� _�' z N _ _� W =Q =Q i N ed z z n v =C z z T al � � = o a cc _ o a � § � : & w § % L6 : § � : @ � ; § � k .§ § 2 L t ; LLI a z § § mc @ 1- B B �§ �z BI § � ■2 \ B§ kk\ D ) § § ) ! ; @ 19 k § I ! � § § )o iz :z )§ (� :L :§ 2 2 J k � k 7 2 2 k eaa= § § ;o :z :z :§ .� :L a �we(/\\ kR�\ ■ § CL kk )o =z ■� =z )§ M )lL _ )§ 0 0 to W LL F W ,r p o o o o O» _ p m a Qw = a6a r r M N N a 0 0 W O fA 0 O 0 O = a c W a V. w o 0 C PS � moo o =n LN ait a r a _Z W o 0 W fA N3 0 !9 o M = C o 0 W f9 fA ldj+ =L C � J J F OO O W O Q _ 6 b V = ri z z V = I— F- W W = a o w z z z z W G = Z g Q m = W y e rn rn rern rn z =_ z W F 0 a a s = k W =LL K =LLLU W co =W / S M u) N aLU 23=a Z a � 0—O =Z 0 ww co w = N z w? _Z zw Do Ew OQ G _ O =dLu Z Z N DOM g z W z z z z e 0 a z O F m M W 0— cli W O N � YWY 4� w a N yxyZj e0002� W e �i i m B d N N 0 w 0 I O O r N» a O N =� 0> O `z �J = Z 0 w 0 as =W ♦Y L 5W : 01 : Of :0 :z w m a N C6 A 0 #19 NOTICE OF MEETING — 5/25/2022 19. Approval of bills and payroll. (RHM) INDIGENT RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese COUNTY RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese ADJOURNED AT 10:58 AM. Page 15 of 15 May 25, 2022 202E APPROVAL LIST - 2022 BUDGET COMMISSIONERS COURT MEETING OF 05/25/22 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 28 SPARKLIGHT LIBRARY INTERNET SERVICE BILLY LANGFORD VA TRAVEL REIMBURSMENT EMERGENCY MANAGEMENT CELL PHONE AT&T SERVICE MAY 2022 PAYROLL FOR MAY 27, 2022 TOTAL PAYROLL AMOUNT: CALHOUN COUNTY INDIGENT HEALTH CARE TOTAL IN VESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: $921,356.60 A/P $ 168.93 A/P $ 161.23 A/P $ 210.00 $ 921,896.76 P/R S 344,952.20 S 344,952.20 $ 12,053.81 S 12,053 81 TOTAL AMOUNT FOR APPROVAL: S 1,278,902.77 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LOST FOR ---Myl 252022 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDS TOTAL NURSING HOME UPL EXPENSES TOTAL INTER -GOVERNMENT TRANSFERS $ 867,460.01 $ 487,076.62 v $ 732,588.33 $ 2,486,414.63 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---Maw 252022 PAYABLES AND PAYROLL 5/19/2022 Weekly Payables 381,708.28 5123/2022 McKesson-340B Prescription Expense 11,17720 5/23/2022 Amedsource Bergen-340B Prescription Expense 606.34 5/23/2022 Payroll Liabilities -Payroll Taxes 116,044.22 5123/2022 Payroll 357,477.66 5/23/2022 Payroll Liabilities for supplemental payroll -Payroll Taxes 42.31 6/23/2022 Supplemental Payroll 199.25 Prosperity Electronic Bank Payments 5/16/2022 Credit Card & Lease Fees 240.16 5/16-5/20/22 Pay Plus -Patient Claims Processing Fee 84.69 TOTAL PAYABLES, PAYRfILL AND ELECTRONIC BANK PAYMENTS $ 867,400.01' TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 5119/2022 MMC Operating to Ashford -correction of insurance and QIPP payment 73,002.69 deposited Into MMC Operating 5/19/2022 MMC Operating to5olera-correction of NH QIPP payment deposited into 19,23123 MMC Operating 5/19/2022 MMC Operating to Fort bend -correction an NH Insurance and QIPP payment 30,028.57 deposited into MMC Operating 5/19/2022 MMC Operating to Broadmoor-correction of NH QIPP payment deposited into 20,174.57 MMC Operating 6/19/2022 MMC Operating to Crescent -correction of NH insurance and QIPP payment 46,677.74 deposited into MMC Operating in error 5/19/2022 MMC Operating to Golden Creek -correction of NH Insurance and QIPP 132,493.14 payment deposited Into MMC Operating in error 6/19/2022 MMC Operating to Gulf Pointe Plaza -correction of NH Insurance and QIPP 37,584.80 payment deposited into MMC Operating 5/19/2022 MMC Operating to Tuscany Village -correction of NH insurance and medicare 53,666.08 payment deposited into MMC Operating 5/19/2022 MMC Operating to Bethany -correction of NH insurance payment deposited 74,217.80 into MMC Operating In error TOTAL TRANSFERS BETWEEN FUNDS $ 487,016 62. NURSING HOME UPL EXPENSES 5123/2022 Nursing Home UPL-Cantex Transfer 413,171.43 5/23/2022 Nursing Home UPL-Nexion Transfer 101,798.88 5/23/2022 Nursing Home UPL-HMG Transfer 37,171.16 5123/2022 Nursing Home UPL-Tuscany Transfer 42,395.68 6/23/2022 Nursing Home UPL-HSL Transfer 138,051.18 TOTAL NURSING HOME UPL EXPENSES $ 732,580.33 INTER -GOVERNMENT TRANSFERS 6123/2022 IGTQIPP Year 6 to be paid June 03, 2022 2,485,414.63 TOTALINTER-GOVERNMENT TRANSFERS111 2,4$5;41483 GRAND TOTAL DISBURSEMENTS APPROVED May 26, 2022 $ 4,672,639.59 Page 1 of 17 RECEIVED BYTHE COUNTY AUDITOR ON reffal912% 202Z MEMORIAL MEDICAL CENTER 1321 AP Open Invoice List CALHOUN COUNTY, TEXAS Due Dates Through: 06/09/2022 Vendor# Vendor Name Class Pay Code 10995 ABILITY NETWORK (SHIFTHOUND) ✓ Invoice# Camplent Tran of Inv of Due of Check D Pay Gross 22M0067473 / 05/12/20 05/09/20 06/08/20 647.28 SCHEDULING SERV Vendor Totals Number Name Gross 10995 ABILITY NETWORK (SHIFTHOUND) 64728 Vendor# Vendor Name Class Pay Code 10950 ACUTE CARE INC,% Invoice# Comment Tran Dt Inv of Due DI Check D Pay Gross INV730 f 05/18/20 05/20120 06101/20 1,400.00 RFID FEE Vendor Totals Number Name 10950 ACUTE CARE INC 0 ap_open_invoice.tempiate Discount No -Pay Net 0.00 0.00 647.28 ✓ Discount No -Pay Net 0.00 0.00 647.28 Discount No -Pay Net 0.00 0.00 1 A00.00 ` Grass Discount No -Pay Net 1,400.00 0.00 0.00 1.400.00 Vendor# Vendor Name Class Pay Code /f A1679 AIR SPECIALTY & EQUIPMENT CO v' M Invoice# Comment Tran of Inv of Due of Check D Pay Gross Discount No -Pay Net 504711 f� 05111120 05/09/20 06108/20 3,191.52 0.00 0.00 3,191.52 SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net A1679 AIR SPECIALTY & EQUIPMENT CO 3,191.52 0.00 0.00 3,191.52 Vendor# Vendor Name Class Pay Code A1680 AIRGAS USA, LLC- CENTRAL DIV d� M Invoice# Co meet Tran Or Inv Of Due Of Check D Pay Gross Discount No -Pay Net 9988221061 ✓� 05/17/20 04/30/20 05/25/20 523.46 0.00 0.00 523.46 OXYGEN 9988221062/ 05M 7120 04/30/20 05/25/20 126.13 0.00 0.00 126.13"'' OXYGEN 9988222386 �/� 05/17/20 04/30/20 05/25/20 875.55 0.00 0.00 875.55 RENTAL 9125437993 f` 05/17120 05/03/20 05128/20 322.08 0.00 0.00 322.08 J` OXYGEN Vendor Totals Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC -CENTRAL DIV 1,847.22 0.00 0.00 1,847.22 Vendor# Vendor Name Class Pay Code 1 A1705 ALIMED INC. VF M Invoice# Comment Tran of Inv of Due of Check D Pay Gross Discount No -Pay Net RPSVO8807623 f 05/18/20 05/04/20 05/19/20 913.53 0.00 0.00 913.53 ✓I SUPPLIES Vendor Totals Number Name Grass Discount No -Pay Net A1705 ALIMED INC. 913.53 0.00 0.00 913.53 Vendor# Vendor Name Class Pay Code 14028 AMAZON CAPITAL SERVICES ✓ Invoice# Comment Tran of Inv of Due of Check D Pay Gross Discount No -Pay. Net 13VO4H9W3H7V 1�J 05111/2005/0512006/04/20 91.94 0.00 0.00 91.94 1,Ir yg (U,�PPL,IES 116D67C93N2r( 05/16/20 03/30/20 04/29/20 29.14 0.00 0.00 29,14 SUPPLIES file:///C:/Users/ltrevino/cpsi/memmed.cpsinet-com/u88125/data_5/tmp_cw5report536549... 5/ 19/2022 Page 2 of 17 Vendor Totals Number Name Gross Discount Na-Pay Net 14028 AMAZON CAPITAL SERVICES 121.08 0.00 0.00 121.08 Vendor# Vendor Name Class Pay Code A1553 APPLIED CARDIAC SYSTEMS tZ M Invoice# Comment Tran Of Inv Ot Due Dt Check DPay Gross Discount No -Pay Net 04092209 / 05118/20 05/11120 05/20/20 7,650,00 0.00 0.00 7,650.00 SERV CONTRACT/3 YR EXTEP 41/' Vendor Totals Number Name Gross Discount No -Pay Net. A1553 APPLIED CARDIAC SYSTEMS 7.650.00 0.00 0.00 7.650.00 Vendor# Vendor Name Class Pay Code A2218 AQUA BEVERAGE COMPANY v:' M Involca# Comment Tran Dt Inv Ot Due Dt Check DPay Gross Discount No -Pay Net 19267 �% 05/19/20 03/10120 04/04/20 43.00 0.00 0.00 43.00 qu WATER L✓ 16FA63 05119/20 03/31/20 04/25/20 10.00 0.00 0.00 10.00 ' � LATE FEE V 197499 ✓ 05/1 W20 04/07/20 OS/02/20 45.96 0.00 0.00 45.96 WATER 201845 05119/20. 04/30/20 05/25/20 10.00 0.00 0.00 10.00 WATER Vendor Totals Number Name Gross Discount No -Pay Net A2218 AQUA BEVERAGE COMPANY 108.96 0.00 0.00 108.96 Vendor# Vendor Name Class Pay Code 12800 AUTHORITYRX t/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D'Pay Gross Discount No -Pay Net 1333 v/ 05118/20 03102/20 03/03/20 8,222.00 0.00 0.00 8,222.00 ✓ ADVACED CLAIMS CAPTURE Vendor Totals Number Name Gross Discount No -Pay Net 12800 AUTHORITYRX 8,222,00 0.00 0.00 8,222.00 Vendor# Vendor Name Class Pay Code. 61150 BAXTER HEALTHCARE ✓ W invDlce# mment Tran Dt Inv Dt Due Dt 1 Check D Pay Gross Discount No -Pay Net 74768056 05/18/20 04/18/20 05/13/20 507.47 0.00 0.00 507.47 SUPPLIES 74840607,.% 05/18/20 04/26/20 05120/20 20.96 0.00 0.00 20.96 SUPPLIES v% 74882437 ✓ 05/18/20 04/28/20 05/23/20 55.45 0.00 0.00 55.45 UPPLIES 74875082 05/18/20 04/28/20 06/23/20 507.47 0.00 0.00 507.47"/ SUPPLIES 74988405 05/18/20 05/04/20 05/29/20 647,78 0.00 0,00 647.78 1,/ SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net B1150 BAXTER HEALTHCARE 1,739.13 0.00 0.00 1,739.13 Vendor# Vendor Name Class Pay Code 11544 BAY STORAGE V Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 20210258 / 05/17/20. 05/06/20 05/25/20 2,070.00 0.00 0.00 2,070.00 6 MTHS UNIT 175, 180, 191 _ Vendor Totals Number Name Gross Discount No -Pay Net 11544 BAY STORAGE 2,070.00 0.00 0.00 2,070.00 file:///C:lUsers/]trevino/cpsi/memmed.cpsinet.com/u88125/data_5hmp_cw5repart536549... 5/ 19/2022 Page 3 of 17 Ventlor# Vendor Name Class Pay Code M2485 BAYER HEALTHCARE ✓,, M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 6UD9611394 �% 05/18/200412912005118120 1,198,28 0.00 0.00 1,196.28 SUPPLIES Vendor Total$ Number Name Gross Discount No -Pay Net M2485 BAYER HEALTHCARE 1,196,25 0.00 0.00 1,196.28 Vendor# Vendor Name Class Pay Code B1220 BECKMAN COULTER INC M Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 109875442 ✓ 05/17/20 05/09/20 06/03/20 259.27 0.00 0.00 259.27 SUPPLIES L/ 109880203 �f 05/17/20 05/10/20 06/04120 1,599.82 0.00 0.00 1,599.82 ✓ SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net B1220 BECKMAN COULTER INC 1,859.09 0.00 0.00 1,859.09 Vendor# Vendor Name Class Pay Code C1325 CARDINAL HEALTH 414, INC. f W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 80026311996 ,` 05/17/20 04/23/20 05/28/20 276.17 OAO 0.00 276,17v-' SUPPLIES Vendor Totals Number Name Gross Discount NO -Pay Net 01325 CARDINAL HEALTH 414, INC. 276.17 0,00 0.00 276.17 Vendor# Vendor Name Class Pay Code 14260 CAREFUSION SOLUTIONS, LLC / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 10018801374 05/18/20 05/09/20 06/01/20 2.00 0.00 0,00 2.00 WIFI IT 10018801366 05/1 W20 05/09/20 06/01/20 1,788.00 0,00 0.00 1,788.00 V� PYXIS EQUIPMENT Vendor TotalENumber Name Gross Discount No -Pay Net 14260 CAREFUSION SOLUTIONS, LLC 1,790.00 0.00 0.00 1,790.00 Vendor#Vendor Name Class Pay Code C1390 CENTRAL DRUG ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross Discount No -Pay Net 022122 05/19/20 OPJ21/2003/23/20 19.40 0.00 0.00 19.40 INVENTORY 032122 05/19/20 03/21/20 04/20/20 24.25 0.00 0.00 24.25 INVENTORY Vendor TotalENumber Name Gross Discount. No -Pay Net 01390 CENTRAL DRUG 43.65 O.OD 0.00 43.65 Vendor# Vendor Name Class Pay Cade 13284 CERVEY, LLC •/ Invoice# Comment Tran Dt Inv Ot Due of Check D Pay Gross Discount No -Pay Net 16100 ✓/ 05/11/20 05110/20 06/04/20 1,699.00 0.00 0.00 1,699.00 : MONTHLY INVOICE LZ Vendor Totals Number Name Gross Discount No -Pay Net 13264 CERVEY, LLC 1,699.00 0.00 0.00 1,699.00 Vendor# Vendor Name Class Pay Code 10786 CLINICAL PATHOLOGY Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net file://iC:/Users/ltrevino/cpsi/memmed.cpsinet,coral1a88125/data_5/tmp_cw5report536549,., 5/19/2022 Page 4 of 17 2022040 05/17/20 04/30/20 05/25/20 18,349.20 0.00 0.00 18,349.20 PATHOLOGY SERV Vendor Totals Number Name Gross Discount No -Pay Net 10786 CLINICAL. PATHOLOGY 18,349.20 0.00 0.00 18,349.20 Vendor# Vendor Name Class Pay Cade 13260 CLSI LOCKBOX ✓J Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 715093 '''r 05/17/20 02/17/20 03tl7/20 198.00 4 0.00 0.00 198.00 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 13260 CLSI LOCKBOX 128.00 0.00 0.00 198.00 Vendor# Vendor Name Class Pay Code C1166 COASTAL OFFICE SOLUTONS ✓ - Vtt Invoice# Comment Tran Dt Inv Ot Due Ot Check D Pay Gross Discount No -Pay Net OEQT202281 �/� 05/17/20 05/06/20 05/16/20 83.26 0.00 0.00 83.26 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net C1166 COASTAL OFFICE SOLUTONS 83.26 0.00 0.00 83.26 Vendor# Vendor Name Class Pay Code C2157 COOPER SURGICAL INC f.. M Invoice# Comment Tran Dt Inv or Due Ot / Check D Pay Gross Discount No -Pay Net 6223108 05/18/20 04/30/20 05/18/2o 956.67 0.00 0.00 956.67 SUPPLIES 6224124 ✓ 05/18/2005/02J2005/18/20 323.00 0,00 0.00 323.00 v/ SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net C2157 COOPER SURGICAL INC 1,279.67 0.00 0.00 1,279.67 Vendor# Vendor Name Class Pay Code 14080 CORROHEALTH, INC. : '" Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 755289 / 05/17/2005/05/2006/04/20 1,679,15 0.00 0.00 1,879.15 HIM SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 14080 CORROHEALTH, INC. 1.879.15 0.00 0.00 1,879.15 Vendor# Vendor Name / Class Pay Code C2297 COVER ONE ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 20202 05/1712010/28/2011/28/20 319.00 0.00 0:00 319.00 Vendor Totals Number Name Gross Discount C2297 COVER ONE 319,00 0.00 Vendor# Vendor Name f 14400 CULINARY CONCESSIONS LLC Class Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount INV00005639 / 05/17/20 04/30120 05/30120 28,005.33 0.00 Vendor Totals Number Name Gross Discount 14400 CULINARY CONCESSIONS LLC 28,005.33 0.00 Vendor# Vendor Name Class Pay Code C1443 CYGNUS MEDICAL LLC M v" Invoice# Comment Trap Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 0.00 319.00 No -Pay Net 0.00 28,005.33 No -Pay Net 0.00 28,005,33 No -Pay Net file:///C:/Users/itrevino/cpsi/memmed,Qpsinet.com/u88125/data 5/trnp ew5reDort536549... 5/19/2022 Page 5 of 17 / 376560 " 05118/20 05/03/20 06/02/20 419.00 0.00 0.00 419,00 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net C1443 CYGNUS MEDICAL LLC 419,00 0.00 0.00 419,00 Vendor# Vendor Name Class Pay Code 11368 CYRACOM LLC f Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount. No -Pay Net 2022015923 ✓ 06/16/20 04/30/20 05/30/90 238.95 0.00 0.00 238.95 INTERPRETATION SERVICES Vendor Totals Number Name Grass Discount No -Pay Net 11368 CYRACOM LLC 238.95 0.00 0.00 238.95 Vendor# Vendor Name Class Pay Code 14292 DEARBORN LIFE INSURANCE COMPAN r,% Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 051322 05/18/20 05/13/20 06/01 /20 3,426.45 0.00 0.00 3,426.45 PAYROLLDEDUCTS Vendor Totals Number Name Gross Discount No -Pay Net 14292 DEARBORN LIFE INSURANCE COMPAN 3,426,45 0.00 0.00 3,426.45 Vendor# Vendor Name Class Pay Code 10388 DEWITT POTH & SON ✓� Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 6805900 ✓'' 05/17/20 05/03/20 05/28/20 229.42 GAD 0.00 229.42 ✓� / SUPPLIES 6808360 ✓ 05/17/20 05/03/20 05128/20. 151.64 0100 0.00 151.84 SUPPLIES 600EI040 f 05/17/20 05/03/20 05/25/20 338.18 0.00 0,00 338.1 a ✓ SUPPLIES 68089501,/� 05/17/20 05/04/20 05129120 144,36 0100 0.00 144.36 SUPPLIES 6808330 ✓f 05/17/20 05/04/20 05/29/20 130.85 0.00 0.00 130.85 SUPPLIES 6811260 ✓ 05/17/20 05/05/20 06/30/20 42.74 0.00 0.00 42,74 SUPPLIES 6811250 06/17/20 05/05/20 05/30/20 11.83 0.00 0.00 11.83 4.-- SUPPLIES 6802721 ✓'" 05/17/20 05/09/20 06/03/20 62.96 0.00 0.00 62,96 v' SUPPLIES 6811930 ✓ 05/17/2005/0912006/03/20 377.88 0.00 0.00 377,88 ✓ SUPPLIES 6811970 y/� 05/18/20 05/06/20 05/31/20 37.00 0.00 0.00 37.00 SUPPLIES 6802531 �/ 05/18/20 05/12/20 06/06/20 15,04 0.00 0.00 15.04 ✓ SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SON 1,542,10 0.00 0.00 1,542.10 Vendor# Vendor Name Class Pay Code 11291 DOWELL PEST CONTROL Of Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9408 1/ 05/17/20 05/09/20 06/03/20 40.00 0.00 0.00 40.00 t,/t / TREATMENT 9257 ✓ 05/19/20 05/02/20 05/27/20 40.00 0.00 0.00 40.00 file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/tt88125/data 5/tmp_cw5report536549... 5/19/2022 Page 6 of 17 PEST CONTROL 9500 ✓ 05/19/20 05/13/20 06/01/20 75.00 0.00 0.00 75.00 ✓" PEST CONTROL 9522 r// 05/19/20 05/14/20 06/01/20 505.00 0.00 0.00 505.00 PESTCONTROL Vendor Total£ Number Name Gross Discount No -Pay Net 11291 DOWELL PEST CONTROL 660.00 0.00 0.00 660.00 Vendor# Vendor Name i Class Pay Code 11284 EMERGENCY STAFFING SOLUTIONS ✓ Invoice N / Comment Tram Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 41187 ✓ 05/18/20 04/30/20 05/10/20 6,820.00 0,00 0.00 5,820.00 y% r ER PHYSICIAN STAFFING 41204 . 05118/2005115/2005/25/20. 40,062.50 0.00 0.00 40,062.90 r% ER PHYSICIAN STAFFING ( 1-15-%i Vendor Total: Number Name Gross Discount No -Pay Net 11284 EMERGENCY STAFFING SOLUTIONS 46,882.50 0.00 0.00 45,882.50 Vendor# Vendor Name. 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Discount No -Pay Net 042922 05/18/20 04/29/20 05/29/20 3,700.00 0.00 0100 3,700.00 DIETICIAN SERVICES LO - 4 IM IV 9) 4,!' _ Vendor Totals Number Name Gross Discount No -Pay Net 12380 HEALTH SOLUTIONS DIETETICS 3,700.00 0.00 0.00 3,700.00 Vendor# Vendor Name Class Pay Code 10922 HUNTER PHARMACY SERVICES �/� Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross Discount No -Pay Net 4900 05118/2004/3012005/20/20 14,630.40 0,00 0.00 14.630.40 f PHARM SRVS-ADOLPH Vendor Totals Number Name Gross Discount No -Pay Net 10922 HUNTER PHARMACY SERVICES 14.630.40 oxil 0.00 14,63OA0 Vendor# Vendor Name Class Pay Code 14256 INFICARE HEALTH, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net file:/(/C:/Users/ttrevino/cpsi/memmed,cpsinet.com/u88125/data 5/tmp_cw5report536549... 5/19/2022 Page 8 of 17 MMCO217 05/18/2002/1712003/04120 2,232.00 0,00 0.00 2.232.00 ✓� TRAVEL NURSE STAFFING N7.1,10ruj- Vendor Totals Number Name Gross Discount No -Pay Net 14256 INFICARE HEALTH, INC. 2,232.00 0,00 0.00 2,232.00 Vendor# Vendor Name Class Pay Code 13900 IRONSIDE HUMAN RESOURCES Vj Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 3431 t,// 05/17/2005/09/2006/01/20 3,500.00 0.00 0.00 3,500.00 ANNUAL SUBSCRIPT SEARCI- VendorTotel<Number Name Gross Discount No -Pay Not 13900 IRONSIDE HUMAN RESOURCES 3,500.00 0.00 0.00 3,500.00 Vendor# Vendor Name Class Pay code 11264 ITA RESOURCES, INC VJ Invoice# Comment Tran DI Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net MMC052022 y/� 05/18/20 05/16/20 05/25/20 27.636.89 0.00 0.00 27.636.69 �..' 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V NIP Invoice# omment Tran Dt Inv Dt Due Dt Check D Pay Gross ; 30352276 05/17/20 04/01/20 04/21/20 16.17 rINDIGENT 30367595 J 05/17/20 04/15/20 05/05/20 43,71 INDIGENT Vendor Totals Number Name Gross 10813 MEDIMPACT HEALTHCARE SYS, INC. 59.88 Vendor# Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC f M Invoice# Comment Tran Dl Inv Dt. Due DI Check D Pay Gross / 2208283622 ✓ 05109NO 04/22/20 05/17/20 33.65 SUPPLIES / 2208546927 ✓ 05/09/20 04/26/20 05/21120 86.60 SUPPLIES 2208854610 0.00 Discount No -Pay 0,00 0.00 Discount No -Pay 0.00 0.00 Discount No -Pay 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 05/09/20 04/27/20 05/22/20 4.76 0.00 SUPPLIES 2208717394 �� 05109/2004127/2005/22/20 1,072.50 0.00 SUPPLIES 2208854611 ✓ 05/09/20 04/27/20 0512PJ20 11896.59 0.00 SUPPLIES 2209109252 �% 05/09/2004MI2005/23/20 169.06 0.00 SUPPLIES 2209299187 V 05/09/20 04/29/20 05/24/20 88.41 0.00 SUPPLIES 2209656925 1/` 05/09/20 05/03/20 05/28/20 77.43 0.00 SUPPLIES 2209656926 / 05/09/20 05/03/20 05/28/20 119.78 0.00 SUPPLIES 2209750912 / 05/09/20 05/04/20 05/29/20 38.19 0.00 SUPPLIES 2209750914 / D5/09/20 05/04/20 05/29/20 1,278.36 0.00 SUPPLIES 2209750919 j 05/09/20. 05/04/20 05/29/20 287.27 0.00 SUPPLIES 2209819603 j 05/09/20 05/04/20 06/29/20 33.41 0.00 SUPPLIES 2209750916 V' 05/09/20 05/04/20 05/29/20 123.00 0.00 SUPPLIES 2209750918 f 05/00/20 05/04/20 05/29/20 44.59 0.00 SUPPLIES 2209750917 Z 05/09/20 05/04/20 05/29/20 177.63 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,522,00 Net 889,47 r,/ Net 889.47 Net 15:17 f 43.71 Net 59.88 Net 33.65 ,/ 86.60 f 4.75 1,072.50t, 1,896.59 169.06 88.41 Lf 77.43 �+ 119.78 38.19 r/ 1,278.36 f 287.27 f' $3,41 y/ 123.00 44.50 / v 177.63 file:///C:1Users/ltrevino/cpsilmemmed.epsinet.com/u88125/data_5/tmp_cw5rei)ort536549... 5/19/2022 Page 11 of 17 SUPPLIES 2209626963 / 05/17/20 05/03/20 OW28120 6.37 0.00 0.00 6.37 SUPPLIES 2209863534 / 0511712005/04/2005/29/2o -35.49 0.00 0,00 -35.49�r� CREDIT 1981080387 , 2209819604 V 05/17/20 05/04/20 05/29/20 2.174.92 0.00 0.00 2,174.92y'' SUPPLIES - 2208631943 ✓ 05/1812004126/2005/21/20 212.95 0.00 0Z 212.95 SUPPLIES 2208717396 t/ 05/18/20 04/27/20 05/22/20 -824,75 0.00 0.00 -824.75 CREDIT 2207809246 2206996954 w/ 05118/20 04/28/20 05/23/20. 221.54 0.00 0.00 221.54 f" SUPPLIES 2200421758 -' 05/18/20 04/30/20 05/25/20 40.84 0.00 0.00 40.84 SUPPLIES SUPPLIES , 2209495098 05/18/20 05/02/20 05/27/20 1,003.15 0.00 0.00 1,003.15 V!'/ SU PLIES 2209495099 05/18/20 05/02/20 05/27/20 82.23 0.00 0.00 82.23 SUPPLIES 2209656922 J 05/18/20 05/03/20 05/28/20 13.08 0.00 0.00 13.08 „^ SUPPLIES 2209656928 ✓� 05/18/20 05/03/20 06/28/20 490.80 0.00 0100 490.80 ✓r SUPPLIES 2209916775 „r� 05/18/20 05/04/20 05/29/20 65.37 0,00 0.00 65.37 SUPPLIES 2209958507 v� 05/18/20 05/05/20 05/30/20 361.17 0100 0100 361.17 SUPPLIES 2209958508 7 05/18/20 05/05/20 05/30/20 686.57 0.00 0.00 686.57 SUPPLIES Vendor Total -Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 10,029,97 0.00 0100 10,029.97 Vendor# Vendor Name Class Pay Code 10904 MERCK SHARP & DOHME CORP Vr' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No.Pay Net 7016084670 L// 05/18/20 04/18/20 05118/20 830.61 0.00 0.00 830.61 INVENTORY 7016109104 / 05/18/20. 05/03/2006/01/20 4,753.30 0.00 0.00 4,753.30 INVENTORY . Vendor Total: Number Name Grass Discount No -Pay Net 10904 MERCK SHARP & DOHME CORP 5,583,01 0.00 0.00 51583.91 Vendor4 Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC ✓ InvoiceiF Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 8193304 ✓ 05/19/20 05/10/20 05/20/20 35.58 0.00 0.00 35.50 ✓ INVENTORY 2203r% 05119/20 06/10120 05120/20 -148.03 0.00 0.00 -148.03 ✓ CREDIT 8193302 J 05/19/20 05/10/20 05/20/20 9.69 0.00 0.00 9.59 ✓- )INVENTORY 8193303 05/19/20 05/10/20 05/20/20 202.16 0.00 0.00 202.16 INVENTORY file:///C:/Userslltrevinolcpsilmemmed.cpsinct.com/u88125/data_5/tmp_cw5report536549... 5/19/2022 Page 12 of 17 8193305 ✓ 05/19/20 05/10/20 05/20/20 786.21 0.00 0.00 786.21 „✓ / INVENTORY , 8197659 v% 05/19/20 05/11/20 05/21/20 45.12 0.00 0.00 45.12 /INVENTORY 8198958 ,/ 05/19120 05/11/20 06/21120 385.47 0.00 DAO 385,47 INVENTORY 8195616 ✓/ 05/19/20 05/11/20 05/21/20 188.20 0.00 0.00 188.20 ✓' INVENTORY 6194916✓ 05/19/20. 05/1112005/21/20 3,997.18 0.00 0.00 3,997.18 .% INVENTORY / 8197660 ✓ 05/19/20 05/11/20 05/21/20 460.88 0.00 0.00 460.88 v� INVENTORY / 8197351 ✓ 05/19/20 05/11/20 05/21/20 27.44 0.00 0.00 27.44 ✓� JNVENTORY I CM38888✓/ 05/19l2005/12(2005/22I20 -5:32 0.00 0.00 -5.32 ✓ CREDIT CM39247 ,/� 05119/20 0&13/20 05/23/20 -906.87 0.00 0.00 -906.87 ✓r ,CREDIT CM39246 05119/2005/1312005/23/20. -5.06 0.00 0,00 -5.05 CREDIT 8207961 ✓ 05/19/20 05/16/20 05/25/20 2,026.60 0.00 0,00 2,026.50 /.INVENTORY 8200904 ✓ . 05/19/20 05/15/20 05/25/20 1,154.85 0.00 0.00 1,154.85 ✓ INVENTORY 8209903 ✓ 05/10/20 05/15/20 05/25/20 380.63 0.00 0.00 380.63 INVENTORY 8207962 ✓ 05/19/20 05/16/20 05/25/20 609.91 0.00 0.00 609.91 INVENTORY 8214205 ✓ 05/19/20 05/16/20 05/26/20 294.03 0.00 0.00 / 294.03 ✓ INVENTORY 8211322 05/19/20 05/16/20 05/26/20 8.330,41 0.00 0.00 8,330.41 ✓/ INVENTORY 8214204v/ 05/19/20 05/16/20 05/26/20. 241.25 0.00 0.00 241.25 ✓ /INVENTORY 8211319A/ 05/1912005/16/2005/26/20 3,615.86 0.00 0100 3,615.86 INVENTORY 8211320 ✓ 05/19/20 05/16/20 05/26/20 127.05 0.00 0100 127.05 ✓ INVENTORY 8211321 ✓ 05/19/20 05/16/20 05/26/20 684,60 0.00 0.00 684.60 ./ INVENTORY 8219908 ✓� 05/19/20 05/17/20 05/27/20 0.97 0.00 0.00 0.97 ✓z INVENTORY 8216406,/ 05/19/20 05/17/20 05/27/20 749.92 0.00 0.00 749.92 ✓" INVENTORY 8216405 ✓ 05/19/20 05/17/20 05/27/20 140.89 0.00 0.00 140.89 INVENTORY 8219030 ✓ 05/19/20 05/17/20 05/27/20 95.73 0.00 0.00 95.73 �✓ INVENTORY CM39769 ✓ 05119/20. 05117/2005/27/20 -138 0.00 0.00 -1.38 V✓ -CREDIT 8218230 ✓/` 05/19/20 05/17/20 05/27/20 808,81 0.00 0.00 808.81 file:/!/C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report536549... 5/ 19/2022 Page 13 of 17 INVENTORY 8219909 f' 05/19/20 05/17/20 05/27/20 330.88 0.00 0.00 330.88 V INVENTORY 8218806 05/19/20 05/17/20 05/27/20 349.76 0.00 0.00 349.76 INVENTORY v/ 8218392 , / 05/19/20 05/17/20 05/27/20 97.75 0.00 0.00 97.75 INVENTORY ✓ Vendor Totah Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 25,110.97 0.00 0.00 25,110.97 Vendor# Vendor Name Class Pay Code M2659 MXR IMAGING, INC .�` M Invoice# C/omment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 8800895091 d 05118/20 04/29/20 05/29/20 146.84 0,00 0.00 /46.84 ,% SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net M2659 MXR IMAGING, INC 146.84 0.00 0.00 146.84 Vendor# Vendor Name Class Pay Code 13624 NEXION HEALTH AT NAVASOTA INC 1! Invoice# Comment Tran DI Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net TELME d - q 0 gQ 4tj0;, 05/17/20 05/04/20 05/25/20 11000.00 0.00 0.00 1,000.00 TELEMED REIMBURSEMENT Vendor Total: Number Name Gross Discount No -Pay Net 13624 NEXION HEALTH AT NAVASOTA INC 1,000.00 0.00 0.00 1,000.00 Vendor# Vendor Name Class Pay Code 11472 OCCUPRO LLC r/ Invoice# Comment Tran Dt Inv DI Due Dt Check DL Pay Gross Discount No -Pay Net 26003 / 05/12/20 05/07/20 06/06120 487.47 0.00 0.00 487.47,X LICENSE Vendor Total; Number Name Gross Discount No -Pay Net 11472 OCCUPRO LLC 487.47 0.00 0.00 487,47 Vendor# Vendor Name ; Class Pay Code 01500 OLYMPUS AMERICA INC ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 32612475 ✓/ 05/18/20 05/05/20 05/30/20 194.03 0.00 0.00 194.03 r f SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net 01500 OLYMPUS AMERICA INC 194.03 0.00 0.00 194.03 Vendor# Vendor Name Class Pay Code 10372 PRECISION DYNAMICS CORP (PDC) ✓f Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross 9349950232 Discount No -Pay Net �/ 05/18/20 04129/20 05/29/20 168.10 0.00 0.00 168.10 L/ SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net 10372 PRECISION DYNAMICS CORP (PDC) 188.10 0.00 0.00 168.10 Vendor# Vendor Name Class Pay Code / 12480 PRO ENERGY PARTNERS LP ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross / Discount No -Pay Net 22040600 r 05/19/20 04/30/20 05/15/20 5,331.87 0.00 0.00 f 5,331.87 NATURAL GAS APR 22 ij Vendor Totals Number Name Gross Discount No -Pay Not 12480 PRO ENERGY PARTNERS LP 5,331.87 0.00 0.00 5.331.87 file;///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report536549... 5/19/2022 Page 14 of 17 Vendor# Vendor Name Class Pay Cade 1089E OIAGEN INC Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 998304090 05/18/20 05/05/20 06/04/20 359.28 0.00 0.00 359.28 u% SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10896 OIAGEN INC 359.28 0.00 0.00 359,28 Vendor# Vendor Name Class Pay Code 11080 RAOSOURCE v1/ Invoice# Comment Tran Dt Inv Dt Due Ot Check D-Pay Gross Discount No -Pay Net SC32090622 / 05117/2005tl 2/2006/01/20 1.791,67 0.00 0.00 1,791.07 SERVICE CONTRACT , Vendor Totals Number Name Gross Discount No -Pay Net 11080 RADSOURCE 1,791.67 0.00 0.00 1,791.67 Vendor# Vendor Name `/Class Pay Code G0425 ROBERTS, ODEFEY, WITTE & WALL ✓ W Invoice# Comment Tran Dt Inv DI Due Ot Check D pay Grass Discount No -Pay Net 043022 05/18/2005/16/2005/26/20 17,110.5D 0.00 0.00 17,110.50 a/ LEGAL SERV 9/21 -4/22 Vendor Totals Number Name Gross Discount No -Pay Net 00425 ROBERTS, ODEFEY, WITTE & WALL 17,110.50 0.00 0.00 17,110.50 Vendor# Vendor Name Class Pay Code 10936 SIEMENS FINANCIAL SERVICES ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Or Pay Gross Discount No -Pay Net 56382200035164 ✓ 05117/2004/29/2005/19/20 1,333.33 0.00 0.00 1,333.33 yr-' LEASE Vendor Totals Number Name Gross Discount No -Pay Net 10936 SIEMENS FINANCIAL SERVICES 1,33S,33 0.00 0.00 1,333.33 Vendor# Vendor Name Class Pay Code 32362 SMITH & NEPHEW ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D'Pay Gross Discount No -Pay Net 943529344 ✓ 05/18/20 05/10/20 05/18/20 601.40 0.00 0,00 601,40 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 52362 SMITH & NEPHEW 601.40 0.00 0.00 601.40 Vendor#Vendor Name Class Pay Code 52345 SOUTHEAST TEXAS HEALTH SYS IN Invoice# Comment Tran Dt Inv DI Due Ot Check D Pay Gross Discount No -Pay Net 26637 05/18/20 04/01/20 05/01/20 5.000.00 0.00 0.00 5.000.00 y� OTRLY DUES APR-JUN 22 Vendor Totals Number Name Gross Discount No -Pay Net 52345 SOUTHEAST TEXAS HEALTH SYS 5,000.00 0.00 0.00 5,000.00 Vendor# Vendor Name Class Pay Code S$940 STERIS CORPORATION ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net f 10062878 „/' 05/17/20 05/04/20 05/29/20 247.05 0.00 0.00 247.05 SUPPLIES 10061831 ✓/05/17/20 05/04/20 05/29/20 153.10 0.00 0.00 153.10 SUPPLIES 100615157 vf 05/17/20 05/05/20 05/30/20 526.03 0.00 0,00 526.03 „✓ SUPPLIES file:///C:/Users/Itrevino/epsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report536549... 5/19/2022 Page 15 of 17 Vendor Totals Number Name Gross Discount No -Pay Net S3940 STERIS CORPORATION 926.18 0.00 0.00 926.18 Vendor# Vendor Name Class Pay Code 10735 STRYKER SUSTAINASILITY r// Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 4432846 r% 05/18/20 05/12/20 06/01/20 389.88 0.00 0.00 389.88 ✓' SUPPLIES 4383908 ✓/ 05/19/20 03/04/20 04/03/20 -11.00 0.00 0.00 -11.00 j CREDIT y 4385775 ✓ 05/19/20 03/08/20 04/07/20 -22.00 0.00 0.00 -22.00 f CREDIT Vendor Totals Number Name Gross Discount No -Pay Net 10735 STRYKER SUSTAINABILITY 356.88 0.00 0.00 356.86 Vendor# Vendor Name Class Pay Code 11944 TALX CORPORATION ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2051752239 ✓ 05/17/20 03/08/20 04/07/20 10.99 0.00 0.00 10.99 4�,s EMPLOYEE VERIF 2051884697 t j 05/17/20 04/08/20 05/08/20 1.0.99 0.00 0.00 10.99 EMPLOYEE VERIF 2052374518 05/17/20 05/W20 06/07/20 10.99 0.00 0.00 10.99 EMPLOYEE VERIF Vendor Totals Number Name Gross Discount No -Pay Net 11944 TALX CORPORATION 32.97 0.00 0.00 32.97 Vendor# Vendor Name Class Pay Code T2204 TEXAS MUTUAL INSURANCE CO W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1003668932 ,/ 05/18/20 05/05/20 05/25/20 6,440.00 0.00 0.00 6,440.00 WRK COMP INS Vendor Totals Number Name Gross Discount No -Pay Net ' T2204 TEXAS MUTUAL INSURANCE CO 6,440.00 0.00 0.00 6,440.00 Vendor# Vendor Name Class Pay Code 14224 THE TACT CORPORATION OF NYC v/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9266703770 v 05/1812003/04/2,,r004/03/20 6,226.00 0.00 0.00 6,228.00 TRAVEL NURSE STAFFING 1414-SJ14I14, UJI. 9266704886 �% 05/18120 05/06/20 06/05/20 6.228.00 0.00 0.00 6,228.00 .� TRAVEL NURSE STAFFING 41,77- 9266704887 �/ 05/1 W20 05/06/20 06/03/20 6,228.00 0.00 0.00 6,228.00 TRAVEL NURSE STAFFING 9266705099 05/18/20 05113/20 06/01/20 6,228.00 0.00 0.00 6,228.00 TRAVEL NURSE STAFFING Vendor Totals Number Name Gross Discount No -Pay Net 14224 THE TACT CORPORATION OF NYC 24,912.00 0.00 0.00 24,912.00 Vendor# Vendor Name Class Pay Code 11908 TMS SOUTH Invoice# omment Tran Dt Inv Dt Doe Dt Check D, Pay Gross Discount No -Pay Net INV46954/1 05/17120 05/04/20 06/03120 111.26 0.00 0.00 111.26 ✓ SUPPLIES INV47077 ✓/0511712005/05/2006/04/20 76.50 0.00 O.OD / 76.50 ,t SUPPLIES file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u8 8125/data_5/tmp_cw5report536549... 5/19/2022 Page 16 of 17 Vendor Totals Number Name Gross Discount No -Pay Net 11908 TMS SOUTH 187.76 0.00 0.00 187.76 Vendor# Vendor Name Class Pay Code 14208 TRUSTED HEALTH, INC / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net INV9497 / 05/18/20 04116120 05/16120 5,657.50 0.00 0.00 5,667.50 TRAVEL NURSE STAFFING 01 S I " �l'iIsI21-,�AJgUeg INV9851 V,/ 05/18/20 04/30/20 05/30/20 618.75 0,00 0.00 5,618.76 TRAVEL NURSE STAFFING iglaa-41a�11 yry) 1�d�/147 INV9972 L,/ 05118/20 05/07120 06106/20 5,618.75 0.00 0.00 5,618.75 TRAVEL AVEL NURSE STAFFING 151111) yQ120 INV10003 ,IS/�U TRAVEL NURSE STAFFING (y I � , I I2U� ylA-Y425 1i-1 0.00 0.00 5,54125 Vendor Totals Number Name Gross Discount No -Pay Net 14208 TRUSTED HEALTH, INC 22,430,25. 0,00 0.00 22.436.25 Vendor#Vendor Name Class Pay Code 11001 ULINE Invoice# Comment Tran Dt Inv of Due Dt Check D Pay Gross Discount No -Pay Net 148171242 ✓ 05/17/20 04/26/20 05/26/20 25.60 0.00 0.00 25.50 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11001 ULINE 25.50 0,00 0.00 25.50 Vendor# Vendor Name Class Pay Code U1064 UNIFIRST HOLDINGS INC Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Not 8400394052 f 05/17/20 05/05/20 05/30/20 175.96 0.00 0.00 176.96 LAUNDRY 8400394619 ..f� 05117/2005/1 W2008/01120 118,79 0.00 0,00 118.79 ,.` LAUNDRY 8400394583 r / 05/17/20 05/12/20 06/01/20 205.33 0.00 0.00 205.33 ✓/ LAUNDRY 8400394579 05/17/20 05/12/20 06/01/20 ,/ 42.82 0.00 0.00 / LAUNDRY 8400394596 ✓ 05/17/20 05/12/20 06/01/20 86.72 0.00 0.00 66,72 1% LAUNDRY 8400994582� 05/17/2005/12/2006/01/20 194:81 0.00 0.00 184.81 LAUNDRY 84003946D4 ✓/05/17/20 05/12/20 06/01/20 1,672.50 0.00 0.00 1,67250 f LAUNDRY . 8400394581 ✓f 05/17/20 05/12/20 06/01/20 200.02 0.00 0.00 200.02 ` LAUNDRY 8400394580 ✓ 05/17/20 05/12/20 06/01/20 201.59 0.00 0.00 201.59 LAUNDRY 8400394785 ,f 05/17/20. 05/1612006/01/20 48.15 0.00 0,00 48.15 VX LAUNDRY 8400394810 1/ 05/17/20 05/16/20 06/01/20 2,122.95 0.00 0.00 2.122.95 LAUNDRY 8400394786 V/� 05/17120 05116120 06101120 69,82 0.00 0100 59.82 V,r' LAUNDRY Vendor Total: Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 5,129.40 0.00 0.00 5,129.46 file:///C:/Users/ltrevinolcpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report536549.,. 5/ 19/2022 Page 17 of 17 Vendor# Vendor Name Class Pay Code U1200 UNITED AD LABEL CO INC ✓ M Invoice# Co ment Tran Dt Inv Ot Due Dt Check D,Pay Gross 472799056 ✓ 05/17/20 04/20/20 05115/20 90.22 SUPPLIES 510814690 f 05/17/20 05/04/20 05/29/20 169.56 - SUPPLIES Vendor Totals Number Name Gross U1200 UNITED AD LABEL CO INC 259.78 Vendor# Vendor Name Class Pay Code 12208 WAGEWORKS I/ Invoice# Comment Tran Dt .Inv Dt Due Ot Check D Pay Grass 0422DR46779 05/19/20114130120 05/15/20 155.52 C BRA INV3774592 ✓ 05/19/20. 05/16/2006/01120 496.25 MONTHLY COMPLIANCE FEE Vendor Totals Number Name Gross 12208 WAGEWORKS 651,77 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC V/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 9111155968 ✓ 05/17/20 05/09/20 06/03/20 434,50 SUPPLIES Vendor Totals Number Name Gross 11110 WERFEN USA LLC 434,50 Vendor# Vendor Name Class Pay Code 10556 WOUND CARESPECIALISTS / Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross WSC00004904A 05/19/20 12JO1120 12130/20 15,725.00 WOUND CARE Vendor Total: Number Name Gross 10556 WOUND CARE SPECIALISTS 15,725.00 Report Summary Grand Totals: Gross Discount 381,708.28 0.00 MAY 19 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Discount No -Pay 0.00 0.00 Net 90.22 ✓ 0.00 0.00 169.56 Discount NO -Pay Net 0.00 0.00 259.78 Discount No -Pay Net 0.00 0.00 155.52 0.00 0.00 496.26 Discount No -Pay Net 0.00 0.00 651.77 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 No -Pay 0.00 Net 434.50 Net 434.50 Net 15,725.00 / Net 15,725.00 Net 381,708.28 file:///C:lUsers/Itrevino/cpsi/memmed.cpsinct.com/u88125/data_51tmp_cw5report536549... 5/19/2022 MWESSON STATEMENT As nt' 05/20/2022 Pagan 002 To answer proper credA to yom .ccavrt, detach and Mum this ramo.=v: a. ffiW WAIT your Ie11111tB11Ce DC: 8115 MEMORIAL MEDICAL CENTER As of: 05/20/2022 Pa,: 002 Mail I. Co., 8000 AMT DUE REMITTED VIA ACH OMIT Tenttory: 815 N VIRGINIA STREET &element for information only AMT DUE REMITTM VIA ACH OMIT POW LAVACA TX 77479 CustenWr: 632536 Statement for information only Dale: 05/21/2022 Coat: 632536 PLEASE CHECK ANY Date: 05MI12022 DEMS NUT PAID (1) at Due RaradvaWeIrtiWWl Account /l6 Oeta Date Number Before. Description Ulemunl Amount F (9.) Amount 1 Q F Nu�w babes PP ealumn ImleM: P = Poet Due hem, F = Future Due Item, blank = Current One Item TOTAL• Nelbnal Aeot 892638 MHHOBAL M®ICAL CBaT9e SuMwtelae 11,405.32 USD Future Do.. 0.00 Paq Due: 0.00 If Paid 13y 0512412022, Due If Paid On 9me: USD 11.177.20 Pay Thle Amount: 11.1 ]T.20 USD Dix bet A pent W. 03/ OTI202017 P12,451.97 OB/ If Paul After 0512412022, Dun A Pald late: z28.12 Pay this Amount: 11,405.32 USD DEC 11,405.32 10238-10 -. 222 • 04 652.86 , 62-56 `1I, 177. 2L m APPROVED ON MAY 2 3 2022 CALHOONCOUAUDITOR ,4s For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As N: 05120/2022 Page: 001 To a Proper met" to your C9mymV: a000 aeCelmt, Mach and edurn tM1b stub with your mnntellea WALMART AMT DUE IMAM Mm PHS MICgL CENTERory: MBNORIAL M®I 815VICKYN KALIS� Sletemanl 915 N IA 5T REFA"ED VIA ACH OMIT for inlormatian only DC: 8115 Tents 400 CUNomar. 266992 to: A. of: 05/20/2022 Page: 001 No Cmnp: 8000 VIA ACH D®IT AMT DUE lot Information Statement tar intormali0n only AVAC PORT IAVADA T% ]]879 Data: 05/21/2022 Cud; 256342 PLEASE CHECK ANY ONm 05121/2022 IfE WS NOT PAID (u) Bill, teDue Date Recaleawl4dionel Account SI&38 Number Merence OexNptbn Cash Discount Amount P (goes) F Amount P hrelvabb ( t) P Numb Comoner Number 256342 WAUAART lowUMEN Mm PINS 06/16/2022 05/24/2022 06/16/2022 05/24/2022 05/16/2022 05/24/2022 05/16/2022 05/2442022 05/16/2022 05/24/2.022 05/17/2022 05/24/2022 05/17/2022 05/24/2022 05/17/2022 05/24/2022 05/I8/2022 05/24/2022 05/18/2022 05/24/2022 OSIIW2022 05/24/2022 OWIW2022 05/24/2022 05/18/2022 05/24/2022 05/19/2022 05/24/2022 05/19/2022 05/24/2022 05/20/2022 05/24/2022 05/20/2022 05/24/2022 05/20/2022 05/24/2022 7342333967 7342333968 7342333969 7342543244 7342694211 7342653941 7342853942 7342653943 7342894672 7342894573 7342894574 7343044480 7343044489 7343136604 7343314931 7343394661 7343394662 7343562251 33483027 33516816 33701668 0513220926 0616221032 33805469 33805469 33813101 3388IS64 33861664 33941338 0517220906 0517220957 34001213 0518221050 34124657 34124667 0519220839 1151nveice 1151nvaico 1151nvolce 1951nvalca 1151nvoica 1151nvoice 1151nvoice 1151nvoice 1151nvaice 1151nvolce 1151nvoiae I951nvoice 1151nvoice 1151nvolce 1151nvaice 11510volce 1151nvoice 1951nvalce 8.49 12.11 2.3t 7.89 21.91 1L54 4.14 17.59 5.80 8.46 34.92 11.42 0.03 32.87 5.80 0.01 23.67 424,39 605.70 115.38 394.59 1,095,57 576.83 207.00 879.36 289.91 422.69 0.02 1,745,79 571.02 1.27 1,643.36 289.91 0,63 1.183.50 415.9011 7342333967 593.59✓ 7342333968 113.07✓ 7342333969 386.70 ✓ 7342543244 1.073.66 ✓ 7342694211 565.291/ 7342OS3941 202.06✓ 7342653942 861.77✓ 7342653943 284. 11✓ 7342894572 414.43✓ 7342894573 0,02✓ 7342894574 1g10.87 ✓ 7343044408 669.60 ✓ 7343044469 1.24 ✓ 7343136504 1,610A9 ✓ 7243314931 284.11 ✓✓ 7343394661 0,82 1/ 7343394662 1,159,83 1✓ 7343562251 PF aofumn bgeae: P Post 0. Ilan, F = Future Due Item, blank - Current Due Item TOTAL CUNomer Number 25834R WALMAB71099/MQa Mm ME Subtebb: 10,447,12 USD Put. Ooe: Pant Dow 0.00 It If Paltl By 0512412022, Pay This Amount: 10,238.16 USD 0. If Paid On Tlma: USD 10,238.18 ✓ Dow, ION N paitl btu: Lap Pa anent Y 11,642.]9 05/16/2022 If Peitl After O/RY40 S422. Pay One Amount: 10,447.12 USD 208.96 Due If Nud late: USD 1D,447.12 APPROVED ON ", For AR Inquiries please contact 800-867-0333 COUNTYEly CALF OUN COUNTY, TroC- (AAs MSKESSON STATEMENT As 0: 06/20/2022 Page: 001 To onPge proper Creditto your seemed, EMach and mlom Onto camw•x: sm. club with your ramiltanm OC: 6115 CVS PHCV ]OOfi/MnAOWA INS As of: 05/20/2022 Pegs: 001 Mail ro: Camp: 8000 DUE REMITTED VIA ACH DEBIT Ten% MWORIAL MEDICAL CENTEq m: 400 VICKY KAUSEK Statement for information only AMT DUE RRAITTED VIA ACH DEBIT 815 N IA Customer. 262252 Statement for infmmellon only PORE LAVACA TX )]9]9 Date: 05/21/2022 VAC Cud: 262252 PUSASE CHECK ANY Deter OS/M/2022 I113118 NDT PAID (n) Ilee 0� Reesivablrelio al Account MIPS Cash Date Number Reteromm Description Discount Amount P (glow) F Amou t P NeceNabk ( t) F N lea Cueromer Number 262252 CVS PHCY 7006/MEMOWA MS MI S/2022 05/24/2022 7342885718 1698079 1151nvolce 0.03 1.61 1.50 7342HUS718 O PF wlumn legentl: P = Pact Due Item, F e Mum Due Item, blank = Cununt Due ttxn TOTAL• CUNomx Numhar 262252 CVS PKCY T006/MEMOWA PHIt SuMWels: 1.61 USD Mum ew: 0.00 Pact D.:It PARJ By 06124/2022, 0. If Paid On Tlnm: USD 1.58 0.00 Pay This Amount: 1.58 USD ,E Dine lest it Peitl late: Last payment urn 11,842.)9 If Pant AIM OS/29/2022, 0.03 Due 11 PaItl late: OS/18/2022 Rey this Amount: 1.61 USE, USD 1.61 For AR Inquiries please contact 800-867-0333 APPROVED OM MAY 23 2022 BY COUNTY AUDITOR CAWOUN COUNTY, TEAS MSKESSON STATEMENT UmPoGY: GOOD HIM PHY FC 490/MB4 MC PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CENTER Slet¢ment for Inl4rmation only VICKY KALISBC 815 N VIRGINIA ST PORT LAVACA T% 77979 As of: 05/20/2022 Page: 001 To Gnaws propr Coach to your attaurK, &a h am Most, this ww1 with your rewhwtloe VC, 8115 As of: 05/20/2022 Pape: 00 TeMt.y: 400 Ma9 to: Comp: 8000 AMT DUE REMITTED VIA ACH D®ICost.Cu 464460 Staiamenl forfor infinlormelion only Data: OS121/2022 Coat: 464450 PLEASE CHECK ANY Date: 05/21/2022 ITEMS NOT PAID (,) all Due Roeaivaboatlolwl Aomant /TB Cash pmounl P Amount P Receivabfo Date Date Number Reference 0esorlplion Discount (a.) F had) F N9wber Customer Numb. 464460 H® MY PC 490/MEM MC PHS 05/16/2022 05/24/2022 7342275201 55.498491 1151nvolce 2.44 12221 119.77 ✓ 7342275201 05/19/2022 05/24/2022 7343128699 5SX506193 115lnvoice 0.58 29.04 28.46✓ 7343128699 05M912022 05/24/2022 7343132700 55.506450 1151nvoice 1.51 75.32 73.81 ✓ 7343132700 PF ealumn 1OWd: P = Past Dua Usm, F = Folum Due It., blank = Currant 0. Nem TOTAL Caod4m. Number 454450 H® MY PC 49o/M@,t MC PHS Sublolalc: 226.67 USO Form Due: 0.00 0. It PtlN 0. Time: Post Oue: If Paid By 05/2412022, USD 222.04 0.00 Ray This A.Gunt: 222.04 Use Disc food K paid I.W. Last ft nmt 05116MG22 11,642.79 N Paid Aft. 0512412022, 4.53 Due If Paid Late: Pay this Amount: 226.57 USD USO 226.57 For AR Inquiries please contact 800-867-0333 APPROVED ON MAY 23 2n72pp CALLHODUN COUNTY )TLE`7lAS MSKESSON STATEMENT ..pen,: BOO. CVS PHCY 7475/MEM MC MS MEMORIAL MEDICAL CENTER AMT DUE RBMITnD VIA ACH DEBIT VICKY KAUSEK Statement for Information only y 815 N VIRGINIA ST MST LAVACA TX 71979 As of: 05/20/2022 DC: 8115 Territory: 400 Customer, 835438 Date: OSM112022 Page: 001 To were, Peter cmtlk to your mmQUAt, Wtaeh entl Mum this stub with your ntnMtameo As of: 05/20/2022 Pape: 001 Mall W: Comp: 8000 ANT DUE REMITTED VIA ACH DEBIT Statement for information only Cush 835438 PLEASE CHECK ANY Date: 05/21/2022 REIS NOT PAID (�) BIAInD Due Restiv ptlonal Account ryjir36 Ceeh Amount P AmeuM P (4ecekabk Date Osle Number {laiemna OeBCOption plceouM (gmsa) F (neN F Number Customer Number 835438 CVS PHCY TOTS/MEM MC PNS 05/18/2022 05/24/2022 7343076113 1698554 115menn.e 13.32 666.18 652.86 ✓ 7343075113 O W eolumn kgentl: P = P Due Item, F = Mum Ow Item, blank = Cement Due Item TOTAL Goshen r Number 835438 CVS PHCY 7476IMEM MC PHS Summ.1a: 666.18 USD wtwe Dw: 0.00 D. N Pula an Time: 11 Pant By 0512412022, USD 552.86 Post Dw: 0.00 Pay This Amount: 662.86 USD Dies loaf N pak late: Last Payment 11,642.79 R PsM After 05/24I2022, 13.32 05/16/2022 Ow N Pala EMe: Pay this Ameem: 666.16 USD USD 666.18 For AR Inquiries please contact 800-867-0333 APPROVED ON MAY 23 Z022 oe >a 4;v AUDITOR �C,hM JOLIACOUNTY,.TEXAS MCKESSON MCKESSON CORPORATION DCp8115 3301 POLOK DRIVE CONROE TX 77303 SILL TO: HER PHCY 0434/MEM MED FHS PO BOX 25 PORT LAVACA TX 77979 Invoice Phone: 85SM25.4677 DEA: RM0328408 SHIP TO: DFA: SH7402604 HEB PHCY 04341MEM MED PH$ PHCY: 21209 101 CALHOUN PLAZA PORT IAVACA TX 77970 Billing No.: 7342866635 Billing Data: 05/161ID22 PON: 2017D51668 190813 261 128 1 of 3 Customer I nets. Stop Page 111 cud m. as in+'oie nut k _Wl ' u w4wa mtib W p Psi« aJlwvvmu. Tou _ F W."I, d akw vnd+pPepl+ub "'eu [II dnmuu, issW.- w eW_ mJ mru [ub,tlnti w RduJ +W wu pmerNrcN Im1U, re,e Wa9un+MdMre ?kJlma +N Mwkidi W to pvride Uu invwa aW n14+ JIµtamunuuon w Po,vrvnm wlM1elilln on rcGueslin vemWvrtv xilp [II ayPli[+Me laxa vnd rcW+veu i,xld'me u USC 13S1riE1NW W+ Jiwrourc oh A1VP OR R NDC/UPCp ITEMS DEL DOCN QTY Uhl ITP.M DESCRIPTION RETAIL C UNIT I EXTENDED N PRICE D AMOUNT M 9fedgve January 7, 200B Mckesson Corporation Is complying with the voluntary DEA request to distribute Methadone 40mg product Only to those fadlities authorized for detoxification and maintenance treatment, and hospitals. Please contact Mckessan Service Flat at 8004823784 with any questions ^ • B &4un-Dispensing Rns Consumer/Patient Level Redell " MULTI -AD PINOP2600 BRAD CS50; NDC S02/412005; Eem,02230785 ConsumenwCOnsumers should contact (heir physician far further medical movies. if you have any questions regarding the recall, please call E Braun at 333426.1484, Addilonal information available on Melanesian Concede. 605054170.07 1944883 688059215 1 EA PRAVAST NA TAB 40MG APX IOW® 4,793.99 R 40.50 A 40.30 TABLET 33342-006540 370-1059 68BD59215 I EA VALSARTAN TAB 320MG MACL 909 217.30 R 22.06 K 22.06 TABLET 68130A216A9 118-53DS 688059215 0 - EA LOSARTAN P,11YD100112.5 LUP 90 153 K Above Item I EA Manufachrut cannot supply TABLET SUMMARY TOTAL RX PURCHASES: $02.50 TOTAL CONTRACT PURCHASES: $62.86 TOTAL OTC PURCHASES: $000 TOTAL NON CONTRACT PURCHASES: $0.00 NET PAYABLE BY STATEMENT DATE 0612412022: S52.56 GROSS PAYABLE AFTER STATEMENT DATE 00/2412022d $B3.84 APPROVED ON MAY 2 3 2W BY COUNTY AUDITOR CALHOUN tol- V, TEXAS IN STATEMENT Statement Number: 63056712 AIY1erisourceBeP9en- Date: 05-20-2022 l Of 1 AMERISOURCEBERGEN DRUG CORP WALGREENS #12494 MOB 100135284 r 037028186 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER SUGAR LAND TX 7747MI01 1302 N VIRGINIA ST PORT LAVACA TX 7797&2509 DEA: RA0289276 fiat - Fri Ow In 7 nays 866451-9655 AMERISOURCEBERGEN P.O. Box 905223 CHARLOTTE NC 282905223 Not Yet Due: 0.00 Current: 508.34 Past Oue: 0.00 Total Due: 606.34 Account Balance: 506.34 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 0&1&2022 06-27-2022 30926BN31 452197 F43 Invoice 102.61 0.00 102.51 0&16.2022 OS27-2022 30W951989 IN913 Invoice 102.42 0.00 102.42 0&1&2022 05-27-2022 30N952120 18016 Invoice 24.15 0.00 24.15 7 05-1&2022 05-27-2022 3092952121 16%14 Invoice 1.01 0,00 1.01 0&1&2022 05-27-2022 3000OUN 165963 Invoice 4.14 0.00 4.14' 0&17-2022 05-27-2022 3093126962 165970 Invoice 9.44 0.00 9.44 0&18.2022 0&27-2022 309327012 1659M Invatce 260.16 0.00 260.16 0&la@022 O&27.2022 3093276313 165979 Invoice 0.18 0.00 0.10 0&19-2022 0&27-2022 30OU17637 166985 Invoice 2.W 0.00 233 Current 1.16 Days 16.30 Days 31�0 Days 61-90 Days 91-720 Days Over 120 Days W&M 0.00 0.00 0.00 0.00 0.00 0.00 Thank You for Your Payment Reminders Date Amount Due Date Amount 05-20-2022 (3,824.34) 0527-2022 506.34 Total Due: 506.34 APPROVED Oid MAY 23 2022 / BY COUNTY AUDITOR TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) F7"ENTER 9-DIGIT TAXPAYER IDENTIFICATION NUMBER" "ENTER YOUR 4-DIGIT PIN" "MAKEA 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-DIGIT TAX FILING ENDING MONTH" 1ST QTR - 03 (MARCH) -Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) -July, Aug, Sept 4TH QTR -12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT- FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" E_T6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER #w ENTER: W41 t-� 941 # 116,044.22' 1 $ 59,457.16 $ 13,905.46 $ 42,681.60 CHECK $ CALLED IN BY: CALLED IN DATE: CALLED IN TIME: # GAFinanw ShereWP-Payroll FileslPayrall Tues120221#11 R1 MMC TAX DEPOSIT WORKSHEET 5.19.22.As 5/20/2022 Run Late: 05/20122 MEMORIAL MEDICAL W.B1 Page ill Tina: 14:C4 Fevroll Register 9i-Needy 22REG Pay Per:cd 05/06;22 - 05119/22 Fur 1 Final Summary •-- P a y C o d e S u m m a r y ____ .._-------------------'-. D e d U c t -. 0 n a S c m a a r y---------.--_. j PayCd Description Mrs 10TjSHjWEIE01 CBj Gross I Code ?mount j ................................................................................................................................. 1 REGULAR PAY-SI 9569.75 11 N 11 209251).88 A/R 483.99 AJR2 A/R3 1 REGULAR PAY-S1 1929.25 N N 11 17 90492.32 OVANC AWARDS BCBSVI 969.54 1 REGULAR PAY-S1 471.50 Y N 11 14224.4E BCOTS CAPS E CAFE-1 2 REGULAR PAY-S2 2421, 00 N N 1; 60261.36 CAFE-2 CAPE" CAFE-4 . REGULAR PAY-S2 2535C '. N it P.;a.06 CA7E•5 CA.,:.c CAFE-D 1571.69 3 REGULAR FAY-S3 1319.25 N V IT 39557.87 CAFE•F CAFE-H 21325.96 CAFE -I 3 REGULAR PAY-S3 14i.SC Y N II 6248.76 CAFE-L CAFE-P CANCER CALL PAY 2429.50 N 1 N N 4655.0C CHILD 6C2.7, CLINIC 325.48 CCM9P: HE.13 D DOUBLE TIME 16.00 N 1 N N 370.56 CREDUN DO ADV DENTAL C TUB3.E IINE 1i.25 N 2 N 11 452.7C DEP-77 G15-LF EAT C DOUBLE TIME 8.75 A 3 N IT 30E.32 EWCSF. FEDTAX 42E61.60 F3CA•M 6952.73 0 DOUBLE TINE 6.25 Y 3 N IT 678.75 FICA-0 29728,59 FIRSTC FLEX S 3410.17 E EX"RA WAGES N .: N N aC'-;.31 FIX: FE FOFr D MA E EXTRA WAGES N 1 N IT 13 19635,ED Gies S 136.41 GRANT GRP•IN' FUN:".7AL LEAVE 32.1C N 1 N :4 _e_.E4 GTL ECEP-I T: TFT :NSERVICE 2E.30 N I N N 92i.4i LE.,,F 1EGx'i 2C5.00 PASA 751.OG IIISSRVICE 7.50 Y 1 N N 324.41 MEALS 135.20 M23VIS M:SC ? E7I . . .. S:c IVCSER NWFP:L I95,C2 P PAI3•TLM= OFF 240.00 N N N N 4697.2[1 0-10 PHI PHI••' P PAID -TIME -OFF IID2.00 N I N N 22929.56 PR FIN RELAY' REPAY X CALL PAY 2 106. CC N 1 N G 212.:C SAMS SIFUES SIGNOR Y YMCA/CURVES N N N N 75.00 S_.-TX STONDF 640.8E SI04E Z CALL PAY 3 96.0C N I V N 299.IC S-3.22 S7DEG SUMAC 755.i0 SUNILL 813.00 SUNIND 511.72 SINLIF 75E.06 SNISTD '-198.45 Sums SURCBG 3S5.00 ISA-I TSA-2 TSA-C TSA-P TSA-R 35747.59 TUTIOG UNIFOR 40e.00 T41HUS ---------------- Grand Grand Totals; 20414.50 ....... ! Grass: 510679.19 Deductions: 153201.53 Net: 351471:66 j Checks ......._ Coant:•7 190 P7 9 Other 43 Ferala 224 HRIe ...........................................................................__--_...................................... 23 Credit Crerk% 16 2eroNa- Tern Total: 247 j TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8883) "ENTER 9-DIGIT TAXPAYER IDENTIFICATION NUMBER" El"ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" "IF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGIT TAX FILING YEAR" "ENTER 2-DIGITTAX FILING ENDING MONTH" 1ST QTR - 03 (MARCH) - Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) - July, Aug, Sept 4TH QTR -12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT- FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" E—T"6-DIGIT SETTLEMENT DATE" "ITO CONFIRM" ACKNOWLEDGEMENT NUMBER #i ENTER: ### L — J 0 $ 42.31 1 $ 29.76 $ 6,96 $ 5.59 CHECK S CALLED IN BY: CALLED IN DATE: CALLED IN TIME: U J:1AP•Payroll FileslPayroll Taxes120221#11 R1 MMG TAX DEPOSIT VVORKSHEET 5.19.22 R2.xis 5/2312022 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 CAFE-P CANCER CHILD CLINIC COMBIN CREDUN DENTAL ❑EP-LF SUNLIFE TERM LIFE SUNLIFE HOSP INDEM FED TAX FICA-M FICA•O FIRST C FLEX S FLX.FE GIFTS GRP-IN GTL HOSP4 LEGAL OTHER NATIONAL FARM LIFE MED SURCHARGE. PR FIN RELAY REPAY STONEDF STONE STONE 2 STUDEN TSAR UWIHOS TOTAL DEDUCTIONS NET PAY: TOTAL CAFE 125 PLAN: TAXABLE PAY: $ 240.00 $ 240.00 "CALCULATED" From MMC R." Difference FICA - MED (ER) $ 3.48 FICA - MED(EE) usx $ 3.48 $ 3.48 $ - FICA -SOC SEC (ER) ... $ 14.88 FICA -SOC SEC(EE) x=% $ 14.88 $ 14.88 $ - FED WITHHOLDING 5 6.59 5 5.59 TAXOEPOSIT: S 42.21 S 42.31 FICA -MEDICARE xxon S 6.96 $6.96 FICA -SOCIAL SECURITY Ix In $ 29.76 $29.76 PREPARED BY: FED WITHHOLDING $ 5.59 $5.69 PREPARED DATE: TOTAL TAX: It 42.31 $42.31 $ - REVISED 311W014 TOTALS $ 240.00 5.59 3.48 14.88 16.80 40.75 199.25 Exempt Amt: Employees over FICASS Cap: $ Payeode3-Employee Relm6.: TOTAL: $ Mayra Martinez _. 512312022 X11 Rl MMC TAX DEPOSIT WORKSHEET 5.19.22 R2.xla; TAX DEPOSIT WORKSHEEWM022 Ran Date: 05/2O/22 MEMORIAL Y:EDICAL CENTER HI-Kuay Page _ Time 15:27 ^« CheG:-Aelatar ^^ .3D1sT? . Pay Period 05!06/22-45/19/22 Ruc; 1 "ycE=18S 'rC000901 O?EFiA'IRS - F3➢sP?4irl Hurt. Rene Pmuu.7c CHECK NUN. DATE 02322 RICK OSORNIA 33777 OD063156 05/27/22 07147 CRAG A VORCE 2172.79 00MIE7 05/27!22 38702 AIMM VANESSA PENNELL 986.12 00063158 35/27/22 4-617 JACOGELIRE N FARTINEZ 917.91 00063159 05/21/22 65583 HAMM MORALES $84.76 00063160 05!27/22 6056E CHRISTOPHER HUMMED 919.79 00063163 05121/22 00041 CA.RL 3E Kill', 1269.99 DD 05/27122 00083 SYLVIA A VARGAS 346.82 OD 05/27/22 00094 SYLVIA A MINDOZA 99C.73 DC C5/27/22 00113 JACL:N CARF.37E 3043.0E DD til21 (22 00132 S.ANDRA A BRAUN 845.01 DC C5/27122 07152 ERENDA D PEN. 1396.6E DC CS/27122 OD270 ANGELA M BURGIN 1169.80 OD 05/27/2, 00344 SANDRA LEE RUDDICK 2661.50 DD 15/27124 003e? BILLIE F DUCKWORTH 3903.80 DO 05/27/22 00392 MONICA T CARR 1036.31 DD 05/27122 00399 LINDA J TIT'AIDA 1960, 13 DO 05/27122 00401 VE24A J PINA 1761.00 DO 05/27/22 0041? SHERRY L KING 3319.14 DD 05127/22 01423 MEN V STRINGO 2325._2 OD 05/27112 00492 Mr.. FIKAC MIX DO 05/27/22 00577 DIANA CARCIA 2374.73 OD -5127122 00581 CYNTHIA L RUSHING 1732.94 DD 05/27/22 0067E SHEILA KAY APAT:HCO:K 1158.00 DO 05/27122 006B1 R RENEE KCOD 2047.64 DO 05!27/22 00697 MARIA C FAP.IAS 1D35.80 DO 05/27/22 00707 KIMBERLY R BLLIU7A 1333.78 DO 05/27/e. OOB95 EMZLIE DIANE WILKEY 1650.81 DO 05/27/22 GIPIS SUSAN 3 SMALLEY 1090.09 ➢O 15/27/22 0.191 SHARON M SPARKS 2305.04 DD 05/27/22 .1234 MISS 17 SVETLIK 2008.12 DO 051'27122 01367 vkRIUN A SANDERS 3626.52 ➢O OSJ21/22 01791 HAUSMAN J MON➢AY 2514.62 DO DS/21/22 01011 ER:H R CLEVENGER 3090.71 ➢O OS/2112. 02014 AGAPITA C CANTU 20.4a DO 05/27/22 12021 ERIKA OSOPNIA-SAUCHEZ 2211.94 DO OS/27/27 02822 APA21?-A.0 GRIPES 24 .ii DC G5/27122 02064 ANNA LAURA GARCIA 430.61 DO OS127122 02.197 KYLIE K GAI➢ES 2090.05 ➢O OS/27!22 02099 TRACI M 911BPCIK 2913.71 DO OS(21122 02112 LESLIE THOMAS 2295.77 DO 05/27/22 02122 DARN LUNA 345.23 DO 05/27/22 02165 CAYDENCE N CAIDILL 414.15 DO 05/27/22 02153 TIF.? VENGLAR 3396,7E DO 05/27/22 02272 DAKN J RUBENIK 2022A2 DD 05/27122 02301 NICOLAS TIMMI 3669.68 ➢D OS/27122 02302 CATHERINE MFALE DMIGS 900.0 DD OS/21/22 02303 MNIIIE M LUNA 3491.21 DO 05/27/22 42315 MNA N GREEN 4523.39 DO 05/27122 C2331 JESSICA B RIFFLE 2132.46 DD 05/27/22 02346 JEANETTE L FAS,CON 116.21 0O 05,27122 C2356 CPALEY M412ON 1343.20 DD 05j27/22 02416 JARELLE SCOTT 1767.83 DD 05!21122 Run DAGe: 05/2D/22 0KRIAL MEDICAL CEWEP. Tire: 15:27 •... Check Roister •-I' Pay Period 05106122-45119/22 7ype-12, 20000601 OPERATING !Tuff. Name k0anc CHECK TJM ]ATE 0251E PAG7ALEAn SEPUVSDA 1111.47 OC O5/27/22 C2535 STEFAWIE M SOLi2 1627•B5 DO 05/27/22 02552 VERONICA RAGUSIN 2440.20 DD 05/27/22 02584 SWRICE FaGD 2154.52 DD 05/27/22 02678 MELISSA NESIANEY 2485,68 DO 05/27/22 027C1 RONCA DA*A'N2:,E GOHLKE 2127.23 DC f5/2712Y 02719 DAWN M MCCLEL.AND 2040.87 DO CS/27/22 02135 ZANIRA A GARCIA 2855.45 DD 05/27/22 C2763 JESSICA COPPIN 1779.47 DD 05/27122 02794 HEATHER L HOW. LRR 1797.09 DO 05/27/22 02812 ERITTA.\'Y N RU003CK 3718.40 DD 35/m22 02507 NARIA F LONGORIA 1054.84 D➢ 05/27122 02927 KICHAEL L GAINES 5227.89 In 05/27/22 02963 DOROTHY J R3NDON 65me DO 05/27122 02970 DIANNIE G ATUNSON 1996.41 DD 05/27/22 03864 JACUUELII7E R EEF.F.EPA 12F9.66 ➢O 05/27/22 05003 COURTNE D THURLKILL 2892.57 DO 05/27/22 05006 IEGINA A MART:VEZ 236,39 OD 05!27122 05007 JANIS K NEYLAND 2055,45 DD OS/27122 05345 3.1:C4 NGU'YRN 450.64 DD 05/27122 05641 A..VJ= A KEY 1798.66 DD 05/27/22 05757 SWUM T HOLDER. 2514.43 DD 15/27/22 57,166 DBLPHINE PADRON 2723.04 DD 05/27/22 07123 CYNTHIA GUERRA 1505.34 DO 0S/27/22 07Z7F DIANA C SAUCEDA. 122C.85 D➢ 25127/22 10519 MARISSA LYNN HUNT 413.00 DD 05/27/22 11157, CATHERINE A SAW 3960.6.1 DD OS121!22 11412 COURTNEY L M➢RKOVSKY 370.15 DD 05/27/22 12011 KIMBERLY J REYNA 1669.51 DO 05/27122 12115 LIEA J HLKDJOSA 948.82 DO 75/27122 25097 KYLE L DANIEL 2653.61 DD 05127!22 15131 SA'7A20 HARUTI 3167.90 DD 05/27122 15171 JESSICA BARRON 1876.21 DO 05/27/22 15296 ➢AF?I 17 EAREK 2360.59 DD 05/27/22 15555 STEPHANIE MARTIN 1716.21 DO 05127/22 309 JULI3 NOE:1 1025.43 DD C5/27/22 :5915 3RIANNE J KEY 1930.59 DD 05!27l22 20102 MAYA HAWK'-NS 1671.13 D➢ 05127l22 20112 YU11A ?ATRICA RODRIGUEZ 806142 DO 05j"M22 20144 SOPHIE V. PECENA 350,59 DD 05/27/22 20145 NATALIE SOTO 560.$7 DD C5127/22 20156 ERID ASHLEY WISDOH 2502,74 DD 05/27/22 20184 MEL_SSA ZA'lORANC 919A5 DD 05/27/22 20206 KELLI E GO"? 1495,52 DO 05/27/22 20207 SEAWNA G RAETL 2695.82 DO 0427/22 20243 MELANIE CORTEZ 1974.56 DD 05!27172 20294 JE98ICA D WALTHER 826.i6 DD 05/27/22 20;_5 KAREN 8 MCEUEN 197.:6 DD C5127/22 20456 SAYDI A ST CLAIE 780.9E DO 0/27/22 20434 ERLAI4NA S PASSMDRE 70.60 DD OS /27/22 20548 JAMES 0 AKIN 1171.71 DD 05727/22 20742 CYNTHIA LOPEZ 200.31 DD 05!27/22 20733 JAH:E SADLER 1069.e3 DO 05127/2i 20788 JAYLIN RAMIREZ 697.76 ➢➢ D5/27/22 SI•WEEKLI' RllT.: 1 - PF.OSPFRrn Foe - F2DiSiP Rr. Date: 05i20/22 MSEOR:AL RVICAL Cc1ITEF. BL6FRK]Y Page 3 '.'r,_: 15:27 •••• Chec2 Resister *_•, P27ISTP Pay Period 05/QPj22•-9E1_9/22 Run: 1 Type=NET 20J00001 OPERATING • PROSP2RIT6 11 ...ur,.. Naoe AlOunt CHECK YR: :A7E 20797 BEI'M N DIGGS 1063.42 DD 05/27/22 20816 JOI'e I PENk 325. SS DD 05/27/22 20837 DAIS? MADRIGAL 1553.82 DO OS/21/22 2085-1 JA?Y1N1 GREED 388:34 ➢o OS/27/22 20896 OANIELA CAMACO 28.70 DD 05/27/22 L0977 CHERYL 1 TESCF. 1542.60 DD OSf27/22 2i45C DIANA E LF.AL 1555.51 DO 051271u 2i629 JACOBY R CP.ANFon 2560.69 DD 05j27122 21736 ALLISON GOULOEH 514.19 DD 05/27/22 2919R KELLY A SCHOTT 315.09 Do 05/27!22 30451 ARLESN jrD 211,42 DO 05/27/22 31m STACIE L EPLEY 1e95,78 DD 05/27/22 31O54 LO.RA L LA4ADEN e62,31 DO DS/27/22 31LI99 ARACELY Z GARCIA 2186.13 Do 35/27/22 ii165 JERRY A FINDLEY 363,66 Co 0B/27/22 i:219 LAUREN PH!LLIPS 1539.60 DO 05/21/22 3_313 KATHERINE LYNN JIMB'EZ 1108.60 DO 05/27/22 31319 STACY L PARKER 170I,55 D➢ 05/27/22 3'4E3 EDNAt1D E ?AT'JL'n 2225,E4 Do 0J27/21 31506 RACHEL A HEFFNER 2136.67 0o 05127/22 31821 KAYLA N ALVAREZ 1575,12 DD DS/27/22 31832 SHAH; D KRESTA 586.91 Do 05/27/22 31s49 CCDY L JWAAK 490,84 DO 05!27122 33118 KRYST ALA P KISIAH 1016,50 DD 25/27/22 38413 DEVAI ORTA 1436.55 DD DS/27/22 41112 ANASTASIA L PEREZ 665.13 Do 05/27122 9ll71 TOPKIE N 7ESVINO 502.71 DD OSJ27/22 41205 JEANETTE ALVAWO 771.43 DD 3512712, 41225 LESLIE A CRAICEN 903,30 DD 05/27/22 41236 PAMELA K VAMKOY 1360.57 Do 15/27/22 41275 KAREN 6A01 9e3.64 DD 05i27122 4i219 ?AMEI;, R HA MON 545.61 DD 05127al 41347 A.ORIAN11A D STRANDS 614.40 DD 05127/22 4:3E9 LORFITA A LEAL 574.74 DO 05/27/22 41429 ANGEL F: CASSEL 1052.75 Do D5i27122 4'sC7 OLGA I BETANCJUR'• 767.99 Do 05/27!22 41612 SONJA A GUAJARAO 627,79 Do D5/27/22 4.705 KELSEY A TAYLOR 944.55 Do D5/27/22 4L655 RENAS EICRELLE EMERY 5es.84 OD 05,127/22 4i897 ROKANNA MARTINEZ 752.89 D➢ 05i27/22 41901 JUANITA R MILLER 1167.72 DD 05/27/22 41924 BRITINEY V STRICELIN au A7 00 35/27/22 4210E CHRISTY SILVAS 992_7 ➢D 05/27/22 42112 SOCOP.AO C GONZALS 695.77 DD 05/27122 42122 LEI RNA CNAVANA 1592.71 Do 06/27/22 42125 LUCY CALZAOA 760.05 Do 05/21/22 42304 E1N: T NG!9aN 1974.50 DD 15/27/22 42320 MIC'.XL A PFEEIL 3004.14 DD 05/27/22 42820 NARIA D CHAVEZ 627.45 Do 05/27/22 42842 SHANNA S 0 DONNELL 3214.08 Do 05/27/22 50ole EICELLE X KDRALES 133"..41 Do 05/27/22 E0134 'LORNA VALC22 1078.25 DD 0Sj27/22 Soil's PENNY GOULOEN 3027.35 Do OS/27/22 50161 BRrmDY MICHELL! ZAMOR.A 494.14 Do 05j2N22 For. Date: C5120/22 MEMORIAL N.EDICAL DENIER. BI-KEENLY Pap 4. Time: 15:23 ••" Check ReUiateI "•• MIST? Pay Period C51061'e2--09/i5122 I-z.: 1 Tyoe=NRI 10000001 OPERATING - PROSPERITY Num. Name Amount CHECK wip. DATE 5D248 MCFJ2GY7A VILLEGAS 351.65 OD 05/27/22 50282 JACOB N HAMILTON 2576.27 OD O5/27122 50310 JASMINE GRIGSBY 781.95 DO 05/27/22 50546 MELANIE E SAMAYOA 2D73.34 DD 05/27/22 50313 D?AHA R DAVIS 1E54.31 DO OS/27122 50596 BETTY S DAVIS 1991.62 DD OS/27122 50719 DEBRA N MUSTERED 2221.84' CO 0S/27/22 50923 ADINA RO➢RIQUEZ 592.96 DD 05/27/22 `.3541 JACL'IN B MAIL 1518.54 ➢➢ 65/27/22 55025 LEA C RESF•.30EZ 547.99 DD OS/21122 SE02E I01E S PEREZ 437.40 DO '5127/22 55106 CRYSTAL M CHAVEZ 110,08 DO 05123/22 55127 MIL Y KMALA 2771.61 OD 0S/2712; 55371 BLANCA HERNANDEZ 2310.96 DD 05/27/22 55182 SHAIRAN JACILDO 1609.9i DD 05/11/u 55658 LAJUAN 'WILES 719.96 DD 05/27/22 58510 RITA L POLINSNY 035.1E DO '5127/2, 60112 ROBERT A RODRIQUEZ 1993.71 DO 05/27/22 50131 NORA 07A.2 582,70 DD 05127/22 60163 MIGOluIA CLAiG 765.63 OD U5/27/22 601E5 TERESA A BENITEZ 2009.62 D➢ 05/27/22 60271 REBEKAH GERYN 572.93 DO 55127/22 50412 CP.RISTOPHYP GALIN➢0 984.03 DD 05/27/22 60616 DOR03HY A LONGORIA 796.27 DO 05/27/22 60718 ANNA C GGIMEZ 710.:1 DO 05/27/22 5043=. CONSi�ELO ZAMORA 789.65 D➢ 05/27/22 63124 SANJUAN M GARCIA 622,82 OD 15/27/22 63299 JASON .l'JBIO 1394,21 DD 05/27/22 65100 PELICITA SONDE 564.60 IS DS/27/22 65121 VIVIANA P NEDINA 331.07 DO 05127/22 65147 BLANCAROSA VILLARREAL TD4.44 DO 05/27/22 65151 ELIA JLACRIA 657.27 ➢D 85/17122 65213 LEE SIMERLY 1069.63 OD 05/27/22 65241 LUCILA LOPEZ DE 0p8ON 971.1T DO DE127/22 6536E CYNTHIA GARCIA 1311.97 DD 05127/27 65191 RA'40A A PEREZ 1118.45 DD OE/27h2 E5453 AMALIA L FLORES 990,1E DO 05/2112Z 554£3 XMIA I VELOZ 912.:0 DO 05/27/22 6548E BOSA RODRiGOEZ 883.1E DO 05/27/22 65513 WMA M,OMES 911.E4 DO 05/27122 65705 ➢OMTT_LA HERRERA 942.81 DO 05/17/22 65065 MAR2A F LEDEZMA 644.05 DO OS/27/22 68163 CRYSM MARTINEZ 1006.29 00 D5/27/22 68792 NAZARIO DIAZ NEPNAADEZ 1683.81 DO 05/27/22 75119 BARA N BLEDSOE 2257.47 DD 15/27/22 73149 GLORIA N REID 2293,21 DD 05/27/22 15190 RIKA NILLEE 2101.79 DD 15/2712; 75003 IRMA DELEON 665.91 DD 05/27/22 7E110 TARAH SUBLETT 695.2E 00 05/27/21 76115 JEENNIFE.R R CARLCCE 745.31 DO 05/27/22 75120 RACHEr CARALES 1271.94 DO 05/27 ti 76138 RAREN D GARCIA 690.61 DD 05127/22 7E210 ZOE VILLARR3AL 446.55 DO 051211:2 MOO AIDA JIP.EIEZ 736.37 DO 05/27/22 Ecn Date: 05/2D122 MEMORIAL MEDICAL CENTER Ei-KEEKLY Page 5 Tin=_: 15:27 •«+ Check Register `... P2DISTP Pay Per'_od OSJ06j22--05/:9/22 Roc: i "yoe=IFT 10000001 OPE96TINC - PROSPERI% No,. Name Amount CHECK Kilt ]ATE 76313 PAMELA L EASTON 725.12 CO 05/27122 76463 KATRINA A POKLUDA 1276,1 CO 05/27/22 7664E CHERYL A SSE 980.I5 DO 05/27/22 76786 CRIGORI' E MORALES 630.83 DO 35l27/22 7676E LAURA F PHSINA 066.51 OP 75/27/22 76654 NARY PATTERSON 883.30 DD OBY27/22 76985 VANESSA TP.ISTAI 241,94 CO GS/27/22 77646 FARE A GONZALES 918.77 OD 05/27/22 70020 MISTY R PASSNORE 1115.92 CD 05/27/12 IB058 KYA14K J POWER 209.60 DO 05/27/22 70012 DCNIIA V. RAWLINCS I107,61 CO O5/27122 78186 AlVDREA F COOK 16.61 DO 05/27/22 7819I JAEIS J GRASSE 245.95 CO 05/27/22 78287 FARISSA D AUMANZAR 3B70.56 DO 05/27/22 7A336 JESSICA L ZVEE 14B2.04 CO O5/27/22 70S66 MELISSA K G3E 012.36 DO 0S/27/22 18764 ASNLSY D NAD:EY 1B82.:1 CD 05/27122 78775 SARA N RUBIO 2060.95 CD 05/27/22 7878E K.RISi3K R MACEICEK 2337.00 OD C5/27/22 78787 FARAH I JAMAK 2380.43 DO 05/27/22 78879 YESENIA CQUEZADA $1.07 DO 05/27/22 78897 DAYLE J MCLAUGHLIN 537,55 OD 05/27/22 80008 :DAM ➢ BESIO 2451.35 CC 05127/12 80141 JEAINIE OR -A. 1656.39 CD G5/27/22 62227 CAITLIN A CLEVEN(NI 1033.58 CO 05/27/2, 86432 KRISTI L BOYD 1995.04 CC D5/27/22 86462 MEGAN M. 3ARTER 773.46 DD 05/27/22 88125 LISA 14 TREVINO 1092.30 ➢O 05/27/22 88806 1LARL3Y 2 ODON'N'ELL 2219.99 DO 15/27/22 689N NAYRA K MARTINEZ 1509.29 CO 0S/27/22 90320 ROSF2.NDA S THOMAS 3366.30 CD 05%27122 93231 ANDRIE M. FLORES 1114.30 DO 75/27/22 98756 AORim,"A A WAN 1576.21 DO 05/27/22 357477.65 941 RECITAX DEPOSIT FOR MMC PAYROLL -e PAY PERIOD: BEGIN -516120221. yQ PAY PERIOD: END '511912022' PAY DATE: .E127120#, GROSS PAY: S 510,679.19 DEDUCTIONS: AIR 5 483.99 ADVANC BOOTS SUNLIFE CRITICAL ILLNESS $ 811.00 SUNLIFE ACCIDENT S 755.30 SUNLIFE VISION S - SUNLIFE SHORT TERM DIS S M98.45 BCBS VISION S 969.54 CAFE-D S 1,673.80 CAFE-H S 21,825,96 It S - CAFE-P CANCER CHILD S 602.77 CLINIC $ 328.78 COMBIN 5 308.09 CREDUN S DENTAL S DEP-LF SUNLIFE TERM LIFE 5 788.08 SUNLIFE HOSP INDEM $ 511.72 FED TAX S 42,681.60 FICA,M 5 6,95Z.73 FICA•O S 2%728.58 FIRST C $ - FLEX S $ 3,410.17 FLX-FE S - GIFT S S 136.41 GRP-IN GTL HOSPA LEGAL S 966.00 OTHER $ 643.20 NATIONAL FARM LIFE S 1,854.02 MED SURCHARGE 5 385.00 PR FIN 5 RELAY REPAY STONEOF $ 840.86 STONE STONE 2 STUDEN TSA-R S 35.747.69 UWIHOS $ - TOTAL DEDUCTIONS: 5 163,201.53 5 -aeouio MaFllMnoer ••woula NET PAY: S 357 477.66 1S TOTAL CAFE 125 PLAN: $ 31,194.97 Le: S REVISED 3/182014 NALCKIII TOTALS $ 610.679.19 $ 483.99 s - S S 811.00 5 755.30 S - S 1,198.45 $ 969.64 S 1,573,69 $ 21.826.96 5 - 5 - S - S - 5 602.77 S 328.78 S 306.09 788.08 6'11.72 42,681.60 6,952.73 29,728.58 3.410.17 136.41 5 966.00 S 543,20 5 1,854.02 5 386,00 5 - 5 - $ 640.86 S - 5 - $ S 35.747.S9 5 5 - S - $ - S 153,201.53 &qWe ANttK R®OR1��BIIgaOMI,TbIPFpg11�•'61gU40 WttMFFPIXIT•- S S E $ 367,477.86 'AXABLE PAY: $ 479,494.22 $ 4T9,494.22 ••CALCULATEO•. Fmm MMCR.wd Difference ICA - MED (ER) 14M $ 6.952,67 ICA- MED(EE) I'm $ 6.952.67 $ 6.952,73 $ (OAE ICA-SOC SEC (ER) isx $ 29.728.64 ICA-SOC SEC(EE) s1m, $ 29,728.64 $ 29,728.66 $ 0.0E ED WITHHOLDING $ 42,681.60 S 42,681.60 TAX DEPOSIT: S 116.04422 H6.044.22 5 FICA -MEDICARE xwx $ 13,905.34 $13,905.46 FICA -SOCIAL SECURITY ,z,sx $ 59,457.28 $59,457.18 PREPARED BY: FED WITHHOLDING $ 42,681.60 $42.681.60 PREPARED DATE: TOTAL TAX: S 116,044.22 $118,044. 22 $ - Exempt AmL• Employees over FICA4S Cap: S S - Payeode S - Employee Relme,: TOTAL: $ Mayra Martinez $12012022 Mil R1 MMC TAX DEPORTWORKSHEET 6.1921x1s; TAX DEPOSITWORKSHEET WM022 Run Date: 05i23(22 MEHORIAL MED:CAL CEAfiR Pane 1 T:re: li:52 Payroll Register f H Weekly I P2REG Pay Period 051OE/22 - 5i.9/22 Fur.@ 2 Department 020 Dept. SeTjenc. •-- E r� p 1 0 y a a ----- • -- T i n e.....................—_.-.._-____-_--._...... D a d u c t i o a s .......................... l Hum/Type/➢ame(Pay/ExemptlPayCd Dept Hrs jGiJSHjMEjHOjC3j Race Coss I Code Amount .................. ..... ..b..----- .__....____.----------- ................ _------- ........... 2020E FT Hrly: 24.0000 P 020 19.00 4 ;1 17 W 24.c000 240.00. FEDTAR 5,59 FICA-M. 3.4S FICA-0 :4.98 ,ELL" E GOP? TSAR 15.80 Fed -Ex: S-00 St-SX: .00 -----------------• Total: 10.00------------•-•• ( Gross: 240.00 Deductions: 40.75 Net; 199.25 I Department SRMary P ay Code S uT m a: y............. .. educt.cr.s j PayCd Description Hra jOTj SF.jwEj HCICaj Gross I Come Amounc ---------- ............... .__..--..__..____.--................................................. ..... _. P 10.00 N N H H 240.00 A/R AIR2 ADVAIC ECCTS CAFE-2 CAFE-5 CAFS-F CAPE-1. ciD CK1111 OEP-:F ACCSH FICA-0 FIX FE G..I S GTL LEAF MEALS MISC( OTHER FF. FIE SAMS ST-TX ST0:132 SUM SLIISTD TSA-1 TSA-P ONIFOR AMARDS CAFE F. CAFS-3 CAFE-C fAFS-H CAFS_g CLINIC 03 ADV D:S-LF FEDTAX 14.88 FIP.STC FORT D GRANT EDSP-I LEGAL MRTVIS MACSHR PHI RSL.T SCRunS STGXDF S:LDEN SUNIH'U S'A'4'IS TSA-2 TSA-R UW1HOS $ t n m a r - _.._.... A/P.3 HCHS1'I CAL . -I CAFE-; CAF"a-➢ CAFE-T CANCER CC:3IN OEHTAL EAT 5.59 FICA-M 3.48 FLEX e FDIA GRP-II. ID ITT HAS. RISC RATFML PHD•• REPAY SIGHGN SbHE SONACC SUHLIF SUFCHG TSA-C 18.80 TUTIC,V ._............. Departrent Tonle; 10,00 ------- ! Gross: 240.00 %duc.ioxs: 40. i'. Net: 155,25 1 Checks Count:- :i 1 FT Ot§er Fera:e I }!ale Credit OVerAmc 2er3Net Tarr Total: ; .................................................. .._-...... .---------------------- ...... ........................... ------'._.. Fca Cate: 05i23i22 'MENT.I'L =Cal C39TEE 37-nE2iLry Page 1 Time; 1h09 ••rr Chec% Reoister r... P2715TP Pay Period 05106i22--05719122 dun: 2 7yTe-ITK :0000001 CPIRAII O - PROSPERITI iLr. Sare Am7]: CHECK SCR! DATE 20205 KELM 5 GOFF 199.25 00063162 OSW/22 199.-a9 MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT--- May 16, 2022 - May 22, 2022 Data Bank Description 5/16/2022 PAY PLUS ACHTRANS 452579291101000696208875 5/16/2022 TEXAS COUNTY DRS RECEIVABLE 0419 21MOO25743 5/16/2022 FDMS TOMS PYMT 052-174354B-OOD 4100012007988 5/1612022 FDMS FOMS PYMT 052-1743547-00041OW12007989 5/16/2022 FDMS FDMS PYMT 052-1737276-OOD 4100012007895 5/17/2022 PAY PLUS ACHTRANS 452579291101000697148570 5/17/2022 MCKESSON DRUG AUTO ACH ACH0502628691000014S 5/18/2022 PAY PLUS ACHTRANS 452579291103000697991525 5/19/2022 PAY PLUS ACHTRANS 452579291 10ION698925611 5/19/2022 WIRE OUT CBNA INCOMI NG SETTLEMENT ACCOUNT 5/20/2022 WEBFILE TAX PYMT 00 90Z/06013716 21000023091 5/20/2022 PAY PLUS ACHTRANS 452579291101000699595593 5/20/2022 AMERISOURCE BERG PAYMENTS 0100007768 2100002 MMC Notes - 3rd Parry Payor Fee - Retirement Funding -Credit Card Processing Fee - Credit Card Processing Fee -Credit Card Processing Fee - 31d Party Payer Fee - 340B Dme Program Expense -3rd Party Payor Fee -3rd Party Payor Fee -Citibank Corporate Card Payment Sales Tax - 3rd Party Payor Fee 3406 Drug Program Expense �bYAD—l1S �YY3,��{ May 23, 2022 R.dsmda Thomas, lnterlCEO sy Memorial Medical Center A �VNro✓� 8y'I�'2Z' PROSPERITYBANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT— ESTIMATED ACHS Date DescdMian 6/3/2022 OIPP IGT MMC Not. ACCRUED NH DIPP IGT 7 �I--- j ' v 11 tY'1 May 23, 2022 Roshanda hemas, Interim CEO Memorial Medical Center APPROVED l MAY 2 3 2022 13Y COUNTY AUDITOR CALHOUN COUNTY, TEXAS Amount 260,041194* 80.06 40.02 120.08 i '1�i2P'!r 11642A 3,476.59-# 1,246.41,1t' 20;,36 3 824.39,�. 280,535.87 vo vim 0.47 13. 20 +' 19.81 - 0.95 - 3U•16 V s L kJ Sd•06 40.02 120•08 + 240-1.6.* 64.59 't 240. 16 + Sop.•75 :k 280+6�•$'L - 2Li0,0auyy - Amount 2i99sa;g:Fa, I I , Ci 4 'e 19 - 1,246.41 - �,624.;;4 -. 2A85,414.63 304 , '/ 5 304 •'I5 0 • O 1.1 Transaction Summary Transaction Complete Trace #1: Texas Health and Human Services Commission Memorial Medical Center Operating County 4.63 ,U Page No: i of t Run Date: WaV2022 Run Time: 08:42:42 Marley ODonnell From: Roshanda S. Thomas Sent: Wednesday, May 18, 2022 8:09 AM To: Marley ODonnell Cc: Anthony Richardson Subject: FW: (BULK] QIPP IGT Notification First Half of Year 6 (SFY23) FYI... i=i ✓ul :7 j}rJ rl rjd C Thoril-is, I'nHA I Interim 'n''9f Ex9cuii` r Offi0@r Memorial Medical Center 815 N. Virginia SL., Port Lavaca, TX 77979 Ph(361)552-0240 Fax(361)552-0220 rth omasPrr mcoortlavaca.com From: Texas Health and Human Services Commission <txhhs@public.govdelivery.com> Sent: Tuesday, May 17, 2022 3:39 PM To: Roshanda S. Thomas <rthomas@mmcportlavaca.com> Subject: (BULK) QIPP IGT Notification First Half of Year 6 (SFY23) 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. w. TEXAS Id Health and Human Services QIPP IGT Notification First Half of Year 6 (SFY23) HHSC is providing notification of the first half Intergovernmental Transfers (IGT) call for Quality Incentive Payment Program (QIPP) Year 6. The IGT amounts can be found in column D of the "QIPP Year 6 IGT Call — May 2022" file, This file can be found under QIPP Year 6 (SFY23) Related Documents on the QIPP Provider Finance website. The IGT must be entered into TexNet no later than close of business June 2, 2022 with a settlement date of June 3, 2022. • This settlement date is non-negotiable. • The funds need to be placed in the "QIPP" Bucket. Please transfer funds through TexNet. TexNet instructions are available here. Send an email with a screen shot or PDF of the confirmation/trace sheet to HHSCPFDQIPPPayments(d)hhs texas gov. Please email any questions regarding this change or the calculation in general to QIPP(@hhs.texas.gov. You have subscribed to get updates about Texas Health and Human Services (HHS). For snore information about HHS, please visit our website. Stay Connected ' tj �(en espanoq SHARE Subscriber Services Manage Preferences I Unsubscdbe i Help This email was sent to rthomas(btmmeoodlavaoa.com using govOelivery Communicada ns Cloud on behalf of Texas Healdi and HulVan Services Commission 707171h S1, Suile 4000 Denver. CO 30202 gom a1VERY� This list contains the suggested requested amounts. No excess funds have been added. Suggested IGT was updated as a result of changes In ownership for enrolled facilities. FACILITY FACILITY NAME FACILITY OWNER (MEMORIAL 3UNE REQUEST 4628 FORT BEND HEALTH CARE MEDICAL CENTER 178 670.03 4811 ASHFORD GARDENS MEMORIAL MEDICAL CENTER 572 339.29 100806 GULF POINTE PLAZA MEMORIAL MEDICAL CENTER 1 251 540.97 102540 GOLDEN CREEK HEALTHCARE AND REHABILITATION CENTER MEMORIAL MEDICAL CENTER 331 658.42 103462 TUSCANY VILLAGE MEMORIAL MEDICAL CENTER 338557.10 105006 SOLERA AT WEST HOUSTON MEMORIAL MEOSCAL CENTER 171346.22 105314 THE CRESCENT MEMORIAL MEDICAL CENTER 157 935.34 105818 THE BROADMOOR AT CREEKSIDE PARK MEMORIAL MEDICAL CENTER 211733.46 110301 BETHANY SENIOR LIVING MEMORIAL MEDICAL CENTER 271 633.80 2,485,414,63 C"(�T Slz;/zz QIPP Year 6 Maximum dollars based on a fully funds IPP Year 6 Eligibility Cut-off Point Total Number of Nursing Facilities Number of Qualifying NSGO Facilities Number of ualif ing Private Facilities Facility ID Facility Name 4628 FORT BEND HEALTH CARE 4811 ASHFORD GARDENS 100806 GULF POINTE PLAZA 102540 GOLDEN CREEK HEALTHCARE AND REHABILITATION CENTER 103462 TUSCANY VILLAGE 105006 ISOLERA AT WEST HOUSTON 105314 THE CRESCENT 105818 THE BROADMOOR AT CREEKSIDE PARK 110301 BETHANY SENIOR LIVING ad program meeting 100% quality metrics Facilities marked i 65.00% 951 701 260 Owner Privately Owned, Non -State Government Owned (NSGO), or State Owned County MEMORIAL MEDICAL CENTER NSGO FORT BEND MEMORIAL MEDICAL CENTER NSGO HARRIS MEMORIAL MEDICAL CENTER NSGO ARANSAS MEMORIAL MEDICAL CENTER NSGO GRIMES MEMORIAL MEDICAL CENTER NSGO BRAZORIA MEMORIAL MEDICAL CENTER NSGO HARRIS MEMORIAL MEDICAL CENTER NSGO FORT BEND MEMORIAL MEDICAL CENTER NSGO HARRIS MEMORIAL MEDICAL CENTER NSGO CALHOUN n red have been updated with changes of ownership (CHOW) which hnva hPen ffiNd ha Fn6-,iai- la erne SDA Medicare Number NPI Eligibility Report P Contract Number Used for CR or AR Most Recent CR or AR Begin Date Most Recent CR or AR End Date Total Medicaid Days HARRIS 675663 1730577503 2020 CR 1026586 01/01 2020 12/31/2020 9,246 HARRIS 675423 1326436189 2020 CR 1026516 01/01 2020 12/31/2020 29,618 NUECES 1675892 1922092790 2020 CR 1030445 01 01/2020 12/31/2020 13,017 NUECES 676097 1588075964 2020 CR 1028605 01/01 2020 12/31/2020 17,163 HARRIS 676201 1275717894 2020 CR 1030895 03 01 2020 12/31/2020 14,640 HARRIS 676310 1497143259 2020 CR 1026585 01/01 2020 12/31/2020 8,867 HARRIS 676323 1669860425 2020 CR 1026584 01 01 2020 112/31/20201 8 173 HARRIS 1676357 1669860433 2020 CR 1026524 01/01 2020 12/31/2020 10,957 NUECES 676481 1538719836 2020 CR 1030947 06/01 2020 12 31/2020 8,203 Total NSGO Days Total All Days Component 1 Value Component 2 Component 3 Value Value 12,310,938 I - 16,988,134 - ----- .f $-,484,606,000 . --- -� $ 159,808,o00 ---- -- $ 239,712,000 -- Total Days of Service Medicaid Percent Utilization Annualized Medicaid Days Percent of Components 1 & 4 Percent of Components 2 & 3 Estimated Max Value of Component 1 Estimated Max Value Component 2 Estimated Max Value of Component 3 14,544 63,57% 9,246 0.075% 0.0544% $ 363,957 $ 86,977 $ 130,466 34,565 85.69% 29,618 0.241% 0,1743% $ 1,165,876 $ 278,618 $ 417,926 24,13 53.94% 13,017 0.106% 0.0766% $ 512,398 $ 122,451 $ 183,677 25,456 67.42% 17,163 0.139% 0.1010% $ 675,600 $ 161,453 $ 242,179 28,717 50.98% 17,520 0.142% 0.1031% $ 689,653 $ 164,811 $ 247,217 23,983 36.97% 8,867 0.072% 0.0522% $ 349,039 $ 83,412 $ 125,118 20,668 39,54% 8,173 0.066% 0.0481% $ 321,720 $ 76,884 1 $ 115,326 25,757 42.54% 10,957 0.089% 0.0645% $ 431,309 $ 103,073 1 $ 154,6 99 16,59 49.440/a 14,057 0.114%u 0.0827% $ 553,328 $ 132,233 $ 198,349 Component 4 Estimaited f P i Total June Total December Total Year IGT Value Components IGT Request IGT Request Request 17------ 000 $ 1,080,125 000_ L $ 237,897,000 $ - 237,897,000 $ 475,794,000 Estimated Max Value of Component 4 Estimated Maximum Value from Components to Provider $ 132,183 $: 713,584 $ 423,426 $ 2,285,846 $ 186,094 $ 1,004,621 $ 245,366 $ 1,324,599 $ 250,470 $ 1,352,152 $ 126,765 $ 684,334 $ 116,843 $ 630,773 $ 156,644 $ 845,635 $ 200,959 $ 1,084,869 I June IGT Request December IGT Request Total Request for (1/2 i of total) (1/2 of total) Year 6 $ 178,670.03 $ 178,670.03 $ 357,340.06 j I $1,144,678.58 i $ 251,540.97 $ 251 540 97 $ 503 081.94 r $ 331,658.42 $ 331,658.42 $ 663,316.84 $ 338,557 10 $ 338,557.10 $ 677,114.20 $ 171,346.22 $ 171,346.22 $ 342,692.44 $ 157,935 34 $ 157,935 34 $ 315,870 68 $ 211,733 46 I $ 211,733 46 $ 423,466 92 $ 271,633.80 $ 271,633.80 $ 543,267.60 j 2�485,414,63 2,485,414,63 4,970,829.26 RECEIVED BY THE COUNTYAUDITOR ON MAY ,11 2022 MEMORIAL MEDICAL CENTER 05/19/2022 0 CAUQ0 COUNTY, TEXAS AP Open Invoice List ap open_Invoice.template D as Through. Vendor# Vendor Name Class Pay Code 11816 ASHFORD GARDENS Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount 050922 05/13/20 05109/20 06M 0/20 7,801.21 0.00 TRANSFER Nit kuyltt1Lf. W jtpahi}„j irt-h wo,[. OPM+il rip 051222 05/13/2005/12/2 06/10/20 69,197.69 0. UHC Q2 QIPP PAYMENT 051222A 05/13/20 05/12/20 06/10/20 6,003.79 0.00 UCH MARCH QIPP PMT Vendor Total; Number Name Gross Discount 11816 ASHFORD GARDENS 73,002.69 0.00 Report Summary Grand Totals: Gross Discount No -Pay 73.002.69 0.00 0.00 APPROVED ON MAY 19 200 By COUNTY AUDITOR CALHOUN COUNTY, TEXAS Page 1 of 1 No -Pay Net 0.00 7,801.21 0.00 59.197.69 0.00 6,003.79�/ No -Pay Net 0.00 73,002.69 Net 73.002.69 file:///C:/Users/itrevino/epsi/memmed.cpsinet.coinItt88125/data_5/tmp^cw5report573010... 5/ 19/2022 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON 2022 MEMORIAL MEDICAL CENTER 12AP AP Open Invoice List 0 10 CALHOUON COUNTY, TEXAS Dates Through: ap_open_invoice.template Vendor# Vendor Name Class Pay Code 11828 SOLERA WEST HOUSTON Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 051222 05/131200511212D 06/10/20 2,319.28 o.ao 0.00 UHC MARCH QIPP PMT 051222A 05/13/20 05/12/20 08/10120 16,911.95 0.00 0.00 UHC 02 QIPP PMT Vendor Totals Number Name Gross Discount No -Pay 11828 SOLERA WEST HOUSTON 19,231.23 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 19,231.23 0.00 0.00 APPROVED ON MAY 19 2022 BY COUNTY,AUDITOR_ CALHOUN`COUNTY,TEXAS Net 2,319.28 16,911.95 � Net 19,231.23 Net 19,231.23 file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.coin/u88125/data_5/tmp_cw5report231562... 5/ 19/2022 Page I of 1 RECEIVED BY THE COUNTY AUOROR ON l2Q2 MEMORIAL MEDICAL CENTER pp��pIlyr�/1 pyl'1Q'4� y L�22 AP Open Invoice List 0 Dates Through: ap_open_Invoice.templale CALHOW110ftNW,dff564We Class Pay Code 11820 FORTBEND HEALTHCARE CENTER Invoice# Comment Tran Dt Inv Dt Due Dt Check D* Pay Gross Discount No -Pay Net 050522 05/u13/20 05/05/20 06/10/20 555.45 0.00 0.00 555.45 051222 TRANSFER jKUWhlt. ry��,,.�• [IC '�c� ITT L IY t DnY.hL / 05/13/20 05l12l20 06/10/20 2,390.52 0.00 �{ 0.00 2.390.52 UHC MARCH QIPP PMT v 051222A 05/13/2005/12/2006/10/20. 27.082.60 0.00 0.00 27.082.60 UHC 02 QIPP PMT Vendor Total: Number Name Gross Discount No -Pay Net 11820 FORTBEND HEALTHCARE CENTER 30,028.57 0.00 0.00 30,028.57 Report Summary Grand Totals: Gross Discount No -Pay Net 30.028.57 0.00 0.00 30,028.57 APPROVED ON MAY 19 2022 BY COUNTY AUDITOR CALHOUN COUNTY. TEXAS file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5repolt123674... 5/19/2022 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON W 9/422022 MEMORIAL MEDICAL CENTER AP Open Invoice List 0 10:46 ap_open_invoice.template • CALHOUN COUNTY TEXAS D t Th h a as roug . Ventlor# Vendor Name Class Pay Code 11832 BROADMOOR AT CREEKSIDE PARK Invoice# Comment Tran Dt Inv Dt Due or Check D Pay Gross Discount 051222 05/13/20 05/12/20 06/10/20 17,833.51 0.00 UHC Q2 QIPP PMT 051222A 06/13/20. 05/12(2006/10/20 2,341.06 0.00 UHC MARCH QIPP PMT Vendor Totals Number Name Grass Discount 11832 BROADMOOR AT CREEKSIDE PARK 20,174.57 0.00 Report Summary Grand Totals: Gross Discount No -Pay 20,174.57 0.00 0.00 APPROVEo ON9 MAY 19 2022 AUDITO CAL OUN COUNTY. TEXAS No -Pay Net 0.00 17,833.51 0.00 2,341.06 No -Pay Net 0.00 20,174.57 Net 20,174.57 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.coin/u88125/data_51tmp_cw5report626022... 5/ 19/2022 Page 1 of I RECDBYC.OUN YAUDRORON - z 1 9 2022 MEMORIAL MEDICAL CENTER oMA 0 AP Open Invoice List CAL &N, COUNTY, 7gW ap_open_Invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11824 THE CRESCENT Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 050522 05//113/20 05/05/20 06/10/20 37,768.60 0.00 0.00 37,768.60 TRANSFER NI IV1Sl1 ivu W111dep)G' A iKA WiL Up&b--)1 051222 06/13/20 05/12/20 06/10/20 1,945.27 0.00 0.00 / 1,945.27 t/ UHC MARCH QIPP PMT 061222A - 05113120 05/12120 06/10/20 6,963.87 0.00 0.00 6,963.87 UHC 02 QIPP PMT Vendor Totals Number Name Gross Discount No -Pay Net 11824 THE CRESCENT 46.677.74 0.00 0.00 40,677.74 Report Summary Grand Totals: Gross Discount No -Pay Net 46.677.74 0.00 0.00 46,677.74 dAPPROit•EDON. MAY 19 2022 BY COUNTY. AUDITOR CALHOUN COUNTY• TEAS file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report416965... 5/19/2022 Page 1 of 1 RECEIWED BY TOE COTINTY AUDTTDR ON 4902329 2022 MEMORIAL MEDICAL CENTER 10:53 AP Open Invoice List 0 CAltiOUN COUNTY, TEXAS Dates Through: ap_open_invoice.template Vendor# Vendor Name Class Pay Code 11836 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 050522 05/13120. 05/06/20 06/10/20 14,529.06 0.00 0.00 ` 14,529.06 ✓ TRANSFER NN I RWI(P Ct- p8M+ Jepo6c+,j ik 6 Ml pjcer-+i h� 050622A 05/13/20 05/06/20 06 10120 82.48 0.00 0. 82.48 ✓ TRANSFER It it 050922 003/20 05109/20 06/10/20 6,877.10 0.00 0.00 6,677.10 TRANSFER 11 It 051022 05113/20. 05/10/20 06/10/20 62.677.30 0.00 0.00 62,677.30 TRANSFER 051222A 05/13/200511212006110/20 44,113,15 0.00 0.00 44,113.15 UHC 02 QIPP PMT 051222 05/13/20 05/13/20 06/10/20 3,918.68 0.00 0.00 3,918.68 UHC MAR QIPP PMT 051322 05/18/20 05/13/20 06/10/20 295.37 0.00 0.00 295.37 TRANSFER it Vendor Total: Number Name Gross Discount It No -Pay Net 11836 GOLDENCREEK HEALTHCARE 132,493.14 0.00 0.00 132,493,14 Report Summary Grand Totals: Gross Discount No -Pay Net 132,493.14 0.00 0.00 132,493.14 APPROVED ON MAY 19 2022 13Y COUNTY AUDITOR CALHOUN COUNTY, TF_XAS file:///C:/Users/ltrevinolepsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5repoil776223... 5/19/2022 Page 1 of 1 RECEIVED By THE COUNTY AUDITOR ON WWI 910122022 MEMORIAL MEDICAL CENTER 11:05 AP Open Invoice List 0 CALHOUNCOUNTY,TEXAS Dates Through: ap_open invoice.template Vendor# Vendor Name Class Pay Code 12696 GULF POINTE PLAZA Invoice# Comment Tmn Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 050522 05/113/20 05/05/20 06/10/20 13t9.75 0.00 0.00 139.75 TRANSFER NN IYlMQV1.1L12 (YA,,,+ a ;��! (K•R IAML 0v%M L' 051222 05/13/20 05112/20 06110120 1,725.45 0.00 0 1,725.45 UHC MAR OIPP PMT 051222A 05/13/20 05/12/20 06110/20 21,632.26 0.00 0.00 21,632.26 y� UHC 02 OIPP PMT 051222B 05/18/20. 05/12/2006110/20 4,673.36 0.00 0.00 4,673.36 TRANSFER it Lz 051322 05/18/20 05/13/20 06/10/20 9,413.98 0.00 0.00 9,413.98 TRANSFER it r Vendor Totals Number Name Gross Discount No -Pay Net 12696 GULF POINTE PLAZA 37,584.80 0.00 0,00 37,584.80 Report Summary Grand Totals: Gross Discount No -Pay Net 37,584.B0 0.00 0.00 37,584,80 APPROVED Old MAY 19 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS file:///C:/Userslltrevino/cpsilmemmed.cpsinet.com/u88l 25/data_5/tmp_gw5report371827... 5/ 19/2022 Page I of 1 RECEfVED BY THE COUNTY AUDITOR ON 05/19AA1 p 19 2022 MEMORIAL MEDICAL CENTER 0 11:06 AP Open Invoice List Dates Through: ap_open_involce.template VRAoR�e04SUMS Class Pay Code 13004 TUSCANY VILLAGE Invoice# Comment Tran Dt Inv Of Due of Check D Pay Gross Discount No -Pay Net 050522 05/13/20 05/05/20 06110/2011 9.947.00 0.00 0.00 9,947.00 TRANSFER WN 1hSofth,(. WtACV04i1 ((,, e1 L 14 iYau OpCo_+ 050522A 05/13/20 05/05/20 06/10/20 13,682.11 0.00 1.p.00 13,682,11 TRANSFER it 1 050622A 05/13/20 05/06/20 06/10/20 640.01 0.00 0.00 540,01 TRANSFER tt 1 050922A 05/13/20 05/09/20 06/10/20 51.45 0.00 0.00 51.45 TRANSFER It 11 050922 05/13/20 05/09/20 06/10/20 1,361.50 0.00 0.00 / 1.361.50 TRANSFER 1t It 051222 05/13/20 05/12/20 06110120. 3.459.72 0.00 0.00 3,459.72 UHC MAR QIPP PMT 05122A 05113/20 05/12120 06/10/20 20,547.70 0.00 0.00 20,547.70 UHC Q201PP PMI 051122A 05/17/20 05/11/20 06/10/20 622.37 0.00 0.00 522.37 TRANSFER k 11 1% 051322A 05/18/20 05/13/20 06/10/20 3.431.72 0.00 0.00 3,431.72 TRANFER tt /t 051322 05/18120. 05/13/20 06/10/20 22.50 0.00 0.00 22.50 TRANSFER It Vendor Total: Number Name t� Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 53,666.08 0.00 0.00 53,666.08 Report Summary Grand Totals: Gross Discount No -Pay Net 53,666.08 0.00 0.00 53,666.08 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report254767... 5/19/2022 Page I of 1 RECEIVED BY THE COUNTY AUDITOR ON %I�191n« Z022 MEMORIAL MEDICAL CENTER CAL118A COUNTY, TEXAS AP Open Invoice List 0 ap_open_invoice.lemplate Dates Through: Vendor# Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount 050522 0I�51/13/2005/0512006110/20 1,716.37 0,00 ,,I TRANSFER 1 i t altU, P�At J.Lpi0hi74 ea '14 N 1P'w oy'*+I%� 060622 05/13120 05/06/20 06110/20 5,515.11 0.00,JJ TRANSFER It it 050922 05/13/20 05/09/20 06/10/20 5,060AI 0.00 TRANSFER It 11 051022 05/13/20. 0511012006110/20 15,268.68 0,00 TRANSFER 11 tl 051122 05/17/20 05/11/20 06/10/20 37,540.37 0.00 TRANSFER it A 051222 05/18/2005/12/2006/10/20. 7,523.00 0.00 TRANSFER ut it 051322 05/18/20 05/13/20 06/10/20 1,593.86 0.00 TRANSFER h 1' Vendor Totals Number Name Gross Discount 12792 BETHANY SENIOR LIVING 74,217.80 0.00 Report Summary Grand Totals: Grass Discount No -Pay 74,217.80 0.00 0.00 APPROVED ON MAY JA 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS No -Pay Net 0.00 1,716.37 0.00 5,515.11 ✓ 0.00 5,060.41 ✓ 0.00 15,268.68 0.00 37,540.37 ✓ 0.00 7,523.00 0.00 1,593.86 V No -Pay Net 0.00 74,217.80 Net 74,217.80 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report332679... 5/19/2022 Memorial Medical Center Nursing Home UPL Weekly Can uTraolter Prosperity Accounts 5/23/2022 Pm ur Mwum 641 Itll Xu N.-h. wwd TarrnM lnnrlx.ln i i56,N1.Y 156.336e1 rfi.5n1.A w ,_ ".-11 113,982A3 ✓32a.910]6 103,a9166�/ WWWASWIp].01n.t]�6.SOfi.]0✓ 105ASa96 affiliffiffmEn 19Aw.0 ✓]9,Sw.el ar 63.609.Y ✓ RIMMENIM 245,115d15/145,169.61 ✓ 9g91<.66 , 46,544°7.' .I. 107,291,-6c .r 105,75u-kj4 aaeiAamx 62n609=44 90+974.66 413.171.47 NrlrWrprauxa nl x'rr5L0UM0permntlMrrCLpnrnurwlpnmlr NWe p: [aMa[ewnLMropmrpplmttp/SIw Mm MMCOrWYLHro4enr®una 1:\NN W nlryhan0m\NN VPL1nnYn SummLM10t3\MrV\XN OLinnrlN fYmm W 05.53]Ltln Mwvnryu 1r In whrM 1r Xurrina a6fiw.15 Oankfal. 46.659.75 varuna UN.MeahnW Iw.w .pmin4lw U.01-/ Mry Mhrrn IPnl mensa / Aelwum.naRmwhrnma Y,w.l! a/ - 1olAoa.a1 // ID],391.66 1ank0dan4 IwAw.31 Varlanra IaiW In eilmu low Apmmuml IL66./ MLVlnlarnl Inntln{xRl Adlw{9ahmeRnn.lerpm{ 103,a9L66 I05.maAI / 10SA50.96 Bankft.W r 105,953.01 ✓ VaXarw 4rveM BLNnn INA, APmin{aaan 107 1` rmylnrrm JunHnleltll Aeima W.nnRrmtlNAml 109,]SO.M B3,]163 fi$,509,66 Bmk Wan4 61.7106s Vniana 4rveM atlm[e lw.w A1010 411 5.19 f mlpn{eren lunr W.unt A61urt Bahntt/fonmerAml 646w.Y ✓ SIAN 55 Bank Bahnre 91,ON 96 ✓ Varlanrr �iPPROM ON 4minatlama wB.aB Mellnnelpp AMXEmvPGIPP MAY 2 3 20'22 ByCOUNTY A OR Apoilru Mt N, / CALNOUN COUNTY M.yl..I.W n 1. t 3ununlub{ a6iun BalanYRranflerAml �•! 90,9]A66 TOTuIRAII1r185 w,vl.0 C Approved: C,J� �� '431'lkh5 ROSNANOATNO ,INTERIM CEO SJ33/20I3 n3 S/16/i0]] UXf fCMMUXNYPIHCCWMGAI]1699M119tKW 5/I6I19}i UNC[DMMUXIIYPI N[f111MPMI MpW]11191W W 5/IY= NPAIIN NMIMNSVGKKLWMpM]ommIl130M] 5/1]/]O>] UNCOWMUNTPiMRWMPMrySK9N11910MA 5/,Wlm] UHCmMMUNMK=UHW`M1T190W "Ig0C0 OQ SARI UHCHMTH UMANS HO M]MIGMOGtlSA12 $119/2022 WIREO HUMANSVCNCMIMPMTI)4TERVID 3W5 } 5/19IM22 WIMOroupM0ROXF ImPw3nm7s2MD 5119IM22 Am6HAl0Yp N6CNCCIAI MPMTB001)5361110i3 5/19/z022 HOVNASSOIIIIION M[[IAMPMT 6151}lg2NOp139 5/IM/20}2 540/$II72 UeCOO UNC[OMMUNNY P2 HCCIAIMPMT7490034119100W 5/N/]WT YMp(XMGLIXGREN[MIMPMT)410J161111Q31 M16/]W2 HYMANAIR Aul MX AIWAAT 1M616341HARO C6S 5/t2/1M5 NYMANAfNApI58 MCMIMPMT 59M6149000]1156 IUIS WHpe SAR 14002 H UMAN A }0NV(MCATWMMpMpIMlAN6CLLMtG1E1C1E4N30E1NgW]5I1Wp 1291 5 1181202HEALTH HUMAN WI $1192022 5/19/IOII HNM-EpV NMIMFMT746DD3t114u ODI4907 5/30/2022 CN3W 5/29/ID22 NM9-ECHO HKUIMPCC 146W3411MM1191M 563.34 50l,M 512012002 UNCCOMMUNM PLNC IMFWTT)43S7411910W0 - IDS.B - 5/30/]021 NOVRAS SDIMDN NCMIMPMI M635]42P:W125 - .� fi5259.64 / - 65159u 1 "0.16/ W).291.66 . rU166 N't N T.Mftm.I (UPP/COmpt QIPP/CAmp2 S!/Gnp) EUM/C-Pulug ORIN YHtOXHON - lZlu - 223,12 31]9J 3,8 62 .9109 - 131I.0 - 1,191.0 181.11 112.11 - 1915]S) 13.097.5 - 101)51 2.01151 1.41I50 2A11.50 205.274.19 • 16,350,34 - 16.350.51 2.22GS1 - zu91 5/16/W32 NNO.FM0NKWMPMFA6WAl1 MWW3]Mt0 -- 5/I6/2022 NNNOq.146W341444COW1 5/CtOMMUn MCCW9t00Wp13113)19l4lDO W /161 WNAHMWAW1669K0425 6/I61OU ARIP MCWMPMA Z4314 120 HECHOflEQAI HI1440=3)6415 $117130 2 xUMANACA 0158 HCOUIMPMT390861 G2W W1I56 5/31/22 UNCOO 5/11/n2022 UNCCOMMUHR/PL NCCUIMPMT )4W034[1910W0 5/16/2022 HEAIMHHMRNIV4.NOUAIMP MTI)1100983324 3 S/18/2022 OEVOTEDHEILTMPNCNUMPMT 111IMSH33i433 5/LWMZ DEVOTED HGITNPNCMIMPMt 12I14W9633H1f 5/19/202Z WgEOUifMNE%HFALMGRFCENTFRS qI SIM/IW2 OHCCWMPMi)/6W311241WWN960) 5/20/2022 CK240 CHNO SM/2022 UNCMM WTIOPLMMIMPMF)66a42 12W 5/IO/I012 NOVILRSSOWIIOHNC[ULIMPMi 6)63236]000pISS wti 5117/2022 NEplTN XYMANSYCNC<UIMPMZ I]IfiW3/{130063 5/18/2022 04pMN 19/2U23 51XENMNUMAN SVCHCMIMIMT]TI6W31113W61 5/19/2022 WARP SUPpImnE)t HKWMARE CTN W34111M394 5/10/2022 WIRE DUTGNIER HEALTHCARE KHTERSIII $12012022 NOVHAf SOlI1T0NNKIA MPMT 6>566312WDp136 S/20/2022 (111112 5/20/2025 AORTAS HKWMPMT 615663 g20pOp125 5/I6/2032 UHCCOMMUNHYPLHCCIAIMPMT)45010{11916000 5116AP22 CIONA MKWMPMT 3/9i143]499100W11B}lSII 5/11/2W2 NN/doll HCCW MPMT 149W31/1MW W31W5 5/17/2022 HNO-EMO HCMIMPMTbW0MILI A4W WP6665 5/3)/MZz UHCCQMpUNMPLC CWMS31MMG48111/W SAVIo 2 UNCCOMMUNIIYPI X[CWMPMTN6W34119100W 5AE/3022 OARARI MOUNT 5/18/29U UHCCO MUMVCLHCKW2PM1494=34113W 5/19/2022 WIRE OMMUNItt P3NKWMRE CENTERS IR IWW 5/19/2Wi MR6OHT.ITXk FAIMGREKNIER3111 S/11M22 MANAGE9d NIHOCIAIMPMTPN149)14325903W S/19/2022 MANA9EANOHMHC MPMN1WOCOYOOO4044 41 5/19/2022 UPIt46H6411hGn NCCWMPMT iAfiWM31124381 5/30/2022 1AICCO S(2012022 UOVffAd MUWONH CCWMPMT)Ib00361CODM 5/30/3922 IIVWNAOAOIONHUC IIMPMT6)E31D430000135 5/30/3Ui2 HUMAN=oA015000CIAIMPMT 390063/38 WI3Z6 S/30/NIII C2NA HCMIMPMY 349119335991W Wt31Mi1) / J 2 / ZS6J21J2 ILlM.>3 ug 2190.39 - 65NJ! MMCPQRom L1.1coNpi Tra.0,4"I YnuGMp NFP(CpmpZ QIPP/Cpmp QIPP/comp lopm QIPPN NHpORNON • ISAI - 1,%S.W - ISW 621.63 9,3W.W 1913 623.61 1W11.61 - L915.R0 - 6"As 16,014.01 - 9.0135 - 616.fi5 15.44101 1,364.13 l,]W,33 MMCPOMIOH TiJ.fA1,Ot T • MPP/Cpnpl qMP/�pa qIM/omAoi SHIP 1/f pG wpPN HN P00.NON - 59J7 162.53 - 50.91 - 314.91 l6252 - 4901),W - 324.91 MAW - 10.119.11 389.00 - 2,32S.W 10,13631 - S.44SWI - 2.315,00 9W{.W 1 5,40.01 6,)DA,50 3,501W - LMOO 6,10.6D • 4•M'W I.M.W uD,ezl.e: - 4p00W - 5.00219- 6COKES- 5,60119 - 29F6D.1fi - IS,16R)6 - 946.9t6'!0 1 I / 6[.fu1.N .l _ 29I04.99 MMCPOMON T8ON1,00 TN. . OIPP/C...l OIIPPtOmm . QIPP(Gmp9 NIP/C01p11Y Ml T NNPOM1ON ),336)6 - ).334J6 399.31 USE"- 359.33 1.556W KISSER 4,947.11 304"a J 36 W.6 ]9,593.01 61109.N 6 E09:14 MMCPORNON a}� d bi k Tnn]IeNn NPP/Gmp] NPP/1anp3 NW/Camp NP!/CPmpt916p] IN NHPDRNON 0.52 - 0.52 1,200.00 - 1.3W.00 3,33i39 - 31821" 7,634.93 1,63418 - L18S.74 IJ65.74 - 1,39LS0 IS92.50 - U9,00 39400 - 5.920.50 - 5,92D,50 2,335.90 190.62640 - - 453.83 - 453.13 - 6,651.99 - S'Wl193 - 6.930.0 14,M3.ol - - - 4,749.30 - 4.749.30 /36,444.91 36,444,91 5AIDJ1 5,423.91 I0TAL5 7WM,50 413.173.43 413.171.43 5123/2022 Quick View Select Quick View Accounts Accouni Number t Name Account Type Treasury Center Select Group Groups Adtl Group IUUA Data reported as I May 23 202 Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7.013,284.31 $7.403,236.38 $7,013,204.31 $6,610,868.E '4551 CAL CO INDIGENT HEALTHCARE $59,788.07 $59,788.07 $59,788.07 $59,788.0 '4454 MEMORIAL MEDICAL NH GOLDENN CREEK S10191644 5143,641.46 $101,916.44 599.650.E HEALTHCARE '4365 MEMORIAL MEDICAL CENTER •CLINIC SERIES $536.33 5536.33 S536.33 5536.2 2014 '4357 MEMORIAL MEDICAL CENTER -OPERATING $6,108,582.55 $5,234.072.36 S5,108,582.55 54,841,890.E '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.76 5431.76 $431.76 5431.7 WAIVER CLEARING •4381 MEMORIAL MEDICAL $46.659.75 ✓ 549,305.32 $46.669.75 $95,522.0 CENTER I NH ASHFORD '4403 MEMORIAL MEDICAL $107,403.32 ✓ CENTER / NH 5108,761.09 S107,403.32 $56,916.1 BROADMOOR •4411 MEMORIALMEDICAL $105,863.01 % $115.423.84 5105,863.01 $53.182.1. CENTER I NH CRESCENT '4446 MEMORIAL MEDICAL $62.714.63 ✓ $74.94BA7 $62,714.63 549,662.2 CENTER l NH FORT BEND '4438 MEMORIAL MEDICAL CENTER lSOLERA AT $91,088.56 $96,288.13 $91.088.56 554,314.2 WEST HOUSTON '2998 MMC-MONEY MARKET FUND $1,110.243.27 51,110,243.27 $1.110,243.27 $1,110,243,2 'S508 MMC-NHBETHANY SENIOR LIVING 5138,178.77 5242,287.36 5138,178,77 $114,714.E '5441 MMC -NH GULF POINTE PLAZA- $31.587.56 $119,084,12 $31.587.56 $22,667.2 MEDICAREIMEDICAID 'S433 MMC-NH GULF POINTE $5,794.61 $5,928.12 $5,794,61 $5,726.E PLAZA -PRIVATE PAY '3407 MMC-NH TUSCANY $42,495,68 $42.495.68 542,495.68 $45.622.2 VILLAGE https:llprosperity.olbanking.comionlineMessenger 1l1 Memorial Medical Center Nursing Home UPL Weekly Nexion Transfer Prosperity Accounts 5/23/2022 P-WOue Isount Be91'"'Im 101,909.BB NO. «nryb.mn-ro{avers$WO.0tbe N.Mf ...am thenu«fn9home. NON 2.Posh p[-unt h.s a boas beNn-ofsl00 that MMCdep IWNopen a«ounh APPROVED ON MAY 2 3 2022 BY COUNTY AUD'r j- ' CALHOUN COUNT-1''I TE'A:# P.M[, T-d-VO&91nnin9 MOM N ee T-M"Nd to Nunn, l0_Nntib gala.- u Bank Bolan- 101,916.ss Vartan- - 1-voln Mlen- 100A0 ApNlln"'M 1T36 ✓ M.".teren 1.n.lnt«-t MAe' Aalu#Belantt/Tnnel«xmt 101>>NAB. J � p.�� ` Pp-ve N09NANOATMOMr3,INTENM CEO 9�23/20A 1\NN Weekly TtamO—%NH uPMann«summeM3013tMaY\NN BPLTranE« 9ummeN 05.19.22.ab. MMCm.. OIPP/COmp9 1 IR9i�TJ Il9p5ftfJp QIPp/(pmpt 41pp(lamp2 ypp/CpTp3 W ! O NXPoR1fOX Y943.93 ;043.93 1l•60&0] 11.608W ' 6351&31 e1.9 0a1 3.61 1,I67.0 3,361.0] 15.09 ]5.99 1&]03-0p 1.493'0 IAIS 00 OAS 0.06 - 5,169.&1 1165.65 u]lL]! lotne.6y — o neu S/16/IOSS MNLIWON(LAIm )W0dX4 00M3bSID ' 5(I)/5031 NN&- ECHO NRIAIMFMI)K00321440000 NIS 5/10/1011 O ,0t 5/I0110R TS)ySMNSIIW BXM SRM5 S056645556)691]9 5/16/SOSS HNB.Fg10NCMIMPIM )<6WBOIIM[WOSS)L99 AE]NMNXION MIMf1566UMENC100001t9i1 5119/n31 S/19/SOSS WIREOY)NSYION HFASTNAT 40WFN fAFFN S/19/2022 NSi1BSTBKC05SlM HNS-E 5/n/SOSS XNB-ECHO NCl]AIMPMf)46W3CIlMD]pJ349635 .1155 2499 5/10/3011 HN0ECHO NCCUIMPAR )460034114pWpp3Bi450 5/23/2022 Quick View Select Quick View Accounts Account Number I Name Account Type IF Sea ch All DDA Account Number Current Balance Number of Accounts: 15 $7,013,284.31 '4651 CAL CO INDIGENT $59,788.07 HEALTHCARE 454 MEMORIAL MEDICAL / $101.916.44 NH GOLDEN CREEK HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.33 2014 '4357 MEMORIAL MEDICAL S5,108,582.55 CENTER - OPERATING '4 73 MEMORIAL MEDICAL 5431.76 CENTER - PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL $46,659,75 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL $107,403,32 CENTER/NH BROADMOOR '4411 MEMORIAL MEDICAL $105,863.01 CENTER/NH CRESCENT •4446 MEMORIAL MEDICAL S62.714.63 CENTER INH FORT BEND '4438 MEMORIAL MEDICAL Sg1,088.56 CENTER I SOLERA AT WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,243.27 FUND '5506 MMC-NH BETHANY S138,178.77 SENIOR LIVING '5441 MMC -NH GULF POINTE S31,587.56 PLAZA - MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE S5,794.61 PLAZA -PRIVATE PAY '3407 MMC -NH TUSCANY $42,495.68 VILLAGE https:ltprosperity.alba nking.comtonlinaMessenger Treasury Center Select Group Groups Add Group Data reported as of May 23. 202; Available Balance Collected Balance Prior Day Balanc $7,403,235.38 $7.013,284.31 $6,610,868.8 $59.788.07 $59.786.07 $59,788.0 $143,641.46 S101,916.44 S99,650.E S536.33 S536.33 S536.' S5,234,072.36 S5,108,582.55 S4,841,890.6 S431.76 S431.76 $431.7 S49,305.32 $46,659.75 $95522.0 $108,761.09 $107,403.32 $56.916.1 $115.423.84 S105,863.01 $53,182.1 S74.948.47 S62,714.63 $49,662.? $95.288.13 $91,088.56 S54.314.2 S1,110,243.27 $1,110,243.27 S1,110,243.2 $242.287.36 S138,178.77 $114.71,1 $119,084.12 $31,687.56 S22,667.' $5.928.12 $5,794.61 $5,726.° $42.495.68 $42,495.68 S45,622,2 r V1 Memorial Medical Canter Nursing Home UPh Weekly HMG Transfer Prosperity ACCounrs 5/23/2022 he'" >maw,twN P[taunl Be6lnnln6 PeMIN TnMemtlle Xunln Nam XYmhar NNnn .T lmla ut Tnmpnn [Ltle[M t T fae lm efWn NUMn Mnme Mp9£93 f.fi9].lk S.19161 6r693,2$ Nnk Nlmw k.]9461 V>Xtnw L.W1NNnn Jesse Pyltllnnwp E.36 M' MWInY1nN luminleml 0.liwl Nlarrte/Trmnwpmt f.6921f Ir[vbu. YwentwN P[wwt NruWn( v.ndM6 Tnnnnr.tlw Huhn Name "^— - NWn in NnWt TnmNl.ln tlu OenM N N TeL fN LW N n uM Nmme 9_N _ e' 6.$n.)] k,WS.I] 31.OB.p1 31,3g56 31fE.91 Nnk NNMe E,p6156 Vnienn Nan: Cnlr baMce3Yl ow $S,me nwer 9rmfrNrN 9p Me numnp hwne. N011 ]. fa(11awaMf Inf nNn6OlannOf$IMIM1atMMClfpaN(60waLMO([MM1r P9r'rr9O EI)Qltl MAY 2 3 2022 C�COUNTY ODUN Cp NTTY,, TEXAS W.In NNn[r low AW H.. 9,M 1lnitrunR lum nrt Aceuft NltMdTlmthrNnt TN]NTMNf]Eflf ((//1V1/ R03NNIWTN �IP6113rEXIMrEO 9l>I/aW2 r�Vm WtNNTan1fm1NX XrurwaaSN SrQUIWAAN uFunn.rn J-1101312Jn :a...-, a r. 5/16/2022 HNB-ECHO HCCIAIMPMT]44003411"(XXXI29511 $11012022 HN6-ECHOHCCWIMPMTT4SW3411440XKO29S10 5/16/2022 HUM4N41NSCOHCCWMPMT6249B2630000301135 5/16/2022 HUPMNACHAOIS6 NCOAIMPMT6249924)000016Pi UL7/1022 HUMANACHAOISR HCCIAIMPMT6249R14200a0113] 5/19/2022 WIREOUTHM65EHVICE5,0. $11912022 HN6-ECHONCCIAIMPMT7N 1411411)000349919 5/20/2022 PNOECHOHUOIMPMT7460034114100012T093592 q .,..Zcen3P-- ... - 5/14/2022 XNB-ECHO HCCWmPMT)46003411MW00229310 5/16/2011 NNO-ECHO HCCCAMPMT 74GW3411 M0pW229511 5/19/1P31 w"lit 5/18/2022 MEACXANTBANKO QFPOST49M)6$16BN 9100001 5119/2022 WIRE OUTNMGSERmCIS,QC 3tlWM22 MEfi0lA 8JWKCOOEPO5x494O6S1984991000p1 5/19/2011 HNB-ECHO HCCIIaMPMT 746003411 00000249760 5/E0/SOII XHfi•ECXO N[CWMPMT )46003911 MOOOO1B345B Mmcroanox QIPp/C p QIPPica 0 h4QiI5Pe93 TnnMeM^ QIPPlca ll 3 QIPPIQp P3 JIUM QIPPT "PORTION 34]0 - 34.30 111.54 121.39 1.290.14 I.290.M 3,193.74 - 3.03.74 370M 310.00 0,495.92 • U446 124.36 66.03 68.03 / 1 M,495.9E / S,fi92.25 S 692.25 MMCPOBTON QIPP/Camp QIPP/Camp! uM1r0u5 TwIfetl QIPP/UMPS 2 gIPP/Camp9 &LepR QIPPT NN PORTION =As - NBAB 4,052.01 - 61053.01 12,395.07 - S2d36.0] - 1.91LOD 1,915.00 6.465.1i • 250.00 - 25000 1.06.09 - 1,636.09 - 9.920.26 - 0.920.26 _ 4A6542.1 31A14.91 314]89 __ 52,961.04 37171.16 i 1)L 6 5/23/2022 Quick View Select Quick View Accounts Account Number I Name Account Type Senrch All DDA Account Number Current Balance Number of Accounts: 15 $7,013,284.31 '4551 CAL CO INDIGENT $59.788.07 HEALTHCARE '4454 MEMORIAL MEDICAL / $101,916.44 NH GOLDEN CREEK HEALTHCARE '4365 MEMORIAL MEDICAL $536.33 CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL S5.108,582.55 CENTER -OPERATING '4373 MEMORIAL MEDICAL $431.76 CENTER - PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL $46,659.75 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL $107.403.32 CENTER/NH BROADMOOR '4411 MEMORIAL MEDICAL $105.863.01 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $62,714.63 CENTER INH FORT BEND '443 MEMORIAL MEDICAL $91,088.56 CENTER ISOLERA AT WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,243.27 FUND '5506 MMC -NH BETHANY $138,178.77 SENIOR LIVING '5441 MMC -NH GULF POINTE / $31,58T56 ✓ PLAZA - MEDICARE/MEDICAID •5433 MMC -NH GULF POINTE S5.794.51 ✓ PLAZA -PRIVATE PAY '3407 MMC -NH TUSCANY S42,495.68 VILLAGE hltps:Ilprosperity.olban king.comfonllneMessenger Treasury Center Select Group Groups Add Group Data reported as of May 23. 202; Available Balance Collected Balance Prior Day Balanc $7,403,235.38 $7,013,284.31 $6,610,868.8 $5%788.07 $59.788,07 S59,788.0 S143.641.46 5101,916.44 $99,650.E S536.33 S536.33 S536.2 S5,234,072.36 65,108,582.55 54,841,890.E $431.76 S431.76 $431.7 S49,305.32 $46.659.75 S95,522.0 $108.761.09 $107,403.32 $56.916.1 $115,423.84 S105,863.01 S53.182A S74.948.47 $62,714.63 $49,662.2 S96,288.13 S91,088.56 $54.314.2 S1,110,243.27 S1,110,243.27 S1.110,243.2 S242,287.36 S138,178.77 $114.714 c $119.084.12 S31,587.56 $22,667.3 S5,928.12 $5.794.61 $5,726 E $42.495.68 $42,495.68 S45,6228 r tl1 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity Accounts 5/23/2022 a.wum v..rier. Gn16.hnw 42.49168 w.u�a �..enan.n<• to.. mnwnswer n.Ml.nreso ",m Mn' InA 1 t 962v Note:Onrybvlalunolr.�+S;eCdwiabrfruvinMmMrnunWeeame 4-�� / / Nefr]: EcxhottpmrAvraEa.e6alen[re(SIMIAeIMMCPrytti(rJrvopm e[[eunc aO6NRNW1NOMlf, JM¢C E APPROVED ON 2 3 2022 BY COUNTY AUDITOR CALNITiN i;UNTY, TEXAS h 5/I72022 Molina HC 4f7%HCCLAIMPMTPN12757178944200 5/18/2022 Deposit 5/19/2022 WIRE OUT LINEAR ENTERPRISES, LLC 5/19/2022 HNB-ECHO HCCLAIMPMT 746009411440000249768 5/20/2022 CK1101 5/20/2022 Molina HC of TX HCCLAIMPMT PN1275717394 4200 5/20/2022 KS PLAN AOMINIST HCCLAIMPMT 179111000OZ1933 520/2022 NOVITAS SOLUTION HCCLAIMPMT 676201420000125 MMC PORTION 41PP/Comp QIPP/Camp QIPP/Comp Transfer -Out Tnnsfer-In 1 QIPP/CompZ 3 4&Upse QIPPTI NHPORTION - 4,013.54 - 4,013.59 - 20,717.56 - 20,717.56 48,776.61 - - 3,011.85 - 3.011.85 17,779.38 - 31511.89 - 3,511.89 - 10,965.54 10,965.54 - 175.26 175.26 5/23/2022 Quick View Select Quick View Accounts Account Numbed Name Account Type Senrrh All DDA Account Number Current Balance Number of Accounts: 15 $7,013,284.31 '4551 CAL CO INDIGENT $59,78B4O7 HEALTHCARE •4454 MEMORIAL MEDICAL / NH GOLDEN CREEK 81D1,916.44 HEALTHCARE •4365 MEMORIAL MEDICAL CENTER- CLINIC SERIES $536.33 2014 •43 7 MEMORIAL MEDICAL S5.108,582.55 CENTER -OPERATING •4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.76 WAIVER CLEARING '4381 MEMORIAL MEDICAL $46,659,75 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $107.403.32 BROADMOOR '4411 MEMORIAL MEDICAL $105.863.01 CENTER/NH CRESCENT •4446 MEMORIAL MEDICAL $62,714.63 CENTER/NH FORT BEND '443B MEMORIAL MEDICAL 591.088.56 CENTER I SOLERA AT WEST HOUSTON '2998 MMC-MONEY MARKET $1.110,243.27 FUND '6506 MMC -NH BETHANY $136,178.77 SENIOR LIVING '5441 MMC -NH GULF POINTE $31.587.55 PLAZA - MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE $5,794.61 PLAZA -PRIVATE PAY '3407 MMC •NH TUSCANY S42.495.68 ✓ VILLAGE hltps:l/prosperity.olbankln9.comlonllneMessenger Treasury Center Select Group Groups Add Group Data reported as of May 23, 202; Available Balance Collected Balance Prior Day Belem: $7,403,235.38 $7,013,284.31 $6,610,868.2 $59,788.07 659.788.07 $59,788.0 5143,641A6 S101,916.44 $99,650.6 $636,33 $536.33 $5362 S5.234,072.36 S5,108,582.55 54,841,890.E $431.76 $431.76 S431.7 $49,305.32 $46.659.75 $95.522.0 S108,761.09 S107,403.32 $56,916.1 $115.423,84 S105,863.01 $53,182.1 $74,948.47 $62,714.&1 $49,6622 $96,288.13 $91,088.56 $54,314.2 S1,110,243.27 $1,110,243.27 S1,110,2432 S242,287.36 S138,178.77 $114,714,5 $119,084.12 S31.587.56 S22.667.: S5,928.12 $5,794.61 $5,726.: S42,495.68 S42,495.68 $45.622.: 1/1 Memorial Medical Center Nursing Home UPL Weekly HSLTrans(er Prosperity Accounts 5/23/2022 Nmunt lL Pr..lnn, Narn: W b.lemo f.S =.1h. N0n11—d.Mewn,np home Note L COm U. fll hM vEvl.Evlan<e 0SIN In"MMCCmmud b 1P0v..0in1. APPROVED ON MAY 2 3 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS 19ntlN1 M.An .P..monml rad.✓ d I gmvunt[v Be Tnnsbmdb M 111.1,41, • 053.18 lu,ne.n WmIn..nn tmrein &Ib.. 1110.W J APAWnrOl 11.59 ✓/ M.rmbn mn.lmm.t Atllm[Nlnx nmin t _ .vsl.la Ann - L� 2Jh aOfWryp0. 0 INIFNM QO 5/al/3oa2 1:wx w..sH mntrnwx ur1 r..nnx smnm. M:avwl.vwx u n annm s.mm.rvas.-» a1,en MMCPORnON TJDI:EC TNna/erA QIlP/Compl glw/Cemp3 ww/Comw DIPP/Cpmp6iu P. QIIPPn I "FORMON 1,5ss.00 w IMP,) 5.925.10 x,<9G10 5.5.0 Oool.s020x.0o ' 1RLa9mcas 1ol,voe.ds IOB,)16,16 - _ .. sn612 REryn Dy N sdcRO2] Oall 5/16/IDES HN9-EOp HCCWMPM 7lW3<11G60000xH510 s/17120u O.pe%I' 5/19/2013 D.Pwt 5/19/2011 MIRE OUTBETHPNV SENIOR LIVING, LfD 5120/2022 Da N ll 31.SR3s5 5/N/2011 DIP.., 1919.66 - 0,SU,95 Sb.IR I1605LLL 1919,65 119 D91.L 5/2312022 Quick View Select Quick View Accounts Account Number / Name Account Type Account Number Current Balance Number of Accounts: 15 $7.013.284.31 '4551 CAL CO INDIGENT $59,788.07 HEALTHCARE '4454 MEMORIAL MEDICAL / H S101.916.44 N GOLDEN CREEK HEALTHCARE •4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL CENTER I NH ASHFORD '440 MEMORIAL MEDICAL CENTERINH BROADMOOR '4411 MEMORIAL MEDICAL CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL CENTER NH FORT BEND '4438 MEMORIAL MEDICAL CENTER I SOLERA AT WEST HOUSTON '2998 MMC-MONEY MARKET FUND •5506 MMC -NH BETHANY SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA - MEDICAREIMEDICAID -5433 MMC -NH GULF POINTE PLAZA - PRIVATE PAY •3407 MMC -NH TUSCANY VILLAGE https:l/prosperlty.olbanking.com/onllneMessenger $536.33 55,108,582.55 5431.76 546,559.75 $107.403.32 $105.863.01 $62.714.63 591.088.56 $1,110,24327 5138,178.77 531.51IT56 $6,794.61 $42,495.68 Treasury Center Select Group Groups Adtl Group Available Balance $7,403,235.38 $59,768.07 5143,641.46 5536.33 55,234,072.36 5431.76 $49,305.32 $108,761.09 $115,423.84 $74,948.47 $96,288,13 $1,110,243.27 5242.287.36 $119,084.12 $5,928,12 $42.495.68 Data Collected Balance $7,013,284.31 $59,788.07 5101,916.44 $536.33 55,108,582.55 5431.76 $46,659.75 5107,403.32 5105,863.01 $62.714.63 S91,088.56 $1,110.243.27 $138,178.77 531,587.56 $5,794.61 $42,495.68 as of May 21 '202: Prior Day Balanc $6,610,868.6 $59,788.0 599,650.E 5536.2 $4,841,890.E 54317 $95,522,1 $56.916.1 $63,182.1 $49.662.3 $54.314.2 51,110,243.2 $114.71A S22,667.2 $5,726.E S45,622.2 t 1l1 U W 1A lA W W to W W W W W W W xn c xn xn xn xn xn xn xn xn xa xn xn nm arc �c ac ac ac ac ac ac ac ac ac ac ac or r ar ar Ar Ar Ar Ar Ar Ar Ar ppr Ar Ar -a O^ O "� O "`� v '^ m �n �n gn �n gn gn gn fn fE y 'y0y y0 y0 y0 y0 y0 y0 y O y O y0 O y0 y O -t AF/ AUai H AH AN Ay Ay Ati m mmy Ay N Aram Aw n m m m m m m m m m m m x r r r r r r r r r r r r r r r r r r r r r r r r r r n n n n n n n n n n n n n o 0 0 0 0 0 0 0 0 o O o o n W w w w IPJ IPi W W w W w w w N T P a P P Obi P P T T Obi T P a A A A A A A A W W W W A NA b W O t W b w b m b w b w D r r D r D r a r D r a r D D r D r a r D r D r c r AO O A O AO .b AO A AO AO AO AO Av b0 Nn n �n yn y Nn y� n 51 yn �n yn �n yn �n rn3 y� w3 v`i3 y3 w3 y3 3 rn3 m� c� a ca ca_ ca ca ca ca ca ca ca ca c� Ha Z r r r r r r r r r r r r 0 0 0 0 0 0 0 0 0 0 0 p p o m A A m A m A m A M A m A m A n A m A m A m A m A b n A O IJ U P O] J J N A P W 6 W W J P O in o 0 0 N O O O r N N p 6 2 ax ax <�'^ <m a m0 m0 � -Ai -Al w a a n a n a O O 0 0 �v O c P 3 W N I O C 3 O C 3 aWc a�c nnr nnr zox Z0 ° n°n n°n mom v W+m0 a bm Nm0 a m vA oA a J W n c 0 �3 l7 0 w b n c-1 Z -c-1 wro -ci Z m Z m a r -I a -zz N ry -O D n na O C r A cn s s m 0 z O O O N O N N N m m m P P P P P P P P P P P W U U U U U n P P P P P p. 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I CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME IN GOOD CON ON AND REQUEST THE COUNTY TREASURER TO PAY THE ABOVE GATION. BY: 5/25/2022 m O ""' 3.7 D 0. ?'S ;;w O J ca DEPARTMENT HEAD DATE ©IHS Issued 05/18/22 Source Description Source Totals Report Calhoun Indigent Health Care Batch Dates 05/01/2022 through 05/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Amount Billed Amount Paid 01 Physician Services 2,435.00 242.10 02 Prescription Drugs 59.88 59.88 08 Rural Health Clinics 911.00 775.25 14 Mmc - Hospital Outpatient 5,096.00 2,215.64 15 Mmc - Er Bills 10,332.00 4,649.40 Expenditures 18,863.88 7.972.27 Reimb/Adjustments . _. -30.00 -30.00 Grand Total 18,833.88 7,942.27 Expenses 4,166.67 12,108.94 Copays <50.00> 12,058.94 Medicaid Reimbursements <0.00> 12,058.94 Total 12,058.94 APPROVED ON MAY 18 2022 Pv CA PJ!is"t4:,r, ,,;Pf'Y P A Y MEMORIAL MEDICAL CENTER Ecoi,.1 CHECK REQUEST CALHOUN COUNTY INDIGENT ACCOUNT Date Requested: 5/5/2022 FOR ACCT. USE ONLY imprest Cash E APPROVEDOI� ❑A/PCheck Mail Check to Vendor MAY 12 2022 (` } Return Check to Dept BY COUNTY AUDITOR AMOUNT $50.00 mjio�jy pRM] W§0240000 EXPLANATION: TO TRANSFER INDIGENT CO -PAYS FROM OPERATING ACCOUNT TO THE INDIGENT REQUESTED BY: MAYRA MARTINEZ AUTHORIZED BY: — APPROVED ON MAY 16 ZN2 BY CALHOUN COUNTY AUDITOR RUN DATE: 05/05/22 MEMORIAL MEDICAL CENTER PAGE 127 ME: 15:34 RECEIPTS FROM 04/01/22 TO 04/30/22 RCMRSP Gib RECEIPT PAY CASE RECEIPT DISC COLL GL CASH NUMBER DATE NUMBER TYPE PAYER AMOUNT AMOUNT NUMBER NAME DATE INIT COGS ACCOUNT 50240.000 04/08/22 623497 CA 10.00 10.00 00/00/00 DJM 2 50240.000 04/07/22 623312 CA. 10.00 10.00 00/00/00 RAH 2 50240.000 04/13/22 623903 CA 10.00 10.00 00/00/00 PLB 2 50240.000 04/26/22 625203 CA 10.00 10.00 00/00/00 PLB 2 50240.000 04/27/22 625465 CA 10.00 10.00 00/00/00 PLB 2 "TOM" 50240.000 COUNTY INDIGENT COPAYS 50.00 M E M O RIAL MEDICAL �� CENTER Bill To: Calhoun County 815 N. Virginia St. Pon Lavaca, Texas 77979 (361) 552-6713 Date: 5/5/2022 Invoice # 369 For: Apr-22 DESCRIPTION AMOUNT Funds to cover indigent program operating expenses. $ 4,166.67 An hony Richardson Interim CFO Total $ 4,166.67 MAY t u 2022 untyAudit®r K > ` PROSPERITY BANK® Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13266 4/30/2022 "'""4551 Page 1 of 2 -.. STATEMENT SUMMARY Public Fund Contractual Ckg w Int-Account No •", 4551 i 3 Deposits/Other Credits + $47,305.44 1 Checks/Other Debits - $61.75 04/30/2022 Ending Balance 30 Days in Statement Period $52,697.70 Total Enclosures 3 �DEPOSITSIOTHER CREDITS Date Description Amount 04/08/2022 Deposit $47,220.31 ✓ 04/26/2072 Deposit $80.00 04/30/2022 Accr Earning Pymt Added to Account $5.13 / CHECKS Check Number Date Amount 12522 04-01 $61.75 DAILY ENDING BALANCE 'J Date Balance 04-01 $5,392.26 04-08 $52,612.57 Date Balance 04-26 $52,692.57 04-30 $52,697.70 EARNINGS SUMMARY, Below is an itemization of the Earnings paid this period. " Interest Paid This Period $5.13 Annual Percentage Yield Earned 0.15 % Interest Paid YTD $8.05 Days in Earnings Period 30 Earnings Balance $41,607.83 MEMBER FDIC10%- L= It0N NYSE Symbol "PB" January February March April May June July August September October November December YTD Calhoun County Indigent Care Patient Caseload 2022 Approved Denied Removed Active Pending 1 0 0 7 5 1 0 1 7 4 0 0 0 7 6 0 1 0 7 3 Monthly Avg 1 0 December 2021 Active 6 Number of Charity patients Number of Charity patients below 50% FPL 0 7 5 198 85(�b� Calhoun County Pharmacy Assistance Patient Caseload 2022 January February March April May June July August September October November December Approved Refills Removed Active Value 2 6 0 28 $16,676.00 2 5 0 30 $14,616.00 12 7 0 42 $34,978.00 5 7 0 47 $42,159.00 YTD PATIENT SAVINGS $108,429.00 Monthly Avg 5 6 December 2021 Active 26 37 $27,107.25 0 ©lHS Source Totals Report Issued 05/18/22 Calhoun Indigent Health Care Batch Dates 02/01/2022 through 05/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed u I Amount Paid 01 Physician Services 7,478.00 539.62 01-2 Physician Services -Anesthesia 624.00 165.71 02 Prescription Drugs 256.82 256.82 08 Rural Health Clinics 2,112.00 1,509.16 13 Mmc - Inpatient Hospital 57,628.82 29,523.07 14 Mmc - Hospital Outpatient 32,036.00 12,429.21 15 Mmc - Er Bills 39,165.00 15,605.94 Expenditures 139,422.70 60,142.61 Reimb/Adjustments -123.06 -123.06 Grand Total 139,299.64 60,019.55 Expenses 16,666.68 76,686.23 Copays <240.00> 76,446.23 Medicaid Reimbursements <0.00> 76,446.23 Year to Date Total 76,446.23 �awra�71e 74 r 9 ( Ayw tznt E d Avpq R ©iHS Source Totals Report Issued 05/04/22 Calhoun Indigent Health Care Batch Dates 02101/2022 through 05/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 7,478.00 539.62 01-2 Physician Services -Anesthesia 624.00 155.71 02 Prescription Drugs 249.70 249.70 08 Rural Health Clinics 2,112.00 1,509.18 13 Mmc - Inpatient Hospital 57,628.82 29,523.07 14 Mmc - Hospital Outpatient 32,035.00 12,429.21 15 Mmc - Er Bills 39,165.00 15,605.94 Expenditures 139,415.58 60,135.49 Reimb/Adjustments -123.06 -123.06 Grand Total 139,292.52 60,012.43 Expenses 16,666.68 76,679.11 Copays <240.00> 76,439.11 Medicaid Reimbursements < 0.00 > 76,439.11 Year to Date Total 76,439.11 MAY 10 2022