2022-06-01 Final Packet✓ ,All Agenda Items Properly Numbered
,,Contracts Completed and Signed
II 295's Flagged for Acceptance
umber of 1295's __L)
_ All Documents for Clerk Signature Flagged
On this 6 40v day of 2022 a complete and accurate packet
for LL of 2022 Commissioners Court Regular Session
Day Month
was delivered from the Calhoun County Judge's office to the Calhoun County
Clerk's Office.
Calhoun County Judge/Assistant
COMMISSIONERSCOURTCHECKLIST/FORMS
AGENDA
I Of fvlf l I wI j(c /I/?OZ 1.
Richard H. Meyer
County judge
David Hall, Commissioner, Precinct I
Vern Lyssy, Commissioner, Precinct 2
Joel Behrens, Commissioner, Precinct 3
Cary Reese, Commissioner, Precinct 4
NOTICE OF MEETING
The Commissioners' Court of Calhoun County, Texas will meet on Wednesday,
June 1, 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: 9.33, FILED
AT_0'CLOCK M
4i'.*�'/i/Call meeting to order. MAY 2 7 2022
L. Invocation. ANNA M. GOODMAN
COO TYCLERK lHO lCOUNTY ,TEMS
// BY:
`s. Pledges of Allegiance.
/General Discussion of Public Matters and Public Participation.
'S. Hear report from Memorial Medical Center.
A�gt & (N o cue r Dn�
t . Consider and tak necessary action to lift or retain the county burn ban. (RHM)
Consider and take necessary action to approve the closure of the south portion of
Haterius Park Land and designate the north portion as a one-way street between the
hours of 2:00 pm and 12:00 am on July 3, 2022 during the fireworks display provided by
Bayside Community Church. (JMB)
`B./ Consider and take necessary action to approve grant services between Kathy Smartt and
Calhoun County to manage the CMP grant paperwork for infrastructure improvements at
Olivia Haterius Park at a service fee of $600.00. (JMB)
F14_&nsider and take necessary action to approve proposal #1590A from D & P Coastal
Marine Construction, L.L.C. for emergency work repairs on the breakaway bulkhead
located at Haterius Park using GOMESA funds. (JMB)
r10. Consider and take necessary action to approve the proposed Oil, Gas & Mineral Lease
and Memorandum for the eastern half of the "Frank D Boyd" tract in Calhoun County,
between Initial Energy Services, LLC and Memorial Medical Center. (RHM)
Page 1 of 2
N0fI(1 01 VI1 1IN�,, (,/1/)U))
llsider and take necessary action to authorize the Calhoun County EMS Director to
sign a Field Internship Affiliation Agreement with Health Shield Educational Services.
(RHM)
K. Consider and take necessary action to remove the following vehicles from the Sheriff's
Office inventory and authorize the Sheriff to sell at auction: 2003 Toyota Highlander
VIN JTEGF21AI30090744 (forfeiture), 2014 Ford Explorer VIN 1FM5K8AR5EGB79822,
2016 Dodge Ram Pickup VIN 3C6RR6KT8GG188335, and 2014 Ford Explorer VIN
/1FM5K8AROEGA09125.(RHM)
/ c
13. Accept Monthly Report from the following County Office:
i D strict Clerk — April 2022 - amended
e4. Consider and take necessary action on any necessary budget adjustments. (RHM)
t5'. Approval of bills and payroll. (RHM)
Richard H. Meyer, C�Je
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 — 6/1/2022
Richard H. Meyer
County judge
David ]Hall, Commissioner, Precinct 1
Vern ]Lyssy, Commissioner, Precinct 2
Joel Behrens, Commissioner, Precinct 3
Cary Reese, Commissioner, Precinct 4
Sara Rodriguez, County Attorney
Karla Perez, Deputy Clerk
NOTICE OF MEETING
The Commissioners' Court of Calhoun County, Texas will meet on Wednesday,
June 1, 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.
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.
Commissioner Vern Lyssy invited everyone to the Six Mile Volunteer Fire
Department fundraiser on Saturday, June 4, 2022.
5. Hear report from Memorial Medical Center.
Roshanda Thomas gave the monthly report and presented Commissioners
and Judge Meyer with a token of appreciation for continuous support.
Page 1 of 3
NOTICE OF MEETING — 6/1/2022
6. Consider and take necessary action to lift or retain the county burn ban. (RHM)
Judge Meyer retained burn ban
7. Consider and take necessary action to approve the closure of the south portion of
Haterius Park Land and designate the north portion as a one-way street between the
hours of 2:00 pm and 12:00 am on July 3, 2022 during the fireworks display provided by
Bayside Community Church. (JMB)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
David Hall, Commissioner Pct 1
SECONDER:
Vern Lyssy, Commissioner Pct 2
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
8. Consider and take necessary action to approve grant services between Kathy Smartt and
Calhoun County to manage the CMP grant paperwork for infrastructure improvements at
Olivia Haterius Park at a service fee of $600.00. (JMB)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
Gary Reese, Commissioner Pct 4
SECONDER:
David Hall, Commissioner Pct 1
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
9. Consider and take necessary action to approve proposal #1590A from D & P Coastal
Marine Construction, L.L.C. for emergency work repairs on the breakaway bulkhead
located at Haterius Park using GOMESA funds. (JMB)
Pass
10. Consider and take necessary action to approve the proposed Oil, Gas & Mineral Lease
and Memorandum for the eastern half of the "Frank D Boyd" tract in Calhoun County,
between Initial Energy Services, LLC and Memorial Medical Center. (RHM)
Roshanda explained the agreement on the mineral rights.
Pass
11. Consider and take necessary action to authorize the Calhoun County EMS Director to
sign a Field Internship Affiliation Agreement with Health Shield Educational Services.
(RHM)
Dustin Jenkins stated that they no longer need this agreement.
Pass
Page 2 of 3
NOTICE OF MEETING — 6/1/2022
12. Consider and take necessary action to remove the following vehicles from the Sheriffs
Office inventory and authorize the Sheriff to sell at auction: 2003 Toyota Highlander
VIN 1TEGF21A130090744 (forfeiture), 2014 Ford Explorer VIN 1FM5K8AR5EGB79822,
2016 Dodge Ram Pickup VIN 3C6RR6KT8GG188335, and 2014 Ford Explorer VIN
1FM5K8AROEGA09125. (RHM)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
Vern Lyssy, Commissioner Pct 2
SECONDER:
David Hall, Commissioner Pct 1
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
13. Accept Monthly Report from the following County Office:
I. District Clerk — April 2022 - amended
RESULT:
APPROVED [UNANIMOUS]
MOVER:
Vern Lyssy, Commissioner Pct 2
SECONDER:
Joel Behrens, Commissioner Pct 3
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
14. 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
15. Approval of bills and payroll. (RHM)
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 Bills
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 10:31 a.m.
Page 3 of 3
#5
NOTICE OF MEETING — 6/1/2022
Richard H.MCYeT
County judge
David ][Tall, Commissioner, Precinct I
Vern ]Lyssy, Commissioner, Precinct 2
Joel ]Behrens, Commissioner, Precinct 3
(nary 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,
June 4 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.
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.
Commissioner Vern Lyssy invited everyone to the Six Mile Volunteer Fire
Department fundraiser on Saturday, June 4, 2022.
5. Hear report from Memorial Medical Center.
Roshanda Thomas gave the monthly report and presented Commissioners
and Judge Meyer with a token of appreciation for continuous support.
Page 1 of 11
#6
NOTICE OF MEETING—6/1/2022
6. Consider and take necessary action to lift or retain the county burn ban. (RHM)
Judge Meyer retained burn ban
Page 2 of 11
NOTICE OF MEETING — 6/1/2022
Consider and take necessary action to approve the closure of the south portion of
Haterius Park Land and designate the north portion as a one-way street between the
hours of 2:00 pm and 12:00 am on July 3, 2022 during the fireworks display provided by
Bayside Community Church. (JMB)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
David Hall, Commissioner Pct 1
SECONDER:
Vern Lyssy, Commissioner Pct 2
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 3 of 11
Joel Behrens
Calhoun County Commissioner, Precinct 3
24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309
Email: iocl.bchrcns(@,cathouncotx.or%
Honorable Richard Meyer
Calhoun County Judge
211 S. Ann
Port Lavaca, TX 77979
RE: Agenda Item
Dear Judge Meyer:
Please place the following item on the Commissioner's Court Agenda for June 1, 2022.
• Please Consider and Take Necessary Action on road closure of the south portion of Haterius Park Land and
designate the north portion as a one-way street between the hours of 2:00 pm and 12:00 am on July 3, 2022
during the fireworks display provided by Bayside Community Church.
Sincerely,
O�ea,lv-\ &",^�
Joel Behrens
Commissioner Pet. 3
m 0
uo
NOTICE OF MEETING — 6/1/2022
8. Consider and take necessary action to approve grant services between Kathy Smartt and
Calhoun County to manage the CMP grant paperwork for infrastructure improvements at
Olivia Haterius Park at a service fee of $600.00. (JMB)
RESULT:
APPROVED [UNANIMOUS]
MOVER:
Gary Reese, Commissioner Pct 4
SECONDER:
David Hall, Commissioner Pct 1
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 4 of 11
Joel Behrens
Calhoun County Commissioner, Precinct 3
24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309
Email: icel.behrensQcalhouncotmor¢
Honorable Richard Meyer
Calhoun County Judge
211 S. Ann
Port Lavaca, TX 77979
RE: Agenda Item
Dear Judge Meyer:
Please place the following item on the Commissioner's Court Agenda for June 1, 2022.
• Please Consider and Take Necessary Action to approve grant services between Kathy Smartt and Calhoun
County to manage the CMP grant paperwork for infrastructure improvements at Olivia Haterius Park at a
service fee of $600.00
Sincerely,
Joel Behrens
Commissioner Pet. 3
#9
NOTICE OF MEETING — 6/1/2022
9. Consider and take necessary action to approve proposal #1590A from D & P Coastal
Marine Construction, L.L.C. for emergency work repairs on the breakaway bulkhead
located at Haterius Park using GOMESA funds. (JMB)
Pass
Page 5 of 11
Joel Behrens
Calhoun County Commissioner, Precinct 3
24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309
Email: ioel.behrens(a)calhounootx.ore
Honorable Richard Meyer
Calhoun County Judge
211 S. Ann
Port Lavaca, TX 77979
RE: Agenda Item
Dear Judge Meyer:
Please place the following item on the Commissioner's Court Agenda for June 1, 2022.
• Please Consider and Take Necessary Action to approve proposal #1590A from D & P Coastal Marine
Construction L.L.C. for emergency work repairs on the breakaway bulkhead located at Haterius Park using
GOMESA funds.
Sincerely,
Joel Behrens
Commissioner Pct. 3
D & P Coastal Marine Construction L.L.C.
834 CR 422
El Campo, TX 77437
Name/Address
County Texas
Estimate
Date
Estimate#
5/252022
1590A
Project
Description
Qty
Rate
Total
Remove the existing framing members within the 50' repair
1 19,839.00
19,838.00
segment
Reuse the existing piling in place.
A new 3x8 waler will be secured to the existing post with stainless
steel lag Screws.
New 10' length, 4.1 profile Everlast vinyl sheets (3.1 profile which
is thinner would save almost $900.00; 21 profile would save almost
$1,000.00).
A new 3x8 wafer will be installed outside the vinyl & secured to
each existing piling with galvanized timber bolts.
This would be considered a temporary fix that can be added to in the
future (All proposed materials could be used in the future on the
"permanent fix").
Tom key total cost as described above:
If approved, we can fit this rehab project into our schedule ASAP;
wejust need the wind to cooperate.
Thanks,
12 will be due balance and balance when completed
Revised adding a 2nd lower 2.5 marine treated 3x8 water secured to
the existing post.
Revised cost:
$19,839.00
Total
$19,838.00
QUOTE #088
5/25/2022
PILL TO
CALHOUN COUNTY
Details
MOBILIZATION
REMOVAL AND DISPOSAL OF EXISTING BREAKWATER
(46') EXCEPT PILING
FOR
REPLACEMENT OF VINYL
BREAKWATER.
INTALLATION OF NEW BREAKWATER. MECHANICALLY
DRIVING 28-EVERLAST 3.1 20"X10' SHEETS TO REFUSAL
(MINIMUM 4'). WILL BE SECURED WITH 2 3"X8"
WHALERS, ATTACHED USING 3/4" GALVANIZED BOLTS
THROUGH EXISTING PILING. A 3/4" GALVANIZED BOLT
WILL BE INSTALLED INBETWEEN EVER PILING AS WELL.
THE WORK WILL BE EXCUTED USING A BARGE
MOUNTED EXCAVATOR. $9,000.00
MATERIAL COST $5.700.00
SUBTOTAL $21,700.00
OTHER
TOTAL $21,700.00
Make all checks payable to:
Machacek Marine LLC.
PO BOX 899
PALACIOS TX 77465
Amount
If you have any questions concerning this invoice, use the following contact information:
Darrell Machacek
mach ace kma ri n e@outlook. corn
979-240-9828
THANK YOU FOR YOUR BUSINESS!
#10
NOTICE OF MEETING — 6/1/2022
10. Consider and take necessary action to approve the proposed Oil, Gas & Mineral Lease
and Memorandum for the eastern half of the "Frank D Boyd" tract in Calhoun County,
between Initial Energy Services, LLC and Memorial Medical Center. (RHM)
Roshanda explained the agreement on the mineral rights.
Pass .
Page 6 of 11
Mae Belle Cassel
From:
pfikac@mmcportlavaca.com (Pam Fikac) <pfikac@mmcportlavaca.com>
Sent:
Wednesday, May 25, 2022 3:31 PM
To:
Mae Belle Cassel(maebelle.cassel@calhouncotx.org)
Cc:
Roshanda S. Thomas
Subject:
Agenda Item for Commissioner's Court
CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless
you recoenize the sender and know the content is safe.
Hello Mae Belle,
Would you please add a separate agenda item to the Commissioner's Court agenda for next week?
Consider and take necessary action to approve the proposed Oil, Gas & Mineral Lease and Memorandum for the
eastern half of the "Frank D Boyd" tract in Calhoun County, with Initial Energy Services, LLC.
Not sure if this is the exact wording but we will get back with you. We will also provide a copy of the documents soon.
Thank you.
Yam gdmc
Executive Assistant
Credentialing Coordinator
815 N Virginia Street
Port Lavaca, TX 77979
(361)552-0222
(361) 552-0220 Fax
pfikac@mmcportlavaca.com
MEMORIAL
MFlDIC;AC'I NTC 2
So Much.., 7o C,losel
INITIAL ENERGY SERVICES, LLC
8620 N NEW BRAUNFELS AVE, SUITE 543
SAN ANTONIO TX 78217
Dear Administrator for the Memorial Medical Center,
Included in this mailing please find an Oil, Gas & Mineral Lease as well as a Memorandum of said
Oil, Gas & Mineral Lease covering the eastern half of the "Frank D Boyd" tract in Calhoun County. Bonus
consideration for the lease is $200 per net mineral acre. If satisfactory, please sign in front of a notary and
return the Oil & Gas lease as well as Memorandum, the latter of which will be filed of record in the County
Clerk's Office in Calhoun County, Texas.
We anticipate re -working one of the old wells on the Frank Boyd and pooling the tract into the unit along
with other planned workovers and new drills in the unit.
After some fitful starts, things are finally proceeding at a rapid pace on the Sheriff Field, and we will be in
touch soon regarding a division order. Thank you very much and we hope this letter finds you well.
Sincerely,
Qom, M 4
Peter Margolis
OFFICE 210 822 1221
NOTICE OF CONFIDENTIALITY RIGHTS: IF YOU ARE A NATURAL PERSON YOU MAY REMOVE
OR STRIKE ANY OF THE FOLLOWING INFORMATION FROM THIS INSTRUMENT BEFORE IT IS
FILED FOR RECORD IN THE PUBLIC RECORDS: YOUR SOCIAL SECURITY NUMBER OR YOUR
DRIVER'S LICENSE NUMBER.
MEMORANDUM OF OIL AND GAS LEASE
STATE OF TEXAS §
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF CALHOUN §
BE IT REMEMBERED that on the 4'h day of May, 2022, a Paid Up Oil and Gas Lease was
made and entered into by and between Memorial Medical Center of Port Lavaca, whose
address is 815 N Virginia Street, Port Lavaca, TX, 77979, hereinafter called "(LESSOR)"; and
Initial Energy Services, LLC., whose address is 8620 N. New Braunfels Ave. Suite 543, San
Antonio, Texas 78217, hereinafter called ("LESSEE"), where LESSOR hereby rents, leases and
lets exclusively to LESSEE for the purpose of exploring for, developing, producing and marketing
oil and gas, along with all hydrocarbon substances produced in association therewith, from the
following described land situated in Calhoun County, Texas, to -wit:
40 acres, more or less, being the eastern 40 acres of a 78.75 acre
tract situated in the Bonifacio Rodriquez League, A-33 in Calhoun
County, Texas and being the same land described as Tract No. 4
in Partition Deed Record dated August 25, 1913 between Mrs.
Fannie Boyd, et al, recorded in Volume 4 Page 543, of the Deed
Records of Calhoun County, Texas.
Subject to the other provisions therein contained, said lease provides for a primary term
of Three (3) years, from the date thereof, and as long thereafter as oil or gas or other
substances covered therein are produced in paying quantities from the leased premises or from
lands pooled therewith, or this lease is otherwise maintained in effect pursuant to the
provisions therein.
An Executed copy of said Oil and Gas Lease is in the possession of LESSEE at its address
indicated above.
Executed this day the 41h day of May, 2022.
"LESSOR"
C
Memorial Medical Center of Port Lavaca, Roshanda Thomas, Director
"LESSEE"
Initial Energy Services, LLC.
Peter Margolis
ACKNOWLEDGEMENTS
THE STATE OF §
COUNTY OF §
This instrument was acknowledged before me on this the day of
2022 by Roshanda Thomas.
G
Notary Public, State of
THE STATE OF TEXAS §
COUNTY OF §
This instrument was acknowledged before me on the _ day of
2022 by Peter Margolis, President of Initial Energy Services, L-C.
Notary Public, State of Texas
NOTICE OF CONFIDENTIALITY RIGHTS: IF YOU ARE A NATURAL PERSON, YOU MAY REMOVE OR STRIKE ANY
OF THE FOLLOWING INFORMATION FROM THIS INSTRUMENT BEFORE IT IS FILED FOR RECORD IN THE PUBLIC
RECORDS: YOUR SOCIAL SECURITY NUMBER OR YOUR DRIVER'S LICENSE NUMBER.
PAID -UP OIL AND GAS LEASE
THIS LEASE is made and entered into to be effective 5/4/2022 deemed the Effective Date, between
Memorial Medical Center of Port Lavaca, hereinafter referred to as Lessor, (whether one or more), whose address
is 815 N Virgina Street, Port Lavaca, TX, 77979, and Initial Energy Services, LLC referred to as Lessee, whose
address is 8620 N. New Braunfels Ave. Suite 543, San Antonio, TX 78217;
1. Lessor, in consideration of Ten Dollars and other valuable consideration ($10.00 & OVC), the receipt and
sufficiency of which is acknowledged, and for the royalties reserved in this Lease, GRANTS, LEASES, and LETS the
lands described below, exclusively to Lessee, for the purpose of exploring, drilling, producing and owning, oil,
gas, and all other minerals produced with them, and conducting all activities necessary or reasonably incident
to the exploration for, operations in search of, and production of oil, gas, and other minerals. The lands subject
to this Lease (referred to as the "land" or the "leased premises") are located in Calhoun County, Texas, and are
described as follows:
40 acres, more or less, being the eastern 40 acres of a 78.75 acre tract situated
in the Bonifacio Rodriquez League, A-33 in Calhoun County, Texas and being the
same land described as Tract No. 4 in Partition Deed Record dated August 25,
1913 between Mrs. Fannie Boyd, et al, recorded in Volume 4 Page 543, of the
Deed Records of Calhoun County, Texas.
This Lease also covers and includes land owned or claimed by Lessor adjacent or contiguous to the land
described above, whether in the same or adjacent surveys, although not included within the boundaries of the
land described above, and (a) owned or claimed by Lessor by limitation, prescription, possession, reversion, or
unrecorded instrument, or (b) as to which Lessor has a preferential right of acquisition. Lessor agrees to execute
any supplemental instrument requested by Lessee for a more complete or accurate description of the land. For
the purpose of determining the amount of any payments provided for in this Lease, the land shall be deemed
to contain 78.75 acres, whether actually containing more or less, and the recital or acreage in any tract shall be
deemed to be the true acreage in each tract. Lessor accepts the bonus as consideration for this Lease and all
rights under it.
2. This is a Paid Up Lease. No payments are due Lessor during the primary term except the payment of
royalty as provided for in paragraph 3. Subject to its other provisions, this Lease shall be for a term of Three
(3) years from the Effective Date (the "primary term") and as long thereafter as operations are being conducted
on the leased premises or lands pooled with it, or oil, gas or other minerals are produced from the land or land
with which the land is pooled under the terms of this Lease, or this Lease is maintained by any of its other
provisions. If, at the end of the primary term Lessee has drilled and abandoned a well on the leased premises,
or lands pooled with it, this Lease shall not terminate at the end of the primary term, if Lessee, within 180 days
of the end of the primary term, commences additional operations on the Leased premises, or lands pooled with
it, which operations shall be deemed operations during the primary term of this Lease and serve to maintain it
in full force and effect. When used in this Lease, the term "operations" means: placing equipment on location;
surface location preparation or maintenance; drilling; testing; completing; reworking; recompleting; deepening;
Page I
plugging back or repair of awe I I in search of or in an endeavor to obtain production of oil, gas, or other minerals;
or, production of oil, gas, or other minerals, whether or not in paying quantities.
3. Lessor reserves as royalty, and Lessee agrees to pay Lessor as royalty on oil, other liquid hydrocarbons,
and non-gaseous minerals produced and saved from the leased premises (the "oil"), 20% part of the net amount
received by Lessee for the sale of the oil at the time it is run from the storage tanks, or into the pipeline to which
the well or wells on the leased premises are connected. In either case, Lessor's interest shall bear the stated
part of all taxes, and costs of treating the oil to render it marketable. Lessee shall pay Lessor as royalty on gas
and casinghead gas produced from the leased premises 20% of the net amount received by Lessee for the gas
if sold at the wellhead, at a location on the leased premises, or on lands with which the leased premises are
pooled, with Lessor's share of those proceeds to bear its proportionate share of all taxes, and costs incurred by
Lessee in delivering, processing, compressing, or otherwise making the gas merchantable or enhancing its
marketability. On all other gas and casinghead gas, Lessee shall pay Lessor as royalty 20% of the net amount
received by Lessee for the gas so sold, less its proportionate share of all taxes, costs of transportation,
compression, processing, treating, and all other costs of marketing. For all gas sold, Lessor shall bear its
proportionate share of all adjustments for heating content, shrinkage, and deductions for impurities. At the
expiration of the primary term or at any later time or times, if there is a well or wells on the land or on lands
with which the land or any portion of it has been pooled, capable of producing oil or gas, and all wells are shut-in,
this Lease shall, nevertheless, continue in force as though operations were being conducted on the land for so
long as the wells are shut-in, and Lessee pays the shut-in royalty provided below, and then this Lease may be
continued in force as if no shut-in had occurred. Lessee covenants and agrees to use reasonable diligence to
produce, utilize, or market the minerals capable of being produced from the wells, but in the exercise of
diligence, Lessee shall not be obligated to install or furnish facilities other than well facilities and ordinary lease
facilities of flow lines, separator, and lease tank, and shall not be required to settle labor trouble, or to market
oil or gas on terms unacceptable to Lessee. If, at any time after the expiration of the primary term of this Lease,
all the wells, oil or gas, on the leased premises, or lands pooled with it, are shut in and this Lease is not otherwise
maintained in effect, Lessee may pay or tender, by its check or draft, as shut in royalty, an amount equal to One
Dollar ($1.00) for each acre of land then covered by this Lease (the "shut-in royalty"), on or before the end of
each 12 month period during which all wells on the leased premises, or lands pooled with it, are shut in and oil
and gas is not being produced, sold, or used, and this Lease is not otherwise being maintained. Each payment
or tender shall be made to the parties who at the time of payment would be entitled to receive the royalties
which would be paid under this Lease if the wells were producing, or may be deposited in the Paid Directly To
Lessor, or its successors, which shall continue as the depository bank for the parties, regardless of changes in
the ownership of shut-in royalty. If at any time that Lessee pays or tenders shut-in royalty, two or more parties
are, or claim to be, entitled to receive payments, Lessee, at its election, may, in lieu of any other method of
payment provided for in this Lease, pay or tender shut-in royalty, in the manner specified above, either jointly
to the parties or separately to each in accordance with their respective ownership. Any payment may be made
by Lessee's check or draft, deposited in the mail or delivered to the party entitled to receive payment, or to the
depository bank provided for above, on or before the last date for payment. Lessee's failure to pay, or to
properly pay or tender any sum due as shut in royalty shall render Lessee liable for the amount due, but shall
not operate to terminate this Lease. Nothing in this Lease shall impair Lessee's right to release this Lease, in
whole or in part, as provided in paragraph 5. below. In the event of assignment of this Lease, in whole or in
part, liability for any payments of any sums which may be due under this Lease, shall rest exclusively on the then
owners of this Lease, severally as to acreage owned by each, and the original Lessee, or an assignee will have
no obligation for royalties payable on production after an assignment to a subsequent or successor lessee or
assignee.
4. At its option, Lessee is granted the right and authority to pool, unitize, or combine the land covered by
this Lease or any portion of it as to oil and/or gas, with any other land covered by this Lease, and/or with any
other land, lease, or leases in the immediate vicinity of the leased premises, when in Lessee's judgment it is
necessary or advisable to do so in order to explore, develop, and operate the leased premises in compliance
Page 2
with the spacing rules of the Railroad Commission of Texas, or other lawful authority, or when to do so would,
in the judgment of Lessee, promote the conservation of oil and/or gas in and under and that may be produced
from the leased premises. Units pooled for oil shall not substantially exceed 40 acres each in area, and units
pooled for gas shall not substantially exceed 320 acres each in area, plus, in both instances, a tolerance of ten
percent (10%); provided, should a governmental authority having jurisdiction prescribe, allow, or permit the
creation of units larger than those specified, for the drilling or operation of a well, drilled either vertically or
horizontally, to comply with existing or subsequently established field rules, or for obtaining a greater allowable
from any well to be drilled, drilling, or already drilled, units created may conform substantially in size with those
permitted, allowed, or prescribed by applicable governmental regulations, now in existence, or later enacted.
Lessee may pool or combine acreage covered by this Lease or any portion of it as to oil and/or gas in any
one or more strata. The units formed by pooling as to any stratum or strata need not conform in size or area
with the unit or units into which the Lease is pooled or combined as to any other stratum or strata, and oil units
need not conform to the area within gas units. Pooling in one or more instances shall not exhaust the rights of
the Lessee to pool this Lease or portions of it into other units. On execution by Lessee of an instrument
describing and designating the pooled acreage as a pooled unit, the unit shall be effective as to all parties, their
heirs, successors, and assigns, irrespective of whether or not the unit is likewise effective as to all other owners
of surface, mineral, royalty, or other rights in land included in the unit. Within a reasonable time following the
execution of the instrument designating the pooled unit, Lessee shall file the instrument for record in the
appropriate records of the county in which the leased premises are located. Any unit formed may be revised,
re-formed, increased, or decreased in size, or changed in configuration, at the election of Lessee, at any time
either before or after commencement of operations or production from the unit well. Lessee may, at any time,
at its election, dissolve orterminate any unit formed, by written instrument filed for record in the county where
the land is located, which instrument shall specify the date of termination of the unit.
Lessee may exercise its right to pool at any time and from time to time, while this Lease is in force and
effect, whether before or after commencing operations, completing an oil or gas well, or establishing production
on the leased premises, or on any land pooled or unitized with the leased premises. Any operations for drilling
on or production of oil or gas from a pooled unit which includes all or a part of the leased premises, regardless
of whether the operations for drilling were commenced, or the production was secured, before or after the
execution of this Lease or the instrument designating the pooled unit, shall be considered operations for drilling
on or production of oil and/or gas from land covered by this Lease, whether or not the well or wells is located
on the leased premises. In that event, operations for drilling shall be deemed to have been commenced on the
leased premises within the meaning of this Lease; and, the entire acreage constituting the unit or units, as to oil
and/or gas, shall be treated for all purposes, except the payment of royalties on production from the pooled
unit, as if it were included in this Lease.
For the purpose of computing the royalties to which owners of royalties and payments out of production
shall be entitled on production of oil and/or gas from a pooled unit, there shall be allocated to the land covered
by this Lease and included in a unit (or to each separate tract within the unit if this Lease covers separate tracts
within the unit) a pro rata portion of the oil and/or gas, produced from the pooled unit after deducting that
used for operations on the lease or pooled unit. The allocation shall be on an acreage basis; i.e., there shall be
allocated to the acreage covered by this Lease and included in the pooled unit (or to each separate tract within
the unit if this Lease covers separate tracts within the unit) that pro rata portion of the oil and/or gas, produced
from the pooled unit which the number of surface acres covered by this Lease (or in each separate tract) and
included in the pooled unit bears to the total number of surface acres included in the pooled unit. Royalties shall
be computed on the portion of the production, whether it be oil or gas, allocated to the land covered by this
Lease and included in the unit just as though the production were from the land. The production from an oil
well will be considered as production from the Lease or oil pooled unit from which it is producing and not as
production from a gas pooled unit; and, production from a gas well will be considered as production from the
Lease or gas pooled unit from which it is producing and not from an oil pooled unit.
Pale 3
The formation of any unit shall not have the effect of changing the ownership of any shut-in royalty which
may become payable under this Lease. If this Lease now or later covers separate tracts, no pooling or unitization
of royalty interest as between any separate tracts is intended or shall be implied or result merely from the
inclusion of the separate tracts within this Lease, but Lessee shall nevertheless have the right to pool, as
provided above, with the consequent allocation of production as provided above. As used in this paragraph, the
words "separate tract" mean any tract with royalty ownership differing, now or later, either as to parties or
amounts, from that as to any other part of the leased premises.
5. If at the expiration of the primary term, oil, gas, or other minerals are not being produced on or from the
land, or on or from the land with which it is pooled, but Lessee is then engaged in any operations, or shall have
completed a dry hole prior to the end of the primary term, this Lease shall remain in force, as provided in
paragraph 2., so long as operations on the well or for drilling or reworking of any additional well are prosecuted
with no cessation of more than ninety (90) consecutive days, and if they result in the production of oil, gas, or
other minerals, so long as oil, gas, or other minerals are produced from the land, or from land pooled with it. If,
after the expiration of the primary term of this Lease and after oil, gas, or other minerals are produced from the
land, or from land pooled with it, the production should cease from any cause, this Lease shall not terminate if
Lessee commences operations for drilling or reworking within ninety (90) days afterthe cessation of production,
but shall remain in force and effect so long as operations are prosecuted with no cessation of more than ninety
(90) consecutive days, and if they result in the production of oil, gas, or other minerals, so long thereafter as oil,
gas, or other minerals are produced from the land, or from land pooled with it. Lessee may at anytime execute
and deliver to Lessor or place of record a release or releases covering any portion or portions of the leased
premises as to any depths, and surrender this Lease as to that portion, portions, or depths, and be relieved of
all obligations as to the acreage or depths surrendered.
6. Lessee shall have the right at any time during or after the expiration of this Lease to remove all property
and fixtures placed on the land, including the right to draw and remove all casing. When reasonably necessary
to accommodate an immediate impending use of the surface estate by Lessor, or anyone claiming by, through,
or under Lessor, Lessee will bury all pipelines below ordinary plow depth. No well shall be drilled within two
hundred feet (200') of any building or structure now on the land without Lessor's consent.
7. The rights of either party may be assigned in whole or in part, and the provisions of this Lease shall extend
to their heirs, successors, and assigns; but, no change or division in ownership of the land, or royalties, however
accomplished, shall operate to enlarge the obligations or diminish the rights of Lessee; and, no change or
division in ownership shall be binding on Lessee until sixty (60) days after Lessee is furnished by registered U.S.
mail at Lessee's principal place of business with a certified copy of the recorded instrument or instruments
evidencing the changes or division of ownership. In the event of an assignment of this Lease, in whole or in
part, liability for a breach of any obligation shall rest exclusively on the owner of this Lease or of a portion of it
who commits the breach.
8. The breach by Lessee of any obligation arising under this Lease shall not work a forfeiture or termination
of this Lease or cause a termination or reversion of the estate created by it, or be grounds for cancellation in
whole or in part. No obligation to develop the leased premises shall arise during the primary term. Should oil,
gas, or other minerals be discovered on the leased premises, then after the expiration of the primary term,
Lessee shall develop the acreage retained as a reasonably prudent operator. If after the expiration of the
primary term, Lessor considers that operations are not at any time being conducted in compliance with this
Lease, Lessor shall notify Lessee in writing of the facts relied on as constituting a claimed breach of this Lease,
and Lessee, if in default, shall have sixty (60) days after receipt of the notice in which to commence compliance
with the obligations imposed by virtue of this Lease.
9. Lessor hereby warrants and agrees to defend the title to the land and agrees that Lessee, at it's option,
may discharge any tax, mortgage, or other lien on the land, either in whole or in part. In the event Lessee does
so, it shall be subrogated to the lien discharged, with the right to enforce it and apply royalties and any other
payments accruing under this Lease toward satisfying the lien. Without impairing Lessee's rights under the
warranty in event of failure of title, it is agreed that if this Lease covers a less interest in the oil, gas, or other
Page 4
minerals in all or any part of the land than the entire and undivided fee simple estate (whether Lessor's interest
is specified or not), or no interest, then the royalties, and other monies accruing from any part where this Lease
covers less than the full interest, shall be paid only in the proportion which the Lessor's interest, if any, covered
by this Lease, bears to -the whole and undivided fee simple estate. All royalty interest covered by this Lease
(whether or not owned by Lessor) shall be paid out of the royalty provided for above. Should any one or more
of the parties named above as Lessor fail to execute this Lease, it shall nevertheless be binding on the party or
parties executing this Lease.
10. Should Lessee be prevented from complying with any express or implied covenant of this Lease, from
conducting drilling or reworking operations, or from producing any oil, gas, or other minerals by reason of
scarcity of or inability to obtain or to use equipment or material, or by operation of force majeure, or federal or
state law or any order, rule, or regulation of governmental authority, then while so prevented, Lessee's
obligation to comply with any covenant shall be suspended, and Lessee shall not be liable in damages for failure
to comply with the provisions of this Lease; and, this Lease shall be extended while and so long as Lessee is
prevented by any cause from conducting drilling or reworking operations on or from producing oil or gas from
the lease premises, and the time while Lessee is so prevented shall not be counted against Lessee,
notwithstanding anything in this Lease to the contrary.
This Lease is executed as of the date of the acknowledgment of the undersigned's signature, but shall be
deemed effective for all purposes as of the Effective Date stated above.
Memorial Medical Center of Port Lavaca
By: Memorial Medical Center of Port Lavaca, Roshanda Thomas, Director
Lessor
Initial Energy Services, LLC
By: Peter Margolis, Initial Energy Services, LLC
Lessee
C
Page 5
************See Attached Addendums***********
Acknowledgements
THE STATE OF
THE COUNTY OF
This instrument was executed and acknowledged before me on this the day of 2022,
by
Notary Stamp or Seal:
Notary Public - State of
Commission Expires: _
THE STATE OF
ItMIA14ji11L1IM619
This instrument was executed and acknowledged before me on this the day of 2022,
by
Notary Stamp or Seal:
Notary Public - State of
Commission Expires: _
Page 6
Attached to and made a part of that certain Oil, Gas and Mineral Lease from Memorial Medical Center of Port Lavaca as
Lessor to Initial Energy Services, LLC., dated May 4, 2022.
11. Reference in this lease to "other minerals" shall be deemed to include, in addition to all and gas, only such related
sulfur and hydrocarbons as may be produced therewith and extracted therefrom, and shall not include coal, lignite,
uranium, fissionable materials, other sulfur or any other unrelated or hard minerals.
12. Lessee agrees to indemnify and hold Lessor harmless from any claim or cause of action that may arise on the lands
described herein by virtue of Lessee's operations hereunder.
13. The right to maintain this lease in force and effect by the payment of shut-in royalties is a recurring right which may
be exercised from time to time, but shall not exceed an aggregate or cumulative period of time more than two (2) years
beyond the primary term hereof. Shut-in royalty payments made under this lease shall be the sum of $20.00 per net
mineral acre.
14. In the event a pooled unit is created under the provisions of Paragraph 4 supra, production, drilling or reworking
operations on said unit shall not be effective to maintain this lease in force as to acreage outside of such unit beyond the
end of the primary term.
15. If any gas produced from the Leased Premises is sold by Lessee to a third party purchaser entirely independent of and
not affiliated with Lessee, in a bona fide arms -length transaction, the market value thereof shall be determined on the
basis of the entire proceeds realized by Lessee at the point of sale for the gas sold. However, as to any gas sold by Lessee,
the market value thereof for royalty purposes shall be calculated on the basis of the higher of (x) the entire proceeds
realized by Lessee at the point of sale for the gas so sold or (y) the entire proceeds realized by such affiliate of Lessee at
the point of resale of such gas by such affiliate of Lessee.
16. Lessee, its agents, servants, employees, contractors or sub -contractors shall not be permitted to carry firearms on to
the leased premises nor to fish or hunt thereon, and any breach of this covenant shall make such party liable as a
trespasser under the laws of the State of Texas, and such person shall not again be permitted to come on to the leased
premises.
17. It is agreed by the Parties hereto that this Lease will not and cannot be recorded in the Records of Calhoun County,
Texas, but instead a "Recording Memorandum" will be filed.
18. This Agreement and the attachments hereto constitute the entire agreement between Lessor and Lessee and shall
supersede all prior oral or written agreements, commitments or understandings with respect hereto. The provisions
hereof shall be binding upon and extended to the respective heirs, administrators, successors and assigns of the Parties.
**********************+End ofAddendums***********************************.********.****
Signed For Identification:
Lessor
Memorial Medical Center of Port Lavaca
By: Memorial Medical Center of Port Lavaca, Roshanda Thomas, Director
Page 7
#11
NOTICE OF MEETING — 6/1/2022
11. Consider and take necessary action to authorize the Calhoun County EMS Director to
sign a Field Internship Affiliation Agreement with Health Shield Educational Services.
(RHM)
Dustin Jenkins stated that they no longer need this agreement.
Pass
Page 7 of 11
Mae Belle Cassel
From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org>
Sent: Thursday, May 26, 2022 10:54 AM
To: Mae Belle Cassel; Donna Hall; Lori McDowell
Subject: Commissioners Court Items
Attachments: CCEMS Agreement.pdf
Mae Belle,
Please place the following item on the next Commissioners Court Agenda:
1. Consider and take necessary action to authorize the Calhoun County EMS Director to sign a Field Internship
Affiliation Agreement with Health Shield Educational Services.
The 1295 is the last page in the attachment, let me know if anything else is needed.
Thanks,
Dustin
From: "hsesdirectorl@gmail.com (Chris Ramirez)" <hsesdirectorl@gmail.com>
To: dustin.jenkins@calhouncotx.org
Date: Thu, 26 May 2022 08:11:26 -0500
Subject: Agreement
CAUTION: This email originated from outside of the organization. Do not click links or open
unless
Greetings!
Attached is the Agreement.
Thanks!
Chris Ramirez, Jr.
EMS Program Director
Health Shield Educational Services
361.649.7567 Cell
the sender and know the
J. Dustin Jenkins, DMin, MBA, LP
Director of Emergency Medical Services
705 Henry Barber Way
Calhoun County, TX
dustin.jenkins@calhouncotx.org
(361)571-0014
Calhoun County Texas
FIELD INTERNSHIP AFFILIATION AGREEMENT
BETWEEN
Calhoun County
Emergency Medical
Service
705 Henry Barber Way
Port Lavaca, Texas
77979
361.552.1140
AND
Health Shield Educational Services
PO Box 674
Hallettsville, Texas 77964
361.649.7567
It is mutually agreed by Calhoun County Emergency Medical Service, Port Lavaca, Texas,
hereinafter referred to as "affiliate" and Health Shield Educational Services hereinafter
referred to as "HSES", that the field internship experience for students enrolled in the
Emergency Medical Service Program at HSES will be provided at Calhoun County
Emergency Medical Service.
It is agreed that HSES and the affiliate will jointly select and assign learning experiences.
HSES will provide the service with a list of learning objectives and schedule of student
assignments prior to the beginning of each experience.
HSES and Calhoun County Emergency Medical Service are affirmative action/equal
opportunity institutions in regards to all programs and activities. No discrimination shall be
made between individuals with regard to race, color, religion, national origin, sex, age, or
handicap.
OBJECTIVE AND SCOPE OF FIELD INTERNSHIP:
The field internship is a period of supervised experience on an EMS vehicle which provides
the student a progression of increasing patient care responsibilities proceeding from
observation, to supportive roles, and finally acting as a team member. The affiliate must be
licensed by the Texas Department of State Health Services as an EMS Provider and the
vehicle must be staffed, equipped, and operate at least at the level the student is in training;
i.e. BLS vehicle for EMT students, ALS for AEMT students, and MICU for Paramedic students.
This agreement supports the training for EMT and students being trained at the Advanced
level (ex: AEMT). The student must at all times be under the direction and supervision of an
assigned preceptor. The preceptor must be currently certified to at least the level of which
the student is in training. The initial student role shall be that of observer. After participating
in actual patient care, the student may finally function as a patient care leader. However, the
student shall not be placed in a position of being a necessary part of the regular EMS team.
The team shall function without any necessary use of the student.
HSES RESPONSIBILITIES:
HSES EMS Program agrees to:
a. Place only those students who are registered and academically qualified for
internship experience for the purpose of learning in the field setting.
b. Confer with the affiliate's administration, prior to registration for each semester,
concerning the assignment of students to the service.
C. Provide the affiliate with a detailed schedule including student name, date &
times of assignment, and level of student training.
d. Conduct administrative and educational activities of the EMS Program according
to the established policies of HSES. These include provisions for students health; keeping
records of students' experiences, such as records of rotations, attendance. and
proficiency; and evaluation and counseling of students with regard to performance.
e. Guarantee that each student has a report of current immunizations and TB test
results. The report shall include immunization history for diphtheria/tetanus,
measles/mumps/rubella, and if applicable, HBV. TB tests results must be within one
year of program entry and must be repeated annually throughout the program.
f. Guarantee that each student and faculty member has professional liability
insurance coverage. Terms of coverage or copies of the policy are available at the HSES
office.
g. Guarantee that each faculty member and student agrees to abide by the policies
and procedures as set forth by the affiliate and HSES.
h. If a student sustains injury, sudden illness, or exposure to communicable disease
or bodily fluids occurs during performance of duties; said injury, illness, or exposure will
be handled according to HSES and affiliate policy. The student is responsible for any cost
of medical treatment.
AFFILIATE RESPONSIBILITIES:
The Calhoun County Emergency Medical Service agrees to:
a. Provide for EMS Program students, without compensation to the student,
assignments to the affiliate for purpose of field internship experience. Provide and
assign preceptors for each student experience.
b. Provide overall control and supervision of patient care.
C. Provide orientation of assigned EMT Program students.
d. Maintain a qualified staff, vehicles, and equipment as required by the Texas
Department of State Health Services.
e. Evaluate student field performance and communicate the results to the EMS
Program Clinical Coordinator.
PRECEPTORS:
The field preceptor is the person responsible for overseeing the student's activities during
an ambulance rotation. Preceptors must be certified to at least the level of certification the
student is currently seeking. Preceptors will be jointly approved and oriented by HSES and
the affiliate. The preceptor does not have to be present during basic, non-invasive care,
but must direct and witness any invasive procedure. Preceptors are also responsible for
evaluating student clinical performance and reporting to the HSES Program Clinical
Coordinator. A list of approved preceptors will be maintained by the affiliate.
SCHEDULING:
Date and time perimeters will be finalized prior to scheduling any rotations. If the affiliate
has or establishes any other affiliations, assignments will be coordinated to avoid
duplication of schedules. Students will schedule rotations through the HSES EMS Program's
Clinical Coordinator according to date/time perimeters set by the affiliate, preceptor
availability, and their personal schedule. HSES will submit to the affiliate, a schedule
indicating the date, times, student name, and training level.
TERMS OF AGREEMENT:
This affiliation will be effective when all parties have signed this agreement. It will be
effective for a one year period beginning/ending 5/25/22-12/31/22; provided however, this
agreement may be terminated at any time for cause and/or violations of the terms herein.
Furthermore, either party may terminate this agreement upon thirty (30) days written notice
to the other party. A new agreement may be initiated if major changes or revisions in
policies are considered necessary by HSES or the affiliate.
Chris Ramirez, Jr. Date
EMS Program Director
Health Shield Educational Services
Date
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos,1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2022-891261
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Health Shield Educational Services
Hallettsville, TX United States
Date Filed:
05/25/2022
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
Calhoun County EMS
Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
122
Clinical Affiliation Agreement
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
5 Check only if there is NO Interested Party.
X
6 UNSWORN DECLARATION
My name is l�L. ✓ • s2 /G4 M^•�'r _ and my date of birth is.
My address is ( � �ax �//
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
�.^�-
Executed in C� b 4-A e 4—County, State of 'r"X•+ �! , on the � day of 0� , 20 -17- .
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
F-- ..
�• —v.— ,.- -r ,�n� �•����� ��,,,�„��aivr, www.ernics.siateax.us Version V1.1.191b5cdc
#12
NOTICE OF MEETING — 6/1/2022
12. Consider and take necessary action to remove the following vehicles from the Sheriffs
Office inventory and authorize the Sheriff to sell at auction: 2003 Toyota Highlander
VIN JTEGF21A130090744 (forfeiture), 2014 Ford Explorer VIN 1FM5K8AR5EGB79822,
2016 Dodge Ram Pickup VIN 3C6RR6KT8GG188335, and 2014 Ford Explorer VIN
1FM5K8AROEGA09125.(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 8 of 11
CALHOUN COUNTY, TEXAS
COUNTY SHERIFF'S OFFICE
211 SOUTH ANN STREET
PORT LAVACA, TEXAS 77979
PHONE NUMBER (361) 553-4646
FAX NUMBER (361) 553-4668
MEMO TO: RICHARD MEYER, COUNTY JUDGE
SUBJECT: REMOVE VEHICLE FROM INVENTORY
DATE: MAY 31, 2022
Please place the following item(s) on the Commissioner's Court agenda for the date(s)
indicated:
AGENDA FOR MAY 31, 2022
* Consider and take necessary action to the following vehicles from our
inventory and allow the Sheriff's Office to sale in auction:
2003 TOYOTA HIGHLANDER VIN JTEGF21A130090744 (FORFIETURE)
2014 FORD EXPLORER VIN IFM5K8AR5EGB79822
2016 DODGE RAM PICK UP VIN 3C6RR6KT8GG188335
2014 FORD EXPLORER VIN IFM5K8AROEGA09125
Sincerely,
Bobbie Vickery
Calhoun County Sheriff
#13
NOTICE OF MEETING — 6/1/2022
13. Accept Monthly Report from the following County Office:
I. District Clerk — April 2022 - amended
RESULT:
APPROVED [UNANIMOUS]
MOVER:
Vern Lyssy, Commissioner Pct 2
SECONDER:
Joel Behrens, Commissioner Pct 3
AYES:
Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese
Page 9 of 11
AMENDED APRIL 2022 MONTHLY REPORT (see amendments marked with *)
F2022APR004,
008,024,038)
MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS
5/23/2022 COURT NAME: DISTRICT CLERK
MONTH OF REPORT: APRIL
YEAR OF REPORT: 2022
ACCOUNT NUMBER ACCOUNT NAME DEBIT CREDIT
1000-001-44190
SHERIFF'S SERVICE FEES
$1,311.07
1000-00144140
JURY FEES
$250.00
1000-001-44045
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
GRIM - SUPP OF IND LEGAL SVCS - COUNTY
$0.78
7865-999-20740-999
GRIM - 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-CRIM - 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
1-44050
DISTRICT CLERK FEES
$391.74
9-10010
CASH - AVAILABLE
$391.74
1-44055
RECORD MGMT/PRSV FUND - COUNTY
$244.84
9-10010
CASH - AVAILABLE
$244.84
1-44050
COUNTY JURY FUND
$9.79
9-10010
CASH - AVAILABLE
$9.79
1-44055
COURTHOUSE SECURITY
$97.94
9-10010
CASH - AVAILABLE
$97.94
1-44050
CO & DIST CRT TECHNOLOGY FUND
$39.17
9-10010
CASH - AVAILABLE
$39.17
1-44050
COUNTY SPECIALTY COURT FUND
$244.84
9-10010
CASH - AVAILABLE
$244.84
TOTAL:
$1,028.32
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 825.00
,REFUND OF OVERPAYMENTS 100.00
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 TREASUREWS RECEIPTS (17,032.64)
Revised 01/31/20 OVER / (SHORT) $0.00
DISTRICT COURT
APRIL
STATE COURT COSTS REPORT
2022
APRIL
SECTION I: REPORT FOR OFFENSES COMMITTED
COLLECTED
COUNTY
STATE
01/1120 - Present
7,
181.17
1,630.51
01/01/04 - 12/31/19
$525.4T
52.55
472.92
09/01/01-12/31/03
ick T.
-
-
09/01/99 - 08/31/01
09/01/97 - 08/31/99
�. t t
5.15
46.39
09/01/95 - 08/31/97
nnin�
*.,.
i
-
-
DNA TESTING FEES
53.21
5.32
47.89
EMS TRAUMA FUND
345.52
34.55
310.97
JUV. PROS. 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 FROG 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 PROS 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
7'.
$70.00
3.50
66.50
FAMILY PROTECTION FEE
........................
JUDICIAL SUPPORT FEE
3.'..
$87.11
$87.11
JUDICIAL & COURT PERSONNEL TRANING FEE
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
$ 92T67
TOTAL BOTH REPORTS
$ 4,057.37
$ 440.51
$ 3,616.87
CALHOUN DISTRIBUTION
COUNTY REQUEST
201 West Austin DR# 420 A 44704
PAYEE PAYOR
Name: Calhoun County Oper. Acct. Official: Anna Kabela
Address: Title: District clerk
City:
State:
Zip:
Phone:
ACCQUNT NUMBER
DESCRIPTION
AMOUNT
7340-999-20759.999
District Clerk Monthly Collections - Distribution
$16,107.64
APRIL
2022
V# 967
TOTAL 16,107.64
..-�.r 2p•vL
Signature of Official Date
#14
i NOTICE OF MEETING — 6/1/2022
14. 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 10 of 11
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#15
NOTICE OF MEETING — 6/1/2022
15. Approval of bills and payroll. (RHM)
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 Bills
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 10:31 a.m.
Page 11 of 11
June 1, 2022
2022 APPROVAL LIST - 2022 BUDGET
COURT MEETING OF
BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 16
06/01/22
$174,203.92
FICA
PAYROLL
05/27/2022
P/R
$
57,997.56
MEDICARE
PAYROLL
05/27/2022
P/R
$
13,564.08
FWH
PAYROLL
05/27/2022
P/R
$
38,616.85
NATIONWIDE RETIREMENT SOLUTIONS
PAYROLL
05/27/2022
P/R
$
4,605.00
OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT
PAYROLL
05/27/2022
P/R
$
1,681.84
$
290,669.25
TOTAL AMOUNT FOR APPROVAL:
$
290,669.25
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR ---June 01 2022
TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES
TOTAL,PAYABLES, PAYROLL,AND ELECTRONIC; BANK PAYMENTS
TOTAL TRANSFERS BETWEEN FUNDS'
TOTAL NURSINGHOME UPL EXPENSES
TOTAL ;INTER -GOVERNMENT TRANSFERS.
$ 529146Z98 Y
$ 87,375.10' V/
1,094,688i80 /
$, 84,00,.001
GRAND,TOTAL DISBURSEMENTS APPROVED June, 01, 2022 $ 1 795 61188 /
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR ---June 01 2022
PAYABLES AND PAYROLL
5/2612022 Weekly Payables
510,718.16
5/31/2022 McKesson-340B Prescription Expense
7,944.24
513112022 Ameriscurce Bergen-340B Prescription Expense
697.52
Prosperity Electronic Bank Payments
5/23-5/27122 Pay Plus -Patient Claims Processing Fee
485,80
5/2712022 ExpertPay- child support
607.27
TOTALPAYA6LE9, PAYROLL AND ELECTRONIC BANK PAYMENTS
$ 629,46Z98`
TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES
5/26/2022 MMC Operating to Golden Creek -correction of NH insurance payment
1,766.23
deposited into MMC Operating in error
512612022 MMC Operating to Gulf Points Plaza -correction of NH Insurance payment
20,510.64
deposited into MMC Operating
6/2612022 MMC Operating to Tuscany Village -correction of NH insurance payment
22,224.41
deposited into MMC Operating
5/26/2022 MMC Operating to Bethany -correction of NH insurance payment deposited
42.873.82
into MMC Operating in error
TOTAL TRANSFERS,BETWEEN FUNDS
$ 87,375:10
NURSING HOME UPL EXPENSES
5/3112022 Nursing Home UPL-Cantex Transfer
515,341.75
5131/2022 Nursing Home UPL-Nexian Transfer
44,843.00
5131/2022 Nursing Home UPL-HMG Transfer
109,827.61
5/31/2022 Nursing Home UPL-Tuscany Transfer
139,794.81
5/31/2022 Nursing Home UPL-HSL Transfer
284,881.63
TOTALiNURSIN0,HOME UPL,EX090SES _
$1,094,688.,80
INTER -GOVERNMENT TRANSFERS
5/31/2022 IGT CHRIP Year 2 to be paid on June 16, 2022 84,097.00
TOTAL INTER GOVERNMEIIR' TRANSFERS $' 84;097:00'
GRAND-TO7ALIDISBURSEMENTS APPROYSD JUI)6 01, 2022 $ 1 788 813:58'
Page 1 of 13
RECEIVED BY THE
COUNTY AUDITOR ON
rrcBJ/¢62&22022 MEMORIAL MEDICAL CENTER
12:30
AP Open Invoice List
CALHOUN COUNTY, TEXAS Due Dates Through: OV16/2022
Vendor# Vendor Name Class Pay Code
10250 41MPRINT, INC. V/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
9897561 ,% 05/25/20 04/26/20 05/26/20 2,040.73
HEALTHFARR
9930030 i 05/2512005/30/2006110/20 11119
SUPPLIES
Vendor Totals Number Name Grass
10250 41MPRINT, INC. 2,151.92
Vendor# Vendor Name Class Pay Code
R1200 ADTCOMMERCIAL ✓�
Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross
145401604 ,% 06/26/20 05/03/20 05/28/20 49.18
FIRE MONITORING
Vendor Totals Number Name Gross
R1200 ADT COMMERCIAL 49.18
Vendor# Vendor Name Class Pay Code
A1680 AIRGAS USA, LLC -CENTRAL DIV M
Invoice* Comment Tran Ot Inv Dt Due Dt Check 0Pay Gross
9125776738 ✓ 05/26/20 05/11/20 06/05/20 549.00
OXYGEN
Vendor Totals Number Name Gross
A1680 AIRGAS USA, LLC -CENTRAL DIV 549.00
Vendor# Vendor Name Class Pay Code
10958 ALLYSON SWOPE ,%
Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross
052522 05/26/20 05/25/20 06/01/20 2,967.75
TRANSCRIPTION SERVICES
Vendor Totals Number Name Gross
10958 ALLYSON SWOPE 2,967.75
Vendor# Vendor Name Class Pay Cade
A2150 ANNOUNCEMENTS PLUS TOO AGAIN ,/ W
Invoice4 Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
707 ✓ 05/25/2005/01/2005/11/20 72.00
FLAGS
A32 05/25/20 05101/20 05/11/20 40.00
SIGN (?aqun�)
Vendor Totals Number Name Gross
A2150 ANNOUNCEMENTS PLUS TOO AGAIN 112.00
Vendor# Vendor Name Class Pay Code
B1150 BAXTER HEALTHCARE ✓ W
Invoice# Comment Tran Ot Inv Dt Due Dt Check D' Pay Gross
75002203 v' 05/25/20 05/05/20 05/30/20 41.91
SUPPLIES
75048306 J 05/25/20 05/10/20 06/04/20 507.47
SUPPLIES
75077213 4/� 05/25/20 05/12120 06/06/20 4229
SUPPLIES
0
ap_openJnvolce.template
Discount No -Pay Net
0.00 0.00 2,040.73
0.00 0.00 111.19
Discount No -Pay Net
0.00 0.00 2,151.92
Discount No -Pay Net
0.00 0.00 49.18 �.
Discount No -Pay Net
0.00 0.00 49.18
Discount No -Pay Net
0100 0.00 549.00 i-
Discount NaPay Net
0.00 0.00 549.00
Discount No -Pay Net ,
0.00 0.00 2,967.75
Discount No -Pay Net
0.00 0.00 2,967.75
Discount No -Pay Net
0.00 It= 72.00 �f
0.00 0.00 40.00 ✓'�
Discount No -Pay Net
0.00 0.00 112.00
Discount No -Pay Net
0.00 0,00 41.91 ✓e
0.00 0.00 507,47
0.00 0100 42.29
file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report686690... 5/26/2022
Page 2 of 13
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
61150 BAXTER HEALTHCARE
591.67
0.00
0.00
591.67
Vendor# Vendor Name Class
Pay Code
B1220 BECKMAN COULTER INC �,. M
Invoice# CJomment Tran Dt Inv Dt Due of
Check D Pay Gross
Discount
No -Pay
Net
109869019 ✓ 05125/20 05/04/20 05129/20
185.39
0.00
0.00
185.39 ✓
SUPPLIES
109871169 ✓f. 05125120 05/05/20 0513MO
1,379.50
0.00
0.00
1,379.50 V /
SUPPLIES
5457215 �j 05126/2005/05/2005/30/20
6,249.42
0.00
0.00
6,249,42 f
SUPPLIES
5457538 r% 05/25/20 05113/20 00/07/20
5,016.58
0.00
0.00
5,016.58
LEASE/CONTRACT
109888885 ✓ 05/25/2005/16/2006110/20
1,288.45
0.00
0.00
1,288.45 ✓"
CONTACT
109889265 „% 05/25/20 05/16/20 06/10/20
7T25
0.00
0.00
77.25 ✓�
SUPPLIES
109896242 .,/ 05/25/2005118/2006112/20
1,236.00
0.00
0.00
1,236,00
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
81220 BECKMAN COULTER INC
15,432.59
0.00
0.00
15,432.59
Vendor# Vendor Name Class
Pay Code
B1320 BEEKLEY CORPORATION v" M
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
INV1500130 05/23120 01/24120 02/01/20
118,45
0.00
0.00
118,45
,/
F'
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
B1320 BEEKLEY CORPORATION
118.45
0.00
0.00
118.45
Vendor# Vendor Name Class
Pay Code
12324 BLUE CROSS BLUE SHIELD .-
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
051822A 05/25/20 06118/20 06/01/20
1.516.83
0100
0.00
1,516.83
COBRAJUNE22
,
051822 05125/20 05118/20 00101/20
217,102.99
0.00
0.00
217,102.99 ri
PAYROLL DEDCUT
Vendor Totals Number Name
Gross
Discount
No -Pay
Not
12324 BLUE CROSS BLUE SHIELD
218.619.82
0.00
0.00
218,619.82
Vendor# Vendor Name Class
Pay Code
11224 CABLES AND SENSORS ,✓
Invoice# Comment Tran Dt Inv Dt Due Ot
Check D Pay Gross
Discount
No -Pay
Net
131331 / 05/25120 05/16120 06/01120
303.00
0.00
0,00
303.00
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11224 CABLES AND SENSORS
303.00
0.00
0.00
303.00
Vendor# Vendor Name Class
Pay Code
C1992 CDW GOVERNMENT, INC. W/� M
Involce# Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
`Comment
V560590 ✓ 05/25/20 04/06/20 05/06/20
65.57
0.00
0.00
55.57
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
01992 CDW GOVERNMENT, INC.
55.57
0.00
0.00
55.57
file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88l25/data_5/tmp_cw5report686690.,, 5/26/2022
Vendor# Vendor Name Class
Pay Code
12768 CHEMAQUA
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
7785470 05125/20 05/10/20 05/20/20
518.75
0.00
0.00
WATER TREATMENT
Vendor Totals Number Name
Gross
Discount
No -Pay
12768 CHEMAQUA
518.75
0.00
0,00
Vendor# Vendor Name Class
Pay Cade
C1730 CITY OF PORT LAVACA W
�;'
Invoice# Comment Tran Dt Inv Dt Due Ot
Check D Pay Gross
Discount
No -Pay
051722B 05/26/20 06/17/20 06/06/20
27.04
0.00
0.00
WATER
051722C 05/26/20 05/17/20 06/06/20
75.84
0.00
0.00
WATER
051722 05/26120 05/17/20 06/06/20
62.29
0.00
0.00
WATER
051722A 05/26/2005/1712006/06/20
5,229.75
0.00
0.00
WATER
Vendor Totals Number Name
Gross
Discount
No -Pay
C1730 CITY OF PORT LAVACA
5,394.92
0=
0.00
Vendor# Vendor Name Class
Pay Code
C1186 COASTAL OFFICE SOLUTONS W
Invoice# Comment Tran Ot Inv Dt Due Dt
Check D Pay Gross
OE346141 t/ 05125/2005/13/2005123/20
62.60
SUPPLIES
Vendor TotaleNumber Name
Gross
C1166 COASTAL OFFICE SOLUTONS
62.50
Vendor# Vendor Name Class
Pay Code
13336 COCA COLA SOUTHWEST BEVERAGES
Invoice# Comment Tran Ot Inv Ot Due Dt
Check D Pay Gross
24165200799 ,J 05/26120. 05/15/20 06/14/20
449.30
DRINKS
Vendor Totals Number Name
Gross
13336 COCA COLA SOUTHWEST BEVERAGES 449.30
Vendor# Vendor Name Class
Pay Code
L1430 CONMED LINVATEC ,-' M
Invoice# Comment TranDt Inv Dt Due Dt
Check D Pay Gross
3867980 ri 05/10/20 04121120 04/21/20
49.44
SUPPLIES
Vendor Totals Number Name
Gross
L1430 CONMED LINVATEC
49.44
Vendor# Vendor Name Class
Pay Code
11368 CYRACOM LLC V'
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
2022001511 ,! 05/26/20 02/28/20 03/30/20
493.29
INTERPRETATION SERVICES
Vendor Totals Number Name
Gross
11368 CYRACOM LLC
493.29
Vendor# Vendor Name Class
Pay Code
i
10368 DEWITT POTH & SON ..�
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
0.00
0.00
Discount
No -Pay
0.00
0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
0.00 0.00
Discount No -Pay
0.00 0.00
Page 3 of 13
Net
518.75
Net
518.75
Net
27,04
75,84
62.29
5,229.75
Net
5,394,92
Net
62.50 VI
Net
62.50
Net
449.30
Net
449.30
Net
49.44 v''
Net
49.44
Discount
No -Pay.
Net
0.00
0.00
493.29
Discount
No -Pay
Net
0100
0,00
493.29
Discount No -Pay Net
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Page 4 of 13
6802530 05/20/20 04/27/20 05/22/20
412.51
0.00
SUPPLIES
i$21080 t,/ 05/25/2005/16/2006/10120
79.16
0.00
SUPPLIES
Vendor Total: Number Name
Gross
Discount
10368 DEWITT POTH & SON
491,67
0.00
Vendor# Vendor Name Class
Pay Code
10789 DISCOVERY MEDICAL NETWORK INC „%
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
MMC051522 09/26/20 05/15120 05/16/20
162,120.86
0.00
PHYSICIAN SERVICES
Vendor Totals Number Name
Gross
Discount
10789 DISCOVERY MEDICAL NETWORK INC 162,120.86
0.00
Vendor# Vendor Name Class
Pay Code
11291 DOWELL PEST CONTROL ,✓
Invoice# Comment Tran Ot Inv Dt Due Ot
Check O Pay Gro
Discount
9647 ✓ 05/25120. 05/19/20 06/01/20
82P.60
0.00
PEST CONTROL
Vendor Totals Number Name
Gross
Discount
11291 DOWELL PEST CONTROL
826,60
0.00
Vendor# Vendor Name Class
Pay Code
10689 FASTHEALTH CORPORATION ✓
Invoice# Comment Tran Dt Inv Ot Due Dt
Check D Pay Gross
Discount
/
05A22MMC ✓ 05/25/20 05/01120 05116/20
495.00
0.00
WEBSITE
Vendor Totals Number Name
Gross
Discount
10689 FASTHEALTH CORPORATION
495.D0
0.00
Vendor# Vendor Name Class
Pay Cade
14338 FIRETRON, INC ✓�
Invoice# Comment Tran Dt Inv Dt Due Dt
Check 0 Pay Gross
Discount
197056 V/ 05/26120. 04/29/20 06/29/20
852.00
0.00
4" WATERFLOW SWITCHES
Van dor Totals Number Name
Gross
Discount
14336 FIRETRON, INC
852.00
0.00
Vendor# Vendor Name Class
Pay Code
F1400 FISHER HEALTHCARE „/ M
Invoice# Comment Tran Ot Inv Dt Due Dt
Check D Pay Gross
Discount
1740717 ✓' 05/10/20 04/12/20 05/07/20
89.51
0.00
SUPPLIES
2379306 ,�� 05/25/20 05/02/20 05/27/20
469.30
0.00
SUPPLIES
2379305 05/25/20 05/02120 05/27/20
1,304.51
0.00
SUPPLIES
/
2424981 j 05/25/20 05/03/20 05/28/20
6.12
0.00
SUPPLIES
25267,94 vi 05/25/20 05/05/20 05/30/20
228.16
0.00
SUPPLIES
2574177 ✓ 05/25/20 05/06/20 05/31/20
314.30
0.00
0.00 412.51
0.00 79.16
No -Pay Net
0.00 491.67
No -Pay Net
0.00 162,120.86 V
No -Pay Net
0.00 162,120,86
No -Pay
Net
80
0.00
8276 yr"
No -Pay
Net
0.00
82"0
No -Pay Net
0.00
495.00
y ,
No -Pay
Net
0.00
496.00
No -Pay Net
0.00 852.00 ✓+
No -Pay Net
0.00 852.00
No -Pay Net
0.00
89.51 ,
0.00
469.30
0.00
1,304.61
0.00
6.12 if
0.00 228.16 v,
46101
SUPPLIES
2618789 f 05/25/20 05/09/20 06/03/20 22.83 0.00 0.00
SUPPLIES
314.30 �„•'-
22.83
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Page 5 of 13
2664041 �,.` 05/25/20 05/10/20 06104/20
183.37
0,00
0.00
183.37
SUPPLIES
2710925,' 05/25/20 05111 /20 06/05/20
41.44
0.00
0.00
41.44 ,..
SUPPLIES
2757524 „/ 06/25/20 05/12/20 06/06/20
125.95
0.00
0100
125.95 v'
SUPPLIES
2757526 ,�' 05/25/20 05/12120 06/06/20
41.46
0.00
0.00
41.46
SUPPLIES
..
2757525 ,f' 05/25/20 05/12/20 06/06/20
114.40
0.00
0.00
114,40
SUPPLIES
i
P424982 05/25/20. 05/13/20 06/07/20
320.96
0.00
0.00
320.98
y,,%'
�-
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net.
F1400 FISHER HEALTHCARE
3,262.31
0.00
0.00
3.262.31
Vendor#
Vendor Name Class
Pay Code
13960
G & S MANAGEMENT GROUP LLC ,.'
'
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D- Pay
Gross
Discount
No -Pay
Net
340385174 05/25/20 05/12/20 05/22/20
260.55
0,00
0.00
260.55
v,,
APRIL WASTE
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
13960 G & S MANAGEMENT GROUP
LLC
260,55
0.00
0.00
260.55
Vendor#
Vendor Name Class
Pay Code
W1300
GRAINGER M
Invoice# Comment Tran Dt Inv Dt Due Ot
Check D Pay
Gross
Discount
No -Pay
Net
9304499008✓- 05/25/20 05/06/20 05131120
61.50
0100
0.00
61.50
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
W1300 GRAINGER
61.50
0,00
0.00
61.50
Vendor#
Vendor Name Class
Pay Code
G1210
GULF COAST PAPER COMPANY 4r M
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D-Pay
Gross
Discount
No -Pay
Nei
22243251/05/20/20 04/26120 05/26/20
1,073.92
0.00
0.00
1,073.92
V.
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
01210 GULF COAST PAPER COMPANY
1,073.92
0.00
0.00
1,073.92
Vendor#
Vendor Name Class
Pay Code
10829
HEALTHSTREAM, INC. �/
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D- Pay
Gross
Discount
No -Pay
Net
0289398 1f' 05/26/20 05/10120 06109120
9115
0=
0.00
9.15 ✓,'
HSTREAM
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10829 HEALTHSTREAM, INC.
9.16
0,00
0.00
9.15
Vendor#
Vendor Name Class
Pay Code
H0416
HOLOGIC INC ,,/
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay
Gross
Discount
No -Pay
Net
f
10109915 f 05/0912004/28/2005/09/20
1,260.00
0.00
0.00
1,260.00
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
H0416 HOLOGIC INC
1.260.00
0.00
0100
1,260,00
Vendor#
Vendor Name; Class
Pay Code
14440
INSIGMA „r/
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Page 6 of 13
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
6746SHIRRE ✓ 05126120 10131/20 11/30/20
11,040,00
0.00
0.00
11,040,00 ✓'
TRAVEL NURSE STAFFING
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
14440 INSIGMA
11,040.00
0.00
0.00
11,040.00
Vendor# Vendor Name , Class
Pay Code
10442 INTERSTATE ALL BATTERY CENTER ✓,
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
1901102018091 V/ 05/25/20 05/12/20 06101/20.
539.40
0.00
0.00
5$9.40
RADIO BATTERY
Vendor TotalE Number Name
Gross
Discount
No -Pay
Net
10442 INTERSTATE ALL BA77ERY CENTER
539,40
0.00
0,00
539.40
Vendor#Vendor Name Class
Pay Code
11200 IRON MOUNTAIN y'
Invoice# Comment Tran Ot Inv Dt Due Ot
Check D Pay Gross
Discount
No -Pay
Net
y. 05/25/20 04/30/20 06/30120
GMLJ798
1,251.81
0.00
0.00
1,251.81
Y
4r,...
SHRED SERV
,
Vendor Total: Number Name
Gross
Discount
No -Pay
Net
11200 IRON MOUNTAIN
1,251.81
0.00
0.00
1,251.81
Vendor# Vendor Name Class
Pay Code
14436 JUAN CARDENAS TRUCKING ✓
Invoice# Comment Tran Dt Inv Dt Due of
Check D Pay Gross
Discount
No -Pay
Net
610315 ✓ " 05125/20 04/28/20 05/28/20
228.00
0.00
0.00
228.00 �
TOP SOIL
11�
510318 f 05/25/20 05/04/20 06/01/20
190,00
0.00
0.00
190.00
TOP SOIL
Vendor Total: Number Name
Gross
Discount
No -Pay
Net
14435 JUAN CARDENAS TRUCKING
418.00
0.00
0.00
418.00
Vendor# Vendor Name .Class
Pay Code
,
14432 LGC CLINICAL DIAGNOSTICS, INC. ✓'r
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
i
90183897 j 05/25/20 05/03/20 06/01/20
741,00
0.00
0.00
741.00
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
14432 _GC CLINICAL DIAGNOSTICS,
INC. 741.00
O.OD
0.00
741.00
Vendor# Vendor Name Class
Pay Code
10972 M G TRUST /
Invoice# Comment Tran Dt Inv of Due Dt
Check D Pay Gross
Discount
No -Pay
Net
052022 05/25/20 05/20/20 06/01/20
640,86
0.00
0.00
640.86
PAYROLL DEDCUT
!r
Vendor Tatah Number Name
Gross
Discount
No -Pay
Net
10972 M G TRUST
640.86
0.00
0.00
640.86
Vendor# Vendor Name Class
Pay Code
M2178 MCKESSON MEDICAL SURGICAL INC /
Invoice# Comment Tran Dt Inv DI Due Dt
Check D Pay Gross
Discount
No -Pay
Net
19172886 of 0512012003/15/2003/30/20
472,50
0.00
0.00
472.50
SUPPLIES
19393058 ✓ 05125120 05/17/20 06/01/20
338.50
0.00
0.00
338.50✓'
SUPPLIES
_
19397967 f 05/25/20 05/18/20 06/02/20
121.11
0.00
0.00
121.11
SUPPLIES
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Page 7 of 13
Vendor Totals Number Name
Gross
Discount
No -Pay
M2178 MCKESSON MEDICAL SURGICAL INC 932.11
0.00
0.00
Vendor# Vendor Name Class
Pay Cade
M2470 MEDLINE INDUSTRIES INC V;, M
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
2208854608 ✓ 05/09/20 04/27/20 05/22/20
669.73
0.00
0.00
SUPPLIES
2208717393✓ 0510912004/2712005/22/20.
39.66
0,00
0.00
SUPPLIES
2208717395 ✓ 05/09/20. 0412712005/22/20
433,22
0100
0.00
SUPPLIES
2209750915 r/ 05/09/2005/04/2005/29/20
4,204,90
0.00
0.00
SUPPLIES
2209750911 �/ 05/09/20 05/04/20 05/29/20
33.34
0.00
0.00
SUPPLIES
2209819605 j 05/09/20 05/04/20 05/29/20
617.91
0.00
0.00
SUPPLIES
2208303164 ✓' 05/18/20 04/23/20 05/18/20
195.00
0.00
0.00
SUPPLIES
2205548496 yd' 05/20/20 04/06/20 05/01/20
265.88
0.00
0.00
SUPPLIES
2206438186 f 05/2D/20 04/12/20 05/07/20
518.28
0.00
0.00
SUPPLIES
2207898489v'� 05/20/20 04120/20 05116/20
1,257.67
0.00
0.00
SUPPLIES
2210109938 r 05/25/20 05/05/20 05/30/20
220.49
0.00
0.00
V
SUPPLIES
`f
2210295001 05/25/20 05/06/20 05/31/20
449.25
0,00
0.00
,
SUPPLIES
2210421987 1/ 05/25/20 05/07/20 06/01/20
380.88
0.0D
0.00
FAIR SUPPLIES
,7UTH
2206658243 ✓/ 05/26/20 04/13/20 05/08/20
2,036.74
0.00
0.00
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
M2470 MEDLINE INDUSTRIES INC
11,322.95
0.00
0.00
Net
932.11
Net
669.73
39.66 ✓'
433,22
4,204,90 v,
33,34
617.91 L/
195.OD ✓
265.88 V
518.28
1,257.67f
220.49 !
449,25 /
i
380,88 uj
2.036.74 Y/
Net
11,322.95
Vendor# Vendor Name Class
Pay Code
10963 MEMORIAL MEDICAL CLINIC �%
Invoice# Comment Tian Dt Inv Dt Due Dt
Check D Pay Grass
Discount
No -Pay
Net
052022 05/25/20 05/20/20 06/01/20
328.78
0.00
0.00
328.78
PAYROLL DEDUCT
_
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10a63 MEMORIAL MEDICAL CLINIC
328.78
JAM
0.00
328.78
Vendor# Vendor Name Class
Pay Code
G0333 MICHAEL GAINES w
Invoice# Comment Tran Dt Inv or Due Dt
Check D, Pay Gross
Discount
No -Pay
Not
052522 05/26/20 05/25/20 06/01 /20
120,00
0.00
0.00
120.00
V-,
FNP RECERT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
G0333 MICHAEL GAINES
120.00
0.00
0.00
120.00
Vendor# Vendor Name Class
Pay Code
M2621 MMC AUXILIARY GIFT SHOP ✓'w
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Page 8 of 13
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
052522 05/26/20 05/26/20 06/01/20
271.44
0100
0.00
271.44
PAYROLL DEDUCT
. ✓
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
M2621 MMC AUXILIARY GIFT SHOP
271.44
0.00
0.00
271.44
Vendor# Vendor Name Class
Pay Code
M2659 MXR IMAGING, INC ' M
Invoice# Comment Tran Dt Inv Dt Due Dt
Check 0 Pay Gross
Discount
No -Pay
Net
18800662881 OW25/20 09/08/20 10/08/20
2.273.84
0.00
0.00
2,273.84�. '
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
M2659 MXR IMAGING, INC
2,273.84
0.00
0100
2,273.84
Vendor# Vendor Name Class
Pay Code
10868 NOVA BIOMEDICAL v/
Invoice# Co/�tmenl Tran or Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
90999388 / 05/26/20 05/16/20 06/13/20
2,988.00
0.00
0.00
2,988.00
S✓✓✓UPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10868 NOVA BIOMEDICAL
2,988.00
0.00
0.00
2.988.00
Vendor# Vendor Name Class
Pay Code
00920 OFFICE DEPOT V,1
Invoice# Comment Tran Dt Inv DI Due Dt
Check D Pay Gross
Discount
No -Pay
Net
241266338001 �f 05/25/20 05/03/20 05/25/20
270,99
0.00
0.00
270.99
SUPPLIES
241266338002 ✓/ 05/26/20 05/04/20 05125/20.
403.33
0.00
0.00
403.33 ./
SUPPLIES
241266339001 05/25/20 05/04/20 05/25/20
289.99
0.00
0.00
289.99
f'
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
00920 OFFICE DEPOT
964.31
0.00
0.00
964.31
Vendor# Vendor Name Class
Pay Code
01500 OLYMPUS AMERICA INC ,j M
Invoice# Comment Tran Ot Inv or Due Dt
Check D Pay Gross
Discount
No -Pay
Net
32624219 ,j' 05125/20 05107120 06/01/20
1,137.51
0.00
0.00
1,137,51 w`
CONTRACT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
01500 OLYMPUS AMERICA INC
1,137.61
0.00
0.00
1,137.51
Vendor# Vendor Name Class
Pay Code
01416 ORTHO CLINICAL DIAGNOSTICS
Invoice# Comment Tran of Inv or Due or
Check D Pay Gross
Discount
No -Pay
Net
/
1852375976 ✓ 05/26/20 04/2612D 05/26/20
752.16
0.00
0.00
752.16 -
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
01416 ORTHO CLINICAL DIAGNOSTICS 752.16
0.00
0.00
752.16
Vendor# Vendor Name Class
Pay Code
OM425 OWENS & MINOR ✓
Invoice# Comment Tran Dt Inv or Due Dt
Check D Pay Gross
Discount
No -Pay
Net
2075265254 j 05125/20 05105/20 06/04/20
585.28
0.00
0.00
585.28
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
OM425 OWENS & MINOR
585.28
0.00
0.00
585.28
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Page 9 of 13
Vendor# Vendor Name Class
Pay Code
11764 ROBERTRODRIQUEZ j
Invoice# Comment Tran Dt Inv Dt Due of
Check D Pay Gross
Discount
No -Pay
Net
051922 05/25/20 05/19/20 06/01/20
20.48
0.00
0.00
20.48
MILEAGE REIMS
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11764 ROBERTRODRIQUEZ
20.48
0.00
0.00
20.48
Vendor# Vendor Name j Class
Pay Code
10927 ROSHANDA THOMAS ✓/
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D, Pay Gross
Discount
No -Pay
Net
052322 05/25/20 05/23/20 06/01/20
46,99
0.00
0.00
46.99
BUStTRANSP REIMB
♦ /
V ,
Vendor Total -Number Name
Gross
Discount
No -Pay
Net
10927 ROSHANDATHOMAS
46.99
0.00
0.00
45.99
Vendor# Vendor Name Class
Pay Code
10699 SIGN AD, LTD. _ j
'
Invoice# Comment Tran Dt Inv Dt Due Dt
Check Or Pay Gross
Discount
No -Pay
Net
274020 j 0512512006/0i/2005/11/20
400.00
0.00
0.00
400.00
LEASE ADVERTISING
'v
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10699 SIGN AD, LTD.
400.00
0.00
0.00
400.00
Vendors Vendor Name Class
Pay Code
10195 SINGLETON ASSOCIATES PA .� ICP
Invoice# !Comment Tran Ot Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
51-11 05/26120, 03/31/20 04/30/20
109.10
0.00
0.00
109.10 f`
CONTRACT BILLING
51-12 05/26/20,04/29/20 05/29/20
215.66
0100
0.00
215.66 � f
CONTRACT BILLING
,
51-13 05/26/20 05/26/20 06/26/20
109.10
0.00
0.00
109.10 aj
CONTRACT BILLING
51-14A ✓� 05126120 06/29/20 07/29/20
54.65
0.00
0.00
54.55 4J`
CONTRACT BILLING
51-15 05/26/20 07/27/20 08/27/20
226.93
0.00
0.00
226.93
CONTRACT BILLING
51-16 „! 05/26/20 0813DI20 09/30/20
302.96
0.00
0.00
302.96
CONTRACT BILLING
51-17 05/26/20 09/30/20 10/30/20
226.57
0.00
0.00
226.57
CONTRACT BILLING
51.18 05/26/20 11/30/20 12/30/20
163,65
0.00
0.00
163.65
CONTRACT BILLING
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10195 SINGLETON ASSOCIATES PA
1,408.52
0.00
0.00
1,408.52
Vendor# Vendor Name Class
Pay Code
11296 SOUTH TEXAS BLOOD & TISSUE CEN '//
Invoice# Comment Tran Ot Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
10702271 ✓ 05/25(20 05/15/20 06/09/20
6,280.00
0.00
0.00
6,280.00 v''
BLOOD
CM6967 �f 05/26/20 05/15/20 06/09/20
-2,844,00
0.00
0.00
-2,844.00
CREDIT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11296 SOUTH TEXAS BLOOD & TISSUE CEN 3,436.00
0.00
0.00
3,436.00
file:///C:/Users/itrevino/cpsi/memmed.cpsinut.com/u8 8125/data_5/tmp_cw5report686690... 5/26/2022
Page 10 of 13
Vendor#Vendor Name Class
Pay Code
C1010 SPARKLIGHT ,/ W
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
051622 05/25/20 05/16/20 06/01/20
115.78
0.00
0.00
115,78 /
CABLE
051622A 05/26/20 05/16/20 06/01/20
2,258,00
0.00
0.00
2,258.00
CABLE
051622B 05125120 05116120 06/01/20
1,683.58
0.00
0.00
1,683.58
CABLE
051622C 05/25/20 05/16/20 06/01/20
60.25
0.00
0.00
6025 .%-
CABLE
Vendor Totals Number Name
Gross
Discount
No -Pay
Not
C1010 SPARKLIGHT
4017al
0.00
0.00
4,117.61
Vendor# Vendor Name Class
Pay Code
14148 SPECTRUM HEALTH PARTNERS, LLC
Invoice# Comment Tran Dt Inv Dt Due Dt
Cheek D Pay Gross
Discount
No -Pay
Net
JUMIOMMC22 Z 0512512005/23/2006101120
24,905.00
0,00
0.00
24.905.00
CFO STAFFING - rT{ ,wj Illdt $qt
VendorTotals Number Name
Gross
Discount
No -Pay
Net.
14148 SPECTRUM HEALTH PARTNERS, LLC 24,905.00
0.00
0.00
24,905,00
Vendor# Vendor Name Class
Pay Code
10094 ST DAVIDS HEALTHCARE v�
Invoice# Comment Tran Dt Inv Dt Due Dt
Check 0- Pay Gross
Discount
No -Pay
Nat
MMCPL20224 ,r 05120/2005/25/2006/01/20
420.00
0.00
0.00
420.00 r'
CONNECTIVITY FEE APR 22
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
- 10094 ST DAVIDS HEALTHCARE
420.00
0.00
0.00
420.00
Vendor# Vendor Name Class
Pay Code
S3960 STERICYCLE, INC 1�
Invoice# Comment Tran Dt Inv Dt Due Dt
Check. D Pay Gross
Discount
No -Pay
Net
4010963862 V,/ 05/26/20 06/01/20 06/15/20
2,662,55
0.00
0.00
2,062.55 V'
MEDICAL WASTE DISPOSAL
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
S3960 STERICYCLE, INC
2,662.55
0.00
0.00
2.662.55
Vendor# Vendor Name Class
Pay Coda
13528 STRYKER FLEX FINANCIAL
Invoice# ,- Comment Tran Dt Inv Dt Due of
Check D Pay Gross
Discount
No -Pay
Net
249489 % 05/25/20 05/10/20 06/09/20
1.294.26
0.00
0.00
1,294.26 f
LEASE
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
13528 STRYKER FLEX FINANCIAL
1,294,26
0.00
0.00
1.294.26
Vendor# Vendor Name Class
Pay Code
14212 SURGICAL DIRECT SOUTH ,/
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
/
8719 ✓ 06126120 05124120 06/15120
2,315.00
0.00
0.00
2,315.00
SUPPLIES
VendorTotalsNumber Name
Gress
Discount
No -Pay
Net
14212 SURGICAL DIRECT SOUTH
2,316,00
0.00
0.00
2.315.00
Vendor# Vendor Name Class
Pay Cade
11067 TRIZE770 PROVIDER SOLUTIONS,/
Invoice# Comment Tran Dt Inv or Due Dt
Check D Pay Gross
Discount
No -Pay
Net
file:!//C:/Users/ltrevino/cpsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5report686690... 5/26/2022
Page 1 t of 13
35FK052200 �� 05/25/20. 051011200512MO
1,631,07
0.00
0,00
1,631.07 �"
PATIENT STATEMENTS
t
. Vendor Total£ Number Name
Gross
Discount
No -Pay
Net
11067 TRIZETTO PROVIDER SOLUTIONS
1,631.07
0,00
0.00
1,631.07
Ventlor# Vendor Name Class
Pay Code
11001 ULINE
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
148721121A1 05/26120 05/09120 06108120
17.91
0100
0.00
17.91
v-`F
FREIGHT
Vendor Totals Number Name
Gross
Discount
No -Pay
Not
11001 ULINE
17.91
0.00
0.00
17,91
Vendor# Vendor Name Class
Pay Code
U1064 UNIFIRST HOLDINGS INC ..
Invoice# Comment Tran Dt Inv Dt Due Ot
Check D Pay Gross
Discount
No -Pay
Net
8400395103 ✓ 05126/20 05/19/20 06/13/20
175.75
0.00
0.00
175.75
LAUNDRY
8400395102 / 05/26/20 05/19/20 06/13/20
201,59
0.00
0.00
201.59
LAUNDRY
8400395104 05/26/20 05/19/20 06/13/20
226.93
0.00
0.00
228,93
v,,%"
LAUNDRY
8400395120 .� 05/26/20 05/19/20 06/13/20
83.90
0.00
0.00
83,90
LAUNDRY
8400395127 �.� 05/26/2005/19/2006/13/20
1,024.54
0.00
0.00
1,624.54
LAUNDRY
8400395105 1,! 05126/20 05/19/20 06/13/20
223.13
0.00
0.00
223.13
LAUNDRY
8400395141 05/26/20 05/19/20 08/13/20
62,69
0.00
0.00
62.69
LAUNDRY
8400396101 05126120 05119/20 06/13/20
8312
0.00
0,00
83,12 of
LAUNDRY
$400395318 / 05/26/20 05/23/20 06/13/20
48.15
0.00
0.00
48.15
LAUNDRY
$400395344 1' 05/26120 05123/20 06/13/20
2,221.15
0.00
0.00
2,221.15
LAUNDRY
8400395319 ! 05/26/20 05/23/20 06/13/20
LAUNDRY
59.82
0.00
0.00
59.82
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
U1064 UNIFIRST HOLDINGS INC
5,010.77
0.00
0.00
5,010.77
Vendor# Vendor Name Class
Pay Code
10968 UNITED RENTALS (NORTH AMERICA)
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
205782083001 �'� 05/25120. 05/02/2006101/20
118.97
0.00
0.00
118.97�,.%
RENTAL
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10968 UNITED RENTALS (NORTH AMERICA)
118.97
0.00
0.00
118.97
Vendor# Vendor Name Class
,
Pay Code
V0552 VERATHON INC J
Invoice# Comment Tran Dt Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
80469222 L;/ 05/25/20 04/21/20 05/16/20
2,550.00
0,00
0.00
2,550.00,,.-
PREM EX WARRANTY
Vendor Totals Number Name
Gross
Discount
No•Pay
Net
file:///C:/Userslltrevino/cpsi/menuned.cpsinet, com/tt88125/data_5/tmp_cw5report686690... 5/26/2022
Page 12 of 13
V0552 VERATHON INC
2,550.00
0.00
0.00
2,550.00
Vendor# Vendor Name Class
Pay Code
10768 VICTORIA MEDICAL FOUNDATION
Invoice# Comment Tran Ot Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
22 ✓ 05/26/20 05/10/20 05/10/20
500.00
0.00
0.00
500.00
ANNUAL MEMBER DUES O'DC
93A ✓ 05/25/20 05/10/20 05/10/20
725.00
0.00
0.00
725.00 tom'
ANNUAL MEMBER DUES SCHI
47 05/25/20 05/10/20 05/10/20
725.00
0.00
0.00
725.00
ANNUAL MEMBER DUES BUNT
134 ,/� 05/25120 05/10/20 05/10/20
725.00
0.00
0.00
725,00 `
ANNUAL MEMBER DUES SCHI
89 % 05/26/20061101PO 05/10/20
725.00
0.00
0.00
725.00
✓ ANNUAL MEMEBER DUES HIN
36 / 05125/2005/10/2005/10/20
725.00
0.00
0.00
725.00
ANNUAL DUES 22- ROJAS
25 05/25/20 05/10/20 05/10/20
500.00
0.00
0.00
500,00
ANNUAL MEMEBER DUES SHI
23 05/25/20 05/10/20 05/10/20
500.00
D.00
0.00
500.00
V/.
ANNUAL. MEMBER DUES PFEI
29B 05/25/20 05H0/20 06/10/20
500.00
0.00
O.00
500.00 -`
H�+`
ANNUAL MEMBER DUES THUI
145B 05/25120. 05/10/2005/10/20
725.00
0.00
0.00
725.00
���
,✓'-
ANNUAL MEMBER DUES LON
57 „% 05/25/20 05/10/20 06/10/20
725.00
0.00
0.00
725.00
ANNUAL MEMB DUES CROWL
143B 05125/2005/10/2o 05/10/20
726.00
0.00
0,00
725.00
` ANNUAL MEMEBER DUES TRI
14 �� 05125/20 05110/20 05/10/20
500.00
0.00
0.00
500.00
ANNUAL MEMBERSHIP DUES
v
Vendor Total: Number Name
Gross
Discount
No -Pay
Net
10768 VICTORIA MEDICAL FOUNDATION 8,300.00
0.00
0.00
8,300,00
Vendor# Vendor Name Class
Pay Code
10793 WAGEWORKS, INC.
�/
Invoice# Comment Tran Dt Inv Ot Due Ot
Check D Pay Gross
Discount
No -Pay
Net
052022 05/25/20 05/20/20 06/01/20
3,410.17
0.00
0.00
3,410.17
PAYROLLDEDUCT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10793 WAGEWORKS, INC.
3,410.17
0.00
0.00
3,410.17
Vendor# Vendor Name Class
Pay Code
11110 WERFENUSALLC
Involce# Comment Tran Ot Inv Dt Due Dt
Check D Pay Gross
Discount
No -Pay
Net
9111154932 f' 05/18/20 05/05/20 05/30/20
234.96
0.00
0.00
234.96 '
L
4
SUPPLIES
9111158085 05125/20 05113/20 06/07/20
1,571.67
0.00
0.00
1,671.67 Vr
SUPPLIES
9111160307 .'` 05/2512G 05/17/2006111/20
1,028.66
0.00
0.00
1,028.66
SUPPLIES
Y
9111160889 j 05/25/20 05/18/20 06/12/20
704.00
0.00
0.00
704.00
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
file:///C:/Users/ltrevinD/cpsi/memmed.cpsinet.corn/u88125/data_5/tmp_cw5report686690... 5/26/2022
Page 13 of 13
11110 WERFEN USA LLC
Grand Totals: Grass
520,544.75
0•C
520,54it 'l�� m
8 60 -
5 1 9 v '% 1 z,, '1 5
MAY 2 6 2022
BYOO(JCALHOUNNiY 0,
CaUp1t1', a
Report Summary
Discount
0.00
3,539.29 0.00
No -Pay
0.00
0.00 3,539.29
Net
520,544.75
file:///C:/Userslltrovino/epsilmemmed. cpsinet.com/u88125/data_5/tmp_cw5report686690... 5/26/2022
MSKESSON
STATEMENT
As al: 0512]/2022
Page: 002
TO enwm lumper crt.dA to your
ecc&^ detar:h and return this
:+ rvm xuon
Nub NAh Your mmtlti one
DC: 8115
A6 of: 05/27/2022 Page: 002
MEMORIAL MEDICAL CENTER
AMT DUE REMITTED VIA ACH DEEII
Territory:
Mall to: Came: 6000
AP
815 N VIRGINIA STREET
Statement lot mlormalion only
AMT DUE REMITTED VIA ACH DEBIT
PORT fAVACA T% ]IW9
Cumomer: 03253G
Slatemenl for informnlian only
Date: 05/28/2022
Cum: 632536 PLEASE CHECK ANY
Dal. 05/2812022 REIAS NOT PAID (+(
DI31n9 Out.
Data Deta
National Account 8�q9n 6
fa Dlddera
Cash
Amon P
Amount P tieceivabk =+
Number
Number Relemnce Description Discount
(goes) F
(ml) F Number _I s.
PF column Mgend: P = Past Out, Item, F = Future Dua Rem, blank = Curren Due Item
TOTAL NaRlanal Acet 892536
MEMORIAL MEDICAL CENTER
------/
SUMNeIa:
8,106.35 USD
Future Due:
0.00
Out. It Pald On Time:
If Paid BY (5/3112022,
USD 7.944.24
Pam Oue:
O.UO Pay This Amount:
7,944.24
USD
Disa ION A paltl late:
taut universes
2,451.9] H P41tl After 05131/2022,
162.11
Due It Pald late:
08/0]/201]
Pay this Amount:
8,106.35
USD
USD 13.106.35
7r 065•`,/
482 YY
264Ii1 +
131 45t
7•944 2e
APRWMGN
MAY .1 2022
By �InUNaty
For AR Inquiries please contact 800-867-0333
MSKESSONSTATEMENT
,,... ao
c...,v.,
WALMART 10980,1W MOD PHS
MEAORIAL MEDICAL CENTER AMT DUE for informITITED VIA ACH OMIT
VICKY KALISIX Statement for information BnIY
815 N VIRGINIA ST
PORT LAVACA TX 77979
As of: 0512D2022
DC: 8115
Tertiary: 400
-
Cudomec 256342.
Date: 0512012022
Page: 001
To ensure proper crefia to your
eeaauntI detach and rotu a th s
dub W 9h your remittance
As of: 05/27/2022 Page: 001
Mail to: Camp: 8000
Statement b�inlom alien onlH DEBIT
Y
Cod: 256342 PLEASE CHECK ANY
Dale: 05/28/2022 FENS NOT PAID (r)
911b9
�Ne Delbnel Accaunl �T�]85/te
Cecil
A.. P
Amolalt P ReeNvable
00.
Ode Oate
_.`_.. _..._.
Number
Mo..
Description
Discount
(gro®) F
(rreQ F
Ir
Customer Number 256342 WAWART 1098/MBA Mm
PHS
0512W2022 05/31/2022
73436899SS
34270537
11510voice
5.93
296.69
290.76 ✓ ]3438B9939
0512312022 0513U2022
7343850537
052022U853
Ii51nva.a
34.92
1,745.79
1.710.87 ✓ ]34385853]
05,2312022 05/31/2022
734385R538
05POP20904
1951nvolce
0.24
_
U.24 / 7343858538
05124,2022 05/3112022
7343996519
34570156
1151nvoK.
0.16
0.16 / ]343996519
05/24/2022 0513W2022
7344147817
0523220956
1t51nvalca
1,04
52.24
$1.20 `7 73.14141017
OS12512022 051311P022
7344244937
34649084
1151nvoice,
26,00
1.300.16
_
1W4.I0'/ 7344244937
05/25/2022 05131/2022
7344244938
34/07901
1151nvobe
0.09
_
0.09'� I344244938
05/2512022 05131/2022
7344244939
34721672
115Ins.m.
0.09
0.09'� 734a244939
05/25/2022 05,3112022
7344244940
34721672
11 Stover..
0.01
0.63
D.62 ✓ 73"4244940
0512W2022 0513l;202'2
7344384824
052422071/
1951nvoice
6.27
313.49
307.22 ]344384824
0512W2022 OW31/2022
7344384025
052422D943
1151nvoica
4.56
227.86
223,30 ✓ 1344384825
0512W2022 05/9f12022
7344513686
34768335
IISInvOica
6.99
349.66
342.89/ 7344513686
05126/2022 05/3112022
7344513697
34836106
1151moice
2.81
140.53
137.72 ✓ 7344513687
0512612022 05/3112022
7344666686
0525221034
1151nvoic0
0.01
0.32
0.31 ✓ 7344666686
05/27QU22 05/3U2022
7344779358
34589353
11510101ce
5.80
289.91
284.11 ✓ 7344779358
OW2712022 05/3112022
7344779359
34949345
1isimmlce
16.98
040.78
_
031.80 ✓/ 1344779359
0512712022 05/31/2022
7344944168
0525220602
1951nvaico
32.87
1,643.60
1,610.73 / 7344944168
PF column lagend: P = Pam Due Rem, F = Future
Due Item, blank = Cmrom Due hem
TOTAL Customer Number 268942 WALMANT tOBeIMBA M® PHS
Subtatde:
7.210.10
USD
Fulu s out;
0.00
0. N Me an Time:
If Paid By OS/31/2022,
USD 7,065.97
Pad Due:
0.00
Pay This Amount:
7,065.97
USD
Dhe, last it paitl late:
44.19
Ind P2Ymerr,,1,.��,,,,���� 11.17].20
If Pant Alter 2022,
Due 11 Pale Leta:
OS/29/202WITMlIVFJJ Qi11
Pay this Amaum:
Amount:
7,210.tfi
U8O
UBO 7,210.16
MAY 31 ZW
11V COUNTY AUDITOR
CALHOUN COUNTY, TEXAS
For AR Inquiries
plebs.
Contact 800-867-0333
MSKESSON
STATEMENT As el: 05/2712O22
Page: 001
To senors proper overall to year
aceount, astaeh end return this
u.•ms.mr W.
stub with with your remittance
OC: fi115
CVS FHCV ]006/MEMOPoA MSS
As t: 05/27/2022 Page: 00
Mail to:
pMi DUE REMITTED VIA ACH DEHII' Territory: 400
MEMORIAL MEDICAL CENTER
Comp: 8000
Statement for fnanamion only
KALISIX
VIC815
AMT DUE RGMITTED VIA ACH DEBIT
N Cupomer. 262252
815 N IA
Slelemonl for Information only
AVAC Data: 05/28/2022
FORT IAVACA TX I]9T9
Cum: 262252 PLEASE CHECK ANY
Vale: 05/28/2022 ITEMS NOT PAID jw)
all90al Ars unl WM134c3fi
6(Il19 Due Rece(vabf� [Itderr
Cash
Oele Oate Number Refrome Description Discount
Amount P
(9.) F
Amount P Recomalse I
lent)
Customer Number 262252 CVS PNCY 7006/MEMOPoA PHS
05/25/2022 05/31/2022 7344227523 1707055 1151nvoice 9.05
492.62
482.]] w/ 7344227523
IT column legend: P = Pall Des Nam, F = Future Due Item. blank = Current Due Nem
TOTAL• Customer Nwmbx 262252 CVS PNCY ]OOfiIM@dOPoq PNS
--�-"--
—
SubtatI 492.62 USD
Future W. 0.00
If PeM By o5/3112022,
0. It Paid On Time:
Peat Due: 0.00 Pay nis Amount: 482]]
USO
USD 482.T]
Of- lost N Rid Wis.-
Lard Payment 11,1]].20 If Paid After 0613112022,
9.85
Due III Paid Late:
05/23/2022 Pay this Amount: 492.62
USD
USD 492.62
APPROVED ON
MAY 31 2022
BY COUNTY AUDITOR
CAIJMN COUIM TEXAS
For AR Inquiries please contact 800-867-0333
MSKESSON
HEB MY FC 4901MBd MC PHS
MWORIAL MEDICAL GMTES
VICKY KALISEK
815 N VIPGINIA ST
MPT LAVACA TX 77979
STATEMENT
AMT DUE REMITTED VIA ACH Of
Statement for information only
As of: 05/27/2022
no: 8115
Tomiary: 400
Customer: 464450
Dale: 05/28/2022
D9in9 Due
Natimet Account 536
Carol
Data Dale
Nureteer Reffer
NumM— ikremnce
Daacriptbn
Diueunl
—
Customer Number 464450 H® MY k 490IMF31 MC MS
05123/2022 05131/2022
73436SU370 55XS11520
11511MIum
4.96
05124/2022 051311202P
7343972561 55x513797
IISlnvolco
0.14
05/25/2022 05131/2022
7344217145 55.517358
116lrrvoine
0.03
05/27/2022 05/31f2022
7344756499 55x52237e
IIslnvaice
D26
PF column loosed: P = Pam
Due Item, F = Future Due hem, blank =
Cummn Due Item
WUL Cuammer Numhar AWWO N® PNY FL 4B0IMEM MC PNS
Sublolal9:
269.40 USO
RWm D.:
Pam Due:
Diet Payment
05123/2022
aSFR&AD W
MAY 31 ,
0.00
H laad OV 0513112022,
0.00 Pay This Amount:
11,172.20 It Peld After 05/3t/2022,
Pay this Amount:
Page: 001 To endeme Proper eredt to your
aecoert, detach and return this
stub Nhh your remHlanc,
As at: 05/27/2022 Page: 001
Ma9 I. Comp: 6000
AMT DUE PEMITTED VIA ACH DEBIT
Statement for infunnsraon end,
Cum: 464450 P fASE CHECK ANY
Date: 05/28/2022 frEMS NOT PAID (.r)
Amount P—
(groan) F
Amount P
(mH) F
— I s 1
Mints,
249.9
242.9P�7343651137072�J
0.95
6.91✓
1343W2561
fi1
1.48
1.45✓l
7344217145 _
13.10
12.64 ✓
]344]66499
294.01 LAID
269.40 USD
For AR Inquiries please contact 800-867-0333
Duo It Path On TI.:
USD 264,01 ,'
01. foes If paid kte:
5.39
Due It Potd Data:
USD 269.40
m_R�awN STATEMENT As of:0512712022
Polls;
To—Mproporeredhtoyour
amount, detach and ream this
c<voyn. noon
eWb with your mmhtanm
DC: 8115
As or: 05/2712022 Pago: ODI
CVS PHCY 74751MFM MC PHS ANT DUE RBAITT® VIA ACH DEBIT TeMtory: 400
Mail to: Comp: 8000
M6'MORIAL MEDICAL CENTER Statement for information only
AMT DUE REMITTED VIA ACH DEBIT
VICKY KALISEK Customar. 835438
Statement IOr information only
815 N VIRGINIA ST Who 05/203543
12022
PORT LAVACA T% 77979
Cum: 835438 PLEASE CHECK ANY
Unto: 05/28/2022 ITEMS NOT PAID (r)
Amount R3eN Dash
Date Due
Amount P
Amount P Resolvable
Number
Oats Data Number iktereme Description Olacwnl
(gross) F
(mi) F NunA,tt
Customer Number 835438 CVS PHCY 7475/14I301 MC PHS
05125/2022 05131/2022 7344420299 1708387 1151avo1ce 2.68
134.17
131,49 7344420299
PF column legend: P = Past Due ham. F = Mum Dos th n1, blink = Coolant D. Itgm
TOTAL CUMgmer Number 895438 CVS PHCY ]4]5IMEM MC PHS
astounds: 134.17 USD
Forum Due: 0.00
Due D Paid On Tim;
It Paid By 0513112022,
USD 131.49,/
Pact Duo: 0.00 Pay This Amount: 131.49
USD
Dias lost K Paid Is[e:
Last Peymenl 11.177.20 If Mid After 2022,
Ous If Paid late: 2.68
05123/2022 Payy this Amount: 134.17
USD
USD 134.17
Ate RWWON
MAY 31 2022
t:ARW
LH01N COUM'Yi
For AR Inquiries please contact 800-867-0333
1 STATEMENT Statement Number: 83081419
AmertsourceBergen• Date: 05-27-2022
i of
AMERISOURCERERGEN
DRUG CORP
WALGREENS#12494340B
12727 W. AIRPORT BLVD.
MEMORIAL MEDICAL CENTER
111352841037028166
SUGAR LAND TX 77478.6101
13M N VIRGINIA ST
PORT LAVACA TX 77979.2509
DEA: RAD289276
gel -Fri Due in 7 days
866AS1-9655
AMERIMURCEBERGEN
P.O. Box 905223
Not Yet Due.
00
CHARLOTTE NC 28290-5223
7.52
897.52
PosiOu
Pacl Oue:
U.00
Total Cu.:
607.62
A unl Balance:
697.62
Account Activity
Document Due
Reference
Purchase Order
Document
Original
Last Receipt Amount Received
Date Date
Number
Number
Type
Amount
05.23-2022 0603-2022
3093710926
165997
Invoke
36.60
0.00
_I
M-23-2022 06.03-2022
3093710927
165999
Invdce
0.91
0.00
O 23.2022 06-03-P022
3093710928
165998
Involve
18.94
0.00
0.23-2022 06.034022
3093710020
166000
Wall.
28.24
am
06-23-222 08.03-2022
3093761190
166046
Invoice
337.46
0.00
0.524-2022 06-03-2022
3093886243
166054
Invdce
9.25
0.00
M-25-2022 06�03.2022
3094036434
16B005
Invdce
59.81
0.00
05 26-2022 06-03-2022
3094189528
166074
tryst. _
156.31._
_ _ _
0.00
Current
1.16 Days
18�0 Drays 31.60 Oays. -61-90 Days
91.120 Days Over 120 Days
l
6B7sz
9.09
D.90 990 6.69
6.06 - u.00
Thank You for Your Payment 1
Date Amount)
05-27-2022 -::(508.34)
&I'llftmom
MAY 31 2022
B+'COUNTy w
au"°" DDtanus
Reminders
Due Date Amount
06.03-2022 697.52
Total Due: 697.52
MEMORIAL MEDICAL CENTER
PROSPERITY BANK
ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT-- May 23, 2022- May 29, 2022
Data Bank Description
5/23/2022 PAY PLUS ACHTRAN5452579291101000690496325
5/24/2022 PAY PLUS ACHTRANS 452579291101000691413397
5/24/2022 MCKESSON DRUG AUTO ACH ACH05031205 910000126
5/25/2022 PAY PLUS ACHTRANS 452579MI 101000692265225
5/26/2022 PAY PLUS ACHTRANS 452579291101000693099953
5/27/2022 PAY PLUS ACHTRANS 452579291101000693983422
5/27/2022 EXPERTPAY EXPERTPAY 746OD341191000012213637
5/27/2022 AMERISOURCE BERG PAYMENTS 01MOD77M 2100002
5/27/2022 MEMORIAL MEDICAL PAYROLL 746003411113122650
MMCNotes
- 3rd Party Payor Fee
- 3rd Party Payor Fee
-340B Dmg Program Expense
- 3rd Party Payor Fee
-3rd Parry Payor fee
-3rd Party Payor Fee
-Child Support Payment -Payroll Ending 5.19.22
- 3408 Drug Program Expense
Payroll
Anthony Richardson, interim CFO �� May 31, 2022
Memorial Medical Center
PR05PERITY BANK
ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT— ESTIMATED AOIS
Oun
3S`62
35;62
11,177.20A
139.6
506.3
351,456.S2.#
364,233.13
PlLj vim
2 6 ii
JS^b<
139-67
I&S^ IU
C,�4:81 5r ti17:,':;
%ALvvi-?.xq
607. 2'r
485.811
607+t'/
Date e5M a MMC Notes Amount 3 6 4, c 5 C; I , ,
6/16/2022 CHIRP IGT -IGT I I , I ('/ I�
Be'097.00
I. �:"� 1,OA••i1y
Anthonyay 31, 2022honV Richardson, Interim CFO 1 t7't •
Memorial Medical Center . U 9 - i r
0.00
APPROvi
MAY 31 2022
BY COUNTY AUDITOR
C:ALHOUN COUNTY. TEXAS
Transaction Summary
Transaction Complete
Trace
Texas Health and Human Services Commission
Memorial Medical Center Operating County
Page No: t of f
Run Date: v2w=2
Run Time: 14:23:53
Marlev ODonnell
From: Texas Health and Human Services Commission <txhhs@public.govdelivery.com>
Sent: Friday, May 27, 2022 2:18 PM
To: Marley C)Donnell
Subject: Comprehensive Hospital Increase Reimbursement Program IGT Notification First Half of
Year (SFY23)
outside ofthe organization. Do not click links or open attachments unless you
TEXAS
tb ' Health and. Human Services
Comprehensive Hospital Increase
Reimbursement Program IGT
Notification First Half of Year 2 (SFY23)
HHSC is providing notification of the first half Intergovernmental
Transfers (IGT) call for the Comprehensive Hospital Increase
Reimbursement Program (CHIRP) Year 2.
The IGT amounts can be found in column AR on the "CHIRP Payment
Calc" tab of the Suggested IGT file. This file has been updated today,
May 27, 2022, and can be found under Suggested IGT on the Provider
Finance CHIRP website.
• The IGT must be entered into TexNet no later than close of
business June 15, 2022 with a settlement date of June 16, 2022.
• This settlement date is non-negotiable.
• The funds need to be placed in the "CHIRP" Bucket.
Please transfer funds through TexNet (instructions are available here),
and send an email with a screen shot or PDF of the confirmation/trace
sheet to H HSCPFDCHIRPPa yments(W hhs.texas oov.
Please email any questions regarding the calculation in general
to PFQ HosoitalsCD hhsc.state tx us.
You have subscribed to get updates about Texas Health and Human Services (HHS). For more information about HHS, please visit our
website.
Stay Connected
s
(en espatlop
:1 SHARE
Subscriber Services
Manage Preferences I Unsubscribe I Hein
This email was sent to m000nnell®mmcporilavaca.com using govDelivery Communications Cloud on behalf of, Texas Health and
Human Services Commission 70717th St, Suite 4000 - Denver, CO 80202 9OVDELNERY�
2
CHIRP SFY2023 Payment Calculation
Master TPIllst Enrollment Enrollment Enrollment
Model
Enrollment
Standard Dollar Standard Dollar
Amnunh P11. Arnnnn« n1.-
IP Medicare UPL Test
and IMD Medicare UPL OP Medicare UPL
Actuarial Analysis Actuarial Analvsis rest Tecr — n a r Tnnn�
$3.404,974.340 192.095.813.360 AS-Snn-727 9001
$2,199,91B,194
$590,777,521
Combined Rates Clam
li
I
ns 3
BDp
Total SFM All
6ncaunters
'*
$1,051,54211 $961,127 $2,012,669
Rural Nueces
$121196
-$79,110
Calculated in the ACR
model tab using
enrollment and UPL
info; for IMDs, need
Medicaid charges as
well.
Calculated in the
ACR model tab using
enrollment and UPL
Info.
% of ACR before
r, tk i,
$2,790,695,715
$4,278.262.3731 $1,507,983,123
$5,786,245,496
Iy` 70^h
7otePUPL Gap
a� ,`"`Full
ACR bap-
DOea the;HoaPital Have
P4a1Hve IP ACR.Reom7
$42,086
$93,304 $221,987
$315 291
Yes
$2,284,063,388
$627,674,532
Dow
tivivthe ACRa1 Have
Positive OP ACR Roota7.
IP UMRIP Rate
OP UHRIP Rate
3P URRIP Payment
OP:UHRIP Payment
Yes
17%
13%
$ 178,762
$ 124,946
$2,891,738,100
Total UNRIP Payment
Requested to
Participate in ACIA
IP ACIA paymenfls
-
OP ACIA payment
Total ACIA
IP ACIA Rate
Component?
> $0
Is > $0.
payment ia> $0
$303,709
Yes
No
Yes
Yes
0%
$1,627,668,878
$641,874,896
$2,269,043,774
Ke0uC01on
IP ACIA Payment
OP ACIA Payment
OP ACIA Rate
before reduction to
(before reduction
Total ACIA
Revsed IP ACIA
Revised OP ACIA
stay at 90% of ACR
to stayat 90% of
Payment
Rate
Rate
7%
0
$67 279
$67,279
0%
7%
$171,128,159 $47 097,632
$1,456,540,719
$594,277,264
$4,942,556,082
g304,411,923
Revised IP ACIA
Revised OP ACIA
Payment to stay at
Payment to stay at
Inpatient CHIRP
Rate
Outpatient CHIRP
Hospital Recelves
MCO Feea
90% of ACR
90% of ACR.
Rabe
$0
$67 279
17%
20%
370,988
22,880
State Share
39.54%
$3,246,968,003
$2,240,623,241
$1,120,311,621
$1,120,311,621
Total Hospital
Suggested Total
Receives Plus MCO
16T for Declaration
suggested IOT for
Suggaated X(rr far
Fees
of intent after 8%
1st 6 months
2nd 6 months
(12 months)
393,867
168,194
$84 097
$,4,097
Page 1 of 1
RECEIVED BY THE
COUNT' AUDITOR ON
MAY 2 6 2022
05/26/2022
MEMORIAL MEDICAL CENTER
CALH680OUN1Y,TEXAS
AP Open Invoice List
0
ap_open_invoice.template
Dates Through:
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
051622A
05/25/20 05/16/20 06/17/20 106.25
0.00
0.00
106.25
TRANSFER W q insuvwn.�, pu��.i jgoi11 jd_ ik, nAWVI Oht*M1•
�0
051622
05/25/20 05/16/20 06 7120 52.09
0.00
00
/
52.09
TRANSFER 4
Ir
051722
05125/20 05/17/20 05117/20 261,23
0.00
0.00
261.23
TRANSFER N
It
052022
05/25/20 05/20/20 06/17/20 1,346.66
0.00
0.00
1.346.66
TRANSFER
It
Vendor Totalp Number Name Gross
Discount
No -Pay
Net
11836 GOLDENCREEK HEALTHCARE 1,766.23
0.00
0.00
1,766,23
Report Summary
Grand Totals:
Gross Discount
No -Pay
Net
1,766.23 0.00
0.00
1,766.23
AAPRf1MDrt*
MAY 2 6 Z022
file:/!/C:1Users/ltrevino/cpsi/memmed.cpsinet.coin/u88125/data_5/tmp_cw5report191636... 5/26/2022
Page I of 1
RECEIVEDSY71HE
COUNTY AUDITOR ON
MAYos GAW2
MEMORIAL MEDICAL CENTER
AP Open Invoice List
0
12:44
ap_open invoice.template
CAW OUN COUNTY, TRAS
Dates Through:
Vendor# Vendor Name Class Pay Code
12696 GULF POINTE PLAZA
Invoice#
Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
Net
051622
05/25/20 05/16/20 06/17/20 7,132.84
0.00
0.00
J
7,132.84 ✓
TRANSFER N" iyi5oMft(R_ p0K+6tp0(ii+ea Ihfil KUL
UK'i'ln�)
051722
05/25/20 05/17/20 06/17/20 13,377.80
0.00
0.00
13,377.80 ✓
TRANSFER tt
tr
Vendor Totals Number Name Gross
Discount
No -Pay
Net
12696 GULF POINTE PLAZA 20,510.64
0.00
0.00
20,510.64
Report Summary
Grand Totals:
Grass Discount
No -Pay
Net
20,510.64 0.00
0.00
20,510.64
X*Wfinom
MAY 2 6 2022
C��y,
file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.comlu88125/data_5/tmp__cw5report150919... 5/26/2022
Page 1 of I
flEGEIVED BY THE
COUNTY AUDITOR ON
MAY 2 6 2022
MEMORIAL MEDICAL CENTER
05/26/2022
0
AP Open Invoice List
GALHOII'�UtVTY,iEXAy
ap_open_invoice.template
Oates Through:
Vendor# Vendor Name
Class Pay Code
13004 TUSCANY VILLAGE
Invoice#
Comment Tran Dt Inv Dt Due Dt Check D Pay
Gross
Discount No -Pay
Net /
051622
05/25/2005/1612006/17/2L0
8,918.60
0.00
0.00
8,918.60 L
1
TRANSFER W 'iiwrLnp. K"I Af. v&4r!
jK-u l\ m ,
opts vicj
051622A
05/25/20 05/16/20 06 17120
397.76
0.00
0.00
397.76 „sue
TRANSFER 11
it
061722A
05125120 05/17120 06/17/20
1,226.21
0.00
0.00
1,226.21
It
TRANSFER
ti
051722
05/25/20 05/17/20 06/17/20
172.32
0,00
0.00
172.32
TRANSFER I`
It
052022
05/2512005/20/2006117/20
11,509.52
0.00
0.00
11,509.52
TRANSFER 1,
It
Vendor Totak
Number Name
Gross
Discount No -Pay
Net
13004 TUSCANY VILLAGE
22,224.41
0.00
0.00
22,224.41
Report Summary
Grand Totals:
Gross Discount
No -Pay
Net
22,224.41 0.00
0.00
22,224.41
MAY 2 6 2022
BY10011WYAUDUM
CALH0UN,CMffM,M=
file:///C:/Userslltrevino/cpsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5report219085... 5/26/2022
Page 1 of 1
RECEIVED BY THE
COUNTY AUDITOR ON
MAY 2 6 2022 MEMORIAL MEDICAL CENTER
05/26/2022
�ALH0 m3cOUNTY,TEXA3 AP Open Invoice List
Dates Through:
0
ap_open_involce.template
Vendor# Vendor Name
Class Pay Code
12792 BETHANY SENIOR LIVING
Invoice#
Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
Discount
No -Pay
051622
06/2512005/1612006/17/2110
0.00
0.00
}
TRANSFER N4 lftl/lIM 100 ty1�90/71'U
``4,592.85
Wb CKV4U.
1
Ope.n--i1ho
061722
05/25/20 05/17/20 0
/17/20
19,239.99
0.00 tJ
0.00
TRANSFER tt
11
052022
05/25/20 05120/20 06/17/20
2,879.49
0.00
0.00
SUPPLIES l t
t
052022A
06125/20 05/20/20 06/17/20
16,161.49
0.00
0.00
TRANSFER t%
11
Vendor Total;
Number Name
Gross
Discount
No -Pay
12792 BETHANY SENIOR LIVING
42,873.82
0.00
0.00
Report Summary
Grand Totals:
Gross Discount
No -Pay
42,873,82 0.00
0.00
MAY 2 6 2022
BYCOUMYAUDW
CALHOUN COUNTY, T�1M
Net
4,592.85
19,239.99
2.879.49
a. �
16,161.49
V
Net
42,873.82
Net
42,873.82
file:///C:/UserslltrevinolcpsUmemmed.cpsinet.com/u88125/data_5/tmp_cw5reportl23995... 5/26/2022
Memorial Medical Center
Nursing Home UPL
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Prosperity Accounts
5/31/2022
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5/26/101 UM W MP 11219M
5/26/2022 UMCCOMWNIWFLHbIMPMT?4MU2t5MOW
51261302E O[YOTED HEALTH P HOUMPMT 2140MS
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5/r/2022 MMAGNN MMW 3960
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5/2/3011 NNB-64NOMCWMPMT74041144M257910
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5/24JW12 HEALTH HUMAN SEE HCCINMPMT 174GW341130M2
5/24IMl2 H WLTX HUMAN SVC NCMIMPMT 3746M3311M
5/25IM22 MRN.A MMUNFIT PC e,MPMTPNU305]1M342M
5/15/M22 UHC WMMUNNT PC HCCUIMIMT 746MM119300 2
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5131 t2022 Treasury Center
Quick View
Select Quick View Accounts Select Group
Account Number / Name Groups
Account Type AnA Grnap
[DDA
Data reporter) as of May 31 202'
Account Number Current Balance
Available Balance
Collected Balance
Prior Day Balanc
Number of Accounts: 15
$7,364,483.25
$7,661,034.54
$7,354,483.25
$7,457,1I S.;
'4561
CAL CO INDIGENT
55.720.23
$5,720.23
$5.720.23
55,720.2
HEALTHCARE
'4454
MEMORIAL MEDICAL 1
NH GOLDEN CREEK
$44,960.56
552.905.97
544.960.56
541,847.;
HEALTHCARE
'4365
MEMORIAL MEDICAL
CENTER - CLINIC SERIES
$536,33
5536.33
$536.33
$536.:
2014
•4357
MEMORIAL MEDICAL
55,150,850.71
55,393,488.25
55,150,850.71
55,373,294.0
CENTER -OPERATING
'4373
MEMORIAL MEDICAL
CENTER - PRIVATE
$431.76
5431.76
5431.76
5437.7
WAIVER CLEARING
'4381
MEMORIAL MEDICAL
$161,946.09 �%
$173,379.26
$161,946.09
$101.333.2
CENTER/NH ASHFORD
'4403
MEMORIAL MEDICAL
CENTER INH
$103.648.30
$103.648.30
$103,648.30
$97,355 c
BROADMOOR
•4411
MEMORIAL MEDICAL
$93.733.36
5104,147.64
$93,733.36
$85,763.7
CENTER/NH CRESCENT
14446
MEMORIAL MEDICAL
$54,879.52/
$54,979.78
$54.879.52
$54.869.;
CENTER I NH FORT BEND
`4438
MEMORIAL MEDICAL
/
CENTER SOLERA AT
$101,692.32 ✓
5106,347.48
5101,692.32
$94,051.E
WEST HOUSTON
'2998
MMC-MONEY MARKET
$1.110,243.27
$1,110,243.27
51,110,243.27
51,110,243.2
FUND
'S506
MMC-NH BETHANY
$285.009.22
5288,042.41
5285,009.22
5272,740.E
SENIOR LIVING
'5441
MMC -NH GULF POINTE
PLAZA.
5109,936.26
5709,936.26
5109,936.26
$106,181.1
MEDICARE/MEDICAID
'S433
MMC -NH GULF POINTE
$1,000.51
53,182.25
$1,000.51
$1,000.°
PLAZA - PRIVATE PAY
'3407
MMC -NH TUSCANY
$139,894.81
5154,065.35
SlX894.81
$111.745.4
VILLAGE
httpsalprosperity.olbanking.com/onlineMessenger
IM
Memorial Medical Center
Nursing Home UPL
Weekly Nexlon Transfer
Prosperity Accounts
5/31/2022
Previous
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5/3112022
Quick View
Select quick View Accounts
Account Number/Name
Account Type
IF
Srarch All
DDA
Account Number
Current Balance
Number of Accounts: 15
$7,364,483.25
'4551
CAL CO INDIGENT
55.720.23
HEALTHCARE
'4454
MEMORIAL MEDICAL!
$44.960.56
NH GOLDEN CREEK
HEALTHCARE
'4365
MEMORIAL MEDICAL
$536.33
CENTER - CLINIC SERIES
2014
,4357
MEMORIAL MEDICAL
S5,150,850.71
CENTER - OPERATING
'4373
MEMORIAL MEDICAL
CENTER - PRIVATE
$g3t.76
WAIVER CLEARING
'4381
MEMORIAL MEDICAL
$161.946.09
CENTER / NH ASHFORD
'4403
MEMORIAL MEDICAL
5103,648.30
CENTER/NH
BROADMOOR
'4411
MEMORIAL MEDICAL
$93.733-36
CENTER/NH CRESCENT
'4446
MEMORIAL MEDICAL
$54.879.52
CENTER I NH FORT BEND
'4438
MEMORIAL MEDICAL
$101,692.32
CENTER I SOLERA AT
WEST HOUSTON
'2998
MMC-MONEY MARKET
$1,110,243.27
FUND
'5506
MMC -NH BETHANY
S285.009.22
SENIOR LIVING
'5441
MIMIC -NH GULF POINTE
PLAZA-
5109.936.26
MEDICAREIMEDICAID
•5433
MMC-NH GULF POINTE
S1,000.51
PLAZA - PRIVATE PAY
'3407
MMC-NH TUSCANY
S139,894,81
VILLAGE
https:I/prosperity.olbanking.comfonlineMessenger
Treasury Center
Select Group
Groups
Add Group
Data reported as of May 31, 202;
Available Balance Collected Balance Prior Day Balanc
$7.661,034.54 $7,364,483.25 $7,457,1161
$6,720.23 $5.720.23 S5,720.2
S52,905.97
$44.960.56
$41,847„
5536.33
S536.33
S536
S5,393,488.25
S5,150,850.71
S5,373.294.0
S431.76
$431.76
S431a
S173.379.26
S161,946.09
S101.333.2
5103,648.30
S103,648.30
$97,355.�
S104,147Z4
$93,733.36
$85,763,7
$54,979,78
$54.879.52
S54,859,'
S106,347.48
S101,692.32
S94,051 E
S1,110.243.27
51,110,243.27
S1,110,243.2
S288,042.41
9285,009.22
S272,7401
S109,936.26
S109,936.26
5106,181.1
$3.162,25 S1,000.51 $1,000,p
S154.065.35 S139,894.81 S111.745A
10
Memorial Medical Center
Nursing Home UPL
Weekly HMG Transfer
Prosperity accounts
5/31/20n
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5/23/2022 HN8- ECHO HC=tMPMT 74SM34114400p0211447
3/24/2024 MUMMA CHA OAD HCCWMPMT 624982420D001294
5/24/2022 AE1NA A601 HW WMPMT 1912G9990510W013120
5/2612022 WIRE OUT HMO SERVICES, ILC
5/26/2022 HNR - ECHO HCCUMMPMT 746003421441=222618
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5/23/2022 HNR• ECHO HCCWMPMT 746003411440000212401
5/23/2022 NORIDULN)3AHC=IMPMT67589242000D1299551
5/24/2022 NORIDIAN)3AHCCAIMPMT6258924200001235818
5/25/2022 MERCMANTOANKCD OEPO51T4364T651RR899100 l
5/25/2022 WPS-TMEP ODNTRAC HCCIAIMPMT 230p31313$21WO
$/25/2022 NOMDIAN 13A HCCWMPMT 675892 420=1409118
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5R712022 PNC-ECHOHCCIAIMPMT7460034114100012566301a
5/27/2022 MERCHANT 9ANKC0 DEPOSIT4964765168899100001
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QMP/Comp QIpP/Comp4
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lzo. 9 - 12027
12.74 - 12.34
330.21 - 390.21
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Traveler.Oul nnT sferAn QIPP/COmpl 2 QIpP/C4mP3 &bPea 41PPT
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1L012.30 -
11,012.38
- 95.664.18
35.6M.18
- 13.ST3.86 -
13,S71.85
- 2•730.00 -
2,950.00
• 211.10 -
211.10
- 2p43.01 -
2.043.01
31,478.91 -
-
- 46.52 -
46.52
- 3.708.56 -
3,700.56
31pTB.91 109p29.61 k 109 63T 61
37-17L16 110.725.75 110 735 76
5/31/2022 Treasury Center
Quick View
Select Quick View Accounts Select Group
Account Number/Name Groups
Account Type Atld Grnup
0
IDDA
Data reported as of May 31 202;
Account Number
Current Balance
Available Balance
Collected Balance
Prior Day Balanc
Number of Accounts: 15
$7,364,483.25
$7,661.034.54
$7,364,483.25
$7,457,115.2
'4551
CAL CO INDIGENT
$5.720.23
$5,720.23
55,720.23
$5,720.2
HEALTHCARE
*44 4
MEMORIAL MEDICAL/
NH GOLDEN CREEK
544,960.56
$52.905.97
$44,960.56
541.847,5
HEALTHCARE
'4365
MEMORIAL MEDICAL
CENTER - CLINIC SERIES
$536.33
5536.33
5536.33
5536.3
2014
'4357
MEMORIAL MEDICAL
55.150.850.71
55,393,488.25
55,150,850.71
55,373,294.0
CENTER -OPERATING
•4373
MEMORIAL MEDICAL
CENTER - PRIVATE
$431,76
5431.76
5431.76
5431.7
WAIVER CLEARING
'4381
MEMORIAL MEDICAL
$161,946.09
$173,379.26
5161,946.09
$101,333.2
CENTER INH ASHFORD
14403
MEMORIAL MEDICAL
CENTER/NH
5103,648.30
5103,648.30
5103,648.30
$97,355 <_
BROADMOOR
•4411
MEMORIAL MEDICAL
$93.733.36
5104,147.54
593,733.36
$85,763.7
CENTER/NH CRESCENT
'4446
MEMORIAL MEDICAL
$54,879.52
554.979.78
S54,a79.52
$54,869.`'
CENTER/NH FORT BEND
438
MEMORIAL MEDICAL
CENTER I SOLERA AT
$101.692.32
5106,347.48
$101,692.32
$94,051.:
WEST HOUSTON
'2998
MMC-MONEY MARKET
51,110,243.27
51,110.24327
S1,110,243.27
$1,110,243.2
FUND
1550G
MMC -NH BETHANY
5265.009.22
5288,042AI
$285,009.22
5272,740.E
SENIOR LIVING
'5441
MMC -NH GULF POINTE
/
PLAZA-
5109,936.26 1/
5109.93626
5109,936.26
5106,181.1
MEDICAREIMEDICAID
'5433
MMC -NH GULF POINTE
$1.000.51 ✓
$3,162, 25
$1,000,51
$1,000 E
PLAZA -PRIVATE PAY
•3407
MMC -NH TUSCANY
$139,894,81
$154,065.35
5139,894.81
$111.745.4
VILLAGE
r
hitps:/Iprosperity.oibanking.comlonlineMessenger
1/1
Memorial Medical Center
Nursing Home UPI
Weekly Tuscany Transfer
Prosperity Aecounos
5/31/2022
Pwunt
Nunlm Hame •` '
Nete:OIlY6Wen[ne/eVn$r.QG wJIDflrOnllNrrlb MenunigAwne.
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5/24/2022 HNS- ECHO HCCLAIMPMT74600341144000D255958
1,721.06 -
1,721.06
5/24/2022 NOVITAS SOLUTION HCCLAIMPMT 676201420DO0140
43,838.62 -
43,838.62
5/26/2022 WIRE OUT UNBAR ENTERPRISES, U-C 42,395.68
- _
.
5/26/2022 NOVITAS SOLUTION HCCLAIMPMT 676201420000124 -
66,085.76
66.08576
5/27/2022 Molina HC of TK HCCLAIMPMT PN12757178944200 -
3,512.89
3,511.89
5/27/2022 HNB - ECHO HCCLAIMPMT 7460034114400D0257935
6,453.96 -
6,453.96
5/27/2022 NOVITAS SOLUTION HCCLAIMPMT 676201420GM139
6.023.52 -
6,023.52
5/27/2022 KS PLAN ADMINIST HCCLAIMPMT 179113000022808
12,160.00 -
12,160.00
41,395.66,
339,794.81 //
139,794.81
5/3112022
Treasury Center
Quick View
Select Quick View Accounts
Account Number/ Name
Select Group
Groups
Account Type
Add Group
IDDA
Data reported as of May 31 202:
Account Number
Current Balance
Available Balance
Collected Balance
Prior Day Balanc
Number of Accounts: 15
S7,364,483.25
$7,661,034.54
$7,364,483.25
$7,457,115.2
'4551
CAL CO INDIGENT
S5,720.23
$5.720.23
$5,720.23
S5,720.<
HEALTHCARE
'4454
MEMORIAL MEDICAL /
NH GOLDEN CREEK
$44.960.56 ,/
$52,905.97
$44.960.56
$41,847.E
HEALTHCARE
'4365
MEMORIAL MEDICAL
CENTER - CLINIC SERIES
$536.33
$536.33
$536.33
S536.2
2014
•4357
MEMORIAL MEDICAL
S5.150,850.71
S5,393,488.25
S5,150,850.71
$5.373,294.0
CENTER -OPERATING
•4373
MEMORIAL MEDICAL
CENTER -PRIVATE
$431.75
$431.76
S431.76
S431.7
WAIVER CLEARING
'4391
MEMORIAL MEDICAL
$161.946.09
$173,379.26
S161,946.09
S101,333.2
CENTER/NH ASHFORD
'4403
MEMORIAL MEDICAL
CENTER/NH
$103.648.30
$103.648,30
S103,648.30
$97,355.<
BROADMOOR
'4411
MEMORIAL MEDICAL
$93.733.36
S104,147.64
S93,733.36
$85,7633
CENTER/NH CRESCENT
'4446
MEMORIAL MEDICAL
$54,879.52
$54,979.78
$54,879.52
$54A69.E
CENTER/NH FORT BEND
'4438
MEMORIAL MEDICAL
CENTER lSOLERA AT
$101.692.32
5106,34T.48
$101,692.32
$94,051.E
WEST HOUSTON
'2998
MMC-MONEY MARKET
S1,110,243.27
$1,110,24327
S1,110,243.27
$1,110.243.2
FUND
'5506
MMC -NH BETHANY
$285.009.22
3288.042.41
$265,009,22
S272,740.E
SENIOR LIVING
'5441
MMC-NH GULF POINTE
PLAZA-
$109.936.26
$109.936.26
$109,936.26
$106.181,1
MEDICARElMEDICAID
'5433
MMC •NH GULF POINTE
S1,000.51
$3.162.25
$1,000.51
$1,000.5
PLAZA • PRIVATE PAY
'3407
MMC-NH TUSCANY
$139,894.81
S154,065.35
S139,894.81
$111,745.4
VILLAGE
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Account Number Current Balance
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Collected Balance
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$7.364,433.25
$7,661,034.54
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55,720.23
55,720.23
$5.720.23
$6,720.2
HEALTHCARE
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$44,960.56
552.905.97
$44,960.56
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$536.33
$536.33
5536.33
$536.:
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55,150,850.71
55,393,488.25
55.150,850,71
55,373,294.0
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$431.76
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$431.76
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5103.648.30
$103.648.30
5103,648.30
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$93.733.36
5104,147.64
$93,733.36
$85,763.7
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$54,879.52
$54,979.78
$54,879.52
$54,869.E
CENTER I NH FORT BEND
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CENTER SOLERA AT
$101,692.32
$106.347.48
$101,692.32
594,051.E
WEST HOUSTON
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MMC-MONEY MARKET
$1,110.243.27
$1.110,243.27
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$285.009.22 ,/�
$288,042.41
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5272,740.E
SENIOR LIVING
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5109.936.26
$109.936,26
$109,936.26
5106.181,1
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MEDICAREIMEDICAID
'5433
MMC-NH GULF POINTE
$1,000.51
$3.162.25
$1,000,51
$1,000°
PLAZA - PRIVATE PAY
'3407
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5139,894.81
5154,065.35
5139,894.81
$111,745.4
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