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2022-10-12 Final PacketAll Agenda Items Properly Numbered Contracts Completed and Signed All 1295's Flagged for Acceptance (number of 1295's I_) All Documents for Clerk Signature Flagged (All documents needing to be attested to need to be signed day of Commissioner's Court.) On this day of av 2022 a complete and accurate packet for I k of 2022 Commissioners Court Regular Session Day Month was submitted from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Calhoun County Judge/Assistant C:\Users\Maebelle.Cassel\Appdata\Local\Microsoft\ Windows\Inetcache\Content.Outlook\3 CU9II QW\PACKET COMPLETION SHEET.Docx AGENDA NO-1-ICE OF MEETING - 10/J 2/2022 Richard rd H. foyer 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, October 12, 2022 at I0:00 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: Call meeting to order. 2. Invocation. Pledges of Allegiance. `Keneral Discussion of Public Matters and Public Participation. Cc FILED AY 120'CLOCK_M. OCT 0 7 '2022 ANNAM.G000MAN COUNTY CLERKCALHOUN COUM .TEXAS BY•,�.,�� v'� yrr�U�Y EP Consider and take necessary action to approve the proposal for Professional Services from CivilCorp for the engineering through bidding and construction oversite for the replacement of the first wooden bridge on Brighton Road (closest to SH 316) with a proposed engineering fee of $47,200 and an estimated construction cost of $215,000 utilizing GOMESA funds and authorize all appropriate signatures. (DEH) 5./Consider and take necessary action to accept funds from C. M. Company Auctions in the amount of $31,778.10 and place funds in Precinct 4 R & Bs Machinery & Equipment account — 570-73400. (GDR) 7. Consider and take necessary action to authorize the Calhoun County EMS Director to sign the attached Agreement Amendment with PHI to extend/continue the previous agreement. (RHM) Consider and take necessary action to authorize the Calhoun County EMS Director to complete the attached credit application for Quadmed to purchase supplies not available from current vendors. (RHM) < Consider and take necessary action to approve the Access and Utility Easement Agreement with Black Mountain Energy. (RHM) Page 1 of 2 I NO1ICE 01 IV! EETING — 10/12/2022 ,10. Consider and take necessary action to approve grant services with Kathy Smartt at a fee of $500.00 to submit application for FEMA DR-4332 PW 6436 PAAP-DAC Excess Funds and authorize the County Judge to sign any required documents. (RHM) 11. Accept Monthly Reports from the following County Offices: l,r—Floodplain Administration — September 2022 Justice of the Peace, Precinct 1— September 2022 Justice of the Peace, Precinct 2 — September 2022 IV' Justice of the Peace, Precinct 4 — September 2022 +Justice of the Peace, Precinct 5 — September 2022 vK Sheriffs Office — September 2022 T2/Consider and take necessary action on any necessary budget adjustments. (RHM) i3. Approval of bills and payroll. (RHM) Richard H. Meyer, Cour Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.org under "Commissioners' Court Agenda" for any official court postings. Page 2 of 2 NOTICE OF MEETING — 10/12/2022 Richard H. Meyer County judge David ]Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Kaddne Smith, Deputy Clerk REGULAR TERM 2022 § OCTOBER 12, 2022 BE IT REMEMBERED THAT ON OCTOBER 12, 2022, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting was called to order at 10 a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag- Commissioner Gary Reese Texas Flag- Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. n/a 5. Consider and take necessary action to approve the proposal for Professional Services from CivilCorp for the engineering through bidding and construction oversite for the replacement of the first wooden bridge on Brighton Road (closest to SH 316) with a proposed engineering fee of $47,200 and an estimated construction cost of $215,000 utilizing GOMESA funds and authorize all appropriate signatures. (DEH) Commissioner David Hall explained the bridge needing repairs. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 1 of 3 NOTICE OF MEETING— 10/12/2022 6. Consider and take necessary action to accept funds from C. M. Company Auctions in the amount of $31,778.10 and place funds in Precinct 4 R & Bs Machinery & Equipment account — 570-73400. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to authorize the Calhoun County EMS Director to sign the attached Agreement Amendment with PHI to extend/continue the previous agreement. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to authorize the Calhoun County EMS Director to complete the attached credit application for Quadmed to purchase supplies not available from current vendors. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to approve Access and Utility Easement Agreement with Black Mountain Energy. (RHM) *AMEND COMPANY NAME TO BLACK MOUNTAIN ENERGY STORAGE* RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to approve grant services with Kathy Smartt at a fee of $500.00 to submit application for FEMA DR-4332 PW 6436 PAAP-DAC Excess Funds and authorize the County Judge to sign any required documents. (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 2 of 3 NOTICE OF MEETING— 10/12/2022 11. Accept Monthly Reports from the following County Offices: i. Floodplain Administration — September 2022 ii. Justice of the Peace, Precinct 1 — September 2022 iii. Justice of the Peace, Precinct 2 — September 2022 iv. Justice of the Peace, Precinct 4 — September 2022 v. Justice of the Peace, Precinct 5 — September 2022 vi. Sheriff's Office — September 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. 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 13. Approval of bills and payroll. (RHM) MIMIC 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: 10:10 a.m. Page 3 of 3 # 05 NOTICE OF MEE(ING ---10/12/2022 5. Consider and take necessary action to approve the proposal for Professional Services from CivilCorp for the engineering through bidding and construction oversite for the replacement of the first wooden bridge on Brighton Road (closest to SH 316) with a proposed engineering fee of $47,200 and an estimated construction cost of $215,000 utilizing GOMESA funds and authorize all appropriate signatures. (DEH) Commissioner David Hall explained the bridge needing repairs. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 10 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax(361)553-8734 Please place the following item on the Commissioners' Court Agenda for October 12th, 2022. Consider and take necessary action to approve proposal for Professional services from CivilCorp for the engineering through bidding and construction oversite for the replacement of the first wooden bridge on Brighton Rd (closest to HWY 316) and a proposed engineering fee of $47,200 and an estimated construction cost of $215,000 utilizing GOMESA fundsand authorize all appropriate signatures Sqerel, David E. Hall DEH/apt r 44CMICorp 1l, ENGINEERS - SURVEYORS September 14, 2022 Mr. David Hall Calhoun County Commissioner Precinct 1 202 South Ann Port Lavaca, Texas 77979 Re: Bridge Replacement Project- Brightan Road Proposal for Professional Services Dear Commissioner Hall: It is with pleasure that we submit this proposal for professional services to assist Calhoun County with project development to replace the north timber bridge on Brighten Road. As you know, CivilCorp has performed several of these type of projects for various TxDOT districts across the state. The work will basically consist of providing engineering, surveying, environmental coordination, geotech, bidding and construction management. The preliminary estimate for the proposed 26 ft wide x 25 ft long slab span bridge is $215,000. The associated design tasks are as follows: • Utility Investigations/ Coordination • Prepare a proposed bridge layout • Prepare preliminary drawings to identify potential environmental impacts and coordinate/ mitigate issues • Assist the County with presentations by preparing the exhibits, as required • Perform geotech needed to support foundation designs • Develop bridge design plans meeting TxDOT requirements • Assist county with bidding project • Assist county with project award and construction management • Designs for the above work shall be prepared in accordance with applicable requirements of TxDOT Specifications, Standards and Manuals • Probable Cost estimates • Coordination with TxDOT as required for acceptance of bridge into the BRINSAP Program The project fee is estimated as follows: 1. Survey $ 3,200 2. Bridge Design $ 30,000 3. Environmental Coordination $ 2,500 4. Geotech $ 2,500 5. Bidding $ 1,500 6. Construction Management $ 7,500 Proposed Engineering Fee: $ 47,200 4611 E. Airline Rd., Ste. 300 r Victoria, Texas 77904 • Tel: (361) 570.7500 Victoria a Houston • Austin . Corpus Christi "JCI ENGINE.E nSa S'J nVEYU RS Rates for Additional Services (if requested) Principal Engineer $200.00 Senior Engineer $185.00 Registered Professional Engineer $160.00 Registered Professional Land Surveyor $155.00 Engineer in Training $110.00 Senior Designer $115.00 Designer $ 90.00 Project Inspector $ 90.00 Clerical $ 65.00 CADD Technician $ 85.00 Field Crew -2 man $200.00 3 man $225.00 Please let me know if you need any additional information or if you need anything else. Thank you for the opportunity to submit this proposal. We are looking forward to working with you and on this project. Sincerely, Ben L. Galvan, P.E., R.P.L.S. President — CivilCorp, LLC 4611 E. Airline Rd., Ste. 300 • Victoria, Texas 77904 • Tel: (361) 570-7500 Victoria s Houston 9 Austin s Corpus Christi # 06 NOTICE OF MEETING—10/12/2022 6. Consider and take necessary action to accept funds from C. M. Company Auctions in the amount of $31,778.10 and place funds in Precinct 4 R & Bs Machinery & Equipment account — 570-73400. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER:: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, CommissionerHall, Lyssy, Behrens, Reese ' Page 3 of 10 Gary D. Reese County Commissioner County of Calhoun Precinct 4 October 6, 2022 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for October 12, 2022. • Consider and take necessary action to accept funds from C.M. Company Auctions in the amount of $31,778.10 and have funds placed in Precinct 4 R&B's Machinery & Equipment - 570-73400. Sincerely, Gary D. Reese GDR/at P.O. Box 177 — Seadrift, Texas 77983 -- email: Qarv.reeseacalhouncotx.om -- (361) 785-3141 -- Fax (361) 785-5602 CALHOUN COUNTY TREASURER DATE 9/26/2022 ISSUED: RECEIPT ISSUED TO: RECEIPT RECEIPT NUMBER: 2022SEP096 C.M. COMPANY AUCTIONS DESCRIPTION - AMOUN AUCTION PROCEEDS 8.28 22 / R&6 PCT. 4 RECEIPT ISSUED RECEIPT TOTAL RH NDA S. KOKENA COUNTY TREASURER 202 S. ANN, SUITE A PORT LAVACA, TX 77979 (361)553-4620 $31,778.10 $31,778.10 # 07 NOTICE OF MEETING -- 10/1.2/2022 7. Consider and take necessary action to authorize the Calhoun County EMS Director to sign the attached Agreement Amendment with PHI to extend/continue the previous agreement. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 10 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins)<Dustin.Jenkins@calhouncotx.org> Sent: Friday, September 30, 2022 9:51 AM To: Mae Belle Cassel Cc: Lori McDowell Subject: Fwd: Amendment Agreement Attachments: [20221 Calhoun County Amendment No 1 EMS Agreement for Air Medical Transport Services [EXP 05-31-251.pdf Mae Belle, Please add the attached Agreement Amendment with PHI to the next Commissioners Court agenda for permission to sign. This will extend/continue our previous agreement with them. Thanks again! Dustin From: "jthomasson@phiairmedical.com (Jeremy Thomasson)" <jhomasson@phiairmedical.com> To:"dustin.jenkins@calhouncotx.org"<Dustin.Jenkins@calhouncotx.org> Date: Thu, 29 Sep 2022 23:01:11 +0000 Subject: Amendment Agreement CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Hey Dustin, Here is the signed version. Regards, Jeremy Thomasson, FP-CINRP, CMTE Program Director -Central Region PHI -Texas PHI Health, LLC Confidentiality Notice: This e-mail transmission (including any attachments) may contain confidential, proprietary, and/or privileged information, including patient information protected by federal and state privacy laws. The information is intended only for the use of the individual or entity designated above. If you are not the intended recipient, or the person responsible for delivering it to the intended recipient, you are hereby notified that any review, disclosure, copying, distribution or use of any of the information contained in or attached to this transmission is strictly prohibited and may be unlawful. If you have received this transmission in error, please notify the sender by telephone at 800-421-6111 immediately, and destroy all copies of the original message and its attachments. 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 HEALTH NO.1 AMENDMENT TO AIR MEDICAL TRANSPORT SERVICES AGREEMENT This Amendment No. 1 ("No. 1 Amendment") is made effective October 1, 2022 (the "No. 1 Amendment Effective Date") by and between PHI Health, LLC, a Louisiana Limited Liability Company and successor in interest to PHI Air Medical, LLC ("PHI") and Calhoun County EMS ("Calhoun County"). PHI and Calhoun County may hereinafter be referred to individually as a "Party" and collectively as the "Parties". WHEREAS, PHI and Calhoun County entered into the Agreement as has been amended (the "Original Agreement"); and WHEREAS, the Agreement has been in effect since June 1, 2019; and WHEREAS, PHI and Calhoun County now desire to modify certain terms of the Agreement, as set forth in this No. 1 Amendment to be effective as of the No. 1 Amendment Effective Date. NOW, THEREFORE, the parties hereby agree that as of the No. 1 Amendment Effective Date 1. The Term. The term of the Original Agreement is hereby extended for three (3) years through May 31, 2025 (the "Renewal Term"), unless sooner terminated in accordance with the terms of the Agreement. This Agreement shall automatically renew for once -year terms until such time as either party exercises their right to terminate the agreement. 2. General. This No. 1 Amendment is incorporated into the Agreement and made a part thereof. All other terns, conditions and obligations of the Agreement are hereby ratified, reaffirmed and remain in full force and effect. Capitalized terms used but not defined herein will have the meanings given such terms in the Agreement. In the event of a conflict between the terms of this No. 1 Amendment and the Agreement, the terms and conditions of this No. 1 Amendment control. This No. 1 Amendment may be executed in counterparts, including electronic counterparts. Signatures submitted via facsimile or electronic means (including PDF files or documents signed via methods such as DocuSign) will be deemed original signatures of the parties and will be valid and binding upon the parties hereto. IN WITNESS WHEREOF, each Party has caused this No. 1 Amendment to be executed by its duly authorized officer or delegate, as of the No. 1 Amendment Effective Date. PHI HEALTH, LLV,? Signed: Name: ..,._ //ffi4fJ/P/'7d7L Title: J�I-evdoLk Date: a?.,/ CALHOUN COU :=. Sign,.,\ Name: a%�t�t/.�Ttt!- —AJlei,j-e Title: _ t ✓L� L� ° F € A..S Date: I Z 2 D 2? 2800 N. 44th St. • Saite 125 • Phoenix, Arizona 85008 • www.phiheolth.c= AIR PATIENT ir'II� MNAVIGATION 09 CARES • 1: NO] ICE OF MEETING - 10/12/2022 8. Consider and take necessary action to authorize the Calhoun County EMS Director to complete the attached credit application for Quadmed to purchase supplies not available from current vendors. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5 of 10 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustm.Jenkins@calhouncotx.org> Sent: Friday, September 30, 2022 9:43 AM To: Mae Belle Cassel Subject: Fwd: NEW VENDOR-QUADMED Attachments: Calhoun Co EMS - Form 1295.pdf; QuadMed CreditApplication.pdf, QuadMed W9-1-2021.pdf Mae Belle, Please place the following credit application on the next Commissioners Court agenda for permission to sign. Thanks, Dustin From: "Dustin Jenkins"<Dustin.Jenkins@calhouncotx.org> To: "Mae Belle Cassel" <MaeBelle.Cassel@calhouncotx.org> Cc: "Donna Hall" <Donna.Hall@calhouncotx.org>, "Lori McDowell" <Lori.McDowell@calhouncotx.org>, "Cindy Mueller" <cindy.mueller@calhouncotx.org> Date: Thu, 29 Sep 2022 14:58:23 -0500 Subject: Fwd: NEW VENDOR - QUADMED Cindy, Please review and see what else we might need to apply for an account with QuadMed. Also, will I be signing this or you? Thanks, Dustin From: "Lori. McDowell@calhouncotx.org (Lori McDowell)" <Lori.McDowell@calhouncotx.org> To: "Dustin Jenkins"<Dustin.Jenkins@calhouncotx.org> Cc: "Donna Hall" <Donna,Hall@calhouncotx.org> Date: Thu, 29 Sep 2022 14:06:40 -0500 Subject: NEW VENDOR - QUADMED Hi Dustin, I would like to get this vendor, Quadmed, set up with the county. They offer some supplies (like bi-level) that our current vendors do not. Please let me know if I need any additional documents. Thanks! Lori McDowell, BS, LP, EMS Coordinator, CADS Assistant EMS Director Calhoun County EMS 705 Henry Barber Way Port Lavaca, TX 77979 (361) 552-1140 lori.mcdowell@calhouncotx.org CONFIDENTIALITY NOTICE: The contents of this email message and any attachments are intended solely for the addressee(s) and may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message or their agent, or if this message has been addressed to you in error, please immediately alert the sender by reply email and then delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited. Calhoun County Texas 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 Farm W"'9 Request for Taxpayer (Rev. October 2018) Identification Number and Certification Give Form to the requester. Do not Department of the Treasury Internal Revenue Service ► Go to wwwdrs.gov/FormW9 for instructions and the latest information. send to the IRS. 1 Name (as shown on your Income tax return). Name Is required on this line; do not leave this line blank. QuadMed, Inc. name, Ii different from abava 2 Business name/disregarded entitycli 3 Check appropriate box for federal tax classification of the person whose name is entered an line 1. Check only one of the 4 Exemptions (codes apply only to n following seven bones. certain entitles, not individuals; see p ❑ Individual/sole proprietor or ❑`' C Corporation ❑ S Corporation rp ❑ Partnership ❑ TrusVesfate instructions on page 3): 0 single -member LLC Exempt payee code (if any) ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Padnership) ► ` o Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is 4 u another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that code (if any) is disregarded from the owner should check the appropriate box for the tax classification of Its owner. y ❑ Other (see instructions)► wpu��samxaavnrsmv„mmmn„mw me us; of 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 11210 Philips Industrial Blvd. E., Suite 1 9 City, state, and ZIP code Jacksonville, FL 32256 7 List account number(s) here (optional) ltihcation Number Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Sr backup withholding. For individuals, this is generally your social security number (SSN). However, for a r resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a L TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and C Number To Give the Requester for guidelines on whose number to enter. 1— Under I certify that: ©vo©onnonn 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S, citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting Is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured propegancell 'gn of debt, contributions to an individual retirement arrangement (IPA), and generally, payments other than interest and dividends, you are net r �11 ad si the certification, but you must provide your correct TIN. Seethe instructions for Part II, later. .,rarr Signature of Here I U.S. person► bate► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer Identification number (EIN), to repot on an Information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan Interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-20181 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1ofl Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos.1, 2, 3, 5, and 6 0 there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING certificate Number: 2022-936032 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. QuadMed, Inc. Jacksonville, FL United States Date Filed: 2 Name of governmental entity or state agency that is a party tot the contract ror w 1E t e orm is 09/20/2022 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. 497 Emergency Medical Supplies Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary Calhoun County EMS Port Lavaca, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is ell n and my date of birth is l�'4w/ ,,) My address is ��7-j 0 — �hilb',n5 7;1 dits Tfc;4 a✓, lubsen✓i//e rl- -'1720 6 USA . (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in /l it ✓t,( County, State of on the 219dey of Cep f , 20 ZZ . (month) (year) t Signature of aut orized gent of contracting business entity (D claranr) Forms provided by Texas Ethics Commission www.ethics.state.tx.us - version v1.1.191Dbcdc QuadMed, Inc. P.O. Box 550773, Jacksonville, FL 32255-0773 TEL : 800-933-7334 FAX: 877-367-7759 SALESCWOUADMED.COM WWW.QUADMED.COM CUSTOMER CREDIT APPLICATION BUSINESS CONTACT INFORMATION Name: -----. ---------- ------------- ----- Title: --- ------ .. __.--- Name: Title: Purchasing Contact Person. ----- ----------- Title: Telephone: Fax. E-mail: BUSINESS AND CREDIT INFORMATION, Bank name. -----._.. ----------- Bank address. Phone. ------ -- City. State. ZIP Code: Type of account (Check all that apply) List Account Number(s) Below: '.. Savings ❑_-- Checking ❑ — -- Other ----- ..__.-- BUSINESS/TRADE REFERENCES — MUST HAVE RECENT ACTIVITY / WITHIN PAST 12 MONTHS Company name: '�., Type of Account: Address: City: State: ZIP Code: Phone: Fax. E-mail: -, Company name: Type of Account:I, Address: City: State: ZIP Code: Phone: Fax: E-mail: Company name: Type of Account: Address: City: State: ZIP Code: Phone: Fax:. E-mail: I,..... AGREEMENT '.. 1. All invoices are to be paid 30 days from the date of the invoice. 2. Claims arising from invoices must be made within ten (10) working days.'.. 3. Refer to our Catalog's General Information page for other pertinent information regarding Terms. 4. By submitting this application, I authorize QuadMed, Inc. to make inquiries into my banking and business/trade references. .....SIGNATURES Signature:'., Signature: Title: Title: Date: Date:', MA NOTICE OF MEETING—10/12/2022 9. Consider and take necessary action to approve Access and Utility Easement Agreement with Black Mountain Energy. (RHM) *AMEND COMPANY NAME TO BLACK MOUNTAIN ENERGY STORAGE* RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner'Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 10 NOTICE OF CONFIDENTIALITY RIGHTS: IF YOU ARE A NATURAL PERSON, YOU MAY REMOVE OR STRIKE ANY OR ALL OF THE FOLLOWING INFORMATION FROM ANY INSTRUMENT THAT TRANSFERS AN INTEREST IN REAL PROPERTY BEFORE IT IS FILED FOR RECORD IN THE PUBLIC RECORDS: YOUR SOCIAL SECURITY NUMBER OR YOUR DRIVER'S LICENSE NUMBER. STATE OF TEXAS COUNTY OF CALHOUN § ACCESS AND UTILITY EASEMENT T EASEMENT AGREEMENT (this "Agreement"), dated as of the �. day of 2022 (the "Effective Date"), by and between the COUNTY OF CALHOUN, a political subdivision of the STATE OF TEXAS ("Grantor"), and BLACK MOUNTAIN ENERGY STORAGE II, LLC ("Grantee"). Recitals A. Grantor is the fee owner of certain real property located in Calhoun County, Texas, more particularly depicted on the attached Exhibit A ("Parcel A"). B. Grantee is the fee owner of certain real property consisting of a acre tract located in Calhoun County, Texas, in the vicinity of and/or adjacent to Parcel A, more particularly described by metes and bounds on Exhibit B and depicted on Exhibit A ("Project Land"), and is conducting activities related to the development, construction, ownership and operation of one or more integrated energy storage projects on said Project Land. C. Grantor is willing to grant to Grantee, and Grantee is willing to receive an access and utility easement across Parcel A for a utility easement for the transmission of electricity but also for the construction, operation, maintenance, and removal of various improvements, equipment, infrastructure and facilities related to the projects on the Project Land. The access and utility easement is over and across Parcel A and is a 70- foot-wide easement and consists of 248 acres of land, which is described by metes and bounds in Exhibit C and depicted on Exhibit A (the "Easement Property"). NOW, THEREFORE, for good and valuable consideration paid by Grantee to Grantor and the mutual covenants, terms, and conditions set forth herein, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: 1. Grant of Easement. The undersigned, being the County Judge and all of the duly elected and incumbent members of the Commissioners Court of Calhoun County, Texas, acting herein in their official capacity for and on behalf of Grantor, hereby grants to Grantee, its heirs, successors, and assigns, a perpetual, non-exclusive Access and Subsurface Utility Easement ("Easement") in, under, upon, about, over, and through the Easement Property. 2. Purpose and Scope. This access and subsurface utility easement granted herein, with its rights and privileges, shall be used only for the purpose of placing, constructing, operating, inspecting, repairing, maintaining, and removing underground lines, circuits, underground cables and conduits, wires, and appurtenances on the Easement. Within this document is also a grant of access within the Easement so that Grantee may access the Project Land. This grant of access and easement includes the following rights and obligations on the Easement Property: a. The right, in coordination with Grantor, of ingress and egress, over, under, across, and upon said Easement Property for the purpose of constructing, operating, reconstructing or burying and replacing underground cables and conduits (including necessary ditching and backfilling), enlarging,inspecting, patrolling, repairing, maintaining, upgrading and removing said underground lines, circuits, underground cables and conduits, wires, and appurtenances, the right to relocate the same along the general direction of said lines, cables, and conduits, and the right to remove from said land all structures, obstructions, and tress, and parts thereof using generally accepted vegetation management practices, which may, in the sole Judgment of Grantee, endanger or interfere with the safe and efficient operation and maintenance of said cables, conduits, or appurtenances. b. the right to excavate for, inspect, install, replace, maintain, and use lines, circuits, underground cables and conduits, wires, subsurface utility facilities, and in coordination and with the approval of Grantor, above ground anpurtenances related thereto; c. the right to inspect, install, maintain, use and replace all parts, fixtures, and equipment that are reasonably necessary in connection with facilitating the ongoing use of the subsurface utility Facilities; d. in coordination with and with approval from Grantor, the right to install above -ground appurtenances, such as manholes, and other facilities in a manner that does not substantially interfere with the use of the surface of the Easement Property; e. the right of Grantee, its agents, contractors, subcontractors, employees, authorized representatives, vehicles, and equipment to enter and travel along the surface of the Easement Property for the purposes described in this document; f. The roadway shall be built in accordance with the standards as set forth by Calhoun County, Texas. g. The right to cut and trim trees and shrubbery that may encroach on the Easement Area along with the right to remove other obstructions which in Grantee's opinion may endanger or interfere with the safety and efficiency of said facilities; and h. Subject to the following restrictions: (i) all utilities shall be buried at a minimum depth of forty-eight (48) inches, in conduit, and shall have a red, concrete laver one foot above the minimum depth; (ii) any overhead utility lines shall be incompliance with industry standards for residential and agricultural purposes; and (iii) any road construction shall comply with the subdivision requirements for Calhoun County, Texas and shall include the installation of at least two twenty-four (24") inch drainage nines at the "w" outflow drainage ditch approximately three -fourths of the way down the Easement Property. Grantee shall verify and obtain approval for placement of this drainage infrastructure from Grantor. 3. Use. Grantee may use the Easement for the purposes expressed or implied herein. Grantor may not use, nor permit to be used the Easement Property in any manner that would lead to Grantee being in violation of any law, rule or regulations of any governmental entity or regulatory agency. 4. Duration of Easement. The duration of the Easement shall be nemetual. 5. Temporary Access. Except in case of an emergency, or not less than three (3) days prior written notice to Grantor, Grantee shall have access over that part of Parcel A which may be reasonably required for temporary use of Grantee to perform improvements —such as, but not limited to building, repairing or replacing pipelines or fences, maintenance, and other repairs as further described herein. Grantee agrees not to unreasonably disturb Grantor's use of Parcel A, and if such interruption is necessary, such interruption shall be temporary in nature and designed to limit any interruption of access to and from the remaining lands of Grantor. 6. Termination and Release. Grantee may, at Grantee's sole discretion and at any time, terminate and release all or any portion of its right, title, and interest in the Easement Property by executing and causing to be acknowledged and recorded in the real property records, a release describing with particularityportion of such right, title, or interest so released and the part of the Easement Property to which it applies. Such release shall become effective and shall be deemed delivered to and accepted by Grantor upon such recordation. Upon any such release by Grantee, the Parties' respective rights and obligations hereunder shall cease as to the portion of the Easement Property or the right, title, or interest therein to which such release applies, but the Parties' respective rights and obligations hereunder shall remain in full force and effect as to any other portions of the Easement Property and any right, title, and interest of Grantee not so released. 7, Assienment. Only with prior written approval of Grantor, shall Grantee have the right, to grant, sell, lease, convey or assign Grantee's interest in this Agreement and the Easement to an unaffiliated third party. Grantor shall be provided with a copy of each assignment and said prior written approval shall not be unreasonably withheld. All assignees will be subject to all of the obligations, covenants and conditions applicable to the Grantee under this Agreement. Any attempted assignment or delegation by Grantee to an unaffiliated third party without the prior written consent of Grantor, which shall not be unreasonably withheld, shall be void ab initio. Notwithstanding the foregoing, no assignment, nor any approval thereof, shall be required to transfer the rights granted herein to a successor owner of the Project Land. Upon Grantee's assignment of its entire interest under this Agreement as to all or any portion of the Easement, or as may otherwise be provided in the applicable grant, sale, lease, conveyance or assignment document, Grantor shall recognize the assignee or transferee as Grantee's proper successor, the assignee shall have all of the rights, benefits and obligations of Grantee under and pursuant to this Agreement, and Grantee shall be relieved of all of its obligations relating to the assigned interests under this Agreement that relate to acts or omissions which occur or accrue following the effective date of such grant, sale, lease, conveyance or assignment. 8. Notices. Any notice required or permitted under this agreement must be in writing. Any notice required by this Agreement will be deemed to be delivered (whether actually received or not) when deposited with the United States Postal Service, postageprepaid, certified mail, return receipt requested, and addressed to the intended recipient at the address shown in this Agreement. Notice may also be given by regular mail, personal delivery, courier delivery, facsimile transmission, or other commercially reasonable means and will be effective when actually received. Any address for notice may be changed by written notice delivered as provided herein. 9. Venue. The Parties each hereby irrevocably submit in any suit, action or proceeding arising out of or related to this Agreement or any other instrument, document, or agreement executed or delivered in connection herewith and the transactions contemplated hereby and thereby, whether arising in contract, tort, equity, or otherwise, to the jurisdiction of any state or federal court located in the county of Calhoun, State of Texas. 10. Indemnity. Grantee, to the extent allowed by law, hereby binds itself, its successors and assigns, to indemnify and hold Grantor, and Grantor's heirs, personal representatives and representatives, and assigns to the extent that any such Claim is caused by or is the result of (i) the negligent acts and/or omissions of Grantee and its agents and employees, in connection with the exercise of any right or privilege hereunder; and GO any condition created, maintained or suffered to exist on or about the Easement Property to the extent same is due to the negligent acts or omissions of Grantee and its agents and employees. This indemnity shall survive termination of this Agreement. In no event shall Grantee be responsible for defending, indemnifying or holding harmless Grantor to the extent of any Claim caused by, arising from the negligence or willful misconduct of Grantor or Grantor's em llooyees, contractors, subcontractors, agents or representatives. 11. Reservation of Rights. Grantor reserves all right, title, and interest in and to the Easement Property that may be used and enjoyed without interfering with the rights conveyed by this Agreement; provided, however, that Grantor shall not: (a) erect or maintain any buildings that may cause damage to or interfere with the access and utility easement; or (b) develop, landscape, or beautify the Easement Area in any way that would unreasonably or materially increase the costs to Grantee of installing improvements/facilities or restoring the Easement Property after such installation. Grantor shall have the right to grant additional easement rights in the Easement Area to other individuals or entities, provided same shall not interfere with or otherwise adversely affect any of Grantee's rights herein. Grantor shall not grant any other easement rights within the Easement Area to any other individual or entity (each, an "Other Interest Holder") without first obtaining from Grantee and Other Interest Holder an indemnity agreement reasonably satisfactory to Grantee, which agreement shall be between Grantee, Grantor, and Other Interest Holder and shall provide Grantee with an indemnification from Other Interest Holder in connection with Other Interest Holder's use of the Easement Area. Grantor's use and enjoyment of the Easement Area and any other grants to individuals or entities in the Easement Property shall not interfere with or adversely affect any of Grantee's rights herein. 12. Representations and Warranties. Grantor hereby represents and warrants to Grantee that: (a) it has the full right, power, title, and interest to grant the Easement to Grantee; (b) such grant of the Easement and any rights granted under this Agreement may be fully and thoroughly enjoyed and utilized by Grantee pursuant to the covenants, terms, and conditions hereof; and (c) Grantee's easement rights hereunder shall not be defeased, impaired, or adversely affected by superior title. 13. Restrictions. This conveyance is made subject to all leases, easements, restrictions, reservations, encumbrances and other matters appearing of record in Calhoun County, Texas, to the extent (but no further) that the same are valid and subsisting as of the date hereof and affect title to the above described property, and have not otherwise been subordinated to the rights, titles and privileges herein conveyed. 14. Damages. Grantee shall repair any unreasonable damages to Grantor's premises that may result from its use. 15. Covenants Running with the Land. The parties to this Agreement hereby acknowledge and agree that the Easements and other rights conferred by this Agreement are intended to, and do, constitute covenants that run with the land and shall inure to the benefit of and be binding upon the parties and their respective grantees, heirs, successors, and assigns. 16. Attorneys' Fees. If any action is brought by either party against the other in connection with or arising out of this Agreement or any of the documents and instruments delivered in connection herewith or in connection with the transactions contemplated hereby, the prevailing party shall be entitled to recover from the other party its reasonable out-of-pocket costs and expenses, including without limitation reasonable attorneys' fees incurred in connection with the prosecution or defense of such action. Binding Effect. This Agreement binds and inures to the benefit of the Parties and their respective heirs, successors, and permitted assigns. 17. Severability. If any portion of this Agreement, or its application to any party or circumstances, shall be determined by any court of competent jurisdiction to be invalid or unenforceable to any extent, the remainder of this Agreement or the application of such provision to such person or circumstances, other than those as to which it is so determined invalid or unenforceable, shall not be affected thereby, and each provision hereof shall be valid and shall be enforced to the fullest extent permitted by law. The Parties to this Agreement have each had an opportunity to comment and draft the same and therefore the drafting of this Agreement shall not be construed against either Party. 18. Counterparts. This Agreement may be executed in any number of counterparts and evidenced by facsimile and/or electronic scanned signature with the same effect as if all signatory parties had signed the same document. All counterparts will be construed together and will constitute one and the same instrument. 19. Further Assurances. Each party agrees to do such things, perform such acts, and make, execute, acknowledge, and deliver such documents as may be reasonably necessary and customary to carry out the intent and purposes of this Agreement, so long as any of the foregoing do not materially increase any parties' obligations hereunder or materially decrease any parties' rights hereunder. CALHOUN UNTY,TEXAS B: County Judge Calhoun ounty, Texas By: �"Wm aal" Commissioner, Precinct Three By: o Commis •oner, Precinct Four THE STATE OF TEXAS COUNTY OF CALHOUN instrument was acknowledged before me c9A thins theA I Z Vy day of 4/ 2g22 by County Judge /G,r�I , and U the Calhoun County Commissioners' Court on behaV of Calhoun County. [SEAL] NOTARY PUBLIC IN AND FOR THE STATE OF TEXAS :4t MAE BELLE CASSEL �= My Notary ID N 132012524 ;F ;:E'.'•' Exoros May 14, 2023 DEPICTION OF PARCEL A L4A.IL-Ikr Description of Project Land BUNG a 16.89 acre tract out of a 76.88 acre tact as described in swhi ne 111, page 455 CAaun County Deed Record:. oid of the Maximo Sanchez Survey, AbstrxtNo. 35, Callwua Comity, Texas, and being leaser describedby mein and bounds as Follows: BEGINNINGat a 12 ioch itnn and fonud fm the Soutbwest coiner, same being the Southwest comer of said 76,88 am tract THENCERWIT16'1W. 1341.33 feet along theWest hne ofsaid 76.88 acre tract to a 112 inch iron rod found fm the Notthurest comer, same being the Southerly mostNotthncst canner of said 76.88 acts tract; THENCEN53'57WE. 550.00 feet along tlx soudvarly most Ninth Inm of said 76,88 acre tract to a 12 inch iron rod with cap "CEC 10194378" set for the Northeast rnmer. THENCE 5.W16'S3'E. 1334,02 feet to a IP inch iron rod with cap set in the South line of said 76,88 acre nact fm the Southeast comer, THENCE S.53*1VIT` V 550,00 feet along said South line to the POINT OF BEGINNING and containing 16.99 acres of hmd, more in less. Description of Easement Property BMNG a 70.00 feet Elechic Easement being 35.00 feet either side of centerline, out of I.ot 7, Block 1, BKCK Dee-elopment, an addition to the city of Pori Las a, according to the plat thereof recorded m Slide 621 AB, Imtnumou No. 2019.03920 of the Official Plat Records, Calhoun County,. Texas, and being fimher described by metes and bounds as follows: BEGL%M NG at a point m the Somh Ime of a 16.89 am tract, from which the Southwest cor of said tract bats, 5.53'1117"W 307.60 feet; THENCE 5.34.52'48'E. 681.71 feet to a point foa a corner, TfffidCEN.53'14'25"E. 427.14 feet to a point far a comer; THENCE 5.36'49'06"E. 590.64 feet to the POINTOF TMtINATION and containing 2.68 acres of lead, more or less. #10 I NOTICE OF MEE FING -- 10/12/2022 10. Consider and take necessary action to approve grant services with Kathy Smartt at a fee of $500.00 to submit application for FEMA DR-4332 PW 6436 PAAP-DAC Excess Funds and authorize the County Judge to sign any required documents. (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 7 of 10 Mae Belle Cassel From: cindy.mueller®calhouncotx.org (cindy mueller) <cmdy.mueller@calhouncotx.org> Sent: Thursday, October 6, 2022 3:40 FM To: Mae Belle Cassel; Richard Meyer Cc: ksmartt7@gmad.com; everett wood Subject: Agenda Item Request Attachments: Smartt Grants fee proposal FEMA apphcatfon.pdf Please place the following item on the agenda for 10/12/22: • Consider and take necessary action to approve grant services with Kathy Smartt at a fee of $500.00 to submit application for FEMA DR-4332 PW 6436 PAAP-DAC Excess Funds and authorize the County Judge to sign any required documents. Cindy Mueller County Auditor Calhoun County 202 S. Ann, Suite B Port Lavaca, TX 77979 V: 361.553.4610 F: 361.553.4614 Cindv.muellerCcDcalhouncotx.ore Calhoun County Texas Smartt Grants 3801 Menchaca 47 Austin, Texas 78704 (512)800-4740 October 5, 2022 Richard H. Meyer County Judge 211 S. Ann, Suite 301 Port Lavaca, TX Re: DR-4332 I Calhoun County I PW 6436 1 Excess Funds Judge Meyer: I will prepare a letter to FEMA on behalf of the County to request the excess funds from DR- 4332. In preparation, I will work with Rolando Cisneros and Everett Wood to propose a suitable project and collect all necessary supporting documentation. I will provide these services for $500. Thank you. Kathy Smartt #11 I NOTICE OF MEETING— 1.0/1.2/2022 11. Accept Monthly Reports from the following County Offices: i. Floodplain Administration — September 2022 ii. Justice of the Peace, Precinct 1— September 2022 iii. Justice of the Peace, Precinct 2 — September 2022 iv. Justice of the Peace, Precinct 4 — September 2022 v. Justice of the Peace, Precinct 5 — September 2022 vi. Sheriffs Office — September 2022 RESULT. APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 10 Calhoun County Floodplain Administration 211 South Ann Street, Suite 301 Port Lavaca, TX 77979-4249 Phone: 361-553-4455/Fax: 361-553-4444 e-mail: karen.rinasz@calhouncotx.org September 2022 Development Permits New Homes — 7 Renovations/Additions —1 Mobile Homes — 2 Boat Barns/Storage Buildings/Garages -1 Commercial Buildings/RV Site - 0 Tower Addition — 0 Fence — 0 Pool-1 Drainage-1 Total Fees Collected: $780 '2t .11 1 HILL COUNTRY SOFTWARE MO. RE PORT OR REQUESTING DISBURSEMENT D.R. REQUESTING DISBURSEMENT D.R. REQUESTING DISBURSEMENT OR REQUESTING DISBURSEMENT OR. REQUESTING DISBURSEMENT MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/3/2022 ACCOUNTNUMBER CR 1000-001-45011 CR 1000-001-44190 CR 1000-001-44361 CR 1000-001-44010 CR 1000-001-44061 CR 1000-001-44090 CR 1000-001-49110 CR 1000-001-44322 CR 1000-001-44145 CR 1000-999-20741 CR 1000-999-20744 CR 1000-999-20745 CR 1000-999-20746 CR 1000-999-20770 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 0 ACCOUNT NAME FINES SHERIFF'S FEES ADMINISTRATIVE FEES: AMOUNT 5,179.48 530.07 DEFENSIVE DRIVING 50.00 CHILD SAFETY 0.00 TRAFFIC 123.29 ADMINISTRATIVE FEES 1,866.59 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 TOTAL ADMINISTRATIVE FEES 2,039.88 CONSTABLE FEES -SERVICE 450.00 JP FILING FEES 0.00 COPIES / CERTIFIED COPIES 0.00 OVERPAYMENTS (LESS THAN $10) 0.00 TIME PAYMENT REIMBURSEMENT FEE 107.00 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 DUE TO STATE -DRIVING EXAM FEE 0.00 DUE TO STATE-SEATBELT FINES 0.00 DUE TO STATE -CHILD SEATBELT FEE 0.00 DUE TO STATE -OVERWEIGHT FINES 0.00 DUE TO JP COLLECTIONS ATTORNEY 671.18 TOTAL FINES, ADMIN. FEES & DUE TO STATE $8,977.61 CR 2670-001-44061 COURTHOUSE SECURITY FUND $338.72 CR 2720-001-44061 JUSTICE COURT SECURITY FUND $3.25 CR 2719-001-44061 JUSTICE COURT TECHNOLOGY FUND $281.55 CR 2699-001-44061 JUVENILE CASE MANAGER FUND $1.72 CR 2730-001-44061 LOCAL TRUANCY PREVENTION & DIVERSION FUND $335.67 CR 2669-001-44061 COUNTY JURY FUND $6.71 CR 2728=001-44061 JLISTICE'C©URT SUPPORT FUND $200.00' CR 2677-001 44061 COUNTY'DISPUTE RESOLUTION FUND - $40:00 - CR 2725-001-44061 LANGUAGE ACCESS FUND $24:00°' CR 7020-999-20740 CR 7070-999-20610 CR 7070-999-20740 CR 7072-999-20610 CR 7072-999-20740 CR 7860-999-20610 CR 7860-999-20740 STATE ARREST FEES DPS_FEES P&W FEES TABC FEES DR 7070-999-10010 DR 7072-999-10010 25.22 0.00 0.00 TOTAL STATE ARREST FEES 25.22 CCC-GENERAL FUND 12.99 CCC-STATE 116.94 129.93 STATE CCC- GENERAL FUND 416.23 STATE CCC- STATE 3,746.07 4,162.30 STF/SUBC-GENERAL FUND 1.50 STF/SUBC-STATE 28.50 DR 7860-999-10010 30.00 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 80.20 CR 7860-999-20740 STF- EST 9/1/2019- STATE 1,924.88 DR 7860-999-10010 2.005.08 Page 1 of 3 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/3/2022 CR 7950-999-20610 CR 7950-999-20740 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 0 DR 7950-999-10010 TP-GENERAL FUND TP-STATE 72.34 36.17 36.17 Page 2 of 3 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/3/2022 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 0 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 0.00 DR 7480-999-10010 0.00 CR 7865-999-20610 CR 7865-999-20740 CR 7970-999-20610 CR 7970-999-20740 CR 7505-999-20610 CR 7505-999-20740 - CR 7857-999-20610 CR 7857-999-20740 CR 7856-999-20610 CR 7856-999-20740 CR 7502-999-20740 DR 7865-999-10010 DR 7970-999-10010 DR 7505-999-10010 DR 7857-999-10010 DR 7856-999-10010 CRIM-SUPP OF IND LEG SVCS-GEN FUND 0.45 CRIM-SUPP OF IND LEG SVCS-STATE 4.04 4.49 TUFTA-GENERAL FUND 26.49 TUFTA-STATE 52.99 79.48 J PAY - G EN ERAL FU N D 1.21 JPAY=STATE 10.88 12.09 JURY REIMB. FUND- GEN. FUND 0.80 JURY REIMB. FUND- STATE 7.21 8.01 CIVIL JUSTICE DATA REPOS.- GEN FUND 0.01 CIVIL JUSTICE DATA REPOS.- STATE 0.07 0.08 JUD/CRT PERSONNEL TRAINING FUND- STATE 0.00 DR 7502-999-10010 0.00 7998-999-20740 TRUANCY PREVENT/DIV FUND - STATE 1.01 7998-999-20701 JUVENILE CASE MANAGER FUND 1.01 DR 7998-999-10010 2.02 7403-999-22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 7858-999-20740 STATE CONSOLIDATED CIVIL FEE 168.00 REVISED 02/02/2022 168.00 TOTAL (Distrib Req to OperAcct) $16,908.27 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT: 30.00 OUT -OF -COUNTY SERVICE FI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 1,347.25 WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $1,377.25 TOTAL COLLECTED -ALL FUNDS $18,286.52 LESS: TOTAL TREASUER'S RECEIPTS $18,285.52 OVER/(SHORT) $0.00 Page 3 of 3 CALHOUN COUNTY 201 West Austin PAYEE Name: Calhoun County Oper. Acct. Address: City: State: Zip: Phone: ra PAYOR Official: Title: —( Z — '2 -z— of Official L_/ Date DISTRIBUTION REQUEST DR# 450 A 44838 Hope Kurtz Justice of the Peace, Pct. 1 Wes. W e. ENTER COURT NAME: IJUSTICE OF PEACE NO.2 ENTER MONTH OF REPORT ISEPTEMBER ENTER YEAR OF REPORT 12022 CODE AMOUNT CASH BONDS 0.00 REVISED 02/02/2022 ADMINISTRATION FEE-. AOMF 10.00 BREATH ALCOHOL TESTING - BAT 0.00 CONSOLIDATED COURT COSTS -CCC 233.56 STATE CONSOLIDATED COURT COST-2020 906.41 LOCAL CONSOLIDATED COURT COST-2020 136.04 COURTHOUSE SECURITY -CHS 23.35 - CJP 0.00 CIVIL JUSTICE DATA REPOSITORY FEE -CJDR 0.32 CORRECTIONAL MANAGEMENT INSTITUTE -CMI 0.00 CR 0.00 CHILD SAFETY -CS 0.00 CHILD SEATBELT FEE -CSBF 0.00 CRIME VICTIMS COMPENSATION-CVC 0.00 DPSC/FAILURE TO APPEAR -OMNI-DPSC 108.78 ADMINISTRATION FEE FTA/FTP (aka OMNI). 2020 105.34 ELECTRONIC FILING FEE -EEF 0.00 FUGITIVE APPREHENSION - FA 0.00 GENERAL REVENUE -GR 0.00 GRIM- IND LEGAL SVCS SUPPORT -IDF 11.68 JUVENILE CRIME&DELINQUENCY -JCD 0.00 JUVENILE CASE MANAGER. FUND -JCMF 26.64 JUSTICE COURT PERSONNEL TRAINING -JCPT 0.DO JUROR SERVICE FEE -JSF 23.35 LOCAL ARREST FEES -LAF 51.98 LEMI 0.00 LEDA 0.00 LEDO 0.00 - OCL 0.00 PARKS& WILDLIFE ARREST FEES -PWAF 0.00 STATE ARREST FEES - SAF 20.80 SCHOOL CROSSING/CHILD SAFETY FEE-SCF 0.00 SUBTITLE C-SUBIC 60.00 STATE TRAFFIC FINES -EST 9.1.19-.STF 387.23 TABC ARREST FEES -TAF O.OD TECHNOLOGY FUND -TF 23.35 TRAFFIC -TFC 9.00 LOCAL TRAFFIC FINE- 2020 20.23 TIME PAYMENT -TIME 25.00 TIME PAYMENT REIMBURSEMENT FEE-2020 91.35 TRUANCY PREVENTION/DIVERSION FUND `-TPDF 9.68. LOCAL& STATE WARRANT FEES -WRNT 4B5.12 COLLECTION SERVICE FEE-MVBA-CSRV 1,381.56 DEFENSIVE DRIVING COURSE -DOC 0.00 DEFERRED FEE - OFF 212.00 DRIVING EXAM FEE- PROV DL 0.00 FILING FEE -FFEE 0.00 STATE CONSOLIDATED CIVIL FEE -2022 210.00 LOCAL CONSOLIDATED CIVIL FEE -2022 330.00 - FILING FEE SMALL CLAIMS -FFSC 0.00 JURY FEE -JF 0.00 COPIES/CERTIFED COPIES - CC 0.00 INDIGENT FEE -CIFFor INDF O.OD JUDGE PAY RAISE FEE -JPAY 35.D4 SERVICE FEE -SFEE 225.DO OUT -OF -COUNTY SERVICE FEE 0.DO ELECTRONIC FILING FEE -EEF CV 0.00 EXPUNGEMENTFEE-EXPG 0.00 - EXPIRED RENEWAL-EXPR 0.00 ABSTRACT OF JUDGEMENT -AOJ 5.00 ALL WRITS -WOP/WOE 0.00 - CPS FTA FINE -DPSF 1,044.13 - LOCAL FINES - FINE 2,939.51 LICENSE &WEIGHT FEES -LWF 0.00 PARKS&WILDLIFE FINES -PWF 0.00 SEATBELT/UNRESTRAINED CHILD FINE - SEAT 0.00 /- JUDICIAL & COURT PERSONNEL TRAINING-JCPT 0.00 OVERPAYMENT (OVER $10)-OVER 0.00 • OVERPAYMENT($10 AND LESS) -OVER 0.00 RESTITUTION - REST 0.00 PARKS & WILDLIFE -WATER SAFETY FINES-WSFI 0.00 MARINE SAFETY PARKS & WILDLIFE- MSOI 0,00 TOTAL ACTUAL MONEY RECEIVED TYPE: AMOUNT TOTAL WARRANT FEES 485.12 ENTER LOCAL WARRANT FEES 167.13NECORDONTOTAL PAGE OF NIILCOUNTW SOMARl=MO. Fern" _ STATE WARRANT FEES - $317.99 RECORD ON TOTAL PAGE of HILL COUNTRY WO AREMO.REPORT - DUETOOTHERS: AMOUNT DUE TO CCISD-.50% of Fine on JV cases 0.00 PLEASEINI 6KREQUESTINGGISBORSEMENT DUE TO DA RESTITUTION FUND COO PLFASEINGLUDE DA.REQUESTIINGDISGURSEMENT'. REFUND OF OVERPAYMENTS 0.00 PLFnsEINCLUDE D.R.REQUESTINGDISBURSEWNT OUT -OF -COUNTY SERVICE FEE -0.00 PLEASEINCLUDE OR.REQUEsf INGOISRURSEMENT CASH BONDS 0.00 PLEABEINCLUDE D.R.MQUES➢NGDISBUFMMENT(IFREQUIE0) TOTALDUE TO OTHERS $0.00 TREASURERS. RECEIPTS FOR MONTH: AMOUNT CASH, CHECKS, M_ .O.s & CREDIT CARDS $8,151.45 Calculate from ACTUAL Treasteore Receipts TOTAL TREAS. RECEIPTS $9161.46 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/4/2022 ACCOUNTNUMBER CR 1000-001-45012 CR 1000-001-44190 CR 1000-001-44362 CR 1000-001-44010 CR 1000-001-44062 CR 1000-001-44090 CR 1000-001-49110 CR 1000-001-44322 CR 1000-001-44145 CR 1000-999-20741 CR 1000-999-20744 CR 1000-999-20745 CR 1000-999-20746 CR 1000-999-20770 COURT NAME: JUSTICE OF PEACE NO. 2 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2022 ACCOUNTNAME AMOUNT FINES 3,983.64 SHERIFF'S FEES 490.14 ADMINISTRATIVE FEES; DEFENSIVE DRIVING 0.00 CHILD SAFETY 0.00 TRAFFIC 29.23 ADMINISTRATIVE FEES 327.34 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 TOTAL ADMINISTRATIVE FEES 356.57 CONSTABLE FEES -SERVICE 225.00 JP FILING FEES 5.00 COPIES / CERTIFIED COPIES 0.00 OVERPAYMENTS (LESS THAN $10) 0.00 TIME PAYMENT REIMBURSEMENT FEE 91.35 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 DUE TO STATE -DRIVING EXAM FEE 0.00 DUE TO STATE-SEATBELT FINES 0.00 DUE TO STATE -CHILD SEATBELT FEE 0.00 DUE TO STATE -OVERWEIGHT FINES 0.00 DUE TO JP COLLECTIONS ATTORNEY 1,381.56 TOTAL FINES, ADMIN. FEES & DUE TO STATE $6,533.26 CR 2670-001-44062 COURTHOUSE SECURITY FUND CR 2720-001-44062 JUSTICE COURT SECURITY FUND CR 2719-001-44062 JUSTICE COURT TECHNOLOGY FUND CR 2699-001-44062 JUVENILE CASE MANAGER FUND CR 2730-001-44062 LOCAL TRUANCY PREVENTION & DIVERSION FUND CR 2669-001-44062 COUNTYJURYFUND CR 2728-001-44062 JUSTICE COURT SUPPORT FUND CR 2677-001-44062 COUNTY DISPUTE RESOLUTION FUND CR 2725-001-44062 LANGUAGE ACCESS FUND CR 7020-999-20740 CR 7070-999-20610 CR 7070-999-20740 CR 7072-999-20610 CR 7072-999-20740 CR 7860-999-20610 CR 7860-999-20740 STATE ARREST FEES DPS FEES P&W FEES TABC FEES DR 7070-999-10010 DR 7072-999-10010 DR 7860-999-10010 $65.13 $5.84 $62.22 $26.64 $48.59 $50.00 67.76 0.00 0.00 TOTAL STATE ARREST FEES 67.76 CCC-GENERAL FUND 23.36 CCC-STATE 210.20 233.56 STATE CCC- GENERAL FUND STATE CCC- STATE STF/SUBC-GENERAL FUND STF/SUBC-STATE CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND CR 7860-999-20740 STF- EST 9/1/2019- STATE DR 7860-999-10010 90.64 815.77 906.41 3.00 57.00 60.00 15.49 371.74 Page 1 of 2 Ssr. 10/4/2022 CR 7950-999-20610 CR 7950-999-20740 CR 7480-999-20610 CR 7480-999-20740 CR 7865-999-20610 CR 7865-999-20740 CR 7970-999-20610 CR 7970-999-20740 CR 7505-999-20610 CR 7505-999-20740 CR 7857-999-20610 CR 7857-999-20740 CR 7856-999-20610 CR 7856-999-20740 CR 7502-999-20740 7998-999-20740 7998-999-20701 7403-999-22889 7858-999-20740 REVISED 02/02/2022 YEAR DR 7950-999-10010 DR 7480-999-10010 DR 7865-999-10010 DR 7970-999-10010 DR 7505-999-10010 DR 7857-999-10010 DR 7856-999-10010 DR 7502-999-10010 DR 7998-999-10010 DR 7403-999-22889 NAME: JUSTICE OF PEACE NO. 2 !PORT: SEPTEMBER !PORT: 2022 TP-GENERAL FUND 12.50 TP-STATE 12.50 25.00 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CIVIL INDIGENT LEGAL -STATE 0.00 0.00 CRIM-SUPP OF IND LEG SVCS-GEN FUND 1.17 CRIM-SUPP OF IND LEG SVCS-STATE 10.51 11.68 TUFTA-GENERAL FUND 36.26 TUFTA-STATE 72.52 108.78 JPAY - GENERAL FUND 3.50 JPAY - STATE 31.54 35.04 JURY REIMB. FUND- GEN. FUND 2,34 JURY REIMB. FUND- STATE 21.01 CIVIL JUSTICE DATA REPOS.- GEN FUND 0.03 CIVIL JUSTICE DATA REPOS.- STATE 0.29 0.32 JUD/CRT PERSONNEL TRAINING FUND- STATE 0.00 0.00 TRUANCY PREVENT/DIV FUND - STATE 4.84 JUVENILE CASE MANAGER FUND 4.84 9.68 ELECTRONIC FILING FEE - CV STATE 0.00 0.00 STATE CONSOLIDATED CIVIL FEE 210.00 210.00 TOTAL (Distrib Req to Oper Acct) $9,151.45 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENTS 0.00 OUT -OF -COUNTY SERVICE FE 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 0.00 WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $0.00 TOTAL COLLECTED -ALL FUNDS $9,151.45 LESS: TOTAL TREASUER'S RECEIPTS $9,151.46 OVER/(SHORT) $0.00 Page 2 of 2 CALHOUN DISTRIB-;)XIDN COUNTY REQUEST 201 West Austin DR# 450 A 44838 PAYEE MOR Name: Calhoun County Oper. Acct. Official: Hope Kurtz Address: Title: Justice of the Peace, Pct. 2 City: State: Zip: Phone: ACCOUNT NUMBER- -` DESCRIPTIONS - AMOUNT 7542-999-20759-999 JP2 Monthly Collections - Distribution $9,151.45 SEPTEMBER 2022 V# 967 TOTAL 9,151.45 Signature of Official Date 10-06-22;09:42 ;From:Calhoun County JP4 To:3615534444 ;3617852179 # 1/ 5 FAX COVER SHEET October 6, 2022 FROM: JUSTICE COURT PCT. 4, CALHOUN COUNTY 103 W. Dallas Street, P.O. Box 520 Seadrift, Texas 77989 PHONE: 361-785-7082 FAX: 361-785-2179 TO: County Judge Office FAX: 361-553-4444 Ref: JP4 - SEPTEMBER Money Distribution Report Please give me a call if you have any questions. Fax Cover: Pages to Follow: ,-,,,.4— Thank you, JUNE CANTRELL, Court Clerk Judge lwesCey J. Hunt 10-06-22;00:42 ;Frnm:Cu|hnVD County JP4 TU:3615534444 ;3017852170 # 2/ 5 i JUSTICE OF PEACE NO, 4 SEPTEMBER 2022 30.01) p. 4.00 4.00 25.00 0.00 ij 1,167.51) zk RECORD ON TOTAL PAGE OF HILL COUNTRY SOFTWARE MO. REPORT AMOUNT 0.01PLEASE INCLUDE D.R. REQUESTING )MBUIRSEMENT L. A09p PLEASE INCLUDE D.R. RfqVqFlNg 015BURK-MENT i' PLE&SEINCLUDS C.R.- REQUESTING 101S.B.P.RSEMENT (F REQUIRED) AMOUNT- ----� I � ^ F � 10-06-22;09:42 ;From;Calhoun County JP4 To:3615534444 ;3617852179 # 3/ 5 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/5/2022 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT. SEPTEMBER YEAR OF REPORT: 2022 ACCOUNTNUMBER ACCOUNTNAME AMOUNT CR 1000-001.45014 FINES 1;167.59 CR 1000.001.44190 SHERIFF'S FEES 93.00 ADMINISTRATIVE ADMINISTRATIVE FEES: DEFENSIVE DRIVING 0.00 CHILD SAFETY 0.00 TRAFFIC 18.80 ADMINISTRATIVE FEES 0.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001.44364 TOTAL 'ADMINISTRATIVE FEES 18.80 CR 1000-001-44010 CONSTABLE FEES -SERVICE 75.00 CR 1000-001-44064 JP FILING FEES 0.00 CR 1000-001-44090 COPIES/CERTIFIED COPIES 0.00 OR 1000-001.49110 OVERPAYMENTS (LESS THAN $10) 0.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 15.00 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE D.00 OR 100&899.20741 DUE TO STATE -DRIVING EXAM FEE D.00 CR 1000.999.20744 DUE TO STATESEATSELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATSELT FEE 0.00 CR 1000-999.20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999.20770 DUE TO JP COLLECTIONS ATTORNEY 124.50 TOTAL FINES, ADMIN. FEES & DUE TO STATE $1,493,89 CR 2670-001-44064 COURTHOUSE SECURITY FUND $42.20 CR 2720-001-44064 JUSTICE COURT SECURITY FUND $1,00 CR 2719.001-44064 JUSTICE COURT TECHNOLOGY FUND $36.00 CR 2699-001-44064 JUVENILE CASE MANAGER FUND $5.00 OR 2730.00144084 LOCAL TRUANCY PREVENTION & DIVERSION FUND $40.00 CR 2669.001-44064 COUNTY JURY FUND $0.80 CR 2728-001-44084 JUSTICE COURT SUPPORT FUND $100.00 CA. 2677-601-44064 COUNTY DISPUTE RESOLUTION FUND $20.00 CR 2725-0D144064 LANGUAGE ACCESS FUND $12.00 STATEARRESTFEES DIPS FEES P&W FEES 2.00 0.00 TABC FEES 0,00 CR 7020.999-20740 TOTAL STATE ARREST FEES 2.00 OR 7070-999-20610 CCC-GENERAL FUND CR 7070.999-20740 CCC-STATE 4.00 ` 36.00 DR 7070-999-10010 40.00 CR 7072-999-20610 STATE CCC- GENERAL FUND 49.60 CR 7072-999.20740 STATE CCC- STATE 446.40 DR 7072.999-10010 496.00 OR 7800-999-20010 STF/SUSC-GENERAL FUND 0.00 CR 7860-999-20740 STF/SUBC-STATE 0.00 DR 7860-998-10010 0.00 CR 7860-999.20510 STF- EST 9/l/2019- GENERAL FUND 121254 CR 7860-999.20740 STF-EST 9!1@019- STATE .54 300.87 DR 7860-999.10010 313.41 Page 1 of 3 10-06-22;09:42 ;From:Calhoun County JP4 To:3615534444 ;3617852179 # 4/ 5 MONTHLY REPORT OF COLLECTIONS AND DISTRISUTIONS 10/5/2022 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2022 CR 7950-999.20610 TP-GENERAL FUND 12.50 CR 7950-999-20740 TP-STATE 12.50 DR 7850.999.10010 2500 P Page 2 of 3 10-06-22;09:42 ;From:Calhoun County JP4 To:3615534444 ;3617652179 # 5/ 5 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 10/5/2022 CR 7480-999.20810 CR 7480.999.20740 CR 7865.999-20610 CR 7866-999-20740 CR 7970-999.20610 CR 7970.999-20740 CR 7505-999-20610 CR 7505.999-20740 CR 7857-999-20610 CR 7857-999-20740 CR 785"99-20610 CR 7855-999.20740 CR 7502-999-20740 7998-999-20740 7998.999-20701 7403-999-22889 7858-999-20740 REVISED 02/02/2021 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: SEPTEMBER YEAR OF REPORT: 2022 CIVIL INDIGENT LEGAL-GEN. FUND 0.10 CIVIL INDIGENT LEGAL -STATE 1.00 DR 748(.999-10010 2.00 CRIM-SUPP OF IND LEG SVCS-GEN FUND 0.00 CRIM•SUPP OF IND LEG SVCS-STATE 000 DR 7865.999.10010 0.00 TL/FTA-GENERAL FUND 10.00 TL/F-A-STATE 20.00 DR 7970.999.10010 30.00 JPAY• GENERAL FUND 0.60 JPAY- STATE 5.40 DR 7505-999.10010 8.00 JURY REIMS. FUND-GEN. FUND 0.40 JURY REIMS. FUND- STATE 3.60 DR 7857-999-10010 4,00 CIVIL JUSTICE DATA REPOS: GEN FUND 0.01 CIVIL JUSTICE DATA REPOS- STATE 0.09 DR 7858.999.10010 0.10 JUD/CRT PERSONNEL TRAINING FUND - STATE 0.00 DR 7502-999.10olo 0,00 TRUANCY PREVENT/DIV FUND- STATE 1.00 JUVENILE CASE MANAGER FUND 1.00 DR 7996-998.10010 - 2.00 ELECTRONIC FILING FEE • CV STATE 0.00 DR 7403.998-22889 0.00 STATE CONSOLIDATED CIVIL FEE 84 0o N.00 TOTAL Pstrfb Rep to Operpcct) $2,755.40 DUE TO OTHERS (Distrib Req Atroho) CALHOUN COUNTY ISD DA - RESTITUTION REFUND OF OVERPAYMENT; OUT -OF -COUNTY SERVICE FI CASH BONDS PARKS & WILDLIFE FINES WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $0.00 TOTAL COLLECTED -ALL FUNDS $2,755.40 LESS: TOTAL TREASUER'S RECEIPTS $2ro OVER/(SHORT) Page 3of3 10-04-22;22:42 ;From:Calhoun County Pct. 5 To:3615534444 ;3619832461 # 1/ 7 FAX COVER SHEET JUDGE NANCY POMYKAL AND.IUSMCC' FO/C AU..... P 0 BOX 454 PORT O' CONNOR, TX.77982 (361)983-2351 -TELEPHONE (361)983-2461 - FAX COUNTY OF CALHOUN JUSTICE COURT PCT. 5 DATE: OCTOBER 4, 2022 PAGES: 7 Including this cover TO: JUDGE RICHARD MEYER & COUNTY COMMISSIONERS ATT.- MaeBelle FAX NUMBERS) 361-553.4444 SUBJECT: SEPTEMBER 2022 — MONEY DISTRIBUTION REPORT NOTE: MaeBelle. I am faxing the, above report for SEPTEMBER, 2022. please ,give me a call if you have any questions Thank you, fal-144 iae THE CONTENTS OF THIS FAX MESSAGE ARE INTENDED SOLELY FOR THE ADDRESSEE(S) named in this message. This communication is intended to be and to remain confidential and may be subject to applicable attorney/client and/or work product privileges. If you are not the intended recipient of this message, or if this message has been addressed to you in error, please immediately alert the sender by fax and then destroy this message and its attachments. Do not deliver, distribute or copy this message and/or any attachments and if you are not the intended recipient, do not disclose the contents or take any action in reliance upon the information contained in this communication or any attachments. 10-04-22;22:42 ;From:Calhoun County Pet, 5 To:3615534444 ;3619832461 # 2/ 7 Money Distribution Report Rci Cause/Defendant CodesNAmovate CALHOUNco. J.B.REPORT 377731 2022-0167 09.07-2022 eft 26.33 LAP Total PVSCHMAN. MASON HUNTER 2.12 LCCC .05 OMNR 4.24 TPRP 11.39 S3 -00 to .......... . 377733 2022.0208 09-08-2022 CCC G2. ob LAP 6.00 "cc 14.D0 LTpC 3.00 SLEDGE, BRIAN LOYO DEFF 196.00 STFI 50.00 300.00 Credit Card 37.77.3 . .... . 022"0225:: FINE L j:30 25 00 i 377735 2022-0298 09-12-2022 CCC 62.00 LAP 5.00 LCCC 24.00 LTPC 3.00 FOX, OULIE KAY DDC 10.06 STFI 50,00 114.00 ..... credit Card I.: .... i�� .... ..... 20240.1 EAgk 00ptirly: Check: ..... ..... 5612 277737 2021.0274 09.21-2022 CCC 62.00 SAP 5.00 WANT 50.00 LCCC 14.00 Mi MARCUS LEE BRANDALE FINS 239.06 CS RV I14.00 O;MNR 20.00 194,0D Company check # 105750 3 2 02i'V617 8 09121ZQPM CC C! ::a 4.00, r rINT �53 ..mR=S: RAY, ... .... ... bd .... :2,62: Do Credit;, Ceti n�. . .. ... .. .. .. . 377739 2 22 31 09-27-2022 CCC 42,00 . . . .. . ... LAP 5.00 �Ccc 1�.Oo . , , DONEE, LjAMNR PI NE 3 9. 00 1 4 0 .00 Credit Card 377.74D.:... E022:6302. ...:.:.-b . : :.0928 202,2 CCC .... 52 DO - - ....... 5 0 . PWFr '!Is it .. ... . ... .. .. 377741 2021.0109 09.28-2022 GUTIERAtz-VASOUEz, KEVIN AVAN CCC 62.O0 LAP 5.00 WANT ... 50.00 LCCC 14.00 F FINE 104.00 305.50 CSRV 70.50 3 ! 7�-;.-CAmh : 6307.t ... . ........... ....... 4 .... .. 377943 2022-0303 09-28-2022 CCC REYNOLDS, SCOTT MERRITT Perennial Check # 1216 t QvPoi Chock Ind. 377745 2022-0125 0-28.2o22 FINE SARRERA, EMILY KhTHERTNE Credit Card 37 : 74 , B2 - 7� . , 0 , 22z . b , ji� , j I _... .. .: .. .., . .. . , m: :JDARRE RA;.%EM=Y MATHERIW 52. 00 LAP 5.00 LCCC 14.00 87 C : S . R . V 060. 6 60: 377747 2022-0300 09-29-2022 etc 62.00 LAP JOi LEAFY ANN DDC 10.00 Perki Check 4144 10-04.2022 too 94.00 175.00 2 it WIW;: ........ 24-21 . .... . 5.00 LCCC 24.00 LTFc 3.00 5TF1 $0.00 144.00 Page 1 10-04-22;22:42 ;From:Calhoun County Pet. 5 To:3815534444 ;3619832461 # 3/ 7 Money Dintributlen Report CAGAOUNCO. J,F. S SBpT8MB8R 2022 REPORT Type Code DeeCripefon Count Retained Diaburned moray -Totals The fallowing totals represent - Caah and Check, Collected COST CCC CONSOLIDATED COURT COSTS 7 COST LAP SHERIFF'S FEE 43 .4D 39D.60 34 43A,00 LC COST CC LOCAL CONSOLIDATED COURT COST 1.1.20 5 25.00 25.0D 0.00 .00 COST LCCF LOCAL CONSOLDATED CIVIL FEES 1.1-20 7 0.00 98.00 COST QMNR OMNI REIMBURSEMENT FEE (Err. 1.1.10) 1 0.00 33.00 33.00 COST SAF DpS 1 10.00 D.00 10.00 COST STFI STATE TRF FINE 9-1.15 2 8.00 2.00 10.00 COST TFC LOCAL TRF. FIND• FORMERLY TRF, 9-1-19 1 2.00 48.00 50.00 COST TPRF TIME PAYMENT REIMBURSEMENT FEE 1 3.00 0.00 3.00 COST WRNT WARRANT FEE D 0.00 0.00 0.00 PEES CSRV COLLECTION SERVICES FEE 2 100.00 0.00 100.00 FEES DbC GR SAFETY COURSE L0 2 18a.50 0'00 184.50 FEES SCCF STATE E CONSOLIDATED CIVIL FEE 1 10.00 0.0D 10.00 FINE CPLD COMPLIANCE DISMISSAL FINE 1 0.00 21.00 21.00 FINE DEPF DEFERRED FIND 1 10.00 0.00 20.00 FINE PINE FINE 0 0.00 0100 0.00 FINE LTFC LOCAL TRAFFIC FINE (Err. 9,1.19) 3 46P.00 0.00 469,00 PINE PWF PARKS & WILDLIFE FINE 1 3.00 O.DO 3.00 FINE STFI STATE TRAFFIC FINE (BFF, 9.1.19) 1 17.85 101.13 IIP,00 FIND WSP WATER SAFETY FINE:1 2.00 48.00 50.00 2 31.95 161.05 213.00 Money Totals 9 1,017.70 E24.00 1,592.50 The £allowing totalo represent - Transfer¢ Collected COST CCC CONSOLIDATFp COURT COSTS COST LAF SHERIFF'S FEE D 0.00 0.00 0.00 COST LCCC LOCAL CONSOLIDATED COURT COST 1• 1.20 0 0.00 0.00 0.00 COST LCCF LOCAL CONSOLDATED CIVIL FEES 1.1-20 0 0.00 D.00 01000 COST OMNR OMNI REIMBURSEMENT FEE (EFF. 1, 1.20) 0.00 0100 0.60 COST SAP ➢PS 0 0.00 0100 0.00 COST STP1 STATE TRF FINE 9.1-19 D 0.00 0.00 0.00 COST TFC LOCAL TRF, FINE- FORMERLYTRF, 5-1�19 0 0.00 0,00 0.00 COST TPRF TIME PAYMENT REIMBURSEMENT FEE 0 0.00 0.00 0100 00ST WENT WARRANT FEE O 0.00 0.00 0.00 FEES CSRV COLLECTION SERVICES FEE 0 0,00 0.00 0100 FEES DUC DRIVER SAPDTY COURSE - 2020 0 0.00 0.00 0.00 FEES SCCr STATE CONSOLIDATED CIVIL FEE 0 0•00 0.00 0.00 FINE CPLD COMPLIANCE DISMISSAL FINE 0 0.00 0.00 0.00 FINE DOFF DEFERRED FINE 0 0.00 0.00 0.00 FINE FINE FINE D 6.00 0.00 0.00 FINE LTFC LOCAL TRAFFIC FINE (ErF. 9.1,19) 0 0.00 0.00 0.00 FINE FWF PARKS & WILDLIFE FINE 0 0.00 0.00 0.00 FINE STFI S-ATE TRAFFIC PINE (Epp. 9.1,19) 0 9.90 0.00 0.00 FINE WSP WATER SAFETY FINE 0 0.00 0.00 0.00 0 0.90 0.00 0.00 Trans£or Totele 0 0.00 0.00 0.00 The following totals represent - Jail Credit and Community Service COST CCC CONSOLIDATED COURT COOTS COST LAP SHERIFF'S FEE 0 0.00 0.09 0.00 COST LCCC LOCAL CONSOLIDATED COURT COST 1-1-20 0 0.00 0.00 0.00 COST LCCF LOCAL CONSOLDATED CIVIL FEES 1-1.20 0 O.OD 0.00 0,00 COST OMMA OMNT REIMBURSEMENT FEE (EFF. 1.1.20) 0 0.00 0.66 0.00 COST SAP OF9 0 0.00 0.00 0.00 COST STFI STATE TRF FINE 9.1-19 0 0.00 0.00 0.00 COST TFC LOCAL TRF. FIVE- FORMERLY TRF, 9-1-19 0 0.00 0100 0.00 COST TPRF TIME PAYMENT REIMBURSEMENT FEE 0 0.00 0.00 0.00 COST WENT WARRANT FED 0 0.00 0.00 0.00 FEES CSRV COLLECTION SERVICES FEE 0 0.00 0.00 0.00 PEES DDC DRIVER SAFETY COURSE - 2020 0 0.00 0.00 0.00 FEES SCCF STATE CONSOLIDATED CIVIL FEE D 0.00 0.00 0.00 PINE CPLD COMPLIANCE DISMISSAL FINE 0 0.00 0.00 0.00 FINE DEFr• DEFERRED FINE D 0.00 0.00 0,00 FINE FINE FINE 0 0.00 0.00 0.00 FINE LTFC LOCAL TRAFFIC FINE (EPr. 9.1.19) D 0.00 0.00 0.00 FIND PWF PARKS &WILDLIFE FINE D 0.00 0.00 0.00 ° 0.00 O.OD 0.00 10.09 -2023 Page 2 10-04-22;22:42 ;From:Calhoun County Pot. 5 To:3615534444 ;3619832461 # 4/ 7 Money Divtribution Report Pe Code Ceveri Rion CALHOONCD. J.F. 5 S¢PT¢M¢ER 2a22 ¢¢PORT FINE STPY STATE TRAFFIC FINE (EPF. 9,1.19) Count Rotained Di,burved MvRt-TVC,Ya FINE WSF WATER SAFETY FINE 0 0.00 0.00 0,00 0 0.00 0.00 0.00 Credit Totals 0 0.60 0.00 0.00 The following totalS regreeent - Credit Card Payments COST CCC CONSOLIDATED COURT COSTS COST LAF SHERIPF'S FEE 6 30.43 273.91 304.34 COST LCCC LOCAL CONSOLIDATED COURT COST 1.1.29 6 24.54 0.00 24.54 COST LCCF LOCAL CONSOLOATED CIVIL FEES 1.1-RO 6 98.73 0.00 69,73 COST OMNR OMNI REIMBURSEMENT FEE (EEE. 1120) 0 0.00 0.00 0.00 .. COST SAP CPS 3 19.00 0.00 19.08 COST STF1 STATE TRF FINE 9-1.19 0 00 0.00 0.00 COST TFC LOCAL TRF, FINE- FORMERLY TRP. 9-2.19 0 0.00 0,00 0.00 COST TPRF TIME PAYMENT REIMBURSEMENT FEE 0 0.00 0.00 0.00 COST WRNT WARRANT FEE 1 11.36 D.OD 11.36 FEES CSRV COLLECTION SERVICES FEE 1 24.21 0.00 24.21 FEES DOC DRIVER SAFETY COURSE • 2020 1 90.00 0.00 60.00 FEES SCCF STATE CONSOLIDATED CIVIL FEE 1 10.00 0.00 10.00 FINE CPLD COMPLIANCE DISMISSAL FINE 0 0.00 0.00 0.00 FINE DIIFF OSFERRED FINE 0 0.00 0.09 0.00 FINE FINE FINE 1 16G.DO 0.00 169.00 FINE LTFC LOCAL TRAFFIC PINE(EFP. 9,1.19) 4 376.63 0.00 276.63 FINE PWF PARKS & WILDLIFE FINE 3 6.30 0.00 6.30 FINE STFS STATE TRAFFIC FINE (EFF. 9.1.19) 0 0100 0.00 0.00 FINE WSF WATER SAFETY FINE 3 4.20 100,74 104.94 0 0.00 0.00 D.00 Cr9di0 Card Totals 8 801.40 374.65 1,176.13 The following totals rePrevent - Combined money COST CCC CONSOLIDATED COURT COSTS COST LAP SHERIFF'S FEE 13 73.83 664.51 73a,34 COST LCCC LOCAL CONSOLIDATED COURT COST 1- 11 49.54 0.00 49,54 COST LCCF LOCAL CONSOLOATED CIVIL PISS 1.1-2020 13 166.73 0,00 156.73 COST OMNR OMNI REIMBURSEMENT FEE (EPF. 1.1.20) 1 0.00 33.00 33.00 COST SAP CPS 4 29.09 0.00 29.00 COST STF1 STATE TRP FINE 9-1.19 2 0.00 2.00 10,00 COST TFC LOCAL TRP. FINE- FORMERLY TRF. 9-1-19 1 2.00 49.00 yp,pp COST TPRP TIME PAYMENT REIMBURSEMENT FEE 1 3.00 0.00 3.00 COST WENT WARRANT FEE 1 11.36 0.00 11.36 FEES CSRV COLLECTION SERVICES FEE 3 124.21 0.00 124.21 FEES DOC DIVER SAFETY COURSE 202 3 244.50 0.0p0 249.50 FEES SCCP STATE CONSOLIDATED CIVIL FEE 2 20.00 0.00 20.00 FINE CPLD COMPLIANCE DISMISSAL FINE 1 0,00 21.00 21,pp FINE DEFF DEFERRED FINII 1 10.00 0.00 10.00 FINE FINE FINE 1 166,00 0.00 196.00 F;NE LIFT LOCAL TRAFFIC FINE (Epp. 9.1.19) 7 845.93 0.00 845.63 FINE PWF PARKS & WILDLIFE FINE 4 9.30 0.00 P.30 FINE STF1 STATE TRAFFIC FINE (EFF. 9.1.19) 1 17.85 301.15 119,00 FINE WSP WATER SAFETY FINE 4 6.20 148.74 154.94 2 31.95 281.05 213.00 Money Totals 17 1, 819.16 3,199.45 7, 01e,63 The following total, regreannt - Combined Money and Credite COST CCC CONSOLIDATED COURT COSTS COST LAP SHERIFF'S FEE 13 73.83 664.31 738.34 COST LCCC LOCAL CONSOLIDATED COURT COST 1-2.20 3L 49.54 0.00 49.54 COST LCCF LOCAL CONSOLOATED CIVIL FEES 1-I-t6 13 186,73 0,00 169,73 COST OMNR OMNI REIMBURSEMENT FEE (EFF, 1.1.20) 1 0.00 33.00 33.00 COST SAF CPS 4 29.08 0.00 29.08 COST STPI STATE TRF FINE 9.1-19 2 8.00 2.00 10.00 COST TPC LOCAL TRF. FINE- FORMERLY TRF. 9.1-19 1 2.00 48.0o 50.00 COST TPRF TIME PAYMENT REIMBURSEMENT FEE 1 3.00 0.00 3.00 COST WRNT WARRANT PEE 1 12,36 0.00 11.36 FEES CSRV COLLECTION SERVICES P.M. 3 124,21 0.00 124.21 FEES DOC DRIVER SAFETY COURSE - 2020 3 244.50 O.DD 244.50 FEES SCCF STATE CONSOLIDATED CIVIL FEE 2 20.00 0.00 20.00 FINE CPLD COMPLIANCE DISMISSAL FINE 1 0.00 21.00 21.00 1 10.00 6.00 10.00 Fag, 10-04-22;22:42 ;From:Calhoun County Pct, 5 To:3615534444 ;3619832461 # 5/ 7 Roney Didtributien Report CALxOVNCO. a.P. 5 ssexENB3rt a022 REFORT type Cede DER— FINE DCFF DEFEFERRREDEDFI SINE Ceunc ad Di burned Rea y x t 10 PINE PINE FINE 1 166.00 0.00 366.00 FINE LTFC LOCAL TRAFFIC FINE (EPF. 9.1.19) 7 545.93 0.00 545.63 FINE PWF PARKS & WILDLIFE PINE 4 9.30 0.00 9.30 FINE STF1 STATE TRAFFIC FINE (EFF, 9.1, 19) 1 17.85 161.15 119.00 FINE WSP WATER SAFETY FINE 4 6.20 148.74 154.94 2 31.95 IBL.05 211.00 ROPOIL TOCAIE 17 1.519.16 11199.45 3,01E.63 10-04-2022 Page 4 10-04-22;22:42 ;From:Calhoun County Pot. 5 To:3615534444 ;3619832461 # 6/ 7 Roney nistrlbutiea Report Dee* 00.00.0000 Payeant Type Cash & Checks Collected Jail Credits & Comm Service Credit Corda & Transfers Total of all Ce1lecCiena Pines 0.00 0.00 0.00 9.00 Court Coots 0.00 0.00 0.00 0.00 CALAOOECO. Pees 0.00 000 . 0.00 0.00 J.P. 5 sEPTEMEIIA 2022 REPORT Honda Rooeitueios 0.00 0.00 0.00 9.00 0.00 0.00 0.00 0.00 Ocher 0.00 0.00 0.00 0.00 Total 0.00 also 0.00 0,00 09-01-1991 Cash & Checks Collected Jail Credits & Comm Service Credit Cards & Transfers Total of all Collections O.OD 0.00 a.dd 0.00 0.00 O.pO 0.d0 0.00 0.00 0.00 0.00 0.00 0.00 o•00 0.00 0.00 plod 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 01-01.2004 Cash & Chocks Collected Jail Credits & Comm Service Credit Cards & Transff Transfers Total or all Collections 040 O.Do . 000 o.Do 0.00 0.00 0,00 o.00 0.00 0.00 0.00 0.00 0.00 . 000 0.00 also 0.00 0.00 0.00 9100 0.00 0.00 0,00 0,00 0.00 0.00 0.00 also D1-01.2020 Cash & Checks Collected Jail Credits & Comm service Credit Cards & Transfers Total of all Collections 864,00 0.00 03,87 1,517.97 763.00 0.00 452.26 1,215.26 215.50 0.00 70.00 235.50 O.Ca 0 a0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,840.00 6.00 3,018.63 3,018.63 TOTALS Cash & Checks Collected Jail Credits & Comm Service Credit Cards & Transfers Total of all Collections 064,00 0.00 653.87 1,517.B7 763,00 O.Oo 452.26 1, 215.26 215.50 0.00 70.00 285.50 0.00 0.00 . 000 0.00 O,pO O.DD 0.00 0.00 0,00 0.00 0.00 0.00 1,842.50 0.00 1,176.13 3,01e.63 2022 Pagq 10-04-22;22:42 ;From:Calhoun County Pet. 5 Tc:3615534444 ;3619832461 # 7/ 7 Money Distribution Report CAAHODNCO. J.P. 5 SEPTPMBER 2022 RR Descr! eion FORT CounE Collected ReEaipod Dinbureed State of Texas Ouareerly Reporting Totals State Comptroller Coat and Fees Report Section 1: Report for Offenses Committed 02-n-20 Forward 01-01-04 12.31.19 D9-01.91 - 12.31-03 Bail Bond Fee DNA Testing Fee - Juvenile EMS Trauma Fund (Ems) Juvenile Probation Diversion Fees State Traffic Fine (eff. og-01-19) State Traffic Fine (prior 09-OS-19) Intoxicated Driver Fine Prior Mandatory Coots (JRF,1Dr,JS) Moving violation Fees DNA Testing Fee - Conviction, DNA Testing Fee - Comm Supvn Truancy Prevention and Diversion Fund Failure to Appear/Pay reel Time Payment Foes Judicial Fund - Conat County Court Judicial Fund - Statutory County Court Section IT: As Applicable Peace Officer Pees Motor Carrier Weight Violations Driving Record Fee Report Sub Total State Comptroller Civil Fees Report CF, Birth Certificate Fees CF: Marriage License Peas CF: o0clar4tion of Informal Marriage CF: Juror Donations CF: JP Consolidated Civil Fee Cr: Stat Prob Court Consol Civil Fee CF: Stet Drab Court Filing Foe Other Cr: Stat Cnty Court Coneol Civil Fee CF: Stat Cncy Court Filing Fee Other CF: Cost enty Cou;t C0nep1 Civil Fee CF: Came Cnty Court Filing Fee Other Cr! Dist Court Conacl Civil Fee CF; Dist Court Filing Fee Other CF; Cnty Alt Dispute Resolution Fund CF. Nondisclosure Foos CF: Justice Court Tndig Filing Fees CF; Stat Prot Court Tndig Filing Fees CF; Seat Prob Court Judie Filing Fees CF: Star Croy Court Indig Filing Fees CF: Stat Caty Court Judie Filing race CF: CASt Cnty Court Indig Filing Face CF; Cast Cnty Court Judie Filing reel CF: Dist Court Divorce a Family Law CF: Diet Court Other Divorce/Family Law CF: Dist Court Indig Legal Services CF: Judicial 3upPOrt Fee CF: Judicial a Court Pars. Training Fee Report Sub Total Total Due For This Period 13 0 0 0 0 0 D 4 2 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 THE, STATE Or TEXAS Before me, the undersigned authority, this day County of Calhoun County personally appeared Nancy Pomykal, Justice of the Peace, Precinct No 5, Calhoun County, Texas, who being duly ,worn, deposes and says that the above d/�regeing report is true and correct. Witness my hand this 17 day of 736.34 73.83 664.51 0.00 0.00 oleo 0.00 0.00 D.00 0.00 0.00 Oleo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 D.00 1$a•94 6.20 149.94 SO.00 2.00 48.00 0.00 0.00 oleo O.DO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0199 Oleo Oleo 0.00 0.90 0.00 0.00 0.00 0.00 D,Do 0.00 0.00 0.60 0.00 0.00 10.00 8.00 2.00 0.00 0.00 0.00 0.00 oleo 0.00 953.28 96.03 OG3.25 0.00 0,00 0.00 0.00 oleo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 O.OD 0.00 0.00 0.00 O.OD 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 e.00 0.00 0.00 0.00 0.00 0.0o o.DD 0.00 0.00 0.00 0.00 0.00 D.00 Oleo 0.00 0.00 0.00 0.00 0.00 Oleo 0.00 0.06 0.00 o.OD 0.00 0.00 0.00 0.00 0.00 0.00 0.00 010D 0.00 0.00 0.00 0.00 0.00 Oleo 0.00 0.00 0.00 oleo 0.00 6.00 0.00 0.00 oleo 953.28 90.03 863.25 Calhoun SHERIFF'S OFFICE MONTHLY REPORT Sep-22 BAIL BOND FEE $ 645.00 CIVIL FEE $ 291.32 CASH BOND $ 6,500.00 JP#1 $ 2,934.90 JP#2 $ 2,317.35 JP#3 $ 994.50 JP#4 $ - JP#5 $ 494.00 SEADRIFT MUN. PC MUN $ 3,143.40 PROPERTY TAX SALE $ 125,840.00 OTHER TOTAL: I $ 143,160.47 #12 NOTICE OF MEETING- 10/1.2/2022 12. 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 9 of 10 § ■ § § B § Bm § k B ) B ±�■ § ) (A k 2 m q N 2 ) § � § k § '---8lm )000 ®-■ 8 }\\\ §©k ■ ` 2: ■ § � a: m % M; I $ ■; ■ z: 7 k §: ■: M: m M: m m| ■ �| § § §) ; � ) \ § ; § k m § m: § a: % ■: k § W § k: $ § §) s: 2 m| m �| §; § n; o! \ §(. e . k 0 t m q A 2 ) § N N W O a Z p a 3 m O 3 m i a O `o= "1 v ' m =_ a= �= 3= z _=_ Z= m m�� W m y m Z m Z z m m G)Cl) A p�q �G F 3 m �_ m Zcn 3 m r = m 3 B co Ai a y = zz O o o a e m = n yooZ O = z o00 C! 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X O z n A R C O C z N n c 0 n m m m In C c 0 v 2 ) E § k m ) 91 VI T m k § m§ § a■ 2 ; % �§ ■§ m § k) a t 0 §) M| ) .-� o « m z( § § o! o ■ @ I �7t k 2 § 0 #13 NO1lCE OF MEETING—.10/1.2/2022 13. 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: 10:10 a.m. Page 10 of 10 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---October 12 2022 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYASLES, PAYROLL AND ELECTRONIC BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDS TOTAL NURSING HOMEIUPL EXPENSES TOTAL INTER -GOVERNMENT TRANSFERS $ 206,024Z3 —' $ 808,166 25 , $ GRAND TOTAL DISBURSEMENTS APPROVEDOctober 12, 2022 $ 2,244,272,77 %AI IHi 69 69 b O O b Y xowMz� r xn�roro r m Om� ° MHz i tj o yy H r p O E i yoo ro po13 0 7 N H W xm vi 8 3 W CC 4 H C 2 W K ro m r O t m G 3 b x z� H A P n ❑ro } 00 C ,Zpp C M H H S gH tl G d m 0 a q am•] W 6 L m Y tMW L•JM yNN C{ N pa N N O N N .❑tl N N m po as x as fll N � PO O 4] r 0 0 w N C lz� C O t7 m C �n b?�rorororo rorozzwx z H N fA 69 � � Lf iR Lf i/t N {/f W N iP 01 Y N m W a A T � N m 1p b N tp Y y A o UI W 61 l0 m Y iP N W Vi N i MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---October 12 2022 PAYABLES AND PAYROLL 10/6/2022 Weekly Payables 127.399.67 10/612022 Patient Refunds 3,477.75 10/10/2022 Premier Sleep Disorders Center -sleep study 4,525.00 10/1012022 Emergency Staffing Solutions -physician services 43,662.50 10/10/2022 Great America Financial Services -copiers 10.849.65 10/10/2022 Clearny-phone 1,213.12 10/10/2022 Itsersource-monthly, phone support 250.00 10/10/2022 Ace Hardware -supplies 770.62 10/1012022 Discovery Medical Network Inc -physician services 229,209.48 10/10/2022 DSHS Central Lab -lab services 3,59621 10/10/2022 Frontier -phone services 32A6 10/1 D/2022 McKesson-340B Prescription Expense 4,471.99 10/10/2022 McKesson-3408 Prescription Expense 4,394-69 10/10/2022 Amerisource Bergen-340B Prescription Expense 308.36 10110/2022 Amerisource Bergen-3408 Prescription Expense 1,367.98 1 Oft 0/2022 Payroll Liabilities -Payroll Taxes 122,755.99 10110/2022 Payroll 375,587.51 Prosperity Electronic Bank Payments 10/3-10/5/22 Credit Card & Lease Fees 830.28 10120/2022 Sales Tax for September 2022 1,631.57 10/15/2022 TCDRS September Retirement 291,012.41 9/30-10/7122 Pay Plus -Patient Claims Processing Fee 410.04 9/30/2022 ExpertPay- child support 2,290.01 10/4/2022 Authnet Gateway Billing-3rd Party Payor Fee 35.70 TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENT$ TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 10/6/2022 MMC Operating to Solera-correction of NH insurance payment deposited into 8,681,25 MMC Operating 10/6/2022 MMC Operating to Broadmoor-correction of NH insurance payment deposited 4,752.00 into MMC Operating 10/612022 MMC Operating to Crescent -correction of NH insurance payment deposited 17,540.00 into MMC Operating in error 10/6/2022 MMC Operating to Golden Creek -correction of NH insurance payment 49,570.27 deposited into MMC Operating in error 10/6/2022 MMC Operating to Gulf Pointe Plaza -correction of NH insurance payment 21,551.76 deposited into MMC Operating 10/6/2022 MMC Operatng to Tuscany Village -correction of NH insurance payment 34,780.47 deposited into MMC Operating 101612022 MMC Operating to Bethany -correction of NH insurance payment deposited 69,148.78 into MMC Operating in error TOTAL TRANSFERS BETWEEN FUNDS: NURSING HOME UPL EXPENSES 10/10/2022 Nursing Home UPL-Cantex Transfer 349,637.45 10/1012022 Nursing Home UPL-Nexion Transfer 41,796.81 10/10/2022 Nursing Home UPL-HMG Transfer 99,644.16 10/10/2022 Nursing Home UPL-Tuscany Transfer 23,966,56 10/10/2022 Nursing Home UPL-HSL Transfer 125,177.88 QIPP CHECKS TO MMC 10110/2022 Ashford 40,679.05 10/10/2022 Broadmoor 15,776.36 10/10/2022 Crescent 13,502.21 10110/2022 Fort Bend 16.589.67 10110/2022 Solent 16,051.00 1011012022 Golden Creek 28,250.90 10/10/2022 Gulf Pointe 12,526.73 10/10/2022 Tuscany 24,137.81 631,010.99 $ 1,230;08199+ $ 206 994.5-3 TRANSFER BETWEEN FUNDS TO MMC OPERATING 10/1012022 Ashford -Interest Earned 10/10/2022 Broadmoor-Interest Earned 10/10/2022 Crescent -Interest Earned 10/10/2022 Fort Bend -Interest Earned 10/1012022 Solera-Interest Earned 10/10/2022 Golden Creek -Interest earned 10/1012022 Gulf Pointe MM-Interest Earned 10/10/2022 Gulf Pointe PP -Interest Earned 10/10/2022 Bethany -Interest Earned TOTAL NURSING HOME UPL EXPENSES TOTAL INTER -GOVERNMENT TRANSFERS 55.77 51.21 57.16 28.16 72.52 42.02 33.65 8.47 78.91 $ 808,166.26 GRAND TOTAL DISBURSEMENTS APPROVED October 12, 2022 $ 2,244 272.77- Page 1 of 16 RECEIVED BY THE COUNTY AUDITOR ON O0PIV16021022 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 12:24 ap_open invoice.template Due Dates Through: 10127l2022 CAL' pW,'n% nClass Pay Code 10250 41MPRINT, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 23697933%/" 09/28/20 09121l20 10/04/20 1153.38 0.00 0.00 1,153.36 tr' SUPPLIES 10430568 yf 09130/2009127/2010/04120 1,153.38 0.00 0.00 1,153.38 .i SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10250 41MPR[NT,INC. 2,306.76 0.00 0.00 2,306.76 Vendor# Vendor Name Class Pay Code R1200 ADTCOMMERCIAL / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 147072919 ✓ 09/30/200910612010/01/20 5$.61 0.00 0.00 $3.51 M; FIRE MONITORING , Vendor Totals Number Name Gross Discount No -Pay Net R1200 AOTCOMMERCIAL 53.61 0.00 0.00 53.61 Vendor# Vendor Name Class Pay Code A1680 AIRGAS USA, LLC - CENTRAL DIV ✓' M Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9991823508r/' 09/30/2009/30/2010/25/20 929.23 0,00 0.00 929.23 kF' OXYGEN 9130573711 ✓ 09/30/2009/30l2010/25/20 2,386.72 0.00 0.00 2,385.72 ✓ RENTAL Vendor Totals Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC -CENTRAL DIV 3,314.95 0.00 0.00 3,814.95 Vendor# Vendor Name Class Pay Cade 12232 ALCOR SCIENTIFIC ✓- Invoice# Comment Tran Dt Inv DI Due Dt - Check D- Pay Gross Discount No -Pay Net 111784 K,: 09/30/20 04/12/20 05/12/20 1,500.00 0.00 0.00 1,500.00 CONTRACT 3/22.2/23 Vendor Totals -Number Name Gross Discount No -Pay Net 12232 ALCOR SCIENTIFIC 1,500.00 0.00 0.00 1,500.00 Vendor# Vendor Name Class Pay Code A1746 ALPHA TEC SYSTEMS INC ,% M Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net INV00108465 ✓ 09/30/20 09/23/20 10/05/20 124,31 0.00 0.00 124.31 .,.� SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net A1746 ALPHA TEC SYSTEMS INC 124.31 0.00 0.00 124.31 Vendor# Vendor Name Class Pay Code 14028 AMAZON CAPITAL SERVICES Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 116CMC1 DD7J4 ✓ 09/30/20 09/29/20 10/27/20 83.32 0.00 0100 83.32 SUPPLIES 1GV9PN4PFH8G ✓`09/30120 09129/20 10127/20 36.50 0.00 0.00 36.50 SUPPLIES Vendor Vendor Totals Number Name Gross Discount No -Pay Net 14028 AMAZON CAPITAL SERVICES 119.82 0.00 0.00 119,82 file:///C:/Users/ltrevino/epsUmemmed,epsinet,coin/u88125/data_5Ainp_cw5report933842... 10/6/2022 Page 2 of 16 Vendor# Vendor Name Class Pay Code 10419 AMBU INC ,r Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 222155600 / 09/30/20 09/24/20 10/04/20 87.00 0.00 0.00 87.00 ✓ SUPPLIES Vendor Total, Number Name Gross Discount No -Pay Net 10419 AMBU INC 87.00 0.00 0.00 87.00 Vendor# Vendor Name Class Pay Code A1360 AMERISOURCEBERGEN DRUG CORP ✓ W Invoice# Comment Tran Dt Inv Ot Due Ot Check D Pay Gross Discount No -Pay Net 995307622�/ 09130120 06101/20 06107120 150,67 0.00 0.00 150.87 ✓'� INVENTORY 803610925 109/30/20 07/15/20 (17/21/20 19,92 0.00 0.00 19.92 INVENTORY 3106107579 v 09/30/20 09/15/20 09/25/20 24.64 0.00 0.00 24,64 ,s INVENTORY , Vendor Total Number Name Grass Discount No -Pay Net A1360 AMERISOURCEBERGEN DRUG CORP 195.43 0.00 0.00 195.43 Vendor# Vendor Name Class Pay Code i 14550 APRIL KUBALA ✓' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 092822 09/3W20 09/26/20 10/15/20 60.00 0.00 0.00 60.00 RENEWAL COURSE _ Vendor TotalE Number Name Gross Discount No -Pay Net 14556 APRILKUBALA 60.00 0.00 01o0 60,00 Vendor# Vendor Name Class Pay Code A1551 ASPEN SURGICAL PRODUCTS INC M ter% Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net CD2869639 v/09/30/20 09116/20 10/05/20 386,23 0.00 0.00 386.23 SUPPLIES Vendor Total; Number Name Gross Discount No -Pay Net A1551 ASPEN SURGICAL PRODUCTS INC 386.23 0.00 0.00 366.23 Vendor# Vendor Name Class Pay Code A0400 AUREUS RADIOLOGY LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2753887 ,,.' 09/30/20 09/19/20 10/19/20 2,720.00 0100 0,00 2.720.00 LAB STAFFING tglz-RI$I22) SAlri)u161 2762127 ✓ 09/30/2009125/2010/26120 3,400.00 0.00 0.00 3,400,00 LABSERVICES Lglq- Vendor TotalE Number Name Gross Discount No -Pay Net A0400 AUREUS RADIOLOGY LLC 6,120.00 0,00 0.00 6,120.00 Vendor# Vendor Name Class Pay Code 14088 AZALEA HEALTH ✓� Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 79166 / 09130/20 10101/20 10/01/20 550.00 0.00 0.00 560.00 ` MONTHLY FEE . Vendor TotalE Number Name Gross Discount No -Pay Net 14088 AZALEA HEALTH 550.00 0,00 0.00 550.00 Ventlor# Vendor Name Class Pay Code B1150 BAXTER HEALTHCARE `' W ' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net tile:!//C:/Users/ltrevino/cpsi/memmed,cpsinet.comht88125/data_5/tinp_cw5report933842... 10/6/2022 Page 3 of 16 i 76560218 ✓ O9/30/2009121/2010/16/20 628.50 0.00 0.00 LICENSE 78560227 ✓ 09/30/20 09/21/20 10/16/20 2,367.60 0.00 0.00 LEASE SP4246A 75574612 ✓ 09/30/20 09/23/20 10/18/20 591.50 0.00 0.00 SPECTRUM 12552728 .r O9/30/20 09/24/20 10/19/20 10.22 0.00 0.00 FEE 76597151 ✓" 09/30/20 09/26/20 10121/20 507.47 0.00 0.00 SUPPLIES Vendor Totals Number Name Grass Discount No -Pay 81150 BAXTER HEALTHCARE 4,106.19 0.00 0,00 Vendor4 Vendor Name Class Pay Code 61220 BECKMAN COULTER INC v'� M Invoice# Comment Tram Dt Inv Dt Due Dt Check D Pay Gress Discount No -Pay 110138112 1/ 09/30/20 09/13120 10/08/20 154.50 0.00 0.00 SUPPLIES 5462953 ✓ 09/30/2009/13/2010/08/20 5,016.58 0.00 0.00 LEASE 110150436 09/30120 09120/20 10/15/20 1,422.78 0.00 0.00 110171736 vj 09/30/20 09/23/20 10/18/20 298.95 0.00 0.00 SUPPLIES 6483462 ✓/ 09(30/20 09/25/20 10/20/20 1,307.05 0.00 0.00 LEASE Vendor Totals Number Name Gross Discount No -Pay B1220 BECKMAN COULTER INC 81229.86 0.00 0.00 Vendor# Vendor Name Class Pay Cede 10024 BECTON, DICKINSON & CO (BD) r'/ Invoice# Comment Tran DI Inv Dt Due Dt Check D Pay Gross Discount No -Pay 9110320686 09130120. 09/21/2010/21/20 241.75 0.00 0.00 SUPPLIES Vendor Total:Number Name Gross Discount No -Pay 10024 BECTON, DICKINSON & CO (BD) 241.75 0.00 0.00 Vendor# Vendor Name Glass Pay Code 13892 BLUE CROSS BLUE SHIELD REFUND ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 091222 09/30120 09/12120 10/12120 983.29 0.00 0.00 Vendor Totals Number Name Gross 13892 BLUE CROSS BLUE SHIELD REFUND 983.29 Vendor# Vendor Name Class Pay Code B1650 BOSART LOCK & KEY INC .:' M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 124975 r+'� 09/30/20 09/27/20 10127/20 10.95 SUPPLIES Vendor Totals Number Name Gross B1650 BOSART LOCK & KEY INC 10.95 Vendor# Vendor Name Class Pay Code C1048 CALHOUN COUNTY +% w Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 0.00 0.00 Discount No -Pay 0.00 0.00 629.50 ✓ 2,367.50 ✓ 591.50 10.22 507.47 u Net 4.106.19 Net 154.50 5,016,58 ram' 1,422.78 298.95 ✓ 1,337.05 ✓ Net 8,229.86 Net 241.75 Net 241.75 Net 983.29 Net 983.29 Net 10.96 ✓� Discount No -Pay Net 0.00 0.00 10.95 Discount No -Pay Net file:///C:/Users/ltrevino/cpsi/nieiTimed.cpsinet.com/u88125/data_5/tmp_cw5 report933842... 10/6/2022 Page 4 of 16 092422 09/30/20 09/24/20 10/19/20 91.97 0.00 0.00 91.97 FUEL Vendor Totals Number Name Grass Discount No -Pay Net C1046 CALHOUNCOUNTY 91.97 0.00 0.00 91.97 Vendor# Vendor Name Class Pay Code 10650 CAREFUSION 2200, INC / 'I Invoice# Comment Tran Ot Inv Dt Due Dt Check 0 Pay Grass Discount No -Pay Net 9110211535 ✓^ 09/30/20 09/21/20 100120 44.74 0.00 0.00 44.74 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10650 CAREFUSION 2200, INC 44.74 0.00 0.00 44.74 Vendor# Vendor Name Class Pay Code 13028 CAVALLO ENERGY TEXAS LLC .,. Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net 18250206 v�� 09/30120 09/16/20 10/20/20 637,98 0,00 0.00 637.98 v ENERGY 16250207 ✓`• 09/30/20 09/10/20 10/20/20 17.50 0.00 0.00 17.50 rr ` ERGY f 18250205 09/30/20 09/16120 10120120 1.862.61 0.00 0.00 1,862.61 v ENERGY 18272103 v'' 09/30/20 09/20/20 10/24/20 10.17 0.00 0.00 10.17 ENERGY `1 Vendor Totals Number Name Gross Discount No -Pay Not 13028 CAVALLO ENERGY TEXAS LLC 2,528,26 0.00 0.00 2,528.26 Vendor# Vendor Name Class Pay Code C1992 CDW GOVERNMENT, INC. v'• M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net OW04353 ✓ OWS0120 09119/2010119/20 139A2 0.00 0.00 139.42 ,i"• ^ SUPPLIES - VendorTotalsNumber Name Gross Discount No -Pay Net C1992 CDW GOVERNMENT, INC. 139.42 0.00 0.00 139,42 Vendor# Vendor Name Class Pay Code C1390 CENTRAL DRUG ,,.•' W Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 092622 09/3012009/20/2010126/20 24.25 0.00 0.00 24.25 INVENTORY Vendor Total: Number Name Grass Discount No -Pay Net C1390 CENTRAL DRUG 24.25 0.00 0.00 24,25 Vendor# Vendor Name Class Pay Code C1730 CITY OF PORT LAVACA W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 091922C 09/30/20 09/19/20 10/05/20 65.49 0.00 0.00 65.49 WATER Vendor Totals Number Name Gross Discount No -Pay Net 01730 CITY OF PORT LAVACA 65.49 0.00 0.00 65.49 Vendor# Vendor Name Class Pay Code C1165 COASTAL OFFICE SOLUTONS r;' W Invoice# Comment Tran 01 Inv Dt Due Ot Check D- Pay Gross Discount No -Pay Net OEOT204871 09/28/20 07/15/20 07/25/20 250.00 0.00 0.00 250.00 SUPPLIES OEOT201431 �/^ 09/30/20 05/13/20 05/23/20 55.56 0.00 0.00 55.56 file:///C:/Users/Itrevino/cpsi/inemmed.cpsinct.com/u88125/data 5/tmp_cw5report933842... 10/6/2022 Page 5 of 16 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net C1166 COASTAL OFFICE SOLUTONS 305.56 0.00 0.00 305.56 Vendor# Vendor Name Class Pay Code 11030 COMBINED INSURANCE v'F Invoice# Comment Tran DI Inv Dt Due Dt Check D-Pay Gross Discount No -Pay Net 093022 09/30/20 09130/20 10101120 561,74 0.00 0,00 561.74 .- PAYROLLDEDUCT Vendor Totals Number Name Gross Discount No -Pay Net 11030 COMBINED INSURANCE 561.74 0.00 0.00 561.74 Vendor# Vendor Name Class Pay Cade C1970 CONMED CORPORATION ,: M - Invoice# , Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 997899 v`� 09/30/2009/2412010121/20 572.89 0.00 0.00 572.89 SUPPLIES Vendor Totals Number Name Grass Discount No -Pay Net 01970 CONNED CORPORATION 572.89 0100 0.00 572.89 Vendor# Vendor Name Class Pay Code 10509 DA&E ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Grass Discount No -Pay Net 18294 ✓-� 09/30120 09120/20 10/20/20 3,490.00 0.00 0.00 3,490.00 f LEGAL Vendor Totals Number Name Gross Discount No -Pay Net 10509 DA&E 3,490.00 0.00 0.00 3,490.00 Vendor# Vendor Name Class Pay Code 11524 DATA INNOVATIONS LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 85366 ✓f 09/30120 09122120 10/17120 1,500.00 0.00 0.00 1,500.00 LICENSE Vendor Totals Number Name Gross Discount No -Pay Net 11524 DATA INNOVATIONS LLC 1,500.00 0.00 0.00 1,500.00 Vendor# Vendor Name Class Pay Code 10060 DETAR HOSPITAL ✓ ICP Invoice# Comment Tran Ot Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Not OTR2209021 Vr 09/30120 09130120 10115120 1.334.46 0.00 0.00 1,334.46 LAB SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 10060 DETAR HOSPITAL 1,334.46 0.00 0.00 1,334A6 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 6951471 ✓ 09128/20 09/26/20 10/21/20 25.80 0.00 0.00 25.80 Vr. SUPPLIES 6954580 ✓ 09/30/20 09/28/20 10/23/20 184.07 0.00 0.00 184.07 v' SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SON 209.87 0.00 0.00 209.87 Vendor# Vendor Name Class Pay Cade 11291 DOWELL PEST CONTROL , / Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net 11997 r� 09/30/20 09/12/20 09/12/20 160.00 0.00 0.00 160.00 ✓ filc:1//C:lUsers/ltrevino/cpsi/tnemmed.cpsinet.coin/u88125/data_5/tmp_cw5report933842... 10/6/2022 Page 6 of 16 PESTCONTROL 12053 09/30/20 09/14/20 09/14/20 65.00 0.00 0.00 65.00 ram" PESTCONTROL 12358 ✓ 09130/20 09/28/20 09/28/20 260.00 0.00 0.00 260.00 ✓� PEST CONTROL . 12354 r' 09/30/20 09/28/20 09/28/20 505.00 0.00 0.00 505.00 1_11, PESTCONTROL Vendor Totals Number Name Gross Discount No -Pay Net 11291 DOWELL PEST CONTROL 990.00 0.00 0.00 990.00 Vendor# Vendor Name Class Pay Cade E1070 EDWARDS PLUMBING INC ✓'� W Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross Discount No -Pay 1 Net 65463 ,/ 09/30/20 09/30/20 09/30/20 594.00 0.00 0.00 594.00 BACFLO TEST - VendorTotaNNumber Name Gross Discount No -Pay Net E1070 EDWARDS PLUMBING INC 594.00 0.00 0,00 694.00 Vendor# Vendor Name Class Pay Code ' F1100 FEDERAL EXPRESS CORP. �� W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 768442233 ✓ 09/30/20 09/15/20 10/10/20 25,06 0.00 0.00 25.06 FREIGHT _ l 789124651 �� 09/30/20 09/22/20 10/17/20 15.41 0.00 0.00 15,41 ✓` i FREIGHT i 789882158 ✓ 09/30/20 09129M 10124/20 147.19 0.00 0.00 147.19 FREIGHT Vendor Totals Number Name Gross Discount No -Pay Net F1100 FEDERAL EXPRESS CORP. 187.66 0.00 0.00 187.66 Vendor# Vendor Name Class Pay Cade F1403 FISHER & PAYKEL HEALTHCARE v' M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 91648579 ✓ 09/30/20 07/13/20 08/13/20 62.40 0.00 0.00 62,40 ,SUPPLIES 91703437 -/ 09/30/20 08/26/20 09/26/20 640.00 0.00 0.00 640.00 SUPPLIES 917398364/ 09130/20 09123/20 10/23/20 125.84 0.00 0.00 125.84 SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net F1403 FISHER & PAYKEL HEALTHCARE 828.24 0.00 0.00 828.24 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1838461 ,% 09130120 04/14/20 05/09120 1,710.88 0.00 0.00 1.710.88 SUPPLIES 6528000 ,J 09/30/20 09/19/20 10/14/20 510.73 0.00 0.00 510.73 SUPPLIES 6527999 ,/ 09/30120 09/i 9120 10/14/20 428.23 0.00 0.00 428.23 SUPPLIES 6571839 v' 09/30/20 09/20/20 10/15/20 160.83 0.00 0.00 160.83 ✓` SUPPLIES 6616263 ,1/ 09/3012009/21/2010/16120 -1,169,31 0.00 0.00 -1,169.31 v� CREDIT $le:///C:/Users/ltrevino/cpsi/meinmed.cpsinet.com/u88125/data 51tmp_cw5report933842... 10/6/2022 Page 7 of 16 8615284 N' 09/30/20.0912i/20 10/16/20 568,80 0.00 0.00 568.80 y ' SUPPLIES k 6654423 ✓' 09/30/20 09/22120 10/17/20 194.65 0.00 0.00 194.65 SUPPLIES , 6654424 M� 09130/20 09122120 10/17/20 596,69 0.00 0.00 596.69 ✓'� SUPPLIES ' 6736898 v 09/80/20 09/26/20 10/21/20 400.16 0.00 0.00 400.16 ✓' `' SUPPLIES 6736899 09130120 09126/20 10121120 105.00 0.00 0.00 105.00 ✓ SUPPLIES 6736900 09/30/20 09/26120 10/21/20 751.20 0.00 0.00 761.20 SUPPLIES 6780563 v' 09/30/20 09/27/20 10/22/20 562,05 0.00 0.00 562.05 ✓"` SUPPLIES 6760550 +/ � 09/30/20 09/27/2010/22120 -592.80 0.00 0.00 -592.80 CREDIT 6780552 ✓ 09/30/20 09/27/20 10/22/20 200.51 0.00 0.00 200.51 -' SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 4,427.62 0.00 0.00 4,427.62 Vendor# Vendor Name Class Pay Code 10599 FORVIS v- , Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net BKO1662172 v' 09/30/20 09/29/20 10/24/20 9.765.01 0.00 0.00 - 9,765,01 r PROF SERVICES Vendor Totals Number Name Grass Discount No -Pay Net 10899 FORVIS %765.01 0.00 0,00 9,765.01 Vendor# Vandor Name Class Pay Code 11163 FRONTIER v,. Invoice# Comment Tran Dt Inv Dt Due DI Check 0 Pay Gross Discount No -Pay Net 091922 09/30/20. 09/19/20 10/13/20 70.40 0.00 0.00 70.40 v' TELEPHONE Vendor Total: Number Name Gross Discount No -Pay Net 11183 FRONTIER 70.40 0.00 0.00 70.40 Vendor# Vendor Name Class Pay Code 12636 FUSION CLOUD SERVICES, LLC v` Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net r' 28659087 v` 09/30/2008l76/2010/16/20 1,06777 0.00 0.00 1,067.77 TELEPHONE Vendor Totals Number Name Gross Discount No -Pay Net 12636 FUSION CLOUD SERVICES, LLC 1,067.77 0,00 0.00 1,067.77 Vendor# Vendor Name Class Pay Code W1300 GRAINGER r`� M Invoice# Comment Tran Dt Inv Dt Due DI Check D Pay Gross Discount No -Pay Net 9456445064 v' 09/30/21) 09/23120 10/18/20 254.10 0.00 0.00 254.1 Q_,,`� SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net W1300 GRAINGER 254.10 0.00 0.00 254.10 Vendor# Vendor Name Class Pay Cade G0401 GULF COAST DELIVERY ✓' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report933 842... 10/6/2022 Page 8 of 16 093022 09/30/20 09/30/20 10/15/20 200.00 0.00 0.00 200.00 REPORT/SLIDES (R 1 % - -11-4-11--> Vendor Totals Number Name Gross Discount No -Pay Net G0401 GULF COAST DELIVERY 200.00 0.00 0.00 200.00 Vendor# Vendor Name Class Pay Code G1210 GULF COAST PAPER COMPANY ✓� M Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross Discount No -Pay Net 2132924A ✓ 09/28/20 11/02120 12/02120 30.97 0.00 0.00 30.97 r' SUPPLIES 2262606 ,/ 09/28/20 07/22/20 08/22/20 202.22 0.00 0.00 202.22 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 01210 GULF COAST PAPER COMPANY 233.19 0.00 0.00 233.19 Vendor# Vendor Name Class Pay Code 12380 HEALTH SOLUTIONS DIETETICS „r Invoice# Comment Tran Ot Inv Dt Due Dt Check DL Pay Gross Discount No -Pay Net 093022 09/30/20 09/30/20 10/15/20 4,250.00 0.00 0.00 4.250.00 DIETARY SERVICES L A 1 2,1 13d 1zz ) Vendor Totals Number Name Gross Discount No -Pay Net 12380 HEALTH SOLUTIONS DIETETICS 4,250.00 0.00 0.00 4,250.00 Vendor# Vendor Name .Class Pay Code H0031 HEB CREDIT RECEIVABLES DEPT308 L,/ Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net .�.. 3578 09/30/20 09/28/20 10/25/20 924.23 0.00 0.00 924.23 L,r" SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net H0031 HEB CREDIT RECEIVABLES DEPT308 924.23 0.00 0.00 924.23 Vendor# Vendor Name Class Pay Code H0416 HOLOGIC INC v' Invoice# Comment Tran Dt Inv Ot Due Ot Check D Pay Gross Discount No -Pay Net 10272622 v 09/30/20 09/22/20 10/22/20 708.75 0.00 0.00 708.75 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net H0416 HOLOGIC INC 70a.75 0100 0.00 708.75 Vendor# Vendor Name Class Pay Cade 12868 HOLT CAT ,. Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net WIEZ0035195 ✓/ 09/30/2009/22/2010/07/20 559.50 0.00 0.00 559.50 250 HOUR MAINT Vendor Total: Number Name Gross Discount No -Pay Net 12868 HOLT CAT 559.50 0.00 0.00 559.50 Ventlor# Vendor Name Class Pay Code 10530 HUMANA HEALTH CARE PLANS v' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 160341 09/30/20 09/01/20 09/30/20 160.49 0.00 0.00 160.49 P 091222 09/3uI20 09/12/20 10/12/20 148.90 0.00 0.00 148.90 v- Vendor Totals Number Name Gross Discount No -Pay Net 10530 HUMANA HEALTH CARE PLANS 309.39 0.00 0.00 309.39 Vendor# Vendor Name Class Pay Code 1 file:///C:/Users/ltrevino/cpsi/memmed.r,psinet.com/u88l25/data_5/tmp_cw5report933842... 10/6/2022 Page 9 of 16 J0150 J & J HEALTH CARE SYSTEMS, INC ✓' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net i 929927772 r" 09/30120 06/22/20 07/22/20 558.24 0.00 0.00 558.24 ✓ � SUPPLIES 930018990 ✓ 09/30/20 06/29/20 07/29/20 138.00 0.00 0.00 138,00 SUPPLIES 930213640 ✓� O9/30120 07/15/20 08/14/20 108.45 0.00 0.00 108.45 SUPPLIES 930241004 ✓ 09/30/20 07/18/20 08/17/20 2,629.88 0.00 0.00 2,529.88 ✓' SUPPLIES 501316036 ✓ 09/30/2009/20/2010120/20 -1,578,23 0.00 0.00 -1,578.23 CREDIT 501316035 09/30/20 09/20/20 10/20/20 •81.60 0.00 0.00 •B1.60 CREDIT Vendor Total=Number Name Gross Discount No -Pay Net S J0150 J & J HEALTH CARE SYSTEMS, INC 1.674.74 0.00 0.00 1.674.74 Vendor# Vendor Name Class Pay Code 14368 LEE SIMERLY ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 092722 09130/20 09/27/20 10/15/20 187.90 0.00 0.00 187.90 REIMBURSEMENT-itn4LI-6 Picll up lifr-lbble lkt UNZ.1S Vendor Totals Number Name Gross Discount No -Pay Net 14368 LEE SIMERLY 187.90 0.00 0.00 187.90 Vendor# Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC ,f M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2229475389 y' 09/30/20 09/20/20 10/16/20 26.90 0.00 0.00 28.90 ter` SUPPLIES 2229475386 09/80/20 09/20/20 10/15/20 117.62 0.00 0.00 117.62 SUPPLIES 2229475387 =' 09/30/20 09/20/20 10/15/20 119.79 0.00 0.00 119.79 SUPPLIES 2229635716✓/ 09130/20 09121120 10/16/20 82.17 0.00 0.00 82.17 SUPPLIES 2229635718 „/ 09/30120 09/21120 10/16t20 3,640.13 0.00 0.00 3,640.13 ✓" SUPPLIES 2229636720 f 09130/20 09121/20 10/16/20 11.20 0.00 0.00 11.20 SUPPLIES 2229635717 �% 09/30/2009/2112010116/20 1,195.13 0.00 0.00 1,195A3 ✓% SUPPLIES 2229635719 ✓ 09/30/20 09/21/20 10/16/20 441.71 0.00 0.00 441.71 U/ SUPPLIES 2229765590 09130120 09/21/20 10116/20 126.25 0.00 0.00 126.25 �,� SUPPLIES 2229635721 ./ 09/30/20 09/21/20 10/16/20 50.58 0.00 0.00 50.58 / SUPPLIES 2229635722 ✓ 09/30/20 09/21 /20 10/16/20 18.88 0.00 0.00 18.88 ✓' SUPPLIES 2229841698 r% 09M0/20 09/22/20 10/17/20 26.21 0.00 0.00 25.21 �• ' SUPPLIES 2229843111 r,/ 09/30/20 0912PJ20 10/17/20 96.60 0.00 0.00 96.60 v' file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report933 842... 10/6/2022 Page 10 of 16 SUPPLIES i 2229843106 1f 09/30I20 092220 10/17/20 6.05 0.00 0.00 8.05 SUPPLIES 2229843102 / 09/30/20 09122/2/) 10/17/20 5.14 0.00 0.00 5.14 „Z SUPPLIES 2229843109 .,'" 09130/20 09122/20 10/17/20 96.60 0.00 0.00 w60 SUPPLIES 2229843101 "-U 09/30/20 09/22/20 10/17/20 139.51 0.00 0.00 139.51 SUPPLIES 2229843104 ,/ 09/30/20 09/22/20 10/17/20 33,15 0.00 0.00 33.15 ✓" SUPPLIES 2229991849 4+` 09/30/20 09/23/20 10/18/20 29.27 0.00 0.00 29.27 L A SUPPLIES 2230377025 1/ 09/30/20 09/24120 10119/20 246.19 0100 0.00 246.19 SUPPLIES 2230399569 „--' 09/30/2009/2612010/21/20 •25.60 0.00 0.00 •25,60 v'`i CREDIT 2230405665 y,+� 09/30/20 09/26/20 10121 /20 85.94 0.00 0.00 85,94 v' SUPPLIES 2230399568 / 09130/2009/26/2010/21/20 -51.22 0.00 0.00 -51.22 ✓'j CREDIT 2230515460 v/ 09/30(2009/27/2010/22120 44.90 0.00 0.00 44.90 SUPPLIES 2230484031 ./ J 09/30/20 09/27/20 10/22/20 37.69 0.00 0.00 37.69 SUPPLIES 2230615461 /' 09/30/20 09/27/20 10/22/20 9.72 0.00 0.00 9.72 SUPPLIES 2230515459 �/ 09/30/20 0927/20 10/22/20 195.04 0.00 0.00 195.04 ✓' SUPPLIES 2230516467 09/30/20 0927/20 10/22/20 169.84 0.00 0.00 169.84 SUPPLIES M0515458 ✓" 09/3012009127/201022/20 119.64 0.00 0,00 119.54 v' SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 7,096.93 0.00 0,00 7,096.93 Vendor# Vendor Name Class Pay Code 10791 MINDRAY DS USA, INC. V Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 0600947020 �� 09/01/20 07/20/20 08/09/20 690.00 0.00 0.00 690.00 LABOR 0000941861 / 09/30/20 05/24/20 07/14120 2.400.00 0.00 0.00 2,400.00 �f PCV Vendor Totals Number Name Gross Discount No -Pay Net 10791 MINDRAY DS USA, INC. 3.090.00 0.00 0.00 31090.00 Vendor#Vendor Name Class Pay Code 14576 MIRION TECHNOLOGIES f� Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Grass Discount No -Pay Net 165284 �' o9/30/20 o6/29/20 o7/29/20 31U-i-13 3,500A0 // 0.00 u031111.13 // 3,50,O.ao SUPPLIES 167678 L/' 09/30/20 08/09/20 09/09/20 .3,200.00 0.00 0M -3,200.00 CREDIT file:///C:/Users/Itrevino/cpsi/inenmied.cpsinet.com/u8 8125/data_5/tmp_cw5report433 842... 10/6/2022 Page 11 of 16 Vendor Totals Number Name Gross 14576 MIRION TECHNOLOGIES 300,010 Vendor# Vendor Name Class Pay Cade 111.13 M2621 MMC AUXILIARY GIFT SHOP W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 092822 02/30/20 09/28/20 10112/20 398,05 PAYROLL DEDUCT Vendor Totals Number Name Gross M2621 MMC AUXILIARY GIFT SHOP 398.05 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC ,- Invoice# Comment Tran Dt Inv DI Due of Check DPay Gross 8679777 09/30/20 09121/20 10101/20 143.83 INVENTORY 8677486 v" 09/30/20 09/21120 10/01/20 74.69 INVENTORY CM67324 09130/20 09/21120 10101/20 -23.16 CREDIT 8679778 09130120 09121120 10/01/20 7.76 INVENTORY 8679776 w! 09130120 09/21/20 10/01/20 702.16 INVENTORY 8677467 ,,,% 09/30/20 09/21 /20 10/01/20 17,37 INVENTORY r 8677486 „% 09/30/20 090120 10/01/20 79.50 INVENTORY 8682592 ✓� 09/30/20 09/22/20 10/02/20 74.69 INVENTORY 4142 ✓ 09/30/20 09/22/20 10/02/20 -78.23 CREDIT CM68382y/ 09/30/20 09123/20 10/03/20 -77.68 CREDIT 8691950 of 09130/20 09/25/20 10/05/20 442.38 .INVENTORY 8691951/ 09130/2009/251201010WO 359.48 ,INVENTORY 869564&/ 09/30/2009/26/2010/0e/20 4Z8 INVENTORY S00857 ✓' 09130/20 09126/20 10/06120 121.05 INVEUTM GavvfLc 6-1) -. 8693477 �; ` 09/30/20 09/26/20 10/06/20 609.91 INVENTORY 8693476 ..' 09/30/20 09/26/20 10/06/20 64.07 INVENTORY 8694859 % 09/30/20 09/26/20 10/06/20 79.90 INVENTORY 8695643 ,f 09/30/20 09/26/20 10/06/20 322.99 ,INVENTORY 8694696 09/30/20 09/26/20 10/06/20 439.69 INVENTORY SCO859 ✓ 09/30/20 09/26/20 10/06/20 196,26 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 0.00 0,00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 Net 300,00 -71-1.13 Net 398.05 ✓ Net 398.05 Net 143.83 ✓ , 74.69 4. -23.16 a„r" 7.78 702.16 17.37 79.50 "' 74.69 ✓! -78.23 -77.68 442.38 W 859.48 .� 4.58 v' 121.05 609.91 64.07 79.90 ✓ 322.99 vi 439.69 196.26 �-- file:///C:/Users/Itrevino/cpsi/Memmed.cpsinet.com/u8 8 125/data5/tmp_cw5report933842... 10/6/2022 Page 12 of 16 -FREIGHT QY'ViU- dwl� SC0858 W'� 09/30/2009/26/2010/06/20 438.46 O.OD 0.00 438.46 -FREIGHT 8694858 09/30/20 09/26/20 10/06/20 41.23 0.00 0.00 41.23 INVENTORY V 8698546 09/30/20 09/27/20 10/07/20 64.07 0.00 0.00 64.07 ..= INVENTORY 8702294 ,/- 09/30/20 09/27/20 10/07/20 201.14 0,00 0.00 201.14 INVENTORY 8698547 „i` 09/30120 09/27/20 10/07/20 163.70 0.00 0.00 163.70 INVENTORY . 8698548�/ 09130/20 09127120 10107/20 116.46 0.00 0.00 116.46 INVENTORY 8702295 ,/' 09/30/2009/27/2010107/20 2,528.18 0.00 0.00 2,528.18 v" INVENTORY 8707002 09/30/20 09/28/20 10/08/20 848.58 0.00 0.00 848.58 ✓ INVENTORY 8707001 v' 09130/2009/28/2010/08/20 5.34 0.00 0.00 5.34 ✓'� INVENTORY 8707000 ✓ 09/30/20 09/28/20 10/08/20 106.71 =0 0.00 106.71 L� INVENTORY , 8703776 ,:` 09/30120 09128/20 10/08/20 684.60 0.00 0.00 684.60,j INVENTORY 8703778 „% 09/30/20 09/28/2010/08120 46.89 0.00 0.00 46.89 ' INVENTORY « 8703777 ,J 09/30/20 09/28/20 10/08/20 30.65 0.00 0.00 3D.55 INVENTORY 8703182 V 09/3012009/2812010/Os/20 4,122,42 0.00 0.00 4,122.42 INVENTORY 8704800 ✓ 09/30/20 09/28/20 10/08/20 207.23 0.00 0.00 207.23 INVENTORY 8708663 «%' 09/30/20 09/29/20 10/09/20 6.87 0.00 0.00 0.87 %�- INVENTORY 0709690 . 09/30/20 09/29/20 10/09/20 18.70 0.00 0.00 18.70 ✓' INVENTORY 5726 ✓/ O9/30/20 09/29/20 10/09/20 -599.97 0.00 0.00 -599.97 I. CREDIT 8709691 09/30/20 09/29/20 10/09120 330.03 0.00 0.00 330.03 ,INVENTORY 8710900 „'� 09/30/20 09/29/20 10/09/20 199.52 0.00 0.00 199.52 INVENTORY 8710899 „! 09/30/20 09/29/20 10/09/20 387.87 0.00 0.00 387.87 INVENTORY . Vendor Total -.Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 14,009.92 0.00 0.00 14,009.92 Vendor# Vendor Name Class Pay Code 01500 OLYMPUS AMERICA INC .-`� M Invoice# Comment Tran Ot Inv Ot Due or Check D Pay Gross Discount No -Pay Net 33275881 09/30/20 09/23/20 10/18/20 194,03 0.00 0.00 194,001--1 1 SUPPLIES Vendor Total. Number Name Gross Discount No -Pay Net a file:///C:/Users/ltrevino/cpsi/memmed.epsinet.com/u88125/data_5/tmp_ew5report933 842... 10/6/2Q22 Page 13 of 16 01600 OLYMPUS AMERICA INC 194.03 0.00 0.00 194.03 Vendor# Vendor Name Class Pay Code OM425 OWENS & MINOR oi' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2079190644 ✓ 09/30/20 09/20/20 10/20/20 104.22 0.00 0.00 104.22 SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net OM425 OWENS & MINOR 104.22 0.00 0.00 104.22 Vendor# Vendor Name Class Pay Code 10152 PARTSSOURCE, LLC ✓ Invoice# Comment Tran Ot Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 04508614 �/ 09/50/20 09/16/20 10/16/20 45,44 0.00 0.00 t 45.44 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net a. 10152 PARTSSOURCE, LLC 45.44 0.00 0.00 45A4 Vendor# Vendor Name Class Pay Code 12708 POC ELECTRIC, LLC ✓' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 3636 r/' 09/28/20 09/26/20 09/26/20 VLaN( 1•*,l% 7,368.64 0.00 0.00 7,368.64 Vendor Totals Number Name Gross Discount No -Pay Net 12708 POC ELECTRIC, LLC 7,36B.64 0.00 0.00 7,368.64 , Vendor# Vendor Name Class Pay Code P2200 POWER HARDWARE ✓ W \ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 093022 09/3012009/3012010110120 10.80 0100 0.00 10.80 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net P2200 POWER HARDWARE t0.80 0.00 0.00 10.80 Ventlor# Vendor Name Class Pay Code 10372 PRECISION DYNAMICS CORP (PDC) �✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Grass Discount No -Pay Net 9350971820 ✓ 09130/20 09/05/20 1010512U 102.18 0.00 0.00 102.1 e SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10372 PRECISION DYNAMICS CORP (PDC) 102-18 0.00 0.00 102.18 Vendor# Vendor Name Class Pay Code 11080 RADSOURCE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net SC32690822 ,% 09/30/20 07/16/20 08/10/20 1,708.33 0.00 0.00 1,708.33 4; SERV AGREE 8/16-9/15 SC32091022/ 09/30120 09112/20 10/07120 1,791.67 0100 0.00 1,791.67 ✓' SERV AGREEMENT 10/12-1111 , Vender Totals Number Name Gross Discount No -Pay Net 11080 RADSOURCE 31500.00 0.00 0100 3,500.00 Vendor# Vendor Name Class Pay Code 12328 RAWLINGS FINANCIAL SERVICES,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 091222A 09130/20 0911PJ20 10/12/20 148.10 0.00 0100 148.10✓ 091222 09/30/20 09112/20 10/12/20 60,02 0.00 0.00 60.w v' file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.coin/u88125/data_5/tmp_cw5report933 842,.. 10/6/2022 Nige 14 of 16 Vendor Totals Number Name Grass Discount No -Pay Not 12328 RAWLINGS FINANCIAL SERVICES 208.12 0.00 0.00 208.12 Vendor# Vendor Name Class Pay Code S1700 SHARN INC ✓ M Invoice# Comment Train Ot Inv Dt Due D1 Check D Pay Gross Discount No -Pay Net IN01774090 f 09128/20 09/26/20 10104120 140.43 0.00 0.00 140.43 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Not S1700 SHARN INC 140.43 0.00 0.00 140.43 Vendor# Vendor Name Class Pay Cade 12472 SOMETHING MORE MEDIA, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1864 ,�' 09/30/20 09/30/20 10115/20 2,225.00 0.00 - 0100 2,225.00 ✓ ADVERTISTING Vendor Totals Number Name Gross Discount No -Pay Net 12472 SOMETHING MORE MEDIA, INC. 2,225.00 0.00 0.00 2,225.00 Vendor# Vendor Name Class Pay Code 11298 SOUTH TEXAS BLOOD & TISSUE CEN ✓' Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net r CM7892 i, 09/3012009/30/2010/25/20 3,555.00 0.00 0.00 -3,565.00 ✓ CREDIT 107025668 ✓ 09/30/20 09/30/20 10/25120 7,629.00 0.00 0.00 7,029.00 ✓' BLOOD Vendor Totals Number Name Gross Discount No -Pay Net 11298 SOUTH TEXAS BLOOD & TISSUE CEN 4.074.00 0.00 0.00 4,074.00 Vendor# Vendor Name Class Pay Code 11672 STANLEY ACCESS TECH LLC ✓' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 0906656102 09/3012009/22/2010106/20 1,423.77 0.00 0.00 1,428.77 Vendor Totals Number Name Gross Discount No -Pay Net 11672 STANLEY ACCESS TECH LLC 1,423.77 0.00 0.00 1,423.77 Vendor# Vendor Name Class Pay Code 10845 STAPLES ADVANTAGE ✓ Invoice# Comment Tran Ot Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 3519215305 ✓' 09/30/20 09/20/20 10/05/20 17.79 0.00 0.00 17.79 SUPPLIES 3519215304 ✓ 09/30/20 09/26/20 10/06/20 45.36 0.00 0.00 45.36 .% SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10845 STAPLES ADVANTAGE 63.15 0.00 0.00 63.15 Vendor# Vendor Name Class Pay Code S3940 STERIS CORPORATION M Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net ✓ 10359057 09/30/20 08/22/20 09/16/20 545.39 0.00 0.00 545.39 v ` SUPPLIES 10453510 ✓ 09/30/20 09/23/20 10/18/20 100.29 0.00 0,00 100.29 ✓' SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Not S3940 STERIS CORPORATION 645.68 0.00 0.00 645.68 file:///C:/Userslltrevino/cpsi/menimed.cpsinet.com/u88l 25/data_5/tmp_cw5report933842... 10/6/2022 Page 15 of 16 Vendor# Vendor Name Class Pay Code 13528 STRYKER FLEX FINANCIAL 4/ Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 263935,/ 10/06/2009/1412010/14/20 1,294.26 0.00 0.00 1,294.26 LEASE Vendor Totals Number Name Gross Discount No -Pay Net 13528 STRYKER FLEX FINANCIAL 1,294.26 0.00 0.00 1,294.26 Vendor# Vendor Name Class Pay Code 14212 SURGICAL DIRECT SOUTH „� r Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9830 v/ 09/30/20 09/27/20 10/27/20 2,510,00 0.00 0.00 2,510.00 SUPPLIES Vendor Total* Number Name Gross Discount No -Pay Net 14212 SURGICAL DIRECT SOUTH 2,510.00 0.00 0.00 2.510.00 Vendor# Vendor Name Class Pay Code 14524 SYSMEX AMERICA, ING,,.' Invoice# Comment Tran Dt Inv Dt Due Ot Check D- Pay Gross Discount No -Pay Net / 94422756 �/ 09/30/20 09/24/20 10/04/20 527.44 0.00 0.00 527.44 SUPPLIES Vendor Total Number Name Gross Discount No -Pay Net 14524 SYSMEX AMERICA, INC. 527,44 0.00 0.00 52T44 Vendor# Vendor Name Class Pay Code S1801 TRACI SHEFCIK v' W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 092922 09/30/20 09/29/20 10/15/20 174.99 0.00 0.00 174.99 ANNUALRENEWAL Vendor Totals Number Name Gross Discount No -Pay Net S1801 TRACI SHEFCIK 174.99 0.00 0.00 174.99 Vendor# Vendor Name Class Pay Code U1064 UNIFIRST HOLDINGS INC �..1/ Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Nei 8400404672 j 09130/20 09/22/20 10/17/20 1,844.49 0.00 0.00 1,644.49 LAUNDRY / 8400404649 09/30/20 09/22/20 10/17/20 208.13 0.00 0.00 208.13 LAUNDRY 8400404666 ✓ 09130/2009/22/2010/17/20 79.49 0.00 0.00 79.49 LAUNDRY 8400404646 ✓ 09/30/20 09/22/20 10/17/20 201.59 0.00 0.00 201.59 ✓` LAUNDRY 8400404648 ✓ 09/30/20 09/22/20 10/17/20 200.81 0.00 0.00 200.81 LA}JNDRY , 8400404645 v 09/30/20 09/22/20 10/17/20 29.07 0.00 0.00 29.07 ✓ LAUNDRY 8400404875 ,/' 09/3012009/2612010121120 2.182,70 0.00 0.00 2,182.70 LAUNDRY 8400404054 ,j/ 09130/20 09/26120 10/21/20 48.15 0.00 0.00 48.15,,..' LAUNDRY 8400404855 . 09/30/20 09/26120 10/21/20 32.26 0.00 0.00 32,26 LAUNDRY 8400405212 ✓ 09/30/20 09/29/20 10/24/20 98,23 0.00 1 98.23 LAUNDRY file:///C:/Users/ltrevino/cpsi/menuned.cpsinet.com/u88125/data_5/tnip_cw5report933 842... 10/6/2022 Page 16 of 16 8400405196 ✓ 09/30/20 09/29/20 10/24/20 1,508.33 0.00 0.00 1,508.33 LAUNDRY 8400405188 % 09/30/20 09/29/20 10/24/20 80.70 0.00 0100 80.70 LAUNDRY 8400405175 v' 09/30/20 09/29/20 10/24/20 211.12 0.00 0.00 211.12 V' LAUNDRY 8400405174 ✓ 09/30/20 09/20/20 10/24/20 190.01 0.00 0.00 ". 190.01 ` LAUNDRY 8400406173 ✓'. 09/30/2009/29/2010124/20 231.83 0.00 0100 231.83 - LAUNDRY 84OD406171 ✓ 09/30/2009/2912010124/20 29.07 0.00 0.00 29.07 y: LAUNDRY 8400405172 �'� 09/30/2009l29/2010/24/20 201.59 0.00 0.00 201.59 :"i% LAUNDRY Vendor Totals Number Name Gross Discount No -Pay Net U1064 UNI FIRST HOLDINGS INC 7,177.57 0.00 0.00 7,177.57 Vendor# Vendor Name Class Pay Code U1056 UNIFORM ADVANTAGE �� W Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Grass Discount No -Pay Net SIV12797627 _i 09/28/20 09/14120 09/20120 168.18 0.00 0.00 168.18 V' gSUPPLIES SIV12802168' r/+ 09130/20 09/15/20 09/30/20 138.12 0.00 0.00 t 138.12 v SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net U1056 UNIFORM ADVANTAGE 306.30 0.00 0,00 306.30 Vendor# Vendor Name Class Pay Code 14276 UNITED HEALTHCARE / Invoice# Comment Tran Dt Inv Dt Due or Check D Pay Gross Discount No -Pay Net 091222 09/30/2009/12/2010/12/20 1110 0.00 0.00 1.10 ✓` PT PATRICIA BRETT Vendor Totals Number Name Gross Discount No -Pay Net 14276 UNITED HEALTHCARE 1.10 0.00 0.00 1.10 Vendor# Vendor Name Class Pay Code W1040 WATERMARK GRAPHICS INC M �% Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 135767 09/30/20 02/28/20 03130/20 383,25 0.00 0.00 383,25 ✓' V PAYROLLDEDUCT 136573 ✓ 09130/20 04129/20 05/29120 1,544.30 0.00 0.00 1,544.30 .; PAYROLL DEDUCT Vendor Totals Number Name Gross Discount No -Pay Net W1040 WATERMARK GRAPHICS INC 11927.55 0.00 0.00 1,927.55 Vendor# Vendor Name Class Pay Code 0110 WERFEN USA LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 9111214352 ✓/ 09/3012009/15/2010110120 1.571,67 0.00 0.00 1,571.67 CONTRACT Vendor Totals Number Name Gross Discount No -Pay Net 11110 WERFEN USA LLC 1,571.67 0.00 0.00 1.571.67 fyR9 -"'Report A"ROVO._. - Summary Grosa,,,T 7Q22 Discount No -Pay, Net - 126,98�. 4 0.00 0.00 126,982.54 �� to 1� CuYA � wt <351'G. BY COUNTY AUDITOR 3'if7 . 13 TY CALHOUN couN. TEXAS 1 ��i- � a3,3a7 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report933 842... 10/6/2022 BEENVv��D YTHE RUgCO17-Fl,',WOH ON TIME: 11:19 OCT 0 6 2022 PATIENT TOTAL ARIN0001 TOTAL OCT 06 2022 By GOUWY AUMOR CALHOUN COUNTY, TEXAS MEI40RIAL MEDICAL CENTER EDIT 61ST FOR PATIENT REFUNDS ARID=0001 DATE 0622 3021 0622 0622 0622 0622 0622 0622 0622 2422 0622 0622 0322 0622 0622 0622 2622 0622 0622 ---------------- PAY PAT AMOUNT CODE TYPE DESCRIPTION .............. 500.00 ✓ 40.00 ✓ 1008.59 ✓ 25.00 ✓ 40.00 ✓ 18.98 ✓ 158.40 ✓ 101.70 ✓ 21.00 ✓ 40.13 ✓ 73.50 ✓ 431.82 ✓ 280.57 / 150.96✓ 50.00 ✓ 160.00 ✓f 121.87 160,00✓ 94.63 ✓ 3477.75 3477.75 PAGE 1 APCDEDIT GL MR4 Pb'l Vim MEMORIAL MEDICAL CENTER S �. PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT-- September 30, 2022. October 09, 2022 CPS Date Bank Description MMCNmes Amount 9/30/2022 STATE COMPTRLR TEXNET 07293117/209292100002 -UC IGT 483,628.58ft 9/30/2022 PAY PLUS ACHTRANS 452579291101000697453452 -3rd Parry Payor Fee SILM 9/30/2022 MEMORIAL MEDICAL PAYROLL 746OD3411113122650 -Payroll 40355801: 4. 1 LI' II L 9/30/2022 EXPERTPAY EXPERTPAY 746003411910MG10243360 4. , -Child Support Payment - QI}a90 i 9/30/2022 AMERISOURCE BERG PAYMENTS 0IM0077682100002 - 340B Drug Program Expense '.0 3,422330 10/3/2022 PAY PLUS ACHTRANS 4525792911D10D0598471533 - 3rd Parry Payor Fee �8>@4.1- 10/3/2022 MERCHANT BANKCD FEE 9]316091388)93000014]53 - Credit Card Processing Fee 121.68 t`;ye "t ' 10/3/2022 MERCHANT Hall FEE 97116091038391000014753 - Credit Card Processing Fee 1" -- 9.95 P" 30/3/2D22 MERCHANT BANKCD MISCOUNT 971160910883920000 - Credit Card Processing Fee 19.95 sW 30/3/2022 MERCHANT BANKCD DISCOUNT 9]11609138g] 910000 Credit Card Processing Fee - 3WA }_ 10/3/1022 MERCHANT BANKCD INTERCHNG 97116091388791000 - Credit Card Processing Fee = 157.82 _ 10/3/2022 In USATAXPYMT 22026]6652994]36103601000075 -Payroll Taxes �. 135,109.44'it+ 10/3/2022 In USATAXPYMT 2202676725866936103601000076 -Payroll Taxes 491.57-f 10/412022 PAY PLUS ACHTRAN54525]9291101000699925492 - 3rd Party Payer fee I' `' - 'Si 'at 10/4/2022 MCKESSON DRUG AUTO ACH ACH0519881591000D163 - 340B Drug Program Expense 4,39ttlAw ' Ir , p 10/4/2022 AUTHNET GATEWAY BILLING 1248644941040000173 - 3rd Party Payer Fee 35.70 1 10/5/2022 PAY PLUS ACHTRAN5452579291101000691347814 - 3rd Patty Payor Fee fi0.58. 10/5/2022 FOMS FOMSPYMT052-2000500.000410001205S054 - Credit Card Processing Fee IU% 30/5/2022 FDMS FONTS PYMT052-1601820-0004100012052055 - Credit Cartl Processing Fee 3Z45 10/6/2022 PAY PLUS ACHTRAN5452579291101WO692271343 - 3rd Party Payor Fee � L't.. ' 7.03 fss 10/7/2022 STATECOMPTRLR TEXNET 07318861/210062100002 -USH IGT , 40535.20 A111 _ 10/2/2022 PAY PLUS ACHTRAN5452579291101000693416NO - 3rd Party Peter Fee r:12<,IOi ]0/]/2022 AMEP150URCf BERG PAYMENTS 010000]]fi82100002 - 340B Drug Pogram Expense 11 i11 3,3fi].98***-1 1,076,473.83 - -' October 10. 2022 WILLIAM LITTLE, CFO (VTI9IV.A 10 c g$•ry1 (L 4 [ Memorial Medical Center .i $ iyPQNJui Oq'2S'�1LL .I I - PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT --ESTIMATED ACHS �/(IK F1ppNVs.�Oh'21ZZCr. 1 ._ _.5L 2J'I. Date Description MMC Notes Amount - - 10/15/2022 RETIREMENT - Retirement Funding 29p011A1 10/20/2022 SALESTAX -Sales Tax 1,631.S7 292,643.98 October 10, 2022 ��wEDIXq WILUAM LITTLE, CFO Memorial Medical Center OCT 10 2022 OYCOUNTYAUDITORI CALHOUN COUNTY, TEKAS Date/Ttme 10-04-2022/01:35 PM Submitted By Pay Date 09.30.2022 Employee Deposits $115,024.73 Employer Contributions $175,987.68 Group Term Life Premiums $0.00 Total $291,012.41 Comments Payroll File September 2022 Retirement Upload.xlsx Q Confirmation: You Have Filed Successfully Sales and Use Tax Period Ending 09/30/2022 (2209) TexpayerlD:' Taxpayer Name: Entered By. User ID MEMORIAL MEDICAL CENTER Email Address: Reference Number:, Taxpayer Address: Date and Time of Filing: 815 N VIRGINIA ST PORT LAVACA. TX Telephone Number. 10/07/2022, 08:46:28 AM 77979-3025 IP Address: PAYMENT SUMMARY Electronic Check Payment Reference Number: Type of Bank Account. State Amount: $1,236.04 Trace Number:: Accountholder Name: ' Local Amount: $395.53 Bank Routing Number Amount to Pay: $1,631.57 Bank Account Number;'^ Electronic Check: $1,631.57 Payment Effective Date. CREDIT SUMMARY Credits Taken Are you taking credit to reduce taxes due on this return? No Licensed Customs Broker Exported Sales Did you refund sales tax for this filing period an items exported outside the United States based on a Texas Licenced Customs No Broker Export Certifications? LOCATION SUMMARY Total Texas Locx Taxable Sales Taxable Subject to State Subject to State lax Due Lacal7ax Rate Local Tax Due Sates Purchases Tax (Rate .0625) Local Tax 00004 19876 19976 0 19976 1242.25 19876 0.02 397.52 SubTotai 198T6 29376 0 19876 1242.25 12876 397,52 Total Tax for Locations $1,639.77 Total Tax Due: $1,639.77 Timely Filing Discount: - $8.20 Balance Due: $1,631.57 Pending Payments: -S0.00 Total Amount Due and Payable: $1,631.57 ( State amount due is S1,236O4 ) ( Local amount due is 5395.53 ) Page 1 of 1 RECENEDBYTHE COUNTY AUDITOR ON OCTa VO922 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 11:OB ap_open_invoice.lemplate Dates Through: CALHOUVeWd'.VIAlnYnAgme Class Pay Code P1725 PREMIER SLEEP DISORDERS CENTER M Invoice# Comment Tran Dt Inv Dt Due DI Check D Pay Gross Discount No -Pay Net 100422 10110120 10/04120 10/19/20 4,525.00 0.00 0.00 4.525.00 SLEEP STUDY Vendor Totals Number Name Gross Discount No -Pay Net P1725 PREMIER SLEEP DISORDERS CENTER 4.525.00 0.00 0.00 4.525.00 Report Summary Grand Totals: Gross Discount No -Pay Net 4,525.00 0.00 0.00 4.525.00 F.T.MNaku e OCT 10 2022 BY COUNTY AUDITOR CALHOUN COUNTY. TEXAS tile:///C:lUsers/ltreN,itiolepsilmemmed.cpsiiiet.com/u881 25/data_5/tmp_cw5report74451... 10/1012022 HECEIVED BY THE COUNTY AUDITOR ON OCT 10 2022 'P1l;,tiQl7.R C.S�F3r�F C. TEi(A., MEMORIAL MEDICAL CENTER 6 AP Open Invoice List 11:05 ap open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11284 EMERGENCY STAFFING SOLUTIONS Invoice#/ Comment Tran Dt Inv Ot Due Ot Check D Pay Gross Discount No -Pay 41566./ 10/10/20 09/30/20 10/10/20 3,060.00 0.00 0.00 CAPEK 41565 J ! 10/10120 09130/20 10/10120 40.602.50 0.00 0.00 PHYSICIAN SERVICES Vendor Total; Number Name Gross Discount No -Pay 11284 EMERGENCY STAFFING SOLUTIONS 43.662.50 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 43,662.50 0.00 0.00 OM ON OCT 10 2022 BY COUNTY AUDITOR CALHOUN COUNTY, MAAi3 Page I of 1 Net $1060.00 40.602.50 v/ Net 43,662.50 Net 43.662.50 file:///C:/Users/itrevino/epsi/memmed.cpsiiiet.com/u88l25/d ita_5/imp_cw5report81963... 10/10/2022 RECEIVED BY THE COUNTY AUDITOR ON OCTi 01+dhA22 MEMORIAL MEDICAL CENTER 11:07 AP Open Invoice List CALHOUN COUNTY,TEX4§ Dates Through: Vendor# Vendor Name `' Class Pay Code 12948 GREAT AMERICA FINANCIAL SVCS ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 32551366 10/10120 10/03/20 IW31/20 10,849.65 COPIER Vendor Totals Number Name 12948 GREAT AMERICA FINANCIAL SVCS Report Summary Grand Totals: Gross Discount 10,849,65 0.00 OCT 10 2022 BY GQUwY AUDITOR CALHOUN COUNTY, TEXAS Page 1 of 1 0 ap_open_involce.template Discount No -Pay Net 0.00 0.00 10,849.65 Gross Discount No -Pay 10.849.65 0.00 0.00 No•Pay 0.00 Net 10,849.65 Net 10,849.65 tile:///C:lUsers/ltrevino/epsi(memmed.cpsinet.com/u88125/data_5/tmp_cwireport71581... 10/ 10/2022 RECEIVED BYTHE COUNTY AUDITOR ON OCT 10 2022 MEMORIAL MEDICAL CENTER lono/za2z a CALHO4y.6PUNTY, TEXAS AP Open Invoice List ap_open_invoice.lemplale Dates Through: Vendor# Vendor Name Class Pay Code 13000 CLEARFLY Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay INV457738 ✓/ 10/10/20 10/01/20 10115120 1,213.12 0.00 0.00 PHONE Vendor Totals Number Name Gross Discount No -Pay 13000 CLEARFLY 1,213.12 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 1.213.12 0.00 0.00 Page I of I Net / 1,213.12 Not 1,213.12 Net t,213.12 file:///C:/Userslltrevinolepsilmemmed.cpsinet. com/n88 l 25/data_5/tmp_ew5report62029.,. 10/ 10/2022 RECEIVEDBYTHE COUNTY AUDITOR ON OCT 10 2022 MEMORIAL MEDICAL CENTER 10/10 '�`.4iHl'�t{ttj�OUNTY, TEXAS OU AP Open Invoice List Dates Through: Vendor# Vendor Name Class Pay Cade 11108 ITERSOURCE CORPORATION ✓ Invoice# Comment Tran Ot Inv or Due Ot Check D Pay Gross 711544 f 10/10/20 10/01120 10101120 250.00 MONTHLY SERVICES Vendor Total: Number Name Gross 11108 ITERSOURCE CORPORATION 250.00 Report Summary Grand Totals: Gross Discount 250.00 0.00 OCT 10 2022 SY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Page 1 of 1 0 ap open Invoice.template Discount No -Pay Net 0.00 0.00 250.00 /( 4- Discount No -Pay Nei 0.00 0.00 250.00 Nc-Pay Net 0.00 250.00 h le:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u881251data_5/lmp_cw5report32694... 10/10/2022 d 'M Page i of 1 HECENEOB`( -..raUi AUOTTO OCT 10 2022 (�Q MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: ap open_invoice.template , Vendor# Vendor Name Class Pay Code 11263 ACE HARDWARE 15521 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 093022 10/10/20 09/30/20 10/25120 770.62 0.00 0.00 770.62 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11263 ACE HARDWARE 15521 770.62 0.00 0.00 770.62 Report Summary Grand Totals: Gross Discount No -Pay Net 770.62 0.00 0.00 770.62 t i APPROVMON OCT 10 ? SYCOUNTYAUDROR CALHOUN COUNTY, TMM tile:///C:/Usersiltrevinolcpsilmemmed.cpsinet.comhi881251data_51tmp_c W5report31988... 10/10/2022 RECEIVED BY THE COUNTY AUDITOR ON OCT 10 2022 MEMORIAL MEDICAL CENTER 10/1012022 0 CALHOU1d COJNL U Y, TEXAS AP Open Invoice List 11 2p_open, invoiea.template Dates Through: Vendors Vendor Name Class Pay Code 10709 DISCOVERY MEDICAL. NETWORK INC✓ Invoices Comment Tram Dt Inv Dt Due Dt Check D Pay Gress Discount MMC093022 V 09/30/2009/30/2010101120 101,222.63 0.00 PHYSICIAN SERVICES Sl.yiiwkw, 14-N114w MMG083122 a% 10110120 08/31/20 09101120 127,986.85 0.00 PHYSICAN SERVICES kk�IASJ d4-st, �6aY Vendor TotalE Number Name Grass Discount 10789 DISCOVERY MEDICAL NETWORK INC 229,209.48 a.00 Report Summary Grand Totals: Gross Discount No -Pay 229.209.48 0.00 0,00 OCT 10 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Page 1 or 1 No -Pay Net 0,00 101,222.63 0.00 127,966.85 No -Pay Net 0.00 229,209.48 4 Net 229,209.48 , Y file:///C:/U sers/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report55 887... 10/ 10/2022 RECEIVED BY THE COUNTY AUDrTOR ON OCT 10 2022 ,ALHOUN COUNTY, TEXAS MEMORIAL MEDICAL CENTER 10/10/2022 0 AP Open Invoice List 12:08 ap_open_Involce.template bates Through: Vendor# Vendor Name Class Pay Code 10175 DSHS CENTRAL LAB MC2004 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay CM1838032022A .! 10/10/2Q01/06/2001/21/20 50.48 0.00 0.00 LAB SE�VICES ON0426012022A f 10/10/20.01/26/2002J20/20 1.588.75 0.00 0.00 LAB SF�RVICES CN0426052022A f 10110/20.05/13120 06107/20 1.906.50 0.00 0.00 LAB SERVICES CM1838072022A J 10110/20, 05/1712008111/20, 50.48 0.00 0.00 LAB SERVICES Vendor Total! Number Name Gross Discount No -Pay 10175 DSHS CENTRAL LAB MC2004 3,596.21 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 3,596.21 0.00 0.00 APPROvoloN OCT 10 2022 BYGOLINITYAUDITOR CALHOUN COUNTY, TEXAS Page 1 of 1 Net 50.48 1.588.75 1,906.50 / 50.48 a Not 3,596.21 Net 3,596.21 file:/!/C:/UsersAtrevino/cpsi/memmed.cpsinet.comlu 88125/data_5/tmp_cw5report38992... 10/10/2022 Page I of I RECEIVEOBYTHE COUNTY AOD1TOn ON OCT 10 2022 19[ 220�2222 '1LH13:32 ctfi7NTY, TEXAu MEMORIAL MEDICAL CENTER 0 13:32 AP Open Invoice List Due Dates Through: 10/2712022 ap_open_involce.template Vendor# Vendor Name Class Pay Code 11183 FRONTIER Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 091922 09/30/20 09/19/20 10/13/20 70,40 0.00 0.00 70k TELEPHONE OR\VLLICIy PuyAb(C tisk 092322A 10/10/2009/23/2010/17/20 32.46 0.00 0.00 32.46 TELEPHONE Vendor Total: Number Name Gross Discount No -Pay Net 11163 FRONTIER 102 W6 0.00 0.00 10a6 Report Summary Grand Totals: Gross/ Discount No -Pay Net 102.46 0.00 0.00 102.86 ppRoVEDOW OCT 10 2022 C' ��UN COUP �Y fi le:///C:/U sers/Itrevino/cpsi/memmed.cpsinet-com/ti88125/data_5/ttnp_cw5report37031... 10/10/2022 MWESSON awee, ems MEMORIAL MEDICAL CENTER AP 815 N VIRGINIA STREET PORT tAVACA TX 77979 STATEMENT AMT DUE REMITTED VIA ACH DEDIT Statement for information only As 0: 10107/2022 DC: fills Territory: Customer. 632536 Gets: IOM8/2022 Page: 002 To ovum pope, craft Im your aceount, detach and reture this stub Will your authoress As of: 10/07/2022 Pegs: 002 Mail to: Comp; 80(10 AMT DUE REMITTED VIA ACH DEBIT Statement for information only Cost: 632536 PLEASE CHECK ANY Date: 10/0802022 REAS NOT PAID fv) ailing Due IbceiyadeNelloiml Account MSyT6 Cash Amount P Annual P Recefaabe Data Date Number Reference Desaiplat) on Discount (groF (.1) F Numhor PF autumn IOgerM: P . Pow Due It... F = Future Due Item, blank = Curren 0. Item TOTAL Nalioml Aca 632536 MEMORIAL MEDICAL CENTER Subtmals Future Due: 0.00 It Paitl By 1011112022, Past Due: 0.00 Pay This Amount: last Payment 2,451.97 It Paid Alter 1011112022, 08/07/2017 pay this Amount: ovEDON OCT ] 0 2022 CALLHOOUN COUNTY 4,563.25 USD 4,47 f.99 USD 4.563.25 USO For AR Inquiries please contact 800-867-0333 Due If Past On Tlme: USO 4,471!99 Give lost K paid Ile: 91.26 Due N Paid late: USD 4.563.25 MSKESSON STATEMENT A. of: 10f0712022 Page: 001 To ensure proper area" to your account, detach am return this mmovor: aooe stub with your renfraslca WALMANT 1096/MEM MED PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL K CENTER Statement for informalion. only 815VICN KSEIRGINIA ST FORT IAVACAVACA T% ]]979 DC: 8115 Territory: 400 Cudernor. 256342 Date: 10/08/2022 As of: 10/07/2022 Pogo: OD1 Mail to: Comp: 8000 AMT DUE HENBTED VIA ACH OMIT Statement tar information only Duet: 256342 PLEASE CHECK ANY Dale: 10/08/2022 IT@AS NOT PAID (+) Da1ta9 Dtaa N Ndaie,j diarof Amount 9M2er38 Number merance Dees bn rl t Oleo Discount Amount P (gross) F AmouM to (set) F Reaelvebb Number Customer Nmnbw 256342 WAMART 1095IMM MED MS 10/0112022 1g11112022 7369608520 48412288 11514voice 2.25 112.27 110.02✓ 7369698520 10/01/2022 10/11/2022 7369698521 48337090 1151nvoice 0.01 0.32 0.31✓ 7369698521 1010=022 10/11/2022 7369035741 48326049 1151malce 16.85 842.62 825.77, 7369635741 10/03/2022 10/11/2022 7369(335742 48364409 1151nvoica 2.20 110.01 107.81 ✓ 7369635742 10103/2022 10111/2022 7369835743 48437453 11510voice 0.04 1.90 1.86 ✓ 7369635743 10/03/2022 10/11/2022 7369635744 48471387 1151molce 8.32 416.18 407.86✓ 7369635744 10/03/2022 10/11/2022 7369635745 48532846 1151nvome 8.32 416.18 407.86 ✓ 7369635745 10/03/2022 10)11/2022 7369635746 48532846 1151nvoice 0.01 0.32 0.31 ✓ 7369635746 10/04/2022 10/11/2022 7369929707 48567417 1151nvolce 0.01 0.63 0.62 ✓. 7569929707 10/04/2022 10111/2022 7370067874 48573491 1951nvake 0.01 0.63 0.62 ✓ 7370067874 10/04/2022 10/11/2022 7370067875 48575062 1151nvoice 3.86 493.02 189.1fi ✓ 7370067675 10/05/2022 10111/2022 1370183745 48718753 1151nv01C0 9A1 0.63 0.62 ✓ 7370183745 10/05/2022 10/11/2022 7370183746 48784938 1151nv0ice 8.32 416.18 407.66 7370183746 10/05n022 10/11/2022 7370345223 48725025 19Slnvaica 0.04 1.90 ,j 1.56 ✓ 7370345223 10/05/2022 10/11/2022 7370345224 48729743 1151nvwce 1.47 73.30 71.B3 ,/ 7370345224 10/06/2022 10/11/2022 7370444689 48851466 1151nvolce 0.01 0.63 0.62 7370444607 10/0672022 10/11/2022 7370444688 46919105 1151nvolce 4.40 220.12 215.72 ✓ 7370444688 10/06/2022 10/1112022 7370596336 48857773 1951nvolce 0.02 0.95 0.93 7370596336 10/062022 UVIV2022 7370596337 48062546 1/51nv01ce 4.40 219.96 215.56 ✓ 7370596337 10/07/2022 101t1/2022 7370704164 48967575 1151nvaice 6.33 416.35 408.02 ✓ 7370704164 10/07/2022 10/31/2022 7370704165 46967576 1151nvoice 8.60 439.86 431.06 ✓ 7370704165 10/67/2022 1W11/2022 7370008094 48970637 1151nva1ce 11.50 579.00 , 567.4B ✓ 7370888094 For AR Inquiries please contact 800-867.0333 MSKESSON STATEMENT As of: 10/07/2022 Page: 002 TO anon proper cm0d to your account, mtech and diary this oo,nc�r: so44 nub with your remittances DC: 8115 As of: 10/0712022 Page: 002 WALMARr 1098/MR.1 MEO MS qMT DUE HRANTm VIA ACH OMIT Teniiory: 400 Mail to: Comp: BODO MEDICAL CBJTRi Statement for information only AMT DUE NEMITTED VIA AM DEBIT VICKYMEMOKAL 256342 Statement IOr information only 815 N VIRGINIf 815 N AVAC IA ST PoRr IAVACA T% ]]9]9 Date: Oete: 10/OB/2022 Cum: 256342 PLEASE CHECK ANY Date: 10/08/2022 R9dS NOT PAID IV) out rg Due Rpggxap�etInset Account W5T6 Cash Date Date Number Bafemrma Description Discount Amount Amount P (gross)F Amount P Hecelvebla (net) F Number RE cclumn Ieged: P = Pan Due Item, F = Mum Due hem, blank = Current Due Item TOTAL Cunomer Number 256342 WpITAARr f088/M@B Mm PHS Subheads: 4.463.02 USO Future Due: 0.00 Due If Reid On Time: If Paid By 1011112022, Poet Due: USD 4,373.96,/ 0.00 Pay This Amount: 4.373.76 USD 01. Ion If paid late: Led Payment 4,394.89 If Paitl After 10lHPaid022, One If Palate: 89.26 10/03/2022 Ray One Amdum: 4,463.02 USD USD 4.463.02 APPROVED ON OCT 10 2022 BYCOUIV YAUMOR CALHOUN COUNTY, TMS For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of 10/0712022 Page: 001 TO amure proper credit to your account, tletach and Mum this c mwm�. 0000 stub w8h yaw mmlltanse DC: 8115 As of: 10/07/2022 Page: 001 HIM MY FC 490/MBA MC MS qMi DUE REMITTED VIA qCH DEBIT Territory: 400VIC Mau o: Comp: 8000 MEMORIAL AL MEDICAL CENTER Statement for intonation only ANT DUE REMITTED VIA ACH DEBT KIRGINIALISW Customer. 464450 Statement Icr information only 815 N 815 N rkVAC IA ST PORT IAVACA TX 77979 We: 10/08/2022 Curt 464450 PLEASE CHECK ANY Data; 10/08/2022 ITEMS NOT PAID (�) Billing Doe Data Neceivablludemo l Account WI36 cam Amount P Amount Is Fkc0lvabM Gale Number Relerenca Description (Smsd F (stet) F Number Customs, Number 464450 HER MY FC 490/MM MC Me 10/03/2022 10/11/2022 7369599846 022094I55-102988 1151nvoice 0.06 2.98 2.92✓ 7389599846 10/04/2022 10/11/2022 7369933787 82210-055-103102 1151nvolce 0.78 39.12 38.34 ✓ 7369933787 10/05/2022 10/11/2022 7370175770 B2210.055-103238 lislnvuice 0.10 8.84 8.86 ✓ 7370175]]0 10/06/2022 10/11/2022 7370420377 B2210455.103286 1151nvnice 0.29 14.70 MA ,j- 73704203]] PI, column Island: P m Past Due clam, F = Future Due Item, bonAr = Current Due Item TOTAL Cus omer Number 464460 HIM MY FC 490/MEM MC PHS Subblals: 65.64 USD Future Due: 0.00 Due N Paid On Time: If Paid By 10MI12022, USD 64.33 Peat Due: DOD Pay This Amount: 64.33 USD L/ Disc (art N Paid let.: last Payment 4.394.69 N After 10/11I2022, Du. it Paid late: L31 10/03f2022 Payy this thla Amount: 65.64 USD USD 85.64 APPROMON OCT 10 2022 BY COUNTYAUOROA CALHOUN COUNTY, TIXM1S For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 10/07/2022 Page: 001 TO arson, praiser ashat to your aceoent, debom seat return this aoewm. a00D slab I your rnmnlarlce DC: sits As ol: 10/07/2022 Page: 001 CVS PHCY )4T5/MErt MC MS ANT DUE REMITTED VIA ACH DEBIT Territory: 400 Man to: Camp: 8000 MEMORIAL MEDICAL CENTER Statement for information only AMT DUE REMITTED VIA ACH DEST VICKY KAUSEI( Customer. 835430 Statement for information only 815 N VIRGINIA ST Date: 10/08/2022 PORT LAVACA TX 71978 cum: 835438 R.EASE CHECK ANY Date: IQ N8/2D22 ITEMS NOT PAID (1) Bill 0. ....National Account VA{I16 Cash Amount P Amount P FkamlVew Date Date Number Water. Description Discount (own) F (net) F Numfrer Customer Numtwr 835438 CVS PHCY 7475IMENI MC MS 10/05/2022 10/11/2022 7370391356 1911018 1151mroice 0.69 34.59 33.90, ) 7370391356 O PF column legend: P = Past Oue Nam, F = Future Due Xem, blank = Current Duo Item TOTAL Cusomer Number 835438 CVS PHCY 7475/MEM MC P113 Sablmals: 34,69 USD Future Due: 0.00 Due It Paid On n w: H Net By 10/1112022, USD 33.90 Net Doe: 0.00 Pay This Amount: 33.90 USD Disc last If pant late: 0.69 use Payment 4.394.69 It Poid After 1011112022, 0. If Paid ute: 10/03/2022 Pay this Amount: 34.59 USD USD 34.59 AMMEDON OCT 10 2022 BY COUNTY AUOiTOA CALHOUN COUNTY TEXAS For AR Inquiries please conflict 800-867-0333 1 STATEMENT Statement Number. 63871409 AmerlsourceBergenDate: 10-07-2022 1 Of 1 AMERISOURCESERGEN DRUG CORP WALGREENS N12494 3408 100135284 / 037028IN 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER SUGAR LAND Ti( 77478.0101 1302 N VIRGINIA ST PORT LAVACA T% 77979.2509 Sal - Fri Due in 7 days DEA: RA0289276 866-451-9655 AMERISOURCEBERGEN PO Bea 905223 Not Yet Due: p.00 CHARLOTTE NC 262905223 Cuaenl: W13.36 Pawl on.: 0.00 Total Due: 308.36 Account Sea.: 308.36 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount ID-03-20n 1040.2022 3107986938 167836 Invake 121.26 0.00 121.26 10-03-2022 10-14-2022 3107966939 167837 Invoice 9.65 0.00 9.65 10.0}2022 10-14-2022 3107967190 16708 Invoice 1.01 0.00 1.01� 10-03-2022 10-14-2022 31D7967191 167840 Invoice 11.64 0.00 11.84 10-M-2022 10-14-202Z 3103098731 167848 Imnlce 145.50 See 145.50 10-01-2022 10.14-2022 3ID6098732 167849 Invelm 19.30 0.00 19.30 Current 1.15 Days 1I6-30 Days 31-60 Days 61-90 Days 91420 Days Over 120 Days 308.36 0.00 p.00 0.00 O.pO 0.00 0.00 Thank You for Your Payment Reminders Date Amount Due Date Amount 1"7.2022 (1,36].88) 10.142022 308.36 Total Due: 308.36 .VPPRDVmON C� 3y OCT 101022 BY000N9YAU01T(Iq CALHOih1: :.Uu�!^. IrE)6' f MSKESSONSTATEMENT As of; 09/30/2022 Page: 002 To endure Proper ored8 to your detaell e mlmA this, all at.Y,It Co,, e000 re wph your mhtame DC: at 15 As or: 09/30/2022 Page: 002 1A6dORIAL MEDICAL CMIR AMT DUE HEMITfED VIA ACH OMIT Territory: Mall to: Come: 8000 AP 815 N VIRGINIA STREET Slalamenl for information only AMT WE REMITTED VIA ACH DEBIT Statement for mformalion only PORT LAVACA TX 77979 Customs.. 632536 Dale: 10/01/2022 Cud: 632536 PLEASE CHEDK ANY Date: 10/01/2022 ITEMS NOT PAID (.�) Si01ng Due PecehabPtlonel Amount /t6 Gale pale Number Retwerms Cash peaedptbn Disemnl Amount P (grew) F Amount P ReoaHabk (net) F Numher PF column legentl: P = Past Due Item, F = Future Due Item, blank = Conn Due Item TOTAI: Nellonal Aml fi32536 MFMOWAL MEDICpI CB4T9i SUMmale: 4,484.38 USD Fmum 0. 0.00 If Paid By 1010412022, Duo It Pald On ilme: / Pas! : 0.00 Pay This Amount: 4,394.69 USD USD Dise lost N paw rate; 4.30tl.69 last Payment 2.451.9T Ifpaitl After 10104/2022, Dw It Pall late: 89.69 08107M17 Pay this Aerosol: 4,494.38 USD use 4,484.30 AMOMON OCT 10 2022 HY COUNTY AUDMR CAUIOUN C0UWV.1EY," For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 09/30/2022 Page: 001 To amount proper eretlh to your aosount, tlet oth and .1. this .many: awe dub w0h your romiltanoe DC: fill$ As of: 09/30/2022 page: 001 M® FMCY 0434/1dB4 Men MS ANT DUE REMITTED VIA ACH DEBIT Territory: 7001 Mall 1¢ Comp: 8000 MEMORIAL MEDICAL CENTER Statement for information only VICKY NAUSEK AMT DUE REMITTM VIA ACM OMIT 615 N VIRGINIA ST Customer. 190813 Statement for information Only PORT LAVACA TX 77979 Data 10/01/2022 Cud: 190813 PLEASE CHECK ANY Date: 10/01/2022 R S NOT PAID (a) DMe9 Due BeuWableNallanal Aee4unl 5� 6 Leah Date Number Reference Description Discount Amount P (Bross) F Amount P Rttrolvabia (nd) F Number Cuslamse Number 190813 HIM PMCY 0434AREIR MED MS 09/28f2022 10/04/2022 7368800846 2017062125 11 Slnvome 0.19 9.67 9.481/ 7368808846 PF column legsntl: P = Pad Due Item, F = FNure Due Item, bmsk = Conant Due Item TOTAL Gudomer Number 190813 H® PMDY 0434/MEM M® PHa 9ubletals: 9.67 USD Future Due: 0.00 I 0. If Isaitl On Thee: If Pais By 1010412022, Use 9.48 1/Pad Due: 0.00 Pay This Amount: 9.48 USD Of. led 8 lid Ida: Land Payment 3,085.38 If Paitl After 10I04/2022, Oue If Paid late: 0.19 09/26/2022 NY this Amount: 9.67 Use USD 9.67 APPROYEUOPI OCT 10 2022 BYCOUNTYAUDROR QACaOUN COUNTY, MAE For AR Inquiries please contact 800-867-0333 MWESSON cema.nr. ac44 WALMART 1098/MFM MED PHS MEMORIAL MEDICAL CE4TE9 VICKY KALISE( 615 N VIRGINIA ST POW LAVACA TX 77979 STATEMENT A. ol: 09/30/2022 Page: 001 To ensure proper credit to your account, detach aM return this " stub win your remittance OC: ails As of: 0913=022 Page: 001 Mae to: Camp; 8000 VIA ACN DEBIT AMT DUE for Territory: 400 int iniorm)m Statement Iw mion only AMT DUE HEM ITTm VIA ACH OMIT Customer.Statement 256342 [or Information only Date:e; 1010101/2022 Cast: 256342 PLEASE CHECK ANY Date: 1010V2022 RETAS NOT PAID (a( otlonel Attounl 6 t%IIMg put. Number ��♦1 Cash Amount P Amount P Rexameabi pale Date Number Reference Descdpibn Discount (grow) F (stag F Numbr Customer Number 256342 WALMART 1098/MEM MED PHS 09/26/2022 10/04/2022 7368243094 47704671 1151nvoice 0.38 18.63 18.45✓ 7368243094 09/26/2022 10/04/2022 7368252165 47670155 1151nvoice 0.04 0.04V 7368252165 09/26/2022 10/04/2022 7368252166 47765118 IIslrvdce 11.40 509.80 558.40✓ 7368252166 09/26/2022 10/04/2022 7368491406 47641647 1951nveke 0.03 1.42 1.39 ✓ 7368491406 09/27/2022 40/04/2022 7368558779 47800086 11510voice 2.20 109.98 107.78✓ 7368558779 09/27/2022 10/0412022 7368658780 471166880 1151nuoice 5.70 284.90 279.20,✓ 7360558700 09/21IM022 10/04/2022 7365813498 480t8486 1151nvoice 5.70 264.94 279.24./ 7368813498 09/28/2022 10/04/2022 7368975494 47964755 11 Savolce 0.03 1.27 1.24 ✓ 7360975494 09/29/2022 10/04/2022 7369060774 48150526 1151nvoice 19.50 975.14 955.64 ✓ 7369080774 _ 09/29/2022 10/04/2022 7369080775 48150526 1151nvoice 0.01 0.32 0.31✓ T369080775 09/30/2022 10/04/2022 7369321847 46199018 1151nveice 0.01 0.03 0.62✓ 7369321847 09/30/2022 10/04/2022 7369321848 48263585 1151nvoic0 37.48 1.874.08 1,836.60 ✓ 7369321848 OW30/2022 10/04/2022 7369472853 48206351 195lnvake 0.02 0.96 0.94 ✓ 7369472853 09/30/2022 10/04/2022 7362472854 411210119 1151nvowe 0.05 2.53 2.48 l/ 73694-12654 PF column legend: P = Post Due Item, F = Fu1um Duo Item, blank = Current pan Item TOTAL Customer Number 256342 WAUTART 109a/MEM MED PNS 9,Alme s, 4.124.84 USD Future Due: 0.00 Due It Paid On Time: II Paid By 10/0412022, USD 4,042.33 Pop Due: 0.00 Pay Thtc Amount: 4,042.33 USD Oiso lost K Tend Mte: last Poymont 3,065.39 It Paid Alter 10104/2022, 82.51 Due If Paid Late: 09/26/2022 Pay this Amount: 4.124.84 USO USD 4.124.84 APPROVED ON OCT 10 2022 AUJOUNCO NNITTeOitAS For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 09/30/2022 Paps: 001 To ereeure pmper creWl to your account, delaen and me. We Wmpmy: a0 v eIUE WNtI year w111I1terIEB DC: 8115 As of: 09/30I2022 Page: oat HIED MY FC 490/ld M MC MS pMT DUE RBAITTm VIA ACH D®IT Territory: 400VIC Mail to: Camp: 0000 MEMORIAL MEDICAL CENTER Statement he Inlremation only AMT DUE REMITT® VIA ACH DEBIT L 464450 Statement for inimmallmi only 815 N VI INI 815 N AVAC M ST Date; 101 112022 PORT UIVACA T% ]T9]9 Date: 10/Ot/2022 Car: 464450 PIFASE CHECK ANY Data. 10/01/2022 IfBAS NOT PAID (1) filling Due PecelvabkNs6Ena1 Account WA5yT8 Cssb Oate Date Number Relerence Description Discount Amount P (grew) F Amount P Neceke0k (cet) F Number Customer Number 464460 HEB MY PC 490/1WBA MC MS 09/26/2022 10104/2022 73GS181163 82209.055.101366 1151nvuce 0.12 6.14 6.02✓ 7368181163 09/2712022 10/D412022 73685585t9 M209-055.102486 115Invoice 1.40 69.92 68.52'`/ 7368558619 09/30/2022 10/04/2022 7309315790 B2209-055-102835 I151nvoice 0.56 28.98 28.40 1/ ]369315]90 PF column legend: P = Per Duo Item, F = allure Dun Item, blank = Current Due Nem TOTAL Customer Number g6g450 HEO PHY FC 480AN FM MC PHa Sublolsla: 105.04 USD Future Due: 0.00 Ow It Pal6 On Three: It If Paid By 1010412022, USD 102.94 ✓ Peso Due: Pay This Amount: 102.94 USD Dke lost If pre late: Last Payment 3.065.39 If NM After 1010412022, 2.10 Due If Paid late•. 09/26/2022 Pay this Amour: 105.04 USD USD 105.04 wPII()VE[)0N OC1 10 2022 By coUNV AUDITOR CAo10UN COUNTY. TEXAS For AR Inquiries please contact 800-867-0333 MSKESSONSTATEMENT As 0: 09/30/2022 Page: 001 To ensure Proper creditto your Account, detach and Mum this =cost: so4e stub with your mmhtenoe DC: 8116 A. of: 09/30/2022 Pap: 001 CVS PHCY 692311AW MC PHS AMT DUE REMITTED VIA ACH DEBIT Territory: 400 Mall to: Camp: Idea MBAORIAL MEDICAL CENTER Statement for information only AMT DUE REN ITTED VIA ACH DEBIT VICKY KALISE( Customer•. 835434 - Statement for information only 815 N VIRGINIA ST PORT LAVACA TX 71979 Data: 10/01/2022 Dust: 835434 PLEASE CHECK ANY Date: 10/01/2022 ITENIS NOT PAID (v) ailing Due ReceivebaNatlenal Account Slips Cash Data Amount P Amount P Pxeivabk Data Number Reference Desor lan Discount (greas) F (net) F Number Customer Number Inal CVS PRICY 8923/MFM MC PHS 09/28/2022 10/04/2022 7360828942 1899008 1151nvoice 0.31 15.73 16.42 7368828942 O PF Column Intern: P = Pam Due Item, F = Future Due Item, bank = Current One Item TOTAL Customer Number W54]9 WS PHCY I923/MEa MC WE SubMals: 15.73 USD Future Due: 0.00 Use If Mid On Time: If Paid By 10/04/2022, USD 15.42 'f Pam Due: 0.00 Pay That, Amount: 15.42 USD Died lost 8 paid ate: Use Payment 3,065.3E ITPeld After 10/04/2022, Due It Pall late: 0.31 09/26/2022 Pay this Amount: I5.73 USD USD 15.73 APPROM ON OCT 10 2022 RY GOUNTYAUDrron CALHOUN COUMY, TEXAS For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 09130/2022 Page: 001 To ereum proper creOK to your exam[, dal mM rotten this co,,I, saos stub with your romittaKe DC: 8115 As of: 09/30/2022 Pape: 001 CVS PHCY 7475/MEM MC MIS AMT DUE MU117® VIA ACH DEBIT Tenllory: 400 Mail to: Comp: 8000 MEMORIAL MEDICAL CENTER Statement for mammon only A DUE DEBIT VIArmation VICKY KALISM a' ment 'RkMor 'oTE) POH 815 N VIRGINIA ST Customer. 835438 PORT LAVACA TX 97979 Date: 10/01/2022 Coat: 835438 PLEASE CHECK ANY Date: 1=112022 ITENIS NOT PAID (+) allies Due Receivablr"eilonal Account We Cesh Amount P Amount P Iisceh ale 0a1e Data Number Iiefererco Description OlxouM (grew) F (eat) F Number Customer Number 835438 CVS PHCY 7476/MEM MC PHS 09/23/2022 10/04/2022 7369025967 1899323 115lnvcica 4.58 229.10 224.52 �" 7369025967 O PF column "no; P = Pont Due Nan, F = Mum, Due Item, blank = Cement Due Hem TOTAL Customer Number 836438 CVS PHCY 7475/MM MC Me Subtotake 229.10 USD Mute Due: 0.00 Due if Pale On Tarrm It Pala By 10/0412022, USD 224.52 Pall Due: 0.00 Pay This Amount: 224.52 USD Obe Ion H paid late: 4.58 tan Payment 3A65.39 If Poi0 After 1010412022, Due H Paid late: 09/26/2022 Pay this Amount: 229.10 USO USD 229.10 OCT 10 2022 SYCOUNWAUDITM CAL NOUN COUNTY TSM For AR Inquiries please contact 800-867-0333 STATEMENT Statement Number: 63817342 AmerlsourceEiergen Date: 09-30.2022 1 Of 1 AMERISOURCEBERGEN DRUG CORP WALGREENS m2494 340E 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER 1001352M/037028106 SUGAR LAND TX 77478.6101 1302 N VIRGINIA ST PORT LAVACA TX 77979.2509 DEA: RA0289276 Sal - Fri oue in 7 days 866451-9655 AMERISOURCEBERGEN PO Box 905223 Nat Yet Due: 0.00 CHARLOTTE NC 28290-5223 Courant 1.257.98 Past Oue: 0.00 Total Due: 1,257.98 Account Balance: 1,257.98 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 09-26-2D22 10-07-2022 3IDnO7374 167667 Involve 26.01 0.00 2s. 11 09.27.2022 10.07-2022 3107372806 167739 Invoice 60.29 0.00 W3.29 09-27.2022 10A7-2022 3107372807 167742 Invoice 8.19 0.00 0.19 0427-2022 10-07-2022 3107372808 167740 Involee 26.38 0.00 26.38 , 09.28.2022 10-07.2022 3107512695 167753 Invoice 205.05 0.00 205.09� W-29.2022 1007-2022 3107644893 167763 Involee 317.02 0.00 317.02 09-29-2022 10-07-2022 3107644694 167764 Invoice 1.44 0.00 1.44 0910-2022 10-07-2022 3107766569 1W776 Invoke 10.56 000 10.66 ECurrent 1 1.15 Days 1630 Days 31.60 Days 61-90 Days 91-120 Days Over 120 Days 1,257A8 0.00 0.00 0.00 0.00 0.00 0.00 Thank You for Your Payment Reminders Date Amount Due Date Amount 09.30-2022 (3422.33) t0A7-2022 1,257.98 Total Due: 1,257.98 AAMCVM 011 i . OCT 10 2022 BY COtINTY AUDITOR CAunoUN cOuNTY.I€101Z3 TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1.800.572-8683) a"ENTER 9-DIGITTAXPAYER IDENTIFICATION NUMBER" 7"ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" FTIF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGIT TAX FILING YEAR" "ENTER 2-DIGIT TAX FILING ENDING MONTH" 1ST QTR - 03 (MARCH) - Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) - July, Aug, Sept 4TH QTR - 12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" ❑"6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER u### ENTER: ###L- 1 ►7 U $ 12275599 1 $ 62,757.98 $ 14,677.24 $ 45,320.77 CHECK $ CALLED IN BY: CALLED IN DATE: CALLED IN TIME: J:%P-Payroll FilesYPayroll Taxes120221#21 R1 MMC TAX DEPOSIT WORKSHEET 10.06.22 Ri.xls 101712022 941 REC/TAX DEPOSIT FOR MMC PAYROLL REVISED 311612074 PAY PERIOD: BEGIN 912312022 VOIDEDCKHI PAY PERIOD: END 10/6/2022 PAY DATE: 10114/2022 GROSS PAY: $ 638,367.08 DEDUCTIONS: AIR $ 610.16 ADVANC BOOTS SUNLIFE CRITICAL ILLNESS $ 859.18 SUNLIFE ACCIDENT $ 749.28 SUNLIFE VISION SUNLIFE SHORT TERM DIS $ 1,230.90 SCSS VISION $ 1,028.09 CAFE-D S 1,622.46 CAFE-H $ 22,866.94 $ S CAFE-P CANCER CHILD 5 2,281.01 CLINIC S 345.00 COMBIN $ 280.87 CREDUN $ DENTAL 5 DEP•LF SUNLIFE TERM LIFE $ 866.90 SUNLIFE HOSP INDEM 5 637.74 FED TAX $ 45,320.77 FICA-M 5 7,338.62 FICA-0 $ 31.378,99 FIRST $ FLEX S $ 3,243.15 FLX-FE S GIFT S S 05.93 GRP-IN GTL HOSP-1 LEGAL $ 977.44 OTHER S 794.67 NATIONAL FARM LIFE $ 1,667.92 MEDSURCHARGE $ 365.D0 PR FIN $ RELAY REPAY STONEDF S 840.86 STONE STONE2 STUDEN TSA-R $ 37,674.69 UWIHOS $ - TOTAL DEDUCTIONS: 5 162,769.67 5 KHAWYIMMNREICR NET PAY: S 378,887.51 S ^aiawu4Rxmsmt-- TOTAL CAFE 126 PLAN: S 32,244.86 S AXABLE PAY: $ 608,112.22 $ 506.112.22 ••CALCULATED•• P.m MMC Repo" Difference 9CA-MEO (ER) ,sx 5 7,335,63 'ICA-MED(EE) ,sx $ 7,338.63 $ 7.335.62 S 0.01 'ICA - SOC SEC (ER) e.mx $ 31,378.98 'ICA -SOC SEC(EE) emx $ 31,378.96 $ 31.378.99 $ (0.03 ED WITHHOLDING $ 45.320.77 $ 45.320.77 $ INAL OK 111 TOTALS $ 538,367.08 $ 670.16 5 - $ 5 859.18 5 749.28 S 5 1.236.90 $ 1,026.09 $ 1,622.46 $ 22.966.94 S S S 2.281,01 5 345.00 S 280.87 $65,90 537.74 45.320.77 7,338.62 31,378.99 3,243.15 85.93 977.44 794.67 1,667.92 365.00 640.86 37,674.69 162,769.57 SNO1xD MARN A&Oxi,• R}q W e IMRN RBGRi•• S $ $ 376,6H7.67 eN]ul1 wRx Armor ^&1o,.ao unm((N1:DwTl- Exempt Amt: Employees over FICASS Gap: $ S - S - Paycode S - Employee Reimb.: TAX DEPOSIT: s 122.755.95 3 122.766..99 FICA - MEDICARE xxox $ 14,677.26 $14.677.24 FICA -SOCIAL SECURITY rzaax $ 62,7$7.92, $62,757.98 PREPARED BY: FED WITHHOLDING $ 45,320.77 $45,320.77 PREPARED DATE: TOTAL TAX: $ 122,755.96 $122.765.99 $ (0.04) TOTAL: $ Meyra Martinez 10/7/2022 421 R1 MMC TAX DEPOSIT WORKSHEET 10.06.22 RI Ms: TAX DEPOSIT WORKSHE97R2022 F.un Cate: 30107i22 ME903IAL MEDICAL CENTER Pace 109 Fine: 14:54 Payroll Register 19 Weekly t P2BEG Pay Period 05/23/22 - 10/06j22 Rues : Final Summary •-- P a y C o d e S u m m a r y-----------------------------------------+-- D e d u c t i o n s S u n n a r y-------------� PayCd Description 3rs JOTj SBjV3jxOjCBJ Gross I Code Amount -------------------- .------------------------------- ..------- .----------- ...._........................ .._.__..'__'------ .-----.. 1 REGULAR PAY-81 9695.75 N N N 210203,0E Alp. 610.16 A/R2 AIR3 1 REGULAR PAY-S1 2079.00 N N 11 N 93904.09 AOVANC AWARDS BCBSVI M6,05 1 REGULAR PAY-S1 398.25 Y N N 12190.00 BOOTS CAPE F. CAF2-1 2 REGMA.R PAY-S2 2613.00 N N N 63921.71 CAW: 2 CAF3-3 CA? 2 REGULAR PAY-S2 193.25 Y N 11 7530.94 CAFE-5 CAFE-C CAPE-D :622.46 3 REGULAR PAY-S3 1488.75 N N 11 45445.79 CAWS-F CAF:'-H 22866.94 CA^ -I 3 REGULAR PAY-S3 111.50 Y N II 5845.51 CAF3-L CAFE-P CANCER CALL BACK PAY 27.00 N 1 N II Y 1104.12 CHILD 2251.01 CLINIC 345,00 CONEIN 280,87 4 CALL BACK PAY 37.00 N 2 N N Y 1498.31 CREOLN DD ADV DENTAL 4 CALL BACK PAY 2.00 H 3 N N Y 10.04 DBP-S,F DIS-LF EAT . CALL BACK PAY 1.00 Y I N N Y 36.00 EATCSH FEDTAX 45320.77 FICA-K 7331.62 4 CALL BACK PAT MD Y 2 N t1 Y 52.07 FICA-0 31373.99 FIRSTC FLEX S 3213.15 C CALL MY 2364.00 N 1 N II 4728.00 FLY, F"E FORT D FU7A. C DOUBLE 21HE 34.25 S 1 N 11 945.05 GIFT S 95.93 GRANT CRP-IE C DOUBLE TIME 10.75 N 2 N N 3293t, G-L HO5?-I ID TIT D DOUBLE TIME S0 N 3 N, 11 16.77 LEAF LEGAL 222.44 HASA 155.00 E DOUBLE TIME 6.23 Y 3 N N 314.44 REALS 202.20 METVIS M?SC E EXTRA WAGES K 1 N N N 51752,00 H:sc/ MOM NATFML 1661.92 FUNERAL LEAVE 40.00 N 1 N N VM6 OTHER PHI PRI.. 1 INSERVICE 8.00 N 1 N 11 287.1E PR FIN RELAY REM I INSERVICE 2.50 Y 1 N NI 147.56 SAMS SCRUBS SLGNOK ;d1P.Y LEAVE 12.00 Y 1 N 11 165.4E ST-TX STONDF 640.06 STONE K EXiEADED-ILLNESS-BATIK 152.00 N 1 N 11 4363.52 S-ONR2 STW.'T SLNACC 749.23 P PAID -TINE -OFF 367.57 W N 11 N 6581.45 RMILL 359.16 SININD 537.74 SUNL1f 965.90 P PAID -ME -OFF 934.00 N 1 N N 24939.67 S03TD :234.90 SUNVIS SUP.CHS 365.00 X CALL PAY 2 96.00 N 1 N N 152.00 TSA-1 7SA-2 ?SA-: Z CALL PAY 3 96.00 N 1 N N 388.00 TSA•? 7SA-R 37-M.65 TUT ON t PEONE & DATA N N II N 1035.00 @EIFOR 592.47 74JUDS '- •------------------ Grand Totals: 20771,32 ....... I Grass: 538351.09 Deductions: 162769.57 Net: 375567.51 1. , Checks Couat:- FT 199 PT R Other 54 Female 214 ^tale 25 Credit OcerAmt 16 ZeroNet Tern Total: 259 � ............................... ..__............. .--------------- .--- .---- ................. .-------- --- .............._...... Rc7 Date: 10110/22 MEMORIAL NEDICAL CENTER El-ZEEKLY Page ' Txe: 95:31 •... a.eck Raois-- ..•. P29ISTP Pat Period 09i23i22--10/06/22 Ron: I}'06=7IE4 10ODG001 OPERATING - PROSPERITY Num. Name ?mount CHECK NUM DATE C2£22 JESUSA MARI3 '7ILIAR.RFAL 1341.79 OOC63215 10/14122 02145 BING VALDEZ 154.31 OEC6323C 15/14122 76139 KB.REM D GARCIA 671.41 OOC63231 !O/14122 55392 SFIJO:N JACIICO 1639.60 00063232 !0/14122 60867 RUDOLPHD VASQUEZ 1513.44 00061231 10/14122 65269 NATALIE BAREFIELD 964.57 00063234 10/14/22 65715 NARLA R CCMEZ 147.99 00063235 10/14122 65162 CLAUDIA RUTZ 623.33 00063236 10/14/22 65189 ELVIRA SANCHEZ 375.54 00063237 2D/14/22 74159 CAROL VILLAR.REAL 87.20 00063239 10/14/22 78186 ANORES P COOK 291.37 00063235 !0/14/22 00141 JEA)WE OR"".. 1576.03 OOC63240 15114/22 06321 AND3_d DE LDS S.NTOS 261C.17 OOC63241 19/14/22 C8041 CNIL LEE KING 792.06 DD 11/14/22 00083 SYLVIA. A VARCAS 978.06 DD 10/14/22 OD094 SYLl4A A MENDOZA 858.72 DO 1O/14l22 00113 JACLYN CaRRSCN 1044.6B DC 10/14I22 00132 S.ANDRA A BRAUN 801.19 DD ID/14/22 00192 BRENDA D PENA 2638.23 OD 10/14/22 00344 SANDRA LEE RUDDIC:0 2720.:0 OR 10/14/22 00387 BILLIE F UUC.KWORTH 2521.91 00 10/14/22 00392 KONICA T CARR 2213.21 ➢O 1O/li/2i 00399 LINC.A J TIJE3TNA 2557.:1 DD 10/14122 00401 VELMA J PI9A. 2176.03 DO 10/14/22 00417 SHERRY' L KINS 3074.59 OD 10/14/22 00423 DDNN V STRINGO 2101..1 DD 13j14/22 00482 ?AM FIKAC 1353.E0 DO l0/l4/22 00581 CY1mrk L F.USAING 1625.65 DD 10/14,122 00676 SHEILA KAY HEATHCOCK 959.45 DD 10/14/22 DO601 RILLA RENEE WDOD 1673.90 OD 10/14/22 00692 DEBORAH E WI7DIEBERT 410.70 DO 10/14/22 00657 614RIA C FARIAS 932.31 OD !0/14/22 00707 KIEBERLY R BiNKA 1611.'.5 DD !7/14/22 00395 .H:LIE D1AN0 W2LK?Y 364.39 DO 10/14/22 Olu15 SUSAN 3 SPALLEY 2125.26 OD 1J(id/22 01191 SFARON I. SPARKS 813.91 9D 10114/22 01234 JEYISE N SVEPLIZ. 1904.54 DO 10i14122 01367 V117LYY A SANDERS 4972.54 DO 101W22 01543 JACKIR E WILLIAMS 1970.16 DO 10/14/22 01791 RAUS:4ANA34 J WONDAI' 1460.65 DO 10/14/22 02011 ERIN R CLEVENGER 3257,39 DO 10/14/22 02014 AGAPITA C C.N%TU 833.51 DO 10114/22 02021 SRIK.5 OSOPRIA-SANCHEZ 1549.58 DD 10114/12 DZ022 ?MA DA J CP.ICGS 24B6.25 DD 10/14122 02064 AA7LY (AURA GA3CIA 333.49 DJ 3/14/2i *)97 KYL:: Y. GAINES 1604.12 DO i0/li/u 02095 MCI N S.iFC:K 2913.71 DD 10114/22 C2112 LESLIR 7!iCYAS 4036.2. DO 101'14/22 02122 DA.R:N U114 3202.42 DD 10/14/,22 02154 JUS:INE STRELCZYK 3095.11 DD 10/14/22 02168 JENSICA RIIGHT 1188.12 DO 10/14/22 C2193 TIN: VRNGLAR 2473.OB DO 10114i22 02271 DAWN J BUBENIK 2022.02 DO 10114/22 Run Date: 10/10/22 MEMORIAL MEDICAL C3NIER 9I-NEFKLY Page 2 Vne: 08:37 ..++ Check Register I--, P2D19TP Pay Per ed C9!23!22--10!05/22 Rm 1 yC¢=1ET 10B00001 OPE.RAi INC - PROSPERITY MT.. Name Amount CHECK HIM DATE 02301 MCCLAS TIJERINA 1704.BB GO 10/1,122 02303 CON;ls 8 LN1A 2568.93 CD 10/14/22 02115 NINA M GERM 5746.81 DO 02331 JESSICA B RIFFLE 766.72 CD 10/I4/22 02346 JEANETTE L FALCM 1727.90 DD 10/1;/22 02356 CHALEY 10MON 2244,50 DD 10/14/22 02416 J1iELLE SCOTT 1414.10 DO 10/14/22 02511 M-AGCALENA SEPULV4MA 658.92 DO 10/14Y22 02535 STEFANIE N SOVZ 855.22 CO 10/14i22 D2552 VERCNICA RAGOS:N 1729,16 ➢D 10/14/22 02584 BEATRICE MEN 2096.31 DD 10/14/22 02E78 MELISSA NESLCNEY 2535.59 OD 10/14/22 02101 RONTA D.;3 LLE GOHLEE 3178.27 DO 10/14/22 D2719 DA611 N MCCLELfAl2O 17e9.31 DD 10Y1;(22 02735 ZANDF-A A GARCIA 1532.32 DD 15/14/22 02763 JESSICA COPPIN M5.89 DD 10/14/22 02789 11Y E STRIECLBR 466.10 DD 10/14/22 O7794 HEATHER L R'?CHLER 1710.01 DD 10/14/22 02812 9RI-TA.NY N RUDDICK 2725.75 DD 10/14/22 02907 PWRIA P LONGORIA 1074.92 DD 10/14/22 02927 MICHAEL L GAINES 3041.39 DD 10/14/22 02963 DOROTHY J RENDOII 925.91 DD 10/14/22 92570 DIANNE G AC:CINSOA 1996.11 DD 10/1V22 03864 JMGMINE I F.ERE uI 1273,65 DD 10114/22 05003 CCURTNE D ':NIRVILL 2592.57 DD 101144/2, 05006 REGINA A MARTINEZ 2917.34 DD 10/14/22 05122 MA.RISSA RANCEL 1685.66 D➢ 10/14/22 05195 KIMBERLY HALT 356.04 DD 10/1022 05345 Ed1CA SN15V 2335.:4 DD 10/14/22 OSc;1 7NA11CA. R K3't 2903.47 DD 10/1422 05757 SFARO9 T HOLDER. 1891.84 OD 10/14/22 07C07 URSULA S BRYA14 310.63 DD 10/14/22 07123 MMIA GUERRA 1646.72 DD 10/1,122 07147 Cho' A WICE 2470.33 DO 10/11122 07VO DIAMA C SAUCEDA 1217.99 DD 14/14/2. 11197 CAI..ERIYE A SAENZ 1562.68 OD 10/14/22 12412 COUR^.IEY L MORKOVSKY 1140.61 DD 10/14/22 12011 KIMBERLY J REM 2436.58 DD 10/14/22 12115 LISA J <NOJOSA 926.6E DD ID/14/22 12153 JUL3A MCNTeS 2C61.63 DD 1G7I4Y22 15097 'Kyu L DAUM 3202.73 DO 10114/22 15131 SA7AME HAR:E'Y 203,17 DO I8/14/22 MIS KR:S"SV NICOLE BALM 1511.51 DD 10/1412.2 15171 JESSICA BARRON $69.51 DO 10/14/22 152i6 COURHBEY A SAIAZAR 2305.3i OD 10/14/22 'S29b DAA77 61 FARE( 1559.71 DD 15/1,122 :i509 in'" NGUYEV 171.64 DD IL/14/22 :i915 RIIAME J FV 2791.OB DD 10/14/22 20302 N4YA HAWKI9S 1282.13 DD ID/14/22 21112 YJIPA PATRICA RODRIGUEZ 919.40 DO 10/14122 20145 :aZALIE SOTO 66C.:0 DD 10/I4 L2 41150 ERIN ASELEY r13SD04' 2193.13 DD 10il;122 2017e AKY GARCIA 740A3 DO 10/14!.2 20104 NELSSSA ZAMOBANO -198.38 DO 17/l;!22 Run Date: 10/10/22 MEMORIAL MRDICAL CENTER EI-WEEKLY Page 3 VM 08:37 .... Check Register ... P2DISTP Pay Period 09123/22--10/06/22 Run: I T}�oe-1 7/0000002 OPERATING - PROSPERITY Num. Nat" AlMit CHECK NUF. DATE 20206 KELLI B GOPP 2081.37 DO 10/14/22 20207 SHA'ANA G HARTL 2464.28 OD 10/11/22 20241 MSUNIE CORTEZ 1085.44 DD l0/14/22 20254 JESSICA D PALMER 759.98 DO :0/14/22 20419 KAREIN N MCEum 119.70 DO 30/14/22 20456 SAYDI A ST CLAIP, 632.07 CD '_0)14/22 20404 BRIANNA S PASSKORE 73.5E DO :0/14122 20742 CYNTHIA LOPEZ 209.11 DD :0/14/22 20759 JAMIE SADLER 414.60 DD .0114122 2079E JAYLIN RAMIREZ 496.97 DO :0/14/22 20797 BET{A1B N DICAS 1308.49 DO :0i 1412E 20816 JOLE L P21A 831.8: ➢O :Oil!122 20837 DAISY MADRIGAL 1050,03 TO 10/14/2" 20854 JAM GREEN 182.2i DO 10/14/22 20977 CHERYL L 7ESCH 2566.91 DO 1D/14/22 21450 DIANA E LEAL 1737.13 DO 1D/14122 21629 JACOBY R CRAWFORD 1523.66 00 1011412E 2:726 ALLISON GOLIDEN 741.91 DO 10114/22 21960 DEBORAH. L'YNN 2LAC8 2503.E3 DD 10114i22 1261E REAMER L SMITH 943.19 DD 10/14122 26186 JANE7 ORDJ%'O 2294.:1 DD 10114/22 2B034 KRISTINA A BUERGER 1644,51 DD 10114122 2812C JESSICA V SEINEPA 1067.04 OD 10/14/22 29195 SELLY A SCHOTT 4566.54 DO 10/1412e 3'D35 STACIE L EPLEY 1543.6i CO I➢i1,22 3:054 -'ORA L LAMBORN 947,2E DO 30/14/22 3:099 ARACELY Z GARCIA 2330.42 DO 10/14/22 3':219 UVREN PHILLIPS 1198.73 DO 10/14/22 31251 CW7MIA L BIAS 1655.BB DO 10/14/22 3:313 KATRBBINE UNN JIMENEZ 2248,11 W 10/14/22 31319 STACY L FANNEE 1708,41 DO 10/14122 31463 EDWARD E RATJLA 2236.23 DO 10/14/22 1150E RACHEL A H"EFFNEER 2694.73 DD 10/1.,'22 31821 EAYLA M ALVAREZ 1,95.49 DO 10/14122 Y832 SHANE D XRESTA 33158 W 10/14/22 31849 CODY L e-UREK 914.55 DD I0114122 3831E XRYSTOLIA F USIrH IMA9 DO 10114!22 3815E REGAN V. CARO B75.55 ➢D 10/14122 38702 AA7w WNESSA PENNELL 957.60 DO 1004121' 41112 AHSST.4SIA L PEREZ 692.04 DD 10/14/22 41171 70MMIE F1 TREVISO 472.16 DO 10/14/22 41205 JEAN7ETTE ALVAAAW 760.25 DO 10/14/22 41225 LESLIE A CPAIGEN 926.56 DO 10/14/22 41236 PA&ELA Y VANNOY 1360.57 W 10/14122 4i274 XA�RI GAO! 1142.83 ➢O 30/14/22 4:279 2ARELA R H.ANNON' 823.73 DO 10'14 ! /22 41347 ADEIANNA O STRA.KOS 697.57 D➢ 10/14/22 41169 LORETTA A LEAL 472.14 DO 10/!4122 4241E ANGEL 14 CASSEL 997.41 DD 10/14/22 4:50o JOSEFAT LOGO TOPRES 638.50 DO 10/14122 4:501 OLGA 1 BETANWUr'." 841.7E DO 10114l22 4'-612 SOSJA A GOAJARDO 860.01 00 10(14122 41617 JACQUELINE M FART.INEZ 846.45 ON 3i/14/22 41896 RENAE M7C:4BLLE EMERY 571.7E ➢D 37'14/22 Run Case: 10,10122 N2p@tT4L MEDICAL CENTER 3I-BEEKL'Y Page 4 Time: 08:37 Check Register ++++ P2DIS7P Pa}' Fedod 09/23/22--10106/22 Run: 1 ':}pe=tE^ 10000001 OPERATING - ?R05PBRIif Mum. Name Amount CHECK MDM DATE 41897 ROKAN2IA MUNOZ 7B7.56 DD 10/14/22 419D1 JUANITA R MILLER 1105.32 DD 10/14/22 41924 39I7R7EY 'I STRICKL?N 703.56 DO 10/14/22 42106 CNR?5`.Y SILVAS 992,85 CD 10f14f2i 42112 SUCORRO C GONZALES 79.3.50 DD 10/14/22 42122 LEI AIIA CHAVANA 1549.22 DD 10/14/22 42125 LUC'6 CALZAEA 790.26 ➢D 1G/34/22 42304 MIMI ": K%''YEN 18E7.5B DD 10/14/22 42320 MICHAEL A PFSIL 3OD4.34 DO 10/14/22 42820 MAR:A D CRAVEZ 755.9i DO 10114, ti 42842 SHAIRIA S 0 D00EL'u 3400.18 DD 10/14/2' 49600 JESSICA BUSH 193.32 DD 20/14/22 5001E MICHELLE M MORA25 1549.E7 DD 10/14/22 50022 RESIN. A Ju:Nsell 860.32 DD ID/14/Z2 50148 PEAKY GODLDEN 3118.51 OD 10/14/22 50161 3RIn. EY MICHELLE ZA40RA 1356.31 DO 10/14/22 5024E MCEEINA VTLLEGAS 345.90 DD 10l14(2i 50282 JACOB W HAMILTON 2610.5E OD 10/14/22 5031D JASMINE GRIGSBY 783.50 DD 10/14/22 50546 MELANIE K SA'•AYCA 2C63.28 DD 10/l4122 50573 DEANA R DAVIS 1267.81 DD 30il4/22 S0596 BETTY S DAVIS 1985.49 DD 10/14/22 50715 DEBRA K MUSTERED 2220.33 DO 10/14/22 SG929 eD:'NA RCDRIGUEZ 660.23 OD lIilv22 53541 JACLYN B HARTL 1568,40 DD 30/14/22 SSP25 LEA C RESENOEZ 518.11 DD 1D/14/22 55026 IRE3E E P£RS2 - 529.36 DD I'll/W22 55106 CRYSTAL M CEAVEZ 654.09 DO 10/14/22 55127 APRIL N KUBF3.A 2705.55 DD 10A4/22 55371 BLANCA HERNANDEZ 391.49 DD SD/14122 55658 L.AOUAN WILKE 609.67 DD 10/14/22 58115 3ECKY MARIE SALINAS 880.93 DD 10/14/22 SB510 RITA '.?OLEMSK'Y 7E4.17 CD 10/1022 50112 PDBERT A RODII0UE2 2002.26 DD 10/14/22 60131 MORA OVALLE 561.19 DD 10/14/22 60156 D.ANIELLE N TAGLE 939.42 D 10/14/22 60163 MIG31IA CV.Ro 667.22 DD 10/14/22 60265 TERESA A BENITEZ 1892.82 DD 13/14/22 60412 CHRISTOPEEF. CALIM➢D 951.53 DD 10/14/22 60616 DOROTHY A LONCCRIA 906.92 DD HAV22 50914 CONSUELO ZAMORA 1807,93 DD 10/14/22 63124 SANJUAM M GARCIA 1,79.84 DD 10/14/22 632S9 JASON REBID 572.53 OD 10/14/22 65100 fEL?C?TA BONOZ 349.91 DD 10/14/22 65121 VIVIANA P MEDINA 294.00 DD 10/14/22 65136 TINA KORANEK 902.72 ED 10/1,122 65147 BLANAROSA VILLARMAL 566.6'r DD 20/li/n 65151 ELIA OLn;{IA 654.:9 DD 10/14/22 65168 NORA MIRELES E79.;7 CC 15/14/22 65213 LEE SIMERLY 1066,4E D➢ 15/14(22 65353 R4MCIL4 A PEREZ 2339.32 OD 10/14?22 65453 ANALIA L FLARES 1012.60 DO 10/14122 65463 MLRIA I VELOZ 811.45 '1a LGA02 65486 Rash RC'DRIGCEZ 991.W DD 10/14/22 Run Date: 10/10/22 MEMORIAL MEDICAL CENTER. EI-EEEELI' Page 5 Pink: 06:77 C:7ec7 Re0isteT '+•• P2DISTP Pay Period 09123j22--10136j22 Run: l TYN-IGT 10000001 OPERAIING • PRDSPERIPI Nurt.. Na*.,e Wonc CHECK RUM. DATE 555!3 MARIA MCFv9LES 969.02 DD 1011V22 65705 CONITIIA HERRER.A 828A2 DD 10/14/22 6585E ALEJA7DRO R VELASQUEZ 210.66 DD 10/24/22 65865 MARIA F LEDEZMA 656.96 DD 10/15/22 68368 DOM1711A GARC2A 163.71 OD 10/1,/21 6BS6e CHR'3S70PEER RU79RFORD 867.09 DD 10/14/22 68792 NAZARiO DIAZ HER.NAMDEZ 1924.75 DD 10j34/22 70119 SARA N EL£DSCE 2216.49 DD 101/4/22 73749 GLORIA N REID 2406.91 DO I01'14/22 75190 RIBA MILLER 1783.08 DD 1C/1?/22 75e03 IRMe DZLEON 102,93 OD 1D/14122 75C67 PAI"u£ GEDRGIA CBATHAX 817.94 DD 10/14/22 76110 TARA4 SUBLETS 740.54 DD 10/1?/22 76115 JEN71FER R CA.RLOCR 73431 DD 10/14/22 76120 RACHEL LANALES 1330.27 DD 10/14/22 76210 ZOE VILLARRE.AL 391.12 DO 10/14/22 76300 AIDA JIMENEZ 678.44 OD 10/14/22 76313 ?AMELA L BARTON 726.35 DO 10/14122 76403 KATRI1lA A POKLUOA 1221.94 OD 10/14/22 76647 CHERYL A SEE 1227,83 DD IDJ14/22 76706 GREGORY E MORALES 636.76 DD 16115/22 76854 MARY PAI^iERSON 679.81 DO 10/14/22 76905 VANESSA TRISTAN 226.30 DO 10/I4122 71646 FAREN A GONZALES 1054.91 DO 10/14/22 78020 NIST'Y R FASSMCRH 1228.53 DD 10i14i22 7BG59 aY J POWER 360.17 DD 10114/22 18072 DONNA F. RANLINGS 1271.Ifi DD 10/14/22 7819I JAM, E J GRASSE 711.0E DD 4114/22 78287 VARISSA D A_YANZAR 1E40.75 DD 1D/14/22 78326 JESSICA I GLDVEP. 1421.88 DD 10/14/22 78566 MELISSA F. GEE 957.17 DD 10/14/22 78764 ASHLEY D HA➢LEY 1080.65 D➢ 10/14122 7877E SA%A id RU810 2186.93 DD 101IL122 78781 KRIS71EN R HACF:ICER 2236.39 OD 10114/22 78767 FARAi 1 JAIAZ 2456.42 OD 10j1r'122 76597 DAYLE J RORIRSON 545,08 OD 1D/14/22 80006 AW D BESI0 2784.10 OD 1Dj1412: 82227 CAiiLIN A CLENTMER 771.79 DD 10i1?/22 86482 RE0a17 V. HARPER 754.P0 OD 10/Ir122 00125 LISA N TREVINO 1090.12 DD ID1141Y 88600 MARLEY E ONVELL 1970.43 DD 13/14/22 09904 MAYRA R MARTINEZ 1425,83 DD 10.1N/22 9U1i9 WILLIAM T LITTLE 3619,20 UP 10/14/22 90320 ROSHFNDA S THOMAS 4449.02 DD 30/14/22 93231 ANDRIE R £LORES 1079.23 OD 1011022 98756 ADRIWA . GALVAN 1527.22 DD 10/14/22 375507.51 gECEN nsYSOR ON COUNTY l3Cl 0 u LDLL 10/06lUN2 -fm* MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: 0 ap_open_invoice.template Vendor# Vendor Name Class Pay Code 11828 SOLERA WEST HOUSTON Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 092622 09/30120 09/26/20 10/28/20 8,681.25 0.00 0.00 TRANSFER Vjgt ij#,KLL f9N/1.i &Lpot;t6� ,,1t "11,W,,L- UFLO—& Vendor Totals Number Name Gross Discount o-Pay 11828 SOLERA WEST HOUSTON 8,651.25 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 8,681.25 0.00 0.00 .,wnuED6w OCT 0 6 2022 ay CUUUWY AUDITOR c,Au4mr4cuM9,Y. TEXAS Page 1 of 1 Net 8,681.25;�` A Net h 8,681.25 Net 8,681.25 file:///C:/Users/]trevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report768651... 10/6/2022 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON %T 6 2022 1 /06 2022 i_ALHWWCOUNW, TEXAS MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: Vendor# Vendor Name Class Pay Cade 11832 BROADMOOR AT CREEKSIDE PARK Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 092922 09/30/20 09/29/20 10/29/20 4,752.00 TRANSFER NN In.untnuz pn,}u nwtj dc;7a�rfiNl Vendor Totals NumberNa Gross 11832 BROADMOOR AT CREEKSIDE PARK 4,752.00 Report Summary Grand Totals: Gross Discount 4,752.00 0.00 OCT OG 2022 BY COUNTY AUDITOR CALHOUN COUNTY. TEXAS 0 ap_open_i nvotce.template Discount No -Pay Net 0.00 0.00 4.752.00 V Iy ykl t{ Discount Np-day Net ' t. 0.00 0.00 4,752.00 No -Pay Net 0.00 4752.00 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/tt88125/data_5/tmp_cw5report894869... 10/6/2022 Page 1 of 1 By COU�AUORORD ON Y0UAA 2022 MEMORIAL MEDICAL CENTER AP Open Invoice List 0 7 t:_At Dates Through: -t1UUN COUNTY, TEXAS ap_openinvoioe.tem late p Vendor# Vendor Name Class Pay Code 11824 THE CRESCENT Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 092922 09/30/20 09/29/20 10/29/20 3,040.00 0.00 0.00 3t04O.00 TRANSFER Oil JASuVj ALt v aoffiak i dtpowjt k 'Inl� i1 wL L, ovtfit� w, 092922A 09/30/20 09/29/20 10/29/20 14,500,00 0.00 0.00 (r 14,500.00 TRANSFER tl �� Vendor Totals Number Name Gross Discount No -Pay Net 11824 THE CRESCENT 17,540.00 0.00 0,00 17,540.00 Report Summary Grand Totals: Gross Discount No -Pay Net 17,540.00 0.00 0.00 17,540.00 APPROVm ON OCT 06 19022 13Y COUNTY AUDITOR CAU40UN COUNTY, TEXAS tile:///C:/Users/Itrevino/cpsi/memmed. cpsinet.com/u88125/data_5ltlnp_cw5report702177... 10/6/2022 Page 1 of 1 RECEIVED BY THE COUNTY/ AUDII9T�pOR ON OC1T0/86TI0221Z2 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 11:36 ap_open_Involce.template ::�-.t_H"vJN COUNTY,'1't'l(AII 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 092322 09/30/2009/23/2010/28120 0.03 0.00 0.00 0.03v,/ TRANSFER Ali 11\S0.Yk1\f.P_ pA"LWV JLVoeikeA In-h MW L 0P4%.+ac . 092322A 09/30/20 09/23/20 10/28/20 10,263.85 0.00 0.00 10,263.85 ✓' TRANSFER r} 092622 09/30/20 09/26/20 10/28/20 38,491.60 0.00 0.00 38,491.60 of TRANSFER " I 092722 09/3012009127/2010/28/20 113.84 0.00 0.00 113,84 v' TRANSFER It 11 092622A 09/30/20 09/28/2010/28120 79.42 0.00 0.00 79.42 ✓ TRANSFER It 11 092822 09/30/20 09/28/20 10/28/20 621.53 0.00 0.00 621.53 TRANSFER a 1, Vendor Total; Number Name Gross Discount No -Pay Net 11836 GOLDENCREEK HEALTHCARE 49,570.27 0.00 0.00 49,570.27 Report Summary Grand Totals: Gross Discount No -Pay Not 49,570.27 0.00 0.00 49,570.27 OCT 06 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TW8 file:///C:/Users/ltrevino/cpsi/inemmed.cpsitiet.com/u88125/data_5/tmp_cw5report313635... 10/6/2022 Page 1 of I RECEIVED BY THE COUNTY AUDITOR ON 2022 MEMORIAL MEDICAL CENTER WO/Q6/fie2 0 AP Open Invoice List 11;$7 ap_opan Invoice.template i;ALJiOUN COUNTY, TFAAB 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 092322 09t/30/20 09/23/20 10/28/20 348.9l9 0.00 0.00 348.99 TRANSFER N"ti }Y1�U1/R'rtlL }'0.u�IW-i.'� /,tC'lUhi'fit �t. 'jk- u Milk(- gx(4c1h h�s 092622 09130/20 09126/20 10/28/20 2,886.46 0100 0.00 2,886.45 TRANFER tt 092722 09130/20 09127120 10/28/20 11,096.18 0.00 0.00 11,096.18 TRANSFER it 092822 09/30/20 09/28/20 10/28/20 570.22 0.00 0.00 570.22 r/ SUPPLIES 4 rr 092922D 09/30/20 09/29/20 10/29/20 61.69 0.00 0.00 / 61.69 ✓ TRANSFER 1t it 092922A 09/30/20 09/29/20 10/29/20 5,224.00 0.00 0.00 5.224.00 TRANSFER It 1) 092922 09/30/2009/29/2010/29/20 1,264.23 0.00 0.00 / 1,364.23 ,! TRANSFER it V Vendor Total! Number Name Gross Discount No -Pay Net 12696 GULF POINTE PLAZA 21,551.76 0.00 0.00 21,551.76 Report Summary Grand Totals; Gross Discount No -Pay Net 21,551.76 0.00 0.00 21,551.76 OCT 06 2022 BY COUNTY ALIMOR CALHOUN COUNTY, TEXAS file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report643493... 10/6/2022 Page 1 of 1 RECEtVEO BY THE COUNTY AUDITOR ON OCT 0 6 2022 10/06/2022 MEMORIAL MEDICAL CENTER D ,;n44kWN COUNTY,' EXA9 AP Open Invoice List ap_open Invoice template Dates Through: Vendor# Vendor Name Class Pay Cade 13004 TUSCANY VILLAGE Invoice# Comment Tram Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 09262.2 09/30/2009/26/2010128120. 4,156.85 0.00 0.00 4,156.85 TRANSFER W0 )0&0VMLp_ f6t 6% ct dtf71XA j-4A th}D Vym_ OP-n4n 092722 09/30/2009/27l2010/28/20 3,695.50 0.00 10 0 0 3,695.50✓. TRANSFER it �t 092722A 09/30120 09/27/20 10/28/20 400.80 0.00 0.00 400.80✓ TRANSFER " I 0927220 09/30/20 09127120 10128/20 11.263,32 0.00 0.00 11,263.32✓' TRANSFER I " ` 092822 0913012009128/2010/28/20 15,264.00 0.00 0.00 15,264.0O.-Y TRANSFERlt r` Vendor Totals Number Name Grass Discount No -Pay Net 13004 TUSCANY VILLAGE 34,780.47 0.00 0.00 34,780.47 Report Summary Grand Totals: Gross Discount No -Pay Net 34,780.47 0.00 0.00 34,.?80.47 APPROUt"il?' OW OCT 0 6 2022 BY COUNTY AUDITOR CALROUN COUNTY, TEXAS file:///C:/Users/Itrevino/cpsi/memmed.cpsinet. corn/W 8125/data_5/tlnp_cw5report428507... 10/6/2022 RECEIVED BY THE COUNTY AUDITOR ON � 'i 0742022022 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 11 11:35 ap_opan_Invoice.templat CALHOUN�p��N1� 7�r Dates Through: Vendork-VertdorNa a Class Pay Code 12702 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 092322A 09/30/20 09/23/20 10/28/20 20.00 0.00 0.00 TRANSFER NVl j", uAj TILL vA�y➢�L A LIMO'-r1'J I+l'�1 iV VWL O) CVL-bYI� 092322 09130/20 09/23/20 1012/20 11,471.54 0.00 0.00 TRANSFER �% 't 092622 09/$0/2009/2612010/28120 31,951.30 0.00 0.00 TRANSFER 't 't 092722A 09/30/20 09/27/20 10/28/20 1,247.75 0.00 0.00 TRANSFER " I , 092722 09/30/20 09/27/20 10/28/20 16,609.37 0.00 0.00 TRANSFER n 092822 09/30/20 09/28/20 10/28/20 16.51 0.00 0.00 TRANSFER u n 092922A 09130120 09129/20 10/29/20 2,917.50 0.00 0.00 TRANSFER " f5 092922 09/30/20 09/29/20 10/29/20 11.79 0.00 0.00 TRANSFER" 't 093022 09/30/20 09/30/20 10/30/20 4,903.02 0.00 0.00 TRANSFER v< i1 Vendor Totals Number Name Gross Discount No -Pay 12792 BETHANY SENIOR LIVING 69,148.78 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 69,148.78 0.00 0.00 OCT 0 6 2022 13Y COUNTY AUDITOR CALHOUN COUNTY, TEXAS Page I of I i e Net 20.00 ✓ 11,471.54 t., 31,951.30 1,247.75' 16.609.37 ..' 16,51 2,917.60 ✓ 11.79 v' 4,903.02 Mom/ Net 69.148.78 Net 69,148.78 f le:i//C:/UsersAtrevino/cpsi/memmed.cpsine.t.com/u88125/data_5/tmp_cw5report227283... 10/6/2022 Memorial Medical Center Nursing Home UPL Weekly Canted Transfer Prosperity Accounts 10/10/2022 Pmuur Tede/. Aeeevm w,mmne AQd fend., ees.nmr Amrommeereanneneem xmm�, un.fxem. x.meer e..nee T nrenw. nommnn rwwm, wGM. wme 168.103 E3 {/I6D.Wf.1 1ov"p9 \% Iw,902.87 63,Md.05 _ 0an4 RaI,n,, Varlanee 103190E.87 UP.v.m B.Nna 39044 MOUNAAUGQIPP 14,908.e91/ AMENGROUPAUG(i 16,21IM../ mylnurest ni AievAinterm sexav Sw enswoo sel 16.91 Adju,l Belence/rnn.r.,., 45.il ✓ wN f A / / 99,8)0J2✓ 99.)14359/ 64,681 63 (l517.10 48.839.53 yJ j a� Bank Oalanu 6y617.10 Vast — Us ... In 0alenee low MOUNAAUGQRP 5,58) 75V AMERIGROUPAUGOIPP mows1v 1.1,humen 14.35✓ AumalAMn.l 22.12✓/ SePendsolatlwn 54.74✓ Adjust BalancegranaNrAmt "Mosel I%1 / 106.I)1.51✓ I08.D4.36 141,93i.% � 148,W5 le / 134,415.]] Bank ealanw lde,msaa Y✓ valance lNve In andntd made MOUNAAUGQIPP <,38231 AMERIGROUPAUGOIPP 8.119.90 ✓ wry I.I.F. is.n✓ Anus InUTAA 22.01✓ sepumeer Iota.. ii ✓/,' Adjuu Balrnte/rramfa Aml s31,41s.n ✓ J/ SS.OB1.96✓54,962.50 ✓✓32,.sPLo. ,J 31,607.96� 15,BW.13 emkeahn.e 32,6w,% VsrNnue W.I.SnaM, room MWNAAUGQIPP 59355d✓ AMENGROUPAUONPP taJu.13✓ Iul21nMw1 5.3s ✓l AU"Insurel E3.]1✓ S,PIanO,r.NUAA BAG✓�� Adjust Balanse/Sramfer ant 15,890.13 1/ 113.13391Y✓/142.91d.32 ✓103.SUB91 103,59)A9 i 87r373.9) Bank Balance IOl.597.49 ✓ v„i.u. -'eftftC" Iene Me.l.nv loom OCT G AMERRGGPAUICUPP 10366.O0 r/ j O ZOr2 a1 tan/anI PmJIM,mpmm� /yam OUWY 11My.... reelvly f t' _• 3uMMWM (�2��)ya�as Ai 3).S ,/ Qilf ;' lj?I `vvrL+3VQi3 ,��k7Ri, AUNnmYreR 31.w✓ Sommeolobent 23.9e ✓! Asull UWIPRnnller Amt B3j)3.9] TOCAlTMN31[M1S 349.637A6 men,.vn9no-n. WILLIAM L13TLE, CFO ' i 10110/2021 MCd<denndrodden ottoum oUm weolr neMNU\xx UPI Tanner sulMn.MEw>\aMvladxx UPI mmm SummaM 10 mliaw MINI TI-NN-V-- 0I WBnWnNV@M4neG.rmX0)p5 D-MudNORlnm IRVs1pu,N. Py!1 RTION .11 MMCPC1 PI i M� Tr n 1 -IOIPP/fLT 1 0PP/UTpy QPP/CMAO QPP/COTPG9I3PSG pPPSI NX PpkJ1pN '.:.. •9fYA ::HIM..iB� .. ::.• ,., _ 10•Vp.. ��' ,it99 IWM02: MAI ALINNOHL1111BMON CARE �][PMYifI1l S.SSLSo - S.SS1.50 10/3/10Sf WIRE dtttlMPoPO MpLMC.SRFCfMRAl10 160,UM,65 IUMPQ NNI-ECHOHCCNIMPM)L6QQHUII i2I5334 'III ME ],6101 I'MaN, AmxiM[uPISSCNCCNNARCUlAtCO3lMlllC(O ion lA/5/]oR,MOUNAN[YTHCAAMbI1NAAM01M41a4M0p10 � tf/OW 1j9I59a ]•RS%y 10.39 iA�4W.a9 ],1I155- 10/S/]OL NNR1[Jp M[fNIMIMY }i6plWILN'lWIIK)3 A691.W 4.0946E IW 72 UNNUHMIN0N NCCNIMPM51a60D141I lla3M LO'A" I9AI-Z512011 N[fp... PC xL[WMIMI INSI'M LOSO.b IDIS]lOL NNo-MNHMW We 1..1 ,00O2 NMPMi 11MU0011 EU iIA W I,575.98 MMIM, 1153 3 XN"N", CMIMPM))NC03O1MNMbg95 ),It. Homm MCMIMlMIl1lY]SRlllltlM 3D/6)d1ZZ 1111, 7.956.45 1.956.45 JHCC MMUM M`MTNA,. )IfW3a11910.M ]opmet 580 139.59 MNM.N N`.IR CX3U. SOp/WR UNN[NMNIum NCMIMPMI)G9WM1191[gM ISE." $9.p9 fOC"C"I OLNCf1MMIMEmm"MARMEWHAR, IOP170,11IPM USEElmo 159.36 II Wl/A]ECI4M NCluIMPMf 1326[361P9910]C0114ltll[ yl,i5ptl 159.16 T0I}(1q]i:,fmCMI06Wl WAPOIJAMLlMRS1GYSS111W] - )yK y3}y,16. 162•m 37,650.05 - I60.064.45 J - MI,)Y-09 1! ]6,1O5.M T.NYA9 b. ZA MIN, lN, MmcPDlrtlax ji�Ii D,�OuJ Tnntic Jn 0PI/WmD1 0PP/fpmp2 0PP/CpmP3 OIPP/CpmpiiY Se 01Pi1 NH PORTION 9/31 Pi9�LA 1P�ifi_ ...... N13SM2 _ OW11.11AT[CLNRINER. 93,131.15 W3UNIRONEUTHWE1611MIxbMll (liM IltW1/All 6.9HU. 6,01000 o/3mWa IIMIMIIi w[C.OMLCNImpurUWmal.v.0Jllau, 6}13% - 93OW ERMINE] XVIMXq[M1pNPKKMWIMIlZY61RONdRM i.MI.W 02 6,UMIA. M/5(MM MWNR.N[M1fKM1 MIflINIO101119N341W)DIp S,�Wii 4,I10.]d 3pLp1 - 4203.01 f$4-)5 303 Os 10/P(lI! HN6- LCHONfCMIMIMC ACE)MI MMJRE.IMI L3p)95 1,30395 WR/3011 UnHe4neMmnre NCCUIMPmm>atl3pR IIIA IopARE] UN[WMMVNIIY I3NttNIMIM}iail4AI191TN 566.9f 9", - 6U0R WSARR HOVNMSOWIIONHCMIMPML61a351G]RNlii 6355M 565.93 IOI6p0] HND�[CNOXCMIMOMC)aYOL11410[0l])JfM - 1.655.5E AB509 IpII 1,6TS.SR MCCCUMMurt11KWMIMIAibAA1NlM]150. IW6p011 VN[[OMMUNT'PL MCENIMIMF>[6WHI191OID - l,M II6A011 XOVI}m SOLWONNCCNIMIMl6]63S]AhVEIfiS 9AR.11 YN IUHM2!wpm NNB [CIO N[[WMIMIA4m N]IYW A±.If 9,013.)] NUREIHNNEE 56Y - 392.39 Wn.VNM[MMIMUGNttWMIMiNRIMAG191UN WA/1R}lunC[pNMVNT'ILN[MIMIMTla6NYL191fxLb 961b so.W lI)/MI] HFALTXNUMANSWRCfW.MU27ILWAIEMEN2 HIM 90.60 W}MMlM6RIDRWIC0W.[PAYMLMIFSi4tW LIkpO SOSYM 911916 ]> 10,02 99,T34II 64.6Ag63 � . 16197,10 1LV.St L61 N 6 M%MRR 0W MMCPOMION -„ -wit, TMAN41x @PP/CI I COINCnmP3 OUP/C4 S OPPICHA PM WRAP RAN I001W - ... .d.�_. d. :.kr t..,.. vim ..:M 9/3D/Al1 PNGECHO NCCNIMMA})a60034)1HWRl1H9R1[RS - I,YI5.6] 9/l0/]Ell MANA4FANONEiIYIRMNS PMNiOWCCROWRp31fiH1 I,Y15.6} 9/30/IOl2 MNR-f[Iro H[MIMIMi ]6600M114i00003W003 5,105.]5 49)550 9/30/1022 UHCCOMMUH"PLNCCUIMPMTVWD)412910W0 13.36 - 5.105.75 91HEALYX HUMAN SVC HCU.IIMPMT 11N00341130062 314073.34 9/3W10I2 OVPLfDHEALTNPNLP3131140939]U9 356.00 02 OFVCHEI RIN PMET 411M383W1N} W,666.00 - 3R)3.M 56011 1W3/1072 WIREOUTGMEHHEALTHGRE[ENEERUHI MIME, - 1[9I 10/31I023 DGpMft 4,379.16 - - HOPOCE HN9 ECN0HCCNIMPMT?&MORRIEN00W]3HE31 - 3.71516, 1,.67 10/3/2D22 UNOONHCCWMPM0311R43Y 1,11.. I7155 10/312OUXCCOMMUETYKHCCMPM3 M6 4O 711.38 1,11 HURXNVI HCCWMPM}1O14121b6I 293)9 1101312OU OW0IFONEALTHPXUNIMPMI 3213U9 1,46M III10//20M ] O6V0]F9)IhomKCKIAIMOMT IN3403%10259 4,640.00 W5U --- t,aa IDM/y012 fAI IM5)4b03[R1191H 60,D0 1yU f9 UNCUnftRIMUNIM LHM IWI/MR UNCCpMMUNIb PINKUIMPM}}96W3911910000 927.74 bb 10DEVOTFOHFALMPXKNIMPMI IS1140391I6)106 1,W9,00 - 021.75 ]W41=24/IOlI DfVOTFOHFAIiXPNKNIMIMI 131E4DI91)61105 111100 - yRINI 10151 - f.i4R.w 4.9Tfffi 9n.{T yylyb 10 EI HERB -1C 0 HCCWMPW 71M3411 NOGOp1i10}4 1,3}3.I0 k!"LLkL"HERE 10101=2 NOVRASS(llUDOx H[CUIMPMT6l6)134EONORf � 95).9a - 1,3]3,10 10/6/2022 0EVOlfDMfAITIPXCCNIMIMF 1211403913E VI5 61110.0 - at. 1016IW21 PfVWIDXEALTHPNCCNIMIMT R110392361731 SARI 6,31O W 10/7120II YNIeNI441thWIHCCNIMPMT7400034111243B1 11 I00(]022651IAN COMMIT HCCLMMIMT EASIER 11100 195 550.00 - 4,510.M 10/1/2022 HVMWA CHA 0ISH NCCMMIMT 390804yWW1993 1,950.00 - SSO,M 1017/3022 HMLTH HUMAN SVC HCCIMMPMT 276600341130012 9,p41,16 - 3'm III 100/2022 O11,0110NNLINP ECCLAMPM11211401MI1416 AX)GO 5015 26 - 1 IOO/10110NOR9 HNIIN P HCCWMPMT IZ124039WO414 - 42C0.00 .w 12000 l0/]/M2x 0EVOiFi]Nul1HO H[tuIMIML 1311b39W1}ali - j' Is,ld1,M 1i ybm 10/}/IOIl AMENOPOUPtWP0fPAYMENi ELS216165}311W0 91di13 i6TLAl WI EYlllB Y HI14].93yJ6 USTM Z".0I l3102i1 lA MM[90R11IX1 �IIII Tm5I", TMOHhN WFFICA i WPpIFnnM3 QI9P10mp3 WH/Cemp4cupu CHEAP" I NNPOR9106 ?3k`._ ,!b,{kti km 7 ' �.+NLP 9MINON HEALTH HUMAN St[ NKWMPMt IMMUI X052 a JMJ76 I'm ]6 1011/21123 WMFOUTC NI(M NFM}X [gl1[KNl[Y III 54,96150 . 10/04 NN0-(.OH[C3AMBM314W311l NOpgl39191 3.136.96 IOR/611I f330,t0 S,ISOAS 4360:12 Ys61fY0 3vitas UHCCO MUNIWPIHCWIMPITNMP9ICCWIO IVh/30II VNC[OMMUMIRIIMCMIMIMi3g6WMl19lIXW 3,Y9.5) 81956' 3,B39.1 O HONAVU311N0-SWON[CIMMLl"'Imt - 3Rg6 12,16 MIREM IVIEK) 10I UgHMNIAAAPIurN.W.fNWMPM21MI.MIIU43 - I,R3.M - L125.W 10M/]O13 YP➢SuppNnr[MNCCWMPMi M6WM11 W3Y 4,0 - a,N0,89 IWJAO31MN0-f0IV XfCWMIMT>IMnNl1NbL1166W � M0i act - 4 0.@ t96/MII WAfP14W01 COg1O[.pYM(Ni145'3Y3A5{llltlq - 3LYS.11 9,iT4'R ilRBl AET1All 1;.135,i1i ` 51,9625A 324µ501% 10.6M.90 3�30-13 - I6m" ✓ 35A96Y lR!Mj}',6u AASa6Cal`NF 9/JO/A1] 00p0Y1 9/M/)4SS MRXAUFOMDN{il)19MXSIMNi11RS11 9(MM/ l Nn1VOMSOLUM NCCUItMPi YU3114]L101 9/IOgO}S NOYRtl30(U(IONMCCOAlMl 61631011O11tlll 913NMx1 XUE OUr.U.EFAITHCAM IERIM(I130J)1 10/3/M2 2 WIRE WCLV(]!R M[LL]NGRE (txilRlrll 10/RnW1 oxauulvMr]1]mw111Km13avl Ip/]nW) HERE NNR([NOM[LU1MpM]]16%HII YDY01]R]Il M/3/101] NNOVRPS30MCCWMPMi9)6110 1WY1 M/NWl nerlpauphSCNUSCER KUIMPMe3191CWM1 311M M/1/1015 MOVR45 S0(V110X NLCWMM1i6]iD101]QWI]D 1x/111.XNMnNGLMn 01]BMCCWA3pMi3A96x1169'/J1x50 10/1/)O21x2 MNMRW.fXn 01fBNCCWMIMi I%46SNNSIED9 10/S,IMlS MOUXa M[.LL]XfAt MOV]IM[IfO3U901R1]RWM IMINxx MMB- ECHO NCCUIMPM] 74MUll M 1(C4W 106/ML MX6 f[NOMCCUIMPMi 116MA111IMN111Mi 10 INU VnIOdHoupiMXNCCWMlMT3)91 "III IMW IWIMIE Unlle OMMUN XCCWM]MMT]4=lUIDM 10(5/]012 NNCCOMMIOUTEF MNSPHAMi]1RWL119M" l0]6iD]i MnXMi[121DX[il]0MNSPMMC]M)MNSYLI IM12 XNI [CXONfMIMPMI ]]iW)111110KOITM9 IIRn/MMEn M4wMeMlomm�9mrom113r9oopocamao:uxll IOPMU;IMfR1GR0UPCOPPo4�PA9MfMf[9x4169R11M00 (ejLy91_nQf Tnndml^I 41PP/C.pt. OIW/Cumpx CI011o pl MMIQIHPp m GIPPO I NN PORTION MAS Rams .,S w. r 1,]36.50 49N.W 9SIDM }.95aR3 - 2704 M IM.I+ � Tou9 "I'llU] 1AIA.w - 1,525.91 19.96591 14,915.91 Ig931 - ],66932 I=. IAW.W 33A990] 1049W - 6TTA( SIPHON Ll69At 564A0 59U4 Mot Mfil 1AIMS 7p15.10 J406.50 - 3.306.M 13 1.. - 1,305W IIi4] - 3,234.33 - pW.m - 3.76000 - 1.14I.Il 6.M9.W 11NL)6 9rNa98 ;M.ECE 601)66A6 Iy099.66'. / 14247a32 ✓ MS.Y[91 ✓ 149)6.10 3dW.]p 1605Ltl0 ✓ 6;i9]A 363.964.71 15],3M." 9XIDS.10 W66.34 MiS9ah i19 1011012022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number Name Groups Account Type Add Group v. (DDA Data reported as of Oct 10 2022 Account Number Current Balance Available Balance Collected Balance Prior Day Belane Number of Accounts: 15 $4,404.454.06 $4,719,344.28 $4,404,454.06 $4,109,091.0 '4551 CAL CO INDIGENT S12,353.93 $12,353.93 $12.353.93 $12,353..< HEALTHCARE '4454 MEMORIAL MEDICAL 1 NH GOLDEN CREEK $70.190.63 $72,605.78 $70.190.53 $35,909.0 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.68 $536.68 $536,68 $5368 2014 •4357 MEMORIAL MEDICAL S3,286,121.25 S3,585,649.22 $3,286,121.25 S3,212,012.1 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $432.05 $432.06 $432.05 S432.0 WAIVER CLEARING 14381 MEMORIAL MEDICAL $103,902.87 $104.106,65 S103.902.87 $47.103.12 CENTER / NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $64.817.10 $64,817.93 $64,817.10 $52,834; BROADMOOR '4411 MEMORIAL MEDICAL $148.075.14 $161,803.61 S148.075.14 $103.662.7 CENTER / NH CRESCENT '4446 MEMORIAL MEDICAL $32.607,96 $33,946.75 $32,607.95 520,710,4 CENTER I NH FORT BEND '4438 MEMORIAL MEDICAL CENTER / SOLERA AT $103,597.49 $111,272.62 S103,597.49 $85,702.7 WEST HOUSTON '2998 MIMIC -MONEY MARKET $295,844,90 $295,844,90 $295.844.90 S296,844 c FUND '5506 MMC -NH BETHANY $125,356.79 S125,356.79 S125,356.79 $115.932.2 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA. $77,976.92 $77,976.92 S77.976.92 S76.553.£ MEDICAREIMEDICAID '5433 MIMIC -NH GULF POINTE $34,436.08 $34,436.08 $34.436,08 $20,594.E PLAZA - PRIVATE PAY '3407 MMC-NH TUSCANY $48,204.37 S48,204.37 $48.204.37 $28,907.7 VILLAGE t https:tlprosperity.albanking.com/onlineMessonger 111 Memorial Medical Center Nursing Home UPL Weekly Neslion Transfer Prosperity Accounts 10/10/2022 Novi.. Accowt BaOlnnlnB P.min1 TodaYS Byinnlo0 amount to Be Transferred to NuelnO Nunln Heme Number Behnce rT.enderAul iTransferm ,oe psln Babnce Nome 09,2/d-0s ✓ 89,11.A1 ✓ 70,19053 41,796.61 ✓/ Bent Balan[e 70,190.53 Veriana Nart:OnNbvfvncesv/vver53,000 will be oomhand to hheoumiN Avme. NWe 2: FPcA [[ceunthalabaee bolvn<e o/$]00 ehvtMMCdepvseetl to oaenvccvunc OCT 10 2022 BYCOUNIYAUorroA CALHOUN COUNTY, TEXAS leave In BaNna 200,00 supahloRmacupP 20.2so.my IulPlnt.mot 13.03 r% AUOustlnteren 17.41 Septembh,mu v, II.3B J AtlIusl Oalmu/rnnsfer Amt �. f�applPleP WILUPM11R1E,ff0 t 10/10/2022 I V H Weebr T,.mleMNN ues rumrer summary\lBu\MebarNn u9s10.I., sumn.q 10.10.22.41. MMCrO w EM ampv T^1�l14144) T n E OIPP/[amos afr/tvmo2 prop/Um 3 aY &Ulu aPrn NNPORIKKf - 9/30/2M2 - 9,610b 9,61<.M WIRCO950W0pHNCC4IMOMT6)609}d10080163 Wip[OOTNEXION NfALM AT001➢FNUfEX I"W"22 2 wu 831.0 W131M 15 10/3nO22 51381Mb M..11 - ISKM 1.126.10 HNH-IECHOHC5 MF5T7 11T9 10/3p02} HEALNKU HC 4n4IW34L 82)1 _ )65,89 yU5 g5 1a3/2W2 NF/LMN $VCHCWIMf } L129..96 1116.19 lO VI RXCDMLIMPM(1M6M)d9l79 T5Y5/3MryYIRSTBM[OyiLMT5U64y358>U9l]9 I0.339.96 32996 10.94LIB 1025/ID226a0fNCN91RW Li SMU 5 1.960.00 - d,960A0 1a6/M3i 15Y5/IRUN$(IR)i BBCO STLMi5d3645558)691]9 D$TLWSIiGM5697G9179 690.88 69688 10/6/ID22 TSOW M 1.515.08 1,S75.0a L=ONHMWMPW6Tl"74691]9 10/6/2@S HOVIS8y 50lVilONN[CNIM9Mf62609)dI000W65 dp25.75 4.625..)) 10022 MMNSFIWANCOnMMMM5554691)4 2,0 },) ] 60WXCREfRNG)MEflC0FP 12ID00 40. 0}00000 Onma<0nvMtlMB3314ll0m : 3MA 3$,39Ai6 4]0506 ]I2E0.90 1,65E56 B9.L6 )O,OWg9 I/lS.390i6 5.905.M UE5090✓ 8100919 10110/2022 Quick View Select Quick View Accounts Account Number I Name Account Type Treasury Center Select Group Groups Add Group Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $4,404,454.06 $4,719,344.28 $4,404,454.06 $4,109,091,C '4551 CAL CO INDIGENT $12,353.93 $12,353.93 $12,353.93 $12,353.f HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $70,190.53 S72,605.78 $70.190.53 $35,909.0 HEALTHCARE 365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.68 S536.68 $536,68 S536.E 2014 •4357 MEMORIAL MEDICAL $3,286,121.25 $3,585,649.22 $3,286,121.25 $3,212,012.? CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $432.05 $432.05 S432.05 S432.0 WAIVER CLEARING '4381 MEMORIAL MEDICAL $103,902.87 S104,106.65 S103,902.87 $47,103.0 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH S64,817.10 S64,817.93 $64,817.10 S52,834.E BROADMOOR '4411 MEMORIAL MEDICAL $148,075.14 S151,803.61 S148,075.14 $103,662.7 CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $32.607.96 $33.946.75 532,607.9E S20,710.4 CENTER I NH FORT BEND •4438 MEMORIAL MEDICAL CENTER/SOLERA AT S103,597.49 $111,272.62 S103.597.49 $85.702.7 WEST HOUSTON '2998 MMC -MONEY MARKET $295.844.90 S295,844.90 $295.844.90 S295,844.E FUND '5506 MMC-NH BETHANY $125,356.79 $125,356.79 $125.356.79 S115,932.£ SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- $77 976 92 $77.976.92 $77,976.92 $76,553.5 MEDICAREIMEDICAID '5433 MMC -NH GULF POINTE $34,436,08 $34,436.08 S34,436.08 $20,594.E PLAZA - PRIVATE PAY '3407 MMC •NH TUSCANY $48,204.37 $48,204.37 $48,204.37 $28.907.7 VILLAGE https:llprosperily.0lbanking.camlonlineMessenger 1!1 Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 10/10/2022 vmleu' amennunee m<wmt ee0nNX0 PendMl rnmfemme 09 x.m. r.,Tw. a.l.nte nnnn.o.< mmhrin iaru<.rta b b Tna, <er �mm w.m ry nt. Nnme 3se]a9 Jr 3q.6>359 </ IP,g6gl SIRIW.BI &nt &Imn 31,106.96 Welm[< Leweln &Nnn IOO.W // seP6RWR AVG MPP ISF26A c/ IulY lnlmat EaE� AulmHnnnn iM �/ hPlentealnE.36 ✓ XalunuunMnnnnAmn v.ggX.m PrrWnva ACgwt eryiwnl ve�nl Amnlxrtma nn enMn Nunln Neme Numev 0<I<nce lrrnrenVut iTnnsler-In .prpnne p 9in TPCe SBe NNn 9rWr NunN Home Rr8NL9ttIF. 161,39013 161R6].i9 rf ]]1a3,6B A,916.92 ✓A.e63.17 Hnk Llance ]].17692 viMin<e NO(c GlyXalvn<n of vvnS5.0agwlllbuvm/MiM to Uenurvnq Xame. Na(f]: EPNPt<Wnldvl vlwSeeNvn[eof$1W IXvtMMC efNlrt<dlo Cpm Ocfvunt. OCT 10 2022 SY COUNiYAU01TOR CALHOUN COUNTY. TEMS LLnveln Balanu 1NYlmrnat 9.n,/ AYgntlmrnat ".I91� hPtemtrnmmat Iq.rt ✓/// neiXn eslmnrtnn.InAnt _ T].ol.l> I// rorumAnM6u ss 6N ls. µr Mer6we: •" �"� / WIWRM In11F,Ci0 10/!0/29E3 omx nwtrynmalenylxyrinrminsummaM]OEIIgminNlx url rnmhrfummrn so 022 Oh. MARC PORTION OIPP/Comp OIPP/C.nU4 Tran4TeK-Out I..Ner.16 QIPP/C.Pl 2 QIPP/CPmp3 &Y Be QIPPTI PORTION NINION r..' 9(20j10 ! Qi4 oP,A4 4Y_pt ,. . .... 9/90/2022 HUB- ECHO HC<EAIMPMT 7460034114460002R,SSA 94.14 10/3/2022 HUB• ECHO NCCLAIMPATT 746003411440000238331 - 15.89 - 94.14 10/4/2012 HNB - ECHO HCCLAIMPMT74600341144D000295557 226.12 15.69 226.12 10/5/2022 HAS - ECHO HCCU3IMPMT 7000MIl 440000240662 - 364.61 - 364.61 1D/6/2022 N DC SWEEP PAC 4261 ZIOM24905674 SWEEP FR - 14,992.90 - 14,992.90 30/6/2022 HNB - ECHO HCCIAIMPMT 746MA411440000278195 - 423.68 10/6/2022 HN8-ECHO HCODUMPMT)46003311440900178196 - 25.62 422.68 10/6/2022 HNB-ECHO HCCLAIMPMT]46DO34114400001]8195 - 4SAUl - 23.62 /0/612022 HNB-ECHONCCIAIMPM1`74600341144DOW27782S - M2,57 - 48A8 10/]/3022 Gntene MamyRme pCH OOBT6544353411300002i< - 13.B4I.43 11,3/L02 2,619.41 12,516.0; 842.A 1,32p.]S 30.8]3.59 11212.02 L629A1 U52673 189488T 9/30IM22 MERCHNNTMNKCPOFP051T496'1385188899100W1 9/30/2022 NORIDWN 13A HCMIMPMTW58924200MIlMOT6 ION2022 WIRE OUT HMO SERVICES, LIK 10/3/IOR O."n 1013120U HEALTH HUMAN SVC HCCMIMPMT 174WU2130132 10/5/2022 MERCHANT BANKCO DEPOSIT 4964305 HOUR 9100001 1015120V NORIDMN33AHCCIAIMPMT675893420W01446963 Y/5/2022 HEALTH HUMAN SVC HCCYIMPMT 174MU111132 10/6/2022 MERCHANT BANKCO DEPOSIT 4WINISINHOS 00002 1017/20U HEALTH HUMAN SVC HCCUMMPMI I7400341130132 MMCPORTION QIPP/COmP QIPP/C91np4 Trander•O4t TUIASEN.I. I QIPP/Cempl 2 QIPp/COmp3 &Ypee QIPPTE I NHPORTION 2,13SAID - 3,135.Op 1.120,20 - 3.120.20 1,42BA0 - 7.428A0 1.412.62 1,412.62 42,430.81 - 42.639.81 5,279.00 - 5,729.0 IIA39.27 11.410.27 4467A0 2A67.00 1.422.97 - 1.422.97 161,26>.49 ]).BS3.fi8 E/' - T/B5360 262,267.49 1011,)2].27 11812.02 2629A1 12,926.73 96,20U.55 1011012022 Quick View Select Quick View Accounts Account Number! Name Account Type IF Search All DDA Account Number Current Balance Number of Accounts: 15 $4,404,454.06 '4551 CAL CO INDIGENT $12,353.93 HEALTHCARE '4454 MEMORIAL MEDICAL / $70, 190.53 NH GOLDEN CREEK HEALTHCARE '4365 MEMORIAL MEDICAL $536.68 CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL 53,266,121.25 CENTER -OPERATING '4373 MEMORIAL MEDICAL 5432.05 CENTER - PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL $103,902.87 CENTER / NH ASHFORD '4403 MEMORIAL MEDICAL $64.817.10 CENTER/NH BROADMOOR '4411 MEMORIAL MEDICAL $148,075.14 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $32,607.96 CENTER / NH FORT BEND '4438 MEMORIAL MEDICAL $103,597.49 CENTER I SOLERA A7 WEST HOUSTON '2998 MMC-MONEY MARKET $295,844.90 FUND 'S606 MMC-NH BETHANY $125,356.79 SENIOR LIVING 441 MMC -NH GULF POINTE PLAZA- $77 976 92 MEDICARE/MEDICAID 'S433 MMC -NH GULF POINTE $34,436.08 PLAZA -PRIVATE PAY '3407 MMC -NH TUSCANY 548.204.37 VILLAGE https.,/Iprosperity.olbanking.com/onlineMossenger Treasury Center Select Group Groups Add Group Data reported as of Oct 10, 2022 Available Balance Collected Balance Prior Day Balanc $4,719,344.28 $4,404,454.06 $4,109,091.0 $12,353.93 $12.353.93 $12,353.5 $72,605.78 $70,190.53 $35,909.0 S536.68 $536.68 $536.E 53,585,649.22 53,286,121.25 53,212,012.3 5432.05 5432.05 5432.0 $104,106.65 5103,902.87 $47,103.0 $64,817.93 $64.817.10 $52,834.5 5151,803.61 S148,075.14 5103,662.7 $33,946,75 $32,607,96 520,710.4 $111,272.62 $103,597.49 $85,702.7 5295,844,90 $295.844.90 5295,844.5 $125,356.79 S125,356.79 $115.932.2 $77,976.92 $77,976.92 $76,553 c 534,436.08 $34.436.08 $20,594.E $48.204,37 $48.204.37 $28,907.7 tlt Memorial Medical tenter Nursing Home UPL Weekly Tuscany Transfer Prosperity Accounts 10/10/2022 P.M. Atmvnl Bblmyn{ Nud�Nome vmW P64ma 86,bt$<b Nu.: a+MBnrum o/ow.sP,ava.nveenmt/nredtomenvnrnPhomn. Neh2: Fe[A xmvntAm o6orehnNnce of}1W IilotMMCdemiiteOrovpen rxvwnl. a 1" 1 !�7>f 1)'� OCT 10 2022 BY COUNTY AUDITOR CALHOUN OOUNTy, TEXAS 68.1o.W Am uMMav Pendlq Tnm}medu, lun4 UW,n bBRGI.I>� Var mte lvwvin BVWb MAG MVIINAAIIGGIP1, AMWGRWPAOGryvp t5$N.0 4dfult&InNe(rnnAvrAmt 219663d 8i A rand' lononon wluuvA umP,vo I 9/30/202Z Added b Acmunl 10/3/2022 WIRE OUT UNBAR EId7ERPRISES, LLC 10/3/2022 0eMsit 10/3/2022 MOUNA HEALTHCAR MONNAACH OU39NS 420 MW 10/5/2022 HNB - ECHO HCCIAIMPMT 746003411440000240673 10/5/2022 HNB- ECHO HCCIAIMPMT 746003411440M00241138 10/7/2022 HNB-ECHO HCCIAIMPMT 746MUll MOOM2266W 10/7/2022 AMENGROUP.CORPO&PAYMENT EES2441659 IIIRX) MMC PORTION QIPPIComp gIPP/Comp CUPP/COMP Transfer ut T nin 1 QIPP/Cgmpt 3 4611pse QIPPTI NHPORTION - L7.6B - 17.68 86,312.44 - - 11.M..01 - 11,596.01 9,471AS 7,625.22 IM6,23 8,548.35 923 12 3.872.38 - 3,872.38 1,830.19 - 3,850.19 2,02B.81 - 2,028.81 17,267.85 13,911.08 3,356.77 IS;569A7 1,679.39 86,332.44 f 48 304 21,536.30 6 203.00 24,137.SO J 23,966.57 10/10/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/Name Groups Add Group Account Type v' Search F Ali LDDA Data reported as of Oct 10 2022 Account Number Current Balance Available Balance Collected Balance Prior Day Balane Number of Accounts: 15 $4,404,454.06 $4,719,344.28 $4,404,454.06 $4,109,091A '4551 CAL CO INDIGENT $12,353.93 512,353.93 $12,353.93 $12,353.E HEALTHCARE '4454 MEMEDICAL! NH GOLDENOLDEN CREEK $70,190.53 $72,605.78 570,190.53 $35,909.0 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER • CLINIC SERIES $536.68 $536.63 5536.68 5536.E 2014 '4367 MEMORIAL MEDICAL 53186,121.25 $3,585,649.22 53,286,121.25 53,212,012.: CENTER -OPERATING "4373 MEMORIAL MEDICAL CENTER -PRIVATE 5432 05 5432.05 5432,05 $432.0 WAIVER CLEARING '4381 MEMORIAL MEDICAL 5103,902.87 5104,106.65 S103,902.87 $47,103.0 CENTER/NH ASHFORD `4403 MEMORIAL MEDICAL CENTER/NH $64,817.10 $64,817.93 $64.817.10 $52,834.t BROADMOOR '4411 MEMORIAL MEDICAL $148,075.14 5151,803.61 5148,075.14 $103,662.7 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $32.607.96 $33,946.75 $32.607.96 $20,710.4 CENTER/NH FORT BEND •4438 MEMORIAL MEDICAL CENTER / SOLERA AT $103.597.49 $111.272.62 5103,597.49 $85.702.1 WEST HOUSTON '2998 MMC -MONEY MARKET FUND $295,844.90 5295,844.90 5295.844.90 5295,844..< 'S506 MMC -NH BETHANY SENIOR LIVING $125.356.79 $125.356.79 5125,356.79 $115,932.2 'S441 MMC •NH GULF POINTE PLAZA- $77.976.92 $77,976.92 $77,976.92 $76,553.E MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE PLAZA - PRIVATE PAY $34 436.08 534,436.08 $34,436.08 520.594.E 4 7 MMC -NH TUSCANY VILLAGE $48,204.37 $48.204.37 $48,204.37 $28,907.7 https://prosperily.albanking.com/onlineMessenger 1/1 Memorial Medical Center Nursing Home IIPL Weekly HSLTransfer Prospetity Accounts 10/10/2022 ...t NotcPJVEWonmo)amSS.CW wiF6[front/nrtdmtM1enunmgFant. Nole2:rv[Fo[tnwtFolaI.IEe(entto%SIMIIN A1MC dlppNlNtoopen n[a L OCT 10 2022 BY COUIM AUDITOR MMOUN COUNTY, TOWS Iendlry Medium BeeYBLm[e Valline! [cave in8ahn[e 333,33639 IW.W MnOun<IOBf Inmlenedtf mhlme[fn VIsIv AVVwt Nhntl x3.I. J/ YfpumG1111If1fi1 I"M Miun YhnnRlemhl Mnt / ]161A.p -� Mptwed: WIU14M llr1{E CiO / Ipf10/lYii f.Wn WnYM inmlm\Nn W[ Irendnwmm.rv\xva\onoMnxn VOL 4m51e11umm.n HLIO22Ju MMCPORTIOH inm ..a3 y Tjt 0y3A1Q CUPT/Oompl OVP/COmp2 01PP/Q.p3 NPP/COmpldu,. yPIT NM PORPM i.dAlEC9At _ -29.32; .. 25a1'. 9/3p/l0}} 13.155.19 .:. 13.139A6 9/30/]012 Corm, - 123,50 - 15529 9/30/W23 HML7H 00311130161 NUMANSVAa IS},50 WME0 No,MPMi31<6 10/3/2011 W10E 01fI POPiGVAG NN,IIC ll4693.9] - SA,50 10/3/1G22al . N,J13.50 - 14.J13.10 10{3/lll}} pepOiil M,.o � 32,I6Z50 12,182.502. 2WI2022 Deposit Z203,16 03.16 10310RHO ECHO NOMW341 9926 SO/3/l022 NOYITAS SOLUTION HCMIMPM81MA143o00j81 ZMI, - 9.16 10/6/2012 Co"91 41.051.47 }}l6yly 10/7/2022 0[pmit l,7A.M - at,OSLO 10/712022 DepoUl ],163.39 - l.R0A9 10/]/3023 HGLTNN0MFt2 yVC N[MIMPMTI]JYOWI130162 % 516.69 J62 13e 1J6,ip3.9J 129.M D SS6.fi9 M 192 30 10/10/2022 Quick View Select Quick View Accounts Account Number / Name Account Type_._ Treasury Center Select Group Groups Add Group Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $4,404,454.06 $4.719,344.28 $4,404,454.06 $4,109,091.0 '4551 CAL CO INDIGENT $12.353.93 $12,353,93 $12.353.93 $12,353.9 HEALTHCARE '4454 MEMORIALMEDICAL/ C NH GOLDENNGREEK 570,190.53 $72.606.78 $70,190.53 $35,909.0 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES $536.68 $536.68 $536.68 $536.E 2014 '4357 MEMORIAL MEDICAL $3.286,121.25 $3.585,649.22 $3,286,121.25 $3,212,012.: CENTER -OPERATING _373 MEMORIAL MEDICAL CENTER -PRIVATE $432.05 $432.06 S432.05 5432.0 WAIVER CLEARING •4381 MEMORIAL MEDICAL $103.902.87 5104,106.65 5103,902.87 $47,103.1 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $64,817.10 $64,817.93 $64.817.10 552.834.E BROADMOOR '4411 MEMORIAL MEDICAL $146,076.14 5151,803.61 $148,075.14 $103,662.7 CENTER / NH CRESCENT '4446 MEMORIAL MEDICAL $32,607.96 $33,946.75 532,607,96 $20,710.4 CENTER / NH FORT BEND •4438 MEMORIAL MEDICAL CENTER/SOLERA AT $103,697.49 $111.272,62 $103,597.49 $85,702.7 WEST HOUSTON '2998 MMC -MONEY MARKET $295.844.90 S295,844.90 $295,644.90 5295.844 FUND 'S506 MMC -NH BETHANY 5125,356.79 $125,356.79 5125,356.79 $115.932.e SENIOR LIVING 'S441 MMC -NH GULF POINTE PLAZA- $77 976 92 $77,976.92 577,976.92 576,553.E MEDICARE/MEDICAID 'S433 MMC -NH GULF POINTE $34,436.08 $34.436.08 $34,436.08 $20.594.E PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY 548,204.37 $48,204.37 548,204.37 $28,907.7 VILLAGE r https://prosperity.olbanking.comlonlineMossenger 111 MEMOMAL IMEDIfIAL CEN i IER (-�HFCK REQlJf-'..S'-hshiv-A F, MEMORIAL MEDICAL CENTER )aft Requested: 10/10/22 --------- - -- ---- — A y AMOUNT [XPLAj'VAT!0,'\J': AUGUST QIPP PAYMENTS Mayra Martinez �%PPROVEBOM OCT 10 2022 By COUMY AUDITOR -,Aum'N' mwy, TtyAs FOR ACCT. USE ONLY olrnprmt Cash F-1A/p Chei-h [IN-bil Ohcclto Vendor IlReturn iu Dew G/t NUMBER,! 10255040 AUTH,U R 12" FP f3l 1: C'ENTER MEMORIAL MEDICAL CENTER e.>ues10/10/22 APPROVED ON OCT 10 2022 eyCOUNTY AUDITOR CAU40UN COUNW, TEYAS i-UR AU - i , U.5L (IM , 'y 11 imprest Cash FIA/P Chec',, FlMail Check to Vmdor R e t L: r i. Ch K 10 D e _j w.tiouwr NUrVISFR: 10255040 L.X F L 1UH AT: 0,'%!: AUGUST QIPP PAYMENTS .. .......... .. .. Mayra Martinez t Vl- 11 By. EVLMA, NAEDI-ALCEN'FER 5 lr`,CK REQUE"51 p MEMORIAL MEDICAL CENTER A AMOUNT EXPLA\WAT!01\1: AUGUST QIPP PAYMENTS Lb R', Mayra Martinez DatF Requested: 10/10/22 FOR ACCT. USE OINKY APPROVE-DOM Llimprestcash 11A/0 Check OCT I () 2022 1 1], Mail Check to V.�,ndor BY COUNTY AUDITOR I nfteiurn cirleck 0 Dent CALHOUN COUNTY, TWS ...... G/LNUNIBER: 10255040 1, A ---------- - . ..... NA E Nil 0 R i A i- INA E D I (-"A L CE N 1- E R CK R E 0 U E 5-1 - fort 6,3 MEMORIAL MEDICAL CENTER 10/10/22 AIVIOU-NIT FXKANAT!ohf: AUGUST QIPP PAYMENTS FOR ACCT. USE ONLY APPROVEDON I-] Irnpi est casil OCT 10 2022 nA/P Check 1Moil Check W V-ndor BYGOLINITYAUDITOR CALHOUN COUNTY, TEXAS 011 R 6 t L 1111 C f i (-, C 1 0 Dept 10255040 Mayra Martinez - - ---------- - NAEIVIOMAL MEDICAL CENTER REQ't.jF.5_lF - Soler._ p MEMORIAL MEDICAL CENTER Date Requested: 10/10/22 A y FOR ACCT. USE ONLY F"jimprest Ciso CA/P Ched, 9c I 10 2022 I Mai! Chr-ck to Vendor -BY COUNTY AUDITOR Retum. Chick La Dept CALHOUN COUNTY, TEXAS AIVIOUN-f G/l 1`10KABER: 10255040 AUGUST QIPP PAYMENTS Mayra Martinez At.) f WDRIZFE' B;"� p A y . ........... . ... IMEN1110MAL MEIDKI'Al. D-!E,*ILT EtVcLv— MEMORIAL MEDICAL CENTER Date Requested: 10/10/22 OCT .10 2022 By COUNTY AUDITOR CALHOUN COUNTY, TM(AS FOP, ACCT. USE ONLY II 21 Imp. est c7ish FIA/P Cheri: 0 Mail Check to Vendor F, Retui r, Chfed', CC. Dept AMOUNT GA NUMBFR: 10255040 r Y. P LA lJfA-10, �'c AUGUST QIPP PAYMENTS -,- - - ------------ -- !lf COJF.., Mayra Martinez MEMORIAL MEDICAL CENTER _ F pats Requested: 10/10/22 A FOR ACCT. USE ONLY LiiroprestCash ❑A/P Check OCT 10 2022 I-1Mail Check to vendor _._ �YCOUtMAUDITOR rclReturn Check W Dep: __. ,.......__..._.__ CALHOUN COUNTY, TEXAS AMOUNT $12526,73E:/L:-I0IVBE.R: 10255040 LXPLA IA110Pi: AUGUST QIPP PAYMENTS i-[(+cq- Mayra Martinez BY. I ..V10MAL PvqEDl(_'Al_ (TN"FE'. R '(K _- R!H U-ST-1wraol MEMORIAL MEDICAL CENTER 10/10/22 _OCT 1 0 2022 BYCOUWY CALHOUN COU UD AlvIOUNIT i*X�,LANAC"ION: AUGUST QIPP PAYMENTS POR ACCT. USE ONLY F-1 Imprest Cash QA/P ched, EfAail Check "o Vendor 171 Return Check to Dept i,IIAMBFR: 10255040 Mayra Martinez RIZH! Ll MEMORIAL MEDICAL CENTER 10/11/22 APPROVIED ON [-lA� cha�� OCT Y82022 ||10-ai|Check tnYe"clu, |>|Rac/rc0`n�k/oDaa� BY COUNTY ---`--.... ' CxuHVVNCOUNTY, &EM AMOUNT GA JVU- SEFr M&[R|NTEREST[ARNE0 . -----------'- — - -- ' ----- '''— -- -_ -- ! MpymyWarbnez �' ( - -�----' �---- S T MEMORIAL MEDICAL CENTER Onte 10/11/22 A FOR ACCT. USE ONLY APPROMON Imprest Cash L OCT 10 2022 OA/P Che:-I, 1 11 Mail Check to Vendor By COUNTY AUDITOR - iRewrr� Chvi�l� Lu Dept -------- .... _W" GALNOUN AN40LINT 51.21 G/L HUfV,&,FQ: 21400009 l:XP,LA.,JATlGflJ. JULY- SEPTEMBER INTEREST EARNED WMaVra Martinez I'vENIJORIAL MEDICAL k.. MEMORIAL MEDICAL CENTER 10/11/22 OCT 10 2022 EIA/P 'Imai Che-cktoVendor BY COUNTY AUDIT09 ! 7 COUNTY, TEXAS 1 1 i j L-J 21400010 ------------ -------------- JULY- SEPTEMBER INTEREST EARNED Mayra Martinez it i? I F Bl 2 (A 1, CT N TER % MEMORIAL MEDICAL CENTER e�uc10/11/22 FOR AccT, us7 a!t.y AMID "Som !I 'Jimprestc.ash 0 A / P On e o,; OCT 10 2022 []Mail 'r-hecl, Li veiijoi ay GOLIN9`f AOIDTFOR — Retui,i: CALHOUN GOUNTM TEi ILXAS Mi!:::IVI0, I t 3AED (,'�1.L. < FN !'r"' r� I ' I P MEMORIAL MEDICAL CENTER ,;t pt >ur,a,9: 10/11/22 A Y AA/IOUNT 72.52 )P ACCT. USE C)NIN � mprest Cash, I]Ai i> Cne.,k OCT 10 2022 EIMailCheck toVendor BYCOUMYAUD1TOR — jRatuir; Creck Lo Depc CAL40UN COUPM, TEXAS ! / L NUMBER: 21400011 FxFVWA?'!Oi3: JULY-SEPTEMBER INTEREST EARNED i Mayra Martinez BY. 1.. _. .__.._. .. _..._ __ .._.. _...._-._. _.. _._ . _ ..... _. ._. -._.. --------- -._..._ _.__..-.-_-_. .._ _... p A y E F !lil Fl-M 0 fiIAI, i 1EDi(;AL ?-"E N'`'; i MEMORIAL MEDICAL CENTER Dot Regijest(A: 10/11/22 1 FOR ACCT. USE ONLY l7trnpresFCasn -- OCT 10 2022 ❑A/:'Chcidk E Mail Cheri to V,F odor BY COUNTY AUDITOR � RBCtlieChecl:taDa71 ..-----(,ALKQUINMWNTY' TEXAS I � i G AIbiOLINT $42.82 (;/( tdUi��6f_•^21400013 FVPI AWA-!'.( f- 1111 V_ GFPTPNA IIFP It,ITFPFfT Fe Pn¢n I'VIEMORHAL MEMORIAL MEDICAL CENTER 10/11/22 A I POP. ACCT. USE ONLY F OCT 10 2022 LE AI'P Chest [] MAI Check o Vmcior F. ByCOUWYAUDffOR Elletum Check 6) Depi. t"OUN COUNITY. TMOS AMOUNT _$33.65— ....... GANUInUi: 21400014 A�,j,'O':C)N: JULY- SEPTEMBER INTEREST EARNED ij I I 1 3 Mayra Martinez PB — ---------- V!,TVIONAL MEDI(M. TER FN i c RECI! MEMORIAL MEDICAL CENTER 10/11/22 FOR ACCT. USE (DININ []A/P Chec;� ocl 10 2022 E ... ............ .. By COUWi'Y AUVITOR Return Check Lo Dep i: AMOLI HT $8.47 C,/l HUMPFR: 21400014 , L XPLAWI"'10N! JULY- SEPTEMBER INTEREST EARNED Mayra Martinez 0-:-HoU." IZF 0 L', Y: "'HECK RFCktjl-�3-1- MEMORIAL MEDICAL CENTER �,�r� l��rf,�e�;x.d: 10/11/22 A [WR ACCT. USE ONLY APPROVEDW LIlrnprest Cash h r "-'"-_--- OCT 10 2022 �A/" Ceer, ClMail t'h�a^icto t'ncior E BYCOUN9YAUDTOR �R_rurn Chcc;: is liep': C.ALHOUNCOUN7Y.TEXAS L_J AVOLT $78.91 G./IL t•IIJIVBER: 21400015 CAPLANATiON: JULY-SEPTEMBER INTEREST EARNED ;r B" Mayra Martinez „ RI%F. 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