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2023-02-01 Final PacketAll Agenda items Properly Numbered Contracts Completed and Signed J� All 1295's Flagged for Acceptance (number of 1295's -Z� ) J1 All Documents for Cleric Signature Flagged (All documents needing to be attested to need to be signed day of Commissioner's Court.) On this IVi, day of 2023 a complete and accurate packet for 14* of 2 U 3 Commissioners Court Regular Session Day Month was submitted from the Calhoun County Judge's office to the Calhoun County Cleric's office. 40,4� Calhoun CountyJudge/Assistant C:\Users\Maebelle.Cassel\Desktop\Agenda Templates\PACKET COMPLETION SHEET.Docx AGENDA NOTICE OF MEETING — 2/1/2023 Richard H. Meyer County judge David Hall, Commissioner, Precinct II Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4- NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, February 1, 2023 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: AT : I I /Call meeting to order. j�� Invocation. cou g 1 A BY: La/Pledges of Allegiance. <F General Discussion of Public Matters and Public Participation. t Consider and take necessary action to allocate the funds from the Local Assistance and Tribal Consistency Fund through the U. S. Department of the Treasury to be used for %the generator for the Combined Dispatch Building. (DEH) `6 Consider and take necessary action to accept the resignations of Teri Elliot and Steve Dublin from the Parks Board and appoint Jody Wiltsey and Keith Hubbard as their rgplacements. (DEH) `rj Consider and take necessary action to accept the bids for completing the Six. Mile Boat Ramp Project and Engineer's Letter of Recommendation for Award and award the contract to RW South Texas Concrete, Inc., and authorize Commissioner Lyssy to execute the contract. (VLL) 8,. Consider and take necessary action to authorize Commissioner Behrens to sign the 2023 maintenance contract with Hurt's Wastewater Management for the Precinct 3 septic /system. (JMB) 99. Consider and take necessary action to continue participation in TAC HEBP ARTS Program and authorize the County Judge to sign the agreement. (RHM) Page 1 of 2 I NOTICE OF MEETING — 2/1/2023 K-Approve the minutes of the January 25, 2023 meeting. ti onsider and take necessary action on any necessary budget adjustments. (RHM) r2. Approval of bills and payroll. (RHM) Richard H. Meyer,. County Ju Calhoun County, Texas. A copy of this Notice has been placed on the outside bulletin board of the Calhoun County: Courthouse, 211South Ann . Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county"s website at www,calhouncotx ore under "Commissioners' Court Agenda' for any official court postings. Page 2 of 2 MINUTES February 1, 2023 MEETING MINUTES OF CALHOUN COUNTY COMMISSIONERS' COURT MET IN A REGULAR MEETING AT 10:00 A.M. IN THE COMMISSIONERS' COURTROOM IN THE COUNTY COURTHOUSE AT 211 S. ANN STREET SUITE 104 PORT LAVACA, CALHOUN COUNTY, TEXAS. THE FOLLOWING MEMBERS WERE PRESENT: Richard Meyer David Hall Vern Lyssy Joel Behrens Gary Reese Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. County Judge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order by Judge Richard Meyer at 10 a.m. 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. Sheriff Vickery reminds the public that 6mile Volunteer Fire Department is having their annual fundraiser. Page 1 of 4 5. Consider and take necessary action to allocate the funds from the Local Assistance and Tribal Consistency Fund through the U. S. Department of the Treasury to be used for the generator for the Combined Dispatch Building. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct'2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 6. Consider and take necessary action to accept the resignations of Teri Elliot and Steve Dublin from the Parks Board and appoint Jody Wiltsey and Keith Hubbard as their replacements. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to accept the bids for completing the Six Mile Boat Ramp Project and Engineer's Letter of Recommendation for Award and award the contract to RW South Texas Concrete, Inc., and authorize Commissioner Lyssy to execute the contract. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER:Gary Reese, Commissioner Pct 4 AYES:,' Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to authorize Commissioner Behrens to sign the 2023 maintenance contract with Hurt's Wastewater Management for the Precinct 3 septic system. (JMB) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 4 9. Consider and take necessary action to continue participation in TAC HEBP ARTS Program and authorize the County Judge to sign the agreement. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pet 2 SECONDER:David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Approve the minutes of the January 25, 2023 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11, Consider and take necessary action on any necessary budget adjustments. (RHM) 2022: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 2023: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 , SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 4 12, Approval of bills and payroll. (RHM) APPROVED [UNANIMOUS] David Hall, Commissioner Pct 1 Vern Lyssy, Commissioner Pct 2 County, Bills 2022: 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<2023: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall,Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 4 # 05 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 January 18th, 2023. Consider and take necessary action to allocate the funds from the Local Assistance and Tribal Consistency Fund through the U.S. Department of the Treasury to be used for the generator for the Combined Dispatch Building Si eC rel',111� David E. Hall DEH/apt 5. Consider and take necessary action to allocate the funds from the Local Assistance and Tribal Consistency Fund through the U. S. Department of the Treasury to be used for the generator for the Combined Dispatch Building. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Nall, Lyssy, Behrens, Reese Page 2 of 9 # 06 6. Consider and take necessary action to accept the resignations of Teri Elliot and Steve Dublin from the Parks Board and appoint Jody Wiltsey and Keith Hubbard as their replacements. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall,,: Commissioner Pct 1, SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 9 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 February 1st, 2023. Consider and take necessary action to accept Teri Elliot and Steve Dublin from the Parks Board and place Jody Wiltsey and Keith Hubbard in their places. Si �rel , David E. Hall DE H/apt # 07 7. Consider and take necessary action to accept the bids for completing the Six Mile Boat Ramp Project and Engineer's Letter of Recommendation for Award and award the contract to RW South Texas Concrete, Inc., and authorize Commissioner Lyssy to execute the contract. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pet 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 9 Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 January 25, 2023 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: (361) 552-9656 Fax (361) 553-6664 Please place the following item on the next Commissioners' Court Agenda • Consider and take necessary action to accept the bids for completing the Six Mile Boat Ramp Project and Engineer's Letter of Recommendation for Award and award the contract to RW South Texas Concrete, Inc., and authorize Commissioner Vern Lyssy to execute the contract. Sincer ly, Vern Lyssy VL/Ij G&WENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)552-4509 • f: (361)552-4987 TBPE Firm Registration No. F04188 January 25, 2023 Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., Yd Floor, Suite 301 Port Lavaca, TX 77979 RE: LETTER OF RECOMMENDATION Six Mile Boat Ramp Improvements Dear Honorable Judge & County Commissioners, Bids for construction of the above referenced project were received at G&W's office and we received a total of two bids. We recommend awarding RW South Texas Concrete, Inc. which is the lowest, most qualified, acceptable bid at a project cost of $25,000.00. We have worked with RW South Texas Concrete, Inc. on past projects and they have proven to be qualified and capable of doing the required work for this project. Please call me @ (361) 552-4509 if you have any questions. Sincerely, G & W Engineers, Inc. Scott P. Mason, P.E. Enclosures: Bids Engineering Consulting Planning Surveying M PROJECT NAME: Six Mile Boat Ramp P.roiect Contractor NAME: RW SOUTH TEXAS CONCRETE, INC. Item Quantity Unit Price Total Bid Price Comments 1, 'Furnish all necessary equipment, I `LS $8,000.00 $8,000.00 materials, and labor for mobilization, demobilization; barricades and insurance. 2. For all necessary equipment, 1 LS $12,000.00 $12,000.00 materials and labor for the installation of a temporary cofferdam and removal upon project completion in accordance with the drawings and specifications. I For all necessary equipment, 1 LS $5,000.00 $5,000.00 materials and labor for the installation of the reinforced concrete boat ramp bottom (150 SF) for a complete installation in accordance with the drawings and specifications. TOTAL BASE 810 $ 25,000.00 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are Interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 it there are no interested patties. .CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2023-975430 RW SOUTH TEXAS CONCRETE, INC. ROCKPORT, TX United States Date Filed: 01/24/2023 2 Name of governmental entity or state agency that is a party tot the contract for which the form is being filed. CALHOUN COUNTY 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. HMGP DR -NO. Contractor shall provide all necessary equipment, materials, labor, to reinforced concrete boat ramp as per drawings and specifications. Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Parry. X 6 UNSWORN DECLARATION Mynameis Randy Willingham , and my date of birth is My address is TX- U.S.A. (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed In Aransas County, State of.. Texas 11 on the 25 day of Jan. 20 23 (month) (year) -Signature of authorized agent of contracting business entity (Declarant) Forms provided by I exas tmlcs commission www.etmcs.siaieax.us Version V CERTIFICATE OF INTERESTED PARTIES — FORM 1295 II&IOX911.0j 11 at 1":1*3111 01011AVAO775 Effective January 1, 2016, pursuant to Texas Government Code, Section 2252.908 (the Interested Party Disclosure Act), the County/District may not award a contract to a contractor unless the contractor submits a Certificate of Interested Parties Form 1295 (the Disclosure Form) to the County/District as prescribed by the Texas Ethics Commission (TEC). In the event that the contractor's quote for the County/District is the best bid received, the County/District or its consultant, will promptly notify the contractor. That notification will serve as the conditional verbal acceptance of the bid. Upon this acceptance, the winning contractor must promptly, not later than 5:00 p.m. (CST) on January 19, 2018 file the materials described below. PROCESS FOR COMPLETING THE DISCLOSURE FORM The Disclosure Form can be found at https://www.ethics.state.tx.us/forms/1295.pdf, and reference should be made to the following information in order to complete it: (a) item 2 — Name of County/District (b) item 3 —the identification number (HMGP DR -NO.), and (c) item 3 — description of the goods or services assigned to this contract by the County/District You must: 1) complete the Disclosure Form electronically at the TEC's electronic portal, and 2) print, sign and deliver a copy (scanned and emailed is fine) of the Disclosure Form and Certification of Filing that is generated by the TEC's electronic portal. The following link will take you to the electronic portal for filing: https://www.ethics.state.tx. us/TECCertint/paues/login/certLogin.'sf Also, a detailed instruction video may be found here: https://www.ethics.state.tx.us/whatsnew/elf info form1295.htm Neither the County/District nor its consultants have the ability to verify the information included in a Disclosure Form, and neither have an obligation nor undertake responsibility for advising any business entity with respect to the proper completion of the Disclosure Form. � �a 8. Consider and take necessary action to authorize Commissioner Behrens to sign the 2023 maintenance contract with Hurt's Wastewater Management for the Precinct 3 septic system. (JMB) 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 9 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309 Email: iccl:behrenS(&,calhouncotx = Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for February 1, 2023. • Please Consider and Take Necessary Action to allow Commissioner Behrens to sign the 2023 maintenance contract with Hurt's Wastewater Management for Precinct 3 septic system. Sincerely, Joel Behrens Commissioner Pct. 3 Hurt°s Wastewater Management, Ltd. P.O. Box 662 / 321 Hwy 172 Ganado, TX 77962 Date:./9/2023 To: Calhoun County PCT. 3 24627 St. Hwy 172 Port Lavaca, TX 77979 Installed: 614120DE County: Calhoun aranty Expired: 6/412010 Installer. Colin Marshall Agency: Victoria County Health Dept - Environmental Mfg/Brand; -Norweco 960-500 SVP-900345KV Phone: (800) 841-3447 Fax: (361) 771.3452 www.hurtswastevrater.corn Contract Period Customer ID Start Date: 2/12/2023 2632 End Date: 2/1212024 Site: 24627 St. Flay 172, Port Lavaca. TX r797o1i Email: joel.behmns@calhoun=tx.org Permit: 2008-173 Hurts Wastewater Management. Ltd. 3 visits per year - one every 4 months Subdivision: Map Key: Terms of Maintenance Contract 1.) Three (3) inspections per year (at least one every 4 Months). Inspections include adjustment and servicing of the mechanical, electrical and other applicable components to ensure proper unction. This includes inspecting the control panel, aerators and liters. Replacementirepair costs will be charged directly to the homeowner. A Hurt's Wastewater Management, Ltd. employee will visit the site within 48 hours of a problem being reported. Inspections may be performed anytime during the month they are due, with a two week grace period before and after the month the inspections are due. 2.) The homeowner is responsible for maintaining a chlorine residual of at least 1.0 mg/L in the treatment system. This can be accomplished by using chlorine (caldiun hypochlorite) tablets for systems designed with a tablet chlorinator. Swimming pool tablets must not be used in the aerobic system designed for chlorine tablets because they cause corrosion of the components of the system. At the time or a service inspection, the service representative will inform the homeowner if the chlorinator does not contain sufficient tablets or liquid chlorine (whichever is applicable) to effectively disinfect the wastewater. 3.) The required routine reporting of system operation and function to the local authority, as required by OSSF regulation, will be covered by the policy. Any additional visits, inspections or sample collections required by speck County Agencies, TCEQ or any other regulatory agency in your jurisdiction will not be covered by the policy.. 4.) The contract may be voided if NON -BIODEGRADABLE MATERIALS are used in the system. 5.) All Commercial systems will have a BOD and TSS test performed annually. Additional charges will be charged to owner for BOD and TSS testinc. This warranty is strictly limited to the above terms and does not include the cost of replacement components, chlorine or pumping of sludge build-up. The maintenance policy includes labor charges only for normal routine inspections and maintenance. Additional service calls are not covered by the policy. Service determined to be caused by abuse or neglect is not covered by the policy. Failure to pay for service call, labor• and/or replacement components not covered under warranty will void contract. VIOLATIONS include shutting off the electric current to the system for more than 24 hours, disconnecting the alarm system, restricting ventilation to the aerator• overloading the system above its rated capacity, introducing excessive amounts of harmful matter into the system, or any other form of unusual abuse. The homeowner agrees to provide Hurts Wastewater Management Ltd. with all gate combinations, keys, etc. necessary to gain access to the system for the purpose of conducting routine inspections or service calls prior to the start date of this contract and notify Hurts Wastewater Management immediately with any changes and provide the nevr combinations or keys. By signing this form, both i_•crarcc p: cr�.�r ont :1c7-,&Q'X—, r agree tc ;ha te:-s c`:NsThri;cy. THIS POLICY DOES NOT INCLUDE PUMPING SLUDGE FROM UNIT IF NECESSARY. Please check your contract preference: S300.00 Service contract only; no chlorine (homeowner must install own chlorine) :Z$375.00 Service contract with chlorine provided Please include yo��Pa��ym//entMwith%ft s/�ned contract. Home Owner. ia•c.L. (' i :..1F fl,'tsn f_i Date: Phoneme W: ! '— (� - � Hurts Wastewater'Management Ltd.: � h Date: �i >2 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1af1 Complete Nos. 1- 4 and 6 it there are interested parties. Complete Nos.1, 2.3, 5, and 6 it there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2023-973245 Daze Piled: 01/18/2023 Date Acknowledged: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Hurts Wastewater Management, LTD Ganado, TX United States 2 Name of governmental entity or state agency that is a party tot the contract for which the form is being filed. Calhoun County Precinct 3 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 comracL 2008-173 Septic System Service/Maintenance Contract 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is Brad Hurt and my date of birth is My address is (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Jackson County, State of Texas f, ,on the i8 day of January 2023 (month) (year) Signature of authorized agent of contracting business entity (Declarann Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.3ac88bc0 # 09 9. Consider and take necessary action to continue participation in TAC HEBP ARTS Program and authorize the County Judge to sign the 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 Page 6 of 9 Mae Belle Cassel From: cindy.mueller@calhouncotx.org (cindy mueller) <cmdy.mueller@calhouncotx.org> Sent: Wednesday, January 25, 2023 2:12 PM To: Mae Belle Cassel Cc: rhonda kokena; Richard Meyer Subject: Agenda Item Request Attachments: ARTS Renewal Confirmation Program Agreement 2023.pdf; 2023 ARTS file deadlines.pdf Please place the following item on the agenda for February 1, 2023: Consider and take necessary action to continue participation in TAC HEBP ARTS Program and authorize County Judge to sign agreement. No 1295 is needed because TAC is a governmental entitiy. Note that some parts of the fillable form did not work correctly. Cindy Mueller County Auditor Calhoun County 202 S. Ann, Suite B Port Lavaca, TX 77979 V: 361.553.4610 F: 361.553.4614 Cindv.mueller@calhouncotx.org Calhoun County Texas Ass OCIATION AND EMPLOYLL• January 23, 2023 Affordable Care Act Reporting and Tracking Service (ARTS) Renewal Information The Texas Association of Counties Health and Employee Benefits Pool (TAC HEBP) has begun the renewal process for those counties and districts participating in the Affordable Care Act Reporting and Tracking Service (ARTS). Renewal will enable your entity to produce the forms required by IRS Sections 6055/6056 for calendar year 2023, assuming this reporting continues to be a requirement. Reporting will consist of Form 1095C, which must be provided both to employees and the IRS (plus transmittal Form 1094C, filed with IRS). Current law requires all employers with 50 or more full-time equivalent employees to file these forms. ARTS will provide measurement period tracking for 2023 and beyond (to determine whether an employee must be offered health coverage), as well as affordability testing for groups that require employee contributions toward the cost of their own health coverage. As your county or district provides health benefits through TAC HEBP, ARTS will continue to be available at NO COST in 2023, assuming program deadlines are met. Your entity will need to continue sending employee, payroll, and unpaid leave of absence files to TAC HEBP in order to utilize this service for the 2023 reports. Payroll data must be provided for each payroll cycle. Employee files must be provided, at a minimum, once per quarter. LOA files may be provided if and when applicable. The information provided will be used to determine: 1) whether individuals are eligible for a federal premium subsidy or tax credit; and 2) whether your entity is subject to penalties under the ACA employer mandate. Some payroll vendors have worked with TAC to produce these files for you. You will be responsible for the completion of required information in your payroll system and submission to TAC, but this eliminates the need for manually producing additional spreadsheets. If you use a payroll system that will produce the required IRS forms, and you determine that your entity does not need measurement period tracking or affordability monitoring, you may not need ARTS. It is a service offered by TAC and is completely optional. Enclosed is the ARTS Renewal Confirmation Program Agreement. Please return a signed copy (initials on pages 1 and 2, signature on page 3) to your Employee Benefits Consultant or email to ARTS@county.org no later than bi/31/2023�if your entity wishes to continue its participation in the program. If you have any questions, please contact your Employee Benefits Consultant at (800) 456-5974. ASSOCIATION AND EMYLoYEE ACA Reporting and Tracking Service (ARTS) 2023 Renewal Confirmation Program Agreement HEBP Member: (Pooled Group or ASO) Program Services The ARTS program includes the following services: • Measurement, Administrative, and Stability Period tracking for 2023 and notification of eligibility for part-time / variable / seasonal employees (can provide tracking back to beginning of Measurement Period if 2022 data was provided by county/district); • Reporting for your county/district regarding the status of potential benefits -eligible employees; • Production of your county/district's 1095C forms, shipped to you for distribution to employees (optional direct mail service for additional fee); • Transmission of your countyldistrict's 1094C and 1095C forms to the IRS. Program Requirements 1) Participants agree to provide employer, payroll, employee and unpaid leave of absence (LOA) files related to the group's Health Benefits Plan in the file format designated by TAC HEBP: o Payroll data files must be provided for each payroll cycle, and should be submitted at least once per calendar month. o Employee data files must be provided, at a minimum, once per quarter. o LOA data files may be provided if and when applicable. NOTE: It is critical that you provide your files in the proper format and the correct naming convention. Failure to do so may result in our inability to provide this service to your county or district. 2) Group agrees to pay program fees as described in the 2023 ARTS Fee Schedule. Enrollment and Data Submission Deadlines • Please refer to the enclosed "2023 Deadlines for ARTS Files' document for details. • Groups who wish to participate in the ARTS program must return the signed documents to TAC HEBP no later than March 31, 20231 in order to participate. ■ Data file transmission to TAC HEBP must begin no later than August 4, 2023 to avoid late fees, however, we recommend that you continue sending your files after each payroll or at least monthly to avoid getting backlogged. TAC HEBP- ARTS Renewal Confirmation Program Agreement 2023 - Page lot 3 TEXAS ASSOCIATION Of" COUNTIES HLAL7I3 AND FmpLoYEE BENEErTS POOL ACA Reporting and Tracking Service (ARTS) HEBP Member (Fully Insured or ASO) 2023 Fee Schedule for Renewing Participant 1 �✓ ARTS Annual Subscription Fee *$4.75 / form Waived 2 _ / Optional Forms Distribution (group $1.50 form If applicable, will be billed in 2023 U chooses to have TAC mail employee forms) / after forms are produced Late fee for service election form Li- 3 (after 313112023) $1,500 4 a Late fee for data submission $3If applicable, will be billed in 2023 (after 81812023 andlor 110812024) ,000 after forms are produced Total Amount Due: (if zero, enter 0.00) *Per 1095C form Fees subject to change annually TAC HEBP - ARTS Renewal Confirmation Program Agreement 2023 - Page 2 of 3 $ 0.00 Initials, TEXAS ASSOCIATION Of COUNTIES HEALTH AND EMPLOYEE BLNEPITS POOL Contracting Authority: Calhoun County (Group Name) hereby designates and appoints, as indicated in the space provided below, a Contracting Authority of department head rank or above and agrees that any notice to, or agreement by, a Group's Contracting Authority, with respect to service or claims hereunder, shall be binding on the Group. Each Group reserves the right to change its Contracting Authority from time to time by giving written notice to HEBP. Name: Rhonda Kokena Title: County Treasurer Address: 202 S Ann Ste A Port Lavaca, TX 77979 Phone: Email: rhonda.kokena@calhouncotx.org Fax: Phone 361.553.4620 Fax 361.553.4614 Primary Contact: Main contact for data file and reporting matters pertaining to the ARTS program. Name: Cindy Mueller Mailing Address: Title: County Auditor 202 S Ann Ste B Port Lavaca, TX 77979 Delivery Address (no PO Boxes): Phone: same as above Phone 361.553.4610 Email: cindy.mueller@calhouncotx.org Fax 361.553.4614 Other Contact Emails for ARTS correspondence regarding data files, if any: c of County Judge Authority Date Richard H. Meyer, County Judge Print Name and Title TAC HEBP - ARTS Renewal confirmation Program Agreement 2023 - Page 3 of 3 2023 Deadlines for ARTS files z G o < 0 0 CD CD January -June July — September Cr a Cr CD CD ARTS Files Due to TAC no later than 8/4/23 IDue by Due by Due by Due by Late Penalty: $3,000 10/31/23 11/30/23* 12115/23* 1/08/24*" ARTS Agreement due by 3131/23 Late Penalty. $1,500 .TEXAS A$SoC lArioN Of COUNTIES HEA1. 11 ANn Euvl.mF.v. BENEFITS Pool. * NOTE: If these file deadlines are not met, TAC HEPBwill not guarantee timely production of 1095C forms " If all 2023ARTS files not received by 1108124: Late Penalty: $3,000 #10 10. Approve the minutes of the January 25, 2023 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER; David Hall,Commissioner Pct 1 AYES: Judge Meyer, Commissioner' Hall, Lyssy, Behrens, Reese Page 7 of 9 Richard H. Meyer County judge; David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners'-Cowat of Calhoun County, Texas met on Wednesday, January 25, 2023, at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. Attached are the true and correct minutes of the above referenced meeting. Ri hard H. Meyer, Cou udge Calhoun County, Texas Anna Goodman, County Clerk Deputy Clerk aina3 Page 1 of 1 JANUARY 25, 2023 MEETING MINUTES OF CALHOUN COUNTY COMMISSIONERS' COURT MET IN A REGULAR MEETING AT 10:00 A.M. IN THE COMMISSIONERS' COURTROOM IN THE COUNTY COURTHOUSE AT 211 S. ANN STREET SUITE 104 PORT LAVACA, CALHOUN COUNTY, TEXAS. THE FOLLOWING MEMBERS WERE PRESENT: Richard Meyer David Hall Vern Lyssy Joel Behrens Gary Reese (ABSENT) Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. County Judge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order by Judge Richard Meyer at 10 a.m. 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. District Attorney, Sara Rodriguez introduced Arnold Hayden, a new attorney in the District Attorney's office. 5. Hear report from Memorial Medical Center. Roshanda Thomas. gage the report.. 6. Hear reports from Texas Agrilife Extension agents. Emily DeForest, Haney Hayes antl Karen Lyssy gave th ilr repiirt$' 7. Consider and take necessary action to approve the final payment to Shirley and Sons for Magnolia Beach and Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project. (DEH) RESULT: APPROVED;[UNANIMOUS] MOVER: David Hall, Commissioner Pct i SECONDER: Vern' Lyssy, Commissioner Pdt 2 AYES•„ Judge Meyer, Commissioner' Hall`,,Lyssy, Behrens, Reese `. 8. Consider and take necessary action to approve and ratify the signatures on the quotes/contract from Kraftsman on the Buyboard purchase of the pavilions at Miller Point and the Bird Walk at by Miller Point. (DEH) RESULT APPROVED [UNANIMOUS] .; MOVER Vern Lyssy,.Cpmmission"sr Pct 2!;: SECONDER. David Hall, Commissioner Pct 1 Judge Meyer; .Commissioner Hall,. Lyssy, Behrens, Reese 9. Consider and take necessary action to authorize Sheriff Vickery to make two emergency purchases (one vehicle each) of two vehicles from.one vendor. These are two separate purchases of two separate vehicles from a Chicago Motor Company that specializes in police vehicles and is not on the Buyboard. As these are separate emergency purchases, this will allow the sheriff to spend over the $50k with one vendor within the same year. These two vehicles come totally equipped and the price of both is cheaper than the purchase of one new vehicle. (RHM) RESULT: APPROVED [UNANIMOUS] . MOVER Vern Lyssy, Commissioner Pct 2` SECONDER: Gary Reese, Commissioner Pct 4 . AyESJudge Meyer; Commissioner Half; Lyssy, Behrens; Reese 10. Consider and take necessary action to approve the use of GOMESA funds in the amount of $49,990 for Stantec Consulting Services for the scope of work for the Port Alto Shoreline Permit Amendment. (JMB) RESULT - APPROVED [UNANIMOUS] MOVER Gary Reese; Commissioner Pct 4 SECONDER:; Jpefbehrens, Commissioner•Pct3 AYES: Judge Meyer; Commissioner Hall, Lyssy, Behrens, Reese ` 11. Consider and take necessary action to approve the Preliminary Plat of Bay Club at Falcon Point Ranch, Phase 1, Lot 9R. (GDR) RESULT APPROVED [UNANIMOUS] MO1%ER Gary Reese, Commissioner Pdt 4 SECQNDE.R . - Joel Behrens; Commissioner Pct B AYEss Judge Meyer,;Comt lsslonerNalf Lyssy, Behrehs,;Reese 12. Consider and take necessary action to approve the Matagorda Bay Mitigation Trust, Contract No. 034 - Bulkhead Improvement at Swan Point and authorize Judge Meyer to sign all documents. (GDR) RES�I_r7 APPROVED [UNANINt1OUS] MOVER. Joel Behrens; Commissioner Pct 3 SECONDER: David Hall, Gommissiorser Pct 1' AYES.: Judge Meyer,;Commis'sfanbr HaII;:Lyssy, Behrens; Reese _- 13. Consider and take necessary action to approve the FY 2023 Interlocal Agreements and authorize Judge Meyer to sign all documents. (RHM) (1) Calhoun County Senior Citizen's Association, Inc. $35,000.00 (2) The Harbor Children's Alliance & Victim Center $28,500.00 (3) Calhoun County Crime Stoppers $ 1,000.00 (4) Calhoun County Soil and Water Conservation District No. 345 $7,750.00 RESULT APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2` SEGOIDER: Joel Behrens; Commissioner Pct-3 AYES Judge Meyer; Commissioner Hal_I, Lyssy, Behrens;. Reese -. 14. Consider and take necessary action to transfer a 2007 Toyota Pickup VIN STFRV54187XO14450 (abandoned VEH #C-22-0322) from the Sheriffs Office to Precinct #2, Commissioner Lyssy. (RHM) RESULT APPROVED [UNANIMOUS] Elk., R David Hall; Commissioner Rct 1 SECONDER: Gary Reese, Corrlmissioner Pet 4 AYES Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action to transfer a 2007 Gradall, asset number 24- 0375, from R & B Precinct #1 to R & B Precinct #2 and authorize Commissioner. Lyssy to transfer $50,000 from R & B Precinct #2 account 1000-550-73400 to R & B Precinct #1 account 1000-540-43400 for the transfer of equipment. (DEH) (RESULT. •- APPROVED [UNANIMOUS] MOVER. David Hall 'Commissioner Pct;1 SECONDER: . Vern :Lyssy; C9mmissionerPct2 AYES Judge Meyer, Commissioner Hall; Lyssy, Behrens, Reese 16. Approve the minutes of the January 11, 2023 and January 18, 2023 meetings. RESULT. APPROVED [UNANIMOUS] MOVERi Vern Lyssy; Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pet 4 ES'Meyer, Commissioner Hall, Lyssy, Behrens, Reese; 17. Accept Monthly Report from the following County Office: i. County Clerk - December 2022 RESULT: APPROVED [UNANIMOUS] OVER- Vern Lyssy; Commissioner Pct 2 E.CO _PEM Joel,Behrerts, Commissid-h r PCt 3 AYES .Judge Meyer, Irommissioner Hafl, Lyssy, , , Behrens Reese'" 18. Consider and take necessary action on any necessary budget adjustments. (RHM) None Page 4 of 5 2;\O.COMMISSIONER COURT MINUTES ETC\2023 19. Approval of bills and payroll. (RHM) MMC Brlls RESULT APPROVED [UNANIMOUS] MOVER David Hall; Commissioner Pitt 1 SECONDER: VernLyssy,.Commissibner Pct 2 AYES:; Judge Meyer; Commissioner Ha€I, Lyssy,'eehrens Reese Gounty Bails 2022: RESULT APPROVED [UNANIMOUS] 1140I Ri Davld Hall, Commissioner Pitt 1 SECONDER; VernLyssy, Gommi55ioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, :Roese Copinty 611IIs;2023: RESULT APPROVED [UNANIMOUS] MbVER. David Hall, Commissioner Pct'1' SECONDER: €: .Vern Lyssy,.Commissioner Pct_2;. AYES: Judge Meyer :Commissioner Hall., Lyssy, 6ehreos Reese,: „ Adjourned: 10:56 a.m. Page 5 of 5 Z:\O.COMMISSIONER COURT MINUTES ETC\2023 #11 11. Consider and take necessary action on any necessary budget adjustments. (RHM) 2022: RESULT:. APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 2023: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 9 y F z m O n a Z N O r~a O ((00 co wof w� O O z F z W F L W c W D O OCt O eeQ (A fA C') z Efilzz2 z z QQ z U U U c O O O c z z z Z e Z W W W O rn rn rn a Q W W W O J_ a F Z a a N O � w = Q a ir CL D O U U U Z�� p Ona m D w z O0 W N C N N (NO No1 of 0 m w ofw w� 0 N N Z F z W I� d !W § B& » § § (� )o §z !. 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(RHM) MMC Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall,` Commissioner Pet 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: I Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County Bills 2022: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Co 2023: APPROVED[UNANIM David Hall, CommissionE Vern Lyssy, Commission Judge Meyer, Commissi( I 1 :2 call, Lyssy, Behrens, Reese Page 9 of 9 n N O 0 N M N N O N O N C lO O � Itl N �D 1p M N � N N M N N w N 1p L� M cI L} a a a a a Q 4 4 Q Q W E a E w � N W W W H m 0 W W W N w EHl W IV 0 M U U o a a O N H a a z am H w W M �M�q 9a W O U O m F FA U H U EF U W w q pW N N N N 0 0 0 o a N N N N CA Ad a a u Poll as as E. p w a a a q a a a a DIw w w a a a a a a a a 0 0 0 om P4 pi pi a awwDw O O O O H U U U U WU E H H w a UI UJ w 1 [ �9 E 0. b 1d MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---February 01, 2023 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYAB.LES PAYROLL AND ELECTRONIC BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDS TOTAL NURSING HOME UP.L EXPENSES_ TOTAL INTER-OOVERNMENTTRANSFERS S 1,006,962.38i S 1,845,732.50', '/ $ 3,041,906.261'. ✓ GRAND TOTAL DISBURSEMENTS APPROVED February 01, 2623$ 6;694,fi01:16', MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---February 01 2023 PAYABLE$ AND PAYROLL 1/2612023 Weekly Payables 239179.62 112612023 Patient Refunds 583.19 1/2712023 Blue Cross Blue Shield -Insurance 227,203.19 1/27/2023 Sun Life -Insurance 11,132.26 1/3012023 McKesson-340B Prescription Expense 5,355.37 1/30/2023 Ameriscurce Bergen-340B Prescription Expense 722.70 1/3012023 Payroll Liabilities -Payroll Taxes 118,851.22 1/30/2023 Payroll 378.484.32 1/30/2023 Health Equity -Wage works employee FSA 25,323.12 Prosperity Electronic Bank Payments 11234/27123 Pay Plus Patient Claims Processing Fee 127.39 TOTAL PAYABLE$,PAYROLLAND ELEGTttONIC BANK PAYMENTS: $ 1,006,962.3$', TRANSFERS BETWEEN FUNDS-MMC 1/30/2023 Transfer from Operating to Money Market Account- higher interest rates 1,750,000.00 TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 1126/2023 MMC Operating to Ashfordcorcection of NH insurance and QIPP payment 6,778.42 deposited into MMC Operating 1/26/2023 MMC Operating to Solera-correction of NH QIPP payment deposited into 1,827.56 MMC Operating 1/26/2023 MMC Operating to Fort bend -correction of NH QIPPpayment deposited into 1,904.52 MMC Operating 1/26/2023 MMC Operating to Broadmeor-correction. of NH QIPP payment deposited Into 2,273.54 MMC Operating 1/26/2023 MMC Operating to Crescent -correction of NH QIPP payment deposited into 551.47 MMC Operating in error 1/26/2023 MMC Operating to Golden Creek -correction of NH Insurance and QIPP 3,588.72 payment deposited into MMC Operating In error 1/26/2023 MMC Operating to Gulf Pointe Plaza -correction of NH insurance and QIPP 34,075.90 payment deposited into MMC Operating 1/26/2023 MMC Operating to Tuscany Village -correction of NH insurance and QIPP 41,889.51 payment deposited into MMC Operating 1126/2023 MMC Operating to Bethany -correction of NH insurance and QIPP payment 2,842.56 deposited into MMC Operating In error TOTAL TRANSFERS BETINEENFUNDS:... _ _..... $ 1,646p732.56 NURSING HOME UPL EXPENSES 113012023 Nursing Home UPL-Centex Transfer 1,851,140.30 1/3012023 Nursing Home UPL-Nexion Transfer 96,404.69 113012023 Nursing Home UPL-HMG Transfer 164,438.62 1/3012023 Nursing Home UPL-Tuscany Transfer 319,276.34 1/30/2023 Nursing Home UPL-HSL Transfer 530,055.15 QIPP CHECKS TO MMC 1/30/2023 Ashford 32,432.64 1/30/2023 Broadmoor 12,018.65 1/3012023 Crescent 8,346.69 1130/2023 Fort Bend 10,138.30 1/30/2023 Sclera 9,706.96 1/30/2023 Tuscany 17,94TT4 TOTAL NUR$ING'HOME UPLEXPENSES; $ 3;1141 306.28 TOTAL INTER-GOVERNM„ENTTRANSFERS $' GRANI] TOTAL DISBURSEMENTS APPROVEb Fehrua � 66,694(6011167 Page 1 of 11 RECEIVED 13Y THE r,OUN-IY AUDITOR ON JAgj Aj023 MEMORIAL MEDICAL CENTER 61 0 AP Open Invoice List 1 UN Due Dates Through: 02/11/2023 CA4-NOUN COUNTY, -sExAS 9 ap_opan_invoice.template Ventlor# Vendor Name Class Pay Cade A1360 AMERISOURCEBERGEN DRUG CORP v/ w Invoice# Cgmment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 3119709159 01125/2001/15/2001121120. 25,574,00 0,00 0.00 28.674.00 ✓j INVENTORY Vendor Totals Number Name Gross Discount No -Pay Net A1360 AMERISOURCESERGEN DRUG CORP 28,574.00 0,00 0.00 28,674.00 Vendor# Vendor Name Class Pay Code A2218 AQUA BEVERAGE COMPANY ✓ M Invo[ce# , Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 244670 v' 01126/201PJ311PO 01/25M 10.00 0.00 0.00 10.00 ✓� LATE FEE 244719,/ 01/25/2012/31/2001125120 10.00 0.00 0.00 10.00 ✓'� LATE FEE Vendor Totals Number Name. Gross Discount No -Pay Net A2218 AQUA BEVERAGE COMPANY 20.00 0.00 0.00 20.00 Vendor# Vendor Name Class Pay Code / A0400 AUREUS RADIOLOGY LLC ,/ Invoice# / Comment Tran Dt Inv Dt Due Dt Check 0, Pay Gross Discount No -Pay Net 2884403M 01/1812001109/2002108/20 3,740.00 0.00 OAO 3,740.00 t,- LAB.STAFF] NGi11}'t3-1- 2 )WIL) 1*464 . Vendor Totals Number Name Gross Discount No -Pay, Net A0400 AUREUS RADIOLOGY LLC 3,740.00 0.00 0.00 3,740.00 Vendor# Vendor Name Class Pay Cade 13692 BLUE CROSS BLUE SHIELD REFUND ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 011923 OV26/2001/19/2002111/20 76.52 0.00 0.00 76.52 PATIENT REF , Vendor Totals Number Name Gross Discount No -Pay Net 13892 BLUE CROSS BLUE SHIELD REFUND 76.52 0.00 0.00 76.62 Vendor# Vendor Name Class Pay Code 14064 CAPITAL ONE ✓/- Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1646493207 01/25/20 01119120 02/01120 320.85 0.00 0.00 320.85 ✓� SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 14064 CAPITALONE 320.85 0.00 0.00 320.85 Vendor# Vendor Name Class Pay Code C1325 CARDINAL HEALTH 414, INC../� W Invoice# Cgmment Tran Dt Inv Dt Due Dt Check 0, Pay Gross Discount No -Pay Net 8003050091 � 01/18/20 12/24/2D 01/18/20 471.25 0.00 0.00 471,25 of SUPPLIES 8003038052 / 01/2612012I012001/04/20 401,07 0.00 0.00 401.07 L� SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net C1325 CARDINAL HEALTH 414, INC. $72,32 0.00 0.00 872.32 Vendor# Vendor Name I Class Pay Code 14260 CAREFUSION SOLUTIONS, LLC r/ file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/U88l25/data_5/tmp..cw5report904191... 1 /26/2023 Page 2 of 11 Invoice# comment Tran Dt Inv Dt Due Dt Check Or Pay Gross Discount No -Pay Net 1002006021-5 ✓ 01/25/20. 01109/2002101/20 1,788.00 0.00 0.00 1,788.00 .i MAINT 1002006022-31/ 01/25/20 01/09/20 02/01/20 2.00 0.00 0.00 2.00 MAINT Vendor Total. Number Name Gross Oiscount No -Pay Net 14260 CAREFUSION SOLUTIONS, LLC 1,790.00 0.00 0.00 1,790.00 Vendor# Vendor Name Class Pay Code / C1390 CENTRAL DRUG ,r W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 052322 01/25/20 05/23/20 06/22/20 19.40 0.00 0.00 19.40 J INVENTORY 062722 O1/25/2006/271200712712G 9,70 0.00 0.00 9.70 ✓�� INVENTORY 11212022 01/25120 11/21/20 12121/20 19.40 0.00 0.00 19.40 INVENTORY . Vendor Total=Number Name Gross Discount No -Pay Net C1390 CENTRAL DRUG 48.50 0.00 0,00 48.50 Vendor# Vendor Name Class Pay Code 13264 CERVEY, LLC d- Involce# , Comment Tran or Inv or Due Dt Check D Pay Gross Discount No -Pay Net - 19998 01/25/2001/05/2001/30/20 11699.00 0.00 0.00 1,699.00 .- Vendor Total;Number Name Gross Discount No -Pay Net 13264 CERVEY, LLC 1.699.00 0.00 0.00 1,699.00 Vendor# Vendor Name Class Pay Cade 11956 CMT MEDICAL / Invoice# Comment Tran or Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 4603252 01/17/20 01/10/20 02/10/20 144.69 0.00 0.00 144.69 1/' SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11956 CMT MEDICAL 144.69 0,00 0.00 144.69 Vendor# Vendor Name Class PAY Code C1970 CONMED CORPORATION v/ M Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net 10086528✓ 01/26120 01/07/20 02107/20 197.90 0.00 0.00 197.90 SUPPLIES Vendor Total: Number Name Grass Discount No -Pay Net C1970 CONMED CORPORATION 197.90 0.00 0.00 197.90 Vendor# Vendor Name Class Pay Code 14080 CORROHEALTH, INC.v Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net / 897559v 01/26/2012/3V2001130/20 2,147.60 0.00 0.00 2,147.601 CODING SERVICES , Vendor Total -Number Name Gross Discount No -Pay Net 14080 CORROHEALTH, INC. 2,147.60 0.00 0.00 2,147.60 Vendor# Vendor Name Class Pay Code 14608 COTIVITI Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net 011923C 01/26/20 01/19/20 02/11/20 80.71 0.00 0.00 80.71 o f PT REFN itle:///C:Nserslitrevino/cpsi/memmed.cpsinet.com/u88125/data_51tmp_cw5report904191... 1 /26/2023 Page 3 of 11 011923B 01/26120. 01119/2002/11120 1,935.17 0.00 0.00 1,935.17 PT REF[ 011923D 011261PO 01/19/20 02/11/20 56.96 0.00 0.00 66.96 t/' PT RFD 011923E O1/26120 01/19/20 02/11/20 1,935.17 0.00 0.00 1,935.17 w. ' PT REFND 011923A 01/26/20 U1119/20 02 11120 64.10 0.00 0.00 64.10 PT REFUNC 011923 01/26/20 01/19/20 02/11/20 134.82 0.00 0.00 134.82 ✓ PATIENT REFC , Vendor Total=Number Name Gross Discount No -Pay Net 14608 COTIVITI 4,206.93 0.00 0.00 4,206.03 Vendor# Vendor Name Class Pay Code 10509 DA&E / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 18466 ,/01126/2001/12/2002/01120 1,895.00 0.00 0.00 1,895.00 CAH MEDICARE , Vendor TotalE Number Name Gross Discount No -Pay Net 10509 DA&E 1,895.00 O.00 0,00 11895.00 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON ✓ Invoice# Comment Tran Dt Inv of Due Dt Check D Pay Gross Discount No -Pay Net 7054732 r/ 01/25/2001/i2/2002106120 155.97 0.00 0.00 155.97 v`r SUPPLIES /. 706.9840✓ 01/25/2001 it 7/2002111/20 255.52 0.00 0.00 255,52 ✓ SUPPLIES Vendor Total. Number Name Gross Discount No -Pay Net 10368 DEWITT POTH&SON 411.49 0.00 0.00 411A9 Vendor# Vendor Name Class Pay Code 14708 EQUALIZE RCM SERVICES , / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 529783✓'f 01/18/20 01110/20 02/10120 5,000.00 0.00 0.00 5, sot; ✓F RCM ASSESSEM ENT FEE , Vendor Total: Number Name Gross Discount No -Pay Net 14708 EQUALIZE RCM SERVICES 51000.00 0.00 0100 51000.00 Vendor# Vendor Name Class Pay Code 11944 EQUIFAX WORKFORCE SOLUTIONS Invoice# Co menl Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 2053984369 01110/20 01/06420 02/07/20 10.99 0.00 0.00 10.99 .- EMPLOYEE VERIF . Vendor Totals Number Name Gross Discount No -Pay Net 11944 EQUIFAX WORKFORCE SOLUTIONS 10.99 0.00 0.00 10.99 Vendor# Vendor Name Class Pay Code C2510 EVIDENT -' M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net T2301091378 / Ot/25/20. 0110912001/09/20 10,371.38 0X0 0.00 10,371.38,,- MEDICAL CODING/BUS SERV , T23011713781 0112512001/1712U 01/17/20 7,815.40 0.00 0.00 7.815.40 .- BUSINESS SERV , Vendor Totals Number Name Gross Discount No -Pay Net C2510 EVIDENT 18,186,78 0.00 0,00 18,186.78 file:///C:/Users/Itrevino/cpsi/menmied.cpsinet.com/uSS 125/data_5/tmp_cw5report9O4191,.. 1/26/2023 Page 4 of I 1 Vendor# Vendor Name Class Pay Code S0501 EVOQUA WATER TECHNOLOGIES LLC Invoice# comment Tran Dt Inv or Due Dt Check D' Pay Gross Discount No -Pay Net 905682597 ✓ 01/23/20 01/12/20 02 O6120. 1,514.39 0.00 0.00 1,514.39 SUPPLIES 903150340 1/ 01/25/20 06/23/20 07/18/20 190.80 0.00 0.00 190.80 >-'r FILTER CTRG 903150342 v` 01/25/2006/23/2007/18/20 572.40 0.00 0100 572,40 ✓� CTRG /FILTER 905432089 J 01/25/20 07/01/20 07/26/20 2,511.19 0.00 0.00 2.511.19 . CONTRACT 7122-1213122 905432088 �/ 01/25/20 07/01/20 07/26/20 2,490.35 0.00 0.00 2,490.35 CONTRACT 905444194, 01/25/2007/12/2008106120 524,00 0.00 0.00 524.00 CONTRACT SERV 905627044 / 0112512011/30/2012125/20 540.00 0.00 0.00 540.00 LAB SERV 905687430,E 01/25/2001/01/2001126120 2,755.39 0.00 0.00 2,755.39 " CONTRACT 905667429Y/01125/20 01101/20 01126/20 2,877,96 0.00 0.00 2,877.96 ✓' CONTRCAT 1-1-23-6-23 Vendor Totale Number Name Gross Discount NO -Pay Net S0501 EVOQUA WATER TECHNOLOGIES LLC 13,976.48 0.00 0.00 13,976AS Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE M Invoice# / Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 9357015 ✓ 01/26/2001104/2001(29/20 136.36 0.00 0.00 136.36 J'{ SUPPLIES D394617 v/ 01/26/2001/OMO 01/30/20 1,633.93 0.00 0.00 1.633.93 v SUPPLIES 9394619✓ 01 /26/20 01/05120 01/30/20 1.664.50 0.00 0.00 1,684.50 -' SUPPLIES 9394618 r� 01/28/2001/05/2001/30120 19.81 0.00 0.00 19.81 v'° SUPPLIES 9471940 v' 01/26/20 01/09/20 02 O3120 300A2 0.00 0.00 300.42 SUPPLIES 9471939 ✓1 01/26/20 01/09/20 02/03/20 112.64 0.00 0.00 112.64 ,11 SUPPLIES F 9512729 %/ 01/26/20 01/10/20 02/04/20 14,500.19 0.00 0.00 14,600.19 ✓ SUPPLIES 9512728 ✓ 01/26/20 01/10/20 02/04/20 473.00 0.0o 0.00 473.00 v SUPPLIES 9512726 01/26/20 01110/20 02 O4120 -100.64 0.00 0.00 -100.64 v "! CREDIT 9512730 u/ 01/26/20 01/10/20 02/04/20 323.50 0.00 0.00 323.50 ✓ SUPPLIES 9553171� 01126120 01/11/20 02JOS120 2,422.39 0.00 0.00 2,422.39 v-" SUPPLIES Vendor Totale Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 21,486.10 0.00 0,00 21,486,10 Vendor# Vendor Name Class Pay Code file:/1/C:/Clsers/ltrevino/cpsi/memmed.cpsinet.corn/u88125/data_5/tmp_cw5report904191... 1 /26/2023 Page 5 of 11 10901 GENESIS DIAGNOSTICS ✓� Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 53439A 01/26120 10/26/20 11/25120 102.93 0.00 0.00 102.93 SUPPLIES Vendor Vendor Totals Number Name Gross Discount No -Pay Net 10901 GENESIS DIAGNOSTICS 102.93 0.00 0.00 102.93 Vendor# Vendor Name Class Pay Code G1210 GULF COAST PAPER COMPANY' M Invoice# Comment Tian Ot Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net 2337647 ✓ 01/17/20 01/10/20 02/09/20 645.01 0 W 0.00 645.01 v'l SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPER COMPANY 645,01 0.00 0.00 645-01 Vendor# Vendor Name Class Pay Code H0032 H + H SYSTEM, INC,/ Invoice# Comment Tran or Inv Dt Due Ot Chock D Pay Grass Discount No -Pay Net 0396,08 of 01/26/20 01111/20 01126/20 93.97 0.00 0,00 93.97 SUPPLIES Vendor TotalU, Number Name Gross Discount No -Pay Net H0032 H+HSYSTEM,INC. 9197 0.00 0,00 93.97 Vendor# Vendor Name Class Pay Code 10334 HEALTH CARE LOGISTICS INC ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 308745541 ✓r 01110/20 11130/20 12/25/20 337.61 0.00 0.00 337.61�, SUPPLIES Vendor Total -Number Name Gross Discount No -Pay Net 10334 HEALTHCARE LOGISTICS INC 337.61 0.00 0.00 337,61 Vendor# Vendor Name Class Pay Code H1227 HEALTHSURE INSURANCE SERVICES ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net. 3386 �% 01125120 12130/20 01/01/20 25,901.00 0.00 0.00 25,901.00 OOLI RENEWAL 3387 ✓ 01/25/2012/30/2001/01/20 26,072.83 0.00 0.00 26,072,83 ` BILLING ERRORS/OMISSIONS Vendor Totals Number Name Gross Discount No -Pay Net H1227 HEALTHSURE INSURANCE SERVICES 51.973.83 0.00 0.00 51,973.83 Vendor# Vendor Name Class Pay Code 12868 HOLTCAT ✓ Invoice# cor`0ment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net, WIEZ0036502y' 0 1/25/20 01/06120 01/21120 3,497.24 0.00 0.00 3,497.24�- 500 PM2 MAINT Vendor Totals Number Name Gross Discount No -Pay Net 12868 HOLT CAT 3,497.24 0.00 0.00 3,497.24 Vendor#Vendor Name Class Pay Code 10530 HUMANA v'� Invoice# Comment Tran DI Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 011223, 01/26/20 DIM 2/2002/11/20 61.88 0.00 0.00 61.88 b PATIENT RFO , / 011923 / 01/26/20 01/19/20 02/11/20 156.63 0.00 0.00 156.63- PATIENT RFD Vendor Totals Number Name Gross Discount No -Pay Net file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report904191... 1/26/2023 Page 6 of 11 10530 HUMANA 218.51 0.00 Vendor# Vendor Name �, Class Pay Code 10922 HUNTER PHARMACY SERVICES ✓ Invoice# Comment Tran of Inv of Due Dt Check DPay Gross Discount 5236 ✓/ 01/25/2012/31/2001/20/20 15,128.67 0.00 PHARMACIST SALARY Vendor Totals Number Name Gross Discount 10922 HUNTER PHARMACY SERVICES 15, 128.67 0.00 Vendor# Vendor Name Class Pay Code 12628 LEGATO/ Invoice# Comment Tran of Inv Dt Due Dt Check D' Pay Gross Discount C-2538 01/25/20 09/30/20 10/30/20 100.00 0.00 LOGO REQUEST 1081 �/ 0112512012/31/2001130120 947.50 0.00 FLYER/HANDOUTS Vendor Totals Number Name Gross Discount 12628 LEGATO 1,047.50 0.00 Vendor# Vendor Name Class Pay Code 11203 MEDI-DOSE, INC I /,/ Invoice# Comment Tran of Inv Of Due of Check D Pay Gross Discount / 0875843 �/ 01/25/20 01/13/20 01/25/20 135.60 0.00 SUPPLIES Vendor Totals Number Name Gross 11203 MEDI-DOSE, INC 135.60 Vendor# Vendor Name Class Pay Cade 11612 MEDICAL AIR SERVICES ASSOC../ Invoice# Comment Tran of Inv of Due of Check D Pay Gross 1433778 01/25/20 01/15/20 02101/20 1,777.00 INSURANCE Vendor Totals Number Name Gross 11612 MEDICAL AIR SERVICES ASSOC. 1,777.00 Vendor# Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC M Invoice# Comment Tran of Inv Of Due of Chock D, Pay Gross 224538489901/11/200111112002/05/20 t06A19 SUPPLIES 2246428508 /1 01/11/20 01/11/20 02105/20 25.34 S/UpPLIES 2248031301 ✓ 01/25120 01101/20 01/26120 28727 SUPPLIES 2247269018 ✓ 01/25/20 01/06/20 01/31/20 449.20 SUPPLIES 2247443343✓ 01/25/20 01107/20 02101/20 12.23 SUPPLIES 2524744334P �/ 01125/20 01/07/20 02101/20 33.00 S/Up PLIES 2247868209 ✓ 01/25/20 01/10/20 02/04/20 22.84 SUPPLIES 2247868208 v/ 01/25/20 01/10/20 02/04/20 41.18 SUPPLIES 2248030395✓ 01125/20 01111120 02/05/20 1,632.40 0.00 218.51 No -Pay Net 0100 15,128.67 "f No -Pay Net 0.00 15,128.67 No -Pay Net 0.00 100.00 0.00 947.50 r.+ No -Pay Net 0.00 1,047.50 No -Pay Net 0.00 135.60 ✓f Discount No -Pay Net 0.00 0.00 135.60 Discount No -Pay Net 0.00 0.00 1,777.00 Discount No -Pay Net 0.00 0.00 1,777,00 Discount No -Pay Net 0.00 O.00 106.16✓ 0.00 0.00 25.34✓ 0.00 0.00 2e7.27^^d..'` 0.00 0.00 449.20 0.00 0.00 12,23 0.00 0.00 33.00 0.00 0.00 2284�/' 0.00 0.00 41.18 ✓Z 0.00 0.00 1,632.40 v/ file:///C:/UsersAtrevino/cpsi/memmed.cpsiiiet.com/u88125/data 5/tmp_cw5report904191... 1/26/2023 Page 7 of 11 SUPPLIES 2248030390 ✓/ 01/25/20 01/11/20 02/05/20 4.15 0.00 0.00 4.15 SUPPLIES 2248030396 ✓ 01/25/20 01/11/20 02/05/20 67.32 0.00 0.00 67.32 ✓'� SUPPLIES 2248030387 ✓ 01/25/20 01/11/20 02/05/20 38.61 0.00 0.00 38.61 SUPPLIES 2248030391✓r 01125/2001/1112002/05/20 134.64 0.00 0.00 134.64 �1 SUPPLIES 2248030394v/ 01/25/2001/11/2002/05120 34.68 0.00 0.00 ,r 34.68 SUPPLIES 2248030385 r// 01/25/200111112002/05/20 108.50 0.00 0.00 M. 108.50 V SUPPLIES 2248031303 v� 01/25/2001/11/2002/05/20 40,60 0.00 0.00 40.60✓� SUPPLIES 2248030399 �/ 01/25/20 01/11/20 02/05/20 925.74 0.00 0.00 925.74✓/ 88 PPLIES 2248030393✓ 01/25/20 01/11/20 02/05/20 214.05 0.00 0.00 214.05 ✓'� SUPPLIES 2248030398 ✓/ 01l25/20 01/1t/20 02l05/20 260.36 0.00 0.00 250.36 .: SUPPLIES 2248030368 ✓ 01/25/20 01/11/20 02/05/20 132.1E 0.00 0.00 132.15 SUPPLIES 2248030397,/ 01/25/2001/11/2002105/20 134.64 0.00 0.00 134.64 ✓' SUPPLIES 2248007920 v'/ 01/25/2001/11/2002105/20 10,194.61 0.00 0= 10,194.61 V� SUPPLIES 2248031304 / 01/25/20 01111120 02/05/20 4171 0.00 0.00 41.71 v/ SUPPLIES 2248030389 of 01/25/20 01/11/20 02/05/20 8.30 0.00 0.00 8.30 ✓` SUPPLIES 2248031302V1 01/2512001/11/2002O5120 3,700.00 0.00 0.00 3,700.00 SUPPLIES 2248030392 ✓1 01/26/2001/1112002/05/20 201.98 0.00 0.00 201.96 SUPPLIES 2248230391 v- 01/25120 01/12/20 02/06120 38.15 0.00 0.00 3B.15 .. � SUPPLIES 2248230393 v// 01125/20 01/12/20 02106/20 207.17 0100 0.00 207.17r! SUPPLIES 2248230395✓ 01/25120 01/12120 02/06/20 207.17 0.00 0.00 207.17 ✓� SUPPLIES 2248230394 �/ 01/25/20 01/12/20 02/06/20 148.90 0.00 0.00 148.90 vl SUPPLIES � 2248230396✓ 01/25/20 01/12/20 02/06/20 28.51 0.00 0100 28.51 v SUPPLIES 2248230392 z Ot/2512001/12/2002/O6/20 39.94 0.00 0.00 39.94 v+"f SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 19,511.47 0,00 0.00 19,511.47 Vendor# Vendor Name Class Pay Code 10904 MERCK SHARP & OOHME CORP / file:///C:/Users/ltrevino/cpsi/memmed.epsinet,comlu88125/data_5/tmp_cw5report904191... 1 /26/2023 Page 8 of 11 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 7016612740E 12/31/2012/0712002105120 1,512.79 0,00 0.00 1,512.79 f INVENTORY PHARM 7016629517 /� 01/11/20 12113/20 02111120 1,520.29 0.00 0,00 1.520.29 v' v INVENTORY Vendor Totals Number Name Gross Discount No -Pay Net 10904 MERCK SHARP & DOHME CORP 3.033.08 0.00 0.00 3,033.08 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC y11' Invoice# Comment Tran Dt Inv Dt Due Dt Check 0, Pay Gross Discount No -Pay Net 9101537,E 01/2512001111/2001/21120 1,779.76 0.00 0.00 1,779.76 ✓' INVENTORY 9115042 rf 01/25/20 01/15/20 01/25/20 T40 0.00 0.00 7.40 . INVENTORY 9115040/ 01/25/20 01/15/20 01/25/20 58,75 0.00 0.00 58.75 ✓� INVENTORY " 9115041 r% 01 /25/20 01/15/20 01/25/20 737.36 0.00 0.00 737.36 INVENTORY 9113175 V' 01/25/20 01/15/20 01/25/20 941.51 0.00 0.00 941.51 ✓ INVENTORY , 9116836.r 0112512001/16/2001/26/20 4.92 0.00 0.00 4.92 ✓ INVENTORY , 9119469 ✓ 01/25/20 01/16/20 01126/20. 270.65 0.00 0.00 270.65 INVENTORY 9116838✓/ 01125120 01116/20 01126/20 1,646.81 0.00 0.00 1,546.81 INVENTORY 9116834 ✓ 01/25120 01/16/20 01126/20 1.48 0.00 0.00 1,48 INVENTORY 9116837 ,! 01/25120 01/16/20 01/26/20 5.20 0.00 0.00 5.20 ✓� JNVENTORY 9116835/ 01/25/2001/16/2001/26/20 46.32 0.00 0.00 46.32 +.^' INVENTORY 9119470 rs 01/25/20 01/16120 01/26/20 663.58 0.00 0.00 883.58 INVENTORY 9123855V� 01/25/20 01117/20 01/27/20 200,47 OAO 0.00 200.47 INVENTORY 9123866 01125120 01117120 01/27/20 10.22 0.00 0.00 10.22 % INVENTORY 9121792 ✓ 01/25/2001 ry 712001127120. 1.48 0.00 0.00 1.46 V.= INVENTORY Vendor Totals,Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 8,278.91 0.00 0.00 6,275.91 Vendor# Vendor Name Class Pay Code 13548 NACOGDOCHES TRANSCRIPTION rZ Invoice# Comment Tran Dt Inv Dt Due Dt Check 0, Pay Gross Discount No -Pay Net 7953 a'` 01125/200112312D 02/02/20 258.86 0.00 0.00 258.86 TRANSCRIPTION SERV (t{-1 Vendor Totals Number Name Gross Discount No -Pay Net 13548 NACOGDOCHES TRANSCRIPTION 258.86 0.00 0.00 258.66 Vendor#Vendor Name Class Pay Cade 12388 NATIONAL FARM LIFE INSURANCE file:///C:/UsersAtrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report904191... 1/26/2021 Page 9 of 11 Invoice# Comment Tran Dt Inv DI Due Dt Check D- Pay Gross Discount No -Pay Net 3867396 101/25/20 01/16/20 02/01/20 3,787.76 0.00 0.00 3,787.76 ✓' INSURANCE Vendor Totals Number Name Gross Discount No -Pay Net 12388 NATIONAL FARM LIFE INSURANCE 3,787.76 0.00 0.00 3,787.76 Vendor# Vendor Name Class Pay Code ` 11472 OCCUPRO LLC �,r Invoice# , Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 28712 0112612012fO7/2001/06/20. 502.11 0.00 0.00 502.11 MONTHLY LICENSE Vendor Totals Number Name Gross Discount No -Pay Net 11472 OCCUPROLLC 502.11 0.00 0.00 502.11 Vendor# Vendor Name Class Pay Code 01416 ORTHO CLINICAL DIAGNOSTICS ✓ Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1852753726 ..`' 01/11/2001/11/2002/1O120 752.16 0.00 0.00 752.16,,.' Vendor Totals Number Name Gross Discount No -Pay Net 01416 ORTHO CLINICAL DIAGNOSTICS 752.16 0.00 0.00 752.16 Vendor# Vendor Name Class Pay Code OM425 OWENS & MINOR Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay, Net 2082260909 ✓ 01/26/20 01/05120 02104/20 70.93 0.00 0.00 70.93 .. SUPPLIES 2082400920 1/01/26/20 01110/20 02109120 141.86 0.00 0.00 141.56 � SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net OM425 OWENS & MINOR 212.79 0.00 0.00 212.79 Vendor# Vendor Name Class Pay Code 10896 OIAGEN INC Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 998634489 ✓ 01/26/20 01/06120 02105120 359.93 0.00 0.00 359.93 .- SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10896 OIAGEN INC 359.93 0.00 0.00 359.93 Vendor# Vendor Name , Class Pay Code / 11080 RADSOURCE Invoice# Comment Tran Dt Inv Ot Due Or Check D Pay Gross Discount No -Pay Net SC32090223 01/25/20 01112120 02/06120 1,791.67 0.00 0.00 1,791.67 SERVAGREEMENT SCS2690223 yri 01125/20 01/16120 02/10/20 1,708.33 0.00 0.00 1,708.33 SERVICE AGREEMENT Vendor Totals Number Name Gross Discount No -Pay Net 11080 RADSOURCE 31500.00 0.00 0.00 3.600.00 Vendor# Vendor Name Class Pay Code 11251 RAPID PRINTING LLC V Invoice# Comment Tran Dt Inr Dt Due Dt CheckOPay Gross Discount No -Pay Net 16111 r/ 01125120 12/07/20 12110/20 30.00 0.00 0.00 30.00 f' FOAMSOARD Vendor Totals Number Name Gross Discount No -Pay Net 11251 RAPID PRINTING LLC 30.00 0.00 0.00 30.00 file:///C:/Userslltrevinolepsi/memmed.epsinet.com/u88125/data 5/tmp_ew5report904191... 1/26/2023 Page 10 of I 1 Vendor# Vendor Name Class Pay Code 11764 ROBERT RODRIQUEZ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Nat D11523 01/25/20 01/15/20 01/25/20 48,93 0.00 0.00 48.93 TRAVEL[ 7Ltt' jji;p3 wjua ills-, tilk) Vendor Totals Number Name Gross Discount No -Pay Net 11764 ROBERT RODRIQUEZ 48.93 0.00 0.00 48.93 Vendor# Vendor Name Class Pay Cade S2001 SIEMENS MEDICAL SOLUTIONS INC ," M Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net 116319644 r 01126/20 01/16/20 02110/20 2,375.92 0.00 0.00 2,375.92 CONTRACT SN 1530 .. Vendor Totals Number Name Gross Discount No -Pay Not S2001 SIEMENS MEDICAL SOLUTIONS INC 2,375.92 0.00 0.00 2,375.92 Ventlor# Vendor Name Class Pay Code 10699 SIGN AD, LTD... '� Invoice# Comment Tran of Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 283371 01/26/2001/1612001/26/20 410.00 0.00 0.00 410.00 k,i L,f ADVERTISING Vendor Totals Number Name Gross Discount No -Pay Net 10699 SIGN AD, LTD. 410.00 0.00 0.00 410.00 Vendor# Vendor Name Class Pay Code S2345 SOUTHEAST TEXAS HEALTH SYS v w Invoice# Comment Tran Dt Inv Dt Due Dt Check D. Pay Gross Discount No -Pay Net f. 26725 yr 01/25/20 01/05/20 02104/20 5,000.00 0.00 0.00 5,000.00 ✓ 20231ST OTR MEMBERSHIP , 26713 01/26120 11/06/20 12/05/20 175.00 0.00 0.00 175.00 f CR EDIENTIALI NG/GAIN ES Vendor Total:Number Name Gross Discount No -Pay Net S2345 SOUTHEAST TEXAS HEALTH SYS 51175,00 0.00 0.00 5.175.00 Vendor# Vendor Name Class Pay Code C1010 SPARKLIGHT w Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Nei 0114238 01/25/20 01/14/20 01/15/20 122.07 0= 0.00 122.07 w. CABLE 011423A 01/25/20 01/14120 01115/20 lgj5415 4694-12 0.00 0.00 1;W471'2 JU-16,15 CABLE 011423 01125120 01/14120 01/15/20 1315M 269,47, 0.00 0.00 269.47- 13Ej,-7 7 CABLE 0114230 01/25/2001/14/2001/15/20 2,250.00 0100 0.00 2,250.00V INTERNET Vendor Totals Number Name Gross Discount No -Pay Net 1 C1010 SPARKLIGHT 11 !'(1,°I'''j 4335:56 0.00 0.00 4,3S5:66-r"i',�E,Z, h Vendor# Vendor Name Class Pay Code 00080 UAL Invoice# Comment Tran Dt Inv Dt Due Dt Chock D Pay Gross Discount No -Pay Net 079987826 ✓ 01/26/2001111/2001/26120 235.70 0.00 0.00 235.70 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 00080 UAL 235.70 0.00 0.00 235.70 Vendor# Vendor Name Class Pay Code file:I//C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report904191... 1 /26/2023 Page 11 of 11 U1064 UNIFIRST HOLDINGS INC / Invoice# Comment Tian Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay 8400412975 ✓ 01/18/20 01/12/20 02/06/20 200.84 0.00 0.00 LAUNDRY 8400412995e/ 01118120 01/12/20 02106120 74,33 0.00 0.00 LAUNDRY 8400413916 ✓ 01/18/20 01/12/20 02/06/20 125.98 0.00 0.00 LAUNDRY 8400412977 v`' 01/18/20 01/12/20 02/06/20 211.82 0.00 0.00 LAUNDRY 8400412978 Y 01/18/20. 01/12/20 02/06/20 210.98 0.00 0.00 LAUNDRY $400412974 v% 01/18/20 01/12/20 02/06/20 33.27 0.00 0.00 LAUNDRY 8400412976 ! 01/18/20 01/12/20 02/06/20 190.72 0,00 0.00 LAUNDRY 8400413001 V / 01/18/20 W112/20 02/06/20 2,294.34 0.00 0.00 LAUNDRY 8400413178 v'/ 01/25/20 01/16/20 02/1D/20 60.77 0.00 0.00 LAUNDRY 8400413177 ✓/ 01/25/20 01/16120 02/10/20 47.40 0.00 0.00 LAUNDRY 8400413198 >/ 01/25/2001116/2002/10/20 2,505.36 0,00 0.00 LAUNDRY Vendor Totals Number Name Gross Discount No -Pay U1064 UNIFIRST HOLDINGS INC 5,955.81 0.00 0,00 Vendor# Vendor Name Class Pay Code 14192 UNITED HEALTHCARE •/ Invoice# Comment Tran Dt Inv or Due Dt Check 0 Pay Gross 011923 01/26/2001/19/2002111120 123,00 PATIENT REF Vendor Totals Number Name Gross 14192 UNITED HEALTHCARE 123.00 Vendor# Vendor Name Class Pay Cade 11110 WERFEN USA LLC ✓'` Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross 9111269355 ,/ 01/1712001111/2002(05/20 384.18 SUPPLIES Net 200.84 r' 74.33 125.98,.i' 211.62,r..% 210.98 v' 33.27 _�' 190.72 2,294.34 60.77 47,40 v- 2,505.36 �rf Net 51955.81 Discount No -Pay Net 0.00 0.00 123.00 Discount No -Pay Net 0.00 0.00 123.00 Discount No -Pay Net 0.00 0.00 384.18 9111269354 _. 01/17120 01111/20 02/05/20 2,301.00 0.00 0.00 2,301.00 - SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11110 WERFEN USA LLC 2,685.18 0.00 0.00 2,685.18 Report Summary Grand Totals: Gross Discount No -Pay Net 239,332.29 0.00 0.00 239,332.29 239=332e APPROWDON ("�10(GY;oiin 14t335,�ab7 4 , 335-or 4• IS 2 9 Y )AN 2 6 2023 239,1'79 - b z- 2 > 9.. 1 7 9 . 6 :'! :r ggY COUNTY Ut1DrTp C.4l,HOUN COU�TY. TES file:///C:/Users/Itrevino/cpsi/menirned.cpsinet.com/u88125/data_5/tmp_cw5report9O4l9l... 1 /26/2023 A£CENEDBYTHE RUIf2tENTdl)WjWOA ON 5AN' i 2023 PATIENT NLPIDERDUN amfiFw19 Ems ---------------------_-----------' --... ARID=0001 TOTAL TOTAL APPROVED 00 JAN 2 6 2023 8'f COUNTY U 0, ITT€XDR CALHOUN DA.S 14EMORIAL MEDICAL CENTER PAGE 1 EDIT LIST FOR PATIENT REFUNDS ARID=0001 APCDEDIT PAY PAT OATH AMOUNT CODE TYPE DESCRIPTION GL 01 ----------------------------------------------------- 012623 65.00 ✓/3 ...-----------------------... REFUND FOI 012621 95.00 ✓ 2 REFUND FO! 012623 130.00 2 REFUND FOR 012623 78.52 2 REFUND FOR 012623 69.95 ✓ 2 REFUND FOR 012623 99.72 ✓ 2 REFUND FOR ' 012623 ------------------------------------- 45.00 -," 2 REFUND FOP - ---------------------------------------- 583.19 583.19 RECEIVED By THE COUNT`/ AUDITOR ON JAN 2 7 2023 01l2 pOUNTY,'T0" cJu.Hc�t�r�2' MEMORIAL MEDICAL CENTER AP Open Invoice List 0 Dates Through: ap_openJnvoice.template Vendor# Vendor Name Class Pay Code 12324 BLUE CROSS BLUE SHIELD Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay 011823 W27/20 01118120 02 O1120 227,203.19 0.00 0.00 FEB 2023 INSURANCE Vendor Total: Number Name Gross Discount No -Pay 12324 BLUE CROSS BLUE SHIELD 227,203.19 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 227,203.19 0.00 0.00 �PPE�tSV-t) t is JAN 2 7 2D23 CALOO N COUNI ROBS Page 1 of 1 Not 227,203.19 Net 227.203.19 Net 227.203.19 file:U/C:lUsers/ltrevinc/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5repott122190... 1 /27/2023 Page I of 1 RECEIVED B'VTtt COUNTY AUDDIM tSN MEMORIAL MEDICAL CENTER JQN01,712W 0 13:444 AP Open Invoice List ap_apen_Invoice.template ,"OU O Dates Through: o Vame Class Pay Cade 12476 SUN LIFE FINANCIAL Invoicag Comment Trap Ot Inv Dt Duo Dt Check D Pay Gross Discount No -Pay Net 012623 01/271200112312002/10120 11,132,26 0.00 0.00 11,132.26 JAN 23INSURANCE , Vendor Totals Number Name Gross Discount No -Pay Net 12476 SUN LIFE FINANCIAL 11,132.26 0.00 0.00 11,132.26 Report Summary Grand Totals: Gross Discount No -Pay Net 11.132.26 0.00 0.00 11.132,26 APPROVED ON JAN 2 7pp2023 i:.ALPOUNU COU' NTTYDI TEXAS file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp cw5report804811... 1/27/2023 MSKESSON c Pam: 0000 MEMORIAL MEDICAL CE4TEi AP 615 N VIRGINIA STREEF PORT LAVACA T% 77979 STATEMENTAs ol: 01/2712023 Page: 002 To amure proper Credit to yom account, tletaMl aM M. thla stub wAb ymu retnNtanee OC: 8115 As Of: 01127I2023 Page: 002 AMT DUE MATTED VW ACH DEBIT TOMory: Man to: Comp. 8000 Stalemenl lar inlonnali0n only AMT DUE REMITTED VIA ACH DEBIT Customer: 632536 Statement for Information only Date: 0112812023 Cust: 632536 PLEASE CNECK ANY Date: 01/26/2023 17131S NOT PAID (+) BHitg D. NecelvablPeuoml Account MOP Date Data Number Reference Description Okesunt (11.) P Amount P F1eeelvaMa (9roae) F Ann F Number PF column legend: P = Paffi Due asm, P e Future Ow Item, blank = Curren Due Item TOTAL Natloml Acat 632538 MBMOSIAL MEDICAL CENTEt Sumenals: 5,464.66 USD Returo Doo. 0.00 Cue It Paltl On Tima: N Peltl B/ 01/31/2023, USD 6,356.37 ✓ Pest Due: 0.00 Pay This Amount: 5,356.37 USO Olso Well N pold Mt. Last PrymeM 2,451,97 N Paid After 01/31/2023, Oue N Peltl late: 09.29 08/07/2017 Pay tole A.M: 5,464.66 USD USD 5.464.66 5, 344 •0 - li3�l2�j 10°5= 5+35:.Sf * APPP OVET1 otd AUD(Yppqq For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As 0: 01/2712023 Page: Out T4 emure Pmpar medlt to your aacaumdates„ and!thisstub co ,a .. aaaa with your mmRlanonenm DC: 8115 A. at: 01127/2023 Page: Out WALMART 1096/MEM MEG MS AMT DUE REd1TT® VIA ACH DEBIT Terdlory: 400 Nail to: Camp: 8000 MEMOPIAL MEDICAL CENTER VIC" KAUSEt Statement for information only AMT DUE HEMNTED VIA DEBIT VIRGIAVAC Iq ST Custamw: 256342 Statement for inmrmali0n only my FORTN PORT IAVACA TX ]]979 Date: 01/23/2023 Cush 256342 PLEASE CHECK ANY Oara: 01/28/2023 ITEMS NOT PAID (>) ailing Due p�Ngb�4etbnei Account gape Data Dam Number MGM".. Cash Oexrplbn Discount Amount P (gross) F Amount P RecelvaMa (.0 F Number Craft. Numbm 256342 WALWART 1098/14I31 MED ME 01/23/2023 01/31/2023 7392998665 61329637 1151nvoice 0.06 0.06 ✓ 7392998665 01/23/2023 01/31/2023 7392999666 61370438 1151nvoiCe 0.01 0.39 0.361/ 7392998666 Ut/23/2023 O1/31/2023 7392998667 81414766 1151nvoice 6.44 322A7 315.73✓ 7392990667 01/23/2023 01/31/2023 7392998968 61476198 1151nvoic, 7.20 359.90 352.70✓ 7392998668 01/23/2023 01131/2023 7393203505 61312781 1951nvoice 0.01 0.32 0.31✓ 7393203505 01/23/2023 D113112023 7393203506 61425272 1151nvoice 35.96 1,798.13 1,762d71/ 7393203506 01/23/2023 01/31/2023 7393203507 61341540 1151nvoice 0.02 0.95 0.93 ✓ 73932D3507 01/24/2023 01/31/2023 7393353719 61664966 1151nvoice 1.32 65.95 64.63 ✓ 7393363719 O1/24/2023 01/$1/2023 7393650169 61578597 1951nvoice 0.65 32.72 32.137-'� 7393550169 01/24/2023 01/31/2023 7393778177 61771649 1151nvatca 0.89 44.43 43.54✓ 7393778177 01/25/2023 01/31/2023 7393643904 61758410 f151nvolce 12.22 610.99 598.77 7393643RO4 01/25/2023 OIISIM023 7393643905 61628571 1151nvoice 4.05 202.33 198.28 7093643905 01/26/2023 01/31/2023 7303950576 61901226 1151nvolca 2.63 131.34 128.71 7393950576 01/26/2023 01/31/2023 7394154411 61894542 195ludea 0.01 0.32 0.31 7394164411 01/27/2023 01/31/2023 7334240171 62029172 1151nvoice ISA9 794.45 778.58 ✓ 7394240171 01/27/2023 01/31/2023 7394240172 62029172 1151nvoke 9.25 462.55 453.30 1/ 739424017R 01/27/2023 01/31/2023 7394240173 62029172 1151nvolce 0.54 27.24 26.70 ✓/ 7394240173 01/27/2023 01/31/2023 7394422801 62042482 1/51nvo1ce 11.99 599.69 587.70 ,/ 7394422801 PF Column legerrd: P = Pact a. 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Item, blank = Cutmm Duo Rem TOTAL• Customer Number 258942 WAIMgRT 109e/MBA Mm pHs SuMmeN: 5,453,93 USD Future Use: o.aD Ors, If Feld On Time: / If Paid By 01/81/2023, USD 5,344.85✓✓/ Past Due: 0.00 Pay MIS Amount: 5.344.86 USD Dix lost n Paid Mtn: Last t 10,923.33 If 4Yth After Ot/91Y2033, 09.08 If Pom Inlo: O1f23/2023 2023 Affl Pey this gmourR: 5,459.93 USD u0.se USD 5,453.93 nn ��nn � � Xn LL For AR Inquiries please contact 800-867-0333 4' 30 (- MSKESSON STATEMENT umpo�r: eoco CVS PHCY 7475IM5M MC MS AMT DUE HBdITTED VIA ACH D®IT M RIC IAL MEDICAL CENTER Statement for information only VICKY KALISBK 815 N VIHCINIA ST RTNr LAVACA TX 77979 A. of: 0112712023 Page: 001 To mwum Proper eremt to your aaawt, clamch and return We mub with ymm rerralnneo DC: 8115 As al: 01127/2023 Pege: 001 Territory: 400 Mail to: Comp: 3000 ANT DUE fIITTm VIA ACH OMITCualomvr. 836438 Statement for Information only Date: 01/28/2023 Cuet: 835438 PLEASE CHFCK ANY Date: 01/28/2023 IIB4S NOT PAID (�) Bing Due F 'jf tfmwl Accoum va&36 CaeM1 Amount P Amount P Heceivabb Date Ome Number Reference Desadption Decreed Inman) F (rmt) F Number CW. Number 835438 CVS PHCY 7475/MEN MC PHS 01/25/2023 01/31/2023 7393850340 2122334 1151nvaice PF cmunn legend: P = Pam Ow Kem, F = Forum Due Lem, blank = Cwreal Due Kam / 0.21 10.73 10.52 ✓ 7393950340 O TOTAL Cumomar Number 836438 CVS P cnr 7476m Gnat MC MIS SuMmeb: 10.73 USD rMum Due: 0.00 If Pan By 0113112023, Due If Palo On Time: Pam Due, 0.00 Pay This Amount: USD 10.52 USD Dbe Iom 8 pan ete: 10.52 Lea011 Payment 10,928.33 If Pont AHED 2023, Due If Palo late: 0.21 Ot/23/2023 pay This Amount: 10.73 USD USD 10.73 � \ 1�3o�Z3 For AR Inquiries please contact 800-867-0333 29 STATEMENT Statement Number. 64510189 ArTtensourceBergen, Date: 01-27-2023 1 Of 1 AMERISOURCEBERGEN DRUG CORP WALGREENS e12494 340E 1001352MID37MBIBS I= W. AIRPORT BLVD. MEMORWL MEDICAL CE ER SUGAR LAND TX 7747MI01 1302 N VIRGINIA ST PORT tAVACAT 77979-2509 sat -Fd Due in 7 days DEA: RA0289276 866-051-9655 AMERISOURCEBERGEN PO Box 905223 Na Yet Due- Natranl: 0.00 CHARLOTTE NC 28290.5223 722.70 Past Due: 0.00 Total Due: 722.70 A.I4 Balance: 722.70 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 01,23.2o23 02-012023 3120641962 169322 I.i. 358.49 0.00 358.49 01-2 2023 02-08-2023 3120641M 169323 Inwice 29.03 0.00 29.03 01.254023 02-03.2023 3121004239 169385 Invalm 272.85 0.00 272.85 01.252023 02-U12023 3121004550 1093M Wow 29.03 0.00 29.03 11 M-27-2023 02-012023 3121314660 1694M W01ce 33.30 0.00 33.30 Current 1-15 Days 16-30 Days 31.60 Days 61.90 Days 91-120 Days Over 120 Days 722.70 0.00 0.00 son B.00 0.00 0.00 Thank You for Your Payment Reminders Date Amount Due Date Amount 0147.2023 (589.i9) 02-03.2023 72270 Total Duee:T�`ny----��A12270 .... APPROVED ON nn��pp''__--^^ U/+3lJ�TA' �I/�I.TlLl1 [ 13 0 ( 2..3 jani 3 0 2121 CA°Hau°r�'?o�vnAiiY°��as TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) a"ENTER 9-DIGIT TAXPAYER IDENTIFICATION NUMBER" "ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" ETIF 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" F—JACKNOWLEDGEMENT NUMBER #### ENTER: ###E� 0 0 941 # L � 1 $ 110 851.22 1 $ 62,673,20 $ 14,657.50 $ 41,520.52 CHECK $ CALLED IN BY: CALLED IN DATE: CALLED IN TIME: n R%P-Payroll FilesTayroll TaxesU023102 R2 MMG TAX DEPOSIT WORKSHEET 1.12.23.xis 1/3012023 941 RECITAX DEPOSIT FOR MMC PAYROLL PAY PERIOD: BEGIN 11113151023, ^ENTER MOCKS 6S NECi1Nl MUMOEKS.. VOIDED CK to VOIDED CK Iz PAY PERIOD: ENO 12I25I2023 PAY DATE: 273/2023- GROSS PAY: $ 638,566.49 DEDUCTIONS: AIR $ 420.00 ADVANC BOOTS SUNLIFE CRITICAL ILLNESS S 1,178.73 SUNLIFEACCIDENT S 743.66 SUNLIFE VISION SUNLIFE SHORT TERM DIS S 2,005.70 SCSS VISION S 949.66 CAFE-D S 1,481.61 CAFE-H S 22.633.61 S S CAFE•P CANCER CHILD 5 602.77 CLINIC S 326.00 COMBIN S 280.87 CREDUN $ DENTAL S OEP-LF SUNLIFE TERM LIFE S 938.02 SUNLIFE HOSP INOEM S 619,50 FED TAX 5 41,520.52 FICA-M $ 7,328.75 FICA-0 S 31,336.00 FIRST C FLEX S S 3,494.40 FLX-FE S GIFTS 5 259.99 GRP-IN GTL HOSP4 LEGAL S 1o(I OTHER S 2.364:7S NATIONAL FARM LIFE S 1,706.93 MEDSURCHARGE S 420.00 PR FIN S RELAY REPAY STONEDF S 640.86 STONE STONE STUDEN TSA-R S 37,699.04 UWIHOS $ TOTAL DEDUCTIONS: S 160,072.17 S - S - -avzia " EBAeP: w1w>I�ais-,v,1oL1D+M1cN4t+a NET PAY: S 378 484.32 S $ ... YI'fTy1BC14N1-'�BtlYSDI4tti1AWC ^ONY{5Y44T1FRg'4{1+' TOTAL CAFE 125 PLAN: S 33,128.42 Less Exempt: 'AXABLE PAY: $ 605.423.07 S 505,428.07 "CALCULATED" From MMCRemn Difference 1CA - MED (ER) +E,i S 7,328.71 :ICA-MED(EE) ,sa $ 7.328.71 S 7,328-75 S (0.04 9CA - SOC SEC (ER) sxa $ 31.336.54 :ICA -SOC SEC(EE) s:oK S 31,338,54 S 31.336.60 S (0A6 'ED WITHHOLDING $ 41.520.52 $ 41,520.52 S REVISED 3/182014 INAL CK 111 TOTALS IS 638,556.49 S 420.00 S S S 1.178.7' S 743.06 S 2,005.70 5 949.65 S 1,481.61 S 22.633.61 S - S S 5 - 5 602.77 S 325.00 S 280.87 936.92 618.50 41,520.52 7,328.75 31.336.60 3,494.40 259.99 1,043.7i 2.354.75 1.796.93 420.00 640.86 37.699.04 �avwosNia IIawRE^-sraaawttwRawaT- $ S S 378.484.32 sEgYsaKlltalimcpE-^Yip4e TiMg1E[{'l[I. Exempt Amh Employees over FICA•SS Cap: Shanna Odonnell Roshan4a Thomas S - Payceee S - Employee Rolmh.: TAX DEPOSIT: S 119,551.02 5 11065122 FICA -MEDICARE 2ws S 14,657A2 $14,657.50 FICA - SOCIAL SECURITY ,..o.. $ 62.673.08 s62.673.20 PREPARED BY: FED WITHHOLDING S 41,520.52 $41.520.52 PREPARED DATE: TOTAL TAX: $ 118,851.02 $118,861.22 $ (0.20) TOTAL: S Caillm Clevenger 1/30/2023 e2R2MMCTAXOEPOSITWORKSHEET11223.KIs.TAXOEPOSITWORKSHEET 113MO23 Eca Cats: Oy30'2i g_{0E?Ai !E➢IC CE.'uEE ea;= ..? Tze: IC:;3 Pay::1: FsEist=r E:•n=ail; F2REG Final. 5uc7:ary • - -Pa,v Code Summary i PayCd Dzsaiptian ..___........... ............... EFGi'.A.4 FAY•51 . EEGL�:R PAF•S1 REGi,':.AR PAY-Sl 2 REGL":di PAY•52 2 REGL'_AR FAY-S2 REGGirR FAY•S3 3 REGULAR PAY-53 3 REG117AR PAY -Si CALL W PAY CAL' 3ACR eta CAL 2ACF.:Ai M. E.=.CR :.Y CALL en? C Crn" ME C XUBLE SINE C L UBLE TINE C FULL: TINE C Nu.:E TIRE .. EXTRA nnGES F FUNERAL LEAS P PAL^-TI9Ev" X CALL PAY 2 YN Aranv:S 2 CALL PAY _ c PA?D TI:`�3 �.. 2�03ATPCR _ e.0➢E 5 DF.iA Ers I OTI SRINEI Po C3 Ers I OTI SRINEI Po C3 . ---- I ................. 10316.7E 8 .. i696.5C !I N, N 2753. ii A `i 5 1;0.25 . 9 15e6.25 N R MOP A II ?i ?7 66.2E ? fi li 38.25 N e F N 1' 48.26 E? 2 N, N 'F I.00 '. '. S !i Y 1154.'':0 1 N S 15.25 Y 3 9 N N ! R N 6.00 .1 N R 6.CC S i ;t !1 8.00 A 1 0 N v ., N ., ............. . e d u c t_ c r. s S u m o a r y .............. Gmas I Coia wawa: ................................................................ 22iB;i,'_ AlF. '"G.0'J nln Alp: iI-1111A,. SCuu ,..v_..CAn.. Gc3 75.7E u;F� E CAFa-C C;F2 7 ;8053.?6 CA%?-L CAPE-: CA::CiR 176.00 CHILD 6(2.77 CLINIC 325.00 C'CMSIN S123.5; CP.EDUN ED AD7 DE!ITAL 1290.7E ➢EP-LF DI5-LF EAT 2164.53 EAT, CS3 FEDIAX 41520.52 FICA-M ;2.75 F:C.`. C 3:33v. i0 F?Fz PLE:6 S 17.E6 FL.0 F3 FORT ] FG A Ip gm i32.3: LFAF lE AL 173..1 RASA '.64.45 MEA:i 33F.10 MEMS RISC 363.2i MIEC/ W-SRR RAURML li54.83 DT ]R ?Hi FRI"• 50520.00 PR PIN HUY REPAY :E6.65 SANE SCRUBS SIGROM 34.10 97.TX 5T09DF E,0.96 STORE 751.78 S;P.IIL1' :173.C3 Slh.'i\7 ElE 50 SL'!,?F ..ce.26 S:OI579 1105.7^ SU'NIS SLPCEG ..G.9( 7S1-1 ?Ski '.SA-: :E.aO TSke ZSA•P. 37699.'% 77M; IOti FOR 2IS .6] GA�PDC .05.0E 12:a.al -----•-------------- Grand Totals: 20,55.12 •------ S Gros: "IHHE.19 Coach Count: .. 199 P'. . Other 6( Fe,-.5:= 237 Male 2: C:=.dCt ....................................... ............................... i;6L61 280.57 1326.7E 0.'30 1766.23 753.5E 53E.i2 ;2C.G0 Deducticos: 160072.17 set: 3t645Ci33 }✓ OverAnt 2:2erc:Iet Tem Total 261 2•�at23 ......................................... t1130 n a Date: C:; 7•?(i3 X5V.DR;AL KE71G:LIMNI E eI-ncaE:Y eeee :Oi{0, �. _.� S1$2 - PRGCPEE?'E Ii.c. Nan: An-m: CfiCz `„v _.,:: 'ulE: %ELSEY Re2:IO'^ 0:.32 700E:2e, S:1C3!:3 20343 -02"NA° N SCS.-FRA- 2E4.75 MM,2ac 86452 MY ELLECs 26E.93 nc6326i' S2j Cil23 00041 CAYL LEE BINS 792.37 DD 02i 0312E 00083 SY'LVIA A VASCAS 836.73 OD O1/u1/2? 00054 SYLVIA A NE.YDMA B62.42 OD 02/0312i 10113 JACLYN CARREON 1342.85 OD 02M3/23 00132 SANCRA A SPAUN 656.76 DD 02/03(23 H192 MMA D FEW, 3075.4E Du O2/031-13 00344 SAIMM LEE MITCE 23BS.B7 DD 02103/23 00387 MLIE E CUCRn0P.i7! 322E.88 D'u 32101/:3 e392 KFIC5 T CASE 96,.17 00355 1^A J TIJER7A 3E46.3L 00401 VELD-. J :INN 115G.93 _� 721C'3723 :0221 M.M V STRIN_. 2114.47 __ :_f v3!u3 :04B2 PAY EI?:AC 5350.43 __ 32i Ci k: 1V51: REE:Li :hl F:E41:?C2C31 M.0, O6B1 RKLA 8W>:E KID: 163C.47 D, ......- 00692 CEBCPA9 E NLi.iEEE.9T 3FE.33 00 3., .:... O'769i M_i:RLA C PAEIAS 007E (INEERL't R BLIU9A .0H,82 OOE95 "METE 018IE XCLM' 1672.83 3D D210!23 0?015 SUSAN S 9NALLE'i I866.52 L 02iW27 01191 SFARON M.SPABS 159,138 T• 32103/2/ 03234 MUSS N SVRTLIR i98R.Od DD 0:1ni23 OL241 MIRY MACE 2040.2E DD 0210/23 u13E7 NfBILYN A SANOERS 3579.0 uD 02/03/23 0i593 7ACXIE E nIGL-Al i626.43 00 02/03I2i 01791 AAUSUTN.". J MMAY 1546.?5 P2103123 02C.1i Mli R UVEYOER. 3510.73 ➢^ Jii0112i 32014 A^.=32TA C UM, B86.e9 DD 02021 ERSF? OMLIIIA-M =:Ez 1565.03 _. .2/0i 123 02022 A.MPA J CRICr ._DE; :2.3c7 3T1__ !! SAi9Et 2?51.4? 07 3!23 :2099 , ':iACI N. S3EPC:.. 285i.45 DC :2�5:'P. 121'2 .cSdE :C'E;L• ]:CC.:n C2122 DAR.n :DtiA 2453.41 uD 02i,9 EINC VALDE2 52154 a'UMN: STE3:C2?i1 1727.23 D0 .:i 031c 02162 RIRlm %ASL C4 2546.59 DO 02i'33l23 0216E JENSICA F241CST 3405.2E 0u ;21i•3123 02192 Tll'3 VEE'7LAR 2139.42 D0 2(03i23 D2271 DANII J SUSE.5IR 2O21.77 OD 1i01/23 02301 NICOLAS T;JE.R;IiA 2452.45 DD 02/03/23 02303 CONNIE X L".iA 2217.31 DD 02103/23 02315 3IIIiA I4 MEN 2145.52 CD '203113 02322 RICK OSORN3A 2971. B0 CD :2723/23 02331 JESSICA 8 3IPFLE '.772.20 DD OL03/23 02346 2T;.4_TTE L FA.LCON !Q2 .,3 DD S2 illi1:3 Rua Date: J:i30!23 9H:D3:A1 71EDICAI C_ViER EL-HEE1.LY Page 2 ...... 1:..- ...r CPC[ Rec:=Cer .... ...siF 1I,ECft.C,:.Cc=y1•:i °.$FSR2ii NLT.. Ya--e kmn: CHECK 'W! DAY- G291E JANELLE SiCS': 3f50.1-0 DD C'2r 13/2P iMI S34DniiliA "NUM, 302E-2C LC C3'Z3 G?i35 EYEPe2i:'e 3' 2272:15 ED :.. 33/23 02552 '2RDIDCA u7isiII 1739.6E M C21@1123 02522 JESDSA MRIE VILL?RREAL 362.42 DD G2/03123 2f79 MELTS. -A I✓:SUIEY 2315.4i DD G27Ci RC1.1'A DAnIIELLF. COE73'E....- C27tE C21?5 Lil ?l. A 5ARCa 237E.1E DL 02763 JESSICA RAeptz 100.66 DD 021071,13 C2794 E!=;:iii 1 !7CTi=.Ei t:12.7? 7➢ i2i 0?%2i 02312 RRTT;A_A"i N Rum !Ct lElL 3S ]] :21CirS3 02H7 WRIA. F !D`.'CCRIA ID75.H __ 02327 %IUM- L CRISES 3019.36 �] JZl•}3'23 02963 CO3DM J REWN 1137.52 DD 02/0312/ 02970 DIAIRIE G ATKINSON 1996.2E DD d21N/2i i3 oE4 JACQ1r 111i R lmmps. 12i3.9e' D3 :'3123 :5303 CCDRI'.=-eSSSR�❑ 250?.'- __ .:1'.'.. __ .iGCf REC:AA Au;?5%' !1Ei i:9i.ii Cd .. ^: r: 05122 PAR:SSA rkNGEL 990.41 DD D2/0312i 05345 ZRICA SG'JY-'7 2117.75 DD 02103!23 rc-4i MVAO;$ R ICF 255S.2'r 99 '2'11J23 C973.' a:C:� 1 E'.�L =R ?179it C i:23 {Y:1-an G' %A 19P6. is DD ie i2311? M471 7.M A :'CRC= 171C.G1 DD C21C3123 C7379 DMIA C SAUCEDA 1246.53 DD 02/M/23 7:197 i.ATHRiAi A SAENZ 3992.27 DD 02(P:/23 ..412 -CUR7NE'Y L 92::^1SK 235:.?e :2G1: EIY.3ERLY J HRIG i575.i3 .,, ..,.. 12i35 LISA J RISCJGS 504.11 D: 42103f23 12153 dt$:A MONIES 2026.i4 DD C21G3f 1 22392 3IANZA CADY 205.26 DJ Oil''-'!23 .:097 KILE L DA!i 3L 3121. s'9. :EI?1 SA%ANNE:-: HA?_EY I36? 9 ': it C31C3 ...:9 1"R:6:EL ll:{1LL: 9iw'2L 25171 JESSICA DARRCS 2653.60 DD 42123123 :525i CGLRNEY A SALUAR 1M AS CD 021i:;v :5"E 39011 N. ME 23?5. Z4 :3 ;:IC3i23 .ai: 3R7M, r AEI . .?.74 :D "c.I t 3iit 20i02 £4YA HAW !iS 1226.7G DD 02Mi23 20133 1MISHA TURNER 644.3? DD 02103!2? 70144 ?CFHr v [ECE.SA 195.73 M '2,''113!23 "-S?cy 200. A47 IARC:A ..:i D. 2013E NEL:SSA 2AVOP.A1u 1261.3E DD Gi1i?(23 20206 YSLLI 3 CJZF 164M9 DD D2/03123 10201 3INIM C ?ARYL 3275.51 DD ?^.242 ci= ?E ....EZ 2HE.71 DD 20294 20419 AAREN :I xZUB 31E.:. DD 4 EAYA A S' CAI;. 63E.E4 DD 02103!23 20742 CYT: 2A LOREZ M. DD G2(P3121 20759 JAR . S2ZrUm 497.Of DD Rai Eau0:: 32i 2i .1.YR:z y»pICAi.;age Yice: 11:23 ^ • Ctea:: RegisCec i4^ MIEN Pay FmA C1; L•'25-•C2!iEl2? R�:.: i :Iredr: TDC;'^.: .. _..A:ItIC • EEDSEEEI:'i S:-.. raze r=':. MCE N7. 2'SE 207?2 MLIV RA4IREZ 75;.6; ED 02,03/23 2D797 3'eli4API F. ➢ICGS 1560.i& DO 02J13123 2D?16 J02E > S21A M.4; ➢D 22i83123 27i7; CEEBBS C :ES'"? ly]6.i7 CD Ci!i3123 29950 9V ;7 -. ?2 '3'23 ._45E' ➢IUNI. C LEA- L529 JACOEY R C??.UM i526J6 ED ;I-j33i23 22516 EEAYRER L LMU 350.73 ED 02j D3123 26186 DARE: ORV210 264ML) ED 02103123 C?03; ?3LE:IiA .S BMI72R. ..24 ED .3,CV2i -e912€ JEESICA. . SEyFk! fRc:,v DJ .'D3%23 SCEOTT 3UZA:: 31D35 ETA -I-. ! _R-K' ii65.j7 D0 32i P:!<n 'ii, -DR; 31D99 A?ACELY Z GARCIA 291 i. Si D➢ 02%03/23 ?1219 71➢EEM FEiLLLES 124F.71 ED D2/03!23 4.751 Ci'L:d?r. L Ri}» i56E.2! ➢L' D...... 3?3?3 tiF.-i RIIS LYR; JivR �Z 1?52.29 =_ c2i'>312i _..I5 .: .. _ FkRMER. 31463 SDk;ED 5 YATJCA 3415.:. DG ;2%4312: ::SC? RW---L A NEFRI;F 1960.56 ➢➢ DZ%'?B123 11521 EEYLA DE LA ZhLLEJA. 33;.55 ED 3152i ??YLA Y. AWASH 13a1.' ..='r n %BEST?. ....C; 36115 �:iSCELL?. ? E?S:AE 5?3.92 DD '.., D?ne. A:E? SEwl Y. CAbD '336.5 12i'T"I AM ANNA VWESSA PEINELL 347.69 DD 02/03123 6?012 FIRIA SIZ.01"AL 635.11 DD Ninl23 A4iSiASIA L .EEEZ 573.5? ➢? .2!C.i.. ,i171 TOY4IE y SR?r?rJ 665.62 __ :2N2!22 412?5 JV-4'Iz T, E ALP.._0 7v:.46 DC 02r =2123 1.225 SL1E A CLAZC'i 35.5; .,_ 212312i ;236 8U. O 2'2?C1 J3 4.25i SkVA MONO EU.42 DD D21?3(23 ;i27, tiA8R7 2A'N ?D95.E2 DE 02li3 /23 ED n ::RntD_ 721'. r D:I'• ED 41:415 IMEL X LAn 567.H r:, .i1-P'13 415C6 JDEEFA': LUDO TURIS M.15 C'D i2!?3/2i ii5F7 OLGA 15SWI;CIM- ]99.N ➢➢ 021D3123 Sit EGrJA A 37.iwfcJ 5?2.C'c R. i2!?3(23 is996 EN4ExiC 3:7: Ems 4L257 EGi MIA KNEE 97616 DC 0210ii 23 4501 IrMil"A R AIL = 1117.42 ED 62103123 42106 Ci.R'SD" S7LVU ?17.26 ED ;2125Ce M 123:4 E3Ni ' NM'?E!; 216E. ie. 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DD C<'/C:/[ ?3231 :b'PR?: tt FLORSS 1090.72 DD C2/D3!23 rE76E A.D.IKA..ZA v D.Z-Tv'A 153452 DD 92/'73li1. 37i3?3.32 by: Memorial Medical Center ACH Payment Request 25,323.1� Operating. •4357 MUFG Union Bank Account Number: 3120004394 pouting Number: 122000496 Wage Works Employee FSA Payment Invoices 4683724,4457380, 4561699,4662847, 4643285, 461117S, 4587686, 4571179, 4534930, 4509386,4489984, 4470028, 4437698, 4413906, 4392120 Caitlin Clevenger 27 Date: 1 30 2023 �TPROVED ON) nn by. 1/30/2023 --�� JAN 3 Q 2023 Ifn. �)YOcI � �iCn M�Irt'V\Date: �ABHONN COUNTY TEXAS HealthEquity To: Memorial Medical Center PC Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to: MUFG Union Bank, N.A. Admin Fee Acct# 3120004386, routing # 122000496. Please include Invoice # and Account # in your payment addenda for ACH Credit or Wire payment. Check Payment: WageWorks Inc P.O Box 45772. San Francisco, CA 94145.0772. Please include the invoice # in remittance advice or return a copy of the Invoice with the check. INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 Account# Invoice Date 2052366 01/25/2023 PO# invoice #-', i INV4683724 DUE DATE AMOUNT DUE i 02/24/2023 $595.50 Description Quantity Fee Amount Healthcare - Benefit Period: Jan 2023 '. Monthly Compliance Fee 1 50.00 50.00 HC FSA Admin Fee - Current Plan Year 77 5.25 404.25 HCDC FSA Admin Fee - Current Plan Year 3 ! 5.25 15.75 HC FSA Admin Fee - Prior Plan Year 21 11. 5.25 110.25 DC FSA Admin Fee - Prior Plan Year 1 5.25', 5.25 Total Amount Due $5(185.50 Ci�.n�t4+►J"-4J='GQdt � 0� (3o�z3 Page 1 of 1 HealthEquity° To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to: MUFG Union Bank, N.A. Admin Fee Acct# 3120004386, routing # 122000496. Please include Invoice # and Account # in your payment addenda for ACH Credit or Wire payment. Check Payment: WageWorks Inc RO Box 45772, San Francisco, CA 94145.0772. Please include the invoice If in remittance advice or return a copy of the invoice with the check. Description Healthcare - Benefit Period: Nov 2022 Monthly Compliance Fee HC FSA Admin Fee - Current Plan Year DC FSA Admin Fee - Current Plan Year Total Amount Due Quantity Fee INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 Account # Invoice Date 2052366 11/23/2022 -- PCHI Invoice# INV4457380 DUE DATE ! AMOUNT DUE 12/23/2022 $564.50 Amount 1 50.00 50.00 97 5.25 509.25 1 5.25 5.25 $564.50 / Q �� Aa l(3d/23 Page 1 of 1 HealthEquity° To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to: MUFG Union Bank, N.A. Admin Fee Acct# 3120004386, routing # 122000496. Please include Invoice # and Account # in your payment addenda for ACH Credit or Wire payment. Check Payment: WageWorks Inc P.0 Box 45772, San Francisco, CA 94145.0772. Please include the invoice # in remittance advice or return a copy of the invoice with the check. Description Quantity Fee Healthcare • Benefit Period: Dec 2022 Monthly Compliance Fee 1 HC FSA Admin Fee - Current Plan Year 97 DC FSA Admin Fee - Current Plan Year 1 Total Amount Due INVOICE WageWorks, Inc, 4609 Regent Blvd. Irving, TX 75063 214.596.6900 Account # Invoice Date 2052365 12/2312022 Po#- — Invoice# INV4561699 DUE DATE AMOUNT DUE 01/23/2023 $564.50 Amount 50.00 50.00 5.25 509.25 5.25 5.25 (� _' `ti�� $$55664.550/ p Page 1 of 1 HealthEquity® To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRA(DC Acct #: 3120004394 Routing #:122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com PMB Payments - HCFSA 2023 PMP Payments - HCFSA 2023 Visa Card Payments - HCFSA 2023 Repayments - HCFSA 2022 PMB Payments - HCFSA 2022 ii I INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 ` Account# Invoice Date _ 2052366 ''. 01/23/2023 Po # DUE DATE —' 04124/2023 Invoice# AMOUNT_D_U_E_ INV4662847 $4,145.80 Plan Code ' Amount HCFSA2023 296.161 HCFSA2023 524.67' i HCFSA2023 3,064.97'.. HCFSA2022 (45.00) HCFSA2022 305.00 Total Amount Due p j1 $4,145.80 ,/ u4 (LR23 HealthEquity To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRA/DC Acct #: 3120004394 Routing #: 122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving,TX 75063 214.596.6900 Account# `InvolceDate 2052366 01/17/2023 # DUE DATE 04/17/2023 Invoice # AMOUNT DUE INV4643285' $2,995.27_--- Description _ Plan Code I Amount Visa Card Payments - HCFSA 2022 — �— ----- y HCFSA2022 8575 PMB Payments - DCFSA 2022 I DGFSA2022 358.00 Visa Card Payments - HCFSA 2023 HCFSA2023 2,551.52 Total Amount Due n yn,� 113b Z3 HealthEquity® To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRAIDC Acct#:3120004394 Routing #:122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 Account # i Invoice Date 2052366 01109/2023 . DUE DATE 04/10/2023 Invoice # AMOUNT DUE INV4611175 $2,525.09 Description — Plan Code Amount PMP Payments - HCFSA 2023 !! HCF8A2023 79.34 .' Visa Card Payments - HCFSA 2023 j HCFSA2023 2,160.98 Visa Card Payments - HCFSA 2022 ! HCFSA2022 284.77 Total Amount Due p p jpNJ $2,525.09 f HealthEquity To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRA/DC Acct #: 3120004394 Routing #:122000496 Please include Invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com Description Visa Card Payments - HCFSA 2022� INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 --- —. #—_ Account#. — -- —n Invoice Date — 2052366 01103/2023 PO # -,.. DUE DATE ,,--,_ 04/03/2023 Invoice # AMOUNT DUE INV4587686 $1,136.78 Plan Code Amount HCFSA2022 1,136.78 Total Amount Due t��Lo �� $1,136.78 f I3 HealthEquity. To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRA/DC Acct #: 3120004394 Routing #:122000496 Please Include invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com ------ —_ _. _ --- - ---- - ___ 1 Description Visa Card Payments - HCFSA 2022 i INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 Account # Invoice Date 2052366 12/27/2022 — - PO#---.._L_. -' — DATE -.DUE 03l2712023 Invoice # AMOUNT DUE -_INV4571179 -A --$1,74306 ---, Plan Code. -'Amount HCFSA2022 1,743.06 Total Amount Due 11^�A7t� L Q� $1 743 06 f 1130(23 HealthEquity- WageWorks To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRAIDC Acct #: 3120004394 Routing #:122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer welhsite to view detailed invoice reports: employer.wageworks.com --- ---- — Description PMP Payments - HCFSA 2022 Visa Card Payments - HCFSA 2022 INVOICE WageWorks, Inc. 4609 Regent Blvd, Irving, TX 75063 214.596.6900 Account # Invoice Date 2052366 12/19/2022 PO # DOE DATE 03/20/2023 Invoice # AMOUNT DUE INV4534930 $1,620,30 _ Plan Code Amount Fm HCFSA2022 35.71 j HCFSA2022 1,784.59 Total Amount Due LplVtp�D1L4A )�Q YLAbt� $1,620.30 f 113d(Z3 HealthEquity To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRAtOC Acct #: 3120004394 Routing #: 122000496 Please include invoice # in your payment addenda for ACM Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596,6900 Account # Invalca Date i_ -1 2052366 12/12/2022. _ PO # .__„_....._.�_ DUE DATE ---- 03/1312023 Invoice# wo-miDUE -.. _ INV4509386 I $2.222.55 Description Plan Code Amount -- _ — - — PMB Payments - HCFSA 2022 HCFSA2022 - 68.80 '., Visa Card Payments - HCFSA 2022 �j HCFSA2022 2.154.05 Total Amount Due i (3o I23 sz,zzz.65/ HealthEquity- To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRA/DC Acct #: 3120004394 Routing #: 122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment. Lag on to our employer website to view detailed invoice reports: employer.wageworks.com INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 t # Invoice Date 2052320523 66 I 12/0512022 Po# ----- 03/06/2023 _ Involce �— AMOUNT DUE INV4489984 $1,281.86 uescnpuon _ Plan Code Amount 1 Repayments - HCFSA 2022 HCFSA2022 i (92.71)-- PMB Payments - HCFSA 2022 HCFSA2022 171.85 Visa Card Payments - HCFSA 2022 HCFSA2022 ! 1,202.72 i Total Amount Due 11.30(2-3 $1,281.86 HealthEquity WageWorks To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRA/OC Acct #: 3120004394 Routing #:122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com Description - — _- PMB Payments - DCFSA 2022 Repayments - HCFSA 2022 PMB Payments - HCFSA 2022 ! Visa Card Payments - HCFSA 2022 Total Amount Due INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 .__Account # Invoice Date_ i 2052366 11/28/2022 PO #_ DUE DATE _' 02f2712023 Invoice # j AMOUNT DUE '�INV4470028 _ r $2,099.16 , Plan Code i Amount DCFSA2022 358,00 HCFSA2022 ',. (306.15) i HCFSA2022 306.15 HCFSA2022 2,541.16 1 (50 f23 $2,899.16,/ HealthEquity° WageWorks To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRAfDC Acct #: 3120004394 Routing #:122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment, Log on to our employer website to view detailed invoice reports: employerwageworks.com INVOICE WageWorks, Inc. 4609 Regent Blvd, Irving, TX 75063 214.596.6900 Account # Invoice Date 2052366 -_i —Po # . 11/2112022 DUE DATE ----i........ 02/20/2023 Invoice # AMOUNT DUE INV4437698 $1440.89 ascription Plan Code Amount Visa Card Payments - HCFSA 2022 i HCFSA2022j 1 440,89 : Total Amount Due • $1,440.89� HealthEquity- WageWorks To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRA/DC Acct #: 3120004394 Routing #:122000496 Please include invoice # in your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employer.wageworks.com Description Visa Card Payments - HCFSA 2022 i INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 4ccount # Invoice Date ---- -- — - 2052366 11l14/2022 DUE DATE 02/1312023 .. Invoice# _ AMOUNT DUE_ INV4413906 $1,186.59 _. ---. -, Plan Code Amount HCFSA2022 1,186.59 Total Amount Due n- _e " QQ 6 $1,186.59� FlealthEquity To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to MUFG Union Bank, N.A. FSA/HRAIDC Acct #: 3120004394 Routing #: 122000496 Please include invoice # In your payment addenda for ACH Credit or Wire payment. Log on to our employer website to view detailed invoice reports: employerwageworks.com Description i Visa Card Payments - HCFSA 2022 - - INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 —_- Account# -in v_ole_eData --� 2052366 11/07/2022—' PO # DUE DATE 02106/2023 - Invoice # -: - — _ AMOUNT DUE INV4392110 $210.97 Plan Code Amount HCFSA2022 210.97 $210.97✓ MEMORIAL MEDICAL CENTER PROSPERM BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNTJanuary23, 2023 -January 29, 2023 Date Bank Description 1/23/2023 PAY PLUS ACHTRANS 452579291101000694679093 1/23/2023 IRS USATAXPYMT 270342312594544 610IS01001123 1/24/2023 PAY PLUS ACHTRAN545257929110100(1695692035 1/24/2023 MCKESSON DRUG AUTO ACH ACH05342158 91000012E 1/25/2023 PAY PLUS ACHTRAN54525792911010MG9651SWO 1/26/2023 WIRE OUT CBNA INCOMING SETTLEMENTACCOUNT 1/26/2023 PAY PLUS ACHTRAN54525792911010ON97384126 1/27/2023 PAY PLUS ACHTRANS 452579291101000699361420 1/27/2023 AMERISOURCE BERG PAYMENTS 01000077682100002 MMCNetes - 3rd Party Payer Fee -Payroll Taus -3rd Parry Payer Fee -3408 Drug Program Expense -3rd Party Payer Fee .CiVDank Corporate Card Payment .3rd Parry Payer Fee - 3rd Parry Payer Fee -340B Drug Program Expense N tL.tSh r'•+^'••'^`^ January 30,2023 ANDREW DE LOS SANTOS Memorial Medical Center'�Ftey,{ PROSPERITY BANK '`a �- P�tyWef UI. 7Fj•Zj ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT— ESTIMATED ROB Date Description ANDREW DE LOS SANTOS Memorial Medical Center CPS.... Amount. Pl- I vim 11653 16.93 +j 145,266.85t as9'i 6.99 = 10,928.334* 39 • 4 5 .50 14 • 57 9AS 2,4R 4s>@ 49. 45 49,45 159,3641 5 9• 3 6 4°< 6 145- 26C. 3- - 52-Sll - 569.1s, - 127.39 MM[Notes Amoun 127.39 27. 39 - 30, 2023 D • 0 0 » APPRDVEI3 ON JAN 3 0 2023 x�V COUNTY A1101TOR CAIHOUN COUNTY TEXAS AYEE MEMORIAL MEDICAL CENTER TRANSFER REQUEST Memorial Medical Center —Money Market Date Requested: 1/30/23 �, JAN 3 6 2023 RV GODUTV AU©170R CALHOUN COUNTY,, TEXAS AMOUNT $1,750,000 i/ G/L NUMBER: EXPLANATION: TO TRANSFER $1,750,000 FROM OPERATING (*4357) TO MONEY MARKET ACCOUNT (*2998) REQUESTED BY: Mayra Martinez AUTHORIZED BY; 1130 1/30/2023 Treasury Center Account Number Current Balance Available Balance Collected Balance Prior Day Balanc MEMORIAL MEDICAL $7.626.432.36 57,701,721.22 $7.626,432.36 87,862,139.1i CENTER -OPERATING FUND Copyright 2023 Prosperity Bank. httpsllprosperityolbanking.comtonlineMessenger 1/1 TIECEIVBy THE COUNTY �D OR ON AN 2 6 2023 01/26/2023 MEMORIAL MEDICAL CENTER 0 COUt`npy,'7'F�(A,S AP Open Invoice List CAtAIfi2.L Dates Through: ap_open _involce.template Vendor# Vendor Name Class Pay Code 11816 ASHFORD GARDENS Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay 011723 01/26/20 01/17/20 02117120 710.94 0.00 0.00 TRANSFER �� tOJtNti�ku. pytaI cl+.jzusi7Gv� 1n� IL�Y1�L �y11,w /'" 012023 01/26/20 01/20/20 02/20/20 6.067,48 0.00 .00 UHC NOV QIPP Vendor Totals Number Name Gross Discount No -Pay 11816 ASHFORD GARDENS 6,778.42 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 6,778.42 0.00 0.00 ggyy iAN 2 6 2a23pp CAWDUNUCOUNTY ITEXAS Page 1 of 1 Net 710.94 6,067,48 ✓ ' Net 6,778.42 Net 6.778.42 file:///C:/Userslltrevino/cpsilmemmed.cpsinet.com/u88125/data 5/tmp_cw5report806941... 1/26/2023 Page 1 of 1 RECEIVED BY THE COUNTYAAUDR4R ON JAON2yA&D MEMORIAL MEDICAL CENTER O/ ;3 AP Open Invoice List 0 C ALHO OUNIY, TP.XAg Dales Through: ap_open_involce.template Vendor# Vendor Name j Class Pay Code 11828 SOLERA WEST HOUSTON Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 012023 01/26/2D 01/20/2002/20/20 1,827.56 0.00 0.00 1,827.56 UHC NOV QIPP Vendor Totale Number Name Gross 11828 SOLERA WEST HOUSTON 1,827.56 Report Summary Grand Totals: Gross Discount 1,827.56 0.00 AN 2 6 2423 CALH0U 1 COUPITy,tTEXA5 Discount No -Pay Net 0.00 0.00 1,827,56 No -Pay Net 0.00 1,027.56 file:///C:/Users/ltrevino/epsi/memmed.cpsinet.com(u88125/data 5/tmp_cw5reportl62530... 1/26/2023 Page 1 of 1 RECEIVED RY THE COUNTY AUDTrOFI ON 01 MEMORIAL MEDICAL CENTER J/-1/IVeg /!,r'D�p�3 2023 AP Open Invoice List 0 11:24 Dates Through: ap_openJnvoice.template rAUAwwwV4w0r Iw&fi8 Class Pay Code 11820 FORTBEND HEALTHCARE CENTER Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 012023 01/26120 01/20/20 02/20/20 1,904.62 0.00 0.00 1,904.52 ✓ UHC NOV OIPP Vendor Total, Number Name Gross 11820 FORTBEND HEALTHCARE CENTER 1,904.52 Report Summary Grand Totals: Gross Discount 1,904.52 0.00 cr Pitt VSD 04 JAN 2 6 202 CALHOUNU COUNNTTY,, TY (TEXAS Discount No -Pay Net 0.00 0.00 1,904.52 No -Pay Net 0.00 1,904.52 file:!//C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report271971... 1 /26/2023 Page 1 of 1 REGENED 8Y THE COAgj3Dr1 0 11 ON MEMORIAL MEDICAL CENTER AP Open Invoice List 0 `Jim 2 6 ZOZ Dates Through: ap_open_invoice.template Vendor# Vend r NaGnA Class Pay Cade OA,"t CBROADMOOR AT CREEKSIDE PARK Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 012023 01/26/20 01/20/20 02/20/20 2,273.54 0.00 0.00 UHC NOV OIPP Vendor Total* Number Name 11832 BROADMOOR AT CREEKSIDE PARK Report Summary Grand Totals: Gross Discount 2,273.54 0.00 APj,Fj0VwON 3AN 2 6 2023 catHot1 e0utAa °L6 ° As Net 2,273.54 Gross Discount No -Pay Net 2,273,54 0.00 0.00 2,273,54 No -Pay Net 0.00 2,273.54 file:(//C:lUsers/Itrevino/cpsi/memmed.cpsinet.com/ti88125/data_5/tmp_cw5report789315... 1 /26/2023 Page 1 of 1 RECEIVED BY'THE COUNRYAUDITOR ON JAN 2 6 2023 MEMORIAL MEDICAL CENTER 01/26/2023 0 AP Open Invoice List C.ALH0t111F?,QIUNTY, TEXAS ap_open_invoice.template Dates Through: Vendor# Vendor Name / Class Pay Code 11824 THE CRESCENT✓ Invoice# Comment Tmn Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 012023 01/26/20 0112MO 02/20/20 551.47 0.00 0.00 551.47,/ UHC NOV OIPP Vendor Total: Number Name Gross Discount No -Pay Net 11824 THECRESCENT 551.47 0.00 0.00 551.47 ReportSummary Grand Totals: Gross Discount No -Pay Net 551.47 0.00 0.00 551.47 :iPFROI/lk1) CJnj iAN 2 6 2023 aaPOU1.1 t rrT�i�IT% file:///C:/Users/ltrevino/cpsi/mernmed.cpsinet,com/u88125/data 5/tmp_cw5report681973... 1/26/2023 Page 1 of 1 RECEIVED BYCOUNTY AUDITOR ON JAWOW2g23, MEMORIAL MEDICAL CENTER L03 AP Open Invoice List 0 11:24 ap_open_Invoice.tempiate Dates Through: "AI.HOU'%hd&dT Eft4f,Vame Class Pay Code / 11836 GOLDENCREEK HEALTHCARE ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 011823 01/2612001/1812002/`18/20 131.12 0.00 0.00 TRANSFER �µlyj,�(7y0.yt,1. pyMt7 (1L17e6i }� )tj l VAL 0PO 012023 01/26/2001/20/2002/20/20 3,457.60 0.00 Y0.00 UHC NOV OIPP Vendor TotalE Number Name Gross Discount No -Pay 11838 GOLDENCREEK HEALTHCARE 3,588.72 0.00 0X0 Report Summary Grand Totals: Gross Discount No -Pay 3,588.72 0.00 0.00 \PpoltlVm ()M AN 262023 a& Ci ftlY AUDITOR FAI GeOUNTV, TEXAS Net 131.12 v 3,457.60 Net 3,588.72 Net 3,588.72 file://1C:/Users/itrevinolepsi/memmed.cpsinet.coinlu88125Idata_51tmp_cw5report352024... 1 /26/2023 Page 1 of i HECEiVED BY THE COUNTY AUDITOR ON '�Q/jbA 2023 11:25 CALHOUN COUNTY, TSM Vendor# Vendor Name 12696 GULF POINTE PLAZA MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: Class Pay Cade 0 ap_open invoice.template Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 011523 5,345.00 0.00 0.00 `0'1/26/2001/'18/200tt2//18120 (� 1 TRANSFER N� i115u�.6.f PjlJKi Atpo"A - ik-} OAAI'. d'P 011923 01/26/2001/1912002/19/20 26,102.03 0.00 0. TRANSFER r' rr 012023 01126/20 01/20/20 02120/20 2,628.87 0.00 0.00 UHC NOV OIPP Vendor Totals Number Name Gross Discount No -Pay 12696 GULF POINTE PLAZA 34,075.90 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 34,075.90 0.00 0.00 "I"PRl7VED fj11 n, NN 2 6 2023 CALLH0 °t"'collNC'T°,RONAS Net 5.345.00 DF/ 26,102.03 ✓'! 2,628.87 Net 34,075.90 Net 34,075.90 file:///C:/Users/ltrevino/epsi/inemmed.cpsinet.com/u88l25/data_5/tmp_cw5 report269951... 1 /26/2023 Page 1 of 1 ;',OUNTY AUDKOR ON 11:26 •^ALNOUN COUNTY. TF_%AG Vendor# Vendor Name 13004 TUSCANY VILLAGE MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: Class Pay Code 0 ap_open_involce.template Invoice0 Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 011123 01126120 01/11/20 02/12120 2l,190.82 0.00 0.00 TRANSFER 04 jY�bftw F�otl JAl114i lc.t �tn;. pnW-L UW4L4, " 01172318 01126/20 01/17/20 02117/20 3,185.00 0.00 0.00 TRANSFER Il x 011723A 01/26120 01117/20 02/17/20 4,629.00 0.00 0.00 TRANSFER k 4 011923A 01/26/20 01119/20 02/19120 3.10 0.00 0.00 TRANSFER " 11 011923 01/26/20 01 /19/20 02/19/20 30,441.30 0.00 0.00 TRANSFER I� a 012023 01/26120 01120/20 02120/20 1,240.S9 0.00 0.00 UHC NOV OFF Vendor Totals Number Name Gross Discount No -Pay 13004 TUSCANY VILLAGE 41,889.81 0,00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 41,889.81 0.00 0.00 Net 2,190.82 3,185.00 4,829.00 3.10 30,441.30 1,240.59 Net 41,889.81 Net 41,889.81 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report333161... 1 /26/2023 Page I of 1 'RECEIVED BYTHE COUNTY AUDITOR ON :JAN 2 6 2023 01/26/2023 MEMORIAL MEDICAL CENTER rTALHt3k7tPssOUNTY,TF-XA4 AP Open Invoice List 0 ap_open_invoice.template Dates Through: Vendor#Vendor Name - Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 011723 0f11/2'6/20 01/17/20 02/17/20 0.04 0.00 0.00 / 0.04 v/ TRANSFER W n tYISUYPftlt p�AC4 atpo61 }cd I',"h WML tptfti-f1n�) _ 012023 01126/20 01/20/20 02/20120 2,842.52 0.00 0.00 2,842.52 UHC NOV QIPP , Vendor Totals Number Name Gross Discount No -Pay Net 12792 BETHANY SENIOR LIVING 2,842.56 0.00 0.00 2,842.56 Report Summary Grand Totals: Gross Discount No -Pay Net 2,842.56 0.00 0.00 2.842.56 :,VCj?t_va) ON ALH000 6OLINTYRTEXFIS file:/!/C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report422032... 1/26/2023 Memorial Medical Center Nursing Home UPE Weekly Cantex Transfer Prosperity Accounts 1/30/2023 rmwm uwum a Ndhas"' Xunl Xomv v ) aw vin9m ITnMIerW[ ffnnrteMn .Oanor6a TK.r'[ eglnnly NMUMwev Baham / Tnm3anN 1. 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W)120z] XVMP)u INf m WCWMPMT 3w2N6Y1w3)63m 3/I7/2013 OIVDLfO NMLnIPI1fGWMPMf 13{IGW9)20W1 NM!' t.ry ISd m m W"n mPORnd9 6,589.w - 66.i> 232H 14 13.34 ]9 A3 I 38Bw 3t 9,661.05 • ]sxw 9,6]1,5] 11,g1Y V45411 14,199.I3 - - 540.O.m SO.Omm ' 36,9]IJ] Ifi,w1.91 - A.053.9) 9,098.93 - 3561M 3.4d.w - I1136.N - 11,316.CR H3.Id Sat". 24 / N.199.13 312616J6 ]9,15].3E 6E9039 32tlLw V ]6gO6A!}✓ MMOPORTIOX Tne,Ia Qj Tnn3MNn WPP/Gegl NPP/C4"t mW/CpmP3 wFloayilkly1p (yPPn NN PORmt, ' 9,LMw - 6.Cw.04) - 1}580 - ).m. - Liex]0 IF87.70 iS,242,M - ILI6L9] - 11,4097 0.155.31 - Q55531 I.n1.Y - L]5],I3 - I.mla 9,183.]9 Um.W LnO.w - 1.7717S - 33Alan 23,97471 to" vaot6+ ;Pau 1lr011yb' 1,14.61 "9Im9 - - SOm0.W 50.000m ' IWIR.Y - 10,161.99 IMI.S3 - UU.S1 - U.WW - ICWO9 LWO S,m9 - Y319M - 4.3ZgM 10.3]9A6 5.11L10 1m"IIMIL" 4.190" 10,190,H1 ' 1.931W - IA09.91 ] z:a ! 9 9 9931].{9 KCJq IOIKw 13931 - 011.63 3 4 193 w]J6 MMCMITI SI Tnn M T-tteO, A"/(pmPI 0IPP/mmP1 QIPP/WIWd QW/Wi 69YP16 Q"TI XNmmm - S.M. - 43PAm 115mm - 1£5wm - 2531.87 - I.SI5.81 ' Claw - 6.950w - 11.400.W l2NMm 15]m.]5 - 15.230.75 - Imm" ss.5B090 R.22161 - M.22462 u95W 1394m Mplt w.)l LMTel ]s9]91 wa]LOt 49.61a.O1 2MLlp PpStEB 990A2 wmm sO.Ow.w 5.76401 Siw.w 6 xsz0l 6,)13.5] 9t166I 918.61 IOA4S7 - 3057 - ].900W ],m m • Im w 9.6w.m W. IAVOW - ' ]t569.16 - i2,lw l6 1d19.50 ,300.16 - B21.54 % 323m 82153 IANN WanN➢amWMWk OQWWWWAl *HWIXRH&inkO WMnG 01-I3-41nry 0"9g013.1I wfeI EEEEEEEEES MMCPoRI W Tn IfOw1 Txn9Nrvin QWCPmPi gIPP/COMP2 QIVP/Cnmp1 QIPP/@Tp4 m CUPPIl NHPONTION l/L9/IDL MNB-f[M NCGGIMPM3f46MHllYRMMXg9 URAS 951M US!/N3] YNffCMMYNIIYPLMlCU1MPM3x600N1191®] - Ii)651 • 3;i16.55 ULi/YIII NWx45G(VIIONN(fIxMPM161566)410.O]369 4,1et4 ]yAp))XMIIN XUMINSVCKf41MI.Mlla69]3f1IX395E - Ifb.6) L6H,bl U14/A13 XNB.IGNONLCILMPME]lNtlilll YQA31438] - 4419].9] ll.l9).93 191AD4 YN[mNMYNNYPI NCCWMEMI x(lOLl193fN] ]0]PLN - 30,IB5.10 IMMD NMNIGWNGNl3al14mWAWMMP�W3191LOOS - 1R9Ii013UXCCOxMUNDYvIxttWMIM3>6EmLllPIOm ),)31.95 03&4].33600 l(!N{011(iME1W60URC0/J6(iYM{ME[i1f01t1)itllfp I1y6,6] I'm" 2.0!)A} IA.Ifgm Lo1e.s4: LGIAS5 WIPEOYIGNRx NGIMGNECENRM HI W.M.I 1/l0lPPN[ 50.27D00 MNWfANNGLWMNA}]40IY1143b Un" 104W pMo UNMx 1S% UIIMM MAIMGGXOMITVLBMMPMMbx]941i - M{pl , 41)/MM UMCGONMYNNYPLHCCWYPMTIE(WHIl9l® - 1,999.65 - 1199.0 3 7Mil NOVrtK501U110N NCMIMPMT M56631M1Ylll 3A]l.0 , ).0]E.03 I/ Mgll HfA1TXMUMPNSVCHCCWMFWlTIW] 2l M1 2".. - / i,334.W S.14991 IS49.T4. 4119.)6 x03f09 W 13LW N 3f9A - / LEW MMCPO m jf3pl/9($kI jE611(COIO QIPP/Ginpl QPP/Cempi QIPP/GNIP) QIM/UMpI01104 QIMn NMPONTIQN UM/2013 UM1e0N4M4aa NCCGIMPM3)I600311191CW0 1430 - 39A0 lll3/103l UXCCOMMUNMFLNCCWMPM3)i6WI4llll M 3LD3).M 13lN%S6 NNMANACML0150MGCWMPME390%j4EWW16Tl 1,669.3] • 3664]I VUIIeM UM/303311N0-fCHOMC[WMpMf]i6003411 44000p14096 11.766.10 - ll,)66.I0 1134/1013RmxlgmuplVS<MCC3NMpMT 31W5619PS 1116W - 1g,6. 1460.g9 /14/1013 fVPLHWPMNW0191101YW0 - N" e6 Ul4/MM UHCWMU 14W2UL }Y16. 31 1/MOTASDSUNHCI0000 1IL2aM LLM8 (ON.xuMAW)M.ccWMPSATIV6ZS300WS6820 4M.EE 00 140 9fi5.W 1124124" WAAbmHCGWIMPMT3M6141WW191 3]10.W ,M-00 - 1,71000 1/29/2MWEIAGIAOE MPM390M915 5,35LW 3.35L00 U5/2021 UXCCOMMUN"PtHWMPM>46M4nllp0 336457 136151 Ul5/iW3 NONTAS SOLUIIONNCCWIMPMT6)631041000pM3 g),WL01 ejWLG UTAP=EARE g0UPCOpfKWINvN933TE8 f1000. Ig6x4t 0.]+1so t9s6.fa. 9,n6L6. 9n.4 MjjlS 1/16/= WIPEDIIT[MIR%HGITNGRECENIFASIII )},jg6]3 U26/MM OEWA 315,020.00 -315AM,W L36/1023 01 - 9,IMA0 S,Iw.oe HNa4CH HLUAT1f5MN5PSE0301.W0D2MfiU U]F/M13 HN6-ECNOMONKM3]C6W367010 Y0216633 49,60 ggb0 Ul6/3013 - J.372.29 � ll)].i4 HUN%X3OW110NHCCIRIM?W3W3104MWY1W UE6/M]3 XUMANA[NAOBBHCCWMPMI3WW}RGOWIHis - 4,650.W 011ME3 MRII0.4pANONFII)16MMf PMN30]NW W0001463ai 3,96LG0 3.9saw V2)/]0II NNA. IMO NCCWIMPMT]46W34114400W}i133i .3A5 ,96806 4)]3. 1/27/IW3 NNg-[MONCCWPM IMl HfA034114GG06Mt)35 9,fifi).D4 PADS." j/3]IlOM AMPSupplemE[rtE HC[IPIMPMT)C6W34llll<36i J M4,0 / t94 S0 )239693 )14W.-J' 4)M.60 L954.91 - 9M696 141W. I yL6511W1}/ TOTAL[ IH5.114]3 19N.16S.N 65.69}.31 13.WSW )L641}2 1/3012023 Treasury Center Account Number Current Balance Available Balance Collected Balance Prior Day Balanc + Number of Accounts: i6 $11,059,490.61 $11,193,350460 $11,059,490.61 510,998,032.E '4551 CAL CO INDIGENT $11.859.79 S11,859.79 $11.859.79 $11.859.7 HEALTHCARE '3660 GULF POINTE PLAZA- S100.00 $100.00 S100.00 S1001 DACA '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $126,919.03 $135,705.10 S126,919.03 $126,919.0 HEALTHCARE •4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $537.01 S537.01 $537.01 S537,C 2014 '4357 MEMORIAL MEDICAL $7,626,432,36 $7,701,721.22 S7,626.432.36 S7,862,139.E. CENTER -OPERATING •4373 MEMORIALMEDICAL CENTER - PRIVATE $432.32 $432432 S432.32 S432.3 WAIVER CLEARING '4381 MEMORIALMEDICAL $312.981.92 S316,833.23 S312,981.92 $29D,816.3 CENTER I NH ASHFORD '4403 / MEMORIAL MEDICAL CENTERINH $g04,914.78 ✓ $409.840.86 S404,914.78 5349.550.7 BROADMOOR '4411 MEMORIAL MEDICAL $306,758.85,/ S310,753.63 $306,758.85 5286,105.E CENTER NH CRESCENT '4446 MEMORIAL MEDICAL $175,410.73,� $176,411.99 $175.410.73 $167,140.11 CENTER INH FORT BEND `4438 M TER I SOLERA AT L MEDICAL CENTERlS $725.142 96 S735,918.86 $725,142.96 S705,5215 WEST HOUSTON '2996 MMC-MONEY MARKET $297,150.11 $297,150.11 $297,150.11 $297,150.1 FUND `5506 MMC -NH BETHANY $555,072.73 $573,454.03 S555,072.73 S400,571.E SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- $154.538.62 S160,270.59 $154,538.62 S150,501.7 MEDICARE/MEDICAID •5433 MMC -NH GULF POINTE $23,915.32 $23.915.32 $23.915.32 $23,915.2. PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY VILLAGE $337,324.08 S338,446.54 $337,324.08 $324,768,C ' indicate:. Page generated on 01130!2023: Copyright 2023 Prospedly Bank. h0ps:71prosperityolhanking.com/onlineMessenger i!i Memorial Medical Center Nursing Home t1PL Weekly Nekion Transfer Prosperity Accounts 1/30/2023 ARc0urR NBtt'nnim unin Xeme _ p1aMn. B law MEMMOMM 49;32B.a1 Nate: aMYbvlanTef o/overSS,WOwllbe rmrupmd m Menumne name. NOW I: Feed veeeum daa a basebalcnre of $10a rbvr MMC de0mNed 0 open armvnr. o�oi°v count y° f0 1;\NH Weekly TranflerANH UPt Transfer 3ummanVW3\NH UPL Transfer Summary 01 n.i3.tlaa Pendbe Tadin.11e9lnn1nE An,.WR.Be Tramtered WNWane 0 esiN Balance Home - 126.919.03ve BBAOd.B9a Bank Babnn 126,919A3 Vanann wavein Babnee LOOM 6UPERIQRNQVQIPP Q`6J 30,414.14 aNvber Internet Nauemberintereft Oecemberinmrnt Adlun ealanTe/Tmnafar&Wt 96404M9 NHaREw OE LOSSaNT06 3/30/3023 MaMCPCNTON aPP/mmw Tnm GLI aProrol aM/GmPi HX PDRi RXGY6l/ifNMM1119MXANYfY[ - 10.0 ]o. 0 MAIN.R0.XfiXXrc&W DIP MAMSH91791 1.4s.. 1 1Y/1l9/1033 N[MDIPC111Mt ILIfiCW)9UTW9l lli 6.US MAIM I S.MM 9.99061 VlVNXEI LlO.li 71,481.3.1 YWUWTNgIDNNP4]X"f*QPDfXCflt[KUC I4,M3.Bt2M XX9 Itl Ut - IWAl 96.b119 J 96.W119,/ 113012023 Treasury Center Account Number Current Balance Available Balance Collected Balance Prior Day Baleen Number of Accounts: 16 $11,059,490.61 $11.193,350.60 $11,059,490.61 $10,998,032.0 '4651 CAL CO INDIGENT S11,859.79 $11,859.79 $11.859.79 $11.859.7 HEALTHCARE '3660 GULF POINTE PLAZA- $100.00 S100.00 $100.00 $100.0 DACA '4454 MEMORIAL MEDICAL! NH GOLDEN CREEK $126,919.03 f $135,705.10 S126,919.03 S126,919.0 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $537.01 $537.01 $537.01 SS37.0 2014 '4357 MEMORIAL MEDICAL $7,626,432.36 $7.701,721.22 $7,626,432.36 $7,862,139.E CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $432.32 S432.32 $432.32 $432.2- WAIVER CLEARING '4381 MEMORIAL MEDICAL $312.981.92 $316,833.23 $312,981.92 $290,816.: CENTER I NH ASHFORD '4403 MEMORIAL MEDICAL CENTER lNH $404,914.78 $409,840.86 S404,914.78 5349,5%7 BROADMOOR '4411 MEMORIAL MEDICAL $306,758.85 S310,753.63 S306,758.85 3286,105.E CENTER NH CRESCENT '4446 MEMORIAL MEDICAL $115,4/0.73 $176,411.99 $175,410,73 $167,140.£ CENTER f NH FORT BEND •4438 MEMORIAL MEDICAL CENTER I SOLERA A7 $725,142.96 $735,918.86 $725,142.96 S705,523.£ WEST HOUSTON '2998 MMC-MONEY MARKET $297,150,11 $297,150.11 $297,150,11 $297,160.1 FUND '5506 MMC-NH BETHANY $555,072.73 $573,454.03 S555,072.73 5400,571.E SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- $154.538.62 $160.270.59 S154,538.62 $150,501.7 MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE $23,915.32 $23,915,32 $23,915.32 $23,915.2 PLAZA -PRIVATE PAY '3407 MMC-NH TUSCANY $337,324.08 $338,446.54 S337,324.08 $324,768,C VILLAGE ' indieate. Pape generated an 01/3012023: Copyright 2023 Prosperity Bank. A 1 h"ps:l/prosperity.olbanking.comlonlineMessenger if1 Memorial Medial Center Nursing Home UPI. Weekly HMG Transfer ProsperityAccount$ 1/30/2023 aneum Nunl Nem< Numf+• II Omteiunm zi,9]5.33 Vilbntt i<>vi„NNnce 3mao SePWoanw WIP ot5 33,mY53 v<iPMrrmm3i Nnremb<rinl<M embrini<mf Fdfml P<lin«/T.infM1tMnt NYIS vnauui lnwvnru6i duwm PielnNn6 P[nexa T.n.r.n.en NO... Nwnu.- Winn T{nul<rOut IT[iulinln /nutleirte Oenedu TadiY<e<NnMn Pal a3,130.<6 it dY030.K� iSi,[38.61J 13i530.63 356p36.6b Bunt B>lann sKS30,6I vimnee _ NMa: QtNdtlw<m d [m$$,[WmV bruvM/griritPMenuninv Mmr. Nn<Y. C4[A eC[OW[Aeiehni[bd91n0/$IW IrKK MMCd[PoihMfOPom R[Owf. APPROVED ON c>3ati uNCiu�WPA§ LpnwnWmmren\IlxuvtumNmavmmmVPaUlnurtninilnwnwmoNg3] tlu l .Mlaunn ftiobalm<ml XonmbnlnmM oeumbxmfeme AdIMPalwn/nieiMNnt 1seaTaeY TmhtTxnxsysu sss.uzTT.! NNOBnvmlosswrOs y3yxd]3 I/24IM23 HNII-EUIDHCCIANIPMT ]CfbDiLI i4WOON969C I/N/2025 NNE- [NO HCCIAVUPMT 746OW41144WCOUBWE 1/26/2D23 WIRE OUT HMO SERWES, IIC 1/26120"HNB-ECHOHCC MPMT]46W34134CWCO215]39 1/26/2023 HNO -ECHO HCCMIMPMT 7460W4I1640W W 15613 1/29/2023 NORIDIAN33AHCCWIMPMT6)SB92420000177862) 1/23/2023 HEALTH HUMAN WE HCCIAIMPMT 1746MU113013 2 1/24/208 WPS-TMEP CONTRAC HCCWIMPMT 24020U4311100 1/25/2D23 NOMOMN MA HCCWMPMT 6758924200001129553 1/26/2D23 WIRE OUT HMO SCRWCES, QC 1/26/2021 O4pP4it 1/26/2023 MERCHANT BAN6CO DEP05049647BSISSO99300001 1/27/2023 MERCHANT SANACD DEPOSIT 49M7851888993E000I MM<PURTION QUIP/Comp glPv(Cemp4 TranAAtaut T.......QIPP/COMPI 2 QIPv(Cwnp9 &lapis QIPPTI NH PORTION 23.52 - 23.52 57398 - 573,98 9.497.22 - 66.09 8026 66.09 $0.16 74375/ MM<pOR110N QIPPIM-P QIPP/C0m14 Mn3Ter-Out T..".n QIPP/COMPS 2 QIPP/COmp3 &lapse QIPPTI NN PORTION 82.OSOS3 - 8I,010.53 2,861 6 - 2.961.26 543.S7 - 543.5) 10,467A4 - 10,467.44 43.030.46 - - 50,838.65 - SQ838.65 4,680.51 - 4,680.31 4,035.36 - 4,036,'0 03,030A6, 154,038.62, 154,6396y/ 52.527.53 155,18237 - B5118237 1/30/2023 L" Treasury Center cyu Account Number Current Balance Available Balance Collected Balance Prior Day Salanc Number of Accounts: 16 $11,059,490.61 $11,193,350.60 $11.059.490.61 $10,998,032.E '4551 CAL CO INDIGENT 511,859.79 $11,859.79 511,859.79 $11,859,7 HEALTHCARE '3660 GULF POINTE PLAZA - S10D.00 $100.00 5100.00 $100.0 DACA '4454 MEMEDICAL NH GOLDENOLDEN CREEK / $126,919.03 $135,705.10 $126,919.03 $126,919.0 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $53Z01 5537,01 5537.01 5537.0 2014 '4357 MEMORIAL MEDICAL 57,626,432.36 $7,701,721.22 57,626,432.36 57,862,139.E CENTER -OPERATING 14373 MEMORIAL MEDICAL CENTER -PRIVATE $432.32 5432.32 S432.32 5432.3 WAIVER CLEARING '4381 MEMORIAL MEDICAL $312,981A2 $316.833.23 $312,981.92 5290,816.1 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $404,914.78 5409.840.86 5404,914.78 5349,550.7 BROADMOOR '4411 MEMORIAL MEDICAL $306,758.85 5310,753.63 $306,768,85 5286,105.E CENTER / NH CRESCENT '4446 MEMORIAL MEDICAL $175,410.73 S176,411.99 $175.410.73 $167,140S CENTER/NH FORT BEND la 38 MEMORIAL SOLEEDICA! CENTER/SOLERA AT $725.142.96 5735,918.86 5725,142.96 S705,523.E WEST HOUSTON '2998 MMC-MONEY MARKET $297,150.11 $297,150.11 $297,150.11 $297,150.1 FUND 'S506 MMC -NH BETHANY SENIOR LIVING $555.072,73 $573.454.03 5555,072.73 $400,571.8 '5441 MMC-NH GULF POINTS PLAZA- $154,538.62, 5160,270.59 $154,538.62 $150.501.7 MEDICARE/MEDICAID •5433 MMC-NH GULF POINTE $23.915.32 $23,915.32 $23,915.32 $23,915.3 PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY VILLAGE $337,324.08 5338,446.54 5337,324.08 $324,768.0 ' indicate:' Page generated on 0113012023; Copyrignl 2023 Prosperity Bank. hftps://prosperity.olbanking.com/onlineMessenger 1/1 Memorial Medical Center Nursing Home UPI. Weekly Tuscany Transfer Prosperity Accounts 00/2023 A nt xun H. u._�. xof c Only ORmva of ava GS,000 volt pv twm/med ro the nwmR Avme. Able]: EOM v.awrAvavbmehvlvncevJ$IW tMt MMCtivn.itNwopertxvwa. PROVED ON JAN 3 0 2023 U CAWONUc(TM7U Y.lTEE-XAQ Pandma eankwbnn vuv.n<e lerve In Batmn AMFRIGRWPNCVQIPP 10.0 A,nwMroea Adiult Bilanva/M1antret Amt 319 ]bN (\ 1 PpO,prtdaJVp Gui' Jo � 1/30/10➢ NIYR9W YF l495AXiG] MMCPORTION QIPP/Comp CUPP/Comp QIPP/Comp Transfer,Out TmnsfeMn 1 gIPP/[omp2 3 48,lapse WPPTI NHPORTION - 1,143.78 - 1,143.79 • 4.743.68 4,743.68 - 14,274.25 14.274,25 - 8,703.29 8,703.29 - 17S,714.79 - 175,714.79 - 23.71 - 23.71 - 18,611.34. 27,274.14 2,347.20 174947.74 573,60 50,673.61 - - 1/23/2023 NNB• ECHO HCCIAIMPMT74fi0034114400W203008 1/23/2023 HNB-ECHO HGCIAIMP W 74GW3411440000203008 1/23/2023 HNB-ECHO HCCW MPMT746003411440000102226 1/24/2023 HNB- ECHO HCCMMPW74CM341144Wd024SM6 1/24/2023 NOVITA5501I ON HCCIAIMPMT616201420000194 1/25/2023 HNB- ECHO HCCIAIMPMT 746MUll 4M0002M029 1/25/201I AMEIOGROOPOORPO E-PAYMENE E61515M IIIOX V26/2023 WIRE OOTONSAR ENTERPRISES, LLC 1/2612023 Dimwit - 62,985.25 - 62,985.25 1/26/2023 HNB-ECHOHCCWIMPM774RM3411440W0215613 - 1,519.89 1,529.89 1/26/2023 NOVITASSOLVTION HCCIAIMPMT676301420000199 - 35,938.10 - 36,939.10 1/27/2023 HNB-ECHO HCMIMPMT 746003412"GpD0252059 - 1"314.71 - 11,384.78 1/2712023 HN8- ECHO HCCWIMPMT 746003411440DO0252055 - i 1.171.22 /7 - 117122 60,673.61 337SZ4.08// 17.274.14 1,347.20 11,941,74 319,176.34 / 1/30/2023 Treasury Center l" Account Number Current Balance Available Balance Number of Accounts: 16 $11,059,490.61 $11,193,350.60 •4551 CAL CO INDIGENT $11,859.79 $11,859.79 HEALTHCARE '3660 GULF POINTE PLAZA • $100.00 S100.00 DACA '4454 MEMORIAL MEDICAL 1 NH GOLDEN CREEK $126,919.03 $135,705.10 HEALTHCARE '4365 MEMORIAL MEDICAL S53T01 S537.01 CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL $7,626.432.36 S7,701,721.22 CENTER• OPERATING '4373 MEMORIAL MEDICAL S432.32 S432.32 CENTER •PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL $312,981.92 $316,833.23 CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $404,874.78 5409,840.86 BROADMOOR '4411 MEMORIAL MEDICAL $306,758.85 $310,753,63 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $175,410.73 $176,411.99 CENTER/NH FORT BEND '4438 MEMORIALMEDICAL CENTER / SOLERA AT $725,742.96 $735,918.86 WEST HOUSTON '2998 MMC -MONEY MARKET $297,150,11 $297,150,11 FUND '5506 MMC •NH BETHANY $555.072.73 $573.454.03 SENIOR LIVING '5441 MMC NH GULF POINTE PLAZA- $154,538.82 5160,270.59 MEDICARE/MEDICAID '5433 MMC-NH GULF POINTE $23,915.32 $23.915.32 PLAZA -PRIVATE PAY '3407 MMC -NH TUSCANY $337,324.08,/ $338,446.54 VILLAGE Copyright 2023 Prosperity Bank. hops:!/prosperity.oibanking.com/oniineMossonger Collected Balance $11,059.490.61 $11,859.79 $100.00 $126,919.03 Prior Day aslant 510,998,032,E $11,859.7 $100.0 $126,919.0 S537.01 S537,C S7,626.432.36 S7.862,139.E $432.32 $432.' $312,981.92 $290,816.; S404,914.78 S349,550.7 $306.758.85 S266,105.E S175,410.73 $167,140.£ S725,142.96 5705,523.E $297,150.11 $297,150.- $555,072.73 5400,571.E S154,538.62 $150,501.7' $23,915.32 $23,9152 $337.324.08 $324,768.0 - indicate: Page generated on 01130/2023 Memorial Medial Center Nursing Home UPL Weakly HSLTlansfer Prosperity Accounts 1/30/2023 PMaow P.ndu, amwnttoBa ivawt NENNq / M.dlun TnMemdm NUNn Xnm. / bumb.r W.nn tiwbnOu[ % Te.nalee.n /6[tlnntl N BMIIIIII JE / If�f�' I06.131A1 fiyOB.16 S3I,R9A1 - 530f}44.14✓ Bank Ll.nn SSS.01.13 yuim lnnln Wl.nn IQO.w 4aPEPICK.. 1111 1)1E/ 34.9IIM Oetnbeelnt.r.0 xwemb.rinterM anmMrmt..0 Mjx.t Balnu/I Erram. �'...n\.�j /...,�ssaassJs�- Ndr. mhkomwn ywnssAwwm5r3row/mnmin.nunmphann Au,wm:aMQIL13_ IS _. .&A 1.113: E.1h OE rh.,.W,Wpnn.1sI. IMt MMCE.p Ile1.0pfn irnunt gNOaFW OF Ia9LNlM f/3J 33 APPROVED ON JAN R 0 2023 ;ALBY HOOU�NU COUM ,iTESCA.�. I:wxw..X/Tnna.nlxX uel3r.mlosYmm ry\toxlwx Vn Tun., IV—WIM.3 21.du MMCPOWION IIBo21c^9s1 }•!�11i.Efm9 MVPlmmnt yx/Dpmpi Wvv/mmp3 Orr/tomwsuPN QPPV nx MMM UE3/]031 "I L374.32 U]UEUIJ XFµIX NUNANSVCXCDIIM]M]{]960•YI]1016E n LTS]61 1 1.]5].61 uzuzMa wpem P{ 6Nze NI mm 4epout 41� SEWN ] 5 BS83 NCMil HNBrLNOHCC MPWUMMACICC 2N 6 M269 09L69 NC/ID2l H0UrtKWLUTW-HC MMITNNBl12COAW 2C0.5G5,M 240545. U35/]O31 NowmM XONKKCWMPM]6]NMIN wl IO.ISTA6 10.35 U35/ID23 NFAlTN NUMhV SVCNCCWMPMTITW WN3130162 6.N5= M CUM 1/E6/I0E1 WIREOUT VOW NVBCBNH UC 61.ID3.N 1/E6/1023 De ft 93,11M 93,118.16 U1612021 Drowlt 17,02.16 3I,NLl6 3/27/2013 DSWtit _ 2.621.74 1AMA 1/27/E0E3 NWITAfi WMR10.YHC[LUMPMT6T6<B10ICOfi0lll � ]SlA>9.1fi MAMA 0240LM 53tAE6A]. MlAnA1 1/30/2023 l" Treasury Center Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 16 $11,059,490.61 $11,193,350.60 $11,059,490.61 $10,998,032.6 '4551 CAL Co INDIGENT $11,859.79 $11,859.79 $11.859.79 $11,859.7 HEALTHCARE '3660 .GULF POINTE PLAZA - $100A0 S100.00 $100.00 S100.0 DACA '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $126,919.03 S135,705.10 S126,919.03 S126,919.0 HEALTHCARE •4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $537.01 S537.01 S537.01 S53TC 2014 '4357 MEMORIAL MEDICAL. $7,626,432.36 $7.701,721,22 $7,626.432.36 57,862,139.E CENTER - OPERATING •4373 MEMORIAL MEDICAL CENTER - PRIVATE 5432.32 5432.32 3432.32 $432 WAIVER CLEARING '4381 MEMORIAL MEDICAL $312,981 92 $316,833.23 S312,981.92 $290,816.e CENTER/NH ASHFORD •4403 MEMORIAL MEDICAL CENTER INH $404,914.78 $409,840.86 S404,914.78 $349,560.7 BROADMOOR '4411 MEMORIAL MEDICAL $306,75B.85 S310,753.63 $306.758.85 S286,105.E CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $175,410.73 $176,411.99 $175.410.73 5167,140.E CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER/SpLERA AT $725.142.96 $735.918.86 S725,142,96 $705,523 c WEST HOUSTON •2998 MMC-MONEY MARKET $297,150.11 $297,150.11 $297,150.11 $297,150.1 FUND -5506 MMC -NH BETHANY $555,072.73,� S573,454.03 $555,072,73 S400,571.E SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- $154,538.62 $160,270.59 $154,638,62 S150,501.7, MEDICARE/MEDICAID `5433 MMC -NH GULF POINTE $23,915.32 $23,915.32 $23,915.32 $23,915.3 PLAZA - PRIVATE PAY •3407 MMC -NH TUSCANY VILLAGE $337,324.08 S338,446.54 $337,324.08 S324,768.0 - indicate: Page generated on 01/3012023: Copyright 2023 Prosperity Bank. t hllps:flprosp8rity.olhanking.comlonlineMessenger 1/1 rl A y F E IMF[; MORIAL MEDICAL CENTER . -.HFCII" REQUEST - Aslx&,A- MEMORIAL MEDICAL CENTER Dat= Requested: 1/30/23 -APPROVED ON JAN 3 0 2021, LIAUNTY R& C,AL UON FOR ACCT. USE ONLY 0 1 mprest Cash IAIPC ' he� - % i;to Vendor II ORerum Ched, Lo Dept AIVIOUNIT --32 432,64 G/LNUMBFR: 10255040 EXPLANA-PON: AMERIGROUP NOV QIPP ----- ---------- witpw-.sTEF) BY: Mayra Martinez IMEMORIAL IIMEWAL CENTER CHEM( REQUESIF NwudmuUr IN MEMORIAL MEDICAL CENTER A Date. Requostod; 1/30/23 y z*PROVED ON JAN 3 0 2023 BY COUNTY A -ALHOUN COUNR"WAs Amouf,rr 12018.65 EXPI-AiNATION: AMERIGROLIP NOV QIPP Mayra Martinez --- ------- - ------ --- - FOR ACCT. USE 0 N! LY F-1 I m prest Cash []A/P Check. [-]Mail Check -,o Vendor -URA-T.urn Check to Depi G/L NUMBER: 10255040 Ak ITHIC r(IZFD 21�1: P MEMORIAL MEDICAL CENTER Date Requested: 1/30/23 A eVPROVED ON JAN E— C.AgI.HO103 0237�AUNJRqqY ! AMOUNT 98,346.69-----.__-- EXPLANATIGINI: AMERIGROUP NOV REQUESTED BY, Mayra Martinez FOR .ACCT. USE) N LY i-Imprest Cash O.A/P Check Mail Chcck to Vendor Return Check to Dept G/L NUMBER: 10255040 AUTO ORI.'.Fi, B,;:U!�Du%Lfx..s�'Q„��'Ys�w 1 1 t'3 012. 3 p A E AMOUNT MEMORIAL NAEMCAL CENTER REQUEST-ButA- f"l � I MEMORIAL MEDICAL CENTER EXPLANATiONI: AMERIGROUP NOV QIPP Rl CAUESTLD BY: Mayra Martinez Date Requestnd: 1/30/23 FOR ACCT, USE 0 KY APPROVED ON FlImp. est cash JAN 3 0 2023 �A/P Check Mail Checkto Vendor CARHCO'N' 'COUNT []Return Check to Depl: Qt NUMBER: 10255040 AJi7i, Q'l BY: — ------------ ------- f-- &Ald MEIN/10MAL 11"AMCAL ("ENIFEAR CHFIC—K REQUIE'ST - sol,n- p MEMORIAL MEDICAL CENTER A Date Requested: 1/30/23 y -APPROVED ON JAN 3 0 2023 CAMY0 0'PMOLIMITTY4S AMOUNT _$g 6_g6 EXPLANAPON: AMERIGROUP NOV QIPP cf) BYMayra Martinez FOR ACCT. USE ONLY 1-1imprest Cash [JA/P Check 1-1 Mall Check to Vendor n ReLum Check is Dept G/L NUMBER: 10255040 11 C)f 2-3 MEMORIAL MEDICAL CENTER t CH E CK R E QUEST - 014 .I JILSL p MEMORIAL MEDICAL CENTER A y E. E AMOUNT _17�947.74 EXPLANATION: AMERIGROUP NOV QIPP Rf-QUFsTED BY: Mayra Martinez Date Requested: 1/30/23 -TPROVED OAI JAN 3 0 '?023 ABOUOU00JW"WA8 FOR ACCT. USE ONLY F1 Irnprest mash FIA/P Check IMail Check to Vendor 1j, Retum Check to Dept G/L NUMBER: 10255040 AUTHORIZED BY: 'LAX g nn O� nn O 0 3C yC: �m 9 a y� y0 O ^Aid G.,yc� mZ O = o 'o zcz n > z y� AMA m m C) o n w o c � 0 n 00 00 ao z xo A xy yzy oz-7 mt' r O r my y r A OtP '9a Ao Ay mr' y XN -7 XN =1 -i �N Z n M Wy y0 A W y cn W m m0 o h n D h $ A +rim m i m b CO CO F � O m y x S S O A = O O O r z 3 m m n m cn m N a P P a a a a n P u u w o 0 a n i= SS n n] n n n O KZ c^m AD 3= - m C'1 y 0 j O O O O O 0 o z x (A(�r� Z m y z z bW v o v Z w n J,O on v,0 O O O O n n y'� m 0 A -A7 -Ai -Ai -Ai -AI O z a r < < < < z y z < n m m n D 9 > D � D 9 o A z 91 zPn fmmn mmnn -a �D f yL Nn m �.� r..'o� mO.� r 9.�. 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