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2024-07-17 Final PacketNOTICE OF MEFTING - 7/17/2024 July 17, 2024 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 at loam by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. n/a Page 1 of 4 N0TICE OF MEETING — 7/].7/)024 5. Approve July 3, 2024 and July 10, 2024 Commissioners' Court Regular Meeting Minutes. (RHM) Court agreed to approve the Minutes for July 10, 2024. Minutes for July 3 2024 are not yet ready for approval. 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 approve the Final Plat of Bayshore Ranchettes. (JMB) Terry Ruddickexplained the final plat. RESULT: APPROVED;[UNANIMOUS], MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of$75.00. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct'1 AYES:" Judge Meyer, Commissioner` Hall, Lyssy, Behrens, Reese' 8. Consider and take necessary action to authorize Judge Meyer to sign letter of request to Texas Historical Commissioner requesting the use of a small brush hog/hydroax to clear the walking paths for the Green Lake Enhancement Project in Calhoun County, Texas (Texas Antiquities Permit No. 30942; THC Tracking# 202407616). (GDR) Matt Glaze explained the request. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 4 I NOTICE OF MEETING — 7/1.7/2024 9. To Approve and Accept switching employee elected insurance to UNUM. This would take the place of policies with Principal, Reliance and Trustmark except leaving cashed bases policies in place. If approved this would begin October 1, 2024. (RHM) Rhonda Kokena explained the reason it would be beneficial to switch. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese' 10. Consider and take necessary action to approve the Final Plat of the Amended Plat of In the Oaks at Swan Point Subdivision. (RHM) Henry;Danysh; explained final plat. RESULT: APPROVED [UNANIMOUS], MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to approve Agreement #3068497 with Dewitt Poth & Sons for Copy Machine Lease for the Elections Office and allow the Elections Administrator to sign agreement. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to approve the contract with Keith Staff dba. Staff Concrete Construction for Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas and authorize the County Judge to sign. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct I SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 4 I NOTICE OF MEETING - 7/17/2024 13. Accept Monthly Reports from the following County Offices: i. Sheriff's Office - June 2024 ii. Justice of the Peace, Pct 4 - June 2024 RESULT: APPROVED{UNANIMOUS] MOVER: Joel Behrens, Commissioner Pet 3 SECONDER: Gary Reese, Commissioner Pd 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT: APPROVED (UNANIMOUS]' MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens; Commissioner Pct 3 AYES: Judge Meyer; Commissioner Hall, Lyssy, Behrens, Reese 15. Approval of bills and payroll. (RHM) MMC Bills: RESULT: APPROVED,EUNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2- AYES., Judge Meyer; Commissioner Hall, Lyssy, Behrens, Reese Indigent Healthcare: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer; Commissioner Hall, Lyssy, Behrens, Reese County Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned 10:20am Page 4 of 4 (�\I\II�:�I��\I:I"�' I"."MMMAI ( N)\II"I.Iu�IvI(ei ;III I All Agenda items Properly Numbered v ✓ Contracts Completed and Signed All 1295's Flagged for Acceptance (number of 1295's) All Documents for Clerk Signature Flagged (All documents needing to be attested to need to be signed day of Commissloner's Court.) On this �ay of `JI for the %� day of Court Regular Session was su itted to the Calhoun County Clerk's Office. A j, L r Calhoun County ]udge/Assistan 2024, the packet 2024 Commissioners' the Calhoun County Judge's office LAA V45 I N0TICE OF fVIEL- [ ING - 7/170024 NOTICE OF Richard ]H . Meyer County judge David Ball, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, July 17, 2024 at 10:00 a.m. in the Commissioners'Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows 1. Call meeting to order. 2. Invocation. 3. Pledges of Allegiance. AT � I FIO ECLDOCK �M 4. General Discussion of Public Matters and Public Participation. JUL 12 2024 COUNT1Y CLER�KNNCA H,fOUP �U/N�7Y, .TEEXAQ DFVIIN' 5. Approve July 3, 2024 and July 10, 2024 Commissioners' Court Regular Meeting Minutes. (RHM) 6. Consider and take necessary action to approve the Final Plat of Bayshore Ranchettes. (JMB) 7. Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of$75.00. (RHM) 8. Consider and take necessary action to authorize Judge Meyer to sign letter of request to Texas Historical Commissioner requesting the use of a small brush hog/hydroax to clear the walking paths for the Green Lake Enhancement Project in Calhoun County, Texas (Texas Antiquities Permit No. 30942; THC Tracking# 202407616). (GDR) 9. To Approve and Accept switching employee elected insurance to UNUM. This would take the place of policies with Principal, Reliance and Trustmark except leaving cashed bases policies in place. If approved this would begin October 1, 2024. (RHM) Page I of 2 I NOI ICL UI fVIE:ETING—7/17/2024 10. Consider and take necessary action to approve the Final Plat of the Amended Plat of In the Oaks at Swan Point Subdivision. (RHM) 11. Consider and take necessary action to approve Agreement #3068497 with Dewitt Poth & Sons for Copy Machine Lease for the Elections Office and allow the Elections Administrator to sign agreement. (RHM) 12, Consider and take necessary action to approve the contract with Keith Staff dba. Staff Concrete Construction for Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas and authorize the County Judge to sign. (DEH) 13. Accept Monthly Reports from the following County Offices: i. Sheriff's Office — June 2024 ii. Justice of the Peace, Pct 4 — June 2024 14. Consider and take necessary action on any necessary budget adjustments. (RHM) 15. Approval of bills and payroll. (RHM) 7 Richard H. Meyer, County J d Calhoun County, Texas A copy of this Notice has been placed on the inside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public during regular business hours. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www,calhouncotx.org under "Commissioners' Court Agenda" for any official court postings. Page 2 of 2 # 04 I NOTICE OF MEETING - 7/17/2024 July 17, 2024 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]udge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at loam by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. n/a Page 1 of 13 ' NOTICE OE MEETING — 7/17/2024 5. Approve July 3, 2024 and July 10, 2024 Commissioners' Court Regular Meeting Minutes. (RHM) Court „agreed >to approve the Minutes; for July 10, 2024. Minutes for July 3 2024 are not yet ready for approval RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 13 NOTICF OF MFFTING — 7/10/2024 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Clyde Syma, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, July 10, 2024, 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. 1 Richard Meyer,toun u Calhoun County, Texas Anna Goodman, County Clerk 4ua*-LVD� Deputy Clerk Page 1 of 1 NOTICE OF MEETING-7/].0/2024 5) Consider and take necessary action on re -appointments of Teddy Hawes and Louis (Buzzy) Dillon to the West Side Calhoun County Navigation District. (RHM) RESULT APPROVED [UNANIMOUS] MOVEIR :Gary`Reese,:ComrnlssionerPct+ SECOINDER: ;' Joel.Behrens. Commissioner<pct 3 AYES : = Judge Meyer;>Commtssioner Hall, Lgssy, Behrens, Reese 6) Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited Into the Motivation account (2697-001-49082-679) in the amount of $250.00. (RHM) RESULT APPROVED'[UNANIMOUSI. MOVER David Hall,'Commissioner Pct:1 SEC014OER ..Vern Lyssy,':Commiss' loner Pct:2. AYES;: " Judge Meyer' Commissioner HaII, Lyssy; Behrens; Reese 7) Consider and take necessary action to approve the contract with Lester Contracting, Inc. for Bid No. 2024.05 Seadrift Drainage Improvements Project for Calhoun County, Texas under Texas General Land Office Contract No. 22-085-014-D245 and authorize the County Judge to sign. (GDR) 8) Consider and take necessary action to approve the Asbestos Abatement Proposal with KMAC Construction Services, Inc. for $10,660.00 and any demolition and/or any Structural Removal for the Courthouse Parking lot Project. (RHM) RESULT APPROVED [UNANIMOUS] MOVER: Gary Reese.;;Commissioner Pd4 SEC Elk - Joel Behrens, Commissioner Pct3 AYES:' Judge Meyerj,. COmmisS'ioner Hall; Lyssy, Behrens; :Reese Page 2 of 4 NOTICE OF MEETING— 7/10/2024 9) Consider and take necessary action remove the following Items from Sheriff's Office Inventory. They were stolen out of unit while at training. (RHM) A. APX8000 PORT ABLE RADIO SERIAL #5790XT6259 ASSET #565-0977 B. ASER GUN X26P SERIAL #X1200ABX4 ASSET #565-0850 *** For reference attached is a list of items stolen but not on inventory. RESULT' APPROVED [UNdN]CMOUS� :. M01/ER4 Davld Hall,.Corrfmissloner Pct 3 '. SECONDER.:_ Vern Lyssy; Commissioner Pct 2 AYES:W ge Meyer, Commissioner Hall, Lyssy, 6ehreps, Reese 10) Consider and take necessary action to approve the May and June donation, surplus/salvage and waste lists for the Calhoun County Library. (RHM) RESULTC APPROVED[ MOVER Gary.Reese; Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct3 AYES;.: Judgo Meyer;.Commissioner Hall., Lyssy, Behrens, Reese , 11) Accept Monthly Reports from the following County Offices: 1. Justice of the Peace, Pct 1— June 2024 ii. Justice of the Peace, Pct 2 — June 2024 Ill. Justice of the Peace, Pct 3 — June 2024 Iv. Floodplain Administration — June 2024 v. District Clerk — June 2024 A. Texas Agrilife Extension Service — May 2024 a. 4-H and Youth Development b. Agriculture and Nature Resources c. Family and Community Health d. Coastal and Marine RBSIIL*T APPROVED [UNANIMOUS] MOVER. Vern Lyssy; Commissioner Pct 2 SECONDER. Gary. Reese; Commissioner Pct 4 AYES: Judge Meyer Commissioner.Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action on any necessary budget adjustments. (RHM) None Page 3 of 4 I NOTICE OF MEETING— 7/10/2024 July 10, 2024 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 at 10am by Judge Richard Meyer 2) Invocation. Commissioner David Hall 3) . Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4) General Discussion of Public Matters and Public Participation. Joel Behrens thanked Bayside Beach Church for giving aid to residents in need. Page 1 of 4 NOTICE OF MEETING — 7/10/2024 13. Approval of bills and payroll. (RHM) MMC Bills REULT APPROVED [UNANIMOUS] . MpVER; Obvid HaII .Commissioner Pct 1 ' SCbNDR. Uerrt Lyssy Cbmrriss!on er. Ptt: AYIErS: Judge Meyer, Conlmissloner H81,1, Lyssy;Behrens; Reese CtsS�nty Ei�la . RESULT APPROVED [UNANIM001 M01fER David Hail;: Commissioner Act 1 SECONDER Vern Lyssy, Commissioner Pct 2 AYES;:` Judge Meyers Commissioner Hall; Lyssy, Behrens, Reese Page 4 of 4 NOTICE OF MEETING — 7/17/2024 6. Consider and take necessary action to approve the Final Plat of Bayshore Ranchettes. (JMB) Terry Ruddick explained the final plat. RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES:Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 13 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: joel.behrensncalhouncotx.oM 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 July 17, 2024. Consider and take necessary action to approve the final plat of Bayshore Ranchettes. Sincerely, Joel Behrens Commissioner Pet. 3 AUSI Land Surveying+Aerial lorcaging 8Nw 1881 July 9, 2024 Joel Behrens County Commissioner Precinct #3 24627 State Highway 172' Port Lavaca, TX77979 RE:Bayshore Ranchettes Dear Commissioner Behrens, Please consider this letter as my request to have the following item placed on the July 17, 2024 Commissioner's Court agenda: Consider and take necessary action to approve the Final Plat of BayshareRanchettes. If I can provide additional information, please do not hesitate to contact me. Sin rely, T rry1.11 dick, R.P.L.S. C.E.O. (514769.02) Victoria SanAntonio Duero 2004N.Commerce 12661 Silicon. Drive 104 E. French Street Victoria, TX:77001 SanAntonio,TX 78249 G, Cuem,TX 77954 tlrbansurveying.com 381-578-9837 210-287-8654 3S1 277-9061 Firm 6: 10021100 Firm a: 10193843 Firm H:10021101 �p e ��v` 7- x C s�3 1 r E•• c O _.iL:LI J f � 6} � LxaiSl � e ai V SAC O 0111 7 Y fEE �= fi�}g1 i di3nf g��f ,L ax C Ylx 9 i I?{5 Q :I 1 11cC0 A.K.9,t02 � 1 L , Awe I'. •• ',SiS ALM I i?` is }I •t �/yivmJ � If 1 1 .cmm is " I x Ig I ».... la nix Ily_ Hi} r_ I :P xi• im ia"x it -I ��J ;� YRx� :'�', •_3 "c �": l.a]S Apes 1 1 � y txw Cm • lots w I I 1 'LEII9• s �.. ••eP.mv. F ]yM, g i gy:� li i Y; iiC 1 P. Y##�{ q•.�y�� i.q � I p S� 'ySyep 9'� <• � "'1 i �g9t 3 x$�S w w x gZ �0 3 CJO m 3 NOTICE OF MEEFING — 7/17/2024 7. Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of$75.00. (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 4 of 13 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 F&X NUMBER4361) 5534668• MEMO TO: RICHARD MEYER, COUNTY JUDGE SUBJECT: ACCEPT DONATION TO SHERIFF'S OFFICE 09 DATE: July 1-7, 2024 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR July 17, 2024 * Consider and take necessary action to accept anonymous donation to the Sheriff's Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of $75.00. Sincerely, f /obbie Vickery Calhoun County Sheriff u a •R 114�1 I n NOTICE OF MEETING; — 7/1.7/2024 8. Consider and take necessary action to authorize Judge Meyer to sign letter of request to Texas Historical Commissioner requesting the use of a small brush hog/hydroax to clear the walking paths for the Green Lake Enhancement Project in Calhoun County, Texas (Texas Antiquities Permit No. 30942; THC Tracking# 202407616). (GDR) Matt Glaze explained the request. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, ,Commissioner Pct 4 SECONDER: ` Joel Behrens, Commissioner'Pct 3 AYES: Judge Meyer, CommissionerHall, Lyssy, Behrens, Reese Page 5 of 13 Gary D. Reese County Commissioner County of Calhoun Precinct 4 July 10, 2024 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for July 17, 2024. • Consider and take necessary action to authorize judge Meyer to sign letter of request to Texas Historical Commissioner requesting the use of a small brush hog/hydroax to clear the walking paths for the Green Lake Enhancement Project in Calhoun County, Texas (Texas Antiquities Permit No. 30942; THC Tracking # 202407616). Sincerely,, 'J Gary D. Reese GDR/at P.O. Box 177 —Seadrift, Texas 77983 —email: earv.reese a calhouncom.ore — (361) 785-314I —Fax (361) 785.5602 RICHARD H. MEYER 211 S. Ann Street, Suite 301 - Port Lavaca, Texas 77979 (361) 553-4600 - Email: richard.meyer@calhouncotx.org July 17, 2024 Mr. Jeff Durst Texas Historical Commission 108 West 16th Street Austin, TX 78701 County Judge Re: Response to comments: Draft: Cultural Resources Survey for the Green Lake Enhancement Project in Calhoun County, Texas (Texas Antiquities Permit No. 30942; THC Tracking # 202407616). Mr. Durst, This letter acknowledges receipt of comments on the subject document via eTRAC dated April 16, 2024, and via email correspondence between you and Gray & Pape dated June 7, 2024, and provides the following response. The Calhoun County Parks Board agrees to adhere to the required stipulations. Specifically: No heavy vehicular or mechanical equipment impacts to these sites will be incurred during the implementation or subsequent maintenance of the planned trails. No equipment larger than a small brush hog /hydroax as depicted below, standard sized riding lawn mower, a small all -terrain vehicle, also known as a light utility vehicle, a quad bike or quad as defined by the American National Standards Institute (being a vehicle that travels on low-pressure tires, has a seat that is straddled by the operator, and has handlebars), will be used Any brush or tree removal will be performed by equipment no larger than the brush hog/hydroax as depicted above. Additionally, as stated in the draft wwwxalhouncomorg report the following provisions will be put in place during construction activities: • Temporary protective fencing will be in place at the site boundaries during construction where planned impacts are to be within 60 meters (200 feet). • Archeological monitoring will take place during road improvement activities within the site boundaries and during any surface or below -ground disturbances to areas that are within 30 meters (100 feet) or less of the site boundaries. • If cultural materials are encountered during construction or disturbance activities, work should cease in the immediate area; work can continue where no cultural materials are present. • An Unanticipated Discoveries Plan will be put in place to manage any new discoveries should they occur. The Calhoun County Parks Board requests that with the submittal of this letter committing to the required stipulations, that the work be allowed to proceed immediately. Sincerely, Richard H. Meyer Calhoun County Judge Cc: Caitlin Brashear—Texas Historical Commission Tracy Lovingood — Texas Historical Commission Jerry Androy — US Army Corps of Engineers, Galveston District # 09 I NOTICE OF MEET ING -- 7/17/2024 9. To Approve and Accept switching employee elected insurance to UNUM. This would take the place of policies with Principal, Reliance and Trustmark except leaving cashed bases policies in place. If approved this would begin October 1, 2024. (RHM) Rhonda Kokena explained the reason it would be beneficial to switch. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 13 Debbie Vicke From: rhonda.kokena@calhouncotx.org (rhonda kokena) <rhonda.kokena@calhouncotx.org> Sent: Thursday, July 11, 2024 10:07 AM To: Debb1e.Vickery@ca1houncotx.6rg Subject: AGENDA ITEM / JULY 17 Attachments: Rate Comparison.pdf; Proposal for Changing Voluntary Benefits Carriers.pdf Importance: High Good Morning - Please add to the next agenda - attachments included. To Approve and Accept switching employee elected insurance to UNUM. This would take the place of policies with Principal, Reliance and Trustmark except leaving cashed bases policies u1 place. If approved this would begin October 1. Rhonda S. Kokena Calhoun Co Treasurer 202 S. Ann Street, Suite A Port Lavaca, Texas 77979 361-553-4619 Calhoun County Texas Attained age refers to a rating method where employees move into new premium brackets every five years based on their age, causing their rates to increase as they age. In contrast, issue age means that the rate remains the same as when the insurance was initially purchased, regardless of the employee's age overtime. Age Existing Rate UNUM Rate <25 $0.44 $0.44 25-29 $0.44 $0.44 30-34 $0.44 $0.44 35-39 $0.44 $0.44 40-44 $0.55 $0.55 45-49 $0.55 $0.55 50-54 $0.62 $0.62 55-59 $0.62 $0.62 60-64 $0.73 $0.73 65+ $0.73 $0.73 Notes: Benefit Percentage: 65% of weekly income Maximum Weekly Benefit: $1,500 Elimination Period:.14 days Benefit Duration: 26 weeks (existing) vs. 24 weeks (UNUM) Age Basis: Issue Age for both existing and UNUM LTD (Semi -Monthly Rates per rr of Monthly Covered Payroll) Age Existing Rate UNUM Rate <25 $0.19 $0.17 25-29 $0.19 $0.17 30-34 $0.19 $0.17 35-39 $0.19 $0.17 40-44 $0.53 $0.48 45-49 $0.53 $0.48 50-54 $1.00 $0.90 55-59 $1.00 $0.90 60-64 $1.91 $1.72 65-69 $1.91 $1.72 70+ $1.91 $1.72 Notes: Benefit Percentage: 60% of monthly income Maximum Monthly Benefit: $6,000 Elimination Period:181 days (existing) vs.180 days (UNUM) Benefit Duration: 5 years Age Basis: Issue Age for both existing and UNUM Critic at I Ilness with Cancer (Semi -Monthly Rates per 000 Age Existing Non- Existing Smoker UNUM Employee Smoker Rate Rate Rate <25 $0.20 25-29 $0.24 30-34 $0.29 35-39 $0.62 $0.99 $0.36 40.44 $0.89 $1.55 $0.47 45-49 $1.18 $2.18 $0.62 50-54 $0.84 55-59 $1.13 60-64 $1.88 65-69 $2.52 70-74 $3.43 75-79 $4.74 80-84 $6.47 85+ $9.54 Notes: Coverage Amounts: $5,000 to $50,000 (existing) vs. Up to $30,000 (UNUM) Guaranteed Issue: Up to $20,000 (existing) vs. Up to $30,000 (UNUM) Purchase Increments:$5,000 Age Basis: Issue Age for existing and Attained Age for UNUM Accident (Semi -Monthly Rates) Coverage Existing Rate UNUM Rate Employee Only $5.79 $3.57 Employee & $8.23 $6.40 Spouse Employee & $11.92 $10.04 Child(ren) Family $14.36 $12.87 Notes: Coverage Type: Off -job onlyfor both existing and UNUM Existing Non- Existing Non- ExistingTobacco ExistingTobacco UNUM Non- UNUMTobacco Age Tobacco Rate Tobacco Amount Rate Amount Tobacco Rate Rate 35 $6.50 $9,194 $13.00 $14,668 $0.3625(per $0.626(per $1,000) $1,000) 45 $13.00 $12,547 $17.33 $14,668 $0.364(per $0.6315(per $1,000) $1,000) 55 $17.33 $14,668 $21.67 $14,668 $0.365 (per $0.6365 (per $1,000) $1,000) 35 $13.00 $9,194 $13.00 $14,668 $0.3665 (per $0.642 (per $1,000) $1,000) Notes: Coverage Amounts: $5,000 to $150,000 (UNUM Employee), $5,000 to $35,000 (UNUM Spouse) Guaranteed Issue: $50,000 (Employee), $10,000 (Spouse) Purchase Increments: $5,000 Age Basis: Issue Age for both Grou p Term Life (Semi-MonthLy Rates per rrr Age Existing Rate UNUM Rate 15-24 $0.06 $0.04 25-29 $0.06 $0.04 30-34 $0.06 $0.05 35-39 $0.09 $0.08 40-44 $0.13 $0.12 45-49 $0.20 $0.18 50-54 $0.31 $0.28 55-59 $0.51 $0.44 60-64 $0.77 $0.60 65-69 $1.40 $0.79 70-74 $2.82 $1.38 75+ $2.82 $2.50 Notes: Coverage Amounts: Up to $500,000 for both existing and UNUM Guaranteed Issue: $130,000 (UNUM) vs. $100,000 (existing) Benefit Increment: $10,000 for both existing and UNUM Elimination Period: None Age Basis: Attained Age for both existing and UNUM Proposal for Changing Voluntary Benefits Carriers Overview Glass, Sorenson, & McDavid Inc. (GSM) is proposing changes to Calhoun County's voluntary benefits carriers to consolidate billing, upgrade benefits, and lower rates. The suggested changes are outlined below: Current and Proposed Carriers 1. Short and Long Term Disability (STD & LTD) o Current Carrier: Reliance o Proposed Carrier: UNUM • Short Term Disability: • UNUM matched the current benefits and rates. • Long Term Disability: • UNUM offered lower rates while matching current benefits. 2. Voluntary Term Life o Current Carriers: Reliance and Principal o Proposed Carrier: UNUM • UNUM offers lower rates and a higher guarantee issue amount: • Current Guarantee Issue Amount: $100,000 • UNUM Guarantee Issue Amount: $130,000 • Recommendation to cancel the existing voluntary term life plans with Reliance and Principal. 3. Accident Insurance o Current Carrier: Trustmark o Proposed Carrier: UNUM • UNUM provides lower rates and upgraded benefits, including an organized sports benefit: • Organized Sports Benefit: Additional 10% benefit if a covered injury occurs during non-professional organized sports (e.g., high school football, adult recreational league basketball). 4. Critical Illness Insurance o Current Carrier: Trustmark o Proposed Carrier: UNUM • UNUM offers: • Lower rates. • Simplified billing with uniform rates for: • Cancer -included coverage. • Tobacco and non -tobacco users. 5. Whole Life with Long Term Care o Current Carriers: Trustmark and Chubb o Proposed Carrier: Remain with current carriers • Whole life policies with cash value are not transferable to another carrier. • GSM recommends continuing with the current whole life policies. • Option to offer anew whole life policy through UNUM with a $50,000 guaranteed issue plan. Benefits of Proposed Changes 1. Consolidated Billing: o Simplifies the billing process by reducing the number of carriers. 2. Upgraded Benefits: o Enhanced coverage options, such as the organized sports benefit in the accident insurance plan. 3. Lower Rates: o Cost savings for employees on STD, LTD, voluntary term life, accident, and critical illness plans. 4. Higher Guarantee Issue Amounts: o Increased coverage without the need for additional medical underwriting. 5. Simplified Billing for Critical Illness: o Uniform rates regardless of tobacco use or cancer inclusion, making administration easier. For further information or questions, please contact: Lauren Ramey 361-727-3075 #10 NO 11(1 OF MFFTING — 7J7 7%2024 10. Consider and take necessary action to approve the Final Plat of the Amended Plat of In the Oaks at Swan Point Subdivision. (RHM) Henry Danysh; explained final plat. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES:Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 13 Gary D. Reese County Commissioner County of Calhoun Precinct 4 July 11, 2024 Honorable Richard Meyer Calhoun Countyjudge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for July 17, 2024. • Consider and take necessary action to approve the Final Plat of the Amended Plat of In the Oaks at Swan Point Subdivision. Sincerely, 0 Gary D Reese GDR/at . P.O. Box 177 — Seadrift. Texas 77993 — email: nary MesCQcalhouncotx ore — (361) 785-3141 — Fax (361) 785-5602 RpP9 ppwo " O= S OC T'��•"' W J1� � F 6 >omU 0 [rT-y W o n U F d y�ry Q 0. 6 Fes( m � m a O r-w_k 6 G W W Wa F� A m y�gi w F U• �- 3>gY a o - m fig= e a m ltlld p34N3Wtl m m oc o ZE zz fill NO Vk �� F2 \ NA \$ `. i m m • gg aa q L 4w ` V i Vh � gg R RS ° y v xR• gSRR 3 age �•€ e �a n s RR o g a III a F III 2 z x €° b tzj o'� m nn a ron�'z y 3gEgE g3ag gg o 9 O y B• @p6 AIR z Via$ as § z v a �" q x �d 9x = G95(� �• yN� LJ � oil c>'z xgg ytz zi a�AS R x; om� d 0 If ro @Rx t.8 ail R, i^E- Eg{SP ppg px�Ri?. +to- sQ.4 7A A G & W ENGINEERS INC. T F'i • ENGINEERING • SNRVEYING • P4ANNING • " i'S s Q i :+ z e P 3 a 105 w: UK ONt SI ,, PORT UVAC& 1 )m)a � `.1 N ly'. O B Y 0 0 •• o :. 1BPI8 ilaN HQ: TOOR5100 4' u m m AMENDED PLAT `` (aei). 55z-45M. POOT WACA (aro) 3 a 71M DAY Ow S NOTK-.F OF MEETING - 7/17/2024 11. Consider and take necessary action to approve Agreement #3068497 with Dewitt Poth & Sons for Copy Machine Lease for the Elections Office and allow the Elections Administrator to sign agreement. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese; Page 8 of 13 CALHOUN COUNTY ELECTIONS DEPARTMENT 211 S. ANN ST, PORT LAVACA, TX 77979 • PH: 361-553-4440 • FAX 361-553-4443 July 11, 2024 Honorable Richard Meyer Calhoun County Judge 211 S. Ann St. Port Lavaca, Texas 77979 RE: AGENDA ITEM Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for July 17, 2024. * Consider and take necessary action to approve and allow the Elections Administrator to sign contract agreement #3068497 for a new copy machine lease with Dewitt Poth & Son. Thank You, A—(a� Mary Ann 0 a Calhoun County Elections Administrator dewitt poth son i FZ ifGkti Gil"-^i nt141 eL L!iti ��TfJllfiY .sstwo UNYt11 a office Equipment t IT Services 1 office Supplies 1 Promotional Products W? 'W('�St Sweet Yc +kur r, ,49 ! }vww d�wittUo2,ir_¢orn Kyocera MA4000cifx — Black/Color Machine • 42 pages per minute black/color output • 100-sheet Single Pass Document Feeder/Scanner • Scan up to 60 pages per minute • Letter, Legal • Copy/Print/Scan • Scan to Folder/email • 1 x250-sheet paper drawer • 1x500-sheet paper drawer • Cabinet 63-month FMV Lease $125.00 per month Maintenance Contract Black images at .0125. Color images at .07. Parts, labor and all toner included at no additional charge. Delivery, networking and training provided at no additional charge. Free delivery of all supplies. Amendment IM GreatAmerica 111"PINA.NCIA.L SERVICES This Amendment amends that certain agreement by and between GreatAmerica Financial Services Corporation ('Owner") and Calhoun. County of ("Customer") which agreement is identified in the Owner's internal books and records as Agreement No. 3QQ0497 the "Agreement"). All capitalized terms used in this Amendment, which are not otherwise defined herein, shall have the meanings given to such terms in the Agreement. Owner and Customer have mutually agreed that the following modifications be made to the Agreement, The. Section entitled INSURANCE Is hereby detailed In Its entirety and replaced vAth the following: 'You Agree: (a) to keep the Equipment fully Inswed against lose at its replacement cost and (b) to maintain cwnprehansive public liability Insurance' Except as specifically modified by this Amendment, all other terms and conditions of the Agreement remain in full force and effect. if, and to the extent there is a conflict between the terms of this Amendment and the terms of the Agreement, the terms of this Amendment Shall control. A facsimile copy of this Amendment bearing authorized signatures may be treated as an original. This Amendment is not binding unlit accepted by Owner. GrestAmerica Financial Services Corporation By; LZ, hW1i-� Signature i..Rawi W►LKEdS:u , �pG 5 ('c[sar�y+gr _ Print/NameB TRle Date Accepted: Calhoun Countyof C'q-Q�}-ns Customer 4--1- 4,tz , Ilia-tb> c Signature Print i l t��ilt-L Norma& TWe YES 1 r 1 Date: ,j j � . , � rf �j}�L-�• OIUMVOan" 1107 71111ZOM11,04 M. 13S AGREEMENT GREATAWRICA FINANCIAL SERVICES CORPORATION r'E G re a to m e ri ca PAYMENT, WWS6. PO Elm 0511831, Dallas TX 752W031 CPLUS TAX) TERM IN MONTHS:•' 63 • Y _ MONNLY PAYMENT AmOmr: S1125.00 PLRICHAEEOPTIOw: Fair Market value ADDITIONAL TERMS AND CONDITIONS AGREEMENT. Yw w1M a M row PaY Yaia Valda bt tl(e emANnMlM1'a aofMme mlertncea herein AISSIUNCF. Ym, r�u�n.na.�:.rn....s.w „�,.xe.uur.e.......u�,.:. v_..,:_ _� DAMAGE. You n of ramp M tam y w ag.aw, Nei dd 0 M rf... 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IafROulseutUdlepUrrmle.voarmMpeyarddanpoMMdalameREwipMdpbratro EXPRESS aRRPOSE EeDse dmoalaamMMd RneaaMntNemyanP,.yw.med�MualaMaawauNose:M I A P YOU RAWWARRANFsaF YOU COEPTFD TIES 1 A PARtMW, rylelMnYwleeequdla5!i plSNmndMtlhvpld latN.Egdpmad INS THE VENDOR THE VENODR ARO AKI AND tiEgW DEFAULflgEIESblS. ga �rtlallbetmmgl0rdryapatdw,aRyouoNMN6amaMAUkApaeMrd ENTJOU MAY RNF.YOUAOYtMMTAaf YOUR YEI FQRAX AWEAsESIa yoaaRNinddrU,alawsmylaPieaMYwidAnSle EgNuMtbu NpatapM•e eld pyu:T) e11RIgACnMER ORYBItIOR ES PROYOMO. WE AsSpR PROVIU Y PaI d• a3% w app eal d P un. Dam Ma bPdee ra m as tst 5. Reopen ea 3% tM .Md wo uth o Egdpau d" mama ft E d eaW teed do" o raPeMNt 4d ar sumeae ale Eq" o aAgwhole aDblA a a a men renepas amapkbu.YW aFxbpryYaoW Mq MgMaas (aduelplmeNuealUmyhepuw e. You ay ( mmatew theEgw1p unMlpaa rgN.mnmFPipmMA in adwN orin pSM1;bagam lntulaUyapoNvdtl.YumWdbSeaAFaaMId.YalapeebpaywhWwlMdpatdrMMUb dwaNap,UmaaiglawtlMreaadplN 6uldBwlbeal6Kct aUrAWMRWsbodittlol thead UC. apehNlls aaryoa glee 0) aTtbN: You mthat G rl a'Rr thaw th tld UCC. You agora that Rde ApeUIWd b ownw IUm teblYb tlea Agreaanl Sd begmremd b/ lays IBM. ANY d C " I ft 0le dehnedm Ntda?A d Sly UnYant 1l+aatgldU Code ('UCCry, Yw egM la Ingo the dghR old. MCC P M ;4—y cludetm3&GmWg&I+clobroiaeanpsmn:.rnmdaMe a'q¢opdaadmFewva-m uayeuuarmeapinmNnl any n,-m—fi rlamiwahYhrewigtimmMmele pord'mdan+neiame AUSMMNM ft 10 rayolgmboalfueled Id wNdlhurobwomarehMa.MW Penally aaWWW owems to true lobe goof me oyPMas ofrou S taEgUpamd b theJaMSMI de%WW by w). plMW au of IeastlWi (30) One pbr to the awl rime dal PUN mr wNch hmNwMa al 4paptated. Your CNMExammw Coffee, for 1.00 CaePoQ ddaas tea a wrikalb (m 00") ON" clot (a) yw me a Ua1e are AAy cm**dpdael wWWmw egweyd apostate, n-F&h you embmled; (b).hmas have beeneepopnsDdPrthe applicable gtm pMkd 1•pO domledueumlMbaAgammad (4)Muhn >ap+omaoandd al roueham my ado Utah bad by Vow, and (d)yw haw aNustad hinds Ingwyawhala brgMpaymeradmmmadw dw de AgeMaMd You agm thot Nspeapmph.MY my k adyII. Md to dw"Withat. auto Ian precludes wuhanawing mloale Aaammlil boAmeaewl eanatlabs a muhia umrdovnal manlo-0lpdion. BLOVVIIERt •SIGnATTRE a reMAGF MIWONOMCAHMMLEFORTNEFULLAGREEEW7MM.IMAGREPARWSBIWMYMESNWEEIESCUTETWRAGREEMENTANDPAYFORTNEED MENT. H owNER: GreatAl1medaa. Financial Services Corporation cusxCMEa /1�As Stated A6otye �1 rt a� �SIGNATME: LZ �Vli�a�" OATE'41JZJ SIGNATUNE'1 � � � DATE. IJ 1�I /^rX� PRINT NAME S TITLE: II, U LISUldcby vac. a(`4L1Ad.W PRwr xaMesTlTte)'i'Vltr !-.tom C1t'-1-a Iec�iOYLS.f a1fY'}i Y} UCERTIFICATE OF DELIVERY AND ACCEPTANCE y Tlie Customm hereby m1fles that ay the Equipment 1) has bean mmwd. IMalled, and mspodaq Md 2) m fully apamame and ummdlamdy xcpeplad. S SIGNATURE: x. NAME AND TITLE:. DATE: r VGO1M(TL) D51O 07111124 135 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. i - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2.3. 5, and 6 if there are no interested parties. CERTIFICA71ON 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. DeWitt Poth &Son 2024-1186070 YOAKUM, TX United States Date Rled: 07/11/2024 2 Name of governmental entity or state agency that is a parry to the contract or which the form is being flied. 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. 1936246 COPIERS 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Dewitt Poth & Son, U-C Yoakum, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is JESSIE LEMKE 04/30/195 and my date of birth is My address is 102 WEST ST YOAKUM TX 77995 US (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in DEWITT County, State of TX , on the 11 day of JULY 20 24 (month) Signature uth ized agent of contracting business entity ONO (Dedarent) FnrmS nmviNoN by Tnvnc GAr..- n........:....:.... ._.__ _.._�_ _ _... Version V4.1.0.d378aba0 #12 NOTICE OF MEETING— 7/17/2024 12. Consider and take necessary action to approve the contract with Keith Staff dba. Staff Concrete Construction for Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas and authorize the County Judge to sign. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER:. Vern Lyssy, Commissioner Pct'2 AYES:Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 13 ATTORNEY'S REVIEW CERTIFICATION BID NUMBER 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Project I, the undersigned, ,LM. V�In . J02 the duly authorized and acting legal representative of CALHOUN COUNTY, do hereby certify as follows: I have examined the attached contract(s) and surety bonds and am of the opinion that each of the agreements may be duly executed by the proper parties, acting through their duly authorized representatives; that said representatives have full power and authority to execute said agreements on behalf of the representative parties; and that the agreements shall constitute valid and legally binding obligations upon the parties executing the same in accordance with terms, conditions and provisions thereof. Attorney's signature: PrintAttorney's name: KDQ��(i1P Z Texas State Bar Number: STANDARD FORM OF AGREEMENT FOR MATERIALS CONTRACT THIS AGREEMENT made this the 5th day of June, 2024, by and between Keith Staff dba Staff Concrete Construction, an individual trading as Sole Proprietorship, hereinafter called the "Contractor", and CALHOUN COUNTY hereinafter called the "County." WITNESSETH, that the Contractor and the County for the considerations stated herein mutually agree as follows: ARTICLE 1. Statement of Work. The Contractor shall furnish all supervision, technical personnel, labor, materials, machinery, tools, equipment and services, including utility and transportation services, and perform and complete all work required for the construction of the Improvements embraced in the Project; namely, Bid Number 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Project, for the Countv, all in strict accordance with the contract documents including all addenda thereto, numbered No Addenda, dated N/A, all as prepared by G&W Engineers, Inc., acting and in these contract documents preparation. ARTICLE 2. The Contract Price. The County will pay the Contractor for the performance of the Contract in current funds, for the total quantities of work performed at the unit prices stipulated in the Bid for the several respective items of work completed subject to additions and deductions in amount of One Hundred Seventy - Three Thousand Six Hundred Seventeen Dollars and 54 Cents ($173,617.54). ARTICLE 3. The Contract. The executed contract documents shall consist of the following components a. This Agreement h. Special Conditions b. Addenda i. Performance Bond c. Invitation for Bids j. Payment Bond d. Instructions to Bidders k. Technical Specifications e. Signed Copy of Bid I. Drawings f. General Conditions M. Other g. Calhoun County General Conditions ARTICLE 4. Performance. Work, in accordance with the Contract dated June 5, 2024, shall commence on or before as established in an official letter notification to the contractor called "Notice to Proceed" and Contractor shall complete the WORK within 90 consecutive calendar days thereafter. The date of completion of all WORK is therefore established by the Notice to Proceed Letter. This Agreement, together with other documents enumerated in this ARTICLE 3, which said other documents are as fully a part of the Contract as if hereto attached or herein repeated, forms the Contract between the parties hereto. In the event that any provision in any component part of this Contract conflicts with any provision of any other component part, the provision of the component part first enumerated in this ARTICLE 3 shall govern, except as otherwise specifically stated. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed in tri licate original copies on the day and year first above written. KEITH SMITH dba STAFF CONCRETE CALHOUN COUNTY (County) By Name/Title: Richard H. Meyer County Judge PROJECT NAME: Bid idumbor 2024.0T Ma nAtia Beacn — Oct an DYtvo Bulkhead Ga Re laoement Pro ect DUE: DATE. Thursda a 23 20afor:00:00 m. dMB; eaeu nnBASE WORK SCOPE is Bids are invited for ;Items and quantities of work generally as follows; a, new 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"X18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers., Item Quantity Unit - U iY Price Total Bid Priea 1, Furnishing all necessary equipment; 1 LS materials, and labor for Mooifrzatiort; 11,000 11,000 demobilization, barricades, insurance, and bonds as per plans and specifications 2. Furnish all necessary materials, equipment t L5 and labor for the demolition and removal of approximately 482 LF timber cap, 92 tie- 11580 11580 back rods and 482 LF timber waiter in accordance with the drawings and specifications. 3. Furnish all necessary materials, 482 LF equipment, and labor for the installation of reinforced concrete bulkhead cap with 161,25 77722.50 periodic PVC drains approximately every 10 It in accordance with the drawings and specifications. 4. Furnish all necessary materials, 482 LF equipment, and labor for the installation of 30.22 18904.04 a 3' wide sidewalk alongside the proposed concrete cap with minor grading of the produced cut material in accordance with the drawings and specifications. 5. Furnish all necessary materials, 92 BA equipment, and tabor for the installation of stainiess-steel tieback rods connecting 494.50 45494 existing Deadman to propose cap in accordance with the drawings and: specifications.: 6. Furnish all necessary materials, equipment, 482 LF and tabor for the installation of a timber 18.5 8917 waiter in accordance with the drawings and specifications, TOTAL BASE BID " $ 173,61'7.54 SPECIFICATION NOTES Calhoun County is receiving Bids for items and quantities of work generally as follows: Bids are invited for items and quantities of work generally as follows: A new482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24N18" concrete cap and an adjacent '3' sidewalk, The other components of"the bulkhead cap replacement; project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new dead"man fie -back rods and the replacement of existingtimber whalers. County to provide: 1. Unsecured place to store contractor equipment and vehicles 2. Unsecured area to store excess materials required for construction. BIDDER hereby agrees to commence work under this contract on or before a: date to be specified in a written "Notice to Proceed" to be issued by the County and to substantially complete within) 90' consecutive calendar days as stipulated In the specifications. BIDDER further agrees to pay as liquidated I hereby acknowledge the receipt of the following addenda: 11. 2.: SUBCONTRACTORS. The at the project site with his subcontracted and perform Bidder Name Keith Staff dba Staff Concrete Construction Address.4703 John Stockbauer Or. Victoria, TX Phone. 361212-5246r EIN or Tale iD No.: $1`4655949 Signature: Email Address: not CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos. 1 - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. 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. 2024-1175347 Staff Concrete Construction Victoria, TX United States Date Filed: 06/13/2024 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County, Texas Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2024.07 - Magnolia Beach Seawall replacement with concrete cap, sidewalk, and new tieback rods Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION Dylan Staff 10/24/1996 My name is ,and my date of birth is My address is 19705 James Manor St Manor TX 78653 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Travis County, State of TX on the iday of June 2D 24 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V4.1.0.078aba0 PAYMENT BOND Bond Number: 67090].55 KNOW ALL PERSONS BY THESE PRESENTS, That we _Kaith_Staff aba ,Staff -_Concrete Construction 0.Z.Q�_7ob.a_�.G.ockbauar._]Zcad, vacknx.�:�?,?x,77a�n referred to as the Principal, and _._...__. WESTERN SURETY COMPANY as Surety, are held and firmly bound unto County of Calhoun_____—_�_ One Hu referred to as the Obligee, in the sum of _sev_nnt of , hereinafter _ �___. hereinafter enty Three Thousand Six Hundred Dollars ($ .l 1,3,,617 ,_5.1_,_ __„_ ), for the payment of which we bind ourselves, our legal representatives, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Principal has entered into a contract with Obliges, dated --- _54h-_._----- day of __._._.._...June L029_._.,for ._Mayne.Ias,a„Heacti__-_Ucekin_.,Dri—ve . bu,lkhota.d_reP]a�mgnt�ro,j�ct COPY of which contract Is by reference made a part hereof, NOW, THEREFORE, if Principal shall, in accordance with applicable Statutes, promptly make payment to all persons supplying labor and material in the prosecution of the work provided for in said contract, and any and all duly authorized modifications of said contract that may hereafter be made, notice of which modifications to Surety being waived, then this obligation to be void; otherwise to remain in full force and effect. No suit or action shall be commenced hereunder (a) After the expiration of one (1) year following the date on which Principal ceased work on said contract it being understood, however, that if any limitation embodied in this bond is prohibited by any law controlling the construction hereof such limitation shall be deemed to be amended so as to be equal to the minimum period of limitation permitted by such law. (b) Other than in a state court of competent jurisdiction in and for the county or other political subdivision of the state in which the project, or any part thereof, is situated, or in the United States District Court for the district in which the project, or any part thereof, is situated, and not elsewhere. The amount of this bond shall be reduced by and to the extent of any payment or payments made in good faith hereunder. SIGNED, SEALED AND DATED this .. -14 �h -_-- day of ___..___ Jun_e__--- —_—, — _ 9M _, Staff Concrete Construction P .cipal) By--- --- \`__ _-- (Seal) Form P8878 State of Texas Claim Notice Endorsement To be attached to and form a part of Bond No. ------- In accordance with Section 2253.021(f) of the Texas Government Code and Section 53.202(6) of the Texas Property Code any notice of claim to the named surety under this bond(s) should be sent to: CNA Surety 151 North Franklin, 17th Floor Chicago, IL 60606 Telephone: 1-877-672-6115 Farm F6044.6-2016 PERFORMANCE BOND Bond Number: 6709BI55 KNOW ALL PERSONS BY THESE PRESENTS, That we _Ke10,n,$tAff._dba Stan _Cgncrece_.___ _ Construction T ___ _.-_--of 6703 John Stockbauex_Road_,_ Victortia,,_. TX_ 7790� , hereinafter referred to as the Principal, and _. WEST,TRN SURETY COMPANY as Surety, are held and firmly bound unto County of Calhoun )OR referred to as the Obligee, in the sum of �evenl_een and_ 5JLI oo ..... Dollars ($1'7361) .5n ), for the payment of which we bind ourselves, our legal representatives, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Principal has entered Into a contract with Obligee, dated the 5 t.h day of __-._._._ Jurte__ —_7.9:1..4� -__._,for_yA$nolia Paaah—._.Ocean Dzivo._bulkhct 1ro`wcT_ .,._._.._„ ..._... NOW, THEREFORE, if the Principal shall faithfully perform such contract or shall indemnify and save harmless the Obligee from all cost and damage by reason of Principal's failure so to do, then this obligation shall be null and void; otherwise it shall remain in full force and effect. ANY PROCEEDING, legal or equitable, under this Bond may be Instituted in any court of competent jurisdiction in the location in which the work or part of the work is located and shall be Instituted within two years after Contractor Default or within two years after the Contractor ceased working or within two years after the Surely refuses or fails to perform its obligations under this Bond, whichever occurs first, if the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense In the jurisdiction of the suit shall be applicable. NO RIGHT OF ACTION shall accrue on this Bond to or for the use of any person or corporation other than the Obligee named herein or the heirs, executors, administrators or successors of the Obliges. SIGNED, SEALED AND DATED this . 14 th ___ day of Staff Concrete Construction /(Principal) (Surety) Gail Lynne Green Force F4597 (Seal) Western Surety Company Know All Man By 'Those Pro laws of the State of South Dakota, make, constitute and appoint POWER OF ATTORNEY - CERTIFIED COPY Bond No. that WESTERN SURETY COMPANY, a corporation duly oeganiaud and existing under the rvhng its principal office its Sioux fella, South Dakota (the "Company"), does by those prostate its true and lawful attorney(s)-in-fact, with full power and authority hereby conferred, to oxecuto, acknowledge and deliver for and on. its behalf as Suroiy, bonds for; Principal: Keith Staff dba Staff Concrete Construction Obligee: County of Calhoun Amount: $1,000,000.00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Vice President, acaled with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attonrey(s)-in. fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and offect, "Soution 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretcuy, any Assistant Secretary, Treasurer, or any Vice President or by such other officers as the Doord of Directors may authorize. The President, any Vice President, Secretory, any Assistant Secretary, or tale 15rnsuror may appoint Attorneys in Cart or agents who shall have authority to issue bondn, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the vnlidity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal play be. printed by facsimile." This Power of Attorney may be signed by digital signature and sealod by a digital or otherwise electronic -formatted corporate seal under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanlmous written consent slated the 27th clay of April, 2022: ",RESOLVED: That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and confirm the use of a digital or otherwise electronic-formnttad corporate seal, each to be considered the act and dead of the Company." if Bond No. Is not, issued oil or before midnight of Noyermluer 1 st, 2024 , all authority,cileforregl.in this Power of Attorney shall expire and torminate. fitnces'fNltir'oui VJcscern Surety Company has caused those presents to be.. signed by its Vice President, Larry Kasten, and its soot t(fhC; nfirxed,Lhis .19i1a day of WESTERN SURET 7COMPANY ._...,--......_-..- ....... .......u, s+' as -- Latry I 'also, Vice President .President. !!! On this 1.4th day of June - in the year m,2024—, before me, a notary public, personally appeared r Hasten, who being to nor duly sworn, acknowledged that he signed the above Prover of Attorney as the aforesaid officer of TERN 9URIJTY COMPANY and ck owledgod said instrument to bo the voluntary act a dead of said corporation. FS. GREEN NOTARY PUBUC Se�'SOUTH DAKOTA a t4y Commission Expires r(,..bruary 12, 20+27 Notary South Dnketn i the underuigned officer of Western Surety Company, a stock corporation of the Suite of South Dakota, (to hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the hylaws of the Company as set forth in the Power of Attorney is now in force. In testimony whereof, I have hereunto out my hand and seal of Western Surety Company this _jl_ __. day of WES( N SURE COMPANY Levy Kasten, Vice President To validate bond authenticity, go to yy_Yyyysetltt?utS':kY,eorn > Owner/Obligee Services > Validate Bond Coverage. Form F5306-5-2023 Figure: 28 TAC §1.601(a)(2)(B) Have a complaint or need help? If you have a problem with a claim or your premium, call your Insurance company or HMO first. if you can't work out the Issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company or HMO. if you don't, you may lose your right to appeal. Western Surety Company, Surety Bonding Company of America or Universal Surety of America To get information or file a complaint with your insurance company or HMO: Call: Customer Service at 1.605.336.0850 Toll -free: 1.800-331-6053 Email: uwservices@cnasurety.com Mail: PA. Box 5077, Sioux Falls, SD 57117-5077 The Texas Department of Insurance To get help with an Insurance question or file a complaint with the state: Cali with a question: 1-800-252-3439 File a complaint: www.tdi.texas.gov Email: ConsumerProtection@tdi.texas.gov Mail: Consumer Protection, MC: CO-CP, Texas Department of Insurance, P.O. Box 12030, Austin, TX 78711-2030 Tlene Una queja o necesita ayuda? Si bone un probiema con Una reclamac16n o con su prima de seguro, flame primero a su compahfa de seguros o HMO. Si no puede resolver el problema, as posible qua el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre an angles) pueda ayudar. Aun si usted presenta Una queja ante el Departamento de Seguros de Texas, tambl6n debe presenter Una queja a trav6s del proceso de quejas o de apelaciones de su compahfe de seguros o HMO. SI no to hace, podda perder su derecho pare apelar. Western Surety Company, Surety Bonding Company of America or Universal Surety of America Para obtener Information o pare presenter Una queja ante su compahfe de seguros o HMO: Llame a: Servicio at Cllente at 1-605.336.0850 Telefono gratulto: 1.800331.6053 Correo electr6nico: uwservices@cnasurety.com Dlreccl6n postal: P.O. Box 5077, Sioux Falls, SD 57117-5077 El Departamento do Seguros de Texas Para obtener ayuda con Una pregunte refacionada con los seguros o pare presenter Una queja ante el estado: Llame con sus preguntes al: 1-800-252-3439 Presente Una queja en: www.tdi.texas.gov Correo electr6nico; ConsumerProtection@tdi.texas.gov Direccl6n postal: Consumer Protection, MC: CO-CP, Texas Department of Insurance, P.Q. Box 12030, Austin, TX 78711.2030 Form F$365.9-2..023 State of Texas Claim Notice Endorsement To be attached to and form a part of Bond No. _._6.7098155 In accordance with Section 2253.021(f) of the Texas Government Code and Section 53.202(6) of the Texas Property Code any notice of claim to the named surety under this bond(s) should be sent to; CNA Surety 151 North Franklin, 17th Floor Chicago, II_ 60606 Telephone: 1-877-672-6115 Form F6044-0-2010 AC`C)/Ro CERTIFICATE OF LIABILITY INSURANCE DaTE31/20 nvrr) V 05/31/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the' certificate holder in lieu of such endorsements . PRODUCER Harris & Hams Insurance PO Box 1380 Orange Grave TX 78372- CONTACT Jennifer Green PHONE (361)490-4105 FAX .(361)490-4108 E MAIL Jennifer@h-hins.com INSURER 3 AFFORDING COVERAGE NAIL # INSURERA.Chubb Insurance Co. INSURED Keith Staff Staff Concrete INSURERS, National Specialty Insurance INsuRERc:Texas Mutual Insurance Co. 4703 John Stockbauer Rd INSURER O: Victoria TX 77904- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD - INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TVpE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY D9547617A-3 06/10/2024 06/10/2025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 $ 17 POLICY X PRO LOC B AUTOMOBILE LIABILITY X X GMI-0673-00 10/15/2023 10/15/2024 COMBINED SINGLE LIMIT 1,000,000 $ ANY AUTO BODILY INJURY (Per person) BODILY INJURY (Per accident)$ J( ALLOWAUTOSNED SCHEDUTOSULED PROPERTY DAMAGE S X X NON-0WNED HIRED HIRED AUTOS AUTOS $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CI -AIMS -MADE C WORKERS COMPENSATION 0002053623 09/17/2023 09/17/2024 X WC STATU. OTH- AND EMPLOYERS' LIABILITY j�N ANY PROPRIEr0MPARTNERIUECUTIVEI E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMSER EXCLUDED? u (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 1,000,000 DISEASE - POLICY LIMIT $ 11000,000 N yes, Rclog'' urF606RATIONSbelowE.L. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKaah ACORO 101, Addidonal Remark. Schedule, If man apaaa le raq.i.dl Project: Magnolia Beach - Ocean Drive Bulkhead Cap Replacement THE GL & AUTO POLICIES INCLUDE A BLANKET AUTOMATIC ADDITIONAL INSURED ENDORSEMENT THAT PROVIDES ADDITIONAL INSURED STATUS TO THE CERTIFICATE HOLDER ONLY WHEN THERE IS A WRITTEN CONTRACT BETWEEN THE NAMED INSURED & THE CERTIFICATE HOLDER THAT REQUIRES SUCH STATUS. THE GENERAL LIABILITY IS PRIMARY & NON CONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT. THE GL, WORKERS COMP & AUTO POLICIES INCLUDE A BLANKET AUTOMATIC WAIVER OF SUBROGATION ENDORSEMENT THAT PROVIDES THIS FEATURE ONLY WHEN THERE IS A WRITTEN CONTRACT BETWEEN THE NAMED INSURED & THE CERTIFICATE HOLDER THAT REQUIRES IT. CERTIFICATE HOLDER CANCELLATION AI 005234 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Calhoun County tY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 211 South Ann Street Port Lavaca TX 77979- AUTHORIZED REPRESENTATIVE @ 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD A� & CERTIFICATE OF LIABILITY INSURANCE DATE 24 05/31/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER PO B & 380 Insurance Orange Grove TX 78372- Or nge Grove OONTACT Jennifer Green PNONE , (361)490-4105 FAX .(361)490-4108 E-MAIL Jennifer@h-hins.com INSURER(So AFFORDING COVERAGE NAIL# INSURER A: Chubb Insurance CO. INSURED Keith Staff Staff Concrete INSURERS, National Specialty Insurance INSURER c :Texas Mutual Insurance Co. 4703 John Stockbauer Rd INSURER Victoria TX 77904- INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOLSUBR POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY D9547617A-3 06/10/2024 06/10/2025 EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED MED EXP Arr one arson $ i,D00,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERALAGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,000 $ 17 POLICY RO X PIcIT LOC B AUTOMOBILE LIABILITY X X GMI-0673-00 10/15/2023 1Ott 5/2024 COMBINED SINGLE LIMIT 1,000,000 $ ANY AUTO BODILY INJURY (Per person) BODILY INJURY (Per accident) $ 1( ALL OWNED SCHEDULED X AUTOS N NONOOWNEDPROPERTY HIREDAUTOSAUTOS DAMAGE$ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CIAIMSMADE S C WORKERS COMPENSATION 0002053623 09/17/2023 D9/17/2024 X I `VC STATU- CA - AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOMPARTNEWEXECUTIVE❑ E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE -POLICY LIMIT $ 1,000,000 describe under MeR PTI elw DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is required) Project: Magnolia Beach - Ocean Drive Bulkhead Cap Replacement THE GL & AUTO POLICIES INCLUDE A BLANKET AUTOMATIC ADDITIONAL INSURED ENDORSEMENT THAT PROVIDES ADDITIONAL INSURED STATUS TO THE CERTIFICATE HOLDER ONLY WHEN THERE IS A WRITTEN CONTRACT BETWEEN THE NAMED INSURED & THE CERTIFICATE HOLDER THAT REQUIRES SUCH STATUS. THE GENERAL LIABILITY IS PRIMARY & NON CONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT. THE GL, WORKERS COMP & AUTO POLICIES INCLUDE A BLANKET AUTOMATIC WAIVER OF SUBROGATION ENDORSEMENT THAT PROVIDES THIS FEATURE ONLY WHEN THERE IS A WRITTEN CONTRACT BETWEEN THE NAMED INSURED & THE CERTIFICATE HOLDER THAT REQUIRES IT. CERTIFICATE HOLDER CANCELLATION At 005235 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE G & W Engineers, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 205 W. Live Oak Port Lavaca TX 77979- AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD #13 NOTICE.: 01- MEETING — 7/17/2024 13. Accept Monthly Reports from the following County Offices: i. Sheriff's Office — June 2024 ii. Justice of the Peace, Pct 4 — June 2024 RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: ; Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 10 of 13 SHERIFF'S OFFICE MONTHLY REPORT Jun-24 BAIL BOND FEE $ 450.00 CIVIL FEE $ 291.50 CASH BOND $ 500.00 JP#1 $ 4,152.20 JP#2 $ 220.00 JP#3 $ JP#4 $ - JP#5 $ 475.00 SEADRIFT MUN. $ - PC MUN $ PROPERTY SALE PRE-INDITMENT TOTAL: I $ 6,088.70 07/15/2024 07: 20 Ca I houn County JP 4 (FA%)3617852179 P. 002/005 i T NAME: H OF REPORT OFREPORT CASH EDT ADMINISTRATION FEE • A BREATH ALCOHOL TESTING - CIVIL JUSTICE DATA REPOSITORY FES-M CORRECTIONAL MANAGEMENT INSTITUTE -I CHILD SAFETY - GENERALREVENUB- GRIM -IND LEGAL SVCS SUPPORT - JUVENILE CRIME & DELINQUENCY JUVENILE CASE MANAGER FUND- J( JUSTICE COURT PERSONNEL TRAINING -J' JUROR $ERVICE FEE- T. t nnelAPPPRTC=CQ- PARKS & WILDLIFE ARREST FEES- PI STATEARREST FEES - IOOL CROSSINGICHILD SAFETY FEE - SUBTITLE C-S STATE TRAFFIC PINES -SST LOCAL TRAFFIC FIN TIME PAYMEN' TIME PAYMENT REIMBURSEMENT FE TRUANCY PREVENTIONEDWERSION FUND LOCAL & STATE WARRANT FEES COLLECTION SERVICE FEE•MVBA STATE CONSOLIDATED CIVIL FEE - X LOCAL CONSOLIDATED CIVIL FEE -2C FILING FEE SMALL CLAIMS - FF' JURY FEE COPIESICERTIFED COPIES. INDIGENT FEE -CIFF or IN JUDGE PAY RAISE FEE -JP ABSTRACT OF JUDGEMENT ALL WRITS-WOPI DPS PTAFINE-I LOCAL FINES - LICENSE & WEIGHT FEES PARKS& WILDLIFE FINES - SEATBELTIUNRESTRAINED CHILD FINE- -JUDICIAL & COURT PERSONNEL TRAINING. • OVERPAYMENT (OVER $10)- I • OVERPAYMENT (S10 AND LESS)- I RESTITUTION - PARKS & WILDLIFE -WATER SAFETY FINES MARINE SAFETY PARKS & WILDLIFE. TOTAL ACTUAL MONEY RECE TYPE: TOTAL WARRANT FEES ENTER LOCAL WARRANT STATE WARRANT DUE TO OTHERS: DUE TO CCISD -60%c1 Fine on JV cases DUE TO DA RESTITUTION FUND REFUND OF OVERPAYMENTS OUT -OF -COUNTY SERVICE FEE CASH BONDS TOTAL DUE TO OT 20.00 80.00 434.00 98.00 8.00 20.00 4.00 8A0 30.00 15.00 200.00 8.00 12.00 329.10 lo.00 f 42,00 66,00 12.00 75.00 620.00 00.00 9,059.00 0.00 PLFA8EmC410E 9.0. N!ewSrM4M1WIIyYSM' 0.00 REREEIRCWFE e.0. RE01'E511NGOIME 0.00EM RESEWCWCE a.RREOwuTIXe DISNRSEMa1T 0.00 R!NWIR OAR REOwe0R4 e�E&R2VMT(FP3aI.mm 07/15/2024 07:20Calhoun County JP 4 (FA%)3617852179 P.003/005 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/11/2024 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: JUNE YEAR OF REPORT: 2024 ACCOUNT NUMBER ACCOUNT NAME AMOUNT R 1000-001.45014 FINES 1,117.00 OR 1000-001.44190 SHERIFFS FEES 42.00 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 10.00 CHILD SAFETY 0.00 TRAFFIC 12.00 ADMINISTRATIVE FEES 40.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 OR 1000-001-44364 TOTAL ADMINISTRATIVE FEES 6200. OR 1000-001-44010 CONSTABLE FEES -SERVICE 695.00 OR 1000-001.44064 JP FILING FEES 0.00 OR 1000-001.44090 COPIES / CERTIFIED COPIES 0.00 OR 1000-001-49111) OVERPAYMENTS (LESS THAN $10) 0.00 OR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 0.00 OR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 OR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 OR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 OR 1000-999.20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 OR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 OR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 329.10 TOTAL FINES, ADMIN. FEES & DUE TO STATE $2,245.10 GR 2670-001-44064 COURTHOUSE SECURITY FUND $40.30 r,R 2720.001-44064 JUSTICE COURT SECURITY FUND $2.00 OR 2719-001-44064 JUSTICE COURT TECHNOLOGY FUND $36.00 OR 2699-001.44064 JUVENILE CASE MANAGER FUND $0.00 OR 2730-001-44064 LOCAL TRUANCY PREVENTION & DIVERSION FUND $35.00 OR 2669-001-44064 COUNTY JURY FUND $0.70 OR 2728-001-44064 JUSTICE COURT SUPPORT FUND $50.00 OR 2877-001-44064 COUNTY DISPUTE RESOLUTION FUND $10.00 OR 2725-001.44064 LANGUAGE ACCESS FUND I $6.00 STATE ARREST FEES I DPS FEES 3.00 P&W FEES 0.00 TABC FEES 0.00 OR 7020-999-20740 TOTAL STATE ARREST FEES 3.00 OR 7070-999-20610 CCC-GENERAL FUND 8.00 OR 7070-999-20740 CCC-STATE 72.00 DR 7070-999-10010 80.00 OR 7072-999-20610 STATE CCC- GENERAL FUND 43.40 OR 7072-999-20740 STATE CCC- STATE 390.80 DR 7072-999.10010 434.00 OR 7860-999-20810 STF/SUBC-GENERAL FUND 0.00 CR 7860-999-20740 STFISUBC-STATE 0.00 I1 DR 7860-999-10010 0.00 OR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 8.00 OR 7860-999-20740 STF- EST 9/l/2019- STATE 192.00 DR 7860-999.10010 200.00 Page 1 of 3 07/15/2024 07:20Calhoun County JP 4 (FAX)3617852179 P.004/005 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/11/2024 COURT NAME: JUSTICE OF PEACE NO, 4 MONTH OF REPORT: JUNE YEAR OF REPORT: 2024 CR 7950-999-20810 TP-GENERAL FUND 0.00 CR 7950-999-20740 TP-STATE 0.00 DR 7950-999-10010 0.00 Page 2 of 3 07/15/2024 07:20Calhoun County JP 4 9 i (FAX)3617852179 P.005/005 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7111/2024 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: JUNE YEAR OF REPORT: 2024 I I CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CR 7480.999.20740 CIVIL INDIGENT LEGAL -STATE 0,00 DR 7480-999-10010 0.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 0.40 OR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 3.60 DR 7865-999-10010 4.00 CR 7970-999.20610 TLIFTA-GENERAL FUND 0.00 CR 7970-999-20740 TL/FTA-STATE 0.00 DR 7970-999-10010 0.00 CR 7505-999-20610 JPAY - GENERAL FUND 1.20 CR 750"99.20740 JPAY - STATE 10.80 DR 7505-999-10010 12.00 frR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 0.80 CR 7857-999-20740 JURY REIMS. FUND- STATE 7.20 DR 7857-999-10010 8.00 CR 7856.999-20610 CIVIL JUSTICE DATA REPOS, GEN FUND 0.00 CR 7856.999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.00 OR 7855-999.10010 0.00 CR 7502-999-20740 JUD/CRT PERSOt NEL TRAINING FUND- STATE 0.00 DR 7502-999-10010 0.00 7998-999-20740 TRUANCY PREVENT/01V FUND - STATE 0.00 7998-999-20701 JUVENILE CASE MANAGER FUND 0.00 DR 7998-999-10010 0.00 7403-999-22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 7858.999-20740 STATE CONSOLIDATED CIVIL FEE 42.00 42.00 TOTAL (Distrib Req to Oper Acct) $3,208.10 DUE TO OTHERS (Distrib Req Attcbd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT: 0.00 OUT -OF -COUNTY SERVICE FE 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 0.00 WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $0.00 TOTAL ({COLLECTED -ALL FUNDS $3,208.10 LESS: T04ALTREASUER'S RECEIPTS $3,208.10 OVER/(SHORT) $0.00 t' Page 3 of 3 07/09/2024 14;43Calhoun County JP 4 (FAX)3617652179 P.005/005 7/1/2024 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: JUNE YEAR OF REPORT: 2024 CR 7480-999-20610 CIVIL INDIGENT LEGAL.-GEN. FUND 0.00 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 0.00 DR 7480-999.10010 0.00 CR 7865-999-20810 CRIM-SUPP OF IND LEG SVCS-GEN FUND 0.40 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 3.60 DR 7865-999.10010 4.00 CR 7970-999-20510 TUFTA-GENERALIFUND 0.00 GR 7970-999-20740 TUFTA-STATE 0.00 i DR 7970-999-10010 0.00 CR 7505-999-20510 JPAY - GENERAL FUND 1.20 CR 7505-999-20740 JPAY-STATE 10.80 DR 7505-999-10010 12.00 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 0.80 CR 7857-999-20740 JURY REIMB. FUND- STATE 7.20 DR 7857-999-10010 8.00 CR 7856-999-20010 CIVIL JUSTICE DATA REPOS: GEN FUND 0.00 CR 7856.999-20740 CIVIL JUSTICE D/y A REPOS: STATE 0.00 DR 7856-999-10010 0.00 .CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND -STATE 10.00 OR 7502-999-10010 90.00 7998-999-20740 TRUANCY PREVENT/DIV FUND - STATE 0.00 7998-999-20701 JUVENILE CASE MANAGER FUND 0.00 DR 7998-999-10010 0.00 7403-999.22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 7058-999-20740 STATE CONSOLIDATED CIVIL FEE 42.00 42.00 I i TOTAL (Distrib Req to Oper Acaq $3,208.10 DUE TO OTHERS (Dis&lb Req Attchd) CALHOUN COUNTY ISO 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT: 0.00 OUT-OF+COUNTY SERVICE FE 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES I 0.00 WATER SAFETY FINES I 0.00 TOTAL DUE TO OTHERS $0.00 TOTAL COLLECTED -ALL FUNDS $3,203.10 LESS: TOTAL TREASUER'S RECEIPTS $3,203.10 OVER/(SHORT) $0.00 Page 3 of 3 #14 NOTICE OF MEETING— 7/17/2024 14. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 11 of 13 § § j k § / # M= s z Z■ 0k £ . W/ -2 ■ .! ,0 °®0 § �| »: §2m z �( n "I ■; , $ m. /mM; % z: z # � §) Z Z-0 �\q � MR) x ■ § B �) §22■ o ,»■ cm) I 000 � o; (\� � ■ .� ■; § % m: . ■ � m n , §) k ) j § / § |3 B § § z §� // k %! `0 ■� / � 2 , §§ /■ 0 ■ t a T S 0 a O ME m -ci mumi z 7' o z �0 m m A O O e O O zz a 0; m: a: 3? m: Z: 0: �E AE Oe m 30 z a O c m N m z 4 0 In v n m m m a r C O a mu � ■ z I z 0 k q§§ §GG■ $2 0 § WOMOC, m Go 0 � $ m � m k ag QQ§ )(a:■ �� s! \ S3! -§!! k§ /`�- „ \§ §) �)§§- ■■ �,,,■ C:jm mm k/ z( a■ .� ■ §(. §§§§& § ■| 2000E rp_ -b ;nnoo ma.X ni§ m%(§§2 ��e§ M § ■ �| , ` ■ � B§ �_ --©■ z■ o■ - CAf 2 §§§, _t9 _ ) #f §� ) k 00000tO § ks / a s\\\\§B� § $ a 0 � ■ k § � k , 2 � 0 3p � � z I z 0 / § ( A % q 2 ) § v: m: a: 3€ m: Z: 0E WE OE Oe N N A O :tE 0 H O 3 s v; m m; Z m a€ m z 3: m ZE o g z 3: m: m 70 0: m a: o a q� i 0 m a 3 m z I 0 Ul V O m o $ m 3 a C 3 m z I v: m; 3 Z: 0: uli Ofi O; c O n m m m C Z O C 0 z O 0 m a 1 m z z 1 0 0 a r 00 p O C z z W W w o W V N J O � d wp w N W W p � � O m O O a o 0 W W J n a 0 0 `5 0 0 A O ME J D ➢ ➢ 9 0 0 D Z Z A °0 m m « S p D a C A V N ZZ m N m� z� 1 m �m v_N A N 00 f00 (00 t00 D 4J (O (0 x zzzz� D O O O � GA) G) c) z z Z z 111 -I F» v F» I O o 0 lip CJ ^� W O O T r m z O m a 3 m C 3 m z z I 1 -1 m m G 0 n mm a D m 3 m z i 0 a r m=_ a=_ m= p Z= c z= v H o= z OOpp J �� 01 � N J Opp V O O W D C 20 O A A N m'o V .0 c a ea N N T Z z 00 0 zz� m a Z In a m m rn a r C O A m z c m 0 a r m A A A A O O O O O O y N W D) m m 0) Z zm m m m m mmmmm �mmmmm Zmcnrncnm O L L L L L L c c c c c c Cl) cn Nm cn � -i- � N � 400000 5mmmmm m 0 0 0 0 0 l: C') m m m m m 4 I D D D D D a mo000 m mmmm m vvv-ov A AA X;o mmmmm n n n n n ZZZZZ 00000 mo 000000 O O N b O b ZZZZzzp 000000 O G7�)Qp G)G)GAA) zZ zzzzz Z a 3 V J N W ODD W� (NO b tD O N O� A J m O O O O O O O O fA fA psp f9 f9 E9 EA 4fl fA T O 0 0 0 0 0 0 E M ffl T� i EA fA EA EA EA EA T '� O O O O O O O O N IVD O N (Oli W A V�� F O Z: ? a: a m c m; N m; c z; m c' m m: 0 N N A m m m a 3 m: Z: O O O O eC7 J J J J y 0000 D D D D r r r r 0000 ccCc 0 0 0 0 3 A � -i - W N � Z O 0 a r W O 00000E I , O 000000 N d 3 1 a = m; v �' 3 a; m -Zi 3 in Z' o Z: a: o m C m O m € c m: a: 0 3: p m: a � A r � N O Mg m m m 0:; 5S #15 NOTICE OF MFFTING - 7/17/2024 15. Approval of bills and payroll. (RHM) MMC Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER:. Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Indigent Healthcare: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct i SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 12 of 13 mo a o r n e N 1p voi N m b M W W 0p 00 O M M O 00 00 00 O l0 m N Q Q Vl Vl ti N H N N M � � H b9 fA fA b9 EA Yf 0 aQ s N H �'y MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---July 17, 2024 TOTALS TO BE APPROVED -TRANSFERRED FROM ATTACHED PAGES TOTAL':PAKABLES,p,AYROLL'AND ELECTRONIC BANIC�PAYMENTS _ $' 1,0Z39 367.50 TOTALTRANS�ERS9ETTWEEN�F.UNDS _ _ _ � �$ �t2,��934 '� YOTAL•NURSING;HOMEUhLEXPENSEf ,. ,_ _ ,{. .� ...,__�,r,$ _,.1,511,'896�2>� TOTALINTER-aOV( RNR+IENT-TL 4N5F6R6.. GRAND TOTAL DISBURSEMENTS APPROVED Jiily.l7, Zp 4 ' 'Z;4%$,882:$B yc 03 ° QO> 003 0 o o O C C C C G C "7 zZ�� n >o oz o�Z °2oz °�oz oz o z zn zn zn zn zn zn ym 41 yym ym ym txy77m m m tyxl On m Z ow q N [� 9 W W N n O O O m Z m rtn1 A m n y y y C � o n v r m w D -i y U y U ut U In IA ui P P P P n w w w w w w w u u o o r P P P P P P P P J J O O O O O O O O O O O O N N p yy Cn. n C n O n o n A F A F y y O v A A F A m m m m m OS T yTT ry- �pq O t7 n C C C C n n a a a m m m m E E m m pN� N N 4e P W P P P P N N C ry O O O P U 1n Vwi Vwi PP P O O O W Da N A A W W O O O O C a T?t 0�E ca c0 Oz Zz Z Z Sz T Z T'Y N N nr nD -1 O -1 Moo On3 t3 A W AfD Dal DO e m C7 r r 3. r n m < rr' O O y n A n A n 'b C m s n s m= mu c m w v yy o y0 P F -i O pp Q A U A W N M D b b F A N N N to lA �O �p N N U IJ b b b b T W W - n o O o - 0 0 0 0 0 0 3 0 0n0 cc c 9- CC c3 cK Z0 n y y 9 3 N y u c N y w 0 - 0 �T OC n T z D z n K z m S m Z z <� m n O O A y y A Z S m T N fyil �'- m r m y m n y c H C v y N q m r O T y U O ° w m a �m0 0 00 00 v _arm c� x ZZa 0 �r m m ro m m yTy X y N m m m A y J N VUi W J lP/i w 00. 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N U U T a 0 'o o 'o o O N N N N 3 C L ^ 0--1 -1 n-y� -yi-� ti > 1D XD �D DX n Orn yn Orn o Ne m0 C o N nN N n N rM u�C: w o A C m C A m m � < n o n N N N N p JyC D SI u a O O O c a z ° o a 14 >a e S 3 3 m � A rya m D XC S y(Dj m y(D'� cr-yn •ny n (Dj cn- <° _C{ 'dT O a C n A C n ZCn m>C n nn 1 Z mz Mani, Zm >Zm yzm Zm rm -i -Z70 00 0 00 n� ano n� no DD ,�. m m m m C < r y Z 2> y N n y -i n N A A W W W u lA b O VI {A U VI A a m n r m = rK rg r SK D r0 �� yy F zn -i A ; < A D A y C3o w y D o z nm nm tD-O y o > H S m 3 nz ra 0z rx < no a 3 np np cr-m nD m a T r. x Z A O D m O m `a n ti n ° o Z c o r m 00 A J W w U Ce W y U w Oa V� I G uN z 3 O o p A 0 p Ow ^ O O O O C o o A 3 W R ?.Pm ayv--77T0 m< nzv nn , TCnn r n nn �,< �T1 �W << �To To nT�o- < S n m -1 O O O Cn O VjjF3mf >nz wo nm n w5 Zm m m m o 0 o O o N N N N N X T N T p �^ A A A V� U O O O O P MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR -- Ju1y 17 2024 by:CT INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES HEB Pharmacy (Medimpact) Pharmacy Reimbursement 9.97 MMCenter (in -patient $o/ Out -patient $60.50 / ER $0) 440.01 Memorial Medical Clinic 240.00 SUBTOTAL 689.98 Memorial Medical Center (Indigent Healthcare Payroll and Expenses) 4,166.67 Subtotal 4,856.65 Co -pays adjustments for June 2024 {10 pp)I Reimbursement from Medicaid 0.00 00000007/17/2024 04CALHOUN COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY UNIT PRICI TOTAL PRICE 1000-800-98722-999 Transfer to pay -bills for Indigent Health Care $4,846.65 approved by Commissioners Court on 07/17/2024 1000-001-46010 June 30, 2024 Interest $4,834.77 COUNTY AUDITOR APPROVAL ONLY THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY THIS OBLIGATION. I CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME IN GOOD COPTION AND REQUEST THE COUNTY TREASURER TO PAY THE ABO IGATION. f BY: 7/17/2024 APPROVED ON JUL 17 2024 / F'S pU qUp VVV"` CABLHdUN COUNTY�T DEPARTMENT HDATE OWS Source Totals Report Issued 07/09/24 Calhoun Indigent Health Care Batch Dates 07/01/2024 through 07/01/2024 For Vendor: All Vendors Source Description 02 Prescription Drugs 08 Rural Health Clinics 14 Mmc - Hospital Outpatient Expenditures Reimb/Adjustments Grand Total Amount Billed Amount Paid 9.97 9.97 240.06 240.00 852.00 440.01 1,106.39 694.40 -4.42 -4.42 1,101.97 689.98 Expenses 4,166.67 CoPays <10.00> APPROVED ON gJ�UaL�N11 p21324 (SALt10UN GOUNt�I� T6N S 4,846.65 ®1HS Source Totals Report Issued 07/09/24 Calhoun Indigent Health Care Batch Dates 02/01/2024through 07/01/2024 For source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 02 Prescription Drugs 32.60 32.60 08 Rural Health Clinics 240.00 240.00 13 Mmc - Inpatient Hospital 788.00 551.60 14 Mmc - Hospital Outpatient 300.00 151.25 Expenditures 1,385.48 1,000.33 Reimb/Adjustments -24.88 -24.88 Grand Total 1,360.60 975.45 Expenses 25,000.02 Co Pays < 20.00 > 25,799.98 �Irlbl2aa`-� 0 3 C-44 10519WO3 COW. ,r s 815 N. Virginia St. Port Lavaca, Texas 77979 (361) 552-6713 Date: 7/11/2024 Invoice # 397 For: Jun-24 Bill To: Calhoun County DWR1PT10N '` AMOUNT Funds to cover Indigent program operating expenses. $ 4,166,67 Andrew De Los Santos Controller Total $ 4,166.67 APPRoWl) ON JUL 15 2024 olHS Active Client List Page 1 Issued 07/09/24 Calhoun Indigent Health Care Active within 06/01/24-06/30/24 Program Indigent Client # Name Prior DOB Begin Date End Date Prog Status Catego 006498 Hernandez, Reymundo 11/04/64 05/07/24 11/30/24 / 1 005687 Hernandez, Vincente 06/18/68 04/24/24 11/01/24 1 006833 Portilla, Rudolpho J P 05/29/91 12/01/23 06/30/24 1 3 total records 3 unduplicated records w�M JUL 11 2024 CSO�WGOU&" TEXAS Calhoun County Indigent Care Patient Caseload 2024 Approved Denied Removed Active Pending January 0 3 2 1 7 February 0 3 0 1 5 March 0 4 0 1 4 April 1 0 0 2 0 May 1 6 0 3 0 June 0 1 0 3 2 July 0 0 0 0 0 August 0 0 0 0 0 September 0 0 0 0 0 October 0 0 0 0 0 November 0 0 0 0 0 December 0 0 0 0 0 YTD 2 17 2 11 18 Monthly Avg 0 1 0 1 2 December 2023 Active 4 Number of Charity patients 263 Number of Charity patients below 50% FPL 125 Number of Charity patients who meet State Indigent Guidelines 116 Calhoun County Pharmacy Assistance Patient Caseload 2024 Approved Refills Removed Active January 6 18 0 7 February 0 0 0 10 March 3 9 0 17 April 5 15 0 20 May 5 15 0 22 June 1 3 0 26 July 0 0 0 0 August 0 0 0 0 September 0 0 0 0 October 0 0 0 0 November 0 0 0 0 December 0 0 0 0 Value $0.00 $8,345.67 $8,332.53 $13,588.44 $3,567.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 YTD PATIENTSAVINGS $43,495.79 Monthly Avg 2 5 9 $3,624.65 December 2023 Active 36 RUN DATE: 07/09/24 MEMORIAL MICAL CENTER TIKS@ 10:19 RECEIPTS FROM 06/O1/24 TO 06/30/24 G/L RECEIPT PAY CASH NUMBER DATE NUMBER TYPE PAYER AMOUNT ---------------- '------------ •------------- .------------ 50240.000 06/10/24 701641 CA **TOTAL** 50240.000 COUNTY INDIGENT COPAYS 10.00 PAGE 110 RCMREP RECEIPT DISC COLL GL WE AMOUNT NUMBER NAME DATE INIT CODE ACCOUNT -------------------- --------------- 10.00 00/00/00 PLB 10.00 r ` PROSPERITY BANW 4046- THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 5 ANN ST STE A PORT LAVACA TX 77979 13135 Statement Date 6/30/2024 Account No "**4551 Page 1 of 1 06/01/2024 Beginning Balance $9,658.74 1 Deposits/Other Credits + $11.88 0 Checks/Other Debits - $0.00 06/30/2024 Ending Balance 30 Days in Statement Period $9,670.62 DEPOSITS/OTHER CRE Date Description Amount 06/30/2024 Accr Earning Pymt Added to Account $11.88 7DAILY ENDING Date Balance Date Balance 06.01 $9,658.74 06.30 $9,670.62 EARNINGS SUMMARY -- L Below is an itemization of the Earnings paid this period. Interest Paid This Period $11.88 Annual Percentage Yield Earned 1.51 % Interest Paid YTD $68.32 Days in Earnings Period 30 Earnings Balance $9,658.74 o o w � o E2 MEMBER FDIC NYSE Symbol "PB" Iw I�,v I.EHU6R MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR---JUIV 17, 2024 PAYABLES AND PAYROLL 7/11/2024 Weekly Payables 547,063.74 7/15/2024 MCKeason-3408 Prescription Expense 2,647.84 7/2512024 Amerisqurce Bergen-3408 Prescription Expense 2,530.36 7/15/2024 Payroll Liabilities -Payroll Taxes 135,397.69 7/15/2024 Payroll 398,023.31 7/15/2024 Health Equity- Wage Works employee FSA 6,213.61 Prosperity Electronic Bank Payments 7/15/2024 Credit Card Fees 4,627.51 7/15/2024 Sales Tax -June 2024 1,986.52 7/15/2024 Pay Plus -Patient Claims. Processing fee 1,031.36 7/15/2024 Credit Card Lease Fee 516.73 7/15/2024 Health Equity-HSA Contributions 1,322.83 70TAL_0AYABLES, PAYRULLA0464E0TR ;_dANK_P,AYMENT5 _ ,i 1,b�3'9,347vS0 TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 7/11/2024 MMC Operating to The Crescent -Correction of Insurance payment deposited Into MMC Operating in error 6,324.00 7/11/2024 MMC Operating to Golden Creek Healthcare -Correction of insurance payment deposited Into MMC Operating In error 8,748.14 7/11/2024 MMC Operating to Bethany -Correction insurance payment deposited into MMC Operating In error 47,497.20 Y07T tRAN51 ERSvBEMIEEN FUNDS _. $•, b2c8RJt34': NURSING HOME UPL EXPENSES 7/15/2024 Nursing Home.UPL-Cantex Transfer 982,465.64 7/15/2024 Nursing Home UPL-Nexlon Transfer 121,485,86 7/15/2024 Nursing Home UPL-HMG Transfer 10,928.00 7/15/2024 Nursing Home UPL-Tuscany Transfer 181,766.13 7/15/2024 Nursing Home UPL-HSL Transfer 66,949,37 QIPP CHECKS TO MMC 7/15/2024 Ashford - Molina May QIPP hospital portion 12,430.83 7/15/2024 Broadmoor -Molina May QIPP hospital portion 4,584.35 7/15/2024 Crescent- Molina May QIPP hospital portion 3,419,45 7/15/2024 Fort Bend - Molina May QIPP hospital portion 3,870.44 7/15/2024 Solera- Molina May QIPP hospital portion 3,703.09 7/15/2024 Tuscany- Molina May QIPP hospital portion 7,695.10 TRANSFER OF FUNDS BETWEEN NURSING HOMES 7/15/2024 Crescent to Tuscan -Tuscan insurance payment deposited into Crescent in error 8,097.86 7/15/2024 Crescent to Tuscany -Tuscany Insurance payment deposited into Crescent in error 4,500.00 'TOTAILNUR5INGHOME'UPGEKPENSES JOTg4'INTER+GOUERNMENTTRANSFERS RECEIVED BY THE COUNTY AUDITOR ON 07/12/2024 JUL 112024 MEMORIAL MEDICAL CENTER 09:06 AP Open Invoice List ap_open imoice.template 0 CALHOUNCOUNTY. TEXAS Due Dates Through; 08/02/2024 Vendor# /Vendor Name Class Pay Code 10950 ACUTE CARE INC Invoice# Comment Tran Dt Inv Dt Due Ot Check Ot Pay INV1886 Gross Discount No -Pay Net 07/01/202 071201202 07120/202 1,400.00 0.00 0.00 1,400.00 RFID FEE Vendor Totals: Number Name Gross Discount No -Pay Net 10950 ACUTE CARE INC 1,400.00 0.00 0.00 1,400.00 Vendor# Vendor Name Class Pay Code A1680 J AIRGAS USA, LLC - CENTRAL DIV M Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net / 9151356392 06/30/202 06130/202 071301202 2,580.41 0.00 0.00 2,580.41 OXYGEN ✓5509158384 06/30/202 06/30/202 07/30/202 277.65 0.00 0.00 277.65 OXYGEN ` 1/5509158383 06/30/202 06/30/202 07/30/202 073.96 0.00 0.00 973.96 V Vendor Totals: Number Name Gross Discount No -Pay Net A1680 AIRGAS USA. LLC - CENTRAL DIV 3.832.02 0.DO 0.00 3,832,02 Vendor# /Vendor Name Class Pay Cade 14028 ,J AMAZON CAPITAL SERVICES Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay ilKHH4QJ71JLQ Gross Discount No -Pay Net 06130/202 06130/202 07/301202 16.98 0.00 0.00 16.98 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 14028 AMAZON CAPITAL SERVICES 16.98 0.00 0.00 16.98 Vendor# Vendor Name Class Pay Code 14088 (AZALEA HEALTH Invoice# Comment Tran Ot Inv Dt Due Dt Check Ot Pay J106283 071011202 Gross Discount No -Pay Net 07/01/202 07101/202 594.00 0.00 0.00 594.00 JVLY FEES Vendor Totals: Number Name Gross Discount No -Pay Net 14088 AZALEA HEALTH 594.00 0.00 0100 594.00 Vendor# %Vendor Name Class Pay Code M2485 BAYER HEALTHCARE M ✓Invoice# comment Tran Ot Inv DI Due Dt Check Ot Pay 6011242136 06/30/202 06/26/202 07/26/202 Gross 1,104.08 Discount 0.00 No -Pay 0.00 Net 1,104,08 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2485 BAYER HEALTHCARE 1,104,08 0.00 0.00 1,104.08 Vendor# /Vendor Name Class Pay Code B7220 J BECKMAN COULTER INC M Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net / J 111404559 06/30/202 06/27/202 07/27/202 52.64 0.00 0.00 52.64 J J 111406701 06/30/202 001281202 07128/202 367.50 0.00 0.00 367.50 V SUPPLIES r 7 07/03/20207/08/2O208102/202 �I1 146.18 0.00 0.00 148A8 IQ13L05y SUPPLIES J 111415367 07/10/202 07/02/202 08101/202 2,841.08 0.00 0.00 2,841.06 ✓ SUPPLIES J 111413657 07110/202 07/021202 08/011202 1.438.19 OW 0.00 1,438,19 SUPPLIES 1/111416140 07/101202 07/02/202 08101/202 SUPPLIES J111413662 07/10/20207/02/20208101/202 SUPPLIES 111416689 07/10/202 07/03/202 07/28/202 SUPPLIES 1/7365288 07110120207/08120208/02/202 SUPPLIES _.WA9_rr 07/10/202 07/08/202 08/02/202 \�j14 2,111iv3SUPPLIES Vendor Totals: Number Name B1220 BECKMAN COULTER INC Vendor# Vendor Name Class Pay Code 81320 J BEEKLEY CORPORATION M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay JMIN0115396 061301202 06/271202 07/27/202 Vendor Totals: Number Name B1320 BEEKLEY CORPORATION Vendor# Vendor Name Class Pay Code 11072 '� 81O•RAD LABORATORIES, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay f907380664 06/30/202 06/201202 07/20/202 SUPPLIES J 907380663 06130/202 06/20/202 07/20/202 SUPPLIES Vendor Totals: Number Name 11072 BIO-RAD LABORATORIES, INC Vendor# Vendor Name Class Pay Code C1325 .(CARDINAL HEALTH 414, INC. w Invoice# Comment Tran Dt Inv Di Due DI Check Dt Pay J8003551773 06/28/202 06/161202 07127/202 SUPPLIES 8003548113 06/30/202 06123/202 07/301202 SUPPLIES Vendor Totals: Number Name C1325 CARDINAL HEALTH 414, INC. Vendor# )Vendor Name Class Pay Code 14236 J CARRIER CORPORATION JInvoice# Comment Tran Dt Inv Or Due Dt Check Dt Pay 90376110 06/30120206/26/20207/26/202 032524.042124 CHILLER RENTAL Vendor Totals: Number Name 14236 CARRIER CORPORATION Vendor# Vendor Name Class Pay Code 13264 J CERVEY, LLC JInvoice# Comment Tran DI Inv 01 Due DI Check Dt Pay 29622 07110/202 07/05/202 07130/202 MONTHLY FEE Vendor Totals: Number Name 13264 CERVEY, LLC Vendor#�endor Name Class Pay Coda C1600 CITIZENS MEDICAL CENTER W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay J202422 06130/20207M 0/202071101202 CRNA JUNE 24 COVERAGE 100.50 v 100.50 0.00 0.00 175,00 0.00 0.00 175.00 1,420.89 0.00 0.00 1,420.89 J` 7,323.90 0.00 0.00 7,323.90 O.DD 5,759.11 0.00 5,759.11 Gross Discount No -Pay Net 19,626.99 0.00 0.00 19,626.99 Gross Discount No -Pay Net 199,00 0.00 0.00 199.00 ,/ Gross Discount No -Pay Nei 199.00 0.00 0.00 199.00 Gross Discount No -Pay Net / 2,124.24 0.00 0.00 2,124.24 V 358.31 0.00 0.00 358.31 Gross Discount No -Pay Net 2,482.55 0.00 0.00 2.482.55 Gross Discount No -Pay Net 321,68 0.00 0.00 321.68 0.00 209.57 0.00 209.57 Gross Discount No -Pay Net 531,25 0.00 0.00 531.25 Gross Discount No -Pay Net 12,830.00 0.00 0.00 12,830.00 / J Gross Discount No -Pay Net 12,830.00 0.00 0.00 12.830.00 Gross Discount No -Pay Nei 1,650.00 0.00 0.00 1,650.00 Gross Discount No -Pay Net 1,650.00 0.00 0.00 1.650.00 Gross Discount No -Pay Net 58,442.23 0.00 0.00 58,442.23 Vendor Totals: Number Name 01600 CITIZENS MEDICAL CENTER Vendor#/Vendor Name Class Pay Code 15188 J CLARITY ENROLLMENT SOLUTIONS Invoice# Comment Tran Of Inv Of Due Dt Check Of Pay J1661 07/01 /202 07/01 /202 07/31/202 CARRIER CONNECTION Vendor Totals: Number Name 15168 CLARITY ENROLLMENT SOLUTIONS Vendor# /Ventlor Name Class Pay Code C7166 v COASTAL OFFICE SOLUTONS W Invoice``# Comment Tran Dt Inv Of Due Of Check Of Pay VOEOTp74411 07103/202 07108/202 07118/202 /'L SUPPLIES Vendor Totals: Number Name C1166 COASTAL OFFICE SOLUTONS Vendor#/Vendor Name Class Pay Cade 11029 J COASTAL REFRIGERATION Invoice# Comment Tran Dt Inv of Due Ot Check Of Pay 070124 07/01/20207/01/202071101202 FINANCE DEPT UNIT REPAIR Vendor Totals: Number Name 11029 COASTAL REFRIGERATION Vendor#/Vendor Name Class Pay Code 11030 ./ COMBINED INSURANCE Invoice# Comment Tran Dt Inv Of Due Of Check Of Pay 070124 06130/20206/30/20207130/202. Vendor Totals: Number Name 11030 COMBINED INSURANCE Vendor# /�tendor Name Class Pay Code 15116 J COMPUGROUP. MEDICAL • EMUS INC. JfInvoice# Comment Tran Of Inv Dt Due Dt Check Of Pay J 9090067716 07/10/202 07/09/202 07/09/202 EMD HOSTING SERVICES Vendor Totals: Number Name 16116 COMPUGROUP MEDICAL.- EMUS INC. Vandor#Vendor Name Class Pay Code J 12044 CULLIGAN ULTRAPURE INC. Invoice# Comment Tran Of Inv Of Due Dt Check Of Pay J 1430270306302024 06/30/202 06/30/202 07/221202 WATER Vendor Totals: Number Name 12044 CULLIGAN ULTRAPURE INC. Vendor# /vendor Name Class Pay Code 11368 .( CYRACOM LLC JInvoice# Comment Tran Of Inv Of Due DI Check DI Pay 2024042475 06/301202 06130/202 07/301202 INTERPRETATION Vendor Totals: Number Name 11308 CYRACOM LLC Vendor#? Vendor Name Class. Pay Code 10060 DETAR HOSPITAL ICP / Invoice# Comment Tran Dt Inv DI Due Dt Checli DI Pay DTR2406018 06130/202 071011202 07/011202 LAB SERVICES Gross Discount 58,442.23 0.00 Gross Discount 355.50 0.00 Gross Discount 355.50 0.00 No -Pay Nei 0.00 58,44223 No -Pay Net 0.00 355.50 No -Pay Net 0.00 355.50 Gross Discount No -Pay Net 168.00 0.00 0.00 168.00 / J Gross Discount No -Pay Net 168.00 0.00 0.00 168.00 Gross Discount No -Pay Net 934.25 0,00 0100 934.25 Gross Discount No -Pay Net 934.25 0.00 0.00 934.25 Gross Discount No -Pay Net 501.72 0.00 0.00 501.72 Gross Discount No -Pay Net 501.72 0.00 0.00 601.72 Gross Discount 11,308.50 O.OD Gross Discount 11,308,50 0.00 No -Pay Net 0.00 11,308,50 J / No -Pay Net 0.00 11,308.50 Gross Discount NaPay Net 354.00 0.00 0.00 354.80 / Gross Discount No -Pay Net 354.60 D.OD 0.00 354.80 Gross Discount No -Pay Net 616.66 0.00 0.00 516.66 / J Gross Discount No -Pay Net 516.66 0.00 (IM0 516.66 Gross Discount No -Pay Net 628.59 0.00 0.00 628.59 I// Vendor Totals: Number Name 10060 DETAR HOSPITAL Vendor# Vendor Name Class Pay Code 10368 Y DEWITT POTH & SON Invoice# J7599351 comment Tran Ot Inv Dt Due Dt Check Ot Pay 06/301202 06/27/202 07/22/202 SUPPLIES 7602620 06/301202 06/28/202 07/231202 SUPPLIES 7602621 07/01/202 07/01/202 07/26/202 SUPPLIES Vendor Totals: Number Name 10368 DEWITT POTH & SON Vendor# /Vendor Name Class Pay Code 11011 DIAMOND HEALTHCARE CORP Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay JIN20056279 07/01/202 07/01/202 07/31/202 JIN20056280 BEV HEALTH 07/03/202 07101/202 07131/202 JUNE 2024 CPR Vendor Totals: Number Name 11011 DIAMOND HEALTHCARE CORP Vendor# Vendor Name JIDISCOVERY Class Pay Code 10789 MEDICAL NETWORK INC Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay JMMCDO3024 06130/202 06/30/202 07/01/202 PROF FEES CLINIC Vendor Totals: Number Name 10789 DISCOVERY MEDICAL NETWORK INC Vendor# Vendor Name Class Pay Code 11091J ECOLAB Invoice# J6348436927 Comment Tran Dt Inv Dt Due Ot Check Ot Pay 07/10/20207101/20207/31/202 JULY CONTRACT Vendor Totals: Number Name 11091 ECOLAS Vendor# Vendor Name Class Pay Code 11284 „( EMERGENCY STAFFING SOLUTIONS Invoice# J43382 Comment Tran Ot Inv Dt Due Dt Check Dt Pay 071101202 07/15/202 071251202 PHYS SERVICES Vendor Totals: Number Name 11284 EMERGENCY STAFFING SOLUTIONS Vendor# Vendor Name Class Pay Code 10689 J FASTHEALTH CORPORATION Invoice# J07A24MMC Comment Tran Dt Inv Dt Due Dt Check Dt Pay 07110/20207/01/202071161202 WEBSITE MNTHLY INVOICE Vendor Totals: Number Name 10689 FASTHEALTH CORPORATION Vendor#% Vendor Name Class Pay Code F1400d FISHER HEALTHCARE M Invoice# 3357980 Comment Tran Dt Inv Dt Due Dt Check DI: Pay .( 06/301202 06/25/202 07/201202 J$395933 061301202 06/261202 07/211202 Gross Discount No -Pay Net 628.59 0.00 0.00 628.59 Gross Discount No -Pay 0.00 Not 91.75 91,75 0.00 J% 602.02 0.00 0.00 602.02 42.25 42.25 0.00 0,00 J Gross Discount No -Pay Net 736.02 0.00 0.00 736.02 Gross Discount No -Pay Net / 31,144.58 0.00 0.00 31.14456 V 19,166.67 0.00 0.00 19,166.67 Gross Discount No -Pay Net 50,311.25 0.00 0.00 50,311.25 Gross Discount No -Pay Net 142,980.76 0.00 0.00 142,980.76 / J Gross Discount No -Pay Net 142,980.76 0.00 0.00 142,980.76 Grass Discount No -Pay Nei 220.00 0.00 0.00 220.00 Gross Discount No -Pay Nei 220.00 0.00 0.00 220,00 Gross Discount No -Pay Not 40,062.50 0.00 0.00 40,062.50 Gross Discount No -Pay Net 40,062,60 0.00 0.00 40,062.50 Gross Discount No -Pay Net 545.00 0.00 0.00 545.00 J Gross Discount No -Pay Net 545.00 0.00 0.00 545.00 Gross Discount No -Pay Net / 34.90 0.00 0.00 34.90 J 421,47 0.00 0.00 421.47 SUPPLIES / 3395934 06130/202 05/26/202 07121/202 6,533.66 0.00 0.00 6,533.66 SUPPLIES 3432885 06/30/202 06/27/202 07/221202 103.28 0.00 0.00 103.28J SUPPLIES J9967789 07/11/202 01126/202 02/20/202 79.72 0.00 0.00 79.72 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Not F1400 FISHER HEALTHCARE 7,173,03 0.00 0.00 7,173.03 Vendor# Vendor Name Class Pay Code 11149 GES ADMINISTRATORS, INC Invoice# Comment Tram Dt Inv Dt Due Dt Check Ot Pay Gross Discount No,Pay Net 152967207693 06130/202 05120/202 06/01/202 5,230.31 0.00 0.00 � LTD h0 AV O 1 860002436341 07101/202 061201202 07/01/202 5,230.31 0.00 0.00 5,?39,'di LTD no I PIUO \ C'e• ' Vendor Totals: Number Name Gross Discount No -Pay Net 11149 GBS ADMINISTRATORS, INC 10,460.62 0.00 0100 10,460.62 Vendor# Vendor Name Class Pay Code 10642 GLAXOSMITHKLINE PHARMACUETICAL. Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net CM8269082063 06/30/202 06/28/202 06/28/202 -2,914.93 0.00 0100 -2,9 CREDIT rNQ \ fNV01 GQ. / l4- Vendor Totals; Number Name Gross Discount No -Pay Net 10642 GLAXOSMITHKLINE PHARMACUETICAL -2,914.93 0.00 0.00 -2,914.93 Vendor# !Vendor Name Class Pay Code W 1300 �r GRAINGER M JInvoice# Comment Tram Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net / 9146986790 06/25/202 06/25/202 07127/202 159.03 0.00 0.00 159,031/ J9155357800 SUPPLIES06/30/202 J 06/18/202 07/27/202 281,04 0.00 0.00 281.04 SUPPLIES J 9155240485 08/30/20206/18/20207/27/202 173.12 0.00 0.00 173.12 J ' / SUPPLIES 1/ 9487850750 07/101202 061281202 07/231202 258.68 0.00 0.00 258.68 1 SUPPLIES Vendor Totals; Number Name Gross Discount No -Pay Net W1300 GRAINGER 871.87 0.00 0.00 871.87 Vendor#/VandorName Class Pay Code G1210J GULF COAST PAPER COMPANY M JInvoice# Comment Tram Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net / 2547410 06/30/202 06/25/202 07/25/202 942.71 0.00 0.00 942.7 t fSUPPLIES 2649342 06/301202 07/02/202 08/01/202 867,95 0.00 0.00 867.96 / `r SUPPLIES / ,f 2549479 06130/20207/02/20208/011202 46.29 0100 0.00 46:29 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPER COMPANY 1.856.95 0.00 0.00 1,856.05 Vendor# Vendor Name Class Pay Code 11552 J HEALTHCARE FINANCIAL SERVICES Invoice# Comment Tram Dt Inv Dt Due Ot Check Ot Pay Gross Discount No -Pay Net J100907903 06130/202 061271202 08/011202 4,61052 0.00 0.00 4,610.52 LEASE Vendor Totals: Number Name Gross Discount No -Pay Net 11562 HEALTHCARE FINANCIAL SERVICES 4,610.52 0.00 0.00 4,610.52 Ventlor# fJendor Name Class Pay Code H0416 "f HOLOGIC INC Invoiced Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J10988277 06/30/202 06127/202 07/27/202 236.25 0.00 0.00 236,25 f SUPPLIES J Vendor Totals: Number Name Gross Discount No -Pay Net H0416 HOLOGIC INC 236.25 0.00 0.00 236.25 Vendor# endor Name Class Pay Code 15208 HOSPITAL CARE CONSULTANTS INC. Invoice# Comment Tran Or Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net /6582 07/10/202 07/15/202 07/25/202 1 23,663.00 0.00 0.00 23,663.00� PHY SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 15208 HOSPITAL CARE CONSULTANTS INC. 23,663.00 0.00 0.00 23,663.00 Vendor" 'Vendor Name Class Pay Code 10922 7 HUNTER PHARMACY SERVICES Invoiced Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount. No -Pay Net f6069 061301202 06/301202 07/20/202 14,704.03 0.00 0.00 14,704.03 PHARM SALARY Vendor Totals: Number Name Gross Discount No -Pay Not 10922 HUNTER PHARMACY SERVICES 14,704.03 0.00 0.00 14,704.03 Vendor#/Vendor Name Class Pay Code 11200 ✓ IRON MOUNTAIN Invoiced Comment Tran Dt Inv Dt Due Dt JPCB373 06/30/202 G6/30/20207/301202 Check Ot Pay Gross Discount 0.00 No -Pay Net ,I 1,377.01 0.00 1,377.01 / SHREDDING .,/ Vendor Totals: Number Name Gross Discount No -Pay Net 11200 IRON MOUNTAIN 1,377.01 0,00 0.00 1,377,01 Ventlor# Vendor Name Class Pay Code 15524 J- Invoice# Comment Tran Dt Inv Dt Due Or Check Dt Pay Gross Discount No -Pay Net 070924 06/30/202 07109/202 07109/202 52.44 0.00 0.00 52.44 PAYROLL ACH RETURNED Vendor Totals: Number Name Gross Discount No -Pay Net 15624 52.44 0.00 0.00 52.44 Vendor#)Vendor Name Class Pay Code 14540 J JINDAL X LLC Invoice# Comment Tran Ot Inv Dt Due Dt f202425021 06/301202 07/08/202 07/22/202 Check Dt Pay Gross 9,000.00 Discount 0.00 No -Pay Net 9,000.00� REV CYCLE MANAGEMENT SER\ 0.00 Vendor Totals: Number Name Gross Discount No -Pay Nei 14540 JIN DAL X LLC 9,000.00 0.00 0.00 9,000.00 Vendor# Vendor Name Class Pay Code W13727 JOHN B WRIGHT LLC comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net /Invoice# .j 061424A 05/30/20207/09/20207/27/202 1,500.00 0.00 0.00 1,500.00 OB COVERAGE Vendor Totals: Number Name Gross Discount No -Pay Net W1372 JOHNS WRIGHT LLC 1,500.00 0.00 0.00 1,500,00 Ventlor# JVendor Name Class Pay Code L1288 LANGUAGE LINE SERVICES W %Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 11339414 06/SW= 06/30120207/25/202 108,36 0.00 0.00 108.36� INTERPRETATION Vendor Totals; Number Name Gross Discount No -Pay Net L1288 LANGUAGE LINE SERVICES 108.36 0.00 0.00 108.36 vendor# Vendor Nams Class Pay Code 14244,J LONESTAR COMMUNICATIONS, IN Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 149497 06/30/2D206/27/20207127/202 2,757.80 0.00 0,00 2,757.80� Vendor Totals: Number Name Gross Discount No -Pay Nei 14244 LONESTAR COMMUNICATIONS, IN 2,757.80 0.00 0.00 2,757.80 Vendor# %Vendor Name Class Pay Code M2470 v MEDLINE INDUSTRIES INC M Invoice# J Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 2325130008 06/30/202 07/03/202 07/281202 2,606.77 0.00 0.00 2,606.77 / SUPPLIES / .J 2325130003 06130120207/03/20207/281202 101A2 0.00 0.00 101.42 J SUPPLIES 2325128098 06/30/202 071031202 07/28/202 618.83 0.00 0.00 618.83 J% SUPPLIES 232513004 07/11/20207103120207128/202 3,90 0.00 0,00 3.90 SUPPLIES J 2325130010 07/11 /202 07/03/202 07/28/202 158.88 0.00 0.00 158.88 SUPPLIES / j 2325128097 07/11/20207/03120207/28/202 1,003,02 0,00 0.00 1,003.02 SUPPLIES J 2325130002 07lt 1/202 07/03/202 07/28/202 26.25 0,00 0.00 26.25 SUPPLIES J 2325130000 07/11/202 07/031202 07/28/202 99.02 0100 0.00 99.02 SUPPLIES f2324128099 07/111202 07/03/202 07/28/202 290.14 0.00 0.00 290.14 J 5 SUPPLIES 2325130001 07/11/202 07/03/202 07/28/202 30.92 0.00 0,00 30.92 / SUPPLIES 2326128096 07/111202 07/03/202 07/26/202 100.35 0.00 0.00 100.35 J SUPPLIES J ,J 2325130008 07/1 W02 07/03/202 07128/202 81.12 0.00 0.00 81.12 J2325130009 SUPPLIES 07111120207/031202 07/28/202 103.28 0.00 0.00 103.28 / SUPPLIES J2325130005 07111/202 07/031202 07128/202 3.90 0.00 0100 390 / SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Nei M2470 MEDLINE INDUSTRIES INC 5,227,80 0.00 0.00 5,227.80 Vehdef#/Vendor Name Class Pay Code 10536 V MORRIS & DICKSON CO, LLC Invoice# J2161437 Comment Tran Dl Inv Dt Due Dt Check DI Pay 06/30/202 06/30/202 07/10/202 Gross Discount No -Pay Net 159,55 / 159.55 0,00 0.00 2160533 06/301202 06/30/202 07/10/202 207.48 0.00 0.00 207.48 J SUPPLIES 2161438 06/30/202 06/30/202 071101202 457.29 0.00 0.00 457.29 J SUPPLIES 2161440 06/30/202 08/30/202 07/10/202 36.50 0.00 0.00 36.50 SUPPLIES 2161439 06/30/202 061301202 07110/202 2,919.51 0.00 0.00 2,919.51 / J2192791 06130/202 07/09/202 07/19/202 16.57 0,00 0.00 16.57 J2192598 INVENTORY 06/30/202 07/09/202 07/19/202 34.90 0.00 0100 34.90 INVENTORY PHARM 2192790 06130/202 07/09/202 07/191202 74.35 It= 0.00 74.35 / INVENTORY PHARM J 2164081 07101/20207101120207/11/202 48.25 0.00 0.00 48.25 SUPPLIES J 2164080 07/01/202 07/01/202 07/251202 11,31Z59 0.00 0.00 11,317.59 ✓ SUPPLIES J 2170534 07/101202 071051202 07/25/202 400,11 0.00 0.00 400.11 % SUPPLIES J2178833 07110/20207/05120207/25/202 2.171.50 0.00 0.00 2,171.50 SUPPLIES J 2180872 07/10/202 07/05/202 07/25/202 98.62 0.00 0.00 98.62 J J2177318 SUPPLIES 07110/202 07/05/202 07/25/202 1,616.26 0.00 0,00 1.616.25 J2180871 SUPPLIES 07/10/202 07/05/202 07/25/202 19.36 0.00 0.00 19,36 / SUPPLIES ,/2180873 07110120207/05/20207/25/202 35.07 0.00 0.00 35.07 SUPPLIES J 2178830 07/10/202 07/051202 07125/202 2,365.02 0.00 0.00 2,365.02 / SUPPLIES J 2169224 071101202 07/02J202 071251202 185.68 0,00 0.00 185.68 J2169222 SUPPLIES / 07110/20207/02120207/25/202 22.37 0.00 0.00 22.37 J2165685 07M 0/20207/02/20207/25/202 5,048.40 0.00 0.00 5,048.40 2172671 SUPPLIES / 07/10/202 07/02/202 07/25/202 469.50 0100 0.00 469.50 0/ `r 2172672 SUPPLIES / J 07/101202 07/021202 07/26/202 978.94 O,OD 0.00 978.94 w/ J2177319 SUPPLIES 07/10/20207/03/20207/25/202 7,20 0100 0.00 7.20 / 2174521 SUPPLIES / J 071101202 07/03/202 071251202 196.70 0.00 0,00 195.70 J2177316 SUPPLIES 07110/202 07/031202 07/25/202 1,188,51 0.00 0.00 1.188.51 14/ SUPPLIES J 2170533 tl7/10/20207/03/202071251202 164.17 0100 0,00 164.17 J J SUPPLIES 2174523 07/10/202 07/031202 07/25/202 72.90 0,00 0.00 72.90 J SUPPLIES / 2174139 071101202 07/03/202 07/25/202 4,050.02 0.00 0.00 4,050.02 J2177317 SUPPLIES 07/10/20207/03120207125/202 1,128.03 0.00 0.00 1,128.03 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 05,489.34 0.00 0.00 35.489.34 Ventlor# %Ventlor Name Class Pay Code M2659 �l MXR IMAGING, INC M / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not J 8801162217 06/30/202 07/01/202 07/31/202 86.43 0.00 0.00 86A4 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2659 MXR IMAGING, INC 86.43 0.00 0.00 8643 Vendor# J✓endor Name Class Pay Code 01500 J OLYMPUS AMERICA INC M Invoice# Comment Tran DI Inv Ot Due Dt Check DI Pay Gross Discount No -Pay Not / -1136465251 06130120206128I202(17/281202 386.18 0.00 0.00 386,18 J SUPPLIES 1/36602198 07/031202 07/07/202 08/01/202 1,125.00 0.00 0,00 1,125.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 01500 OLYMPUS AMERICA INC 1,511.18 0A0 0,00 1,511.18 Vendor# /Vendor Name Class Pay Code 11932 --f PRESS GANEY ASSOCIATES, INC. /Invoice# Comment Tran Dt Inv DI Due Dt IN000656659 Check Dt Pay. Gross Discount No -Pay Not J 06130/202 08/301202 07/301202 2.838.92 0.00 0.00 2,838.92 / CONTRACT FEES J Vendor Totals, Number Name Gross Discount No -Pay Net 11932 PRESS GANEY ASSOCIATES, INC, 2.838,92 0.00 0.00 2,838.92 Vendor#/Vendor Name Class Pay Code 10936,/ SIEMENS FINANCIAL SERVICES /Invoice# Comment Tran DI Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 1J 66382400055724 06130120206/24/20207/14/202 4,038.24 0.00 0.00 4,038.24 J LEASE NUC MED J Vendor Totals: Number Name Gross Discount No -Pay Net 10936 SIEMENS FINANCIAL SERVICES 41038.24 0.00 0.00 4,038.24 Vendor# /Vendor Name Class Pay Code 10699 „/ SIGN AD, LTD, Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net JInvoice# 302118 07/01/202 07/011202 07/11/202 410.00 0.00 0.00 410.00 ADV LEASE SPACER 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 14868 ✓ SINGLETON ASSOCIATES, P.A. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dl Pay Gross Discount No -Pay Nei J246063024001 06/301202 07/021202 071021202 %132.65 0.00 0.00 9,132.65 JUNE RAD: SERVICES Vendor Totals: Number Name Gross Discount No,Pay Nei 14868 SINGLETON ASSOCIATES, P.A. 9,132.65 0.00 0.00 9,132.65 Vendor# Vendor Name Class Pay Code 10845 STAPLES Invoice# Comment Tran Dt Inv Dt Due DI J6005884343 Check Dt Pay Gross Discount No -Pay Net / 06/30/202 06/301202 07/30/202 17.21 0100 0.00 17.21 / SUPPLIES J / 6005884337 06/30/20206/30/2D207/301202 83.36 0.00 0.00 83.36 SUPPLIES 6005984340 00/30/20206/30l20207130)202 19.99 0.00 0.00 19.99 SUPPLIES Vendar Totals: Number Name Gross Discount No -Pay Net 10845 STAPLES 120.56 0.00 0.00 120.56 Vendor# Vendor Name class Pay Code S3940I STERIS CORPORATION M / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 112537968 06/30l20206127/20207/22/202 202,00 0.00 0.00 202.80 SUPPLIES J12560996 / 07/031202 07103/202 07/28/202 457.10 0.00 0.00 457.10 J SUPPLIES J504685842 07/10/202 07/021202 08/01/202 1.039,00 0100 0.00 1,039.00 Vendor Totals: Number Name Gross Discount No -Pay Net S3940 STERIS CORPORATION 1,698,90 0,00 0.00 1,698.90 Vendor# /uendor Name Class Pay Cade T2539 Y/ T-SYSTEM, ING w JInvoice# Comment Tran DI Inv Ot Due Dt 916763 07/01/202 Check Ot Pay Gross Discount No -Pay Net 06130/202 07130/202 6,130.42 0.00 0100 6,130.42 PHYS TRACKING Vendor Totals: Number Name Gross Discount No -Pay Net T2539 T-SYSTEM, INC 6,130.42 0100 0.00 6,130.42 Vendor# j✓endor Name Class Pay Code 15244 �/ TEXAS ELITE THERAPY TEAM LLC % Invoice# Comment Tran Dt Inv Dt Due Dt 053124 Check Dt Pay Gross Discount No -Pay Net / 'd 06/301202 05/31/202 07/09/202 16,850.00 0.00 0,00 16,850.00 �I / MAY SERVICES ./ 083124 06/30/202 06130/202 06/30/202 14,475.00 0.00 0,00 14,475.00 / JUNE SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 15244. TEXAS ELITE THERAPY TEAM LLC 31,325.00 0.00 0100 31,325.00 Vendor# /Vendor Name Class Pay Code T2204 J TEXAS MUTUAL INSURANCE CO W Invoice# Comment Tran Dt Inv Dt Due Dt .Check DI Pay Gross Discount No -Pay Net J 1005885072 05/30120207/02/20207/241202 4,588.00 0.00 0.00 4,588,00 / J Vendor Totals: Number Name Gross Discount No -Pay Net T2204 TEXAS MUTUAL INSURANCE CO 4,588.0D 0.00 0.00 4,588,00 VendorN /Vendor Name Class Pay Code 10985 J THE COMPLIANCE TEAM, INC Involee# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 00043826 07/10/202 0710M02 07/08/202 2,137.50 0.00 0.00 2,137.50 ACCREDITATION CONTRACT 3RE J Vendor Totals: Number Name Gross Discount No -Pay Net 10985 THE COMPLIANCE TEAM, INC 2,137,50 0.00 0.00 2,137.50 Vendor#/Vendor Name Class Pay Code 11908 V TMS SOUTH Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net INVI26365 06/301202 06/28/202 07128/202 196.8E 0.00 0.00 196.88 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11908 TMS SOUTH 196.88 0.00 0.00 195,88 Vendor# %Vendor Name Class Pay Code 14372 J TRIAGE, LLC Invoice# Comment Tran Dt Inv Dt Due Dt INV1798981529 Check DI Pay Gross Discount No -Pay Not 06/30/202 06/28/202 07/28/202 3,467.5G 0.00 0.00 3,46T50 RAD STAFFING ✓ Vendor Totals: Number Name Gross Discount No -Pay Net 14372 TRIAGE, LLC 3,46750 0.00 0.00 3.467.60 Vendor#/Vendor Name Class Pay Code 10841 TRUBRIDGE, LLC Invoice# Comment Tran Dt Inv Ot Due Dt Check Ot Pay Gross Discount No -Pay Net J T2407091378 07/01/202 07109/202 07/09/202 11,019.43 0.00 0.00 11,019.43 CONSULTING SERV Vendor Totals: Number Name Gross Discount No -Pay Net 10841 TRUBRIDGE, LLC 11,019.43 0.00 0.00 11,019.43 Vendor# /Vendor Name Class Pay Code 14208 TRUSTED HEALTH, INC Invoice# Comment Tran Dt Inv DI Due DI J INV70160 Check Dt Pay Gross Discount No -Pay Not 06/27/202 06/27/202 07/27/202 3,060.00 0,00 0100 3,060.00 AGENCY STAFFING ER Vendor Totals: Number Name Gross Discount No -Pay Net. 14208 TRUSTED HEALTH, INC 3,060.00 0.00 0,00 3,060,00 Vendor# /Vendor Name Class Pay Code UUNIFIRST HOLDINGS INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Nei 2921035950 06/28/202 06/27/202 07/27/202 282.90 0.00 0.00 282.90 J �2921035948 LAUNDRY 06/28/202 06/27/202 07/27/202 230.67 0.00 0.00 230.67✓ LAUNDRY / J 2921035948 06/28/20206/27/20207/27/202 34.04 0M 0.00 34.04 LAUNDRY / 2921035952 08/28/20206127/20207/271202 121,51 0.00 0100 121.51 .1 LAUNDRY ,/2921035961 06/28/20206127/20207/27/202 226.86 0.00 0.00 225.86 / ./ LAUNDRY j2921035947 061281202 06/27/202 07/27/202 2,674,12 0.00 0.00 2,874.12 / J LAUNDRY J2921035945 06/28/202 06127/202 07/27/202 161.77 0.00 0,00 161.77 / J/ 2921036181 LAUNDRU 06/30/20207101120207/31/202 102,07 0.00 0.00 102.07 SUPPLIES J/ 2921035480 07/10/20207/04/20207/291202 34.04 0.00 0.00 34.04 LAUNDRY J2921036478 07/10/202 07104/202 07/29/202 274.10 0.00 0.00 274,10 / J Vendor Totals: Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 4.341.08 0.00 0.00 4,341.08 Vendor# Vendor Name Class Pay Code 11110 JWERFENUSALLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9310053284 07/01/202 07/081202 08/02/202 -1,210.80 0.00 0.00 -1�216:BU" SUPPLIES CREDIT M6 LC'Anc-'- A�r0(.,QSS Vendor Totals: Number Name Grass Discount No -Pay Net 11110 WERFEN USA LLC -1,210.80 0.00 0.00 -1,210.80 Grand Totals: Gross Discount No -Pay Net 553,398.63 0.00 0.00 55 .63 APPROVrf) ()N( 0�")LIIAUDI7bIt77 7A�+Y 1-IY)i I f,YSUFrrt+ Tr1fA;e �nVNczs %cbr G PAS P cln�en r.. 14 c• 9 ,. �. 0 1 lr 2 9 r. he srcp t)1; 9 2 l o F 0 -F .11 C� 2G� 1 nupi (3L ' rQf no �e� �n7 'i4 0 / / \ wLon d GN $ )) ` §!J . \ ) � | 2 z , ! 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DEDUCTIONS: AIR S 225.00 ADVANC 800TS MUTUAL CRITICAL ILLNESS MUTUAL ACCIDENT IRS TAX MUTUAL SHORT TERM DIS MUTUAL VISION $ 857.36 CAF9-D $ 1,248.74 CAFE`-H $ 30,127.26 CAFE -le CANCER CHILD $ 570.69 CLINIC 3 175.00 COMBIN $ 250.96 CREDUN $ DENTAL $ OEP-LP MUTUAL TERM LIFE S 1,377.51 MUTUAL HOSP INDEM $ 517.60 FED TAX $ 50.693.63 FICA•M S 7,847.S2 FICA-0 $ 33,554.60 FICA-M ADDITIONAL FIRST C FLEX S $ 4.931.16 FLX-FE $ - GIFT S $ - 238.41 MUTUAL CRITICAL ILLNESS $ 11091.07 MUTUAL ACCIDENT $ 696.24 MUTUAL SHORT TERM DIS $ 1.399,37 LEGAL $ 1,130.91 OTHER S 1,936.06 NATIONAL FARM LIFE S 1,109.80 MED SURCHARGE $ 295.00 Blank RELAY REPAY STONEDF $ $95.00 STONE STONE 2 STUDEN TSAR _ S 39,674,18 UWIHOS $ _ TOTAL DEDUCTIONS: 5 181,239.40 6 NET PAY: $ 396025.31 TOTAL CAFE 125 PLAN: $ 36.059.60 Less TAXABLE PAY: $ 641,203.21 $ 541 203.21 ••CALCULATEW From MMCR4Aa4 Difference FICA - MED(ER) ,xsw $ 7,847.45 FICA - MED(EE) ,nw $ 7,847.45 $ 7,847,52 S (0.07) FICA - SOC SEC (ER) efow $ 33.564.80 FICA -SOD SEC(EE) cs4w $ 33,564.60 S 33,654.56 S 0.04 FED WITHHOLDING $ 50,593.53 5 50,693.63 S REVISED 3118,7014 7y06 �51ll TOTALS $ 579,262.71 S 225,00 857.36 1,248.74 30,127.26 570.69 175.00 250.86 1.377,61 517,50 50.593.53 7.847.52 33,554,66 4,931.15 233.41 1,091.07 698.24 11899.37 1 134.91 1,935.06 1.106.50 295.00 895,00 $ 39,674,18 $ �m 6 181.239.40 =J $ 398,023.31 EXemptAmt: Employees over FICA -SS Cap: Michael Gaines Paycods S - Employee Relmb.: TOTAL: $ TAX DEPOSIT: 4 133.39763 S 133,397,69 FICA - MEDICARE es4w S 15.694.90 $15.695.04 FICA -SOCIAL SECURITY 1210w $ 67,109,20 567,109.12 PREPARED BY: Collin Clevenger FED WITHHOLDING $ 50,593.53 $50,593,53 PREPARED DATE: 7/15/2024 TOTAL TAX: $ 133,397.63 $133,397.69 $ (0.06) 016RIMMC TAX DEPOSIT WORKSHEET 07. 1024, TAX DEPOSIT WORKSHEET 7115/2024 Run Date: 07/15/24 MEMORIAL MEDICAL CENTER Page 110 Tire: 11:00 Payroll Register ( Bi-Neskly I PZREG Pay Period 06/28/24 - 07/11/24 Runk 1 Final sumnary - *--Pay Code summary Paycd Description REGULAR PAY-S1 REGULAR PAY-SI REGULAR PAY-81 REGULAR PAY-81 REGULAR PAY-S2 REGULAR PAY-S2 REGULAR PAY-S2 REGULARPAY-8) REGULAR PAY-83 REGULAR PAY•S3 CALL SACK PAY CALL BACK PAY CALL BACK PAY SUSPENDED WITH PAY CALL PAY DOUBLE TIME DOUBLE TIME DOUBLE 7114E DOUBLE TIME DOUBLE TIME DOUBLE TIME EXTRA WAGES EXTRA WAGES INSERVICE JURY LEAVE EXTENDED-ILUIESS-BANK PAID -TX -OFF PAID-TIME-GFF CALL PAY 2 CALL PAY 3 HAZARD PAY HAZARD PAY HAZARD PAY HAZARD PAY HAZARD PAY HAZARD PAY HAZARD PAY FAZARD PAY HAZARD PAY PAID TIME OFF - PROBATION ............ ••�GT�SH�89�HO�CO{ 7863.25 N N Il 1637.25 11 N If N 226.75 11 N Y 233.25 Y N If 2046,80 V N If 150.25 N N Y 124.00 Y N If 1163.50 N 11 N 111.00 N N Y 115.75 Y N t7 24.00 N 1 ": 11 Y 21.75 V 2 N 11 Y ,25 Y 2 N N Y 24.00 Y 1 N 11 2442.0C V I N If 4.50 N 2 N H 3.75 .1 $ N Y 8.30 N 3 N L' 9.75 N 3 N Y 2A0 'Y 2 N If 8.00 'Y 3 `3 N 4 N N Y N ] N N N 10,00 N 1 N N 4.00 N I N N 156.00 N 1 N N 50.64 N N N N 303012S t1 N If ec.BDN1NN 24.00 N 1 N N 7,25 N N N 1,00 11 N N N 149.00 N 1 N N 221,75 N 2 N 11 6.50 N 2 N 11 N 205.50 8.25 Y 1 N N 11.75 Y 2 N N 30.25 Y 3 N N 108.00 11 1 N N ..........4-- D e d u c t i o n s S u n n a r y--__-_-._...� Gross I Code .Arcane ...........................................................-' 180854.25 A/R 225.00ZA/R2 A/R3 77335.66 ADVANC A14ARDS BCBSVI 9216.94 BOOTS CAFE I. CAFE-1 9168.71 CAFE-2 CAFE-3 CAFE-4 55926.31 CAFE-5 CAFE-C -E-D 7065.12 CAFE-F CAFE•g 1012225E-I 5468.48 CAFE-L CAFE-P CANCER 40240.90 CHILD 510.69ATNIC 175.040HBIN 5627.85 CREDUN DO AN DENIAI, 6466.93 DEP-LF DIS-LF T li56,2C Er.CBH 3TA.X 50553.53 1CA-M 555.65 IT CA-0 33554.5. 1P.STC FLU 5 12. i9 FLX FE �P..T D FUSA 859.38 GIFT S 238141�GFANr GRP-IN 4860.00 GTL HOSP-2 RSA 422.82 ID TFP IRSTAX AF 452.78 LEGAL 257.41% ASA 873.50,EALS $15.55 MF)VIS MISC M'SC/ 1352. MNCSN9. OACC 685.2 ILL 352.30 30 M00717) Sll,50 ^OLIF 1377.5E 5Ip 9643D MOOVIS 957.36 ATFML 1105,5 TIER 34460.5E PHI PHI.14 PR FIN 1871,25 RELAY REPAY. SAMS 189.24 SCRUBS BOON ST•TX 113.SO STONOF S95.00�OVE STORE2 3673,46 STL'DEN SUAACC SUNILL 1246.40 SUNIh'0 SUHLIF Sr. STD 61024.11 SUIVIS SDRCHG 295.00 SA-) 160.D0 TSA-2 TSA-P 72.00 TSA-P �TT�SAA-C 39674.1B-imm UNIFOF, 163-.13 U'd/HOS 60;00 16372.15 11054.03 39E.50 11255.54 187.87 746.97 3016.23 2982.16 1246.74✓ 250.86V 7iV.5211/ 4167,S1f 763.64v/ 1935 05 :091.07v 139937E '•------------------ Grand Totals: 20612.64--••••• I Gross: 579262.71 Daducticns: 181239 A0 Net: 398027.31 le Caecks Count:- PT 208 PS L1 Other 40 Penile 211 Male 21 Credit OrerAnt 20 Eerclet Term Total: 259 ................... ....... .............. ........... _•-_. •.... _.._..........-_........._-._.........--_.......--.-_.-_...-..-.. ,L HealthEquity° To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWorks Remit: Via Wire or ACH Credit to US BANK FSAIHRAIDC Acot #: outing # 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 Total Amount Due INVOICE WageWorks, Inc. 4609 Regent Blvd. Irvingg, TX 75063 214.596.6900 Account # _ I _ _ Invoice Date 2052366 06/03/2024 PO # _........ DUE DATE 09/03/2024 Invoice # AMOUNT DUE INV6615329 $1,508.88 $1,688.88 `� HealthEquity° To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 WageWarks Remit: Via Wire or ACH Credit to US BANK FSA/HRA/DC Acct #: Routing # 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 LDescrlptlon PMB Payments - DCFSA 2024 Visa Card Payments - HCFSA 2024 Total Amount Due INVOICE WageWorks, Inc. 4609 Regent Blvd. Irving,TX 75063 214.596.6900 Account # Invoico Date .._.._...___ 2D52366 06/17/2024 PO # DUE DATE ' 09/16/2024 -. Invoice # ! - - -- AMOUNT_DUE INV6662430 $3,043.04 Plan Code Amount DCFSA2024 670.00 '. HCFSA2024 2,473.04 ` $3,043.04 l HealthEquity- WageWorks INVOICE To: Memorial Medical Center WageWorks, Inc. PO Box 25 4809 Regent Blvd, Port Lavaca TX 77979 Irving, rX 75063 214,596.6900 Remit: Via Wire orACH Credit to I IS RANK- Account# Invoice Date FSAIHRA/DC Accl #: Routing #: 2052366 06/2412024 Please include invoice # in your payment addenda for ACH- Po # `- DUE DATE - -- Credit or Wire payment 09/23/2024 Log on to our employer website to view detailed invoice Invoice# — AMOUNTDUE---- - — ' reports: employer.wageworks.com INV6681301 $2,524.41 Description I Plan Code Amount PMP Payments - HCF6A 2024 i HCFSA2024 424.06 Visa Caro Payments - HCFSA 2024 I HCFSA2024 i 2,100.33 i I Total Amount Due $2,524.41 G1) HealthEquity° To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 Remit: WageWorks PLEASE NOTE,THIS IS A CREDIT MEMO, DO NOT PAY. Credit Memo WaCorks, Inc. 4609 Regent Blvd. Irvingg,TX 75063 214.596.6900 Account# Date 2052366 OBM 0f2024 PO# ''_ Credit# - CM192868 - AMOUNT $298.50 Description Plan Code _ Amount Options I Vise Cerd Peymente-HCF5A 2024--- IHCF8A2024 29a.50- i i ilk i I i Total Amount — $298.60 Cc x V��r wv iv HealthEquity To: Memorial Medical Center PO Box 25 Port Lavaca TX 77979 Remit: WageWorks PLEASE NOTE, THIS IS A CREDIT MEMO, DO NOT PAY. Credit Memo WageWorks, Inc. 4609 Regent Blvd. Irving, TX 75063 214.596.6900 Account 2052366 0612812024 r PO# Credit4 I .. CM194794 AMOUNT $844.22 Total Amount _$644.22 C` Memorial Medical Center / Transfer Request J 6,213.61 ✓ J Date: 7/15/2024 Account: Operating US BANCORP FSA/HRA/DC ACCT ACCT ROWIng Number: Invoice numbers 6615329,6662430,6681303,CM192968,CM194794 by: MlchelleCumberland by: �I DL APPROVED ON JUL 15 2024 Date: 7 15 2024 2-� Date: .I. .;. .I. .} + 0 ;. + .r -r .I. p M1� a• .r -a- -�. �. + -r .r o N vD O': CAI K1 Or 3° CV t , O Vr J- P-' tD tll N (`:I N N Ca i$- O U V O \D [ co . �Ln n O\ IOW C\I� [— I' • IYl ,o C. J LLGL 9 H 811 O N E O1 N A N Om1 o T w N Pg N P Oel N P P P P m W O1 01 N T N P N L oN,e vSd�9 n°rydge 68. 44 a Fi. FS. LLLL LL ud. �LL �uLLu (� S z2 G)S �9 �(O u • � �3 J u v E v :- •� 'M •+� LL �, c u c e c L c c c c y u £££££ d m i nvcvavc'�.;'iisfi E9f E OO p 9 V 9 'e 9 E 9 a N W N ^� am ,ov o Dim am n m` u` a u` u u u m m S 2 m u V u` u` a' u` 7 x ti n_ o S. W Z Y M J S'. Lli �:• Km O a b NO .. 0 N N N N N b m m N W I 33 n �b�bmblm'1 I.IPCTQ^ NeNQNQ mwei NN ymNN 6 O S g ^�ammmi om ' o g S$ g Z y $oomm F eb vN� °,mmai .n,� .9NPPPPb v RvP �Q"P G �.000 mm. Aqn 25g Sg o Qu ub.0 LLLL"lwgi f meo "rl mn mie e7+3' - rc a E,eSgompP 000v O �j fyTy�.Yp$g 2 I yS N.b+NNNHwtiNNYn 1I� C : mC F S b F- 4 7¢ Q 2 Z Z Z 2¢ Z n 6 Q °• N N N N N V F !' �pN jJ �m�€�� J6$oLLp44aLLmoo�d �� y o _ (. N LL LL LL 4 y LL if b a n�}� t a 6 'aNNNN'a nn¢oomo'�0000 LLo pu` W 3 E� 6¢ S 6 N r F- (- O N P N P P O P P P P P P P P ry P P V d P P N P P N� N N �ol�ooaall000RA '�rotio No'ci' o�oSN'w a, 'rJN` g'$ •n CC ^'C-. •nCC�CC. ,..0 •. C.CCn.Cn. _ ov ¢4 S COMPTROLLEVEXAS.GOV IS 0 Confirmation: You Have Filed Successfully Sales and Use Tax Period Ending06/30/2024 (2406) Taxpayer ID: Taxpayer Name: Entered By: Caitlin Clevenger User ID: � MEMORIAL MEDICAL CENTER Email Address: Reference Number: Taxpayer Address: Date and Time of Filing: 815 N VIRGINIA ST PORT LAVACA, TX Telephone Number: (361) 552-0272 07/1212024,11:24:51 AM 77979-3025 IP Address: 24.116.195.218 PAYMENT SUMMARY Electronic Check Payment Reference Number Type of Bank Account: Checking State Amount: $1,504.94 Trace Number:'. Accauntholder Name: Local Amount: $481.58 Memorial Medical Center Amount to Pay: $1,9B6.52 Bank Routing Number: Electronic Check: $1,986,52 Bank Account Number. Payment Effective Date: 07/19/2024 CREDIT SUMMARY , Credits Taken Are you taking credit to reduce taxes due an this return? No Licensed Customs Broker Exported Sales Did you refund sales tax for this filing period on Items exported No outside the United Slates based on a Texas Licenced Customs Broker Export Certifications? LOCATION SUMMARY Loch Total Texas Sales Taxable sales Taxable Subject to State State Tax Due Subjectto Local Tax Rate Local Tax Due Purchases Tax (Rate ,062S) Local Tax 00004 24,200 24,200 0.00 24,200 1,612.5 24,200 0.02 484 Subliatal 24,200 24,200 0 24,200 1,512.5 24,200 484 Total Tax for Locations 1,996.5 Total Tax Due: $1,996.50 Timely Filing Discount: - $9.9B Balance Due: $1,986.52 Pending Payments: - 80.00 Total Amount Due and Payable: $1,986.52 ( State amount due is S1,504.94) ( Local amount due is $481.58 ) Coverage Start Benefit EE Cost ER Cost 1/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $100.00 $25.00 1/1/2024 Health Savings Account $147.91 $25.00 1/1/2024 Health Savings Account $41.67 $25.00 7/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $60.00 $25.00 1/1/2024 Health Savings Account $10.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $25.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 2/1/2024 Health Savings Account $163.25 $25.00 1/1/2024 Health Savings Account $50.00 $25.00 2/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $100.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 3/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $25.00 $25.00 7/1/2024 Health Savings Account $0.00 $25.00 1/1/2024 Health Savings Account $0.00 $25.00 2/1/2024 Health Savings Account $0.00 $25.00 $722.83 $600.00 $1,322.83 RECEIVED BY THE 07M 1/2024 COUNTY AUDITOR ON MEMORIAL MEDICAL CENTER 13:28 JUL 1,1 207a AP Open Invoice List Due Dates Through: 08/03/2024 Vendorg Vendor Name Class Pay Code 11824 THE CRESCRWMN COUNTY, TEXAS Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount 062724 07/091202 06/27/202 08/03/202 6,324.00 0.00 TRANSFER Il is y>,V1,� OU o iM-D NW r r C ID'�i. 1 r-, t/Y'Or Vendor Totals: Number Name •Yr Gross Discount 11824 THE CRESCENT 6,324.00 0.00 I=+,;.I1r1;I SlifaNpl , Grand Totals: Gross Discount No -Pay 6,324.00 0.00 0.00 APPROVED ON JUL 1 1 2024 CAI- 1QUON/ IX�.TL�NTY. i TEXAS 0 ap_open_i nvolce.template No -Pay Net 0.00 6,324.00 No -Pay Not 0.00 6,324,00 Net 6,324.00 RECHDVEO 8y Ttw COUNTY ALIMOR ON MEDICAL CENTER 0EMORIAL 7/1 Y/2024 JUL�ul y 1 �024 13:29 AP Open Invoice List Due Dates Through: 08/03/2024 Vendor# Vendor lf9if 0LIN COUNTY, TEMS Class Pay code 11836 GOLDENCREEK HEALTHCARE Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount JInvoice# 062824 4,134.66 0.00 (�07/09//22022066/27//2�02�088/03/202 � TRANSFER,+ 1S • �i'+ r 1't . 1 TJf.Y • , ()rb Y 1 tYY�f� O?4.-. • \ rl _U cor J062824A 07/09/202061277120208/03/202 4,257,52 0.00 TRANSFER <• ', J062824B 07/091202 06/27/202 08/03/202 6.22 0.00 TRANSFER 6' ' J062824C 07/09/202 06/27/202 08/03/202 21.18 0.00 TRANSFER � +It J062724 07/09/20206/27/20208103/202 32B.66 0.00 TRANSFER h 1 Vendor Totals: Number Name Gross Discount 11836 GOLDENCREEK HEALTHCARE B,748,14 0.00 id -nor, s>lSnf iYrHY Grand Totals: Gross Discount No -Pay 8,,748.14 0.00 0.00 t, YYtitiPnO D 30. ,JUL 11 2024 on WOWN iwl i -AS 0 ap_open_i nvoice.template No -Pay 0.00 0.00 0.00 0.00 0.00 No -Pay 0.00 Net 8,748.14 Net 4,134,56./ 4,257.52 V 6.22 J/ 21.18 328.66 Net 8,748.14 RECEIVED BY THE COUNTY AUDITOR ON 07/11/2024 MEMORIAL MEDICAL CENTER 13:29 'JUL 112024 AP Open Invoice List Due Dates Through: 08/03/2024 Vendor#/Vendor Name CALHOUNCOUNTY,TFYA§ Class Pay Code 12792 �I BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay J0628241) 07/09/20206/27/20208/03/202 Gross 12,515.28 Discount 0.00 UN- PYWI.ULU, %()b '(11 D Upt. \/-\,t/t'Dr J 062624 07/09/202 06/27/202 08/03/202 250.42 0.00 1 TRANSFER � - r, �) 062724 07/09/20206/27/20208/031202 28,610,50 0.00 TRANSFER " 1 ' J 062824A 07/09/202 06/27/202 08/03/202 6,120.00 0.00 TRANSFER ', 1% Vendor Totals: Number Name Gross Discount 12792 BETHANY SENIOR LIVING 47,497.20 0.00 fl.nPpri sumrne.gr Grand Totals: Gross Discount No -Pay 47,497.20 0.00 0.00 APPAoVEC7 ONI JU771L 1 1gqtt2024 CA©HOI.itV'("'h !hl l'' '; 'A5 0 ap_open_invoice.template No -Pay Net / 0.00 12,516,28 J 0.00 250.42 0.00 28,610.50../ 0.00 6,120.00 No -Pay Net 0.00 47,497.20 Net 47,497.20 Memorial Medical comer Nursing Home UBl w*aw,Ca tm T.mfer BrospeJtyAl.un33 >rySryoN J ,(/ ae xe. rtA q.3es,9r 9cn<r. BOufm 4lforlMMlr[N[fnlfrlfOW 1. AMpen Meuannl t 1 JIf rP90. 1, ✓q�]A J V V 6S.eq.l9 6[.993.19✓53,9199i naseu nnq ,/19n1.n✓ j V 13}BI..a• )Af]I19 _ y 10.1Mf0. �/ i 67 90 3.3 S, a. f:50r° 16e06 TO 4"3 n 57 tx Mnen.Ye 17i,128 '/0 a Wfq O+fvGbnm Na•n 3iIXOwrMnenWrvfela rM vrrlmgnpe Mlr tleAarm.IMra Mff YtlAx bflmrAprM[p WpulMlanxnar'ewf L\n�WNWrr•.xlnaxx4ttlnnlnwmmrnl}gAWllufl Ann+lrriunrner l.{S ]f 1,9.SM.16 lA.g3.93 ✓ 119.Sb116 VVunf< u.nmeavr. loo.ro MOIIn Mry SI}19.AI V eElu+latlannRnmlrtemf IfI,EtUI J / - ,SrAfl.li y� ml0nnn f0!Yf l3 v/ Yavf lna Wnu Imo, MWInrMry f,3Y,13 Aa•xu,nnln..n.,.nf vun.aa V IS[p1151 9.MB.b¢. moss9l ✓ vf.u.. Ya Man...0 IwW Neon. Mq I.-H- / AeulevnnNmlwsm vasu.a ./ n P.nHn.nrt o,9ffq ✓/ Y.n In WYn How Mr11e.MN 5.A11u✓ �J .qnf a.r.r..nf.nen..x. 1A}t93. 110.q{.19 Bu30al.nu I, A,99119 3iB.t0)AB 11,193.557 YMla.wnn Iqq APPROVED ON MMIn. 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UAW." 1-1 35a9.00 1.6a3.30 I,m139 ] wq 39 9?1i:lY 3glfiM: Pl1.gl ).'xp,C9 ti 61923' allsoRAIl1 la,a91.31 1."SW .J 1.91sw E1.030.00 eae9sR 1,919m F,9uw ✓/ a,lao s0 M11 f 11.9M 61 i].96a.61 ' }p10.31 I9.11506 6,331.m / E,n0.i3 19.n506 3A11.31 J 6,33},Do ]AEON RITn. _ _ _ _ _ / &. / ] M908 i0.n0."r0 (/ )M mm 9K493.02 nXIm 69919E U M 17 IM Balances Overview Account Name *4357 MEMORIAL MEDICAL• $3,167,844.24 $3,068,811.84 $3,167,844.24 $2,895,117.58 OPERATING *436S MMC - CLINIC SERIES 2014 $545.22 $545.22 $545.22 $545.22 *4373 MMC •PRIVATE WAIVER CLEARING WAIVER $438.92 $438.92 $438.92 $438.92 *4381 MEMORIAL MEDICAL INH / $179,564.76 $206,370.18 $179,564.76 $80,564.70 ASHFORD ✓ `4403 MEMORIAL MEDICAL/NH / $254,487.75 f J $254,487.75 $254,487.75 $167,560.75 BROADMOOR `4411 MEMORIAL MEDICALINH ✓ $254,035.51 $276,046.14 $254,035.51 $174,774.45 CRESCENT *4438 MEMORIAL MEDICAL I SOLERA@ J $178.931.79 /J $184,255.27 $178,931.79 $133,989.69 WEST HOUSTON •4446 MEMORIAL / MEDICAL NH FORT �' $43,953.99 IJ $43,953.99 $43,953.99 $9,435.65 BEND *4454 MEMORIAL GMEDICALf GOLDSN CREEK OLDEN $121.585.86 $123,630.86 $121,585.86 $114,651.42 HEALTHCARE *4551 CAL CO INDIGENT $9,733.32 $9,733.32 $9,733.32 $9,733.32 HEALTHCARE *5433 MMC -NH GULF POINTEPLAZA- $1,958.93 $1,958.93 $1,958.93 $1,958,93 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA- $11,028.00 $13,685.67 $11,028.00 $300.00 MEDICAREIMEDICAID *5506 MMC -NH BETHANY SENIOR $67,049.37 $67,049.37 $67.049.37 $63,552.96 LIVING TUS NY NH TUSCANY VILLAGE VILLAGE $189,561.23 $189,561.23 $189,561.23 $119,492.28 *3660 MMC •BETHANY SR LIVING - DACA SR LIVING $100.00 $100.00 $100.00 $100.00 *2096 MMC-MONEY MAR MARKET FUND $5,034.00 $5,034.00 $5,034.00 $5,034.00 Total Balance $4,485,852.89 $4,445,662.69 $4,485,852,89 $3,777,249.87 Report generated on 07115f2024 09:47:22 AM CDT Page 2 of 2 Memorial Medical Center Nursing Home UP3 Weekly Nell Transfer Prosperity Accounts 7/15/2024 / PIlalau �,I ,J AAltmann Beginning pMtling Tatlay'a Beginning Amount [40lTransferred to Nuffl4B K red Nome Number Blleem mm1lneat Tleyrfi In ev alit Bala. Home 165,1Q.afi 1fia,61245 3L,485.(6 131,5(6 fib 3i1,4B5.86✓ Bank Oelmee IZ1,685.86 Vatlanae leeve to Be[.... 100.00 Routine lateral lordalden Creek N(ebn Herewith at Sudden Well Fargo Bank, N.A, Adluat Babnee/rnnderAmt 121,48Sofi V Not.: car, Warner a)ever S5,000 will be transferred to the aWsm, hem,. Note 2: Bagh atrium has abase basest 615100 that MMCdepesaed in epee etepanr. ,APPROVED ON JUL 15 20211 By CALHUU ONWAVY I RAS / -I /�, \ ' Apwaaee: I aywo.ibi livJ. f1..1.1C11�> a��y'��4�,� Mtlaew Oa leeSMtos t(1fi/202e I CMe Weekly Trmefepex aPl transfer SammryNW qN0 uol Transfvr Summary 2.IS.ae MMCPONIIfNI pIP1/Cvmpf ]JP=J(fy_I Tr4Men� plop/(om 1 Qlpp/Comp] Wee/C9mpJ 64pv WPPII NM OORLIUN lvo p - R.91ud. Ja]o.lU - Lila.. - LoeBW - 2A1s00 J.199W 1.699.09 v L.00G.W ]a,000.oa ' ]105.91 116W1.69� - f)PJOJI - 1),O)o.J9 1.11961 LH651 I9 191969 1'M 996.6E JaoJ! Op 119W / 69691J J B, J ]JlW 11,.L ]O6BW / J000 GM / 16I.W A UI.NB6 1]LKs.16.1��ws.eB7 )ll]110]C i5]fnPRXt11A41 CA to all LSb45511)69V 91 N9)n0)a OOIVENCREIReu9TMIRCBEP t))0116110Yd. l9f] )n InON G.M."EIR mTMERC O l r I U.1169101991511 )/Il nGta WMIMOINOIOIOM10f$R6b 141116N31))I7 )nmW 9 amxnnn 1x r.r4txr zlsal bnolRlWA]]6 1/10/i011 CI144 )I6 WIA[0U]N[vbN Nf4rN lNh EOIOFN (REEK N[ I/Imol1 1/301}O)1 i5V5/IR>X1fMy}CR [R REr L164SS5R]691)91 1/IU/]Ola NOVITK 101VIlOM NC44MIM]6]CWf9)RW166 1/]OnR4 1141NIIIYM6111VC NC.,mlMI lla.,911]OI).) iMtov CA.eu15 1Hn4A C1.11Jll 1/9/102. OOIOENCRIEMNGtT MER<OEP UMISb 91 00OUll 1/9/20N OOLOFHMIfvMFAT MERC 0fHl10lSb 91lWJ15A 1/1/20)1 NMTN NUM.. I" NCCMMPMT D"11111011) 9/enaa r»smaxsnrsrcR<o on wunanunm Balances Overview Account Name *4357 MEMORIAL MEDICAL- $3,167,844.24 $3,068,811.84 $3,167,844.24 $2,895,117.58 OPERATING *4365 MMC - CLINIC $545.22 $545.22 $545.22 $545.22 SERIES 2014 *4373 MMC - PRIVATE $438.92 $438.92 $438.92 $438.92 WAIVER CLEARING *4381 MEMORIAL MEDICAL INH $179,564.76 $206,370.18 $179,564.76 $80,564.70 ASHFORD *4403 MEMORIAL MEDICAL INH $254,487.75 $254,487.75 $254,487.75 $167,660.75 BROADMOOR *4411 MEMORIAL MEDICAL INH $254,035.51 $276,046.14 $254,035.51 $174,774.45 CRESCENT *4438 MEMORIAL MEDICAL /SOLERA@ $178,931.79 $184,255.27 $178,931.79 $133,989.69 WEST HOUSTON *4446 MEMORIAL MEDICAL / NH FORT $43.953.99 $43,953.99 $43,953.99 $9,435.65 BEND *4454 MEMORIAL MEDICALINH / ✓ $121,585.86 $114,651.42 GOLDEN CREEK $121,585.86 $123,630.86 HEALTHCARE *4651 CAL CO INDIGENT $9,733.32 $9,733.32 $9,733.32 $9,733.32 HEALTHCARE *5433 MMC -NH GULF POINTE PLAZA- $1,958.93 $1,958.93 $1,958.93 $1,958.93 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA- $11,028.00 $13,685.67 $11.028,00 $300.00 MEDICAREIMEDICAID *5506 MMC •NH BETHANY SENIOR $67,049.37 $67,049.37 $67,049.37 $63,552,96 LIVING *3407MMC -NH $189,561.23 $189,561.23 $189,561.23 $119,492.28 TUSCANY VILLAGE '3660 MMC -BETHANY $100.00 $100.00 $100.00 $100.00 SR LIVING - DACA *2998 MMC-MONEY $5,034.00 $5,034.00 $5,034.00 $5,034.00 MARKETFUND Total Balance $4,485,852.89 $4,445,662.69 $4,486,852.89 $3,777,249.87 Report generated an 0711512024 09:4722 AM CDT Page 2 of 2 Memorial Medical Center Nursing Name UPL Weekly HMG Transfer ProSpetity Wts 7/15/2 7/IS/ZOZp ✓ .,Moue / Amounlmas Aamvm a<tlne,ry Rnalne VV rnnmmeea xoam,N ...oa a"", rmY ea. Inn eelmee xen u ._ ... -'�.alx 5.en se mlBs Ilse<7 9vmpn� B<nY &IYnt< 1,95<.9I Vxuntt beveln Behnn IW.OB Ae—t MYryI�aM1 / Numble Narc:OntybobnmoJorx SABN xvllhervvne/medm,M nunmpnxne. No(ei Feeha¢wnrlYmbettbobnre y91M,M,MM[aePo+aedta penee<ew,. V<Min[ .eha..eennn.n<rem, I,esesa BanY Balaea Verie+se arrr..m mee rniul<rrtdM J / NVn1y N<me / fa,96a.0a ✓ leareln Bebna ]m.oa AG 11 lenmpnnlfe<Nmf 10.9[t.M ✓/ I.I.LIRAW9L16 1).116.93 APPnOVF_D ON JUL 15 2024 BY COU<s�TY AUDITOR CALHOUN !'OUNTY. TEXAS A091Cxtl: � J1 Qr1 V 1rr�U_ Pndwrp<Lae Ynln �� r 1/Ia/fBitl I:\HH WeeW innSlx<SXN VVLieenr/er5lvm5hllWe\r111 Vfti/antler y<,n ,715 24 JPANIC PORTION '� QlpP/Camp QIPP/Camp4 a OWN Tnmlm-Col TIm1eL QIPI)Campl 2 QIRP/Comp) &lapse QIRP TI APPORTION 7/9/2024 NNB- ECHO HCCUIMPMT 144W 11440000214155 101d3 101.35 IOlAS � 10iJ5, MMC PORTION QIPP(COmp QIPP/Camp4 S: TnnAenOut / TTMAIN R Q PP(Cemp1 2 QIPP/COmp9 618P44 QIPPTI NH PORTION 7/12/7024 MERCHANTBANSCOOEPOSIT4984185190099100001 J 10,7200 10,728.00 7/11/2024 MERCHANT BRNHCOOfPOS1T4963if5I98f99100001 / 1W.00 - 200.0 ]¢0/1024 WIRF OOTMMG POPfpott SNF, IP Cammerlwl 4L29i,15✓ > J/ 41,292dA 10,91A.00. 10.91A.00 4L297A5 1/929,35 11,02935 Balances Overview Account Name %357 MEMORIAL MEDICAL- $3,167,844,24 $3,068,811.84 $3,167,844.24 $2,895,117.58 OPERATING MMC •CLINIC SERIES 2014 SERIES $545.22 $545.22 $545.22 $545.22 *4373 MMC -PRIVATE WAIVER WAIVER CLEARING $438.92 $438.92 $438.92 $438.92 *4381 MEMORIAL MEDICAL/NH $179,564.76 $206,370.18 $179,564.76 $80,564.70 ASHFORD '4403 MEMORIAL MEDICAL I NH $254,487.75 $254,487.75 $254,487.75 $167,560.75 BROADMOOR *4411 MEMORIAL MEDICAL 1 NH $254,035.51 $276,046.14 $254,035.51 $174,774.45 CRESCENT *4438 MEMORIAL MEDICAL ISOLERA@ $178,931.79 $184,255.27 $178,931.79 $133,989.69 WEST HOUSTON `4446 MEMORIAL MEDICAL I NH FORT $43,953.99 $43,963.99 $43,953.99 $9,435.65 SEND •4454 MEMORIAL OLDEN CREEK G GOLDE $121,585.86 $123,630.86 $121,585.86 $114,651.42 HEALTHCARE *4551 CAL CO INDIGENT $9,733.32 $9,733.32 $9.733.32 $9,733.32 HEALTHCARE `5433 MMC -NH GULF POINTEPLAZA- $1,958.93 $1,958.93 $1,958.93 $1,958.93 PRIVATE PAY •5441 MMC 'NH GULF , POINTEPLAZA . $11,028.00 ,/ $13.686.67 $11,028,00 $300.00 MEDICARE/MEDICAID •5506 MMC •NH BETHANY SENIOR $67,049.37 $67,049.37 $67,049.37 $63,562.96 LIVING *3407 MMC TUSCANY VILLAGE TUSC $189,561.23 $189,561.23 $189.561.23 $119,492.28 *3660 MMC -BETHANY $100.00 $100.00 $100.00 $100.00 SR LIVING - DACA *2998 MMC -MONEY MARKETFUND $5,034.00 $5,034.00 $5,034.00 $5,034.00 Total Balance $4,485,852.89 $4,445,662.69 $4,485,852.89 $3,777,249.87 Report generated on 07115/2024 09:47:22 AM CDT Page 2 of 2 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity A6xaunts 7/15/2024 r,edaa. AemuM Betlnnln( Nunln[N Atl6nd inmM1r ':��rtiV.� 60.61199 6Apt9 rvau: onsybnln.n, o/ow• (Assswrbr ovnpnndmrM1<�unm9nwne, x.nr [omonounenm obonbolonr.MQmmnmiMedromum rvonen aemum. Jpmnunime. J v� tMnnnna m aNxan p6Geaud W.R. otltr TeO. Yee Innln rYn • .In XA / .¢Tie mass G 1e1AN.la e..w ea.n(f 6e9aM.n val.nr. 1<e.ern e.r.nra Dow MdM.M, 1.615.10✓ APPROVED ON JUL 15 2024 cn,Mjqucoli ry °xa Pdert l.hnnJrnmler Am6 IELx64O✓ 11y !" I 7/12/2024 NOVITAS SOLUTION HCOAIMPMT 676201420000114 7/11/2024 HNO- ECHO HCCLAIMPMT 7460 S4114400 O293487 7/10/2024 WIRE OUT VILLAGE P0W ACUTE HEALTH SERVKE 7/10/2024 00p431t 7/10/1024 Deposit 7/10/2024�M0UNAHEALTHCMIMOLINAA0101298321 g20000n 7/10/2024 NOVITAS SOLUTION HCCLAIMPMT 676101420000I66 7/9/2024 Check 1158 7/9/2024 Deposit 7/9/2024 Deposit 7/972024 HNS- ECHO HCCLAIMPMT 746003411440000214201 7/111 HNO- ECHO HCCLAIMPMT 74GM3413 440001 7/8/2024 NOVITAS SOLUTION HCCLAIMPMT 6762W 4200 O178 MMCPORTION QIPP/Comp QIPP/Camp QIPP/Camp Transfer -put Tm 7-In 1 QIPP/Comp2 3 4&Lapse QIPPTI NNPORTION - 10106595 70.068.95 1]9.01 179.01 54.596.63 -/ - 54,737,20 - 64,737.28 J14,089.00 / 14,008.00 eg,691.b8 6,78&52 1.818:8 7.695.20 ,/ ',[90658'. / 3,aOl40 3,W3.48 14,137.30 �/ 16.042.24 - 16,842.24 6,500.00 15.16 61SO0.00 .3 . 93.1.30 Y 91 91 / s5334 3 _ / 1593413 68,723.99 ✓ ]89,461.23. 61788,52 11 13.16 Balances Overview Account Name *4357 MEMORIAL MEDICAL• $3,167.844.24 $3,068,811.84 $3,167,844,24 $2,895,117.58 OPERATING *4365 MMC - CLINIC SERIES 2014 $545.22 $545.22 $545.22 $545.22 •4373 MMC - PRIVATE $438.92 $438.92 $438.92 $438.92 WAIVER CLEARING *4361 MEMORIAL MEDICAL/NH $179,564,76 $206,370.18 $179,564.76 $80,564.70 ASHFORD `4403 MEMORIAL MEDICAL I NH $254,487.75 $254,487.75 $254,467.75 $167,560.75 BROADMOOR *4411 MEMORIAL MEDICAL/NH $254,035.51 $276,046.14 $254,035.51 $174,774.45 CRESCENT *4438 MEMORIAL MEDICAL ISOLERAQ $178.931.79 $184,255.27 $178,931.79 $133,989.69 WEST HOUSTON *4446 MEMORIAL MEDICAL NH FORT $43,953,99 $43,953.99 $43,953.99 $9,435.65 BEND *4454 MEMORIAL MEDICAL GOLDEN CREEK $121,585.86 $123,630.86 $121,585.86 $114,651.42 HEALTHCARE *4561 CAL CO INDIGENT $9,733.32 $9,733.32 $9,733.32 $9,733.32 HEALTHCARE *5433 MMC •NH GULF POINTEPLAZA- $1,958.93 $1,958.93 $1,958.93 $1,958.93 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA • $11.028.00 $13,685.67 $11,028.00 $300.00 MEDICAREIMEDICAID *5506 MMC -NH BETHANY SENIOR $67,049.37 $67,049.37 $67,049.37 $63,552.96 LIVING *3407 MMC-NH / / $189,561,23 J $189,561.23 $189,561.23 $119,492.28 TUSCANY VILLAGE TUSC✓ ,/ `RLIVINMMC -BETHANY SR LIVING • OACA $100.00 $100.00 $100.00 $100.00 *2998 MMC -MONEY MARKETFUND $5,034.00 $5,034.00 $5,034.00 $5,034,00 Total Balance $4,485,852.89 $4,445,662.69 $4,485,852.89 $3,777,249.87 Report generated on 07/15/2024 OB:47:22 AM CDT Page 2 of 2 Memorial Medical Center Nursing Home UPL Weekly HSLTransfer Praspedty Accounts 7/35/2024 J o,.w.m s,/ d alndln\ RJ p<wYM a<\Innlry Mldlwn fmWMle Ot lnMfen<dw MuMn Ilom< Numlrt bhnen innAevOW Tnntlenln LMtln d Re m<M Led1 10! Innln BgL Munl Neme n),6101. E6.9d01I 6),W9.li Ih,939.3> 91n4a<11nt< 6I,W 9.11 V.M luvern Gllnce 1WW Nole;0m'yhelWmofavn$L090 x+'tl Eetmm/inedto epenunln9Aeme. Na<P frm..f pmaMV Oelonn v/SI W tpa; MIM deWvfedfeeveneaWnL APPPIOVED ON JUL 1 5 �1014 iniS l:i n:IPYVDi TRO's polmtaNnnbnmlopm! ,-66919.D ✓ I;MN wam T.waNM1vx vel MMCMRMN T.ne� pIPP/Cpmpl pIPP(CPmp2 QIPP(CO" QIPPICOMP44LSPw QIPPII NNPOAiION l/IL]Od NWPNF06sOlRNpgmmUNi]HuiR[O". ! 3A96., 3,996 41 1=20]e "Ar.X mm VC X(CW MIMt .1. 647M >/IN]O31 WIAt OUirolli gVKAN&LLC ES.USC6 1 ]I/M0]9 XOYNtl301U910X N<(UIMPM96)6.61 NQN166 E)<Em ],)@.03 ]0.W f - ""014CM9\1. )nn9:. Mm 1M. )/Sn9x. CA.MM) Hss ✓ 5LJ )n/Iola n9.s41ee.fiM , nn01a NMSWttpKu9 eUls6uee,xwnr9 N1M12WitUWN 5VC NCCUIMPM) N]W.3CI1]016] ,9.ue5 x9,u68s 1/y]01. XOVRA539lIR0NMKUlA6vMi 61Hp]yWAPI , N.3S961 32.35967 )M: MHO% MUMAN SVC MC M"W 1)..3411M16] J/ / ],]9)p) / ]]4)3) "AM.33 ./ 66.999.33V 66999.37, Balances Overview Account Name *4357 MEMORIAL MEDICAL- $3,167,844.24 $3,068,811.84 $3,167,844.24 $2,895,117.58 OPERATING MMC -CLINIC ` SERIES SERIES 2014 $545.22 $545.22 $545.22 $545.22 *4373 ERCLEARING MMC -PRIVATE VER WAIV WAI $438.92 $438.92 $438.92 $438.92 •4381 MEMORIAL MEDICAL INH $179,564.76 $206,370.18 $179,564.76 $80,564.70 ASHFORD *4403 MEMORIAL MEDICAL INH $254,487.75 $254,487.75 $254,487.75 $167,560.75 BROADMOOR *4411 MEMORIAL MEDICAL INH $254,035.51 $276,046.14 $254,035.51 $174,774.45 CRESCENT '4438 MEMORIAL MEDICAL ISOLERA@ $178,931.79 $184,255.27 $178,931.79 $133.989.69 WEST HOUSTON `4446 MEMORIAL MEDICAL / NH FORT $43,953.99 $43,953.99 $43,953.99 $9.435.65 BEND •4454 MEMORIAL MEDICAL INH $121,585.86 $123,630.86 $121,585.86 $114,651A2 GOLDEN CREEK HEALTHCARE •4551 CAL CO INDIGENT $9,733.32 $9,733.32 $9,733.32 $9,733.32 HEALTHCARE *5433 MMC -NH GULF POINTEPLAZA- $1,958.93 $1.958.93 $1,958.93 $1,958.93 PRIVATE PAY `5441 MMC -NH GULF POINTEPLAZA - $11,028.00 $13,685.67 $11,028.00 $300.00 MEDICAREIMEDICAID *5506 MMC -NH BETHANYSENIOR✓ $67,049.37/ $67,049.37 $67,049.37 $63,552.96 LIVING *3407 MMC -NH $189,561.23 $189,561.23 $189,561.23 $119,492.28 TUSCANY VILLAGE •3660MMC-BETHANY $100.00 $100.00 $100.00 $100.00 SR LIVING - DACA •2998 MMC -MONEY $5,034.00 $5,034.00 $5.034.00 $5,034.00 MARKETFUND Total Balance $4,485,852.89 $4,445,662.69 $4,485,852.89 $3,777,249.87 Report generated on 07/15/2024 09:47:22 AM COT Page 2 of 2 Ashford MEMORIAL MEDICAL CENTER CHECK REQUEST P MMC Operating Date Requested: 7/15/2024 A Y : =OVFD ON E JccUppL nn''1ll 5 ��?0�24pppp E CA©W(tt.lt\u Cl 0 ITYt' T &S AMOUNT: EXPLANATION J $ 12,430.83 Molina May QIPP - Hospital Portion FOR ACCT USE ONLY ❑ imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: f ,,")-(Zt.vil i 115 (2-02-114 f MEMORIAL MEDICAL CENTER CHECK REQUEST P MMC Operating Date Requested: 7/15/2024 A Y E APPROVE15 ON JUL 15 2024 av Col E CZ J/ ✓ AMOUNT: $ 4,584.35 EXPLANATION: Molina May QIPP - Hospital Portion FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY:�� Crescent P A Y E E MMC Operating MEMORIAL MEDICAL CENTER CHECK REQUEST Date Requested: tm-ri,,OVEt! ONI JUL 15 2024 CA.BHO, nIJN101.!N71 I11�. AS J AMOUNT: $ 3,419.45 / EXPLANATION: Molina May QIPP - Hospital Portion J7/15/2024 FOR ACCT USE ONLY ❑ imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caltlin Clevenger AUTHORIZED BY:ILYAtLc--u III Fort Bend P A Y E E AMOUNT: MEMORIAL MEDICAL CENTER CHECK REQUEST MMC Operating Date Requested: 7/15/2024 APPROVED ON EXPLANATION: 111E 15 ?0?4 DY CO�J(�lYUUITR CALHhTInI OIJ dTV 7 -)(AG J $ 3,870.44 Molina May QIPP - Hospital Portion FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: ,&U in CI t ^G : ,"L U7�C -71(S()-o') � Solera ./ ✓ MEMORIAL MEDICAL CENTER CHECK REQUEST P / MMC Operating ✓ A Date Requested: 7/15/2024 y APPI10NI _D t11t1 JUL 15 W4 E pp� 1I iC E GA�UYI C' i.�FRIPIYOIl�i FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor Q Return Check to Dept AMOUNT: $ 3,703.09 / G/LNUMBER: EXPLANATION: Molina May QIPP - Hospital Portion 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY:I�t ,JG1_r�iftn,i�l4 `((151ZL.;2`f MEMORIAL MEDICAL CENTER CHECK REQUEST P ✓ MMC Operating Date Requested: 7/15/2024 A Y n;= noi'r-0 Ohl E JUL 15 ?W4 E CABH(1 PUOry A7V 11d;(Afi AMOUNT: EXPLANATION: J $ 7,695.10 Molina May QIPP - Hospital Portion REQUESTED BY: Caitlin Clevenger FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 AUTHORIZED BY: �2vL�- f(\§\\\\\ \� �$;,w•� :, ■§§§§§%§§/ see,sea; ."!!! (uuu(%(u ; , J�jE- �j crescent P A Y E E AMOUNT: Tuscany / J MEMORIAL MEDICAL CENTER CHECK REQUEST Date Requested: APPROVED t-)N f 5 2024 "" "^, �Y Cuu 4 Ut�TV �WILOH o1 exas J $ 8,097.86 J J 7/15/2024 FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 21400007 EXPLANATION: Claim payment- Transfer from Crescent to Tuscany REQUESTED BY: Michelle Cumberland AUTHORIZED BY:I -1l(5/ZUZL- Crescent MEMORIAL MEDICAL CENTER CHECK REQUEST P J Tuscany A Date Requested: 7/15/2024 Y E APPROVED ON AIL 15 Md E A , unt!�i�vDII XA AMOUNT: $ 4,500.00 Z. FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: EXPLANATION: Claim payment - Transfer from Crescent to Tuscany REQUESTED BY: Michelle Cumberland AUTHORIZED 21400007 7 I ES%20ZH-