ORDER NO.29766 BUDGET AMENDMENT LATE BILL INDIGENT HEALTH CARE Came to be heard this the 26th day of June, 2006, with a motion made by Commissioner Letz, seconded by Commissioner Williams, the Court unanimously approved by vote of 3-0-0 to transfer the following expense codes and issue hand checks in the amount of $415.70, $1,563.60 and $234.56 to Vericlaims, Inc. for June 10, 2006, June 6, 2006 and June 15, 2006 Fee on Claims Paid: Expense Code Description 50-641-486 Third Party Administrator 50-641-200 Eligible Expenses Amendment Increase/QDecrease + $2,213.86 - ($2,213.86) COURT ORDER # a~ (061 O6) BUDGET AMENDMENT REQUEST FORM ,3~~' 3 -d-~ DEPARTMENT NAME: INDIGENT HEALTH CARE CURRENT CURRENT EXPENSE CODE LINE ITEM DESCRIPTION BUDGET EXPENSE UNEXPENDED BUDGET BALANCE REQUESTED AMENDMENT INCREASE/QDECREASE 50-641-486 Third Pa Administrator $26,835.10 $2,213.86 $0.00 + $2,213.86 50-641-200 Eli ible Ex enses $734,164.90 $49,612.89 $109,498.83 ($2,213.86) June 20, 2006 DATE FOR AUDITOR'S OFFICE USE ONLY LATE BILL FOR 6/26/06 - WILL NEED A HANDCHECK 2741 VENDOR # INVOICE # PAID TO: VERICLAIMS INC AMOUNT: $415.70 EXPENSE CODE: 50-641-486 DESCRIPTION: 06/10/06 CLAIMS PAID INV. NUMBER 060610 CLAIMS PAID INV. DATE: 05/24/2006 RCVD DATE: 05/24/2006 DUE DATE: 06/26/2006 VERICLAIMS INC 207 MEADOWGROVE HOUSTON TX 77037-4303 VERIFICATION DATE VeriCiaims, o~c. 207 MeadevNgrove Houston, Texas 7?037-4303 5-2406 Kerr County Auditor's 01lice Attention: Mindy William ~ 700 Maih Street Kerrville, Texas 78028 Indigent Healf:h Care 06/!0/200fi Claims Payments $ 4,237.70* 4.5% Please remit to address :;lGUwn above. Thank you. 2'~~\ $4!5.70 ~,~Jl~~~ ~~ zd i-~dzb:za 9aez bz •Fpw b068sbbtBc 'ON :CHd SIJIFi~:]7 tl3f1 WOtLi FOR AUDITOR'S OFFICE USE ONLY LATE BILL FOR 6/26106 WILL NEED A HANDCHECK 2741 VENDOR # INVOICE # PAID TO: VERICLAIMS INC AMOUNT: $1,563.60 EXPENSE CODE: 50-641-486 DESCRIPTION: O6/O6/06 CLAIMS PAID INV. NUMBER 060606 CLAIMS PAID INV. DATE: 05/23/2006 RCVD DATE: 05/22/2006 DUE DATE: 06/26/2006 VERICLAIMS INC VERIFICATION DATE ~~\ ~/@ftCl~IfnS, If9C. 207 Meadprr~r~ve Hpuston, Texas 77p37-4303 5-23-06 Kerr County Auditor's UffiCe Attention: Mindy WlBiuns 700 Main Street Kerrville, Texas 7802fS Indigent N€~alth Care 06/06/2006 Claims Payrru.nzs S ° 4.5°ro Please remit to address shown above. Thank you. ~~~~ ~~"~~'~\ ~~/~S CLG{%(L45~7~da~ V 6yl C~L4it.(7f~ ~ ~a 9 VVV lI 3~~~.~~~ Y. ~~~a = ~ J5~3 ~~ ?d Wc8b :50 9!~? Z~ 'F pbl b045sbb L52 'ON 'rid 5411 t+1J1L~3!1 W'J~Jd os/2o/os Vericlaims -Adjustments for refunds, reimbursements, etc. 2005-2006 Budget Year Amt Rcvd From Provider Patient Name May'06 $ 262.95 Sid Peterson Florence Aranda-Guzman $ 127.55 Sid Peterson Linda S. Cox $ 25.54 Roger G. Moblad Esther Salinas $ 416.04 $ 416.04 x 4.5% $ 18.72 Amount to be adjusted from invoice for 06/06/06 claims pmt FOR AUDITOR'S OFFICE USE ONLY LATE BILL FOR 6/26/06 WILL NEED A HANDCHECK 2741 VENDOR # INVOICE # PAID TO: VERICLAIMS INC AMOUNT: $234.56 EXPENSE CODE: 50-641-486 DESCRIPTION: 6/15/06 CLAIMS PAID INV. NUMBER 060615 CLAIMS PAID INV. DATE: 06/02/2006 RCVD DATE: 06/02/2006 DUE DATE: 06/26/2006 VERICLAIMS INC 207 MEADOWGROVE HOUSTON TX 77037-4303 VERIFICATION DATE FFCM I~EF'[CLr1ID15 rFY/, N'J. 281445cy1ia,4 Tun. 02 .'t7E16 58: QSRhi P2 VeriCiaims, Inc. `/~y~~~ 207 Meadawgrave v Haustan, Texas 77437-4J03 6/0210& Kerr Gaunty Auditor's Office Attention: Mirsdy Williams 700 M3ln Sheet Kemille, Texas 78028 Indigent Health Care 0 611 5 /2 006 Claims Payments $ 5.?12.55~ 4.5:/0 _ $234.56 Please remit to address shown abo re. Thank you. -~`~I,`~g~, ~o