Okaloosa County BOCC — August 6, 2013 — Emerald Coast CAC Final Payment — reading text

Crowell 714001 125.00 330001 308.36 330001 163.49 330001 38.24 335001 150.00 758201 125.59 330001 163.49 330001 38.24 773001 163.49 773001 38.24 107001 1,851.28 5/3113 711001 DbDos 3,093.75 Renee Carozzoni 711001 125.00 330001 403.13 330001 199.56 330001 46.67 335001 100.00 758201 384.32 330001 199.56 330001 46.67 773001 199.56 773001 48.67 107001 2,085.07 5/31/13 711001 bbeg 2,274.58 Sheila D. Lewellyn 711601 125.00 330001 295.25 330001 148.77 330001 34.79 758201 132.80 330001 148.77 " GIAMN3 at 08:59:52.78 Page: 3 ECCAC, inc. Payroll Journal For the Period From May 1, 2013 to May 31, 2013 Filter Criteria includes: Report order is by Check Date. Report is printed in Detail Format. Date GL Acct ID Reference Debit Amt Credit Amt Employee 330001 34.79 773001 148.77 773001 34.79 107001 1,787.97 5131/13 711001 DD10 3,093.75 Lisa Cotton 711001 125.00 330001 419.58 330001 199.56 330001 : 46.67 758201 221.66 330001 199.56 330001 46.67 773001 199.56 773001 46.67 107001 2,331.28 5/31/13 711001 DD11 2,875.00 William F. Siegal 711001 125.00 330001 497.26 330001 186.00 330001 43.50 758201 155.00 330001 186.00 330001 43.50 773001 186.00 773001 43.50 407001 2,118,24 5/3113 711001 DD12 1,845.42 Christina A. Jeffries 741001 110,06 330001 406.71 330001 121.24 330001 28.35 758201 110,06 330001 121.24 330001 28.35 333001 5.71 773001 121.24 773001 28.35 773001 5.71 107001 1,289.12 48,217.71 48,217.71 Welcome To EFTPS - Payments Page 1 of 1 i Electronic Federal Tax Payment System HOME ENROLLMENT MY PROFILE PAYMENTS HELP & INFORMATION CONTACT US LOGOUT TAXPAYER NAME: EMERALD COAST CHILDRENS ADVOCACY TIN: xxxxx4168 Deposit Confirmation Your payment has been accepted. Payment Successful An EFT Acknowledgement Number has been provided for this payment. Please keep this number for your records. REMINDER: REMEMBER TO FILE ALL. RETURNS WHEN DUE! EFT ACKNOWLEDGEMENT NUMBER: 270354401521749 PLEASE NOTE Any amounts represented in the subcategories of Social Security, Medicare, and Income Tax Withholding are for informational purposes only. Payment Information . Entered Data Taxpayer EIN XXxxx4. 168. Tax Form 941 Employers Federal Tax Tax Type Federal Tax Deposit Tax Period Q2/2013 Payment Amount $12,005.70 Settlement Date 05/24/2013 Subcategories: 1 Social Security $5,517.38 2 Medicare $1,290.34 3 Tax Withholding $5,197.98 Home Enraliment My Profile Payments Help & Information Contact Us Logout USA.gov 1RS.gov Treasury .gov Electronic Federai Tax Payment Systern® and EFTPS@ are registered servicemarks of the U.S. Department of the ‘Treasury's Financial Management Service. https://www.eftps.gov/eftps/payments/payment-confirmation-flow?execution=e2s1 5/23/2013 | Welcome To EFTPS - Payments Page 1 of 1 Slectrone Federal Tax Payment System HOME ENROLLMENT MY PROFILE PAYMENTS HELP & INFORMATION CONTACT US. LOGOUT TAXPAYER NAME: EMERALD COAST CHILDRENS ADVOCACY TIN: xXxxxx4168 Deposit Confirmation Your payment has been accepted. Payment Successful An EFT Acknowledgement Number has been provided for this payment. Please keep this number for your records. REMINDER: REMEMBER TO FILE ALL RETURNS WHEN DUE! EFT ACKNOWLEDGEMENT NUMBER: 270355680562990 PLEASE NOTE Any amounts represented in the subcategories of Social Security, Medicare, and Income Tax iding are for informational purposes only. Payment Information Entered Data Taxpayer EIN 004188 Tax Form 941 Employers Federal Tax Tax Type Federal Tax Deposit Tax Period Q2/2013 Payment Amount $72.35 Settlement Date 06/05/2013 Subcategories: 1 Social Security $35.72 2 Medicare $8.36 3 Tax Withholding _ ; —_ $28.27 _ Home Enrollment My Profile Payments Help & Information Contact Us Logout USA.gov IRS.gov Treasury.gov Electronic Federal Tax Payment System® and EFTPS® are registered servicemarks of the U.S. Department of the Treasury's Financiat Management Service. https://www.ettps.gov/eftps/payments/payment-confirmation-flow?execution-e2s1 6/4/2013 § Coastal Bank and Trust A DIVISION OF SYNOVUS BANK, MEMBER FDIC PO BOX 12866 PENSACOLA. FL 32591-2966 Lildibbdahtabaslbobballtasfatfdclll EMERALD COAST CHILDRENS ADVOCACY CENTER Statement of Account Last statement: April 30, 2013 This statement: May 31, 2013 Total days in statement period: 31 000-009-494-6 031 560 Page 1 of 3 PO BOX 1237 NICEVILLE FL, 32588-1237 Direct inquiries to: 888 825-6954 Beginning balance 317,227.32 Deposits/Credits 84,856.21 Low balance 239,393.09 Withdrawals/Debits 141,389.61 Average balance 287,340.36 Ending balance 260,693.92 Average collected balance 284,528.00 Checks {Number Date Amount | [Number Date Amount | 7975 05-13 7710 8080 * 05-13 980.00 8012 * 05-02 1,000.00 8081 Q5-13 139.65 8027 * 05-13 161.96 8082 05-16 4,345.40 8024 * 05-10 40.00 8083 05-15 652.56 8026 * Q5-07 27,607.00 8084 05-13 15.00 8042 * 05-06 1,500.00 8085, 05-14 250.00 8046 * 05-02 1,315.11 8086 05-13 190.00 8050 * 05-03 450.00 8087 05-16 2,200,00 8051 05-14 55.37 30838 05-20 1,002.87 8054 * 05-01 690.45 808s 05-22 690.45 8062 * 05-06 700.00 8090 G5-17 440.87 8063 05-02 207.57 8091 05-20 1,276.10 8064 05-06 26.68 8092 05-20 $26.75 8065 05-09 886.62 8093 05-20 120.00 8066 05-07 122.00 g094 05-16 125.00 8067 05-09 93.11 8095 05-20 282.31 8068 05-07 1,400.00 8096 05-23 23,850.93 8069 05-13 109.26 8098 * 05-28 171.00 8070 05-13 965.84 8099 05-28 2,362.25 8071 05-15 222.56 87100 05-28 4,015.97 8072 Q5-16 190.50 8101 05-28 1,483.16 8074 * 05-13 317.07 8102 05-28 5,331.73 8075 05-10 310.88 8104 * 05-24 3,500.00 8076 05-13 224,22 8105 05-30 690.99 8077 Q5-17 139.54 8106 05-30 75.85 8078 05-10 322.14 3107 05-30 29.65 j Coastal Bank and Trust A DIVISION OF SYNOVUS BANK, MEBBER FLIC May 31, 2013 000-009-494-6 PO BOX 12966 PENSACOLA. FL 32991-2965 Page 2 of 3 EMERALD COAST CHILDRENS ADVO Checks [Number Date Amount | [Number Amount | ” Skip in check sequence Other Debits | Date Transaction Type Description Amount | 05-02 Preauthorized Wd Bked Processing Bkcd M Dsc 64.81 oc Re 130502 273800043450 05-03 = Preauthorized Wd Merche-Solutions Billing 101.28 Ae A 130503 000000010177032 05-06 Return Deposit Item Rdi charge back debit for seq #38101 50.00 02150 : 05-06 Service Charge _ Return Deposit [te 9.00 Dan he 05-10 = Preauthorized Wd City OF NICEV136 Debits 209.10 130510 010-02640-01 05-15 — Preauthorized Wd City Of Defuniak Utility Pd 203.18 130515 18350 05-17 Preauthorized Wd Okaloosa Gas 211 Debits 51.49 130517 002007870086374 05-21 Preauthorized Wd American Express Collection 7.35 ime B/' 130521 4093656080 Cl S 05-21 Preauthorized Wd Gulf Gulf &FT 1,444.60 130521 2703490002NCV 05-24 Preauthorized Wd IRS Usataxpymt 12,005.70 130524 270354401521749 05-28 = Preauthorized Wd Verizon Wireless Payments 438.63 130528 051348562500001 05-31 Preauthorized Wd Deposits/Other Credits Emerald COAST946 Credits 130531 BATCH OFFSET 32,519.30. | Date Transaction Type Description Amount | 05-02 _ Remote Express Dep 7,940.007 05-09 _ Deposit 284.417, 05-09 Remote Express De; 5, 6Y 05-15 Preauthorized Credit Merche-Solutions Amex Dep 250.00\) 130515 090000010177032 Q5-15 Remote Express Dep 10,452.28 7 95-21 Remote Express Dep 5.273.527 05-23 Preauthorized Credit Square Inc 130523B2 130523 M163573465 243.12 6 \qj (mi JV 05-28 Preauthorized Credit cheexchange dep EFT 130528 NET19831-142039 05-28 Preauthorized Credit Merche-Solutions Amex Dep 240.06 Wi 130528 000000010177032 _, 05-28 Preauthorized Credit Merche-Solutions Merch Dep 425.00,/ 130528 000000010177032 Q5-30 Deposit 530.00 ¥ 5-30 Remote Express Dep 54,086.62 vo Balance Summary Page 3 of 3 May 31, 2013 000-009-494-6 EMERALD COAST CHILDRENS ADVO | Date Amount Date Amount Date ‘Amount "| 04-30 317,227.32 05-10 293,427.24 05-21 292,284.79 05-07 316,536.87 05-13 290,246.54 05-22 291,594.34 5-02 321,889.38 05-14 289,941.17 05-23 267,986.53 05-03 321,338.10 05-15 299,565.15 05-24 252,480.83 05-06 319,052.42 05-16 292,704.25 05-28 239,393.09 05-07 289,923.42 05-17 292,072.35 05-30 293,213.22 05-09 294,309.36 05-20 288,463.82 05-31 260,693.92 NEW YORK LIFE BOX 500 MINNEAPOLIS MN 55440-0500 PHONE: 800-695-1272 CONSOLIDATED BELLING PREMIUM STATEMENT FOR REMITTER ID 021023298 A >OGD2O? 2420923 OGD F215 10z PREPARED ON: APRIL 29, 2013 ie EMERALD COAST CHILBRENS d ADVOCACY CENTER INC PAYMENT MUST BE MADE WITHIN PO BOX 1237 nay aes OF FgHe DUE DATE OF: NICEVILLE FL 32586-1237 PAGE 1 OF 2 IN ORDER TO CONTINUE THE SERVICING AGREEMENT FOR THE CONTRACTS UNDER THE ARRANGEMENT NUMBER(S) LISTED BELOW, THE PAYMENT MUST BE MADE WITHIN 10 DAYS OF THE DUE DATE SHOWN ABOVE. PLEASE REMIT YOUR PAYMENT BY THE SPECIFIED DATE TO PREVENT THE DISCONTINUATION OF YOUR GROUP BILLING. ARRANGEMENT. ARRANGEMENT ; NUMBER OF BILLED NUMBER ARRANGEMENT NAME CONTRACTS AMOUNT N40879 000 EMERALD COAST CHILDRENS 7 690.45 TOTAL AMOUNT DUE 690.45 159201 Mig In JN PLEASE RETURN THIS PART WITH YOUR PAYMENT(S) IN THE ENCLOSED ENVELOPE. PLEASE DO NOT STAPLE YOUR CHECE(S) TO THIS STUB. REMEMBER TO WRITE YOUR REMIZTER ID NUMBER ON ALL CHECKS AND ENCLOSE ANY COMPLETED ADJUSTMENT DETAILS. REMITTER ID 021023294 6 a EMERALD COAST CHILDRENS EMERALD COAST CHILDRENS PREPARED APRIL 29, 2013 PAYHENT(S) DUE 10 DAYS FROM THE DUE DATE OF: MAY 18, 2013 COTE ANY CHANGES TO ABOVE ADDRESS HERE) TOTAL AMOUNT DUE 690.45 DabsolaPedesel sHacafsluslieh babstabaed askalfsstorsfalseslll THENTS C } NEW YORK LIFE ADJUSTHE! PO BOX 742582 (ENCLOSE ADJUSTMENT DETAILS) CINCINNATL OH 45274-2582 AMOUNT REMITTED ( ? 020210232948051013101 O000b904502L023294984 8207 2420928 000414 aODBZT CODtMIGZ E-BT1 (OA) (pore) -ee-a 20002000 ZANGG SH¥NEN ezeNzKe £0z00 NEW YORK LIFE BOX 500 MINNEAPOLIS MN 55440-0500 ADJUSTMENT DETAILS (Please detach and return with your payaent if any adjustments have been made CONSOLIDATED (c] ‘AILS LY IF ANY PREMIUMS ARE NOT PAID AS SHOWN, PLEASE INDICATE THE ADJUSTED AMOUNT AND REASON: Be SPACE PROVIDED. DETACH AND RETURN THE FORM AND BILLING STUB WITH YOUR THE FOLLOWING PAGES CONTAIN A LIST OF THE CONTRACTS THAT SUPPORT THE TOTALS LISTED IN THE CONSOLIDATED BILLING PREMSUN STATEMENT. ENTRIES PRECEDED BY AN (%) INDICATE AMOUNTS DUE BUT NOT PREVIOUSLY BILLED UNDER THE ARRANGEMENT(S). ENTRIES PRECEDED BY A (+) INDICATE THE FIRST PAYMENT DUE FOR A CONTRACT. ; PAGE 2 OF 2 | SORT CONTRACT | ARRANGENENT ] PAID CRITERIA NUMBER NUMBER TO DATE BRINSON Y BRINSON VIDA L 39709980 HaDB79 400 03/28 125.00 125.00 AMOUNT PLUS REASON RENITIED 39709930 CAROZZONI CAROZZONI RYAN 39724824 N40879 000 03/15 450.50 150.50 ‘ 39724824 897258769 N49879 000 93715 479.50 419.80 39725769 CAROZZONI RENER*EL Esployee Deduction Summarized 270.00 270.00 DUNN THON DUNN THOMAS 39711575 N4O0879 000 86— 03/28 125.00 125.00 39711575 HOLLIS DE HOLLTS DRRORAH 39708224 40879 200 03/25 66.00 §6.00 39708224 HURST JUL, HURST JULIE H 39756131 40879 000 03773 34.70 34.70 H . SITE T3T if yy LEWELLYN LERELLYN SHEILA DE 39915987 N40879 000 03712 69.75 69.95 ! 39915937 TOTAL AMOUNT DUE TOTAL ADJUSTMENTS : : TF cptus or mnus) (01) REHOVE CONTRACT FROH BILLING _ | (02) PREMIUM CHANGE AWOUNT RENITTED (03) PAYHENT NOT REQUIRED (4D) NEW CONTRACT OR RESTART EXISTING CONTRACT RENITTER ID: 021023294 6A (A2) HEX BUSINESS ~ NOT TAREN ; DUE DATE: NAY 16, 2073 CONTACT: TELEPHONE: Note: If a Participant is removed from a Ponsion Plan, Please refer to your Trust Agreonont for instructions on disposition of contracts fron the trust. " @age 1 of 2) COASTAL BANK AND TRUST \ FERALD COAST CNLDRENS ADVOCACY CETER, INC ; emerald coast FA }OX 1247 g x NICEVILLE, Ft. 32588-1237 63:914-632 : Corde ns ICEVI j | — DATE AMOUNT a | May 13, 2013 “$690.45 i ray Six Hundred Ninety and 45/100 Dollars j | TOTHE ‘ cnecKs OvER $1500.00 HEAUEE | ‘iio SIGNATURES j QRPER New York Life Insurance on, | | 75 Remittance Dr, Suite3021 & “| Chicago, tL 60675-3027 Ker bere 7 Hot te 2 AUTHORIZED SIGNATURE ae g G wv a £ t i i ] pug Guise , Jepioy pawl any wolmeey AINA § SNDU] PSGINe ‘pals; Jou we 7 ‘ ' 2 ?