controller of california, state of california ......el dorado county treasurer placerville, ca 95667...

59
CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA P O BOX 942850, SACRAMENTO, CA 94250-0001 REMITTANCE ADVICE 10/15/2012 CLAIM SCHEDULE NUMBER: PAYMENT ISSUE DATE: 1221 OAK ST ALAMEDA COUNTY TREASURER OAKLAND, CA 94612 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health Services apportionment amount for current period 2,832,642.03 Mental Health Services Fund apportionment per AB1467 09/01/2012 09/30/2012 Collection Period: To Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section 5891(c) Additional Description: $2,832,642.03 Gross Claim $2,832,642.03 Net Claim / Payment Amount YTD Amount: $20,916,896.91 Page 1 of 59 For assistance, please call: John Bodolay at (916) 323-2154 Remittance Advice - EFT

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Page 1: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

1221 OAK ST

ALAMEDA COUNTY TREASURER

OAKLAND, CA 94612

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 2,832,642.03

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$2,832,642.03Gross Claim

$2,832,642.03Net Claim / Payment Amount

YTD Amount: $20,916,896.91

Page 1 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 2: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 217

ALPINE COUNTY TREASURER

MARKLEEVILLE, CA 96120

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 72,214.45

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$72,214.45Gross Claim

$72,214.45Net Claim / Payment Amount

YTD Amount: $533,248.55

Page 2 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 3: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

810 COURT ST

AMADOR COUNTY TREASURER

JACKSON, CA 95642

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 129,989.82

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$129,989.82Gross Claim

$129,989.82Net Claim / Payment Amount

YTD Amount: $959,875.48

Page 3 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 4: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

2081 CENTER STREET

BERKELEY CITY TREASURER

BERKELEY, CA 94704

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 240,009.40

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$240,009.40Gross Claim

$240,009.40Net Claim / Payment Amount

YTD Amount: $1,772,286.02

Page 4 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 5: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

25 COUNTY CENTER DR

BUTTE COUNTY TREASURER

OROVILLE, CA 95965

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 463,305.02

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$463,305.02Gross Claim

$463,305.02Net Claim / Payment Amount

YTD Amount: $3,421,153.56

Page 5 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 6: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

GOVERNMENT CENTER

CALAVERAS COUNTY TREASURER

SAN ANDREAS, CA 95249

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 140,555.68

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$140,555.68Gross Claim

$140,555.68Net Claim / Payment Amount

YTD Amount: $1,037,896.31

Page 6 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 7: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

546 JAY ST

COLUSA COUNTY TREASURER

COLUSA, CA 95932

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 117,044.75

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$117,044.75Gross Claim

$117,044.75Net Claim / Payment Amount

YTD Amount: $864,286.07

Page 7 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 8: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

625 COURT ST RM 102

CONTRA COSTA COUNTY TREASURER

MARTINEZ, CA 94553

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,799,382.87

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,799,382.87Gross Claim

$1,799,382.87Net Claim / Payment Amount

YTD Amount: $13,287,067.56

Page 8 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 9: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

981 H ST STE 150

DEL NORTE COUNTY TREASURER

CRESCENT CITY, CA 95531

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 123,200.59

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$123,200.59Gross Claim

$123,200.59Net Claim / Payment Amount

YTD Amount: $909,742.20

Page 9 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 10: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

360 FAIR LN

EL DORADO COUNTY TREASURER

PLACERVILLE, CA 95667

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 322,001.93

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$322,001.93Gross Claim

$322,001.93Net Claim / Payment Amount

YTD Amount: $2,377,738.20

Page 10 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 11: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1406

FRESNO COUNTY TREASURER

SACRAMENTO, CA 95812

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,948,352.45

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,948,352.45Gross Claim

$1,948,352.45Net Claim / Payment Amount

YTD Amount: $14,387,094.05

Page 11 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 12: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

516 WEST SYCAMORE STREET

GLENN COUNTY TREASURER

WILLOWS, CA 95988

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 123,866.45

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$123,866.45Gross Claim

$123,866.45Net Claim / Payment Amount

YTD Amount: $914,659.06

Page 12 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 13: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

825 FIFTH ST RM 125

HUMBOLDT COUNTY TREASURER

EUREKA, CA 95501

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 285,748.63

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$285,748.63Gross Claim

$285,748.63Net Claim / Payment Amount

YTD Amount: $2,110,035.26

Page 13 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 14: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

940 WEST MAIN ST

IMPERIAL COUNTY TREASURER

EL CENTRO, CA 92243 2863

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 393,664.54

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$393,664.54Gross Claim

$393,664.54Net Claim / Payment Amount

YTD Amount: $2,906,911.80

Page 14 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 15: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX O

INYO COUNTY TREASURER

INDEPENDENCE, CA 93526

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 83,544.35

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$83,544.35Gross Claim

$83,544.35Net Claim / Payment Amount

YTD Amount: $616,911.21

Page 15 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 16: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 981240

KERN COUNTY TREASURER

SACRAMENTO, CA 95798 1240

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,681,509.95

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,681,509.95Gross Claim

$1,681,509.95Net Claim / Payment Amount

YTD Amount: $12,416,666.10

Page 16 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 17: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1406

KINGS COUNTY TREASURER

SACRAMENTO, CA 95812 1406

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 330,797.45

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$330,797.45Gross Claim

$330,797.45Net Claim / Payment Amount

YTD Amount: $2,442,686.38

Page 17 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 18: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

255 NORTH FORBES ST RM 215

LAKE COUNTY TREASURER

LAKEPORT, CA 95453

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 163,888.47

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$163,888.47Gross Claim

$163,888.47Net Claim / Payment Amount

YTD Amount: $1,210,191.10

Page 18 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 19: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

COUNTY COURTHOUSE RM 103

LASSEN COUNTY TREASURER

SUSANVILLE, CA 96130

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 123,395.36

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$123,395.36Gross Claim

$123,395.36Net Claim / Payment Amount

YTD Amount: $911,180.42

Page 19 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 20: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1859

LOS ANGELES COUNTY TREASURER

SACRAMENTO, CA 95812

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 22,617,795.24

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$22,617,795.24Gross Claim

$22,617,795.24Net Claim / Payment Amount

YTD Amount: $167,015,134.96

Page 20 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 21: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1859

C/O BANK OF AMERICA

MADERA COUNTY TREASURER

SACRAMENTO, CA 95812 1859

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 346,463.75

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$346,463.75Gross Claim

$346,463.75Net Claim / Payment Amount

YTD Amount: $2,558,370.03

Page 21 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 22: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

CIVIC CENTER

PO BOX 4220

MARIN COUNTY TREASURER

SAN RAFAEL, CA 94913

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 448,848.51

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$448,848.51Gross Claim

$448,848.51Net Claim / Payment Amount

YTD Amount: $3,314,403.29

Page 22 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 23: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 36

MARIPOSA COUNTY TREASURER

MARIPOSA, CA 95338

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 84,185.67

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$84,185.67Gross Claim

$84,185.67Net Claim / Payment Amount

YTD Amount: $621,646.84

Page 23 of 59

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Page 24: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

501 LOW GAP RD 1060

MENDOCINO COUNTY TREASURER

UKIAH, CA 95482

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 199,386.44

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$199,386.44Gross Claim

$199,386.44Net Claim / Payment Amount

YTD Amount: $1,472,316.53

Page 24 of 59

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Remittance Advice - EFT

Page 25: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 981311

MERCED COUNTY TREASURER

WEST SACRAMENTO, CA 95798 1311

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 582,956.21

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$582,956.21Gross Claim

$582,956.21Net Claim / Payment Amount

YTD Amount: $4,304,686.14

Page 25 of 59

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Remittance Advice - EFT

Page 26: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

204 COURT ST RM 101

MODOC COUNTY TREASURER

ALTURAS, CA 96101

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 78,508.84

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$78,508.84Gross Claim

$78,508.84Net Claim / Payment Amount

YTD Amount: $579,727.81

Page 26 of 59

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Page 27: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 495

MONO COUNTY TREASURER

BRIDGEPORT, CA 93517

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 81,879.31

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$81,879.31Gross Claim

$81,879.31Net Claim / Payment Amount

YTD Amount: $604,616.14

Page 27 of 59

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Page 28: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1406

MONTEREY COUNTY TREASURER

SACRAMENTO, CA 95812 1406

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 928,510.24

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$928,510.24Gross Claim

$928,510.24Net Claim / Payment Amount

YTD Amount: $6,856,338.60

Page 28 of 59

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Page 29: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

1195 THIRD ST RM 108

NAPA COUNTY TREASURER

NAPA, CA 94559 3035

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 266,744.32

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$266,744.32Gross Claim

$266,744.32Net Claim / Payment Amount

YTD Amount: $1,969,702.99

Page 29 of 59

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Page 30: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 128

NEVADA COUNTY TREASURER

NEVADA CITY, CA 95959

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 218,325.03

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$218,325.03Gross Claim

$218,325.03Net Claim / Payment Amount

YTD Amount: $1,612,163.54

Page 30 of 59

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Page 31: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 981024

ORANGE COUNTY TREASURER

WEST SACRAMENTO, CA 95798 1024

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 6,436,215.27

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$6,436,215.27Gross Claim

$6,436,215.27Net Claim / Payment Amount

YTD Amount: $47,526,531.65

Page 31 of 59

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Page 32: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

2976 Richardson Dr.

PLACER COUNTY TREASURER

Auburn, CA 95603

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 540,611.20

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$540,611.20Gross Claim

$540,611.20Net Claim / Payment Amount

YTD Amount: $3,992,000.62

Page 32 of 59

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Page 33: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 176

PLUMAS COUNTY TREASURER

QUINCY, CA 95971

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 113,413.80

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$113,413.80Gross Claim

$113,413.80Net Claim / Payment Amount

YTD Amount: $837,474.27

Page 33 of 59

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Remittance Advice - EFT

Page 34: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 4035

C/O UNION BANK OF CA ST GOV

RIVERSIDE COUNTY TREASURER

SACRAMENTO, CA 95812 4035

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 4,128,243.40

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$4,128,243.40Gross Claim

$4,128,243.40Net Claim / Payment Amount

YTD Amount: $30,483,923.01

Page 34 of 59

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Remittance Advice - EFT

Page 35: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 980264

SACRAMENTO COUNTY TREASURER

WEST SACRAMENTO, CA 95798 0264

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 2,544,497.58

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$2,544,497.58Gross Claim

$2,544,497.58Net Claim / Payment Amount

YTD Amount: $18,789,170.31

Page 35 of 59

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Remittance Advice - EFT

Page 36: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

440 FIFTH ST RM 107

COURTHOUSE

SAN BENITO COUNTY TREASURER

HOLLISTER, CA 95023

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 158,276.56

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$158,276.56Gross Claim

$158,276.56Net Claim / Payment Amount

YTD Amount: $1,168,751.47

Page 36 of 59

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Remittance Advice - EFT

Page 37: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1859

SAN BERNARDINO CO TREASURER

SACRAMENTO, CA 95812

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 4,178,392.66

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$4,178,392.66Gross Claim

$4,178,392.66Net Claim / Payment Amount

YTD Amount: $30,854,236.95

Page 37 of 59

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Remittance Advice - EFT

Page 38: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 980304

SAN DIEGO COUNTY TREASURER

WEST SACRAMENTO, CA 95798 0304

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 6,489,004.21

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$6,489,004.21Gross Claim

$6,489,004.21Net Claim / Payment Amount

YTD Amount: $47,916,337.65

Page 38 of 59

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Remittance Advice - EFT

Page 39: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 2920

SAN FRANCISCO COUNTY TREASURER

SACRAMENTO, CA 95814 2920

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,470,039.07

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,470,039.07Gross Claim

$1,470,039.07Net Claim / Payment Amount

YTD Amount: $10,855,115.25

Page 39 of 59

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Remittance Advice - EFT

Page 40: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 981355

SAN JOAQUIN COUNTY TREASURER

WEST SACRAMENTO, CA 95798 1355

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,337,491.12

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,337,491.12Gross Claim

$1,337,491.12Net Claim / Payment Amount

YTD Amount: $9,876,349.91

Page 40 of 59

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Remittance Advice - EFT

Page 41: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1149

SAN LUIS OBISPO COUNTY TREASURER

SAN LUIS OBISPO, CA 93406

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 539,490.88

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$539,490.88Gross Claim

$539,490.88Net Claim / Payment Amount

YTD Amount: $3,983,727.90

Page 41 of 59

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Page 42: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 4035

C/O UNION BANK ST GOVT DEPT

SAN MATEO COUNTY TREASURER

Sacramento, CA 95812

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,291,922.91

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,291,922.91Gross Claim

$1,291,922.91Net Claim / Payment Amount

YTD Amount: $9,539,863.51

Page 42 of 59

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Remittance Advice - EFT

Page 43: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 579

SANTA BARBARA COUNTY TREASURER

SANTA BARBARA, CA 93102

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 919,608.62

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$919,608.62Gross Claim

$919,608.62Net Claim / Payment Amount

YTD Amount: $6,790,606.99

Page 43 of 59

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Remittance Advice - EFT

Page 44: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1406

SANTA CLARA CO TREASURER

SACRAMENTO, CA 95812

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 3,639,372.87

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$3,639,372.87Gross Claim

$3,639,372.87Net Claim / Payment Amount

YTD Amount: $26,873,987.68

Page 44 of 59

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Page 45: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1817

SANTA CRUZ COUNTY TREASURER

SANTA CRUZ, CA 95061

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 584,442.32

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$584,442.32Gross Claim

$584,442.32Net Claim / Payment Amount

YTD Amount: $4,315,659.92

Page 45 of 59

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Remittance Advice - EFT

Page 46: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1859

SHASTA COUNTY TREASURER

SACRAMENTO, CA 95812 1859

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 384,365.47

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$384,365.47Gross Claim

$384,365.47Net Claim / Payment Amount

YTD Amount: $2,838,245.28

Page 46 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 47: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 376

SIERRA COUNTY TREASURER

DOWNIEVILLE, CA 95936 0376

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 73,774.20

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$73,774.20Gross Claim

$73,774.20Net Claim / Payment Amount

YTD Amount: $544,766.07

Page 47 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 48: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

311 FOURTH ST RM 104

SISKIYOU COUNTY TREASURER

YREKA, CA 96097

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 137,128.21

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$137,128.21Gross Claim

$137,128.21Net Claim / Payment Amount

YTD Amount: $1,012,587.04

Page 48 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 49: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

675 TEXAS ST STE 1900

SOLANO COUNTY T TC

FAIRFIELD, CA 94533 6337

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 801,411.09

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$801,411.09Gross Claim

$801,411.09Net Claim / Payment Amount

YTD Amount: $5,917,808.50

Page 49 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 50: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1204

SONOMA COUNTY TREASURER

SACRAMENTO, CA 95812 1204

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 900,467.35

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$900,467.35Gross Claim

$900,467.35Net Claim / Payment Amount

YTD Amount: $6,649,263.30

Page 50 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 51: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 3052

STANISLAUS COUNTY TREASURER

MODESTO, CA 95353 3052

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,020,622.09

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,020,622.09Gross Claim

$1,020,622.09Net Claim / Payment Amount

YTD Amount: $7,536,514.22

Page 51 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 52: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 546

SUTTER COUNTY TREASURER

YUBA CITY, CA 95992

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 378,501.79

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$378,501.79Gross Claim

$378,501.79Net Claim / Payment Amount

YTD Amount: $1,790,818.81

Page 52 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 53: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1150

TEHAMA COUNTY TREASURER

RED BLUFF, CA 96080

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 158,860.87

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$158,860.87Gross Claim

$158,860.87Net Claim / Payment Amount

YTD Amount: $1,173,066.16

Page 53 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 54: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

2008 N GAREY AVENUE

TRI CITY MENTAL HEALTH

POMONA, CA 91767

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 441,393.42

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$441,393.42Gross Claim

$441,393.42Net Claim / Payment Amount

YTD Amount: $3,259,353.14

Page 54 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 55: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1297

TRINITY CO TREASURER

WEAVERVILLE, CA 96093 1297

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 81,570.53

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$81,570.53Gross Claim

$81,570.53Net Claim / Payment Amount

YTD Amount: $602,336.03

Page 55 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 56: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

221 SOUTH MOONEY BL

COUNTY CIVIC CENTER RM 103E

TULARE COUNTY TREASURER

VISALIA, CA 93291

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 966,347.04

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$966,347.04Gross Claim

$966,347.04Net Claim / Payment Amount

YTD Amount: $7,135,734.44

Page 56 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 57: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

2 SOUTH GREEN ST

TUOLUMNE COUNTY TREASURER

SONORA, CA 95370

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 151,811.95

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$151,811.95Gross Claim

$151,811.95Net Claim / Payment Amount

YTD Amount: $1,121,015.24

Page 57 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 58: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 980307

C/O WELLS FARGO BANK

VENTURA COUNTY TREASURER

WEST SACRAMENTO, CA 95798 0307

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 1,648,497.27

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$1,648,497.27Gross Claim

$1,648,497.27Net Claim / Payment Amount

YTD Amount: $12,172,892.66

Page 58 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT

Page 59: CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA ......EL DORADO COUNTY TREASURER PLACERVILLE, CA 95667 Financial_Activity 1200051A Fiscal Year: 2012 Payment Calculations: Mental health

CONTROLLER OF CALIFORNIA, STATE OF CALIFORNIA

P O BOX 942850, SACRAMENTO, CA 94250-0001

REMITTANCE ADVICE

10/15/2012

CLAIM SCHEDULE NUMBER:

PAYMENT ISSUE DATE:

PO BOX 1995

YOLO COUNTY TREASURER

WOODLAND, CA 95695

Financial_Activity

1200051A

Fiscal Year: 2012

Payment Calculations:

Mental health Services apportionment amount for current period 430,210.79

Mental Health Services Fund apportionment per AB1467

09/01/2012 09/30/2012Collection Period: To

Allocation of the Mental Health Services Fund apportionment funds per Welfare and Institutions Code Section

5891(c)

Additional Description:

$430,210.79Gross Claim

$430,210.79Net Claim / Payment Amount

YTD Amount: $3,176,777.94

Page 59 of 59

For assistance, please call: John Bodolay at (916) 323-2154

Remittance Advice - EFT