Funding Information. X. Xxxxxxx must establish and maintain a separate cost center to capture costs incurred for carrying out the FY21 activities for each allocation within this Contract as provided below.
X. Xxxxxxx’s allocations are as follows:
1. EMS/CO a. $402,201.00 (One lump sum payment).
Funding Information. A. Grantee must establish and maintain a separate cost center to capture costs incurred for carrying out the FY20 activities for each allocation within this Contract as provided below.
X. Xxxxxxx’s allocations are as follows:
1. EMS/CO
Funding Information. X. Xxxxxxx must establish and maintain a separate cost center to capture costs incurred for carrying out the activities of each allocation within this Contract as provided below.
X. Xxxxxxx’s allocations are as follows:
1. EMS/CO
Funding Information. The Funding shall (a) take place on [ ] and (b) shall be in an amount equal to $[ ]. Each Purchaser Group’s pro rata share of the Funding shall be: [(i) ; and (ii) .]
Funding Information. The Funding shall (a) take place on [__________] and (b) be in an amount equal to $[_______]. Such Funding shall consist of Eurodollar Loans.
Funding Information. X. Xxxxxxx must establish and maintain a separate cost center to capture costs incurred for carrying out the FY21 activities for each allocation within this Contract as provided below.
X. Xxxxxxx’s allocations are as follows:
1. EMS/CO
a. $68,538.00 (One lump sum payment).
b. Funds availability term:
i. May 1, 2020, through June 30, 2021, if funds are distributed as an advance to the EMS providers; or
ii. May 1, 2020, through July 31, 2021, if funds are distributed as a reimbursement.
2. EMS/CO (Alignment Funding for a 12-month Contract term)
a. $68,538.00 (One lump sum payment).
b. Funds availability term:
i. September 1, 2020, through June 30, 2021, if funds are distributed as an advance to the EMS providers; or
ii. September 1, 2020, through July 31, 2021, if funds are distributed as a reimbursement.
3. EMS/RAC
a. $24,245.00 (One lump sum payment).
b. Funds availability term: May 1, 2020, through August 31, 2021.
4. EMS/RAC (Alignment Funding for a 12-month Contract term)
a. $24,245.00 (One lump sum payment).
b. Funds availability term: September 1, 2020, through August 31, 2021. 5. RAC SYSTEMS DEVELOPMENT a. $50,856.00 (One lump sum payment).
Funding Information. A. Grantee must establish and maintain a separate cost center to capture costs incurred for carrying out the FY22 activities for each allocation within this Contract as provided below.
X. Xxxxxxx’s allocations are as follows:
1. EMS/CO
a. $140,383.00 (One lump sum payment).
b. Funds availability term: September 1, 2021, through August 31, 2022, if funds are distributed as an advance or reimbursement to the EMS providers.
2. EMS/RAC
a. $80,298.00 (One lump sum payment).
b. Funds availability term: September 1, 2021, through August 31, 2022. 3. RAC SYSTEMS DEVELOPMENT a. $79,101.00 (First lump sum payment).
Funding Information. Describe the source of the funds (e.g. personal injury award, class action settlement, inheritance, Social Security back payment, other): If the source is a Personal Injury award, please describe the accident/injury. If the source is a class action settlement, please describe the class action:
A. Amount to be deposited into the trust (estimate if not certain): $
B. Will there be a structured settlement?
C. Will there be a Court ordered settlement? ☐ Yes ☐ No
D. Does the Beneficiary have a Life Care Plan? ☐ Yes ☐ No
X. Xxxx qualification of the Trustee before the Clerk of Court and/or annual filings with the Commissioner of Accounts be required by the Court? ☐ Yes ☐ No
Funding Information. The Funding shall (a) take place on [__________] and (b) shall be in an amount equal to $[_______].
Funding Information. Regular HSA Contribution for tax year: _ HSA Rollover (Must also complete HSA Rollover Form) Transfer from another HSA (Must also complete Account Transfer Form)
