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CABARRU5 COUNTT
<br /> 5ELFINSURANCE
<br /> FUND 620
<br /> As of May 19,2017
<br /> FY 2,017
<br /> ESTIMATED
<br /> ORIGINAL TRANFR5 TRANFRS REVISED wo RETIREE RETIREE INS DS5 RETIREE ONUSED CLAIMS/ (OVEN/UNAER Hea111.
<br /> ORG 001 ACCOU NT DESCRIPTION BUDGET ADJUST ADJUST BUDGET ACTUAL ENCUMBRANCE COBRA PREMIUMS PREMIUMS DRAFT INSURANCE PREMIUMS OTHER FSNR TOTAL BUDGET OA
<br /> 61061917 6606 MP [2,704.00] - - {2,706.00} (2,696A9) - - (260-461 - - - (2,917.14} (21L141 -
<br /> 61061917 6506 WSACC 129,771.00) (29,771.00) 127,265.801 - - (2,476.20) - - - - (29,742.00) 29.00 -
<br /> 61061917 6645 Cilme Ft. - (S1iL00} - {510.901 (3,005.OD) _ _ _ _ _ _ - 13,005.00) 12495.00 21000.00
<br /> 61061917 6641 Iawrance premkums (9,403A66.W) - (9,403,466.DD) 17,355,279.091 (4,632.201 (1,341,520.88) 186,551.00) (7,474.79) 124,44L25) $15.000.00) 1,51&53 {9,433,38$,67] {291$22.671 -
<br /> 61067917 6701 Interest on rnveslmeots (4,000.00) - - 1410110.0) 17.072.48) - _ 4-0=00) - (8,072.481 (4,072.A8) 2,000.00
<br /> 61061917 5804 Insurance Refunds (60,000.00) - - (80,000.00) (224,22L391 - 1224,22L39) 1144,22139) 144,000.00
<br /> 61061917 6901 Fund Balance Apprupdated - 17.500,00} - 17500.001 _ _ - 7,590.00
<br /> 61061917 5902 Contribution From General Fund - - - - - - - - - - - - -
<br /> 61041918 4461 insurance Prnml9ms-Denlak 1409,855.06} E404.855.001 (352.921961 {177.141 070.407.46) _ (423,506.55) (13,65155)
<br /> Total Reven ues (9,929,79&W} ($010-W] (9,.937,808.DO) 17,97242231 14,80934) Ll1dL4,66518) (86,55100} {7,47439} {24,441-251 (6i5.139D.0Y 51053 - !10.124,$53.231 (187,045.231 146.000.00
<br /> 61091917 9391 Mloor ORkr Equ loment - - - - - - - - - - - - - - - - -
<br /> 63091917 9360 Medial Supplies 90,000.00 - - 901OW.00 22;644.43 67,355.57 - - - - - - - - 90,000.06 - -
<br /> 61091917 4401 B&E Rental 31,429.00 30.0 - 31,458.130 26,126.55 5,331-44 - - - - - - - - 31,458.00 - -
<br /> 61091917 4412 Pourer 5,500.130 [2,20100) 130.00) 3,270,00 1,969.07 - - - - - - - 373.61 2,242.88 11027.12
<br /> 61091917 9445 Purchased Servkm(1095 forms) - 8,010.13D 3,64&OD 11,658.00 111,38L25 - - - - - - - - - 10,381.25 1,276.75 -
<br /> 61041917 9465 Administration Fees 1,574,865.D0 - - 1,574,866.00 927,183.33 211,07981 - - - - - 5,06.006 - 1,143,263.14 43LWLSS (410,500.00}
<br /> 61091917 948501 Admin-HSA OrIBUutien Fee 325,000.00 - - 325,OW,00 328,250.00 - - - - - 1,062.50 - 329,312.50 {4,312.50) S,SW.W
<br /> 61091917 948502 ARA Aomunt•Gilsbar WGmw - - 75,752.00 51,154AI4 - - - - - - - 10,460.0 - 61,634.04 14,117,96 11,01001100}
<br /> 51091917 948501 Federal PPACA Fees 37,455-00 21800,0 - 4(1,255.00 37,025,91 - - - - - - - 2,800.00 - 39,825.91 429.09 -
<br /> 61091917 9570 Service Contracts 3871309.00 - - 337,309.00 247,999.14 83,756.76 - - - - - - - 331,750.00 51559.00 -
<br /> 51091917 9506 Cnncu'Imnh - - - - - - - - - - - -
<br /> 51091917 9645 SL4(-F.ured Ik pi9af Claims 7,038,306.06 - 7,033,386.00 6,739,712.09 - - _ - - 1,347,942.42 - 8,087,654.51 (1,049,26&53} 2,100;000.00
<br /> 61091918 9485 Admin Fees-D-W 56,015.00 - 56,015.00 51,90896 - - - - - - - 4,800.0 - 56,708.36 (69335) -
<br /> 611791918 9645 5elf•rnwr4d Dental Claims 353,840.06 353,840.00 305,914.49 561000.00 351,91.4.49 ja 074,49
<br /> 9,929,79$.0 8,640.0 3,618.0 9,937,898.0) 8,750,168..77 367,517.58 1,4219,45&73 10,546,145.08. 1608337.08) 685,000.00
<br /> Total 63tl.W 31418.00 - - - - - - 1537,000,00�
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<br /> F-6 Page 152
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