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Amount to be recouped
1 Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Option (insert 1 Placeholder
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) or 2) Number
2 Alameda LGA Alameda USD 10/11-1 2012-Q4 $ - $ - ### $ 37,303 $ 27,977 $ (9,326) 1
3 Alameda LGA Alameda USD 10/11-2 2013-Q1 $ - $ - ### $ 42,577 $ 31,933 $ (10,644) 1
4 Alameda LGA Alameda USD 10/11-3 2013-Q2 $ - $ - ### $ 54,966 $ 21,986 $ (32,980)
5 Alameda LGA Alameda USD 11/12-3 Err:520 $ 73,636 $ 29,454 $ 44,182 $ - ### $ - 3006
6 Alameda LGA Alameda USD 10/11-4 2013-Q3 $ - $ - ### $ 49,917 $ 37,438 $ (12,479) 1
7 Alameda LGA Alameda USD 11/12-4 Err:520 $ 412,557 $ 165,023 $ 247,534 $ - ### $ - 3801
8 Alameda LGA Alameda USD 11/12-1C-1 Err:520 $ 68,225 $ 27,290 $ 40,935 $ - ### $ - 1457
9 Alameda LGA Alameda USD 11/12-2C-1 Err:520 $ 47,765 $ 35,824 $ 11,941 $ - ### $ - 1 2206
10 Alameda USD Total $ 602,183 $ 257,591 $ 344,592 $ 184,763 $ 119,334 $ (65,429) $ 192,162
11 Alameda LGA Education for Change 11/12-1 Err:520 $ 28,059 $ 25,000 $ 3,059 $ - ### $ - 2 1458
12 Education for Change Total $ 28,059 $ 25,000 $ 3,059 $ - $ - $ - $ 25,000
13 Alameda LGA Hayward USD 11/12-1 Err:520 $ 115,801 $ 46,320 $ 69,481 $ - ### $ - 1459
14 Alameda LGA Hayward USD 10/11-2 2013-Q1 $ - $ - ### $ 167,864 $ 67,146 $ (100,718)
15 Alameda LGA Hayward USD 11/12-2 Err:520 $ 373,582 $ 149,433 $ 224,149 $ - ### $ - 2208
16 Alameda LGA Hayward USD 10/11-3 2013-Q2 $ - $ - ### $ 198,304 $ 79,322 $ (118,982)
17 Alameda LGA Hayward USD 11/12-3 Err:520 $ 275,366 $ 110,146 $ 165,220 $ - ### $ - 3008
18 Alameda LGA Hayward USD 10/11-4 2013-Q3 $ - $ - ### $ 218,102 $ 87,241 $ (130,861)
19 Alameda LGA Hayward USD 11/12-4 Err:520 $ 310,108 $ 124,043 $ 186,065 $ - ### $ - 3803
20 Hayward USD Total $ 1,074,857 $ 429,942 $ 644,915 $ 584,270 $ 233,709 $ (350,561) $ 79,381
21 Alameda LGA Oakland USD 10/11-1 2012-Q4 $ - $ - ### $ 244,337 $ 97,735 $ (146,602)
22 Alameda LGA Oakland USD 11/12-1 Err:520 $ 304,244 $ 121,698 $ 182,546 $ - ### $ - 1460
23 Alameda LGA Oakland USD 10/11-2 2013-Q1 $ - $ - ### $ 314,486 $ 125,794 $ (188,692)
24 Alameda LGA Oakland USD 11/12-2 Err:520 $ 369,632 $ 147,853 $ 221,779 $ - ### $ - 2209
25 Alameda LGA Oakland USD 10/11-3 2013-Q2 $ - $ - ### $ 311,814 $ 124,726 $ (187,088)
26 Alameda LGA Oakland USD 11/12-3 Err:520 $ 384,697 $ 153,879 $ 230,818 $ - ### $ - 3009
27 Alameda LGA Oakland USD 10/11-4 2013-Q3 $ - $ - ### $ 361,151 $ 144,460 $ (216,691)
28 Alameda LGA Oakland USD 11/12-4 Err:520 $ 460,608 $ 184,243 $ 276,365 $ - ### $ - 3804
29 Alameda LGA Oakland USD 12/13-1 Err:520 $ 291,494 $ 116,598 $ 174,896 $ - ### $ - 4576
30 Alameda LGA Oakland USD 12/13-2 Err:520 $ 375,485 $ 150,194 $ 225,291 5345
31 Oakland USD Total Err:502 Err:502 Err:502 $ 1,231,788 $ 492,715 $ (739,073) Err:502
32 Grand Total Alameda LGA Err:502 Err:502 Err:502 $ 2,000,821 $ 845,758 $ (1,155,063) Err:502
33
34
35 Column A County - Reporting LEC/LGA
36 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12
37 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number
38 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed
39 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment
40 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made
41 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
42 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
43 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
44 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
45 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
46 The last subtotal amount is the final amount due to/from the LEC/LGA
47 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
48
49 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
50 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
51 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
52
55 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
56 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
57
58 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
59 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
60 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
61 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
62
1
Pro-Rata Net Negative Distribution Table
2
Total amount
Amount to be recouped Amount to withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + release to 2013 and CUs in Option (insert 1 City College of San
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Brentwood Union SD Francisco Martinez USD Redwood City ESD Sequoia UHSD Travis USD
3 Contra Costa Alameda COE 10/11-3 2013-Q2 $ - $ - ### $ 25,449 $ 25,000 $ (449) 2
4 Contra Costa Alameda COE 12/13-1 Err:520 $ 7,486 $ 6,737 $ 749
5 Alameda COE Total $ 7,486 $ 6,737 $ 749 $ 25,449 $ 25,000 $ (449) $ 6,288 0.35% Err:502 Err:502 $ 261.43 $ 520.45 $ 0.83 $ 217.30 $ 651.17 $ 33.61
6 Contra Costa Antioch USD 11/12-1 2013-Q4 $ - $ - ### $ 89,963 $ 35,985 $ (53,978)
7 Contra Costa Antioch USD 11/12-2 2014-Q1 $ - $ - ### $ 68,376 $ 27,350 $ (41,026)
8 Contra Costa Antioch USD 11/12-3 Err:520 $ 129,708 $ 51,883 $ 77,825 $ - ### $ -
9 Contra Costa Antioch USD 10/11-4 2013-Q3 $ - $ - ### $ 40,151 $ 30,113 $ (10,038) 2
10 Contra Costa Antioch USD 11/12-4C-1 Err:520 $ 95,577 $ 38,231 $ 57,346 $ - ### $ -
11 Contra Costa Antioch USD 12/13-1 Err:520 $ 20,697 $ 18,627 $ 2,070
12 Antioch USD Total $ 245,982 $ 108,741 $ 137,241 $ 198,490 $ 93,448 $ (105,042) $ 3,699 0.20% Err:502 Err:502 $ 153.79 $ 306.16 $ 0.49 $ 127.83 $ 383.06 $ 19.77
13 Contra Costa Brentwood Union SD 10/11-1 2012-Q4 $ - $ - ### $ 263,526 $ 105,410 $ (158,116)
14 Contra Costa Brentwood Union SD 11/12-1 Err:520 $ 296,279 $ 118,512 $ 177,767 $ - ### $ -
15 Contra Costa Brentwood Union SD 10/11-2 2013-Q1 $ - $ - ### $ 185,936 $ 74,374 $ (111,562)
16 Contra Costa Brentwood Union SD 11/12-2 Err:520 $ 220,089 $ 88,036 $ 132,053 $ - ### $ -
17 Contra Costa Brentwood Union SD 10/11-3 2013-Q2 $ - $ - ### $ 342,795 $ 137,118 $ (205,677)
18 Contra Costa Brentwood Union SD 11/12-3 Err:520 $ 326,386 $ 130,554 $ 195,832 $ - ### $ -
19 Contra Costa Brentwood Union SD 10/11-4 2013-Q3 $ - $ - ### $ 232,460 $ 92,984 $ (139,476)
20 Contra Costa Brentwood Union SD 11/12-4C-1 Err:520 $ 101,510 $ 40,604 $ 60,906 $ - ### $ -
21 Contra Costa Brentwood Union SD 12/13-1 Err:520 $ 51,978 $ 20,791 $ 31,187
22 Contra Costa Brentwood Union SD 12/13-2 Err:520 $ 52,114 $ 20,846 $ 31,268
23 Contra Costa Brentwood Union SD 12/13-3 Err:520 $ 50,552 $ 20,221 $ 30,331
24 Contra Costa Brentwood Union SD 13/14-1 Err:520 $ 9,158 $ 8,242 $ 916
25 Contra Costa Brentwood Union SD 13/14-2 Err:520 $ 30,468 $ 22,851 $ 7,617
26 Contra Costa Brentwood Union SD 13/14-3 Err:520 $ 24,475 $ 22,028 $ 2,447
27 Contra Costa Brentwood Union SD 13/14-4 Err:520 $ 13,610 $ 12,249 $ 1,361
28 Contra Costa Brentwood Union SD 12/13-4 Err:520 $ 45,989 $ 34,492 $ 11,497
29 Brentwood Union SD Total $ 1,222,608 $ 539,426 $ 683,182 $ 1,024,717 $ 409,886 $ (614,831) $ (75,405) 15.52%
30 Contra Costa Byron Union ESD 11/12-1 Err:520 $ 61,220 $ 21,427 $ 39,793 $ - ### $ -
31 Contra Costa Byron Union ESD 11/12-2 Err:520 $ 25,551 $ 17,886 $ 7,665 $ - ### $ -
32 Contra Costa Byron Union ESD 11/12-3 Err:520 $ 33,637 $ 23,546 $ 10,091 $ - ### $ -
33 Byron Union ESD Total $ 120,408 $ 62,859 $ 57,549 $ - $ - $ - $ 62,859 3.47% Err:502 Err:502 $ 2,613.40 $ 5,202.79 $ 8.25 $ 2,172.27 $ 6,509.48 $ 336.01
34 Contra Costa Cabrillo USD 10/11-2 2013-Q1 $ - $ - ### $ 34,653 $ 25,990 $ (8,663) 2
35 Contra Costa Cabrillo USD 10/11-3 2013-Q2 $ - $ - ### $ 31,310 $ 25,000 $ (6,310) 2
36 Contra Costa Cabrillo USD 10/11-4 Err:520 $ 28,873 $ 25,000 $ 3,873 $ - ### $ - 2
37 Cabrillo USD Total $ 28,873 $ 25,000 $ 3,873 $ 65,963 $ 50,990 $ (14,973) $ 10,027 0.55% Err:502 Err:502 $ 416.88 $ 829.93 $ 1.32 $ 346.51 $ 1,038.36 $ 53.60
38 Contra Costa Castro Valley USD 10/11-2 2013-Q1 $ - $ - ### $ 26,684 $ 25,000 $ (1,684) 2
39 Contra Costa Castro Valley USD 11/12-2 Err:520 $ 36,544 $ 27,408 $ 9,136 $ - ### $ - 2
40 Castro Valley USD Total $ 36,544 $ 27,408 $ 9,136 $ 26,684 $ 25,000 $ (1,684) $ 25,724 1.42% Err:502 Err:502 $ 1,069.49 $ 2,129.16 $ 3.38 $ 888.97 $ 2,663.90 $ 137.51
41 Contra Costa Chabot College 11/12-2 Err:520 $ 29,057 $ 20,340 $ 8,717 $ - ### $ -
42 Contra Costa Chabot College 11/12-3 Err:520 $ 25,057 $ 17,540 $ 7,517 $ - ### $ -
43 Contra Costa Chabot College 11/12-4 Err:520 $ 28,688 $ 20,082 $ 8,606 $ - ### $ -
44 Chabot College Total $ 82,802 $ 57,962 $ 24,840 $ - $ - $ - $ 57,962 3.20% Err:502 Err:502 $ 2,409.81 $ 4,797.47 $ 7.61 $ 2,003.04 $ 6,002.36 $ 309.83
45 Contra Costa City College of San Francisco 10/11-1 2012-Q4 $ - $ - ### $ 212,190 $ 74,267 $ (137,923)
46 Contra Costa City College of San Francisco 11/12-1 Err:520 $ 261,968 $ 91,689 $ 170,279 $ - ### $ -
47 Contra Costa City College of San Francisco 10/11-2 2013-Q1 $ - $ - ### $ 184,822 $ 64,688 $ (120,134)
48 Contra Costa City College of San Francisco 11/12-2 Err:520 $ 180,536 $ 63,188 $ 117,348 $ - ### $ -
49 Contra Costa City College of San Francisco 10/11-3 2013-Q2 $ - $ - ### $ 210,619 $ 73,717 $ (136,902)
50 Contra Costa City College of San Francisco 11/12-3 Err:520 $ 180,050 $ 63,018 $ 117,032 $ - ### $ -
51 Contra Costa City College of San Francisco 10/11-4 2013-Q3 $ - $ - ### $ 200,022 $ 70,008 $ (130,014)
52 Contra Costa City College of San Francisco 11/12-4 Err:520 $ 154,897 $ 54,214 $ 100,683 $ - ### $ -
53 Contra Costa City College of San Francisco 12/13-1 Err:520 $ 54,665 $ 19,133 $ 35,532
54 Contra Costa City College of San Francisco 12/13-2 Err:520 $ 19,970 $ 19,970 $ -
55 Contra Costa City College of San Francisco 12/13-3 Err:520 $ 19,043 $ 19,043 $ -
56 Contra Costa City College of San Francisco 13/14-1 Err:520 $ 4,318 $ 4,318 $ -
57 Contra Costa City College of San Francisco 13/14-2 Err:520 $ 6,038 $ 6,038 $ -
58 Contra Costa City College of San Francisco 13/14-3 Err:520 $ 10,568 $ 10,568 $ -
59 Contra Costa City College of San Francisco 13/14-4 Err:520 $ 3,942 $ 3,942 $ -
60 Contra Costa City College of San Francisco 12/13-4 Err:520 $ 19,735 $ 19,735 $ -
61 City College of San Francisco Total $ 915,730 $ 374,856 $ 540,874 $ 807,653 $ 282,680 $ (524,973) $ (150,117) 30.89%
62 Contra Costa Contra Costa COE - SELPA 10/11-3 2013-Q2 $ - $ - ### $ 31,494 $ 25,000 $ (6,494) 2
63 Contra Costa Contra Costa COE - SELPA 11/12-3 Err:520 $ 28,494 $ 25,000 $ 3,494 $ - ### $ - 2
64 Contra Costa Contra Costa COE - SELPA 11/12-4 Err:520 $ 27,133 $ 25,000 $ 2,133 $ - ### $ - 2
65 Contra Costa COE - SELPA Total $ 55,627 $ 50,000 $ 5,627 $ 31,494 $ 25,000 $ (6,494) $ 43,506 2.40% Err:502 Err:502 $ 1,808.79 $ 3,600.96 $ 5.71 $ 1,503.48 $ 4,505.34 $ 232.56
66 Contra Costa Contra Costa COE - Student Programs 10/11-1 2012-Q4 $ - $ - ### $ 50,547 $ 20,219 $ (30,328)
67 Contra Costa Contra Costa COE - Student Programs 11/12-1 Err:520 $ 52,392 $ 20,957 $ 31,435 $ - ### $ -
68 Contra Costa Contra Costa COE - Student Programs 10/11-2 2013-Q1 $ - $ - ### $ 56,620 $ 22,648 $ (33,972)
69 Contra Costa Contra Costa COE - Student Programs 11/12-2 Err:520 $ 62,857 $ 25,143 $ 37,714 $ - ### $ -
70 Contra Costa Contra Costa COE - Student Programs 10/11-3 2013-Q2 $ - $ - ### $ 56,227 $ 22,491 $ (33,736)
71 Contra Costa Contra Costa COE - Student Programs 11/12-3 Err:520 $ 49,786 $ 37,340 $ 12,446 $ - ### $ - 2
72 Contra Costa Contra Costa COE - Student Programs 10/11-4 2013-Q3 $ - $ - ### $ 47,029 $ 35,272 $ (11,757) 2
73 Contra Costa Contra Costa COE - Student Programs 11/12-4 Err:520 $ 59,819 $ 23,928 $ 35,891 $ - ### $ -
74 Contra Costa Contra Costa COE - Student Programs 12/13-1 Err:520 $ 22,986 $ 20,687 $ 2,299
75 Contra Costa COE - Student Programs Total $ 247,840 $ 128,055 $ 119,785 $ 210,423 $ 100,630 $ (109,793) $ 18,262 1.01% Err:502 Err:502 $ 759.25 $ 1,511.53 $ 2.40 $ 631.10 $ 1,891.15 $ 97.62
76 Contra Costa Diablo Valley College 11/12-3 Err:520 $ 25,160 $ 17,612 $ 7,548 $ - ### $ -
77 Contra Costa Diablo Valley College 11/12-4 Err:520 $ 25,527 $ 17,869 $ 7,658 $ - ### $ -
78 Diablo Valley College Total $ 50,687 $ 35,481 $ 15,206 $ - $ - $ - $ 35,481 1.96% Err:502 Err:502 $ 1,475.15 $ 2,936.74 $ 4.66 $ 1,226.15 $ 3,674.30 $ 189.66
79 Contra Costa Dublin Unified SD 10/11-4 2013-Q3 $ - $ - ### $ 27,989 $ 25,000 $ (2,989) 2
80 Contra Costa Dublin Unified SD 12/13-1 Err:520 $ 2,678 $ 2,410 $ 268
81 Contra Costa Dublin Unified SD 12/13-2 Err:520 $ 3,110 $ 2,799 $ 311
82 Contra Costa Dublin Unified SD 12/13-3 Err:520 $ 4,535 $ 4,082 $ 453
83 Dublin Unified SD Total $ 10,323.00 $ 9,291.00 $ 1,032.00 $ 27,989 $ 25,000 $ (2,989) $ 6,302 0.35% Err:502 Err:502 $ 262.01 $ 521.61 $ 0.83 $ 217.78 $ 652.61 $ 33.69
84 Contra Costa Emery USD 11/12-1 Err:520 $ 30,255 $ 25,000 $ 5,255 $ - ### $ - 2
85 Contra Costa Emery USD 10/11-2 2013-Q1 $ - $ - ### $ 33,103 $ 25,000 $ (8,103) 2
86 Contra Costa Emery USD 11/12-2 Err:520 $ 82,741 $ 33,096 $ 49,645 $ - ### $ -
87 Contra Costa Emery USD 10/11-3 2013-Q2 $ - $ - ### $ 26,653 $ 25,000 $ (1,653) 2
88 Contra Costa Emery USD 11/12-3 Err:520 $ 69,691 $ 27,876 $ 41,815 $ - ### $ -
89 Contra Costa Emery USD 10/11-4 2013-Q3 $ - $ - ### $ 27,621 $ 25,000 $ (2,621) 2
90 Contra Costa Emery USD 11/12-4 Err:520 $ 72,949 $ 29,180 $ 43,769 $ - ### $ -
91 Emery USD Total $ 255,636 $ 115,152 $ 140,484 $ 87,377 $ 75,000 $ (12,377) $ 102,775 5.67% Err:502 Err:502 $ 4,272.94 $ 8,506.61 $ 13.49 $ 3,551.69 $ 10,643.05 $ 549.38
92 Contra Costa Fairfield-Suisun USD 10/11-1 2012-Q4 $ - $ - ### $ 56,342 $ 22,537 $ (33,805)
93 Contra Costa Fairfield-Suisun USD 11/12-1 Err:520 $ 97,173 $ 38,869 $ 58,304 $ - ### $ -
94 Contra Costa Fairfield-Suisun USD 10/11-2 2013-Q1 $ - $ - ### $ 126,589 $ 50,636 $ (75,953)
95 Contra Costa Fairfield-Suisun USD 11/12-2 Err:520 $ 163,338 $ 65,335 $ 98,003 $ - ### $ -
96 Contra Costa Fairfield-Suisun USD 10/11-3 2013-Q2 $ - $ - ### $ 147,645 $ 59,058 $ (88,587)
97 Contra Costa Fairfield-Suisun USD 11/12-3 Err:520 $ 125,502 $ 50,201 $ 75,301 $ - ### $ -
98 Contra Costa Fairfield-Suisun USD 10/11-4 2013-Q3 $ - $ - ### $ 149,499 $ 59,800 $ (89,699)
99 Contra Costa Fairfield-Suisun USD 11/12-4 Err:520 $ 131,997 $ 52,799 $ 79,198 $ - ### $ -
100 Contra Costa Fairfield-Suisun USD 12/13-1 Err:520 $ 55,990 $ 22,396 $ 33,594
101 Contra Costa Fairfield-Suisun USD 12/13-2 Err:520 $ 90,307 $ 36,123 $ 54,184
102 Contra Costa Fairfield-Suisun USD 12/13-3 Err:520 $ 74,414 $ 29,766 $ 44,648
103 Fairfield-Suisun USD Total $ 738,721 $ 295,489 $ 443,232 $ 480,075 $ 192,031 $ (288,044) $ 7,445 0.41% Err:502 Err:502 $ 309.53 $ 616.22 $ 0.98 $ 257.28 $ 770.98 $ 39.80
104 Contra Costa Fremont USD 10/11-1 2012-Q4 $ - $ - ### $ 62,571 $ 25,028 $ (37,543)
105 Contra Costa Fremont USD 11/12-1-C1 Err:520 $ 43,269 $ 32,452 $ 10,817 $ - ### $ -
106 Contra Costa Fremont USD 10/11-2 2013-Q1 $ - $ - ### $ 104,853 $ 41,941 $ (62,912)
107 Contra Costa Fremont USD 10/11-3 2013-Q2 $ - $ - ### $ 110,040 $ 44,016 $ (66,024)
108 Contra Costa Fremont USD 11/12-3 Err:520 $ 86,956 $ 34,782 $ 52,174 $ - ### $ -
109 Contra Costa Fremont USD 10/11-4 2013-Q3 $ - $ - ### $ 177,148 $ 70,859 $ (106,289)
A B C D E F G H I J K L M N O P Q R S T U
2
Total amount
Amount to be recouped Amount to withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + release to 2013 and CUs in Option (insert 1 City College of San
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Brentwood Union SD Francisco Martinez USD Redwood City ESD Sequoia UHSD Travis USD
110 Contra Costa Fremont USD 11/12-4 Err:520 $ 133,424 $ 53,370 $ 80,054 $ - ### $ -
111 Contra Costa Fremont USD 11/12-2C-1 Err:520 $ 91,514 $ 36,606 $ 54,908 $ - ### $ -
112 Contra Costa Fremont USD 12/13-1 Err:520 $ 27,216 $ 20,412 $ 6,804
113 Contra Costa Fremont USD 12/13-2 Err:520 $ 43,030 $ 32,273 $ 10,757
114 Contra Costa Fremont USD 12/13-3 Err:520 $ 51,648 $ 20,659 $ 30,989
115 Contra Costa Fremont USD 13/14-1 Err:520 $ 27,408 $ 20,556 $ 6,852
116 Contra Costa Fremont USD 12/13-4 Err:520 $ 71,037 $ 28,415 $ 42,622
117 Fremont USD Total $ 575,502 $ 279,525 $ 295,977 $ 454,612 $ 181,844 $ (272,768) $ 6,757 0.37% Err:502 Err:502 $ 280.93 $ 559.27 $ 0.89 $ 233.51 $ 699.73 $ 36.12
118 Contra Costa Jefferson ESD 11/12-1 Err:520 $ 56,845 $ 22,738 $ 34,107 $ - ### $ -
119 Contra Costa Jefferson ESD 10/11-2 2013-Q1 $ - $ - ### $ 71,139 $ 28,456 $ (42,683)
120 Contra Costa Jefferson ESD 11/12-2 Err:520 $ 181,411 $ 72,564 $ 108,847 $ - ### $ -
121 Contra Costa Jefferson ESD 10/11-3 2013-Q2 $ - $ - ### $ 56,752 $ 22,701 $ (34,051)
122 Contra Costa Jefferson ESD 11/12-3 Err:520 $ 97,019 $ 38,808 $ 58,211 $ - ### $ -
123 Contra Costa Jefferson ESD 10/11-4 2013-Q3 $ - $ - ### $ 41,180 $ 30,885 $ (10,295) 2
124 Contra Costa Jefferson ESD 11/12-4 Err:520 $ 112,962 $ 45,185 $ 67,777 $ - ### $ -
125 Jefferson ESD Total $ 448,237 $ 179,295 $ 268,942 $ 169,071 $ 82,042 $ (87,029) $ 92,266 5.09% Err:502 Err:502 $ 3,836.02 $ 7,636.79 $ 12.11 $ 3,188.52 $ 9,554.77 $ 493.21
126 Contra Costa Jefferson UHS 10/11-2 Err:520 $ 34,080 $ 23,856 $ 10,224 $ - ### $ -
127 Jefferson UHS Total* $ 34,080 $ 23,856 $ 10,224 $ - $ - $ - $ 23,856 1.32% Err:502 Err:502 $ 991.83 $ 1,974.54 $ 3.13 $ 824.41 $ 2,470.45 $ 127.52
128 Contra Costa Jefferson Union HS 11/12-2 Err:520 $ 30,528 $ 21,370 $ 9,158 $ - ### $ -
129 Contra Costa Jefferson Union HS 10/11-3 Err:520 $ 61,600 $ - ### $ -
130 Contra Costa Jefferson Union HS 11/12-3 Err:520 $ 35,049 $ 24,534 $ 10,515 $ - ### $ -
131 Contra Costa Jefferson Union HS 10/11-4 Err:520 $ 41,019 $ 28,713 $ 12,306 $ - ### $ -
132 Jefferson Union HS Total* $ 168,196 $ 74,617 $ 31,979 $ - $ - $ - $ 74,617 4.11% Err:502 Err:502 $ 3,102.25 $ 6,175.99 $ 9.79 $ 2,578.61 $ 7,727.10 $ 398.86
133 Contra Costa Knightsen SD 10/11-3 2013-Q2 $ - $ - ### $ 29,822 $ 25,000 $ (4,822) 2
134 Contra Costa Knightsen SD 12/13-1 Err:520 $ 6,214 $ 5,593 $ 621
135 Contra Costa Knightsen SD 12/13-2 Err:520 $ 5,716 $ 5,144 $ 572
136 Knightsen SD Total $ 11,930.00 $ 10,737.00 $ 1,193.00 $ 29,822 $ 25,000 $ (4,822) $ 5,915 0.33% Err:502 Err:502 $ 245.92 $ 489.58 $ 0.78 $ 204.41 $ 612.54 $ 31.62
137 Contra Costa Livermore Valley Joint USD 10/11-1 2012-Q4 $ - $ - ### $ 25,975 $ 25,000 $ (975) 2
138 Contra Costa Livermore Valley Joint USD 11/12-1 Err:520 $ 50,504 $ 20,202 $ 30,302 $ - ### $ -
139 Contra Costa Livermore Valley Joint USD 10/11-2 2013-Q1 $ - $ - ### $ 51,162 $ 20,465 $ (30,697)
140 Contra Costa Livermore Valley Joint USD 11/12-2 Err:520 $ 82,774 $ 33,110 $ 49,664 $ - ### $ -
141 Contra Costa Livermore Valley Joint USD 10/11-3 2013-Q2 $ - $ - ### $ 45,203 $ 33,902 $ (11,301) 2
142 Contra Costa Livermore Valley Joint USD 11/12-3 Err:520 $ 67,350 $ 26,940 $ 40,410 $ - ### $ -
143 Contra Costa Livermore Valley Joint USD 10/11-4 2013-Q3 $ - $ - ### $ 37,288 $ 27,966 $ (9,322) 2
144 Contra Costa Livermore Valley Joint USD 11/12-4 Err:520 $ 68,474 $ 27,390 $ 41,084 $ - ### $ -
145 Livermore Valley Joint USD Total $ 269,102 $ 107,642 $ 161,460 $ 159,628 $ 107,333 $ (52,295) $ 55,347 3.05% Err:502 Err:502 $ 2,301.09 $ 4,581.03 $ 7.26 $ 1,912.68 $ 5,731.56 $ 295.86
146 Contra Costa Martinez USD 10/11-3 2013-Q2 $ - $ - ### $ 25,238 $ 25,000 $ (238) 2
147 Martinez USD Total $ - $ - $ - $ 25,238 $ 25,000 $ (238) $ (238) 0.05%
148 Contra Costa Mill Valley Elm 11/12-3 Err:520 $ 64,102 $ 25,641 $ 38,461 $ - ### $ -
149 Contra Costa Mill Valley Elm 11/12-4 Err:520 $ 46,473 $ 34,855 $ 11,618 $ - ### $ - 2
150 Mill Valley Elm Total $ 110,575 $ 60,496 $ 50,079 $ - $ - $ - $ 60,496 3.34% Err:502 Err:502 $ 2,515.16 $ 5,007.21 $ 7.94 $ 2,090.61 $ 6,264.77 $ 323.38
151 Contra Costa Mt. Diablo USD 10/11-1 2012-Q4 $ - $ - ### $ 52,504 $ 52,504 $ -
152 Contra Costa Mt. Diablo USD 10/11-2 2013-Q1 $ - $ - ### $ 145,516 $ 145,516 $ -
153 Contra Costa Mt. Diablo USD 10/11-3 2013-Q2 $ - $ - ### $ 131,026 $ 131,026 $ -
154 Contra Costa Mt. Diablo USD 11/12-3 Err:520 $ 161,247 $ 161,247 $ - $ - ### $ -
155 Contra Costa Mt. Diablo USD 09/10-4 2012-Q3 $ - $ - ### $ 107,603 $ 107,603 $ -
156 Contra Costa Mt. Diablo USD 10/11-4 2013-Q3 $ - $ - ### $ 116,269 $ 116,269 $ -
157 Contra Costa Mt. Diablo USD 11/12-4C-1 Err:520 $ 114,212 $ 114,212 $ - $ - ### $ -
158 Mt. Diablo USD Total $ 275,459 $ 275,459 $ - $ 552,918 $ 552,918 $ - $ 275,459 15.19% Err:502 Err:502 $ 11,452.39 $ 22,799.53 $ 36.15 $ 9,519.28 $ 28,525.65 $ 1,472.46
159 Contra Costa Napa Valley USD 10/11-1 2012-Q4 $ - $ - ### $ 82,227 $ 32,891 $ (49,336)
160 Contra Costa Napa Valley USD 10/11-2 2013-Q1 $ - $ - ### $ 116,190 $ 46,476 $ (69,714)
161 Contra Costa Napa Valley USD 10/11-3 Err:520 $ 222,758 $ - ### $ -
162 Contra Costa Napa Valley USD 11/12-1 Err:520 $ 184,779 $ 73,912 $ 110,867 $ - ### $ -
163 Contra Costa Napa Valley USD 11/12-2 Err:520 $ 273,270 $ 109,308 $ 163,962 $ - ### $ -
164 Contra Costa Napa Valley USD 11/12-3 Err:520 $ 200,065 $ 80,026 $ 120,039 $ - ### $ -
165 Contra Costa Napa Valley USD 09/10-4 2012-Q3 $ - $ - ### $ 46,209 $ 34,657 $ (11,552) 2
166 Contra Costa Napa Valley USD 10/11-4 Err:520 $ 285,972 $ 114,389 $ 171,583 $ - ### $ -
167 Contra Costa Napa Valley USD 11/12-4C-1 Err:520 $ 143,052 $ 57,221 $ 85,831 $ - ### $ -
168 Napa Valley USD Total* $ 1,309,896 $ 434,856 $ 652,282 $ 244,626 $ 114,024 $ (130,602) $ 304,254 16.78% Err:502 Err:502 $ 12,649.56 $ 25,182.87 $ 39.93 $ 10,514.38 $ 31,507.57 $ 1,626.38
169 Contra Costa New Haven USD 10/11-1 2012-Q4 $ - $ - ### $ 68,676 $ 27,470 $ (41,206)
170 Contra Costa New Haven USD 11/12-1 Err:520 $ 49,373 $ 37,030 $ 12,343 $ - ### $ - 2
171 Contra Costa New Haven USD 10/11-2 2013-Q1 $ - $ - ### $ 84,246 $ 33,698 $ (50,548)
172 Contra Costa New Haven USD 11/12-2 Err:520 $ 75,203 $ 30,081 $ 45,122 $ - ### $ -
173 Contra Costa New Haven USD 10/11-3 2013-Q2 $ - $ - ### $ 117,816 $ 47,126 $ (70,690)
174 Contra Costa New Haven USD 11/12-3 Err:520 $ 133,459 $ 53,384 $ 80,075 $ - ### $ -
175 Contra Costa New Haven USD 11/12-4 Err:520 $ 113,625 $ 45,450 $ 68,175 $ - ### $ -
176 Contra Costa New Haven USD 10/11-4C-1 Err:520 $ 119,139 $ 47,656 $ 71,483 $ - ### $ -
177 New Haven USD Total $ 490,799 $ 213,601 $ 277,198 $ 270,738 $ 108,294 $ (162,444) $ 51,157 2.82% Err:502 Err:502 $ 2,126.89 $ 4,234.23 $ 6.71 $ 1,767.88 $ 5,297.66 $ 273.46
178 Contra Costa Newark USD 10/11-1 2012-Q4 $ - $ - ### $ 26,765 $ 25,000 $ (1,765) 2
179 Contra Costa Newark USD 10/11-2 2013-Q1 $ - $ - ### $ 84,736 $ 33,894 $ (50,842)
180 Contra Costa Newark USD 11/12-2 Err:520 $ 48,935 $ 36,701 $ 12,234 $ - ### $ - 2
181 Contra Costa Newark USD 10/11-3 2013-Q2 $ - $ - ### $ 73,092 $ 29,237 $ (43,855)
182 Contra Costa Newark USD 11/12-3 Err:520 $ 27,544 $ 25,000 $ 2,544 $ - ### $ - 2
183 Contra Costa Newark USD 10/11-4 2013-Q3 $ - $ - ### $ 72,597 $ 29,039 $ (43,558)
184 Contra Costa Newark USD 11/12-4 Err:520 $ 29,068 $ 25,000 $ 4,068 $ - ### $ - 2
185 Contra Costa Newark USD 12/13-1 Err:520 $ 12,133 $ 10,920 $ 1,213
186 Contra Costa Newark USD 12/13-2 Err:520 $ 18,511 $ 16,660 $ 1,851
187 Contra Costa Newark USD 12/13-3 Err:520 $ 17,373 $ 15,636 $ 1,737
188 Contra Costa Newark USD 12/13-4 Err:520 $ 23,355 $ 21,020 $ 2,335
189 Newark USD Total $ 176,919 $ 150,937 $ 25,982 $ 257,190 $ 117,170 $ (140,020) $ 10,917 0.60% Err:502 Err:502 $ 453.88 $ 903.59 $ 1.43 $ 377.27 $ 1,130.53 $ 58.36
190 Contra Costa Novato USD 10/11-1 2012-Q4 $ - $ - ### $ 27,287 $ 25,000 $ (2,287) 2
191 Contra Costa Novato USD 10/11-2 2013-Q1 $ - $ - ### $ 35,228 $ 26,421 $ (8,807) 2
192 Contra Costa Novato USD 11/12-2 Err:520 $ - $ - ### $ -
193 Contra Costa Novato USD 10/11-3 2013-Q2 $ - $ - ### $ 32,712 $ 25,000 $ (7,712) 2
194 Contra Costa Novato USD 09/10-4 2012-Q3 $ - $ - ### $ 30,226 $ 25,000 $ (5,226) 2
195 Contra Costa Novato USD 10/11-4 Err:520 $ 36,798 $ 27,599 $ 9,199 $ - ### $ - 2
196 Contra Costa Novato USD 12/13-1 Err:520 $ 5,455 $ 4,910 $ 545
197 Novato USD Total $ 42,253 $ 32,509 $ 9,744 $ 125,453 $ 101,421 $ (24,032) $ 8,477 0.47% Err:502 Err:502 $ 352.44 $ 701.63 $ 1.11 $ 292.95 $ 877.85 $ 45.31
198 Contra Costa Oakley Union ESD 11/12-1 Err:520 $ 67,189 $ 23,516 $ 43,673 $ - ### $ -
199 Contra Costa Oakley Union ESD 11/12-2 Err:520 $ 48,057 $ 33,640 $ 14,417 $ - ### $ -
200 Contra Costa Oakley Union ESD 11/12-3 Err:520 $ 50,522 $ 17,683 $ 32,839 $ - ### $ -
201 Contra Costa Oakley Union ESD 11/12-4 Err:520 $ 40,928 $ 28,650 $ 12,278 $ - ### $ -
202 Oakley Union ESD Total $ 206,696 $ 103,489 $ 103,207 $ - $ - $ - $ 103,489 5.71% Err:502 Err:502 $ 4,302.62 $ 8,565.71 $ 13.58 $ 3,576.36 $ 10,716.99 $ 553.20
203 Contra Costa Pacifica ESD 11/12-2 Err:520 $ 35,120 $ 26,340 $ 8,780 $ - ### $ - 2
204 Contra Costa Pacifica ESD 11/12-3 Err:520 $ 32,556 $ 25,000 $ 7,556 $ - ### $ - 2
205 Pacifica ESD Total $ 67,676 $ 51,340 $ 16,336 $ - $ - $ - $ 51,340 2.83% Err:502 Err:502 $ 2,134.49 $ 4,249.37 $ 6.74 $ 1,774.20 $ 5,316.61 $ 274.44
206 Contra Costa Pittsburg USD 10/11-1 2012-Q4 $ - $ - ### $ 26,032 $ 25,000 $ (1,032) 2
207 Contra Costa Pittsburg USD 10/11-2 2013-Q1 $ - $ - ### $ 60,862 $ 24,345 $ (36,517)
208 Contra Costa Pittsburg USD 11/12-2 Err:520 $ 25,238 $ 25,000 $ 238 $ - ### $ - 2
209 Contra Costa Pittsburg USD 10/11-3 Err:520 $ 50,220 $ - ### $ -
210 Contra Costa Pittsburg USD 11/12-3 Err:520 $ 31,502 $ 25,000 $ 6,502 $ - ### $ - 2
211 Contra Costa Pittsburg USD 10/11-4 Err:520 $ 41,336 $ 31,002 $ 10,334 $ - ### $ - 2
212 Pittsburg USD Total $ 148,296 $ 81,002 $ 17,074 $ 86,894 $ 49,345 $ (37,549) $ 43,453 2.40% Err:502 Err:502 $ 1,806.59 $ 3,596.57 $ 5.70 $ 1,501.64 $ 4,499.85 $ 232.28
213 Contra Costa Pleasanton Unified - Horizon & Village High 10/11-2 2013-Q1 $ - $ - ### $ 28,569 $ 25,000 $ (3,569) 2
214 Contra Costa Pleasanton Unified - Horizon & Village High 11/12-2 Err:520 $ 25,298 $ 25,000 $ 298 $ - ### $ - 2
215 Contra Costa Pleasanton Unified - Horizon & Village High 10/11-3 2013-Q2 $ - $ - ### $ 50,995 $ 20,398 $ (30,597)
216 Contra Costa Pleasanton Unified - Horizon & Village High 11/12-3 Err:520 $ 44,058 $ 33,044 $ 11,014 $ - ### $ - 2
217 Contra Costa Pleasanton Unified - Horizon & Village High 10/11-4 2013-Q3 $ - $ - ### $ 54,745 $ 21,898 $ (32,847)
218 Contra Costa Pleasanton Unified - Horizon & Village High 11/12-4 Err:520 $ 54,163 $ 21,665 $ 32,498 $ - ### $ -
A B C D E F G H I J K L M N O P Q R S T U
2
Total amount
Amount to be recouped Amount to withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + release to 2013 and CUs in Option (insert 1 City College of San
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Brentwood Union SD Francisco Martinez USD Redwood City ESD Sequoia UHSD Travis USD
219 Pleasanton Unified - Horizon & Village High Total $ 123,519 $ 79,709 $ 43,810 $ 134,309 $ 67,296 $ (67,013) $ 12,696 0.70% Err:502 Err:502 $ 527.84 $ 1,050.84 $ 1.67 $ 438.75 $ 1,314.76 $ 67.87
220 Contra Costa Ravenswood City ESD 11/12-1 Err:520 $ 35,066 $ 24,546 $ 10,520 $ - ### $ -
221 Contra Costa Ravenswood City ESD 10/11-2 2013-Q1 $ - $ - ### $ 69,914 $ 24,470 $ (45,444)
222 Contra Costa Ravenswood City ESD 11/12-2 Err:520 $ 82,501 $ 28,875 $ 53,626 $ - ### $ -
223 Contra Costa Ravenswood City ESD 10/11-3 2013-Q2 $ - $ - ### $ 43,729 $ 30,610 $ (13,119) 2
224 Contra Costa Ravenswood City ESD 11/12-3 Err:520 $ 69,203 $ 24,221 $ 44,982 $ - ### $ -
225 Contra Costa Ravenswood City ESD 10/11-4 2013-Q3 $ - $ - ### $ 61,322 $ 21,463 $ (39,859)
226 Contra Costa Ravenswood City ESD 11/12-4 Err:520 $ 83,612 $ 29,264 $ 54,348 $ - ### $ -
227 Ravenswood City ESD Total $ 270,382 $ 106,906 $ 163,476 $ 174,965 $ 76,543 $ (98,422) $ 8,484 0.47% Err:502 Err:502 $ 352.73 $ 702.21 $ 1.11 $ 293.19 $ 878.58 $ 45.35
228 Contra Costa Redwood City ESD 10/11-1 2012-Q4 $ - $ - ### $ 104,428 $ 41,771 $ (62,657)
229 Contra Costa Redwood City ESD 11/12-1 Err:520 $ 42,986 $ 32,240 $ 10,746 $ - ### $ - 2
230 Contra Costa Redwood City ESD 10/11-2 2013-Q1 $ - $ - ### $ 207,588 $ 83,035 $ (124,553)
231 Contra Costa Redwood City ESD 11/12-2 Err:520 $ 111,059 $ 44,424 $ 66,635 $ - ### $ -
232 Contra Costa Redwood City ESD 10/11-3 2013-Q2 $ - $ - ### $ 144,999 $ 58,000 $ (86,999)
233 Contra Costa Redwood City ESD 11/12-3 Err:520 $ 115,001 $ 46,000 $ 69,001 $ - ### $ -
234 Contra Costa Redwood City ESD 09/10-4 2012-Q3 $ - $ - ### $ 151,180 $ 60,472 $ (90,708)
235 Contra Costa Redwood City ESD 10/11-4 2013-Q3 $ - $ - ### $ 133,351 $ 53,340 $ (80,011)
236 Contra Costa Redwood City ESD 11/12-4 Err:520 $ 59,461 $ 23,784 $ 35,677 $ - ### $ -
237 Contra Costa Redwood City ESD 12/13-1 Err:520 $ 47,515 $ 35,636 $ 11,879
238 Contra Costa Redwood City ESD 12/13-2 Err:520 $ 37,081 $ 27,811 $ 9,270
239 Contra Costa Redwood City ESD 12/13-3 Err:520 $ 42,489 $ 31,867 $ 10,622
240 Contra Costa Redwood City ESD 13/14-1 Err:520 $ 17,598 $ 15,838 $ 1,760
241 Contra Costa Redwood City ESD 13/14-2 Err:520 $ 43,785 $ 32,839 $ 10,946
242 Contra Costa Redwood City ESD 13/14-3 Err:520 $ 34,578 $ 25,934 $ 8,644
243 Contra Costa Redwood City ESD 13/14-4 Err:520 $ 43,109 $ 32,332 $ 10,777
244 Contra Costa Redwood City ESD 12/13-4 Err:520 $ 44,728 $ 33,546 $ 11,182
245 Redwood City ESD Total $ 639,390 $ 382,251 $ 257,139 $ 741,546 $ 296,618 $ (444,928) $ (62,677) 12.90%
246 Contra Costa San Leandro USD 10/11-1 2012-Q4 $ - $ - ### $ 29,908 $ 25,000 $ (4,908) 2
247 Contra Costa San Leandro USD 11/12-1 Err:520 $ 44,818 $ 33,614 $ 11,204 $ - ### $ - 2
248 Contra Costa San Leandro USD 10/11-2 2013-Q1 $ - $ - ### $ 67,716 $ 27,086 $ (40,630)
249 Contra Costa San Leandro USD 11/12-2 Err:520 $ 77,479 $ 30,992 $ 46,487 $ - ### $ -
250 Contra Costa San Leandro USD 10/11-3 2013-Q2 $ - $ - ### $ 65,202 $ 26,081 $ (39,121)
251 Contra Costa San Leandro USD 11/12-3 Err:520 $ 44,096 $ 33,072 $ 11,024 $ - ### $ - 2
252 Contra Costa San Leandro USD 10/11-4 Err:520 $ 55,721 $ 22,288 $ 33,433 $ - ### $ -
253 Contra Costa San Leandro USD 11/12-4 Err:520 $ 41,252 $ 30,939 $ 10,313 $ - ### $ - 2
254 San Leandro USD Total $ 263,366 $ 150,905 $ 112,461 $ 162,826 $ 78,167 $ (84,659) $ 66,246 3.65% Err:502 Err:502 $ 2,754.22 $ 5,483.13 $ 8.69 $ 2,289.32 $ 6,860.22 $ 354.12
255 Contra Costa San Lorenzo USD 10/11-1 2012-Q4 $ - $ - ### $ 40,291 $ 30,218 $ (10,073) 2
256 Contra Costa San Lorenzo USD 11/12-1 Err:520 $ 27,673 $ 25,000 $ 2,673 $ - ### $ - 2
257 Contra Costa San Lorenzo USD 10/11-2 2013-Q1 $ - $ - ### $ 83,398 $ 33,359 $ (50,039)
258 Contra Costa San Lorenzo USD 11/12-2 Err:520 $ 49,520 $ 37,140 $ 12,380 $ - ### $ - 2
259 Contra Costa San Lorenzo USD 10/11-3 2013-Q2 $ - $ - ### $ 93,866 $ 37,546 $ (56,320)
260 Contra Costa San Lorenzo USD 11/12-3 Err:520 $ 112,700 $ 45,080 $ 67,620 $ - ### $ -
261 Contra Costa San Lorenzo USD 10/11-4 2013-Q3 $ - $ - ### $ 72,711 $ 29,084 $ (43,627)
262 Contra Costa San Lorenzo USD 11/12-4 Err:520 $ 86,302 $ 34,521 $ 51,781 $ - ### $ -
263 Contra Costa San Lorenzo USD 12/13-1 Err:520 $ 26,315 $ 19,736 $ 6,579
264 Contra Costa San Lorenzo USD 12/13-2 Err:520 $ 42,659 $ 31,994 $ 10,665
265 San Lorenzo USD Total $ 345,169 $ 193,471 $ 151,698 $ 290,266 $ 130,207 $ (160,059) $ 33,412 1.84% Err:502 Err:502 $ 1,389.13 $ 2,765.49 $ 4.38 $ 1,154.65 $ 3,460.04 $ 178.60
266 Contra Costa San Mateo COE 10/11-1 2012-Q4 $ - $ - ### $ 70,081 $ 28,032 $ (42,049)
267 Contra Costa San Mateo COE 11/12-1 Err:520 $ 68,302 $ 27,321 $ 40,981 $ - ### $ -
268 Contra Costa San Mateo COE 10/11-2 2013-Q1 $ - $ - ### $ 111,842 $ 44,737 $ (67,105)
269 Contra Costa San Mateo COE 11/12-2 Err:520 $ 114,064 $ 45,626 $ 68,438 $ - ### $ -
270 Contra Costa San Mateo COE 10/11-3 2013-Q2 $ - $ - ### $ 96,269 $ 38,508 $ (57,761)
271 Contra Costa San Mateo COE 11/12-3 Err:520 $ 105,119 $ 42,048 $ 63,071 $ - ### $ -
272 Contra Costa San Mateo COE 09/10-4 2012-Q3 $ - $ - ### $ 61,790 $ 24,716 $ (37,074)
273 Contra Costa San Mateo COE 10/11-4 2013-Q3 $ - $ - ### $ 92,996 $ 37,198 $ (55,798)
274 Contra Costa San Mateo COE 11/12-4 Err:520 $ 109,604 $ 43,842 $ 65,762 $ - ### $ -
275 Contra Costa San Mateo COE 12/13-1 Err:520 $ 30,610 $ 22,958 $ 7,652
276 Contra Costa San Mateo COE 12/13-2 Err:520 $ 46,534 $ 34,901 $ 11,633
277 Contra Costa San Mateo COE 12/13-3 Err:520 $ 43,384 $ 32,538 $ 10,846
278 Contra Costa San Mateo COE 12/13-4 Err:520 $ 40,759 $ 30,569 $ 10,190
279 San Mateo COE Total $ 558,376 $ 279,803 $ 278,573 $ 432,978 $ 173,191 $ (259,787) $ 20,016 1.10% Err:502 Err:502 $ 832.18 $ 1,656.71 $ 2.63 $ 691.71 $ 2,072.79 $ 107.00
280 Contra Costa San Mateo Foster City 10/11-2 2013-Q1 $ - $ - ### $ 31,352 $ 25,000 $ (6,352) 2
281 Contra Costa San Mateo Foster City 11/12-2 Err:520 $ 31,641 $ 25,000 $ 6,641 $ - ### $ - 2
282 San Mateo Foster City Total $ 31,641 $ 25,000 $ 6,641 $ 31,352 $ 25,000 $ (6,352) $ 18,648 1.03% Err:502 Err:502 $ 775.30 $ 1,543.48 $ 2.45 $ 644.44 $ 1,931.13 $ 99.68
283 Contra Costa San Rafael City School 09/10-4 2012-Q3 $ - $ - ### $ 27,948 $ 27,948 $ -
284 San Rafael City School Total $ - $ - $ - $ 27,948 $ 27,948 $ - $ -
285 Contra Costa Sequoia UHSD 10/11-1 2012-Q4 $ - $ - ### $ 82,488 $ 32,995 $ (49,493)
286 Contra Costa Sequoia UHSD 10/11-2 2013-Q1 $ - $ - ### $ 294,354 $ 117,742 $ (176,612)
287 Contra Costa Sequoia UHSD 11/12-2 Err:520 $ 69,917 $ 27,967 $ 41,950 $ - ### $ -
288 Contra Costa Sequoia UHSD 10/11-3 2013-Q2 $ - $ - ### $ 205,681 $ 82,272 $ (123,409)
289 Contra Costa Sequoia UHSD 11/12-3 Err:520 $ 36,908 $ 27,681 $ 9,227 $ - ### $ - 2
290 Contra Costa Sequoia UHSD 10/11-4 2013-Q3 $ - $ - ### $ 205,241 $ 82,096 $ (123,145)
291 Contra Costa Sequoia UHSD 11/12-4 Err:520 $ 81,951 $ 32,780 $ 49,171 $ - ### $ -
292 Contra Costa Sequoia UHSD 12/13-1 Err:520 $ 29,751 $ 22,313 $ 7,438
293 Contra Costa Sequoia UHSD 12/13-2 Err:520 $ 79,287 $ 31,715 $ 47,572
294 Contra Costa Sequoia UHSD 12/13-3 Err:520 $ 59,080 $ 23,632 $ 35,448
295 Contra Costa Sequoia UHSD 13/14-1 Err:520 $ 14,255 $ 12,830 $ 1,425
296 Contra Costa Sequoia UHSD 13/14-2 Err:520 $ 38,943 $ 29,207 $ 9,736
297 Contra Costa Sequoia UHSD 13/14-3 Err:520 $ 38,259 $ 28,694 $ 9,565
298 Contra Costa Sequoia UHSD 13/14-4 Err:520 $ 18,106 $ 16,295 $ 1,811
299 Contra Costa Sequoia UHSD 12/13-4 Err:520 $ 42,301 $ 31,726 $ 10,575
300 Sequoia UHSD Total $ 508,758 $ 284,840 $ 223,918 $ 787,764 $ 315,105 $ (472,659) $ (187,819) 38.65%
301 Contra Costa So. San Francisco USD 10/11-1 2012-Q4 $ - $ - ### $ 27,819 $ 25,000 $ (2,819) 2
302 Contra Costa So. San Francisco USD 10/11-2 2013-Q1 $ - $ - ### $ 66,144 $ 26,458 $ (39,686)
303 Contra Costa So. San Francisco USD 11/12-2 Err:520 $ 82,975 $ 33,190 $ 49,785 $ - ### $ -
304 Contra Costa So. San Francisco USD 10/11-3 2013-Q2 $ - $ - ### $ 53,040 $ 21,216 $ (31,824)
305 Contra Costa So. San Francisco USD 11/12-3 Err:520 $ 52,857 $ 21,143 $ 31,714 $ - ### $ -
306 Contra Costa So. San Francisco USD 10/11-4 2013-Q3 $ - $ - ### $ 48,272 $ 36,204 $ (12,068) 2
307 Contra Costa So. San Francisco USD 11/12-4 Err:520 $ 36,976 $ 27,732 $ 9,244 $ - ### $ - 2
308 Contra Costa So. San Francisco USD 12/13-1 Err:520 $ 2,436 $ 2,192 $ 244
309 Contra Costa So. San Francisco USD 12/13-2 Err:520 $ 16,993 $ 15,294 $ 1,699
310 So. San Francisco USD Total $ 192,237 $ 99,551 $ 92,686 $ 195,275 $ 108,878 $ (86,397) $ 13,154 0.73% Err:502 Err:502 $ 546.89 $ 1,088.75 $ 1.73 $ 454.57 $ 1,362.19 $ 70.31
311 Contra Costa Travis USD 10/11-2 2013-Q1 $ - $ - ### $ 38,781 $ 29,086 $ (9,695) 2
312 Travis USD Total $ - $ - $ - $ 38,781 $ 29,086 $ (9,695) $ (9,695) 2.00%
313 Contra Costa Vacaville USD 10/11-1 2012-Q4 $ - $ - ### $ 30,563 $ 25,000 $ (5,563) 2
314 Contra Costa Vacaville USD 11/12-1 Err:520 $ 38,071 $ 28,553 $ 9,518 $ - ### $ - 2
315 Contra Costa Vacaville USD 10/11-2 2013-Q1 $ - $ - ### $ 42,687 $ 32,015 $ (10,672) 2
316 Contra Costa Vacaville USD 11/12-2 Err:520 $ 37,239 $ 27,929 $ 9,310 $ - ### $ - 2
317 Contra Costa Vacaville USD 10/11-3 2013-Q2 $ - $ - ### $ 37,844 $ 28,383 $ (9,461) 2
318 Contra Costa Vacaville USD 11/12-3 Err:520 $ 41,365 $ 31,024 $ 10,341 $ - ### $ - 2
319 Contra Costa Vacaville USD 10/11-4 2013-Q3 $ - $ - ### $ 38,165 $ 28,624 $ (9,541) 2
320 Contra Costa Vacaville USD 11/12-4 Err:520 $ 46,576 $ 34,932 $ 11,644 $ - ### $ - 2
321 Vacaville USD Total $ 163,251 $ 122,438 $ 40,813 $ 149,259 $ 114,022 $ (35,237) $ 87,201 4.81% Err:502 Err:502 $ 3,625.44 $ 7,217.56 $ 11.44 $ 3,013.48 $ 9,030.26 $ 466.13
322 Contra Costa West Contra Costa USD 10/11-1 2012-Q4 $ - $ - ### $ 115,632 $ 46,253 $ (69,379)
323 Contra Costa West Contra Costa USD 11/12-1 Err:520 $ 134,435 $ 53,774 $ 80,661 $ - ### $ -
324 Contra Costa West Contra Costa USD 10/11-2 2013-Q1 $ - $ - ### $ 134,637 $ 53,855 $ (80,782)
325 Contra Costa West Contra Costa USD 11/12-2 Err:520 $ 178,071 $ 71,228 $ 106,843 $ - ### $ -
326 Contra Costa West Contra Costa USD 10/11-3 2013-Q2 $ - $ - ### $ 151,565 $ 60,626 $ (90,939)
327 Contra Costa West Contra Costa USD 11/12-3 Err:520 $ 157,972 $ 63,189 $ 94,783 $ - ### $ -
A B C D E F G H I J K L M N O P Q R S T U
2
Total amount
Amount to be recouped Amount to withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + release to 2013 and CUs in Option (insert 1 City College of San
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Brentwood Union SD Francisco Martinez USD Redwood City ESD Sequoia UHSD Travis USD
328 Contra Costa West Contra Costa USD 10/11-4 2013-Q3 $ - $ - ### $ 163,421 $ 65,368 $ (98,053)
329 Contra Costa West Contra Costa USD 11/12-4 Err:520 $ 176,204 $ 70,482 $ 105,722 $ - ### $ -
330 Contra Costa West Contra Costa USD 12/13-1 Err:520 $ 75,536 $ 30,214 $ 45,322
331 Contra Costa West Contra Costa USD 12/13-2 Err:520 $ 67,587 $ 27,035 $ 40,552
332 Contra Costa West Contra Costa USD 12/13-3 Err:520 $ 72,313 $ 28,925 $ 43,388
333 West Contra Costa USD Total $ 862,118 $ 344,847 $ 517,271 $ 565,255 $ 226,102 $ (339,153) $ 5,694 0.31% Err:502 Err:502 $ 236.73 $ 471.29 $ 0.75 $ 196.77 $ 589.65 $ 30.44
334 Grand Total Contra Costa LEC Err:502 Err:502 Err:502 $ 9,095,028 $ 4,437,219 $ (4,657,809) Err:502 Err:520 Err:520 Err:502 $ 75,405 $ 150,117 $ 238 $ 62,677 $ 187,819 $ 9,695
335 The sum of Column N equals the sum of "Column K" (Net Total) minus
336 the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
337 Column A County - Reporting LEC/LGA
338 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12 Pro-Rata Table
339 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Check Total Err:502 <-- Enter check total here
340 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed Sum of Net Green $ 1,813,681
341 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment Sum of Net Red $ (485,951)
342 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made
343 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
344 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
345 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
346 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
347 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
348 The last subtotal amount is the final amount due to/from the LEC/LGA
349 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
350 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
351 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
352 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
353 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
354
357 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
358 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
359
360 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
361 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
362 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
363 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
364
1 Amount to be recouped
from paid deferred
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Amount to be Released Original Paid Deferred Settlement Amount claims (Due Back to Net (Column F + Option (insert 1
County Claiming Unit FY/QTR FFY/QTR (Placehled) Placeholder Amount Placeholders Due to LEC/LGA from Placeholder Amount for Paid Deferred DHCS) Column J) or 2) Placeholder Number
2 Fresno LGA Central USD 10/11-1 2012-Q4 $ - $ - ### $ 74,641 $ 74,641 $ -
3 Fresno LGA Central USD 10/11-2 2013-Q1 $ - $ - ### $ 114,850 $ 114,850 $ -
4 Fresno LGA Central USD 09/10-4 2012-Q3 $ - $ - ### $ 77,472 $ 77,472 $ -
5 Fresno LGA Central USD 11/12-4 Err:520 $ - $ - $ - ### $ -
6 Central USD Total $ - $ - $ - $ 266,963 $ 266,963 $ - $ -
7 Fresno LGA Clovis USD 10/11-3 Err:520 $ 219,223 $ 87,689 $ 131,534 $ - ### $ - 670
8 Fresno LGA Clovis USD 10/11-1 2012-Q4 $ - $ - ### $ 190,559 $ 76,224 $ (114,335)
9 Fresno LGA Clovis USD 11/12-1 Err:520 $ 161,506 $ 64,602 $ 96,904 $ - ### $ - 1509
10 Fresno LGA Clovis USD 10/11-2 2013-Q1 $ - $ - ### $ 282,093 $ 112,837 $ (169,256)
11 Fresno LGA Clovis USD 11/12-2 Err:520 $ 255,125 $ 102,050 $ 153,075 $ - ### $ - 2258
12 Fresno LGA Clovis USD 11/12-3 Err:520 $ 186,640 $ 74,656 $ 111,984 $ - ### $ - 3060
13 Fresno LGA Clovis USD 09/10-4 2012-Q3 $ - $ - ### $ 293,830 $ 117,532 $ (176,298)
14 Fresno LGA Clovis USD 10/11-4 Err:520 $ 228,914 $ 91,566 $ 137,348 $ - ### $ - 995
15 Fresno LGA Clovis USD 11/12-4 Err:520 $ 201,381 $ 80,552 $ 120,829 $ - ### $ - 3855
16 Clovis USD Total $ 1,252,789 $ 501,115 $ 751,674 $ 766,482 $ 306,593 $ (459,889) $ 41,226
17 Fresno LGA Firebaugh-Las Deltas USD 09/10-4 2012-Q3 $ - ### $ 41,493 $ 31,120 $ (10,373) 2
18 Madera - LEC Firebaugh Las Deltas USD 12/13-1 Err:520 $ 19,641 $ 17,677 $ 1,964 4894
19 Firebaugh-Las Deltas USD Total $ 19,641 $ 17,677 $ 1,964 $ 41,493 $ 31,120 $ (10,373) $ 7,304
20 Fresno LGA Kings Canyon Joint USD 10/11-1 2012-Q4 $ - $ - ### $ 99,932 $ 39,973 $ (59,959)
21 Fresno LGA Kings Canyon Joint USD 10/11-2 2013-Q1 $ - $ - ### $ 137,153 $ 54,861 $ (82,292)
22 Fresno LGA Kings Canyon Joint USD 11/12-2 Err:520 $ 93,763 $ 37,505 $ 56,258 $ - ### $ - 2259
23 Fresno LGA Kings Canyon Joint USD 10/11-3 Err:520 $ 103,074 $ 41,230 $ 61,844 $ - ### $ - 671
24 Fresno LGA Kings Canyon Joint USD 11/12-3 Err:520 $ 92,679 $ 37,072 $ 55,607 $ - ### $ - 3061
25 Fresno LGA Kings Canyon Joint USD 09/10-4 2012-Q3 $ - $ - ### $ 114,692 $ 45,877 $ (68,815)
26 Fresno LGA Kings Canyon Joint USD 10/11-4 Err:520 $ 115,878 $ 46,351 $ 69,527 $ - ### $ - 996
27 Fresno LGA Kings Canyon Joint USD 11/12-1 Err:520 $ 78,229 $ 31,292 $ 46,937 $ - ### $ - 1465,1470,1491,1730,1732 1465 1470 1491 1730 1732
28 Fresno LGA Kings Canyon Joint USD 11/12-4 Err:520 $ 78,463 $ 31,385 $ 47,078 $ - ### $ - 3857 $ 3,061 $ 13,098 $ 3,360 $ 11,061 $ 712
29 Kings Canyon Joint USD Total $ 562,086 $ 224,835 $ 337,251 $ 351,777 $ 140,711 $ (211,066) $ 13,769
30 Fresno LGA Selma USD 11/12-1 Err:520 $ 41,816 $ 31,362 $ 10,454 $ - ### $ - 2 1510
31 Fresno LGA Selma USD 10/11-2 2013-Q1 $ - $ - ### $ 70,259 $ 28,104 $ (42,155)
32 Fresno LGA Selma USD 11/12-2 Err:520 $ 98,301 $ 39,320 $ 58,981 $ - ### $ - 2260
33 Fresno LGA Selma USD 10/11-3 2013-Q2 $ - $ - ### $ 62,680 $ 25,072 $ (37,608)
34 Fresno LGA Selma USD 11/12-3 Err:520 $ 94,374 $ 37,750 $ 56,624 $ - ### $ - 3062
35 Fresno LGA Selma USD 11/12-4C-1 Err:520 $ 106,177 $ 42,471 $ 63,706 $ - ### $ - 3855 3855
36 Fresno LGA Selma USD 10/11-4 2013-Q3 $ - $ - ### $ 65,255 $ 26,102 $ (39,153) $ 42,471
37 Selma USD Total $ 340,668 $ 150,903 $ 189,765 $ 198,194 $ 79,278 $ (118,916) $ 31,987
38 Fresno LGA West Hills Community College 10/11-1 2012-Q4 $ - $ - ### $ 139,173 $ 55,669 $ (83,504)
39 Fresno LGA West Hills Community College 11/12-1 Err:520 $ 67,434 $ 26,974 $ 40,460 $ - ### $ - 1512
40 Fresno LGA West Hills Community College 10/11-2 2013-Q1 $ - $ - ### $ 103,441 $ 41,376 $ (62,065)
41 Fresno LGA West Hills Community College 11/12-2 Err:520 $ 54,895 $ 21,958 $ 32,937 $ - ### $ - 2262
42 Fresno LGA West Hills Community College 10/11-3 Err:520 $ 86,667 $ 34,667 $ 52,000 $ - ### $ - 673
43 Fresno LGA West Hills Community College 11/12-3 Err:520 $ 65,496 $ 26,198 $ 39,298 $ - ### $ - 3064
44 Fresno LGA West Hills Community College 10/11-4 Err:520 $ 108,532 $ 43,413 $ 65,119 $ - ### $ - 1105,1123,1299 1105 1123 1299
45 Fresno LGA West Hills Community College 11/12-4 Err:520 $ 64,202 $ 25,681 $ 38,521 $ - ### $ - 3860 $ 1,454 $ 4,435 $ 37,524
46 West Hills Community College Total $ 447,226 $ 178,891 $ 268,335 $ 242,614 $ 97,045 $ (145,569) $ 33,322
47 Grand Total $ 2,622,410 $ 1,073,421 $ 1,548,989 $ 1,867,523 $ 921,710 $ (945,813) $ 127,608
48
49
50 Column A County - Reporting LEC/LGA
51 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12
52 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number
53 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed
54 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment
55 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made
56 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
57 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
58 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
59 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
60 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
61 The last subtotal amount is the final amount due to/from the LEC/LGA
62 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
63
64 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
65 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
66 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
67
70 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
71 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
72
73 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
74 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
75 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
76 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
77
1
Pro-Rata Net Negative Distribution Table
2 Total amount
Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Amount to release to 2013 and CUs in Option (insert 1 Red Bluff Joint Union University Preparatory
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Chico USD Enterprise USD Gridley USD Orland USD Oroville Union HSD Paradise USD HSD Shasta Union HSD Trinity Alps USD School
3 Glenn Academy of Personalized Learning 09/10-2 2012-Q1 $ - $ - ### $ 26,439 $ 25,000 $ (1,439) 2
4 Glenn Academy of Personalized Learning 9/10-3 2012-Q2 $ 15,645
5 Glenn Academy of Personalized Learning 11/12-4 Err:520 $ 25,049 $ 25,000 $ 49 $ - ### $ - 2
6 Academy of Personalized Learning Total $ 40,694 $ 25,000 $ 49 $ 26,439 $ 25,000 $ (1,439) $ 23,561 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
7 Glenn Anderson Union HSD 11/12-1 Err:520 $ 68,523 $ 27,409 $ 41,114 $ - ### $ -
8 Glenn Anderson Union HSD 11/12-2 Err:520 $ 95,949 $ 38,380 $ 57,569 $ - ### $ -
9 Glenn Anderson Union HSD 11/12-3 Err:520 $ 96,926 $ 38,770 $ 58,156 $ - ### $ -
10 Glenn Anderson Union HSD 10/11-4 2013-Q3 $ - $ - ### $ 76,864 $ 30,746 $ (46,118)
11 Glenn Anderson Union HSD 11/12-4 Err:520 $ 70,753 $ 28,301 $ 42,452 $ - ### $ -
12 Anderson Union HSD Total $ 332,151 $ 132,860 $ 199,291 $ 76,864 $ 30,746 $ (46,118) $ 86,742 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
13 Glenn Butte COE 10/11-1 2012-Q4 $ - $ - ### $ 112,841 $ 45,136 $ (67,705)
14 Glenn Butte COE 9/10-3 2012-Q2 $ 152,467
15 Glenn Butte COE 11/12-1 Err:520 $ 89,035 $ 35,614 $ 53,421 $ - ### $ -
16 Glenn Butte COE 09/10-2 2012-Q1 $ - $ - ### $ 123,525 $ 49,410 $ (74,115)
17 Glenn Butte COE 10/11-2 2013-Q1 $ - $ - ### $ 132,524 $ 53,010 $ (79,514)
18 Glenn Butte COE 11/12-2 Err:520 $ 133,833 $ 53,533 $ 80,300 $ - ### $ -
19 Glenn Butte COE 10/11-3 Err:520 $ 101,803 $ 40,721 $ 61,082 $ - ### $ -
20 Glenn Butte COE 11/12-3 Err:520 $ 108,865 $ 43,546 $ 65,319 $ - ### $ -
21 Glenn Butte COE 09/10-4 2012-Q3 $ - $ - ### $ 172,698 $ 69,079 $ (103,619)
22 Glenn Butte COE 10/11-4 Err:520 $ 69,732 $ 27,893 $ 41,839 $ - ### $ -
23 Glenn Butte COE 11/12-4 Err:520 $ 62,722 $ 25,089 $ 37,633 $ - ### $ -
24 Glenn Butte COE 12/13-1 Err:520 $ 34,877 $ 26,158 $ 8,719
25 Glenn Butte COE 12/13-3 Err:520 $ 29,795 $ 22,346 $ 7,449
26 Glenn Butte COE 12/13-4 Err:520 $ 29,469 $ 22,102 $ 7,367
27 Glenn Butte COE 13/14-1 Err:520 $ 5,507 $ 4,956 $ 551
28 Glenn Butte COE 13/14-2 Err:520 $ 25,073 $ 18,805 $ 6,268
29 Glenn Butte COE 12/13-2 Err:520 $ 30,338 $ 22,754 $ 7,584
30 Butte COE Total $ 873,516 $ 343,517 $ 377,532 $ 541,588 $ 216,635 $ (324,953) $ 18,564 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
31 Glenn Cascade Union ESD 10/11-1 2012-Q4 $ - $ - ### $ 36,395 $ 27,296 $ (9,099)
32 Glenn Cascade Union ESD 11/12-1 Err:520 $ 32,313 $ 25,000 $ 7,313 $ - ### $ - 2
33 Glenn Cascade Union ESD 10/11-2 2013-Q1 $ - $ - ### $ 38,990 $ 29,243 $ (9,747)
34 Glenn Cascade Union ESD 11/12-2 Err:520 $ 40,924 $ 30,693 $ 10,231 $ - ### $ -
35 Glenn Cascade Union ESD 11/12-3 Err:520 $ 38,139 $ 28,604 $ 9,535 $ - ### $ -
36 Glenn Cascade Union ESD 09/10-4 2012-Q3 $ - $ - ### $ 47,845 $ 35,884 $ (11,961)
37 Glenn Cascade Union ESD 10/11-4 2013-Q3 $ - $ - ### $ 31,376 $ 23,532 $ (7,844)
38 Glenn Cascade Union ESD 11/12-4 Err:520 $ 37,672 $ 28,254 $ 9,418 $ - ### $ -
39 Glenn Cascade Union ESD 10/11-3C1 Err:520 $ 30,494 $ 25,000 $ 5,494 $ - ### $ - 2
40 Cascade Union ESD Total $ 179,542 $ 137,551 $ 41,991 $ 154,606 $ 115,955 $ (38,651) $ 98,900 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
41 Glenn Chico USD 10/11-1 2012-Q4 $ - $ - ### $ 249,011 $ 99,604 $ (149,407)
42 Glenn Chico USD 11/12-1 Err:520 $ 219,156 $ 87,662 $ 131,494 $ - ### $ -
43 Glenn Chico USD 10/11-2 2013-Q1 $ - $ - ### $ 431,264 $ 172,506 $ (258,758)
44 Glenn Chico USD 11/12-2 Err:520 $ 259,886 $ 103,954 $ 155,932 $ - ### $ -
45 Glenn Chico USD 10/11-3 2013-Q2 $ - $ - ### $ 307,172 $ 122,869 $ (184,303)
46 Glenn Chico USD 11/12-3 Err:520 $ 267,521 $ 107,008 $ 160,513 $ - ### $ -
47 Glenn Chico USD 09/10-4 2012-Q3 $ - $ - ### $ 266,005 $ 106,402 $ (159,603)
48 Glenn Chico USD 10/11-4 2013-Q3 $ - $ - ### $ 227,657 $ 91,063 $ (136,594)
49 Glenn Chico USD 11/12-4 Err:520 $ 193,200 $ 77,280 $ 115,920 $ - ### $ -
50 Glenn Chico USD 12/13-1 Err:520 $ 59,216 $ 23,686 $ 35,530
51 Glenn Chico USD 12/13-2 Err:520 $ 67,029 $ 26,812 $ 40,217
52 Glenn Chico USD 12/13-3C-1 2015-Q2 $ 78,582 $ 31,433 $ 47,149
53 Glenn Chico USD 13/14-1 Err:520 $ 9,152 $ 8,237 $ 915
54 Glenn Chico USD 13/14-2 Err:520 $ 30,244 $ 22,683 $ 7,561
55 Glenn Chico USD 13/14-3 Err:520 $ 24,150 $ 21,735 $ 2,415
56 Glenn Chico USD 13/14-4 Err:520 $ 26,458 $ 19,844 $ 6,614
57 Glenn Chico USD 12/13-4 Err:520 $ 30,465 $ 22,849 $ 7,616
58 Chico USD Total $ 1,265,059 $ 553,183 $ 711,876 $ 1,481,109 $ 592,444 $ (888,665) $ (335,482) 38.09%
59 Glenn Columbia ESD 10/11-2 2013-Q1 $ - $ - ### $ 28,005 $ 25,000 $ (3,005) 2
60 Glenn Columbia ESD 11/12-2 Err:520 $ 30,861 $ 25,000 $ 5,861 $ - ### $ - 2
61 Glenn Columbia ESD 11/12-3 Err:520 $ 27,490 $ 25,000 $ 2,490 $ - ### $ - 2
62 Glenn Columbia ESD 09/10-4 2012-Q3 $ - $ - ### $ 61,406 $ 24,562 $ (36,844)
63 Glenn Columbia ESD 11/12-4 Err:520 $ 26,945 $ 25,000 $ 1,945 $ - ### $ - 2
64 Columbia ESD Total $ 85,296 $ 75,000 $ 10,296 $ 89,411 $ 49,562 $ (39,849) $ 35,151 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
65 Glenn Corning Union ESD 10/11-1 2012-Q4 $ - $ - ### $ 31,007 $ 21,705 $ (9,302)
66 Glenn Corning Union ESD 11/12-1 Err:520 $ 28,593 $ 20,015 $ 8,578 $ - ### $ -
67 Glenn Corning Union ESD 10/11-2 2013-Q1 $ - $ - ### $ 41,068 $ 28,748 $ (12,320)
68 Glenn Corning Union ESD 11/12-2 Err:520 $ 38,042 $ 26,629 $ 11,413 $ - ### $ -
69 Glenn Corning Union ESD 10/11-3 2013-Q2 $ - $ - ### $ 35,251 $ 24,676 $ (10,575)
70 Glenn Corning Union ESD 11/12-3 Err:520 $ 25,268 $ 17,688 $ 7,580 $ - ### $ -
71 Glenn Corning Union ESD 10/11-4 2013-Q3 $ - $ - ### $ 37,084 $ 25,959 $ (11,125)
72 Glenn Corning Union ESD 11/12-4 Err:520 $ 36,449 $ 25,514 $ 10,935 $ - ### $ -
73 Corning Union ESD Total $ 128,352 $ 89,846 $ 38,506 $ 144,410 $ 101,088 $ (43,322) $ 46,524 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
74 Glenn Corning Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 37,719 $ 28,289 $ (9,430)
75 Glenn Corning Union HSD 11/12-1 Err:520 $ 32,085 $ 25,000 $ 7,085 $ - ### $ - 2
76 Glenn Corning Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 49,811 $ 37,358 $ (12,453)
77 Glenn Corning Union HSD 11/12-2 Err:520 $ 40,664 $ 30,498 $ 10,166 $ - ### $ -
78 Glenn Corning Union HSD 10/11-3 2013-Q2 $ - $ - ### $ 44,597 $ 33,448 $ (11,149)
79 Glenn Corning Union HSD 11/12-3 Err:520 $ 38,113 $ 28,585 $ 9,528 $ - ### $ -
80 Glenn Corning Union HSD 10/11-4 2013-Q3 $ - $ - ### $ 45,130 $ 33,848 $ (11,282)
81 Glenn Corning Union HSD 11/12-4 Err:520 $ 41,356 $ 31,017 $ 10,339 $ - ### $ -
82 Corning Union HSD Total $ 152,218 $ 115,100 $ 37,118 $ 177,257 $ 132,943 $ (44,314) $ 70,786 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
83 Glenn Cottonwood Union SD 09/10-4 2012-Q3 $ - $ - ### $ 34,219 $ 25,664 $ (8,555)
84 Glenn Cottonwood Union SD 12/13-1 Err:520 $ 3,117 $ 2,805 $ 312
85 Glenn Cottonwood Union SD 12/13-2 Err:520 $ 6,999 $ 6,299 $ 700
86 Cottonwood Union SD Total $ 10,116.00 $ 9,104.00 $ 1,012.00 $ 34,219 $ 25,664 $ (8,555) $ 549 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
87 Glenn Durham USD 11/12-2 Err:520 $ 45,443 $ 34,082 $ 11,361 $ - ### $ -
88 Glenn Durham USD 10/11-3 2013-Q2 $ - $ - ### $ 33,627 $ 25,220 $ (8,407)
89 Glenn Durham USD 11/12-3 Err:520 $ 35,441 $ 26,581 $ 8,860 $ - ### $ -
90 Glenn Durham USD 10/11-4 2013-Q3 $ - $ - ### $ 27,420 $ 25,000 $ (2,420) 2
91 Glenn Durham USD 11/12-4 Err:520 $ 26,067 $ 25,000 $ 1,067 $ - ### $ - 2
92 Durham USD Total $ 106,951 $ 85,663 $ 21,288 $ 61,047 $ 50,220 $ (10,827) $ 74,836 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
93 Glenn Enterprise ESD 10/11-1 2012-Q4 $ - $ - ### $ 49,850 $ 37,388 $ (12,462)
94 Glenn Enterprise ESD 11/12-1 Err:520 $ 49,792 $ 37,344 $ 12,448 $ - ### $ -
95 Glenn Enterprise ESD 10/11-2 2013-Q1 $ - $ - ### $ 57,752 $ 23,101 $ (34,651)
96 Glenn Enterprise ESD 11/12-2 Err:520 $ 56,214 $ 22,486 $ 33,728 $ - ### $ -
97 Glenn Enterprise ESD 10/11-3 2013-Q2 $ - $ - ### $ 51,759 $ 20,704 $ (31,055)
98 Glenn Enterprise ESD 11/12-3 Err:520 $ 57,420 $ 22,968 $ 34,452 $ - ### $ -
99 Glenn Enterprise ESD 09/10-4 2012-Q3 $ - $ - ### $ 110,671 $ 44,268 $ (66,403)
100 Glenn Enterprise ESD 10/11-4 2013-Q3 $ - $ - ### $ 51,348 $ 20,539 $ (30,809)
101 Glenn Enterprise ESD 11/12-4 Err:520 $ 53,080 $ 21,232 $ 31,848 $ - ### $ -
102 Glenn Enterprise ESD 12/13-1 Err:520 $ 6,126 $ 5,513 $ 613
103 Glenn Enterprise ESD 12/13-2 Err:520 $ 9,153 $ 8,238 $ 915
104 Glenn Enterprise ESD 12/13-3 Err:520 $ 5,845 $ 5,261 $ 584
105 Glenn Enterprise ESD 13/14-1 Err:520 $ 1,889 $ 1,700 $ 189
106 Glenn Enterprise ESD 13/14-2 Err:520 $ 6,086 $ 5,477 $ 609
107 Glenn Enterprise ESD 13/14-3 Err:520 $ 5,414 $ 4,873 $ 541
108 Glenn Enterprise ESD 13/14-4 Err:520 $ 4,159 $ 3,743 $ 416
109 Glenn Enterprise ESD 12/13-4 Err:520 $ 6,332 $ 5,699 $ 633
110 Enterprise ESD Total $ 261,510 $ 144,534 $ 116,976 $ 321,380 $ 146,000 $ (175,380) $ (30,846) 3.50%
111 Glenn Evergreen Union ESD 10/11-1 2012-Q4 $ - $ - ### $ 27,052 $ 25,000 $ (2,052) 2
112 Glenn Evergreen Union ESD 11/12-1 Err:520 $ 25,261 $ 25,000 $ 261 $ - ### $ - 2
113 Glenn Evergreen Union ESD 10/11-2 2013-Q1 $ - $ - ### $ 33,188 $ 25,000 $ (8,188) 2
114 Glenn Evergreen Union ESD 11/12-2 Err:520 $ 32,197 $ 25,000 $ 7,197 $ - ### $ - 2
115 Glenn Evergreen Union ESD 10/11-3 2013-Q2 $ - $ - ### $ 33,119 $ 25,000 $ (8,119) 2
116 Glenn Evergreen Union ESD 11/12-3 Err:520 $ 36,181 $ 27,136 $ 9,045 $ - ### $ -
117 Glenn Evergreen Union ESD 10/11-4 2013-Q3 $ - $ - ### $ 43,324 $ 32,493 $ (10,831)
118 Evergreen Union ESD Total $ 93,639.00 $ 77,136.00 $ 16,503.00 $ 136,683 $ 107,493 $ (29,190) $ 47,946 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
119 Glenn Gateway USD 10/11-1 2012-Q4 $ - $ - ### $ 105,478 $ 42,191 $ (63,287)
120 Glenn Gateway USD 11/12-1 Err:520 $ 126,154 $ 50,462 $ 75,692 $ - ### $ -
121 Glenn Gateway USD 10/11-2 2013-Q1 $ - $ - ### $ 165,537 $ 66,215 $ (99,322)
122 Glenn Gateway USD 11/12-2 Err:520 $ 151,508 $ 60,603 $ 90,905 $ - ### $ -
123 Glenn Gateway USD 10/11-3 2013-Q2 $ - $ - ### $ 175,388 $ 70,155 $ (105,233)
124 Glenn Gateway USD 11/12-3 Err:520 $ 147,543 $ 59,017 $ 88,526 $ - ### $ -
125 Glenn Gateway USD 10/11-4 2013-Q3 $ - $ - ### $ 177,869 $ 71,148 $ (106,721)
126 Glenn Gateway USD 11/12-4 Err:520 $ 154,895 $ 61,958 $ 92,937 $ - ### $ -
127 Glenn Gateway USD 12/13-1 Err:520 $ 40,516 $ 30,387 $ 10,129
128 Glenn Gateway USD 12/13-2 Err:520 $ 49,036 $ 36,777 $ 12,259
129 Glenn Gateway USD 12/13-3 Err:520 $ 41,642 $ 31,232 $ 10,410
130 Glenn Gateway USD 13/14-1 Err:520 $ 18,308 $ 16,477 $ 1,831
131 Glenn Gateway USD 13/14-2 Err:520 $ 35,522 $ 26,642 $ 8,880
A B C D E F G H I J K L M N O P Q R S T U V W X Y
2 Total amount
Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Amount to release to 2013 and CUs in Option (insert 1 Red Bluff Joint Union University Preparatory
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Chico USD Enterprise USD Gridley USD Orland USD Oroville Union HSD Paradise USD HSD Shasta Union HSD Trinity Alps USD School
132 Glenn Gateway USD 12/13-4 Err:520 $ 66,476 $ 26,590 $ 39,886
133 Gateway USD Total $ 831,600 $ 400,145 $ 431,455 $ 624,272 $ 249,709 $ (374,563) $ 25,582 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
134 Glenn Glenn COE 10/11-2 Err:520 $ 31,116 $ 23,337 $ 7,779 $ - ### $ - 1
135 Glenn Glenn COE 11/12-2 Err:520 $ 33,713 $ 25,285 $ 8,428 $ - ### $ - 1
136 Glenn Glenn COE 11/12-3 Err:520 $ 33,511 $ 25,133 $ 8,378 $ - ### $ - 1
137 Glenn Glenn COE 11/12-4 Err:520 $ 35,471 $ 26,603 $ 8,868 $ - ### $ - 1
138 Glenn COE Total $ 133,811 $ 100,358 $ 33,453 $ - $ - $ - $ 100,358 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
139 Glenn Gridley USD 10/11-1 2012-Q4 $ - $ - ### $ 34,303 $ 25,727 $ (8,576)
140 Glenn Gridley USD 10/11-2 2013-Q1 $ - $ - ### $ 62,977 $ 25,191 $ (37,786)
141 Glenn Gridley USD 11/12-2 Err:520 $ 50,637 $ 20,255 $ 30,382 $ - ### $ -
142 Glenn Gridley USD 10/11-3 2013-Q2 $ - $ - ### $ 55,522 $ 22,209 $ (33,313)
143 Glenn Gridley USD 11/12-3 Err:520 $ 40,353 $ 30,265 $ 10,088 $ - ### $ -
144 Glenn Gridley USD 09/10-4 2012-Q3 $ - $ - ### $ 124,199 $ 49,680 $ (74,519)
145 Glenn Gridley USD 10/11-4 2013-Q3 $ - $ - ### $ 46,715 $ 35,036 $ (11,679)
146 Glenn Gridley USD 11/12-4 Err:520 $ 45,197 $ 33,898 $ 11,299 $ - ### $ -
147 Glenn Gridley USD 12/13-1 Err:520 $ 7,379 $ 6,641 $ 738
148 Glenn Gridley USD 12/13-2 Err:520 $ 20,025 $ 18,023 $ 2,002
149 Glenn Gridley USD 13/14-1 Err:520 $ 5,059 $ 4,553 $ 506
150 Glenn Gridley USD 13/14-2 Err:520 $ 10,623 $ 9,561 $ 1,062
151 Glenn Gridley USD 13/14-3 Err:520 $ 7,439 $ 6,695 $ 744
152 Glenn Gridley USD 13/14-4 Err:520 $ 9,041 $ 8,137 $ 904
153 Glenn Gridley USD 12/13-4 Err:520 $ 8,842 $ 7,958 $ 884
154 Glenn Gridley USD 12/13-3 Err:520 $ 19,647 $ 17,682 $ 1,965
155 Gridley USD Total $ 224,242 $ 163,668 $ 60,574 $ 323,716 $ 157,843 $ (165,873) $ (2,205) 0.25%
156 Glenn Hamilton USD 10/11-2 Err:520 $ 29,277 $ 25,000 $ 4,277 $ - ### $ - 2
157 Glenn Hamilton USD 11/12-2 Err:520 $ 31,463 $ 25,000 $ 6,463 $ - ### $ - 2
158 Glenn Hamilton USD 09/10-3 2012-Q2 $ - $ - ### $ 36,154 $ 27,116 $ (9,038)
159 Glenn Hamilton USD 10/11-3 Err:520 $ 35,544 $ 26,658 $ 8,886 $ - ### $ -
160 Glenn Hamilton USD 11/12-3 Err:520 $ 26,704 $ 25,000 $ 1,704 $ - ### $ - 2
161 Glenn Hamilton USD 09/10-4 2012-Q3 $ - $ - ### $ 48,250 $ 36,188 $ (12,062)
162 Hamilton USD Total $ 122,988.00 $ 101,658.00 $ 21,330.00 $ 84,404 $ 63,304 $ (21,100) $ 80,558 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
163 Glenn Lassen COE 10/11-2 Err:520 $ 31,967 $ 25,000 $ 6,967 $ - ### $ - 2
164 Glenn Lassen COE 11/12-2 Err:520 $ - ### $ -
165 Glenn Lassen COE 09/10-3 2012-Q2 $ - $ - ### $ 41,160 $ 30,870 $ (10,290)
166 Glenn Lassen COE 10/11-3 Err:520 $ 29,282 $ 25,000 $ 4,282 $ - ### $ - 2
167 Glenn Lassen COE 11/12-3 Err:520 $ - $ - ### $ 30,348 $ 25,000 $ (5,348) 2
168 Glenn Lassen COE 09/10-4 2012-Q3 $ - $ - ### $ 54,464 $ 21,786 $ (32,678)
169 Glenn Lassen COE 10/11-4 Err:520 $ 30,826 $ 25,000 $ 5,826 $ - ### $ - 2
170 Glenn Lassen COE 11/12-4 Err:520 $ 35,992 $ 26,994 $ 8,998 $ - ### $ - 2
171 Lassen COE Total $ 128,067 $ 101,994 $ 26,073 $ 125,972 $ 77,656 $ (48,316) $ 53,678 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
172 Glenn Modoc COE 10/11-2 2013-Q1 $ - $ - ### $ 26,845 $ 25,000 $ (1,845) 2
173 Glenn Modoc COE 11/12-2 Err:520 $ 33,434 $ 25,076 $ 8,358 $ - ### $ -
174 Glenn Modoc COE 10/11-3 2013-Q2 $ - $ - ### $ 25,238 $ 25,000 $ (238) 2
175 Glenn Modoc COE 10/11-4 2013-Q3 $ - $ - ### $ 27,631 $ 25,000 $ (2,631) 2
176 Modoc COE Total $ 33,434.00 $ 25,076.00 $ 8,358.00 $ 79,714 $ 75,000 $ (4,714) $ 20,362 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
177 Glenn Mt. Shasta Union ESD 10/11-4 2013-Q3 $ - $ - ### $ 30,899 $ 25,000 $ (5,899) 2
178 Glenn Mt. Shasta Union ESD 11/12-4 Err:520 $ 33,772 $ 25,329 $ 8,443 $ - ### $ - 2
179 Mt. Shasta Union ESD Total $ 33,772 $ 25,329 $ 8,443 $ 30,899 $ 25,000 $ (5,899) $ 19,430 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
180 Glenn Orland USD 09/10-1 2011-Q4 $ - $ - ### $ 118,620 $ 47,448 $ (71,172)
181 Glenn Orland USD 10/11-1 Err:520 $ 87,485 $ - ### $ -
182 Glenn Orland USD 09/10-2 2012-Q1 $ - $ - ### $ 165,020 $ 66,008 $ (99,012)
183 Glenn Orland USD 10/11-2 Err:520 $ 127,659 $ 51,064 $ 76,595 $ - ### $ -
184 Glenn Orland USD 11/12-2 Err:520 $ 104,192 $ 41,677 $ 62,515 $ - ### $ -
185 Glenn Orland USD 09/10-3 2012-Q2 $ - $ - ### $ 138,498 $ 55,399 $ (83,099)
186 Glenn Orland USD 10/11-3 Err:520 $ 114,724 $ 45,890 $ 68,834 $ - ### $ -
187 Glenn Orland USD 11/12-3 Err:520 $ 77,627 $ 31,051 $ 46,576 $ - ### $ -
188 Glenn Orland USD 09/10-4 2012-Q3 $ - $ - ### $ 146,128 $ 58,451 $ (87,677)
189 Glenn Orland USD 10/11-4 Err:520 $ 121,036 $ 48,414 $ 72,622 $ - ### $ -
190 Glenn Orland USD 12/13-1 Err:520 $ 13,622 $ 12,260 $ 1,362
191 Glenn Orland USD 12/13-2 Err:520 $ 13,552 $ 12,197 $ 1,355
192 Glenn Orland USD 12/13-3 Err:520 $ 12,865 $ 11,579 $ 1,286
193 Glenn Orland USD 13/14-1 Err:520 $ 2,176 $ 1,958 $ 218
194 Glenn Orland USD 13/14-2 Err:520 $ 5,529 $ 4,976 $ 553
195 Glenn Orland USD 13/14-3 Err:520 $ 4,564 $ 4,108 $ 456
196 Glenn Orland USD 13/14-4 Err:520 $ 4,664 $ 4,198 $ 466
197 Glenn Orland USD 12/13-4 Err:520 $ 7,829 $ 7,046 $ 783
198 Orland USD Total* $ 697,524 $ 276,418 $ 333,621 $ 568,266 $ 227,306 $ (340,960) $ (64,542) 7.33%
199 Glenn Oroville City ESD 10/11-1 2012-Q4 $ - $ - ### $ 51,282 $ 20,513 $ (30,769)
200 Glenn Oroville City ESD 11/12-1 Err:520 $ 34,151 $ 25,613 $ 8,538 $ - ### $ -
201 Glenn Oroville City ESD 10/11-2 Err:520 $ 82,103 $ 32,841 $ 49,262 $ - ### $ -
202 Glenn Oroville City ESD 11/12-2 Err:520 $ 40,827 $ 30,620 $ 10,207 $ - ### $ -
203 Glenn Oroville City ESD 11/12-3 Err:520 $ 26,735 $ 25,000 $ 1,735 $ - ### $ - 2
204 Glenn Oroville City ESD 09/10-4 2012-Q3 $ - $ - ### $ 111,731 $ 44,692 $ (67,039)
205 Glenn Oroville City ESD 10/11-4 Err:520 $ 54,190 $ 21,676 $ 32,514 $ - ### $ -
206 Glenn Oroville City ESD 10/11-3 Err:520 $ 47,283 $ 35,462 $ 11,821 $ - ### $ -
207 Oroville City ESD Total $ 285,289 $ 171,212 $ 114,077 $ 163,013 $ 65,205 $ (97,808) $ 73,404 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
208 Glenn Oroville Union HSD 11/12-1 Err:520 $ 28,539 $ 25,000 $ 3,539 $ - ### $ - 2
209 Glenn Oroville Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 31,541 $ 25,000 $ (6,541) 2
210 Glenn Oroville Union HSD 11/12-2 Err:520 $ 42,107 $ 31,580 $ 10,527 $ - ### $ -
211 Glenn Oroville Union HSD 09/10-3 2012-Q2 $ - $ - ### $ 139,853 $ 55,941 $ (83,912)
212 Glenn Oroville Union HSD 10/11-3 2013-Q2 $ - $ - ### $ 47,230 $ 35,423 $ (11,807)
213 Glenn Oroville Union HSD 11/12-3 Err:520 $ 35,848 $ 26,886 $ 8,962 $ - ### $ -
214 Glenn Oroville Union HSD 09/10-4 2012-Q3 $ - $ - ### $ 161,578 $ 64,631 $ (96,947)
215 Glenn Oroville Union HSD 10/11-4 2013-Q3 $ - $ - ### $ 32,164 $ 25,000 $ (7,164) 2
216 Glenn Oroville Union HSD 11/12-4 Err:520 $ 29,184 $ 25,000 $ 4,184 $ - ### $ - 2
217 Glenn Oroville Union HSD 12/13-1 Err:520 $ 17,521 $ 15,769 $ 1,752
218 Glenn Oroville Union HSD 12/13-2 Err:520 $ 22,114 $ 19,903 $ 2,211
219 Glenn Oroville Union HSD 12/13-3C-1 2015-Q2 $ 15,423 $ 13,881 $ 1,542
220 Glenn Oroville Union HSD 13/14-1 Err:520 $ 4,458 $ 4,012 $ 446
221 Glenn Oroville Union HSD 13/14-2 Err:520 $ 17,948 $ 16,153 $ 1,795
222 Glenn Oroville Union HSD 13/14-3 Err:520 $ 9,283 $ 8,355 $ 928
223 Glenn Oroville Union HSD 13/14-4 Err:520 $ 10,207 $ 9,186 $ 1,021
224 Glenn Oroville Union HSD 12/13-4 Err:520 $ 8,648 $ 7,783 $ 865
225 Oroville Union HSD Total $ 241,280 $ 203,508 $ 37,772 $ 412,366 $ 205,995 $ (206,371) $ (2,863) 0.33%
226 Glenn Palermo Union SD 10/11-1 2012-Q4 $ - $ - ### $ 45,165 $ 33,874 $ (11,291)
227 Glenn Palermo Union SD 11/12-1 Err:520 $ 36,918 $ 27,689 $ 9,229 $ - ### $ -
228 Glenn Palermo Union SD 10/11-2 2013-Q1 $ - $ - ### $ 87,581 $ 35,032 $ (52,549)
229 Glenn Palermo Union SD 11/12-2 Err:520 $ 72,161 $ 28,864 $ 43,297 $ - ### $ -
230 Glenn Palermo Union SD 10/11-3 2013-Q2 $ - $ - ### $ 72,636 $ 29,054 $ (43,582)
231 Glenn Palermo Union SD 11/12-3 Err:520 $ 69,121 $ 27,648 $ 41,473 $ - ### $ -
232 Glenn Palermo Union SD 10/11-4 2013-Q3 $ - $ - ### $ 74,986 $ 29,994 $ (44,992)
233 Glenn Palermo Union SD 11/12-4 Err:520 $ 71,601 $ 28,640 $ 42,961 $ - ### $ -
234 Glenn Palermo Union SD 12/13-1 Err:520 $ 11,332 $ 10,199 $ 1,133
235 Glenn Palermo Union SD 12/13-2 Err:520 $ 18,579 $ 16,721 $ 1,858
236 Glenn Palermo Union SD 12/13-3 Err:520 $ 22,224 $ 20,002 $ 2,222
237 Palermo Union SD Total $ 301,936 $ 159,763 $ 142,173 $ 280,368 $ 127,954 $ (152,414) $ 7,349 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
238 Glenn Paradise USD 10/11-1 2012-Q4 $ - $ - ### $ 96,010 $ 38,404 $ (57,606)
239 Glenn Paradise USD 11/12-1 Err:520 $ 72,132 $ 28,853 $ 43,279 $ - ### $ -
240 Glenn Paradise USD 10/11-2 2013-Q1 $ - $ - ### $ 94,945 $ 37,978 $ (56,967)
241 Glenn Paradise USD 11/12-2 Err:520 $ 71,284 $ 28,514 $ 42,770 $ - ### $ -
242 Glenn Paradise USD 10/11-3 2013-Q2 $ - $ - ### $ 99,871 $ 39,948 $ (59,923)
243 Glenn Paradise USD 11/12-3 Err:520 $ 66,259 $ 26,504 $ 39,755 $ - ### $ -
244 Glenn Paradise USD 10/11-4 2013-Q3 $ - $ - ### $ 70,706 $ 28,282 $ (42,424)
245 Glenn Paradise USD 11/12-4 Err:520 $ 51,027 $ 20,411 $ 30,616 $ - ### $ -
246 Glenn Paradise USD 12/13-1 Err:520 $ 17,651 $ 15,886 $ 1,765
247 Glenn Paradise USD 12/13-2 Err:520 $ 15,347 $ 13,812 $ 1,535
248 Glenn Paradise USD 13/14-1 Err:520 $ 4,229 $ 3,806 $ 423
249 Glenn Paradise USD 13/14-2 Err:520 $ 12,378 $ 11,140 $ 1,238
250 Glenn Paradise USD 13/14-3 Err:520 $ 9,016 $ 8,114 $ 902
251 Glenn Paradise USD 13/14-4 Err:520 $ 8,246 $ 7,421 $ 825
252 Glenn Paradise USD 12/13-4 Err:520 $ 8,915 $ 8,024 $ 891
253 Glenn Paradise USD 12/13-3 Err:520 $ 13,647 $ 12,282 $ 1,365
254 Paradise USD Total $ 350,131 $ 184,767 $ 165,364 $ 361,532 $ 144,612 $ (216,920) $ (32,153) 3.65%
255 Glenn Pittsburg USD 10/11-1 $ - ### $ -
256 Pittsburg USD Total $ - $ - $ - $ -
257 Glenn Plumas USD 10/11-1 2012-Q4 $ - $ - ### $ 36,187 $ 27,140 $ (9,047)
258 Glenn Plumas USD 09/10-2 2012-Q1 $ - $ - ### $ 92,404 $ 36,962 $ (55,442)
259 Glenn Plumas USD 10/11-2 Err:520 $ 56,147 $ 22,459 $ 33,688 $ - ### $ -
260 Glenn Plumas USD 11/12-2 Err:520 $ 46,429 $ 34,822 $ 11,607 $ - ### $ -
261 Glenn Plumas USD 09/10-3 2012-Q2 $ - $ - ### $ 86,852 $ 34,741 $ (52,111)
262 Glenn Plumas USD 11/12-3 Err:520 $ 39,863 $ 29,897 $ 9,966 $ - ### $ -
A B C D E F G H I J K L M N O P Q R S T U V W X Y
2 Total amount
Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Amount to release to 2013 and CUs in Option (insert 1 Red Bluff Joint Union University Preparatory
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Chico USD Enterprise USD Gridley USD Orland USD Oroville Union HSD Paradise USD HSD Shasta Union HSD Trinity Alps USD School
263 Glenn Plumas USD 09/10-4 2012-Q3 $ - $ - ### $ 84,625 $ 33,850 $ (50,775)
264 Glenn Plumas USD 10/11-4 Err:520 $ 27,628 $ 25,000 $ 2,628 $ - ### $ - 2
265 Glenn Plumas USD 11/12-4 Err:520 $ 43,169 $ 32,377 $ 10,792 $ - ### $ -
266 Glenn Plumas USD 12/13-1 Err:520 $ 13,891 $ 12,502 $ 1,389
267 Glenn Plumas USD 12/13-2 Err:520 $ 42,460 $ 31,845 $ 10,615
268 Plumas USD Total $ 269,587 $ 188,902 $ 80,685 $ 300,068 $ 132,693 $ (167,375) $ 21,527 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
269 Glenn Red Bluff Joint Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 79,590 $ 31,836 $ (47,754)
270 Glenn Red Bluff Joint Union HSD 11/12-1 Err:520 $ 86,109 $ 34,444 $ 51,665 $ - ### $ -
271 Glenn Red Bluff Joint Union HSD 09/10-2 2012-Q1 $ - $ - ### $ 127,897 $ 51,159 $ (76,738)
272 Glenn Red Bluff Joint Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 124,296 $ 49,718 $ (74,578)
273 Glenn Red Bluff Joint Union HSD 11/12-2 Err:520 $ 129,814 $ 51,926 $ 77,888 $ - ### $ -
274 Glenn Red Bluff Joint Union HSD 09/10-3 2012-Q2 $ - $ - ### $ 126,535 $ 50,614 $ (75,921)
275 Glenn Red Bluff Joint Union HSD 10/11-3 2013-Q2 $ - $ - ### $ 117,252 $ 46,901 $ (70,351)
276 Glenn Red Bluff Joint Union HSD 11/12-3 Err:520 $ 104,658 $ 41,863 $ 62,795 $ - ### $ -
277 Glenn Red Bluff Joint Union HSD 09/10-4 2012-Q3 $ - $ - ### $ 140,020 $ 56,008 $ (84,012)
278 Glenn Red Bluff Joint Union HSD 10/11-4 2013-Q3 $ - $ - ### $ 117,554 $ 47,022 $ (70,532)
279 Glenn Red Bluff Joint Union HSD 11/12-4 Err:520 $ 119,007 $ 47,603 $ 71,404 $ - ### $ -
280 Glenn Red Bluff Joint Union HSD 12/13-1 Err:520 $ 25,686 $ 19,265 $ 6,421
281 Glenn Red Bluff Joint Union HSD 12/13-2 Err:520 $ 32,048 $ 24,036 $ 8,012
282 Glenn Red Bluff Joint Union HSD 12/13-4 Err:520 $ 36,559 $ 27,419 $ 9,140
283 Glenn Red Bluff Joint Union HSD 12/13-3 Err:520 $ 33,011 $ 24,758 $ 8,253
284 Red Bluff Joint Union HSD Total $ 566,892 $ 271,314 $ 295,578 $ 833,144 $ 333,258 $ (499,886) $ (228,572) 25.95%
285 Glenn Red Bluff UESD 10/11-3 Err:520 $ 77,962 $ 27,287 $ 50,675 $ - ### $ -
286 Red Bluff UESD Total* $ 77,962 $ 27,287 $ 50,675 $ - $ - $ - $ 27,287 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
287 Glenn Red Bluff Union ESD 10/11-1 2012-Q4 $ - $ - ### $ 57,181 $ 20,013 $ (37,168)
288 Glenn Red Bluff Union ESD 11/12-1 Err:520 $ 40,882 $ 28,617 $ 12,265 $ - ### $ -
289 Glenn Red Bluff Union ESD 10/11-2 Err:520 $ 80,376 $ 28,132 $ 52,244 $ - ### $ -
290 Glenn Red Bluff Union ESD 11/12-2 Err:520 $ 29,610 $ 20,727 $ 8,883 $ - ### $ -
291 Glenn Red Bluff Union ESD 11/12-3 Err:520 $ 31,766 $ 22,236 $ 9,530 $ - ### $ -
292 Glenn Red Bluff Union ESD 09/10-4 2012-Q3 $ - $ - ### $ 64,845 $ 22,696 $ (42,149)
293 Glenn Red Bluff Union ESD 10/11-4 Err:520 $ 63,396 $ 22,189 $ 41,207 $ - ### $ -
294 Red Bluff Union ESD Total* $ 246,030 $ 121,901 $ 124,129 $ 122,026 $ 42,709 $ (79,317) $ 42,584 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
295 Glenn Redding ESD 10/11-1 2012-Q4 $ - $ - ### $ 26,597 $ 18,618 $ (7,979)
296 Glenn Redding ESD 10/11-2 Err:520 $ 29,337 $ 20,536 $ 8,801 $ - ### $ -
297 Glenn Redding ESD 11/12-2 Err:520 $ 35,190 $ 24,633 $ 10,557 $ - ### $ -
298 Glenn Redding ESD 10/11-3 Err:520 $ 31,750 $ 22,225 $ 9,525 $ - ### $ -
299 Glenn Redding ESD 11/12-3 Err:520 $ 28,320 $ 19,824 $ 8,496 $ - ### $ -
300 Redding ESD Total $ 124,597 $ 87,218 $ 37,379 $ 26,597 $ 18,618 $ (7,979) $ 79,239 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
301 Glenn Scott Valley USD 09/10-2 2012-Q1 $ - $ - ### $ 28,604 $ 25,000 $ (3,604) 2
302 Glenn Scott Valley USD 12/13-1 Err:520 $ 2,584 $ 2,326 $ 258
303 Glenn Scott Valley USD 12/13-2 Err:520 $ 5,594 $ 5,035 $ 559
304 Scott Valley USD Total $ 8,178 $ 7,361 $ 817 $ 28,604 $ 25,000 $ (3,604) $ 3,757 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
305 Glenn Shasta COE 10/11-1 2012-Q4 $ - $ - ### $ 30,236 $ 25,000 $ (5,236) 2
306 Glenn Shasta COE 10/11-2 2013-Q1 $ - $ - ### $ 26,801 $ 25,000 $ (1,801) 2
307 Glenn Shasta COE 10/11-3 2013-Q2 $ - $ - ### $ 28,489 $ 25,000 $ (3,489) 2
308 Glenn Shasta COE 10/11-4 2013-Q3 $ - $ - ### $ 28,221 $ 25,000 $ (3,221) 2
309 Glenn Shasta COE 12/13-1 Err:520 $ 12,666 $ 11,399 $ 1,267
310 Glenn Shasta COE 12/13-2 Err:520 $ 9,776 $ 8,798 $ 978
311 Shasta COE Total $ 22,442 $ 20,197 $ 2,245 $ 113,747 $ 100,000 $ (13,747) $ 6,450 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
312 Glenn Shasta Secondary Home School 09/10-3 2012-Q2 $ - $ - ### $ 28,306 $ 25,000 $ (3,306) 2
313 Glenn Shasta Secondary Home School 09/10-4 2012-Q3 $ - $ - ### $ 31,970 $ 25,000 $ (6,970) 2
314 Glenn Shasta Secondary Home School 12/13-1 Err:520 $ 696 $ 626 $ 70
315 Glenn Shasta Secondary Home School 12/13-2 Err:520 $ 1,654 $ 1,489 $ 165
316 Glenn Shasta Secondary Home School 13/14-1 Err:520 $ 1,977 $ 1,779 $ 198
317 Glenn Shasta Secondary Home School 13/14-2 Err:520 $ 2,664 $ 2,398 $ 266
318 Glenn Shasta Secondary Home School 13/14-3 Err:520 $ 2,730 $ 2,457 $ 273
319 Glenn Shasta Secondary Home School 13/14-4 Err:520 $ 2,654 $ 2,389 $ 265
320 Glenn Shasta Secondary Home School 12/13-4 Err:520 $ 1,887 $ 1,698 $ 189
321 Glenn Shasta Secondary Home School 12/13-3 Err:520 $ 1,275 $ 1,148 $ 127
322 Shasta Secondary Home School Total $ 15,537.00 $ 13,984.00 $ 1,553.00 $ 60,276 $ 50,000 $ (10,276) $ 3,708 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
323 Glenn Shasta Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 60,173 $ 24,069 $ (36,104)
324 Glenn Shasta Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 97,499 $ 39,000 $ (58,499)
325 Glenn Shasta Union HSD 09/10-3 2012-Q2 $ - $ - ### $ 88,651 $ 35,460 $ (53,191)
326 Glenn Shasta Union HSD 10/11-3 Err:520 $ 44,179 $ 33,134 $ 11,045 $ - ### $ -
327 Glenn Shasta Union HSD 09/10-4 2012-Q3 $ - $ - ### $ 89,770 $ 35,908 $ (53,862)
328 Glenn Shasta Union HSD 10/11-4 Err:520 $ 57,885 $ 23,154 $ 34,731 $ - ### $ -
329 Glenn Shasta Union HSD 12/13-1 Err:520 $ 6,946 $ 6,251 $ 695
330 Glenn Shasta Union HSD 12/13-2 Err:520 $ 7,442 $ 6,698 $ 744
331 Glenn Shasta Union HSD 12/13-3 Err:520 $ 4,168 $ 3,751 $ 417
332 Glenn Shasta Union HSD 13/14-1 Err:520 $ 1,005 $ 905 $ 100
333 Glenn Shasta Union HSD 13/14-2 Err:520 $ 4,356 $ 3,920 $ 436
334 Glenn Shasta Union HSD 13/14-3 Err:520 $ 3,658 $ 3,292 $ 366
335 Glenn Shasta Union HSD 13/14-4 Err:520 $ 1,877 $ 1,689 $ 188
336 Glenn Shasta Union HSD 12/13-4 Err:520 $ 5,758 $ 5,182 $ 576
337 Shasta Union HSD Total $ 137,274 $ 87,976 $ 49,298 $ 336,093 $ 134,437 $ (201,656) $ (113,680) 12.91%
338 Glenn Siskiyou COE 10/11-1 2012-Q4 $ - $ - ### $ 28,756 $ 25,000 $ (3,756) 2
339 Glenn Siskiyou COE 11/12-1 Err:520 $ 26,673 $ 25,000 $ 1,673 $ - ### $ - 2
340 Glenn Siskiyou COE 10/11-2 2013-Q1 $ - $ - ### $ 26,117 $ 25,000 $ (1,117) 2
341 Glenn Siskiyou COE 10/11-4 2013-Q3 $ - $ - ### $ 29,000 $ 25,000 $ (4,000) 2
342 Glenn Siskiyou COE 11/12-4 Err:520 $ 25,551 $ 25,000 $ 551 $ - ### $ - 2
343 Siskiyou COE Total $ 52,224 $ 50,000 $ 2,224 $ 83,873 $ 75,000 $ (8,873) $ 41,127 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
344 Glenn Susanville SD 10/11-2 2013-Q1 $ - $ - ### $ 28,954 $ 25,000 $ (3,954) 2
345 Glenn Susanville SD 12/13-1 Err:520 $ 3,243 $ 2,919 $ 324
346 Glenn Susanville SD 12/13-2 Err:520 $ 3,776 $ 3,398 $ 378
347 Glenn Susanville SD 12/13-3 Err:520 $ 4,526.00 $ 4,073 $ 453
348 Susanville SD Total $ 11,545.00 $ 10,390.00 $ 1,155.00 $ 28,954 $ 25,000 $ (3,954) $ 6,436 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
349 Glenn Tehama County DOE-CDE 09/10-2 2012-Q1 $ - $ - ### $ 26,061 $ 25,000 $ (1,061) 2
350 Glenn Tehama County DOE-CDE 10/11-2 2013-Q1 $ - $ - ### $ 29,044 $ 25,000 $ (4,044) 2
351 Glenn Tehama County DOE-CDE 09/10-3 2012-Q2 $ - $ - ### $ 29,392 $ 25,000 $ (4,392) 2
352 Glenn Tehama County DOE-CDE 12/13-1 Err:520 $ 6,146 $ 5,531 $ 615
353 Glenn Tehama County DOE-CDE 12/13-2 Err:520 $ 6,874 $ 6,187 $ 687
354 Tehama County DOE-CDE Total $ 13,020.00 $ 11,718.00 $ 1,302.00 $ 84,497 $ 75,000 $ (9,497) $ 2,221 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
355 Glenn Thermalito Union SD 10/11-1 2012-Q4 $ - $ - ### $ 52,095 $ 20,838 $ (31,257)
356 Glenn Thermalito Union SD 09/10-3 2012-Q2 $ 87,502
357 Glenn Thermalito Union SD 11/12-1 Err:520 $ 36,582 $ 27,437 $ 9,145 $ - ### $ -
358 Glenn Thermalito Union SD 09/10-2 2012-Q1 $ - $ - ### $ 96,943 $ 38,777 $ (58,166)
359 Glenn Thermalito Union SD 10/11-2 2013-Q1 $ - $ - ### $ 87,171 $ 34,868 $ (52,303)
360 Glenn Thermalito Union SD 11/12-2 Err:520 $ 73,495 $ 29,398 $ 44,097 $ - ### $ -
361 Glenn Thermalito Union SD 10/11-3 2013-Q2 $ - $ - ### $ 95,509 $ 38,204 $ (57,305)
362 Glenn Thermalito Union SD 11/12-3 Err:520 $ 46,830 $ 35,123 $ 11,707 $ - ### $ -
363 Glenn Thermalito Union SD 09/10-4 2012-Q3 $ - $ - ### $ 70,409 $ 28,164 $ (42,245)
364 Glenn Thermalito Union SD 10/11-4 Err:520 $ 88,751 $ 35,500 $ 53,251 $ - ### $ -
365 Glenn Thermalito Union SD 11/12-4 Err:520 $ 37,173 $ 27,880 $ 9,293 $ - ### $ -
366 Glenn Thermalito Union SD 12/13-1 Err:520 $ 14,810 $ 13,329 $ 1,481
367 Glenn Thermalito Union SD 12/13-2 Err:520 $ 14,990 $ 13,491 $ 1,499
368 Glenn Thermalito Union SD 12/13-4 Err:520 $ 13,883 $ 12,495 $ 1,388
369 Glenn Thermalito Union SD 13/14-1 Err:520 $ 7,344 $ 6,610 $ 734
370 Glenn Thermalito Union SD 13/14-2 Err:520 $ 19,946 $ 17,951 $ 1,995
371 Glenn Thermalito Union SD 13/14-3 Err:520 $ 18,030 $ 16,227 $ 1,803
372 Glenn Thermalito Union SD 12/13-3 Err:520 $ 18,278 $ 16,450 $ 1,828
373 Thermalito Union SD Total $ 477,614 $ 251,891 $ 138,221 $ 402,127 $ 160,851 $ (241,276) $ 10,615 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
374 Glenn Trinity Alps USD 10/11-1 2012-Q4 $ - $ - ### $ 25,710 $ 25,000 $ (710) 2
375 Glenn Trinity Alps USD 09/10-2 2012-Q1 $ - $ - ### $ 83,759 $ 33,504 $ (50,255)
376 Glenn Trinity Alps USD 10/11-2 2013-Q1 $ - $ - ### $ 31,933 $ 25,000 $ (6,933) 2
377 Glenn Trinity Alps USD 11/12-2 Err:520 $ 27,582 $ 25,000 $ 2,582 $ - ### $ - 2
378 Glenn Trinity Alps USD 09/10-3 2012-Q2 $ - $ - ### $ 60,802 $ 24,321 $ (36,481)
379 Glenn Trinity Alps USD 10/11-3 2013-Q2 $ - $ - ### $ 29,212 $ 25,000 $ (4,212) 2
380 Glenn Trinity Alps USD 11/12-3 Err:520 $ 26,441 $ 25,000 $ 1,441 $ - ### $ - 2
381 Glenn Trinity Alps USD 09/10-4 2012-Q3 $ - $ - ### $ 59,927 $ 23,971 $ (35,956)
382 Glenn Trinity Alps USD 10/11-4 2013-Q3 $ - $ - ### $ 32,149 $ 25,000 $ (7,149) 2
383 Glenn Trinity Alps USD 11/12-4 Err:520 $ 26,233 $ 25,000 $ 1,233 $ - ### $ - 2
384 Glenn Trinity Alps USD 12/13-1 Err:520 $ 3,196 $ 2,876 $ 320
385 Glenn Trinity Alps USD 12/13-2 Err:520 $ 5,770 $ 5,193 $ 577
386 Trinity Alps USD Total $ 89,222 $ 83,069 $ 6,153 $ 323,492 $ 181,796 $ (141,696) $ (58,627) 6.66%
387 Glenn Trinity COE 09/10-4 2012-Q3 $ - $ - ### $ 37,282 $ 27,962 $ (9,320)
388 Glenn Trinity COE 12/13-1 Err:520 $ 4,538 $ 4,084 $ 454
389 Glenn Trinity COE 12/13-2 Err:520 $ 6,510 $ 5,859 $ 651
390 Trinity COE Total $ 11,048.00 $ 9,943.00 $ 1,105.00 $ 37,282 $ 27,962 $ (9,320) $ 623 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
391 Glenn Tulelake Basin Joint USD 10/11-1 Err:520 $ 25,821 $ - ### $ -
392 Glenn Tulelake Basin Joint USD 09/10-3 2012-Q2 $ - $ - ### $ 45,753 $ 34,315 $ (11,438)
A B C D E F G H I J K L M N O P Q R S T U V W X Y
2 Total amount
Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Amount to release to 2013 and CUs in Option (insert 1 Red Bluff Joint Union University Preparatory
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit Red) or 2) Chico USD Enterprise USD Gridley USD Orland USD Oroville Union HSD Paradise USD HSD Shasta Union HSD Trinity Alps USD School
393 Glenn Tulelake Basin Joint USD 11/12-3 Err:520 $ 30,695 $ 25,000 $ 5,695 $ - ### $ - 2
394 Glenn Tulelake Basin Joint USD 09/10-4 2012-Q3 $ - $ - ### $ 57,332 $ 22,933 $ (34,399)
395 Glenn Tulelake Basin Joint USD 12/13-2 Err:520 $ 10,344 $ 9,310 $ 1,034
396 Glenn Tulelake Basin Joint USD 12/13-3 Err:520 $ 12,107 $ 10,896 $ 1,211
397 Glenn Tulelake Basin Joint USD 12/13-1 Err:520 $ 11,752 $ 10,577 $ 1,175
398 Tulelake Basin Joint USD Total $ 90,719.00 $ 55,783.00 $ 9,115.00 $ 103,085 $ 57,248 $ (45,837) $ 9,946 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
399 Glenn University Preparatory School 09/10-2 2012-Q1 $ - $ - ### $ 29,013 $ 25,000 $ (4,013) 2
400 Glenn University Preparatory School 09/10-3 2012-Q2 $ - $ - ### $ 25,740 $ 25,000 $ (740) 2
401 Glenn University Preparatory School 09/10-4 2012-Q3 $ - $ - ### $ 45,690 $ 34,268 $ (11,422)
402 Glenn University Preparatory School 12/13-1 Err:520 $ 3,123 $ 2,811 $ 312
403 Glenn University Preparatory School 12/13-2 Err:520 $ 1,489 $ 1,340 $ 149
404 Glenn University Preparatory School 12/13-3 Err:520 $ 178 $ 160 $ 18
405 Glenn University Preparatory School 12/13-4 Err:520 $ 51 $ 46 $ 5
406 University Preparatory School Total $ 4,841.00 $ 4,357.00 $ 484.00 $ 100,443 $ 84,268 $ (16,175) $ (11,818) 1.34%
407 Glenn Willows USD 10/11-1 2012-Q4 $ - $ - ### $ 35,314 $ 26,486 $ (8,828)
408 Glenn Willows USD 10/11-2 2013-Q1 $ - $ - ### $ 42,230 $ 31,673 $ (10,557)
409 Glenn Willows USD 11/12-2 Err:520 $ 34,605 $ 25,954 $ 8,651 $ - ### $ - 2
410 Glenn Willows USD 10/11-3 2013-Q2 $ - $ - ### $ 36,963 $ 27,722 $ (9,241)
411 Glenn Willows USD 11/12-3 Err:520 $ 34,255 $ 25,691 $ 8,564 $ - ### $ - 2
412 Glenn Willows USD 09/10-4 2012-Q3 $ - $ - ### $ 57,189 $ 22,876 $ (34,313)
413 Glenn Willows USD 10/11-4 Err:520 $ 35,738 $ 26,804 $ 8,934 $ - ### $ -
414 Glenn Willows USD 11/12-4 Err:520 $ 30,978 $ 25,000 $ 5,978 $ - ### $ - 2
415 Willows USD Total $ 135,576 $ 103,449 $ 32,127 $ 171,696 $ 108,757 $ (62,939) $ 40,510 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
416 Glenn Yreka Union ESD 11/12-1 Err:520 $ 26,048 $ 18,234 $ 7,814 $ - ### $ -
417 Glenn Yreka Union ESD 10/11-3 2013-Q2 $ - $ - ### $ 37,185 $ 26,030 $ (11,155)
418 Glenn Yreka Union ESD 10/11-4 2013-Q3 $ - $ - ### $ 35,330 $ 24,731 $ (10,599)
419 Glenn Yreka Union ESD 12/13-1 Err:520 $ 6,002 $ 6,002 $ -
420 Yreka Union ESD Total $ 32,050.00 $ 24,236.00 $ 7,814.00 $ 72,515 $ 50,761 $ (21,754) $ 2,482 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
421 Grand Total Glenn LEC Err:502 Err:502 Err:502 $ 9,528,054 $ 4,696,692 $ (4,831,362) Err:502 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520 Err:520
422 The sum of Column N equals the sum of "Column K" (Net Total) minus
423 the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
424 Column A County - Reporting LEC/LGA
425 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12
426 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Pro-Rata Table
427 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed Check Total $ 5,187 <-- Enter check total here
428 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment Sum of Net Green Err:520
429 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made Sum of Net Red $ (880,788)
430 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
431 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
432 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
433 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
434 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
435 The last subtotal amount is the final amount due to/from the LEC/LGA
436 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
437 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
438 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
439 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
440 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
441
444 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
445 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
446
447 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
448 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
449 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
450 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
451
41 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
42 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
43 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
44
47 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
48 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
49
50 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
51 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
52 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
53 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
54
25 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
26 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
27 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
28
31 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
32 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
33
34 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
35 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
36 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
37 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
38
1
Pro-Rata Net Negative Distribution Table
Amount to release
2 to claiming unit
Amount to be recouped from DHCS Total amount
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata settlement withheld (FFY 2013 Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent check(s) and CUs in Red) or 2) Green Dot Public Schools Hacienda La Puente USD
3 Los Angeles ABC USD 10/11-1 2012-Q4 $ - $ - ### $ 96,864 $ 38,746 $ (58,118)
4 Los Angeles ABC USD 11/12-1 Err:520 $ 77,497 $ 30,999 $ 46,498 $ - ### $ -
5 Los Angeles ABC USD 10/11-2 2013-Q1 $ - $ - ### $ 144,339 $ 57,736 $ (86,603)
6 Los Angeles ABC USD 11/12-2 Err:520 $ 117,799 $ 47,120 $ 70,679 $ - ### $ -
7 Los Angeles ABC USD 10/11-3 Err:520 $ 143,256 $ 57,302 $ 85,954 $ - ### $ -
8 Los Angeles ABC USD 11/12-3 Err:520 $ 118,208 $ 47,283 $ 70,925 $ - ### $ -
9 Los Angeles ABC USD 10/11-4 Err:520 $ 114,244 $ 45,698 $ 68,546 $ - ### $ -
10 Los Angeles ABC USD 11/12-4 Err:520 $ 117,944 $ 47,178 $ 70,766 $ - ### $ -
11 ABC USD Total $ 688,948 $ 275,580 $ 413,368 $ 241,203 $ 96,482 $ (144,721) $ 130,859 Err:520 Err:520 Err:520 Err:520 Err:520
12 Los Angeles Alhambra SD 10/11-1 2012-Q4 $ - $ - ### $ 48,624 $ 36,468 $ (12,156) 2
13 Los Angeles Alhambra SD 11/12-1 Err:520 $ 131,887 $ 52,755 $ 79,132 $ - ### $ -
14 Los Angeles Alhambra SD 10/11-2 2013-Q1 $ - $ - ### $ 133,854 $ 53,542 $ (80,312)
15 Los Angeles Alhambra SD 11/12-2 Err:520 $ 176,918 $ 70,767 $ 106,151 $ - ### $ -
16 Los Angeles Alhambra SD 10/11-3 2013-Q2 $ - $ - ### $ 245,327 $ 98,131 $ (147,196)
17 Los Angeles Alhambra SD 11/12-3 Err:520 $ 143,564 $ 57,426 $ 86,138 $ - ### $ -
18 Los Angeles Alhambra SD 10/11-4 Err:520 $ 234,296 $ 93,718 $ 140,578 $ - ### $ -
19 Los Angeles Alhambra SD 11/12-4 Err:520 $ 219,388 $ 87,755 $ 131,633 $ - ### $ -
20 Alhambra SD Total $ 906,053 $ 362,421 $ 543,632 $ 427,805 $ 188,141 $ (239,664) $ 122,757 Err:520 Err:520 Err:520 Err:520 Err:520
21 Los Angeles Alliance for College Ready Public Schools 10/11-4 Err:520 $ 58,398 $ 20,439 $ 37,959 $ - ### $ -
22 Alliance for College Ready Public Schools Total $ 58,398 $ 20,439 $ 37,959 $ - $ - $ - $ 20,439 Err:520 Err:520 Err:520 Err:520 Err:520
23 Los Angeles Antelope Valley Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 127,303 $ 50,921 $ (76,382)
24 Los Angeles Antelope Valley Union HSD 11/12-1 Err:520 $ 127,984 $ 51,194 $ 76,790 $ - ### $ -
25 Los Angeles Antelope Valley Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 149,517 $ 59,807 $ (89,710)
26 Los Angeles Antelope Valley Union HSD 11/12-2 Err:520 $ 137,319 $ 54,928 $ 82,391 $ - ### $ -
27 Los Angeles Antelope Valley Union HSD 11/12-3 Err:520 $ 164,297 $ 65,719 $ 98,578 $ - ### $ -
28 Los Angeles Antelope Valley Union HSD 09/10-4 2012-Q3 $ - $ - ### $ 106,742 $ 42,697 $ (64,045)
29 Los Angeles Antelope Valley Union HSD 10/11-4 Err:520 $ 138,381 $ 55,352 $ 83,029 $ - ### $ -
30 Los Angeles Antelope Valley Union HSD 11/12-4 Err:520 $ 149,258 $ 59,703 $ 89,555 $ - ### $ -
31 Antelope Valley Union HSD Total $ 717,239 $ 286,896 $ 430,343 $ 383,562 $ 153,425 $ (230,137) $ 56,759 Err:520 Err:520 Err:520 Err:520 Err:520
32 Los Angeles AZUSA USD 10/11-1 2012-Q4 $ - $ - ### $ 63,671 $ 25,468 $ (38,203)
33 Los Angeles AZUSA USD 11/12-1 Err:520 $ 46,301 $ 34,726 $ 11,575 $ - ### $ - 2
34 Los Angeles AZUSA USD 10/11-2 2013-Q1 $ - $ - $ - $ 68,197 $ 27,279 $ (40,918)
35 Los Angeles AZUSA USD 11/12-2 Err:520 $ 65,881 $ 26,352 $ 39,529 $ - ### $ -
36 Los Angeles AZUSA USD 10/11-3 2013-Q2 $ - $ - $ - $ 75,018 $ 30,007 $ (45,011)
37 Los Angeles AZUSA USD 11/12-3 Err:520 $ 95,807 $ 38,323 $ 57,484 $ - ### $ -
38 Los Angeles AZUSA USD 09/10-4 2012-Q3 $ - $ - $ - $ 75,504 $ 30,202 $ (45,302)
39 Los Angeles AZUSA USD 10/11-4 Err:520 $ 83,854 $ 33,542 $ 50,312 $ - ### $ -
40 Los Angeles AZUSA USD 11/12-4 Err:520 $ 117,964 $ 47,186 $ 70,778 $ - ### $ -
41 AZUSA USD Total $ 409,807 $ 180,129 $ 229,678 $ 282,390 $ 112,956 $ (169,434) $ 10,695 Err:520 Err:520 Err:520 Err:520 Err:520
42 Los Angeles Baldwin Park USD 10/11-1 2012-Q4 $ - $ - $ - $ 113,458 $ 45,383 $ (68,075)
43 Los Angeles Baldwin Park USD 11/12-1 Err:520 $ 139,794 $ 55,918 $ 83,876 $ - ### $ -
44 Los Angeles Baldwin Park USD 10/11-2 2013-Q1 $ - $ - $ - $ 154,499 $ 61,800 $ (92,699)
45 Los Angeles Baldwin Park USD 11/12-2 Err:520 $ 168,316 $ 67,326 $ 100,990 $ - ### $ -
46 Los Angeles Baldwin Park USD 10/11-3 2013-Q2 $ - $ - $ - $ 130,487 $ 52,195 $ (78,292)
47 Los Angeles Baldwin Park USD 11/12-3 Err:520 $ 150,272 $ 60,109 $ 90,163 $ - ### $ -
48 Los Angeles Baldwin Park USD 10/11-4 2013-Q3 $ - $ - $ - $ 90,648 $ 36,259 $ (54,389)
49 Los Angeles Baldwin Park USD 12/13-1 Err:520 $ 102,430 $ 40,972 $ 61,458
50 Los Angeles Baldwin Park USD 12/13-2 Err:520 $ 89,597 $ 35,839 $ 53,758
51 Los Angeles Baldwin Park USD 11/12-4 Err:520 $ 168,998 $ 67,599 $ 101,399 $ - ### $ -
52 Baldwin Park USD Total $ 819,407 $ 327,763 $ 491,644 $ 489,092 $ 195,637 $ (293,455) $ 34,308 Err:520 Err:520 Err:520 Err:520 Err:520
53 Los Angeles Bassett USD 11/12-3 Err:520 $ 28,256 $ 25,000 $ 3,256 $ - ### $ - 2
54 Los Angeles Bassett USD 11/12-4 Err:520 $ 28,277 $ 25,000 $ 3,277 $ - ### $ - 2
55 Bassett USD Total $ 56,533 $ 50,000 $ 6,533 $ - $ - $ - $ 50,000 Err:520 Err:520 Err:520 Err:520 Err:520
56 Los Angeles Bellflower USD 10/11-1 2012-Q4 $ - $ - $ - $ 74,605 $ 29,842 $ (44,763)
57 Los Angeles Bellflower USD 11/12-1 Err:520 $ 86,813 $ 34,725 $ 52,088 $ - ### $ -
58 Los Angeles Bellflower USD 10/11-2 2013-Q1 $ - $ - $ - $ 102,435 $ 40,974 $ (61,461)
59 Los Angeles Bellflower USD 11/12-2 Err:520 $ 109,907 $ 43,963 $ 65,944 $ - ### $ -
60 Los Angeles Bellflower USD 10/11-3 2013-Q2 $ - $ - $ - $ 113,491 $ 45,396 $ (68,095)
61 Los Angeles Bellflower USD 11/12-3 Err:520 $ 115,694 $ 46,278 $ 69,416 $ - ### $ -
62 Los Angeles Bellflower USD 10/11-4 Err:520 $ 101,779 $ 40,712 $ 61,067 $ - ### $ -
63 Los Angeles Bellflower USD 11/12-4 Err:520 $ 113,163 $ 45,265 $ 67,898 $ - ### $ -
64 Bellflower USD Total $ 527,356 $ 210,943 $ 316,413 $ 290,531 $ 116,212 $ (174,319) $ 36,624 Err:520 Err:520 Err:520 Err:520 Err:520
65 Los Angeles Bonita USD 10/11-1 2012-Q4 $ - $ - ### $ 43,861 $ 32,896 $ (10,965) 2
66 Los Angeles Bonita USD 11/12-1 Err:520 $ 52,423 $ 20,969 $ 31,454 $ - ### $ -
67 Los Angeles Bonita USD 10/11-2 2013-Q1 $ - $ - $ - $ 93,179 $ 37,272 $ (55,907)
68 Los Angeles Bonita USD 11/12-2 Err:520 $ 72,847 $ 29,139 $ 43,708 $ - ### $ -
69 Los Angeles Bonita USD 10/11-3 2013-Q2 $ - $ - ### $ 48,322 $ 36,242 $ (12,080) 2
70 Los Angeles Bonita USD 11/12-3 Err:520 $ 71,670 $ 28,668 $ 43,002 $ - ### $ -
71 Los Angeles Bonita USD 11/12-4 Err:520 $ 74,299 $ 29,720 $ 44,579 $ - ### $ -
72 Los Angeles Bonita USD 10/11-4 Err:520 $ 75,081 $ 30,032 $ 45,049 $ - ### $ -
73 Bonita USD Total $ 346,320 $ 138,528 $ 207,792 $ 185,362 $ 106,410 $ (78,952) $ 59,576 Err:520 Err:520 Err:520 Err:520 Err:520
74 Los Angeles Burbank USD 11/12-4 Err:520 $ 43,868 $ 32,901 $ 10,967 $ - ### $ - 2
75 Burbank USD Total $ 43,868 $ 32,901 $ 10,967 $ - $ - $ - $ 32,901 Err:520 Err:520 Err:520 Err:520 Err:520
76 Los Angeles Castaic Union SD 11/12-3 Err:520 $ 26,439 $ 25,000 $ 1,439 $ - ### $ - 2
77 Los Angeles Castaic Union SD 11/12-4 Err:520 $ 27,399 $ 25,000 $ 2,399 $ - ### $ - 2
78 Castaic Union SD Total $ 53,838 $ 50,000 $ 3,838 $ - $ - $ - $ 50,000 Err:520 Err:520 Err:520 Err:520 Err:520
79 Los Angeles Centinela Valley Union HSD 11/12-4 Err:520 $ 41,930 $ 31,448 $ 10,482 $ - ### $ - 2
80 Centinela Valley Union HSD Total $ 41,930 $ 31,448 $ 10,482 $ - $ - $ - $ 31,448 Err:520 Err:520 Err:520 Err:520 Err:520
81 Los Angeles Cerritos Community College 10/11-2 2013-Q1 $ - $ - ### $ 27,452 $ 25,000 $ (2,452) 2
82 Los Angeles Cerritos Community College 12/13-1 Err:520 $ 11,850 $ 10,665 $ 1,185
83 Los Angeles Cerritos Community College 10/11-4 2013-Q3 $ - $ - ### $ 26,308 $ 25,000 $ (1,308) 2
84 Cerritos Community College Total $ 11,850.00 $ 10,665.00 $ 1,185.00 $ 53,760 $ 50,000 $ (3,760) $ 6,905 Err:520 Err:520 Err:520 Err:520 Err:520
85 Los Angeles Charter Oak USD 10/11-1 2012-Q4 $ - $ - ### $ 44,259 $ 33,194 $ (11,065) 2
86 Los Angeles Charter Oak USD 11/12-1 Err:520 $ 47,771 $ 35,828 $ 11,943 $ - ### $ - 2
87 Los Angeles Charter Oak USD 10/11-2 2013-Q1 $ - $ - $ - $ 62,614 $ 25,046 $ (37,568)
88 Los Angeles Charter Oak USD 11/12-2 Err:520 $ 76,702 $ 30,681 $ 46,021 $ - ### $ -
89 Los Angeles Charter Oak USD 10/11-3 2013-Q2 $ - $ - $ - $ 77,831 $ 31,132 $ (46,699)
90 Los Angeles Charter Oak USD 11/12-3 Err:520 $ 94,559 $ 37,824 $ 56,735 $ - ### $ -
91 Los Angeles Charter Oak USD 10/11-4 Err:520 $ 82,437 $ 32,975 $ 49,462 $ - ### $ -
92 Los Angeles Charter Oak USD 11/12-4 Err:520 $ 127,357 $ 50,943 $ 76,414 $ - ### $ -
93 Charter Oak USD Total $ 428,826 $ 188,251 $ 240,575 $ 184,704 $ 89,372 $ (95,332) $ 92,919 Err:520 Err:520 Err:520 Err:520 Err:520
94 Los Angeles Claremont USD 11/12-1 Err:520 $ 33,720 $ 23,604 $ 10,116 $ - ### $ -
95 Los Angeles Claremont USD 11/12-2 Err:520 $ 39,603 $ 27,722 $ 11,881 $ - ### $ -
96 Los Angeles Claremont USD 10/11-4 Err:520 $ 36,533 $ 25,573 $ 10,960 $ - ### $ -
97 Los Angeles Claremont USD 11/12-4 Err:520 $ 38,012 $ 26,608 $ 11,404 $ - ### $ -
98 Claremont USD Total $ 147,868 $ 103,507 $ 44,361 $ - $ - $ - $ 103,507 Err:520 Err:520 Err:520 Err:520 Err:520
99 Los Angeles Compton USD 10/11-2 2013-Q1 $ - $ - ### $ 25,141 $ 25,000 $ (141) 2
100 Los Angeles Compton USD 11/12-2 Err:520 $ 41,062 $ 30,797 $ 10,265 $ - ### $ - 2
101 Los Angeles Compton USD 11/12-3 Err:520 $ 73,464 $ 29,386 $ 44,078 $ - ### $ -
102 Los Angeles Compton USD 11/12-4 Err:520 $ 45,969 $ 34,477 $ 11,492 $ - ### $ - 2
103 Compton USD Total $ 160,495 $ 94,660 $ 65,835 $ 25,141 $ 25,000 $ (141) $ 94,519 Err:520 Err:520 Err:520 Err:520 Err:520
104 Los Angeles Covina Valley USD 10/11-1 2012-Q4 $ - $ - ### $ 28,746 $ 25,000 $ (3,746) 2
105 Los Angeles Covina-Valley USD 10/11-4 Err:520 $ 57,766 $ 23,106 $ 34,660 $ - ### $ -
106 Los Angeles Covina Valley USD 11/12-1 Err:520 $ 67,612 $ 27,045 $ 40,567 $ - ### $ -
107 Los Angeles Covina Valley USD 10/11-2 2013-Q1 $ - $ - $ - $ 75,901 $ 30,360 $ (45,541)
108 Los Angeles Covina Valley USD 11/12-2 Err:520 $ 113,399 $ 45,360 $ 68,039 $ - ### $ -
109 Los Angeles Covina Valley USD 10/11-3 2013-Q2 $ - $ - $ - $ 75,091 $ 30,036 $ (45,055)
110 Los Angeles Covina Valley USD 11/12-3 Err:520 $ 116,607 $ 46,643 $ 69,964 $ - ### $ -
111 Los Angeles Covina Valley USD 09/10-4 2012-Q3 $ - $ - $ - $ 84,498 $ 33,799 $ (50,699)
112 Los Angeles Covina Valley USD 11/12-4 Err:520 $ 117,219 $ 46,888 $ 70,331 $ - ### $ -
113 Covina Valley USD Total $ 472,603 $ 189,042 $ 283,561 $ 264,236 $ 119,195 $ (145,041) $ 44,001 Err:520 Err:520 Err:520 Err:520 Err:520
114 Los Angeles Downey USD 10/11-1 2012-Q4 $ - $ - $ - $ 135,813 $ 54,325 $ (81,488)
115 Los Angeles Downey USD 11/12-1 Err:520 $ 243,290 $ 97,316 $ 145,974 $ - ### $ -
116 Los Angeles Downey USD 10/11-2 2013-Q1 $ - $ - $ - $ 396,146 $ 158,458 $ (237,688)
117 Los Angeles Downey USD 11/12-2 Err:520 $ 421,277 $ 168,511 $ 252,766 $ - ### $ -
118 Los Angeles Downey USD 10/11-3 2013-Q2 $ - $ - $ - $ 316,522 $ 126,609 $ (189,913)
119 Los Angeles Downey USD 11/12-3 Err:520 $ 434,042 $ 173,617 $ 260,425 $ - ### $ -
120 Los Angeles Downey USD 10/11-4 Err:520 $ 366,475 $ 146,590 $ 219,885 $ - ### $ -
121 Los Angeles Downey USD 11/12-4 Err:520 $ 445,332 $ 178,133 $ 267,199 $ - ### $ -
122 Downey USD Total $ 1,910,416 $ 764,167 $ 1,146,249 $ 848,481 $ 339,392 $ (509,089) $ 255,078 Err:520 Err:520 Err:520 Err:520 Err:520
123 Los Angeles Duarte USD 10/11-2 2013-Q1 $ - $ - $ - $ 65,298 $ 65,298 $ -
124 Los Angeles Duarte USD 10/11-3 2013-Q2 $ - $ - ### $ 49,256 $ 49,256 $ - 2
125 Los Angeles Duarte USD 09/10-4 2012-Q3 $ - $ - ### $ 37,034 $ 37,034 $ - 2
126 Los Angeles Duarte USD 11/12-4 Err:520 $ - $ - $ - ### $ - 2
127 Duarte USD Total $ - $ - $ - $ 151,588 $ 151,588 $ - $ -
128 Los Angeles East Whittier City SD 10/11-1 2012-Q4 $ - $ - $ - $ 103,172 $ 41,269 $ (61,903)
A B C D E F G H I J K L M N O P Q R S T U V W
Amount to release
2 to claiming unit
Amount to be recouped from DHCS Total amount
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata settlement withheld (FFY 2013 Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent check(s) and CUs in Red) or 2) Green Dot Public Schools Hacienda La Puente USD
129 Los Angeles East Whittier City SD 11/12-1 Err:520 $ 99,581 $ 39,832 $ 59,749 $ - ### $ -
130 Los Angeles East Whittier City SD 10/11-2 2013-Q1 $ - $ - $ - $ 169,813 $ 67,925 $ (101,888)
131 Los Angeles East Whittier City SD 11/12-2 Err:520 $ 188,666 $ 75,466 $ 113,200 $ - ### $ -
132 Los Angeles East Whittier City SD 10/11-3 2013-Q2 $ - $ - $ - $ 184,948 $ 73,979 $ (110,969)
133 Los Angeles East Whittier City SD 11/12-3 Err:520 $ 104,141 $ 41,656 $ 62,485 $ - ### $ -
134 Los Angeles East Whittier City SD 10/11-4 Err:520 $ 198,866 $ 79,546 $ 119,320 $ - ### $ -
135 Los Angeles East Whittier City SD 11/12-4 Err:520 $ 198,104 $ 79,242 $ 118,862 $ - ### $ -
136 East Whittier City SD Total $ 789,358 $ 315,742 $ 473,616 $ 457,933 $ 183,173 $ (274,760) $ 40,982 Err:520 Err:520 Err:520 Err:520 Err:520
137 Los Angeles Eastside Union ESD 10/11-1 2012-Q4 $ - $ - $ - $ 38,898 $ 27,229 $ (11,669)
138 Los Angeles Eastside Union ESD 10/11-2 2013-Q1 $ - $ - $ - $ 37,729 $ 26,410 $ (11,319)
139 Los Angeles Eastside Union ESD 11/12-2 Err:520 $ 43,201 $ 30,241 $ 12,960 $ - ### $ -
140 Los Angeles Eastside Union ESD 10/11-3 2013-Q2 $ - $ - $ - $ 43,476 $ 30,433 $ (13,043)
141 Los Angeles Eastside Union ESD 10/11-4 Err:520 $ 37,918 $ 26,543 $ 11,375 $ - ### $ -
142 Eastside Union ESD Total $ 81,119 $ 56,784 $ 24,335 $ 120,103 $ 84,072 $ (36,031) $ 20,753 Err:520 Err:520 Err:520 Err:520 Err:520
143 Los Angeles El Camino College 11/12-1 Err:520 $ 37,246 $ 26,072 $ 11,174 $ - ### $ -
144 Los Angeles El Camino College 10/11-2 2013-Q1 $ - $ - $ - $ 25,195 $ 17,637 $ (7,558)
145 Los Angeles El Camino College 11/12-2 Err:520 $ 34,092 $ 23,864 $ 10,228 $ - ### $ -
146 Los Angeles El Camino College 10/11-3 2013-Q2 $ - $ - $ - $ 25,862 $ 18,103 $ (7,759)
147 Los Angeles El Camino College 11/12-3 Err:520 $ 32,518 $ 22,763 $ 9,755 $ - ### $ -
148 Los Angeles El Camino College 11/12-4 Err:520 $ 37,673 $ 26,371 $ 11,302 $ - ### $ -
149 El Camino College Total $ 141,529 $ 99,070 $ 42,459 $ 51,057 $ 35,740 $ (15,317) $ 83,753 Err:520 Err:520 Err:520 Err:520 Err:520
150 Los Angeles El Monte City SD 10/11-1 2012-Q4 $ - $ - $ - $ 152,127 $ 60,851 $ (91,276)
151 Los Angeles El Monte City SD 11/12-1 Err:520 $ 160,978 $ 64,391 $ 96,587 $ - ### $ -
152 Los Angeles El Monte City SD 10/11-2 2013-Q1 $ - $ - $ - $ 275,537 $ 110,215 $ (165,322)
153 Los Angeles El Monte City SD 11/12-2 Err:520 $ 296,824 $ 118,730 $ 178,094 $ - ### $ -
154 Los Angeles El Monte City SD 10/11-3 2013-Q2 $ - $ - $ - $ 237,362 $ 94,945 $ (142,417)
155 Los Angeles El Monte City SD 11/12-3 Err:520 $ 301,464 $ 120,586 $ 180,878 $ - ### $ -
156 Los Angeles El Monte City SD 10/11-4 Err:520 $ 260,596 $ 104,238 $ 156,358 $ - ### $ -
157 Los Angeles El Monte City SD 11/12-4 Err:520 $ 288,726 $ 115,490 $ 173,236 $ - ### $ -
158 El Monte City SD Total $ 1,308,588 $ 523,435 $ 785,153 $ 665,026 $ 266,011 $ (399,015) $ 124,420 Err:520 Err:520 Err:520 Err:520 Err:520
159 Los Angeles El Monte Union HSD 10/11-2 2013-Q1 $ - $ - $ - $ 73,840 $ 29,536 $ (44,304)
160 Los Angeles El Monte Union HSD 11/12-2 Err:520 $ 27,216 $ 25,000 $ 2,216 $ - ### $ - 2
161 Los Angeles El Monte Union HSD 10/11-3 2013-Q2 $ - $ - $ - $ 112,766 $ 45,106 $ (67,660)
162 Los Angeles El Monte Union HSD 12/13-1 Err:520 $ 6,479 $ 5,831 $ 648
163 Los Angeles El Monte Union HSD 12/13-2 Err:520 $ 12,740 $ 11,466 $ 1,274
164 Los Angeles El Monte Union HSD 12/13-3 Err:520 $ 7,640 $ 6,876 $ 764
165 Los Angeles El Monte Union HSD 12/13-4 Err:520 $ 5,537 $ 4,983 $ 554
166 Los Angeles El Monte Union HSD 13/14-1 Err:520 $ 8,555 $ 7,700 $ 855
167 Los Angeles El Monte Union HSD 13/14-2 Err:520 $ 23,907 $ 21,516 $ 2,391
168 Los Angeles El Monte Union HSD 13/14-3 Err:520 $ 17,997 $ 16,197 $ 1,800
169 Los Angeles El Monte Union HSD 10/11-4 Err:520 $ 59,191 $ 23,676 $ 35,515 $ - ### $ -
170 El Monte Union HSD Total $ 169,262 $ 123,245 $ 46,017 $ 186,606 $ 74,642 $ (111,964) $ 11,281 Err:520 Err:520 Err:520 Err:520 Err:520
171 Los Angeles El Rancho USD 10/11-1 2012-Q4 $ - $ - $ - $ 148,874 $ 59,550 $ (89,324)
172 Los Angeles El Rancho USD 10/11-2 2013-Q1 $ - $ - $ - $ 256,744 $ 102,698 $ (154,046)
173 Los Angeles El Rancho USD 11/12-2 Err:520 $ 411,857 $ 164,743 $ 247,114 $ - ### $ -
174 Los Angeles El Rancho USD 10/11-3 2013-Q2 $ - $ - $ - $ 279,872 $ 111,949 $ (167,923)
175 Los Angeles El Rancho USD 11/12-3 Err:520 $ 325,480 $ 130,192 $ 195,288 $ - ### $ -
176 Los Angeles El Rancho USD 10/11-4 Err:520 $ 298,374 $ 119,350 $ 179,024 $ - ### $ -
177 Los Angeles El Rancho USD 11/12-4 Err:520 $ 188,296 $ 75,318 $ 112,978 $ - ### $ -
178 Los Angeles El Rancho USD 11/12-1C-1 Err:520 $ 207,895 $ 83,158 $ 124,737 $ - ### $ -
179 El Rancho USD Total $ 1,431,902 $ 572,761 $ 859,141 $ 685,490 $ 274,197 $ (411,293) $ 161,468 Err:520 Err:520 Err:520 Err:520 Err:520
180 Los Angeles Glendale USD 10/11-1 2012-Q4 $ - $ - $ - $ 185,033 $ 185,033 $ -
181 Los Angeles Glendale USD 10/11-2 2013-Q1 $ - $ - $ - $ 279,431 $ 279,431 $ -
182 Los Angeles Glendale USD 10/11-3 2013-Q2 $ - $ - $ - $ 260,132 $ 260,132 $ -
183 Los Angeles Glendale USD 09/10-4 2012-Q3 $ - $ - $ - $ 151,534 $ 151,534 $ -
184 Los Angeles Glendale USD 11/12-4 Err:520 $ 307,463 $ 307,463 $ - $ - ### $ -
185 Los Angeles Glendale USD 11/12-3C-1 Err:520 $ 268,338 $ 268,338 $ - $ - ### $ -
186 Glendale USD Total $ 575,801 $ 575,801 $ - $ 876,130 $ 876,130 $ - $ 575,801 Err:520 Err:520 Err:520 Err:520 Err:520
187 Los Angeles Glendora USD 11/12-2 Err:520 $ 30,587 $ 25,000 $ 5,587 $ - ### $ - 2
188 Los Angeles Glendora USD 11/12-3 Err:520 $ 26,018 $ 25,000 $ 1,018 $ - ### $ - 2
189 Los Angeles Glendora USD 10/11-4 Err:520 $ 30,185 $ 25,000 $ 5,185 $ - ### $ - 2
190 Los Angeles Glendora USD 11/12-4 Err:520 $ 25,364 $ 25,000 $ 364 $ - ### $ - 2
191 Glendora USD Total $ 112,154 $ 100,000 $ 12,154 $ - $ - $ - $ 100,000 Err:520 Err:520 Err:520 Err:520 Err:520
192 Los Angeles Green Dot Public Schools 10/11-1 2012-Q4 $ - $ - $ - $ 144,840 $ 50,694 $ (94,146)
193 Los Angeles Green Dot Public Schools 11/12-1 Err:520 $ 221,212 $ - ### $ -
194 Los Angeles Green Dot Public Schools 10/11-2 2013-Q1 $ - $ - $ - $ 73,655 $ 25,779 $ (47,876)
195 Los Angeles Green Dot Public Schools 11/12-2 Err:520 $ 148,659 $ - ### $ -
196 Los Angeles Green Dot Public Schools 10/11-3 2013-Q2 $ - $ - $ - $ 87,031 $ 30,461 $ (56,570)
197 Los Angeles Green Dot Public Schools 11/12-3 Err:520 $ 113,340 $ - ### $ -
198 Los Angeles Green Dot Public Schools 09/10-4 2012-Q3 $ - $ - $ - $ 146,731 $ 51,356 $ (95,375)
199 Los Angeles Green Dot Public Schools 12/13-1 Err:520 $ 22,919
200 Los Angeles Green Dot Public Schools 12/13-2 Err:520 $ 21,194
201 Los Angeles Green Dot Public Schools 12/13-3 Err:520 $ 17,603
202 Los Angeles Green Dot Public Schools 12/13-4 Err:520 $ 9,779
203 Los Angeles Green Dot Public Schools 10/11-4 Err:520 $ 88,705 $ - ### $ -
204 Los Angeles Green Dot Public Schools 11/12-4 Err:520 $ 59,728 $ - ### $ -
205 Green Dot Public Schools Total $ 703,139 $ - $ - $ 452,257 $ 158,290 $ (293,967) $ (293,967) 81.32%
206 Los Angeles Hacienda La Puente USD 11/12-2 Err:520 $ 63,490 $ 22,222 $ 41,268 $ - ### $ -
207 Los Angeles Hacienda La Puente USD 10/11-3 2013-Q2 $ - $ - $ - $ 177,889 $ 62,261 $ (115,628)
208 Los Angeles Hacienda La Puente USD 11/12-3 Err:520 $ 46,264 $ 32,385 $ 13,879 $ - ### $ -
209 Los Angeles Hacienda La Puente USD 10/11-4 2013-Q3 $ - $ - $ - $ 103,428 $ 36,200 $ (67,228)
210 Los Angeles Hacienda La Puente USD 12/13-1 Err:520 $ 11,095 $ 11,095 $ -
211 Los Angeles Hacienda La Puente USD 12/13-2 Err:520 $ 7,915 $ 7,915 $ -
212 Los Angeles Hacienda La Puente USD 12/13-3 Err:520 $ 9,827 $ 9,827 $ -
213 Los Angeles Hacienda La Puente USD 12/13-4 Err:520 $ 4,753 $ 4,753 $ -
214 Los Angeles Hacienda La Puente USD 11/12-4 Err:520 $ 38,760 $ 27,132 $ 11,628 $ - ### $ -
215 Hacienda La Puente USD Total $ 182,104 $ 115,329 $ 66,775 $ 281,317 $ 98,461 $ (182,856) $ (67,527) 18.68%
216 Los Angeles Hawthorne SD 10/11-1 2012-Q4 $ - $ - $ - $ 33,393 $ 23,375 $ (10,018)
217 Los Angeles Hawthorne SD 11/12-1 Err:520 $ 52,025 $ 18,209 $ 33,816 $ - ### $ -
218 Los Angeles Hawthorne SD 10/11-2 2013-Q1 $ - $ - $ - $ 33,083 $ 23,158 $ (9,925)
219 Los Angeles Hawthorne SD 11/12-2 Err:520 $ 56,944 $ 19,930 $ 37,014 $ - ### $ -
220 Los Angeles Hawthorne SD 10/11-3 2013-Q2 $ - $ - $ - $ 36,931 $ 25,852 $ (11,079)
221 Los Angeles Hawthorne SD 11/12-3 Err:520 $ 39,180 $ 27,426 $ 11,754 $ - ### $ -
222 Los Angeles Hawthorne SD 10/11-4 Err:520 $ 41,343 $ 28,940 $ 12,403 $ - ### $ -
223 Los Angeles Hawthorne SD 11/12-4 Err:520 $ 67,821 $ 23,737 $ 44,084 $ - ### $ -
224 Hawthorne SD Total $ 257,313 $ 118,242 $ 139,071 $ 103,407 $ 72,385 $ (31,022) $ 87,220 Err:520 Err:520 Err:520 Err:520 Err:520
225 Los Angeles Inglewood USD 10/11-2 2013-Q1 $ - $ - ### $ 31,871 $ 25,000 $ (6,871) 2
226 Los Angeles Inglewood USD 10/11-3 2013-Q2 $ - $ - ### $ 25,516 $ 25,000 $ (516) 2
227 Los Angeles Inglewood USD 11/12-3 Err:520 $ 53,067 $ 21,227 $ 31,840 $ - ### $ -
228 Los Angeles Inglewood USD 11/12-4 Err:520 $ 52,331 $ 20,932 $ 31,399 $ - ### $ -
229 Inglewood USD Total $ 105,398 $ 42,159 $ 63,239 $ 57,387 $ 50,000 $ (7,387) $ 34,772 Err:520 Err:520 Err:520 Err:520 Err:520
230 Los Angeles Lancaster SD 10/11-1 2012-Q4 $ - $ - $ - $ 65,673 $ 26,269 $ (39,404)
231 Los Angeles Lancaster SD 11/12-1 Err:520 $ 74,602 $ 29,841 $ 44,761 $ - ### $ -
232 Los Angeles Lancaster SD 10/11-2 2013-Q1 $ - $ - $ - $ 71,177 $ 28,471 $ (42,706)
233 Los Angeles Lancaster SD 11/12-2 Err:520 $ 75,856 $ 30,342 $ 45,514 $ - ### $ -
234 Los Angeles Lancaster SD 10/11-3 2013-Q2 $ - $ - $ - $ 71,822 $ 28,729 $ (43,093)
235 Los Angeles Lancaster SD 11/12-3 Err:520 $ 61,623 $ 24,649 $ 36,974 $ - ### $ -
236 Los Angeles Lancaster SD 10/11-4 Err:520 $ 75,457 $ 30,183 $ 45,274 $ - ### $ -
237 Los Angeles Lancaster SD 11/12-4 Err:520 $ 101,280 $ 40,512 $ 60,768 $ - ### $ -
238 Lancaster SD Total $ 388,818 $ 155,527 $ 233,291 $ 208,672 $ 83,469 $ (125,203) $ 30,324 Err:520 Err:520 Err:520 Err:520 Err:520
239 Los Angeles Las Virgenes USD 10/11-2 2013-Q1 $ - $ - $ - $ 42,997 $ 30,098 $ (12,899)
240 Los Angeles Las Virgenes USD 11/12-2 Err:520 $ 37,133 $ 25,993 $ 11,140 $ - ### $ -
241 Los Angeles Las Virgenes USD 10/11-3 2013-Q2 $ - $ - $ - $ 49,559 $ 34,691 $ (14,868)
242 Los Angeles Las Virgenes USD 11/12-3 Err:520 $ 36,721 $ 25,705 $ 11,016 $ - ### $ -
243 Los Angeles Las Virgenes USD 10/11-4 Err:520 $ 49,851 $ 34,896 $ 14,955 $ - ### $ -
244 Los Angeles Las Virgenes USD 11/12-4 Err:520 $ 35,169 $ 24,618 $ 10,551 $ - ### $ -
245 Las Virgenes USD Total $ 158,874 $ 111,212 $ 47,662 $ 92,556 $ 64,789 $ (27,767) $ 83,445 Err:520 Err:520 Err:520 Err:520 Err:520
246 Los Angeles Lawndale ESD - PPS 10/11-1 2012-Q4 $ - $ - ### $ 37,726 $ 28,295 $ (9,431) 2
247 Los Angeles Lawndale ESD - PPS 11/12-1 Err:520 $ 41,587 $ 31,190 $ 10,397 $ - ### $ - 2
248 Los Angeles Lawndale ESD - PPS 10/11-2 2013-Q1 $ - $ - $ - $ 69,887 $ 27,955 $ (41,932)
249 Los Angeles Lawndale ESD - PPS 11/12-2 Err:520 $ 101,572 $ 40,629 $ 60,943 $ - ### $ -
250 Los Angeles Lawndale ESD - PPS 10/11-3 2013-Q2 $ - $ - $ - $ 80,150 $ 32,060 $ (48,090)
251 Los Angeles Lawndale ESD - PPS 11/12-3 Err:520 $ 88,863 $ 35,545 $ 53,318 $ - ### $ -
252 Los Angeles Lawndale ESD - PPS 10/11-4 2013-Q3 $ - $ - $ - $ 92,045 $ 36,818 $ (55,227)
253 Los Angeles Lawndale ESD - PPS 11/12-4 Err:520 $ 118,384 $ 47,354 $ 71,030 $ - ### $ -
254 Lawndale ESD - PPS Total $ 350,406 $ 154,718 $ 195,688 $ 279,808 $ 125,128 $ (154,680) $ 38 Err:520 Err:520 Err:520 Err:520 Err:520
255 Los Angeles Lennox SD-Pupil Health Services 10/11-1 2012-Q4 $ - $ - ### $ 46,963 $ 46,963 $ -
256 Los Angeles Lennox SD-Pupil Health Services 10/11-2 2013-Q1 $ - $ - ### $ 25,845 $ 25,845 $ -
A B C D E F G H I J K L M N O P Q R S T U V W
Amount to release
2 to claiming unit
Amount to be recouped from DHCS Total amount
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata settlement withheld (FFY 2013 Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent check(s) and CUs in Red) or 2) Green Dot Public Schools Hacienda La Puente USD
257 Los Angeles Lennox SD-Pupil Health Services 10/11-3 2013-Q2 $ - $ - ### $ 29,910 $ 29,910 $ -
258 Los Angeles Lennox SD-Pupil Health Services 11/12-4 Err:520 $ - $ - $ - ### $ -
259 Lennox SD-Pupil Health Services Total $ - $ - $ - $ 102,718 $ 102,718 $ - $ -
260 Los Angeles Little Lake City ESD 10/11-2 2013-Q1 $ - $ - ### $ 41,703 $ 31,277 $ (10,426) 2
261 Los Angeles Little Lake City ESD 11/12-4 Err:520 $ 27,914 $ 25,000 $ 2,914 $ - ### $ - 2
262 Little Lake City ESD Total $ 27,914 $ 25,000 $ 2,914 $ 41,703 $ 31,277 $ (10,426) $ 14,574 Err:520 Err:520 Err:520 Err:520 Err:520
263 Los Angeles Long Beach USD 11/12-2 Err:520 $ 293,513 $ 117,405 $ 176,108 $ - ### $ -
264 Los Angeles Long Beach USD 11/12-3 Err:520 $ 228,611 $ 91,444 $ 137,167 $ - ### $ -
265 Los Angeles Long Beach USD 10/11-1 2012-Q4 $ - $ - $ - $ 229,161 $ 91,664 $ (137,497)
266 Los Angeles Long Beach USD 11/12-1 Err:520 $ 175,176 $ 70,070 $ 105,106 $ - ### $ -
267 Los Angeles Long Beach USD 10/11-2 2013-Q1 $ - $ - $ - $ 269,309 $ 107,724 $ (161,585)
268 Los Angeles Long Beach USD 10/11-3 2013-Q2 $ - $ - $ - $ 276,287 $ 110,515 $ (165,772)
269 Los Angeles Long Beach USD 10/11-4 Err:520 $ 257,920 $ 103,168 $ 154,752 $ - ### $ -
270 Los Angeles Long Beach USD 11/12-4 Err:520 $ 233,574 $ 93,430 $ 140,144 $ - ### $ -
271 Long Beach USD Total $ 1,188,794 $ 475,517 $ 713,277 $ 774,757 $ 309,903 $ (464,854) $ 10,663 Err:520 Err:520 Err:520 Err:520 Err:520
272 Los Angeles Los Angeles COE 10/11-1 2012-Q4 $ - $ - $ - $ 463,181 $ 185,272 $ (277,909)
273 Los Angeles Los Angeles COE 11/12-1 Err:520 $ 485,407 $ 194,163 $ 291,244 $ - ### $ -
274 Los Angeles Los Angeles COE 10/11-2 2013-Q1 $ - $ - $ - $ 605,758 $ 242,303 $ (363,455)
275 Los Angeles Los Angeles COE 11/12-2 Err:520 $ 689,937 $ 275,975 $ 413,962 $ - ### $ -
276 Los Angeles Los Angeles COE 10/11-3 Err:520 $ 667,379 $ 266,952 $ 400,427 $ - ### $ -
277 Los Angeles Los Angeles COE 11/12-3 Err:520 $ 526,722 $ 210,689 $ 316,033 $ - ### $ -
278 Los Angeles Los Angeles COE 09/10-4 2012-Q3 $ - $ - $ - $ 760,280 $ 304,112 $ (456,168)
279 Los Angeles Los Angeles COE 10/11-4 Err:520 $ 734,539 $ 293,816 $ 440,723 $ - ### $ -
280 Los Angeles Los Angeles COE 11/12-4 Err:520 $ 648,307 $ 259,323 $ 388,984 $ - ### $ -
281 Los Angeles COE Total $ 3,752,291 $ 1,500,918 $ 2,251,373 $ 1,829,219 $ 731,687 $ (1,097,532) $ 403,386 Err:520 Err:520 Err:520 Err:520 Err:520
282 Los Angeles Lynwood USD 10/11-1 2012-Q4 $ - $ - $ - $ 98,885 $ 98,885 $ -
283 Los Angeles Lynwood USD 10/11-2 2013-Q1 $ - $ - ### $ 40,541 $ 40,541 $ - 2
284 Los Angeles Lynwood USD 10/11-3 2013-Q2 $ - $ - ### $ 33,209 $ 33,209 $ - 2
285 Los Angeles Lynwood USD 09/10-4 2012-Q3 $ - $ - $ - $ 256,176 $ 256,176 $ -
286 Los Angeles Lynwood USD 11/12-4 Err:520 $ - $ - $ - ### $ -
287 Lynwood USD Total $ - $ - $ - $ 428,811 $ 428,811 $ - $ -
288 Los Angeles Monrovia USD 10/11-1 2012-Q4 $ - $ - $ - $ 81,820 $ 32,728 $ (49,092)
289 Los Angeles Monrovia USD 11/12-1 Err:520 $ 68,871 $ 27,548 $ 41,323 $ - ### $ -
290 Los Angeles Monrovia USD 10/11-2 2013-Q1 $ - $ - $ - $ 90,941 $ 36,376 $ (54,565)
291 Los Angeles Monrovia USD 11/12-2 Err:520 $ 80,028 $ 32,011 $ 48,017 $ - ### $ -
292 Los Angeles Monrovia USD 10/11-3 Err:520 $ 102,137 $ 40,855 $ 61,282 $ - ### $ -
293 Los Angeles Monrovia USD 11/12-3 Err:520 $ 84,453 $ 33,781 $ 50,672 $ - ### $ -
294 Los Angeles Monrovia USD 09/10-4 2012-Q3 $ - $ - $ - $ 116,002 $ 46,401 $ (69,601)
295 Los Angeles Monrovia USD 10/11-4 Err:520 $ 93,555 $ 37,422 $ 56,133 $ - ### $ -
296 Los Angeles Monrovia USD 11/12-4 Err:520 $ 77,381 $ 30,952 $ 46,429 $ - ### $ -
297 Monrovia USD Total $ 506,425 $ 202,569 $ 303,856 $ 288,763 $ 115,505 $ (173,258) $ 29,311 Err:520 Err:520 Err:520 Err:520 Err:520
298 Los Angeles Montebello USD 10/11-1 2012-Q4 $ - $ - $ - $ 163,650 $ 65,460 $ (98,190)
299 Los Angeles Montebello USD 10/11-2 2013-Q1 $ - $ - $ - $ 173,661 $ 69,464 $ (104,197)
300 Los Angeles Montebello USD 11/12-2 Err:520 $ 278,635 $ 111,454 $ 167,181 $ - ### $ -
301 Los Angeles Montebello USD 10/11-3 Err:520 $ 194,212 $ 77,685 $ 116,527 $ - ### $ -
302 Los Angeles Montebello USD 11/12-3 Err:520 $ 279,573 $ 111,829 $ 167,744 $ - ### $ -
303 Los Angeles Montebello USD 10/11-4 Err:520 $ 207,440 $ 82,976 $ 124,464 $ - ### $ -
304 Los Angeles Montebello USD 11/12-4 Err:520 $ 252,966 $ 101,186 $ 151,780 $ - ### $ -
305 Los Angeles Montebello USD 11/12-1C-1 Err:520 $ 201,946 $ 80,778 $ 121,168 $ - ### $ -
306 Montebello USD Total $ 1,414,772 $ 565,908 $ 848,864 $ 337,311 $ 134,924 $ (202,387) $ 363,521 Err:520 Err:520 Err:520 Err:520 Err:520
307 Los Angeles Mountain View SD 11/12-3 Err:520 $ 59,460 $ 23,784 $ 35,676 $ - ### $ -
308 Los Angeles Mountain View SD 11/12-4 Err:520 $ 37,285 $ 27,964 $ 9,321 $ - ### $ - 2
309 Mountain View SD Total $ 96,745 $ 51,748 $ 44,997 $ - $ - $ - $ 51,748 Err:520 Err:520 Err:520 Err:520 Err:520
310 Los Angeles Mt. San Antonio Comm College 11/12-1-C1 Err:520 $ 36,706 $ 25,694 $ 11,012 $ - ### $ -
311 Los Angeles Mt. San Antonio Comm College 11/12-2C-1 Err:520 $ 67,156 $ 23,505 $ 43,651 $ - ### $ -
312 Los Angeles Mt. San Antonio Comm College 11/12-3C-1 Err:520 $ 37,885 $ 26,520 $ 11,365 $ - ### $ -
313 Los Angeles Mt. San Antonio Comm College 11/12-4C-1 Err:520 $ 48,258 $ 33,781 $ 14,477 $ - ### $ -
314 Mt. San Antonio Comm College Total $ 190,005 $ 109,500 $ 80,505 $ - $ - $ - $ 109,500 Err:520 Err:520 Err:520 Err:520 Err:520
315 Los Angeles Newhall ESD 11/12-1 Err:520 $ 31,550 $ 25,000 $ 6,550 $ - ### $ - 2
316 Los Angeles Newhall ESD 10/11-2 2013-Q1 $ - $ - ### $ 35,313 $ 26,485 $ (8,828) 2
317 Los Angeles Newhall ESD 11/12-2 Err:520 $ 30,504 $ 25,000 $ 5,504 $ - ### $ - 2
318 Los Angeles Newhall ESD 10/11-3 2013-Q2 $ - $ - ### $ 29,082 $ 25,000 $ (4,082) 2
319 Los Angeles Newhall ESD 10/11-4 2013-Q3 $ - $ - ### $ 26,931 $ 25,000 $ (1,931) 2
320 Los Angeles Newhall ESD 11/12-4 Err:520 $ 42,481 $ 31,861 $ 10,620 $ - ### $ - 2
321 Newhall ESD Total $ 104,535 $ 81,861 $ 22,674 $ 91,326 $ 76,485 $ (14,841) $ 67,020 Err:520 Err:520 Err:520 Err:520 Err:520
322 Los Angeles Norwalk-La Mirada USD 10/11-1 2012-Q4 $ - $ - ### $ 34,293 $ 25,720 $ (8,573) 2
323 Los Angeles Norwalk-La Mirada USD 11/12-1 Err:520 $ 28,292 $ 25,000 $ 3,292 $ - ### $ - 2
324 Los Angeles Norwalk-La Mirada USD 10/11-2 2013-Q1 $ - $ - $ - $ 57,172 $ 22,869 $ (34,303)
325 Los Angeles Norwalk-La Mirada USD 11/12-2 Err:520 $ 50,421 $ 20,168 $ 30,253 $ - ### $ -
326 Los Angeles Norwalk-La Mirada USD 10/11-3 2013-Q2 $ - $ - ### $ 45,963 $ 34,472 $ (11,491) 2
327 Los Angeles Norwalk-La Mirada USD 11/12-3 Err:520 $ 36,578 $ 27,434 $ 9,144 $ - ### $ - 2
328 Los Angeles Norwalk-La Mirada USD 10/11-4 Err:520 $ 55,641 $ 22,256 $ 33,385 $ - ### $ -
329 Los Angeles Norwalk-La Mirada USD 11/12-4 Err:520 $ 41,403 $ 31,052 $ 10,351 $ - ### $ - 2
330 Norwalk-La Mirada USD Total $ 212,335 $ 125,910 $ 86,425 $ 137,428 $ 83,061 $ (54,367) $ 71,543 Err:520 Err:520 Err:520 Err:520 Err:520
331 Los Angeles Palmdale ESD 10/11-1 2012-Q4 $ - $ - $ - $ 164,454 $ 65,782 $ (98,672)
332 Los Angeles Palmdale ESD 11/12-1 Err:520 $ 155,622 $ 62,249 $ 93,373 $ - ### $ -
333 Los Angeles Palmdale ESD 10/11-2 2013-Q1 $ - $ - $ - $ 170,429 $ 68,172 $ (102,257)
334 Los Angeles Palmdale ESD 11/12-2 Err:520 $ 148,217 $ 59,287 $ 88,930 $ - ### $ -
335 Los Angeles Palmdale ESD 10/11-3 2013-Q2 $ - $ - $ - $ 131,379 $ 52,552 $ (78,827)
336 Los Angeles Palmdale ESD 11/12-3 Err:520 $ 170,386 $ 68,154 $ 102,232 $ - ### $ -
337 Los Angeles Palmdale ESD 09/10-4 2012-Q3 $ - $ - $ - $ 124,457 $ 49,783 $ (74,674)
338 Los Angeles Palmdale ESD 10/11-4 Err:520 $ 138,921 $ 55,568 $ 83,353 $ - ### $ -
339 Los Angeles Palmdale ESD 12/13-1 Err:520 $ 73,343 $ 29,337 $ 44,006
340 Los Angeles Palmdale ESD 12/13-2 Err:520 $ 122,774 $ 49,110 $ 73,664
341 Los Angeles Palmdale ESD 11/12-4 Err:520 $ 157,432 $ 62,973 $ 94,459 $ - ### $ -
342 Palmdale ESD Total $ 966,695 $ 386,678 $ 580,017 $ 590,719 $ 236,289 $ (354,430) $ 32,248 Err:520 Err:520 Err:520 Err:520 Err:520
343 Los Angeles Paramount USD 11/12-2 Err:520 $ 40,133 $ 30,100 $ 10,033 $ - ### $ - 2
344 Los Angeles Paramount USD 11/12-3 Err:520 $ 33,877 $ 25,408 $ 8,469 $ - ### $ - 2
345 Los Angeles Paramount USD 11/12-4 Err:520 $ 35,911 $ 26,933 $ 8,978 $ - ### $ - 2
346 Paramount USD Total $ 109,921 $ 82,441 $ 27,480 $ - $ - $ - $ 82,441 Err:520 Err:520 Err:520 Err:520 Err:520
347 Los Angeles Pomona USD 10/11-1 2012-Q4 $ - $ - $ - $ 191,903 $ 76,761 $ (115,142)
348 Los Angeles Pomona USD 11/12-1 Err:520 $ 388,087 $ 155,235 $ 232,852 $ - ### $ -
349 Los Angeles Pomona USD 10/11-2 2013-Q1 $ - $ - $ - $ 308,660 $ 123,464 $ (185,196)
350 Los Angeles Pomona USD 11/12-2 Err:520 $ 496,220 $ 198,488 $ 297,732 $ - ### $ -
351 Los Angeles Pomona USD 10/11-3 2013-Q2 $ - $ - $ - $ 304,611 $ 121,844 $ (182,767)
352 Los Angeles Pomona USD 11/12-3 Err:520 $ 463,503 $ 185,401 $ 278,102 $ - ### $ -
353 Los Angeles Pomona USD 10/11-4 Err:520 $ 291,190 $ 116,476 $ 174,714 $ - ### $ -
354 Los Angeles Pomona USD 11/12-4 Err:520 $ 513,334 $ 205,334 $ 308,000 $ - ### $ -
355 Pomona USD Total $ 2,152,334 $ 860,934 $ 1,291,400 $ 805,174 $ 322,069 $ (483,105) $ 377,829 Err:520 Err:520 Err:520 Err:520 Err:520
356 Los Angeles Redondo Beach USD 10/11-2 2013-Q1 $ - ### $ 37,580 $ 26,306 $ (11,274)
357 Los Angeles Redondo Beach USD 11/12-2 Err:520 $ 40,808 $ 28,566 $ 12,242 $ - ### $ -
358 Los Angeles Redondo Beach USD 10/11-3 2013-Q2 $ - ### $ 25,833 $ 18,083 $ (7,750)
359 Los Angeles Redondo Beach USD 10/11-4 Err:520 $ 29,358 $ 20,551 $ 8,807 $ - ### $ -
360 Los Angeles Redondo Beach USD 11/12-4 Err:520 $ 32,227 $ 22,559 $ 9,668 $ - ### $ -
361 Redondo Beach USD Total $ 102,393 $ 71,676 $ 30,717 $ 63,413 $ 44,389 $ (19,024) $ 52,652 Err:520 Err:520 Err:520 Err:520 Err:520
362 Los Angeles Rosemead SD 10/11-3 2013-Q2 $ - $ - ### $ 26,753 $ 25,000 $ (1,753) 2
363 Los Angeles Rosemead SD 10/11-4 Err:520 $ 27,397 $ 25,000 $ 2,397 $ - ### $ - 2
364 Rosemead SD Total $ 27,397 $ 25,000 $ 2,397 $ 26,753 $ 25,000 $ (1,753) $ 23,247 Err:520 Err:520 Err:520 Err:520 Err:520
365 Los Angeles Rowland USD 10/11-1 2012-Q4 $ - $ - $ - $ 192,565 $ 77,026 $ (115,539)
366 Los Angeles Rowland USD 11/12-1 Err:520 $ 155,120 $ 62,048 $ 93,072 $ - ### $ -
367 Los Angeles Rowland USD 10/11-2 2013-Q1 $ - $ - $ - $ 350,740 $ 140,296 $ (210,444)
368 Los Angeles Rowland USD 11/12-2 Err:520 $ 263,713 $ 105,485 $ 158,228 $ - ### $ -
369 Los Angeles Rowland USD 10/11-3 2013-Q2 $ - $ - $ - $ 370,272 $ 148,109 $ (222,163)
370 Los Angeles Rowland USD 11/12-3 Err:520 $ 284,136 $ 113,654 $ 170,482 $ - ### $ -
371 Los Angeles Rowland USD 09/10-4 2012-Q3 $ - $ - $ - $ 344,823 $ 137,929 $ (206,894)
372 Los Angeles Rowland USD 10/11-4 Err:520 $ 375,629 $ 150,252 $ 225,377 $ - ### $ -
373 Los Angeles Rowland USD 12/13-1 Err:520 $ 135,548 $ 54,219 $ 81,329
374 Los Angeles Rowland USD 12/13-2 Err:520 $ 141,877 $ 56,751 $ 85,126
375 Los Angeles Rowland USD 12/13-3 Err:520 $ 162,743 $ 65,097 $ 97,646
376 Los Angeles Rowland USD 12/13-4 Err:520 $ 140,685 $ 56,274 $ 84,411
377 Los Angeles Rowland USD 11/12-4 Err:520 $ 262,224 $ 104,890 $ 157,334 $ - ### $ -
378 Rowland USD Total $ 1,921,675 $ 768,670 $ 1,153,005 $ 1,258,400 $ 503,360 $ (755,040) $ 13,630 Err:520 Err:520 Err:520 Err:520 Err:520
379 Los Angeles San Gabriel USD 10/11-1 2012-Q4 $ - $ - $ - $ 61,731 $ 24,692 $ (37,039)
380 Los Angeles San Gabriel USD 11/12-1 Err:520 $ 47,491 $ 35,618 $ 11,873 $ - ### $ - 2
381 Los Angeles San Gabriel USD 10/11-2 2013-Q1 $ - $ - $ - $ 87,199 $ 34,880 $ (52,319)
382 Los Angeles San Gabriel USD 11/12-2 Err:520 $ 94,132 $ 37,653 $ 56,479 $ - ### $ -
383 Los Angeles San Gabriel USD 10/11-3 2013-Q2 $ - $ - $ - $ 58,713 $ 23,485 $ (35,228)
384 Los Angeles San Gabriel USD 11/12-3 Err:520 $ 67,129 $ 26,852 $ 40,277 $ - ### $ -
A B C D E F G H I J K L M N O P Q R S T U V W
Amount to release
2 to claiming unit
Amount to be recouped from DHCS Total amount
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata settlement withheld (FFY 2013 Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent check(s) and CUs in Red) or 2) Green Dot Public Schools Hacienda La Puente USD
385 Los Angeles San Gabriel USD 10/11-4 Err:520 $ 90,618 $ 36,247 $ 54,371 $ - ### $ -
386 Los Angeles San Gabriel USD 11/12-4 Err:520 $ 98,655 $ 39,462 $ 59,193 $ - ### $ -
387 San Gabriel USD Total $ 398,025 $ 175,832 $ 222,193 $ 207,643 $ 83,057 $ (124,586) $ 51,246 Err:520 Err:520 Err:520 Err:520 Err:520
388 Los Angeles Santa Clarita CCD - College of the Canyons 11/12-1 Err:520 $ 26,637 $ 25,000 $ 1,637 $ - ### $ - 2
389 Los Angeles Santa Clarita CCD - College of the Canyons 11/12-2 Err:520 $ 32,121 $ 25,000 $ 7,121 $ - ### $ - 2
390 Los Angeles Santa Clarita CCD - College of the Canyons 10/11-3 2013-Q2 $ - $ - ### $ 38,012 $ 28,509 $ (9,503) 2
391 Los Angeles Santa Clarita CCD - College of the Canyons 10/11-4 2013-Q3 $ - $ - ### $ 45,025 $ 33,769 $ (11,256) 2
392 Los Angeles Santa Clarita CCD - College of the Canyons 11/12-4 Err:520 $ 30,292 $ 25,000 $ 5,292 $ - ### $ - 2
393 Santa Clarita CCD - College of the Canyons Total $ 89,050 $ 75,000 $ 14,050 $ 83,037 $ 62,278 $ (20,759) $ 54,241 Err:520 Err:520 Err:520 Err:520 Err:520
394 Los Angeles Santa Monica - Malibu USD 10/11-2 Err:520 $ 67,898 $ 27,159 $ 40,739 $ - ### $ -
395 Santa Monica - Malibu USD Total $ 67,898 $ 27,159 $ 40,739 $ - $ - $ - $ 27,159 Err:520 Err:520 Err:520 Err:520 Err:520
396 Los Angeles Santa Monica-Malibu USD 10/11-1 2012-Q4 $ - $ - $ - $ 69,976 $ 27,990 $ (41,986)
397 Los Angeles Santa Monica-Malibu USD 11/12-1 Err:520 $ 54,212 $ 21,685 $ 32,527 $ - ### $ -
398 Los Angeles Santa Monica-Malibu USD 11/12-2 Err:520 $ 82,731 $ 33,092 $ 49,639 $ - ### $ -
399 Los Angeles Santa Monica-Malibu USD 10/11-3 2013-Q2 $ - $ - $ - $ 90,562 $ 36,225 $ (54,337)
400 Los Angeles Santa Monica-Malibu USD 11/12-3 Err:520 $ 85,004 $ 34,002 $ 51,002 $ - ### $ -
401 Los Angeles Santa Monica-Malibu USD 09/10-4 2012-Q3 $ - $ - $ - $ 79,862 $ 31,945 $ (47,917)
402 Los Angeles Santa Monica-Malibu USD 10/11-4 Err:520 $ 85,178 $ 34,071 $ 51,107 $ - ### $ -
403 Los Angeles Santa Monica-Malibu USD 11/12-4 Err:520 $ 93,845 $ 37,538 $ 56,307 $ - ### $ -
404 Santa Monica-Malibu USD Total $ 400,970 $ 160,388 $ 240,582 $ 240,400 $ 96,160 $ (144,240) $ 16,148 Err:520 Err:520 Err:520 Err:520 Err:520
405 Los Angeles Saugus USD 10/11-1 2012-Q4 $ - $ - $ - $ 65,441 $ 26,176 $ (39,265)
406 Los Angeles Saugus USD 11/12-1 Err:520 $ 57,124 $ 22,850 $ 34,274 $ - ### $ -
407 Los Angeles Saugus USD 10/11-2 2013-Q1 $ - $ - $ - $ 76,037 $ 30,415 $ (45,622)
408 Los Angeles Saugus USD 11/12-2 Err:520 $ 65,374 $ 26,150 $ 39,224 $ - ### $ -
409 Los Angeles Saugus USD 10/11-3 Err:520 $ 59,434 $ 23,774 $ 35,660 $ - ### $ -
410 Los Angeles Saugus USD 11/12-3 Err:520 $ 60,664 $ 24,266 $ 36,398 $ - ### $ -
411 Los Angeles Saugus USD 10/11-4 Err:520 $ 55,934 $ 22,374 $ 33,560 $ - ### $ -
412 Los Angeles Saugus USD 11/12-4 Err:520 $ 54,369 $ 21,748 $ 32,621 $ - ### $ -
413 Saugus USD Total $ 352,899 $ 141,162 $ 211,737 $ 141,478 $ 56,591 $ (84,887) $ 56,275 Err:520 Err:520 Err:520 Err:520 Err:520
414 Los Angeles South Whittier ESD 10/11-1 2012-Q4 $ - $ - ### $ 28,010 $ 25,000 $ (3,010) 2
415 Los Angeles South Whittier ESD 11/12-1 Err:520 $ 48,833 $ 36,625 $ 12,208 $ - ### $ - 2
416 Los Angeles South Whittier ESD 10/11-2 2013-Q1 $ - $ - $ - $ 51,519 $ 20,608 $ (30,911)
417 Los Angeles South Whittier ESD 10/11-3 2013-Q2 $ - $ - $ - $ 64,662 $ 25,865 $ (38,797)
418 Los Angeles South Whittier ESD 10/11-4 Err:520 $ 65,045 $ 26,018 $ 39,027 $ - ### $ -
419 Los Angeles South Whittier ESD 11/12-2C-1 Err:520 $ 62,230 $ 24,892 $ 37,338 $ - ### $ -
420 Los Angeles South Whittier ESD 11/12-3C-1 Err:520 $ 58,067 $ 23,227 $ 34,840 $ - ### $ -
421 Los Angeles South Whittier ESD 11/12-4C-1 Err:520 $ 63,258 $ 25,303 $ 37,955 $ - ### $ -
422 South Whittier ESD Total $ 297,433 $ 136,065 $ 161,368 $ 144,191 $ 71,473 $ (72,718) $ 63,347 Err:520 Err:520 Err:520 Err:520 Err:520
423 Los Angeles Sulphur Springs SD 10/11-1 2012-Q4 $ - $ - $ - $ 70,373 $ 28,149 $ (42,224)
424 Los Angeles Sulphur Springs SD 11/12-1 Err:520 $ 68,906 $ 27,562 $ 41,344 $ - ### $ -
425 Los Angeles Sulphur Springs SD 10/11-2 2013-Q1 $ - $ - $ - $ 82,303 $ 32,921 $ (49,382)
426 Los Angeles Sulphur Springs SD 11/12-2 Err:520 $ 65,045 $ 26,018 $ 39,027 $ - ### $ -
427 Los Angeles Sulphur Springs SD 10/11-3 2013-Q2 $ - $ - $ - $ 76,541 $ 30,616 $ (45,925)
428 Los Angeles Sulphur Springs SD 10/11-4 Err:520 $ 70,561 $ 28,224 $ 42,337 $ - ### $ -
429 Los Angeles Sulphur Springs SD 11/12-4 Err:520 $ 75,815 $ 30,326 $ 45,489 $ - ### $ -
430 Los Angeles Sulphur Springs SD 12/13-1 Err:520 $ 69,324 $ 27,730 $ 41,594
431 Los Angeles Sulphur Springs SD 11/12-3C-1 Err:520 $ 59,559 $ 23,824 $ 35,735 $ - ### $ -
432 Sulphur Springs SD Total $ 409,210 $ 163,684 $ 245,526 $ 229,217 $ 91,686 $ (137,531) $ 26,153 Err:520 Err:520 Err:520 Err:520 Err:520
433 Los Angeles Temple City USD 10/11-1 2012-Q4 $ - $ - ### $ 25,962 $ 25,000 $ (962) 2
434 Los Angeles Temple City USD 10/11-2 2013-Q1 $ - $ - ### $ 31,743 $ 25,000 $ (6,743) 2
435 Los Angeles Temple City USD 11/12-2 Err:520 $ 33,969 $ 25,477 $ 8,492 $ - ### $ - 2
436 Los Angeles Temple City USD 11/12-3 Err:520 $ 29,395 $ 25,000 $ 4,395 $ - ### $ - 2
437 Los Angeles Temple City USD 10/11-4 Err:520 $ 26,679 $ 25,000 $ 1,679 $ - ### $ - 2
438 Los Angeles Temple City USD 11/12-4 Err:520 $ 26,005 $ 25,000 $ 1,005 $ - ### $ - 2
439 Temple City USD Total $ 116,048 $ 100,477 $ 15,571 $ 57,705 $ 50,000 $ (7,705) $ 92,772 Err:520 Err:520 Err:520 Err:520 Err:520
440 Los Angeles Torrance USD 11/12-1 Err:520 $ 149,768 $ 59,907 $ 89,861 $ - ### $ -
441 Los Angeles Torrance USD 10/11-2 2013-Q1 $ - $ - ### $ 28,820 $ 25,000 $ (3,820) 2
442 Los Angeles Torrance USD 11/12-2 Err:520 $ 139,719 $ 55,888 $ 83,831 $ - ### $ -
443 Los Angeles Torrance USD 10/11-3 2013-Q2 $ - $ - ### $ 37,622 $ 28,217 $ (9,405) 2
444 Los Angeles Torrance USD 11/12-3 Err:520 $ 95,542 $ 38,217 $ 57,325 $ - ### $ -
445 Los Angeles Torrance USD 10/11-4 Err:520 $ 38,469 $ 28,852 $ 9,617 $ - ### $ - 2
446 Los Angeles Torrance USD 11/12-4 Err:520 $ 87,245 $ 34,898 $ 52,347 $ - ### $ -
447 Torrance USD Total $ 510,743 $ 217,762 $ 292,981 $ 66,442 $ 53,217 $ (13,225) $ 204,537 Err:520 Err:520 Err:520 Err:520 Err:520
448 Los Angeles Walnut Valley USD 11/12-1 Err:520 $ 30,515 $ 25,000 $ 5,515 $ - ### $ - 2
449 Los Angeles Walnut Valley USD 10/11-2 2013-Q1 $ - $ - $ - $ 100,677 $ 40,271 $ (60,406)
450 Los Angeles Walnut Valley USD 11/12-2 Err:520 $ 35,067 $ 26,300 $ 8,767 $ - ### $ - 2
451 Los Angeles Walnut Valley USD 10/11-3 Err:520 $ 88,541 $ 35,416 $ 53,125 $ - ### $ -
452 Los Angeles Walnut Valley USD 11/12-3 Err:520 $ 30,903 $ 25,000 $ 5,903 $ - ### $ - 2
453 Los Angeles Walnut Valley USD 10/11-4 Err:520 $ 86,096 $ 34,438 $ 51,658 $ - ### $ -
454 Los Angeles Walnut Valley USD 11/12-4 Err:520 $ 31,378 $ 25,000 $ 6,378 $ - ### $ - 2
455 Walnut Valley USD Total $ 302,500 $ 171,154 $ 131,346 $ 100,677 $ 40,271 $ (60,406) $ 110,748 Err:520 Err:520 Err:520 Err:520 Err:520
456 Los Angeles West Covina USD 10/11-1 2012-Q4 $ - $ - ### $ 89,124 $ 35,650 $ (53,474)
457 Los Angeles West Covina USD 10/11-2 2013-Q1 $ - $ - ### $ 114,048 $ 45,619 $ (68,429)
458 Los Angeles West Covina USD 11/12-2 Err:520 $ 115,521 $ 46,208 $ 69,313 $ - ### $ -
459 Los Angeles West Covina USD 10/11-3 2013-Q2 $ - $ - ### $ 133,709 $ 53,484 $ (80,225)
460 Los Angeles West Covina USD 11/12-3 Err:520 $ 118,028 $ 47,211 $ 70,817 $ - ### $ -
461 Los Angeles West Covina USD 10/11-4 Err:520 $ 123,148 $ 49,259 $ 73,889 $ - ### $ -
462 Los Angeles West Covina USD 11/12-4 Err:520 $ 125,075 $ 50,030 $ 75,045 $ - ### $ -
463 Los Angeles West Covina USD 11/12-1C-1 Err:520 $ 79,903 $ 31,961 $ 47,942 $ - ### $ -
464 West Covina USD Total $ 561,675 $ 224,669 $ 337,006 $ 336,881 $ 134,753 $ (202,128) $ 22,541 Err:520 Err:520 Err:520 Err:520 Err:520
465 Los Angeles Westside Union SD 10/11-1 2012-Q4 $ - $ - ### $ 122,852 $ 49,141 $ (73,711)
466 Los Angeles Westside Union SD 11/12-1 Err:520 $ 166,701 $ 66,680 $ 100,021 $ - ### $ -
467 Los Angeles Westside Union SD 10/11-2 2013-Q1 $ - $ - ### $ 76,752 $ 30,701 $ (46,051)
468 Los Angeles Westside Union SD 11/12-2 Err:520 $ 164,627 $ 65,851 $ 98,776 $ - ### $ -
469 Los Angeles Westside Union SD 10/11-3 2013-Q2 $ - $ - ### $ 61,664 $ 24,666 $ (36,998)
470 Los Angeles Westside Union SD 11/12-3 Err:520 $ 172,963 $ 69,185 $ 103,778 $ - ### $ -
471 Los Angeles Westside Union SD 09/10-4 2012-Q3 $ - $ - ### $ 62,781 $ 25,112 $ (37,669)
472 Los Angeles Westside Union SD 10/11-4 Err:520 $ 60,404 $ 24,162 $ 36,242 $ - ### $ -
473 Los Angeles Westside Union SD 11/12-4 Err:520 $ 184,640 $ 73,856 $ 110,784 $ - ### $ -
474 Westside Union SD Total $ 749,335 $ 299,734 $ 449,601 $ 324,049 $ 129,620 $ (194,429) $ 105,305 Err:520 Err:520 Err:520 Err:520 Err:520
475 Los Angeles Whittier Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 97,682 $ 39,073 $ (58,609)
476 Los Angeles Whittier Union HSD 11/12-1 Err:520 $ 143,170 $ 57,268 $ 85,902 $ - ### $ -
477 Los Angeles Whittier Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 151,409 $ 60,564 $ (90,845)
478 Los Angeles Whittier Union HSD 11/12-2 Err:520 $ 236,540 $ 94,616 $ 141,924 $ - ### $ -
479 Los Angeles Whittier Union HSD 10/11-3 2013-Q2 $ - $ - ### $ 139,893 $ 55,957 $ (83,936)
480 Los Angeles Whittier Union HSD 11/12-3 Err:520 $ 169,742 $ 67,897 $ 101,845 $ - ### $ -
481 Los Angeles Whittier Union HSD 09/10-4 2012-Q3 $ - $ - ### $ 143,050 $ 57,220 $ (85,830)
482 Los Angeles Whittier Union HSD 10/11-4 Err:520 $ 155,512 $ 62,205 $ 93,307 $ - ### $ -
483 Los Angeles Whittier Union HSD 11/12-4 Err:520 $ 177,429 $ 70,972 $ 106,457 $ - ### $ -
484 Whittier Union HSD Total $ 882,393 $ 352,958 $ 529,435 $ 532,034 $ 212,814 $ (319,220) $ 33,738 Err:520 Err:520 Err:520 Err:520 Err:520
485 Los Angeles William S. Hart Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 93,337 $ 37,335 $ (56,002)
486 Los Angeles William S. Hart Union HSD 11/12-1 Err:520 $ 103,024 $ 41,210 $ 61,814 $ - ### $ -
487 Los Angeles William S. Hart Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 264,950 $ 105,980 $ (158,970)
488 Los Angeles William S. Hart Union HSD 11/12-2 Err:520 $ 148,907 $ 59,563 $ 89,344 $ - ### $ -
489 Los Angeles William S. Hart Union HSD 10/11-3 2013-Q2 $ - $ - ### $ 147,349 $ 58,940 $ (88,409)
490 Los Angeles William S. Hart Union HSD 11/12-3 Err:520 $ 195,042 $ 78,017 $ 117,025 $ - ### $ -
491 Los Angeles William S. Hart Union HSD 10/11-4 2013-Q3 $ - $ - ### $ 100,086 $ 40,034 $ (60,052)
492 Los Angeles William S. Hart Union HSD 12/13-1 Err:520 $ 79,523 $ 31,809 $ 47,714
493 Los Angeles William S. Hart Union HSD 12/13-2 Err:520 $ 67,035 $ 26,814 $ 40,221
494 Los Angeles William S. Hart Union HSD 12/13-3 Err:520 $ 81,613 $ 32,645 $ 48,968
495 Los Angeles William S. Hart Union HSD 12/13-4 Err:520 $ 87,493 $ 34,997 $ 52,496
496 Los Angeles William S. Hart Union HSD 11/12-4 Err:520 $ 221,436 $ 88,574 $ 132,862 $ - ### $ -
497 William S. Hart Union HSD Total $ 984,073 $ 393,629 $ 590,444 $ 605,722 $ 242,289 $ (363,433) $ 30,196 Err:520 Err:520 Err:520 Err:520 Err:520
498 Grand Total $ 33,454,003 $ 14,355,368 Err:502 $ 18,191,575 $ 8,659,984 $ (9,531,591) $ 4,823,777 Err:520 Err:520 Err:520 Err:520 Err:520
499 The sum of Column N equals the sum of "Column K" (Net Total) minus
500 Key Table the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
501 Column A County - Reporting LEC/LGA
502 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12
503 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Pro-Rata Table
504 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed Full check amount Check Total $ 55,495 <-- Enter check total here
505 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment has not been received Sum of Net Green Err:520
506 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made Sum of Net Red $ (361,494)
507 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
A B C D E F G H I J K L M N O P Q R S T U V W
Amount to release
2 to claiming unit
Amount to be recouped from DHCS Total amount
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata settlement withheld (FFY 2013 Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent check(s) and CUs in Red) or 2) Green Dot Public Schools Hacienda La Puente USD
508 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
509 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
510 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
511 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
512 The last subtotal amount is the final amount due to/from the LEC/LGA
513 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
514 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
515 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
516 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
517 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
518
521 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
522 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
523
524 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
525 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
526 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
527 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
528
County Claiming Unit Amount to be released Pro Rata Percent Golden Plains Unified Hanford Joint Union HS Riverdale Joint Unified SCCD-North Centers SCCD-Reedley College West Fresno Elementary
Madera Armona Union Elementary 10/11-1 2012-Q4 $ - $ - ### $ 45,234 $ 33,926 $ (11,308) 2
Madera Armona Union Elementary 10/11-2 2013-Q1 $ - $ - ### $ 49,326 $ 36,995 $ (12,331) 2
Madera Armona Union Elementary 11/12-3 Err:520 $ 60,394 $ 24,158 $ 36,236 $ - ### $ -
Madera Armona Union Elementary 11/12-4 Err:520 $ 66,441 $ 26,576 $ 39,865 $ - ### $ -
Madera Armona Union Elementary 10/11-3 Err:520 $ 42,999 $ 32,249 $ 10,750 $ - ### $ - 2
Madera Armona Union Elementary 11/12-1C-1 Err:520 $ 60,487 $ 24,195 $ 36,292 $ - ### $ -
Madera Armona Union Elementary 11/12-2C-1 Err:520 $ 102,949 $ 41,180 $ 61,769 $ - ### $ -
Armona Union Elementary Total* $ 333,270 $ 148,358 $ 184,912 $ 94,560 $ 70,921 $ (23,639) $ 124,719 5.29% Err:502 Err:502 $ 1,119.51 $ 715.56 $ 258.55 $ 504.35 $ 24.28 $ 214.80 $ 215.81
Madera Atwater Elementary 10/11-2 2013-Q1 $ - $ - ### $ 195,193 $ 78,077 $ (117,116)
Madera Atwater Elementary 10/11-3C2 Err:520 $ 159,882 $ 63,953 $ 95,929 $ - ### $ -
Madera Atwater Elementary 10/11-1 2012-Q4 $ - $ - ### $ 149,036 $ 59,614 $ (89,422)
Madera Atwater Elementary 10/11-4C-1 Err:520 $ 124,830 $ 49,932 $ 74,898 $ - ### $ -
Madera Atwater Elementary 11/12-2 Err:520 $ 148,398 $ 59,359 $ 89,039 $ - ### $ -
Madera Atwater Elementary 11/12-3 Err:520 $ 162,595 $ 65,038 $ 97,557 $ - ### $ -
Madera Atwater Elementary 09/10-4 2012-Q3 $ - $ - ### $ 96,550 $ 38,620 $ (57,930)
Madera Atwater Elementary 11/12-4 Err:520 $ 138,198 $ 55,279 $ 82,919 $ - ### $ -
Madera Atwater Elementary 11/12-1C-1 Err:520 $ 115,223 $ 46,089 $ 69,134 $ - ### $ -
Atwater Elementary Total* $ 849,126 $ 339,650 $ 509,476 $ 440,779 $ 176,311 $ (264,468) $ 75,182 3.19% Err:502 Err:502 $ 674.86 $ 431.35 $ 155.86 $ 304.03 $ 14.64 $ 129.49 $ 130.09
Madera Caruthers USD 10/11-2 Err:520 $ 25,018 $ 25,000 $ 18 $ - ### $ - 2
Caruthers USD Total $ 25,018 $ 25,000 $ 18 $ - $ - $ - $ 25,000 1.06% Err:502 Err:502 $ 224.41 $ 143.43 $ 51.83 $ 101.10 $ 4.87 $ 43.06 $ 43.26
Madera Chawanakee USD 10/11-1 2012-Q4 $ - $ - ### $ 35,908 $ 26,931 $ (8,977) 2
Madera Chawanakee USD 10/11-3C2 Err:520 $ 31,433 $ 25,000 $ 6,433 $ - ### $ - 2
Madera Chawanakee USD 10/11-2 2013-Q1 $ - $ - ### $ 38,129 $ 28,597 $ (9,532) 2
Chawanakee USD Total* $ 31,433.00 $ 25,000.00 $ 6,433.00 $ 74,037 $ 55,528 $ (18,509) $ 6,491 0.28% Err:502 Err:502 $ 58.27 $ 37.24 $ 13.46 $ 26.25 $ 1.26 $ 11.18 $ 11.23
Madera Chowchilla Elementary 10/11-1 2012-Q4 $ - $ - ### $ 27,618 $ 25,000 $ (2,618) 2
Madera Chowchilla Elementary 10/11-2 2013-Q1 $ - $ - ### $ 29,671 $ 25,000 $ (4,671) 2
Madera Chowchilla Elementary 11/12-2 Err:520 $ 31,839 $ 25,000 $ 6,839 $ - ### $ - 2
Madera Chowchilla Elementary 10/11-3 2013-Q2 $ - $ - ### $ 32,481 $ 25,000 $ (7,481) 2
Madera Chowchilla Elementary 11/12-3 Err:520 $ 30,927 $ 25,000 $ 5,927 $ - ### $ - 2
Madera Chowchilla Elementary 11/12-4 Err:520 $ 29,502 $ 25,000 $ 4,502 $ - ### $ - 2
Chowchilla Elementary Total $ 92,268 $ 75,000 $ 17,268 $ 89,770 $ 75,000 $ (14,770) $ 60,230 2.55% Err:502 Err:502 $ 540.64 $ 345.56 $ 124.86 $ 243.56 $ 11.72 $ 103.73 $ 104.22
Madera Chowchilla Union High 10/11-2 2013-Q1 $ - $ - ### $ 44,372 $ 33,279 $ (11,093) 2
Madera Chowchilla Union High 12/13-1 Err:520 $ 1,606 $ 1,445 $ 161
Madera Chowchilla Union High 12/13-2 Err:520 $ 3,897 $ 3,507 $ 390
Madera Chowchilla Union High 12/13-3 Err:520 $ 1,652 $ 1,487 $ 165
Madera Chowchilla Union High 13/14-1 Err:520 $ 3,645 $ 3,281 $ 364
Madera Chowchilla Union High 12/13-4 Err:520 $ 1,705 $ 1,535 $ 170
Chowchilla Union High Total $ 12,505.00 $ 11,255.00 $ 1,250.00 $ 44,372 $ 33,279 $ (11,093) $ 162 0.01% Err:502 Err:502 $ 1.45 $ 0.93 $ 0.34 $ 0.66 $ 0.03 $ 0.28 $ 0.28
Madera Coalinga-Huron Joint USD 10/11-1 2012-Q4 $ - $ - ### $ 57,335 $ 22,934 $ (34,401)
Madera Coalinga-Huron Joint USD 10/11-2 2013-Q1 $ - $ - ### $ 67,707 $ 27,083 $ (40,624)
Madera Coalinga-Huron Joint USD 11/12-2 Err:520 $ 54,192 $ 21,677 $ 32,515 $ - ### $ -
Madera Coalinga-Huron Joint USD 10/11-4C-1 Err:520 $ 27,416 $ 25,000 $ 2,416 $ - ### $ - 2
Madera Coalinga-Huron Joint USD 12/13-1 Err:520 $ 6,501 $ 5,851 $ 650
Madera Coalinga-Huron Joint USD 11/12-1C-1 Err:520 $ 33,381 $ 25,036 $ 8,345 $ - ### $ - 2
Coalinga-Huron Joint USD Total* $ 121,490 $ 77,564 $ 43,926 $ 125,042 $ 50,017 $ (75,025) $ 2,539 0.11% Err:502 Err:502 $ 22.79 $ 14.57 $ 5.26 $ 10.27 $ 0.49 $ 4.37 $ 4.39
Madera Corcoran Joint USD 10/11-1 2012-Q4 $ - $ - ### $ 88,904 $ 35,562 $ (53,342)
Madera Corcoran Joint USD 11/12-2 Err:520 $ 46,308 $ 34,731 $ 11,577 $ - ### $ - 2
Madera Corcoran Joint USD 11/12-3 Err:520 $ 46,084 $ 34,563 $ 11,521 $ - ### $ - 2
Madera Corcoran Joint USD 10/11-2-C1 Err:520 $ 39,366 $ 29,525 $ 9,841 $ - ### $ - 2
Madera Corcoran Joint Unified 10/11-3C2 Err:520 $ 45,079 $ 33,809 $ 11,270 $ - ### $ - 2
Madera Corcoran Joint USD 11/12-1C-1 Err:520 $ 45,405 $ 34,054 $ 11,351 $ - ### $ - 2
Corcoran Joint USD Total* $ 222,242 $ 166,682 $ 55,560 $ 88,904 $ 35,562 $ (53,342) $ 113,340 4.81% Err:502 Err:502 $ 1,017.37 $ 650.27 $ 234.96 $ 458.33 $ 22.06 $ 195.21 $ 196.12
Madera Cutler - Orosi Joint USD 10/11-1 2012-Q4 $ - $ - ### $ 162,411 $ 64,964 $ (97,447)
Madera Cutler - Orosi Joint USD 09/10-4 2012-Q3 $ - $ - ### $ 39,527 $ 29,645 $ (9,882) 2
Madera Cutler - Orosi Joint USD 10/11-2 2013-Q1 $ - $ - ### $ 196,026 $ 78,410 $ (117,616)
Madera Cutler - Orosi Joint USD 11/12-2 Err:520 $ 214,141 $ 85,656 $ 128,485 $ - ### $ -
Madera Cutler - Orosi Joint USD 11/12-3 Err:520 $ 80,894 $ 32,358 $ 48,536 $ - ### $ -
Madera Cutler - Orosi Joint USD 11/12-4 Err:520 $ 72,604 $ 29,042 $ 43,562 $ - ### $ -
Madera Cutler - Orosi Joint USD 10/11-3C2 Err:520 $ 49,901 $ 37,426 $ 12,475 $ - ### $ - 2
Madera Cutler-Orosi JUSD 10/11-4C-1 Err:520 $ 26,791 $ 25,000 $ 1,791 $ - ### $ - 2
Madera Cutler - Orosi Joint USD 11/12-1C-1 Err:520 $ 213,220 $ 85,288 $ 127,932 $ - ### $ -
Cutler - Orosi Joint USD Total* $ 657,551 $ 294,770 $ 362,781 $ 397,964 $ 173,019 $ (224,945) $ 69,825 2.96% Err:502 Err:502 $ 626.77 $ 400.61 $ 144.75 $ 282.36 $ 13.59 $ 120.26 $ 120.82
Madera Delhi Unified 10/11-1 2012-Q4 $ - $ - ### $ 88,399 $ 35,360 $ (53,039)
Madera Delhi Unified 09/10-4 2012-Q3 $ - $ - ### $ 43,279 $ 32,459 $ (10,820) 2
Madera Delhi Unified 10/11-2-C1 Err:520 $ 48,108 $ 36,081 $ 12,027 $ - ### $ - 2
Madera Delhi Unified 10/11-3C2 Err:520 $ 29,443 $ 25,000 $ 4,443 $ - ### $ - 2
Madera Delhi Unified 11/12-1C-1 Err:520 $ 52,461 $ 20,984 $ 31,477 $ - ### $ -
Delhi Unified Total $ 130,012 $ 82,065 $ 47,947 $ 131,678 $ 67,819 $ (63,859) $ 18,206 0.77% Err:502 Err:502 $ 163.42 $ 104.45 $ 37.74 $ 73.62 $ 3.54 $ 31.36 $ 31.50
Madera Farmersville USD 10/11-1 2012-Q4 $ - $ - ### $ 32,587 $ 25,000 $ (7,587) 2
Madera Farmersville USD 11/12-1 Err:520 $ 51,623 $ 20,649 $ 30,974 $ - ### $ -
Madera Farmersville USD 10/11-2 2013-Q1 $ - $ - ### $ 41,726 $ 31,295 $ (10,431) 2
Madera Farmersville USD 11/12-2 Err:520 $ 35,576 $ 26,682 $ 8,894 $ - ### $ - 2
Madera Farmersville USD 10/11-3 2013-Q2 $ - $ - ### $ 28,736 $ 25,000 $ (3,736) 2
Madera Farmersville USD 11/12-3 Err:520 $ 31,912 $ 25,000 $ 6,912 $ - ### $ - 2
Madera Farmersville USD 10/11-4 Err:520 $ 31,902 $ 25,000 $ 6,902 $ - ### $ - 2
Madera Farmersville USD 11/12-4 Err:520 $ 31,287 $ 25,000 $ 6,287 $ - ### $ - 2
Farmersville USD Total $ 182,300 $ 122,331 $ 59,969 $ 103,049 $ 81,295 $ (21,754) $ 100,577 4.27% Err:502 Err:502 $ 902.81 $ 577.05 $ 208.50 $ 406.72 $ 19.58 $ 173.22 $ 174.04
Madera Firebaugh Las Deltas USD 10/11-1 2012-Q4 $ - $ - ### $ 33,978 $ 25,484 $ (8,494) 2
Madera Firebaugh Las Deltas USD 11/12-1 Err:520 $ 35,576 $ 26,682 $ 8,894 $ - ### $ - 2
Madera Firebaugh Las Deltas USD 10/11-2 2013-Q1 $ - $ - ### $ 34,398 $ 25,799 $ (8,599) 2
Madera Firebaugh Las Deltas USD 11/12-2 Err:520 $ 40,509 $ 30,382 $ 10,127 $ - ### $ - 2
Madera Firebaugh Las Deltas USD 10/11-3 Err:520 $ 61,362 $ 24,545 $ 36,817 $ - ### $ -
Madera Firebaugh Las Deltas USD 11/12-3 Err:520 $ 39,624 $ 29,718 $ 9,906 $ - ### $ - 2
Madera Firebaugh Las Deltas USD 10/11-4 Err:520 $ 59,211 $ 23,684 $ 35,527 $ - ### $ -
Madera Firebaugh Las Deltas USD 11/12-4 Err:520 $ 44,877 $ 33,658 $ 11,219 $ - ### $ - 2
Firebaugh Las Deltas USD Total $ 281,159 $ 168,669 $ 112,490 $ 68,376 $ 51,283 $ (17,093) $ 151,576 6.43% Err:502 Err:502 $ 1,360.59 $ 869.65 $ 314.22 $ 612.96 $ 29.51 $ 261.06 $ 262.28
Madera Fresno COE 10/11-1 2012-Q4 $ - $ - ### $ 148,678 $ 59,471 $ (89,207)
Madera Fresno COE 10/11-2 2013-Q1 $ - $ - ### $ 206,958 $ 82,783 $ (124,175)
Madera Fresno COE 11/12-2 Err:520 $ 63,448 $ 25,379 $ 38,069 $ - ### $ -
Madera Fresno COE 11/12-3 Err:520 $ 72,414 $ 28,966 $ 43,448 $ - ### $ -
Madera Fresno COE 09/10-4 2012-Q3 $ - $ - ### $ 33,011 $ 25,000 $ (8,011) 2
Madera Fresno COE 10/11-3C2 Err:520 $ 58,976 $ 23,590 $ 35,386 $ - ### $ -
Madera Fresno COE 10/11-4C-1 Err:520 $ 52,685 $ 21,074 $ 31,611 $ - ### $ -
Madera Fresno COE 12/13-1 Err:520 $ 13,651 $ 12,286 $ 1,365
Madera Fresno COE 12/13-2 Err:520 $ 38,075 $ 28,556 $ 9,519
Madera Fresno COE 12/13-3 Err:520 $ 46,213 $ 34,660 $ 11,553
Madera Fresno COE 12/13-4 Err:520 $ 15,986 $ 14,387 $ 1,599
Madera Fresno COE 13/14-1 Err:520 $ 15,708 $ 14,137 $ 1,571
Madera Fresno COE 11/12-1C-1 Err:520 $ 51,064 $ 20,426 $ 30,638 $ - ### $ -
Fresno COE Total $ 428,220 $ 223,461 $ 204,759 $ 388,647 $ 167,254 $ (221,393) $ 2,068 0.09% Err:502 Err:502 $ 18.56 $ 11.86 $ 4.29 $ 8.36 $ 0.40 $ 3.56 $ 3.58
Madera Fresno Unified 10/11-1 2012-Q4 $ - $ - ### $ 319,918 $ 127,967 $ (191,951)
Madera Fresno Unified 11/12-1 Err:520 $ 287,481 $ 114,992 $ 172,489 $ - ### $ -
Madera Fresno Unified 09/10-2 2012-Q1 $ - $ - ### $ 426,051 $ 170,420 $ (255,631)
Madera Fresno Unified 10/11-2 2013-Q1 $ - $ - ### $ 365,914 $ 146,366 $ (219,548)
Madera Fresno Unified 11/12-2 Err:520 $ 357,040 $ 142,816 $ 214,224 $ - ### $ -
Madera Fresno Unified 10/11-3 Err:520 $ 401,930 $ 160,772 $ 241,158 $ - ### $ -
Madera Fresno Unified 11/12-3 Err:520 $ 335,999 $ 134,400 $ 201,599 $ - ### $ -
Madera Fresno Unified 09/10-4 2012-Q3 $ - $ - ### $ 313,735 $ 125,494 $ (188,241)
Madera Fresno Unified 10/11-4 Err:520 $ 390,611 $ 156,244 $ 234,367 $ - ### $ -
Madera Fresno Unified 12/13-1 Err:520 $ 192,198 $ 76,879 $ 115,319
Madera Fresno Unified 11/12-4 Err:520 $ 288,901 $ 115,560 $ 173,341 $ - ### $ -
Fresno Unified Total $ 2,254,160 $ 901,663 $ 1,352,497 $ 1,425,618 $ 570,247 $ (855,371) $ 46,292 1.96% Err:502 Err:502 $ 415.53 $ 265.59 $ 95.97 $ 187.20 $ 9.01 $ 79.73 $ 80.10
Madera Golden Plains Unified 10/11-2 2013-Q1 $ - $ - ### $ 36,963 $ 27,722 $ (9,241) 2
Madera Golden Plains Unified 10/11-3 2013-Q2 $ - $ - ### $ 43,370 $ 32,528 $ (10,842) 2
Madera Golden Plains Unified 12/13-4 Err:520 $ 4,173 $ 3,756 $ 417
Madera Golden Plains Unified 10/11-4 2013-Q3 $ - $ - ### $ 29,838 $ 25,000 $ (4,838) 2
Golden Plains Unified Total $ 4,173.00 $ 3,756.00 $ 417.00 $ 110,171 $ 85,250 $ (24,921) $ (21,165) 36.67%
Madera Golden Valley USD 10/11-2 2013-Q1 $ - $ - ### $ 43,751 $ 30,626 $ (13,125)
Madera Golden Valley USD 11/12-2 Err:520 $ 29,065 $ 20,346 $ 8,719 $ - ### $ -
Madera Golden Valley USD 10/11-3C2 Err:520 $ 26,754 $ 18,728 $ 8,026 $ - ### $ -
Madera Golden Valley USD 11/12-1C-1 Err:520 $ 31,928 $ 22,350 $ 9,578 $ - ### $ -
Golden Valley USD Total* $ 87,747 $ 61,424 $ 26,323 $ 43,751 $ 30,626 $ (13,125) $ 48,299 2.05% Err:502 Err:502 $ 433.54 $ 277.11 $ 100.13 $ 195.31 $ 9.40 $ 83.19 $ 83.57
Madera Hanford ESD 10/11-1 2012-Q4 $ - $ - ### $ 62,628 $ 25,051 $ (37,577)
Madera Hanford ESD 11/12-1 Err:520 $ 66,651 $ 26,660 $ 39,991 $ - ### $ -
Madera Hanford ESD 10/11-2 2013-Q1 $ - $ - ### $ 83,418 $ 33,367 $ (50,051)
Madera Hanford ESD 11/12-3 Err:520 $ 70,927 $ 28,371 $ 42,556 $ - ### $ -
Madera Hanford ESD 09/10-4 2012-Q3 $ - $ - ### $ 113,582 $ 45,433 $ (68,149)
Madera Hanford ESD 10/11-4 Err:520 $ 68,508 $ 27,403 $ 41,105 $ - ### $ -
Madera Hanford ESD 11/12-4 Err:520 $ 34,016 $ 25,512 $ 8,504 $ - ### $ - 2
Madera Hanford ESD 12/13-1 Err:520 $ 13,457 $ 12,111 $ 1,346
Madera Hanford ESD 12/13-2 Err:520 $ 28,092 $ 21,069 $ 7,023
Madera Hanford ESD 10/11-3C1 Err:520 $ 75,967 $ 30,387 $ 45,580 $ - ### $ -
Hanford ESD Total $ 357,618 $ 171,513 $ 186,105 $ 259,628 $ 103,851 $ (155,777) $ 15,736 0.67% Err:502 Err:502 $ 141.25 $ 90.28 $ 32.62 $ 63.63 $ 3.06 $ 27.10 $ 27.23
Madera Hanford Joint Union HS 10/11-1 2012-Q4 $ - $ - ### $ 49,827 $ 37,370 $ (12,457) 2
Madera Hanford Joint Union HS 10/11-2 2013-Q1 $ - $ - ### $ 54,620 $ 21,848 $ (32,772)
Madera Hanford Joint Union HS 12/13-1 Err:520 $ 1,377 $ 1,239 $ 138
Madera Hanford Joint Union HS 12/13-2 Err:520 $ 187 $ 168 $ 19
Madera Hanford Joint Union HS 12/13-3 Err:520 $ 391 $ 352 $ 39
Madera Hanford Joint Union HS 12/13-4 Err:520 $ 305 $ 275 $ 30
Madera Hanford Joint Union HS 13/14-1 Err:520 $ 30 $ 27 $ 3
Madera Hanford Joint Union HS 13/14-2 Err:520 $ 95 $ 86 $ 9
Madera Hanford Joint Union HS 13/14-3 Err:520 $ 1,865 $ 1,679 $ 186
Madera Hanford Joint Union HS 13/14-4 Err:520 $ 266 $ 239 $ 27
Madera Hanford Joint Union HS 11/12-1C-1 Err:520 $ 36,848 $ 27,636 $ 9,212 $ - ### $ - 2
Hanford Joint Union HS Total $ 41,364 $ 31,701 $ 9,663 $ 104,447 $ 59,218 $ (45,229) $ (13,528) 23.44%
Madera Hilmar USD 10/11-1 2012-Q4 $ - $ - ### $ 52,709 $ 21,084 $ (31,625)
Madera Hilmar USD 09/10-4 2012-Q3 $ - $ - ### $ 44,918 $ 33,689 $ (11,229) 2
Madera Hilmar USD 10/11-1R-1 2012-Q4 $ - $ - ### $ 53,554 $ 21,422 $ (32,132)
Madera Hilmar Unified 10/11-2-C1 Err:520 $ 54,791 $ 21,916 $ 32,875 $ - ### $ -
Madera Hilmar Unified 10/11-3C2 Err:520 $ 34,407 $ 25,805 $ 8,602 $ - ### $ - 2
Madera Hilmar USD 11/12-2C-1 Err:520 $ 43,751 $ 32,813 $ 10,938 $ - ### $ - 2
Madera Hilmar USD 11/12-3C-1 Err:520 $ 41,179 $ 30,884 $ 10,295 $ - ### $ - 2
Hilmar USD Total* $ 174,128 $ 111,418 $ 62,710 $ 151,181 $ 76,195 $ (74,986) $ 36,432 1.55% Err:502 Err:502 $ 327.02 $ 209.02 $ 75.53 $ 147.33 $ 7.09 $ 62.75 $ 63.04
Madera Kerman USD 11/12-1 Err:520 $ 55,975 $ 22,390 $ 33,585 $ - ### $ -
Madera Kerman USD 10/11-2 2013-Q1 $ - $ - ### $ 72,280 $
Total amount
Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Amount to release 2013 and CUs in Option (insert 1 Kings River-Hardwick Union
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent to claiming unit Red) or 2) Golden Plains Unified Hanford Joint Union HS Elem. Riverdale Joint Unified SCCD-North Centers SCCD-Reedley College West Fresno Elementary
Madera Kings COE 11/12-1C-1 Err:520 $ 52,056 $ 20,822 $ 31,234 $ - ### $ -
Kings COE Total $ 290,851 $ 188,563 $ 102,288 $ 93,447 $ 37,379 $ (56,068) $ 132,495 5.62% Err:502 Err:502 $ 1,189.31 $ 760.17 $ 274.67 $ 535.80 $ 25.79 $ 228.20 $ 229.27
Madera Kings River-Hardwick Union Elementary 10/11-1 2012-Q4 $ - $ - ### $ 26,535 $ 25,000 $ (1,535) 2
Madera Kings River-Hardwick Union Elementary 10/11-2 2013-Q1 $ - $ - ### $ 28,353 $ 25,000 $ (3,353) 2
Kings River-Hardwick Union Elementary Total $ - $ - $ - $ 54,888 $ 50,000 $ (4,888) $ (4,888) 8.47%
Madera Kingsburg Elementary Charter 11/12-1 Err:520 $ 29,327 $ 25,000 $ 4,327 $ - ### $ - 2
Madera Kingsburg Elementary Charter 10/11-2 2013-Q1 $ - $ - ### $ 33,662 $ 25,247 $ (8,415) 2
Madera Kingsburg Elementary Charter 10/11-4 Err:520 $ 47,968 $ 35,976 $ 11,992 $ - ### $ - 2
Madera Kingsburg Elementary Charter 11/12-2 Err:520 $ 44,918 $ 33,689 $ 11,229 $ - ### $ - 2
Madera Kingsburg Elementary Charter 11/12-3 Err:520 $ 40,556 $ 30,417 $ 10,139 $ - ### $ - 2
Madera Kingsburg Elementary Charter 11/12-4 Err:520 $ 45,740 $ 34,305 $ 11,435 $ - ### $ - 2
Kingsburg Elementary Charter Total* $ 208,509 $ 159,387 $ 49,122 $ 33,662 $ 25,247 $ (8,415) $ 150,972 6.40% Err:502 Err:502 $ 1,355.17 $ 866.18 $ 312.97 $ 610.51 $ 29.39 $ 260.02 $ 261.24
Madera Lindsay USD 10/11-1 2012-Q4 $ - $ - ### $ 63,168 $ 25,267 $ (37,901)
Madera Lindsay USD 10/11-2 2013-Q1 $ - $ - ### $ 65,415 $ 26,166 $ (39,249)
Madera Lindsay USD 11/12-2 Err:520 $ 114,122 $ 45,649 $ 68,473 $ - ### $ -
Madera Lindsay USD 10/11-3 Err:520 $ 73,379 $ 29,352 $ 44,027 $ - ### $ -
Madera Lindsay USD 11/12-3 Err:520 $ 64,057 $ 25,623 $ 38,434 $ - ### $ -
Madera Lindsay USD 09/10-4 2012-Q3 $ - $ - ### $ 34,719 $ 26,039 $ (8,680) 2
Madera Lindsay USD 10/11-4 Err:520 $ 57,315 $ 22,926 $ 34,389 $ - ### $ -
Madera Lindsay USD 11/12-4 Err:520 $ 98,224 $ 39,290 $ 58,934 $ - ### $ -
Madera Lindsay USD 11/12-1C-1 Err:520 $ 62,953 $ 25,181 $ 37,772 $ - ### $ -
Lindsay USD Total $ 470,050 $ 188,021 $ 282,029 $ 163,302 $ 77,472 $ (85,830) $ 102,191 4.33% Err:502 Err:502 $ 917.30 $ 586.31 $ 211.85 $ 413.25 $ 19.89 $ 176.00 $ 176.83
Madera Los Banos USD 11/12-1 Err:520 $ 109,286 $ 43,714 $ 65,572 $ - ### $ -
Madera Los Banos USD 10/11-2 2013-Q1 $ - $ - ### $ 72,369 $ 28,948 $ (43,421)
Madera Los Banos USD 11/12-2 Err:520 $ 117,373 $ 46,949 $ 70,424 $ - ### $ -
Madera Los Banos USD 10/11-3 Err:520 $ 46,110 $ 34,583 $ 11,527 $ - ### $ - 2
Madera Los Banos USD 11/12-3 Err:520 $ 101,674 $ 40,670 $ 61,004 $ - ### $ -
Madera Los Banos USD 09/10-4 2012-Q3 $ - $ - ### $ 75,185 $ 30,074 $ (45,111)
Madera Los Banos USD 10/11-4 Err:520 $ 64,961 $ 25,984 $ 38,977 $ - ### $ -
Madera Los Banos USD 11/12-4 Err:520 $ 114,322 $ 45,729 $ 68,593 $ - ### $ -
Los Banos USD Total $ 553,726 $ 237,629 $ 316,097 $ 147,554 $ 59,022 $ (88,532) $ 149,097 6.32% Err:502 Err:502 $ 1,338.34 $ 855.42 $ 309.09 $ 602.93 $ 29.02 $ 256.79 $ 257.99
Madera Madera Unified 10/11-1 2012-Q4 $ - $ - ### $ 49,535 $ 37,151 $ (12,384) 2
Madera Madera Unified 10/11-3C2 Err:520 $ 28,017 $ 25,000 $ 3,017 $ - ### $ - 2
Madera Madera Unified 11/12-1C-1 Err:520 $ 30,725 $ 25,000 $ 5,725 $ - ### $ - 2
Madera Madera Unified 10/11-2 2013-Q1 $ - $ - ### $ 52,438 $ 20,975 $ (31,463)
Madera Madera Unified 11/12-2 Err:520 $ 59,262 $ 23,705 $ 35,557 $ - ### $ -
Madera Unified Total $ 118,004 $ 73,705 $ 44,299 $ 101,973 $ 58,126 $ (43,847) $ 29,858 1.27% Err:502 Err:502 $ 268.01 $ 171.31 $ 61.90 $ 120.74 $ 5.81 $ 51.42 $ 51.67
Madera Madera Career and Alt ED 09/10-4 2012-Q3 $ - $ - ### $ 32,806 $ 25,000 $ (7,806) 2
Madera Career and Alt ED Total $ - $ - $ - $ 32,806 $ 25,000 $ (7,806) $ - N/A
Madera Madera COE 10/11-1 2012-Q4 $ - $ - ### $ 147,246 $ 58,898 $ (88,348)
Madera Madera COE 11/12-2 Err:520 $ 71,927 $ 28,771 $ 43,156 $ - ### $ -
Madera Madera COE 11/12-3 Err:520 $ 61,378 $ 24,551 $ 36,827 $ - ### $ -
Madera Madera COE 11/12-4 Err:520 $ 58,594 $ 23,438 $ 35,156 $ - ### $ -
Madera Madera COE 10/11-2-C1 Err:520 $ 83,026 $ 33,210 $ 49,816 $ - ### $ -
Madera Madera COE 10/11-3C2 Err:520 $ 50,720 $ 20,288 $ 30,432 $ - ### $ -
Madera Madera COE 10/11-4C-1 Err:520 $ 46,026 $ 34,520 $ 11,506 $ - ### $ - 2
Madera Madera COE 11/12-1C-1 Err:520 $ 69,300 $ 27,720 $ 41,580 $ - ### $ -
Madera COE Total $ 440,971 $ 192,498 $ 248,473 $ 147,246 $ 58,898 $ (88,348) $ 96,344 4.09% Err:502 Err:502 $ 864.81 $ 552.76 $ 199.73 $ 389.60 $ 18.75 $ 165.93 $ 166.71
Madera Mariposa County Unified 10/11-2 2013-Q1 $ - $ - ### $ 30,469 $ 25,000 $ (5,469) 2
Madera Mariposa County Unified 11/12-2 Err:520 $ 26,180 $ 25,000 $ 1,180 $ - ### $ - 2
Mariposa County Unified Total $ 26,180 $ 25,000 $ 1,180 $ 30,469 $ 25,000 $ (5,469) $ 19,531 0.83% Err:502 Err:502 $ 175.32 $ 112.06 $ 40.49 $ 78.98 $ 3.80 $ 33.64 $ 33.80
Madera Merced Career & Alt Ed 10/11-1 2012-Q4 $ - $ - ### $ 63,170 $ 25,268 $ (37,902)
Madera Merced Career & Alt Ed 10/11-2 2013-Q1 $ - $ - ### $ 39,750 $ 29,813 $ (9,937) 2
Merced Career & Alt Ed Total $ - $ - $ - $ 102,920 $ 55,081 $ (47,839) $ - N/A
Madera Merced City Elementary Schools 11/12-1 Err:520 $ 27,182 $ 25,000 $ 2,182 $ - ### $ - 2
Madera Merced City Elementary Schools 10/11-2 2013-Q1 $ - $ - ### $ 30,964 $ 25,000 $ (5,964) 2
Merced City Elementary SD 10/11-1 2012-Q4 $ - $ - ### $ 35,928 $ 26,946 $ (8,982) 2
Madera Merced City Elementary Schools 11/12-2 Err:520 $ 33,978 $ 25,484 $ 8,494 $ - ### $ - 2
Madera Merced City Elementary Schools 11/12-4 Err:520 $ 31,481 $ 25,000 $ 6,481 $ - ### $ - 2
Merced City Elementary Schools Total* $ 92,641 $ 75,484 $ 17,157 $ 66,892 $ 51,946 $ (14,946) $ 60,538 2.57% Err:502 Err:502 $ 543.41 $ 347.33 $ 125.50 $ 244.81 $ 11.78 $ 104.27 $ 104.75
Madera Merced City ESD 10/11-4 Err:520 $ 29,608 $ 25,000 $ 4,608 $ - ### $ - 2
Merced City ESD Total* $ 29,608 $ 25,000 $ 4,608 $ - $ - $ - $ 25,000 1.06% Err:502 Err:502 $ 224.41 $ 143.43 $ 51.83 $ 101.10 $ 4.87 $ 43.06 $ 43.26
Madera Merced COE 11/12-2 Err:520 $ 120,661 $ 48,264 $ 72,397 $ - ### $ -
Madera Merced COE 11/12-3 Err:520 $ 154,944 $ 61,978 $ 92,966 $ - ### $ -
Madera Merced COE 09/10-4 2012-Q3 $ - $ - ### $ 28,357 $ 25,000 $ (3,357) 2
Madera Merced COE 11/12-4 Err:520 $ 93,713 $ 37,485 $ 56,228 $ - ### $ -
Madera Merced COE 10/11-1C-1 2012-Q4 $ - $ - ### $ 133,464 $ 53,386 $ (80,078)
Madera Merced COE 10/11-2-C1 Err:520 $ 78,799 $ 31,520 $ 47,279 $ - ### $ -
Madera Merced COE 10/11-3C2 Err:520 $ 50,725 $ 20,290 $ 30,435 $ - ### $ -
Madera Merced COE 10/11-4C-1 Err:520 $ 34,747 $ 26,060 $ 8,687 $ - ### $ - 2
Madera Merced COE 11/12-1C-1 Err:520 $ 131,452 $ 52,581 $ 78,871 $ - ### $ -
Merced COE Total $ 665,041 $ 278,178 $ 386,863 $ 161,821 $ 78,386 $ (83,435) $ 146,904 6.23% Err:502 Err:502 $ 1,318.65 $ 842.84 $ 304.54 $ 594.06 $ 28.60 $ 253.01 $ 254.20
Madera Merced Community College- Child Dev. Center 11/12-2 Err:520 $ 31,334 $ 25,000 $ 6,334 $ - ### $ - 2
Madera Merced Community College- Child Dev. Center 11/12-3 Err:520 $ 28,471 $ 25,000 $ 3,471 $ - ### $ - 2
Madera Merced Community College- Child Dev. Center 11/12-4 Err:520 $ 29,112 $ 25,000 $ 4,112 $ - ### $ - 2
Merced Community College- Child Dev. Center Total $ 88,917 $ 75,000 $ 13,917 $ - $ - $ - $ 75,000 3.18% Err:502 Err:502 $ 673.22 $ 430.30 $ 155.48 $ 303.29 $ 14.60 $ 129.17 $ 129.78
Madera Merced Union High 10/11-1 2012-Q4 $ - $ - ### $ 248,599 $ 99,440 $ (149,159)
Madera Merced Union High 11/12-2 Err:520 $ 81,750 $ 32,700 $ 49,050 $ - ### $ -
Madera Merced Union High 11/12-3 Err:520 $ 66,351 $ 26,540 $ 39,811 $ - ### $ -
Madera Merced Union High 09/10-4 2012-Q3 $ - $ - ### $ 88,312 $ 35,325 $ (52,987)
Madera Merced Union High 11/12-4 Err:520 $ 26,575 $ 25,000 $ 1,575 $ - ### $ - 2
Madera Merced Union High 10/11-2-C1 Err:520 $ 120,302 $ 48,121 $ 72,181 $ - ### $ -
Madera Merced Union High 10/11-3C2 Err:520 $ 68,112 $ 27,245 $ 40,867 $ - ### $ -
Madera Merced Union High 10/11-4C-1 Err:520 $ 42,180 $ 31,635 $ 10,545 $ - ### $ - 2
Madera Merced Union High 11/12-1C-1 Err:520 $ 41,669 $ 31,252 $ 10,417 $ - ### $ - 2
Merced Union High Total* $ 446,939 $ 222,493 $ 224,446 $ 336,911 $ 134,765 $ (202,146) $ 20,347 0.86% Err:502 Err:502 $ 182.64 $ 116.74 $ 42.18 $ 82.28 $ 3.96 $ 35.04 $ 35.21
Madera Orange Center Elementary 11/12-2 Err:520 $ 25,290 $ 25,000 $ 290 $ - ### $ - 2
Orange Center Elementary Total $ 25,290 $ 25,000 $ 290 $ - $ - $ - $ 25,000 1.06% Err:502 Err:502 $ 224.41 $ 143.43 $ 51.83 $ 101.10 $ 4.87 $ 43.06 $ 43.26
Madera Parlier Unified 10/11-1 2012-Q4 $ - $ - ### $ 59,005 $ 23,602 $ (35,403)
Madera Parlier Unified 11/12-2 Err:520 $ 66,128 $ 26,451 $ 39,677 $ - ### $ -
Madera Parlier Unified 11/12-3 Err:520 $ 75,896 $ 30,358 $ 45,538 $ - ### $ -
Madera Parlier Unified 11/12-4 Err:520 $ 53,456 $ 21,382 $ 32,074 $ - ### $ -
Madera Parlier SD 10/11-4C-1 Err:520 $ 28,201 $ 25,000 $ 3,201 $ - ### $ - 2
Madera Parlier Unified 10/11-2-C1 Err:520 $ 48,728 $ 36,546 $ 12,182 $ - ### $ - 2
Madera Parlier Unified 10/11-3C2 Err:520 $ 50,260 $ 20,104 $ 30,156 $ - ### $ -
Madera Parlier Unified 11/12-1C-1 Err:520 $ 41,598 $ 31,199 $ 10,399 $ - ### $ - 2
Parlier Unified Total* $ 364,267 $ 191,040 $ 173,227 $ 59,005 $ 23,602 $ (35,403) $ 155,637 6.60% Err:502 Err:502 $ 1,397.04 $ 892.95 $ 322.64 $ 629.38 $ 30.30 $ 268.06 $ 269.31
Madera Planada ESD 10/11-1 2012-Q4 $ - $ - ### $ 31,033 $ 25,000 $ (6,033) 2
Madera Planada ESD 12/13-1 Err:520 $ 2,547 $ 2,292 $ 255
Madera Planada ESD 12/13-2 Err:520 $ 1,696 $ 1,526 $ 170
Madera Planada ESD 12/13-3 Err:520 $ 5,432 $ 4,889 $ 543
Planada ESD Total $ 9,675.00 $ 8,707.00 $ 968.00 $ 31,033 $ 25,000 $ (6,033) $ 2,674 0.11% Err:502 Err:502 $ 24.00 $ 15.34 $ 5.54 $ 10.81 $ 0.52 $ 4.61 $ 4.63
Madera Reef - Sunset USD 11/12-2C-1 Err:520 $ 75,916 $ 30,366 $ 45,550 $ - ### $ -
Madera Reef - Sunset USD 11/12-3C-1 Err:520 $ 32,937 $ 25,000 $ 7,937 $ - ### $ - 2
Reef - Sunset USD Total $ 108,853 $ 55,366 $ 53,487 $ - $ - $ - $ 55,366 2.35% Err:502 Err:502 $ 496.98 $ 317.65 $ 114.78 $ 223.89 $ 10.78 $ 95.36 $ 95.80
Madera Riverdale Joint Unified 10/11-1 2012-Q4 $ - $ - ### $ 39,736 $ 29,802 $ (9,934) 2
Madera Riverdale Joint Unified 12/13-1 Err:520 $ 71 $ 64 $ 7
Madera Riverdale Joint Unified 12/13-2 Err:520 $ 335 $ 302 $ 33
Madera Riverdale Joint Unified 12/13-3 Err:520 $ 37 $ 33 $ 4
Riverdale Joint Unified Total $ 443.00 $ 399.00 $ 44.00 $ 39,736 $ 29,802 $ (9,934) $ (9,535) 16.52%
Madera Sanger USD 10/11-1 2012-Q4 $ - $ - ### $ 76,692 $ 30,677 $ (46,015)
Madera Sanger USD 11/12-1 Err:520 $ 58,887 $ 23,555 $ 35,332 $ - ### $ -
Madera Sanger USD 10/11-2 2013-Q1 $ - $ - ### $ 121,180 $ 48,472 $ (72,708)
Madera Sanger USD 11/12-2 Err:520 $ 122,206 $ 48,882 $ 73,324 $ - ### $ -
Madera Sanger USD 10/11-3 2013-Q2 $ - $ - ### $ 103,651 $ 41,460 $ (62,191)
Madera Sanger USD 11/12-3 Err:520 $ 125,503 $ 50,201 $ 75,302 $ - ### $ -
Madera Sanger USD 09/10-4 2012-Q3 $ - $ - ### $ 139,315 $ 55,726 $ (83,589)
Madera Sanger USD 10/11-4 Err:520 $ 115,006 $ 46,002 $ 69,004 $ - ### $ -
Madera Sanger USD 12/13-1 Err:520 $ 61,424 $ 24,570 $ 36,854
Madera Sanger USD 12/13-2 Err:520 $ 94,324 $ 37,730 $ 56,594
Madera Sanger USD 11/12-4 Err:520 $ 132,037 $ 52,815 $ 79,222 $ - ### $ -
Sanger USD Total $ 709,387 $ 283,755 $ 425,632 $ 440,838 $ 176,335 $ (264,503) $ 19,252 0.82% Err:502 Err:502 $ 172.81 $ 110.46 $ 39.91 $ 77.85 $ 3.75 $ 33.16 $ 33.31
Madera SCCCD - Fresno City College 10/11-1 2012-Q4 $ - $ - ### $ 93,472 $ 37,389 $ (56,083)
Madera SCCCD - Fresno City College 10/11-2 2013-Q1 $ - $ - ### $ 83,829 $ 33,532 $ (50,297)
Madera SCCCD - Fresno City College 11/12-1C-1 Err:520 $ 28,978 $ 25,000 $ 3,978 $ - ### $ - 2
Madera SCCCD - Fresno City College 11/12-2C-1 Err:520 $ 36,731 $ 27,548 $ 9,183 $ - ### $ - 2
Madera SCCCD - Fresno City College 11/12-3C-1 Err:520 $ 39,555 $ 29,666 $ 9,889 $ - ### $ - 2
Madera SCCCD - Fresno City College 11/12-4C-1 Err:520 $ 37,135 $ 27,851 $ 9,284 $ - ### $ - 2
SCCCD - Fresno City College Total $ 142,399 $ 110,065 $ 32,334 $ 177,301 $ 70,921 $ (106,380) $ 3,685 0.16% Err:502 Err:502 $ 33.08 $ 21.14 $ 7.64 $ 14.90 $ 0.72 $ 6.35 $ 6.38
Madera SCCCD - North Centers 10/11-1 2012-Q4 $ - $ - ### $ 25,459 $ 25,000 $ (459) 2
SCCCD - North Centers Total $ - $ - $ - $ 25,459 $ 25,000 $ (459) $ (459) 0.80%
Madera SCCCD - Reedley College 10/11-1 2012-Q4 $ - $ - ### $ 43,811 $ 32,858 $ (10,953) 2
Madera SCCCD - Reedley College 10/11-2 2013-Q1 $ - $ - ### $ 120,666 $ 48,266 $ (72,400)
Madera SCCCD - Reedley College 12/13-1 Err:520 $ 7,645 $ 6,881 $ 764
Madera SCCCD - Reedley College 12/13-2 Err:520 $ 7,593 $ 6,834 $ 759
Madera SCCCD - Reedley College 12/13-3 Err:520 $ 6,632 $ 5,969 $ 663
Madera SCCCD - Reedley College 12/13-4 Err:520 $ 5,003 $ 4,503 $ 500
Madera SCCCD - Reedley College 13/14-1 Err:520 $ 18,508 $ 16,657 $ 1,851
Madera SCCCD - Reedley College 13/14-2 Err:520 $ 4,273 $ 3,846 $ 427
Madera SCCCD - Reedley College 13/14-3 Err:520 $ 4,365 $ 3,929 $ 436
Madera SCCCD - Reedley College 13/14-4 Err:520 $ 6,303 $ 5,673 $ 630
Madera SCCCD - Reedley College 11/12-2 Err:520 $ 30,300 $ 25,000 $ 5,300 $ - ### $ - 2
SCCCD - Reedley College Total $ 90,622 $ 79,292 $ 11,330 $ 164,477 $ 81,124 $ (83,353) $ (4,061) 7.04%
Madera Washington Unified 11/12-3 Err:520 $ 32,171 $ 25,000 $ 7,171 $ - ### $ - 2
Madera Washington Unified 11/12-1C-1 Err:520 $ 27,095 $ 25,000 $ 2,095 $ - ### $ - 2
Washington Unified Total $ 59,266 $ 50,000 $ 9,266 $ - $ - $ - $ 50,000 2.12% Err:502 Err:502 $ 448.81 $ 286.87 $ 103.65 $ 202.19 $ 9.73 $ 86.12 $ 86.52
Madera Weaver Union 10/11-1 2012-Q4 $ - $ - ### $ 76,146 $ 26,651 $
A B C D E F G H I J K L M N O P Q R S T U V
2 Total amount
Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Amount to release 2013 and CUs in Option (insert 1 Kings River-Hardwick Union
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent to claiming unit Red) or 2) Golden Plains Unified Hanford Joint Union HS Elem. Riverdale Joint Unified SCCD-North Centers SCCD-Reedley College West Fresno Elementary
338 Grand Total Madera LEC Err:502 Err:502 Err:502 $ 7,010,392 $ 3,374,710 $ (3,635,682) Err:502 100% Err:502 Err:502 $ 21,165 $ 13,528 $ 4,888 $ 9,535 $ 459 $ 4,061 $ 4,080
339 The sum of Column N equals the sum of "Column K" (Net Total) minus
340 the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
341 Column A County - Reporting LEC/LGA
342 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12
343 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Pro-Rata Table
344 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed Check Total Err:502 <-- Enter check total here
345 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment Sum of Net Green $ 2,357,878
346 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made Sum of Net Red $ (57,716)
347 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
348 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
349 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
350 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
351 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
352 The last subtotal amount is the final amount due to/from the LEC/LGA
353 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
354 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
355 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
356 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
357 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
358
361 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
362 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
363
364 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
365 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
366 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
367 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
368
353 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
354 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
355 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
356
359 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
360 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
361
362 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
363 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
364 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
365 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
366
29 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
30 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
31 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
32
35 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
36 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
37
38 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
39 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
40 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
41 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
42
173 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
174 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
175 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
176
179 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
180 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
181
182 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
183 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
184 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
185 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
186
53 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
54 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
55 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
56
59 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
60 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
A B C D E F G H I J K L M
Amount to be recouped
1 Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Option (insert 1 Placeholder
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) or 2) Number
61
62 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
63 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
64 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
65 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
66
233 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
234 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
235 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
236
239 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
240 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
241
242 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
243 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
244 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
245 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
246
1
Pro-Rata Net Negative Distribution
Total amount
2
Amount to be recouped Amount to withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Column Pro Rata release to 2013 and CUs in Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims J) Percent claiming unit Red) or 2) Chino Valley USD
3 San Bernardino LGA Alta Loma ESD 10/11-1 2012-Q4 $ - $ - ### $ 66,608 $ 23,313 $ (43,295)
4 San Bernardino LGA Alta Loma ESD 11/12-1 Err:520 $ 91,223 $ 31,928 $ 59,295 $ - ### $ -
5 San Bernardino LGA Alta Loma ESD 10/11-2 2013-Q1 $ - $ - ### $ 88,350 $ 30,923 $ (57,427)
6 San Bernardino LGA Alta Loma ESD 11/12-2 Err:520 $ 86,334 $ 30,217 $ 56,117 $ - ### $ -
7 San Bernardino LGA Alta Loma ESD 10/11-3 2013-Q2 $ - $ - ### $ 80,592 $ 28,207 $ (52,385)
8 San Bernardino LGA Alta Loma ESD 11/12-3 Err:520 $ 80,841 $ 28,294 $ 52,547 $ - ### $ -
9 San Bernardino LGA Alta Loma ESD 10/11-4 Err:520 $ 73,596 $ 25,759 $ 47,837 $ - ### $ -
10 San Bernardino LGA Alta Loma ESD 12/13-1 Err:520 $ 15,166 $ 15,166 $ -
11 San Bernardino LGA Alta Loma ESD 12/13-2 Err:520 $ 17,215 $ 17,215 $ -
12 San Bernardino LGA Alta Loma ESD 12/13-3 Err:520 $ 14,396 $ 14,396 $ -
13 San Bernardino LGA Alta Loma ESD 12/13-4 Err:520 $ 7,143 $ 7,143 $ -
14 San Bernardino LGA Alta Loma ESD 11/12-4 Err:520 $ 27,249 $ 19,074 $ 8,175 $ - ### $ -
15 Alta Loma ESD Total $ 413,163 $ 189,192 $ 223,971 $ 235,550 $ 82,443 $ (153,107) $ 36,085 8.82% $ - $ 36,085 $ 34,330.20
16 San Bernardino LGA Apple Valley USD 10/11-1 2012-Q4 $ - $ - ### $ 30,337 $ 30,337 $ -
17 San Bernardino LGA Apple Valley USD 10/11-2 2013-Q1 $ - $ - ### $ 42,060 $ 42,060 $ -
18 San Bernardino LGA Apple Valley USD 10/11-3 2013-Q2 $ - $ - ### $ 28,024 $ 28,024 $ -
19 San Bernardino LGA Apple Valley USD 12/13-1 Err:520 $ 36,210 $ 27,158 $ 9,052
20 San Bernardino LGA Apple Valley USD 12/13-2 Err:520 $ 21,790 $ 19,611 $ 2,179
21 San Bernardino LGA Apple Valley USD 12/13-3 Err:520 $ 29,796 $ 22,347 $ 7,449
22 San Bernardino LGA Apple Valley USD 12/13-4 Err:520 $ 35,784 $ 26,838 $ 8,946
23 San Bernardino LGA Apple Valley USD 11/12-4 Err:520 $ - $ - $ - ### $ -
24 Apple Valley USD Total $ 123,580 $ 95,954 $ 27,626 $ 100,421 $ 100,421 $ - $ 95,954 23.46% $ - $ 95,954 $ 91,288
25 San Bernardino LGA Barstow USD 10/11-1 2012-Q4 $ - $ - ### $ 26,040 $ 18,228 $ (7,812)
26 San Bernardino LGA Barstow USD 12/13-2 Err:520 $ 4,452 $ 4,452 $ -
27 San Bernardino LGA Barstow USD 12/13-4 Err:520 $ 5,592 $ 5,592 $ -
28 San Bernardino LGA Barstow USD 12/13-3 Err:520 $ 10,911 $ 10,911 $ -
29 Barstow USD Total $ 20,955.00 $ 20,955.00 $ - $ 26,040 $ 18,228 $ (7,812) $ 13,143 3.21% $ - $ 13,143 $ 12,504
30 San Bernardino LGA Chino Valley USD 10/11-1 2012-Q4 $ - $ - ### $ 538,006 $ 188,302 $ (349,704)
31 San Bernardino LGA Chino Valley USD 11/12-1 Err:520 $ 434,533 $ 152,087 $ 282,446 $ - ### $ -
32 San Bernardino LGA Chino Valley USD 10/11-2 2013-Q1 $ - $ - ### $ 712,717 $ 249,451 $ (463,266)
33 San Bernardino LGA Chino Valley USD 11/12-2 Err:520 $ 596,547 $ 208,791 $ 387,756 $ - ### $ -
34 San Bernardino LGA Chino Valley USD 10/11-3 2013-Q2 $ - $ - ### $ 762,887 $ 267,010 $ (495,877)
35 San Bernardino LGA Chino Valley USD 11/12-3 Err:520 $ 598,991 $ 209,647 $ 389,344 $ - ### $ -
36 San Bernardino LGA Chino Valley USD 09/10-4 2012-Q3 $ - $ - ### $ 709,982 $ 248,494 $ (461,488)
37 San Bernardino LGA Chino Valley USD 10/11-4 Err:520 $ 750,491 $ 262,672 $ 487,819 $ - ### $ -
38 San Bernardino LGA Chino Valley USD 12/13-1 Err:520 $ 187,112 $ 65,489 $ 121,623
39 San Bernardino LGA Chino Valley USD 12/13-2 Err:520 $ 263,197 $ 92,119 $ 171,078
40 San Bernardino LGA Chino Valley USD 12/13-3 Err:520 $ 287,363 $ 100,577 $ 186,786
41 San Bernardino LGA Chino Valley USD 12/13-4 Err:520 $ 380,162 $ 133,057 $ 247,105
42 San Bernardino LGA Chino Valley USD 11/12-4 Err:520 $ 447,766 $ 156,718 $ 291,048 $ - ### $ -
43 Chino Valley USD Total $ 3,946,162 $ 1,381,157 $ 2,565,005 $ 2,723,592 $ 953,257 $ (1,770,335) $ (389,178) 100%
44 San Bernardino LGA Colton JUSD 10/11-1 2012-Q4 $ - $ - ### $ 133,102 $ 46,586 $ (86,516)
45 San Bernardino LGA Colton JUSD 11/12-1 Err:520 $ 209,078 $ 73,177 $ 135,901 $ - ### $ -
46 San Bernardino LGA Colton JUSD 10/11-2 2013-Q1 $ - $ - ### $ 101,235 $ 35,432 $ (65,803)
47 San Bernardino LGA Colton JUSD 11/12-2 Err:520 $ 188,909 $ 66,118 $ 122,791 $ - ### $ -
48 San Bernardino LGA Colton JUSD 09/10-3 2012-Q2 $ - $ - ### $ 94,929 $ 33,225 $ (61,704)
49 San Bernardino LGA Colton JUSD 10/11-3 2013-Q2 $ - $ - ### $ 105,839 $ 37,044 $ (68,795)
50 San Bernardino LGA Colton JUSD 11/12-3 Err:520 $ 144,058 $ 50,420 $ 93,638 $ - ### $ -
51 San Bernardino LGA Colton JUSD 09/10-4 2012-Q3 $ - $ - ### $ 81,937 $ 28,678 $ (53,259)
52 San Bernardino LGA Colton JUSD 10/11-4 Err:520 $ 107,278 $ 37,547 $ 69,731 $ - ### $ -
53 San Bernardino LGA Colton JUSD 12/13-1 Err:520 $ 45,540 $ 31,878 $ 13,662
54 San Bernardino LGA Colton JUSD 12/13-2 Err:520 $ 50,740 $ 17,759 $ 32,981
55 San Bernardino LGA Colton JUSD 12/13-3 Err:520 $ 65,192 $ 22,817 $ 42,375
56 San Bernardino LGA Colton JUSD 12/13-4 Err:520 $ 47,190 $ 33,033 $ 14,157
57 San Bernardino LGA Colton JUSD 13/14-3 Err:520 $ 32,230 $ 22,561 $ 9,669
58 San Bernardino LGA Colton JUSD 13/14-4 Err:520 $ 26,994 $ 18,896 $ 8,098
59 San Bernardino LGA Colton JUSD 11/12-4 Err:520 $ 61,155 $ 21,404 $ 39,751 $ - ### $ -
60 Colton JUSD Total $ 978,364 $ 395,610 $ 582,754 $ 517,042 $ 180,965 $ (336,077) $ 59,533 14.55% $ - $ 59,533 $ 56,638
61 San Bernardino LGA Ontario-Montclair SD 10/11-1 2012-Q4 $ - $ - ### $ 309,092 $ 123,637 $ (185,455)
62 San Bernardino LGA Ontario-Montclair SD 10/11-4 Err:520 $ 395,875 $ 158,350 $ 237,525 $ - ### $ -
63 San Bernardino LGA Ontario-Montclair SD 11/12-1 Err:520 $ 337,744 $ 135,098 $ 202,646 $ - ### $ -
64 San Bernardino LGA Ontario-Montclair SD 10/11-2 2013-Q1 $ - $ - ### $ 356,249 $ 142,500 $ (213,749)
65 San Bernardino LGA Ontario-Montclair SD 11/12-2 Err:520 $ 368,919 $ 147,568 $ 221,351 $ - ### $ -
66 San Bernardino LGA Ontario-Montclair SD 09/10-3 2012-Q2 $ - $ - ### $ 401,692 $ 160,677 $ (241,015)
67 San Bernardino LGA Ontario-Montclair SD 10/11-3 2013-Q2 $ - $ - ### $ 323,668 $ 129,467 $ (194,201)
68 San Bernardino LGA Ontario-Montclair SD 11/12-3 Err:520 $ 324,267 $ 129,707 $ 194,560 $ - ### $ -
69 San Bernardino LGA Ontario-Montclair SD 09/10-4 2012-Q3 $ - $ - ### $ 333,788 $ 133,515 $ (200,273)
70 San Bernardino LGA Ontario-Montclair SD 12/13-1 Err:520 $ 89,213 $ 35,685 $ 53,528
71 San Bernardino LGA Ontario-Montclair SD 12/13-2 Err:520 $ 156,549 $ 62,620 $ 93,929
72 San Bernardino LGA Ontario-Montclair SD 12/13-3 Err:520 $ 166,130 $ 66,452 $ 99,678
73 San Bernardino LGA Ontario-Montclair SD 12/13-4 Err:520 $ 167,621 $ 67,048 $ 100,573
74 San Bernardino LGA Ontario-Montclair SD 13/14-1 Err:520 $ 65,512 $ 26,205 $ 39,307
75 San Bernardino LGA Ontario-Montclair SD 13/14-2 Err:520 $ 161,146 $ 64,458 $ 96,688
76 San Bernardino LGA Ontario-Montclair SD 13/14-3 Err:520 $ 177,794 $ 71,118 $ 106,676
77 San Bernardino LGA Ontario-Montclair SD 11/12-4 Err:520 $ 189,605 $ 75,842 $ 113,763 $ - ### $ -
78 Ontario-Montclair SD Total $ 2,600,375 $ 1,040,151 $ 1,560,224 $ 1,724,489 $ 689,796 $ (1,034,693) $ 5,458 1.33% $ - $ 5,458 $ 5,193
79 San Bernardino LGA Rialto USD 10/11-1 2012-Q4 $ - $ - ### $ 164,521 $ 65,808 $ (98,713)
80 San Bernardino LGA Rialto USD 11/12-1 Err:520 $ 208,363 $ 83,345 $ 125,018 $ - ### $ -
81 San Bernardino LGA Rialto USD 11/12-2 Err:520 $ 319,682 $ 127,873 $ 191,809 $ - ### $ -
82 San Bernardino LGA Rialto USD 10/11-2 2013-Q1 $ - $ - ### $ 118,910 $ 47,564 $ (71,346)
83 San Bernardino LGA Rialto USD 10/11-3 Err:520 $ 121,305 $ 48,522 $ 72,783 $ - ### $ -
84 San Bernardino LGA Rialto USD 11/12-3 Err:520 $ 219,072 $ 87,629 $ 131,443 $ - ### $ -
85 San Bernardino LGA Rialto USD 09/10-4 2012-Q3 $ - $ - ### $ 339,659 $ 135,864 $ (203,795)
86 San Bernardino LGA Rialto USD 10/11-4 Err:520 $ 106,950 $ 42,780 $ 64,170 $ - ### $ -
87 San Bernardino LGA Rialto USD 12/13-1 Err:520 $ 39,509 $ 29,632 $ 9,877
88 San Bernardino LGA Rialto USD 12/13-2 Err:520 $ 47,972 $ 35,979 $ 11,993
89 San Bernardino LGA Rialto USD 12/13-3 Err:520 $ 24,541 $ 22,087 $ 2,454
90 San Bernardino LGA Rialto USD 12/13-4 Err:520 $ 34,541 $ 25,906 $ 8,635
91 San Bernardino LGA Rialto USD 11/12-4 Err:520 $ 172,497 $ 68,999 $ 103,498 $ - ### $ -
92 Rialto USD Total $ 1,294,432 $ 572,752 $ 721,680 $ 623,090 $ 249,236 $ (373,854) $ 198,898 48.62% $ - $ 198,898 $ 189,226
93 Grand Total San Bernardino LGA Err:502 Err:502 Err:502 Err:502 Err:502 Err:502 Err:502 100% $ - $ 409,071 $ 389,178
94 The sum of Column N equals the sum of "Column K" (Net Total) minus
95 the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
96 Column A County - Reporting LEC/LGA
97 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12 Pro-Rata Table
98 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Full check amount Check Total $ - <-- Enter check total here
99 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed has not been received Sum of Net Green $ 409,071
100 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment Sum of Net Red $ (389,178)
101 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made
102 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
103 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
104 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
105 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
106 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
107 The last subtotal amount is the final amount due to/from the LEC/LGA
108 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
109 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
A B C D E F G H I J K L M N O P Q R S T U V
Total amount
2
Amount to be recouped Amount to withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Column Pro Rata release to 2013 and CUs in Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims J) Percent claiming unit Red) or 2) Chino Valley USD
110 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
111 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
112 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
113
116 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
117 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
118
119 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
120 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
121 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
122 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
123
Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
25 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
26 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
27 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
28
31 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
32 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
33
34 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
35 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
36 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
37 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
38
39 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
40 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
41 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
42
45 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
46 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
47
48 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
49 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
50 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
51 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
52
1
Pro-Rata Net Negative Distribution Table
2
Amount to be recouped Amount to
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + release to Total amount withheld (FFY 2013 and
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit CUs in Red) Option (insert 1 or 2) East Side Union HSD Children's Ctr. East Side Union HSD General Admin.
3 Santa Clara LGA Cambrian SD 10/11-1 2012-Q4 $ - $ - ### $ 28,215 $ 25,000 $ (3,215) 2
4 Santa Clara LGA Cambrian SD 11/12-1 Err:520 $ 27,589 $ 25,000 $ 2,589 $ - ### $ - 2
5 Santa Clara LGA Cambrian SD 10/11-2 2013-Q1 $ - $ - ### $ 39,649 $ 29,737 $ (9,912) 2
6 Santa Clara LGA Cambrian SD 11/12-2 Err:520 $ 58,602 $ 23,441 $ 35,161 $ - ### $ -
7 Santa Clara LGA Cambrian SD 10/11-3 2013-Q2 $ - $ - ### $ 44,240 $ 33,180 $ (11,060) 2
8 Santa Clara LGA Cambrian SD 11/12-3 Err:520 $ 46,836 $ 35,127 $ 11,709 $ - ### $ - 2
9 Santa Clara LGA Cambrian SD 10/11-4 2013-Q3 $ - $ - ### $ 35,850 $ 26,888 $ (8,962) 2
10 Santa Clara LGA Cambrian SD 11/12-4 Err:520 $ 59,358 $ 23,743 $ 35,615 $ - ### $ -
11 Cambrian SD Total $ 192,385 $ 107,311 $ 85,074 $ 147,954 $ 114,805 $ (33,149) $ 74,162 12.83% $ - $ 74,162 $ 11,959.23 $ 11,443.31
12 Santa Clara LGA Campbell Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 41,131 $ 30,848 $ (10,283) 2
13 Santa Clara LGA Campbell Union HSD 11/12-1 Err:520 $ 94,454 $ 37,782 $ 56,672 $ - ### $ -
14 Santa Clara LGA Campbell Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 109,015 $ 43,606 $ (65,409)
15 Santa Clara LGA Campbell Union HSD 11/12-2 Err:520 $ 222,140 $ 88,856 $ 133,284 $ - ### $ -
16 Santa Clara LGA Campbell Union HSD 10/11-3 2013-Q2 $ - $ - ### $ 82,968 $ 33,187 $ (49,781)
17 Santa Clara LGA Campbell Union HSD 11/12-3 Err:520 $ 218,418 $ 87,367 $ 131,051 $ - ### $ -
18 Santa Clara LGA Campbell Union HSD 10/11-4 2013-Q3 $ - $ - ### $ 85,631 $ 34,252 $ (51,379)
19 Santa Clara LGA Campbell Union HSD 11/12-4 Err:520 $ 201,282 $ 80,513 $ 120,769 $ - ### $ -
20 Campbell Union HSD Total $ 736,294 $ 294,518 $ 441,776 $ 318,745 $ 141,893 $ (176,852) $ 117,666 20.35% $ - $ 117,666 $ 18,974.60 $ 18,156.05
21 Santa Clara LGA Campbell Union SD 10/11-1 2012-Q4 $ - $ - ### $ 40,475 $ 30,356 $ (10,119) 2
22 Santa Clara LGA Campbell Union SD 11/12-1 Err:520 $ 48,705 $ 36,529 $ 12,176 $ - ### $ - 2
23 Santa Clara LGA Campbell Union SD 10/11-2 2013-Q1 $ - $ - ### $ 139,843 $ 55,937 $ (83,906)
24 Santa Clara LGA Campbell Union SD 11/12-2 Err:520 $ 198,197 $ 79,279 $ 118,918 $ - ### $ -
25 Santa Clara LGA Campbell Union SD 10/11-3 2013-Q2 $ - $ - ### $ 128,425 $ 51,370 $ (77,055)
26 Santa Clara LGA Campbell Union SD 11/12-3 Err:520 $ 160,878 $ 64,351 $ 96,527 $ - ### $ -
27 Santa Clara LGA Campbell Union SD 10/11-4 2013-Q3 $ - $ - ### $ 121,778 $ 48,711 $ (73,067)
28 Santa Clara LGA Campbell Union SD 12/13-1 Err:520 $ 3,707 $ 3,336 $ 371
29 Santa Clara LGA Campbell Union SD 12/13-2 Err:520 $ 28,069 $ 21,052 $ 7,017
30 Santa Clara LGA Campbell Union SD 11/12-4 Err:520 $ 120,730 $ 48,292 $ 72,438 $ - ### $ -
31 Campbell Union SD Total $ 560,286 $ 252,839 $ 307,447 $ 430,521 $ 186,374 $ (244,147) $ 8,692 1.50% $ - $ 8,692 $ 1,401.66 $ 1,341.19
32 Santa Clara LGA East Side Union HSD Children's Ctr. 10/11-1 2012-Q4 $ - $ - ### $ 63,418 $ 25,367 $ (38,051)
33 Santa Clara LGA East Side Union HSD Children's Ctr. 11/12-4 Err:520 $ 59,332 $ 23,733 $ 35,599 $ - ### $ -
34 Santa Clara LGA East Side Union HSD Children's Ctr. 11/12-1 Err:520 $ 46,594 $ 34,946 $ 11,648 $ - ### $ - 2
35 Santa Clara LGA East Side Union HSD Children's Ctr. 10/11-2 2013-Q1 $ - $ - ### $ 101,135 $ 40,454 $ (60,681)
36 Santa Clara LGA East Side Union HSD Children's Ctr. 11/12-2 Err:520 $ 59,706 $ 23,882 $ 35,824 $ - ### $ -
37 Santa Clara LGA East Side Union HSD Children's Ctr. 10/11-3 2013-Q2 $ - $ - ### $ 90,423 $ 36,169 $ (54,254)
38 Santa Clara LGA East Side Union HSD Children's Ctr. 11/12-3 Err:520 $ 59,029 $ 23,612 $ 35,417 $ - ### $ -
39 Santa Clara LGA East Side Union HSD Children's Ctr. 10/11-4 2013-Q3 $ - $ - ### $ 77,366 $ 30,946 $ (46,420)
40 East Side Union HSD Children's Ctr. Total $ 224,661.00 $ 106,173.00 $ 118,488.00 $ 332,342 $ 132,936 $ (199,406) $ (93,233) 51.10%
41 Santa Clara LGA East Side Union HSD General Admin. 10/11-1 2012-Q4 $ - $ - ### $ 141,833 $ 56,733 $ (85,100)
42 Santa Clara LGA East Side Union HSD General Admin. 11/12-1 Err:520 $ 301,426 $ 120,570 $ 180,856 $ - ### $ -
43 Santa Clara LGA East Side Union HSD General Admin. 10/11-2 2013-Q1 $ - $ - ### $ 381,802 $ 152,721 $ (229,081)
44 Santa Clara LGA East Side Union HSD General Admin. 11/12-2 Err:520 $ 449,915 $ 179,966 $ 269,949 $ - ### $ -
45 Santa Clara LGA East Side Union HSD General Admin. 10/11-3 2013-Q2 $ - $ - ### $ 340,076 $ 136,030 $ (204,046)
46 Santa Clara LGA East Side Union HSD General Admin. 11/12-3 Err:520 $ 401,912 $ 160,765 $ 241,147 $ - ### $ -
47 Santa Clara LGA East Side Union HSD General Admin. 10/11-4 2013-Q3 $ - $ - ### $ 248,249 $ 99,300 $ (148,949)
48 Santa Clara LGA East Side Union HSD General Admin. 11/12-4 Err:520 $ 291,659 $ 116,664 $ 174,995 $ - ### $ -
49 East Side Union HSD General Admin. Total $ 1,444,912 $ 577,965 $ 866,947 $ 1,111,960 $ 444,784 $ (667,176) $ (89,211) 48.90%
50 Santa Clara LGA Franklin McKinley SD 11/12-1 Err:520 $ 36,218 $ 27,164 $ 9,054 $ - ### $ - 1
51 Santa Clara LGA Franklin McKinley SD 11/12-2 Err:520 $ 68,504 $ 27,402 $ 41,102 $ - ### $ -
52 Santa Clara LGA Franklin McKinley SD 11/12-3 Err:520 $ 75,830 $ 30,332 $ 45,498 $ - ### $ -
53 Santa Clara LGA Franklin McKinley SD 11/12-4 Err:520 $ 63,255 $ 25,302 $ 37,953 $ - ### $ -
54 Franklin McKinley SD Total $ 243,807 $ 110,200 $ 133,607 $ - $ - $ - $ 110,200 19.06% $ - $ 110,200 $ 17,770.65 $ 17,004.03
55 Santa Clara LGA Luther Burbank SD 10/11-2 2013-Q1 $ - $ - ### $ 36,138 $ 27,104 $ (9,034) 2
56 Santa Clara LGA Luther Burbank SD 11/12-2 Err:520 $ 35,552 $ 26,664 $ 8,888 $ - ### $ - 2
57 Santa Clara LGA Luther Burbank SD 10/11-3 2013-Q2 $ - $ - ### $ 33,127 $ 25,000 $ (8,127) 2
58 Santa Clara LGA Luther Burbank SD 11/12-3 Err:520 $ 27,964 $ 25,000 $ 2,964 $ - ### $ - 2
59 Santa Clara LGA Luther Burbank SD 11/12-4 Err:520 $ 30,987 $ 25,000 $ 5,987 $ - ### $ - 2
60 Luther Burbank SD Total $ 94,503 $ 76,664 $ 17,839 $ 69,265 $ 52,104 $ (17,161) $ 59,503 10.29% $ - $ 59,503 $ 9,595.34 $ 9,181.41
61 Santa Clara LGA Moreland SD 10/11-1 2012-Q4 $ - $ - ### $ 50,461 $ 20,184 $ (30,277)
62 Santa Clara LGA Moreland SD 11/12-1 Err:520 $ 38,465 $ 28,849 $ 9,616 $ - ### $ - 2
63 Santa Clara LGA Moreland SD 10/11-2 2013-Q1 $ - $ - ### $ 87,526 $ 35,010 $ (52,516)
64 Santa Clara LGA Moreland SD 11/12-2 Err:520 $ 55,450 $ 22,180 $ 33,270 $ - ### $ -
65 Santa Clara LGA Moreland SD 10/11-3 2013-Q2 $ - $ - ### $ 49,155 $ 36,866 $ (12,289) 2
66 Santa Clara LGA Moreland SD 11/12-3 Err:520 $ 67,230 $ 26,892 $ 40,338 $ - ### $ -
67 Santa Clara LGA Moreland SD 10/11-4 2013-Q3 $ - $ - ### $ 47,593 $ 35,695 $ (11,898) 2
68 Santa Clara LGA Moreland SD 11/12-4 Err:520 $ 45,082 $ 33,812 $ 11,270 $ - ### $ - 2
69 Moreland SD Total $ 206,227 $ 111,733 $ 94,494 $ 234,735 $ 127,755 $ (106,980) $ 4,753 0.82% $ - $ 4,753 $ 766.46 $ 733.40
70 Santa Clara LGA Orchard SD 11/12-3 Err:520 $ 97,090 $ 38,836 $ 58,254 $ - ### $ -
71 Santa Clara LGA Orchard SD 11/12-4 Err:520 $ 75,660 $ 30,264 $ 45,396 $ - ### $ -
72 Orchard SD Total $ 172,750 $ 69,100 $ 103,650 $ - $ - $ - $ 69,100 11.95% $ - $ 69,100 $ 11,142.94 $ 10,662.24
73 Santa Clara LGA San Jose USD 11/12-1 Err:520 $ 231,972 $ 92,789 $ 139,183 $ - ### $ -
74 Santa Clara LGA San Jose USD 10/11-3 2013-Q2 $ - $ - ### $ 321,315 $ 128,526 $ (192,789)
75 Santa Clara LGA San Jose USD 10/11-4 2013-Q3 $ - $ - ### $ 343,981 $ 137,592 $ (206,389)
76 Santa Clara LGA San Jose USD 11/12-2C-1 Err:520 $ 275,904 $ 110,362 $ 165,542 $ - ### $ -
77 Santa Clara LGA San Jose USD 11/12-3C-1 Err:520 $ 260,888 $ 104,355 $ 156,533 $ - ### $ -
78 Santa Clara LGA San Jose USD 11/12-4C-1 Err:520 $ 274,105 $ 109,642 $ 164,463 $ - ### $ -
79 San Jose USD Total $ 1,042,869 $ 417,148 $ 625,721 $ 665,296 $ 266,118 $ (399,178) $ 17,970 3.11% $ - $ 17,970 $ 2,897.81 $ 2,772.80
80 Santa Clara LGA Union SD 11/12-1 Err:520 $ 44,322 $ 33,242 $ 11,080 $ - ### $ - 2
81 Santa Clara LGA Union SD 11/12-2 Err:520 $ 67,756 $ 27,102 $ 40,654 $ - ### $ -
82 Santa Clara LGA Union SD 11/12-3 Err:520 $ 53,465 $ 21,386 $ 32,079 $ - ### $ -
83 Santa Clara LGA Union SD 11/12-4 Err:520 $ 45,845 $ 34,384 $ 11,461 $ - ### $ - 2
84 Union SD Total $ 211,388 $ 116,114 $ 95,274 $ - $ - $ - $ 116,114 20.08% $ - $ 116,114 $ 18,724.33 $ 17,916.57
85 Grand Total Santa Clara LGA $ 5,130,082 $ 2,239,765 $ 2,890,317 $ 3,310,818 $ 1,466,769 $ (1,844,049) $ 395,716 100% $ - $ 578,160 $ 93,233 $ 89,211
86 The sum of Column N equals the sum of "Column K" (Net Total) minus
87 the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
88 Column A County - Reporting LEC/LGA
89 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12
90 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Pro-Rata Table
91 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed Full check amount Check Total <-- Enter check total here
92 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment has not been received Sum of Net Green $ 578,160
93 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made Sum of Net Red $ (182,444)
94 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
95 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
96 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
97 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
98 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
99 The last subtotal amount is the final amount due to/from the LEC/LGA
100 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
101 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
102 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
103 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
104 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
105
108 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
109 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
110
111 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
112 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
113 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
114 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
A B C D E F G H I J K L M N O P Q
2
Amount to be recouped Amount to
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + release to Total amount withheld (FFY 2013 and
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Pro Rata Percent claiming unit CUs in Red) Option (insert 1 or 2) East Side Union HSD Children's Ctr. East Side Union HSD General Admin.
115
1
Pro-Rata Net Negative Distribution Table
Total amount
2 Period of Amount to be recouped withheld (FFY
Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata Amount to release to 2013 and CUs in Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent claiming unit Red) or 2) Salinas Union HSD
3 Santa Cruz Alisal Community Healthy Start FRC 11/12-4 Err:520 $ 26,254 $ 25,000 $ 1,254 $ - ### $ - 2
4 Alisal Community Healthy Start FRC Total $ 26,254 $ 25,000 $ 1,254 $ - $ - $ - $ 25,000 0.98% $ 9,178 $ 15,822 214.61
5 Santa Cruz Alisal Union - Sp. Ed. 11/12-3 Err:520 $ 34,614 $ 25,961 $ 8,653 $ - ### $ - 2
6 Santa Cruz Alisal Union - Sp. Ed. 11/12-4 Err:520 $ 27,111 $ 25,000 $ 2,111 $ - ### $ - 2
7 Alisal Union - Sp. Ed. Total $ 61,725 $ 50,961 $ 10,764 $ - $ - $ - $ 50,961 1.99% $ 18,708 $ 32,253 $ 437
8 Santa Cruz Alum Rock Union ESD 11/12-1 Err:520 $ 67,579 $ 27,032 $ 40,547 $ - ### $ -
9 Santa Cruz Alum Rock Union ESD 10/11-2 2013-Q1 $ - $ - ### $ 71,972 $ 28,789 $ (43,183)
10 Santa Cruz Alum Rock Union ESD 11/12-2 Err:520 $ 87,262 $ 34,905 $ 52,357 $ - ### $ -
11 Santa Cruz Alum Rock Union ESD 10/11-3 2013-Q2 $ - $ - ### $ 59,348 $ 23,739 $ (35,609)
12 Santa Cruz Alum Rock Union ESD 11/12-3 Err:520 $ 80,704 $ 32,282 $ 48,422 $ - ### $ -
13 Santa Cruz Alum Rock Union ESD 10/11-4 2013-Q3 $ - $ - ### $ 69,892 $ 27,957 $ (41,935)
14 Santa Cruz Alum Rock Union ESD 11/12-4 Err:520 $ 80,023 $ 32,009 $ 48,014 $ - ### $ -
15 Alum Rock Union ESD Total $ 315,568 $ 126,228 $ 189,340 $ 201,212 $ 80,485 $ (120,727) $ 5,501 0.21% $ 2,019 $ 3,482 $ 47
16 Santa Cruz Berryessa Union Elementary 10/11-2 Err:520 $ 48,709 $ 36,532 $ 12,177 $ - ### $ - 2
17 Santa Cruz Berryessa Union Elementary 11/12-2 Err:520 $ 66,624 $ 26,650 $ 39,974 $ - ### $ -
18 Santa Cruz Berryessa Union Elementary 11/12-3 Err:520 $ 52,009 $ 20,804 $ 31,205 $ - ### $ -
19 Santa Cruz Berryessa Union Elementary 10/11-3 Err:520 $ 48,998 $ 36,749 $ 12,249 $ - ### $ - 2
20 Santa Cruz Berryessa Union Elementary 10/11-4 Err:520 $ 48,265 $ 36,199 $ 12,066 $ - ### $ - 2
21 Santa Cruz Berryessa Union Elementary 11/12-4 Err:520 $ 63,723 $ 25,489 $ 38,234 $ - ### $ -
22 Berryessa Union Elementary Total* $ 328,328 $ 182,423 $ 145,905 $ - $ - $ - $ 182,423 7.12% $ 66,970 $ 115,453 $ 1,566
23 Santa Cruz Cupertino Union SD 10/11-1 2012-Q4 $ - $ - ### $ 81,463 $ 32,585 $ (48,878)
24 Santa Cruz Cupertino Union SD 11/12-1 Err:520 $ 77,242 $ 30,897 $ 46,345 $ - ### $ -
25 Santa Cruz Cupertino Union SD 10/11-2 2013-Q1 $ - $ - ### $ 126,366 $ 50,546 $ (75,820)
26 Santa Cruz Cupertino Union SD 11/12-2 Err:520 $ 152,039 $ 60,816 $ 91,223 $ - ### $ -
27 Santa Cruz Cupertino Union SD 10/11-3 2013-Q2 $ - $ - ### $ 123,834 $ 49,534 $ (74,300)
28 Santa Cruz Cupertino Union SD 11/12-3 Err:520 $ 130,104 $ 52,042 $ 78,062 $ - ### $ -
29 Santa Cruz Cupertino Union SD 10/11-4 2013-Q3 $ - $ - ### $ 115,279 $ 46,112 $ (69,167)
30 Santa Cruz Cupertino Union SD 12/13-1 Err:520 $ 57,847 $ 23,139 $ 34,708
31 Santa Cruz Cupertino Union SD 12/13-2 Err:520 $ 75,939 $ 30,376 $ 45,563
32 Santa Cruz Cupertino Union SD 12/13-3 Err:520 $ 71,482 $ 28,593 $ 42,889
33 Santa Cruz Cupertino Union SD 11/12-4 Err:520 $ 130,725 $ 52,290 $ 78,435 $ - ### $ -
34 Cupertino Union SD Total $ 695,378 $ 278,153 $ 417,225 $ 446,942 $ 178,777 $ (268,165) $ 9,988 0.39% $ 3,667 $ 6,321 $ 86
35 Santa Cruz Evergreen ESD 10/11-2 2013-Q1 $ - $ - ### $ 40,476 $ 30,357 $ (10,119) 2
36 Santa Cruz Evergreen ESD 11/12-2 Err:520 $ 40,266 $ 30,200 $ 10,066 $ - ### $ - 2
37 Santa Cruz Evergreen ESD 10/11-3 2013-Q2 $ - $ - ### $ 35,044 $ 26,283 $ (8,761) 2
38 Santa Cruz Evergreen ESD 11/12-3 Err:520 $ 32,737 $ 25,000 $ 7,737 $ - ### $ - 2
39 Santa Cruz Evergreen ESD 10/11-4 2013-Q3 $ - $ - ### $ 32,869 $ 25,000 $ (7,869) 2
40 Santa Cruz Evergreen ESD 11/12-4 Err:520 $ 30,346 $ 25,000 $ 5,346 $ - ### $ - 2
41 Evergreen ESD Total $ 103,349 $ 80,200 $ 23,149 $ 108,389 $ 81,640 $ (26,749) $ 53,451 2.09% $ 19,622 $ 33,829 $ 459
42 Santa Cruz Foothill - DeAnza Comm College Dist 10/11-1 2012-Q4 $ - $ - ### $ 50,053 $ 20,021 $ (30,032)
43 Santa Cruz Foothill - DeAnza Comm College Dist 11/12-1 Err:520 $ 42,256 $ 31,692 $ 10,564 $ - ### $ - 2
44 Santa Cruz Foothill - DeAnza Comm College Dist 10/11-2 2013-Q1 $ - $ - ### $ 51,725 $ 20,690 $ (31,035)
45 Santa Cruz Foothill - DeAnza Comm College Dist 11/12-2 Err:520 $ 58,441 $ 23,376 $ 35,065 $ - ### $ -
46 Santa Cruz Foothill - DeAnza Comm. College District 10/11-3 Err:520 $ 62,945 $ 25,178 $ 37,767 $ - ### $ -
47 Santa Cruz Foothill - DeAnza Comm College Dist 11/12-3 Err:520 $ 50,515 $ 20,206 $ 30,309 $ - ### $ -
48 Santa Cruz Foothill - DeAnza Comm College Dist 10/11-4 Err:520 $ 56,637 $ 22,655 $ 33,982 $ - ### $ -
49 Santa Cruz Foothill - DeAnza Comm College Dist 11/12-4 Err:520 $ 51,522 $ 20,609 $ 30,913 $ - ### $ -
50 Foothill - DeAnza Comm College Dist Total* $ 322,316 $ 143,716 $ 178,600 $ 101,778 $ 40,711 $ (61,067) $ 82,649 3.23% $ 30,341 $ 52,308 $ 709
51 Santa Cruz Gilroy USD 10/11-1 2012-Q4 $ - $ - ### $ - ### $ - 2
52 Santa Cruz Gilroy USD 10/11-2 Err:520 $ - $ - $ - $ - ### $ -
53 Santa Cruz Gilroy USD 11/12-4 Err:520 $ - $ - $ - $ - ### $ -
54 Gilroy USD Total $ - $ - $ - $ - $ - $ - $ -
55 Santa Cruz Hollister ESD 11/12-2 Err:520 $ 49,967 $ 37,475 $ 12,492 $ - ### $ - 2
56 Santa Cruz Hollister ESD 11/12-3 Err:520 $ 38,801 $ 29,101 $ 9,700 $ - ### $ - 2
57 Santa Cruz Hollister ESD 11/12-4 Err:520 $ 40,626 $ 30,470 $ 10,156 $ - ### $ - 2
58 Hollister ESD Total $ 129,394 $ 97,046 $ 32,348 $ - $ - $ - $ 97,046 3.79% $ 35,627 $ 61,419 $ 833
59 Santa Cruz Milpitas USD 11/12-2 Err:520 $ 73,954 $ 29,582 $ 44,372 $ - ### $ -
60 Santa Cruz Milpitas USD 11/12-3 Err:520 $ 38,341 $ 28,756 $ 9,585 $ - ### $ - 2
61 Santa Cruz Milpitas USD 10/11-4 Err:520 $ 25,263 $ 25,000 $ 263 $ - ### $ - 2
62 Milpitas USD Total $ 137,558 $ 83,338 $ 54,220 $ - $ - $ - $ 83,338 3.25% $ 30,594 $ 52,744 $ 715
63 Santa Cruz Monterey COE - Home Charter 10/11-3 Err:520 $ 37,152 $ 27,864 $ 9,288 $ - ### $ - 2
64 Santa Cruz Monterey COE - Home Charter 11/12-3 Err:520 $ 30,702 $ 25,000 $ 5,702 $ - ### $ - 2
65 Santa Cruz Monterey COE - Home Charter 11/12-4 Err:520 $ 25,655 $ 25,000 $ 655 $ - ### $ - 2
66 Monterey COE - Home Charter Total $ 93,509 $ 77,864 $ 15,645 $ - $ - $ - $ 77,864 3.04% $ 28,585 $ 49,279 $ 668
67 Santa Cruz Monterey COE - Sp Ed 10/11-1 2012-Q4 $ - $ - ### $ 48,772 $ 36,579 $ (12,193) 2
68 Santa Cruz Monterey COE - Sp Ed 11/12-1 Err:520 $ 45,853 $ 34,390 $ 11,463 $ - ### $ - 2
69 Santa Cruz Monterey COE - Sp Ed 10/11-2 2013-Q1 $ - $ - ### $ 48,366 $ 36,275 $ (12,091) 2
70 Santa Cruz Monterey COE - Sp Ed 11/12-2 Err:520 $ 50,893 $ 20,357 $ 30,536 $ - ### $ -
71 Santa Cruz Monterey COE - Sp Ed 10/11-3 2013-Q2 $ - $ - ### $ 72,523 $ 29,009 $ (43,514)
72 Santa Cruz Monterey COE - Sp Ed 11/12-3 Err:520 $ 49,160 $ 36,870 $ 12,290 $ - ### $ - 2
73 Santa Cruz Monterey COE - Sp Ed 10/11-4 2013-Q3 $ - $ - ### $ 51,901 $ 20,760 $ (31,141) 2
74 Santa Cruz Monterey COE - Sp Ed 11/12-4 Err:520 $ 44,756 $ 33,567 $ 11,189 $ - ### $ - 2
75 Monterey COE - Sp Ed Total $ 190,662 $ 125,184 $ 65,478 $ 221,562 $ 122,623 $ (98,939) $ 26,245 1.02% $ 9,635 $ 16,610 $ 225
76 Santa Cruz Monterey COE- Alt Ed. 10/11-1 2012-Q4 $ - $ - ### $ 38,659 $ 27,061 $ (11,598)
77 Santa Cruz Monterey COE - Alt Ed 10/11-3 Err:520 $ 43,312 $ 30,318 $ 12,994 $ - ### $ -
78 Santa Cruz Monterey COE- Alt Ed. 10/11-2 2013-Q1 $ - $ - ### $ 31,916 $ 22,341 $ (9,575)
79 Santa Cruz Monterey COE - Alt Ed. 11/12-1 Err:520 $ 32,415 $ 22,691 $ 9,724 $ - ### $ -
80 Santa Cruz Monterey COE - Alt. Ed. 10/11-4 Err:520 $ 29,485 $ 20,640 $ 8,845 $ - ### $ -
81 Santa Cruz Monterey COE- Alt Ed. 11/12-3 Err:520 $ 36,722 $ 25,705 $ 11,017 $ - ### $ -
82 Santa Cruz Monterey COE- Alt Ed. 11/12-4 Err:520 $ 33,712 $ 23,598 $ 10,114 $ - ### $ -
83 Monterey COE- Alt Ed. Total $ 175,646 $ 122,952 $ 52,694 $ 70,575 $ 49,402 $ (21,173) $ 101,779 3.97% $ 37,364 $ 64,415 $ 874
84 Santa Cruz Monterey Peninsula USD 11/12-1 Err:520 $ 39,635 $ 29,726 $ 9,909 $ - ### $ - 2
85 Santa Cruz Monterey Peninsula USD 11/12-2 Err:520 $ 36,116 $ 27,087 $ 9,029 $ - ### $ - 2
86 Santa Cruz Monterey Peninsula USD 11/12-3 Err:520 $ 34,291 $ 25,718 $ 8,573 $ - ### $ - 2
87 Santa Cruz Monterey Peninsula USD 09/10-4 2012-Q3 $ - $ - ### $ 41,343 $ 31,007 $ (10,336) 2
88 Santa Cruz Monterey Peninsula USD 10/11-4 Err:520 $ 26,721 $ 25,000 $ 1,721 $ - ### $ - 2
89 Monterey Peninsula USD Total $ 136,763 $ 107,531 $ 29,232 $ 41,343 $ 31,007 $ (10,336) $ 97,195 3.79% $ 35,681 $ 61,514 $ 834
90 Santa Cruz N. Monterey County USD 10/11-1 2012-Q4 $ - $ - ### $ 57,681 $ 23,072 $ (34,609) 2
91 Santa Cruz N. Monterey County USD 11/12-1 Err:520 $ 45,550 $ 34,163 $ 11,387 $ - ### $ - 2
92 Santa Cruz N. Monterey County USD 10/11-2 2013-Q1 $ - $ - ### $ 52,913 $ 21,165 $ (31,748) 2
93 Santa Cruz N. Monterey County USD 11/12-2 Err:520 $ 39,883 $ 29,912 $ 9,971 $ - ### $ - 2
94 Santa Cruz N. Monterey County USD 11/12-3 Err:520 $ 51,215 $ 20,486 $ 30,729 $ - ### $ -
95 Santa Cruz N. Monterey County USD 10/11-4 Err:520 $ 88,118 $ 35,247 $ 52,871 $ - ### $ -
96 Santa Cruz N. Monterey County USD 11/12-4 Err:520 $ 55,380 $ 22,152 $ 33,228 $ - ### $ -
97 Santa Cruz N. Monterey County USD 10/11-3 Err:520 $ 87,642 $ 35,057 $ 52,585 $ - ### $ -
98 N. Monterey County USD Total $ 367,788 $ 177,017 $ 190,771 $ 110,594 $ 44,237 $ (66,357) $ 110,660 4.32% $ 40,625 $ 70,035 $ 950
99 Santa Cruz Oak Grove SD 11/12-1 Err:520 $ 27,555 $ 25,000 $ 2,555 $ - ### $ - 2
100 Santa Cruz Oak Grove SD 10/11-2 2013-Q1 $ - $ - ### $ 71,542 $ 28,617 $ (42,925)
101 Santa Cruz Oak Grove SD 11/12-2 Err:520 $ 64,439 $ 25,776 $ 38,663 $ - ### $ -
102 Santa Cruz Oak Grove SD 10/11-3 2013-Q2 $ - $ - ### $ 52,329 $ 20,932 $ (31,397)
103 Santa Cruz Oak Grove SD 11/12-3 Err:520 $ 73,044 $ 29,218 $ 43,826 $ - ### $ -
104 Santa Cruz Oak Grove SD 10/11-4 2013-Q3 $ - $ - ### $ 70,752 $ 28,301 $ (42,451)
105 Santa Cruz Oak Grove SD 12/13-1 Err:520 $ 17,221 $ 15,499 $ 1,722
106 Santa Cruz Oak Grove SD 11/12-4C-1 Err:520 $ 70,867 $ 28,347 $ 42,520 $ - ### $ -
107 Oak Grove SD Total $ 253,126 $ 123,840 $ 129,286 $ 194,623 $ 77,850 $ (116,773) $ 7,067 0.28% $ 2,594 $ 4,473 $ 61
108 Santa Cruz Pacific Grove USD 11/12-3 Err:520 $ 34,258 $ 25,694 $ 8,564 $ - ### $ - 2
109 Pacific Grove USD Total $ 34,258 $ 25,694 $ 8,564 $ - $ - $ - $ 25,694 1.00% $ 9,433 $ 16,261 $ 221
110 Santa Cruz Salinas City ESD 10/11-1 2012-Q4 $ - $ - ### $ 36,173 $ 27,130 $ (9,043) 2
111 Santa Cruz Salinas City ESD 11/12-1 Err:520 $ 41,192 $ 30,894 $ 10,298 $ - ### $ - 2
112 Santa Cruz Salinas City ESD 10/11-2 Err:520 $ 47,459 $ 35,594 $ 11,865 $ - ### $ - 2
A B C D E F G H I J K L M N O P Q R S T U
Total amount
2 Period of Amount to be recouped withheld (FFY
Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata Amount to release to 2013 and CUs in Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent claiming unit Red) or 2) Salinas Union HSD
113 Santa Cruz Salinas City ESD 11/12-2 Err:520 $ 33,582 $ 25,187 $ 8,395 $ - ### $ - 2
114 Santa Cruz Salinas City ESD 10/11-3 Err:520 $ 52,247 $ 20,899 $ 31,348 $ - ### $ -
115 Santa Cruz Salinas City ESD 11/12-3 Err:520 $ 53,451 $ 21,380 $ 32,071 $ - ### $ -
116 Santa Cruz Salinas City ESD 09/10-4 2012-Q3 $ - $ - ### $ 38,140 $ 28,605 $ (9,535) 2
117 Santa Cruz Salinas City ESD 10/11-4 Err:520 $ 52,475 $ 20,990 $ 31,485 $ - ### $ -
118 Santa Cruz Salinas City ESD 11/12-4 Err:520 $ 49,759 $ 37,319 $ 12,440 $ - ### $ - 2
119 Salinas City ESD Total $ 330,165 $ 192,263 $ 137,902 $ 74,313 $ 55,735 $ (18,578) $ 173,685 6.78% $ 63,762 $ 109,923 $ 1,491
120 Santa Cruz Salinas Union HSD 10/11-1 2012-Q4 $ - $ - ### $ 28,906 $ 25,000 $ (3,906) 2
121 Santa Cruz Salinas Union HSD 10/11-2 2013-Q1 $ - $ - ### $ 61,536 $ 24,614 $ (36,922)
122 Santa Cruz Salinas Union HSD 10/11-3 2013-Q2 $ - $ - ### $ 77,529 $ 31,012 $ (46,517)
123 Santa Cruz Salinas Union HSD 12/13-1 Err:520 $ 2,139 $ 1,925 $ 214
124 Santa Cruz Salinas Union HSD 12/13-2 Err:520 $ 2,665 $ 2,399 $ 266
125 Santa Cruz Salinas Union HSD 12/13-3 Err:520 $ 20,606 $ 18,545 $ 2,061
126 Santa Cruz Salinas Union HSD 12/13-4 Err:520 $ 7,056 $ 6,350 $ 706
127 Santa Cruz Salinas Union HSD 13/14-1 Err:520 $ 8,287 $ 7,458 $ 829
128 Santa Cruz Salinas Union HSD 13/14-2 Err:520 $ 15,250 $ 13,725 $ 1,525
129 Santa Cruz Salinas Union HSD 13/14-3 Err:520 $ 18,400 $ 16,560 $ 1,840
130 Santa Cruz Salinas Union HSD 13/14-4 Err:520 $ 11,052 $ 9,947 $ 1,105
131 Santa Cruz Salinas Union HSD 10/11-4 2013-Q3 $ - $ - ### $ 46,250 $ 34,688 $ (11,562) 2
132 Salinas Union HSD Total $ 85,455.00 $ 76,909.00 $ 8,546.00 $ 214,221 $ 115,314 $ (98,907) $ (21,998) 100%
133 Santa Cruz San Jose City College 10/11-1 2012-Q4 $ - $ - ### $ 30,170 $ 21,119 $ (9,051)
134 Santa Cruz San Jose City College 09/10-4 2012-Q3 $ - $ - ### $ 26,058 $ 18,241 $ (7,817)
135 Santa Cruz San Jose City College 10/11-4 Err:520 $ 26,430 $ 18,501 $ 7,929 $ - ### $ -
136 San Jose City College Total $ 26,430.00 $ 18,501.00 $ 7,929.00 $ 56,228 $ 39,360 $ (16,868) $ 1,633 0.06% $ 599 $ 1,034 $ 14
137 Santa Cruz Santa Clara COE 10/11-1 2012-Q4 $ - $ - ### $ 232,627 $ 93,051 $ (139,576)
138 Santa Cruz Santa Clara COE 11/12-1 Err:520 $ 197,738 $ 79,095 $ 118,643 $ - ### $ -
139 Santa Cruz Santa Clara COE 10/11-2 Err:520 $ 301,195 $ 120,478 $ 180,717 $ - ### $ -
140 Santa Cruz Santa Clara COE 11/12-2 Err:520 $ 239,398 $ 95,759 $ 143,639 $ - ### $ -
141 Santa Cruz Santa Clara COE 10/11-3 Err:520 $ 204,811 $ 81,924 $ 122,887 $ - ### $ -
142 Santa Cruz Santa Clara COE 11/12-3 Err:520 $ 226,334 $ 90,534 $ 135,800 $ - ### $ -
143 Santa Cruz Santa Clara COE 09/10-4 2012-Q3 $ - $ - ### $ 203,899 $ 81,560 $ (122,339)
144 Santa Cruz Santa Clara COE 10/11-4 Err:520 $ 241,806 $ 96,722 $ 145,084 $ - ### $ -
145 Santa Cruz Santa Clara COE 11/12-4 Err:520 $ 242,709 $ 97,084 $ 145,625 $ - ### $ -
146 Santa Clara COE Total $ 1,653,991 $ 661,596 $ 992,395 $ 436,526 $ 174,611 $ (261,915) $ 399,681 15.60% $ 146,728 $ 252,953 $ 3,431
147 Santa Cruz Santa Clara USD 10/11-1 2012-Q4 $ - $ - ### $ 31,360 $ 25,000 $ (6,360) 2
148 Santa Cruz Santa Clara USD 11/12-1 Err:520 $ 85,478 $ 34,191 $ 51,287 $ - ### $ -
149 Santa Cruz Santa Clara USD 10/11-2 2013-Q1 $ - $ - ### $ 37,499 $ 28,124 $ (9,375) 2
150 Santa Cruz Santa Clara USD 11/12-2 Err:520 $ 113,460 $ 45,384 $ 68,076 $ - ### $ -
151 Santa Cruz Santa Clara USD 10/11-3 Err:520 $ 44,228 $ 33,171 $ 11,057 $ - ### $ - 2
152 Santa Cruz Santa Clara USD 11/12-3 Err:520 $ 100,119 $ 40,048 $ 60,071 $ - ### $ -
153 Santa Cruz Santa Clara USD 09/10-4 2012-Q3 $ - $ - ### $ 33,980 $ 25,485 $ (8,495) 2
154 Santa Cruz Santa Clara USD 10/11-4 Err:520 $ 34,323 $ 25,742 $ 8,581 $ - ### $ - 2
155 Santa Cruz Santa Clara USD 11/12-4 Err:520 $ 103,504 $ 41,402 $ 62,102 $ - ### $ -
156 Santa Clara USD Total $ 481,112 $ 219,938 $ 261,174 $ 102,839 $ 78,609 $ (24,230) $ 195,708 7.64% $ 71,847 $ 123,861 $ 1,680
157 Santa Cruz Santa Cruz City Schools 11/12-2 Err:520 $ 38,409 $ 28,807 $ 9,602 $ - ### $ - 2
158 Santa Cruz Santa Cruz City Schools 11/12-3 Err:520 $ 45,019 $ 33,764 $ 11,255 $ - ### $ - 2
159 Santa Cruz Santa Cruz City Schools 11/12-4 Err:520 $ 46,051 $ 34,538 $ 11,513 $ - ### $ - 2
160 Santa Cruz City Schools Total* $ 129,479 $ 97,109 $ 32,370 $ - $ - $ - $ 97,109 3.79% $ 35,650 $ 61,459 $ 834
161 Santa Cruz Santa Cruz City Schools - Branciforte Sm. Sch. 10/11-3 Err:520 $ 33,728 $ 25,296 $ 8,432 $ - ### $ - 2
Santa Cruz City Schools- Branciforte Small
162
Santa Cruz Schools 11/12-3 Err:520 $ 29,179 $ 25,000 $ 4,179 $ - ### $ - 2
163 Santa Cruz Santa Cruz City Schools-Branciforte Small Sch 10/11-4 Err:520 $ 28,390 $ 25,000 $ 3,390 $ - ### $ - 2
164 Santa Cruz City Schools - Branciforte Sm. Sch. Total* $ 91,297 $ 75,296 $ 16,001 $ - $ - $ - $ 75,296 2.94% $ 27,642 $ 47,654 $ 646
165 Santa Cruz Santa Cruz COE - Alt Ed 10/11-1 2012-Q4 $ - $ - ### $ 60,547 $ 24,219 $ (36,328)
166 Santa Cruz Santa Cruz COE - Alt Ed 11/12-1 Err:520 $ 59,510 $ 23,804 $ 35,706 $ - ### $ -
167 Santa Cruz Santa Cruz COE - Alt Ed 10/11-2 Err:520 $ 81,542 $ 32,617 $ 48,925 $ - ### $ -
168 Santa Cruz Santa Cruz COE - Alt Ed 11/12-2 Err:520 $ 67,081 $ 26,832 $ 40,249 $ - ### $ -
169 Santa Cruz Santa Cruz COE - Alt Ed 10/11-3 Err:520 $ 118,855 $ 47,542 $ 71,313 $ - ### $ -
170 Santa Cruz Santa Cruz COE - Alt Ed 11/12-3 Err:520 $ 103,218 $ 41,287 $ 61,931 $ - ### $ -
171 Santa Cruz Santa Cruz COE - Alt Ed 10/11-4 Err:520 $ 107,162 $ 42,865 $ 64,297 $ - ### $ -
172 Santa Cruz Santa Cruz COE - Alt Ed 11/12-4 Err:520 $ 84,233 $ 33,693 $ 50,540 $ - ### $ -
173 Santa Cruz COE - Alt Ed Total $ 621,601 $ 248,640 $ 372,961 $ 60,547 $ 24,219 $ (36,328) $ 212,312 8.29% $ 77,942 $ 134,370 $ 1,823
174 Santa Cruz Santa Cruz COE - Sp Ed 10/11-1 2012-Q4 $ - $ - ### $ 31,318 $ 25,000 $ (6,318) 2
175 Santa Cruz Santa Cruz COE - Sp Ed 11/12-1 Err:520 $ 32,892 $ 25,000 $ 7,892 $ - ### $ - 2
176 Santa Cruz Santa Cruz COE - Sp Ed 10/11-2 2013-Q1 $ - $ - ### $ 43,289 $ 32,467 $ (10,822) 2
177 Santa Cruz Santa Cruz COE - Sp Ed 11/12-2 Err:520 $ 40,105 $ 30,079 $ 10,026 $ - ### $ - 2
178 Santa Cruz Santa Cruz COE - Sp Ed 10/11-3 Err:520 $ 50,949 $ 20,380 $ 30,569 $ - ### $ -
179 Santa Cruz Santa Cruz COE - Sp Ed 11/12-3 Err:520 $ 52,110 $ 20,844 $ 31,266 $ - ### $ -
180 Santa Cruz Santa Cruz COE - Sp Ed 10/11-4 Err:520 $ 36,458 $ 27,344 $ 9,114 $ - ### $ - 2
181 Santa Cruz Santa Cruz COE - Sp Ed 11/12-4 Err:520 $ 42,797 $ 32,098 $ 10,699 $ - ### $ - 2
182 Santa Cruz COE - Sp Ed Total $ 255,311 $ 155,745 $ 99,566 $ 74,607 $ 57,467 $ (17,140) $ 138,605 5.41% $ 50,884 $ 87,721 $ 1,190
183 Santa Cruz Santa Rita UESD 11/12-3 Err:520 $ 50,902 $ 17,816 $ 33,086 $ - ### $ -
184 Santa Cruz Santa Rita UESD 11/12-4 Err:520 $ 26,872 $ 18,810 $ 8,062 $ - ### $ -
185 Santa Rita UESD Total $ 77,774 $ 36,626 $ 41,148 $ - $ - $ - $ 36,626 1.43% $ 13,446 $ 23,180 $ 314
186 Santa Cruz Soledad USD 11/12-1 Err:520 $ 26,966 $ 25,000 $ 1,966 $ - ### $ - 2
187 Santa Cruz Soledad USD 11/12-2 Err:520 $ 39,336 $ 29,502 $ 9,834 $ - ### $ - 2
188 Santa Cruz Soledad USD 10/11-3 Err:520 $ 32,010 $ 25,000 $ 7,010 $ - ### $ - 2
189 Santa Cruz Soledad USD 11/12-3 Err:520 $ 59,552 $ 23,821 $ 35,731 $ - ### $ -
190 Santa Cruz Soledad USD 11/12-4 Err:520 $ 57,953 $ 23,181 $ 34,772 $ - ### $ -
191 Soledad USD Total $ 215,817 $ 126,504 $ 89,313 $ - $ - $ - $ 126,504 4.94% $ 46,441 $ 80,063 $ 1,086
192 Santa Cruz Sunnyvale SD 10/11-2 2013-Q1 $ - $ - ### $ 31,758 $ 25,000 $ (6,758) 2
193 Santa Cruz Sunnyvale SD 11/12-2 Err:520 $ 36,862 $ 27,647 $ 9,215 $ - ### $ - 2
194 Santa Cruz Sunnyvale SD 10/11-4 2013-Q3 $ - $ - ### $ 28,890 $ 25,000 $ (3,890) 2
195 Sunnyvale SD Total $ 36,862.00 $ 27,647.00 $ 9,215.00 $ 60,648 $ 50,000 $ (10,648) $ 16,999 0.66% $ 6,241 $ 10,758 $ 146
196 Santa Cruz Pajaro Valley USD 11/12-1 Err:520 $ 56,678 $ 22,671 $ 34,007 $ - ### $ -
197 Santa Cruz Pajaro Valley USD 11/12-2 Err:520 $ 33,072 $ 25,000 $ 8,072 $ - ### $ - 2
198 Santa Cruz Pajaro Valley USD 11/12-3 Err:520 $ 53,929 $ 21,572 $ 32,357 $ - ### $ -
199 Santa Cruz Pajaro Valley USD 10/11-1 2012-Q4 $ - $ - ### $ 90,995 $ 36,398 $ (54,597)
200 Santa Cruz Pajaro Valley USD 10/11-2 2013-Q1 $ - $ - ### $ 91,944 $ 36,778 $ (55,166)
201 Santa Cruz Pajaro Valley USD 10/11-3 Err:520 $ 105,194 $ 42,078 $ 63,116 $ - ### $ -
202 Santa Cruz Pajaro Valley USD 10/11-4 Err:520 $ 62,494 $ 24,998 $ 37,496 $ - ### $ -
203 Santa Cruz Pajaro Valley USD 11/12-4 Err:520 $ 27,562 $ 25,000 $ 2,562 $ - ### $ - 2
204 Pajaro Valley USD Total $ 338,929 $ 161,319 $ 177,610 $ 182,939 $ 73,176 $ (109,763) $ 51,556 2.01% $ 18,927 $ 32,629 $ 443
205 Grand Total Santa Cruz LEC $ 7,715,845 $ 3,925,240 $ 3,790,605 $ 2,759,886 $ 1,375,223 $ (1,384,663) $ 2,540,577 100% $ 940,752 $ 1,621,823 $ 21,998
206 The sum of Column N equals the sum of "Column K" (Net Total) minus
207 the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
208 Column A County - Reporting LEC/LGA
209 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12 Pro-Rata Table
210 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Full check amount Check Total $ 940,751 <-- Enter check total here
211 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed has not been received Sum of Net Green $ 2,562,575
212 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment Sum of Net Red $ (21,998)
213 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made
214 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
215 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
216 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
217 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
218 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
219 The last subtotal amount is the final amount due to/from the LEC/LGA
A B C D E F G H I J K L M N O P Q R S T U
Total amount
2 Period of Amount to be recouped withheld (FFY
Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata Amount to release to 2013 and CUs in Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent claiming unit Red) or 2) Salinas Union HSD
220 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
221 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
222 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
223 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
224 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
225
226 Released
Claiming Unit Invoice on placeholder to be paid 100%
227
228 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
229 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
230
231 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
232 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
233 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
234 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
235
39 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
40 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
41 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
42
45 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
46 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
47
48 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
49 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
50 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
51 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
52
144 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
145 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
146 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
A B C D E F G H I J K L M
Period of Submitted for Amount to be recouped
1 Service Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Option (insert 1 Placeholder
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) or 2) Number
147
148 Released
Claiming Unit Invoice on placeholder to be paid 100%
149
150 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
151 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
152
153 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
154 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
155 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
156 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
157
1
Pro-Rata Net Negative Distribution Table
Total amount
2 Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata Amount to release to 2013 and CUs in Option (insert 1 Modesto Jr. College -
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent claiming unit Red) or 2) Hughson USD Lammersville ESD Yosemite CCD
3 Stanislaus Amador County USD 10/11-1 2012-Q4 $ - $ - ### $ 30,667 $ 25,000 $ (5,667) 2
4 Stanislaus Amador County USD 11/12-1 Err:520 $ 41,654 $ 31,241 $ 10,413 $ - ### $ - 2
5 Stanislaus Amador County USD 10/11-2 2013-Q1 $ - $ - ### $ 25,923 $ 25,000 $ (923) 2
6 Stanislaus Amador County USD 11/12-2 Err:520 $ 33,221 $ 25,000 $ 8,221 $ - ### $ - 2
7 Stanislaus Amador County USD 10/11-3 2013-Q2 $ - $ - ### $ 29,079 $ 25,000 $ (4,079) 2
8 Stanislaus Amador County USD 11/12-3 Err:520 $ 27,542 $ 25,000 $ 2,542 $ - ### $ - 2
9 Stanislaus Amador County USD 10/11-4 2013-Q3 $ - $ - ### $ 28,237 $ 25,000 $ (3,237) 2
10 Stanislaus Amador County USD 11/12-4 Err:520 $ 34,277 $ 25,708 $ 8,569 $ - ### $ - 2
11 Amador County USD Total $ 136,694 $ 106,949 $ 29,745 $ 113,906 $ 100,000 $ (13,906) $ 93,043 2.08% $ 15,999 $ 77,044 $ 172.91 $ 1,588.41 $ 196.46
12 Stanislaus Calaveras COE 10/11-1 2012-Q4 $ - $ - ### $ 25,764 $ 25,000 $ (764) 2
13 Stanislaus Calaveras COE 12/13-1 Err:520 $ 2,438 $ 2,194 $ 244
14 Calaveras COE Total $ 2,438 $ 2,194 $ 244 $ 25,764 $ 25,000 $ (764) $ 1,430 0.03% $ 246 $ 1,184 $ 2.66 $ 24.41 $ 3.02
15 Stanislaus Ceres USD 10/11-1 2012-Q4 $ - $ - ### $ 151,918 $ 60,767 $ (91,151)
16 Stanislaus Ceres USD 11/12-1 Err:520 $ 115,842 $ 46,337 $ 69,505 $ - ### $ -
17 Stanislaus Ceres USD 10/11-2 2013-Q1 $ - $ - ### $ 177,473 $ 70,989 $ (106,484)
18 Stanislaus Ceres USD 11/12-2 Err:520 $ 112,550 $ 45,020 $ 67,530 $ - ### $ -
19 Stanislaus Ceres USD 10/11-3 2013-Q2 $ - $ - ### $ 123,419 $ 49,368 $ (74,051)
20 Stanislaus Ceres USD 11/12-3 Err:520 $ 115,915 $ 46,366 $ 69,549 $ - ### $ -
21 Stanislaus Ceres USD 10/11-4 2013-Q3 $ - $ - ### $ 173,898 $ 69,559 $ (104,339)
22 Stanislaus Ceres USD 12/13-1 Err:520 $ 85,437 $ 34,175 $ 51,262
23 Stanislaus Ceres USD 12/13-2 Err:520 $ 70,298 $ 28,119 $ 42,179
24 Stanislaus Ceres USD 12/13-3 Err:520 $ 85,354 $ 34,142 $ 51,212
25 Stanislaus Ceres USD 12/13-4 Err:520 $ 79,864 $ 31,946 $ 47,918
26 Stanislaus Ceres USD 13/14-1 Err:520 $ 52,543 $ 21,017 $ 31,526
27 Stanislaus Ceres USD 13/14-2 Err:520 $ 93,344 $ 37,338 $ 56,006
28 Stanislaus Ceres USD 11/12-4 Err:520 $ 132,898 $ 53,159 $ 79,739 $ - ### $ -
29 Ceres USD Total $ 944,045 $ 377,619 $ 566,426 $ 626,708 $ 250,683 $ (376,025) $ 1,594 0.04% $ 274 $ 1,320 $ 2.96 $ 27.21 $ 3.37
30 Stanislaus Denair USD 11/12-1 Err:520 $ 37,913 $ 28,435 $ 9,478 $ - ### $ - 2
31 Stanislaus Denair USD 10/11-2 2013-Q1 $ - $ - ### $ 29,087 $ 25,000 $ (4,087) 2
32 Stanislaus Denair USD 11/12-2 Err:520 $ 43,825 $ 32,869 $ 10,956 $ - ### $ - 2
33 Stanislaus Denair USD 10/11-3 2013-Q2 $ - $ - ### $ 25,349 $ 25,000 $ (349) 2
34 Stanislaus Denair USD 11/12-3 Err:520 $ 31,855 $ 25,000 $ 6,855 $ - ### $ - 2
35 Denair USD Total $ 113,593 $ 86,304 $ 27,289 $ 54,436 $ 50,000 $ (4,436) $ 81,868 1.83% $ 14,077 $ 67,791 $ 152.15 $ 1,397.63 $ 172.86
36 Stanislaus Empire Union SD 10/11-1 2012-Q4 $ - $ - ### $ 102,232 $ 40,893 $ (61,339)
37 Stanislaus Empire Union SD 11/12-1 Err:520 $ 96,714 $ 38,686 $ 58,028 $ - ### $ -
38 Stanislaus Empire Union SD 10/11-2 2013-Q1 $ - $ - ### $ 38,347 $ 28,760 $ (9,587) 2
39 Stanislaus Empire Union SD 11/12-2 Err:520 $ 84,028 $ 33,611 $ 50,417 $ - ### $ -
40 Stanislaus Empire Union SD 10/11-3 2013-Q2 $ - $ - ### $ 32,971 $ 25,000 $ (7,971) 2
41 Stanislaus Empire Union SD 11/12-3 Err:520 $ 65,488 $ 26,195 $ 39,293 $ - ### $ -
42 Stanislaus Empire Union SD 10/11-4 2013-Q3 $ - $ - ### $ 36,163 $ 27,122 $ (9,041) 2
43 Stanislaus Empire Union SD 11/12-4 Err:520 $ 63,398 $ 25,359 $ 38,039 $ - ### $ -
44 Empire Union SD Total $ 309,628 $ 123,851 $ 185,777 $ 209,713 $ 121,775 $ (87,938) $ 35,913 0.80% $ 6,175 $ 29,738 $ 66.74 $ 613.10 $ 75.83
45 Stanislaus Escalon USD 10/11-2 2013-Q1 $ - $ - ### $ 44,802 $ 33,602 $ (11,200) 2
46 Stanislaus Escalon USD 10/11-3 2013-Q2 $ - $ - ### $ 25,578 $ 25,000 $ (578) 2
47 Stanislaus Escalon USD 11/12-1C-1 Err:520 $ 26,793 $ 25,000 $ 1,793 $ - ### $ - 2
48 Stanislaus Escalon USD 11/12-2C-1 Err:520 $ 28,125 $ 25,000 $ 3,125 $ - ### $ - 2
49 Escalon USD Total $ 54,918 $ 50,000 $ 4,918 $ 70,380 $ 58,602 $ (11,778) $ 38,222 0.85% $ 6,572 $ 31,650 $ 71.03 $ 652.52 $ 80.70
50 Stanislaus Hughson USD 10/11-1 2012-Q4 $ - $ - ### $ 27,736 $ 19,415 $ (8,321) 2
51 Hughson USD Total $ - $ - $ - $ 27,736 $ 19,415 $ (8,321) $ (8,321) 8.83%
52 Stanislaus Jefferson Elementary SD 11/12-2 Err:520 $ 39,445 $ 29,584 $ 9,861 $ - ### $ - 2
53 Stanislaus Jefferson Elementary SD 11/12-4 Err:520 $ 25,756 $ 25,000 $ 756 $ - ### $ - 2
54 Jefferson Elementary SD Total $ 65,201 $ 54,584 $ 10,617 $ - $ - $ - $ 54,584 1.22% $ 9,386 $ 45,198 $ 101.44 $ 931.85 $ 115.25
55 Stanislaus Lammersville ESD 10/11-1 2012-Q4 $ - $ - ### $ 44,904 $ 33,678 $ (11,226) 2
56 Stanislaus Lammersville ESD 11/12-1 Err:520 $ 30,419 $ 25,000 $ 5,419 $ - ### $ - 2
57 Stanislaus Lammersville ESD 10/11-2 2013-Q1 $ - $ - ### $ 69,080 $ 27,632 $ (41,448)
58 Stanislaus Lammersville ESD 11/12-2 Err:520 $ - $ - $ - ### $ -
59 Stanislaus Lammersville ESD 10/11-3 2013-Q2 $ - $ - ### $ 56,660 $ 22,664 $ (33,996)
60 Stanislaus Lammersville ESD 11/12-3 Err:520 $ - $ - $ - ### $ -
61 Stanislaus Lammersville ESD 10/11-4 2013-Q3 $ - $ - ### $ 67,906 $ 27,162 $ (40,744)
62 Stanislaus Lammersville ESD 12/13-1 Err:520 $ 2,355 $ 2,120 $ 235
63 Stanislaus Lammersville ESD 12/13-2 Err:520 $ 5,781 $ 5,203 $ 578
64 Stanislaus Lammersville ESD 12/13-3 Err:520 $ 3,496 $ 3,146 $ 350
65 Stanislaus Lammersville ESD 12/13-4 Err:520 $ 3,898 $ 3,508 $ 390
66 Stanislaus Lammersville ESD 13/14-1 Err:520 $ 2,660 $ 2,394 $ 266
67 Stanislaus Lammersville ESD 13/14-2 Err:520 $ 5,195 $ 4,676 $ 519
68 Stanislaus Lammersville ESD 13/14-3 Err:520 $ 3,670 $ 3,303 $ 367
69 Stanislaus Lammersville ESD 13/14-4 Err:520 $ 1,807 $ 1,626 $ 181
70 Stanislaus Lammersville ESD 11/12-4 Err:520 $ - $ - $ - ### $ -
71 Lammersville ESD Total $ 59,281 $ 50,976 $ 8,305 $ 238,550 $ 111,136 $ (127,414) $ (76,438) 81.13%
72 Stanislaus Lincoln USD 10/11-1 2012-Q4 $ - $ - ### $ 35,502 $ 26,627 $ (8,875) 2
73 Stanislaus Lincoln USD 11/12-1 Err:520 $ 26,090 $ 25,000 $ 1,090 $ - ### $ - 2
74 Stanislaus Lincoln USD 10/11-2 2013-Q1 $ - $ - ### $ 54,740 $ 21,896 $ (32,844)
75 Stanislaus Lincoln USD 11/12-2 Err:520 $ 31,646 $ 25,000 $ 6,646 $ - ### $ - 2
76 Stanislaus Lincoln USD 10/11-3 Err:520 $ 44,969 $ 33,727 $ 11,242 $ - ### $ - 2
77 Stanislaus Lincoln USD 11/12-3 Err:520 $ 40,137 $ 30,103 $ 10,034 $ - ### $ - 2
78 Stanislaus Lincoln USD 09/10-4 2012-Q3 $ - $ - ### $ 48,936 $ 36,702 $ (12,234) 2
79 Stanislaus Lincoln USD 10/11-4 Err:520 $ 47,346 $ 35,510 $ 11,836 $ - ### $ - 2
80 Lincoln USD Total $ 190,188 $ 149,340 $ 40,848 $ 139,178 $ 85,225 $ (53,953) $ 95,387 2.13% $ 16,402 $ 78,985 $ 177.27 $ 1,628.42 $ 201.41
81 Stanislaus Linden USD 10/11-2 2013-Q1 $ - $ - ### $ 47,563 $ 47,563 $ -
82 Stanislaus Linden USD 10/11-3 2013-Q2 $ - $ - ### $ 25,297 $ 25,297 $ -
83 Stanislaus Linden USD 10/11-4 2013-Q3 $ - $ - ### $ 41,965 $ 41,965 $ -
84 Linden USD Total $ - $ - $ - $ 114,825 $ 114,825 $ - $ -
85 Stanislaus Lodi USD 10/11-1 Err:520 $ 398,405 $ - ### $ -
86 Stanislaus Lodi USD 10/11-2 Err:520 $ 455,552 $ 182,221 $ 273,331 $ - ### $ -
87 Stanislaus Lodi USD 11/12-2 Err:520 $ 233,521 $ 93,408 $ 140,113 $ - ### $ -
88 Stanislaus Lodi USD 10/11-3 Err:520 $ 381,506 $ 152,602 $ 228,904 $ - ### $ -
89 Stanislaus Lodi USD 11/12-3 Err:520 $ 294,235 $ 117,694 $ 176,541 $ - ### $ -
90 Stanislaus Lodi USD 10/11-4 Err:520 $ 330,942 $ 132,377 $ 198,565 $ - ### $ -
91 Stanislaus Lodi USD 11/12-4 Err:520 $ 145,673 $ 58,269 $ 87,404 $ - ### $ -
92 Stanislaus Lodi USD 11/12-1C-1 Err:520 $ 212,452 $ 84,981 $ 127,471 $ - ### $ -
93 Lodi USD Total $ 2,452,286 $ 821,552 $ 1,232,329 $ - $ - $ - $ 821,552 18.35% $ 141,267 $ 680,285 $ 1,526.79 $ 14,025.34 $ 1,734.68
94 Stanislaus Manteca USD 10/11-1 Err:520 $ 436,225 $ - ### $ -
95 Stanislaus Manteca USD 11/12-1 Err:520 $ 330,953 $ 132,381 $ 198,572 $ - ### $ -
96 Stanislaus Manteca USD 10/11-2 Err:520 $ 521,615 $ 208,646 $ 312,969 $ - ### $ -
97 Stanislaus Manteca USD 11/12-2 Err:520 $ 520,591 $ 208,236 $ 312,355 $ - ### $ -
98 Stanislaus Manteca USD 10/11-3 Err:520 $ 540,846 $ 216,338 $ 324,508 $ - ### $ -
99 Stanislaus Manteca USD 11/12-3 Err:520 $ 341,578 $ 136,631 $ 204,947 $ - ### $ -
100 Stanislaus Manteca USD 10/11-4 Err:520 $ 627,834 $ 251,134 $ 376,700 $ - ### $ -
101 Stanislaus Manteca USD 11/12-4C-1 Err:520 $ 108,777 $ 43,511 $ 65,266 $ - ### $ -
102 Manteca USD Total $ 3,428,419 $ 1,196,877 $ 1,795,317 $ - $ - $ - $ 1,196,877 26.73% $ 205,805 $ 991,072 $ 2,224.30 $ 20,432.81 $ 2,527.17
103 Stanislaus Modesto City Schools 10/11-1 2012-Q4 $ - $ - ### $ 127,579 $ 44,653 $ (82,926)
104 Stanislaus Modesto City Schools 11/12-1 Err:520 $ 91,648 $ 32,077 $ 59,571 $ - ### $ -
105 Stanislaus Modesto City Schools 10/11-2 2013-Q1 $ - $ - ### $ 119,714 $ 41,900 $ (77,814)
106 Stanislaus Modesto City Schools 11/12-2 Err:520 $ 107,728 $ 37,705 $ 70,023 $ - ### $ -
107 Stanislaus Modesto City Schools 10/11-3 2013-Q2 $ - $ - ### $ 99,576 $ 34,852 $ (64,724)
108 Stanislaus Modesto City Schools 11/12-3 Err:520 $ 113,425 $ 39,699 $ 73,726 $ - ### $ -
109 Stanislaus Modesto City Schools 10/11-4 2013-Q3 $ - $ - ### $ 103,316 $ 36,161 $ (67,155)
110 Stanislaus Modesto City Schools 12/13-1 Err:520 $ 45,313 $ 31,719 $ 13,594
111 Stanislaus Modesto City Schools 12/13-2 Err:520 $ 39,040 $ 27,328 $ 11,712
112 Stanislaus Modesto City Schools 12/13-3 Err:520 $ 47,595 $ 33,317 $ 14,278
113 Stanislaus Modesto City Schools 12/13-4 Err:520 $ 40,858 $ 28,601 $ 12,257
114 Stanislaus Modesto City Schools 13/14-1 Err:520 $ 22,558 $ 22,558 $ -
115 Stanislaus Modesto City Schools 13/14-2 Err:520 $ 68,945 $ 24,131 $ 44,814
116 Stanislaus Modesto City Schools 11/12-4 Err:520 $ 80,863 $ 28,302 $ 52,561 $ - ### $ -
117 Modesto City Schools Total $ 657,973 $ 305,437 $ 352,536 $ 450,185 $ 157,566 $ (292,619) $ 12,818 0.29% $ 2,204 $ 10,614 $ 23.82 $ 218.83 $ 27.06
118 Stanislaus Modesto Jr. College - Yosemite CCD 10/11-1 2012-Q4 $ - $ - ### $ 48,046 $ 36,035 $ (12,011) 2
119 Stanislaus Modesto Jr. College - Yosemite CCD 12/13-1 Err:520 $ 2,396 $ 2,156 $ 240
120 Stanislaus Modesto Jr. College - Yosemite CCD 12/13-3 Err:520 $ 14 $ 13 $ 1
121 Stanislaus Modesto Jr. College - Yosemite CCD 13/14-3 Err:520 $ 226 $ 203 $ 23
122 Stanislaus Modesto Jr. College - Yosemite CCD 13/14-4 Err:520 $ 205 $ 185 $ 20
123 Modesto Jr. College - Yosemite CCD Total $ 2,841 $ 2,557 $ 284 $ 48,046 $ 36,035 $ (12,011) $ (9,454) 10.03%
124 Stanislaus Newman-Crows Landing USD 10/11-3 Err:520 $ 33,211 $ 25,000 $ 8,211 $ - ### $ - 2
125 Newman-Crows Landing USD Total $ 33,211 $ 25,000 $ 8,211 $ - $ - $ - $ 25,000 0.56% $ 4,299 $ 20,701 $ 46.46 $ 426.79 $ 52.79
126 Stanislaus Oakdale JUSD 11/12-1 Err:520 $ 77,382 $ 30,953 $ 46,429 $ - ### $ -
A B C D E F G H I J K L M N O P Q R
Total amount
2 Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata Amount to release to 2013 and CUs in Option (insert 1 Modesto Jr. College -
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent claiming unit Red) or 2) Hughson USD Lammersville ESD Yosemite CCD
127 Stanislaus Oakdale JUSD 10/11-2 2013-Q1 $ - $ - ### $ 27,100 $ 25,000 $ (2,100) 2
128 Stanislaus Oakdale JUSD 11/12-2 Err:520 $ 78,184 $ 31,274 $ 46,910 $ - ### $ -
129 Stanislaus Oakdale JUSD 11/12-3 Err:520 $ 59,842 $ 23,937 $ 35,905 $ - ### $ -
130 Stanislaus Oakdale JUSD 10/11-4 2013-Q3 $ - $ - ### $ 31,650 $ 25,000 $ (6,650) 2
131 Stanislaus Oakdale JUSD 11/12-4 Err:520 $ 73,668 $ 29,467 $ 44,201 $ - ### $ -
132 Oakdale JUSD Total $ 289,076 $ 115,631 $ 173,445 $ 58,750 $ 50,000 $ (8,750) $ 106,881 2.39% $ 18,378 $ 88,503 $ 198.63 $ 1,824.65 $ 225.68
133 Stanislaus Patterson JUSD 10/11-1 Err:520 $ 75,451 $ - ### $ -
134 Stanislaus Patterson JUSD 10/11-2 Err:520 $ 129,417 $ 51,767 $ 77,650 $ - ### $ -
135 Stanislaus Patterson JUSD 11/12-2 Err:520 $ 71,076 $ 28,430 $ 42,646 $ - ### $ -
136 Stanislaus Patterson JUSD 10/11-3 Err:520 $ 135,207 $ 54,083 $ 81,124 $ - ### $ -
137 Stanislaus Patterson JUSD 11/12-3 Err:520 $ 41,989 $ 31,492 $ 10,497 $ - ### $ - 2
138 Stanislaus Patterson JUSD 10/11-4 Err:520 $ 92,701 $ 37,080 $ 55,621 $ - ### $ -
139 Stanislaus Patterson JUSD 11/12-4 Err:520 $ 37,119 $ 27,839 $ 9,280 $ - ### $ - 2
140 Patterson JUSD Total $ 582,960 $ 230,691 $ 276,818 $ - $ - $ - $ 230,691 5.15% $ 39,668 $ 191,023 $ 428.72 $ 3,938.30 $ 487.10
141 Stanislaus San Joaquin COE - Creative Child Care 10/11-1 2012-Q4 $ - $ - ### $ 29,901 2
142 Stanislaus San Joaquin COE - Creative Child Care 12/13-1 Err:520 $ 2,007 $ 1,806 $ 201
143 Stanislaus San Joaquin COE - Creative Child Care 12/13-2 Err:520 $ 2,416 $ 2,174 $ 242
144 Stanislaus San Joaquin COE - Creative Child Care 12/13-3 Err:520 $ 574 $ 517 $ 57
145 Stanislaus San Joaquin COE - Creative Child Care 13/14-2 Err:520 $ 932 $ 839 $ 93
146 Stanislaus San Joaquin COE - Creative Child Care 10/11-2 2013-Q1 $ - $ - ### $ 29,776 $ 25,000 $ (4,776) 2
147 San Joaquin COE - Creative Child Care Total $ 5,929.00 $ 5,336.00 $ 593.00 $ 59,677 $ 25,000 $ (4,776) $ 560 0.01% $ 96 $ 464 $ 1.04 $ 9.56 $ 1.18
148 Stanislaus San Joaquin COE - SJCOE 11/12-1 Err:520 $ 171,687 $ 68,675 $ 103,012 $ - ### $ -
149 Stanislaus San Joaquin COE - SJCOE 10/11-2 Err:520 $ 187,740 $ 75,096 $ 112,644 $ - ### $ -
150 Stanislaus San Joaquin COE - SJCOE 11/12-2 Err:520 $ 210,611 $ 84,244 $ 126,367 $ - ### $ -
151 Stanislaus San Joaquin COE - SJCOE 10/11-3 Err:520 $ 185,591 $ 74,236 $ 111,355 $ - ### $ -
152 Stanislaus San Joaquin COE - SJCOE 11/12-3 Err:520 $ 209,831 $ 83,932 $ 125,899 $ - ### $ -
153 Stanislaus San Joaquin COE - SJCOE 10/11-4 Err:520 $ 236,664 $ 94,666 $ 141,998 $ - ### $ -
154 Stanislaus San Joaquin COE-SJCOE 10/11-1 Err:520 $ 219,569 $ - ### $ -
155 Stanislaus San Joaquin COE - SJCOE 11/12-4 Err:520 $ 168,190 $ 67,276 $ 100,914 $ - ### $ -
156 San Joaquin COE - SJCOE Total* $ 1,589,883 $ 548,125 $ 822,189 $ - $ - $ - $ 548,125 12.24% $ 94,251 $ 453,874 $ 1,018.65 $ 9,357.46 $ 1,157.35
157 Stanislaus Stanislaus COE 10/11-1 2012-Q4 $ - $ - ### $ 259,834 $ 103,934 $ (155,900)
158 Stanislaus Stanislaus COE 11/12-1 Err:520 $ 167,951 $ 67,180 $ 100,771 $ - ### $ -
159 Stanislaus Stanislaus COE 10/11-2 Err:520 $ 249,944 $ 99,978 $ 149,966 $ - ### $ -
160 Stanislaus Stanislaus COE 11/12-2 Err:520 $ 195,522 $ 78,209 $ 117,313 $ - ### $ -
161 Stanislaus Stanislaus COE 10/11-3 Err:520 $ 218,896 $ 87,558 $ 131,338 $ - ### $ -
162 Stanislaus Stanislaus COE 11/12-3 Err:520 $ 173,123 $ 69,249 $ 103,874 $ - ### $ -
163 Stanislaus Stanislaus COE 10/11-4 Err:520 $ 262,581 $ 105,032 $ 157,549 $ - ### $ -
164 Stanislaus Stanislaus COE 11/12-4 Err:520 $ 193,487 $ 77,395 $ 116,092 $ - ### $ -
165 Stanislaus COE Total $ 1,461,504 $ 584,601 $ 876,903 $ 259,834 $ 103,934 $ (155,900) $ 428,701 9.57% $ 73,716 $ 354,985 $ 796.71 $ 7,318.68 $ 905.19
166 Stanislaus Stanislaus Union SD 10/11-1 2012-Q4 $ - $ - ### $ 47,647 $ 35,735 $ (11,912) 2
167 Stanislaus Stanislaus Union SD 11/12-1 Err:520 $ 70,093 $ 28,037 $ 42,056 $ - ### $ -
168 Stanislaus Stanislaus Union SD 10/11-2 2013-Q1 $ - $ - ### $ 43,414 $ 32,561 $ (10,853) 2
169 Stanislaus Stanislaus Union SD 11/12-2 Err:520 $ - $ - $ - ### $ -
170 Stanislaus Stanislaus Union SD 10/11-3 2013-Q2 $ - $ - ### $ 43,755 $ 32,816 $ (10,939) 2
171 Stanislaus Stanislaus Union SD 10/11-4 2013-Q3 $ - $ - ### $ 46,520 $ 34,890 $ (11,630) 2
172 Stanislaus Stanislaus Union SD 11/12-4 Err:520 $ - $ - $ - ### $ -
173 Stanislaus Stanislaus Union SD 11/12-3C-1 Err:520 $ - $ - $ - ### $ -
174 Stanislaus Stanislaus Union SD 12/13-1 Err:520 $ 25,872 $ 19,404 $ 6,468
175 Stanislaus Stanislaus Union SD 11/12-4C-2 Err:520 $ - $ - $ - ### $ -
176 Stanislaus Union SD Total $ 95,965 $ 47,441 $ 48,524 $ 181,336 $ 136,002 $ (45,334) $ 2,107 0.05% $ 362 $ 1,745 $ 3.92 $ 35.97 $ 4.45
177 Stanislaus Stockton USD 10/11-1 2012-Q4 $ - $ - ### $ 553,522 $ 221,409 $ (332,113)
178 Stanislaus Stockton USD 11/12-1 Err:520 $ 763,254 $ 305,302 $ 457,952 $ - ### $ -
179 Stanislaus Stockton USD 10/11-2 2013-Q1 $ - $ - ### $ 718,024 $ 287,210 $ (430,814)
180 Stanislaus Stockton USD 11/12-2 Err:520 $ 574,024 $ 229,610 $ 344,414 $ - ### $ -
181 Stanislaus Stockton USD 10/11-3 2013-Q2 $ - $ - ### $ 829,664 $ 331,866 $ (497,798)
182 Stanislaus Stockton USD 10/11-4 2013-Q3 $ - $ - ### $ 647,466 $ 258,986 $ (388,480)
183 Stanislaus Stockton USD 11/12-3C-1 Err:520 $ 448,415 $ 179,366 $ 269,049 $ - ### $ -
184 Stanislaus Stockton USD 12/13-1 Err:520 $ 313,122 $ 125,249 $ 187,873
185 Stanislaus Stockton USD 12/13-2 Err:520 $ 260,313 $ 104,125 $ 156,188
186 Stanislaus Stockton USD 12/13-3 Err:520 $ 333,934 $ 133,574 $ 200,360
187 Stanislaus Stockton USD 12/13-4 Err:520 $ 198,270 $ 79,308 $ 118,962
188 Stanislaus Stockton USD 13/14-1 Err:520 $ 260,203 $ 104,081 $ 156,122
189 Stanislaus Stockton USD 13/14-2 Err:520 $ 365,150 $ 146,060 $ 219,090
190 Stanislaus Stockton USD 13/14-3 Err:520 $ 350,066 $ 140,026 $ 210,040
191 Stanislaus Stockton USD 11/12-4C-1 Err:520 $ 332,772 $ 133,109 $ 199,663 $ - ### $ -
192 Stockton USD Total $ 4,199,523 $ 1,679,810 $ 2,519,713 $ 2,748,676 $ 1,099,471 $ (1,649,205) $ 30,605 0.68% $ 5,263 $ 25,342 $ 56.88 $ 522.48 $ 64.62
193 Stanislaus Sylvan Union SD 10/11-1 2012-Q4 $ - $ - ### $ 92,747 $ 37,099 $ (55,648)
194 Stanislaus Sylvan Union SD 11/12-1 Err:520 $ 87,026 $ 34,810 $ 52,216 $ - ### $ -
195 Stanislaus Sylvan Union SD 10/11-2 2013-Q1 $ - $ - ### $ 110,093 $ 44,037 $ (66,056)
196 Stanislaus Sylvan Union SD 11/12-2 Err:520 $ 94,972 $ 37,989 $ 56,983 $ - ### $ -
197 Stanislaus Sylvan Union SD 10/11-3 2013-Q2 $ - $ - ### $ 110,015 $ 44,006 $ (66,009)
198 Stanislaus Sylvan Union SD 11/12-3 Err:520 $ 126,721 $ 50,688 $ 76,033 $ - ### $ -
199 Stanislaus Sylvan Union SD 10/11-4 2013-Q3 $ - $ - ### $ 82,450 $ 32,980 $ (49,470)
200 Stanislaus Sylvan Union SD 12/13-1 Err:520 $ 68,734 $ 27,494 $ 41,240
201 Stanislaus Sylvan Union SD 12/13-2 Err:520 $ 62,513 $ 25,005 $ 37,508
202 Stanislaus Sylvan Union SD 12/13-3 Err:520 $ 69,342 $ 27,737 $ 41,605
203 Stanislaus Sylvan Union SD 11/12-4 Err:520 $ 113,053 $ 45,221 $ 67,832 $ - ### $ -
204 Sylvan Union SD Total $ 622,361 $ 248,944 $ 373,417 $ 395,305 $ 158,122 $ (237,183) $ 11,761 0.26% $ 2,022 $ 9,739 $ 21.86 $ 200.78 $ 24.83
205 Stanislaus Tracy Joint USD 10/11-1 Err:520 $ 192,212 $ - ### $ -
206 Stanislaus Tracy Joint USD 10/11-2C-1 Err:520 $ 207,252 $ 82,901 $ 124,351 $ - ### $ -
207 Stanislaus Tracy Joint USD 10/11-3 Err:520 $ 327,027 $ 130,811 $ 196,216 $ - ### $ -
208 Stanislaus Tracy Joint USD 10/11-4C-1 Err:520 $ 186,598 $ 74,639 $ 111,959 $ - ### $ -
209 Tracy Joint USD Total* $ 913,089 $ 288,351 $ 432,526 $ - $ - $ - $ 288,351 6.44% $ 49,582 $ 238,769 $ 535.88 $ 4,922.66 $ 608.84
210 Stanislaus Tracy USD 11/12-1 Err:520 $ 226,151 $ 90,460 $ 135,691 $ - ### $ -
211 Stanislaus Tracy USD 11/12-2 Err:520 $ 204,659 $ 81,864 $ 122,795 $ - ### $ -
212 Stanislaus Tracy USD 11/12-3 Err:520 $ 198,503 $ 79,401 $ 119,102 $ - ### $ -
213 Stanislaus Tracy USD 11/12-4 Err:520 $ 163,954 $ 65,582 $ 98,372 $ - ### $ -
214 Tracy USD Total* $ 793,267 $ 317,307 $ 475,960 $ - $ - $ - $ 317,307 7.09% $ 54,562 $ 262,745 $ 589.69 $ 5,416.99 $ 669.98
215 Stanislaus Tuolumne COE 11/12-2 Err:520 $ - $ - $ - ### $ -
216 Stanislaus Tuolumne COE 10/11-3 2013-Q2 $ - $ - ### $ 27,753 $ 27,753 $ -
217 Tuolumne COE Total $ - $ - $ - $ 27,753 $ 27,753 $ - $ -
218 Stanislaus Turlock USD 11/12-1 Err:520 $ 327,247 $ 81,812 $ 245,435 $ - ### $ -
219 Stanislaus Turlock USD 11/12-2 Err:520 $ 316,303 $ 79,076 $ 237,227 $ - ### $ -
220 Stanislaus Turlock USD 10/11-3 2013-Q2 $ - $ - ### $ 674,325 $ 168,581 $ (505,744)
221 Stanislaus Turlock USD 11/12-3 Err:520 $ 320,440 $ 80,110 $ 240,330 $ - ### $ -
222 Stanislaus Turlock USD 10/11-4 Err:520 $ 926,251 $ 231,563 $ 694,688 $ - ### $ -
223 Stanislaus Turlock USD 11/12-4 Err:520 $ 262,616 $ 65,654 $ 196,962 $ - ### $ -
224 Turlock USD Total $ 2,152,857 $ 538,215 $ 1,614,642 $ 674,325 $ 168,581 $ (505,744) $ 32,471 0.73% $ 5,583 $ 26,888 $ 60.34 $ 554.34 $ 68.56
225 Stanislaus Vallecito Union SD 11/12-3 Err:520 $ 27,525 $ 19,268 $ 8,257 $ - ### $ -
226 Vallecito Union SD Total $ 27,525 $ 19,268 $ 8,257 $ - $ - $ - $ 19,268 0.43% $ 3,313 $ 15,955 $ 35.81 $ 328.94 $ 40.68
227 Stanislaus Waterford USD 10/11-2 2013-Q1 $ - $ - ### $ 62,392 $ 24,957 $ (37,435)
228 Stanislaus Waterford USD 12/13-1 Err:520 $ 10,213 $ 9,192 $ 1,021
229 Stanislaus Waterford USD 12/13-2 Err:520 $ 3,085 $ 2,777 $ 308
230 Stanislaus Waterford USD 12/13-3 Err:520 $ 2,138 $ 1,924 $ 214
231 Stanislaus Waterford USD 12/13-4 Err:520 $ 560 $ 504 $ 56
232 Stanislaus Waterford USD 13/14-1 Err:520 $ 1,319 $ 1,187 $ 132
233 Stanislaus Waterford USD 13/14-2 Err:520 $ 3,546 $ 3,191 $ 355
234 Stanislaus Waterford USD 11/12-2 Err:520 $ 52,488 $ 20,995 $ 31,493 $ - ### $ -
235 Waterford USD Total $ 73,349 $ 39,770 $ 33,579 $ 62,392 $ 24,957 $ (37,435) $ 2,335 0.05% $ 402 $ 1,933 $ 4.34 $ 39.86 $ 4.93
236 Grand Total Stanislaus LEC Err:502 Err:502 Err:502 $ 6,587,475 $ 2,924,082 $ (3,633,492) Err:502 100% $ 769,904 $ 3,707,547 $ 8,321 $ 76,438 $ 9,454
237 The sum of Column N equals the sum of "Column K" (Net Total) minus
238 the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
239 Column A County - Reporting LEC/LGA
240 Column B Claiming unit within county - Subtotals reflect offsetting between all paid and unpaid deferred invoices through Fiscal Years 10/11 and 11/12 Pro-Rata Table
241 Column C Period of Service in fiscal year and quarter format - Also referred to as the invoice number Full check amount Check Total $ 769,906 <-- Enter check total here
242 Column D Submitted for Payment federal fiscal year and quarter - The federal fiscal year and quarter for when the invoice was submitted to be paid or early claimed has not been received Sum of Net Green $ 4,477,451
243 Column E The Original Unpaid Placeholder Amount is the original claim amount that was submitted to DHCS for payment Sum of Net Red $ (94,213)
244 Column F The Settlement Amount agreed upon in the CMS letter dated October 7, 2014. For invoices >$25,000 & $50,000 a 75% payment will be made and for invoices >$50,000 a 40% payment will be made
245 Column G The unallowed amount for unpaid placeholders is the difference between the original invoice amount and the settlement amount
246 Column H The original paid deferred amount is the invoice amount that was paid according to the CMS 1-64 reports for quarters ending 12/31/11, 3/31/12, 6/30/12, 9/30/12
247 Column I The settlement amount for the paid deferred invoices represent the pay percentage according to the CMS letter dated October 7, 2014
248 Column J The remainder amount is the difference between the original paid deferred amount and the settlement amount for the deferred paid invoices. This is the amount due back to DHCS
249 Column K This is the subtotal column and represents the total amount owed to/from each claiming unit. It balances the unpaid deferred(what is owed to the CU) against the paid deferred(what is owed to DHCS)
A B C D E F G H I J K L M N O P Q R
Total amount
2 Amount to be recouped withheld (FFY
Period of Service Submitted for Payment Original Unpaid Settlement Amount for Unpaid Original Paid Deferred Settlement Amount from paid deferred Net (Column F + Pro Rata Amount to release to 2013 and CUs in Option (insert 1 Modesto Jr. College -
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount Placeholders Due to LEC/LGA(75% & 40%) Amount to be released Amount for Paid Deferred claims Column J) Percent claiming unit Red) or 2) Hughson USD Lammersville ESD Yosemite CCD
250 The last subtotal amount is the final amount due to/from the LEC/LGA
251 Column L The option column is where the LEC/LGA will input which option they want their claiming unit to exercise for invoices that are >$25,000 & $50,000. Input a 1 or a 2, depending on which option chosen
252 Column N The sum of Column N equals the sum of "Column K" (Net Total) minus the sum of "Net Red" (Pro Rata Table) minus the "Check Total" (Pro Rata Table)
253 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
254 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
255 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
256
259 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
260 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
261
262 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
263 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
264 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
265 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
266
227 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
228 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
229 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
230
231 Released
Claiming Unit Invoice on placeholder to be paid 100%
232
233 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
234 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
235
A B C D E F G H I J K L M N O P Q R S T U V W
Submitted for Settlement Amount for Unpaid Total amount
1 Period of Service Payment Original Unpaid Placeholders Due to LEC/LGA(75% & Original Paid Deferred Settlement Amount Net (Column F + Column Amount to release to withheld (FFY Option (insert 1
County Claiming Unit FY/QTR FFY/QTR Placeholder Amount 40%) Amount to be released Amount for Paid Deferred Amount to be recouped from paid deferred claims J) Pro Rata Percent claiming unit 2013) or 2)
236 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
237 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
238 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
239 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
240
121 Note1 If columns H,l,J are blank, this means the invoice is an unpaid, deferred placeholder
122 Note2 If columns E,F,G are blank, this means the invoice is a paid deferred placeholder
123 Note3 If columns E,F,G,H,l,J are all filled in, this is a subtotal row
124
127 Invoices on placeholder for amounts >$50,000 and a 40% payment will be made
128 Invoices on placeholder for amounts >$25,000 & $50,000 and a 75% payment will be made
129
130 Paid deferred invoices on the CMS I-64 Report for quarter ending 12/31/2011
131 Paid deferred invoices on the CMS I-64 Report for quarter ending 3/31/2012
132 Paid deferred invoices on the CMS I-64 Report for quarter ending 6/30/2012
133 Paid deferred invoices on the CMS I-64 Report for quarter ending 9/30/2012
134