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11/05/2025 9:35 AM A/P HISTORY CHECK REPORT PAGE: 3 <br /> VENDOR SET: 01 City of Mounds View <br /> BANK: PYBNK American National Bank <br /> DATE RANGE: 0/00/0000 THRU 10/28/2025 <br /> CHECK CHECK CHECK CHECK <br /> VENDOR I.D. NAME STATUS DATE AMOUNT DISCOUNT NO STATUS AMOUNT <br /> E1200 EFTPS-Direct CONT <br /> I-T4 20251016 Medicare W/H D 10/16/2025 000989 <br /> 730 2011 FICA & FEDERAL W/H TAX PAYABLEMedicare W/H 182.59 <br /> 730 4820-0300 SOCIAL SECURITY Medicare W/H 34.25 <br /> 730 4823-0300 SOCIAL SECURITY Medicare W/H 148.30 <br /> 740 2011 FICA & FEDERAL W/H TAX PAYABLEMedicare W/H 10.92 <br /> 740 4416-0300 SOCIAL SECURITY Medicare W/H 10.91 <br /> 745 2011 FICA & FEDERAL W/H TAX PAYABLEMedicare W/H 139.88 <br /> 745 4415-0300 SOCIAL SECURITY Medicare W/H 130.65 <br /> 745 4417-0300 SOCIAL SECURITY Medicare W/H 9.24 45,773.94 <br /> H1016 HSA Bank <br /> I-12520251016 C1211 HSA CONTRIBUTIONS D 10/16/2025 000990 <br /> 100 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 3,062.11 <br /> 100 4130-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 182.12 <br /> 100 4150-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 179.50 <br /> 100 4180-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 225.00 <br /> 100 4200-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 1,962.50 <br /> 100 4360-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 222.15 <br /> 100 4410-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 116.00 <br /> 100 4460-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 27.50 <br /> 100 4465-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 72.50 <br /> 100 4470-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 146.88 <br /> 100 4472-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 91.88 <br /> 100 4475-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 25.63 <br /> 210 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 40.29 <br /> 210 4350-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 18.50 <br /> 230 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 201.04 <br /> 230 4650-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 95.00 <br /> 252 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 103.86 <br /> 252 4350-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 94.38 <br /> 252 4730-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 116.88 <br /> 252 4732-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 206.87 <br /> 290 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 49.54 <br /> 290 4420-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 23.50 <br /> 700 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 521.11 <br /> 700 4820-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 51.63 <br /> 700 4823-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 319.98 <br /> 700 4825-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 42.49 <br /> 730 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 247.60 <br /> 730 4820-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 51.62 <br /> 730 4823-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 337.13 <br /> 740 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 18.25 <br /> 740 4416-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 22.63 <br /> 745 2014 ACCRUED INSURANCE PAYABLE C1211 HSA CONTRIBUTI 68.80 <br /> 745 4415-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 175.23 <br /> 745 4417-0400 HEALTH INSURANCE - EMPLOYER COC1211 HSA CONTRIBUTI 5.00 9,125.10 <br />