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					                                                                            Community Care, Inc.
                                                                             CREDIT CARD REPORT

CC NAME:                                                                            LOCATION:


  DATES:                   Please Select Date Range                                  LAST 4 CARD DIGITS:



 DATE      MERCHANTS NAME             DESCRIPTION                                               AMOUNT     DEPT 1   DEPT 2   DEPT 3   DEPT 4   EXPENSE ACCOUNT
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                                                                  TOTAL CREDIT CARD ACTIVITY        0.00

                                                      SIGNATURE                                      DATE
            Prepared by:
            Approved by:                                                   Pin #


                            Below: For Accounts Payable Use Only
        DATE REC'D                                            DATE PAID:
        VOUCHER #                                              CHECK #:
                                                                                                                                                   (120312)
Credit Card Report Form Procedures

            Each credit card number must have a separate Credit Card Report form filled out.

            The Credit Card Report form must be filled out for all credit card purchases made on and between the date
            ranges specified on the form.

            Department head will designate one person to be the "gatekeeper" of the general card for that facility and
            will be the keeper of their own card assigned to them. As the designated cardholder, you are responsible for
            the security of that card.



            Staff should only be given the credit card when properly checked out. To properly check out the card, staff
            must have director/manager approval. This approval will be indicated by a completed "Petty Cash/Credit
            Card" form to be given to gatekeeper at the time staff is requesting to check out the card.

            When staff returns the card to the gatekeeper, they must also turn in the receipt from the purchase(s).



            Gatekeeper will record purchase(s) on Credit Card Report form and file receipt(s) together.

            The preparer of the Credit Card Report form will e-mail the report to their director/manager one day after
            the ending date on the date range selected.

            Director/Manager will receive a statement from the credit card company and will use that to reconcile
            purchases during the date ranges specified. Reconciliation should be completed no more than one business
            day after receipt of statement. After statement(s) are reconciled, director/manager will have all receipts
            along with a hard copy of the report attached, mailed to the accounts payable department. Also, that day,
            director/manager will need to e-mail the report(s) to accounts payable person.



            If purchases are made by a director/manager with an assigned card, accounts payable will be responsible for
            getting the CEO's signature for approval. Director/manager are not to approve their own Credit Card Report
            form.
How to fill out the form
        1. CC NAME: Enter the name on the Credit Card. This may be the name of the Director/Manager whose name
           is on the card or the name of the facility/activity if the card is assign to a facility/activity.

         2. LOCATION: Enter the Location of the card. For example: DeWitt, Anamosa, Heritage etc.
         3. DATES: The dates are included in the drop down menu. Please select the proper time frame for this
            particular report. Note that the second date in the time frame is the last day that will be included in the
            statement from the bank. If you use the card on that day, please be sure to enter the transaction on this
            report.
         4. LAST 4 CARD DIGITS: Enter the last 4 digits of the credit card.
         5. DATE: Enter the date of the transaction / purchase.
         6. MERCHANT'S NAME: Name of the merchant/ store where the purchase was made
         7. DESCRIPTION: Enter a brief description of the item purchased.
         8. AMOUNT: Enter the amount of the transaction.
         9. DEPT 1: If the purchase is to be charged against only one cost center, choose the cost center from the drop-
            down menu. If the cost is to be applied EVENLY to more than one cost center, chose the appropriate cost
            centers from DEPT 2, DEPT 3, and DEPT 4. For any other form of split (ie, unequal percentages) Please
            choose SPECIAL and make a notation under DESCRIPTION for the split.
        10. PREPARED BY: Name of the person completing the form. This will be the person named on the credit card
            or the "gatekeeper" of the card.
        11.
            Approved By: Name of person who reconciled the Credit Card Report form with the Credit Card Statement.
        12. Pin #: The person who approved the form will use their assigned pin #.
        13. CEO Approval (Direct Report): If a Director/Manager is using the Credit Card Report form for their credit
            card usage, the form must be signed by the CEO for final approval.
The following is to be filled in by Accounts Payable only
        14. Date Rec'd: Stamp with the date the form was received.
        15. Voucher #: After inputting into accounts payable, there will be a voucher # assigned, enter # here.
        16. Date Paid: Date the check was printed
        17. Check #: Enter check # assigned by computer
Click below to access form
Petty Cash/Credit Card Slip
Credit Card Use:

COMMUNITY CARE, INC.
AGENCY CREDIT CARD POLICY

Policy: Each staff will follow the agency credit card procedure when obtaining and using the CCI credit card.
Purpose: To ensure that use of the agency credit card is properly authorized and accounted for.

Procedure:
      1. The agency credit card is for company-approved purchases only and improper use of the card can be considered misappropriation of company funds.
      This may result in disciplinary action up and including termination of employment and prosecution for theft. All charges will be billed directly to and
      paid directly by the company. The credit card company cannot accept any monies from employees directly; therefore any personal charges billed to the
      company could be considered misappropriation of company funds.
      2. If the credit card is lost or stolen, the credit card company and the Controller and/or CFO will be notified immediately by telephone to ensure no
      unauthorized purchases are made on the card.
      3. Any time the person requesting the credit card is expecting the charge(s) to exceed $500.00, they will need to alert the CFO who will then contact
      the President and CEO to make sure the purchase is approved.
      4. The agency credit card is not necessarily provided to all employees. Assignment is based on need to purchase materials for the business and/or
      provide for business travel. The card can be revoked based on change of assignment or location. The card is not an entitlement nor reflective of title or
      position.
      5. The following provisions apply if one of the cards is being checked out:
             a. The agency will designate a staff member to keep track of the credit card(s) assigned to them, and he/she will be responsible for the security of
             the card(s).
             b. The credit card can only be used when properly checked out by a staff with department director or designee’s approval. Presenting a completed

            c. At the time of credit card check out, the designated cardholder is to log the appropriate information onto the “Credit Card Report” form.
            d. A receipt from purchases will be turned in at the same time the credit card is returned. The cardholder will attach the receipts to the “Petty
            Cash/Credit Card” form. This will be turned into Accounts Payable with the “Credit Card Report” when the billing cycle is completed for payment
            processing.
       6. The following provisions apply if a staff carries a CCI Credit Card :
            a. The staff will have to sign the Credit Card Agreement form stating that they will have the card in their possession and abide by all rules stated
            on it.

             b. The card will be surrendered immediately upon termination of employment, whether for retirement, voluntary or involuntary reasons.
             c. As the card is issued in staff’s name, no other persons may use the card and the staff issued the card is considered responsible for any and all
             charges against the card.
             d. As the card is company property, it is understood the staff may be periodically required to comply with internal control procedures designated
             to protect the company assets. This may include being asked to produce the card to validate its existence and account number, and being asked to
             produce receipts and statements to audit its use.
             e. The staff that the card is issued to will receive a Monthly Reconciliation Statement (MRS) from the credit card company, which will report all
             activity during the statement period. The staff will resolve any discrepancies by either contacting the supplier or the bank. Receipts (invoices)
             matched to the Monthly Reconciliation Statement along with completing the credit card report will be submitted to Accounts Payable for payment
             processing.
             f. The charges made against the card are automatically assigned to the cost center assigned to the card as specified by management. This code
             cannot be changed without management involvement. When, changed, the new accounting code will not affect charges made prior to the change
             but will affect future charges.

Agency Credit Card Policy A-11
Reviewed 09/30/10

				
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