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Home My WebLink AboutFinal Agenda Packet CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room Thursday, August 19, 2004 3:30 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF JULY 22, 2004 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO 7/31/2004 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON July 22, 2004 Kathy Keolker-Wheeler, Mayor Randy Corman, Council Finance Committee Chair Bonnie Walton, City Clerk Ray Barilleaux, Fire Department Representative William Henry, Fire Department Representative William Larson, Fire Department Alternate The regular meeting of the Firemen's Pension Board was called to order by Chairman Kathy Keolker-Wheeler at 3:37 p.m. in the Mayor's conference room, 7th floor of Renton City Hall. In attendance were Board members Kathy Keolker-Wheeler, Bill Henry, Ray Barilleaux and Bonnie Walton; and Jill Masunaga, Finance Department Representative. Board member Randy Corman arrived at 3:42 p.m. MINUTES APPROVAL MOVED BY BARILLEAUX, SECONDED BY HENRY, THE PENSION BOARD APPROVE THE MINUTES OF THE JUNE 17, 2004, MEETING. CARRIED. MONTHLY STATEMENT The financial report as of June 30, 2004, was reviewed. Total cash/investment balance was $5,019,971.61. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY BARILLEAUX, SECONDED BY HENRY,THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR JULY 2004, IN THE TOTAL AMOUNT OF $31,227.57. CARRIED. UNFINISHED BUSINESS MOVED BY HENRY, SECONDED BY BARILLEAUX, THE BOARD APPROVE USE OF THE REVISED PHARMACY/MEDICAL CLAIM REIMBURSEMENT REQUEST FORM. CARRIED. ADJOURNMENT MOVED BY BARILLEAUX, SECONDED BY CORMAN, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 3:44 p.m. £07t &CL/ Bonnie I. Walton, City Clerk Member and Secretary, Firemen's Pension Board CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF JULY 31, 2004 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 ❑2004 ❑2003 a h l0 ; 4 0 0 H 1 0 1.P 2 1 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CURRENT 2004 2004 LAST YEAR 2003 2003 ACTIVITY: MONTH YTD BUDGET CURR MO YTD ADJ BUDGET BEGINNING CASH/INV BALANCE $5,019,971.61 $5,133,315.47 $5,133,315 $5,198,099.48 $5,312,164.41 $5,312,164 RECEIPTS: Property Taxes 0.00 0.00 $0 0.00 0.00 $0 Fire Insurance Premium Tax 0.00 70,249.69 $40,000 0.00 63,087.83 $32,000 Investment Interest 455.25 9,014.98 $110,000 743.77 8,934.83 $115,000 DISBURSEMENTS: Fire Pension 30,932.24 219,733.52 $375,000 28,870.67 206,391.49 $355,000 Office/Operating Supplies 0.00 0.00 $400 0.00 0.00 $400 Actuarial/Firemen's Pens 0.00 0.00 $0 0.00 4,575.00 $4,000 Reimb General/Clerical&Acct 558.00 3,910.00 $6,700 542.00 3,790.00 $6,500 ENDING CASH/INV BALANCE $4,988,936.62 $4,988,936.62 $4,901,215 $5,169,430.58 $5,169,430.58 $5,093,264 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $30,305.54 $61,340.53 $94,892.52 $123,561.42 INVESTMENTS CD's&State Investment Pool 529,767.46 529,767.46 749,767.46 749,767.46 Snohomish County Housing Authority 0.00 0.00 98,272.00 98,272.00 Federal National Mortgage Assn 99,555.84 99,555.84 0.00 0.00 Treasury Strips&Zero Coupon Bonds 4,329,307.78 4,329,307.78 4,226,498.60 4,226,498.60 Corporate Bonds 0.00 0.00 0.00 0.00 Convertable Bonds 0.00 0.00 0.00 0.00 Mutual Funds 0.00 0.00 0.00 0.00 TOTAL CASH AND INVESTMENTS $4,988,936.62 $5,019,971.61 $5,169,430.58 $5,198,099.48 The State Investment Pool interest 1.1543% 1.0312% 1.0866% 1.1904% H:\FINANCE\FINPLAN\FIREPEN\2003 Fire Pension\1_Fire_Pension_2003.xls Page 1 8/13/2004 4trr.0 FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR AUGUST, 2004 Recipient Pension Amt Medicals Total ANKENY, Charlie (Captain) $83.60 83.60 ASHURST, James (Assistant Chief) $3,927.00 - 3,927.00 BANASKY, George (Captain) $830.82 830.82 BEATTEAY, Karlen (Widow) $173.27 173.27 BERGMAN, Claudette (Widow) $107.78 107.78 CHRISTENSON, Chuck(Firefighter) $256.48 256.48 COLOMBI, Jack (Captain) $351.97 351.97 CONNELL, Robert(Captain) $604.89 604.89 GOODWIN, Charles (Captain) $3,563.00 4,072.29 7,635.29 GOODWIN, Donald (Firefighter) $835.12 835.12 * HAWORTH, Constance(Widow) $2,472.05 2,472.05 HAWORTH, Jack(Firefighter) $2,688.00 - 2,688.00 HENRY, Teresa A. (Widow) $235.62 235.62 HENRY, William, Jr. (Captain) $1,099.60 1,099.60 HURST, Gerald (Firefighter) $436.61 436.61 JONES, Gerald D. (Firefighter) $188.09 188.09 LAVALLEY, Theodele (Captain) $274.95 274.95 MC LAUGHLIN, JACK(Battalion Chief) $656.13 656.13 NEWTON, Gary (Lieutenant) $204.14 204.14 NICHOLS, Gerald (Battalion Chief) $286.52 286.52 PARKS-ANDREASON, Arlene (Widow) $255.17 255.17 PARKS, John (Firefighter) $2,789.50 - 2,789.50 PHILLIPS, Bruce H. (Deputy Chief) $15.71 15.71 PRINGLE, Arthur(Captain) $376.80 376.80 * PRINGLE, S. Joan (Widow) $2,123.77 2,123.77 RIGGLE, David E. (Firefighter D Step) $46.81 46.81 SMITH, Leroy (Firefighter) $325.09 325.09 STROM, Karl (Firefighter) $2,688.00 - 2,688.00 TODD, Franklin (Firefighter) $375.94 375.94 VACCA, Nick(Lieutenant) $238.36 238.36 WALLS, Kenneth (Firefighter D Step) $98.89 98.89 WALSH, David (Firefighter) $874.71 874.71 WALSH, Patrick(Captain) $804.52 804.52 WEISS, Larry (Battalion Chief) $463.47 463.47 WOOTEN, Marilyn E. (Widow) $179.86 179.86 Total Expenses: Pension/Medical 30,932.24 4,072.29 35,004.53 Prior Year Pension/Medical Payments: Total Pension Payments for August, 2003 28,870.67 Total Medical Bills Reimbursed in August, 2003 1,089.47 Total Expenses: Medical/Pension 29,960.14 * Received a 1.5% CPI increase effective July 1. 4_SUMMARY 2004 8/13/2004 9:12 AM V FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN AUGUST, 2004 PAYMENT Page Name Pharmacy/Medical Facility Amount of Bill James Ashurst 0.00 2 Charles Goodwin Bartell Drugs 6.35 2 Charles Goodwin Bartell Drugs 13.63 2 Charles Goodwin Bartell Drugs 278.44 2 Charles Goodwin Bartell Drugs 72.51 3 Charles Goodwin Bartell Drugs 123.93 3 Charles Goodwin Bartell Drugs 123.93 3 Charles Goodwin Bartell Drugs 180.99 3 Charles Goodwin Bartell Drugs 72.51 5 Charles Goodwin EAR Services 3,200.00 4,072.29 Jack Haworth 0.00 John Parks 0.00 Karl Strom 0.00 TOTAL 4,072.29 3_2004 FP Medical 8/13/2004 9:12 AM Now CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM 1 NAME CHiLS �4. OG2c3, DATE '7 - _Q ( AMOUNT OF CLAIM $ Reason for medication/hospitalization/physician's exam: Oestd i ,4 I have not been and will not be compensated by any other organization/ Insurance Carrier or Medicare for the above mentioned claim for reimbursement other that the City of Renton. All of the above are related to my disability from the Fire Department. / Signature em— Note: Proper Documentation must accompany this claim form. Mail forms to: City of Renton Finance Department—Fire Pension 1055 South Grady Way Renton, WA 98055 Revised 12/24/02 PACS I .„„.._ ..4,..,, 7/vov a,t_.4 .,ex..,- 4---,14..... -7--D . xii,c,t-vg_tlize- /0,0_42- Fe Q� al-mx.6� 4• 600.46o, ,R/, 6 1 BARTELL DRUGS BARTELL DRUGS �•�wu.,l,nyfo„•,own Drugstore*�. .. . wn't" "•'Ow �^�/�t +--�� 4700 NE 4TH STREET RENTON,WA 98059 4700 NE 4TH STREET RENTON,WA 98059 RX# 45- 186109 E DR. MOSLEY Rx# 45-208099 E DR. LORCH,GERALD DATE: 05/23/04 R (425)899-3123 DATE: 05/22/04 R (206) 903-9510 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 201 UNION AVE SE 99 201 UNION AVE SE 99 CARBIDOPA/LEVODOPA 25MG/100MG TAB ALLOPU- .�• 100MG TABLET(MYL)-iiil CC� 00093-0293-01 00681312 00378-01.F-01 52493674 t�J XPS $278.41 Z71 9/ XPS $6.35 REFILL 1 QUANTITY 540.00 REFILL YES QUANTITY 30.00 BARTELL DRUGS#45 BARTELL DRUGS#45 425-793- 1015 425-793- 1015 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE. I WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR L L REFILLS 24-48 HOURS IN ADVANCE. BARTELL DRUGS ---WoshLy+un',Own IDtty tose.- BARTELL DRUGS 4700 NE 4TH STREET RENTON,WA 98059 Wa.A6.gtow,Own U.u,.Ao.e. 4700 NE 4TH STREET RENTON,WA 98059 Rx# 45-203166 E DR. FLO DATE: 06/06/04 R ()- Rx# 45- 201856 E DR. FLO NAME: CHARLES GOODWIN DATE: 05/22/04 R 0— 201 UNION AVE SE 99 NAME: CHARLES GOODWIN GEMFIBR TAB 600MG APX 500@ 60505-003 201 UNION AVE SE 99 408 00730919 ATENO %.- -.a , G TABLET(GEN)-481iWr /3, 3 00781-1.'6-10 52324674 XPS $72.51 74•S / XPS $13.63 REFILL 2 QUANTITY 180.00 REFILL YES QUANTITY 90.00 BARTELL DRUGS#45 425-793- 1015 BARTELL DRUGS#45 425-793- 1015 THANK YOU n WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU / l v-! THANK YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR / ��V 1111 REFILLS 24-48 HOURS IN ADVANCE. WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU i 37� 50 WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR / L REFILLS 24-48 HOURS IN ADVANCE. p • —To : 1 -)-U44&67x, Ziel>AL 7/,Ar /6...„,44....., .1_,,,,e.. , ii2,71,,t_. , c/btws c - a / ,J P/ami BARTELL DRUGS I BARTELL DRUGS -wouhGyton',owe Drugstores ---wn,6r yt,ds ow.Drugstores�� 4700 NE 4TH STREET RENTON,WA 98059 4700 NE 4TH STREET RENTON,WA 98059 RX# 45- 200439 E DR. MOSLEY Rx# 45- 199790 E DR. FLO DATE: 06/06/04 R (425) 899-3123 DATE: 07/07/04 R (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 201 UNION AVE SE 99 201 UN 99 AGGRENOX CAP 200/25MG NO ASC 10 G $LET-90CT 00597-0001-60 53536260 000 -1540-6 J 55810339 XPS $123.93 1 XPS $180.99 l gO, / REFILL 1 QUANTITY 62.00 REFILL NO QUANTITY 90,00 BARTELL DRUGS#45 BARTELL DRUGS#45 425-793- 1015 425-793- 1015 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU THANK YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU i REFILLS 24-48 HOURS IN ADVANCE. I WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR L REFILLS 24-48 HOURS IN ADVANCE. BARTELL DRUGS wwbi,Ktoe's owow Drugstores 4700 NE 4TH STREET RENTON,WA 98059 BARTELL DRUGS RX# 45- 203166 E DR. FLO wa an,ta,'s ow,Drug toren DATE: 07/09/04 R 0)- 4700 NE 4TH STREET RENTON,WA 98059 NAM • ARLES GOODWIN 201 UNION SE 99 amt 45- 200439 E DR. MOSLEY GEMF TAB 00MG APX 500@ r/ DATE: 07/08/04 R (425)899-3123 605 -0034-08 02886628 ,� NAME: CHARLES GOODWIN 101,5, 13 201 UNION AVE SE 99XPS $72.51 AGGI20CAP 200/25MG 0059 -0001-6 02579677 REFILL 1 QUANTITY 180.00 XPS $123.93 BARTELL DRUGS#45 425-793- 1015 AltREFILL NO QUANTITY 62,00 THANK YOU BARTELL DRUGS#45 WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU ST I 3 L 425-793- 1015WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR I ,) ' t REFILLS 24-48 HOURS IN ADVANCE. L /If R THANK YOU //-� — ��,^y, �() WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU /-..0 g T�\ /ISI WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR LJ REFILLS 24-48 HOURS IN ADVANCE. iti i1t 1A 3 CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM NAME IA1 1 s eeOb1>W IN DATE 0 1 / AMOUNT OF CLAIM $ 3 2BOO. 00 Reason for medication/hospitalization/physician's exam: I have not been and will not be compensated by any other organization/Insurance Carrier or Medicare for the above mentioned claim for reimbursement other that the City of Renton. All of the above are related to my disability from the Fire Department. Signature Note: Proper Documentation must accompany this claim form. Mail forms to: City of Renton Finance Department—Fire Pension 1055 South Grady Way Renton,WA 98055 Revised 12/24/02 • APPROVED OMB-0938-0008 • PLEASE t DO NOT 1-M °•aire STAPLE ¢ IN THIS W AREA cc 4 U - ; PICA HEALTH INSURANCE CLAIM FORM PICA , '4, 1. MEDICARE MEDICAID CHAMPUS CHAMPVA GROUP FECA OTHER la.INSURED'S I D NUMBER (FOR PROGRAM IN ITEM 1) HEALTH PLAN BLK LUNG ...` (Medicare#) (Medicaid #)n (—1 I(Sponsor's SSN) (VA File #) —1 (SSN or ID) I-1 (SSN) (ID) 5-3 5-- -.5--- �� — 22 SSU 2 PATIENT'S NAME(Last Name,First Name.Middle Initial)l J/��j 3 PATIENT'S BIRTH DATE SEX 4 INSURED'S NAME(Last Name,First Name,Middle(Initial) G0 0 d Uv i/� C i a r/as 0 6, Ur). /j M F 7 5 PATIENT'S ADDRESS(No..Street) 6 PATIENT RELATIONSHIP TO INSURED 7 INSURED'S ADDRESS(No.,Street) r,-,r) i 41/ - I,1/',I mo,-) roc 4 Lie . AJC=306 Self 11V Spouse 1 Child` Other S CITY STATE 8 PATIENT STATUS CITY 1 STATE z D ) O 2 reh fon OA Single-1 Married 7, Other ZIP CODE TELEPHONE(Inrlud""Arra—Cod—,:7— ZIP CODE TELEPHONE(INCLUDE AREA CODE) Q /� �/ / i Employed---i Full-Time Part-Time ( lCC "/ t} (f c� l0 ��5��`J��7d� �_j Student L.J Student \ / 0 9 OTHER INSURED'S NAME(Last Name.Fust Name Middle Initial; 10 IS PATIENT S CONDITION RELATED TO 11 INSURED'S POLICY GROUP OR FECA NUMBER z 0 W a OTHER INSURED S POLICY OR GROUP NUMBER a EMPLOYMENT?(CURRENT OR PREVIOUS) a INSURED'S DATE OF BIRTH SEX cc MM DD YY M YES l NO M'---1 F r V) -- — — I_.I �- Z b OTHER INSURED'S DATE OF BIRTH SEX b AUTO ACCIDENT? PLACE(State) b EMPLOYERS NAME OR SCHOOL NAME o MM DD YY Z M F j r1YES IXNO Q c EMPLOYER'S NAME OR SCHOOL NAME c OTHER ACCIDENT? c INSURANCE PLAN NAME OR PROGRAM NAME //J� Z 'YES NO lire f A //e1---.sPc/-71/6/7 ,64.t,M cl Q d INSURANCE PLAN NAME OR PROGRAM NAME 10d RESERVED FOR LOCAL USE d IS THERE A THER HEALTH BENEFIT PLAN? < riYES Lk NO If yes,return to and complete item 9 a-d READ BACK OF FORM BEFORE COMPLETING&SIGNING THIS FORM. t3 INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize 12 PATIENT S OR AUTHORIZED PERSONS SIGNATURE I authorize the release of any medical or other information necessary payment of medical benefits to the undersigned physician or supplier for to process this claim I also request payment of government benefits either to myself or to the party who accepts assignment services described below below ��/j SIGNED DATE SIGNED " /l'C�/kf . 14 DATE OF CURRENT ILLNESS(Fust symptomi OR 15 IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. 16 DATES PATIENT UNABL O WORK IN CURRENT OCCUPATION MM DD YY ' INJURY(Accidenq OR GIVE FIRST DATE MM DD YY MM DO YY MM DO YY PREGNANCY(LMP) FROM TO 17 NAME OF REFERRING PHYSICIAN OR OTHER SOURCE 17a.I D NUMBER OF REFERRING PHYSICIAN 18 HOSPITALIZATION DATES RELATED TO CURRENT SERVICES MM DD YY MM DD YY FROM TO 19 RESERVED FOR LOCAL USE 20 OUTSIDE LAB'S $CHARGES E YES NO 21 DIAGNOSIS OR NATURE OF ILLNESS OR INJURY (RELATE ITEMS 1,2,3 OR 4 TO ITEM 24E BY LINE) 22.MEDICAID RESUBMISSION XrG CODE ORIGINAL REF NO 1 I Y .i 3. I .___ 23.PRIOR AUTHORIZATION NUMBER 0 2 I ,— 4 1 .— LL 24. A B C D E F G H I J K Z FromDATE(S)OF SERVICE Place Type PROCEDURES,SERVICES.OR SUPPLIES DIAGNOSIS DAYS EPSDT RESERVED FOR O of of (Explain Unusual Circumstances) CODE $CHARGES OR Family EMG COB LOCAL USE ~ MM DO YY MM DD YY Service Service CPT/HCPCS I MODIFIER UNITS Plan 4 1 c1(o 7 jo O6' /S 0 y /1 1 BOG a 1 477-a,;a/ / 00 oo I o Z 2010 /So(it O6 /5" U9/ // 1 VO6,e) 1,7-d,/. c/ - %oo ,ro i w J a 3 CC 0 a Z Q s Fl) >I a 6 25 FEDERAL TAX I,D NUMBER SSN EIN 26.PATIENT'S ACCOUNT NO. 27 ACCEPT ASSIGNMENT'? 28.TOTAL CHARGE 29 AMOUNT PAID 30.BALANCE DUE F-1 (For govt claims,see back) Q �} ^,, /��5�'D y- 1 YES L NO $ -3,Q o0 i 00 $ V 1 $3-26o CSU 31 SIGNATURE OF PHYSICIAN OR SUPPLIER 32 NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE 33.PHYSICIAN'S,SUPPLIER'S BILLING NAME,ADDRESS,ZIP CODE DING DEGREES OR CREDENTIALS RENDERED(If other than home or office) &PHONE Dorothy Muto-Coleman,Au.Q. ce ify t t the to s o he reverse to b nil a part thereof) EAR Services •t• 17800 Talbot Road South SIGNED DATE 400 ?`) 'Q e PIN# Rent• ! A 98055 r P*38990) (APPROVED BY AMA COUNCIL ON MEDICAL SERVICE 8/88) PLEASE PRINT OR TYPE �� S FORM OWCP-1500 FORM RRB-1500 IA Mby Medical Arts Press X19423 -M29423 Medial Arts Press