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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, June 17, 2004 3:30 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF MAY 20, 2004 3. CORRESPONDENCE Fire Insurance Premiums Distribution 4. MONTHLY STATEMENT TO 5/31/2004 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS Legal Opinion of Proposed Forms 7. NEW BUSINESS Cost of Living Increase - Widows 8. ADJOURNMENT MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON May 20, 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 3:38 p.m. in the Mayor's conference room, 7th floor of Renton City Hall. In attendance were Board members Bill Henry, Ray Barilleaux and Bonnie Walton; and Jill Masunaga, Finance Department Representative. MINUTES APPROVAL MOVED BY HENRY, SECONDED BY BARILLEAUX, THE PENSION BOARD APPROVE THE MINUTES OF THE APRIL 15, 2004, MEETING. CARRIED. MONTHLY STATEMENT The financial report as of April 30, 2004, was reviewed. Total cash/investment balance was $5,005,725.02. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY HENRY, SECONDED BY BARILLEAUX, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR MAY 2004, IN THE TOTAL AMOUNT OF $31,161.82. CARRIED. ADJOURNMENT MOVED BY BARILLEAUX, SECONDED BY HENRY, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 3:14 p.m. Bonnie I. Walton, City Clerk Member and Secretary, Firemen's Pension Board low Nor: Afetk MICHAEL J. MURPHY Q,o a: l 1 :�: State Treasurer 9SHINGt�� ; State of Washington Office of the Treasurer May 26, 2004 CITY OF RENTON JUN 0 1 2004 RECEIVED CITY CLERKS OFFICE TO: Cities, Tc": ns and Fire Districts Receiving Fire Insurance Premium Distribution FROM: Linda Lund, Distribution Assistant Office of the State Treasurer SUBJECT: May 2004 Distribution RCW 41.16.050 provides that twenty-five percent of moneys received from the tax on fire insurance premiums be distributed to cities, towns and fire districts for the credit of local pension funds. Enclosed is a copy of a worksheet showing the number of firefighters certified by the city or district and the amount that will be distributed on May 28, 2004. If you have any questions please call me at (360) 902-8960. City of Renton � cc: �� Received V,it..t MAY 2 8 2004 Human Resources & Risk Management Legislative Building,P.O. Box 40200 • Olympia.Washington 98504-0200 • (360)902-900(1 • TDD(360)902-8963 FAX(360)902-9044 • Home Page http://tre.wa.gov State of Washington Revenue Distribution Treasury Management System Date: 05/26/2004 Fire Insurance Premiums Report Id: FirelnsPrem.rpt Time: 09:52:08 AMPage I of I „ 05/28/2004 -we' Ratio Value: 669.0446228766 Number of Paid City/District Firefighters Amount 0010 Aberdeen 35 $ 23,416.56 0060 Anacortes 19 12,711.85 0090 Auburn 79 52,854.53 0120 Bellevue 190 127,118.48 0130 Bellingham 139 92,997.20 0190 Bothell 52 34,790.32 0200 Bremerton 52 34,790.32 0260 Camas 36 24,085.61 0320 Centralia 21 14,049.94 0330 Chehalis 13 8,697.58 0630 Edmonds 50 33,452.23 0660 Ellensburg 21 14,049.94 0730 Everett 182 121,766.12 0960 Hoquiam 22 14,718.98 1050 Kelso 12 8,028.54 1060 Kennewick 76 50,847.39 1070 Kent 148 99,018.60 1090 Kirkland 70 46,833.12 1230 Longview 42 28,099.87 1250 Lynnwood 52 34,790.32 1350 Mercer Island 29 19,402.29 1460 Moses Lake 24 16,057.07 1490 Mount Vernon 33 22,078.47 1480 Mountlake Terrace 25 16,726.12 1660 Olympia 79 52,854.53 1730 Pasco 47 31,445.10 1770 Port Angeles 22 14,718.98 1790 Port Townsend 9 6,021.40 1830 Pullman 21 14,049.94 1840 Puyallup 55 36,797.45 • 1870 Raymond 13 8,697.58 1890 Redmond 103 68,911.60 1900 Renton 105 70,249.69 1920 Richland 54 36,128.41 2030 Seattle 1,024 685,101.69 2070 Shelton 7 4,683.31 2160 Spokane 316 211,418.10 2250 Sumner 17 11,373.76 2260 Sunnyside 14 9,366.62 2270 Tacoma 398 266,279.76 2330 Toppenish 6 4,014.27 2340 Tukwila 61 40,811.72 2400 Vancouver 181 121,097.08 2420 Walla Walla 46 30,776.05 2490 Wenatchee 34 22,747.52 2630 Yakima 70 46,833.12 0179 King County Fire Dist#10 136 90,990.07 0178 King County Fire Dist#2 35 23,416.56 0327 Spokane Fire Dist.#1 140 93,666.25 Totals 4,415 $ 2,953,832.01 CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF MAY 31, 2004 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 - -- ❑2004 ❑2003 5 - - VJ co 0 4 c o h C 111 0 3 g 2 - IT11 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 $5,005,725.02 $5,133,315.47 $5,133,315 $5,188,411.69 $5,312,164.41 $5,312,164 RECEIPTS: Property Taxes 0.00 0.00 $0 0.00 0.00 $0 Fire Insurance Premium Tax 70,249.69 70,249.69 $40,000 63,087.83 63,087.83 $32,000 Investment Interest 6,377.64 8,095.83 $110,000 4,973.57 7,399.45 $115,000 DISBURSEMENTS: Fire Pension 30,864.32 157,936.96 $375,000 29,290.61 148,730.21 $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 2,794.00 $6,700 542.00 2,706.00 $6,500 ENDING CASH/INV BALANCE $5,050,930.03 $5,050,930.03 $4,901,215 $5,226,640.48 $5,226,640.48 $5,093,264 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $92,298.95 $48,377.78 $152,102.42 $113,873.63 INVESTMENTS CD's&State Investment Pool 529,767.46 529,767.46 749,767.46 749,767.46 Snohomish County Housing Authority 0.00 98,272.00 98,272.00 98,272.00 Federal National Mortgage Assn 99,555.84 0.00 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 $5,050,930.03 $5,005,725.02 $5,226,640.48 $5,188,411.69 The State Investment Pool interest 1.0169% 1.0185% 1.2261% 1.2381% H:\FINANCE\FINPLAN\FIREPEN\2003 Fire Pension\1_Fire_Pension_2003.xls Page 1 6/11/2004 FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR JUNE, 2004 Recipient Pension Amt Medicals Total ANKENY, Charlie (Captain) $83.60 83.60 ASHURST, James (Assistant Chief) $3,927.00 339.35 4,266.35 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) $3,563.00 513.23 4,076.23 GOODWIN, Donald (Firefighter) $835.12 835.12 HAWORTH, Constance (Widow) $2,435.52 2,435.52 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) $2,789.50 296.50 3,086.00 PHILLIPS, Bruce H. (Deputy Chief) $15.71 15.71 PRINGLE, Arthur(Captain) $376.80 376.80 PRINGLE, S. Joan (Widow) $2,092.38 2,092.38 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 30,864.32 1,149.08 32,013.40 Prior Year Pension/Medical Payments: Total Pension Payments for June, 2003 28,790.61 Total Medical Bills Reimbursed in June, 2003 1,486.85 Total Expenses: Medical/Pension 30,277.46 4_SUMMARY 2004 6/11/2004 9:28 AM *ow err FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN JUNE, 2004 PAYMENT '{ a �*-'7 u . 6t . . ., ajl r; l l 2 James Ashurst Safeway 52.99 2 James Ashurst Safeway 16.39 2 James Ashurst Safeway 222.32 2 James Ashurst Safeway 47.65 339.35 4 Charles Goodwin Bartell Drugs 123.93 4 Charles Goodwin Walgreens 252.67 4 Charles Goodwin Bartell Drugs 6.35 5 Charles Goodwin Bartell Drugs 6.35 5 Charles Goodwin Bartell Drugs 123.93 513.23 Jack Haworth 0.00 7 John Parks Toledo Pharmacy 14.90 7 John Parks Toledo Pharmacy 96.50 7 John Parks Toledo Pharmacy 120.40 7 John Parks Toledo Pharmacy 21.95 7 John Parks Toledo Pharmacy 42.75 296.50 Karl Strom 0.00• 3_2004 FP Medical 6/11/2004 9:23 AM Now Noe CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM NAME JAMES F. ASHURST DATE MAY 18 :-‘2 0 OA AMOUNT OF CLAIM $ 3 3 9.3 5 Reason for medication/hospitalization/physician's exam: HYPERTF.NSTON,H_R_P_ , REACTION TO MEW-PAT-MN 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 C ,/r • 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 (SJ SAFEWAY PHARMACY (4) SAFEWAY PHARMACY 200 SOUTH 3RD STREET200 SOUTH 3RD STREET RENTON,WA 98055 RENTON,WA 98055 ff1563 (425)226-0325 #1563 (425)226-0325 Official Receipt-Please retain for tax or insurance Official Receipt-Please retain for tax or insurance .4 ASHURST,JAMES (425)255-6154 ASHURST,JAMES (425)255-6154 223 GARDEN AVE N. 02/17 223 GARDEN AVE N. 02/17 RENTON,WA 98055 :, RENTON, WA 98055 DR. GRAVES,DANIEL ":�4 [RS] DR. GRAVES,DANIEL L. [RF] 17900 TALBOT RDS , 17900 TALBOT RD S. RENTON,WA 98055 RENTON, WA 98055 Rx:8802323 Jan 19, 2004 Safety Cap: No Rx:6645916 Apr 20, 2004 Safety Cap: Yes NDC: 16837-0872-60 MMB/TB NDC: 00024-1075-01 HSG/ PEPCID AC 10MG TAB (J&J ) Qty: 120 TAB KAYEXALATE POW (SANO)Qty:454 GM HEALTH CLUB 55 REGENCE BLUESHIELD WASHINGTN Amount Due: $52.99 Amount Due: $222.32 11111111 �tIIiIII1IIIIIIIiIIil Ref:040194155850006999 1111111111111110101 Ref:A7045111072691 j-i SAFEWAY PHARMACY SAFEWAY PHARMACY Ofti 200 SOUTH 3RD STREET 200 SOUTH 3RD STREET RENTON,WA 98055 RENTON,WA 98055 #1563 (425)226-0325 #1563 (425)726-0:425 Official Receipt-Please retain for tax or insurance Official Receipt-Please retain for tax or insurance ASHURST,JAMES (425)255-6154 ASHURST,JAMES (425)255-6154 223 GARDEN AVE N. 02/17 223 GARDEN AVE N. 02/17 RENTON, WA 98055 RENTON,WA 98055 DR. GRAVES900 TA BOT RD S [RS]EL DR 900 TA BOT RD S EL [RS] RENTON,WA 98055 RENTON,WA 98055 Rx:6646643 Jan 19, 2004 Safety Cap: No Rx:6648814 Mar 17, 2004 Safety Cap: Yes NDC: 00172-2907-80 MMB/TB NDC: 00185-0102-01 MMB/ FUROSEMIDE 40MG TAB (IVAX) Qty: 100 TAB LISINOPRIL 20MG TAB (EON ) Qty: 100 TAB Generic for:LASIX 40MG TAB AVEN Generic for:ZESTRIL 20MG TAB ASTR HEALTH CLUB 55 REGENCE BLUESHIELD WASHINGTN Amount Due: $16.39 Amount Due: $47.65 Rei:040194151930005999 Ref:A704477795t� 11111111 IlIllIllIf1111WASHINGTN 11111111 11111111 111 I11111 �� 11 00. ply ti.w .me CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM NAME (_,H � A' 6G_1)CU/ DATE -S—A0h AMOUNT OF CLAIM $ -573- 2-3 Reason for medication/hospitalization/physician's exam: 1-X-- AN" * 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 ? A' - • '�•--` 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 'PAW 3 lid 5-Xid/61 el 4 /, 6_,,, ,,,,_, J--/Au /4-0-er-7a. ' C _ 4- Cao-�uJ��l � . 1 BARTELL DRUGS �.... W shin/ton's Aon Drugstores-.m.... 4700 NE 4TH STREET RENTON,WA 98059 BARTELL DRUGS ...............Washington's Aon Drugstwes�..•• 4700 NE 4TH STREET Rx# 45-208099 E DR. LORCH,GERALD RENTON,WA 98059 DATE: 04/02/04 �::__ (206)903-9510 RX# 45-200439E DR. MOSLEY NAME: CHARLES GOODWIN 04/01/04 R 201 UNION AVE SE 99 DATE: (425)899-3123 ALLOP,'-01 100MG TABLET(MYL)-CI N ME GH LES GOODWIN 00378-0 37-01 33380159 201/UNION� A SE 99 A(3GRENOX P 200/25MG r 00 97-0001-60 84242056 XPS $6.35 ‘ 3c ��3 . 13 XPS $123.93 REFILL YES QUANTITY 30.00 REFILL 3 QUANTITY BARTELL DRUGS#45 62.00 425-793-1015 BARTELL DRUGS#45 425-793-1015 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR THANK YOU I REFILLS 24-48 HOURS IN ADVANCE. WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE. : 7011 E SHEA BLVD SCOTTSDALE,AZ 85254 CHARLES GOODWIN PH (480)948-7820 7222 E GAINEY RANCH RD#125 PATIENT PH (480)991 4045 SCOTTSDALE,AZ 85258 cc w NO 1074531-03177DATE 03/30/04 NDC 00078-0179-15 = LAMISIL 250MG TABLETS MFc NOVARTIS -' QTY 30 a"' _ 3 REFILLS BEFORE 03/03/05 w NEW $288.19 Your Insurance Saved You:$35.52 ac--,7 {� / GDI/TLB $252.67 PLAN PLUS DR M. STEGMAN CLAIM REF# 803301 leiczeypteew,A.Customer Receipt eic,. 0. - / ______ 9c- 4 i4-(1? 1. J /4-4tc_s. Coo.b4d - BARTELL DRUGS wn hi yew,,OW,Dr,igakare. 4700 NE 4TH STREET RENTON,WA 98059 RX# 45-208099 E DR. LORCH,GERALD DATE: 05/02/04 R (206)903-9510 NAME: CHARLES GOODWIN 201 UNION AVE SE 99 ALLOPURINOL 100MG TABLET(MYL)- ,- S 00378-0137-01 34021274 XPS $6.35 REFILL YES QUANTITY 30.00 BARTELL DRUGS#45 425-793-1015 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE. BARTELL DRUGS ,,.Mngeonl Ow..nrw,to,�.--- 4700 NE 4TH STREET RENTON,WA 98059 Rx# 45- 200439 E DR. MOSLEY DATE: 05/03/04 R (425)899-3123 NAME: CHARLES GOODWIN 201 UNION AVE SE 99 AGGRENOX CAP 200/25MG 00597-0001-60 51037746 ��2 C XPS $123.93 REFILL 2 QUANTITY 62.00 4 Ati BARTELL DRUGS#45 425-793- 1015 (-0-m-b L 3111- THANK }THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE. TWA *ow 'gage CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM NAME - G� L 1 J.S DATE 4c n -E ti 0 AMOUNT OF CLAIM $ (,› Reason for medication!hospitalization/physician's exam: wed 1e.1r() .4r -St C9 771 4 d �- cTfd pi-oh -ems 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 1 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 12/24/02 160 Iwo TOLEDO PHARMACY Box 249 Toledo, Wash. 98591 ANIMAL HEALTH SUPPLIES GIFTS PRESCRIPTIONS ` Phone 864-4100 TOLEDO 241 COWLITZ ST. — -6 Pj{, ini(s TOLEDO,WA 98591 t %41 00 ' �� BOX 6 ,TO T`i7 MM BOX 626,TOLEDD WA 98591 Rx#254507 Dr.J RICHARDS ADDR S lvo� METOCLOPRAN 5MO TAB CASH 50111-0517-01 #100 BC /BC„ CASH CHAR T S ND L CALF Price: 16.56 - -10% $ 14.90 rcii �� i m f TOLEDO 241 COWLITZ ST.TOLEDO,WA 98591 Stitt,00 (X.SJ 7/ 9 6 O minks 66226,TKTOLEDOS WA 98591 0 7e0a f ✓,f ye!, Rx#250718 Dr.J RICHARDS REMERON 45M8 'TB_ t( P.. J1L1t , 3ri , (c) NDC# 00052-01 - r ' C 0 #30 CASH BC /BC„ '{l ; PCP Price: 187.22 - -18% $ 96.50 m 1- NA x ►--- c-c_ S. fp 4'iii TOLEDO 241 COWLITZ ST. ` V'' AI�/QCT/ 11 avom sTOLEDO,WA98591 89i/4100 mr'� BOX 625 TOLEDO WA 98591 T� Rx#C257627 Dr.J RICHARDS AMBIEN 10MS TAB NDC# 00024-5421-31 #45 CASH BC /BC- Price: 133.78 - -10% $ 120.40 c, m m -I C254599 120 Par 21.95 J RICHARDS JOHN PARKS 5/03/04 ALPRAZOLAM SI 5M6 TAB 1 DID PRN ANX BC /BC TOLEDO 241 COWLITZ ST. JNHN PARKS TOLEDO,WA 98591 9A� 100 94 BOX 626 TOLEDO WA 98591 Rx#C254599 Dr.J RICHARDS ALPRAZOLAM 0.5M0 TAB NDC# 59762-3720-01 #120 BC /K Price: 24.39 - -10% $ 21.95 m ii TAW 1 4$ CITY OF RENTON CITY, F RENTON Office of the City Attorney JUN 0 7 2004 Lawrence J.Warren Kathy Keolker-Wheeler, Mayor RECEIVED Assistant City Attorneys CITY CLERK'S OFFICE Mark Barber Zanetta L.Fontes Ann S. Nielsen Sasha P. Alessi Jason Weiss MEMORANDUM To: Bonnie Walton, City Clerk From: Lawrence J. Warren, City Attorney Date: June 7, 2004 Subject: Firemen's Pension Board Forms The revised medical claim reimbursement form is approved as to legal form. Assuming without deciding that the Firemen's Pension Board isn't subject to HIPPA, it is wise to use the confidentiality agreement, which is approved as to legal fo Lawrence J. amen LJW:tmj cc: Jay Covington Post Office Box 626-Renton,Washington 98057-(425)255-8678/FAX(425)255-5474 R E N T O N r� AHEAD OF THE CURVE _, This paper contains 50%recycled material,30%post consumer `""'e SEND CLAIM TO: s""'"city of Renton Finance Dept. - Fire Pension 1055 South Grady Way Renton, WA 98055 O‘`CY 0 f 41K) DR A FT CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE 2) DISABILITY RETIREE'S NAME (preprint) 3) ADDRESS (preprint) 4) DISABILITY AT TIME OF RETIREMENT (preprint) 5) DESCRIPTION OF CLAIM: (Supporting documentation must be attached.) (Note: Medical coverage is limited to current treatment of the retiree's disability as determined at the time of retirement. (RCW 41.18) Submit only claims that relate to item#4.) 6) TOTAL AMOUNT OF CLAIM 7) I certify thatAiave not been and will not be compensated by any other organization, insurance carrier or Medicare for the above-mentioned claim for reimbursement other than the City of Renton. I further certify that the above statements are complete and accurate to the best of my knowledge, and that all claims submitted are related to my disability as determined at the time of my retirement from the Renton Fire Department. Signature: (preprint name) Note: Supporting documentation must be attached. Now, JTh1T rSY -%;,NTL, FIREMEN'S PENSION BOARD Confidentiality Agreement I, , hereby agree that I will not at any time - either during or after my term or association with the City of Renton Firemen's Pension Board - use, access or disclose health information concerning any disabled retiree to any person or entity, internally or externally, except as is required and permitted in the course of my duties and responsibilities with the Firemen's Pension Board. I understand that this obligation extends to any health information that I may acquire, whether in oral, written or electronic form and regardless of the manner in which access was obtained. I understand that unauthorized use or disclosure of health information concerning any disabled retiree will result in termination of term or association with the City of Renton Firemen's Pension Board, and the imposition of penalties applicable under federal and state law. I understand that this obligation will survive the termination of my term or association with the City of Renton Firemen's Pension Board Printed Name Title Signature Date 411.01e r✓ CITY OF RENTON CITY CLERK MEMORANDUM DATE: May 14, 2004 TO: Larry Warren, City Attorney FROM: 'ad Bonnie Walton, City Clerk, x6502 SUBJECT: Firemen's Pension Board Forms Background: As you know, the Firemen's Pension Board approves pension payments for those who retired prior to enactment of the LEOFF Act and those electing to retire under a former pension act. For those who retired due to disability, of which there are five individuals, the Board also approves medical/pharmacy claims related to the retirement disability only. (Chapters 41.16 and 41.18 RCW) The Firemen's Pension Board is requesting your opinion on the following: Revised Medical Claim Reimbursement Request Form: In order to ensure that the medical claims being approved are related to the disability only, the Board is considering revising the claim form to make clear what is allowed. Attached is draft of the revised claim form being considered, as well as copy of the current claim form and your last opinion of the current form from 1991. Your opinion of the revised form and its use is requested. Confidentiality Agreement: Though HMA has stated that disability boards, such as the Firemen's Pension Board, are not bound by HIPPA requirements, the Board is considering whether Board members (and possibly certain City staff who may handle the medical claims), should sign a confidentiality agreement. Such form has been drafted and is attached. Your opinion of this form and its use is requested. Your assistance is appreciated. Please contact me if I can provide further information. bw Attachments cc: Firemen's Pension Board Ni„,e N.,„? OR 147 �1` Y O� �u ko) FIREMEN'S PENSION BOARD Confidentiality Agreement I, , hereby agree that I will not at any time - either during or after my term or association with the City of Renton Firemen's Pension Board -use, access or disclose health information concerning any disabled retiree to any person or entity, internally or externally, except as is required and permitted in the course of my duties and responsibilities with the Firemen's Pension Board. I understand that this obligation extends to any health information that I may acquire, whether in oral, written or electronic form and regardless of the manner in which access was obtained. I understand that unauthorized use or disclosure of health information concerning any disabled retiree will result in termination of term or association with the City of Renton Firemen's Pension Board, and the imposition of penalties applicable under federal and state law. I understand that this obligation will survive the termination of my term or association with the City of Renton Firemen's Pension Board Printed Name Title Signature Date "'"'' SEND CLAIM TO: '"city of Renton Finance Dept.- Fire Pension 1055 South Grady Way Renton, WA 98055 �1 `SY O� DR pr „N,° CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE 2) DISABILITY RETIREE'S NAME (preprint) 3) ADDRESS (preprint) 4) DISABILITY AT TIME OF RETIREMENT (preprint) 5) DESCRIPTION OF CLAIM: (Supporting documentation must be attached.) (Note: Medical coverage is limited to current treatment of the retiree's disability as determined at the time of retirement. (RCW 41.18) Submit only claims that relate to item#4.) 6) TOTAL AMOUNT OF CLAIM 7) I certify that have not been and will not be compensated by any other organization, insurance carrier or Medicare for the above-mentioned claim for reimbursement other than the City of Renton. I further certify that the above statements are complete and accurate to the best of my knowledge, and that all claims submitted are related to my disability as determined at the time of my retirement from the Renton Fire Department. Signature: (preprint name) Note: Supporting documentation must be attached. *my iris° ..................................................... R E NTFOR ' >' "F';::EMEN S ENSIO CLACM�FOR REIMBU S M M<;::: :`<`<'<: '<::: >:>>::«:::>;::_ ': NAME DATE AMOUNT OF CLAIM $ 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 than 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. POLICY 6.A. z ♦/ c: '�,r CITY 'r4F RENTON Office of the City Attorney Earl Clymer, Mayor Lawrence J. Warren iiiv OF REMIT s December 24, 1991 DEC � ��,E i�tl;�i`IE.O TO: Marilyn J. Petersen, City Clerk ciN CLERK'S OFFiCL FROM: Lawrence J. Warren, City Attorney RE: Firemen's Pension Claim Reimbursement Form Dear Marilyn: I 've reviewed the claim form as forwarded to me as well as chapters 41 . 16 and 41 . 18 RCW with respect to t1 Firemen's Pension Board. The basic question is whether or not the section in the form requiring disclosure of payment of medical costs by other carriers or Medicare is illegal. I am attaching a copy of AGO 59-60 No. 148 dealing with medical, hospital and nursing care for disability retirees pre-LEOFF. As you can see, the opinion determines that the Pension Board has discretion to provide medical, hospital and nursing care either under the 1947 Act (chapter 41 . 16) or the 1955 Act (chapter 41. 18) . Since the Board has discretion it has the authority to ask for information upon which it may exercise its discretion. I . do not find the questioned section to be illegal . 2r(1- Lawrence J. Warren LJW:as . Encl. cc: Mayor Clymer A8. 77 : 63. Post Office Box 626- 100 S 2nd Street -Renton. Washington 98057 - (2061 2S5-267R Nere CITY OF RENTON MEMORANDUM DATE: June 14, 2004 TO: Members, Firemen's Pension Board FROM: 6" Bonnie Walton, City Clerk/Board Secretary SUBJECT: Cost of Living Increase Payable July 2004 - Widows Washington State Law (RCW 41.18.104) requires that the Firemen's Pension Board meet each year for the purpose of adjusting benefit allowances for widows of firemen pensioned prior to the LEOFF Act (March, 1970). The Board must determine benefits according to the increase in the Consumer Price Index for the previous calendar year for the Seattle, Washington, area as compiled by the Bureau of Labor Statistics of the United States Department of Labor. The Bureau has updated its form for this year and has reported at 1.5% increase in the CPI percentage for Urban Wage Earners and Clerical Workers in the Seattle area for 2003. A copy of the report is attached. I recommend that the Board adopt the 1.5% increase, effective July 1, 2004, and paid July 31, 2004. cc: Victoria Runkle dr1/41jivtp"/ ..,I \ U.S. DEPARTMENT OF LABOR,BUREAU OF LABOR STATISTICS, FAX-ON-DEMAND Phone 415-975-4567 Note: To receive FAX-ON- _ an explanation on how to compute a percentage change between any two periods request FAX-ON-DEMAND Code 9255. To request DEMAND information on using the CPI as an escalator on rental a reeme and other contracts request FAX-ON-DEMAND Code 9256 CODE 9250 SEATTLE-TACOMA-BREMERTONJ 05/14/04 Consumer Price Index,All Items, 1982-84=100 for Urban Wage Earners and Clerical Workers(CPI-W) SEMIANNUAL 1ST 2ND ANNUAL YEAR JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC HALF HALF AVERAGE 1985 103.4 104.2 104.0 104.2 104.1 104.8 103.9 104.5 104.2 1986 105.7 105.0 104.3 104.6 105.3 105.1 105.1 104.9 105.0 105.0 1987 106.4 108.4 107.4 1988 109.9 112.0 110.9 1989 114.7 117.6 116.1 1990 122.0 126.9 124.4 1991 130.2 132.4 131.3 1992 134.8 137.2 136.0 1993 138.9 141.1 140.0 1994 143.7 146.5 145.1 4. 1995 148.3 150.4 149.31. 1996 152.6 155.9 154.3 1997 160.6 158.2 159.9 159.0 1998 162.2 161.9 162.8 163.8 164.9 164.9 162.1 164.4 163.2 1999 166.0 167.8 168.0 168.8 170.2 170.1 167.0 169.5 168.3 2000 171.6(R) 173.3(R) 174 5(R) 175.4(R) 177.5 177.0 172.8(R) 176.4 174.6 2001 179.2 179.4 181.3 181.5 183.1 181.1 179 6 181.9 180.8 2002 182.5 183.6 184 1 184.8 185.5 184.6 183.1 184.9 184.0 2003 186.2 187.0 185.7 188.2 187.8 185.3 186.2 187.1 186.7 2004 187.8 189.1 Table of over-the-year percent increases. An entry for Feb.2000 indicates the percentage increase from Feb. 1999 to Feb.2000(in this example 3.4 percent). 1986 2.2 0.8 0.3 0.4 1.2 0.3 10 0.5 0.8 1987 1.4 3.2 2.3 1988 3.3 3.3 3.3 1989 4.4 5.0 4.7 1990 6.4 7.9 7.1 1991 6.7 4.3 5.5 1992 3.5 3.6 3.6 1993 3.0 2.8 2.9 1994 3.5 3.8 3.6 1995 3.2 2.7 2.9 1996 2.9 3.7 3.3 1997 3.7 2.6 3.0 1998 2.7 2.5 2.8 2.6 1999 2.3 3.6 3.2 3.1 3.2 3.2 3.0 3.1 3.1 2000 3.4(R) 3.3(R) 3.9(R) 3.9 4.3 4.1 3.5(R) 4.1 3.7 2001 4.4 3.5 3.9 3.5 3.2 2.3 3.9 3.1 3.6 2002 1.8 2.3 1.5 1.8 1.3 1.9 1.9 1.6 1.8 2003 2.0 1.9 0.9 1.8 1.2 0.4 1.7 1.2 1.5 2004 0.9 1.1 R:Revised U.S. DEPARTMENT OF LABOR,BUREAU OF LABOR STATISTICS, FAX-ON-DEMAND Phone 415-975-4567 Note: To receive FAX-ON- an explanation on how to compute a percentage change between any two periods request FAX-ON-DEMAND Code 9255. To request DEMAND information on using the CPI as an escalator on rental agreement and other contracts request FAX-ON-DEMAND Code 9256 CODE 9250 SEATTLE-TACOMA-BREMERTON 05/14/04 Consumer Price Index,All Items, 1982-84=100 for All Urban Consumers(CPI-U) SEMIANNUAL 1ST 2ND ANNUAL YEAR JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC HALF HALF AVERAGE 1985 104.8 105.4 105.3 105.6 105.6 106.3 105.2 106.0 105.6 1986 107.3 106.6 106.1 106.2 107.0 106.9 106.8 106.6 106 7 106.7 1987 108.2 110.3 109.2 1988 111.9 113.8 112.8 1989 116.7 119.6 118.1 1990 124.2 129.4 126.8 1991 133.0 135.2 134.1 1992 137.8 140 2 139.0 1993 141.9 143.9 142.9 1994 146.4 149.2 147.8 1995 151.2 153.3 152.3 1996 155.6 159.4 157.5 1997 165.0 161.9 164.1 163.0 1998 166.5 166.4 167 5 168.5 169.3 169.4 166.6 168.9 167.7 1999 170.6 172.2 172.7 173 4 174.7 174.4 171.6 174.0 172.8 2000 176.1(R) 177.8(R) 179.2(R) 180.3(R) 182.1 181.5 177.3(R) 181.1 179.2 2001 184.0 184.2 186.3 186 8 187.9 186.1 184.4 186 9 185.7 2002 187.6 188.8 189.4 190.3 190.9 190.0 188.3 190 3 189.3 2003 191.3 192.3 191.7 194 4 193.7 191.0 191.6 193.1 192.3 2004 193.5 194.3 Table of over-the-year percent increases. An entry for Feb.2000 indicates the percentage increase from Feb. 1999 to Feb.2000(in this example 3.2 percent). 1986 2.4 1.1 0.8 0.6 1.3 0.6 1.3 0.7 1.0 1987 1.5 3.4 2.3 1988 3.4 3.2 3.3 1989 4.3 5.1 4.7 1990 6.4 8.2 7.4 1991 7.1 4.5 5.8 1992 3.6 3.7 3.7 ( 1993 3.0 2.6 2.8 1994 3.2 3.7 3.4 1995 3.3 2.7 3.0 1996 2.9 4 0 3.4 1997 4.0 2.9 3.5 1998 2.7 2.9 2.9 2.9 1999 2.5 3.5 3.1 2.9 3.2 3.0 3.0 3.0 3.0 2000 3.2 3.3(R) 3.8(R) 4.0(R) 4.2 4.1 3.3 4.1 3.7 2001 4.5 3.6 4.0 3.6 3.2 2.5 4.0 3.2 3.6 2002 2.0 2.5 1.7 1.9 1.6 2.1 2.1 1.8 1.9 2003 2.0 1.9 1.2 2.2 1.5 0.5 1.8 1.5 1f 6 2004 1.2 1.0 �- -� R:Revised