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Home My WebLink AboutFinal Agenda Packet '401re Imo CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room January 21, 2004 10:00 A.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF DECEMBER 17, 2003 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO 12/31/2003 5. MONTHLY BILLS AND PENSION PAYMENTS 6. OLD BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT 'err` MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON December 17, 2003 Jesse Tanner, Mayor King Parker, 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 Jesse Tanner at 10:00 a.m. in the Mayor's conference room, 7th floor of Renton City Hall. In attendance were Board members Jesse Tanner, King Parker, Bill Henry, Ray Barilleaux and Bonnie Walton; and Jill Masunaga, Finance Department Representative MINUTE APPROVAL MOVED BY PARKER, SECONDED BY HENRY, THE PENSION BOARD APPROVE THE MINUTES OF THE NOVEMBER 19, 2003, MEETING. CARRIED. CORRESPONDENCE A memo from A. Lee Wheeler, Fire Chief, was read stating that Bill Henry had been re-elected to a two- year term on the Firemen's Pension Board with the new term to expire on December 31, 2005. MONTHLY STATEMENT The financial report as of November 30, 2003, was reviewed. Total cash/investment balance was $5,058,678.52. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY PARKER, SECONDED BY HENRY, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR DECEMBER 2003, IN THE TOTAL AMOUNT OF $29,807.50. CARRIED. NEW BUSINESS Retiring Mayor Jesse Tanner thanked Board members for their work during the past eight years, and advised continued diligence and caution in its management of Firemen's Pension funds. Councilman Parker agreed he also had found his six years of service on the Board to be very rewarding and pleasurable. Ray Barilleaux and Bill Henry expressed appreciation to Mayor Tanner and Councilman Parker on behalf of the Board, and presented each with a plaque commemorating their outstanding service. ADJOURNMENT MOVED BY PARKER, SECONDED BY HENRY, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 10:10 a.m. Bonnie I. Walton, City Clerk Member and Secretary, Firemen's Pension Board CITIF RENTON - FIREMEN'S PENSIUND CASH & INVESTMENT ACTIVITY REPORT AS OF DECEMBER 31, 2003 Fireman's Pension Fund Comparison of Cash and Investment Activity 7 6 - ! : ullhl - N C O g 3 - 1 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 02003 ■2002 CURRENT 2003 2003 LAST YEAR 2002 2002 ACTIVITY: MONTH YTD BUDGET CURR MO YTD ADJ BUDGET BEGINNING CASH/INV BALANCE $5,058,678.52 $5,312,164.41 $5,312,164 $5,337,964.70 $5,491,105.38 $5,491,105 RECEIPTS: Property Taxes 0.00 0.00 $0 0.00 0.00 $0 Fire Insurance Premium Tax 0.00 63,087.83 $32,000 0.00 55,729.79 $32,000 Investment Interest 104,147.54 120,274.09 $115,000 2,030.64 105,542.08 $80,000 Interfund Loan Repmt/Golf Crs 0.00 0.00 $0 0.00 0.00 $0 DISBURSEMENTS: Fire Pension 28,870.67 350,744.84 $355,000 27,230.85 333,706.08 $345,000 Office/Operating Supplies 97.92 391.02 $400 75.08 206.76 $400 Actuarial/Firemen's Pens 0.00 4,575.00 $4,000 0.00 0.00 $0 Repairs&Maintenance 0.00 0.00 $0 0.00 0.00 $0 Reimb General/Clerical&Acct 542.00 6,500.00 $6,500 525.00 6,300.00 $6,300 ENDING CASH/INV BALANCE $5.133,315.47 $5,133,315.47 $5,093,264 $5,312,164.41 $5,312,164.41 $5,251,405 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $26,066.15 $4,140.46 $237,626.35 $63,426.64 INVESTMENTS CD's&State Investment Pool 729,767.46 729,767.46 749,767.46 949,767.46 Snohomish County Housing Authority 98,272.00 98,272.00 98,272.00 98,272.00 Treasury Strips&Zero Coupon Bonds 4,279,307.78 4,226,498.60 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 $5,133,413.39 $5,058,678.52 $5,312,164.41 $5,337,964.70 The State Investment Pool interest 1.0698% 1.0694% 1.4525% 1.5474% H:\FINANCE\FINPLAN\FIREPEN\2003 Fire Pension\1_Fire_Pension_2003.xls Page 1 1/15/2004 9:46 AM 44400 4400 FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR JANUARY, 2004 Recipient Pension Amt Medicals Total * ANKENY, Charlie(Captain) $131.98 131.98 * ASHURST, James (Assistant Chief) $3,927.00 405.49 4,332.49 * BANASKY, George(Captain) $879.57 879.57 * BEATTEAY, Karlen (Widow) $208.39 208.39 * BERGMAN, Claudette(Widow) $142.95 142.95 * CHRISTENSON, Chuck(Firefighter) $296.62 296.62 * COLOMBI, Jack(Captain) $396.62 396.62 * CONNELL, Robert(Captain) $646.73 646.73 * GOODWIN, Charles(Captain) $3,563.00 - 3,563.00 * GOODWIN, Donald (Firefighter) $870.90 870.90 HAWORTH, Constance(Widow) $2,435.52 2,435.52 * HAWORTH, Jack(Firefighter) $2,688.00 790.46 3,478.46 * HENRY, Teresa A. (Widow) $279.74 279.74 * HENRY, William, Jr. (Captain) $1,144.61 1,144.61 * HURST, Gerald (Firefighter) $470.03 470.03 * JONES, Gerald D. (Firefighter) $224.26 224.26 * LAVALLEY, Theodele(Captain) $320.67 320.67 * MC LAUGHLIN, JACK(Battalion Chief) $711.17 711.17 * NEWTON, Gary (Lieutenant) $245.55 245.55 * NICHOLS, Gerald (Battalion Chief) $337.85 337.85 * PARKS, Arlene (Widow) $298.38 298.38 * PARKS, John (Firefighter) $2,789.50 276.80 3,066.30 * PHILLIPS, Bruce H. (Deputy Chief) $81.86 81.86 * PRINGLE,Arthur(Captain) $421.81 421.81 PRINGLE, S. Joan (Widow) $2,092.38 2,092.38 * RIGGLE, David E. (Firefighter D Step) $83.53 83.53 * SMITH, Leroy (Firefighter) $357.23 357.23 * STROM, Karl (Firefighter) $2,688.00 - 2,688.00 * TODD, Franklin (Firefighter) $407.38 407.38 * TONDA, Ernie (Captain) $29.37 29.37 * VACCA, Nick(Lieutenant) $277.17 277.17 * WALLS, Kenneth (Firefighter D Step) $136.30 136.30 * WALSH, David (Firefighter) $909.94 909.94 * WALSH, Patrick(Captain) $842.87 842.87 * WEISS, Larry (Battalion Chief) $518.97 518.97 * WOOTEN, Marilyn E. (Widow) $213.59 213.59 Total Expenses: Pension/Medical 32,069.44 1,472.75 33,542.19 Prior Year Pension/Medical Payments: Total Pension Payments for January, 2003 30,216.33 Total Medical Bills Reimbursed in January, 2003 844.95 Total Expenses: Medical/Pension 31,061.28 * Includes a 3.0%cost of living increase effective January 1 per union contract. 4_SUMMARY 2004 1/12/2004 3:37 PM N FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN JANUARY, 2004 PAYMENT Page Name PharmacylMedical Facility Amount of Bill 2 James Ashurst Safeway 7.99 2 James Ashurst Safeway 48.79 2 James Ashurst Safeway 14.49 2 James Ashurst Safeway 52.99 2 James Ashurst Safeway 14.39 2 James Ashurst Safeway 266.84 405.49 4 Jack Haworth Harbor Drug Co. 39.98 4 Jack Haworth Harbor Drug Co. 28.98 4 Jack Haworth Harbor Drug Co. 39.98 4 Jack Haworth Harbor Drug Co. 24.98 4 Jack Haworth Harbor Drug Co. 11.98 4 Jack Haworth Harbor Drug Co. 39.98 4 Jack Haworth Harbor Drug Co. 28.98 4 Jack Haworth Harbor Drug Co. 24.98 5 Jack Haworth Harbor Drug Co. 28.98 5 Jack Haworth Harbor Drug Co. 39.98 5 Jack Haworth Harbor Drug Co. 24.98 5 Jack Haworth Harbor Drug Co. 28.98 5 Jack Haworth Harbor Drug Co. 26.98 5 Jack Haworth Harbor Drug Co. 11.98 5 Jack Haworth Harbor Drug Co. 39.98 5 Jack Haworth Harbor Drug Co. 39.98 6 Jack Haworth Harbor Drug Co. 24.98 6 Jack Haworth Harbor Drug Co. 28.98 6 Jack Haworth Harbor Drug Co. 39.98 6 Jack Haworth Harbor Drug Co. 14.98 6 Jack Haworth Harbor Drug Co. 28.98 6 Jack Haworth Harbor Drug Co. 24.98 6 Jack Haworth Harbor Drug Co. 39.98 6 Jack Haworth Harbor Drug Co. 11.98 7 Jack Haworth Harbor Drug Co. 28.98 7 Jack Haworth Harbor Drug Co. 24.98 7 Jack Haworth Harbor Drug Co. 39.98 790.46 9 John Parks Toledo Pharmacy 120.40 9 John Parks Toledo Pharmacy 21.95 9 John Parks Toledo Pharmacy 91.70 9 John Parks Toledo Pharmacy 42.75 276.80 'TOTAL 1,472.75 3_2004 FP Medical 1/12/2004 4:05 PM A Nage • SI OR'REIMB� ... ..... ........................................... NAME James F. Ashurst DATE an 2 2004 AMOUNT OF CLAIM $ 405. 49 Reason for medication/hospitalization/physician's exam: HYPERTENSION, HIGH BLOOD PRESSURE, REAC TION TO MEDICATIO N 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. /zi/ Signature %-.%;r,, ' /r -/ Note: Proper Documentation must accompany this claim form. PAt4; l 'err' ,4101? 3) SAFEWAY PHARMACY SAFEWAY PHARMACY 200 SOUTH 3RD STREET 200 SOUTH 3RD STREET RENTON,WA 98055 RENTON,WA 98055 #1563 (425)226-0325 #1563 (425)226-0325 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. GRES900 TALBOT RD S DEL [NW] DR. GRA900VTALDAEL BOT RD S [NW] RENTON, WA 98055 RENTON, WA 98055 Rx:6642964 Oct 06, 2003 Safety Cap: No Rx:88O2O87 Oct 10, 2003 Safety Cap: No NDC: 00172-2908-80 MMB/ NDC: 16837-0872-60 MMB/ FUROSEMIDE 2OMG TAB (ZENI) Qty: 20 TAB PEPCID AC 10MG TAB (J&J ) Qty: 120 TAB Generic for: LASIX 20MG TAB HOEC HEALTH CLUB 55 HEALTH CLUB 55 Amount Due: $7.99 (' Amount Due: $52.99 HI II II 11111 IIII II II I II III Ref:032795285012006999 11111111 IIIIIIIIIJJJIIIIIIIIII Ref:032834895304004999 (s) SAFEWAY PHARMACY SAFEWAY PHARMACY 200 SOUTH 3RD STREET M. 200 SOUTH 3RD STREET RENTON,WA 98055 RENTON WA 98055 #1563 1425)226-0325 #1563 (425)226-0325 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.900VTALBOT RD S IEL �NW] DR.900GRAVTALBOT IEL RD S [NW] RENTON, WA 98055 RENTON, WA 98055 Rx:6643139 Dec 08, 2003 Safety Cap: No Rx:6643140 Oct 10, 2003 Safety Cap: No NDC: 00172-3760-60 HSG/MT NDC: 00172-2907-80 MMB/ LISINOPRIL 2OMG TAB (IVAX) Qty: 100 TAB FUROSEMIDE 4OMG TAB (IVAX) Qty: 100 TAB Generic for: ZESTRIL 20MG TAB ASTR Generic for: LASIX 40MG TAB HOEC HEALTH CLUB 55 HEALTH CLUB 55 Amount Due: $48.79 Amount Due: $14.39 IUI IIII II I I I IIII III I I I 1111 II Ref:033424974288003999 ill II II II I I I IIII II IIII IIII III Ref:032834927834006999 SAFEWAY PHARMACY SAFEWAY PHARMACY (S) ' 200 SOUTH 3RD STREET (S)• 200 SOUTH 3RD STREET RENTON,WA 98055RENTON,WA 98055 #1563 (425)226-0325 #1nBR (425)226-0325 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. GRAVES,DANIEL L. [RS] DR. GRAVES,DANIEL L. RS] 17900 TALBOT RD S. 17900 TALBOT RD S. RENTON, WA 98055 RENTON, WA 98055 Rx:88O2O83 Oct 09, 2003 Safety Cap: No Rx:6645916 Dec 29, 2003C Cap: No NDC: 16837087260 MMB/ NDC: 00024-1075-01PEPCID AC 1OMG TAB (J&J ) Qty:12 TAB KAYEXALATE POW (S :454 GM HEALTH CLUB 55 HEALTH CLUB 55 Amount Due: $14.49 Amount Due: $266.84 H I U I II 1 111111 III II II II II Ref:032824903157006998 II II II II liii Illifi III I Ref:033636302809001999 *Nyez CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM NAME L?A-d <, kt-DMOTLT14 DATE oil IZ104- AMOUNT OF CLAIM $ 14 o • 46 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. 1'A 3 • %.,. Harbor Drug Co.P' criptions , 316 8th St. NM fli 6x•532 3061 v . Harbolr,a�"ug Co.Prescriptions Hoquiam,WA 98550 24 Hr.Rx Re SII(360)538.9978 -a..\" , M INiteaebefi0mllwpddbCetlxdNi6,gb+ypeamawrenp"-b738.9 78 ti 316 8th St Phone 360.5324061 RX# 535122 R DR. MORRIS = Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 5/22/03 DS R2# 522882 R dwlr' " v° xe�. HAWORTH,JACK 7/29/03 DS BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK LOVASTATIN 20 MG BOX 864,OCEAN SHORES,WA 98551 QTY#30 NDC#00781-1210-60 GENEV FUROSEMIDE 20 MG QTY#60 NDC#00054-4297-31 $44.98 $13.91 3 REFILLS DISC- $5.00 PRICE: $39.98 I. MAY REFILL DISC- $1.93 11111111111111111110111111110011111111011111111111 111111111111 $11.98 Illi 11IIIII I1IIIII111111111111111111111111111111111111SII RECEIPT • 51!• Darker Drug Co.Prescripts s, Harbor Drug Co.Prescriptions ��• 3'6 6th St I 316 8th St. w... Hou `WA 98550 24 Hr.Rx Rhe (36 1 1 Hoquiam,WA 98550 24 Hr.Rx Refill Phone 538-9978 °""°�OenV' tr 8976 sHoquj Hoquiam, mm8550 dm. RX# 535122 R � °P�i" ` "r°°'d �0 b ey prem aw M Mret tr Mem pp,pgd RX# 526877 R DR. MORRIS 7/29/03 DS -6/23/03 DSHAWORTH,JACK HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 LOVASTATIN 20 MG ISOSORBIDE MONO.30MG. ER QTY#30 NDC#00781-1210-60 GENEV QTY#30 NDC#59930-1502-01 1 REFILLS $44.98 MAY REFILL $33.85 DISC- $5.00 DISC- $4.87 PRICE: $39.98PRICE: $28.98 1111111111111O11n111Ibeg1II111111111flIIIIIIIIIIIIiiIIIIIIIihB ia.. Harbor Drug Co.Prescriptions Ili 316 8th St Phone 360.532.3061 RECEIPT _ Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 RX#52687!"R d X7171MIT'P"± 12Harbor Drug Co.Prescriptions 8/25/03 DS Alf 316 8th St. Phone 360-532.3061 HAWORTH,JACK Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 BOX 864,OCEAN SHORES,WA 98551 airy22 "'tr.PrinMt"`°""°peaa°°' ISOSORBIDE MONO.30MG. ER 7/1/03 DS QTY#30 NDC#59930-1502-01 HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 $33.85 LOVASTATIN 20 MG MAY REFILL DISC- $4.87 QTY#30 NDC#00781-1210-60 GENEV PRICE: $28.98 2 REFILLS DISC - $5.00 8 III I 111111 II 11111all�lNallfll Illflllllllllfllllplll HMI PRICE: $39.98 IIIIIIIII IIIIIIilllll OHM Ilii 111111111111111 IIIIAIIIIIIIIIII! X1.. earber drug Co.Prescriptions 316 8th St Hoquiam,WA 98550 24 ayHgrr..�Rnx Refill orFearalrwwd++s dm, UK. MI RECEIPT R"j6L543060 8/25/03 DS t11 Harbor Drug Co.Prescriptions HAWORTH,JACK L' 316 8th St. Phone 360.532.3061 BOX 864,OCEAN SHORES,WA 98551 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 raa�,siren,,ImepMd.esWedr.angbegpaaonawMWreRixxhp pe„e„ LORAZEPAM NDC#00781-1404-10 GENEV ;'1 RX#C 543060 R DR. KONN QTY#30 5.00 7/21/03 DS $29 gg HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 3 REFILLS DISC- $24.9 LORAZEPAM 1 MG PRICE: $24.98 QTY#30 NDC#00781-1404-10 GENEV I�NINIIIN�IINNINININ1INIINIIIIIINN��IIN��I�INI�IN�II�INIII�NIN�I��III $29.98 1 1p AWN Ilgpilll N 14 REFILLS DISC- $5.00 PRICE: $24.98 RECEIPT I IIS I 11111111111111 INIMO III III Ill fllflllfl1fl1111111Hl III vows 4 RECEIPT ✓ _I 1 Harbor Dr�o.Prescriptions 1t 1Harbor Drug Co.Prescriptions `L,, 316 8th St phone 360-532.3061 II 316 8th St Phone 360.532.3061 = Hoquiam,WA 91..50 24 Hr.Rx Refill(360)538-9978 Hoquiam,WA98550 24 Hr.Rx Refill(360)538-9978WARNIVI ShlearRdeffillarrprohlbbeasslerdtbdm b.nyFeracn Oar maceix wit= a.oe.n RX# 5268716 dry.'8' "°v� `2 `erwhra>d' RX# 549660 N DR. MORRIS 7/22/03 DS 9/26/03 JR HAWORTH,JACK HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551ROID 0.1 MG TABLET LEVOTHROID MONO.30MG. ER QTY# H0 NDC#00456-0323-00 0323-00 QTY#30 NDC#59930-1502-01 $33.85NO REFILLS $29.77 MAY REFILL DISC- $4.87 DISC - $2.79 PRICE: $28.98 PRICE: $26.98 11111110111111111111111111001111111111111111111111111111 11111111111N111111111111111N11N11N1111111I111111111111I1p1111811 Harbor Drug Co.Prescriptions Harbor Drug Co.Prescriptions D316 8th St. Phone 360.532.3061 316 8th St Phone 360.532.3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 wwaxkSlam FEWlaw paella e.rrdwago.y pawn dile,than pal.,ecr whomP.awa NaweI¢Slab aFalsrtlk,° °'~'d"°"n"°°ray°°°°'"methn"`dic.""n'°"mb.'` RX# 549683 N DR. MORRIS RX# 535122 R DR. MORRIS 9/26/03 JR 9/2/03 DS HAWORTH,JACK HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 • BOX 864,OCEAN SHORES,WA 98551 FUROSEMIDE 20 MG LOVASTATIN 20 MG QTY#60 NDC#00054-4297-31 QTY#30 NDC#00781-1210-60 GENEV $44.98 $13.91 MAY REFILL DISC- $1.93 NO REFILLS DISC- $5.00 PRICE: $11.98 PRICE: $39.98 11111111muniummirmilmill III 111111111011111111111111111101111110111111111111111111 I R Harbor Drug Co.Prescriptions ' - Harbor Drug Co.Prescriptions l�l 316 6th St Phone 360.532 3061 316 8th St Phone 360.532.3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 Hoquiam,WA blsMa 24 Hr.Rx steRll(360)538.9978 wnlwrxi:Hoquiam,WA 98550 24 wbany Refill�rd"t°""""-9971ed "F°d."�.""°v�°'m'""'°"p"'"""°"°"°""°�."�"" "°, DR. MORRIS RX#C 543060 R DR.KONN RX# 549682 N 9/26/03 JR 9/22/03 DS HAWORTH,JACK HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 LORAZEPAM 1 MG ' LOVASTATIN 20MG QTY#30 NDC#00781-1404-10 GENEV 1 QTY#30 NDC#49884 0755 01 PAR $44.98 $29.98 MAY REFILL DISC- $5.00 2 REFILLS DISC- $5.00 PRICE: $39.98 PRICE: $24.98 X11111 ��1NIII a��IIMINI INIINIINIIN�NiII��i�I11 1111111111111111111111110111111111111111111111111ft ti Harbor Drug Co.Prescriptions Harbor Drug Co.`Prescriptions ,e., 316 8th St Phone 360-532.3061 316 8th St Phone 360.532.3061 . Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 wuwr&s Federal taw prohblts trarskrd°'bngn'"ypasonoth rMn°.i.+""*or^°+obe° WANING:Stale or Federal law prohbils transfer dills drop lo any person other Men pellentlorwhon,pesabed. RX# 551324 N DR. MORRIS RX# 526877 R DR. MORRIS 10/21/03 JR 9/22/03 DS HAWORTH,JACK HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 AMIODARONE 200 MG ISOSORBIDE MONO.30MG. ER QTY#30 NDC#00781-1203-05 GENEV QTY#30 NDC#59930-1502-01 $33.85 NO REFILLS MAY REFILL DISC- $4.87 PRICE: $39.98 PRICE: $28.98 IIIIIIIIN1NIIINIIIINIIIIININ1� N!IN�N�flIIIq�vN1I� 11111111111111111111111101111111111111111111111 11 RECEIPT RECEIPT PA6/e s Harbor Drug C i scriptions 1=t; Harbor Drugs Prescriptions 316 8th St. Phone 360.532.3081 �r 316 8th St. Phone 360532.3061 Hoquiam,WA 98550 24 Na Rx Refill 360 538.8978 = Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 I I wARNN3:sig.,F.d.u.pvta.twofer dtin owloay,..maM4m Owltnft.Pn.obal 111.ANNI SUMUF.eralYwpdiblYYedrtdt iapbsyPmnArhinpiwlixw an mai d RX#C 543060 R DR.KONN RX# 551293 R DR. MORRIS 10/21/03 JR 11/24/03 DS HAWORTH,JACK HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 LORAZEPAM 1 MG ISOSORBIDE MONO.30MG. ER QTY#30 NDC#00781-1404-10 GENEV QTY#30 NDC#59930-1502-01 $33.85 1 REFILLS MAY REFILL DISC- $4.87 PRICE: $24.98 PRICE: $28.98 1111M111111101111111101111110111MMIN 111111111110111111111111101111110111111111111011111111111111 ,t I . Harbor Drug Co.Prescriptions ; ,,, Harbor Drug Co.Prescriptions `P 316 8th St. Phone 360.532.3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 \tr' 316 8th St. Phone 360.5324061 wAnex codon weri montitmadward.hgbe p....,dM nonswe wanpwarxn . Hoquiam,WA 98550 Hr.Rx Refill(360)538.9976 wAiprlfG:gHoqui salbgpdi98550rd 24 HDr-a„ix. a eofi N(3wk6 ilb.stpwubd RX# 551293 N DR. MORRIS DR.KONN 10/21/03 JR RX#C 543060 R 11/24/03 DS HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 1 HAWORTH,JACK ISOSORBIDE MONO.30MG. ER BOX 864,OCEAN SHORES,WA 98551 QTY#30 NDC#59930-1502-01 LORAZEPAM 1 MG NDC#00781-140410 GENEV QTY#30 NO REFILLS 1 PRICE: $28.98 L NO REFILLS iPRICE: $24.98 1111/111111111111111111 � t�IIIiI1�I11111111111111011111118�NI�III111111111111aII11111�IIlIl I. Harbor Drug Co.Prescriptions Harbor Drug Co.Prescriptions ``P 316 8th St Phone 360532-3061 11 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 LI 316 8th St. Phone 360-532.3061 MANNccStale,rFm,dm.Prdam dmsapben)monotherthenPatl.dwstem P = Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 RX# 549682 R DR. MORRIS MINwa:SwevFederal law p1p11piSbander dmedug bany Person other than mart for whom wombed. 11/4/03 DS RX# 549682 R DR. MORRIS HAWORTH,JACK 12/1/03 DS BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK LOVASTATIN 20MG BOX 864,OCEAN SHORES,WA 98551 QTY#30 NDC#49884-0755-01 PAR LOVASTATIN 20MG QTY#30 NDC#49884-0755-01 PAR $44.98 $44.98 MAY REFILL DISC— $5.00 MAY REFILL DISC— $5.00 PRICE: $39.98 PRICE: $39.98 I1111111111111111111111111111111111111111111111111II11111111111111I1111111IIIII1111111111I11111 II ••,' Harbor Drug Co.Prescriptions ��P Harbor Drug Co.Prescriptions �/ 316 8th St Phone 3605323061 fr, 316 8th St. Phone 360.5323061 t Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 _ Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 wNlRi[teabarFadxalYwPdiDle9aedera Nadnpba�NPertanaUwtla�palkrtbrwlgmpmub.d WARNING: • SInb a FWxN kw pididb transferdtlev drug beery Prawn other Con Paletbrwtgrn pasxbed RX#C 553409 N DR. MORRIS RX# 549683 R DR. MORRIS 11/20/03 JR 12/18/03 DS HAWORTH.JACK HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 HYDROCO/APAP 5MG/500MG MALLIN FUROSEMIDE 20 MG QTY#30 NDC#00406-0357-05 QTY#60 NDC#00054-4297-31 $16.53 $13.91 1 REFILLS DISC— $1.55 MAY REFILL DISC— $1.93 PRICE: $14.98 PRICE: $11.98 11111 lilll11111 11111 11111111 '111111111111111111111111111111111111111 RECEIPT REC ' allegn MI L to 1• Ma Mi r7= ii ii :1-1 4.0 `rrr+ Harbor Drug Co.Prescriptions 316 8th St Phone 360532.3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)536-9978 WRING:Vasa F lmi IwpdeblrydrdOYA,gbany psamdrfun pWttnftem.oEed RX# 551293 R DR. MORRIS 12/22/03 DS HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 3 ISOSORBIDE MONO.30MG. ER QTY#30 NDC#59930-1502-01 J J • _ $33.85 MAY REFILL DISC- $4.87 PRICE: $28.98 I11111111111111111111111111111 + J . Harbor Drug Co.Prescriptions sof 316 8th St Phone 3605323061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978 WpVreXt BYuapdrNloOdilbl.nkrdlhYdujlowym nc rMp,[wflrMwnPo+Wd RX#C 555853 N DR.KONN 12/29/03 DS HAWORTH,JACK ;-' ' - -' BOX 864,OCEAN SHORES,WA 98651 • , LORAZEPAM 1 MG QTY#30 NDC#00781-1404-10 GENEV 5 REFILLS + ' PRICE: $24.98 - • 111111 1111! 111111 1H11D. Harbor Drug Co.Prescriptions ; : ; 316 8th St Phone 360532.3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 mints sbamptlrail.pratebbadrdndngbmypnochrfropeni. .F....pd - - RX# 549682 R DR. MORRIS 12/31/03 DS , ; HAWORTH,JACK �1 BOX 864,OCEAN SHORES,WA 98551 ; ,- LOVASTATIN 20MG QTY#30 NDC#49884-0755-01 PAR 1 1 • 33r $44.98 MAY REFILL DISC- $5.00 PRICE: $39.98 r ' 11111111101111111101111111111111111111111111 RECEIPT ') • VA 1 CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM NAME LfoAi ,, -Pa /�S DATE / a ^ 31 '-* 0• AMOUNT OF CLAIM $ . Reason for medication/ hospitalization/physician's exam: Y- rt a 9 h 4 it 61 47:e d acbLe-m 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 d?- V-• Note: Proper Documentation must accompany this claim form. Mail forms to: City of Renton Finance Department—Fire Pension 1055 South Grady Way • Rcnton, WA 98055 Revised 12/24/02 r • TOLEDO PHARMACY Box 249 Toledo, Wash. 98591 ANIMAL HEALTH SUPPLIES GIFTS PRESCRIPTIONS Phone 864-4100 1E - - - d NAMF � n ADDRESS%•d t (a2 (4' TOLEDO 241 COWLITZ ST. PHARMACY TOLEDO,WA 98591 864-4100 CASH CHARGE 1^ Ll JOHN PARKS 12/04/03 / BOX 626,TOLEDO NA 98591 Rx#C247425 Dr.J RICHARDS NDC#E0 124G 42 / o�4/2 /1;26 =.�GCA NDC# 00024-5421-31 #45 /pc Price: 133.78 - -10% $ 120.40 a444ao2 C o)/ ? n?:,3 ns- TOLEDO ARMA241 COWLITZ 9 - , �_` r-,_ _ PHARMACY TOLEDO,WA 98591 864-4100 • - y_ BOXH6N26 TOOLREKS DDO WA 98591 12/04/03 I Rx#C244825 Dr.J RICHARDS �,•- O(c ALPRAZOLAM 0.5MG TAB 0'7 b NDC# 00228-2029-10 #120 'j CASH BC /B, l"•� Pfk Price: 24.39 - -10% $ 21.95 m ,�, TOLEDO 241 COWLITZ ST. PHARMACY TOLEDO,WA 98591 864-4100 JOHN PARKS 12/04/03 BOX 626 TOLEDO NA 98591 Rx#24!7426 Dr. J RICHARDS REMERON 30MG TAB NDC# 00052-0107-30 #30 CASH Price: 101.89 - -10% $ 91.70 / o 1