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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, March 16, 2006 1:30 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF FEBRUARY 16, 2006 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO FEBRUARY 28, 2006 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS Hearing Aid Benefits 8. ADJOURNMENT ,I, , MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON February 16, 2006 Kathy Keolker, Mayor Don Persson, Council Finance Committee Chair Bonnie Walton, City Clerk Ray Barilleaux, Fire Department Representative Bruce Phillips, 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 at 1:30 p.m. in the Mayor's conference room, 7th floor of Renton City Hall. In attendance were Board members Kathy Keolker, Don Persson, Ray Barilleaux and Bruce Phillips; Michele Neumann, Deputy City Clerk and acting Board Secretary; and non-member Jill Masunaga, Finance Department Representative. MINUTE APPROVAL MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE PENSION BOARD APPROVE THE MINUTES OF THE JANUARY 19, 2006, MEETING. CARRIED. MONTHLY STATEMENT The final financial report as of December 31, 2005, was reviewed. Total cash/investment balance was $4,811,901.62. The financial report as of January 31, 2006, was reviewed. Total cash/investment balance was $4,772,242.74. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR FEBRUARY 2006, IN THE TOTAL AMOUNT OF $37,597.90. CARRIED. UNFINISHED BUSINESS The 1989-2005 Firemen's Pension Financial History spreadsheet was reviewed. The financial history was requested at the December 2005 meeting in response to discussion as to whether the Board should authorize payment of medical bills for retired firefighters covered under Firemen's Pension from the Firemen's Pension Fund, rather than from the City General Fund. MOVED BY PERSSON, SECONDED BY BARILLEAUX, THE BOARD AUTHORIZE THAT THE MEDICAL PAYMENTS APPROVED BY THE FIREMEN'S PENSION BOARD BE PAID FROM THE FIREMEN'S PENSION FUND, RATHER THAN FROM THE GENERAL FUND, EFFECTIVE JANUARY 1, 2006, AND FOR AS LONG AS THE FIREMEN'S PENSION FUND IS DEEMED TO BE FULLY FUNDED. CARRIED. err Nwr NEW BUSINESS Discussion ensued regarding the possibility of parties collecting the pension payments unlawfully. For example, the Board may not be aware that a pension recipient has died, and the pension payment continues to be mailed out and collected by someone not entitled to the pension. To ensure that the correct parties are receiving the pension payments, it was MOVED BY BARILLEAUX, SECONDED BY PERSSON, THE BOARD AUTHORIZE THAT A VERIFICATION FORM BE SENT TO PENSION RECIPIENTS ANNUALLY. CARRIED. Boardmember and Secretary Bonnie Walton and Finance Department Representative Jill Masunago were asked to draft a verification form and present it to the Board at the next meeting. Board member Bruce Phillips asked that former Board member William Henry be given a certificate in recognition of all his years of service on the Firemen's Pension Board. The Board agreed and Boardmember and Secretary Bonnie Walton was asked to prepare a certificate for the Mayor to sign. ADJOURNMENT MOVED BY PERSSON, SECONDED BY BARILLEAUX, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 2:00 p.m. cYLC.,t.tAit_CeAt..y._/ Michele Neumann, Deputy City Clerk Acting Secretary, Firemen's Pension Board %11 or NW CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF FEBRUARY 28, 2006 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 - ■2006 •2005 5 - - N i co 0 4 ii I i ii I i i I I I o _0 3 2 1 U III Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CURRENT 2006 2006 LAST YEAR 2005 2005 ACTIVITY: MONTH YTD BUDGET CURR MO YTD ADJ BUDGET BEGINNING CASH/INV BALANCE $4,772,242.74 $4,809,572.80 $4,713,823 $4,941,029.78 $4,976,122.73 $4,976.123 RECEIPTS: Property Taxes 0.00 0.00 $0 0.00 0.00 $0 Fire Insurance Premium Tax 0.00 0.00 $73,000 0.00 0.00 $60,000 Investment Interest 2,388.02 2,388.02 $150,000 894.35 894.35 $100,000 DISBURSEMENTS: Fire Pension 36,755.06 73,510.12 $450,000 34,620.65 69,138.60 $410,000 Fire Pension Medical 3,165.75 3,165.75 $0 0.00 0.00 $0 Office/Operating Supplies 0.00 0.00 $400 0.00 0.00 $400 Actuarial/Firemen's Pens 0.00 0.00 $0 0.00 0.00 $5,000 Reimb General/Clerical&Acct 575.00 1,150.00 $6,900 575.00 1,150.00 $6,900 ENDING CASH/INV BALANCE $4,734,134.95 $4,734,134.95 $4,479,523 $4,906,728.48 $4,906,728.48 $4,713,823 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $311,662.94 $349,770.73 $55,354.39 $89,655.69 INVESTMENTS CD's&State Investment Pool 454,767.46 454,767.46 654,767.46 654,767.46 Snohomish County Housing Authority 0.00 0.00 0.00 0.00 Federal National Mortgage Assn 99,555.84 99,555.84 99,555.84 99,555.84 Treasury Strips&Zero Coupon Bonds 3,868,148.71 3,868,148.71 4,097,050.79 4,097,050.79 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 $4,734,134.95 $4,772,242.74 $4,906,728.48 $4,941,029.78 The State Investment Pool interest 4.4223% 4.2322% 2.3955% 2.2197% H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2006.xls\Feb06 Page 1 3/9/2006 �.r Nee FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR MARCH, 2006 ;, F' .t , -00" it ;,,::.. ... i:4: _PensIof Attit" Met +a'; T z r6 o tO ANKENY, Charlie (Captain) $245.97 245.97 ASHURST, James (Assistant Chief) $4,166.00 733.13 4,899.13 BANASKY, George (Captain) $1,200.16 1,200.16 BARILLEAUX, Ray(Battalion Chief) - - BEATTEAY, Karlen (Widow) $297.62 297.62 BERGMAN, Claudette (Widow) $228.57 228.57 CHRISTENSON, Chuck(Firefighter) $398.54 398.54 CONNELL, Robert(Captain) $777.65 777.65 GEISSLER, Dick (Fire Chief) - - GOODWIN, Charles (Captain) $3,780.00 586.82 4,366.82 GOODWIN, Donald (Firefighter) $1,002.32 1,002.32 HAWORTH, Constance(Widow) $2,521.49 2,521.49 HAWORTH, Jack(Firefighter) $2,851.50 - 2,851.50 HENRY,Teresa A. (Widow) $393.40 393.40 HENRY,William, Jr. (Captain) $1,312.78 1,312.78 HURST, Gerald (Firefighter) $660.30 660.30 JONES, Gerald D. (Firefighter) $317.25 317.25 LARSON, William (Firefighter) $51.42 51.42 LAVALLEY, Theodele (Captain) $440.33 440.33 MATTHEW, James (Deputy Chief) - - MC LAUGHLIN, JACK(Battalion Chief) $874.70 874.70 NEWTON, Gary (Lieutenant) $350.88 350.88 NEWTON, Roger(Firefighter) $58.98 58.98 NICHOLS, Gerald (Battalion Chief) $470.56 470.56 PARKS-ANDREASON,Arlene(Widow) $410.74 410.74 PARKS, John (Firefighter) $2,959.50 310.52 3,270.02 PHILLIPS, Bruce H. (Deputy Chief) $231.41 231.41 PRINGLE, Arthur(Captain) $545.98 545.98 PRINGLE, S. Joan (Widow) $2,166.25 2,166.25 RIGGLE, David E. (Firefighter D Step) $168.84 168.84 RUPPRECHT, Jim (Firefighter D Step) $198.99 198.99 SMITH, Leroy (Firefighter) $449.29 449.29 STROM, Karl (Firefighter) $2,851.50 - 2,851.50 TODD, Franklin (Firefighter) $500.94 500.94 TONDA, Lila Jean (Widow) $164.06 164.06 VACCA, Nick (Lieutenant) $378.53 378.53 WALLS, Kenneth (Firefighter D Step) $226.65 226.65 WALLS, Mercedes(Widow) $108.80 108.80 WALSH, David (Firefighter) $1,042.53 1,042.53 WALSH, Patrick(Captain) $978.21 978.21 WEISS, Larry (Battalion Chief) $671.84 671.84 WILLIAMS, Alta (Widow) - - WOOTEN, Maril n E. (Widow) $300.58 300.58 ,.*: -; s `.'t , ;I :.a tssi!i ttiVio i ai #4 6',;55:06 w :t&3{:471,A ,> 8;38. 5Z , ,s Prior Year Pension/Medical Payments: Total Pension Payments for March, 2005 34,570.22 Total Medical Bills Reimbursed in March, 2005 789.54 Total Expenses: Medical/Pension 35,359.76 43/9/2006 2006.XLS 3/9/2006 Noe Noe FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN MARCH, 2006 PAYMENT 51,2mmisingiffmni Pharma" =` Ica 74601 Arne untt°Ot Bill 2 James Ashurst Safeway 79.23 2 James Ashurst Safeway 167.34 2 James Ashurst Safeway 173.68 2 James Ashurst Safeway 6.75 2 James Ashurst Safeway 124.70 2 James Ashurst Safeway 7.75 3 James Ashurst Safeway 173.68 733.13 5 Charles Goodwin Bartell Drugs 72.51 5 Charles Goodwin Bartell Drugs 14.75 5 Charles Goodwin Bartell Drugs 6.35 5 Charles Goodwin Bartell Drugs 131.95 6 Charles Goodwin Bartell Drugs 5.77 6 Charles Goodwin Bartell Drugs 6.35 6 Charles Goodwin Bartell Drugs 131.95 586.82 Jack Haworth 0.00 8 John Parks Olympic Drug 94.01 8 John Parks Olympic Drug 23.22 8 John Parks Olympic Drug 115.02 8 John Parks Olympic Drug 59.38 8 John Parks Olympic Drug 18.89 310.52 Karl Strom 0.00 3_2006 FP Medical.XLS 3/9/2006 SEND CLAIM TO:`,wrf City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98055 OS(cY O� A CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE /448 , 7 'Z-tJv 2) DISABILITY RETIREE'S NAME(print) /Vf r• 3) ADDRESS (2,Q 3 :a (me--- L�t�� /j�-�v rCU� 11) 9fos_ 4) DISABILITY AT TIME OF RETIREMENT / tipe''2-°- -'- l.S'/rv�/j //>'!f !?1 /c j 2df / 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.) h . ` C'.,e c)-e'V_ 't'en+tel 1�i l`� r�/�'C� _4 U e- - r / 3 6) TOTAL AMOUNT OF CLAIM' 7 7) I certify that 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. 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: f „4-e. Note: Supporting documentation must be attached. SASOUHRMACY SAFEWAY PHARMACY 3RD STREET RENTON,WA 98055 RENTON,WA 98055 5 (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)255-61 54 223 B GARDEN AVE N. 12/17 223 8 GARDEN AVE N. 12/17 RENTON,WA 98055 RENTON,WA 98055 DR. GRAVES,DANIEL [NW] DR. GRAVES,DANIEL 17900 TALBOT RD S 17900 TALBOT RD S [RF] RENTON,WA 98055 RENTON,WA 98055 Rx:6672388 Dec 29, 2005 Safety Cap: Yes Rx:6659862 Jan 10, 2006 Safety Cap: Yes COZAAR 50MG TAB (MERC)Qty: 50 TAB METOPROLOL 50MG TAB (URL ) Qty: 100 TAB Ref:A8057630715761 NDC:00006-0952-54 HSGI Ref:A2064102880621 NDC:00677-1482-10 BBAI REGENCE BLUESHIELD WASHINGTN REGENCE BLUESHIELD WASHINGTN Amount Due: $79.23 Amount Due: $6.75 1111111 II I I I IIII II 111 II I II HI `l x EFS SYOUR PRESCRIPTIONS RSCRITIONS HI 11111111111 1 1 11 1 I REFILL YOUR PRESCRIPTIONS u _® [�SAfEWAY.COM §IMINMACY SAFEWAY PHARMACY RENTON,WA 98055 CSiJ 200 SOUTH 3RD STREET RENTON,WA 98055 5 (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)255-61 54 223 B GARDEN AVE N. 12/17 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 RENTON,WA 98055 DR. GRAVES,DANIEL [RF] DR. GRAVES,DANIEL 17900 TALBOT RD S 17900 TALBOT RD S [RF] RENTON,WA 98055 RENTON,WA 98055 Rx:6668820 Dec 29, 2005 Safety Cap: Yes LIPITOR 40MG TAB (PFIZ) Qty: 50 TAB PLAVIX 5M84 Feb 04, 2006 Safety Cap:30AB PLAVIX 75MG TAB (B-M ) Qty:30 TAB Ref:A7057635424691 NDC:00071.0157.23 HSGI HSGI REGENCE 635424691 WASHINGTN Ref:A7064355386031 NDC:63653.1171.01 Amount Due: $167.34 REGENCE BLUESHIELD WASHINGTN Amount Due: $124.70 II II II II II II IIIIII II I IIIl"" (�REFILL YOUR PRESCRIPTIONS if II U U II U VIII)II I IIIIIIIII Rx REFILL YOUR PRESCRIPTIONS • @ SAfEWAY.COM �� SAFEWAY.COM AFSOUT 3R6 S'�ACY SAFEWAY TH3 PHARMACY RENTON,WA 98055 (S_i) 200 RENTON,WA 98055 # (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 B GARDEN AVE N. 12/17 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 RENTON,WA 98055 DR.900 TTa DANIEL [NW]S DR.17900 DANIEL S [NW] RENTON,WA 98055 RENTON,WA 98055 Rx:6672383 Dec 29, 2005 Safety Cap: Yes Rx:6673803 Feb 06, 2006 Safety Cap: Yes PROTONIX 40MG TAB (WYET)Qty: 50 TAB FUROSEMIDE 40MG TAB (SAND)Qty: 100 TAB Generic for:LASIX 40MG TAB Ref:A8057633102211 NDC:00008-0841-81 HSGI Ref:A7064372940391 NDC:00781.1966-10 HSGI REGENCE BLUESHIELD WASHINGTN REGENCE BLUESHIELD WASHINGTN Amount Due: $173.68 Amount Due: $7.75 111111 IIIIII Ii I IlIIhIIlIfRx�\,a REFILL SAFEWAY.COM T/ONS IIII II II III II III1I1II II l l I SIIRx I� REFILL YOUR SAFEWAY.COM PRESCRIPTIONS V6 Z %m+ w is) t {IJIACY RENTON,WA 98055 #1563 (425)226-0325 Official Receipt- Please retain for tax or insurance * '):k.; .JAWS (425)255-6154 B GARDEN AVE N. 12/17 RENTON,WA 98055 DR. GRAVES,DANIEL [RF] 17900 TALBOT RD S RENTON,WA 98055 Rx:6672383 Feb 20, 2006 Safety Cap: Yes PROTONIX 40MG TAB (WYET)Qty:50 TAB Ref:A2084515917551 NDC:00008-0841-81 HSGIMRT REGENCE BLUESHIELD WASHINGTN Amount Due: $173.68 111111111111111111 Rx i I I I I II III II f""`a a REFILL F54FEWAY.COM PRESCRIPTIONS TAW 3 'w "fee SEND CLAIM TO: City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98055 G4 Y 0 • CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE 1;g?/0 2) DISABILITY RETIREE'S NAME (print) C fbit Le s A • (4001) ,,u 3) ADDRESS PO 41 o, /v E A7Eiz),i, qp • 4) DISABILITY AT TIME OF RETIREMENT &f l C,.ifJi'l1Jl� 0/0 Y` it / - t". 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.) (6166qt • 6) TOTAL AMOUNT OF CLAIM --Seo - 7) I certify that I have not been and will not be compensated by any other organization, insurance carrier or Medicare for the above-mentioned claim for reimbursement ether 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. Signatur: Note: Supporting documentation must be attached. 124 .2./A-A).67 w ,....„ i 73 : LLt / "` 1, Adj2...xerj, pp4/1 .. e 1/71- , L=am A . 6ov�(i)1/ BARTELL DRUGS I BARTELL DRUGS RX# — 5-2 X 'g°DR. LO CH,,GERALD RX# 45-2t7tt0 E ogLO DATE: 02/19/06 R (425)251-5110 DATE: 02/21/06 ,,N --(425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 A & JOL 100MG TABLET(MYL GE IL 600MG TABLET(APO 0 K0137- 96880085 6 05-0034-081 96987879 REFILL YES QUANTITY 30.00 REFILL NO QUANTITY 180.00 BARTELL DRUGS PRICE= $10.99 BARTELL DRUGS PRICE= $91.78 WITH XPS THE AMOUNT DUE:$6.35 WITH XPS THE AMOUNT DUE:$72.51 BARTELL DRUGS#45 BARTELL DRUGS#45 (425)793-1015 (425)793-1015 4700 NE 4TH STREET 4700 NE 4TH STREET RENTON,WA 98059 RENTON,WA 98059 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU L REFILLS 24-48 HOURS IN ADVANCE 1 WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR I REFILLS 24-48 HOURS IN ADVANCE — BARTELL DRUGS I BARTELL DRUGS RX# "."7g1 r'o r 'DR. MOSL ir �.ovw Drrtwnn��. Rx# 45-27 '9 E DR- FLO DATE: 02/19/06 R (425)899-3123 DATE: 02/21/06 .N -(4255t-5110 . NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGGR NOX CAP 200/25 ATENOLOL 50MG TABLET(SAN) 00597-0 -6096790085 00781-1506-10 96995879 REFILL ��(/// NO QUANTITY 60.00 REFILL NO QUANTITY 100.00 BARTELL DRUGS PRICE_ $172.99 BARTELL DRUGS PRICE= $26.99 WITH XPS THE AMOUNT DUE:$131.95 WITH XPS THE AMOUNT DUE:$14.75 BARTELL DRUGS#45 BARTELL DRUGS#45 (425)793-1015 (425)793-1015 4700 NE 4TH STREET 4700 NE 4TH STREET RENTON, WA 98059 RENTON,WA 98059 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU L REFILLS 24-48 HOURS IN ADVANCE WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR I L REFILLS 24-48 HOURS IN ADVANCE V t _ 2-AL` 4 7-0 .. f,2,ti' -6,1-6-el-L-, ...., i' , . , . ,..4--44L, ,f ilavo , C',//40-- (--- -=-. A- 6-06occh ,0 (heked)- BARTELL DRUGS I BARTELL DRUGS RX" 46"..VISSI 'ro SLLEY Washington's Own Drugstore.. ....... RX" 45-293093 E DR. MCDANIELS DATE: 02/06/06 R (425) 899-3123 DATE: 01/23/06 N (425)271-1515 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGGRENOX CAP 200/25 AMOXICILLIN 500MG CAPSULE (MO 00597-0001-60 94451814 55370-0885-08 92274442 REFILL 1 QUANTITY 60.00 REFILL NO QUANTITY 16.00 BARTELL DRUGS PRICE_ $172.99 BARTELL DRUGS PRICE= $15.99 WITH XPS THE AMOUNT DUE 4121,91 WITH XPS THE AMOUNT DUE:$5.77 BARTELL DRUGS#45 BARTELL DRUGS#45 (425)793-1015 (TEL425) DRUGS 793-1015 4700 NE 4TH STREET RENTON,WA 98059 4700 NE 4TH STREET RENTON,WA 98059 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR L REFILLS 24 48 HOURS IN ADVANCE I REFILLS 24-48 HOURS IN ADVANCE - 1:YA:Vd3111111 DRUGS BARTELL DRUGS RX# 4- V"''E DR' "p`m.".1 Rx" 2rat " '°°R'gr(i2C GERALD DATE: 02/21/06 ,N (425)251-5110 DATE: 02/06/06 R (425)"k15110 • NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 NORVASC 10MG TABLET ALLOPURINOL 100MG TABLET(MYL 00069-1540-68 96939879 00378-0137-01 94683480 REFILL NO QUANTITY 100.00 REFILL YES QUANTITY 30.00 BARTELL DRUGS PRICE_ $265.29 BARTELL DRUGS PRICE= $10.99 WITH XPS THE AMOUNT DUE:$217.19 WITH XPS THE AMOUNT DUE:$6.35 BARTELL DRUGS#45 BARTELL DRUGS#45 (425)793-1015 (425)793-1015 4700 NE 4TH STREET 4700 NE 4TH STREET RENTON,WA 98059 RENTON,WA 98059 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU REFILLS 24-48 HOURS IN ADVANCE WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR 1. n w a✓ L REFILLS 24-48 HOURS IN ADVANCE Y e((/f[� (a 4\_.).L -,-- ____. --i-'.�-: t) `S4.R1 .R i 400 SEND CLAIM TO: 4iiie City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98055 a seP- CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE . r64.1 3Q b 6 2) DISABILITY RETIREE'S NAME (print) Ci0 71 /, , pc, rh.,S 3) ADDRESS 133 r 34.4ite 46enB Vie-W 14,/ , q b3 4) DISABILITY AT TIME OF RETIREMENT _5' 711 a c)7r e-- i o 1f H- i i a e-r-r( i Vie e-1 S n cr 4 7i j' i ety proh/ein 5 / 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.) 777ed i Ll e ~-Po r 4'1-D7,7 dp ch 4rl,d /91 "Ixie•t? probity/is 6) TOTAL AMOUNT OF CLAIM 3 / . 5_3- 7) I certify that 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. 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 r- ' - ent from the Renton Fire Department. Signature: 4t.rt Vc �Ar� Note: Supporting documentation must be attached. V Me 1 NNW N411010 Value at the smiling'0' Value at the aniline'O' DRUG 115thA vieLoncmaew,WA�9886 32 �Ph.(31.9)4F3-3360 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 a�d� waahwr+o:sr�«r-oe�d�ad�o�+«da�a,�nm+rnaa:nnou�«u�eearMr awffia.�� RX# 571973 DR. RICHARDS RX# 548157 DR. RICHARDS ACCEPTED 1/31/06 CW ACCEPTED 2/2/06 DS PARKS,JOHN PARKS, JOHN liii?111011111111 '1 Iliiiiiiillill 14J 1Miffl ii i Til itiiiI I I III I II II MIRTAZAPINE SOLTAB 45MG • PRILOSEC OTC 20MG TAB^ QTY#30 NDC#66993 0712 30 QTY#84 NDC#37000-0455-03 P&G Generic For:REMERON SOLTAB 45MG 2 REFILLS UNTIL: 1/31/07 2 REFILLS UNTIL: 11/7/06 PRICE: $94.01 PRICE: $59.38 IIIIIIIIIIIIIIIIINIIININIIII'IIIII1IIIINIIII ►ILII IIII'IIIINIIIIII II.INII IINIIIIINIII IRECEIPT RECEIPT Value at the stalling'0' Value at the smiting.O. low *to 1244 15tteh«APaveen.,mvoieanw,W9862 ramoxrOPh.(360))4F3-3360 12 44 NG15th aAve.,mLiewde,WA tr863M2 asai aVierPh.(360)4? 23-3360 was pse'abdl RX#C 571872 DR.RICHARDS RX# 525995 DR.RICHARDS ACCEPTED 1/31/06 CW ACCEPTED 2/1/06 WM PARKS, JOHN PARKS, JOHN 1111 IMMONINMIIIIIII01M1 1118111111111111111111 on mi 111 ALPRAZOLAM 0.5MG TAB LACTULOSE SOL 10G/15ML QTY#120 NDC#00781-1077-05 GENEV QTY#600 NDC#60432-0037.32 MORT 2 REFILLS UNTIL: 7/30/06 8 REFILLS UNTIL: 8/13/06 PRICE: $23.22PRICE: $18.89 II INIINI NI IINNIIIIMIIIII II NIIINININIII I Ill III NIIIIIIIIIIII 11111I`INII�IIIIIII II RECEIPT RECEIPT • 7 :C.) dcwo, Value YMPICDRVG ppemPdm 1 W45thAe,�LvoSewWtr9ug862 oAeVP .(363-36� c� SSS RX#C571862 DR.RICHARDS f� 6 ACCEPTED 1/31/06 CW PARKS, JOHN 1IiT11 i 1l111I1f IN1IniIIINNUII I t'-' ,) • AMBIEN 10MG TABS#### QTY#30 NDC#00024-5421-50 WI NTH 2 REFILLS UNTIL: 7/30/06 PRICE: $115.02 IN�IINIINIININININIININIININII NINIIII"III II IRECEIPT New Business: `"'` Compare & discuss FIREMEN'S PENSION BOARD POLICY#6.D Adopted April 19, 1994 Revised January 17,2001 VISION IMPLEMENTS AND HEARING AIDS 1. VISION IMPLEMENTS: Limitation on vision implements (lenses less tinting, contact lenses, and frames) increased to $600 in a 24-month period. 2. HEARING AIDS: Limitation on hearing aids to a maximum of$1600 each in a 36-month period. (See FPB Minutes,January 17, 2001) LEOFF BOARD POLICY 4. Hearing Aids The Board will approve payment for hearing aids within these guidelines: • Referral must be from a physician. • Up to a maximum of$1,600 per ear within a thirty- six month period. • Up to a maximum of $2,500 per ear for a digitally programmable analog hearing aid within a five- year period. • Up to a maximum of$2,800 per ear for a digital programmable hearing aid within a five-year period • Batteries will be provided as necessary. • On-the-job injuries which result in hearing aid damage are not subject to the limitations above, but will be reviewed on a case-by-case basis. • Amounts will be reduced by any amount received or eligible to be received by Social Security, Medicare, insurance provided by the City or another employer, pension plan, or other similar source.