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Home My WebLink AboutFinal Agenda Packet i.r vigor CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room Thursday, July 19, 2007 1:30 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF JUNE 21, 2007 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO JUNE 30, 2007 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS Cost of Living Increase - Widows 8. ADJOURNMENT '44100 *se MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON June 21, 2007 Kathy Keolker, Mayor Don Persson, Council Finance Committee Chair Bonnie Walton, City Clerk Ray Barilleaux, Fire Department Representative Bruce Phillips, Fire Department Representative Chuck Christensen, Fire Department Alternate The regular meeting of the Firemen's Pension Board was called to order by Acting Chairman Don Persson at 1:32 p.m. in the City Clerk's conference room, 7th floor of Renton City Hall. In attendance were Board members Don Persson, Bruce Phillips, Ray Barilleaux, and Bonnie Walton; and also Jill Masunaga, Finance Department representative. MINUTES APPROVAL MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE PENSION BOARD APPROVE THE MINUTES OF THE MAY 17, 2007, MEETING. CARRIED. MONTHLY STATEMENT The financial report as of May 31, 2007, was reviewed. Total cash/investment balance was $4,570,706.69. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR JUNE 2007, IN THE TOTAL AMOUNT OF $34,567.06 TO BE PAID FROM THE FIREMEN'S PENSION FUND. CARRIED. NEW BUSINESS A brief discussion ensured regarding a Washington State Retired Firefighter's Association letter received by some Board members, and questions regarding inclusion of deferred compensation as "basic salary." ADJOURNMENT MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 1:42 p.m. Bonnie I. Walton, City Clerk Member and Secretary, Firemen's Pension Board NW CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF JUNE 30, 2007 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 ❑2007 ■2006 5 I 1111111 1 2 - 1111111 U U U U U I I Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CURRENT 2007 2007 LAST YEAR 2006 2006 ACTIVITY: MONTH YTD BUDGET CURR MO ACTUAL ADJ BUDGET BEGINNING CASH/INV BALANCE $4,570,690.98 $4,672,241.19 $4,459,523 $4,711,460.23 $4,811,901.62 $4,713,823 RECEIPTS: Fire Insurance Premium Tax 0.00 85,061.56 73,000 0.00 77,820.55 73,000 Investment Interest 2,801.30 15,192.50 175,000 2,269.58 215,553.19 150,000 DISBURSEMENTS: Fire Pension 34,501.54 218,838.60 463,500 34,333.90 414,281.42 450,000 Fire Pension Medical 49.81 3,741.72 20,000 0.00 11,536.51 20,000 Office/Operating Supplies 0.00 0.00 450 79.42 316.24 400 Actuarial/Firemen's Pens 0.00 7,550.00 12,000 0.00 0.00 0 Reimb General/Clerical&Acct 686.00 4,110.00 8,226 575.00 6,900.00 6,900 ENDING CASH/INV BALANCE $4,538,254.93 $4,538,254.93 $4,203,347 $4,678,741.49 $4,672,241.19 $4,459,523 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $332,542.66 $364,994.42 $253,940.66 $286,659.40 INVESTMENTS: CD's&State Investment Pool 454,767.46 454,767.46 454,767.46 454,767.46 Federal National Mortgage Assn 99,555.84 99,555.84 99,555.84 99,555.84 Treasury Strips&Zero Coupon Bonds 3,651,388.97 3,651,388.97 3,870,477.53 3,870,477.53 TOTAL CASH AND INVESTMENTS $4,538,254.93 $4,570,706.69 $4,678,741.49 $4,711,460.23 The State Investment Pool interest 5.2068% 5.1936% 4.9860% 4.8542% H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2007.xls\Jun07 Page 1 7/13/2007 4400, %so FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR JULY, 2007 Ati p Okiit p ;- 4 E tta k g 640011 Ai nt°,k a ei Ica s: tivrota F,.,. ANKENY, Charlie (Captain) $116.94 116.94 ASHURST, James (Assistant Chief) $4,436.00 - 4,436.00 BANASKY, George (Captain) $934.00 934.00 BARILLEAUX, Ray(Battalion Chief) - - BEATTEAY, Karlen (Widow) $207.57 207.57 BERGMAN, Claudette (Widow) $136.28 136.28 CHRISTENSON, Chuck (Firefighter) $295.60 295.60 CONNELL, Robert(Captain) $683.41 683.41 GEISSLER, Dick (Fire Chief) - - GOODWIN, Charles (Captain) $3,893.50 574.75 4,468.25 GOODWIN, Donald (Firefighter) $931.54 931.54 * HAWORTH, Constance (Widow) $2,688.00 2,688.00 HAWORTH, Jack (Firefighter) $2,937.00 1,266.16 4,203.16 HENRY, William, Jr. (Captain) $1,225.73 1,225.73 HURST, Gerald (Firefighter) $494.80 494.80 JONES, Evelyn M. (Widow) $224.42 224.42 LARSON, William (Firefighter) - - LAVALLEY, Theodele (Captain) $324.64 324.64 MATTHEW, James (Deputy Chief) - - MC LAUGHLIN, JACK (Battalion Chief) $914.31 914.31 NEWTON, Gary (Lieutenant) $244.78 244.78 NEWTON, Roger(Firefighter) - - NICHOLS, Gerald (Battalion Chief) $485.25 485.25 PARKS-ANDREASON, Arlene(Widow) $301.76 301.76 PARKS, John (Firefighter) $3,048.00 108.27 3,156.27 PHILLIPS, Bruce H. (Deputy Chief) $226.17 226.17 PRINGLE, Arthur(Captain) $435.83 435.83 * PRINGLE, S. Joan (Widow) $2,309.31 2,309.31 RIGGLE, David E. (Firefighter D Step) $70.23 70.23 RUPPRECHT, Jim (Firefighter D Step) $102.45 102.45 SMITH, Leroy (Firefighter) $372.14 372.14 STROM, Karl (Firefighter) $2,937.00 - 2,937.00 TODD, Franklin (Firefighter) $427.33 427.33 TONDA, Lila Jean (Widow) - - VACCA, Nick (Lieutenant) $280.94 280.94 WALLS, Kenneth (Firefighter D Step) $127.61 127.61 WALLS, Mercedes (Widow) $96.55 96.55 WALSH, David (Firefighter) $974.51 974.51 WALSH, Patrick(Captain) $899.44 899.44 WEISS, Larry (Battalion Chief) $698.23 698.23 WILLIAMS, Alta (Widow) - - WOOTEN, Maril n E. (Widow $214.29 214.29 . of ,4 5 4 X94 ' 3 . 40 Prior Year Pension/Medical Payments: Total Pension Payments for July, 2006 33,669.09 Total Medical Bills Reimbursed in July, 2006 1.088.05 Total Expenses: Medical/Pension 34,757.14 * Received a 3.7% CPI increase effective July 1 per RCW 41.16.145. 4_SUMMARY 2007 XLS 7/13/2007 41009 FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN JULY, 2007 PAYMENT ,rte , . APAW,141 711601 w" =C • 1= James Ashurst 0.00 2 Charles Goodwin Bartell Drugs 278.41 2 Charles Goodwin Bartell Drugs 138.38 2 Charles Goodwin Bartell Drugs 6.35 2 Charles Goodwin Bartell Drugs 138.38 3 Charles Goodwin Bartell Drugs 6.35 3 Charles Goodwin Bartell Drugs 6.88 574.75 5 Jack Haworth Harbor Drug Co. 26.98 5 Jack Haworth Harbor Drug Co. 39.98 5 Jack Haworth Harbor Drug Co. 21.98 5 Jack Haworth Harbor Drug Co. 79.98 5 Jack Haworth Harbor Drug Co. 21.98 5 Jack Haworth Harbor Drug Co. 79.98 5 Jack Haworth Harbor Drug Co. 39.98 5 Jack Haworth Harbor Drug Co. 21.98 6 Jack Haworth Harbor Drug Co. 12.98 6 Jack Haworth Harbor Drug Co. 49.18 6 Jack Haworth Harbor Drug Co. 15.53 6 Jack Haworth Harbor Drug Co. 21.16 6 Jack Haworth Harbor Drug Co. 49.18 6 Jack Haworth Harbor Drug Co. 6.39 6 Jack Haworth Harbor Drug Co. 73.67 7 Jack Haworth Harbor Drug Co. 14.56 7 Jack Haworth Harbor Drug Co. 21.16 7 Jack Haworth Harbor Drug Co. 4.00 7 Jack Haworth Harbor Drug Co. 8.00 7 Jack Haworth Harbor Drug Co. 4.00 7 Jack Haworth Harbor Drug Co. 20.00 7 Jack Haworth Harbor Drug Co. 8.00 7 Jack Haworth Harbor Drug Co. 4.00 8 Jack Haworth Harbor Drug Co. 4.00 8 Jack Haworth Harbor Drug Co. 4.00 8 Jack Haworth Harbor Drug Co. 59.98 8 Jack Haworth Harbor Drug Co. 4.00 8 Jack Haworth Harbor Drug Co. 20.00 8 Jack Haworth Harbor Drug Co. 8.00 8 Jack Haworth Harbor Drug Co. 4.00 8 Jack Haworth Harbor Drug Co. 4.00 9 Jack Haworth Harbor Drug Co. 8.00 9 Jack Haworth Harbor Drug Co. 4.00 9 Jack Haworth Harbor Drug Co. 20.00 9 Jack Haworth Harbor Drug Co. 4.00 9 Jack Haworth Harbor Drug Co. 4.00 10 Jack Haworth Harbor Drug Co. 8.00 10 Jack Haworth Harbor Drug Co. 8.00 10 Jack Haworth Harbor Drug Co. 4.00 3_2007 FP Medical.XLS Page 1 of 2 7/13/2007 �rr�rrr.r IOW* 1.11100 FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN JULY, 2007 PAYMENT F4, .. .SO t z M 8y °: i; I''41** YIl +ot.`[, CtrkiItit ' OkisaViittofii3iiMe 10 Jack Haworth Harbor Drug Co. 4.00 10 Jack Haworth Harbor Drug Co. 20.00 10 Jack Haworth Harbor Drug Co. 4.00 10 Jack Haworth Harbor Drug Co. 20.00 10 Jack Haworth Harbor Drug Co. 20.00 11 Jack Haworth Harbor Drug Co. 4.00 11 Jack Haworth Harbor Drug Co. 4.00 11 Jack Haworth Harbor Drug Co. 4.00 11 Jack Haworth Harbor Drug Co. 4.00 11 Jack Haworth Harbor Drug Co. 8.00 11 Jack Haworth Harbor Drug Co. 4.00 11 Jack Haworth Harbor Drug Co. 4.00 12 Jack Haworth Harbor Drug Co. 4.00 12 Jack Haworth Harbor Drug Co. 4.00 12 Jack Haworth Harbor Drug Co. 4.00 12 Jack Haworth Harbor Drug Co. 20.00 12 Jack Haworth Harbor Drug Co. 4.00 12 Jack Haworth Harbor Drug Co. 4.00 12 Jack Haworth Harbor Drug Co. 4.00 12 Jack Haworth Harbor Drug Co. 4.00 13 Jack Haworth Harbor Drug Co. 4.00 13 Jack Haworth Harbor Drug Co. 20.00 13 Jack Haworth Harbor Drug Co. 20.00 13 Jack Haworth Harbor Drug Co. 20.00 13 Jack Haworth Harbor Drug Co. 20.00 13 Jack Haworth Harbor Drug Co. 20.00 14 Jack Haworth Harbor Drug Co. 20.00 14 Jack Haworth Harbor Drug Co. 20.00 14 Jack Haworth Harbor Drug Co. 20.00 15 Jack Haworth Twin Harbor Eye Center 141.53 1,266.16 17 John Parks Olympic Drug 6.32 17 John Parks Olympic Drug 57.70 17 John Parks Olympic Drug 9.81 17 John Parks Olympic Drug 15.41 17 John Parks Olympic Drug 19.03 108.27 Karl Strom 0.00 ,*10.40i/=L7# .S'£�h.`kr '._'�' �fi,., '?.✓c � `� `' .<,: ?�s. ,u°,; �w.&L `; ` s #'� pow 3_2007 FP Medical XLS Page 2 of 2 7/13/2007 SEND CLAIM TO: City of Renton Finance Dept.- Fire Pension 1055 South Grady Way Renton, WA 98055 1��ND., CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE 0//09- • DISABILITY RETIREE'S NAME (print) cox t.-e . •-' („„)'C1 f A) ft,/ ----R 3) ADDRESS MI/ //46 ü Ii 4--u6 , (r • 1 -W:i (.(14- , 1CL.0 V4) DISABILITY AT TIME OF RETIREMENT 1' // 641414r-ak e11.et.. teLt- 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) ; ,/ ; or 6) TOTAL AMOUNT OF CLAIM "' 591. 7C 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 fr m the Renton Fire Department. Signatu Note: Supporting documentation must be attached. PAct�E 1 ., /z) I- 7 ,r C-V/1-fZ' %\.. SittA--X: ill" / &4L24\ SAajd' Fahr c A , GO 01) eJ' ti; , I BARTELL DRUGS I BARTELL DRUGS assssss....._Washington's Own Drugstores..�� .Washin on'a Own Drugstores RX# 45- 350910 E DR. GRIFFITH,ALIDA RX# 45- 31052 E DR. LORCH,GERALD DATE: 04/27/07 R (425)899-3123 DATE: 04/29/07 R (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 CARBIDOPA/LEVODOPA 25MG/100M ALLOPURINOL 100MG TABLET(*PA 00093-0293-01 45966515 49884-0602-10 45618026 REFILL 3 QUANTITY 540.00 REFILL YES QUANTITY 30.00 p >,1 BARTELL DRUGS PRICE= $388.99 'j BARTELL DRUGS PRICE= $10.99 �` WITH XPS THE AMOUNT DUE:$278.41 J S 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 WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24.48 HOURS IN ADVANCE L REFILLS 24-48 HOURS IN ADVANCE - 1 BARTELL DRUGS BARTELL DRUGS -s Washington's Own Drugstoressemo sWaskington's Own Drugstores�� RX# 45- 356010 E DR. GRIFFITH,ALIDA mot 45- 356010 E DR. GRIFFITH,ALIDA DATE: 04/27/07 R (425) 899-3123 DATE: 05/21/07 R (425) 899-3123 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGGRENOX CAP 200/25 AGGRENOX CAP 200/25 00597-0001-60 45799515 00597-0001-60 47160466 REFILL 2 QUANTITY 60.00 i 4,6g REFILL 1 QUANTITY 60.00 i ��i�`) BARTELL DRUGS PRICE= $181.99 BARTELL DRUGS PRICE= $181.99 IXJ WITH XPS THE AMOUNT DUE:$138.38 WITH XPS THE AMOUNT DUE:$138.38 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 WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24.48 HOURS IN ADVANCE REFILLS 24-48 HOURS IN ADVANCE k//9/e7- . / ROI lc °Hirt A 66616tzi/ BARTELL DRUGS ..........m..Washington'sOwn Drngstores so RX# 45- 370446 E DR. LORCH,GERALD DATE: 05/21/07 N (425)251-5110 NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 ALLOPURINOL 100MG TABLET (*PA 49884-0602-10 47065266 REFILL 1 QUANTITY 30.00 /s'3 •35 BARTELL DRUGS PRICE= $10.99 b WITH XPS THE AMOUNT DUE:$6.35 BARTELL DRUGS#45 (425)793-1015 4700 NE 4TH STREET RENTON,WA 98059 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE L BARTELL DRUGS ......=......Waahtngton's Own S rugstores RX# 45- 372497 E DR. FLO, GAYLE DATE: 06/04/07 01.25) 251-5110 NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 316/ ATENOLOL 50MG TABLET (*SAN) '7 Q 1141/-- �1 00781-1506-10 48114589 . ---.1111-(7k-1 REFILL NO QUANTITY 30,00 BARTELL DRUGS PRICE= $13.49 WITH XPS THE AMOUNT DUE=$6.88, BARTELL DRUGS#45 '� / (425)793-1015 4700 NE 4TH STREET RENTON,WA 98059 THANKBART57 WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU (( WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR L REFILLS 24-48 HOURS IN ADVANCE 2_ SEND CLAIM TO: City of Renton Finance Dept.- Fire Pension 1055 South Grady Way Renton, WA 98055 G��Y 0� n ,L CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE /6 — 07 07 2) DISABILITY RETIREE'S NAME Jk f l(print) C ��. � !"J�%t � u)Or Gi 3) ADDRESS pc) , epx �" O / l/&14f59 9 4) DISABILITY AT TIME OF RETIREMENT /o or �� Z 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.) 74. G3 � .� l , (6 6) TOTAL AMOUNT OF CLAIM l /1:71/ 53 Cru rp Z5 y� �,7/C:n 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 a the time of my retirement from the Renton Fire Department. Signature: 7,7‘erfirl Note: Supporting documentation must be attached. Nis✓ r✓ a Harbor DrugCo. Presc r rinpdons Harbor Drug Co. Prescriptions 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 WARNING:State or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. WARNING:State or Federal law prohibitsrend transfer of this drug to any person other Than person for whom prescribed RX# 583010 R DR. MORRIS RX# 592963 R DR. KONN HAWORTH,JACK11/7/05 DS HAWORTH,JACK 12/.r1/0�. DS BOX 864,OCEAN SHORES.WA.98551 . ........mm..► BOX 864,OCEAN SHORES,WA 98551 LEVOTHYROXINE 0.1MG LOVASTATIN 20MG PUREPAC QTY#60 NDC#0052 7-1345-10 QTY#30 NDC#00228-2634-50 PUREP $30.34 $26.98 2 REFILLS DISC- $ • 5 REFILLS DISC - .00 PRICE: $26.98 PRICE: $21.98 11 it 1lIl I HII11111i H 1111 II1 I!I III Ii.00 I III II !II! IF!l,II!I I�I ISI ill IiII II 1111111 IiiII IIICH. . Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 RECEIPT Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of this drug to any person other than person for shorn prescribed. �� Harbor Drug CO. Prescriptions 1, 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of this drug le any person other than person for whom prescribed. RX# 594826 N DR. MORRIS HAWORTH, JACK 11!`7/Qa. DS BOX 864,OCEAN SHORES.WA 98551 RX# 598935 R DR. KONN AMIODARONE 200 MG HAWORTH,JACK 1/3/06 DS QTY#30 NDC#00781-1203-05 GENEV I BOX 864,OCEAN SHORES.WA 98,551 -�^ $44.98 NORVASC 5MG MAY REFILL DISC $ I I 1 QTY#45 NDC#00069-1530-72 PFIZR f' VIE�� I II ��IIPRICE: $39.9: : $84.98 /ill III I IIIiIIIIIII MI til (fill II II llii I I. 2 REFILLS DISC; - $5.00 PRICE: $79.9; 316 8th St: Phone Harbor Drug Co. Prescriptions lily//IIIIIdliiliiilllilil��Iililliillill��i�i 1111II1iIIl1i111111{Iii I ii 11111 I Hoquiam, dr.WA 98550 24 Rx Refill(360)538-9978 Harbor Drug Co. Prescriptions WAR NG:Stela or Federal law prohibits transfer of this drugg to any person other Than person for whom prescribed. I - 316 8th St. Phone 360-532-3061 .- Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of this drug to any person other than person for whom prescribed RX# 592963 R DR. KONN HAWORTH,JACK 11/7/05 DS BOX 864,OCEAN SHORES.WA 98551 ' RX#RXt`# 594826 R DR. MORRIS LOVASTATIN 20MG PUREPAC 59 H,JACK 1/3/06 DS QTY#30 NDC#00228-2634-50 PUREP BOX 864,OCEAN SHORES,WA 98551 AMIODARONE 200 MG $26.98 QTY#30 NDC#00781-1203-05 GENEV 6 REFILLS DISC - S PRICE: $21.98 $44.98 11111111,11111111111111111111111111111111111 II II li II I MAY REFILL PRDISC ICE: '.39.98 RECEIPT IIII�1 I!11�1111.11111111111IIlillil 11111111011111111111 1111 I 316 8th St. Phone 360-532-3061 Harbor Drug Co. Prescriptions Harbor Drug Co. Prescriptions Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 I 316 8th St, Phone 360-532-3061 WARNING:State or Federal taw prohibits transfer of this drug to any person other than person for whom prescnbed. , Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. RX# 592963 R DR. KONN RX# 598935 R DR. KONN HAWORTH,JACK .1.112.6. DS BOX 864,OCEAN SHORES.WA 98551 HAWORTH,JACK 11/19/05 LL LOVASTATIN 20MG PUREPAC BOX 864,OCEAN SHORES,WA 98551 NORVASC 5MG QTY#30 NDC#00228 2634 50 PUREP QTY#45 NDC#00069-1530-72 PFIZR $26.98 $84.98 4 REFILLS DISC - $5. 1 3REFILLS DISC- $5.00 PRICE: '.21.98 rat ; PRICE: $79.98 � Iill1!1111111,II1111LI11�i11111 II 11 II1111r1I IIIIII,I III' III 111 IIII 11111111111ly I1�111111011111I111111111111 RECEIPT RECEIPT '12,61e�% kHarbcrug Co. Prescriptions 316 8th S 1Phone 360-532-3061 A Harbor Drug Co. Prescrip ions Hoquiam, 98550 24 Hr.Rx Refill(360)538-9978 WARNING-State or Federal law prohibits transfer of this drug to any person other than person for whom prescribed 316 8th St. Phone 360-532-3061 Hoquiam,WH 98550 24,Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. RX# 592963 R DR. KONN HAWORTH,JACK 2/3/06 JR RXi 607372 N DR. MORRIS BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK 1/�3/006� DS LOVASTATIN 20MG PUREPAC BOX 864,OCEAN SHORES,WA 98551 QTY#30 NDC#00228-2634-50 PUREP FUROSEMIDE 20 MG QTY#60 NDC#00054"4297-31 REF# 06034497670701 $5.00 3 REFILLS DISC- $5.11 $14.95 MHRX COPAY: 'x21.16 NO REFILLS DISC7 PRICE: $12 98 illi r11111I II 11I1111111111IIII 111[11111 I 1 II RI II 0 III I I 1 1 't .11111 11111111111110111111,11111 111''111 lI 1 II 1II0II111111 ! RECEIPT RECEIPT Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 _ wspa—__Y_Y+4wN^Co. Prescriptions , Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 Harbor Drug WARNING Slate or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. 316 8th St. Phone 360-532-3061 w• Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of 1hls drug to any person other than person for whom presorted. RX# 608844 R DR. MORRIS HAWORTH,JACK 2/8/06 DS BOX 864,OCEAN SHORES,WA 98551 -1"1"— '"' RX# 608844 N DR. MORRIS CELEBREX 200MG CAP HAWORTH, JACK 1/23/06 DS QTY#15 NDC#00025-1525-31 SEARL BOX 864,0CEAN SHORES,WA 98551 CELEBREX 200MG CAP REFI 06039d74252502 QTY#15 NDC#00025-1525-31 SFARL MAY REFILL MHRX COPAY. $49.18 REF# 02 MAY REFILL DISC— $5.00 ilr11111111111111111111111111111111111111111 II Il I ; r , II�� MHRX COPAY: t.4 w.18 VHarbor Drug Co. Prescriptions 111!II I►11 ILII IIIII III I III.ISI 1111111111 Il ll1 III �' Hoquiam,316 8th St.WA 98550 24 Hr.Rx Refill(3 0)538-9978 111II1I1 I WARNING.Slurs or Federal law prohibits iranster of this drug to any person other Than person for whom prescribed. RECEIPT . .......memanums, _ Harbor Drug Co. Prescriptions RX# 598934 R DR. KONN in 316 8th St. Phone 360-532-3061 HAWORTH,JACK 2/8/06 DS P Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 BOX�864,OCEANSHORES,WA 98551 "'--�' WARNING.SIate or Federal law prohibits transfer of this drug to any person other than person for whom prescnhed. 1SOSO RBIDE MONO. 30MG. ER QTY#15 NDC#59930-1502-01 RX# 609739 N DR. MORRIS REF# 06039474622900 HAWORTH,JACK 2/3/06 JR NO REFILLS 1 BOX 864,OCEAN SHORES,WA 98551 ••• ••••••••....11rMHRX COPAY $6.39 LEVOTH QTY#0YROXN C#005AG-1345.10 1111 1ll.1 IIII11I1 IIJill111IJI�11I1111111 II.BI Ila 11 , i REF# 06034497544902 $3.36 6 REFILLS DISC - RECEIPT MHRX COPAY: $15.5 Ilii ILII IIIII Ill l.lu 111111111.11.'1I11IL IIi1II III, ' ' rr 316 8th St' .. - �� .Pone 60-5 tons u Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING State or federal law prohrblls transfer of this drug to any person other Nan person for whom prescribed RECEIPT RX# 598935 R DR. KONN HAWORTH,JACK 2/17/06 JR BOX 864,OCEAN SHORES,WA 985551 NORVASC 5MG QTY#45 NDCi00069-1530-72 PFI7R REF# 06048459633802 1 REFILLS MHRX COPAY: $73.67 !Ilii 11111111111111111NI IIIHI1.I11111I111IIIII 11111I1 ; ,, / RECEIPT y9D Harbor Drug Co. Prescript I Harbor Drs..,Co. Prescriptions )� 7. 316 8th St. Phon 360-53 316 8th St. Phone 360-532-3061 - Hoquiam,WA 98550 24 Hr.Rx Refill 978 a Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:SIaIe or Federal law prohibits transfer of this dru to WARNING:State or Federal law prohibits Iransler of this drug to any person other than person lar whom prescribed. g an y person other than person for whom prescribed. RX# 594826 R DR. MORRIS RX# 592963 R DR. KONN HAWORTH,JACK 2/2.7%06 DS HAWORTH,JACK 4/3/06 DS BOX 864,OCEAN SHORES.WA!`8551 BOX 864,OCEAN SHORES,WA 98551 AMIODARONE 200 MG LOVASTATIN 20MG PUREPAC QTY#30 NUC#00781-1203-05 SANDOZ QTY#30 NDC#00228-2634-50 PUREPA REF# 06058440750202 REF# 06093448588600 MAY REFILL 1 REFILLS MHRX COPAY: 14.56 MHRX COPAY: .4.00 111111111111111111 11111111 II 11111.11 I ; '!III! I'I IIIH!I11111111 10 11111 II IIIIII II I I I I II Harbor Drug Co, Harbor Drug Co. Prescriptions Prescriptions 316 8th St. Phone 360-532-3061 - 316 8th St. Phone 360-532-3061 R r whom prescribed Hoquiam,WA 98550 24 Hr.Rx Refitn(360)an person 1538 99 78 WARNING�State orFederalHoquiam, WA prohibits er 0124 Hrthis drug�aR ny personRother h(36O)an person fo53$-99]$ WARNING:State or Federal law prohibits transfer of this drug to any parson other d RX# 59.2963 R DR. KONN RX# 598935 R DR. KONN I6 4/3/0OS HAWORTH,JACK 2/27/06� DS BOX 864,OCEAN HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 LOVASTATIN 20MG PUREPAC NORVASC SMGSHORES,WA 98551 QTY#30 NDC#00228-2634-50 PUREPA QTY#45 NDC#00069-1530-72 PFIZER REF# 06058440861700 REF# 06093448509601 2 REFILLS ,i NO REFILLS MHRX COPAY: $21.16 I MHRX COPAY: 20. IIIIIIIIIIII!IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII!IIIIIIIIIIIIIIIIIIII�II!!1111111 14 ll�� 11111111111111111!I�IIIIIIIlIIIIIIIIIIIIIIIIIIIIIIVIil�lilllllllllllllllllllllllllllllll RECEIPT Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 Harbor Drug Co. Prescriptions Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 IG WARNING:Stale or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING Stale or Federal law prohibits transfer of this drug to any person other than person Ior whom prescribed RX# 609739 R DR. MORRIS HAWORTH, JACK 43/06 ,DS RX# 598934 R DR. KONN BOX 864,OCEAN SHORES,WA 98551 HAVVORTH,JACK LM ,JR LEVOTHYROXINE 0.1 MG BOX 864,OCEAN SHORES,WA 98551 QTY#60 NDC#00527-1345-10 LANNET ISOSORBIDE MONO. 30MG. ER QTY#15 NDC#59930-1502-01 WARRIC REF# 06093448332701 5 REFILLS REF# 06067499234702 MHRX COPAY: $8.1 REFILLSMHRX COPA $4.00 III IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 111011111111 (IIIIII III' (�IE 11i1I 111111II 11III.111111I11!.II II.I I RECEIPT RECEIPT . $ Hoquiam31 Harbor Drug Co. Prescriptions Harbor Drug Co. Prescriptions k 316 8th St. Phone 360-532-3061 6 8th St,WA. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 98550 24 Hr.Rx Refill(360)538-9978 WARNING Aisle or Federal law prohibits transfer of this drug to any person other than person for whom prescribed WARNING:Slate or Federal law prohibits transfer 01 this drop to ace person other Than person Ior whom prescribed. RX# 607372 R DR. MORRIS RX# 598934 R DR. KONN HAWORTH,JACK 3/ JR HAWORTH,JACK 4/20/06 TDS BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 FUROSEMIDE 20 MG ISOSORBIDE MONO. 30MG. ER QTY#60 NDC#00054-4297-31 ROXANE QTY#15 NDC#59930 1502-01 WARRIC REF# 06110496009603 REF# 06067505496003 5 REFILLS 5 REFILLS MHRX COPAY: $8.00 MHRX COPA $4.00 II MIN�I�III1I�II11111111111�IIIIII1010 1111111111111111111111111113111 RECEIPT RECEIPT Harbor Drug Co. Prescription Haor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 316 8th St. Phone 360-532-3061 WARNING'State or Federal law prohibits transfer of this drug to any person other than person for whom prescribed Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING.Stare a Federal law prohibits transfer of this drug to any person other than person for whom prescribed RX# 615186 N DR. KONN RX# 616977 N DR. KONN HAWORTH,JACK 4/20/06 DS HAWORTH,JACK 5/17/06 JR BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 --------"I NITROQUICK 0.4 MG 4X25 NORVASC 5MG QTY#25 NDC#58177-0324-18 ETHEX QTY#45 NDC#00069-1530-72 PFIZER REF# 06110523661501 REF# 06137611074202 NO REFILLS 5 REFILLS MHRX COPAY: $4.01 MHRX COPAY. :.20.00 11. 11 0111111 II IIIIIIINIIIIIIIII ll 11 111 II II 11111111.111111110jIIIIIIIIIII NI , 1 RECEIPT _ RECEIPT �(1 Harbor Drug Co. Prescriptions �o no lL1l IoAVP. ocnngE \w 316 8th St. Phone 360-532-3061 Harbor Drug Co. Prescriptions '-,.. Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 316 8th St Phone 360-532-3061 WARNING:State or Federal law prohibits transfer of this drug to arty person other than person for whom prescribed aHoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 w WARNING:State or Federal law prohibits transfer al this drug to any person olher than parson for whom prescribed • RX# 592963 R DR. KONN RX# 607372 R DR. MORRIS HAWORTH,JACK 5/3/06 DS HAWORTH,JACK 5/22/06 DS BOX 864,OCEAN SHORES,WA 98551 LOVASTATIN 20MG PUREPAC BOX 864,OCEAN SHORES,WA 98551 �� QTY#30 NDC#00228-2634-50 PUREPA FUROSEMIDE 20 MG QTY#60 NDC#00054-4297-31 ROXANE • REF# 06123556935901 NO REFILLS REF# 06142427532902 a MHRX COPAY: $4.01a 4 REFILLS - II II IIIIII III 1111111 01110 II IIIII IIS III 11 IN 1111111.MHRX COPAY: ',8.00 11111111111111111111 III.ill III i Harbor Drug Co. Prescriptions , 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978IEGEIP7 WARNING.State or Federal law prohibits transfer of this drug to any person other man person for whom prescubed. , a Harbor Drug Co. Prescriptions 316 8th St Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 RX# 608844 R DR. MORRIS WARNING:State or Federal law[weans transfer of this drug to any person other than person for whom prescribed. HAWORTH,JACK 5/3/06 DS BOX 864,OCEAN SHORES,WA 98551 CELEBREX 200MG CAP RX# 618056 N DR. KONN QTY#15 NDC#00025-1525-31 PFIZER J HAWORTH, JACK 6/1/06 JR BOX 864,OCEAN SHORES,WA 98551 '-'----". $64.98 N LOVASTATIN 20MG PUREPAC MAY REFILL DISC - a � QTY#30 NDC#00228-2634-50 PUREPA PRICE: 59.9: REF# 06152656162102 II IT 1111 ill II I II1111 III I II II 11 III Ilk ` 11 REFILLS HRX COPAY $4.00 RECEIPT-__ i III II III1111 NII/II NIN IIINII11 Harbor DrugCo. Prescriptions I -NI I� ._ . 316 8th St. Phone 360-532-3061 1 e Harbor Drug Co. Prescriptions Hoquiam,WA 98550 24 Hr.Hx Refill(360)538-9978 316 8th St. WARNING:State or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Henn(360)538-9978 WARNING:Stare or Federal law prohibits transfer of Nis drug to any person other than person for whom prescribed RX# 598934 R DR. KONN HAWORTH,JACK ,5/16/0B PN I RX# 594826 R DR. MORRIS BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK 6/1/06 DS ISOSORBIDE MONO.30MG. ER BOX 864,OCEAN SHORES,WA 98551 QTY#15 NDC#59930-1502-01 WARRIC AMIODARONE 200 MG QTY#30 NDC#00781-1203-05 SANDOZ REF# 06136426043901 4 REFILLS REF# 06152533572800 $4.00 MAY REFILL MHRX COPAY: II' II Emilio I�NIIINIIaIINININIIN II' $ II IIIII MHRX COPAY: .4.00 I II III II III II IIII N No II II I l RECEIPT 1-11-1,-11-11 Harbor Drug Co. PresG-°tions Hart,' Drug Co. Prescriptions \ w 316 8th St. Phone�32-3061 w 316 8th phone(336600)-553382--93907681 360-532-3061 Hoquiam,WA 98550 24 Hr,Rx Refill(3 538-9978 -'� Hoquiamm98550 24 Hr.Rx Refill(360)538-9978 WARNING.Stale or Federal law prohibits transfer of this drug to eny person other than person for whom prescribed WARNING:State or Federal law prohibits transfer of this drug to any person other Man person for whom prescribed. RX# 609739 R DR. MORRIS RX# 598934 R DR. KONN HAWORTH,JACK 6/5/06 DS HAWORTH,JACK 7/24/06 DS BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 LEVOTHYROXINE 0.1 MG ISOSORBIDE MONO. 30MG. ER QTY#60 NDC#00527-1345-10 LANNET QTY##15 NDC#59930-1502-01 WARRIC REF# 06156447737200 REF# 06205414119901 4 REFILLS 2 REFILLS MHRX COPAY: $8.00 MHRX COPAY. $4.00 00 11111Ii1111 1111 II II IIIIIIIYII II II II 11 11111111111111111 III IIIII II11II RECEIPT RECEIPT ," Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of This drug to any person other Than person fon whom prescribed RX# 598934 R DR. KONN HAWORTH,JACK 6/19/06 DS BOX 864,OCEAN SHORES,WA 98551 ISOSORBIDE MONO. 30MG. ER QTY#15 NDC#59930-1502-01 WARRIC REF# 06170431764302 3 REFILLS MHRX COPAY $4.01 II111111111111 II II 1111 II II II II RECEIPT Harbor Drug Co. Prescriptions 316 8th St. - 2-3061 Hoquiam,WA 98550 24 Hr.Rx RePt01 1360 a38-9978 WARNING:State or Federal law prohibits transfer of/his drug to any person other Man person for whom prescribed. RX# 616977 R DR. KONN HAWORTH,JACK 7/5/06 DS BOX 864,OCEAN SHORES,WA 98551 NORVASC 5MG QTY#45 NDC#00069-1530-72 PFIZER REF# 06186422960503 4 REFILLS MHRX COPAY: $20.01 III II II/III 1111111 III 11111111111 1111111111111 II Harbor Drug Co. Prescriptions \• 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of this drug to any person other than person or whom prescribed RX# 618056 R DR. KONN HAWORTH,JACK 7,�,5lllra., DS BOX 864,OCEAN SHORES,WA 98551 LOVASTATIN 20MG PUREPAC QTY#30 NDC#00228-2634-50 PUREPA REF# 06186423453404 10 REFILLS "HRX COPAY: $4.00 li►it411I!r11. lilt I 1111IIIIIIIIIOI 11 N 1111 r P I RECEIPT in I - Harbor DrugCo. ri tions "2(� "-rbor Drug Co. Prescriptions „p :th St. Phone 360-532-3061 316 8th St. Phone 360-532-3061 g itraiiam,WA 98550 24 Hr.Rx Refill(360)538-9978 Hoquiam,WA 98550 24 Hr.Rx Refill 360 538-9978 Stale or ederal law prohibits transfer at this tlmp to any person other than parson for whom presoribed WARNING:SIaie or Federal law prohibIIs trenslor al thin drop to any person other Nan Gerson hr whom presrnbed. RX# 607372 R DR. MORRIS RX# 622624 N DR. RUYLE HAWORTH,JACK 8/11/06 JR HAWORTH,JACK 8/4/06 JR BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 ----. PATANOL OPHTHALMIC SOL. 1% FUROSEMIDE 20 MG QTY#5 NDC#00065-0271-05 NESTLE QTY#60 NDC#00054-4297-31 ROXANE REF# 06223513194902 REF# 06216613352201 6 REFILLS 3 REFILLS MHRX COPAY: $20.01 MHRX COPAY. $8.00 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIILIII III IIIII�IIIII�IIIIIIII ! 01111 IIII 11111011110111011111110111 II '3,1) Harbor Drug Co. Prescriptions RECEIPT g316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 . Harbor Drug Co. Prescriptions WARNING.Stele or Federal law ohibits transfer of Nis dru to any person ether than son hr whom prescribed. 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:Slate or Federal law prohbds transfer of this drug to any person other than person lar whom prescribed. RX# 609739 R DR. MORRIS HAWORTH,JACK 8/4/06 JR BOX 864,OCEAN SHORES,WA 98551 _ RX# 598934 R DR. KONN LEVOTHYROXINE 0.1MG HAWORTH,JACK 8/18/06 JR QTY#60 NDC#00527-1345-10 LANNET BOX 864,OCEAN SHORES,WA 98551 ISOSORBIDE MONO. 30MG. ER REF# 06216613609100 QTY#15 NDC#59930-1502-01 WARRIC 3 REFILLS REF# 06230462477104 MHRX COPAY $8.00 1 REFILLS • III II ll ll IIII IIII II Ilillll II 11 II 1111 1 III MHRX COPAY: $4.00 Harbor Drug Co. Prescriptions II I I III I I II I liiiil II'II II 911IILi�!!IIIIIIIIIII 1 �t 316 8th St. Phone 360-532-3061 Harbor Dru rescriptions Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 g Co.■ WARNING.Slate or Fedemt law prohibits transfer a this drug to any person other than person forho wm prescribed. 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 21:d 4 Hr.Rx Ref III(360)538-9976 WARNING.Stale or Federal law prombha transfer of this drug to any person other than person for wham prescribed RX# 618056 R DR. KONN HAWORTH,JACK , 8/4/0Q JR RX# 616977 R DR. KONN BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK 8/18/06 JR LOVASTATIN 20MG PUREPAC ) BOX 864,0CEAN SHORES,WA 98551 QTY#30 NDC#00228-2634-50 PUREPA NORVASC 5MG I, QTY#45 NDC#00069-1530-72 PFIZER REF# 06216613694000 9 REFILLS REF# 06230462583800 II II MHRX Ii If COPAY $4.00 3 REFILLS III, 11111111E III II I11III�IIIIIOIIIIIIIIIIIIIII I I II MHRX COPAY: $20.00 Harbor Drug Co. Prescriptions III IIIIIIII III II II II II 11111111111111 316 8th St. Phone 360-532-3061 HogUiam,WA 98550 24 Hr.Rx Refill(360)538-9978 i WARNING:Stale or Federal law prohibits transfer of Ihis drug to any person ocher than person for whom prescribed. RECEIPT I Harbor Drug Co. Prescriptions 1 316 8th St. Phone -301 RX# 622185 N DR. MORRIS Hoquiam,WA 98550 24 Hr.Rx Refill(360) 360-532 538-99768 8/4/06 JR WARNING:State or Federal law prambrtstransfer at tMs drug to eay person other than parson for whom prescribed. HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551 AMIODARONE 200 MG QTY#30 NDC#00781-1203-05 SANDOZ RX# 623117 N DR. MORRIS HAWORTH,JACK 8/18/06 .JR REF# 06216614057802 BOX 864,OCEAN SHORES,WA 98551 NO REFILLS DIOVAN 160MG MHRX COPAY• $4.00 QTY#30 NDC#00078-0359-34 NOVART 1111111111111111111' IIN1IIIIIIIII1II I i REF# 06230692123203 11 REFILLS RECEIPT MHRX HRX C'PAY• $20.00111111111111111111111111111111 I Pike t oRECEIPT maatr_. +' Harbor Drug Co. Prescripts ``'ow \M: 316 8th St. Phone 360-532-3061 Harbor Drug Co. Presiis Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 ti. 316 8th St. Phon 60-532- 61 WARNING:Stale or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. Hol idem,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING.SIate or Federal law prohibits bander of this drug to any person other than person for whom prestnbed RX# 618056 R DR. KONN RX# 624920 R DR. MORRIS HAWORTH,JACK 8/31/06 DS 10/16/06 DS BOX 864,OCEAN SHORES,WA 98551 —' HAWORTH,JACK LOVASTATIN 20MG PUREPAC BOX 864,OCEAN SHORES,WA 98551 "e------"' QTY#30 NDC#00228-2634-50 ACTAV LISINOPRIL 10 MG QTY#30 NDC#00093-1113-10 TEVA U REF# 06243541566100 8 REFILLS REF# 06289448616203 MAY REFILL MHRX COPA $4.00 MHRX COPAY: '4.00 IIIIIIIIII IIIIIIIIIIIIIIIIIIIi111111IIIII IIIIIIIII11111 III IIIIIIII ' II III II it l l til l l l 11 II III I II II II 11 II II II RECEIPT _ Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 I Harbor Drug Co. Prescriptions Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING Stale or Federal law prohibits transfer of this drug to any person other than person for whom prescribed k 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer of this drug to any person other Than person for whom prescribed RX# 607372 R DR. MORRIS HAWORTH,JACK 10/16/06 DS RX# 624873 N DR. KONN BOX 864,OCEAN SHORES,WA 98551 �� HAWORTH,JACK .9/1 6JR FUROSEMIDE 20 MG BOX 864,OCEAN SHORES,WA 98551 QTY#60 NDC1"r00054-42y7-3 i t2OXANr ISOSORBI MON ER 30MG.-ETHEX QTY#15 NDC#58177-0222-04 ETHEX REF# 06289448785403 2 REFILLS _ REF# 06257572698100 II Hill ill I'C'f HER NPAY: 8.O iw NO REFILLS MHRX COPAY $4.00 II Il ill iilii Ill/lull IIIIU i Illulll l��Illllnlllllll 111111 El 111 11 111111111 Hill fill 1111 it ii 111111 it .71 316 8th St.Harbor Drug Co. Prescriptions t , Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING.State or Federal law prohibits transfer of thrs drug to any person other than person for whom prescribed eacretor-3,/, Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 RX# 624873 R DR. KONN WARNING:State or Federal law prohibits transfer of this drug to any person other than parson for whom prescribed. HAWORTH,JACK 1% DS IBOX 864,OCEAN SHORES,WA 98551 ISOSORBI MON ER 30MG.-ETHEX RX# 624920 N DR. MORRIS QTY#15 NDC#58177-0222-04 ETHEX HAWORTH,JACK 9/18/06 DS BOX 864,OCEAN SHORES,WA 98551 REF# 06289448888801 LISINOPRIL 10 MG 7 REFILLS QTY#30 NDC#00093-1113-10 TEVA U MHRX COPAY: $4.01 REF# 06261675780101 II II HI 11 III 1111111 ill I II II II II ll it MAY REFILL ' MHRX COPAY $4.00 ' RECEIPT 11 1111111111111 11111111111 111111 I 1 I Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 RECEIPT Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING.Srate or Federal law prohibits transfer of Ns drug to any person other than person for whom prescribed RX# 627128 N DR. MORRIS 0/17/06 DS HAWORTH,JACK 1__ BOX 864,OCEAN SHORES,WA 98551 IBUPROFEN 600MG QTY#90 NDC#49884-0778-05 PAR REF# 06290516581700 MAY REFILL MHRX COPAY $4.00 II II IIIlli I til II IIII II ll It II ll it IMI ` RECEIPT 7TJ ll I Harbor Drug Co. Pr.riptions Ham Drug • Co. Prescriptions • li 316 8th St. Pho 360-532-3061 ,, r. Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 \£ 316 8th St. Phone 360-532-3061 WARNING Stats Of Federal law prohibits transfer of this drug to any person other than person for whom prescribed. WARNING. Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING.Slate or Federal law prohibits transfer of this drug to any person oilier than person on wham prescribed RX# 618056 R DR. KONN RX# 618056 R DR. KONN HAWORTH, JACK 11/1/06 DS 11/28/06 DS BOX 864,OCEAN SHORES,WA 98551 ^ HAWORTH,JACK `_w LOVASTATIN 20MG PUREPAC BOX ssa,ocEAN SHORES,WA 98551 QTY#30 NDC#00228-2634-50 ACTAV LOVASTATIN 20MG PUREPAC QTY#30 NDC#00228-2634-50 ACTAV REF# 06305578544701 REF# 06332446203903 6 REFILLS 5 REFILLS MHRX COPAY: $4.00 MHRX COPAY: $4.00 II II IIIII Ili VIII 11VIIVI1111111 II 1111111 I II 111111111111111111110111111 II 111111 RECEIPT RECEIPT imilidar i Harbor Drug Co. Prescriptions I Harbor Drug Co. Prescriptions 316 8th St Phone 360-532-3061 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 HaWA 98550 24 H.Rx Refill(360)538-9978 WARNING:Stale or Federal law prohibits transfer of this drug to any person other than person for whom prescribed. WARNING:State orqFederelulamla,w prohibits transfer of this drug rto any person other than person for whom prescribed. RX# 624920 R DR. MORRIS RX# 622272 R DR. MORRIS HAWORTH,JACK ;I:j1 13/0A DS HAWORTH,JACK11/28/06 DS BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 _—' LISINOPRIL 10 MG AMIODARONE 200MG QTY#30 NDC#00093-1113-10 TEVA U QTY#30 NDC#49884-0458-05 PAR REF# 06317432382702 REF# 06332446120101 MAY REFILL 5 REFILLS MHRX COPAY: $4.00 MHRX COPAY a S I Illi I111111111111110 MIMI III1111111II H 11 111111111 III 1111111'01011 hill 111111 1 Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 RECEIPT WARNING SIHmgFedeal la prom9855,9ro24 Hr.Rxany Rx�Refill erson other t(350)538n person for m 9978 pprescribedI Harbor Drug Co.'Prescriptions `•: 316 8th St. Phone 360-532-3061 , Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:State or Federal law prohibits transfer At this drug to any person other than person for whom prescribed. RX# 624873 R DR. KONN HAWORTH,JACK 11/13/06 DS RX# 631085 N DR. MORRIS BOX 864,OCEAN SHORES,WA 98551 12/15/06 JR ISOSORBI MON ER 30MG.-ETHEX HAWORTH,JACK QTY#15 NDC#58177-0222-04 ETHEX BOX 864,OCEAN SHORES,WA 98551 LISINOPR TAB 10MG IVA 1000 REF# 06317432462501 QTY#30 NDC#00172-3759-80 IVAX P 6 REFILLS MHRX REF# 06349465737103 1 IIIIIIIIIIIIIIIII1111111111111111111I11IIII111111111111IIIIIIIII1111111111I111111111I11 $4 00 MAY REFILL III I I I MHRX COPAY: ;4.00 I Iii 111111111111III1111,11IIII11111111111 A, Harbor Drug Co. Prescriptions Harbor Drug Co. Prescriptions 316 8th St. a 316 8th St. Phone 360-532-3061 Hoquiam,8th S WA 98550 24 Hr.Rx Refill 81I Phone(360) 532-3 Hoquiam,W.4 98550 24 Hr.Rx Refill(360)538-9978 WARNING Slate or Federal law WARNING Slate or Federal law prohibits transfer of this drug to any person otherthan person for whom prescribed prohibits transfer of this drug to any person other than person for whom prescribed RX# 624873 R DR. KONN RX# 616977 R DR. KONN HAWORTH,JACK 12/15/06 JR HAWORTH,JACK 11/17/06 JR BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 —' ISOSORBI MON ER 30MG.-ETHEX NORVASC 5MG QTY#15 NDC#58177-0222-04 ETHEX QTY#45 NDC#00069-1530-72 PFIZER REF# 06349463435005 REF# 06321444917903 5 REFILLS 1 REFILLS MHRX COPAY: $4.00 MHRX COPAY $20.00 111111111 II I III t1111111 II1111II11111111100 II 1111 III IIIIIIIIIIIIIIIIIIilIIIIII II II ll IIIIIII Nil RECEIPT -RECEIPT Pik 1'� mold, • • Harbor Drug Co. P °riptions 316 8th St. Ph360-532-3061 , Harba Drug Co. Prescriptions Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978k 316 8th St. Phone 360-532-3061 WARNING:Stale or Federal law prohibits Rooster al this drug to any person other than person for shorn prescribed Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING•Stale or Federal law prohibits Iranslar of this drug to any person other than person for whom prescribed RX# 627128 R DR. MORRIS HAWORTH,JACK 12/18/06 DS RX# 634652 R DR. MORRIS BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK 2/28/07 DS IBUPROFEN 600MG BOX 864.00EAN SHORES,WA 98551 QTY#90 NDC#49884-0778-05 PAR LUNESTA 2 MG QTY#30 NDC#63402-0191-09 SEPRAC REF# 06352467000402 MAY REFILL REF# 07059455783402 MHRX COPAY: $4.00 NO REFILLS III II 1111111111111111111 III (IIIIIIIIII I MHRX COPAY: $20.00 II 11 111111 1111111 1111 III I 111E01111 1 RECEIPT a su..� RECEIPT Harbor Drug Co. Prescriptions 316 8th St Phone 360-532-3061 Harbor Drug Co. Prescriptions Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 r' 1 316 8th St. Phone 360-532-3061 WARNING.State or Federal lawprohrbrls transfer of this drug to any person other than person for whom prescribed Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING.State or Federal law prohibits transfer of this drug to any person other than person for whom prescnbed RX# 616977 R DR. KONN HAWORTH,JACK 12/18/06 DS RX# 622624 R DR. RUYLE BOX 864,OCEAN SHORES,WA 98551 ��. 2/28/07 DS NORVASC SMG HAWORTH,,0CEJACK BOX 864,OCEAN SHORES,WA 98551 QTY#45 NDC#00069-1530-72 PFIZER PATANOL OPHTHALMIC SOL. 1% QTY#5 NDC#00065-0271-05 NESTLE REF# 06352466899804 NO REFILLS REF# 07059455847202 MHRX COPAY: $20.01 5 REFILLS 1111'111111111111111(IIIII II III III III 1111E 111 I MHRX COPAY: $20.00 II 11 IIIII IN Ill 11111111111 11�11 II Il l I RECEIPT C RECEIPT Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING.Stale or Federal law prohibits transfer of this drug to any person other than person for whom prescribed RX# 634652 N DR. MORRIS HAWORTH,JACK 2/6/07 DS BOX 864,OCEAN SHORES,WA 98551 LUNESTA 2 MG QTY#30 NDC#63402-0191-09 SEPRAC REF# 07037497534501 1 REFILLS MHRX COPAY. $20.00 II .1 lr 1111 11 11 1 I I IIIII II II II II III 51 Harbor Drug Co. Prescriptions 316 8th St. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING Stale or Federal law prohibits transfer of this drug to any person other than person for whom prescribed RX# 635326 N DR. MORRIS HAWORTH,JACK 2/15/07 DS BOX 864,OCEAN SHORES,WA 98551 NORVASC 5MG QTY#45 NDC#00069-1530-72 PFIZER REF# 07046538965701 MAY REFILL MHRX COPAY: 20.00 III 111111111 Hill 111111111111111110111.10010 -Pki6 (3 RECEIPT — — _i Harbor Drug Co. Prescriptions 316 8th S?. Phone 36 532-3061 :11 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 WARNING:$fele or Federal law prohibits tmnsler of this drug to any person other Men Peron lot Mom prescribed RX# 622624 R RUYLE, S., MD HAWORTH, JACK 05/01/07 DS BOX 864,OCEAN SHORES,WA 9855f-----. PATANOL OPHTHALMIC SOL. 1% QTY#5 NDC#00065-0271-05 NESTLE REF#07121425687303 4 REFILLS MHRX COPAY: $20.00 IIII11N 1l1IIlIIIIIIIIUIiilI1liIIIIIIIII1I1IIIIIIl1 Harbor Drug Co. Prescriptions 316 8th St Phon360-532- Hoquiam,WA 98550 24 Hr.Rx Refille(360)538-93906178 WARNING:State or Federal law prohibits transfer of this drug to any person other than person lot whom prescribed. RX# 636243 R RUYLE, S., MD HAWORTH,JACK 05/01/07 DS BOX 864,OCEAN SHORES,WA 98551`1 AZOPT 5ML QTY#5 NDC#00065-0275-05 NESTLE REF#07121425867703 5 REFILLS MHRX II IIIIliII!I!IIIIIIIlhIIIIIIIll1II1IIIililIIIIIIIII�IIII�II�II�I��II!IIIIII�IIIIiJIIIII COPAY: $20.00 1 . RECEIPT — R-a. Ns ao id. in MI. e� Harbor Drug Co. Prescriptions = 316 8th St. PhonR 360-532-3061 Hoquiam,WA 98550 24 is r.Rx fill{360)538-9978 WARNING:Stafe or Federal law prohibits truster of Ibis drug fe any person other then person for whom prescribed. RX# 642295 N MORRIS, R., MD HAWORTH, JACK 05/23ffl DS BOX 864,OCEAN SHORES,WA 98551 PATANOL OPHTHALMIC SOL. 1% QTY#5 NDC#00065-0271-05 NESTLE REF#07143503900501 6 REFILLS MHRX COPAY: '.20.00 III III I IIIIIIIil 11111 l illi I III IIIIIII1101l ill MIMI I IIIII I RECEIPT pA i+ • 02/26/07 141.53 0.00 0.00 141 .53 Please Pay This Amount Date Patient Proce... Description Amount 01/17/07 Haworth, Jack 92012 Est Int Ophthal 79. 00 01/17/07 Haworth, Jack 92135 Heidelberg 50. 00 01/17/07 Haworth, Jack 66821 Yag Laser Capsulot' y 250. 00 02/14/07 Haworth, Jack Medicare Part B - Washington- -26. 44 02/14/07 Haworth, Jack Payment - Medicare Part B - -211.03 Late Fee: Insurance Pending: 0. 00 Patient Owes: 141.53 IF YOU PREFER TO PAY BY CREDIT CARD, PLEASE FURNISH THE FOLLOWING& RETURN THIS PAGE Name: o Visa 0 Mastercard Expiration Date: Card# Authorized Signature: rd/16-41 /0 I:6 ,1 Q7## vn g-- 9- ° `7f -- 9- n s Lff6 JACK E.HAWORTH 3474 xaxe� %uGFLLAN•vE NSA O %BN ' OCEwN/SH011E9 °^7 3-67-:"7 is • V ,ate e:: 4325170751o: 05 02420 2b^ 3474 /0000014153; 03/15/2007 3474 $141 53 PLEASE RETURN TOP PORI ION'WITH YOUR PAYMENT,RETAIN BOTTOM PORTION FOR YOUR RECORDS LCS101MC-BK %so SEND CLAIM TO:4400 City of Renton Finance Dept.- Fire Pension 1055 South Grady Way Renton, WA 98057 OY O,-.% I -- - °� CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE C...1 (l� Y / ;1-6 0 7 2) DISABILITY RETIREE'S NAME (print) Nvi 4, / .yl 4., f fk_S 3) ADDRESS / 35 e-•_,.1 4U , f i 9 L-Q f2g y j, Wa, / 't 3 es 4) DISABILITY AT TIME OF RETIREMENT S' 6 id i / re I P .. U - C -,1 i't 4 `Di I- ti&rn% 'I 2 n A -Yt x e 67 Pe-e5 b 1 em s 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.) • - 4 ► . /i • J t _f if. 1 . 1 ' 6) TOTAL AMOUNT OF CLAI//o � 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: 4,41 ,9., Note: Supporting documentation must be attached. Pk i(. t.. • NNW NW* Value et the smiling 13' YIrIPIC DRUG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS 8x# 656905 For: JOHN PARKS 5.29.07 CRN.02075499572711 1335 3RD AVE#109 LONGVIEW,WA 98632 (3601 577-6684 LACTULOSE SOL 10G/15ML #1400 NBC: 60432-0037-32 DR. RICHARDS,JOHN E ZHA COPAY: $6.32 II l!MHIIIIIIII lilt 11 1111 II II 1111111111 liii Price J Value at the smiling'0' '13t51'YMPIC DRUG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# 687681 For: JOHN PARKS 6-04-07 CR5-00075556213891 1335 3RD AVE#109 • LONGVIEW,WA 98632 (360) 577-6684 PRILOSEC OTC 20MG TAB' #84 NDC: 37000-0455-03 DR. RICHARDS,JOHN E ZHA COPAY: $57.70 1111111111111111111111111111111111111111111, Price J Value at the emiling'0' pKDRuG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# C687675 For: JOHN PARKS 6-04-07 CRN-34075559411611 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ALPRAZOLAM 0.5MG TAB #120 NBC:DR. RICHARDS,JOHNE00781-1077-05 ZHA COPAY: $9.81 111111111 11111 III 1111111 11111111111 11111 11 Price Value et the amiling'0' int) 'YMPIC®RVG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# 687677 For: JOHN PARKS 6-04-07 CRN 01075556220571 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 MIRTAZAPINE SOLTAB 45MG 30 NBC:RICHARDS3-0712-30 ,JOHN DR. ZHA COPAY: $15.41 II II 111111 liii 1111111111111111111 III III 111 Price J istp, Vein.at the smiling'0' �IIIPK DRUG RECEIPT FOR 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE OR TAX RECORDS INSURANCE Rx# C687682 For: JOHN PARKS 6-04-07 CRN A9075559417101 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ZOLPIDEM TAB 10MG #30 NDC: 60505-2605-08 DR. RICHARDS,JOHN E ZHA COPAY: $19.03 111111111 1111111111111 11 11 11 11 III 111111111 Price FA- I *441, Nero (cY 0 ADMINISTRATIVE, JUDICIAL, AND f, LEGAL SERVICES DEPARTMENT Office of the City Clerk MEMORANDUM DATE: July 13, 2007 TO: Members, Firemen's Pension Board FROM: Bonnie Walton, City Clerk/Board Secretary & Member SUBJECT: Cost of Living Increase Payable July 2007 - Widows Washington State Law (RCW 41.18.104) requires that the Firemen's Pension Board meet each year for the purpose of adjusting benefit allowances for widows of firemen pensioned prior to the LEOFF Act (March 1970). The Board must determine benefits according to the increase in the Consumer Price Index for the previous calendar year for the Seattle, Washington, area as compiled by the Bureau of Labor Statistics of the United States Department of Labor. The Bureau has updated its form for this year and has reported a 3.7% annual increase in the CPI percentage for All Urban Consumers in the Seattle area for 2006. A copy of the report is attached. I recommend that the Board adopt the 3.7% increase, effective July 1, 2007, and paid July 31, 2007. cc: Michael Bailey, FIS Administrator 411Elb. Bureau of Labor Statistics Data Page 1 tow too U.S. Department of * - Labor •••' th..11 uz•-$,,,sz. Bureau of Labor Statistics Bureau of Labor Statistics Data WIA" biSki ti Advanced SearchA-Z index BLS Kerne I PrOfitee:s:471;urve.y4 Ge_tPetAkleftStet4tzl."c_S I ..0_105,,e.erY What's New 1,,Eindlt1in,,D, 0,1- Change Output From: 1997 To: 2007 Options: RI include graphs NEW! 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