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Home My WebLink AboutFinal Agenda Packet '`✓ *two CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room Thursday, September 18, 2008 2:00 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF AUGUST 21, 2008 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO AUGUST 31, 2008 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT 'Norr wry MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON August 21, 2008 Denis Law, 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 2:02 p.m. in the Mayor's Conference room, 7th floor of Renton City Hall. In attendance were Board members Don Persson, Ray Barilleaux and Bonnie Walton. Also present: Jill Masunaga, Finance Representative. MINUTES APPROVAL MOVED BY PERSSON, SECONDED BY BARILLEAUX, THE PENSION BOARD APPROVE THE MINUTES OF THE JULY 17, 2008, MEETING. CARRIED. MONTHLY STATEMENT The financial report as of July 31, 2008, was reviewed. Total cash/investment balance was $4,568,402.03. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY PERSSON, SECONDED BY BARILLEAUX, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR AUGUST 2008, IN THE TOTAL AMOUNT OF $42,947.95 TO BE PAID FROM THE FIREMEN'S PENSION FUND. CARRIED. UNFINISHED BUSINESS The passing of LEOFF I members Roger Newton and Kenneth Walls was reported. Death and widow benefits will be processed as appropriate. ADJOURNMENT MOVED BY PERSSON, SECONDED BY BARILLEAUX, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 2:05 p.m. 13061 •11• (Jaltd? Bonnie I. Walton, City Clerk Member and Secretary, Firemen's Pension Board i CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF AUGUST 31, 2008 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 F. 122008 ❑2007 5 --- co 11- 0 "6 g 3 0 i. 2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - CURRENT 2008 2008 LAST YEAR 2007 2007 ACTIVITY: MONTH YTD ADJ BUDGET CURR MO ACTUAL ADJ BUDGET BEGINNING CASH/INV BALANCE $4,568,402.03 $4,694,232.48 $4,203,347 $4,503,940.09 $4,672,241.19 $4,459,523 RECEIPTS: Fire Insurance Premium Tax 0.00 85,949.42 75,000 0.00 85,061.56 73,000 Investment Interest 1,433.89 104,490.96 200,000 3,221.02 389,226.86 175,000 DISBURSEMENTS: Fire Pension 41,475.14 345,645.45 552,400 34,695.56 427,011.96 463,500 Fire Pension Medical 1,263.90 6,127.53 20,000 596.87 9,059.17 20,000 i Office/Operating Supplies 372.78 372.78 459 0.00 450.00 450 Actuarial/Firemen's Pens 0.00 0.00 0 0.00 7,550.00 12,000 Reimb General/Clerical&Acct 829.00 6,632.00 9,948 686.00 8,226.00 8,226 ENDING CASH/INV BALANCE $4,525,895.10 $4,525,895.10 $3,895,540 $4,471,182.68 $4,694,232.48 $4,203,347 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $675,451.72 $717,958.65 $265,470.41 $298,227.82 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 3,206,796.27 3,206,796.27 3,651,388.97 3,651,388.97 INTEREST ACCRUED 89,323.81 89,323.81 TOTAL CASH AND INVESTMENTS $4,525,895.10 $4,568,402.03 $4,471,182.68 $4,503,940.09 The State Investment Pool interest 2.3328% 2.2758% 5.2265% 5.2053% i I-I•\GIMANIr \FIMIPI AM\FIRFPFM1 Firp Pancinn 7nOR xls\Ai,00s Pape 1 9/12/2008 err FIREMEN'S PENSION BOARD '441.✓ PENSION/MEDICAL PAYMENTS FOR SEPTEMBER, 2008 a i4SA :(6 . iR0.01 iieTit. ':,`;.:..:. P,erisio ►tett; , ,Medicals`.;.. . z lotal.r', ,. ANKENY, Charlie(Captain) $90.81 90.81 ASHURST, James (Assistant Chief) $4,569.00 505.39 5,074.39 BANASKY, George(Captain) $1,502.59 1,502.59 BARILLEAUX, Ray(Battalion Chief) - - BEATTEAY, Karlen (Widow) $192.17 192.17 BERGMAN, Claudette (Widow) $118.24 118.24 CHRISTENSON, Chuck(Firefighter) $523.58 523.58 CONNELL, Robert(Captain) $678.13 678.13 GEISSLER, Dick (Fire Chief) $641.73 641.73 GOODWIN, Charles (Captain) $4,010.50 - 4,010.50 GOODWIN, Donald (Firefighter) $1,277.48 1,277.48 HAWORTH, Constance (Widow) $2,792.83 2,792.83 HAWORTH, Jack(Firefighter) $3,025.00 - 3,025.00 HENRY, William, Jr. (Captain) $1,805.36 1,805.36 HURST, Gerald (Firefighter) $488.91 488.91 JONES, Evelyn M. (Widow) $208.91 208.91 LARSON,William (Firefighter) $222.80 222.80 LAVALLEY, Theodele(Captain) $306.38 306.38 MATTHEW, James (Deputy Chief) $193.70 193.70 MC LAUGHLIN, JACK(Battalion Chief) $1,601.18 1,601.18 NEWTON, Gary(Lieutenant) $226.76 226.76 * NEWTON, Roger(Firefighter) $500.00 500.00 NICHOLS, Gerald (Battalion Chief) $467.89 467.89 PARKS-ANDREASON,Arlene (Widow) $284.16 284.16 PARKS, John (Firefighter) $3,139.50 49.12 3,188.62 PHILLIPS, Bruce H. (Deputy Chief) $909.45 909.45 PRINGLE,Arthur(Captain) $421.16 421.16 PRINGLE, S.Joan (Widow) $2,399.37 2,399.37 RIGGLE, David E. (Firefighter D Step) $49.58 49.58 RUPPRECHT, Jim (Firefighter D Step) $83.02 83.02 SMITH, Leroy(Firefighter) $363.04 363.04 STROM, Karl (Firefighter) $3,025.00 108.71 3,133.71 TODD, Franklin (Firefighter) $420.32 420.32 TONDA, Lila Jean (Widow) $531.29 531.29 VACCA, Nick(Lieutenant) $265.10 265.10 * WALLS, Camille (Widow) $608.43 608.43 WALLS, Mercedes (Widow) $729.93 729.93 WALSH, David (Firefighter) $1,322.07 1,322.07 WALSH, Patrick(Captain) $902.97 902.97 WEISS, Larry(Battalion Chief) $1,354.42 1,354.42 WILLIAMS, Alta (Widow) - - WOOTEN, Marilyn E. (Widow) $200.10 200.10 00 '' 0:Ct:*pe ices' Pet slonJMed1ca1 0444018000466047: 43; 16>O8 * Received funeral expenses of$500.00 per RCW 41.18.140. Prior Year Pension/Medical Payments: Total Pension Payments for September, 2007 34,695.56 Total Medical Bills Reimbursed in September, 2007 1,019.11 Total Expenses: Medical/Pension 35,714.67 4_SUMMARY 2008.XLS 9/12/2008 FIREMEN'S PENSION BOARD MEDICAL BS TO BE REIMBURSED IN SEPTEMBEF08PAYMENT !''�.'�`��.'��w6�/� -Amount of Bill 2 James Ashurst Safeway 102.15 2 James Ashurst Safeway 192.80 2 James Ashurst Safeway 10.90 2 James Ashurst Safeway 102.15 2 James Ashurst Safeway 82.54 2 James Ashurst Safeway 14.70 505.39 Charles Goodwin 0.00 Jack Haworth 0.00 4 John Parks Olympic Drug 14.11 4 John Parks Olympic Drug 2.41 4 John Parks Olympic Drug 8.28 4 John Parks Olympic Drug 7.84 4 John Parks Olympic Drug 18.48 49.12 6 Karl Strom Sam's Club 3.00 6 Karl Strom Sam's Club 8.00 6 Karl Strom Sam's Club 5.41 7 Karl Strom Sam's Club 10.00 7 Karl Strom Sam's Club 56.84 7 Karl Strom Sam's Club 25.46 108.71 ; 4..* Nome SEND CLAIM TO: '44se City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 OtiVY ot CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE Sept- 10 - -2008 2) DISABILITY RETIREE'S NAME (print) James.. F_ Ashurst 3) ADDRESS 223 Garden. Ave N #8 Renton Wa_ 98057 4) DISABILITY AT TIME OF RETIREMENT HYPERTENSTON 1H-B-P- 5) DESCRIPTION OF CLAIM: (Supporting documentation must be attached.) (Effective 4/1/2008,pre-LEOFF retirees may submit all prescription drug expenses for reimbursement, whether or not related to the retirement disability,provided that the expense is not covered by another plan,source or insurance coverage. Supporting documentation for all must be attached.) For above proh1 ms 6) TOTAL AMOUNT OF CLAIM: $ 505_ 3 9 Amount of total claim (above) that is related to the Retirement Disability: $ 422885 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 any charges other than prescription drug charges, are related to my disability as determined at the time of my retirement from the Renton Fire Department. Signature: ' y- G Note: porting documentation must be attached. TKA 1 iTriffitiACY AMAIDWS ACY RENTON,WA 98055 RENTON,WA 98055 icbli) (425)226-0325 #(510 (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. GRAVES,DANIEL [NW] DR. GRAVES,DANIEL [RF] 17900 TALBOT RD S, STE 101 17900 TALBOT RD S,STE 101 RENTON,WA 98055 RENTON,WA 98055 Rx:6710376 Jul 03, 2008 Safety Cap: Yes Rx:6710376 Aug 10, 2008 Safety Cap: Yes PANTOPRAZOLE 40MG TAB (PRAS)Qty: 30 TAB PANTOPRAZOLE 40MG TAB (PRAS)Qty:30 TAB Generic for:PROTONIX 40MG TAB Generic for:PROTONIX 40MG TAB Ref:A2085858530351 NDC:00008-0607-01 BRA) Ref:A9086230271511 NDC:00008-0607-01 BBA! REGENCE BLUESHIELD WASH Cash Price: 134.49 REGENCE BLUESHIELD WASH Cash Price: 134.49 Amount Due: $102.15 Amount Due: $102.15 II II II II II II IIIIII I I I I I II III II Rx REFILL @ SAFEWAY.COM PRESCRIPTIONS I)II II II II I)IIIIII fi I I I II III II REFILL f SAfEWAY.COM PRESCRIPTIONS I DPSIMMACY 2MATDPSWIACY RENTON,WA 98055 RENTON,WA 98055 #(510 (425)226-0325 #(510 (425)226-0325 Official Heceipt- Please retain for tax or insurance Official Receipt- Please retain for tax or insurance ,,ix :,,` f vii-N`) (425)255-6154 ASHURST,JAMES (425)255-6154 ARDEN •VE N. 12/17 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 RENTON,WA 98055 DR. GRAVES,DANIEL [RF] DR. GRAVES,DANIEL [RF] 17900 TALBOT RD S,STE 101 17900 TALBOT RD S, STE 101 RENTON,WA 98055 RENTON,WA 98055 Rx:6701701 Jul 08, 2008 Safety Cap: Yes Rx:6706816 Aug 18, 2008 Safety Cap: Yes LIPITOR 40MG TAB (PFIZ) Qty: 50 TAB HUMULIN N VIA (LILL) Qty: 20 ML Ref:A5085905477591 NDC:00071-0157-23 BBA! Ref:A2086310453461 NDC:00002-8315-01 HSOITC I REGENCE BLUESHIELD WASH Cash Price: 240.49 REGENCE BLUESHIELD WASH Cash Price: 89.98 Amount Due: $192.86 Amount Due: $82.54 II II II II VII IIIIII I I I I I II III II Rx I REFILL YOUR SAFEWAI COM PRESCRIPTIONS III II II II I i I 01101 1I'I'l'I IIRx EF@ YOUR SAFEWAY.COM TIONS w sA �w .. 2 I4 1DP PMACY 2D'b'' mmt 3 BgIffMACY RENTON,WA 98055 RENTON,WA 98055 /00 (425)226-0325 #00 (425)226-0325 Official Receipt- Please retain tor tax or insurance Official Receipt- Please retain for tax or insurance ASHURST,JAMES (425)255-6154 _,"“,ii)t ' #' ' -`` (425)255-6154 223 B GARDEN AVE N. 12/17 3 B GARDEN AVE N. 12/17 RENTON,WA 98055 RENTON,WA 98055 DR. GRAVES,DANIEL [RF] DR. ARLEIN,WES J. [NW] 17900 TALBOT RD S,STE 101 4300 TALBOT RD S,STE#315 RENTON,WA 98055 RENTON,WA 980585 Rx:6701702 Jul 08, 2008 Safety Cap: Yes Rx:6712168 Aug 18, 2008 Safety Cap: Yes METOPROLOL 50MG TAB (TEVA)Qty: 100 TAB ACETYLCYST 20% SOL (ROXA)Qty:30 ML Generic for:MUCOMYST 20% SOL Ref:A6085902122121 NDC:00093.0733.10 BRA! Ref:A3086310470701 NDC:00054-3026-02 HSG) REGENCE BLUESHIELD WASH Cash Price: 10.99 REGENCE BLUESHIELD WASH Cash Price: 28.49 Amount Due: $10.99 Amount Due: $14.70 IIII IIII IIIIIIII�IIIIIIIIIIIII (Rx REFILLYOUHPRESCHIPTI0NS' IIIIUV ''I1I 'Iii Rx EF COMPRESCRIPTIONS �6 SAfEWAY.COM _� r.r SEND CLAIM TO: Noo City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 oti�Y �� -sN CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE ' I• 3 eg, 5 o e ' 2) DISABILITY RETIREE'S NAME (print) � j17/ i13�,, 3) ADDRESS ( 3 35 — 3 - Ave 109 I-071-6 v/t3, ,64fop , 4) DISABILLT'Y AT TIME QF RETIREMENT „ v - A $J J eerc �-le-r11t8 axd Aityt Fizik tel 5) DESCRIPTION OF CLAIM: (Supporting documentation must be attached.) (Effective 4/1/2008,pre-LEOFF retirees may submit all prescription drug expenses for reimbursement, whether or not related to the retirement disability,provided that the expense is not covered by another plan,source or insurance coverage. Supporting documentation for all must be attached.) "1— i S r��,� 6) TOTAL AMOUNT OF CLAIM: $ 7 9, r irt Amount of total claim (above) that is related to the Retirement Disability: $ T 1. Z 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 any charges other than prescription drug charges, are related to my disability as determined at the time of my retirement from the Renton Fire Department. Signature. c4/11._ 11111,rdAs‘ orti Note: Sup ng documentation must be attached. Pow 3 Value et the 00 RECEIPT R **le 1244 15th Ave Lpgview,WA 98632 Ph.(am)423-3360 SAVE FOR INSURANCE 793386 OR TAX RECORDS Rol For JOHN PARKS 8-01-08 CRN:46086144275851 1335 3RD AVE#109 LONGVIEW,WA 98632 (3601 577.6684 MIRTAZAPINE SOLTAB 45MG #30 NDC: 65862-0023-06 DR. RICHARDS,JOHN E ZHA COPAY: $14.11 110 II 1101111 I N III0I 111111 IIIIIIIIII III 11 I II Price Value atthe,smiling'CY 400 RECEIPT 1424415th Ave WAOPh.(360)423.3360 SAVEFOR INSURANCE p p OR TAX RECORDS R.# C793388 JOHN NPPPARKS A09 8.01.08 LONGVIEW,WA 98632 1360) 577-6684 ZOLPIDEM TAB 10MG #30 60505-2605-08 RICHARDS,JOHN E DR. ZHA COPAY: $2.41 111 III 10111 II II I II 1101111 II Puce Value atthe emNn.� RECEIPT FOR 124415th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE OR TAX RECOR SCE ng Rol C811174 For JOHN PARKS 8-04-08 CRN:46086175616911 1335 3RD AVE#109 LONGVIEW,WA 98632 1360) 577-6684 ALPRAZOLAM 0.5MG TAB *** #60 NDC: 59762-3720-03 DR. RICHARDS,JOHN E ZHA COPAY: $6.28 1111111IN II III 1111011110111101111111101 IPrice Value pj'IVQ, RECEIPT FOR 124415th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE OR TAX RECORDS INSURANCE Rot 814888 For. JOHN PARKS 8.18.08 CRN:41288310587041 1335 3RD AVE#109 LONGVIEW,WA 98632 1360) 577-6684 ALBUTEROL SULF HFA A INH #8.50 NDC: DR. R CHARDS,JOHN E0.0579-20 ZHA COPAY: $7.84 III 1110111 II 11 I II II 11011 1111111111 II II Price Value at the=Mee'd .� PIC DRUG RECEIPT 124415th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Aol 768298 For. JOHN PARKS 8.19.08 CAN:41086322880831 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 OMEPRAZOLE CAP 20MG *** 90 NDC:RICHARDS62175-0118-43 ,JOHNE DR. ZHA COPAY: $18.48 II II II 11111 I I I I I I 1111M1111111111111111111 Price J Pfild SEND CLAIM TO: City of Renton Now *rif Finance Dept. -Fire Pension 1055 South Grady Way Renton, WA 98057 (vY O� T�$ CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE — W 2) DISABILITY RETIREE'S NAME (print) 3) ADDRESS 4) DISABILITY AT TIME OF RETIREMENT 5) DESCRIPTION OF CLAIM: (Supporting documentation must be attached.) (Effective 4/1/2008,pre-LEOFF retirees may submit all prescription drug expenses for reimbursement, whether or not related to the retirement disability,provided that the expense is not covered by another plan,source or insurance coverage. Supporting documentation for all must be attached.) 6) TOTAL AMOUNT OF CLAIM: $ /b 7r Amount of total claim(above) that is related to the Retirement Disability: $ 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 any charges other than prescription drug charges, are related to my disability as determined at the time of my retirement from the Renton Fire Department. Signature: d Note: Supporting documentation must be attached. S • SAM'S CLUB (425)793-7937 `r' $10.72 SAM'S CLU B(425)79'337 $10.72 901 SOUTH GRADY WAY 901 SOUTH GRADY WAY Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KARL B 07/31/2008 REFILL STROM,KARL B 07/31/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6682146 Ref# P QTY:30 DAW:0 DS:30 RX:6682146 Ref#P QTY:30 DAW:0 DS: 30 NDC:00378-1809-01 LEVOTHYROXIN 100MCG TAB MYL NDC:00378-1809-01 LEVOTHYROXIN 100MCG TAB MYL GRAVES,DANIEL NABP:4930613 GRAVES,DANIEL NABP:4930613 88368077 88368077 ESI Patient Pay $3.00 ESI Patient Pay $3.00 .Y3 o STROM a — 0 m 15616 SE 143RD CC J RENTON.WA 98055 II li 1 I II 5 ir 425)271-8373 Cl) 4 79312 61378 7 Signature Required N RX:6682146 REF#P OC#355 923 871 076 592 884 107 659 238 8 07/31/2008 11:33:35 AM"` ESI Page No : 1 of 2 TOTAL: $3.00 d SAM'S CLUB sol SO79UT7H9 G37RADY WAY $13.78 SAM'S CLUB 9015SOUTH GRADY WAY $13.78 hhaarrIs1y�l��Y RENTON,WA 98055-0000 Ph'$ "a RENTON,WA 98055-0000 P$7gt7M,iCARL B 08/12/2008 REFILL STT�r ,KARL B 08/12/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6683461 Ref#4 QTY:60 DAW:0 DS:30 RX:6683461 Ref#4 QTY:60 DAW:0 DS: 30 NDC:54458-0976-07 ALLOPURINOL 100MG TAB INT NDC:54458-0976-07 ALLOPURINOL 100MG TAB INT BROCKENBROUGH,ANDREW T NABP:4930613 BROCKENBROUGH,ANDREW T NABP:4930613 Patient Pay $8.00 Patient Pay $0,00,. C. KARLOM B a 0 m 15616 SE 143RD RENTON,WA 98055 Il- J tr (425)271-8373 4 79312 64116 2 ,A Q 08/12/2008 (425)793.7937 C') X. Signature Required N RX:6683461 REF=4 OC#165 923 831 076 592 384107 659 238 08/12/2008 11:27:09 AM Page No : 1 TOTAL: $8.00 0. SAM'S CLUB (427 9015)SOUTH GRADY WAY $18.54 SAM'S CLUB (425)793-7937 $18.54 hh��rr��C 901 SOUTH GRADY WAY • PS71�#OIVf,K RL BENTON,WA 98055 08/12/2008 REFILL Pharmacy?, BRENTON,WA 98055-0000 08/12/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6678271 Ref#3 QTY:30 DAW:0 DS:60 RX:6678271 Ref#3 QTY:30 DAW:0 DS:60 . NDC: 00093-7153-98 SIMVASTATIN 10MG TAB TEV NDC:00093-7153-98 SIMVASTATIN 10MG TAB TEV BROCKENBROUGH,ANDREW T NABP:4930613 BROCKENBROUGH,ANDREW T NABP:4930613 Patient Pay $5.41 Patient Pay $5.41 0. ..No e STROM a 0 m 15616 SEL B 143RD F. cc J RENTON,WA 98055 E (425)271-8373 l''' Y 08/12/2008 (425)793-7937 4 79312 64117 9 CO Signature Required N RX:6678271 REF=3 OC#765 923 855 776 592 384 107 659 238 • . 08/12/2008 11:27:13 AM O Page No : 1 of 2 TOTAL: $5.41 11 P4 (o 40to (425)793-7937 ►' lore SAM'S(p (Y C�LUB 901 SOUTH GRADY WAY $52.62 SAM'S CLUB 95)793-7937 01 SOUTH GRADY WAY $52.62 POM KARL BRENTON,WA98055 0000 08/12/2008 REFILL STROM KAFAL BENTON,WA98055-0000 08/12/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6661062 Ref#P QTY:90 DAW:0 DS:90 RX:6661062 Ref#P QTY:90 DAW:0 DS:90 NDC: 00781-2052-01 TERAZOSIN 2MG CAP SAN NDC:00781-2052-01 TERAZOSIN 2MG CAP SAN GRAVES,DANIEL NABP:4930613 GRAVES,DANIEL NABP:4930613 Patient Pay $10.00 Patient Pay $10.00 0. • Y STROM KARL BIII II I 1 11111 oa o15616 SE 143RD m RENTON,WA 98055 CC � (425)271-8373 4 79312 64118 6 Cl)IY 08/12/2008 (425)793-7937 Signature Required N RX:6661062 REF#P OC#365 923 441 076 592 384 107 659 238 '% Q 08/12/2008 11:27:24 AM O Page No : 1 TOTAL: $10.00 d SAM'S CLUB (425)7937937 SAM'S CLUB(425)793-7937 901 SOUTH GRADY WAY 901 SOUTH GRADY WAY PharmacyRENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KRL B 08/20/2008 NEW STROM,KARL B 08/20/2008 NEW 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:2206617 Ref#0 QTY:30 DAW:2 DS: 15 RX:2206617 Ref#0 QTY:30 DAW:2 DS: 15 NDC:59011-0100-10 OXYCONTIN 10MG CR TAB PUR NDC:59011-0100-10 OXYCONTIN 10MG CR TAB PUR MARTIN,MICHAEL M NABP:4930613 MARTIN,MICHAEL M NABP:4930613 Patient Pay $56.84 Patient Pay $56.84 E KARLOB v 0 03 m 15616 SE 143RD ++ CC J RENTON,WA 980551111III U Cl)I (425)271-8373 4 79312 65906 8 `Y 08/20/2008 (425)793-7937 iN Signature Required N RX:2206617 REF=0 OC#465 923 698 976 592 384 107 659 238 ' p 08/20/2008 12:01:35 PM*** Page No : 1 of 3 TOTAL: $56.84 p SAM'S CLUB (425)793-7937 SAM'S CLUB(425)793-7937 901 SOUTH GRADY WAY 901 SOUTH GRADY WAY Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KARL B 08/25/2008 NEW STROM,KARL B 08/25/2008 NEW 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:4412944 Ref#3 QTY: 120 DAW:0 DS: 30 RX:4412944 Ref#3 QTY: 120 DAW:0 DS:30 NDC:00406-0357-05 HYDROCO/APAP5-500MG TAB MAL NDC:00406-0357-05 HYDROCO/APAP5-500MG TAB MAL BROCKENBROUGH,ANDREW T NABP:4930613 BROCKENBROUGH,ANDREW T NABP:4930613 Patient Pay $25.46 Patient Pay $25.46 M STROM at L O ED 11(56616 SE 1143RD N CC RENTON,WA 98055 = 'r r,...-1 (425)271-8373 4 79312 67062 9 I".. q 08/25/2008 (425)793-7937 >. 0 L Signature Required N RX:4412944 REF=3 OC#365 923 155 376 592 384 107 659 238 08/25/2008 02:17:34 PM"' O Page No : 1 of 2 TOTAL: $25.46 d l' 1