The URL can be used to link to this page

Home My WebLink AboutFinal Agenda Packet Ivie N.,0 CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room Thursday, April 17, 2008 2:00 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF MARCH 20, 2008 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO MARCH 31, 2008 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT Airif `41410, MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON March 20, 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 Chairman Denis Law at 2:02 p.m. in the Mayor's conference room, 7th floor of Renton City Hall. In attendance were Board members Denis Law, Don Persson, Ray Barilleaux, and Bruce Phillips; Michele Neumann, Deputy City Clerk and acting Board Secretary; and non- member Jill Masunaga, Finance Department Representative. MINUTES APPROVAL MOVED BY PHILLIPS, SECONDED BY PERSSON, THE PENSION BOARD APPROVE THE MINUTES OF THE FEBRUARY 21, 2008, MEETING. CARRIED. MONTHLY STATEMENT The financial report as of February 29, 2008, was reviewed. Total cash/investment balance was $4,601,298.90. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR MARCH 2008, IN THE TOTAL AMOUNT OF $46,077.83. CARRIED. UNFINISHED BUSINESS As follow-up from the last meeting that he would question the five Fire Pension pre- LEOFF retirees regarding their prescription drug costs beyond the prescription costs necessary for their retirement disability, Bruce Phillips reported that the approximate monthly cost totals $300 to $400 per individual. Discussion ensued regarding whether Firemen's Pension funds should be used pay the extra prescription costs. Don Persson suggested setting a maximum yearly amount, and expressed concern regarding the extra amount of paper work involved in tracking the costs. Jill Masunaga indicated that an ordinance to amend Fire Pens;on Fund 611 for the longevity increase for 2008 will soon go forward to the City Council, and this change can also be included. MOVED BY PHILLIPS, SECONDED BY BARILLEAUX, THE BOARD REIMBURSE EACH OF THE FOLLOWING MEMBERS: JAMES ASHURST, JACK HAWORTH, JOHN PARKS, KARL STROM, AND CHARLES GOODWIN A MAXIMUM OF $2,000 PER YEAR FOR ALL PRESCRIPTION DRUG COSTS, EFFECTIVE APRIL 1, 2008. CARRIED. 3/20/2008 Minutes yw, , two Firemen's Pension Board Page 2 of 2 Jill Masunaga noted that she will work with Bonnie Walton to review and update the Pharmacy/Medical Claim Reimbursement Request form in light of this action. Bruce Phillips asked that a letter be sent to each affected retiree to explain the action taken and to report the effective date. Following discussion, Bruce Phillips indicated that he would contact the affected retirees and encourage them to turn in their prescription bills in a timely manner. ADJOURNMENT MOVED BY PERSSON, SECONDED BY BARILLEAUX, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 2:32 p.m. -711AC)41-'4' --)71(4"11--g Michele Neumann, Deputy City Clerk Acting Secretary, Firemen's Pension Board CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF MARCH 31, 2008 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 Irl 2008 ❑2007 5 --- — — — — — 0 4 -- 0 46 N 0 3 2 - 1 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CURRENT 2008 2008 LAST YEAR 2007 2007 ACTIVITY: MONTH YTD BUDGET CURR MO ACTUAL ADJ BUDGET BEGINNING CASH/INV BALANCE $4,601,298.90 $4,694,232.48 $4,203,347 $4,597,539.08 $4,672,241.19 $4,459,523 RECEIPTS: Fire Insurance Premium Tax 0.00 0.00 75,000 0.00 85,061.56 73,000 Investment Interest 3,318.48 6,871.76 200,000 2,794.37 389,226.86 175,000 DISBURSEMENTS: Fire Pension 46,006.26 138,018.78 477,400 39,275.05 427,011.96 463,500 Fire Pension Medical 143.14 2,959.48 20,000 1,651.95 9,059.17 20,000 Office/Operating Supplies 0.00 0.00 459 0.00 450.00 450 Actuarial/Firemen's Pens 0.00 0.00 0 7,550.00 7,550.00 12,000 Reimb General/Clerical&Acct 829.00 2,487.00 9,948 686.00 8,226.00 8,226 ENDING CASH/INV BALANCE $4,557,638.98 $4,557,638.98 $3,970,540 $4,551,170.45 $4,694,232.48 $4,203,347 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $796,519.41 $840,179.33 $345,458.18 $391,826.81 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 TOTAL CASH AND INVESTMENTS $4,557,638.98 $4,601,298.90 $4,551,170.45 $4,597,539.08 The State Investment Pool interest 3.1375% 3.7871% 5.2372% 5.2768% H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2008.xls\Mar08 Page 1 4/11/2008 FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR APRIL, 2008 * ANKENY, Charlie (Captain) $90.81 90.81 ASHURST, James (Assistant Chief) $4,569.00 895.01 5,464.01 * 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) $4,010.50 609.54 4,620.04 * GOODWIN, Donald (Firefighter) $1,277.48 1,277.48 HAWORTH, Constance (Widow) $2,688.00 2,688.00 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) $231.19 231.19 * NICHOLS, Gerald (Battalion Chief) $467.89 467.89 * PARKS-ANDREASON, Arlene (Widow) $284.16 284.16 PARKS, John (Firefighter) $3,139.50 71.57 3,211.07 * PHILLIPS, Bruce H. (Deputy Chief) $909.45 909.45 * PRINGLE, Arthur(Captain) $421.16 421.16 PRINGLE, S. Joan (Widow) $2,309.31 2,309.31 * 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 - 3,025.00 * TODD, Franklin (Firefighter) $420.32 420.32 * TONDA, Lila Jean (Widow) $531.29 531.29 * VACCA, Nick(Lieutenant) $265.10 265.10 * WALLS, Kenneth (Firefighter D Step) $108.43 108.43 * 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 , T i ai Eic etis 44,r0VMe Medial - n, .157,642:2 4,3;i#8t°8t, * Adjusted to reflect a 3.79% LEOFF cost of living increase effective April 1. Prior Year Pension/Medical Payments: Total Pension Payments for April, 2007 34,517.25 Total Medical Bills Reimbursed in April, 2007 669.55 Total Expenses: Medical/Pension 35,186.80 4_SUMMARY 2008.XLS 4/11/2008 Sae Niro FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN APRIL, 2008 PAYMENT r4:0001Riralliia4iMeotar 2M600(011* 2 James Ashurst Safeway 167.75 2 James Ashurst Safeway 132.65 2 James Ashurst Safeway 94.00 2 James Ashurst Safeway 167J5 2 James Ashurst Safeway 192.86 2 James Ashurst Safeway 6.75 3 James Ashurst Safeway 132.65 895.01 5 Charles Goodwin Bartell Drugs 149.16 5 Charles Goodwin Bartell Drugs 6.35 5 Charles Goodwin Bartell Drugs 278.41 5 Charles Goodwin Bartell Drugs 6.88 6 Charles Goodwin Bartell Drugs 149.16 6 Charles Goodwin Bartell Drugs 6.35 6 Charles Goodwin Bartell Drugs 6.88 6 Charles Goodwin Bartell Drugs 6.35 609.54 Jack Haworth 0.00 8 John Parks Olympic Drug 9.25 8 John Parks Olympic Drug 6.28 8 John Parks Olympic Drug 56.04 71.57 Karl Strom 0.00 r****`^`~~~``` °�'''``' � `' �--'°~'~°'~-` ~~`°`~'��~^ ` �`� ' �=�= -'-~�'��=`''� �``'�`'��=',^�~,, 0' 3_2008 FP Medical xLS Page 1 of 1 4/11/2008 • `ow Vr► SEND CLAIM TO: City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98055 G0 - N'r° CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE Narch 25 2008 2) DISABILITY RETIREE'S NAME (print) Jarnee F..oAshu �t._y. a 223 Garden Ave.N. #B Renton Wa. 98057 3) ADDRESS ;_ � , 4) DISABILITY AT TIME OF RETIREMENT High blood pressure Hypertension Reaction to medicatioA 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.) Hypertension H.B.P. 6) TOTAL AMOUNT OF CLAIM $895. 01 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 t•= ' -n on ''re Department. Signature: C srr Note: Supporting documentation must be attached. pow 0NIUT ID STREET -CY ?oRMAIDMimAcY?r' RENTON,WA 98055 RENTON,WA 98055 LS) (425)226-0325 #1 (425)226-0325 Official Recent- Please retain for tax or insurance Official Receipt- Please retain for tax or insurance ASHtfR1/, A - (425)255-6154 ASHURST,JAMES (425)255-6154 223 B GARDEN AVE N. 12/17 223 B GARDEN AVE N. 1 2/1 7 RENTON,WA 98055 RENTON,WA 98055 DR. GRAVES,DANIEL [RF] DR. GRAVES,DANIEL [RF] 17900 TALBOT RD S 17900 TALBOT RD S, STE 101 RENTON,WA 98055 RENTON,WA 98055 Rx:6699560 Feb 04, 2008 Safety Cap: Yes Rx:6699560 Mar 18, 2008 Safety Cap: Yes PANTOPRAZOLE 40MG TAB (TEV-A)Qty:50 TAB PANTOPRAZOLE 40MG TAB (PRAS)Qty:50 TAB Generic for:PROTONIX 40MG TAB HSGITCI Generic for:PROTONIX 40MG TAB Ref:A3084357177461 NDC:00093.0012.98 Ret:A7084780955171 NDC:00008.0607.01 BBAI REGENCE BLUESHIELD WASHINGTN REGENCE BLUESHIELD WASHINGTN Amount Due: $167.75 Amount Due: $167.75 MIIMM IIIIIIIIIIIIRx EfILL YOUR @SAFEW.YCOMT'° Hmim111111111111Rx REFIeLL=I=TIONS AMMIRAMMACY AMENU p RMACY RENTON,WA 98055 RENTON,WA 98055 331 (425)226-0325 #(5) (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 [RF] DR. GRAVES,DANIEL [RF] 17900 TALBOT RDS 17900 TALBOT RD S,STE 101 RENTON,WA 98055 RENTON,WA 98055 Rx:6702058 Feb 13, 2008 Safety Cap: Yes Rx:6701701 Mar 18, 2008 Safety Cap: Yes PLAVIX 75MG TAB (B M ) Qty:30 TAB LIPITOR 40MG TAB (PFIZ) Qty: 50 TAB Ref:A6084448738891 NDC:63653.1171.06 MACI BBAI Ref:A4084760612001 NDC:00071-0157-23 REGENCE BLUESHIELD WASHINGTN Amount Due: $1 REGENCE BLUESHIELD WASHINGTN Amount Due: $192.86 11111111111111 111111111H (R, REFILL YOUR PRESCRIPTIONS 111111111111111W IIIIIIIIIIIIRx EF'�SAfWARyCOMT/ONS N I IDPSII VIACY 216R1MI805ACY RENTON,WA 98055 RENTON,WA 5 ifit) (425)226-0325 33) (425)226-0325 Official Receipt Please retain for tax or insurance Official Receipt- Please retain for tax or insurance AIJRST,JAMES ' (425)255-6154 ASHURST,JAMES (425)255-6154 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 DR. GRAVES,DANIEL [NW] DR. GRAVES,DANIEL 17900 TALBOT RD S 17900 TALBOT RD S,STE 101 [RF] RENTON,WA 98055 RENTON,WA 98055 Rx:6704477 Feb 14, 2008 Safety Cap: Yes Rx:6701702 Mar 18, 2008 Safety Cap: Yes COZAAR 50MG TAB (MERC)Qty:50 TAB METOPROLOL 50MG TAB (SAND)Qty: 100 TAB Ref:A5084456968671 NDC:00006.0952.31 MACI BBAI REGENCE BLUESHIELD WASHINGTN Ref:A3084780611421 NDC:00781-1223-10 Amount Due: $94.60 REGENCE BLUESHIELD WASHINGTN Amount Due: $6.75 WIIIIIIIIIIIIIIIIIIIIIIIIIiIIR,I REFIeLL SAfEWAyCDMTIO WII11IMIIWIlIhi IIIIIIIIRx REFILL YOUR PRESCRIPTIONS f 1 (d SAFEWAY.COM PAS2- Sp F�WAy HARM v✓ 10�'SOUfH 3RDpS7 prmACY RENTON,WA 98055 #15 (425)226-0325 Official Receipt- Please retain for tax or insurance ASHURST,JAMES (425)255-6154 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 DR. GRAVES,DANIEL [RF] 17900 TALBOT RD S,STE 101 RENTON,WA 98055 Rx:6702058 Mar 18, 2008 Safety Cap: Yes PLAVIX 75MG TAB (B-M ) Qty:30 TAB Ref:A1084787093361 NDC:63653-1171-06 BBAI REGENCE BLUESHIELD WASHINGTN Amount Due: $132.65 1111111111111111111111110 Rx REFILL YOUR SAFEWAY.COM PRESCRIPTIONS PA6f 3 SEND CLAIM TO: City of Renton w''"' "Itinance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE /g }y 2) DISABILITY RETIREE'S NAME (print) �114.4,t SA- 6D,)1f)/4/ 3) ADDRESS /Y/T MD/WC 4 A _....r----ke /.4 4 /ID'. # 6 4) DISABILITY AT TIME OF RETIREMENT c , I / ,v,/'.� 5) DESCRIPTION OF CLAIM: (Supporting documentation must be attached.) (Note: Medical coverage is limited to current treatment of the retiree's disability as determined at the time of retirement. (RCW 41.18) Submit only claims that relate to item#4.) 6) TOTAL AMOUNT OF CLAIM it 620 V' SY 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: y % 6. , Note: Supporting documentation must be attached. PA-6re. - cOdPoP /0 : 1 1 42/AA)bkJYae / d • _ Acf/cuzir Miyj.i /_/-6-,_, — 4 - -c)el) '' i 1 BARTELL_DRUGS - 1 BARTELL DRUGS RX# osw6 9•O DSR •-- �W 'rOwnlhvpMm.� EGRIFFITH ALIDA 45- 3g `� E DR. GRIFFITH,ALIDA DATE: 01/25/08 R (425)899-3123 DATE: 01/25/08 R (425)899-3123 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGG: , OX CAP 200/25 CAR: . •PA/LEVODOPA 25MG/100M 0059'-0001-r4 77475218 000' -129 -81 77531218 REFILL 3 QUANTITY 60,00 REFILL NO QUANTITY 540.00 BARTELL DRUGS PRICE= $195.99 BARTELL DRUGS PRICE= $388.99 7.--gr WITH XPS THE AMOUNT DUE 4149.16 !_/ /' /4 WITH XPS THE AMOUNT DUE 4278.41 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 L r I BARTELL DRUGS I BARTELL DRUGS •EDI Rxu �.a.htngton!,Own ,,, 45-�(� i ` E DR• FLO,GAYLE 45-381218 E DR. LORCH,GERALD DATE: 02/08/08 R (425)251-5110 DATE: 01/25/08 R (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 fR 1414 MONROE AVE NE#306 l� ATENOLOL 50MG TABLET(DAV) /i AL U INOL 100MG TABLET(*PA �/ 67253-0421-11 78387084 498 4-06020- 77449218 66 s REFILL 4 QUANTITY 30.00 REFILL 6 QUANTITY 30.00 BARTELL DRUGS PRICE= $13.49 BARTELL DRUGS PRICE= $10.99 WITH XPS THE AMOUNT DUE-$6.88 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 L REFILLS 24-48 HOURS IN ADVANCE ( REFILLS 24-48 HOURS IN ADVANCE I '/ '% [/ k 0 • ,.30 d 77:-. •'' 4--i--e:6,-, ji/ „.1_ ii.,0 6-it-6)i 'gat- Ow °/ -FEA09: C#--x-e(6.--s ?ei , CD-c.6_&e)//t)' , BARTELL DRUGS 1 BARTELL DRUGS RX# —`—��y Owl�+slans�'� sWashingtons Own Dnsgstores_.� 45-406699 E DR. GRIFFITH,ALIDA RX# 45-406674 E DR. FLO, GAYLE DATE: 02/21/08 R (425)899-3123 DATE: 03/13/08 R (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGGRENOX CAP 200/25 ATENOLOL 50MG TABLET(DAV) 00597-0001-60 78833791 67253-0421-11 80063243 REFILL 2 QUANTITY 60.00 REFILL 3 QUANTITY 30.00 6. gb BARTELL DRUGS PRICE= $195.99 /1/4614 BARTELL DRUGS PRICE= $13.49 /-- WITH XPS THE AMOUNT DUE=$6.88 WITH XPS THE AMOUNT DUE:$149.16 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 i I I BARTELL DRUGS ' 'm....Washington'sOwnDrugstore,.—.._._ 1 BARTELL DRUGS Rx# 45- 381218 E DR. LORCH,GERALD ---Washington's Own s stores�� DATE: 02/22/08 R (425)251-5110 RX# 45- 381218 E DR. LORCH,GERALD NAME: CHARLES GOODWIN DATE: 03/13/08 R (425)251-5110 1414 MONROE AVE NE#306 NAME: CHARLES GOODWIN ALLOPURINOL 100MG TABLET(*PA 1414 MONROE AVE NE#306 S ALLO r RI`s L 100MG TABLET(*PA 49884-0602-10 78868995 V3 49884-6602-10 80051243 REFILL 5 QUANTITY 30.00 / �� BARTELL DRUGS PRICE= $10.99 ✓ REFILL QUANTITY 30.00 • WITH XPS THE AMOUNT DUE:$6.35 BARTELL DRUGS PRICE= $10.99 BARTELL DRUGS#45 WITH XPS THE AMOUNT DUE:$6.35 (425)793-1015 BARTELL DRUGS#45 4700 NE 4TH STREET (425)793-1015 RENTON,WA 98059 4700 NE 4TH STREET RENTON,WA 98059 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU THANK 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 I REFILLS 24-48 HOURS IN ADVANCE J �' I Q(i `j' Skc--Q,--- p & .c SEND CLAIM TO: City of Renton %seNee Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 c.),s .4\ 0 CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE , .,p«('t p�+l o 009 2) DISABILITY RETIREE'S NAME (printY1.1444 �„ ?a4'is 3) ADDRESS 3 Ave4 td id Y( W0. 9e43 + l 4) DISABILITY AT TIME OF RETIREMENT T, 2 A - , S s ' $e) VIQers1 /jr 11-4 4. *4 •f'7(tei 4-1 4 rix-r @T,y PrebJenis 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.) o !71 ,e -P'1)--r -mac ? 71 Xi toy ercrMe 6) TOTAL AMOUNT OF CLAIM ' 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 ref ement from the Renton Fire Department. Signature: ,crrtiVit ' A4424.-- Note: Supporting documentation must be attached. PA-6( 1 *eV ‘44110/0 Value at the smiling'0' latP ThPIC DRUG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# C759930 For: JOHN PARKS 3-03-08 CRN:A6284631932741 1335 3RD AVE#109 LONGVIEW,WA 98632 (3601 577-6684 ZOLPIDEM TAB 10MG #30 NDC: DR. RICHARDS,JOHN5E5 2605-OS ZHA COPAY: $9.25 111111 it III I I II III II 111111111111111111111111 Price Noire the smiling'O' YMPIC DRUG RECEIPT 124415th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# C768297 For. JOHN PARKS 3-03-08 CRN:43284631933121 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ALPRAZOLAM 0.5MG TAB *** #60 11077-05 RICHARDS,JOHN7E DR. ZHA COPAY: $6.28 liii II 011111111 II II III III IIIII II 111110111 Price Valu.atthaamfling'O' RECEIPT YN�IPIC DRUG 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVEOFOR INSURANCE 9 OR TAX RECORDS Rx# 768295 For: JOHN PARKS 30308 CAN:49084638116651 1335 3RD AVE#109 LONGVIEW,WA 98632 1360) 577-6684 MIRTAZAPINE SOLTAB 45MG #30 NDC: 65862-0023-06 DR. RICHARDS,JOHN E ZHA COPAY: $56.04 II IfflIllIllIl 11111111 it II 111111 ff1111 Price PA g