HomeMy WebLinkAboutFinal Agenda Packet CITY OF RENTON
FIREMEN'S PENSION BOARD
Regular Meeting
7th Floor-Mayor's Conference Room
Thursday, May 21, 2009
2:00 P.M.
1. CALL TO ORDER
2. APPROVAL OF MINUTES OF APRIL 16, 2009
3. CORRESPONDENCE
Annual Fire Insurance Premium Reporting
4. MONTHLY STATEMENT TO APRIL 30, 2009
5. MONTHLY BILLS AND PENSION PAYMENTS
6. UNFINISHED BUSINESS
7. NEW BUSINESS
8. ADJOURNMENT
`"r MINUTES Nov
FIREMEN'S PENSION BOARD
CITY OF RENTON
April 16, 2009
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 Mayor Denis Law at 2:04 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, Bruce Phillips and Bonnie Walton. Also in attendance was Jill Masunaga,
Finance Department representative.
MINUTES APPROVAL
A typographical error in the name Barilleaux in the second paragraph of the 3/19/2009 minutes was noted.
MOVED BY PHILLIPS, SECONDED BY BARILLEAUX, THE PENSION BOARD APPROVE THE
MINUTES OF THE MARCH 19, 2009, MEETING. CARRIED.
MONTHLY STATEMENT
The financial report as of March 31, 2009, was reviewed. Total cash/investment balance was $4,344,167.72.
In response to inquiry, Jill Masunaga stated that the bi-annual actuarial study was currently underway.
MONTHLY BILLS AND PENSION PAYMENTS
MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE BOARD APPROVE THE
PENSION/MEDICAL PAYMENTS FOR APRIL 2009, IN THE TOTAL AMOUNT OF $37,364.47 TO BE
PAID FROM THE FIREMEN'S PENSION FUND. CARRIED. It was noted that the payments this month
include a 4.48% LEOFF cost of living increase effective April 1St, and also reflected a funeral expense
payment of$500 for Robert Connell per RCW 41.18.140.
UNFINISHED BUSINESS
A memorandum to the Board from Kristi Rowland of the Finance Department regarding Federal National
Mortgage Association Investment was reviewed. The memo explained that the US Government placed both
Fannie Mae and Freddie Mac into conservatorship under the US Treasury in September 2008. Whether or
not the conservatorship dissolves before or after the maturity of the Fire Pensions FNMA bond that matures
in 2021 remains to be seen. Depending on its comfort level with the conservatorship status and government
backing, the Board could look into selling the FNMA bond early and replacing it with a Treasury Bill,
resulting in a loss in earnings, but not significantly.
ADJOURNMENT
MOVED BY PERSSON, SECONDED BY PHILLIPS, THE MEETING OF THE FIREMEN'S PENSION
BOARD BE ADJOURNED. CARRIED. Time: 2:14 p.m.
Bonnie Walton
Firemen's Pension Board Secretary
ti(0' o� CITY `)F RENTON
0 r�
.a ♦ City Clerk
,e — Denis Law,Mayor Bonnie I.Walton
May 12, 2009
Office of the State Treasurer
Attn: Shirley Jokela
P.O. Box 40209
Olympia, WA 98504-0209
Re: May 2009 Fire Insurance Premium Distribution
Dear Ms. Jokela:
The following information is provided in compliance with RCW 41.16.050 in order for
the City of Renton to receive the annual fire insurance premium tax:
There were 134 paid firemen employed in the City of Renton Fire Department as of
December 31, 2008.
Sincerely,
Bonnie I. Walton
City Clerk/Cable Manager
CERTIFICATION
- I, Bonnie I. Walton, duly appointed and qualified City. Clerk/Cable Manager of and for
the City of Renton, Washington, do hereby certify that the above-cited information is true
and correct as appearing on file in the records of the Finance Department. Signed and
sealed this 12th day of May 2009.
,rte
ctF ENS
Bonnie I. Walton, City Clerk/Cable Manager
1055 South Grady Way-Renton, Washington 98057-(425)430-6510/FAX(425)430-6516 1 ; E N T O N
n AHEAD OF THE CURVE
:ji This paper contains 50%recycled matenal,30%post consumer
CITY OF RENTON - FIREMEN'S PENSION FUND
CASH & INVESTMENT ACTIVITY REPORT
AS OF APRIL 30, 2009
Fireman's Pension Fund Comparison of Cash and Investment Activity
6
❑2009 ❑2008
5
— — — — i
m —
0 4
0
0
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0 C
3 {
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2 1 t
1
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
CURRENT 2009 2009 LAST YEAR 2008 2008
ACTIVITY: MONTH YTD BUDGET CURR MO ACTUAL ADJ BUDGET
BEGINNING CASH/INV BALANCE $4,344,167.72 $4,265,991.35 $3,895,540 $4,557,638.98 $4,694,232.48 $4,203,347
RECEIPTS:
Fire Insurance Premium Tax 0.00 0.00 90,000 0.00 85,949.42 75,000
Investment Interest 527.06 208,184.68 200,000 2,699.28 17,965.67 200,000
DISBURSEMENTS:
Fire Pension 36,376.89 160,956.75 500,000 41,489.16 512,262.83 552,400
Fire Pension Medical 987.58 2,934.97 20,000 3,152.24 9,572.61 20,000
Office/Operating Supplies 0.00 0.00 475 0.00 372.78 459
Actuarial/Firemen's Pens 0.00 0.00 0 0.00 0.00 0
Reimb General/Clerical&Acct 983.00 3,937.00 11,801 829.00 9,948.00 9,948
`ENDING CASH/INV BALANCE $4,306,347.31 $4,306,347.31 $3,653,264 $4,514,867.86 $4,265,991.35 $3,895,540
CURRENT PREVIOUS LAST YEAR LAST YEAR
ACTIVITY: MONTH MONTH CURR MO PREV MO
CASH $767,927.05 $805,747.46 $753,748.29 $796,519.41
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 2,984,096.96 2,984,096.96 3,206,796.27 3,206,796.27
TOTAL CASH AND INVESTMENTS $4,306,347.31 $4,344,167.72 $4,514,867.86 $4,557,638.98
The State Investment Pool interest 0.8905% 1.0301% 2.6998% 3.1375%:
H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2009.xls\AprO9 Page 1 05/08/2009 ,
New Nue
FIREMEN'S PENSION BOARD
PENSION/MEDICAL PAYMENTS FOR MAY, 2009
Recipient Pension Amt Medical Total
ANKENY, Charlie(Captain) $135.71 135.71
ASHURST, James (Assistant Chief) $4,820.50 - 4,820.50
* BANASKY, George(Captain) $1,523.25 1,523.25
BARILLEAUX, Ray(Battalion Chief) - -
BEATTEAY, Karlen (Widow) $231.70 231.70
BERGMAN, Claudette(Widow) $154.09 154.09
CHRISTENSON, Chuck(Firefighter) $259.09 259.09
GEISSLER, Dick(Fire Chief) - -
GOODWIN, Charles (Captain) $4,231.00 786.57 5,017.57
GOODWIN, Donald (Firefighter) $1,018.60 1,018.60
HAWORTH, Constance(Widow) $2,792.83 2,792.83
HAWORTH, Jack(Firefighter) $3,191.50 - 3,191.50
HENRY, William, Jr. (Captain) $1,339.58 1,339.58
HURST, Gerald (Firefighter) $543.59 543.59
JONES, Evelyn M. (Widow) $250.62 250.62
LARSON, William (Firefighter) - -
LAVALLEY, Theodele (Captain) $360.94 360.94
MATTHEW, James (Deputy Chief) - -
MC LAUGHLIN, JACK(Battalion Chief) $1,002.95 1,002.95
NEWTON, Gary(Lieutenant) $273.45 273.45
NICHOLS, Gerald (Battalion Chief) $536.08 536.08
PARKS-ANDREASON, Arlene(Widow) $335.32 335.32
PARKS, John (Firefighter) $3,312.50 64.69 3,377.19
PHILLIPS, Bruce H. (Deputy Chief) $257.12 257.12
PRINGLE, Arthur(Captain) $481.28 481.28
PRINGLE, S. Joan (Widow) $2,399.37 2,399.37
RIGGLE, David E. (Firefighter D Step) $82.78 82.78
RUPPRECHT, Jim (Firefighter D Step) $117.72 117.72
SMITH, Leroy(Firefighter) $409.86 409.86
STROM, Karl (Firefighter) $3,191.50 125.45 3,316.95
TODD, Franklin (Firefighter) $469.71 469.71
TONDA, Lila Jean (Widow) $8.43 8.43
VACCA, Nick(Lieutenant) $311.71 311.71
WALLS, Camille(Widow) $145.64 145.64
WALLS, Mercedes(Widow) $115.77 115.77
WALSH, David (Firefighter) $1,065.19 1,065.19
WEISS, Larry(Battalion Chief) $768.23 768.23
WILLIAMS, Alta (Widow) - -
WOOTEN, Marilyn E. (Widow) $239.28 239.28
Total Expenses: Pension/Medical $36,376.89 $976.71 $37,353.60
* Received funeral expenses of$500.00 per RCW 41.18.140.
Prior Year Pension/Medical Payments:
Total Pension Payments for May, 2008 41,489.16
Total Medical Bills Reimbursed in May, 2008 179.07
Total Expenses: Medical/Pension 41,668.23
4_SUMMARY 2009.XLS 05/08/2009
low 'tome
FIREMEN'S PENSION BOARD
MEDICAL BILLS TO BE REIMBURSED IN MAY, 2009 PAYMENT
Page Name Pharmacy/Medical Facility Date Amount of Bill
James Ashurst 0.00
2 Charles Goodwin Bartell Drugs 02/21/09 194.36
2 Charles Goodwin Bartell Drugs 03/02/09 49.59
2 Charles Goodwin Bartell Drugs 03/07/09 9.89
2 Charles Goodwin Bartell Drugs 03/21/09 84.44
3 Charles Goodwin Bartell Drugs 03/21/09 194.36
3 Charles Goodwin Bartell Drugs 03/28/09 49.68
3 Charles Goodwin Bartell Drugs 04/06/09 9.89
3 Charles Goodwin Bartell Drugs 04/21/09 194.36
786.57
Jack Haworth 0.00
5 John Parks Olympic Drug 03/31/09 55.44
5 John Parks Olympic Drug 03/31/09 9.25
64.69
7 Karl Strom Sam's Club 02/19/09 12.48
7 Karl Strom Sam's Club 03/04/09 4.59
7 Karl Strom Sam's Club 03/04/09 10.00
8 Karl Strom Sam's Club 03/14/09 12.48
8 Karl Strom Sam's Club 03/18/09 13.42
8 Karl Strom Sam's Club 03/30/09 3.00
9 Karl Strom Sam's Club 03/30/09 4.59
9 Karl Strom Sam's Club 03/30/09 4.41
9 Karl Strom Sam's Club 04/11/09 12.48
10 Karl Strom Department of Veterans Affairs 03/05/09 24.00
10 Karl Strom Department of Veterans Affairs 03/05/09 24.00
125.45
TOTAL 976.71
3_2009 FP Medical.XLS Page 1 of 1 05/08/2009
4l'r' SENDCLAIMTO: '`'r? City of Renton
Finance Dept.-Fire Pension
1055 South Grady Way
Renton, WA 98057
O��Y 0
CITY OF RENTON
FIREMEN'S PENSION BOARD
Pharmacy/Medical Claim Reimbursement Request
1) DATE / a 10q
2) DISABILITY RETIREE'S NAME (print) C. /1/4-k I S /4. ( 0,01.)(4.)/
3) ADDRESS /L//7 inoxmoe ve /�. . �c-i0 4-4/70/1// ith eitmS.o
4) DISABILITY AT TIME OF RETIREMENT Wi. < t ! / ,
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: $ I r1�i -
Amount of total claim (above) that is related to the Retirement Disability: '70 •
51"
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.
�/ r-
Signatur ��% �/1tA
Note: Supporting documentation must be attached.
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BARTELL DRUGS
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45-4593 8 E DR. LORC GERALD ��Wa.kt .ori„>ragsa�, ,
DATE: 03/21/09 R RX# 45-488364 E�- LORCH,GERALD
(425)251-5110
NAME: CHARLES GOODWIN DATE: 04/06/09 N `�(425)251-5110
1 1414 MONROE AVE NE#306 NAME: CHARLES GOODWifi
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ALL CAP 200/25 1414 MONROE AVE NE#306
10597-0001-60 �
4067704124659 - • - I. ABLET(*PA
REFILL 4988 -0602-1s 4198655614659 n g�
NO QUANTITY 60.00 "/
BARTELL DRUGS PRICE= $208.99 REFILL 5 QUANTITY 30.00
WITH SR THE AMOUNT DUE:119_4A§ (� /_ BARTELL DRUGS PRICE= $10.99
BARTELL DRUGS#45 /9/ 1� WITH SR THE AMOUNT DUE:$9.89
(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
1 REFILLS 24-48 HOURS IN ADVANCE
WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR
L REFILLS 24-48 HOURS IN ADVANCE
I BARTELL DRUGS BARTELL DRUGS
mmassommas Washington's Own Drugstoress� ��
Washington's Own Drugstores
Rx. 45-481864 E DR KATO Rx. 45- 491232 E DR. LORCH,GERALD
DATE: 03/28/09 R (425)255-9310 DATE: 04/21/09 N (425)251-5110
NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN
1414 MONROE AVE NE#306 1414 MONROE AVE NE#306
AMLODIPINE 5MG TABLET(*GRN)- AGGRENOX CAP 200/25
59762-1530-03 4111561154659 00597-0001-60 3519468958709
REFILL 3 QUANTITY 30.00 REFILL 4 QUANTITY 60.00
BARTELL DRUGS PRICE= $54.59 "T 4'
BARTELL DRUGS PRICE= $208.99
i WITH SR THE AMOUNT DUE 49.68 WITH SR THE AMOUNT DUE- 194.36 1 1`i
BARTELL DRUGS#45 BARTELL DRUGS#45 /
(425)793-1015 (425)793-1015
4700 NE 4TH STREET 4700 NE 4TH STREET
I RENTON,WA 98059 RENTON,WA 98059
I 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
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Rxa LORCH,GERALD DATE: 03/07/09 R 425)25 -5110
DATE: 02/21/09 R (425)251-5110 (425)251-5110
NAME: CHARLES GOODWIN
NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306
1414 MONROE AVE NE#306
ALLOpL 100MG TABLET(*PA
AGG CAP 200/25
498 -0602-1g
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REFILL ----
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BARTELL DRUGS PRICE= $10.99
BARTELL DRUGS PRICE= $208.99
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WITH SR THE AMOUNT DUE= 194.36 WITH SR THE AMOUNT DUE- 9.89
BARTELL DRUGS .-----
BARTELL DRUGS#45 #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
I 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
BARTELL DRUGS
BARTELL DRUGS
, , 'neon sOwn nygto„,.
45- 481864 E DR. KATO �Wa.hin ton's Own Drugstore
DATE: 03/02/09 N
low 45-452010 E DR. FLO, GAYLE
(425)255-9310 DATE: 03/21/09 R
"AME: CHARLES GOODWIN (425)251-5110
i 1414 MONROE AVE NE#306 NAME: CHARLES GOODWIN
1414 MONROE AVE NE#306
AMLODIPINE 5MG TABLET(*Lup) GEMFa ROZIL 600MG TABLET(APX)3062295718709 ( )
60505- -08 4067703184659 � /• �/
REFILL 4 QUANTITY 30.00
U `�� REFILL 1 QUANTITY 180.00
BARTELL DRUGS PRICE= $54.49
WITH SR THE AMOUNT DUE- 49.59 BARTELL DRUGS PRICE_ $91.78
-- WITH SR THE AMOUNT DUE84.44
BARTELL DRUGS#45 ---
(425)793-1015 BARTELL DRUGS#45
4700 NE 4TH STREET (425)793-1015
RENTON, WA 98059 4700 NE 4TH STREET
RENTON,WA 98059
THANK YOU
WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU THANK YOU
I
WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU '
REFILLS 24-48 HOURS IN ADVANCE WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR I�
REFILLS 24-48 HOURS IN ADVANCE
PANG- ,f/to
*of SEND CLAIM TO: City of Renton
Finance Dept.-Fire Pension
1055 South Grady Way
Renton, WA 98057
.
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N r° CITY OF RENTON
FIREMEN'S PENSION BOARD
Pharmacy/Medical Claim Reimbursement Request
1) DATE 6 1 2( J(� 1
2) DISABILIT RETIREE'S NAME (print) 423 //J n 4, f.- rkS
3) M 3) ADDRESS /3 ,....4--- c.. '61/9
/ / f'Yc 4,n 8 V1 L' vi/ 0632—,
4) DISABILITY AT TIME OF RETIREMENT 67 In a q h. Fell/U xd 15 etit$'e..
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.)
pi e-d ' e r n P -9ayr .S�a 141 aC1 il d-n 4 A nxiel Pi 4 if-v75
6) TOTAL AMOUNT OF CLAIM: $ �p q 9
Amount of total claim (above) that is related to the Retirement Disability: $ Zy. 6
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: ,(44 ccitt-P),P
,
Note: Sup rting documentation must be attached.
Pic sitvierle
YI�IPIC RRVG RECEIPT
1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE
OR TAX RECORDS
Ra 855617 For JOHN PARKS
3.3 1.09 CRN:A1094907902881 1335 3RD AVE#109
LONGVIEW,WA 98632 (360) 577-6684
MIRTAZAPINE SOLTAB 45MG
3 65862-0023-06
RICHARDS,JOHN E
DR. ZHA COPAY: $55.44
11111111111011101 II III I IIIIIIIIIIIIIIIIIIIIII11011III Pie
iiPI DR1/ci RECEIPT
124415th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE
OR TAX RECORDS
aid/ C855616 Fon JOHN PARKS
3.3 1.09 CRN:A6094907902671 1335 3RD AVE#109
LONGVIEW,WA 98632 (360) 577-6684
ZOLPIDEM TAB 10MG *** $
30 NBC:
RICHARDS,JOHN60505-2605-08E
DR. ZHA COPAY: $9.25
II 11111 II I I I II I 111111 III II IIII II 11111111 II Price
Vic &/i0
Atw, SEND CLAIM TO: City of Renton
Finance Dept.-Fire Pension
1055 South Grady Way
Renton, WA 98057
1SY
CITY OF RENTON
FIREMEN'S PENSION BOARD
Pharmacy/Medical Claim Reimbursement Request
1) DATE --�
2) DISABILITY RETIREE'S NAME (print) .�4.(2_, 1plz *'►
3) ADDRESS v'C xJ 10 f/-Exe
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.)
)11-7\423 C 4 — 1 b S� s�r�.�, '4 s- ,►, ei(re m /a, ��-
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6) TOTAL AMOUNT OF CLAIM: $ '
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: 6e-1 /4Y
Note: Supporting documentation must be attached.
. PA&C 17[o
SAM'S CLUB (425)793-7937 $25.46 SAM'S CLUB (425)793-7937 $25.46
Pharmacy 901 SOUTH Pharmacy901
RENTON,WAGRADY 98055-0000WAY RENTONSOUTHWA 98055GRADY_WAY
STROM,KARL
STROM,KARL B 02/19/2009 NEW STROM,KARL B 02/19/2009 NEW
15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055
RX:4415157 Ref#2 QTY: 120 DAW:0 DS:30 RX:4415157 Ref#2 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
43911 43911
WHI AARP Patient Pay $12.48 WHI AARP Patient Pay $12.48
STROM
KARL B a
O !b 15616 SE 743RD
CC J RENTON,WA 98055
(425)271-8373
Y02/19/2009 (425)793-7937 4 79313 08792 1 5.
Signature Required N RX:4415157 REF=2 OC#155 923 405 476 592 384 107 659 238 L
02/19/2009 02:32:02 PM WHI 0
Page No : 1 of 2 TOTAL: $12.48 p
SAM'S CLUB (425)793-7937 m00 SAM'S CLUB (425)793-7937 $8.00
Pharmacy 901 SOUTH GRADY WAY Pharmacy 901 SOUTH GRADY WAY
RENTON,WA 98055-0000 RENTON,WA 98055-0000
STROM,KARL B 03/04/2009 REFILL STROM,KARL B 03/04/2009 REFILL
15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055
RX:6697947 Ref#4 QTY: 60 DAW:0 DS:30 RX:6697947 Ref#4 QTY:60 DAW:0 DS: 30
NDC: 16714-0041-01 ALLOPURINOL 100MG TAB NOR NDC: 16714-0041-01 ALLOPURINOL 100MG TAB NOR
BROCKENBROUGH,ANDREW T NABP:4930613 BROCKENBROUGH,ANDREW T NABP:4930613
21131 21131
WHI AARP Patient Pay $4.59 WHI AARP Patient Pay $4.59
3
KAR B v
a
0 15616 SE 143RD
CC m RENTON,WA 98055
F CC (425)277-8373 4 79313 12372 8
03/04/2009 (425)793-7937
Signature Required N RX:6697947 REF=4 OC#655 923 869 176 592 384 107 659 238 C
03/04/2009 12:58:54 PM WHI T.
Page No : 1 TOTAL: $4.59 a
SAM'S CLUB (425)793-7937 SAM'S CLUB (425)793-7937
Pharmacy 90REN1 WY Pharmacy 901 SOUTH GRADY WAY
TONSOUTHWAGRADY 98055 0000 ARENTON,WA 98055-0000
STROM,KARL B 03/04/2009 REFILL STROM,KARL B 03/04/2009 REFILL
15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055
RX:6697979 Ref#0 QTY:90 DAW:0 DS:45 RX:6697979 Ref#0 QTY:90 DAW:0 DS:45
NDC:00378-0232-01 FUROSEMIDE 80MG TAB MYL NDC:00378-0232-01 FUROSEMIDE 80MG TAB MYL
MARTIN,MICHAEL M NABP:4930613 MARTIN,MICHAEL M NABP:4930613
Patient Pay $10.00 Patient Pay $10.00
—
Y
M �oBIII II I 1 1111 1111
°'
0 03 15616 SE 143RD
RENTON,WA 98055
H (425)271-8373 4 79313 12371 1
Q 03/04/2009 (425)793-7937
Y Signature Required N RX:6697979 REF=0 OC#365 923 441 076 592 384 107 659 238 C
03/04/2009 12:58:48 PM
Page No : 1 of 2 TOTAL: $10.00 Ii
' Silo
*raw Iwo
SAM'S CLUB (425)793-7937 $25.46 SAM'S CLUB (425)793-7937 $25.46
901 SOUTH GRADY WAY 901 SOUTH GRADY WAY
Pharmacy_ RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000
STROM,KARL B 03/14/2009 REFILL STROM,KARL B 03/14/2009 REFILL
15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055
RX:4415157 Ref# 1 QTY: 120 DAW:0 DS: 30 RX:4415157 Ref#1 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
99451 99451
WHI AARP Patient Pay $12.48 WHI AARP Patient Pay $12.48
O.
.Y
2
STROM0
0 m KARL B111 a
15616 SE 143RD _
CC RENTON,WA 980551111IIIIII
E— qJ 4 79313 14869 1
(r (425)271-8373
Cl) Y 03/14/2009 (425)793-7937 �.
Vl Y Signature Required N RX:4415157 REF=1 OC#155 923 405 476 592 384 107 659 238
03/14/2009 05:22:07 PM Will O
Page No : 1 of 2 TOTAL: $12.48 d
SAM'S CLUB 901 SOUT7H GRADY WAY $45.72 SAM'S CLUB 15SOUTH $45.72
GRADY WAY
Pharmacy RENTON,WA 98055-0000 03/18/2009 NEW STROM,KARL BENTON,WA 98055-0000
STROM,KARL B 03/18/2009 NEW
15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055
RX:4415515 Ref#0 QTY:30 DAW:0 DS:30 RX:4415515 Ref#0 QTY:30 DAW:0 DS:30
NDC: 00093-0074-01 ZOLPIDEM 10MG TAB TEV NDC:00093-0074-01 ZOLPIDEM 10MG TAB TEV
GRAVES,DANIEL NABP:4930613 GRAVES,DANIEL NABP:4930613
93641 93641
WHI AARP Patient Pay $13,42 WHI AARP Patient Pay $13.42
2 STROM EKARL B
0I/� m 15616 SE 143RD N
CC J RENTON,WA 980551111IIII C
cc (425)271.8373 4 79313 15856 0
Q 03/18/2009 (425)793-7937 A
1 Signature Required N RX:4415515 REF=0 OC#155 923 475 676 592 384 107 659 238
03/18/2009 03:45:26 PM"' WHI O
Page No : 1 of 2 TOTAL: $13.42 d
o .
SAM'S CLUB 9015 SOUTH GRADY WAY 37 $4.00 SAM'S CLUB 9011 SOUTH GRADY WAY)793-7937 $4.00
Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000
STROM,KARL B 03/30/2009 NEW STROM,KARL B 03/30/2009 NEW
201 UNION AVE SE#142 RENTON,WA 98059 201 UNION AVE SE#142 RENTON,WA 98059
RX:6702397 Ref#5 QTY:30 DAW:0 DS: 30 RX:6702397 Ref#5 QTY:30 DAW:0 DS: 30
NDC:00378-0018-91 METOPROLOL TART 25MG TAB MY NDC:00378-0018-91 METOPROLOL TART 25MG TAB MY
BROCKENBROUGH,ANDREW T NABP:4930613 BROCKENBROUGH,ANDREW T NABP:4930613
69121 69121
WHI AARP Patient Pay $3.00 WHI AARP Patient Pay $3.00
3
Y
STROM
2 KARL B E110 m 201 UNION AVE SE#142 —
CC J RENTON,WA 98059111III
(425)271-8373 4 79313 18602 0
03/30/2009 (425)793-7937
Signature Required N RX:6702397 REF=5 OC#555 923 871 076 592 388 107 659 238 L
03/30/2009 07.08:14 PM WHI G
Page No : 1 of 2 TOTAL: $3.00 a
Pk 1/10
Noe ,ftiv
SAM'S CLUB 90 SOUTH GRADY WAY $8.00 SAM'S CLUB (425)793- 7
�1l �11 yy 901 SOUTH GRADY WAY $8.00
PJ 1 RV aCy RENTON,WA 98055-0000 B 03/30/2009 REFILL S ROM AR RENTON,WA 98055-0000
201 UNION AVE SE#142 RENTON,WA 98059 201 UNION AVE SE#142 RENTON,WA/98059 9 REFILL
NRDC: 16714-0041---0147 Ref#3 ALLOPURINOL 0 MG TAB NOR RX: 16714-0041-01 7947 #3 ALLOPURINOL 100MG TAB NOR
BROCKENBROUGH,ANDREW T NABP:4930613 BROCKENBROUGH,ANDREW T NABP:4930613
47761 47761
WHI AARP Patient Pay $4.59 WHI AARP Patient Pay $4.59
t2
2 STROM
0KAM m 201 URN ON AVE SE#142 .Q.
CC J RENTON,WA 98059
(425)271-8373 4 79313 18604 4
03/30/2009 (425)793-7937 5„
Signature Required N RX:6697947 REF=3 OC#655 923 869 176 592 384 107 659 238
03/30/200911:53:34 AM"` WHI O
Page No : 1 TOTAL: $4.59 cr.
SAM'S CLUB (425)793-7937 $18'54 SAM'SCLUB (425)793-7937 $18.54
901 SOUTH GRADY WAY 901 SOUTH GRADY WAY
Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000
STROM,KARL B 03/30/2009 NEW STROM,KARL B 03/30/2009 NEW
201 UNION AVE SE#142 RENTON,WA 98059 201 UNION AVE SE#142 RENTON,WA 98059
RX: 6702400 Ref#5 QTY:30 DAW:0 DS: 30 RX:6702400 Ref#5 QTY:30 DAW: 0 DS:30
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
69161 69161
WHI AARP Patient Pay $4.4.1 WHI AARP Patient Pay $4.41
STROM 3o
KARL B d
0 m 201 UNION AVE SE#142
C RENTON,WA 98059
(425)271-8373 4 79313 18603 7
03/30/2009 (425)793-7937
�,
Signature Required N RX:6702400 REF=5 OC#655 923 865 776 592 884 107 659 238
03/30/2009 07:08:19 PM WHI O
Page No : 1 of 2 TOTAL: $4.41 a.
Database Edition:92.Information Expires 07/16/2009
SAM'S CLUB (425)793-7937 $25.46 SAM'SCLUB (425)793-7937
$25.46
901 SOUTH GRADY WAY 901 SOUTH GRADY WAY
Pharmacy RENTON,WA 98055-0000 04/11/2009 REFILL STROM,KARL BENTON,WA 98055-0000
STROM,KARL B 04/11/2009 REFILL
201 UNION AVE SE#142 RENTON,WA 98059 201 UNION AVE SE#142 RENTON,WA 98059
RX:4415157 Ref#0 QTY: 120 DAW: 0 DS: 30 RX:4415157 Ref#0 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
92281 92281
WHI AARP Patient Pay $12.48 WHI AARP Patient Pay $12.48
11
2
EM
0 m AVE SE#142WA 98059
(425)271.8373 4 79313 21797 7(425)793-79375Signature Required N 5157 REF=0 OC#155 923 405 476 592 384 107 659 23804/11/2009 11:16:59 AM O
Page No : 1 of 2 TOTAL: $12.48 a
0 Department of Veteran Mks-,_ ...I,
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1660 S CAN WAY STATEMENT OF MEDICAL CARE COST RECOVERY ACCOUNT ACTIVITY
WA 981
SEATTLE WA 98108-1532 NAME OF FACILITY
AGENT CASHIER (136MCCR) VA PUGET SOUND HEALTH CARE SYSTEM (663) '*
FOR QUESTIONS ABOUT YOUR ACCOUNT, PLEASE PHONE THE
BELOW NO. 1-866-29o-4618
=0011
III 1 I Ii�fI.1 u1 nn nuII For written inquiries concerning your account please send them -