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Home My WebLink AboutFinal Agenda Packet Noe Nee CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room Thursday, February 19, 2009 2:00 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF JANUARY 15, 2009 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO DECEMBER 31, 2008, (Final) & MONTHLY STATEMENT TO JANUARY 31, 2009 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT *low Nee MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON January 15, 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 Acting Chairman Don Persson at 2:00 p.m. in the Mayor's office, 7th floor of Renton City Hall. In attendance were Board members Don Persson, Bruce Phillips, and Ray Barilleaux. Also in attendance: Jason Seth, Deputy City Clerk and acting Board Secretary, and Jill Masunaga, Finance Department Representative. MINUTES APPROVAL MOVED BY PHILLIPS, SECONDED BY BARILLEAUX, THE PENSION BOARD APPROVE THE MINUTES OF THE DECEMBER 19, 2008, MEETING. CARRIED. CORRESPONDENCE MONTHLY STATEMENT The draft financial report as of December 31, 2008, was reviewed. Total cash/investment balance was $4,265,416.20. Ms. Masunaga stated that the final report for 2008 will be available in February and may include slight changes. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY PHILLIPS, SECONDED BY BARILLEAX, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR JANUARY 2009, IN THE TOTAL AMOUNT OF $46,586.43. CARRIED. Ms. Masunaga stated that the pension payments include the following changes; a 5.5 percent cost of living allowance (COLA) increase, and that the longevity scale has reverted to the old scale and is reflected in the payments. ADJOURNMENT MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 2:10 p.m. 40—CA (.7:;?_ ./' ;', Jason Seth, Deputy City Clerk Acting Secretary, Firemen's Pension Board CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT final AS OF DECEMBER 31, 2008 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 - -- 0 2008 ❑2007 5 041 13 u) c 3 . 0 i 2 - 1 - - 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 $4,307,865.55 $4,694,232.48 $4,203,347 $4,368,674.57 $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 1,031.91 17,965.67 200,000 361,345.71 389,226.86 175,000 DISBURSEMENTS: Fire Pension 40,549.89 512,262.83 552,400 34,695.56 427,011.96 463,500 Fire Pension Medical 1,527.22 9,572.61 20,000 406.24 9,059.17 20,000 Office/Operating Supplies 0.00 372.78 459 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 9,948.00 9,948 686.00 8,226.00 8,226 ENDING CASH/INV BALANCE $4,265,991.35 $4,265,991.35 $3,895,540 $4,694,232.48 $4,694,232.48 $4,203,347 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $727,571.09 $546,745.98 $933,112.91 $162,962.30 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 3,206,796.27 3,206,796.27 3,651,388.97 INTEREST ACCRUED 0.00 0.00 TOTAL CASH AND INVESTMENTS $4,265,991.35 $4,307,865.55 $4,694,232.48 $4,368,674.57 The State Investment Pool interest 1.8183% 2.1903% 4.5607% 4.6985% H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2009.xls\Dec08 final Page 1 02/13/2009 CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF JANUARY 31, 2009 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 ■2009 ■2008 5 a G 4 0 III -4-' , — _ R ., 3 . , _.---li5 1 ' lit . 2 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 $4,265,991.35 $4,265,991.35 $3,895,540 $4,694,232.48 $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 207,076.37 207,076.37 200,000 0.00 17,965.67 200,000 DISBURSEMENTS: Fire Pension 41,526.62 41,526.62 500,000 46,006.26 512,262.83 552,400 Fire Pension Medical 75.15 75.15 20,000 1,160.34 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 988.00 988.00 11,801 829.00 9,948.00 9,948 ENDING CASH/INV BALANCE $4,430,477.95 $4,430,477.95 $3,653,264 $4,646,236.88 $4,265,991.35 $3,895,540 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $892,057.69 $727,571.09 $885,117.31 $933,112.91 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 $4,430,477.95 $4,265,991.35 $4,646,236.88 $4,694,232.48 The State Investment Pool interest 1.2669% 1.8183% 4.3596% 4.5607% H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2009.xls\Jan09 Page 1 02/13/2009 err FIREMEN'S PENSION BOARD vie PENSION/MEDICAL PAYMENTS FOR FEBRUARY, 2009 Recipient. Pension Amt Medical Total: ANKENY, Charlie (Captain) $311.31 311.31 ASHURST, James (Assistant Chief) $4,820.50 593.42 5,413.92 BANASKY, George (Captain) $1,200.19 1,200.19 BARILLEAUX, Ray(Battalion Chief) - - BEATTEAY, Karlen (Widow) $359.17 359.17 BERGMAN, Claudette (Widow) $281.74 281.74 CHRISTENSON, Chuck (Firefighter) $404.78 404.78 CONNELL, Robert (Captain) $901.63 901.63 GEISSLER, Dick(Fire Chief) $229.53 229.53 GOODWIN, Charles (Captain) $4,231.00 941.79 5,172.79 GOODWIN, Donald (Firefighter) $1,148.48 1,148.48 HAWORTH, Constance (Widow) $2,792.83 2,792.83 HAWORTH, Jack (Firefighter) $3,191.50 - 3,191.50 HENRY, William, Jr. (Captain) $1,502.96 1,502.96 HURST, Gerald (Firefighter) $664.91 664.91 JONES, Evelyn M. (Widow) $381.91 381.91 LARSON, William (Firefighter) $93.80 93.80 LAVALLEY, Theodele (Captain) $526.88 526.88 MATTHEW, James (Deputy Chief) - - MC LAUGHLIN, JACK (Battalion Chief) $1,202.72 1,202.72 NEWTON, Gary(Lieutenant) $423.76 423.76 NICHOLS, Gerald (Battalion Chief) $722.39 722.39 PARKS-ANDREASON, Arlene (Widow) $492.16 492.16 PARKS, John (Firefighter) $3,312.50 22.60 3,335.10 PHILLIPS, Bruce H. (Deputy Chief) $497.25 497.25 PRINGLE, Arthur(Captain) $644.66 644.66 PRINGLE, S. Joan (Widow) $2,399.37 2,399.37 RIGGLE, David E. (Firefighter D Step) $216.08 216.08 RUPPRECHT, Jim (Firefighter D Step) $249.52 249.52 SMITH, Leroy(Firefighter) $526.54 526.54 STROM, Karl (Firefighter) $3,191.50 35.07 3,226.57 TODD, Franklin (Firefighter) $583.82 583.82 TONDA, Lila Jean (Widow) $228.89 228.89 VACCA, Nick (Lieutenant) $452.60 452.60 WALLS, Camille (Widow) $281.43 281.43 WALLS, Mercedes (Widow) $345.21 345.21 WALSH, David (Firefighter) $1,193.07 1,193.07 WEISS, Larry(Battalion Chief) $969.70 969.70 WILLIAMS, Alta (Widow) $188.63 188.63 WOOTEN, Marilyn E. (Widow) $361.70 361.70 ' Vit? eii es4 a sion/Medica) 41;52 :6 a. ,. 159z 8 ; :: .1?� 3 0'SQ., . '�_ :�"?� ;Exp. `S .:;F n � �� ' Z ::a�.$ .s �- �. .m$� x. Prior Year Pension/Medical Payments: Total Pension Payments for February, 2008 46,006.26 Total Medical Bills Reimbursed in February, 2008 805.50 Total Expenses: Medical/Pension 46,811.76 4_SUMMARY 2009 XLS 02/13/2009 • err FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN FEBRUARY, 2009 PAYMENT Page Name Ptiarn acy/Medical Facility Date ' Amount of Bill 2 James Ashurst Safeway 12/08/08 10.99 2 James Ashurst Safeway 12/08/08 141.80 2 James Ashurst Safeway 12/08/08 102.15 2 James Ashurst Safeway 12/27/08 82.54 2 James Ashurst Safeway 01/19/09 102.15 2 James Ashurst Safeway 01/29/09 11.99 2 James Ashurst Safeway 01/29/06 141.80 593.42 4 Charles Goodwin Bartell Drugs 12/20/08 182.27 4 Charles Goodwin Bartell Drugs 12/20/08 0.00 4 Charles Goodwin Bartell Drugs 12/21/08 49.59 4 Charles Goodwin Bartell Drugs 12/21/08 9.89 5 Charles Goodwin Bartell Drugs 12/21/08 84.44 5 Charles Goodwin Bartell Drugs 01/24/08 194.36 5 Charles Goodwin Bartell Drugs 01/24/08 49.59 5 Charles Goodwin Bartell Drugs 01/25/08 361.76 6 Charles Goodwin Bartell Drugs 01/31/08 9.89 941.79 Jack Haworth 0.00 8 John Parks Olympic Drug 12/30/08 14.01 8 John Parks Olympic Drug 12/30/08 6.28 8 John Parks Olympic Drug 12/31/08 2.31 22.60 10 Karl Strom Sam's Club 02/02/09 12.48 10 Karl Strom Sam's Club 02/04/09 4.59 10 Karl Strom Sam's Club 02/04/09 9.00 11 Karl Strom Sam's Club 02/05/09 9.00 35.07 3_2009 FP Medical.XLS Page 1 of 1 02/13/2009 +100+ SEND CLAIM TO: ''City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request I) DATE ;Feb. 2, 2009 2) DISABILITY RETIREE'S NAME (print)Jamcs F. Ashui s L -- 3) ADDRESS 223 Garden Ave_ N #B 4) DISABILITY AT TIME OF RETIREMENT HYPERTENSION, 1-1-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.) HYPERTENSTON, HIGH BLOOD PRESSURE 6) TOTAL AMOUNT OF CLAIM: $ 593_ 4 2 Amount of total claim(above) that is related to the Retirement Disability: $ 510. 88 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: GZi1/1'Lit 4?4 Note: Supporting documentation must be attached. MINIM MCY RENTON,WA 98055 §If ►4 NIMMACY # {425)226W- 0325 ($) RENTON,WA 98055 Official Receipt- Please retain for tax or insurance ' #1 (425)226-0325 ASHURST,JAMES (425)255-6154 Official Receipt- Please retain for tax or insurance 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 ASHURST,JAMES (425)255-6154 DR. GRAVES,DANIEL [RF] 223 B GARDEN AVE N. 12/17 17900 TALBOT RD S RENTON,WA 98055 RENTON,WA 98055 AskAF DR. GRAVES,DANIEL [RF] Rx:6701702 Dec 08, 2008 Safety Cap: Yes 17900 TALBOT RD S METOPROLOL 50MG TAB (TEVA)Qty: 100 TAB RENTON,WA 98055 AskAF Rx:6710376 Jan 19, 2009 Safety Cap: Yes Ref:A2087437017951 NDC:00093.0733.10 HSGI PANTOPRAZOLE 40MG TAB (PRAS)Qty:30 TAB REGENCE BLUESHIELD WASH Cash Price: 10.99 Generic for:PROTONIX 40MG TAB Amount Due: $10.99 Ref:30000026284515 NDC:00008-0607-01 HSG( REGENCE BS WASHINGTON Cash Price: 134.49 WI%I� MACY Amount Due: $102.15 (425)2RENTON,WA 98055 II II II II II II IIIIII I I I I I IIIII II f��REFILL f�safEway.COM YOUR PRESCRIPTIONS # (425)226 03225 Official Receipt- Please retain for lax or insu►aiwe 00000068710 e ASHURST,JAMES (425)255-6154 - 223 B GARDEN AVE N. 12/17IIFIWIMACY RENTON,WA 98055 DR. GRAVES,DANIEL [RF] RENTON,WA 98055 17900 TALBOT RD S N , (425)226-0325 RENTON,WA 98055 AskAF Rx:6702058 Dec 08, 2008 Safety Cap: Yes Official Receipt- Please retain for tax or Insurance PLAVIX 75MG TAB (B-M ) Qty: 30 TAB ASHURST,JAMES (425)255-6154 Ref:A5087430544641 NDC:63653.1171.06 HSGI 223 B GARDEN AVE N. 12/17 REGENCE BLUESHIELD WASH Cash Price: 194.99 RENTON,WA 98055 Amount Due: $141.80 DR. GRAVES,DANIEL [RF] 17900 TALBOT RD S RENTON,WA 98055 AskAF WAWA%(' # ACY Rx:6707635 Jan 29, 2009 Safety Cap: Yes RENTON,WA 98055 FUROSEMIDE 40MG TAB (WATS)Qty: 100 TAB Generic for:FUROSEMIDE 40MG TAB 5 (425)226-0325 Ref:30000027336407 NDC:00591.0301.10 BBAI Official Receipt Please retain for tax or insurance REGENCE BS WASHINGTON Cash Price: 11.99 Amount Due: $11.99 (425)255-6154 • GARD V ••VE N. 12/17 111111111111111111111111111111@29002101199 ,flRx.,,� REFILL YOUR PRESCRIPTIONS RENTON,WA 98055 DR. GRAVES,DANIEL [RF] L—�� SAfEWAY.COM 17900 TALBOT RDS _ RENTON,WA 98055 AskAF Rx:6710376 Dec 08, 2008 Safety Cap: Yes �AFFW ��ACY PANTOPRAZOLE 40MG TAB (PRAS)Qty: 30 TAB �1 S IA Generic for:PROTONIX 40MG TAB RENTON,WA 98055 Ref:A7087437018151 NDC:00008.0607.01 HSGI # (425)226-0325 REGENCE BLUESHIELD WASH Cash Price: 134.49 Amount Due: $102.15 ffi ial Receipt - Please retain for tax or FoURNMIIMMAcir ASHURST,JAMES (425)255-6154 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 RENTON,WA 98055 . kii) (425)226-0325 DR. GRAVES,DANIEL [RS] 17900 TALBOT RD S Official Receipt-Please retatwfer tax or Insurance RENTON,WA 98055 AskAF Rx:6719636 Jan 29, 2009 Safety Cap: Yes ASHURST,JAMES (425)255-6154 PLAVIX 75MG TAB (B-M ) Qty: 30 TAB 223 B GARDEN AVE N. 12/17 BBAISDP RENTON,WA 98055 Ref:30000027308929 NDC:63653-1171-06 DR. GRAVES,DANIEL [RF] REGENCE BS WASHINGTON Cash Price: 194.99 17900 TALBOT RDS Amount Due: $141.80 RENTON,WA 98055 AskAF Rx:6706816 Dec 27, 2008 Safety Cap: Yes 111111111111111111 111 �« REFILL YOUR PRESCRIPTIONS HUMULIN N VIA (LILL) Qty: 20 ML [a7 SAfEWAY.COM Ref:30000023933689 NDC:00002-8315-01 HAI 00000068710 ,. REGENCE BS WASHINGTON Cash Price: 89.98 Amount Due: $82.54 1111111111111111111111111111ilI � EF@ SAFEWARY.COM TIONS pgf 2v SENDCLAIMTO: "City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton,WA 98057 YP CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE 3 3� 2) DISABILITY RETIREE'S NAME (print) C Les A__ 6OO D i 3) ADDRESS f (--/ A a Nadi i4-11e ) (,0 - 4) DISABILITY AT TIME OF RETIREMENT #eltri CA6( T//4 91- VtipCi rt- zm) 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 cm1 . g 9 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:�� . Note: Supporting documentation must be attached. IW 3 IL" 1 4 /GC -z—ej / c/0' AO j72611 : CWLeS /- __a d 1,J 1 A) lAtti-lif-:/ BARTELL DRUGS —Washtngton':Own Drugsk es�� BARTELL DRUGS RX# —_wn. on'lOwnDrugstores 45-444249 E DR. KATO,GARY H. Rx>R 45-459318 E DR. LORCH,GERALD DATE: 12/21/08 R (425)255-9310 DATE: 12/20/08 R (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AMLODIPINE 5MG TABLET(*LUP) AGGRENOX CAP 200/25 68180-0751-09 3361112124659 00597-0001-60 2523763508709 REFILL 1 QUANTITY 30.00 REFILL 3 QUANTITY 60.00 BARTELL DRUGS PRICE= $54.49 �1 BARTELL DRUGS PRICE= $195.99lik �� , 11 WITH SR THE AMOUNT DUE:$49.59 ``l WITH SR THE AMOUNT DUE o 182.27 BARTELL DRUGS#45 �J 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 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 Y REFILLS 24-48 HOURS IN ADVANCE WITH THE BEST SERVICE POSSIBLE PLEASE ORDER VOL REFILLS 24-48 HOURS IN ADVANCE 1 BARTELL DRUGS DRUGS ashington s Own Drugstores.. 0........ RXlt ..............Washington't Own Drugstores Rx' 45-459328 E DR. LORCH,GERALD 45-454813BARTELL E DR. LORC RALD W DATE: 12/20/08 R DATE: 12/21/08 R (425)251-5110 (425)251-5110 NAME: CHARLES GOODWIN NAME` CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGGRENOX CAP 200/25 ALLOPURINOL 100MG TABLET(*PA 00597-0001-60 2523763508709 49884-0602-10 2657696269809 REFILL 3 QUANTITY 6�`� '} REFILL 2 QUANTITY 30.00 BAF �K V BARTELL DRUGS PRICE_ PARTII.AVIILLED RXS: $10.99 PI OWE @ NO CHARGE OR ❑$ WITH SR THE AMOUNT DUE- 9.gg ��j- (QQ� WI 0 NO.OF RXS WITH THIS ORDER — 1 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 YOUSEA THANK YOU WE TRULY THE APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR L WITH THE BESTFLLS 24-48 OURS IN ADVANCE YOUR L REFILLS 24-48 HOURS IN ADVANCE _P- ‘7,;A-1--- PA a , 7S •P- . • / 4,,Lei ' n k--- mvi ,, cel l(, L G-O0J)6J� BARTELL DRUGS I BARTELLDRUGS � Warhingtonl ore Own Drugrtr� w a sh E +Own DR. i � rtorer � R)(iY RX# 45-452020 E DR. FLO, GAYLE 45-444249KATO DATE: 12/21/08 R (425)251-5110 DATE: 01/24/09 R (425)255-9310 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 GEMFIBROZIL 600MG TABLET(*TE AMLODIPINE 5MG TABLET(*LUP) 00093-0670-05 2423148927609 68180-0751-09 3031836949809 REFILL 2 QUANTITY 180.00 REFILL NO QUANTITY 30.00 BARTELL DRUGS PRICE= $91.78 vi 0 ILI BARTELL DRUGS PRICE= $54.49 WITH SR THE AMOUNT DUE 484.44 WITH SR THE AMOUNT DUE 449.59 4 1 "S 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 L REFILLS 2448 HOURS IN ADVANCE 1 I BARTELL DRUGS I BARTELL DRUGS --Washington's OwnDrugstoree�� RX# 1280's wnDDrugetores 45-459328 E DR. LORCH,GERALD G GRIFFITH,ALIDA R" DATE: 01/24/09 R (425)251-5110 DATE: 01/25/09 R (425)899-3123 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGG NOX CAP 200/25 CARBIDOPA/LEVODOPA 2 '. = ! i M 00597 0 60 3031838759809 00093-0293-01ate.:°:, 4651 If REFILL1 QUANTI r �� 2 QUANTITY 60.00 � REFILL 540 00 BARTELL DRUGS PRICE= $208.99 BARTELL DRUGS PRIC- = $388.99 WITH SR THE AMOUNT DUE-$194.36 if I� WITH SR THE AMOUNT DUE 4361.76 BARTELL DRUGS#45 BARTELL DRUGS#45 riO (425)793-1015 (425)793-1015 E? I 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 I L REFILLS 24-48 HOURS IN ADVANCE I .1°-6( 'Ak 0O• 1s Id ( 631(\ 46A1 146r/o).4/r- 4_ , -C;6 6()I r4ovir, Liffio&L" I BARTELL DRUGS ._ ioshutgton'a Owls I rugstores Rx# 45-454813 E DR. LORCH,GERALD DATE: 01/31/09 R (425)251-5110 NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 ALLOPURINOL 100MG TABLET(*PA 49884-0602-10 3126798299809 REFILL 1 QUANTITY 30.00 061 BARTELL DRUGS PRICE= $10.99 WITH SR THE AMOUNT DUE $9.89 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 ill"41E-- 41E--PAT-v 0-DIC 3 003-9- G"`"' w _igi,410 .7 9 +0' SENDCLAIMTO: 'City of Renton • Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 4. ..R11 t CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE F -, f 1 6 0 9 2) DISABILITY RETIREE'S NAME (print) Jd h ii L.' F {I is 3) ADDRESS /3 -3 A v`.e,4fi 09 /v o - view, (/(2. 7 86 3 4) DISABILITY AT TIME OF RETIREMENT $ . !1 Q , 11 se45 - H i 47-W- fie rnlc . i net AAxletyQI0 iLe -rri,5 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 CA i e., -1' 14 -e 'sr 1 c_.11TV TH tei 4- /1 )2x.itoly refecti (e90 S 6) TOTAL AMOUNT OF CLAIM: $ ,2j, 6,--f2- Amount of total claim (above) that is related to the Retirement Disability: $ A.- ctr 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. -- c), -4/416 Signature: C%j d . Note: Sup ting documentation must be attached. pkec 1 �riir `�.rrt 42iat°` Value at the smiling'DWG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# 831413 For JOHN PARKS 12-30-08 CAN:A1087658243921 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 MIRTAZAPINE SOLTAB 45MG 30 NDC: 65862-0023-06 RICHARDS,JOHN E DR. ZHA COPAY: $14.01 1111111111111111111M1111110111111111011 III II I I II Price Value it the smiling'- DRUG RECEIPT SAVE FOR INSURANCE 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 OR TAX RECORDS Ro# C831415 For JOHN PARKS 12-30-08 CRN:A4087658243031 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ALPRAZOLAM 0.5MG TAB *** #60 NDC: 59762-3720-03 DR. RICHARDS,JOHN E ZHA COPAY: $6.28 0111111 II 11111 lIl II I IIIIIII 111111 IIIII 11 1 11 Price Value at the smiling'0'12P'IIIMPIC DWG RECEIPT SAVE FOR INSURANCE 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 OR TAX RECORDS R.# C846626 For. JOHN PARKS 12.31.08 CAN:A6087669760141 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ZOLPIDEM TAB 10MG *** $ #30 NDC: 60505-2605-08 ZHA COPAY: $2.31 DR. RICHARDS,JOHN E Il II III II I II IIi0Il II IIII II II 10 Ill00I Price Pkbe g 14.0 SENDCLAIMTO: ''City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 O'S, 0 �� NT°� CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE l t b 9 2) DISABILITY RETIREE'S NAME (print) ! /9--c ( n _ ,D ivt, 3) ADDRESS / ( Vi 0-10 Il WS-Th / Ts-_ : 4-6 it) K'7 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:) tt-o2-6s 4fd °T_ 0-0 tircteoo d 49-09p-(r /01' (-1-ff--E-n-r-7_,-,gi it, ?- gfl I-1 .19 / ) ) pc 1 / G.2 6) TOTAL AMOUNT OF CLAIM: $ j LT 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 Departuret. Signature: et-c._.- e 6 - .,,, Note: Supporting documentation must be attached. • `err' -Nosy SAM'S CLUB (429015S793-7937 OUTH GRADY WAY $25.46 SAM'S CLUB (42 )793-7937 9015 SOUTH GRADY WAY $25.46 Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KARL B 02/02/2009 REFILL STROM,KARL B 02/02/2009 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:4414329 Ref#0 QTY: 120 DAW:0 DS:30 RX:4414329 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 58341 58341 WHI AARP Patient Pay $12.48 WHI AARP Patient Pay $12.48 QQ . STROM. KARL BIIIIIII II I II a 15616 SE 143RD 0 -I RENTON,WA 98055 �i I (425)271-8373 2 004 79313 04758 1 U) LYQL 0/02/29 (425)793-7937 Signature Required N RX:4414329 REF=0 OC#155 923 405 476 592 384 107 659 238 .— 02/02/2009 11:07:51 AM"' WHI G Page No : 1 of 2 TOTAL: $12.48 a Database Edition:91.Information Expires 04/16/2009 SAM'S CLUB (425)793-7937 $8.00 SAM'S CLUB (425)793-7937 $8.00 901 SOUTH GRADY WAY 901 SOUTH GRADY WAY Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KARL B 02/04/2009 NEW STROM,KARL B 02/04/2009 NEW 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6697947 Ref#5 QTY:60 DAW:0 DS:30 RX:6697947 Ref#5 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 68641 68641 WHI AARP Patient Pay $4.59 WHI AARP Patient Pay $4.59. 9 j STROM 0 KARL B IIIIIIIii 0 15616 SE 143RD CC J RENTON,WA 9805511111 „^ (425)271-8373 4 79313 05651 4 N' Y- 02/04/2009 (425)793-7937 Signature Required N RX:6697947 REF=5 OC#655 923 869 176 592 384 107 659 238 t02/04/2009 06:48:23 PM WHI Page No : 1 TOTAL: $4.59 p Database Edition:91.Information Expires 04/16/2009 SAM'S CLUB (425)793-7937 $10.00 SAM'S CLUB (425)793-7937 $10.00 901 SOUTH GRADY WAY 901 SOUTH GRADY WAY Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KARL B 02/04/2009 REFILL STROM,KARL B 02/04/2009 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6692403 Ref#P QTY:90 DAW:0 DS:90 RX:6692403 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 45721 45721 WHI AARP Patient Pay $9.00 WHI AARP Patient Pay $9.00 i Y 2 STROM • KARL B II11Iii' .0 __. . 15616 SE 143RD RENTON,WA 98055 H J (425)271.8373 4 79313 05581 4 COQ 02/04/2009 (425)793.7937 - V/ Y Signature Required N RX:6692403 REF#P OC#155 923 881 076 592 884 107 659 238 '� 02/04/2009 04:14:54 PM WHI Page No : 1 of 2 TOTAL: $9.00 d like(10 a 1111110 '41181 Database Edition:91.Information Expires 04/16/2009 SAM'S CLUByy9011 SOUTH GRADY WAY)793-7937 $10'� SAM'S CLUB 9015)793-7937 SOUTH GRADY WAY $10.00 PSTROM,KARL gENTON,wA 98055 02/05/2009 NEW STROM KARL gPharmacy ENTON,wA 98055-0000 02/05/2009 NEW 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX: 6697979 Ref#1 QTY:90 DAW:0 DS:45 RX:6697979 Ref#1 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 29111 29111 WHI AARP Patient Pay $9.00 WHI AARP Patient Pay $9.00 1 . STROM KARL B PEI 1 1 ill 0 n. 0 m 15616 SE 143RD CC J RENTON,WA 98055 1^i „qr (425)271-8373 4 79313 05801 3 M/ Y 02/05/2009 (425)793-7937 �+ Signature Required N RX:6697979 REF=1 OC#155 923 881 076 592 884 107 659 238 L 02/05/2009 02:29:24 PM WHI 0 Page No : 1 of 2 TOTAL: $9.00 d 174(06 H