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Final Agenda Packet
t f lase CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room Friday, January 18, 2007 *10:00 a.m.* 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF DECEMBER 20, 2007 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO DECEMBER 31, 2007 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT lee .*ure MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON December 20, 2007 Kathy Keolker, Mayor Don Persson, Council Finance Committee Chair Bonnie Walton, City Clerk Ray Barilleaux, Fire Department Representative Bruce Phillips, Fire Department Representative Chuck Christensen, Fire Department Alternate The regular meeting of the Firemen's Pension Board was called to order by Acting Chairman Bonnie Walton at 1:35 p.m. in the Council Conference room, 7th floor of Renton City Hall. In attendance were Board members Bonnie Walton, Ray Barilleaux and Bruce Phillips. Also in attendance was Finance representative, Jill Masunaga. MINUTES APPROVAL MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE PENSION BOARD APPROVE THE MINUTES OF THE NOVEMBER 15, 2007, MEETING. CARRIED. CORRESPONDENCE A memo from Fire Chief David Daniels was reviewed, confirming Bruce Phillips' re-election to the Firemen's Board for a two-year term to be effective January 1, 2008 through December 31, 2009. MONTHLY STATEMENT The financial report as of November 30, 2007, was reviewed. Total cash/investment balance was $4,368,674.57. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR DECEMBER 2007, IN THE TOTAL AMOUNT OF $35,101.80 TO BE PAID FROM THE FIREMEN'S PENSION FUND. CARRIED. UNFINISHED BUSINESS Jill Masunaga explained the Monthly Pension Payments formula handout that she had prepared. Discussion ensued regarding the stipulation in the 2006-2008 Renton Firefighters Local 864 contract that effective January 1, 2008 and ending December 31, 2008, employees who have reached at least 27 years of service in the LEOFF Retirement system shall receive 22% of the employee's base wage in longevity pay. Assuming that stipulation carries over to the Firemen's Pension formula, the impact on the Firemen's Pension Fund in 2008, according to Masunaga, will be approximately$100,000, according to Masunaga. *we valaso Jay Covington, Chief Administrative Officer,joined the meeting and discussion. He assured that a legal opinion could be expedited in time for issuing the January pension payments, assuring that the 2008 LEOFF increase applies to the Firemen's Pension Board formula. ADJOURNMENT MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 2:15 p.m. Bonnie I. Walton, City Clerk Member and Secretary, Firemen's Pension Board 2 • CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF DECEMBER 31, 2007 Vre Fireman's Pension Fund Comparison of Cash and Investment Activity 6 ❑2007 ■2006 5 co co 4 — 0 H 0 2 — 13 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CURRENT 2007 2007 LAST YEAR 2006 2006 ACTIVITY: MONTH YTD BUDGET CURR MO ACTUAL ADJ BUDGET BEGINNING CASH/INV BALANCE $4,368,674.57 $4,672,241.19 $4,459,523 $4,699,993.38 $4,811,901.62 $4,713,823 RECEIPTS: Fire Insurance Premium Tax 0.00 85,061.56 73,000 0.00 77,820.55 73,000 Investment Interest 801,344.49 829,225.64 175,000 6,660.07 215,553.19 150,000 DISBURSEMENTS: Fire Pension 34,695.56 427,011.96 463,500 33,669.09 414,281.42 450,000 Fire Pension Medical 406.24 9,059.17 20,000 168.17 11,536.51 20,000 Office/Operating Supplies 0.00 450.00 450 0.00 316.24 400 Actuarial/Firemen's Pens 0.00 7,550.00 12,000 0.00 0.00 0 Reimb General/Clerical&Acct 686.00 8,226.00 8,226 575.00 6,900.00 6,900 ENDING CASH/INV BALANCE $5,134,231.26 $5,134,231.26 $4,203,347 $4,672,241.19 $4,672,241.19 $4,459,523 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $928,518.99 $162,962.30 $466,528.92 $494,281.11 INVESTMENTS: CD's&State Investment Pool 454,767.46 454,767.46 454,767.46 454,767.46 Federal National Mortgage Assn 99,555.84 99,555.84 99,555.84 99,555.84 Treasury Strips&Zero Coupon Bonds 3,651,388.97 3,651,388.97 3,651,388.97 3,651,388.97 TOTAL CASH AND INVESTMENTS $5,134,231.26 $4,368,674.57 $4,672,241.19 $4,699,993.38 The State Investment Pool interest 4.5607% 4.6985% 5.2134% 5.2229% H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2008.xls\Dec07 draft Page 1 1/11/2008 FIREMEN'S PENSION BOARD 4411.1 PENSION/MEDICAL PAYMENTS FOR JANUARY, 2008 ax * ANKENY, Charlie(Captain) $233.94 233.94 * ASHURST, James (Assistant Chief) $4,569.00 - 4,569.00 * BANASKY, George(Captain) $1,646.80 1,646.80 * BARILLEAUX, Ray (Battalion Chief) - - * BEATTEAY, Karlen (Widow) $296.07 296.07 * BERGMAN, Claudette (Widow) $222.28 222.28 * CHRISTENSON, Chuck(Firefighter) $642.33 642.33 * CONNELL, Robert(Captain) $801.91 801.91 * GEISSLER, Dick(Fire Chief) $847.23 847.23 * GOODWIN, Charles (Captain) $4,010.50 495.21 4,505.71 * GOODWIN, Donald (Firefighter) $1,383.34 1,383.34 HAWORTH, Constance (Widow) $2,688.00 2,688.00 * HAWORTH, Jack(Firefighter) $3,025.00 - 3,025.00 * HENRY,William, Jr. (Captain) $1,938.53 1,938.53 * HURST, Gerald (Firefighter) $587.80 587.80 * JONES, Evelyn M. (Widow) $315.92 315.92 * LARSON, William (Firefighter) $367.18 367.18 * LAVALLEY, Theodele(Captain) $441.64 441.64 * MATTHEW, James (Deputy Chief) $415.56 415.56 * MC LAUGHLIN, JACK(Battalion Chief) $1,764.01 1,764.01 * NEWTON, Gary(Lieutenant) $349.28 349.28 * NEWTON, Roger(Firefighter) $375.26 375.26 * NICHOLS, Gerald (Battalion Chief) $619.75 619.75 * PARKS-ANDREASON, Arlene (Widow) $412.00 412.00 * PARKS, John (Firefighter) $3,139.50 84.96 3,224.46 * PHILLIPS, Bruce H. (Deputy Chief) $1,105.17 1,105.17 * PRINGLE,Arthur(Captain) $554.33 554.33 PRINGLE, S. Joan (Widow) $2,309.31 2,309.31 * RIGGLE, David E. (Firefighter D Step) $158.23 158.23 * RUPPRECHT, Jim (Firefighter D Step) $190.45 190.45 * SMITH, Leroy(Firefighter) $458.14 458.14 * STROM, Karl (Firefighter) $3,025.00 - 3,025.00 * TODD, Franklin (Firefighter) $513.33 513.33 * TONDA, Lila Jean (Widow) $710.98 710.98 * VACCA, Nick(Lieutenant) $379.94 379.94 * WALLS, Kenneth (Firefighter D Step) $219.11 219.11 * WALLS, Mercedes (Widow) $916.95 916.95 * WALSH, David (Firefighter) $1,426.31 1,426.31 * WALSH, Patrick(Captain) $1,016.44 1,016.44 * WEISS, Larry(Battalion Chief) $1,518.63 1,518.63 * WILLIAMS,Alta (Widow) $111.22 111.22 * WOOTEN, Marilyn E. Widow $299.89 299.89 , . Prior Year Pension/Medical Payments: Total Pension Payments for January, 2007 38,540.28 Total Medical Bills Reimbursed in January, 2007 171.66 Total Expenses: Medical/Pension 38,711.94 * Includes a 3.0%cost of living increase and longevity includes an additional calculation for 27 years of service effective January 1 per union contract. 4_SUMMARY 2008.XLS 1/11/2008 ime FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN JANUARY, 2008 PAYMENT *: �i •s ,§ •• ,\•: _�. ..a, a .. , 1, �\1�a '• Fk*"*OVIN James Ashurst 0.00 2 Charles Goodwin Bartell Drugs 23.00 2 Charles Goodwin Bartell Drugs 138.38 2 Charles Goodwin Bartell Drugs 6.35 2 Charles Goodwin Bartell Drugs 6.88 3 Charles Goodwin Bartell Drugs 6.88 3 Charles Goodwin Bartell Drugs 96.48 3 Charles Goodwin Bartell Drugs 72.51 3 Charles Goodwin Bartell Drugs 138.38 4 Charles Goodwin Bartell Drugs 6.35 495.21 Jack Haworth 0.00 6 John Parks Olympic Drug 17.26 6 John Parks Olympic Drug 6.32 6 John Parks Olympic Drug 9.81 6 John Parks Olympic Drug 2.31 6 John Parks Olympic Drug 15.41 8 John Parks Olympic Drug 2.31 8 John Parks Olympic Drug 9.81 8 John Parks Olympic Drug 15.41 8 John Parks Olympic Drug 6.32 84.96 Karl Strom 0.00 3_2008 FP Medical.XLS Page 1 of 1 1/11/2008 SEND CLAIM TO: City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 (.4k, CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE f1/) 2) DISABILITY RETIREE'S NAME (print)Cftg-tkc 6610_,Nd/ 4/ 3) ADDRESS 'Wt./ /110,0, Ave /( * *, ee,t)-704/ilai *Lc-6 4) DISABILITY AT TIME OF RETIREMENT O �&t eiea e4(..A 'i' 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.) /f 4 // 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 retirement from the Renton Fire Department. Signatur d^ Note: Supporting documentation must be attached. r1r • keii i6/46/L, /te, e#1,1t(P;' , 6060e0 ( BARTELL DRUGS ( BARTELL DRUGS an . .oma,. RX# ---Washington's Own Drugetures�.�.� Rx# 45-3812 8 E DR. LORCH,GERALD 45- 347248 E DR. MAYENO, JOHN DATE: 11/30/07 R (425)251-5110 DATE: 1 1/0 1/07 R (425)255-9310 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 ALLOPURINOL 100MG TABLET(*PA SUI,.IFVD; 00MG TABLET(*WAT) 49884-06. 21.3 0 73489036 00 91��-5660-01 73820269 REFILL 8 QUANTITY 30.00 REFILL NO QUANTITY 4.0,00 BARTELL DRUGS PRICE= $10.99 BARTELL DRUGS PRICE= $24.49 LL 0 THIS WITH XPS THE AMOUNT DUE- 6.35 6 WITH XPS THE AMOUNT DUE:$23.00 AND i YOUF3 L BARTELL DRUGS#45 BARTELL DRUGS#45 REFI (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 BARTELL DRUGS Rxu45- 3 r DR""FLO, GALE DATE: 11/30/07 R (425)251-5110 NAME: CHARLES GOODWIN BARTELL DRUGS "��Yaeb a OwnDrngsgonss�s�, 1414 MONROE AVE NE#306 RX# 45- 38154 E DR. GRIFFITH,ALIDA DATE: 11/21/07 R (425) 899-3123 ATENOLOL 50MG TABLET(*DAV) 67253-0421-11 73446036 NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 REFILL NO QUANTITY 30.00 AGGRENOX CAP 200/25 BARTELL DRUGS PRICE= $13.49 00597-0001-60 72133137 WITH XPS THE AMOUNT DUE:$6.88 g? REFILL NO QUANTITY 60.00 BARTELL DRUGS#45 BARTELL DRUGS PRICE= $181.99 (425)793-1015 �( 4700 NE 4TH STREET 13 WITH XPS THE AMOUNT DUE= 8.38 j.�'38 RENTON,WA 98059 BARTELL DRUGS#45 (425)793-1015 THANK YOU 4700 NE 4TH STREET WETRULYAPPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR RENTON,WA 98059 L REFILLS 2448 HOURS IN ADVANCE THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR /9 1 /'1/. REFILLS 24-48 HOURS IN ADVANCE lI p 2- id ' ,./Og 2 r r/e.ofi //-1/1-(-Li- 7f, I BARTELL DRUGS IBARTELL DRUGS -Wash 0wnDrugstore,__ xta 45-40666aE DR. FLO, GAYLE RX# 45-4064 eE DIS. FLO, GAYLE cam 12/27/07 N (425)251-5110 DATE: 12/27/07 N (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 GEMFIBROZIL 600MG TABLET(*AP ATENOLOL 50MG TABLET(*DAV) 60505-0034-08 75305326 67253-0421-11 75123622 REFILL 2 QUANTITY 180.Q0 REFILL 5 QUANTITY 30.00 BARTELL DRUGS PRICE= $91.78 BARTELL DRUGS PRICE= $13.49 WITH XPS THE AMOUNT DUE:$72.51 WITH XPS THE AMOUNT DUE=$6.88 �P��� la? 5'4BARTELL 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 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 BARTELL DRUGS ash Own es�� RX# 45-4066.9 s E DDrugstorR. GRIFFITH,ALIDA I BARTELL DRUGS DATE: 12/27/07 N (425)899-3123 Wsrshtn on'sOwnDrugatores��� NAME: CHARLES GOODWIN Rx 45-40663 E DR• FLO, GAYLE 1414 MONROE AVE NE#306 DATE: 12/27/07 N (425)251-5110 AGGRENOX CAP 200/25 NAME: CHARLES GOODWIN 00597-0001-60 75873652 1414 MONROE AVE NE#306 � REFILL 4 QUANTITY "6,00 5( AMLODIPINE 10MG TABLET(*LUP) - 68180-0752-03 75707622 BARTELL DRUGS PRICE= $181.99 �} WITH XPS THE AMOUNT DUE:$138.38 �/ /31 32 REFILL 2 QUANTITY 100.00 474 BARTELL DRUGS PRICE= $249.29 BARTELL DRUGS#45 ❑n (425)793-1015 WITH XPS THE AMOUNT DUE-$96.48 4700 NE 4TH STREET BARTELL DRUGS#45 RENTON,WA 98059 (425)793-1015 THANK YOU 4700 NE 4TH STREET WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU RENTON,WA 98059 WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR L_ REFILLS 24-48 HOURS IN ADVANCE 4)24 //f/o a'a. f',/' ' T I BARTELL DRUGS ...38W �.aow; aorw.� RXx 45- 12 8 E DR. LORCH,GERALD DATE: 12/27/07 R (425)251-5110 NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 ALLOPURINOL 100MG TABLET(*PA 49884-0602-10 75886231 REFILL 7 QUANTITY 30.00 BARTELL DRUGS PRICE_ $10.99 11TH XPS THE AMOUNT DUE-$6.35 BARTELL DRUGS#45 (425)793-1015 4700 NE 4TH STREET RENTON,WA 98059 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS.TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE BARTELL DRUGS RX# 45-40669 e E DR. DATE: 12/27/07 N (425) 899-3123 NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 AGGRENOX CAP 200/2575s73652 00597-0001-60 II REFILL 4 QUANTITY .00 t BARTELL DRUGS PRICE= $181.99 114: SEND CLAIM TO: City of Renton *awl inance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 OY 0 CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE / O j4'f; d 0'7 2) DISABILITY RETIREE'S NAME (print) datj r F `l(k S 3) ADDRESS 1 3 r 3Abl� l�J BYt yvN/ ' c 9e6 3L 4) DISABILITY AT TIME OF RETIREMENT -.S176 72( 0-17 g / f1jy O,Ls e4,s-F bf ! 8raL / ei� i�1 v/'cers and /J71 �rt'1` � a� J-ms 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.) a i y re -Par � �-)n OM d A n its tery,�.r 1e 5 6) TOTAL AMOUNT OF CLAIM t.67, 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 r- ' _4 ent from the Renton Fire Department. a 1100 Signature: fr„ex, dV' Note: Supporting documentation must be attached. PA �' NPICOR ii RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# 736886 For JOHN PARKS 11-02-07 CRN:A3077067897571 1335 3RD AVE#109 LONGVIEW,WA 98632 1360) 577.6684 OMEPRAZOLE CAP 20MGA s4 NDC: 62175-0118-43 RICHARDS,JOHNE DR. ZHA COPAY: $17.26 liii 11111111 11 I III 11II 11111111111 I III 11111 Price wItPsit ORm • RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE 711222 OR TAX RECORDS Rx# For. JOHN PARKS 11-02.07 CAN:A9077066172191 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 LACTULOSE SOL 10GI15ML #140NDC:RICHARDS,JOHN E20037-32 DR. ZHA COPAY: $6.32 II I I II III II II I I II I lI 11 11 II 11 11 1111111111 II Price RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# C736883 For. JOHN PARKS 11-02-07 CAN:A1077069468681 1335 3RD AVE#109 LONGVIEW,WA 98632 1360) 577-6684 ALPRAZOLAM 0.5MG TAB #120 NDC:DR. RICHARDS,JOHNE00781-1077-05 ZHA COPAY: $9.81 II I I I II 1111011111 1 II II II I I II II II HUll III I I I II Price Value at tha smilin O' /per;ORmi RECEIPT 124415th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# C736881 For JOHN PARKS 11-02-07 CRN:A0077067893401 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ZOLPIDEM TAB 10MG #30 AMC: 60505-2605-08 DR. RICHARDS,JOHN E ZHA COPAY: $2.31 11 11 llIIlI0lIIIIfI III III 111111111 II I III IIII Price Value vire smilin O' 442wYMPI '9 oRuci RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAOR FOR INSURANCE OR TAX RECORDS Rx# 736880 For JOHN PARKS 1 1-02.07 CRN:A4077069468871 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 MIRTAZAPINE SOLTAB 45MG 30 DIDC: 66993-0712-30 RICHARDS,JOHN E DR. ZHA COPAY: $15.41 II 11111111 IIUIII liii III 1111111111 lllIlI fIIPc - Tri b SENDCLAIMTO: City of Renton ',Nrir° 'Mance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 �UvY 0 YPNT°� CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE 4 471 , ,, ?..OGg 2) DISABILITY RETIREE'S NAME (print) V ©kyn 4.: Frfrc lag '3) ADDRESS/33S,, ye. � K (!Ee di Wa .78L32 4) DISABILITY AT TIME OF RETIREMENT .."`f pn)d C.1n "t'e-J t'% •0/sea s€ e2 id ers ) ', dL r lei- i'a 471dA yixiTy j To b i mS 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.) °f<// e. -re - -Po -y- SI"01441ct. 4 "IA 471 xie-T )-ra6t S 6) TOTAL AMOUNT OF CLAIM .. 3: 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: 6" r ``"'t9j-il Note: Supporting documentation must be attached. p 1 'YlIPICDRUG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# C736881 For: JOHN PARKS 12-05.07 CRN:02077399092481 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ZOLPIDEM TAB 10MG #30 NDC: 5.2605-08 RICHARDS,JOHN5E DR. ZHA COPAY: $2.31 11111111111111111111 III 11101111 II I III I I II Price i2toY1,1 m, DR.. RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# C736883 For: JOHN PARKS 12-05.07 CRN:A1077395795031 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ALPRAZOLAM 0.5MG TAB #120 NDC: 00781-1077-05 DR. RICHARDS,JOHN E ZHA COPAY: $9.81 II IlIllIllIllIllO IlHIIIIIIIIllIIIllIIIllPnce iso, Y wow RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# 736880 For: JOHN PARKS 12.05.07 CA8:87077397482291 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 MIRTAZAPINE SOLTAB 45MG #30 NDC: 66993-0712-30 DR. RICHARDS,JOHN E ZHA COPAY: $15.41 II IIII 1111111111111111111111111111 lIf ill IIII III Price leo vow - the anvil °DRUG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rx# 711222 For: JOHN PARKS 12.05.07 CAN:89077391100901 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 LACTULOSE SOL 10G115ML #1400 20037-32 RICHARDS,JOHN E DR. ZHA COPAY: $6.32 11111111111111111111111111111111 IllI11 llIIce 12 "ole MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON November 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 Acting Chairman Don Persson at 2:04 p.m. in the Mayor's Conference room, 7th floor of Renton City Hall. In attendance were Board members Don Persson,Ray Barilleaux, Bruce Phillips, and Bonnie Walton. Also present: Jill Masunaga, Finance Representative. MINUTES APPROVAL MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, THE PENSION BOARD APPROVE THE MINUTES OF THE OCTOBER 16, 2008,MEETING. CARRIED. MONTHLY STATEMENT The financial report as of October 31, 2008, was reviewed. Total cash/investment balance was $4,440,521.13. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY PHILLIPS, SECONDED BY BARILLEAUX, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR NOVEMBER 2008, IN THE TOTAL AMOUNT OF $42,562.45 TO BE PAID FROM THE FIREMEN'S PENSION FUND. CARRIED. Jill Masunago requested confirmation of the prescription drug expense limits as those of Mr. Charles Goodwin have exceeded$2,000. The Board clarified that the$2,000 annual limit is only on non-disability prescription expenses. NEW BUSINESS It was announced that retiree Patrick Walsh passed away November 19, 2008, and that Mr. Walsh's wife is deceased. In response to Mr. Persson's inquiry, it was confirmed that Mr. Walsh's Firemen's pension payment would be paid through the month of November. MOVED BY BARILLEAUX, SECONDED BY PHILLIPS, APPROVE FOR PAYMENT IN NOVEMBER THE$500 DEATH BENEFIT TO THE FAMILY OF PATRICK WALSH. CARRIED. MOVED BY PHILLIPS, SECONDED BY BARILLEAUX TO HAVE THE BOARD SECRETARY OBTAIN A CITY ATTORNEY OPINION ON WHETHER THE DEATH BENEFIT AMOUNT CAN BE INCREASED BEYOND THE $500 AMOUNT SET BY RCW 41.18.140. CARRIED ADJOURNMENT MOVED BY BARILLEAUX, SECONDED BY PHILLIPS,THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 2:17 p.m. Gdz Bonnie I.Walton, City Clerk Member and Secretary,Firemen's Pension Board 4,4w wimp, \.(v1( o ADMINISTRATIVE, JUDICIAL, AND �: _ LEGAL SERVICES DEPARTMENT � NTo� Office of the City Clerk MEMORANDUM DATE: November 20, 2008 TO: I. David Daniels, Fire Chief FROM: Bonnie Walton, City Clerk and Firemen's Pension Board member/Secretary,x6502 SUBJECT: Firemen's Pension Board Term Expiration The two-year term of office for Ray Barilleaux as a member of the Firemen's Pension Board expires on December 31, 2008. An election among the firefighters must be held so that the position may be filled accordingly. Retired members are eligible both to elect and be elected to serve on the board. Following the election, please report the name of the firefighter elected to serve on the board for a two-year term from January 1, 2009 to December 31, 2010. Thank you for your assistance. I can be reached at x6502 if you need additional information. cc: Bob Van Home, Deputy Fire Chief Firemen's Pension Board Members , , CITY OF RENTON - FIREMEN'S PENSION FUND CASH & INVESTMENT ACTIVITY REPORT AS OF NOVEMBER 30, 2008 Fireman's Pension Fund Comparison of Cash and Investment Activity 6 ■2008 ❑2007 5 — ` ter— -- —_ __ _ _ R , 4 I II lir 1 N g 3 o 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 $4,440,521.13 $4,694,232.48 $4,203,347 $4,403,373.58 $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 (88,764.13) 16,933.76 200,000 1,467.05 389,226.86 175,000 DISBURSEMENTS: Fire Pension 41,952.86 471,712.94 552,400 34,695.56 427,011.96 463,500 Fire Pension Medical 1,109.59 8,045.39 20,000 784.50 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 9,119.00 9,948 686.00 8,226.00 8,226 ENDING CASH/INV BALANCE $4,307,865.55 $4,307,865.55 $3,895,540 $4,368,674.57 $4,694,232.48 $4,203,347 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $546,745.98 $590,077.75 $162,962.30 $197,661.31 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 0.00 89,323.81 TOTAL CASH AND INVESTMENTS $4,307,865.55 $4,440,521.13 $4,368,674.57 $4,403,373.58 The State Investment Pool interest 2.1903% 2.4652% 4.6985% 4.9108% H:\FINANCE\FINPLAN\FIREPEN\1_Fire_Pension_2008.xls\Nov08 Page 1 12/12/2008 4 *me vie"FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR DECEMBER, 2008 _:..a.''P. �n,,i"�. °' %til� ����(��: i "n. .. .t....': :� �V� nS't ✓.�i!OJytf4r�; .^o�'/x, qe..,•.�S'r.�Mt �,fr ANKENY, Charlie (Captain) $90.81 90.81 ASHURST, James (Assistant Chief) $4,569.00 536.29 5,105.29 ' 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) $4,010.50 845.26 4,855.76 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 NICHOLS, Gerald (Battalion Chief) $467.89 467.89 PARKS-ANDREASON, Arlene (Widow) $284.16 284.16 PARKS, John (Firefighter) $3,139.50 69.45 3,208.95 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 76.22 3,101.22 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) $108.43 108.43 WALLS, Mercedes (Widow) $729.93 729.93 WALSH, David (Firefighter) $1,322.07 1,322.07 WEISS, Larry(Battalion Chief) $1,354.42 1,354.42 WILLIAMS, Alta (Widow) - - WOOTEN, Marilyn E. (Widow) $200.10 200.10 _'10,010 'irLE1 S'.kP,ei'ts1i)6110 dical .5., ' <:'i$4O 89 `„ l: Z7'2 ,.-.4 444,7 11. Prior Year Pension/Medical Payments: Total Pension Payments for December, 2007 34,695.56 Total Medical Bills Reimbursed in December, 2007 406.24 Total Expenses: Medical/Pension 35,101.80 4_SUMMARY 2008.XLS 12/12/2008 %ow wr` FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN DECEMBER, 2008 PAYMENT 2 James Ashurst Safeway 10/30/08 4.95 2 James Ashurst Safeway 11/03/08 141.80 2 James Ashurst Safeway 11/03/08 192.86 2 James Ashurst Safeway 11/05/08 102.15 2 James Ashurst Safeway 11/23/08 11.99 2 James Ashurst Safeway 11/23/08 82.54 536.29 4 Charles Goodwin Bartell Drugs 10/24/08 182.27 4 Charles Goodwin Bartell.Drugs 10/25/08 9.89 4 Charles Goodwin Bartell Drugs 10/25/08 49.59 4 Charles Goodwin Bartell Drugs 10/27/08 361.76 845.26 Jack Haworth 0.00 7 John Parks Olympic Drug 10/27/08 2.31 7 John Parks Olympic Drug 10/27/08 14.01 7 John Parks Olympic Drug 10/27/08 6.28 7 John Parks Olympic Drug 11/02/08 46.85 69.45 9 Karl Strom Sam's Club 11/14/08 4.41 9 Karl Strom Sam's Club 11/14/08 9.00 9 Karl Strom Sam's Club 11/14/08 3.00 10 Karl Strom Sam's Club 11/14/08 12.48 10 Karl Strom Sam's Club 11/14/08 7.33 10 Karl Strom Sam's Club 11/17/08 9.00 11 Karl Strom Sam's Club 11/25/08 7.00 11 Karl Strom Department of Veterans Affairs 11/18/08 24.00 76.22 1:1:9::„;,,x,;;,,,,701-4r,:,,, _ yA '.i:ce:a:',vk ki:",-. _:4,;,,,,,,„w;0,(,,,,;,'`0 t,,, -> $ �: j1;,?j. ",:d. .,•:.t g7.w' ;-,-<',4001;,,§40: 3_2008 FP Medical.XLS Page 1 of 1 12/12/2008 SEND CLAIM TO: ,_ City o f Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 4G�Y 'et) 41"'NTO CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE NOVEMBER 28 2008 2) DISABILITY RETIREE'S NAME (print) JAMES F. ASHURST 3) ADDRESS 223 GARDEN AVE. N. #B REYTON WA. 98057 .4) DISABILITY AT TIME OF RETIREMENT HYPERTFNS TON = H_R_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.) MEDICATION FOR ABOVE 6) TOTAL AMOUNT OF CLAIM: $ 536 2 9 Amount of total claim (above) that is related to the Retirement Disability: $ 4 4 8. 8 0 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 rescripti_on_drugcharges,_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. P.,6,("EI MHBRI STRT CY MOHRa' 1 RACY RENTON,WA 98055 RENTON,WA 98055 #(5) (425)226-0325 # (425)226-0325 Official Receipt- Please retain for tax or insurance Official Receipt- Please retain for tax or insurance f11 _ " - S (425)255-6154 ASHURST,JAMES (425)255-6154 AVE N. 12/17 223 B GARDEN AVE N. 12/17 RENTON,WA 98055 RENTON,WA 98055 DR. CHANG,WALLACE H J MD [NW] DR.17900 GRAVES, ES,DANIEL S [RF] 17930 TALBOT RD SOUTH RENTON,WA AskAF RENTON,WA 98055 AskAF Rx:6715469 Oct 30, 2008 Safety Cap: Yes Rx:6710376 Nov 05, 2008 Safety Cap: Yes CEPHALEXIN 250MG CAP (TEVA)Qty: 12 CAP PANTOPRAZOLE 40MG TAB (PRAS)Qty: 30 TAB Generic for:KEFLEX 250MG CAP Generic for:PROTONIX 40MG TAB Ref:A5087042488121 NDC:00093.3145.05 HSGIPSH Ref:A7087100325581 NDC:00008.0607.01 H8G( REGENCE BLUESHIELD WASH Cash Price: 9.99 REGENCE BLUESHIELD WASH Cash Price: 134.49 Amount Due: $4.95 Amount Due: $102.15 III II1IIIII11IIIilllIIlllillH pI REFILL YOUR PRESCRIPTIONS H1111111111111111lill111111ll !Rx. REFILL YOUR PRESCRIPTIONS @ SAfEWAY.COM �t7 @ SAfEWAY.COM 29002100495 00000068710 SAFEWAY PHARMACY YYMTIM IACY (Sb) 200 SOUTH 3RD STREET RENTON,WA 98055 RENTON,WA 98055 (425)226-0325 #1563 (425)226-0325 i; -• •I i - . . - : .in ' :x a i sura • 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,DANIELDR. GRAVES,DANIEL [RF] 17900 TALBOT RD S,STE 101 [RF] 17900 TALBOT RD S RENTON,WA 98055 RENTON,WA 98055 Rx:6702058 Nov 03, 2008 Safety Cap: Yes Rx:6707635 Nov 23, 2008 Safety Cap: YesAF PLAVIX 75MG TAB (B-M ) Qty:30 TAB FUROSEMIDE 40MG TAB (WATS)Qty: 100 TAB Generic for:FUROSEMIDE 40MG TAB Ref:01067084111061 NDC:63653.1171.06 BBAIPPN Ref:A2087283558081 NDC:00591-0301-10 KTI REGENCE BLUESHIELD WASH Cash Price: 194.99 REGENCE BLUESHIELD WASH Cash Price: 11.99 Amount Due: $141.80 Amount Due: $11.99 Eill Il II fi I UREf7LL YOUR PRESCRIPTIONS II I I II II II I II Illi II II Ill II I I IIEf@ SAfEWAY.COM,� @ SAfEWAY.COM 00000068710U 29002101199 -' - - - - - - - - - - - .FwA-y i�1A.'5 mai PJ ACY 20'D�OU7H'3RDPIIIIEET --CY Lio RENTON,WA 98055 18) RENTON,WA 98055 (425)226-0325 #1563 (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 RD S,STE 101 17900 TALBOT RD S RENTON,WA 98055 RENTON,WA 98055 AskAF AskAF Rx:6706816 Nov 23, 2008 Safety Cap: Yes Rx:6701701 Nov 03, 2008 Safety Cap: Yes LIPITOR 40MG TAB (PFIZ) Qty:50 TAB HUMULIN N VIA (LILL) Qty: 20 ML Ref:A0087084110801 NDC:00071-0157-23 BBAIPPN Ref:A8087281914961 NDC:00002.8315.01 KTI REGENCE BLUESHIELD WASH Cash Price: 240.49 REGENCE BLUESHIELD WASH Cash Price: 89.98 Amount Due: $192.86 Amount Due: $82.54 HIIIIIIIIIIIIIIII 11111111111 Rx L REf�YOUR SAfEWArC°M�° IIIIIIIIIIIIIIIIIIIIIIIIIIIIII REV YOUR PRESCRIPTIONS 00000068710 _ 0 29002108254 --------.._.._. _..__.._... ' -;r 27 UN 1),(4e z- 'ow SENDCLAIMTO: — City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 `cY 0 'NTo� CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE /000h f 2) DISABILITY RETIREE'S NAME (print) ( 14 t r_. S f l . ( COD t)(V/ Al 3) ADDRESS 8-N YOMP,de U E /(1 , c,.1U(� (-4 41 f JAew-6 4) DISABILITY AT TIME OF RETIREMENT C.(/��z/c , 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.) See, ' , ,/ 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 retirement from the Renton Fire Department. Signature: g-444/1"1-'" Note: Supporting documentation must be attached. Nee.3 . /03/76/DF .. ---770 : ikA-d--(:;)tirlAils° ,....0 _ 06tyt, 0,20,n: Ciiiilic A , C.10 Dc(ii Ai - 1 BARTELL DRUGS I BARTELL DRUGS Washington's Own Drugstores 45-459 tng8.8rDR.gLO RX# 45-444249 E DR. KATO,GARY H. RX# 45-459328 E DR. LORCH,GERALD DATE: 10/25/08 R (425)255-9310 DATE: 10/24/08 N (425)251-5110 GOODWIN CHARLES AME: NAME: CHARLES GOODWIN NAME: MONROE AVE NE 1414 MONROE AVE NE#306 #306 AGGRENOX CAP 200/25 AMLODIPINE 5MG TABLET(*LUP) 00597-0001-60 2008457937609 68180-0751-09 2785296494659 -^ REFILL 3 QUANTITY 30.00 REFILL 5 QUANTITY 60.00 BARTELL DRUGS PRICE= $195.99 BARTELL DRUGS PRICE= $54.49 lri ,C WITH SR THE AMOUNT DUE:$182.27 INN.0)7 WITH SR THE AMOUNT DUE:$49.59 BARTELL DRUGS#45 BARTELL DRUGS#45 (425)793-1015 4700425)793-1015 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 YOURi REFILLS 24-48 HOURS IN ADVANCE L REFILLS 24-48 HOURS IN ADVANCE BARTELL DRUGS I BARTELL DRUGS � ..Washington s Own Drugstores ............Washington'sOwnDraptoreRX# 45-431280 E DR. GRIFFITH,ALIDA RX# 455--454813 E DR. LORCHRCH,GERALD DATE: 10/27/08 R (425) 899-3123 DATE: 10/25/08 R (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 OL 100MG TABLET(*PA CARBIDOPA/LEVODOPA 25MG/100M AL 2785296684659 00093-0293-01 2798789004659 498 REFILL 2 QUANTITY 540.00 ��� ' 1 6 REFILL 4 QUANTITY 30.00 BARTELL DRUGS PRICE= $10.99 4119 BARTELL DRUGS PRICE= $388.99 WITH SR THE AMOUNT DUE' 9.89 WITH SR THE AMOUNT DUE:$361.76 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 YOURi REFILLS 24-48 HOURS IN ADVANCE REFILLS 24-48 HOURS IN ADVANCE /06/61 0/Air -0/14‘/1 :11 g-fiAtj r.+o' AdAl c g_ b{-4,4(, 020 BARTELL DRUGS LBARTELL DRUGS wwwwwww Washington's Own Drugstores RXIS45-444249 E DF>KATO,GARY H. R" 45-459328 E DR. LORCH,GERALD DATE: 11/29/08 R '(425)255-9310 DATE: 11/21/08 R (425)251-5110 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 1414 MONROE AVE NE#306 AGGRENOX CAP 200/25 AMLODIPINE 5MG TABLET(*LUP) 00597-0001-60 3099124484659 68180-0751-09 3170345024659 i REFILL 2 QUANTITY 30.00 REFILL 4 QUANTITY 60.00 1 a 'd� $54.49 ,/q��BARTELL DRUGS PRICE= BARTELL DRUGS PRICE= $195.99y WITH SR THE AMOUNT DUE-$49.59 WITH SR THE AMOUNT DUE 4182.27 BARTELL DRUGS#45 BARTELL DRUGS#45 (425)793-1015 (425)793-1015 441 4700 NE 4TH STREET 4700 NE 4TH STREERENTON,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 BARTELL DRUGS s�.. .Washingtow'sOwnDr gairo. RX# 45- 454813 E DR• LORCH,GERALD DATE: 11/29/08 R x(425)251-5110 NAME: CHARLES GOODWIN 1414 MONROE AVE NE#306 ALLO ,OL (*PA - - - 100MG TABLET 498:4-0602-10 -- 3170345304659 REFILL 3 QUANTITY 30.00 BARTELL DRUGS PRICE= $10.99 -710�j / / 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 L REFILLS 24-48 HOURS IN ADVANCE I 404+ SEND CLAIM TO: `f••+ City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 ‘SY ♦�� "Oa �n ANT°� CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE f)_QA--t 8 o 6 2) DISABILITY RETIREE'S NAME (print)d? /j/il 1.-r Pa 1 hi 3) ADDRESS 6 335'-' 0-A Vie. *1 09 L e �t f,y t<+ r alt/ ` 4 32- v 4) DISABILITY AT TIM OF RETIREMENT,... ,51-0- ao., �4 k'x pts5-ef , 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.) 'Ale 171-Q ©fi 7n• eqt 4 n d A -evo rr'�" -fab 1 'n 6) TOTAL AMOUNT OF CLAIM: $ 4j 9, if( Amount of total claim (above) that is related to the Retirement Disability: $ 61,9-5 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: 2,-RAtty A 411,..„4/14fr Note: Suppor ' documentation must be attached. 141111, ‘44111101# Value at the sm,'Iing•O' 121°'MIMIC DRUG RECEIPT 124415th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FOR INSURANCE OR TAX RECORDS Rxl! C831450 For JOHN PARKS 10-27.08 CAN:M087019547491 1335 3R0 AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ZOLPIDEM TAB 10MG *** $ #30 60505-2605-08 RICHARDS,JOHNE DR. ZHA COPAY: $2.31 111 11111 IIII 111111 11 III II III 11111111 IIIII 01111 Price —7 ow visit the smalnpDRUG RECEIPT 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAVE FORAINSURANCE S Fla 831413 For. JOHN PARKS 10.27.08 CAN:A1087013224251 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 MIRTAZAPINE SOLTAB 45MG #30 NDC: 65862-0023.06 DR. RICHARDS,JOHN E ZHA COPAY: $14.01 111111 1111111 II11111 Ill loll 11011 11111111 II 1111 I II Pric4 Value at the smiling'0' ,1, PR DRUG RECEIPT E FOR 1244 15th Ave.,Longview,WA 98632 Ph.(360)423-3360 SAOR TAX RECORDS Rx# C831415 For. JOHN PARKS 10-27-08 CAN:88087011557181 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 ALPRAZOLAM 0.5MG TAB *** s0 NDC: 59762-3720-03 RICHARDS,JOHNE DR. ZHA COPAY: $6,28 11 II llltlll 11 I 111111111111111 II II II 11111111 Ptic Valee at the.mtling'O' iew p�Q��, RECEIPT 124415th Ave.,Longview,WA98632 Ph.(360)423-3360 SAVEOFOR INSURANCE OR TAX RECORDS 831449 For. JOHN PARKS 11-02-08 CAN:A4087072222761 1335 3RD AVE#109 LONGVIEW,WA 98632 (360) 577-6684 OMEPRAZOLE TAB 20MG(OTC) #00 NDC: 37205-0837-06 DR. R!CHARDS,JOHN E ZHA COPAY: $46.85 lI0Il Illi111111 III IIII lI0lI Il III itIII IIIII IIIII Price VW 1 Now SEND CLAIM TO: `""' City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton, WA 98057 miR CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE � - /- 4 3 2) DISABILITY RETIREE'S NAME (print) KA- / 73 E-1---p_e7/1-1 Karl Strom 3) ADDRESS 201 Union Ave.SE#142 Renton,WA 98059-5177 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.) .5-ill C(tr_/-7 A Yi / E 9, o6 733 c/ Ob 6) TOTAL AMOUNT OF CLAIM: $ Amount of total claim (above) that is related to the Retirement Disability: $ 7/P, 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. Pew CLUB -err" '`✓ TAM'S CLUB (425)793-7937 $18.54 SAM'S CLUB (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 11/14/2008 REFILL STROM,KARL B 11/14/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6678271 Ref# 1 QTY:30 DAW:0 DS:60 RX:6678271 Ref# 1 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 83571 83571 WHIA / WHI AARP Patient Pay $4.41 WHI AARP Patient Pay $4.41 i------------- 3-_ 2STROM 0 m KARL B a. 15616 SE 143RD _ M J RENTON,WA 98055 F— (425)271.8373 4 79312 86354 0 0 '^ 11/14/2008 (425)793-7937 Y Signature Required N RX:6678271 REF=1 OC#655 923 865 776 592 884 107 659 238 11/14/2008 11:47:16 AM WHI C Page No : 1 of 2 TOTAL: $4.41 a TAM'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 11/14/2008 REFILL STROM,KARL B 11/14/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6683460 Ref# 1 QTY:90 DAW:0 DS:30 RX:6683460 Ref#1 QTY: 90 DAW:0 DS:30 • 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 83541 83541 WHI AARP Patient Pay $9.00 WHI AARP Patient Pay $9.00 5 STROM O/��+ m KARL B d 15616 SE 143RD FE CC J RENTON,WA 98055 ?� F— Cr (425)271-8373 4 79312 86353 3 Cl)'A q 11/14/2008 (425)793-7937 Signature Required N RX:6683460 REF=1 OC#155 923 881 076 592 884 107 659 238 11/14/2008 11:47:09 AM WHI C Page No : 1 of 2 TOTAL: $9.00 a IAM'S CLUB 9021 SOUTH GRADY WAY)793-7937 $10.78 SAM'S CLUB 9015 SOUTH GRADY WAY $10.78 Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KARL B 11/14/2008 REFILL STROM,KARL B 11/14/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6672060 Ref#6 QTY:60 DAW:0 DS:30 RX:6672060 Ref#6 QTY: 60 DAW:0 DS:30 NDC: 00378-0018-01 METOPROLOL 25MG TAB MYL NDC:00378-0018-01 METOPROLOL 25MG TAB MYL BROCKENBROUGH,ANDREW T NABP:4930613 BROCKENBROUGH,ANDREW T NABP:4930613 83531 83531 WHI AARP Patient Pay $3.00 WHI AARP Patient Pay $3.00 2 KARLOM B d 0 m 15616 SE 143RD CC J RENTON,WA 98055 425)271-8373 AY 11/14/2008 (425)793-7937 r. (/) 4 '79312 8 6 3 5 2 6 Signature Required N RX:6672060 REF=6 OC#355 923 871 076 592 884 107 659 238 11/14/2008 11:47:04 AM WHI Page No : 1 of 2 , TOTAL: $3.00 a. -Rod 1 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 11/14/2008 REFILL STROM,KARL B 11/14/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:4412944 Ref#0 QTY: 120 DAW:0 DS:30 RX:4412944 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 83501 83501 WHI AARP Patient Pay $12.48 WHI AARP Patient Pay $12.48 STROM KARL B 111n111 15616 SE 143RD O m RENTON,WA 9805511111 F. Y• ) 425 271-8373 Y Y 11/14/2008 (425)793-7937 4 79312 8 6 3 51 9 Signature Required N RX:4412944 REF=0 OC#155 923 405 476 592 384 107 659 238 •Q 11/14/2008 11:46:41 AM WHI Page No : 1 of 2 TOTAL: $12.48 li IAM'S CLUB (425)793-7937 $9.37 SAM'S CLUB (425)793-7937 $9.37 901 SOUTH GRADY WAY 901 SOUTH GRADY WAY Pharmacy RENTON,WA 98055-0000 Pharmacy RENTON,WA 98055-0000 STROM,KARL B 11/14/2008 REFILL STROM,KARL B 11/14/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6681940 Ref# 1 QTY:75 DAW:0 DS: 30 RX:6681940 Ref# 1 QTY:75 DAW: 0 DS:30 NDC:54458-0998-09 LISINOPRIL 5MG TAB INT NDC:54458-0998-09 LISINOPRIL 5MG TAB INT MARTIN,MICHAEL M NABP:4930613 MARTIN,MICHAEL M NABP:4930613 85101 85101 WHI AARP Patient Pay $7.33 WHI AARP Patient Pay $733 • 1 2 STROM IIIIH a 0 m 15616 SE 143RD CC RENTON,WA 98055 (425)271-8373 4 79312 86355 7 ", Q 11/14/2008 (425)793-7937 W Signature Required N RX:6681940 REF=1 OC#855 923 826 576 592 884 107 659 238 O 11/14/2008 11:47:20 AM WHI Page No : 1 of 2 TOTAL: $7.33 O. ►AM'S CLUB (425)793-7937 $10.00 SAM'S CLUB (425)793-7937 $10.00 901 SOUTH GRADY WAY 901 SOUTH GRADY WAY Pharmacy ARL B RENTON,WA 98055-0000 Pharmacy 11/17/2008 NEW STROM,KARL BENTON,WA 98055-0000 STROM,KARL 11/17/2008 NEW 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6692403 Ref#P QTY;90 DAW;0 D8;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 24301 24301 WHI AARP Patient Pay $9.00 WHI AARP Patient Pay $9.00 r 0 2 STROM E.' 0 m 15616 SE 143RD CC J RENTON,WA 98055 N (425)271-8373 4 79312 86349 6 11/17/2008 (425)793 7937 Signature Required N RX:6692403 REF#P OC#155 923 881 076 592 884 107 659 238 0 11/17/2008 11:40:05 AM WHI TOTAL: $9.00 L Page No : 1 a New VZ Department of Vete, .s Affairs E60 S COAO98I0N WAY WA 98108-1532 STATEMENT OF MEDICAL CARE COST RECOVERY ACCOUNT ACTIVITY SEATTLE NAME OF FACILITY AGENT CASHIER (136MCCR) VA PUGET SOUND HEALTH CARE SYSTEM (663) FOR QUESTIONS ABOUT YOUR ACCOUNT, PLEASE PHONE THE BELOW NO. 1-866-290-4618 II,InI„IiII,a,I,1,1iIiuI,In„III,,,Iimill,iIa IiI,iII,I For written inquiries concerning your account please send them 056527 - 112408 to the MCCR or Revenue Office at the facility address above. KARL B STROM JR Payments received after 11/20/2008 will be on — 201 UNION AVE SE UNIT 142 your next statement. RENTON WA 98059-5177 — OMMIMMOMIN CALL WITH YOUR HEALTH INSURANCE INFORMATION MIIIMMIll 'tient Name: KARL B STROM JR Account No: 663-000000-7237347-STROM Stmt Date: 11/24/2008 3W »:: :::::::::::::::: :::::]::: . Fk �AGT'I�1�ta�3 . 5Tc[3'.»:: ; :>:::<:<::::::> >< <::»::»: ::::':`:; `:;>:GESC�3. Cts}. ... . . ... :. ..:...._.................... .... ..__. ........... _>....rte; ... R .: — 10/08/2008 PAYMENT (10/07/2008) 48.00- 663-K807K7E 11/18/2008 COPAY RX:4245408B FD:11/28/2008 24.00 663-K9017V7 DRUG:AMIODARONE HCL (PACERONE) 200MG TAB DAYS:90 QTY:90 PHY:WICHER,JOHN B CHG:$24.00 PS- 1 ---/ 4-- r5/ vi=frtf-co-/ 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 11/25/2008 REFILL STROM,KARL B 11/25/2008 REFILL 15616 SE 143RD RENTON,WA 98055 15616 SE 143RD RENTON,WA 98055 RX:6683461 Ref# 1 QTY:60 DAW:0 DS: 30 RX:6683461 Ref# 1 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 16311 16311 WHI AARP Patient Pay $7.00 WHI AARP Patient Pay $7.00 i KARLOBA 0 0 m 15616 SE 143RD CC J RENTON,WA 98055 li (425)271-8373 4 79312 88872 7 Cl) Y11/25/2008 (425)793.7937 ��`, C) Signature Required N RX:6683461 REF=1 OC#555 923 821 076 592 384 107 659 238 C 11/25/2008 12:17:13 PM WHI Page No : 1 TOTAL: $7.00 p P l(