HomeMy WebLinkAbout314027 07/26/17 i C.6y
<�>^�� "'. CITY OF CARMEL, INDIANA VENDOR: 022520
O ONE CIVIC SQUARE BRAD BARTROM CHECK AMOUNT: $**.....300.00'
:?�rQ CARMEL, INDIANA 46032 Po Box 526 CHECK NUMBER: 314027
+y. CARMEL IN 46062 CHECK DATE: 07/26/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07.24.17 300.00 OTHER EXPENSES
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City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2017 and is eligible for a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02.
Payroll: Please return check to Human Resources for distribution
Plan Participant/Payee:
Brad Bartrom
P.O. Box 526 BE SURE TO USE PO BOX
Carmel, IN 46082
Amount: $300.00
Fund: Medical Escrow Fund (301) Submitted To
Date: July 24,2017
JUL 2 5 2017
Clerk Treasurer