HomeMy WebLinkAbout314030 07/26/17 9o„wf CITY OF CARMEL, INDIANA VENDOR: 00351349
ONE CIVIC SQUARE DOUGLAS CALLAHAN CHECK AMOUNT: $ .....400.00"
: rQ CARMEL, INDIANA 46032 1015 EAST 106TH STREET CHECK NUMBER: 314030
, INDIANAPOLIS IN 46280 CHECK DATE: 07/26/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07.24 .17 400.00 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:
Douglas Callahan
1015 East 106th Street
Indianapolis,IN 46280
Amount: $400.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Submted To
JUL 2 5 2017
Clerk Treasurer