HomeMy WebLinkAbout314047 7/26/2017 (9)
CITY OF CARMEL, INDIANA VENDOR: 109200 CHECK AMOUNT: S LELAND C GOODMAN "�""'"300.00'
ONE CIVIC SQUARE 655 BENNETT ROAD CHECK NUMBER: 314047
CARMEL, INDIANA 46032 CARMEL IN 46032 CHECK DATE: 07126117
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
OTHER EXPENSES
301 5023990 07.24 .17 300.00
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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:
Leland Goodman
2150 E 950 S
Flatrock,IN 47234
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Submitted To
JUL 2 5 2017
Clerk Treasurer