HomeMy WebLinkAbout314064 07/26/17 -9
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CITY OF CARMEL, INDIANA VENDOR: 00353199
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0 ONE CIVIC SQUARE ERNIE MAROON CHECK AMOUNT: $ .....
... 400.00*
:1 r° CARMEL, INDIANA 46032 1004 RETFORD DR CHECK NUMBER: 314064
'�,,;�ow�. WESTFIELD IN 46074 CHECK DATE: 07/26/17
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:
Ernest Maroon
1004 Retford Drive
Westfield, IN 46074
Amount: $400.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Submitted To
JUL 2 5 2017
Clerk Treasurer