314072 07/26/17 9,>, CITY OF CARMEL, INDIANA VENDOR: 00350846 CHECK AMOUNT: $*******400.00*
ONE CIVIC SQUARE KIMBERLY K. PRATT
Q CARMEL, INDIANA 46032 1063 ARROWWOOD DRIVE CHECK NUMBER: 314072
+M. ? CARMEL IN 46033 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:
Kimberly Pratt
1063 Arrowwood Drive
Carmel,IN 46033
Amount: $400.00
Fund: Medical Escrow Fund (301) �m...._....�
Date: July 24,2017 Submit-ted To
JUL 2 5 2017
Clerk Treasurer