314076 7/26/2017 CITY OF CARMEL, INDIANA VENDOR: 00350010
ONE CIVIC SQUARE TERESA RICKARD CHECK AMOUNT: $...****300.00*
CARMEL, INDIANA 46032 539MALAOES FL 32162 HILL
DRIVE CHECK NUMBER: 314076
THE CHECK DATE: 07/26/17
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:
Teressa Rickard
539 Mallory Hill Drive
The Villages,FL 32162
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017 S u b m Y Med To
JUL 2 5 2011
Clerk Treasurer