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Home My WebLink About231285 04/08/14 �Cep... �'...., F CITY OF CARMEL, INDIANA VENDOR: 367222 {; ® ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: 6"""49,211.65` r, _� CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 231285 'g,�roN.�` CHICAGO IL 60686-0020 CHECK DATE: 04/08/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 733172 28,881.75 OTHER EXPENSES 301 5023990 733173 4,374.16 OTHER EXPENSES 1205 4347500 733209 720.00 GENERAL INSURANCE 301 5023990 733285 13,325.66 OTHER EXPENSES 301 5023990 733359 1,910.08 OTHER EXPENSES Indiana University Health Workplace Services, LLC �75 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 )�✓ Phone: 317-963-1534 FEIN: 20-0994452 Invoice April 01, 2014 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite EAP Services/March 2014 1 Civic Square Carmel, IN 46032- Invoice# 733209 Proc Code Date Description City Charge Receipt Adjust Balance EAPSERV 03/01/2014 EAP Services 600.00 720.00 720.00 Balance Due: 720.00 Invoice At 733209 Balance Due: 720.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK r „ � -oe'>J fitted I l~= ', 7 14 k t Gley Cut and -- ---- with payment Please remit 720.00 to IU Health Workplace Services,LLC 2046 Reliable Pkwy Please place invoice number 733209 on check Chicago,IL 60686-0020 Phone: 317-963-1534 [ J MasterCard [ ]Discover [ ]Visa Card Number Exp.Date -/-/ 3 Digit Security Code Signature of Cardholder VOUCHER NO. WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $720.00 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 I 733209 I 43-475.00 I $720.00 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Wednesday, April 02, 2014 Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 04/01/14 733209 EAP Services $720.00 1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer Indiana University Health Workplace Services, LLC 950 North Meridian Street -30l Suite 200 Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice April 01, 2014 Bill to: Barbara Lamb For: City of Cannel-Onsite City of Carmel-Onsite Onsite Fees/March 2014 1 Civic Square Carmel, IN 46032- Invoice# 733173 Proc Code Date Description City Charge Receipt Adjust Balance CARMBUIL 03/01/2014 City of Carmel Clinic Build Out 1.00 2574.16 2574.16 CARMLEAS 03/01/2014 City of Carmel Sports Performance 1.00 1800.00 1800.00 Lease Balance Due: 4374.16 Invoice# 733173 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK Submitted To APR x'2014 Clerk ^17reasurer Cut and return with payment ------------------------------------------------------------------------------------------------------------------------------- Please remit 4,374.16 to IU Health Workplace Services,LLC 2046 Reliable Pkwy Please place invoice number 733173 on check Chicago, IL 60686-0020 Phone: 317-963-1534 [ ]MasterCard [ ] Discover [ ]Visa Card Number Exp.Date / / 3 Digit Security Code Signature of Cardholder Indiana University Health Workplace Services, LLC —30 \ 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice April 01, 2014 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel-Onsite Misc.Onsite/March 2014 1 Civic Square Carmel, IN 46032- Invoice# 733285 Proc Code Date Description _Qty Charge Receipt Adiust Balance 99070 02/09/2014 Young at Heart Clinic Meds 1.00 515.71 515.71 99070 02/23/2014 Young at Heart Clinic Meds 1.00 452.82 452.82 99070 02/23/2014 Young at Heart Mail-Ins 1.00 7734.85 7734.85 99070 02/28/2014 Young at Heart Mail-Ins 1.00 2619.78 2619.78 99070 03/01/2014 Onsite Lab Charges 1.00 1225.34 1225.34 Feb.2014 SBMF Labs 99070 03/16/2014 Young at Heart Mail-Ins 1.00 777.16 777.16 Balance Due: 13325.66 Invoice# 733285 Balance Due: 13325.66 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN '0 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK Submitted To APR 72014 Cje? ' ,- asure --Cutand---- with payment Please remit 13,325.66 to 1U Health Workplace Services,LLC 2046 Reliable Pkwy Please place invoice number 733285 on check Chicago, IL 60686-0020 Phone: 317-963-1534 [ ]MasterCard [ ]Discover [ ]Visa Card Number Exp.Date / / 3 Digit Security Code Signature of Cardholder Indiana University Health Workplace Services, LLC _j D'1 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice April 01, 2014 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Cannel -Onsite Supply Billing/March 2014 1 Civic Square Carmel, 1N 46032- Invoice# 733359 Proc Code Date Description -Q-ty-Q-tCharge Receipt Adiust Balance 99070 03/01/2014 Onsite Operating Supplies 1.00 1910.08 1910.08 March 20/4 Supplies Balance Due: 1910.08 Invoice# 733359 Balance Due: 1910.08 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK f�� Ss� '. T® 5 APR 7 ��'t4 Clerk �re�_ -n d - Cut and return with payment --------------------------------------------------------------------------------------------------------------------------------- Please remit 1,910.08 to IU Health Workplace Services, LLC 2046 Reliable Pkwy Please place invoice number 733359 on check Chicago,11. 60686-0020 Phone: 317-963-1534 [ ]MasterCard [ ]Discover [ ]Visa Card Number Exp.Date —/—/— 3 Digit Security Code Signature of Cardholder Indiana University Health Workplace Services, LLC mol 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice April 01, 2014 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Staff Time/March 2014 1 Civic Square Cannel, IN 46032- - -"Invoice# 733172 Proc Code Date Description City Qharge Receipt Adjust. Balance NURSEMA 03/03/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/03/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSENP 03/03/2014 N.P.Staff Time 2.00 190.00 190.00 Erin McMurray NURSERN 03/03/2014 R.N.Staff'rime 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/04/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 03/04/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 03/04/2014 R.N.StaffTime 6.00 372.00 372.00 Mareesa Martin NURSEMA 03/05/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/05/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 03/05/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/06/2014 M.A.Staff'rime 4.00 112.00 112.00 Kimberly Pride NURSEMD 03/06/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSENP 03/06/2014 N.P.Staff Time 4.00 380.00 380.00 Randi Antworth NURSERN 03/06/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 03/07/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/07/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 03/07/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/10/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/10/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan Invoice# 733172(continued)page 2 NURSENP 03/10/2014 N.P.Staff Time 1.75 166.25 166.25 Erin McMurray NURSERN 03/10/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/11/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 03/11/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 03/11/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 03/12/2014 M.A.StaffTime 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/12/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 03/12/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/13/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 03/13/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSENP 03/13/2014 N.P.Staff Time 2.00 190.00 190.00 Erin McMurray NURSERN 03/13/2014 R.N.StaffTime 4.00 248.00 248.00 Mareesa Martin NURSEMA 03/14/2014 M.A.StaffTime 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/14/2014 MD Staff Time 5.00 875.00 875.00 Dr.Arnett NURSERN 03/14/2014 R.N.StafPTime 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/17/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/17/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSENP 03/17/2014 N.P.Staff Time 2.00 190.00 190.00 Erin McMurray NURSERN 03/17/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 03/18/2014 M.A.Staff Time 6.00 168.00 168.00 Kanherly Pride NURSEMD 03/18/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 03/18/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 03/19/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/19/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 03/19/2014 R.N.Staff"time 6.00 372.00 372.00 Mareesa Martin NURSEMA 03/20/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 03/20/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSENP 03/20/2014 N.P.Staff Time 2.00 190.00 190.00 Debra Mallory NURSERN 03/20/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin lnvoim:# 733i72(c"nbnvrdpage 4 ___--___'-____ � '�'-%7-%mittedTo 72014 ire,r Cut and return with payment 9-=�----------------_____________________________________________________ M,use,ondzx,8x|.7sw 0Health Workplace Services,LCC 2046Reliable pkn' Please place invoice number 73s|7zoil check Chicago,|L 60686'0020 rxooc 317'963'1534 i ]MasterCard [ ]oiom,c, [ lVisa Card Number Invoice# 733172 172(continued)page 3 NURSEMA 03/21/2014 M.A.StaffTime 5.00 140.00 140.00 Kimberly Pride NURSENP 03/21/2014 N.P.StaffTime 5.00 475.00 475.00 Randi Antworth NURSERN 03/21/2014 R.N.StaffTime 5.75 356.50 356.50 Mareesa Martin NURSEMA 03/24/2014 M.A.StaffTime 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/24/2014 MD StaffTime 5.00 875.00 875.00 Dr.Fagan NURSENP 03/24/2014 N.P.StaffTime 2.00 190.00 190.00 Erin McMurray NURSERN 03/24/2014 R.N.StaffTime 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/25/2014 M.A.StaffTime 6.00 168.00 168.00 Kimberly Pride NURSEMD 03/25/2014 mb StaffTime 6.00 1050.00 1050.00 Dr.Fagan NURSERN 03/25/2014 R.N.StaffTime 6.00 372.00 372.00 Mareesa Martin NURSEMA 03/26/2014 M.A.StaffTime 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/26/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 03/26/2014 R.N.StaffTime 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/27/2014 M.A.StaffTime 4.00 112.00 112.00 Abby Ogden NURSEMD 03/27/2014 MD StaffTime 4.00 700.00 700.00 Dr.Fagan NURSENP 03/27/2014 N.P.StaffTime 2.00 190.00 190.00 Debra Mallory NURSERN 03/27/2014 R.N.StaffTime 4.00 248.00 248.00 Mareesa Martin NURSEMA 03/28/2014 M.A.StaffTime 5.00 140.00 140.00 Kimberly Pride NURSEMD 03/28/2014 MD Staff Time 5.00 875.00 875.00 Dr.Kane NURSERN 03/28/2014 R.N.StaffTime 5.00 310.00 310.00 Mareesa Martin NURSEMA 03/31/2014 M.A.StaffTime 5.00 140.00 140.00 Kimberly Pride NURSENP 03/31/2014 N.P.StaffTime 5.00 475.00 475.00 Randi Antivorth NURSERN 03/31/2014 R.N.StaffTime 5.00 310.00 310.00 Mareesa Martin Balance Due: 28881.75 Invoice 9 733172 Balance Due: 28881.75 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE 4 ON CHECK Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee IU Health Workplace Services, LLC Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 04 1010 4 733173 Qnsmte Fees! MaF 2014 4,374.16 0441114 73K85 MiGG Onsite/ MaF 2014 13,325.66 04101114 733359 -Supp! Billing/ MaF 2014 1,910.08 04/01/14 733172 GInsite Staff Time! IVISF 2014 28,881.75 Total 48,491.65 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5-11-10-1.6. 20 Clerk-Treasurer VOUCHER N004/02/14 WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $ 48,491.65 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Fund Board Members Po# INVOICE NO. ACCT#/TITLE AMOUNT DEPT..# I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for 733173 301 $4,374.16 which charge is made were ordered and 733285 $13.325.66 received except 733359 301 si gin us 7TI 179 3041 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund