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234893 07/16/14 CITY OF CARMEL, INDIANA VENDOR: 367222 4 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $****39,435.92* f•. _ CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 234893 CHICAGO IL 60686-0020 CHECK DATE: 07/16/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 733904 888.00 TESTING FEES 301 5023990 733946 26,705.00 OTHER EXPENSES 301 5023990 733947 4,374.16 OTHER EXPENSES 301 5023990 734109 5,399.44 OTHER EXPENSES 1205 4347500 734307 720.00 GENERAL INSURANCE 301 5023990 734474 1,349.32 OTHER EXPENSES Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice July 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fees/June 2014 1 Civic Square Carmel,IN 46032- Invoice# 733947 Proc Code Date Description CQttv Charae Recei t Adjust Balance CARMBUIL 06/01/2014 City of Carmel Clinic Build Out 1.00 2574.16 2574.16 CARMLEAS 06/01/2014 City of Carmel Sports Performance 1.00 1800.00 1800.00 Lease Balance Due: 4374.16 Invoice# 733947 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted '�® JUL 14 2014 Clerk Treasurer Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice July 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/June 2014 1 Civic Square Carmel,IN 46032- Invoice# 734109 Proc Code Date Description Oty Charge Receipt Adjust Balance 99070 05/18/2014 Young at Heart Clinic Meds 1.00 1595.69 1595.69 99070 05/25/2014 Young at Heart Clinic Meds 1.00 39.78 39.78 99070 05/31/2014 Young at Heart Clinic Meds 1.00 416.98 416.98 99070 06/01/2014 Onsite Lab Charges 1.00 1923.91 1923.91 Ma},2014 Labs 99070 06/08/2014 Young at Heart Clinic Meds 1.00 1423.08 1423.08 Balance Due: 5399.44 Invoice# 734109 Balance Due: 5399.44 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To _ JUL 14 2014 Clerk Treasurer Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice July 01, 2014 Bill to:' Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/June 2014 1 Civic Square Carmel,IN 46032- _. _..__v_.. ___.___.._.._�.. .__._.._. _... ..._. .._..__. .._._....__._..... ...._.._. ._._._ .___.. _ ._._ .._.__..._ _ Invoice# 734474 Proc Code Date Description 0-ty Charge Recei t Adiust Balance 99070 06/01/2014 Onsite Operating Supplies 1.00 1349.32 1349.32 June 2014 Supplies Balance Due: 1349.32 Invoice# 734474 Balance Due: 1349.32 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To JUL 14 2014 Clerk Treasurer Cut and return with payment Indiana University Health Workplace Services, LLC of 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Submitted To Phone: 317-963-1534 iill�� FEIN: 20-0994452 JUL 14 2014 Invoice Clerk Treasurer July 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/June 2014 1 Civic Square Carmel,IN 46032- _ Invoice# 733946 Proc Code Date Description Cyt Charge Receipt Adiust Balance NURSEMA 06/02/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/02/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 06/02/2014 R.N.Staff Time 5.00 310.00 310.00 Abby White NURSEMA 06/03/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 06/03/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 06/03/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 06/04/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/04/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 06/04/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/05/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 06/05/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 06/05/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 06/06/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/06/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 06/06/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/09/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/09/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 06/09/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/10/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride Invoice# 733946(continued)page 2 NURSEMD 06/10/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 06/10/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 06/11/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/11/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 06/11/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/12/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 06/12/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 06/12/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 06/13/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/13/2014 MD Staff Time 5.00 875.00 875.00 Dr.Stephen NURSERN 06/13/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/16/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSENP 06/16/2014 N.P.Staff Time 5.00 475.00 475.00 Erin McMurray NURSERN 06/16/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/17/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 06/17/2014 MD Staff Time 6.00 105,0.60 1050.00 Dr.Arnett NURSERN 06/17/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 06/18/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSENP 06/18/2014 N.P.Staff Time 5.00 475.00 475.00 Randi Antworth NURSERN 06/18/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Marlin NURSEMA 06/19/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSENP 06/19/2014 N.P.Staff Time 4.00 380.00 380.00 Randi Antworth NURSERN 06/19/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 06/20/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/20/2014 MD Staff Time 5.00 875.00 875.00 Dr.Arnett NURSERN 06/20/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/23/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/23/2014 MD Staff Time 5.00 875.00 875.00 DrYagan NURSERN 06/23/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin --- --- --------- Invoice# 733946(continued)page 3 .................... 1., 1.1- l.--, 11-1- , ,.,-..,---................ NURSEMA 06/24/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 06/24/2014 MD Staff Time 6.00 1050.00 1050.00 DrYagan NURSERN 06/24/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 06/25/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/25/2014 MD Staff Time 5.00 875.00 875.00 DrYagan NURSERN 06/25/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/26/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 06/26/2014 MD Staff Time 4.00 700.00 700.00 DrYagan NURSERN 06/26/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 06/27/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/27/2014 MD Staff Time 5.00 875.00 875.00 DrYagan NURSERN 06/27/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 06/30/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 06/30/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 06/30/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin Balance Due: 26705.00 Invoice# 733946 Balance Due: 26705.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and return with payment 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)) 07101/14 733947 Onsite Feest I-ne 2014 07101114 734109 Aft-c- 0 nsitel June 220-14 5,399.44 07101114 734474 Supply BilliRg!june 2014 1,349.32 07101.11 7339 _63 Onsite Staff Time!june 2014 26,705.00 Total 37,827.92 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 VOUCH ER0Y1Y4nt_ _WARRANT NO. ALLOWED 20 1!!-He;aIth Workplace Services, LLC IN SUM OF $ 2946 Reliahlin Pk= 60686-0090 ON ACCOUNT OF APPROPRIATION FOR Medical Fund Board Members PO#or DEPT.# INVOICE NO. ACCT#!TITLE AMOUNT 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 733947 394 4.16 which charge is made were ordered and :F54i89 3811 5 399 Ad received except 1344(4 301 733946 301 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC )20� 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 Submitted To FEIN: 20-0994452 FJUL 14 2014 Invoice Clerk Treasurer July 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite/June 2014 1 Civic Square Carmel,IN 46032- Invoice# 733904 Proc Code Date Description ( 15.00 kit 15.00 kit � � Iovoicn# ?339O4(cvubuuud)page 2 ....__......... _--______________-__ � ---------- ' 22.00 � 80100 06//6/2014 Regulated Drug Screen }. 15.00 ---------- Invoice# 733904(continued)page 3 .......... ..................... 06/17/2014 Quick Read UDS/6panel includes 15.00 kit 15.00 Invoice# 733904(continued)page 4 80100 06/18/2014 Regulated Drug Screen 15.00 kit 15.00 Invoice# 733904(continued)page 5 06/24/2014 Quick Read UDS/6panel includes 888.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and reftim with payment 17 -------------------—------------------------------- ----------------- ----------- VOUCHER NO. WARRANT NO. IU Health Workplace Services, LLC ALLOWED 20 IN SUM OF$ 2046 Reliable Pkwy Chicago, IL 60686-0020 $888.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 I 733904 I 43-588.00 I $888.00 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 which charge is made were ordered and received except Mon -y, July 14, 2014 Director, HR 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)) 07/01/14 733904 $888.00 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer I Zl�rj Indiana University Health Workplace Services, LLC -------- 950 North Meridian Street 1 205 Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice July 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/June 2014 1 Civic Square Carmel,IN 46032- Invoice# 734307 Proc Code Date Description aty Charae Receip Adjust Balance EAPSERV 06/01/2014 EAP Services 600.00 720.00 720.00 600 Employees Balance Due: 720.00 Invoice# 734307 Balance Due: 720.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted T® JUL 14 2014 Clerk Treasurer Cut and return with payment VOUCHER NO. WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF$ 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 734307 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 I Monday, July 14, 2014 I 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)) 07/01/14 734307 EAP Services $720.00 I i I 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