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235897 08/13/14
�ur...4�gy CITY OF CARMEL, INDIANA VENDOR: 367222 1 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $'*'*52,571.47* :9 ;_� CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 235897 .y_TON�, CHICAGO IL 60686-0020 CHECK DATE: 08/13/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 734630 720.00 GENERAL INSURANCE 301 5023990 734631 4,374.16 OTHER EXPENSES 1201 4358800 734700 105.00 TESTING FEES 301 5023990 734900 28,750.00 OTHER EXPENSES 301 5023990 735064 1,606.21 OTHER EXPENSES 301 5023990 735127 17,016.10 OTHER EXPENSES Indiana University Health Workplace Services, LLC 950 North Meridian Street S Suite 200 (City of Carmel) .�� Indianapolis, IN 46204 Submitted To 2�1 Phone: 317-963-1534 FEIN: 20-0994452 AUG 112014 Clerk `treasurer Invoice August 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite/July 2014 1 Civic Square Carmel,IN 46032- Invoice# 734700 Proc Code Date Description Balance Due: 105.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Invoice# 734700(continued)page 2 I 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 $105.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 734700 43-588.00 $105.00 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 Monday,August 11, 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)) 08/01/14 734700 $105.00 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 Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice August 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/July 2014 1 Civic Square Carmel,IN 46032- Invoice# 734900 Proc Code pig Description ion (may Charne Receipt just Balance NURSEMA 07/01/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 07/01/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 07/01/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 07/02/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/02/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/02/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/03/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 07/03/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 07/03/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 07/07/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/07/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/07/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/08/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 07/08/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 07/08/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 07/09/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/09/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/09/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/10/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride Invoice# 734900(continued)page 2 NURSEMD 07/10/2014 MD Staff Time 4.00 700.0000.0 7 0 Dr.Fagan NURSERN 07/10/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 07/11/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/11/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/11/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/14/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/14/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/14/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/15/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 07/15/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 07/15/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 07/16/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/16/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/16/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/17/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 07/17/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 07/17/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 07/18/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/18/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/18/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/21/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/21/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/21/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/22/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 07/22/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 07/22/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 07/23/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 07/23/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/23/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin Invoice# 734900(continued)page 3 NURSEMA 07/24/2014 M.A.Staff Time 4.00 112.00 112.00 Angie Diguilio NURSEMD 07/24/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 07/24/2014 R.N.Staff Time 4.00 248.00 248.00 - Mareesa Martin NURSEMA 07/25/2014 M.A.Staff Time 5.00 140.00 140.00 Brittani Flynn NURSENP 07/25/2014 N.P.Staff Time 5.00 475.00 475.00 Murff,NP NURSERN 07/25/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/28/2014 M.A.Staff Time 5.00 140.00 140.00 Bonita Richardson NURSEMD 07/28/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 07/28/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/29/2014 M.A.Staff Time 6.00 168.00 168.00 Brittani Flynn NURSEMD 07/29/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 07/29/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 07/30/2014 M.A.Staff Time 5.00 140.00 140.00 Brittani Flynn NURSEMD 07/30/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan: NURSERN 07/30/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 07/31/2014 M.A.Staff Time 4.00 112.00 112.00 Angie Diguilio NURSEMD 07/31/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 07/31/2014 R.N.Staff Time 4.00 248.00 248.00 MareesatKf tt Subi:itted To Balance Due: 28750.00 AUG 112014 nvoice# 734900 Balance Due: 28750.00 MAKE PAYMENT T THE BELOW1ADDRIESS WITHIN 0 DAYS OF INVOICE DATE'PL >;14Wi ICE#O CHECK 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 August 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/July 2014 1 Civic Square Carmel,IN 46032- Invoice# 735064 Proc Code Date Description Charge Receipt Adjust Balance 99070 07/01/2014 Onsite Operating Supplies 1.00 1606.21 1606.21 July 2014 Supplies Balance Due: 1606.21 Invoice# 735064 Balance Due: 1606.21 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK E d To 014asurer _ lti,r onrl mn.m...fill,navmnnf - 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 August 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/July 2014 1 Civic Square Carmel,IN 46032- Invoice# 735127 Proc Code Date Description (� Charae Receipt Adiust Balance 99070 05/31/2014 Young at Heart Mail-Ins 1.00 3605.97 3605.97 99070 06/30/2014 Young at Heart Mail-Ins 1.00 4148.84 4148.84 99070 06/30/2014 Young at Heart Clinic Meds 1.00 626.30 626.30 99070 07/01/2014 Onsite Lab Charges 1.00 2716.55 2716.55 SBMF June 2014 Labs 99070 07/06/2014 Young at Heart Mail-Ins 1.00 3991.81 3991.81 99070 07/13/2014 Young at Heart Clinic Meds 1.00 969.83 969.83 99070 07/13/2014 Young at Heart Mail-Ins 1.00 956.80 956.80 Balance Due: 17016.10 Invoice# 735127 Balance Due: 17016.10 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To ittl L014 asurer Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice August 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fees/July 2014 1 Civic Square Carmel,IN 46032- Invoice# 734631 Proc Code Date Description ,Qty Charge Receipt Adiust Balance CARMBUIL 07/01/2014 City of Carmel Clinic Build Out 1.00 2574.16 2574.16 CARMLEAS 07/01/2014 City of Carmel Sports Performance 1.00 1800.00 1800.00 Lease Balance Due: 4374.16 Invoice# 734631 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To AUG 112014 Clerk Treasurer Cut and retu o+rh a Pyr 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. r Payee UWQP �� LUI Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 'l Lf c+ 0 b b Rjl�,L-Y �-e 14 ST*t-P `7Sv, o© -[� '73 50 b4_1 -[ `f '73 5) 91 fvv-s6't)r\s t+? 1.)L I l o j o. /6 g -1 q r13 qLP 3 I e s. i-F reL ,To 1i 3 -7 / Total 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 NO. WARRANT NO. ALLOWED 20 IN SUM OF $ ON ACCOUNT OF APPROPRIATION FOR Board Members 1 Po#or INVOICE NO. ACCT#!TITLE AMOUNT DEPT.# j I hereby certify that the attached invoice(s), or 73 y q 00 v I o'�'`7SD v� bill(s) is (are) true and correct and that the '73 5 materials or services itemized thereon for 735 b2'� 3 I °�0 f� I b which charge is made were ordered and 4l 3 ( 301 q3,7�,/� received except I 20 I Signa##ure Cost distribution ledger classification if Title claim paid motor vehicle highway fund Indiana University Health Workplace Services,LLC 950 North Meridian Street I Suite 200 (City of Carmel) 12d Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice August 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/July 2014 1 Civic Square Carmel,IN 46032- Invoice# 734630 Proc Code Date Description -QIY Charae Receipt Aust Balance EAPSERV 07/01/2014 EAP Services 600.00 720.00 720.00 Balance Due: 720.00 Invoice# 734630 Balance Due: 720.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted. To AUG 112014 Clerk Treasurer 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 734630 43-475.00 $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 Monday, August 11, 2014 Director, Adminis ation 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 b p � � Y 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)) 08/01/14 734630 EAP services $720.00 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