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240719 01/07/15 CITY OF CARMEL, INDIANA VENDOR: 367222 d ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: S****64,071.14* r� CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 240719 CHICAGO IL 60686-0020 CHECK DATE: 01/07/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 738255 4,374.16 OTHER EXPENSES 301 5023990 738257 28,355.00 OTHER EXPENSES 1205 4347500 738271 720.00 GENERAL INSURANCE 301 5023990 738557 450.00 OTHER EXPENSES 1201 4358800 738558 75.00 TESTING FEES 1120 4350900 738751 450.00 OTHER CONT SERVICES 301 5023990 738751 28,040.86 OTHER EXPENSES 301 5023990 738836 1,606.12 OTHER EXPENSES Indiana University Health Workplace Services, LLC 950 North Meridian Street 3�1 Suite 950 —� Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice January 02, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fees/Dec. 2014 1 Civic Square Carmel, IN 46032- _,_..____ ---._— -�----- �--� Invoice# 738255 Proc Code Date Description (qty Charge Receipt Adjust Balance CARMBUIL 12/01/2014 City of Carmel Clinic Build Out 1.00 2574.16 2574.16 CARMLEAS 12/01/2014 City of Carmel Sports Performance 1.00 1800.00 1800.00 Lease Balance Due: 4374.16 Invoice# 738255 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and rclurn with paymcnt -------------- ' a Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice January 02, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/Dec. 2014 1 Civic Square Carmel,IN 46032- ��- Invoice# 738751 Proc Code Date 112 Balance Due: 28490.86 Invoice# 738751 Balance Due: 28490.86 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK A Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) —3o ) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice January 02, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/Dec. 2014 1 Civic Square Carmel,IN 46032- _________ �.._.__._.�Invoice# 738836 Proc Code Date Description oty Charge Receipt Adjust Balance 99070 12/01/2014 Onsite Operating Supplies 1.00 1606.12 1606.12 Dec.2014 Supplies Balance Due: 1606.12 Invoice# 738836 Balance Due: 1606.12 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and retum with payment 0 ---------- - _ Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice January 02, 2015 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel-Onsite Staff Time/Dec. 2014 1 Civic Square Carmel,IN 46032- __. Invoice# 738257 Proc Code Date Description City Charge Receipt Adjust Balance NURSEMA 12/01/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberl v Pride NURSEMD 12/01/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/01/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/02/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 12/02/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 12/02/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 12/03/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 12/03/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/03/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/04/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberlv Pride NURSEMD 12/04/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 12/04/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 12/05/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberlv Pride NURSEMD 12/05/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/05/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/08/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberlv Pride NURSEMD 12/08/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fugan NURSERN 12/08/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/09/2014 M.A.Staff Time 6.00 168.00 168.00 Angie DiGuilio r._._,,_._ __._______.,..._....... ..._..__.......�__.._..._._.....__..r----.___...._..-.__...___._....�.._..-..__.______.____..._-.. __._...._..� .�- Invoice# 738257 (continued)page 2 NURSEMD 12/09/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 12/09/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 12/10/2014 M.A.Staff Time 5.00 140.00 140.00 Shantrece Davis NURSEMD 12/10/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/10/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/11/2014 M.A.Staff Time 4.00 112.00 112.00 Shantrece Davis NURSEMD 12/11/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 12/11/2014 R.N.Staff Time 4.00 248.00 248.00 A4areesa Martin NURSEMA 12/12/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 12/12/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/12/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/15/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 12/15/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fugan NURSERN 12/15/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa A4artin NURSEMA 12/16/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 12/16/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 12/16/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 12/17/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberlv Pride NURSEMD 12/17/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/17/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/[8/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberlv Pride NURSEMD 12/18/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 12/18/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 12/19/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberlv Pride NURSEMD 12/19/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/19/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/22/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberlv Pride NURSEMD 12/22/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/22/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin Invoice# 738257(continued)page 3 NURSEMA 12/23/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 12/23/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 12/23/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 12/24/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberl v Pride NURSEMD 12/24/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/24/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/29/2014 M.A.Staff Time 5.00 140.00 140.00 KimberlY Pride NURSEMD 12/29/2014 MD Staff Time 5.00 875.00 875.00 Dr-Fagan NURSERN 12/29/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/30/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberlv Pride NURSEMD 12/30/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 12/30/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 12/31/2014 M.A.Staff Time 5.00 140.00 140.00 KimberlY Pride NURSEMD 12/31/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/31/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin Balance Due: 28355.00 Invoice# 738257 Balance Due: 28355.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and rctUrn with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice January 02, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Physicals/2014 I Civic Square Carmel,IN 46032- ._.__.._ Invoice# 738557 Proc Code Date Balance Due: 450.00 Invoice# 738557 Balance Due: 450.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK I I Cut and return with payment 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 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)) 4,374.16 01/02/15 3825 2014 2014 HR 28,040.86 01/02/15 3875 11111 A FIRE 450.00 01/02/15 3875 1,606.12 01/02/15 738836 supply Billing/ EDec 2014 28,355.00 01/02/15 38257 ns 450.00 OVUM 738557 0 site Physicals/9014 Total 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. 12/08/14 ALLOWED 20 U ealth _eNIrP.S_. LLC IN SUM OF $ ?04tj Kenable Chicago, 63, 76-14 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Board Members Po#or 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 which charge is made were ordered and 738255 received except 738751 301 1120 738751 509 738836 301 $16 06-12 738257 301 $285,355.00 738557 301 $ 50.00 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC —56,3� 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice January 02, 2015 Bill to: Barbara Lamb For: City of Carmel - Onsite City of Carmel-Onsite Onsite/Dec. 2014 1 Civic Square Carmel,IN 46032- _. Invoice# 738558 v♦ —_____._._______..__._..____._.�_.._._..__....,.__ Proc Code Date Description 75.00 Clerk rGea ['A ENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE ,. �.�a�.. DATE-PLEASE INCLUDE INVOICE#ON CHECK �` C!!r and return with av CHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) alth Workplace Services, LLC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER e IN SUM OF $ CITY OF CARMEL Reliable Pkwy An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by ago, IL-60686-0020 whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. $75.00 Payee Purchase Order No. ACCOUNT OF APPROPRIATION FOR Terms Carmel HR Department Date Due Invoice Invoice Description Amount Dept. INVOICE NO. ACCT#/TITLE AMOUNT _ Board Members Date Number (or note attached invoice(s) or bill(s)) 01 738558 43-588.00 $75.00 1 hereby certify that the attached invoice(s), or 01/02/15. 738558 Testing $75.00 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, January 05, 2015 Director, HR Title Cost distribution ledger classification if I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance claim paid motor vehicle highway fund with IC 5-11-10-1.6 ' 20 Clerk-Treasurer 4` 5 Indiana University Health Workplace Services, LLC 950 North Meridian Street 1 ZvS Suite 950 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice January 02, 2015 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel-Onsite EAP Services/Dec. 2014 1 Civic Square Carmel,IN 46032- Invoice# 738271 Proc Code Date Description City Charae Receipt Adiust Balance EAPSERV 12/01/2014 EAP Services 600.00 720.00 720.00 600 Employees Balance Due: 720.00 Invoice# 738271 Balance Due: 720.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE, DATE-PLEASE INCLUDE INVOICE#ON CHECK 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)) 01/02/15 738271 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 VOUCHER NO. WARRANT NO. IU Health Workplace Services, LLC ALLOWED 20 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 738271 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 Monday, January 05, 2015 Director, Administratio Title Cost distribution ledger classification if claim paid motor vehicle highway fund