243990 04/08/15 CITY OF CARMEL, INDIANA VENDOR: 367222
4� t
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $....45,816.36`
;• ?Q; CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 243990
CHICAGO IL 60686-0020 CHECK DATE: 04/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 740548 29,865.00 OTHER EXPENSES
1201 4358800 740600 390.00 TESTING FEES
301 5023990 740750 4,374.16 OTHER EXPENSES
1205 4347500 740751 694.80 GENERAL INSURANCE
301 5023990 740920 9,285.00 OTHER EXPENSES
301 5023990 740952 1,207.40 OTHER EXPENSES
3d 1 Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 950
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
March 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite Fees/March 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 740750
Service Date Description Quanti Charge Receip AdiuslBalance
03/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00
Lease
03/01/2015 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16
CITYCARO Invoice# 740750 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
.APR 0 6 2015
Clerk Treasurer
Cut and return with payment
�ol Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
March 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Misc.Onsite/March 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 740920
Service Date Description Quanti Charge Recei Adjust Balance
02/01/2015 Onsite Lab Charges 1.00 1,494.85 1494.85
Feb.2015 Labs
02/15/2015 Young at Heart Clinic Meds 1.00 361.00 361.00
02/15/2015 Young at Heart Mail-Ins 1.00 950.40 950.40
02/22/2015 Young at Heart Mail-Ins 1.00 1,739.47 1739.47
02/28/2015 Young at Heart Clinic Meds 1.00 1,557.86 1557.86
02/28/2015 Young at Heart Mail-Ins 1.00 1,972.16 1972.16
03/08/2015 Young at Heart Clinic Meds 1.00 128.81 128.81
03/08/2015 Young at Heart Mail-Ins 1.00 1,080.45 1080.45
CITYCARO Invoice# 740920 Balance Due: 9285.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
F
itted T®062015
Clerk Treasurer
Cut and return with payment
!� Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
March 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/March 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 740952
Service Date Descriptio Quanti Charae Recei Ad"US Balance
03/01/2015 Onsite Operating Supplies 1.00 1,207.40 1207.40
March 2015 Supplies
CITYCARO Invoice# 740952 Balance Due: 1207.40
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submfltted To
APR 0 6 2015
Clerk 'Treasurer
Cut and return with payment
Indiana University Health Workplace Services,LLC
Q 01 950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
March 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Staff Time/March 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 740548
Service Date Description Quanti Charge Recei A&U-S Balance
03/01/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride-Admin.Hours
03/01/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin-Admin.Hours
03/02/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
03/02/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/02/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/03/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
03/03/2015 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
03/03/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
03/04/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
03/04/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/04/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/05/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
03/05/2015 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
03/05/2015 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
03/06/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
03/06/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
Submitted To
APR 062015
Clerk Treasurer
Invoice# 740548 (continued)page 2
Service Date Description Quanti Charge Receip Adjust Balance
03/06/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/09/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/09/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/09/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
03/10/2015 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
03/10/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
03/10/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
03/11/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/11/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/11/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
03/12/2015 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
03/12/2015 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
03/12/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
03/13/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/13/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/13/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
03/16/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/16/2015 MD Staff Time 5.00 875.00 875.00
Drr,Fagan
03/16/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/17/2015 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
03/17/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
03/17/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
03/18/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/18/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
Invoice# 740548(continued)page 3
Service Date DescriptionQuant! Charae Recelp Ad'us Balance
03/18/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/19/2015 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
03/19/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
03/19/2015 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
03/20/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Mai-tin
03/20/2015 MD Staff Time 5.00 875.00 875.00
Dr,Naz
03/20/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/23/2015 MD Staff Time 5.00 875.00 875.00
Pilcher
03/23/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/23/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/24/2015 MD Staff Time 6.00 1,050.00 1050.00
Pilcher
03/24/2015 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
03/24/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
03/25/2015 MD Staff Time 5.00 875.00 875.00
Pilcher
03/25/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/25/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/26/2015 MD Staff Time 4.00 700.00 700.00
Pilcher
03/26/2015 R.N.Staff Time 4.00 248.00 248.00
Sarah Fedor
03/26/2015 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
03/27/2015 MD Staff Time 5.00 875.00 875.00
Naz
03/27/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
03/27/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
03/30/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
03/30/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
Invoice# 740548 (continued)page 4
Service Date Description Quanti Charge Receip Adjust Balance
03/30/2015 M.A.Staff Time 5.00 140.00 140.00
Tammy Nelson
03/31/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
03/31/2015 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
03/31/2015 M.A.Staff Time 6.00 168.00 168.00
Bonita Richardson
CITYCARO Invoice# 740548 Balance Due: 29865.00
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))
0
03/31/lb (40920 Misc Onsitei Mar 2015 Q.28500
0
0
Total
I 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
20Clerk-Treasurer
VOUCHER NgSjgW WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC IN SUM OF $
2046 Reliable Pkwy
Chicago_ IL 60686-0020
$44,73156
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Eund
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
i
or bill(s) is (are) true and correct and that
the materials or services itemized thereon
740750 301 for which charge is made were ordered and
740928 received except
740952 3ulI
548 301 329,865.00
i
20
i
�y
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund
Indiana University Health Workplace Services,LLC
.S 950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
March 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite/March 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 740600
Service Date Description Quanti Charge Recei Aau-sl Balance
------ - ----- --- -- --- --------------- -------- - ----- --- -- -----
03/04/2015 Quick Read UDS/6panel
15.00
kit
FP
mitted To
0 6 2015
Clerk `treasurer
Invoice# 740600(continued)page 2
Service Date DescriptionQuant! Charge Receipt Ad"Us Balance
03/27/2015 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
15.00
Invoice# 740600(continued)page 3
Service Date Description Quanti Charge Receip Adjust Balance
03/11/2015 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
Gut 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
$390.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT.
Board Members
1201 740600 43-588.00 $390.00
hereby certify that the attached invoice(s), or.
I � I I
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, April 06, 2015
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 J,.
Date Number (or note attached invoice(s)or bill(s))
03/31/15 740600 Onsite Testing .. $390.00
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
7F_`
75
)� Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
March 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/March 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 740751
Service Date Description Quanti Charge Receip Ad'us Balance
03/01/2015 EAP Services 579.00 694.80 694.80
579 Employees
CITYCARO Invoice# 740751 Balance Due: 694.80
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
APR 0 6 2015
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
$694.80
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 740751 I 43-475.00.1 $694.80 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, April 06, 2015
w
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))
03/31/15: 740751 EAP Services $694.80
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