244937 05/05/15 u�.4�
J^%" `p`� CITY OF CARMEL, INDIANA VENDOR: 367222
• ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $"**48,559.29*
4. ?a CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 244937
9.yiTON�` CHICAGO IL 60686-0020 CHECK DATE: 05/05/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 741124 881.00 TESTING FEES
301 5023990 741131 4,374.16 OTHER EXPENSES
301 5023990 741201 30,218.00 OTHER EXPENSES
301 5023990 741668 577.46 OTHER EXPENSES
1205 4347500 741749 694.80 GENERAL INSURANCE
301 5023990 741762 11,813.87 OTHER EXPENSES
Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
April 30, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite/April 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741124
Service Date Description
15.00
kit
Invoice# 741124(continued)page 2
Service Date Description Quanti Charae Recei Ad'us Balance
Due: 22.00
Invoice# 741124(continued)page 3
Service Date Description Quanti Charge Receip Ad s Balance
04/16/2015 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
Balance Due: 15.00
Invoice# 741124(continued)page 4
Service Date Description Quanti Charge Recei Ad'us Balance
04/24/2015 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
Due: 15.00
Invoice# 741124(continued)page 5
Service Date Description Quanti Charge Recei Ad"Us Balance
04/16/2015 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
Balance Due: 15.00
Invoice# 741124(continued)page 6
Service Date Description Quanti Charcie Receip Ad'us Balance
04/07/2015 Quick Read UDS/6panel
Balance Due: 881.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
MAY 0.4 2015
Clerk Treasurer
R Cut and return with payment
I
VOUCHER NO. WARRANT NO.
IU Health Workplace Services, LLC ALLOWED 20
IN SUM OF$
2046 Reliable Pkwy
Chicago, IL 60686-0020
$881.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 I 741124 I 43-588.00 I $881.00 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, May 04, 2015
I
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
I
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))
04/30/15 741124 $881.00
I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
�S Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
April 30, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Servics/April 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741749
Service Date Description Quanti Charge Recei Adjust Balance
04/01/2015 EAP Services 579.00 694.80 694.80
CITYCARO Invoice# 741749 Balance Due: 694.80
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
MAY 0.4 2015
Clerk Treasurer
Cut and return with payment
VOUCHER NO. WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF$
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 741749 I 43-475.00 I $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, May 04, 2015
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))
04/30/15 741749 EAP Services $694.80
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
o Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
April 30, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Misc.Onsite/April 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741762
Service Date Description Quanti Charae Receip A&AS Balance
03/01/2015 Onsite Lab Charges 1.00 1,663.21 1663.21
March 2015IULabs
03/15/2015 Young at Heart Clinic Meds 1.00 1,501.92 1501.92
03/15/2015 Young at Heart Mail-Ins 1.00 4,544.36 4544.36
03/20/2015 Young at Heart Clinic Meds 1.00 337.50 337.50
03/22/2015 Young at Heart Mail-Ins 1.00 2,134.62 2134.62
03/29/2015 Young at Heart Mail-Ins 1.00 1,352.29 1352.29
03/31/2015 Young at Heart Clinic Meds 1.00 279.97 279.97
CITYCARO Invoice# 741762 Balance Due: 11813.87
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
MAY 0 4 2015
Clerk Treasurer
w Cut and return with payment
Indiana University Health Workplace Services, LLC
3U� 950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
April 30, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/April 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741668
Service Date Description Quanti Charae Receip Ad'us Balance
04/01/2015 Onsite Operating Supplies 1.00 577.46 577.46
April 2015 Supplies
CITYCARO Invoice# 741668 Balance Due: 577.46
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
MAY 0.4 2015
Clerk Treasurer
Cut and return with payment
Indiana University Health Workplace Services, LLC
�o> 950 North Meridian Street
Suite 950
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
April 30, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite Fees/April 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741131
Service Date Description Quanti Charge Recei AW—US-1 Balance
04/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00
Lease
04/01/2015 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16
CITYCARO Invoice# 741131 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
MAY 0.4 2015
Clerk Trea��rer
Gut and return with payment
Indiana University Health Workplace Services, LLC
-3-) 950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
April 30, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Staff Time/April 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741201
Service Date Description Quanti Charae Recei Ad"us Balance
04/01/2015 M.A.Staff Time 5.25 147.00 147.00
Tammy Nelson
04/01/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/01/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/02/2015 M.A.Staff Time 5.50 154.00 154.00
Tammy Nelson
04/02/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
04/02/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
04/03/2015 M.A.Staff Time 5.25 147.00 147.00
Tammy Nelson
04/03/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/03/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/06/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
04/06/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/06/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan -
04/07/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
04/07/2015 R.N.Staff Time 7.00 434.00 434.00
Mareesa Martin
04/07/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
04/08/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
Invoice# 741201 (continued)page 2
Service Date Description Quantity Charge Receipt Ad Us Balance
04/08/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/08/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/09/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
04/09/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
04/09/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
04/10/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
04/10/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/10/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/13/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
04/13/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/13/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/14/2015 M.A.Staff Time 7.00. 196.00 196.00
Kimberly Pride
04/14/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
04/14/2015 R.N.Staff Time 7.00 434.00 434.00
Mareesa Martin
04/15/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride -
04/15/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/15/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/16/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
04/16/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
04/16/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
04/17/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
04/17/2015 MD Staff Time 5.00- 875.00 875.00
Dr.Fagan
04/17/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/20/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
Invoice# 741201 (continued)page 3
Service Date DescriptionQuant! Charge Recei Ad'us Balance
04/20/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/20/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/21/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
04/21/2015 R.N.Staff Time 7.00 434.00 434.00
Steven Osborn
04/21/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
04/22/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
04/22/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/22/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/23/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
04/23/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
04/23/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
04/24/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
04/24/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/24/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/27/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
04/27/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/27/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/28/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
04/28/2015 R.N.Staff Time 7.00 434.00 434.00
Mareesa Martin
04/28/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
04/29/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
04/29/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
04/29/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
04/30/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
Invoice# 741201 (continued)page 4
Service Date Description Quanti Charge Receip Ad'us Balance
04/30/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
04/30/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
CITYCARO Invoice# 741201 Balance Due: 30218.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
MAY 0.4 2015
Clerk Treasurer
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))
onsite04130115 741201 Staff Time/April 2015 30,218.00
04/30115 741131 ' Fees/April 2015 4;374.16
4130/15 74 1668 onsote Supply Billing/April 2015 577.46
11,813.87
04130116 741762 onsite c/A ril 2015
Total 1$46,983.
49
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 NOD5iO4i15 WARRANT NO.
ALLOWED 20
IU HEALTH WORKPLACE SERVICES, LLC
IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$ $46,983.49
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
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
741201 301 $30,218.00 ; the materials or services itemized thereon
741131 301 $4,374.16 for which charge is made were ordered and
741668received except
741762 SJJ-Rl 2 a7
I
I
i
20
'bir« g�at 6r
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund