246381 06/17/15 wqf` CITY OF CARMEL, INDIANA VENDOR: 367222
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $****38,816.22*
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 246381
,,`TONS CHICAGO IL 60686-0020 CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 741806 315.00 TESTING FEES
301 5023990 741863 4,374.16' OTHER EXPENSES
301 5023990 741870 27,611.25 OTHER EXPENSES
1120 4341999 742007 300.00-' OTHER PROFESSIONAL FE
301 5023990 742007 3,845.35- OTHER EXPENSES
301 5023990 742361 1,664.86- OTHER EXPENSES
1205 4347500 742425 705.60- GENERAL INSURANCE
Indiana University Health Workplace Services,LLC
950 North Meridian Street
y)�s Suite 950 (City of Carmel)
_ Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
May 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/May 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 742425
Service Date Description Quantity Charge Receip Adjust Balance
05/01/2015 EAP Services 588.00 705.60 705.60
CITYCARO Invoice# 742425 Balance Due: 705.60
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
JUN 15 2015 -
Clerk `treasurer
Cut and return with payment
VOUCHER NO. WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF$
2046 Reliable Pkwy
Chicago, IL 60686-0020
$705.60
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 742425 I 43-475.00 I $705.60 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, June 15, 2015
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))
05/31/15 742425 EAP Services $705.60
I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
Indiana University Health Workplace Services,LLC
950 North Meridian Street
-5iz Suite 950 (City of Carmel)
2 Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
May 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite/May 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741806
Service Date Description Quanti Charge Recei Adjust Balance
. ..... . .......
05/12/2015 Quick Read UDS/6panelincludes
15.00
kit
Submitt:edTo
JUN 1 5
Clerk Trer
Invoice# 741806(continued)page 2
Service Date
15.00
kit
Invoice# 741806(continued)page 3
Service Date Description Quanti Charge Receip Adust Balance
315.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
�f Cut and return with payment
VOUCHER NO. WARRANT NO.
IU Health Workplace Services, LLC ALLOWED 20
IN SUM OF$
2046 Reliable Pkwy
Chicago, IL 60686-0020
$315.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 I 741806 I 43-588.00 I $315.00 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, June 15, 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
Date Number (or note attached invoice(s)or bill(s))
05/31/15 741806 Testing $315.00
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
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
May 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Staff Time/May 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741870
Service Date DescriptionQuant! Charge Receip Adous Balance
05/01/2015 MD Staff Time 5.75 1,006.25 1006.25
Dr.Fagan
05/01/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
05/01/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/04/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/04/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/04/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/05/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
05/05/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
05/05/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
05/06/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/06/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/06/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/07/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
05/07/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
05/07/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
05/08/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
Submitted To
JUN 15 2015
Clerk Treasurer
Invoice# 741870(continued)page 2
Service Date Description Quanti Charae Receipt AW-Usj Balance
05/08/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/08/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/11/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/11/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/11/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/12/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
05/12/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
05/12/2015 R.N. Staff Time 6.50 403.00 403.00
Mareesa Martin
05/13/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/13/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/13/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/14/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
05/14/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
05/14/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
05/15/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/15/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/15/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/18/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/18/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/18/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/19/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
05/19/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
05/19/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
05/20/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
Invoice# 741870(continued)page 3
Service Date Descriptio Quanti Charge Receipt Ad"us Balance
05/20/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/20/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/21/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
05/21/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
05/21/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
05/22/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/22/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/22/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
05/26/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
05/26/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
05/26/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Sunderman
05/27/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/27/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/27/2015 MD Staff Time 5.00 875.00 875.00
Dr.Sunderman
05/28/2015 M.A.Staff Time 5.75 161.00 161.00
Kimberly Pride
05/28/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
05/28/2015 MD Staff Time 4.00 700.00 700.00
Dr.Sunderman
05/29/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
05/29/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
05/29/2015 MD Staff Time 5.00 875.00 875.00
Dr.Sunderman
CITYCARO Invoice# 741870 Balance Due: 27611.25
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Cut and return with payment
Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 950
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
May 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel -Onsite Onsite Fees/May 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 741863
Service Date Description Quanti Charae Receiat Ad'us Balance
05/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00
Lease
05/01/2015 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16
CITYCARO Invoice# 741863 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
JUN 15
52015
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 ID# 20-0994452
Invoice
May 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/May 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 742361
Service Date Descrintio Quanti Charae Recei Ad"Us Balance
05/01/2015 Onsite Operating Supplies 1.00 1,664.86 1664.86
May 2015 Supplies
CITYCARO Invoice# 742361 Balance Due: 1664.86
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
JUN 15 2015
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 ID# 20-0994452
Invoice
May 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel -Onsite Misc.Onsite/May 2015
1 Civic Square
Carmel, IN 46032-
Invoice# 742007
Service Date
1.00 451.49 451.49
CITYCARO Invoice# 742007 Balance Due: 4145.35
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
11Z�
C:JUN N y 5 2015
k �Treasurer
Cut and return with payment
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth 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))
05/111/15 741 R70 Staff T!Fiqei May 2015
.
05131/15 741863 Onsite Fees!May 2015 4,314.16
05131115 742361 Onliste Supply Billing!May 2e!5 1,b64.66
05131115 742007 Mise Onsitel May 2o4 151 1 R
05131115 742007 rkfi 1 300.00
Ase Onsite/May 20!5 3,845.35
Total
37,795.62
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 N003M 15 WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLCIN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$ 37,795.62
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund i
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
741870 301 $27,611.25 for which charge is made were ordered and
741863 $4,374.16 received except
742361 $1 rsd qGI
I
I
20
S gnatCT 1+R,
Cost distribution ledger classification if I Title
claim paid motor vehicle highway fund