248403 08/1 2/1 5 (''�\. CITY OF CARMEL, INDIANA VENDOR: 367222
"® ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $****47,050.26*
s. ,?� CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 248403
�M?imi�°' CHICAGO IL 60686-0020 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 300.00 MEDICAL EXAM FEES
1120 4340799 -300.00 OTHER MEDICAL FEES
301 5023990 743204 4,374.16 OTHER EXPENSES
1201 435880.0 743272 724.00 TESTING FEES
301 5023990 743330 29,745.00 OTHER EXPENSES
1205 4347500 743540 705.60 GENERAL INSURANCE
1120 4340701 743572 150.00 MEDICAL EXAM FEES
301 5023990 743572 10,883.14 OTHER EXPENSES
301 5023990 743665 468.36 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
July 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Staff Time/July 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 743330
Service Date DescriptionQuant! Charge Recei t AW-us-1 Balance
07/01/2015 R.N.Staff Time 5.00 310.00 310.00
Serina Price
07/01/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/01/2015 M.A.Staff Time 7.00 196.00 196.00
Kimberly Pride
07/02/2015 R.N.Staff Time 4.50 279.00 279.00
Serina Price
07/02/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
07/02/2015 M.A.Staff Time 7.00 196.00 196.00
Kimberly Pride
07/06/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/06/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/06/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/07/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
07/07/2015 M.A.Staff Time 7.50 210.00 210.00
Kimberly Pride
07/07/2015 R.N.Staff Time 7.50 465.00 465.00
Mareesa Martin
07/08/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/08/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/08/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/09/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
Submitted To
AUG 10 2015
Cierk Treasurer
Invoice# 743330(continued)page 2
Service Date Description Quanti Charge Receipt Ad'us Balance
07/09/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
07/09/2015 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
07/10/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/10/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/10/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/13/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/13/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/13/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/14/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
07/14/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
07/14/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
07/15/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/15/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/15/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/16/2015 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
07/16/2015 R.N.Staff Time 3.50 217.00 217.00
Mareesa Martin
07/16/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
07/17/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/17/2015 R.N.Staff Time 6.00 372.00 372.00
Mareesa Marti:
07/17/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/20/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/20/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/20/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/21/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
Invoice# 743330(continued)page 3
Service Date Description Quantity Charge Receipt Adjust Balance
07/21/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
07/21/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
07/22/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/22/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/22/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/23/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
07/23/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
07/23/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
07/24/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/24/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/24/2015 N.P.Staff Time 5.00 560.00 560.00
Andrea Opsal
07/27/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/27/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/27/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/28/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
07/28/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
07/28/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
07/29/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
07/29/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/29/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
07/30/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
07/30/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
07/30/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
07/31/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
Invoice# 743330(continued)page 4
Service Date DescriptionQuant! Charge Recei Adjust Balance
07/31/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
07/31/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
CITYCARO Invoice# 743330 Balance Due: 29745.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
FSubmitted To
AUG 10' 2015
Clergy Treasurer
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
July 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite Fees/July 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 743204
Service Date DescriptionQuant! Charge Recei dust Balance
07/01/2015 City of Cannel Sports Performance 1.00 1,800.00 1800.00
Lease
07/01/2015 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16
CITYCARO Invoice# 743204 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
ed
AUG 10' 2015
Clerk Treasurer
Indiana University Health Workplace Services,LLC
950 North Meridian Street
c7\ Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
July 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/July 2015
1 Civic Square
Cannel,IN 46032-
Invoice# 743665
Service Date Description Quanti Charge Recelp Adjust Balance
07/01/2015 Onsite Operating Supplies 1.00 468.36 468.36
July 2015 Supplies
CITYCARO Invoice# 743665 Balance Due: 468.36
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
AUG 10 2015
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
July 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Misc.Onsite/July 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 743572
Service Date
CITYCARO Invoice# 743572 Balance Due: 11033.14
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
AUG 10 2015
Clerk Treasurer
n. -«a. avment
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))
07431116 Staff Tirnei july 2015 99 745 00
06/30115 -743204 0 Mote Fees/i Lily 2015 43741
06/30/15 _77A_1121= Onlist Supply Billingljuly2015 46836
M38/15 _-7T-_4F-3_1rr__�1TZ-- Mose Onsite/july 2015 FnFe 150 On
06130115 743572 nsitel july 2016 10,88314
45,620.66
Total
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 NOQWIQ/15 WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$ 45,620.66
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
Board Members
PO#or DEPT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
the materials or services itemized thereon
743330 301 $29,745.00 for which charge is made were ordered and
743204 301 $4,374.16 received except
743665 qnl I
3
Z43579 407 01 $150 On
;148572— $19,883.14 1
20
! �v a—
Signature �- Z—
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Indiana University Health Workplace Services,LLC
950 North Meridian Street
ZJ� Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
July 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite/Drug Screen/July
1 Civic Square
Carmel,IN 46032-
Invoice# 743272
Service Date Description Quantity Charge Recei t Adjust . Balance
---- - - - ——-- --- --- -- -- --- ---- - ..... ...... -..
07/15/2015 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
15.00
kit
Submitted To
AUG 10 2015
Clerk Treasurer
Invoice# 743272(continued)page 2
Service Date Description Quanti Charge Receipt Adjust Balance
15.00
Invoice# 743272(continued)page 3
Service Date Description Quanti Charge Receipt Adjust Balance
07/13/2015 Regulated Drug Screen
15.00
Invoice# 743272(continued)page 4
Service Date Description Quanti Charge Receipt Adjust Balance
07/15/2015 Quick Read UDS/6panel
15.00
--------- --.. ------- - - - - - --- ---
i
Invoice# 743272(continued)page 5
Service Date Description Quanti Charge Receipt Adiust Balance
07/14/2015 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
724.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted 'T®
AUG 19 2015
Clerk Treasurer
Q-1 and retum with navment
VOUCHER NO. WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF$
2046 Reliable Pkwy
Chicago, IL 60686-0020
$724.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 I 743272 I 43-588.00 I $724.00 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 10, 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.
i
Terms
i
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
07/31/15 743272 Testing $724.00
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
POP-
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
July 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/July 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 743540
Service Date Description Quanti Charge Receipt A-djust Balance
07/01/2015 EAP Services 588.00 705.60 705.60
CITYCARO Invoice# 743540 Balance Due: 705.60
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
AUG 10 2015
Clerk Treasurer
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
$705.60
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 743540 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, August 10, 2015
Director, Administration
Title
i
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))
07/31/15 743540 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