249325 09/09/1 5 CITY OF CARMEL, INDIANA VENDOR: 367222
(b I ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $"`*35,650.26'
:. ?4 CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 249325
CHICAGO IL 60686-0020 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 743703 4,374.16 OTHER EXPENSES
1201 4358800 743766 225.00 TESTING FEES
301 5023990 743963 28,589.00 OTHER EXPENSES
301 5023990 744291 1,757.70 OTHER EXPENSES
1205 4347500 744336 704.40 GENERAL INSURANCE
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
August 31, 2015
Bill to: Barbara Lamb For: City of Carmel -Onsite
City of Carmel -Onsite Staff Time/August 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 743963
Service Date Description Quantit Charge Receipt Adjust Balance
08/03/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
08/03/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
08/03/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
08/04/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
08/04/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
08/04/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
08/05/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
08/05/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Matin
08/05/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
08/06/2015 MD Staff Time 4.00 700.00 700.00
Dr. Fagan
08/06/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
` 08/06/2015 M.A.Staff Time 4.50 126.00 126.00
Kinrberly Pride
08/07/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
08/07/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Malin
08/07/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberlv Pride
08/10/2015 R.N.Staff Time 5.50 341.00 341.00
A4a•eesa Martin
Invoice# 743963 (continued)page 2
Service Date Description Quanti Charge Recei 1 Adjust Balance
08/10/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberlv Pride
08/10/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
08/11/2015 R.N. Staff Time 7.50 465.00 465.00
Mareesa Martin
08/11/2015 M.A.Staff Time 7A0 196.00 196.00
Kimberlv Pride
08/11/2015 MD Staff Time 6.00 1.050.00 1050.00
Dr.Fagan
08/12/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
08/12/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
08/12/2015 MD Staff Time 5.00 875.00 875.00
Dr. Fagan
08/13/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
08/13/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberlv Pride
08/13/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
08/14/2015 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
08/14/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberlv Pride
08/14/2015 MD Staff Time 5.00 875.00 875.00
Dr. Fagan
08/17/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
08/17/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
08/17/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberlv Pride
08/18/2015 N.P.Staff Time 6.00 672.00 672.00
Jennifer Hoskins
08/18/2015 R.N.Staff Time 7.50 465.00 465.00
Mareesa Mm•tin
08/18/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
08/19/2015 MD Staff Time 5.00 875.00 875.00
Dr. Fagan
08/19/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
08/19/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberlv Pride
08/20/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
I
Invoice# 743963 (continued)page 3
Service Date Descriptio Quantit Charge Receipt Adiust Balance
08/20/2015 R.N. Staff Time 4.50 279.00 279.00
Mareesa Martin
08/20/2015 M.A.Staff Time 5.50 154.00 154.00
Kinrherly Pride
08/21/2015 MD Staff Time 5.00 875.00 875.00
Pamela Pilcher
08/21/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Malin
08/21/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
08/24/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
08/24/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
08/24/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
08/25/2015 M.A.Staff Time 6.50 182.00 182.00
Kimberly Pride
08/25/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
08/25/2015 MD Staff Time 6.00 1,050.00 1050.00
Dr.Fagan
08/26/2015 M.A.Staff Time 5.50 154.00 154.00
Kinrberly Pride
08/26/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
08/26/2015 MD Staff Time 5.00 875.00 875.00
Dr. Fagan
08/27/2015 M.A.Staff Time 4.50 126.00 126.00
Kinrberly Pride
08/27/2015 R.N.Staff Time 4.50 279.00 279.00
Alarcesa Martin
08/27/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
08/28/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
08/28/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin:
08/28/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
08/31/2015 M.A.Staff Time 5.50 154.00 154.00
Kinrherly Pride
08/31/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Malin
08/31/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
I
Invoice# 743963 (continued)page 4
Service Date Description Quanti Chara Recei t Adiust Balance
CITYCARO Invoice# 743963 Balance Due: 28589.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
SEP 042015
Clergy Treasurer
Cut and return with payment g
a.,�...,.:,:,.�...,.-_. �»a-_
Indiana University Health Workplace Services, LLC
o 950 North Meridian Street
Suite 950
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
August 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite Fees/August 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 743703
Service Date Descrii)tio Quanti Charge Receipt Adjust Balance 1
08/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00
Lease
08/01/2015 City of Carmel Clinic Build Out 1.00 2.574.16 2574.16
CITYCARO Invoice# 743703 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submi 'ted To
tted To
SEP 042015
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
August 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/Aug. 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 744291
Service Date Descriptio Quanti Charge Receipt Adjust Balance
08/01/2015 Onsite Operating Supplies 1.00 1,757.70 1757.70
August 2015 Supplies
CITYCARO Invoice# 744291 Balance Due: 1757.70
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
FpSUSbimnitted T®
042015
Cierk Treasurer
Cut and return with payment
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.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))
08131/15 743963 f."Insite Staff Teme/August 2015 28 589.00
08/31/15 7437e3 Gnsite Fees!August 2015- 4 374.16
08131/15 744291 Onliste Supply Billing!August 2015 1 757.70
34,720. 6
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
VOUCHER NCbg/04/15 WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$ 34,720.86
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
the materials or services itemized thereon
743963 301 $28,589.00 for which charge is made were ordered and
MIMI 301 . $1374,16 received except
7-44294 T112S:Z 70
20
i Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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
August 31, 2015
Bill to: Barbara Lamb For: City of Carmel -Onsite
City of Carmel-Onsite Onsite/Drug Screens/Aug.
1 Civic Square
Carmel,IN 46032-
Invoice# 743766
Service Date Description uanti Charge Receipt Adjust Balance
-- • •-- -- . ..... . ....... ......
08/06/2015 Quick Read UDS/6panel
15.00
kit
Submitted To
SEP 042015
Clerk Treasurer
Invoice# 743766(continued)page 2
Service Date Description
225.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
t _ 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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
08/31/15 743766 Onsite Drug Screens $225.00
1 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.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$225.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 I 743766 I 43-588.00 I $225.00 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
Wednesday, September 02, 2015
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
�7 Indiana University Health Workplace Services, LLC
C J— 950 North Meridian Street
�— Suite 950 (City of Carmel)
1 Z'� Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
August 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/August 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 744336
Service Date Descriptio Quanti Charge Receipt dust Balance
08/01/2015 EAP Services 587.00 704.40 704.40
CITYCARO Invoice# 744336 Balance Due: 704.40
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted 'T®
SEP 042015
Clerk 'Treasurer
Cut and return Y 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))
08/31/15 744336 EAP Services $704.40
1 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.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$704.40
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 744336 I 43-475.00 I $704.40 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
Wednesday, September 02, 2015
1141
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund