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Home My WebLink About250294 1 0/07/1 5 u%V ��p'F� CITY OF CARMEL, INDIANA VENDOR: 367222 ,' b ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $""'46,987.94' ?� CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 250294 ,,�, oN co, CHICAGO IL 60686-0020 CHECK DATE: 10/07/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 744470 393.00' TESTING FEES 301 5023990 744601 4,374.16- OTHER EXPENSES 301 5023990 744602 28,495.00' OTHER EXPENSES 1205 4347500 744772 704.40' GENERAL INSURANCE 301 5023990 744917 12,451.18- OTHER EXPENSES 301 5023990 744918 570.20/ OTHER EXPENSES Indiana University Health Workplace Services, LLC 950 North Meridian Street mol Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice September 30, 2015 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Staff Time/Sept. 2015 1 Civic Square Carmel, IN 46032- Invoice# 744602 Service Date Descriotio Quantity Charge Recei t Adjust Balance 09/01/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan 09/01/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 09/01/2015 R.N. Staff Time 6.00 372.00 372.00 Mareesa Martin 09/02/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 09/02/2015 M.A. Staff Time 5.75 161.00 161.00 Kimberly Pride 09/02/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa Martin 09/03/2015 MD Staff Time 4.00 700.00 700.00 Dr. Fagan 09/03/2015 M.A.Staff Time 4.75 133.00 133.00 Kimberly Pride 09/03/2015 R.N. Staff Time 4.50 279.00 279.00 Mareesa Martin 09/04/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 09/04/2015 M.A. Staff Time 5.50 154.00 154.00 Kimberly Pride 09/04/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa Martin 09/08/2015 R.N. Staff Time 6.50 403.00 403.00 Mareesa Martin 09/08/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 09/08/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan 09/09/2015 R.N. Staff Time 5.50 341.00 341.00 A4areesa A4artin FSOPM-nittedTO052015 Clerk Trig )surer Invoice# 744602 (continued)page 2 Service Date Descriptio Quanti Charge Receipt Adjust Balance 09/09/2015 M.A. Staff Time 5.50 154.00 154.00 Kimberly Pride 09/09/2015 MD Staff Time 5.00 875.00 875.00 Dr. Fagan 09/10/2015 M.A. Staff Time 4.00 112.00 112.00 Devon Brown 09/10/2015 R.N. Staff Time 5.00 310.00 310.00 Mareesa Marlin 09/10/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 09/11/2015 R.N. Staff Time 6.00 372.00 372.00 Mareesa Martin 09/11/2015 M.A. Staff Time 4.75 133.00 133.00 Tammy Nelson-Provence 09/11/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 09/14/2015 M.A.Staff Time 5.00 140.00 140.00 Holly Rivers 09/14/2015 R.N. Staff Time 6.00 372.00 372.00 Mareesa Martin 09/14/2015 MD Staff Time 5.00 875.00 875.00 Dr. Fagan 09/15/2015 R.N. Staff Time 6.50 403.00 403.00 Mareesa Martin 09/15/2015 M.A. Staff Time 6.50 182.00 182.00 Kimberly Pride 09/15/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan 09/16/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa Martin 09/16/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 09/16/2015 MD Staff Time 5.00 875.00 875.00 Dr. Fagan 09/17/2015 R.N. Staff Time 4.50 279.00 279.00 Mareesa Martin 09/17/2015 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 09/17/2015 MD Staff Time 4.00 700.00 700.00 Dr. Fagan 09/18/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa Martin 09/18/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 09/18/2015 MD Staff Time 5.00 875.00 875.00 Dr. Fagan 09/21/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa Martin Invoice# 744602 (continued)page 3 Service Date Descriotio Quantit Charae Receipt Adiust Balance 09/21/2015 M.A. Staff Time 5.50 154.00 154.00 Kimberly Pride 09/21/2015 MD Staff Time 5.00 875.00 875.00 Pamela Pilcher 09/22/2015 R.N. Staff Time 6.50 403.00 403.00 A4areesa Martin 09/22/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 09/22/2015 MD Staff Time 6.00 1,050.00 1050.00 Pamela Pilcher 09/23/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa Martin 09/23/2015 M.A. Staff Time 5.50 154.00 154.00 Kimberly Pride 09/23/2015 N.P.Staff Time 5.00 560.00 560.00 Jennifer Hoskins 09/24/2015 R.N.Staff Time 4.50 279.00 279.00 Alareesa Martin 09/24/2015 M.A. Staff Time 4.50 126.00 126.00 Kimberly Pride 09/24/2015 N.P. Staff Time 4.00 448.00 448.00 Debra Mallory 09/25/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa A4artin 09/25/2015 M.A. Staff Time 5.50 154.00 154.00 Kimberly Pride 09/25/2015 MD Staff Time 5.00 875.00 875.00 Pamela Pilcher 09/28/2015 R.N. Staff Time 5.50 341.00 341.00 Mareesa Martin 09/28/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 09/28/2015 MD Staff Time 5.00 875.00 875.00 Dr. Fagan 09/29/2015 R.N. Staff Time 6.50 403.00 403.00 Mareesa Martin 09/29/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 09/29/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 09/30/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 09/30/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 09/30/2015 MD Staff Time 5.00 875.00 875.00 Dr. Fagan Invoice# 744602 (continued)page 4 Service Date Descril2tio Quantit Charae Receipt Adjust Balance CITYCARO Invoice# 744602 Balance Due: 28495.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE - PLEASE INCLUDE INVOICE#ON CHECK Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice September 30, 2015 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Onsite/Fees/Sept. 2015 1 Civic Square Carmel, IN 46032- Invoice# 744601 Service Date Description Quantity Charge Receiot Adjust Balance 09/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease 09/01/2015 City of Cannel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 744601 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE -PLEASE INCLUDE INVOICE#ON CHECK Submitted T® OCT 0 5 2015 Clerk Treasurer Indiana University Health Workplace Services, LLC 950 North Meridian Street 0) Suite 950 (City of Carmel) �J Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice September 30, 2015 Bill to: Barbara Lamb For: City of Carmel - Onsite City of Carmel -Onsite Supply Billing/Sept. 2015 1 Civic Square Carmel, IN 46032- Invoice# 744918 Service Date Descriptio Quanti Charge Receipt Adjust Balance 09/01/2015 Onsite Operating Supplies 1.00 570.20 570.20 Sept. 2015 Billing CITYCARO Invoice# 744918 Balance Due: 570.20 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK Submitted To OCT 0 5 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 September 30, 2015 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel - Onsite Misc.Onsite/Sept. 2015 1 Civic Square Carmel, IN 46032- Invoice# 744917 Service Date Description Quanti Charge Receipt Adjust Balance 08/01/2015 Onsite Lab Charges 1.00 2,545.51 2545.51 August 2015 Labs 08/16/2015 Young at Heart Mail-Ins 1.00 186.99 186.99 08/16/2015 Young at Heart Clinic Meds 1.00 1,694.60 1694.60 08/23/2015 Young at Heart Mail-Ins 1.00 2,319.88 2319.88 08/31/2015 Young at Heart Mail-Ins 1.00 3,575.25 3575.25 09/06/2015 Young at Heart Mail-Ins 1.00 2,035.55 2035.55 09/06/2015 Young at Heart Clinic Meds 1.00 93.40 93.40 CITYCARO Invoice# 744917 Balance Due: 12451.18 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE - PLEASE INCLUDE INVOICE#ON CHECK Submitted To OCT 0 5 2015 Clerk `l•reasurer ------------------- ---------------------- 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)) 09130115- 7-44602 n-site -Staff Tome/Sept 2015 28,495.00 09/30/1 r 74'4'(301- Onsite Fees/Sept 2015 44,374.16 Onsite Supply Billing!Sept 2016 570.20 09/30/15 744917 G-Nnsite Mise/Sept 2016 (pd9121/15) 12,451.18 Total ' 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 NQ,,,,,,—WARRANT NO. ALLOWED 20 I11 Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy hicagn11 60686-0020 $45,39.54 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 $28,495.00 for which charge is made were ordered and 744694 $417416 received except 20 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 \2u\ 317-963-1535 Tax ID# 20-0994452 Invoice September 30, 2015 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Onsite/Drug Screens/Sept. 1 Civic Square Carmel, IN 46032- Invoice# 744470 Service Date Descrivtio Quanti Charae Recei t Adjust Balance 09/30/2015 Regulated Drug Screen 15.00 Submitted To OCT 05 2015 Clerk Treasurer Invoice# 744470(continued)page 2 Service Date Descriptio Quantit Charge Receipt Adjust Balance 09/29/2015 Quick Read UDS/6panel 15.00 09/30/2015 Regulated Drug Screen 22.00 Invoice# 744470(continued)page 3 Service Date Descriptio Quantit Charge Receipt Adiust Balance 09/30/2015 Regulated Drug Screen 1.00 22.00 22.00 393.00 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 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)) 09/30/15 744470 onsite drug screens $393.00 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 $393.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 I 744470 I 43-588.00 I $393.00 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, October 05, 2015 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) �1 5 Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice September 30, 2015 Bill to: Barbara Lamb For: City of Carmel - Onsite City of Cannel -Onsite EAP Services/Sept. 2015 1 Civic Square Cannel, IN 46032- Invoice# 744772 Service Date Descriotio Quantitv Charge Reeeiot Adjust Balance 09/01/2015 EAP Services 587.00 704.40 704.40 CITYCARO Invoice# 744772 Balance Due: 704.40 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To OCT 052015 Clerk Treasurer 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)) 09/30/15 744772 $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 744772 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 Monday October 05, 2015 Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund