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Home My WebLink About253680 01/22/16 a u�_F�q* CITY OF CARMEL, INDIANA VENDOR: 367222 ;� ® ) ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $"*`58,176.53` 9 �?Q CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 253680 ,,`TON L-0 CHICAGO IL 60686.0020 CHECK DATE: 01/22/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 746435 120.00 TESTING FEES 301 5023990 746436 4,374.16 OTHER EXPENSES 301 5023990 746437 30,164.00 OTHER EXPENSES 1205 4347500 746438 711.60 GENERAL INSURANCE 301 5023990 746802 21,206.04 OTHER EXPENSES 301 5023990 746845 1,600.73 OTHER EXPENSES L� 75 Indiana University Health Workplace Services, LLCM S 950 North Meridian Street Suite.950 (City of Carr iel) Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 Invoice December 31, 2015 Bill to: Barbara Lamb. For: City of Carmel Onsite-. City of Cannel Onsite EAP Services/Dec.2015 . 1 Civic Square Cannel,IN 4603.2- Invoice# 746438 Service Date Descriptio Quanti Charge Receip Adjust Balance . 12/01/2015 EAP Services 593.00 711.60 711.60 CITYCARO Invoice# 746438 Balance.Due: 711.60 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE.-PLEASE INCLUDE INVOICE#ON CHECK Submitted To To JAN .1 9 2016- 1 Clerk �rreas' rer 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 Date Invoice# Description Amount Dept. f=und# (or note attached jnvoice(s)or bill(s)) 12/31/15 746438 EAP,Services Dec 2015 $711.60 1205 101 1:hereby.certify that the attached invoice(s), or bill(s), is(are)true and correct and I.have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. IU HEALTH WORKPLACE SERVICES LLC ALLOWED 20 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL.60686-0020 $711.60 ON ACCOUNT OF APPROPRIATION FOR General Administration PO#/Dept. _ INVOICE NO. ACCT#/Fund AMOUNT Board Members 746438 43-475.00 $711.601 1205 101 Prior Year I hereby certify that the attached invoice(s), or I I ( _ 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 Tuesday, January 19, 2016 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) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 2015 Bill to: Barbara Lamb For:" City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/Dec. 2015 1 Civic Square Carmel,IN 46032 Invoice# 746802 Service Date Description Q6antijy Charge Recei t Ad" Balance 11/15/2015 Young at Heart Mail-Ins 1.00 2,889.08 2889.08 11/22/2015 Young at Heart Mail-Ins 1.00 1,209.00 1209.00 11/30/2015, Young at Heart Mail-Ins 1.00:. 3,699.34 . 3699.34 11/30/2015 Onsite Lab Charges 1.00 2,553:13 2553.13 November,2015 Labs 12/01/2015 Young at Heart Mail-Ins 1.00 3,362.71 3362.71" 12/01/2015 Young at Heart Clinic Meds 1.00 3,467.08 3407.08 12/06/2015 CITYCARO Invoice# 746802 Balance"Due: 21206.04 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK ubin'tf-d To JAN 1 9 2016 Clerk shearer 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 December 31, 2015. Bill to: BarbaraLamb . For: :City of Carmel Onsite City of Carmel Onsite Supply.Billing/Dec.2015 1 Civic Square Carmel,IN 46032- Invoice#. 746845 Service Date . Description uanti Charge Receipt Ad"us Balance 12/01./2015 Onsite Operating Supplies 1.00. 1,600.73 1600.73 December.2015 Supplies CITYCARO Invoice# 746845 Balance Due: 1600.73 MAKE PAYMENT.TO THE BELOW ADDRESS WITHIN 30:DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK JAN. 1 9 2016 Clerk Treasurer Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 950 Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 201:5 .Bill to: Barbara Lamb For: City of Carmel Onsite City of Carmel-Onsite Onsite Fee's/Dec: 2015 1 Civic Square Carmel,IN 46032- �� Invoice# 746436 . Service Date Description QuantitV Charge Recei Ad'us Balance 12/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00. Lease 12/01/2015 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 746436 Balance Due: 4374.16 . MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK "Submited To AN 19 2016 Clerk Treasurer Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 ------- 317-963-1535 Submitted To Tax I D# 20-0994452 JAN 19 2016 Invoice Clerk 'Treasurer December 31, 2015 --. Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Dec.2015 1 Civic Square Carmel,IN 46032- Invoice# 746437 Service Date DescriptionQuant! Charge Recei Ad"Us Balance 12/01/2015 R.N. Staff Time 6.75 418.50 418.50 Mareesa Martin 12/01/2015 M.A.Staff Time 7.25 203.00 203.00 Kimberly Pride 12/01/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 12/02/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 12/02/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 12/02/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/03/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 12/03/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 12/03/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 12/04/2015 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 12/04/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 12/04/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan - 12/07/2015 R.N.Staff Time 7.00 434.00 434.00 Mareesa Martin 12/07/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 12/07/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/08/2015 R.N.Staff Time 7.00 434.00 434.00 Mareesa Martin Invoice# 746437(continued)page 2 Service Date Descriptio Quanti Charge Receipt Aldus Balance 12/08/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 12/08/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 12/09/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 12/09/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 12/09/2015 MD Staff Time 5.00 875.00 875.00 Dr Fagan 12/10/2015 R.N.Staff Time 5.25 325.50 325.50 Mareesa Martin 12/10/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 12/10/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 12/11/2015 R.N.Staff Time 6.50 403.00 403.00 Mareesa Marti: 12/11/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 12/11/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/14/2015 R.N.Staff Time 5.75 356.50 356.50 Mareesa Martin 12/14/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 12/14/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/15/2015 R.N.Staff Time 8.00 496.00 496.00 Mareesa Martin 12/15/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 12/15/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 12/16/2015 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 12/16/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 12/16/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/17/2015 R.N. Staff Time 4.50 279.00 279.00 Mareesa Martin 12/17/2015 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 12/17/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 12/18/2015 R.N.Staff Time 5.75 356.50 356.50 Mareesa Martin Invoice# 746437(continued)page 3 Service Date Description Quanti Charge Receipt A&U-st Balance 12/18/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 12/18/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/21/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/21/2015 R.N.Staff Time 6.00 372.00 372.00 Mareesa Marti: 12/21/2015 M.A.Staff Time 5.50 154.00 : 154.00 Kimberly Pride 12/22/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 12/22/2015 R.N.Staff Time 7.50 465.00 465.00 Mareesa Martin 12/22/2015 M.A.Staff Time 7.00 196.00. 196.00 Kimberly Pride 12/23/2015 MD Staff Time 5.00 875'.00 875.00 Dr.Fagan 12/23/2015 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 12/23/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 12/28/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/28/2015 R.N.Staff Time 7.00 434.00 434.00 Mareesa Martin 12/28/2015 M.A.Staff Time 7.00 196.00, 196.00 Kimberly Pride 12/29/2015 MD Staff Time 6.00 1,050:00' 1050.00 Dr.Fagan 12/29/2015 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 12/29/2015 M.A.Staff Time 6.50 182.00. 182.00 Kimberly Pride 12/30/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 12/30/2015 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 12/30/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 12/31/2015 MD Staff Time 4.00 700.00 700.00 Dr.Darroca 12/31/2015 R.N. Staff Time 4.00 248.00 : 248.00 Mareesa Martin 12/31/2015 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride Invoice# 746437(continued)page 4 Service Date Descriptio Quantily Charge Receip AdLusj Balance CITYCARO Invoice# 746437 Balance Due: 30164.00 . MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK 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 Date Invoice# Description Amount Dept. Fund# (or note attached-invoice(s)or bill(s)) 12/31/15 .746802 Misc Dec $21,206.04 301 301 12/31/15 746845 Supply Billing Dec $1,600.73 301 301 12/31/15 746436 Fees Dec $4,374.16 301 301 12/31/15 746437 Staff Dec $30,164.00 301 301 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020- $57,344.93 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Fund PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 746802 110-100.00 $21,206.04 1 hereby certify that the attached invoice(s), or 301 301 Prior Year 746845 110-100.00 $1,600.73 bill(s) is (are)true and.correct and that the 301 301 Prior Year 746436 110-100.00 $4,374.16 materials or services itemized thereon for 301 301 Prior Year which charge is made were ordered and 746437 110-100.00 $30,164.00 301 301 Prior Year received except Tuesday, January 19, 2016 Cost distribution ledger.classification if claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC �r 950 North Meridian Street Suite.950 (City of Carmel) 12D Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite/Drug Screens/Dec. 1 Civic Square Carmel,IN 46032- Invoice# 746435 Service Date Descriptio Quanti Charge. Recei Ad"us Balance 12%28/2015 Quick Read UDS/6panelincludes 15.00 kit Fmitted To JN 1.9 2016 Clerk Treasurer Invoice# 746435 (continued)page 2 Service Date Description Quanti Charae Recei Ad'us Balance . 15.00 CITYCARO Invoice# 746435 Balance Due: 120.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE.-PLEASE INCLUDE INVOICE#ON CHECK 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 12/31/15 I 746435 I Drug Screens Ded I $120.00 1201 101 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. IU HEALTH WORKPLACE SERVICES LLC ALLOWED 20 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $120.00 ON ACCOUNT OF APPROPRIATION FOR Human Resources PO#/Dept. . INVOICE NO. ACCT#/Fund AMOUNT Board Members I 746435 I 43-588.00 I $120.00 1 hereby certify that the attached invoice(s), or 1201 101 Prior Year 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 Tuesday, January 19, 2016 .Cost distribution ledger classification if claim paid motor vehicle highway fund