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Home My WebLink About258439 05/10/16 �'• CITY OF CARMEL, INDIANA VENDOR: 367222 j ® ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $....63,897.31" 9,� ,=a CARMEL, INDIANA 46032 CHICAGO 4LRELIABLE PKWY W0020 CHECK NUMBER: 258439 „oNCHECK DATE: 05/10/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 748950 4,374.16 OTHER EXPENSES 1110 4340701 748951 150.00 MEDICAL EXAM FEES 301 5023990 748951 18,877.19 OTHER EXPENSES 301. 5023990 748959 37,866.32 OTHER EXPENSES 1205 4347500 749160 723.60 GENERAL INSURANCE 1201 4358800 749201 962.00 TESTING FEES 301 5023990 749263 75.00 OTHER EXPENSES 301 5023990 749439 869.04 OTHER EXPENSES VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $962.00 ON ACCOUNT OF APPROPRIATION FOR Human Resources PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Member: 749201 I 43-588.00 I $962.00 1 hereby certify that the attached invoice(s), or 1201 101 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, May 04, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 04/30/16 749201 April Onsite $962.00 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 20Clerk-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 April 30, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Occupational/April 2016 1 Civic Square Carmel,IN 46032- Invoice# 749201 Service Date Description Quanti Charge Receipt Adjust Balance 04/15/2016 Quick Read UDS/6panel 15.00 Submitted To MAY 0 3 2016 Clerk Treasurer Invoice# 749201 (continued)page 2 Service Date Description Quanti Charge Recei Adjust Balance 04/13/2016 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 22.00 Invoice# 749201 (continued)page 3 Service Date Description 15.00 kit Invoice# 749201 (continued)page 4 Service Date Description Quanti Charge Receipt Adjust Balance 15.00 Invoice# 749201 (continued)page 5 Service Date Description Quanti Charae Receipt Adjust Balance 04/27/2016 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 15.00 Invoice# 749201 (continued)page 6 Service Date Description Quanti Charge Receipt Adjust Balance 04/19/2016 Quick Read UDS/6panel includes 22.00 Invoice# :749201 (colitinued)page 7 Service Date Description Quanti Charge. : :Receipt ' Adiust ," Balance " 22:00 'CITYCARO In # 749201 Balance Due:: :" 962.00 MAKE PAYMENT TO THE BELOWADDRESS-WITHIN 30 DAYS OF INVOICE DATE.-;PLEASETNCI UDE . INVOICE WON CHECK ' but and return with payment -- ------------•--•-............................. ------ - - - Please remit 962.00 and Make Cheek Payable to: 0 VISA INVOICE# 749201 IU Health Workplace Seivices,LLC 0 MASITACARD 2046 Reliable Pkwy • Chicago,II,""60686-0U20 ACCOUNT.TIO Exp . . O CODE. ; Wars Phone- 317=963=1535 SIGNATURE. . . O T•PAIDU - - . VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $150.00 ON ACCOU OF APPROPRIATION ROO(PRRIATION FOR PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 11ID j 748951 D_v $150.00 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, May 04, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) —04/30/16 748951 I April Misc Onsite Police Dept I $150.00 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer Indiana University Health Work place SeNices,LLC . " 950 North Meridian:Street Suite 950. (City'of Carmel). . Ind'ianapolis,:IN 46204, 317-9637-1635. 1535. Tax ID#'207-0994452- . Invoice. . . . 130' 20J6: Apri . . Bill,to:. Barbara Lamb : For: City.of Cannel On§ite Ci Misc.Onsite/Apri12016 ty of Carmel-.Onsite 1 Civic Square Carmel,IN 46032- Invoice# 748951 Service Date Description uanti' Charge Receipt Adjust Balance 03/10/2016' Young at Heart'Clinic Meds: :' 1.00: 433:60 : : " .433.60 03/13/2016 1.00: 2',400:61 2400.61 03/28/2016 Yoiing,af Heart Clinic Meds 1.00 981:80: • :.981:80 03/29/2016: : Young'at;Heart Clinic Meds 1.00. 1'0422 104.22 03/31/2016" - Onsite Lab Charges 1.00: 3',782:78 3782.78• " March-2016 Ldbs. 04/01/2016 Young"at;Heart 1VIai1-Ins 1.00 2,534:76 2534.76 :04/13/2016" . Young-it Heart Clinic Meds: . 1.00: 1,24036 1240.36 CITYCARO : Invoice#. 748951 Balance Due: 19027:19 MAKE PAYMENT TO THE BELOW ADDRESS.WITHIN 30 DAYS OF INVOICE DATE PLEASE INCLUDE . . INVOICE#ON CHECK Submitted TO' '. , 1 � �M. Y1 MAY. 0:3 2016. :'.l,�l Mark ¢ as. urer VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $18,877.19 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Fund PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 748951 I 50-239.90 I $18.877.19 1 hereby certify that the attached invoice(s), or 301 301 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, May 04, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 04/30/16 748951 April Misc Onsite $18,877.19 301 301 pug JD 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 April 30, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/April 2016 1 Civic Square Carmel,IN 46032- Invoice# 748951 Service Date Description Quanti Ch- arae Receip Aaumt Balance 03/10/2016 Young at Heart Clinic Meds 1.00 433.60 433.60 03/13/2016 Young at Heart Mail-Ins 1.00 5,489.12 5489.12 03/16/2016 Stress Test 1.00 250.00 250.00 Patient::Adam Miller 03/20/2016 Young at Heart Mail-Ins 1.00 93.96 93.96 03/21/2016 Young at Heart Clinic Meds 1.00 1,715.98 1715.98 03/27/2016 Young at Heart Mail-Ins 1.00 2,400.61 2400.61 03/28/2016 Young at Heart Clinic Meds 1.00 981.80 981.80 03/29/2016 Young at Heart Clinic Meds 1.00 104.22 104.22 03/31/2016 Onsite Lab Charges 1.00 3,782.78 3782.78 March 2016 Labs 04/01/2016 Young at Heart Mail-Ins 1.00 2,534.76 2534.76 04/13/2016 Young at Heart Clinic Meds 1.00 1,240.36 1240.36 CITYCARO Invoice# 748951 Balance Due: 19027.19 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK o FCI'e'rk mitted To 0 3 2016 Treasurer ..Cut and return with payment ® Please remit 19,027.19 and Make Check Payable to: ❑ VISA INVOICE# 748951 IU Health Workplace Services,LLC t^--�ti�.a Elr? MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNT NO CSV EXP CODE DATE Phone: 317-963-1535 SIGNATURE _AMOUNT PAID $ VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $723.60 ON ACCOUNT OF APPROPRIATION FOR General Administration PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Member: 749160 I 43-475.00 I $723.60 1 hereby certify that the attached invoice(s), or 1205 101 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, May 04, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 04/30/16 749160 April EAP Services $723.60 1205 101 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer L125- ersity He orkplace Services,LLC . ;Indiana:Univ,' alth.1N 950 North Meridian:Street S Suite 950 (City of Carmel) Indiianapolis,:IN 46204: . 317-9637-1535, . . . .. Tax ID# 20.0994452 . . . Invoice . .April 2016: Bill.'to:: Barbara Lamb For; City.of Cannel'-Onsite City of Carmel-Onsite EAP Services/April.2016 . .. . . 1 Civic Square Cannel,IN 46032- Invoice# 749160 Service Date' •Description uanti Charge :Recei t . . d'us' Balance 04/01/2016 EAP Services 603.00:' "723:60. 723.60 CITYCARO : Invoice#. 749160 Balance Due:' 723:60 ' MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE=PLEASE INCLUDE- INVOICE#ON.CHECK . „ . Sb1ed To MAY 0 3.2016: Clerk Treasurer . Curt and return With payment _............... .................................. .. ............... .. . Please remit 723:60 and-Make Check Payable to: VISA INVOICE# 749160 IU Health Workplace Services;•LLC 2046 Reliable Pkwy MASTERCARD _ Chicago,IL 6068670020 ACCOUNTNO. . . . . CSV . . EXP. CODEDATE Phone: 317=963=1535 SIGNATURE. - AMOUNT PAID. . - . VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $43,184.52 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Fund PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 749263 50-239.90 $75.00 1 hereby certify that the attached invoice(s), or 301 301 749439 50-239.90 $869.04 bills) is(are)true and correct and that the 301 301 materials or services itemized thereon for 748959 50-239.90 $37,866.32 301 301 which charge is made were ordered and 748950 50-239.90 $4,374.16 received except 301 301 Wednesday, May 04, 2016 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 04/30/16 749263 April Onsite Wellness $75.00 301 301 04/30/16 749439 April Onsite Supply $869.04 301 301 04/30/16 748959 April Onsite Staff Time $37,866.32 301 301 04/30/16 748950 April Onsite Fees $4,374.16 301 301 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 120 Clerk-Treasurer 'I ndiana:Unive'rsiry Health.WorkPl.ace Servi ces,LLC 950 North Meridian.Street Suite 950.'(City of Carmel) Ind'ianapolis,:IN'46204 S " 317=963-1535. .. Tax 1p# 20-0994452•. . . " Invoice A . Aril 30; 2016:. . . Bill.'to:. Barbara Lamb For: "City,of Carmel'-Onsite City of Carmel-"Onsite Wellness/April 2016 " 1'Civic Square' . . . . . " . Caririel,IN 46032-' . Invoice# 749263 . Service Date" Description Quanti Charge :Recelp Adjust "Balance. 04/20/2016 : Q:ulck Read UDS/ : . 75.00" MAKE PAYMENT-TC THE BEL'O W' RIE WIT14IN 0 DAYS OF.INVOICE DATE-:PLEASE INCLUDE" INVOICE#.O CHECK Neck Tre' asure' r GMt and return With payment ........ ----- - ................................................. ----- - - , - Please remit 75:00 and Make Check Payable:to: Q VISAINVOICE# 749263 1U Health Workplace Services;,LLC " 0 MASTERCARDwy 2046 Rliable Pk e Chicago,IL 6068670020 " .. ACCOUNT.NO. . . . . "' CSV. EXP' 3l79631535PhOIecon$ HATE .. .. SIGNATURE' . AMOWT PAID. . : . Indiana:University Health-Workplace Services, LLC, -np� '950 North Meridian Street:. SUite 950.'(City'6f Carmel) . Ind'ianap 6lis,'IN46204:. 317-9637-1535 • Tax ID# "20-0994452 Invoice 4030; 2016:. Bill.'to:: Barbara Lamb For: "City.of Carmel Onsite City of Carmel-Onsite : Supply Billing/April.2016 1"Civic Square . . . . Carmel,IN•46032- . : . Invoice#: Sdrvice Date Description. Quanti "Charge Receipt d'ust', . 'Balance " . . . . . 04/01/2016 'Onsite Operating Supplies' : 1.00: -869.04 _ : . 869.04. 11 2016 Supplies; • CITYCARO Invoice#. 749439 Balance Due: " , . : : 869.04. MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE PLEASE'INCLUDE. . INVOICE.#ON"CHECK •- M12016 0 AY3.2016: " Treasurer. Cut and return with payment'. ...................................................... ................. .................. ................... -- Please ,remit 869:04 a'n'd Make Check Payable to: Q VISA• INVOICE#",749439 IU Health Workplace Services;LLC Q MASTERCARD_. 2046 Reliable Pkwy Chicago,IL 60686-0020 . . ACCOUNTNO • ' .. .. . . CSv... . EXP. . coDE:- - . DATE Phone: 317=963=1535 SIGNATURE " . AMOUNT PAID _ 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 April 30, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/April 2016 1 Civic Square Carmel,IN 46032- Invoice# 748959 Service Date Description Quanti Charge Receipt Adjust Balance 04/01/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 04/01/2016 M.A.Staff Time 8.50 238.00 238.00 Krystal Cheatham 04/01/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 04/01/2016 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 04/04/2016 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 04/04/2016 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 04/04/2016 MD Staff Time 5.00 875.00 875.00 Dr.Day 04/04/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 04/05/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Sunderman 04/05/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 04/05/2016 R.N.Staff Time 7.00 434.00 434.00 Mareesa Mai-tin 04/06/2016 MD Staff Time 5.00 875.00 875.00 Dr.Sunderman 04/06/2016 M.A.Staff Time 5.75 161.00 161.00 Kimberly Pride 04/06/2016 R.N.Staff Time 5.75 356.50 356.50 Mareesa Martin 04/07/2016 MD Staff Time 4.00 700.00 700.00 Dr.Naz 04/07/2016 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride Submitted To MAY 0 3 2016 Clerk Treasurer Invoice# 748959(continued)page 2 Service Date Description Quanti Charge Receioi Adiust Balance 04/07/2016 R.N.Staff Time 4.75 294.50 294.50 Mareesa Martin 04/07/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 04/08/2016 MD Staff Time 5.00 875.00 875.00 Dr.Naz 04/08/2016 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 04/08/2016 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 04/08/2016 Health Coach Staff Time 5.00 320.00 320.00 Marissa Grant 04/11/2016 R.N.Staff Time 10.00 620.00 620.00 Dorothy Goen 04/11/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 04/11/2016 M.A.Staff Time 11.50 322.00 322.00 Kimberly Pride 04/11/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 04/11/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 04/12/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 04/12/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 04/12/2016 R.N.Staff Time 6.75 418.50 418.50 Mareesa Martin 04/13/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 04/13/2016 M.A.Staff Time 10.50 294.00 294.00 Kimberly Pride 04/13/2016 R.N.Staff Time 9.00 558.00 558.00 Mareesa Martin 04/13/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 04/14/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan: 04/14/2016 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 04/14/2016 R.N.Staff Time 4.75 294.50 294.50 Mareesa Martin 04/14/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 04/15/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 04/15/2016 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride Invoice# 748959(continued)page 3 Service Date Description Quanti Charge Receip Adjust Balance 04/15/2016 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 04/15/2016 Health Coach Staff Time 4.00 256.00 256.00 Marissa Grant 04/18/2016 M.A.Staff Time 11.50 322.00 322.00 Kimberly Pride 04/18/2016 R.N.Staff Time 10.00 620.00 620.00 Mareesa Martin 04/18/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 04/18/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 04/18/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 04/19/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 04/19/2016 R.N.Staff Time 6.75 418.50 418.50 Mareesa Martin 04/19/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 04/20/2016 M.A.Staff Time 10.50 294.00 294.00 Kimberly Pride 04/20/2016 R.N.Staff Time 9.00 558.00 558.00 Mareesa Martin 04/20/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 04/20/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 04/21/2016 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 04/21/2016 R.N.Staff Time 4.75 294.50 294.50 Mareesa Martin 04/21/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 04/21/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 04/22/2016 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 04/22/2016 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 04/22/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 04/22/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 04/25/2016 M.A.Staff Time 11.50 322.00 322.00 Kimberly Pride 04/25/2016 R.N.Staff Time 10.00 620.00 620.00 Mareesa Martin Invoice# :748959(continued)page 4 Service Date Description uariti Chan 0. ; .Receipt Adpu f Bal6nce- 04/25/2016- Health Coach Staff Time. 3.00. .19.2.00 192.00, . Marissa Grant . . . .04/25/2016 N.P..S . .. taffTime. ,' . ' . 4.00 ,�. . 450,72. ; ; 450.72; Tina Nitsos 04.'/25/2016 .'MD Staff Time . 5.00: 875.00. 875.00 Dr.Fagan . .. 04/26/2016 . M.A.Staff Time 6.50. .1 •,' $2.00 . .'. � : 182.00.". . Kimberly Pride . 04/26/2016 RX Staff.Time. 6.75 418.50 41.8.50: Mareesa Martin 04/26/2016 MD Staff.Time 6.00. " .1,050.00. 1050.00. . Dr.Fagan 0.4'/27/2016 : M.A.Staff Time 10.50. .. ' . 294.00 . . . _ 294.00. .'. Kimberly Pride . ', .04/27/2016 R:N:Staff•Time. .' 9.00 558.00 : 558.00; . Mareesa Martin 04./27/2016 N.P. Time 4.00: 450.72. Tina Nitsos. 0.4/27/2016 : :MD Staff Tine. : 5.00. 875.00 . . 875.00. : . • . : . .Dr..Fagait : . .04/28/2016 M.A.:StaffTime .' . : . 5.50 . . . 15.4,00- : 154.00; Kimberly Pride: . 04/28/2016 .R N:Staff Time 4.75. 294.'50 . Mareesa Martin. 04/28/2016 : : Health Coach Staff Time. . 4.50. .28.8.00 288.00 A4larissa Grant 04/28/2016 MD Staff Time . : . 4.00� 700.00 ; 700.00 Dr.Fagan 04'/29/20.16 ivLA..S.taff Time 5.00. • 140.00. !40.00' Kimberly Pride 04/29/2016" . :R.N:.StaffTime. : 6.50. 403.00 403.00. . . . Mareesa Marlin . . :04/29/2016 .' Health Coach Staff Time: . 4.50 288.00 288.00; . Marissa Grant 04729%2016• '.MD Staff Time . "5.00: : : 875.00 : : 875.00." _ Dr.Fagan . . CITYCARO Invoice#.748959 Balance Due: 37866.32. . MAKE.PAYMENT TO TRE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-.PLEASE' INVOICE.#ON CHECK Cut and return with payment ••••::........•••.••••=•r••••• •••• -..... •- Please remit 37,866.32 and Make Check,Payable to: " 0 VISA INVOICE# 7.48959 IU Health Workplace Seivices;LLC Q MASTERCARD 2046 Reliable Pkwy: Chicago,IL 6068670020 - ACCOUNO' . . ' .. CSV. EXP T.N ' 1 - - S .. .. .. cone HATE Phone:. 3 7;9615 3� 3 SIGNATURE AMOUNTPAID, Indiana University.Health:Worliplace Sewices,LLC . 1 :. . . 950 North Meridian Street• ° Suite 950 . . . . , •' .Ind'ianaptilis,:IN 46204. . .: 317-963!-1535. TakIQ# 2Q 0994452 . . Invoice APi-il '30; 2016:. Bill.to:: Barbara Lamb For; City.of Carmel Onsite , . _ Osite Fee's/Ap2CityofCamel-.Onsite : . 016 1 Civic Square'. . Carmel,IN•46032 voice# -748950' ' • ; Service Date Description. uanti Charge', • Recei dust . Balance 6 City.of Carmel Sports Performance 1.00. 1;800:00 1800.00 04/01/2'01 , , Lease . 1.00 2,574:16 . . . 2574:16 . 04/01/20.16: .. 'City of Carmel:Clinic Build Out CITYCARO ' : : I nvoice#.748950 Balance Due:, 4374.16 ' MAKE PAYMENT TO THE.BELOW ADDRESS.WITHIN 30 DAYS OF INVOICE DATE:-:PLEASE INCLUDE • • INVOICE#.ON CHECK: . MAY :0-3 2016 . . . J'e'rk Treasurer- Cut and return with payment .. ................. .. ...................... ................................ .. . Please remit-4,374:16 and-Make Check Payable to: Q VISA I4VOICE#.748950 IU Health Workplace Services;L,LC 0 MASTERCARDliable'Pkwy. - -2046 Re Chicago,IL 606867-0020. ACCOUNT.NO -' - CSV. EXP ' CSY DATE Phone: 317=963=1535 SIGNATURE Ab40UNT PAID