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Home My WebLink About259791 06/16/16 y w.5�xb CITY OF CARMEL, INDIANA VENDOR: 367222 °1 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $....60,018.67• s• ;q; CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 259791 9M,•_._._.- CHICAGO IL 60686.0020 CHECK DATE: 06/16/16 ��ON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 749556 4,374.16 OTHER EXPENSES 1201 4358800 749560 435.00 TESTING FEES 301 5023990 749561 90.00 OTHER EXPENSES 1205 4347500 749815 732.00 GENERAL INSURANCE 301 5023990 749816 38,317.78 OTHER EXPENSES 301 5023990 750048 15,823.73 OTHER EXPENSES :301 5023990 750095 246.00 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) IU HEALTH WORKPLACE SERVICES LLC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 2046 RELIABLE PKWY IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service CHICAGO, IL 60686-0020 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $435.00 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Human Resources Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 749560 43-588.00 $435.00 1 hereby certify that the attached invoice(s),or 6/13/16 749560 $435.00 1201 101 1201 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Tuesday,June 14,2016 I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Indiana University Health Workplace Services, LLC S 950 North Meridian Street Z�l Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice May 31, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Occupational/May 2016 1 Civic Square Carmel,IN 46032- Invoice# 749560 Service Date Description Quanti Charge Recei Adjust Balance 05/20/2016 Quick Read UDS/6panel 15.00 05/12/2016 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit Submitted To JUN 1-3 .2016 Clerk Treasurer Invoice# 749560(continued)page 2 Service Date DescrOtion 15.00 kit Invoice# 749560(continued)page 3 Service Date Description Quanti Charge Receipt Adiust Balance 15.00 kit Iinvoice# :749560(continued)page 4 Service Date: . Description uanti Cha�ae. : :Receipt Adiusf ',' Balance ;Rosemary.Waters XXX-XX-2604 Balance I)ue:: . 15.00 05/09/2016: Quick ReadUDS/6panel includes 1.00: 15,00: 15.00. .. INVOICE#.ON CHECK . Cut and return with payment .................................................. ... .. _ Please .remit 435:00 and Make Check Payable ao: QVISAINVOICE# 749560 ' W Health Workplace Services,LLC. Q MASTERCARD � 2046 Reliable P kw3' Chicago,EL, 6068670020_ ACCOUNT.NO CSV. '. . EXP. . Phone: 317-963-1535C66E DATE . . SIGNATURE _ - . . _ _ . . _ _ . . AmouNT.PAID - VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts _ City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service CHICAGO, IL 60686-0020 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $58,851.67 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# 301 Medical Fund Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 749816 50-239.90 $38,317.78 1 hereby certify that the attached invoice(s),or 6/13/16 750095 $246.00 301 301 301 301 749556 50-239.90 $4,374.16 bill(s)is(are)true and correct and that the 6/13/16 749816 $38,317.78 301 301 materials or services itemized thereon for 301 301 750048 50-239.90 $15,823.73 6/13/16 749556 $4,374.16 301 301 which charge is made were ordered and 301 301 749561 50-239.90 $90.00 received except 6/13/16 750048 $15,823.73 301 301 301 301 750095 50-239.90 $246.00 6/13/16 749561 $90.00 301 1 1 301 301 301 Tuesday,June 14,2016 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- Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Indiana University Health Workplace Services, LLC �1 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice May 31, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/May 2016 1 Civic Square Carmel,IN 46032- Invoice# 749816 Service Date Description Quanti Charge Receipt Adjust Balance 05/02/2016 M.A.Staff Time 6.25 175.00 175.00 Kimberly Pride 05/02/2016 R.N.Staff Time 7.00 434.00 434.00 Mareesa Marlin 05/02/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 05/02/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 05/02/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/03/2016 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 05/03/2016 R.N.Staff Time 7.25 449.50 449.50 Mareesa Martin 05/03/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 05/04/2016 M.A.Staff Time 6.50 182.00 182.00 Tammy Nelson-Provence 05/04/2016 M.A.Staff Time 11.00 308.00 308.00 Kimberly Pride 05/04/2016 N.P.Staff Time 4.50 507.06 507.06 Tina Nitsos 05/04/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/05/2016 M.A.Staff Time 4.00 112.00 112.00 Stephanie Williams 05/05/2016 M.A.Staff Time 8.00 224.00 224.00 Kimberly Pride 05/05/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 05/05/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan Invoice# 749816(continued)page 2 Service Date Description Quanti Charge Recent Adjust Balance 05/06/2016 M.A.Staff Time 7.50 210.00 210.00 Kimberly Pride 05/06/2016 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 05/06/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 05/06/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/09/2016 M.A.Staff Time 9.00 252.00 252.00 Kimberly Pride 05/09/2016 R.N.Staff Time 9.50 589.00 589.00 Mareesa Martin 05/09/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 05/09/2016 Health Coach Staff Time 3.50 224.00 224.00 Marissa Grant 05/09/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/10/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 05/10/2016 R.N.Staff Time 7.25 449.50 449.50 Mareesa Martin 05/10/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 05/11/2016 M.A.Staff Time 10.00 280.00 280.00 Kimberly Pride 05/11/2016 R.N.Staff Time 9.25 573.50 573.50 Mareesa Martin 05/11/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 05/11/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/12/2016 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 05/12/2016 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 05/12/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 05/12/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 05/13/2016 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 05/13/2016 R.N.Staff Time 6.25 387.50 387.50 Mareesa Martin 05/13/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/16/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan Invoice# 749816(continued)page 3 Service Date Description Quanti Charoe Receipt Adjust Balance 05/16/2016 R.N.Staff Time 9.25 573.50 573.50 Mareesa Martin 05/16/2016 M.A.Staff Time 9.50 266.00 266.00 Kimberly Pride 05/16/2016 N.P.Staff Time 4.50 507.06 507.06 Tina Nitsos 05/16/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 05/17/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 05/17/2016 R.N.Staff Time 7.00 434.00 434.00 Mareesa Martin 05/17/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 05/18/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/18/2016 R.N.Staff Time 9.25 573.50 573.50 Mareesa Martin 05/18/2016 M.A.Staff Time 9.50 266.00 266.00 Kimberly Pride 05/18/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 05/19/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 05/19/2016 R.N.Staff Time 4.50 279.00 279.00 Mareesa Martin 05/19/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 05/19/2016 Health Coach Staff Time 6.00 384.00 384.00 Marissa Grant 05/20/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/20/2016 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 05/20/2016 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 05/20/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 05/23/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 05/23/2016 R.N.Staff Time 9.25 573.50 573.50 Mareesa Martin 05/23/2016 M.A.Staff Time 9.50 266.00 266.00 Kimberly Pride 05/23/2016 N.P.Staff Time 4.50 507.06 507.06 Tina Nitsos 05/23/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant Invoice# :7498.16,(continued)page 4 Service Date' : Description Quanti Cha�ae. Receipt Adjusf : :Balance 05/24/20,16' MD Staff Time. . . 6.00 1,050.00 . : 1050.00.'.' Dr:Fagan 05/24/2016 R.N..$taffTime 6.:7:g:' ', : 41,8.50. 41.8.50; Mareesa Martin: :05/24/2016 M.A.,$taffTime 6.50 : : • 182:00 I82.00, . Kiinbei-ly Pride 05/25/20.16 : :MD Staff-Time. .: : . . 5.00 875.00 875.00. 05/25/2016 R.N..Staff Time 9.25 . . 573,50 573 50: Mareesa Mdrtin: : :05/25/20.16 M.A.•StaffTime 9.50: : : 266:00 266.00.' Kiinbeily Pride 05/25/20.16 : N.P.-Staff Time. . : . . 4.00 450.72 450.72. Tina Nifsos 05/26/2016 MD Stiff Time ' . 4.00 : 700,00 : . 700.00: . Dr.Fagan :05/26/2016 R.N.Staff Time. 4.50: : : 279:00 279.00. . Mareesa Martin 05/26/2016 : : M.A.Staff Time : : . . : 5:50 154.00 154.00. . : : Kimberly Prde . 05/26/2016 Health Coach Staff Time: . 5.50 352,00 352.00: . Marissa Grant' ' :05/27/2016 MD Staff Time 5.W : : 875:00 .' . : : : 875.00. . Dr.Fagan . . 05/27/2016 . R.N:"Staff Time. 6.00 372.00 372.00. Mareesd Ma�7in. . : . .05/27/2016 M.A.:Staff Time 7-00-. 196.00 : : 196.00: : Kimberly Pride 05127/2016 I lealth.Coach:Staff Time : 3.50: 224:00 224.00 Marissa Grdrit 05/31/20.16MD Staff Time: : : 6.00 1,050.00 1050.00. '.Dr:Fagai: 05/31/2016 R.N.Staff Time 6.75 41.8.50 41.8.50: Mareesa Martin . 05/31/20.16 M.A.,StaffTime 6.50: : : 182.00 1'82.00. ; Kimberly Pride CIT ;CARO Invoice#,749816 Balance Due: 38317.78. . MAKE.PAYMENT TO.THE BELOW ADDRESS WITHIN 30 DAYS Of INVOICE DATE:=PLEASE INCLUDE INVOICE.#ON CHECK. Cut and returnµvith payment Please.remit38,317.78 anti Make Check Payable to: ED] VISA INVOICE#'749816 W Health Workplace Services;LLC MASTERCARD 204'6 Reliable Pkwy Chicago,IL 6068670020 . . ACCOUNT NOiv"- . . : CSV. EXP . . . . . . . ' . . -w%3-1535 coDE DATE Phone: 317 SIGNATURE . . - AMOUNT PAID. Indiana UniversityHealth Workplace Services,LLQ 950 North Meridian Street.. Suite 950. (City of Carmel): Indianapolis,.IN 46204. - � 317 963=1535 � .. Tax ID# 2070994452 Invoice . May 31;2016:' . . Bill.to:: " .Barbara Lamb :" For:'. .City.of Carmel .Onsite " City of Carmel_-,Onsite` Wellness/May'2016 1 Civic Square"." Carmel,IN"46032- . _ ' . Invoice#: 749561 Service Date Description, uanti Charge Receipt Adjust' Balance 04/26/2016 Quick Read UDS/6panel 15.00 Submitted To JUN 13 2016 Clerk TneasUrer Invoice## 749561 (continued)page 2 Service Date: Description Quariti Chao . Recei Adiusf '.' : .Balance• , CITYCARO Invoice# 749561 Balance Due: .90.00 MAKETAYMENT TO THE-BELOW ADDRESS WITHIN:30 DAYS OF INVOICE DATE:-: PLEASE INCLUDE INV(QICE#ON CHECK ', . .. Cut'md return with payment . ri Please remit 90:00,and Make Check Payable to: 0 VISA INVOICE# 749561 IU,Health Workplace Services;LLC 0 MASTERCARD 2046 Reliable Pkwy: Chicago,IL 60686-0020 . ACCOUNT"NO" . . . . . CSV.- '. . EXP . . . . . conE DATE Phone: 317=963-1535 . :SIGNATURE' " . . _ - AMOUNT PAID Indiana:University Health Workplace Services,LLC - 950 North Meridian Street. . Suite:950 Ind'ianapolis,;IN46204 . 317=963=1535. .: : Talo ID# 20.0994452'. . Invoice May'311 2016 Bill.'to:: Barliara Iamb' For:'. .City.of Carmel .Onsite City of Carmel-Onsite Onsite Fee's/1VIay 2016 1-Civic Square .' . Carmel,IN 46032- Invoice#: :749556' Service Date DescriptionQuant!' Charge Receipt Adiust' Balance. 05/01/2016: : City.of Carmel Sports Performance : 1.00: 1.80000 1800.00. L ease • : . . • • . . 05/01/2016: . . City.ofCarmel:Clinic:Build'Out 1.00 2,574:16 2574.16 CITYCARO Invoice'#.749556 Balance Due: 4374.16. ' MAKE PAYMENT TO THE BELOW ADDRESS.WITHIN 30 DAYS OF INVOICE DATE PLEASE INCLUDE ' -INVOICE VON-CHECK SU �1 iod To AN. � x. :2016 : Clerk Sasurer Cut'and return With payment . ...................... ............................................... Please.remit.4,374.16 and Make CheekPayable;to: Q VISA INVOICE# 749556 IU Health Workplace Services;LLC 0 MASTERCARD . . 2046 Reliable Pkwy. Chicago,II,'6068670020. ' 'ACCOUNT.NO' . . - CSV . . •' .. _ _ CODE DATE 'Phone: 317:963 1535 SIGNATURE . . . . . � � � AMOUNTPAID. Indiana:University Health Workplace Services,LLC 950 North Meridian:Street. . Suite 950' (Citybf Carm6l) . Indiianapolis,.IN46204: . - - 317 963:1535. Taz ID# 20- .0994452 • • . Invoice w . May 31;2016.: Bill.to:. Barbara Lamb For: City-of Carmel .Onsite City of Carmel.-Onsite Supply Billing/May 2016. 1 Civic Square. Carni 1,IN 46032- . Invoice# 750095' ' Service Date Description. Quanti Charge :Recei t . A_tust ' 'Balance .05/01/2016: : Onsite Operating Supplies 1.00:' ' : 246:00 246.00• . May 2016 Supplies CITYCARO Invoice'#. 750095 Balance Due: .246.00. MAKE PAYMENT TO THE BELOW ADDRESS.WITHIN-30 DAYS OF INVOICE DATE-PLEASE'INCLUDE' INVOICE#ON CHECK : . • . . JUN .1'.3: 2016 . rk Tnsr asurer p (tit and return with payment . . Please remit 246.00 and-Make Check Payable;to: Q VISAINVOICE# 750095 RJ Health Workplace Services;LLC 0 MASTERCARD 204'6 Reliable Pkwy: • ' Chicago,IL 6068670020 ' ACCOUNT•NO CSV EXP C66EHATE Phone: 317=963=1535 .SIGNATURE . . AMOUNT PAID.' . . : . : : .$ . . - • Indiana University Health Workplace Services,LLC '950 North Meridian:Street. ' Suite 950. (City of Carmel) .Ind'ianapolis,:IN'46204: . ' 317=963=1535. .: Tak ID#'20,-0994452 Invoice :'May 31;2016: Bill.'to:: Barbara,Lamb For:', City-of Carmel .Onsite City of Carmel-Onsite Misc.Onsite/Wy 2016 1,Civic Square',' Carmel,IN 46032 'Invoice#: :750048• . Service Date DescriptionQuant! Charge Recei dust' Balance 03/08/2016: Young'at Heart Mail-Ins• " 1.00: 3;876:32 3876.32• 04/101/2:016: 1Onsite Lab Charges 1.00: 1986:49: 1986.49 • April 2016 Lai5s 04/17/2016: : Young-at Heart Mail-Ins 1.00:'• :2184.25 04/20/2016 : Young'at'Heait Clinic Meds: : 1.00 82:72: 82.72 ' 04/26/2016: . 'Young'at.Heart Clinic Meds 1.00' 1,308:82 :1308.82 04/30/2016:. 'Young at Heart 1VIai1-Ins 1.00. 4,33001 : :4330.01 05/04/2016 Young at Heart Clinic Meds: : 1.00: 622:36:' 622.36 : :05/16/.2016 , " Young aYHeart Clinic Meds ' . 1.00' '1,432:76 1432.76 CITYCARO lnvoice'#.750048 Balance Due:: : : : 15823.73 MAKE PAYMENT TO THE•BELOW ADDRESS.WITHIN 30 DAYS OF INVOICE DATE-:PLEASE INCLUDE; INVOICE#.ON CHECK . u b,' ' 0: JUN 13'2 016 . Clerk, "� usurer: �p ....d return ...........nt............ . : - ......-. .. ...... ...... . : Please remit:15,823:73,and Make Check Payable;to: Q VISA INVOICE# 750048 IU Health Workplace Services;L C 0 MASTERCARD 2046 Reliable Pkwy Chicago,II. '6.0686-0020. ACCOUNT NO CSV. _ EXP' covE HATE" Phone:_317=963-1.535 SIGNATURE' . • ', . . . . . . AMOUNTPAID. . . VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) IU HEALTH WORKPLACE SERVICES LLC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 2046 RELIABLE PKWY IN SUM OF$ CITY OF CARMEL 4 invoice or bill to be properly itemized must show:kind of service,where performed,dates service CHICAGO, IL 60686-0020 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $732.00 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# General Administration Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 749815 43-475.00 $732.00 1 hereby certify that the attached invoice(s),or 6/13/16 749815 $732.00 1205 101 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 Tuesday,June 14,2016 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer 'Indiana,University Health Workplace Services,LLC l 950 North Meridian Street. S Suite 950' (City-of Carmel) Indianapolis,'IN"46204.. 317-063-1535. Taz ID# 20.0994452 . . Invoice . May 31;2016: Bill,to:: Barbara-Lamb- City arbara Iamb For: . .City."of Carmel-.Onsite City of Carmel Onsite . : EAP Services/May:2016; 1 Civic Square' • Carmel,IN.46032- Inyoice#. '749815 , Service Date' Description • Quantity,. Charge Receipt Adiust' Balance 05/01/2016: : EAP Services : : 610.00' : :732:00. . 732.00 CITYCARO Invoice#. 749815 Balance Due: 732.00 MAKE PAYMENT TO-THE-BELOW ADDRESS WITHIN-30 DAYS OF INVOICE DATE: PLEASE INCLUDE INVOICE#ON.CHECK. . • JUN 13 2016 Cut and return with payment ................................... _ - Please remit 732:00,and Make Check Payable:to: VISA IU Health Workplace Services;LLC" ❑Ism INVOICE# 749815 " 2046 Reliable Pkwy: MASTERCARD • Chicago,IL 6068670020',". . . -ACCOUNTNO . . . . - CSV EXP . . - . CODE DATE Phone: 317=963-1535 SIGNATURE AMOUNTPAID.'. . : ..