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Home My WebLink About301710 08/08/16 +ur.C4Ay CITY OF CARMEL, INDIANA VENDOR: 3671222 a; �I ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $***"54,345.96` r, CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 301710 CHIC I IL 60686-0020 CHECK DATE: 08/08/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 750918 4,374.16 OTHER EXPENSES 1205 4347500 750930 728.40 GENERAL INSURANCE 301. 5023990 75 0958 150.00 OTHER EXPENSES 1201 4358800 750959 724.00 TESTING FEES 301 5023990 751018 37,079.39 OTHER EXPENSES 301 5023990 751293 10,410.18 OTHER EXPENSES 301 5023990 751318 879.83 OTHER EXPENSES I VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) IU HEALTH WORKPLACE SERVICES LLC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 2046 RELIABLE PKWY IN SUM OF$ . 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. $52,893.56 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 751018 50-239.90 $37,079.39 I hereby certify that the attached invoice(s),or 7/31/16 750958 Dependent Drug Screen(Wellness Drug $150.00 301 301 301 301 Screen July) 750958 50-239.90 $150.00 bill(s)is(are)true and correct and that the 7/31/16 751018 Staff Time July $37,079.39 301 1 1 301 materials or services itemized thereon for 301 301 - -- - 751318-- —50-239.90— $87.9.837/31/16 751293 Misc Onsite July $10,410.18 301 301 --------vhich charge is made were ordered and 301 301 -- 751293 50-239.90 $10,410.18 received except 7/31/16 751318 Supply Billing July $879.83 301 301 301 301 750918 50-239.90 $4,374.16 7/31/16 750918 Onsite Fees July $4,374.16 301 301 301 301 Tuesday,August 02,2016 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 i 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 I Invoice July 31, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/July 2016 1 Civic Square Carmel,IN 46032- Invoicie# 751018 Service Date DescriptionQuant! Charge Receip Ad'us Balance 06/30/2016 R.N.Staff Time -5.00 -310.00 -310.00 Mareesa Martin-Credit due to no RN Coverage on 6/30 07/01/2016 MD Staff Time 5.00 875.00 875.00 Pilcher 07/01/2016 Health Coach Staff Time 5.50 352.00 352.00 Marissa Grant 07/01/2016 R.N.Staff Time 9.00 558.00 558.00 Mareesa Martin 07/01/2016 M.A.Staff Time 7.25 203.00 203.00 Kimberly Pride 07/05/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 07/05/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 07/05/2016 R.N.Staff Time 9.25 573.50 573.50 Mareesa Martin 07/06/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/06/2016 N.P.Staff Time 4.25 478.89 478.89 Tina Nitsos 07/06/2016 M.A.Staff Time 9.00 252.00 252.00 Kimberly Pride 07/06/2016 R.N.Staff Time 11.75 728.50 728.50 Mareesa Martin 07/07/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 07/07/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 07/07/2016 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 07/07/2016 R.N.Staff Time 7.50 465.00 465.00 Mareesa Martin i F "bM'tte� 'T®AUG 02 2016 rk Troasurer i Invoice# 751018 (continued)page 2 Service Date Description I uanti Charge Receip AdMal Balance 07/08/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/08/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant I 07/08/2016 R.N.Staff Time 11.00 682.00 682.00 Mareesa Martin 07/11/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 07/11/2016 M.A.Staff Time 9.00 252.00 252.00 Kimberly Pride 07/11/2016 R.N.Staff Time 9.50 589.00 589.00 Mareesa Martin 07/11/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/11/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 07/12/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 07/12/2016 R.N.Staff Time 7.25 449.50 449.50 Mareesa Martin 07/12/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 07/13/2016 M.A.Staff Time 10.00 280.00 280.00 Kimberly Pride 07/13/2016 R.N.Staff Time 9.50 589.00 589.00 Mareesa Martin 07/13/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/13/2016 N.P.Staff Time 5.00 563.40 563.40 Tina Nitsos 07/14/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 07/14/2016 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 07/14/2016 R.N.Staff Time 4.75 294.50 294.50 Mareesa Martin 07/14/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 07/15/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 07/15/2016 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 07/15/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/18/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 07/18/2016 M.A.Staff Time 9.00 252.00 252.00 Kimberly Pride I Invoice# 751618(continued)page 3 Service Date Description Quanti Charge Recei Adj-usl Balance 07/18/2016 R.N.Staff Time 9.25 573.50 573.50 Mareesa Martin 07/18/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/18/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 07/19/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 07/19/2016 R.N.Staff Time 7.25 449.50 449.50 Mareesa Martin 07/19/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr,Fagan 07/20/2016 M.A.Staff Time 10.00 280.00 280.00 Kimberly Pride 07/20/2016 R.N.Staff Time 9.75 604.50 604.50 Mareesa Martin 07/20/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/20/2016 N.P.Staff Time I 4.00 450.72 450.72 Tina Nitsos 07/21/2016 Health Coach Staff Time 5.50 352.00 352.00 Marissa Grant 07/21/2016 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride 07/21/2016 R.N.Staff Time 4.75 294.50 294.50 Mareesa Martin 07/21/2016 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 07/22/2016 Health Coach Staff Time 3.50 224.00 224.00 Marissa Grant 07/22/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 07/22/2016 R.N.Staff Time 6.25 387.50 387.50 Mareesa Martin 07/22/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/25/2016 Health Coach Staff Time 3.00 192.00 192.00 Marissa Grant 07/25/2016 M.A.Staff Time 9.00 252.00 252.00 Kimberly Pride 07/25/2016 R.N.Staff Time 9.50 589.00 589.00 Mareesa Martin 07/25/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/25/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 07/26/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride I I I Invoice# 751018(continued)page 4 Service Date Description Quanti Charge Receipt Ad'us Balance 07/26/2016 R.N.Staff Time 7.25 449.50 449.50 Mareesa Martin 07/26/2016 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 07/27/2016 M.A.Staff Time 10.00 280.00 280.00 Kimberly Pride 07/27/2016 R.N.Staff Time 9.50 589.00 589.00 Mareesa Martin 07/27/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 07/27/2016 N.P.Staff Time 4.00 450.72 450.72 Tina Nitsos 07/28/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 07/28/2016 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 07/28/2016 R.N.Staff Time 4.75 294.50 294.50 Mareesa Martin 07/28/2016 MD Staff Time 1 4.00 700.00 700.00 Dr.Fagan 07/29/2016 Health Coach Staff Time 4.50 288.00 288.00 Marissa Grant 07/29/2016 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 07/29/2016 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 07/29/2016 MD Staff Time 5.00 875.00 875.00 Dr.Fagan CITYCARO Invoice# 751018 Balance Due: 37079.39 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK __Cut and return with payment --------------------- Please remit 37 079.39 and Make Check Payable to: ❑ VISA INVOICE# 751018 IU Health Workplace Services,LLC ❑ MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNTNO CSV EXP I CODE DATE Phone: 317-963-1535 I SIGNATURE AMOUNT PAID $ Indiana University Health Workplace Services, LLC 950 North)Meridian Street Suite 950 1(City of Carmel) Indianapolis, IN 46204 317i963-1535 Tax I D# 20-0994452 Invoice July 31, 2016 Bill to: Barbara Lamb For: City of Cannel-Onsite City of Carmel-Onsite Wellness Drug Screen/July 1 Civic Square Carmel,IN 46032- Invoice# 750958 Service Date Description Quanti Charae Recei Ad"Us Balance 07/11/2016 Quick Read UDS/6panel To 2 2016 easurer i i Invoice# 750958(continued)page 2 Service Date Description 150.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK I .-Cut and return with payment Please remit 150.00 and Make Check Payable to: ❑= VISA RWOICIE# 750958 IU Health Workplace Services,LLC E] 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 1 Suite 950((City of Carmel) Indianapolis, IN 46204 3171963-1535 Tax ID# 20-0994452 Invoice July 31, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/July 2016 1 Civic Square Carmel,IN 46032- Invoice# 751318 Service Date Description I QuantilyCharge Recei Aau-si Balance 07/01/2016 Onsite Operating Supplies 1.00 879.83 879.83 July 2016 Supplies CITYCARO Invoice# 751318 Balance Due: 879.83 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To AUG 0 2 2016 r'ier k Treasurer ---Cut and return with payment Please remit 879.83 and Make Check Payable to: E]=V= VISA IU Health Workplace Services,LLC INVOICE# 751318 E] MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNTNO CSV ExP CODE DATEJ Phone: 317-963-1535 SIGNATURE AMOUNT PAID $ I Indiana University Health Workplace Services, LLC 950 North!Meridian Street _3`�) Suite 950 I(City of Carmel) Indianapolis, IN 46204 317i963-1535 Tax I D# 20-0994452 I voice July 31, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/July 2016 1 Civic Square Carmel,IN 46032- Invoice# 751293 Service Date Description Quanti Charge Receip Adlusit Balance 06/01/2016 Onsite Lab Charges 1.00 1,594.98 1594.98 June 20.16 Labs 06/19/2016 Young at Heart Mail-Ins 1.00 1,704.56 1704.56 06/26/2016 Young at Heart Mail-Ins 1.00 716.19 716.19 06/27/2016 Young at Heart Clinic(Meds 1.00 707.46 707.46 06/30/2016 Young at Heart Mail-Ins 1.00 2,655.44 2655.44 07/10/2016 Young at Heart Mail- s 1.00 3,031.55 3031.55 CITYCARO Invoice# 751293 Balance Due: 10410.18 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To AUG 0 2 2016 Clerk Tr easuffer Cut and return with payment ---------------------------------------------------------------------------------------------------------------------------------------- Please remit 10,410.18 and Make Check Payable to: E# 751293 IU Health Workplace Services,LLC El= VISA INVOIC ❑ MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNTNO CSV EXP CODE DATEI Phone: 317-963-1535 SIGNATURE AMOUNT PAID Indiana University Health Workplace Services, LLC 950 North!Meridian Street Suite 950 Indianapolis, IN 46204 317L963-1535 Tax ID# 20-0994452 I Invoice Jul 31, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite i Onsite Fee's/July 2016 1 Civic Square Carmel,IN 46032- Invoi6e# 750918 Service Date Description I Quantily Charae Recei Ad'us Balance 07/01/2016 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease 07/01/2016 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 750918 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE i INVOICE#ON CHECK i AUG 02 2M j Clerk Treasurer usurer i I 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. $728.40 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 750930 43-475.00 $728.40 1 hereby certify that the attached invoice(s),or 7/31/16 750930 EAP Services July $728.40 1205 101 1205 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for - - -- whichcharge-is made-were-ordered-and- received adewere ordered-and received except Tuesday,August 02,2016 I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-663-1535 Tax ID# 20-0994452 Invoice July 31, 2016 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/July 2016 1 Civic Square Carmel,IN 46032- Invoice, # 750930 Service Date DescriptionQuant! Charge Receipt A&U-SI Balance 07/01/2016 EAP Services 607.00 728.40 728.40 CITYCARO Invoice# 750930 Balance Due: 728.40 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK i Submitted To I AUG. 01 zm Clerk Treasurer I VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) IU HEALTH WORKPLACE SERVICES LLC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 2046 RELIABLE PKWY IN SUM OF$ 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. $724.00 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 750959 43-588.00 $724.00 1 hereby certify that the attached invoice(s),or 7/31/16 750959 Onsite Drug Screens $724.00 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,August 02,2016 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 950 North Meridian Street ------------ Suite 9501 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice July 31, 2016 I Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Occupational Drug Screens 1 Civic Square Cannel,IN 46032- Invoice# 750959 i Service Date Description Quanti Charge Recein Adjust Balance 07/19/2016 Quick Read UDS/6panel includes 15.00 07/21/2016 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit I Invoice# 750959(continued)page 2 Service Date Descdptio Quanti Charge 15.00 kit Invoice# 750959(continued)page 3 Service Date Description 15.00 ' I Invoice# 750959(continued)page 4 Service Date DescriptionQuant! Charge Receipt AWS-1 Balance 07/22/2016 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 15.00 07/18/2016 Quick Read UDS/6pinel includes 1.00 15.00 15.00 kit Invoice# 750959(continued)page 5 Service Date Description Quanti Charge Recei Ad"Us Balance 724.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK