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308169 02/13/17 CITY OF CARMEL, INDIANA VENDOR: 367222 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: S"""49,184.81' I3 'a CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 308169 :•. ,_ 9M«oN. CHICAGO IL 60686-0020 CHECK DATE: 02/13/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 754757 45.00 OTHER EXPENSES 301 5023990 754759 8,691.85 OTHER EXPENSES 301 5023990 754943 4,374.16 OTHER EXPENSES 301 5023990 755061 35,788.80 OTHER EXPENSES 301 5023990 755252 285.00 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 Vendor# 367222 ACCOUNTS PAYABLE VOUCHER IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL 2046 RELIABLE PKWY An invoice or bill to be property 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. CHICAGO, IL 60686-0020 Payee $49,184.81 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# 301 Medical Fund Terms 301 Medical Fund Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 754943 50-239.90 $4,374.16 1 hereby certify that the attached invoice(s),or 1/31/17 754943 Jan Onsite Fees $4,374.16 301 301 301 301 754759 50-239.90 $8,691.85 bill(s)is(are)true and correct and that the 1/31/17 754759 Jan Onsite Misc $8,691.85 301 301 materials or services itemized thereon for 301 1 301 755252 50-239.90 $285.00 1/31/17 755252 Jan Onsite Supply $285.00 301 301 which charge is made were ordered and 301 301 754757 50-239.90 $45.00 received except 1/31/17 754757 Jan Onsite Wellness $45.00 301 301 301 301 755061 50-239.90 $35,788.80 1/31/17 755061 Jan Onsite Staff Time $35,788.80 301 301 301 301 Wednesday, February 08,2017 Lamb, Barbara Director 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 -tel Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice January 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fee's/Jan 2017 1 Civic Square Carmel,IN 46032- Invoice# 754943 Service Date Descriptio Quant! Charge Rec i Adjust Balance 01/01/2017 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 01/01/2017 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease CITYCARO Invoice# 754943 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK F �itted �'®13 2017 Clerk Treasurer Indiana University Health Workplace Services,LLC 950 North Meridian Street 3,D) Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 Invoice January 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/Jan 2017 1 Civic Square Carmel,IN 46032- Invoice# 754759 Service Date Description Quanti Charge R c i us Balance 11/30/2016 Young at Heart Mail-Ins 1.00 2,272.49 2272.49 12/01/2016 Onsite Lab Charges 1.00 1,483.96 1483.96 Dec.2016 Labs 12/18/2016 Young at Heart Mail-Ins 1.00 2,949.60 2949.60 12/19/2016 Young at Heart Clinic Meds 1.00 1,790.99 1790.99 12/30/2016 Video Visit 1.00 49.00 49.00 December 2016 Video Visits 01/06/2017 AS Medical Solutions Clinic Meds 1.00 13.40 13.40 01/11/2017 AS Medical Solutions Clinic Meds 1.00 132.41 132.41 CITYCARO Invoice# 754759 Balance Due: 8691.85 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted T® FEB 13 2017 Clerk Trea-Surer 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 January 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/Jan. 2017 1 Civic Square Carmel,IN 46032- Invoice# 755252 Service Date Descriptio Quantily Charge Receip AdLusj Balance 01/01/2017 Onsite Operating Supplies 1.00 285.00 285.00 January 2017 Supplies CITYCARO Invoice# 755252 Balance Due: 285.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To FEB J 3 2017 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 January 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Wellness UDS/Jan 2017 1 Civic Square Carmel,IN 46032- Invoice# 754757 Service Date Description Quant! Charae Receipt Adjust Balance 01/03/2017 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 45.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To FEB 13 2017 Clerk Treasurer Indiana University Health Workplace Services,LLC 950 North Meridian Street pl Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 Invoice January 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Jan 2017 1 Civic Square Carmel,IN 46032- Invoice# 755061 Service Date Descri tp io Quanti Charae Receipt Adjust Balance 01/03/2017 M.A.Staff Time 8.25 237.93 237.93 Kimberly Pride 01/03/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 01/03/2017 R.N.Staff Time 7.50 478.95 478.95 Mareesa Martin 01/04/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 01/04/2017 N.P.Staff Time 10.00 1,160.60 1160.60 Tina Nitsos 01/04/2017 R.N.Staff Time 10.00 638.60 638.60 Mareesa Martin 01/05/2017 Health Coach Staff Time 4.00 263.68 263.68 Marissa Grant 01/05/2017 M.A.Staff Time 6.25 180.25 180.25 Kimberly Pride 01/05/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 01/05/2017 R.N.Staff Time 6.00 383.16 383.16 Mareesa Martin 01/06/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant 01/06/2017 M.A.Staff Time 7.75 223.51 223.51 Kimberly Pride 01/06/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 01/06/2017 R.N.Staff Time 7.50 478.95 478.95 Mareesa Martin 01/09/2017 Health Coach Staff Time 3.00 197.76 197.76 Marissa Grant 01/09/2017 M.A.Staff Time 9.25 266.77 266.77 Kimberly Pride Submitted To FEB.13 2017 Clerk Treasurer Invoice# 755061 (continued)page 2 Service Date Descriptio Quanti Charge ReceJ12 'us B la ante 01/09/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 01/09/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 01/09/2017 R.N. Staff Time 9.25 590.71 590.71 Mareesa Martin 01/10/2017 M.A.Staff Time 7.50 216.30 216.30 Kimberly Pride 01/10/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 01/10/2017 RN.Staff Time 6.75 431.06 431.06 Mareesa Martin 01/11/2017 M.A.Staff Time 9.50 273.98 273.98 Kimberly Pride 01/11/2017 N.P.Staff Time 9.00 1,044.54 1044.54 Tina Nitsos 01/11/2017 R.N.Staff Time 9.00 574.74 574.74 Mareesa Martin 01/12/2017 Health Coach Staff Time 4.00 263.68 263.68 Marissa Grant 01/12/2017 M.A.Staff Time 5.50 158.62 158.62 Kimberly Pride 01/12/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 01/12/2017 R.N.Staff Time 4.75 303.34 303.34 Mareesa Martin 01/13/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant 01/13/2017 M.A.Staff Time 6.25 180.25 180.25 Kimberly Pride 01/13/2017 N.P.Staff Time 7.00 812.42 812.42 Tina Nitsos 01/13/2017 R.N.Staff Time 6.75 431.06 431.06 Mareesa Martin 01/16/2017 M.A.Staff Time 8.50 245.14 245.14 Kimberly Pride 01/17/2017 M.A.Staff Time 7.00 201.88 201.88 Kimberly Pride 01/17/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 01/17/2017 R.N. Staff Time 6.75 431.06 431.06 Mareesa Martin 01/18/2017 M.A.Staff Time 9.50 273.98 273.98 Kimberly Pride 01/18/2017 N.P.Staff Time 8.50 986.51 986.51 Tina Nitsos 01/18/2017 R.N.Staff Time 9.50 606.67 606.67 Mareesa Martin Invoice# 755061 (continued)page 3 Service Date Description Quanti Charge Receip Balance 01/19/2017 Health Coach Staff Time 4.50 296.64 296.64 Marissa Grant 01/19/2017 M.A.Staff Time 6.00 173.04 173.04 Kimberly Pride 01/19/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 01/19/2017 RN.Staff Time 5.00 319.30 319.30 Mareesa Martin 01/20/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant 01/20/2017 M.A.Staff Time 6.00 173.04 . 173.04 Kimberly Pride 01/20/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 01/20/2017 R.N.Staff Time 5.75 367.20 367.20 Mareesa Martin 01/23/2017 Health Coach Staff Time 3.00 197.76 197.76 Marissa Grant 01/23/2017 M.A.Staff Time 5.00 144.20 144.20 Kimberly Pride 01/23/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 01/23/2017 N.P.Staff Time 4.00 464.24 464.24 Tina Nitsos 01/23/2017 R.N.Staff Time 5.00 319.30 319.30 Mareesa Martin 01/24/2017 M.A.Staff Time 6.00 173.04 173.04 Kimberly Pride 01/24/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 01/24/2017 R.N.Staff Time 6.00 383.16 383.16 Mareesa Martin 01/25/2017 M.A.Staff Time 8.00 230.72 230.72 Kimberly Pride 01/25/2017 N.P.Staff Time 8.00 928.48 928.48 Tina Nitsos 01/25/2017 R.N.Staff Time 8.00 510.88 510.88 Mareesa Martin 01/26/2017 Health Coach Staff Time 4.00 263.68 263.68 Marissa Grant 01/26/2017 M.A.Staff Time 4.00 115.36 115.36 Kimberly Pride 01/26/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 01/26/2017 R.N.Staff Time 4.00 255.44 255.44 Mareesa Martin 01/27/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant Invoice# 755061 (continued)page 4 Service Date Description Quant! Charae Receip A 'u Balance 01/27/2017 M.A.Staff Time 5.00 144.20 144.20 Kimberly Pride 01/27/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 01/27/2017 R.N.Staff Time 5.00 319.30 319.30 Mareesa Martin 01/30/2017 Health Coach Staff Time 3.00 197.76 197.76 Marissa Grant 01/30/2017 M.A.Staff Time 5.00 144.20 144.20 Kimberly Pride 01/30/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 01/30/2017 N.P.Staff Time 4.00 464.24 464.24 Tina Nitsos 01/30/2017 R.N.Staff Time 5.00 319.30 319.30 Mareesa Martin 01/31/2017 M.A.Staff Time 6.00 173.04 173.04 Kimberly Pride 01/31/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 01/31/2017 R.N.Staff Time 6.00 383.16 383.16 Mareesa Martin CITYCARO Invoice# 755061 Balance Due: 35788.80 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK