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309010 03/07/17 94.1 uW.CAS** ,;; � CITY OF CARMEL, INDIANA VENDOR: 367222 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $**""57,956.23* CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 309010 �� CHICAGO IL 60686-0020 CHECK DATE: 03/07/17 M�tON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 755468 4,374.16"' OTHER EXPENSES 1205 4347500 755469 745.20 GENERAL INSURANCE 301 5023990 755470 10,274.52 '** OTHER EXPENSES 1201 4358800 755484 492.00' TESTING FEES 301 5023990 755491 39,708.83 OTHER EXPENSES 301 5023990 755581 60.00 OTHER EXPENSES 301 5023990 755806 2,301.52 /' OTHER EXPENSES n n N) < « I I / ) \ 2 k 2 m ƒ O / q 2 #? \ z $ 0 D Z -0 ;o° ¥ $ \ § CD k # \ k k » 0 CL � m £ 3. m � » mak § q < D 3 --1 @ 6 CL ® 2 a / 0 2 \ > z 0- CD / q =r § 6 } a i g F - 2 > Er CD I e p % A / Fu' / 2 / x / 0\ 0 / C { } / » � E; § 3 E m s F I C - C k CD E 7 !\ 8 & a a a " m n 4 g _f _ � kCD \ } / 4 % k \ E CL $ a - I § m & g � 0 ƒ k I / q C f 7 � j \ P , ; cr \ D n 0) R \ 7 0w m < a m 0 jZ } ° / 0 0 ƒ a ; M c # # 2 Z / mn CD �ƒ } } n` 0 > f ; SA- 0 � / 7 -n � aE imE n \ \ 2 ® � / \ n a \ 0 j E CD c m ¢ \ U) } { a C (D q0 / CD 0CL M \ cn CD CL ] CD \ / 9 f to [ > \ \ § q § & § 7 ƒ & § ® k Indiana University Health Workplace Services,LLC 950 North Meridian Street �75 Suite 950 (City of Carmel) Indianapolis, IN 46204 Z r 317-963-1535 Tax I D# 20-0994452 Invoice February 28, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/Feb. 2017 1 Civic Square Carmel,IN 46032- Invoice# 755469 _ Service Date Description Quantity Charge Receipt Adjust Balance 02/01/2017 EAP Services 621.00 745.20 745.20 CITYCARO Invoice# 755469 Balance Due: 745.20 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To MAR 0 8 2017 Clerk Treasurer .� �„ Cut and return with payment 0 n < < m 3 0 k i k 0 k ° / m > q n G) r # c m m \ I \ z E \ m / / 0 % -4 \ 2 � / -0 ;oO 9 2 m 3 0 7 D k k P o m @ 6 j ` \ > 3 § # C m 0 CL 2 0 w 0 2 0 > O k \ \ k , B z � o w � « a i e z > z (DE g 2 ? § % A / E F $ F n 0 m (D a) e J m -n 0 E � § ƒ § - E q F ' ® 3 f / { k - F = m - E 7 \ 7 § ;:w \ 0 o i - , § I R \ o w % ¢ g 7 9 ƒ § CD - 3 ( [ ki K m0 f ƒ 2@ § \ 2 n ; \ 0. 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C CD o = O -E, 0 v m CL M CA ° co ' n CPDD 2) CCD CD CD m y a 4U C (DD N a O A N N <D PD S N W -4 b9 W O n A A POD O O —co C N O W O N 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 February 28, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/Feb.2017 1 Civic Square Carmel,IN 46032- Invoice# 755806 Service Date Description Quantity Charge Receipt gds Balance 02/01/2017 Onsite Operating Supplies 1.00 2,301.52 2301.52 February 2017 Supplies CITYCARO Invoice# 755806 Balance Due: 2301.52 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To MAR 0 8 2017 Clerk Treasurer -Cut and return with payment --------------------------------------------------------------------------------------------------------------------------------- Please remit 2,301.52 and Make Check Payable to: ❑ VISA INVOICE# 755806 ICJ Health Workplace Services,LLC ❑ MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNT NO 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 February 28, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Wellness Drug Screens/Feb 1 Civic Square Carmel,IN 46032- __.__.__,_ Invoice# 755581 Service Date Description Quantity Charge Receipt Al Balance 02/27/2017 Quick Read UDS/6panel 60.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To MAR 0 8 2017 Clerk Treasurer -Cut and return with payment ---------- ---------- Please remit 60.00 and Make Check Payable to: ❑ VISA INVOICE# 755581 IU Health Workplace Services,LLC ❑ MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNT NO 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 February 28, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Feb. 2017 1 Civic Square Carmel,IN 46032- Invoice# 755491 Service Date Description Quantity Charge Receipt Adjust Balance 02/01/2017 N.P.Staff Time 10.50 1,218.63 1218.63 Tina Nitsos 02/01/2017 M.A.Staff Time 10.50 302.82 302.82 Kimberly Pride 02/01/2017 R.N. Staff Time 12.00 766.32 766.32 Mareesa Martin 02/02/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 02/02/2017 M.A.Staff Time 7.25 209.09 209.09 Kimberly Pride 02/02/2017 R.N.Staff Time 8.00 510.88 510.88 Mareesa Martin 02/02/2017 Health Coach Staff Time 4.00 263.68 263.68 Marissa Grant 02/03/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/03/2017 M.A.Staff Time 9.25 266.77 266.77 Kimberly Pride 02/03/2017 R.N.Staff Time 7.75 494.92 494.92 Mareesa Martin 02/03/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant 02/06/2017 Health Coach Staff Time 3.00 197.76 197.76 Marissa Grant 02/06/2017 M.A.Staff Time 12.00 346.08 346.08 Kimberly Pride 02/06/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/06/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 02/06/2017 R.N.Staff Time 10.50 670.53 670.53 Raubyn Barich Submitted To MAR 0 8 2017 Clerk Treasurer Invoice# 755491 (continued)page 2 Service Date Description Quantity Charae Receipt Balance 02/07/2017 M.A.Staff Time 8.25 237.93 237.93 Kimberly Pride 02/07/2017 R.N.Staff Time 8.25 526.85 526.85 Mareesa Martin 02/07/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 02/08/2017 M.A.Staff Time 13.00 374.92 374.92 Kimberly Pride 02/08/2017 R.N.Staff Time 11.75 750.36 750.36 Mareesa Martin 02/08/2017 N.P.Staff Time 8.50 986.51 986.51 Tina Nitsos 02/09/2017 Health Coach Staff Time 4.00 263.68 263.68 Marissa Grant 02/09/2017 M.A.Staff Time 7.25 209.09 209.09 Kimberly Pride 02/09/2017 R.N.Staff Time 7.00 447.02 447.02 Mareesa Martin 02/09/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 02/10/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant 02/10/2017 M.A.Staff Time 8.50 245.14 245.14 Kimberly Pride 02/10/2017 R.N.Staff Time 8.75 558.78 558.78 Mareesa Martin 02/10/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 02/13/2017 Health Coach Staff Time 2.50 164.80 164.80 Marissa Grant 02/13/2017 M.A.Staff Time 10.00 288.40 288.40 Kimberly Pride 02/13/2017 R.N.Staff Time 10.00 638.60 638.60 Mareesa Martin 02/13/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/13/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 02/14/2017 M.A.Staff Time 7.25 209.09 209.09 Kimberly Pride 02/14/2017 R.N.Staff Time 7.00 447.02 447.02 Mareesa Martin 02/14/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 02/15/2017 M.A.Staff Time 9.25 266.77 266.77 Kimberly Pride 02/15/2017 R.N.Staff Time 9.75 622.64 622.64 Mareesa Martin Invoice# 755491 (continued)page 3 Service Date Description Quantity Charae Receipt A" Balance 02/15/2017 N.P.Staff Time 10.00 1,160.60 1160.60 Tina Nitsos 02/16/2017 Health Coach Staff Time 4.50 296.64 296.64 Marissa Grant 02/16/2017 M.A.Staff Time 5.75 165.83 165.83 Kimberly Pride 02/16/2017 R.N.Staff Time 5.25 335.27 335.27 Mareesa Martin 02/16/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 02/17/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant 02/17/2017 M.A.Staff Time 6.50 187.46 187.46 Kimberly Pride 02/17/2017 R.N.Staff Time 6.25 399.13 399.13 Mareesa Martin 02/17/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 02/20/2017 Health Coach Staff Time 3.00 197.76 197.76 Marissa Grant 02/20/2017 M.A.Staff Time 10.00 288.40 288.40 Kimberly Pride 02/20/2017 R.N.Staff Time 9.00 574.74 574.74 Mareesa Martin 02/20/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/20/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 02/21/2017 R.N.Staff Time 6.50 415.09 415.09 Mareesa Martin 02/21/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 02/22/2017 M.A.Staff Time 8.50 245.14 245.14 Shakara Durowoj 02/22/2017 R.N. Staff Time 9.75 622.64 622.64 Mareesa Martin 02/22/2017 N.P.Staff Time 8.50 986.51 986.51 Tina Nitsos 02/23/2017 Health Coach Staff Time 4.00 263.68 263.68 Marissa Grant 02/23/2017 M.A.Staff Time 5.00 144.20 144.20 Shakara Durowoj 02/23/2017 R.N.Staff Time 5.25 335.27 335.27 Mareesa Martin 02/23/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 02/24/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant Invoice# 755491 (continued)page 4 Service Date Description Quantity Charge Receipt Adi= Balance 02/24/2017 M.A.Staff Time 5.50 158.62 158.62 Shakara Durowoj 02/24/2017 R.N.Staff Time 6.50 415.09 415.09 Mareesa Martin 02/24/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan 02/27/2017 Health Coach Staff Time 3.00 197.76 197.76 Marissa Grant 02/27/2017 M.A.Staff Time 10.00 288.40 288.40 Kimberly Pride 02/27/2017 R.N.Staff Time 9.00 574.74 574.74 Mareesa Martin 02/27/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/27/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 02/28/2017 M.A.Staff Time 6.50 187.46 187.46 Kimberly Pride 02/28/2017 R.N.Staff Time 6.50 415.09 415.09 Mareesa Martin 02/28/2017 MD Staff Time 6.00 1,081.50 1081.50 Dr.Fagan CITYCARO Invoice# 755491 Balance Due: 39708.83 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To Submitted T( itte e To MAR- 0 8 2017J 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 February 28, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fee's/Feb. 2017 1 Civic Square Carmel,IN 46032- Invoice# 755468 Service Date Description Quantity Charge Receipt Adjust Balance 02/01/2017 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease 02/01/2017 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 755468 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To MAR0 8 2017 Clerk Treasurer Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 950 (City of Carmel) 3 , Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 Invoice February 28, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc. Onsite/Feb. 2017 1 Civic Square Carmel,IN 46032- Invoice# 755470 Service Date Description Quantity Charge Bece1D1 S Balans& 12/31/2016 Young at Heart Mail-Ins 1.00 5,211.71 5211.71 01/01/2017 Onsite Lab Charges 1.00 3,105.35 3105.35 Jan.2017 Labs 01/25/2017 AS Medical Solutions Clinic Meds 1.00 1,083.49 1083.49 01/31/2017 Video Visit 4.00 196.00 196.00 Jan.2017 Video Visits 02/01/2017 AS Medical Solutions Clinic Meds 1.00 86.39 86.39 02/03/2017 AS Medical Solutions Clinic Meds 1.00 329.74 329.74 02/08/2017 AS Medical Solutions Clinic Meds 1.00 15.50 15.50 02/09/2017 AS Medical Solutions Clinic Meds 1.00 16.81 16.81 02/10/2017 AS Medical Solutions Clinic Meds 1.00 214.03 214.03 02/15/2017 AS Medical Solutions Clinic Meds 1.00 15.50 15.50 CITYCARO Invoice# 755470 Balance Due: 10274.52 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted TO MAR0 8 2017 Clerk Treasurer