310016 04/10/17 9 CITY OF CARMEL, INDIANA VENDOR: 367222
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $****78,682.20*
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 310016
CHICAGO IL 60686-0020 CHECK DATE: 04/10/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 755911 847.00 TESTING FEES
301 5023990 755912 75.00 OTHER EXPENSES
301 5023990 755931 26,773.61 OTHER EXPENSES
1205 4347500 755932 744.00 GENERAL INSURANCE
301 5023990 755933 1,271.00 OTHER EXPENSES
301 5023990 755934 4,374.16 OTHER EXPENSES
301 5023990 755935 43,221.17 OTHER EXPENSES
301 5023990 756303 1,376.26 OTHER EXPENSES
nn N < <
m O 2 m � O
S 0 0 0 0 0 0 0 Z 0 O) m a C
it 0
D
1
C7 0 m
n D = w
O oro * ' Z
V V V V -4 V Z o m O N O
mw w A w <� N m O T
(D (D T V N D
T
a a � m
CD
0 91 -0 C
7 0 0 0 0 0 o m D '� m C
n W N W N W N W N W N W N C T T O D
d O O O w O O w O � d -0 < /�
�* CL a 0
0 0 0 0 0 0 D m
OL Cl) z
3 O r
o r
R 69 D Z O
w �' a 4A rn > T
0 T A W L" CC CD 4 69O
fD �
S V CY) m O O -4
f�
S
F 3 ff z D
c ? — co c
? M v
0 N y
(D N y N0 O m
'n v
C n CODCD CD
CL
3 m S
3 0 4:
v a C y a
W a F m
-ao
O� U CD N
C) cp n
d oB s
�,
fl1 N �C�pp S a W
O C fD D < o
V = :3
2• Q
O SCl) 0 N
O or
33D IO
C 7 W W W W W W D
_am C-11 o o o o o m D n y
�Q 3 O
V V V m n
Ol 0Q O
CD
3 f D
cn
z
3 0 5i
n .�. m m 0 cu
N
V V V V V V C G
S w 0 w rn w Vi w CA w O1n w cin Z y 3 O
a(DC2 W o 0 o co O CO O CO 0 m O n p a
� ff cn - w a - w — w atm C
�*CD (Dd ^ Z D
=r CD
O
c
� c vT'1
O c v
yi p y
'o
0
G o R 07
g x
�I m d = v S "
03 B 0)
Z3 C3
N O O m O fD a C7 m ~
y N N y. _ C z m
m P, 0 p ami m c r
n
cvD m v m m m m Z (D 3 m
`� N N4 y =r C
X 2 _ v d
CDo U o
m m o = n
CL = o m q
w CD o
m �• n -n(D CCD N N /�
0 N N O
N c N N
OL w A En D m zPD
S N W (.J IV V 69n N
CCA -I W
D p O
Z
� rn rn O 0 o � cin
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
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Wellness/March 2017
1 Civic Square
Carmel,IN 46032-
Invoice# 755912
Service Date Description Quantity Charae Receipt Adjust Balance
02/20/2017 Quick Read UDS/6panel includes
MAKE PAYMENT TO THE BELOW ADDRESS WITIN 30 DA*"#i CE DATE PLEASE INCLUDE
INVOICE t ON CHECK
Clerk Treasurer
Cut and return with payment
•-----------------------------------------------------------------------------
Indiana University Health Workplace Services,LLC
950 North Meridian Street
cc?? , Suite 950 (City of Carmel)
Jul Indianapolis, IN 46204
' 317-963-1535
Tax ID# 20-0994452
Invoice
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Misc.Onsite/Mar. 2017
1 Civic Square
Carmel, IN 46032-
Invoice# 755931
Service Date Descroptio Quanti Charge Receip A019 Balan
01/09/2017 AS Medical Solutions Clinic Meds 1.00 578.02 578.02
02/01/2017 Onsite Lab Charges 1.00 3,694.96 3694.96
Feb.2017 Labs
02/10/2017 AS Medical Solutions Mail-In Meds 1.00 5,052.04 5052.04
02/15/2017 AS Medical Solutions Clinic Meds 1.00 76.33 76.33
02/20/2017 AS Medical Solutions Clinic Meds 1.00 388.81 388.81
02/22/2017 AS Medical Solutions Clinic Meds 1.00 187.79 187.79
02/24/2017 AS Medical Solutions Clinic Meds 1.00 530.66 530.66
02/27/2017 AS Medical Solutions Clinic Meds 1.00 417.00 417.00
02/28/2017 AS Medical Solutions Clinic Meds 1.00 90.23 90.23
02/28/2017 Video Visit 1.00 49.00 49.00
February Video Visits
03/01/2017 AS Medical Solutions Mail-In Meds 1.00 7,939.06 7939.06
03/02/2017 AS Medical Solutions Clinic Meds 1.00 355.75 355.75
03/03/2017 AS Medical Solutions Clinic Meds 1.00 75.47 75.47
03/07/2017 AS Medical Solutions Clinic Meds 1.00 243.85 243.85
03/15/2017 AS Medical Solutions Mail-In Meds 1.00 7,094.64 7094.64
CITYCARO Invoice# 755931 Balance Due: 26773.61
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
APR 04 2017
Clerk Treasurer
Cut and return with payment
--------------------------------------------------------------------------------------------------------
Indiana University Health Workplace Services,LLC
950 North Meridian Street
l Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite PEPM/Mar. 2017
1 Civic Square
Carmel, IN 46032-
Invoice# 755933
Service Date Descriptio Quanti Charae Receipt A�1)ust Balance
03/01/2017 Monthly Wellness PEPM 620.00 1,271.00 1271.00
CITYCARO Invoice# 755933 Balance Due: 1271.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
APR 0 4 201;
Clerk Treasurer
CN-CW Cut and return with payment
Indiana University Health Workplace Services,LLC
950 North Meridian Street
�- Suite 950
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel -Onsite
City of Carmel -Onsite Onsite Fee's/Mar. 2017
1 Civic Square
Carmel, IN 46032-
Invoice# 755934
Service Date Description Quantity Charge Receipt Adjust Balan5&
03/01/2017 City of Carmel Sports Performance 1.00 1,800.00 1800.00
Lease
03/01/2017 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16
CITYCARO Invoice# 755934 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE -PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
APR 0 4 2017
Clerk Treasurer
Cut and return with payment
--------------------------- -------------------------------
Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/March 2017
1 Civic Square
Carmel,IN 46032-
Invoice# 756303
Service Date Description Quanti Charae Receipt Adjust Balance
03/01/2017 Onsite Operating Supplies 1.00 1,376.26 1376.26
March 2017 Supplies
CITYCARO Invoice# 756303 Balance Due: 1376.26
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE -PLEASE INCLUDE
INVOICE#ON CHECK
FAPR
mitted To
04 2017
Clerk Treasurer
w Cut and return with payment
Indiana University Health Workplace Services, LLC
-3-� 1 950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Staff Time/Mar. 2017
1 Civic Square
Carmel, IN 46032-
Invoice# 755935
Service Date Description Quantity Charae Receipt Adjust Balance
03/01/2017 N.P.Staff Time 10.25 1,189.62 1189.62
Tina Nitsos
03/01/2017 M.A.Staff Time 9.50 273.98 273.98
Kimberly Pride
03/01/2017 R.N.Staff Time 9.75 622.64 622.64
Mareesa Martin
03/02/2017 M.A.Staff Time 5.25 151.41 151.41
Kimberly Pride
03/02/2017 R.N.Staff Time 6.50 415.09 415.09
Mareesa Martin
03/02/2017 MD Staff Time 4.00 721.00 721.00
Dr.Fagan
03/03/2017 Health Coach Staff Time 5.00 329.60 329.60
Marissa Grant
03/03/2017 M.A.Staff Time 6.25 180.25 180.25
Kimberly Pride
03/03/2017 R.N.Staff Time 6.75 431.06 431.06
Mareesa Martin
03/03/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/06/2017 R.N.Staff Time 7.00 447.02 447.02
Mareesa Martin
03/06/2017 Health Coach Staff Time 3.00 197.76 197.76
Marissa Grant
03/06/2017 N.P.Staff Time 4.75 551.29 551.29
Tina Nitsos
03/06/2017 M.A.Staff Time 9.25 266.77 266.77
Kimberly Pride
03/06/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/07/2017 M.A.Staff Time 6.00 173.04 173.04
Shakara Durowoj
Submitted To
APR 0 4 2017
Clerk Treasurer
Invoice# 755935(continued)page 2
Service Date Description Quantity Charae Receipt Adiust Balance
03/07/2017 M.A.Staff Time 8.50 245.14 245.14
Kimberly Pride
03/07/2017 MD Staff Time 6.00 1,081.50 1081.50
Dr.Fagan
03/08/2017 M.A.Staff Time 8.50 245.14 245.14
Shatara Butler
03/08/2017 N.P.Staff Time 9.75 1,131.59 1131.59
Tina Nitsos
03/08/2017 M.A.Staff Time 12.50 360.50 360.50
Kimberly Pride
03/09/2017 M.A.Staff Time 4.00 115.36 115.36
Shakara Durowoj
03/09/2017 Health Coach Staff Time 4.50 296.64 296.64
Marissa Grant
03/09/2017 M.A.Staff Time 8.50 245.14 245.14
Kimberly Pride
03/09/2017 MD Staff Time 4.00 721.00 721.00
Dr.Fagan
03/10/2017 R.N.Staff Time 6.00 383.16 383.16
Mareesa Martin
03/10/2017 Health Coach Staff Time 6.00 395.52 395.52
Marissa Grant
03/10/2017 M.A.Staff Time 6.00 173.04 173.04
Kimberly Pride
03/10/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/13/2017 R.N.Staff Time 9.25 590.71 590.71
Mareesa Martin
03/13/2017 Health Coach Staff Time 2.50 164.80 164.80
Marissa Grant
03/13/2017 N.P.Staff Time 4.75 551.29 551.29
Tina Nitsos
03/13/2017 M.A.Staff Time 10.00 288.40 288.40
Kimberly Pride
03/13/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/14/2017 R.N. Staff Time 8.50 542.81 542.81
Mareesa Martin
03/14/2017 M.A.Staff Time 7.00 201.88 201.88
Kimberly Pride
03/14/2017 MD Staff Time 6.00 1,081.50 1081.50
Dr.Fagan
03/15/2017 R.N.Staff Time 10.25 654.57 654.57
Mareesa Martin
03/15/2017 N.P.Staff Time 9.25 1,073.56 1073.56
Tina Nitsos
03/15/2017 M.A.Staff Time 10.00 288.40 288.40
Kimberly Pride
Invoice# 755935 (continued)page 3
Service Date Description Quantity Charae Receipt Adjust Balance
03/16/2017 R.N.Staff Time 7.25 462.99 462.99
Mareesa Martin
03/16/2017 Health Coach Staff Time 4.50 296.64 296.64
Marissa Grant
03/16/2017 M.A.Staff Time 5.25 151.41 151.41
Kimberly Pride
03/16/2017 MD Staff Time 4.00 721.00 721.00
Dr.Fagan
03/17/2017 R.N.Staff Time 6.75 431.06 431.06
Mareesa Martin
03/17/2017 Health Coach Staff Time 5.00 329.60 329.60
Marissa Grant
03/17/2017 M.A.Staff Time 6.50 187.46 187.46
Kimberly Pride
03/17/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/20/2017 M.A.Staff Time 9.25 266.77 266.77
Kimberly Pride
03/20/2017 R.N.Staff Time 9.25 590.71 590.71
Mareesa Martin
03/20/2017 N.P.Staff Time 4.75 551.29 551.29
Tina Nitsos
03/20/2017 Health Coach Staff Time 3.00 197.76 197.76
Marissa Grant
03/20/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/21/2017 M.A.Staff Time 8.50 245.14 245.14
Kimberly Pride
03/21/2017 R.N.Staff Time 8.50 542.81 542.81
Mareesa Martin
03/21/2017 MD Staff Time 6.00 1,081.50 1081.50
Dr.Fagan
03/22/2017 M.A.Staff Time 10.00 288.40 288.40
Kimberly Pride
03/22/2017 R.N.Staff Time 10.25 654.57 654.57
Mareesa Martin
03/22/2017 N.P.Staff Time 9.75 1,131.59 1131.59
Tina Nitsos
03/23/2017 M.A.Staff Time 5.00 144.20 144.20
Kimberly Pride
03/23/2017 R.N. Staff Time 7.25 462.99 462.99
Mareesa Martin
03/23/2017 Health Coach Staff Time 5.50 362.56 362.56
Marissa Grant
03/23/2017 MD Staff Time 4.00 721.00 721.00
Dr.Fagan
03/24/2017 M.A.Staff Time 6.00 173.04 173.04
Kimberly Pride
Invoice# 755935(continued)page 4
Service Date Description Quantity Charge Receipt Adjust Balance
03/24/2017 R.N. Staff Time 6.50 415.09 415.09
Mareesa Martin
03/24/2017 Health Coach Staff Time 6.00 395.52 395.52
Marissa Grant
03/24/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/27/2017 M.A.Staff Time 10.00 288.40 288.40
Kimberly Pride
03/27/2017 R.N.Staff Time 9.25 590.71 590.71
Mareesa Martin
03/27/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/27/2017 N.P.Staff Time 4.75 551.29 551.29
Tina Nitsos
03/28/2017 M.A.Staff Time 7.00 201.88 201.88
Kimberly Pride
03/28/2017 R.N.Staff Time 8.50 542.81 542.81
Mareesa Martin
03/28/2017 MD Staff Time 6.00 1,081.50 1081.50
Dr.Fagan
03/29/2017 M.A.Staff Time 10.00 288.40 288.40
Kimberly Pride
03/29/2017 R.N.Staff Time 10.25 654.57 654.57
Mareesa Martin
03/29/2017 N.P.Staff Time 9.25 1,073.56 1073.56
Tina Nitsos
03/30/2017 M.A.Staff Time 5.25 151.41 151.41
Kimberly Pride
03/30/2017 R.N.Staff Time 4.50 287.37 287.37
Mareesa Martin
03/30/2017 MD Staff Time 4.00 721.00 721.00
Dr.Fagan
03/30/2017 Health Coach Staff Time 4.50 296.64 296.64
Marissa Grant
03/31/2017 M.A.Staff Time 5.00 144.20 144.20
Kimberly Pride
03/31/2017 R.N.Staff Time 5.00 319.30 319.30
Mareesa Martin
03/31/2017 MD Staff Time 5.00 901.25 901.25
Dr.Fagan
03/31/2017 Health Coach Staff Time 5.00 329.60 329.60
Marissa Grant
CITYCARO Invoice# 755935 Balance Due: 43221.17
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE -PLEASE INCLUDE
INVOICE#ON CHECK
Cut and return with vavment
G 4
N G O
o
Om 0t;3
Z
i A
8P
� -C, y
Zo O 4 m p
0
�: 3. •p n
chi o (p
100 '00Z
N �
m N
o m. 0
o CD
10, .► �" 3 coo
go, N a
C1 �
� 03 O• pp. �
w m °y rLo
4
tr
� F
c3 t,r n
N OD
O0 p, � N Z � N N � o• 2
O
6, N g
1
n
N �
N
J
a > o Z
-� p• o
D CO,
N a
N
W y
G
OD
N
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
l Indianapolis, IN 46204
317-963-1535
Tax I D# 20-0994452
Invoice
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/Mar.2017
1 Civic Square
Carmel, IN 46032-
Invoice# 755932
Service Date Descriptio Quanti Charae Receipt Adjust Balance
03/01/2017 EAP Services 620.00 744.00 744.00
CITYCARO Invoice# 755932 Balance Due: 744.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
APR 0 4 2017
Clerk Treasurer
Cut and return with payment
-----------------------------------------------------------------------
G
N G
p � C
I
cr 7d
v ° CD
N z1
k
w
N, .�
O
1. 40
4
6'
OA 3N N N
4 ACD. 3 y m n
C5,
(D N O Ni
W
c G m a O
CD
co N
O o
a v
m W o Q,
tAtpp � 6
� N N o• a N N' 36 moo. � a
os � o m � �• c
1 3 c v
8
u� •a `� q
O D t0 (n
I�
f0 h O tP co
5 CD 0-
ZO
105
0
N
q�
4fl °
ie
a
c
N
Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 950 (City of Carmel)
s� Indianapolis, IN 46204
1 Z 317-963-1535
Tax ID# 20-0994452
Invoice
March 31, 2017
Bill to: Barbara Lamb For: City of Carmel -Onsite
City of Carmel-Onsite Occupational/Mar.2017
1 Civic Square
Carmel, IN 46032-
Invoice# 755911
Service Date Description Quantity Charae Receipt Adiuil Balance
03/23/2017 Quick Read UDS/6panel
15.00
kit
Submitted To
APR 0 4 2017
Clerk Treasurer
Invoice# 755911 (continued)page 2
Service Date Description
15.00
Invoice# 755911 (continued)page 3
Service Date Description
15.00
Invoice# 755911 (continued)page 4
Service Date Descriptio
15.00
Invoice# 755911 (continued)page 5
Service Date Description Quantity Charge Receipt Adjust Balance
03/20/2017 Quick Read UDS/6panel
15.00
Invoice# 755911 (continued)page 6
Service Date Description Quanti Charge Receipt Adjust Balance
03/14/2017 Quick Read UDS/6panel includes
847.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
«� Cut and return with payment