The URL can be used to link to this page

Home My WebLink About319507 12/12/2017 GAA. CITY OF CARMEL, INDIANA VENDOR: 367222 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $*'"*54,7T2.77' CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 319507 v CHICAGO IL 60686-0020 CHECK DATE: 12/12/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER. AMOUNT DESCRIPTION 301 5023990 760432 90.00 OTHER EXPENSES 301 5023990 760456 7,139.06 OTHER EXPENSES 1201 4358800 760478 118.00 TESTING FEES 301 5023990 760485 38,741.85 OTHER EXPENSES 301 5023990 760486 4,374.16 OTHER EXPENSES 301 5023990 760523 1,258.70 OTHER EXPENSES 1205 4347500 760803 929.45 GENERAL INSURANCE 301 5023990 760828 2,061.55 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 367222 IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL 2046 RELIABLE PKWY An invoice or bill to be properly 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 $53,665.32 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 760828 50-239.90 $2,061.55 1 hereby certify that the attached invoice(s),or 11/30/17 760828 Nov 2017 Onsite Supply $2,061.55 301 301 301 301 760523 50-239.90 $1,258.70 bill(s)is(are)true and correct and that the 11/30/17 760523 Nov 2017 Onsite PEPM $1,258.70 301 1 301 materials or services itemized thereon for 301 1 301 760486 50-239.90 $4,374.16 11/30/17 760486 Nov 2017 Onsite Fees $4,374.16 301 301 which charge is made were ordered and 301 301 760456 50-239.90 $7,139.06 received except 11/30/17 760456 Nov 2017 Onsite Misc $7,139.06 301 301 301 301 760432 50-239.90 $90.00 11/30/17 760432 Nov 2017 Wellness UDS $90.00 301 301 301 301 760485 50-239.90 $38,741.85 11/30/17 760485 Nov 2017 Onsite Staff Time $38,741.85 301 301 301 301 Tuesday, December 05,2017 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 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite PEPM/Nov.2017 1 Civic Square Carmel,IN 46032- Invoice# 760523 Service Date Description Quanti Charge Recelp Must Balance 11/01/2017 Monthly Wellness PEPM 614.00 1,258.70 1258.70 CITYCARO Invoice# 760523 Balance Due: 1258.70 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK b =¢te' a DEC 0 4 2017 �" � purer Indiana University Health Workplace Services, LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fee's/Nov.2017 1 Civic Square Carmel,IN 46032- Invoice# 760486 Service Date Description Quanti Charae Recelp Ad'us Balance 11/01/2017 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease 11/01/2017 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 760486 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Sub.rjaifled 'Flo DEC 04 2017 LClerk Treasurer � Indiana University Health Workplace Services, LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/Nov.2017 1 Civic Square Cannel,IN 46032- Invoice# 760456 Service Date Description Quanti Charge Recei Adjust Balance 10/01/2017 Onsite Lab Charges 1.00 4,055.40 4055.40 October 2017 Labs 10/01/2017 Video Visit 3.00 147.00 147.00 October 2017 Video Visits 10/23/2017 AS Medical Solutions Clinic Meds 1.00 7.99 7.99 10/26/2017 AS Medical Solutions Clinic Meds 1.00 1,056.78 1056.78 10/31/2017 AS Medical Solutions Clinic Meds 1.00 122.81 122.81 11/06/2017 AS Medical Solutions Clinic Meds 1.00 304.49 304.49 11/08/2017 AS Medical Solutions Clinic Meds 1.00 15.22 15.22 11/13/2017 AS Medical Solutions Clinic Meds 1.00 476.99 476.99 11/14/2017 AS Medical Solutions Clinic Meds 1.00 952.38 952.38 CITYCARO Invoice# 760456 Balance Due: 7139.06 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK hi,n=<;rev,d TO DEC 04 2017 w Cut and return with payment `j) Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/Nov.2017 1 Civic Square Carmel,IN 46032- Invoice# 760828 Service Date Description Quant! Charae Receip A 'us Balance 11/01/2017 Onsite Operating Supplies 1.00 2,061.55 2061.55 November 2017 Supplies CITYCARO Invoice# 760828 Balance Due: 2061.55 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK 'L1,13 u b w, t t e i,R To DEC 0 4 2017 Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Wellnes UDS/Nov.2017 1 Civic Square Carmel,IN 46032- Invoice# 760432 Service Date Description 15.00 Invoice# 760432(continued)page 2 Service Date DescriptionQuant! Charge Receipt Ad"us Balance CITYCARO Invoice# 760432 Balance Due: 90.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK 7To EC017� TMS � � Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Nov.2017 1 Civic Square Carmel,IN 46032- Invoice# 760485 Service Date Description Quanti Charge Recelp Adjust Balance 11/01/2017 N.P.Staff Time 9.00 1,044.54 1044.54 Tina Nitsos 11/01/2017 R.N.Staff Time 9.75 622.64 622.64 Stacey Neese 11/01/2017 M.A.Staff Time 9.00 259.56 259.56 Kimberly Pride 11/02/2017 R.N.Staff Time 4.50 287.37 287.37 Stacey Neese 11/02/2017 M.A.Staff Time 5.00 144.20 144.20 Kimberly Pride 11/02/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 11/03/2017 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 11/03/2017 Health Coach Staff Time 7.00 461.44 461.44 Marissa Grant 11/03/2017 R.N.Staff Time 5.50 351.23 351.23 Stacey Neese 11/03/2017 M.A.Staff Time 6.25 180.25 180.25 Amber Helton 11/03/2017 M.A.Staff Time 6.00 173.04 173.04 Kimberly Pride 11/03/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/06/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 11/06/2017 Health Coach Staff Time 7.00 461.44 461.44 Marissa Grant 11/06/2017 R.N.Staff Time 9.75 622.64 622.64 Stacey Neese 11/06/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride Invoice# 760485(continued)page 2 Service Date Description Quanti Charge Recelp Adjust Balance 11/06/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/07/2017 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 11/07/2017 R.N.Staff Time 9.25 590.71 590.71 Stacey Neese 11/07/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 11/07/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/08/2017 N.P.Staff Time 9.00 1,044.54 1044.54 Tina Nitsos 11/08/2017 R.N.Staff Time 9.75 622.64 622.64 Stacey Neese 11/08/2017 M.A.Staff Time 8.25 237.93 237.93 Mindy Ortiz 11/09/2017 R.N.Staff Time 4.50 287.37 287.37 Stacey Neese 11/09/2017 M.A.Staff Time 4.50 12.9.78 129.78 Kimberly Pride 11/09/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 11/10/2017 Health Coach Staff Time 5.00 329.60 329.60 Marissa Grant 11/13/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/13/2017 N.P.Staff Time 4.75 551.29 551.29 Tina Nitsos 11/13/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 11/13/2017 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 11/14/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/14/2017 N.P.Staff Time 5.00 580.30 580.30 Dayna Wilson 11/14/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 11/14/2017 R.N.Staff Time 10.25 654.57 654.57 Stacey Neese 11/15/2017 N.P.Staff Time 9.25 1,073.56 1073.56 Tina Nitsos 11/15/2017 M.A.Staff Time 9.00 259.56 259.56 Kimberly Pride 11/15/2017 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 11/16/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan Invoice# 760485(continued)page 3 Service Date Description Quanti Charge Recei Ad"Us Balance 11/16/2017 M.A.Staff Time 5.00 144.20 144.20 Kimberly Pride 11/16/2017 R.N.Staff Time 4.50 287.37 287.37 Stacey Neese 11/17/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/17/2017 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 11/17/2017 M.A.Staff Time 6.25 180.25 180.25 Kimberly Pride 11/17/2017 R.N.Staff Time 6.25 399.13 399.13 Stacey Neese 11/17/2017 M.A.Staff Time 6.00 173.04 173.04 Amber Helton 11/20/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/20/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 11/20/2017 M.A.Staff Time 9.25 266.77 266.77 Kimberly Pride 11/20/2017 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 11/21/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/21/2017 N.P.Staff Time 4.25 493.26 493.26 Tina Nitsos 11/21/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 11/21/2017 R.N.Staff Time 10.50 670.53 670.53 Stacey Neese 11/22/2017 N.P.Staff Time 9.25 1,073.56 1073.56 Tina Nitsos 11/22/2017 M.A.Staff Time 7.00 201.88 201.88 Kimberly Pride 11/22/2017 R.N.Staff Time 9.00 574.74 574.74 Stacey Neese 11/27/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/27/2017 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 11/27/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 11/27/2017 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 11/28/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 11/28/2017 N.P.Staff Time 5.00 580.30 580.30 Tina Nitsos Invoice# 760485(continued)page 4 Service Date Description Quant! Charge Recelp Adjust Balance 11/28/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 11/28/2017 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 11/29/2017 N.P.Staff Time 9.25 1,073.56 1073.56 Tina Nitsos 11/29/2017 M.A.Staff Time 9.00 259.56 259.56 Kimberly Pride 11/29/2017 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 11/30/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 11/30/2017 M.A.Staff Time 4.50 129.78 129.78 Kimberly Pride 11/30/2017 R.N.Staff Time 4.50 287.37 287.37 Stacey Neese CITYCARO Invoice# 760485 Balance Due: 38741.85 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK it n e Su bmilt ei DEC 4 4 2017 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL 2046 RELIABLE PKWY An invoice or bill to be properly 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 $118.00 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 760478 43-588.00 $118.00 1 hereby certify that the attached invoice(s),or 11/30/17 760478 $118.00 1201 101 1201 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Tuesday, December 05, 2017 Lamb, Barbara Director I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer s� Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax I D# 20-0994452 S u b 3.vl'-6 ` DEC 0 4 2017 Invoice November 30, 2017 Clerk Treasurer Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Occupational UDS/Nov.2017 1 Civic Square Carmel,IN 46032- Invoice# 760478 Service Date Description Quanti Charge R cei Aau-sl Balance 11/29/2017 Quick Read UDS/6panel 118.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ 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 $929.45 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 760803 43-475.00 $929.45 1 hereby certify that the attached invoice(s),or 11/30/17 760803 EAP Services $929.45 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, December 05,2017 A4--Ocl��o Crider,James Administration 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 2v 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/Nov.2017 1 Civic Square Carmel,IN 46032- Invoice# 760803 Service Date Description Quanti Charge Receip Ad'us Balance 11/01/2017 EAP Services 641.00 929.45 929.45 CITYCARO Invoice# 760803 Balance Due: 929.45 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Subm-Rted To DEC 0 4 2017