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Home My WebLink About320633 01/11/18 CITY OF CARMEL, INDIANA VENDOR: 367222 ® ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $"`*63,567.00' f ?� CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 320633 9i,roN�o` CHICAGO IL 60686-0020 CHECK DATE: 01/11/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 760870 75.00 OTHER EXPENSES 301 5023990 760964 37,639.98 OTHER EXPENSES 301 5023990 761105 1,254.60 OTHER EXPENSES -301 5023990 761106 4,374.16 OTHER EXPENSES 301 5023990 761173 18,478.44 OTHER EXPENSES 301 5023990 761230 1,744.82 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ 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 $63,567.00 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 760870 50-239.90 $75.00 1 hereby certify that the attached invoice(s),or 12/31/17 760870 Dec 2017 Onsite Wellness UDS $75.00 301 301 Prior Year 301 301 760964 50-239.90 $37,639.98 bill(s)is(are)true and correct and that the 12/31/17 760964 Dec 2017 Onsite Staff Time $37,639.98 301 301 Prior Year materials or services itemized thereon for 301 1 301 761105 50-239.90 $1,254.60 12/31/17 761105 Dec 2017 Onsite PEPM $1,254.60 301 301 Prior Year which charge is made were ordered and 301 301 761106 50-239.90 $4,374.16 received except 12/31/17 761106 Dec 2017 Onsite Fee $4,374.16 301 301 Prior Year 301 301 761173 50-239.90 $18,478.44 12/31/17 761173 Dec 2017 Onsite Misc $18,478.44 301 301 Prior Year 301 301 761230 50-239.90 $1,744.82 12/31/17 761230 Dec 2017 Onsite Supply $1,744.82 301 301 Prior Year 301 301 Tuesday,January 09,2018 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 3o) Indiana University Health Workplace Services,LLC �— 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Wellness UDS/Dec.2017 1 Civic Square Carmel,IN 46032- Invoice# 760870 Service Date Description Quanti Charge Receipt Ad'us Balance 12/04/2017 Quick Read UDS/6panel includes 75.00 JAN 11 Z018 Indiana University Health Workplace Services,LLC Jl 714 N.Senate Avenue �^ Suite 200 Indianapolis, IN 46202 317-963-1535 Tax I D# 20-0994452 Invoice December 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Dec.2017 1 Civic Square Carmel,IN 46032- Invoice# 760964 Service Date Description Quant! Charae Recelp Ad'us Balance 12/01/2017 M.A.Staff Time 5.25 151.41 151.41 Mindy Ortiz 12/01/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/01/2017 Health Coach Staff Time 2.50 164.80 164.80 Jenna McClean 12/01/2017 N.P.Staff Time 6.50 754.39 754.39 Tina Nitsos 12/01/2017 R.N.Staff Time 4.00 255.44 255.44 Stacey Neese 12/01/2017 M.A.Staff Time 6.25 180.25 180.25 Kimberly Pride 12/04/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/04/2017 N.P.Staff Time 4.75 551.29 551.29 Tina Nitsos 12/04/2017 R.N.Staff Time 9.75 622.64 622.64 Stacey Neese 12/04/2017 M.A.Staff Time 9.00 259.56 259.56 Kimberly Pride 12/05/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/05/2017 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 12/05/2017 R.N.Staff Time 10.50 670.53 670.53 Stacey Neese 12/05/2017 M.A.Staff Time 10.00 288.40 288.40 Kimberly Pride 12/06/2017 N.P.Staff Time 9.25 1,073.56 1073.56 Tina Nitsos 12/06/2017 R.N.Staff Time 9.50 606.67 606.67 Stacey Neese Invoice# 760964(continued)page 2 Service Date Descri tion Quant! Charae Recei Adjust Balance 12/06/2017 M.A.Staff Time 8.50 245.14 245.14 Kimberly Pride 12/07/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 12/07/2017 R.N.Staff Time 4.25 271.41 271.41 Stacey Neese 12/07/2017 M.A.Staff Time 5.00 144.20 144.20 Kimberly Pride 12/08/2017 M.A.Staff Time 6.00 173.04 173.04 Amber Helton 12/08/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/08/2017 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 12/08/2017 R.N.Staff Time 6.00 383.16 383.16 Stacey Neese 12/08/2017 M.A.Staff Time 5.75 165.83 165.83 Kimberly Pride 12/11/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/11/2017 R.N.Staff Time 11.00 702.46 702.46 Stacey Neese 12/11/2017 M.A.Staff Time 7.75 223.51 223.51 Kimberly Pride 12/11/2017 N.P.Staff Time 4.75 551.29 551.29 Tina Nitsos 12/12/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/12/2017 R.N.Staff Time 11.25 718.43 718.43 Stacey Neese 12/12/2017 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 12/12/2017 M.A.Staff Time 3.25 93.73 93.73 Karol Magyar 12/13/2017 R.N.Staff Time 9.00 574.74 574.74 Stacey Neese 12/13/2017 N.P.Staff Time 9.25 1,073.56 1073.56 Tina Nitsos 12/13/2017 M.A.Staff Time 7.50 216.30 216.30 Mindy Ortiz 12/14/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 12/14/2017 R.N.Staff Time 4.50 287.37 287.37 Stacey Neese 12/14/2017 M.A.Staff Time 3.50 100.94 100.94 Kimberly Pride 12/15/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan Invoice# 760964(continued)page 3 Service Date Description Quanti Charge Re i AW-U-SI Balance 12/15/2017 R.N.Staff Time 5.75 367.20 367.20 Stacey Neese 12/15/2017 M.A.Staff Time 5.75 165.83 165.83 Kimberly Pride 12/15/2017 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 12/15/2017 Health Coach Staff Time 1.00 65.92 65.92 Jenna McClean 12/15/2017 M.A.Staff Time 5.25 151.41 151.41 Karol Magyar 12/18/2017 R.N.Staff Time 9.75 622.64 622.64 Stacey Neese 12/18/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 12/18/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/18/2017 N.P.Staff Time 4.75 551.29 551.29 Tina Nitsos 12/19/2017 R.N.Staff Time 10.50 670.53 670.53 Stacey Neese 12/19/2017 M.A.Staff Time 8.50 245.14 245.14 Kimberly Pride 12/19/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/19/2017 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 12/20/2017 R.N.Staff Time 9.50 606.67 606.67 Stacey Neese 12/20/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 12/20/2017 N.P.Staff Time 9.25 1,073.56 1073.56 Tina Nitsos 12/21/2017 M.A.Staff Time 5.25 151.41 151.41 Kimberly Pride 12/21/2017 M.A.Staff Time 5.25 151.41 151.41 Amber Helton 12/21/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 12/22/2017 R.N.Staff Time 6.00 383.16 383.16 Stacey Neese 12/22/2017 M.A.Staff Time 5.75 165.83 165.83 Kimberly Pride 12/22/2017 M.A.Staff Time 5.75 165.83 165.83 Amber Helton 12/22/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 12/22/2017 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos Invoice# 760964(continued)page 4 Service Date Description Quanti Charge Recelp Ad"Us Balance 12/27/2017 N.P.Staff Time 9.25 1,073.56 1073.56 Tina Nitsos 12/27/2017 M.A.Staff Time 8.75 252.35 252.35 Kimberly Pride 12/27/2017 R.N.Staff Time 9.50 606.67 606.67 Stacey Neese 12/28/2017 M.A.Staff Time 5.00 144.20 144.20 Kathleen Visker 12/28/2017 M.A.Staff Time 4.75 136.99 136.99 Kimberly Pride 12/28/2017 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 12/29/2017 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 12/29/2017 M.A.Staff Time 6.00 173.04 173.04 Kathleen Visker 12/29/2017 M.A.Staff Time 5.25 151.41 151.41 Mindy Ortiz 12/29/2017 M.A.Staff Time 6.00 173.04 173.04 Kimberly Pride 12/29/2017 MD Staff Time 5.00 901.25 901.25 Dr.Fagan CITYCARO Invoice# 760964 Balance Due: 37639.98 JAN 11 2018 I Indiana University Health Workplace Services, LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite PEPM/Dec.2017 1 Civic Square Carmel,IN 46032- Invoice# 761105 Service Date Descri tp ion _Quantily Charge Receip Adjust Balance 12/01/2017 Monthly Wellness PEPM 612.00 1,254.60 1254.60 CITYCARO Invoice# 761105 Balance Due: 1254.60 71 JAN 11 2018 Clerk Treasurer 3� Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fee's/Dec.2017 1 Civic Square Carmel,IN 46032- Invoice# 761106 Service Date Description Quantity Charge Recelp Adjust Balance 12/01/2017 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease 12/01/2017 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 761106 Balance Due: 4374.16 Sub,mn't-tee, To JAN 1 1 2018 Indiana University Health Workplace Services, LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/Dec.2017 1 Civic Square Carmel,IN 46032- Invoice# 761173 Service Date Description Quantity Charge Recelp Ad'us Balance 10/12/2017 AS Medical Solutions Clinic Meds 1.00 545.69 545.69 11/01/2017 Onsite Lab Charges 1.00 3,390.13 3390.13 November 2017 Labs 11/16/2017 AS Medical Solutions Clinic Meds 1.00 44.57 44.57 11/20/2017 AS Medical Solutions Clinic Meds 1.00 1,176.55 1176.55 11/21/2017 AS Medical Solutions Mail-In Meds 1.00 7,645.22 7645.22 12/01/2017 AS Medical Solutions Mail-In Meds 1.00 3,545.30 3545.30 12/01/2017 AS Medical Solutions Clinic Meds 1.00 364.56 364.56 12/02/2017 AS Medical Solutions Clinic Meds 1.00 12.14 12.14 12/12/2017 AS Medical Solutions Clinic Meds 1.00 724.08 724.08 12/13/2017 AS Medical Solutions Clinic Meds 1.00 30.90 30.90 12/18/2017 AS Medical Solutions Clinic Meds 1.00 999.30 999.30 CITYCARO Invoice# 761173 Balance Due: 18478.44 STAbru o To JAN 11 2018 F`ea F"Rs 8 3 G E nP q� 3l Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice December 31, 2017 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/Dec.2017 1 Civic Square Carmel,IN 46032- Invoice# 761230 Service Date Description Quant! Charae Recelp Adiu-SA Balance 12/01/2017 Onsite Operating Supplies 1.00 1,744.82 1744.82 December 2017 Supplies CITYCARO Invoice# 761230 Balance Due: 1744.82 JAN 11 2018 Ar Cut and mfurn with navment