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Home My WebLink About322495 03/05/18 i Cqy CITY OF CARMEL, INDIANA VENDOR: 367222 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $****67,218.72* CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 322495 CHICAGO IL 60686-0020 CHECK DATE: 03/05/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 761801 21,596.28 OTHER EXPENSES 301 5023990 761802 43,433.88 OTHER EXPENSES 301 5023990 761841 1,258.70 OTHER EXPENSES 301 5023990 761928 120.00 OTHER EXPENSES 301 5023990 762281 809.86 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER ILI HEALTH WORKPLACE SERVICES LLC IN SUM OF$ 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 $67,218.72 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 761802 50-239.90 $43,433.88 1 hereby certify that the attached invoice(s),or 2/28/18 761802 Feb Onsite Staff Time $43,433.88 301 301 301 301 761928 50-239.90 $120.00 bill(s)is(are)true and correct and that the 2/28/18 761928 Feb Onsite Wellness UDS $120.00 301 1 1 301 1 materials or services itemized thereon for 301 301 762281 50-239.90 $809.86 2/28/18 762281 Feb Onsite Billing $809.86 301 301 which charge is made were ordered and 301 301 761841 50-239.90 $1,258.70 received except 2/28/18 761841 Feb Onsite PEPM $1,258.70 301 301 301 301 761801 50-239.90 $21,596.28 2/28/18 761801 Feb Onsite Misc $21,596.28 301 301 301 301 Monday, March 05,2018 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 Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice February 28, 2018 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Feb.2018 1 Civic Square Carmel,IN 46032- Invoice# 761802 Service Date Descriptio Quanti Charae Recei A 'us Balance 02/01/2018 RN.Staff Time 4.75 303.34 303.34 Stacey Neese 02/01/2018 M.A.Staff Time 4.86 140.16 140.16 Kimberly Pride 02/01/2018 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 02/02/2018 M.A.Staff Time 7.60 219.18 219.18 Amber Helton 02/02/2018 R.N.Staff Time 5.75 367.20 367.20 Stacey Neese 02/02/2018 Health Coach Staff Time 5.00 329.60 329.60 Kristin Hullett 02/02/2018 M.A.Staff Time 5.80 167.27 167.27 Kimberly Pride 02/02/2018 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 02/02/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/05/2018 N.P.Staff Time 4.75 551.29 551.29 Tina Nitsos 02/05/2018 Health Coach Staff Time 7.00 461.44 461.44 Kristin Hullett 02/05/2018 R.N. Staff Time 10.00 638.60 638.60 Stacey Neese 02/05/2018 M.A.Staff Time 8.97 258.69 258.69 Kimberly Pride 02/05/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/06/2018 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 02/06/2018 R.N.Staff Time 8.50 542.81 542.81 Stacey Neese Invoice# 761802(continued)page 2 M Service Date Descriptio Quanti Char a Recei Ad"US Balance 02/06/2018 M.A.Staff Time 8.70 250.91 250.91 Kimberly Pride 02/06/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/07/2018 N.P.Staff Time 9.50 1,102.57 1102.57 Tina Nitsos 02/07/2018 R.N.Staff Time 9.50 606.67 606.67 Stacey Neese 02/07/2018 M.A.Staff Time 9.10 262.44 262.44 Kimberly Pride 02/08/2018 Health Coach Staff Time 1.50 98.88 98.88 Kristin Hullett 02/08/2018 R.N.Staff Time 5.50 351.23 351.23 Stacey Neese 02/08/2018 MD Staff Time 4.00 721.00 721.00 Pamela Pilcher 02/08/2018 M.A.Staff Time 4.90 141.32 141.32 Kimberly Pride 02/09/2018 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 02/09/2018 Health Coach Staff Time 3.50 230.72 230.72 Kristin Hullett 02/09/2018 R.N.Staff Time 5.25 335.27 335.27 Stacey Neese 02/09/2018 M.A.Staff Time 5.60 161.50 161.50 Amber Helton 02/09/2018 MD Staff Time 5.00 901.25 901.25 Pamela Pilcher 02/09/2018 M.A.Staff Time 5.20 149.97 149.97 Kimberly Pride 02/12/2018 N.P.Staff Time 5.25 609.32 609.32 Holly Barna 02/12/2018 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 02/12/2018 Health Coach Staff Time 7.00 461.44 461.44 Kristin Hullett 02/12/2018 R.N.Staff Time 11.25 718.43 718.43 Stacey Neese 02/12/2018 M.A.Staff Time 8.88 256.10 256.10 Kimberly Pride 02/13/2018 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 02/13/2018 R.N.Staff Time 10.25 654.57 654.57 Stacey Neese 02/13/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/13/2018 M.A.Staff Time 9.27 267.35 267.35 Kimberly Pride Invoice# 761802(continued)page 3 Service Date Description Quanti Charae Recei Ad'us Balance 02/14/2018 N.P.Staff Time 5.00 580.30 580.30 Pamela Pilcher 02/14/2018 N.P.Staff Time 4.25 493.26 493.26 Tina Nitsos 02/14/2018 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 02/14/2018 M.A.Staff Time 8.85 255.23 255.23 Kimberly Pride 02/15/2018 R.N.Staff Time 5.00 319.30 319.30 Stacey Neese 02/15/2018 M.A.Staff Time 5.20 149.97 149.97 Kimberly Pride 02/15/2018 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 02/16/2018 N.P.Staff Time 6.25 725.38 725.38 Tina Nitsos 02/16/2018 Health Coach Staff Time 5.00 329.60 329.60 Kristin Hullett 02/16/2018 R.N.Staff Time 6.75 431.06 431.06 Stacey Neese 02/16/2018 M.A.Staff Time 5.50 158.62 158.62 Amber Helton 02/16/2018 M.A.Staff Time 5.50 158.62 158.62 Sherry Axline 02/16/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/19/2018 Health Coach Staff Time 7.00 461.44 461.44 Kristin Hullett 02/19/2018 M.A.Staff Time 8.25 237.93 237.93 Morgan Majors 02/19/2018 R.N.Staff Time 10.00 638.60 638.60 Stacey Neese 02/19/2018 N.P.Staff Time 4.75 551.29 551.29 Tina Nitsos 02/19/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/20/2018 M.A.Staff Time 9.25 266.77 266.77 Mindy Ortiz 02/20/2018 R.N.Staff Time 8.50 542.81 542.81 Stacey Neese 02/20/2018 N.P.Staff Time 5.50 638.33 638.33 Tina Nitsos 02/20/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/21/2018 R.N. Staff Time 9.50 606.67 606.67 Stacey Neese 02/21/2018 N.P.Staff Time 9.50 1,102.57 1102.57 Tina Nitsos Invoice# 761802(continued)page 4 Service Date Descrii)tio Quanti Charae Receip Balance 02/21/2018 M.A.Staff Time 7.82 225.53 225.53 Kimberly Pride 02/22/2018 R.N.Staff Time 5.50 351.23 351.23 Stacey Neese 02/22/2018 MD Staff Time 4.00 721.00 721.00 Dr.Fagan 02/22/2018 M.A.Staff Time 4.60 132.66 132.66 Kimberly Pride 02/23/2018 M.A.Staff Time 5.25 151.41 151.41 Jenny Broome 02/23/2018 Health Coach Staff Time 5.00 329.60 329.60 Kristin Hullett 02/23/2018 RN.Staff Time 5.25 335.27 335.27 Stacey Neese 02/23/2018 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 02/23/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/23/2018 M.A.Staff Time 4.30 124.01 124.01 Kimberly Pride 02/26/2018 M.A.Staff Time 6.53 188.33 188.33 Kimberly Pride 02/26/2018 Health Coach Staff Time 7.00 461.44 461.44 Kristin Hullett 02/26/2018 R.N.Staff Time 11.25 718.43 718.43 Stacey Neese 02/26/2018 N.P.Staff Time 4.50 522.27 522.27 Tina Nitsos 02/26/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/27/2018 RN.Staff Time 4.00 255.44 255.44 Jenny Broome 02/27/2018 R.N.Staff Time 3.80 242.67 242.67 Stacey Neese 02/27/2018 M.A.Staff Time 8.50 245.14 245.14 Kimberly Pride 02/27/2018 N.P.Staff Time 5.75 667.35 667.35 Tina Nitsos 02/27/2018 MD Staff Time 5.00 901.25 901.25 Dr.Fagan 02/28/2018 R.N.Staff Time 9.50 606.67 606.67 Stacey Neese 02/28/2018 M.A.Staff Time 7.68 221.49 221.49 Kimberly Pride 02/28/2018 N.P.Staff Time 9.50 1,102.57 1102.57 Tina Nitsos Invoice# 761802(continued)page 5 Service Date Descriptio Quanti Charge Receip Ad'us Balance CITYCARO Invoice# 761802 Balance Due: 43433.88 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK MAR 0 5 2018 -Cut and velum with payment --------------------------------------------------------------------------------------------------------------------------------- or, Please remit 43,433.88 and Make Check Payable to: ❑H F, VISA INVOICE# 761802 1U 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 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice February 28, 2018 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Wellness UDS/Feb.2018 1 Civic Square Carmel,IN 46032- Invoice# 761928 Service Date Description Quanti Charae Receipt Ad'us Balance 01/02/2018 Quick Read UDS/ 15.00 kit Invoice# 761928 (continued)page 2 Service Date Description 120.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK ,f PEAR 0 5 2018 Cgni r F yr T cT surer -Cut and return with payment � Please remit 120.00 and Make Check Payable to: ❑ rJ VISA IU Health Workplace Services,LLC INVOICE# 761928 ❑ 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 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice February 28, 2018 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite On-Site Billing/Feb.2018 1 Civic Square Carmel,IN 46032- Invoice# 762281 Service Date Description Quanti Charge Recei Adjust Balance 02/01/2018 Onsite Facility Operations 1.00 68.00 68.00 February 2018 Facility Services 02/01/2018 Onsite Operating Supplies 1.00 741.86 741.86 February 2018 Supplies CITYCARO Invoice# 762281 Balance Due: 809.86 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK l PEAR 0 5 2018 �11 ss-Cut and return with payment � Please remit 809.86 and Make Check Payable to: ❑ VISA INVOICE# 762281 I[T 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 714 N.Senate Avenue Suite 200 3Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice February 28, 2018 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite PEPM/Feb.2018 1 Civic Square Carmel,IN 46032- Invoice# 761841 Service Date Descriptio Quantity Charge Receip Adius-1 Balance 02/01/2018 Monthly Wellness PEPM 614.00 1,258.70 1258.70 CITYCARO Invoice# 761841 Balance Due: 1258.70 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK ,_ r ubm. ed Ta MAR 0 5 2018 Clerk, Treasurer Ell -Cut and return with payment ------------------------------------------------------------------------------------------------------------------------------- � Please remit 1,258.70 and Make Check Payable to: ❑ VISA IIJ Health Workplace Services,LLC INVOICE# 761841 ❑ Nn 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 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice February 28, 2018 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/Feb.2018 1 Civic Square Carmel,IN 46032- Invoice# 761801 Service Date Descriptio Quanti Charge Receip A 'us Balance 12/01/2017 Onsite Lab Charges 1.00 -48.97 -48.97 Credit From December 2017 Labs 01/01/2018 Onsite Lab Charges 1.00 2,456.40 2456.40 January 2018 Labs 01/22/2018 AS Medical Solutions Clinic Meds 1.00 1,054.50 1054.50 01/25/2018 AS Medical Solutions Clinic Meds 1.00 397.75 397.75 01/26/2018 AS Medical Solutions Clinic Meds 1.00 31.86 31.86 01/29/2018 AS Medical Solutions Mail-In Meds 1.00 7,364.37 7364.37 01/31/2018 AS Medical Solutions Mail-In Meds 1.00 -1,074.24 -1074.24 01/31/2018 AS Medical Solutions Clinic Meds 1.00 1,155.97 1155.97 01/31/2018 Video Visit 1.00 49.00 49.00 Janaury 2018 Video Visits 02/01/2018 Utility Expenses 1.00 809.63 809.63 02/01/2018 Lease Expense 1.00 4,316.05. 4316.05 02/01/2018 Building Expenses 1.00 1,086.87 1086.87 02/02/2018 AS Medical Solutions Clinic Meds 1.00 18.60 18.60 02/06/2018 AS Medical Solutions Clinic Meds 1.00 782.46 782.46 02/12/2018 AS Medical Solutions Clinic Meds 1.00 842.00 842.00 02/14/2018 AS Medical Solutions Clinic Meds 1.00 951.31 951.31 02/15/2018 AS Medical Solutions Mail-In Meds 1.00 994.07 994.07 02/16/2018 AS Medical Solutions Clinic Meds 1.00 345.78 345.78 02/28/2018 AS Medical Solutions Clinic Meds 1.00 62.87 62.87 CITYCARO Invoice# 761801 Balance Due: 21596.28 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS O' INVOICE DATE-PLEASE INCIJDE INVOICE#ON CHECK S ubm " ed To h MAR 0 5 2018 Iei- ,rea.- e e r