333958 01/04/19 CITY OF CARMEL, INDIANA VENDOR: 367222
(9)
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: S****67,584.99*
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 333958
CHICAGO IL 60686-0020 CHECK DATE: 01/04/19
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 764477 1,227.95 OTHER EXPENSES
301 5023990 764514 39,562.10 OTHER EXPENSES
301 5023990 764550 26,111.40 OTHER EXPENSES
301 5023990 764577 683.54 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Hoard 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
$67,584.99
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
764514 50-239.90 $39,562.10 I hereby certify that the attached invoice(s),or 12/31/18 764514 Onsite Staff Time Dec 2018 $39,562.10
301 301 Prior Year 301 301
764477 50-239.90 $1,227.95 bill(s)is(are)true and correct and that the 12/31/18 764477 Onsite PEPM Dec 2018 $1,227.95
301 301 1 Prior Year materials or services itemized thereon for 301 301
764550 50-239.90 $26,111.40 12/31/18 764550 Onsite Misc Dec 2018 $26,111.40
301 301 Prior Year which charge is made were ordered and 301 301
764577 50-239.90 $683.54 received except 12/31/18 764577 Onsite Billing Dec 2018 $683.54
301 301 Prior Year 301 301
Thursday,January 3,2019
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
December 31, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Staff Time/Dec.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 764514
Service Date Description Quanti Charge Recei AW-umsi Balance
12/03/2018 M.A.Staff Time 9.97 287.53 287.53
Elizabeth Herald
12/03/2018 MD Staff Time 5.00 901.25 901.25
Dr.Moody
12/03/2018 N.P.Staff Time 5.00 580.30 580.30
Tina Nitsos
12/03/2018 R.N.Staff Time 9.75 622.64 622.64
Stacey Neese
12/03/2018 Health Coach Staff Time 7.00 461.44 461.44
Kristin Hullett
12/04/2018 M.A.Staff Time 10.27 296.19 296.19
Elizabeth Herald
12/04/2018 MD Staff Time 5.00 901.25 901.25
Dr.Moody
12/04/2018 N.P.Staff Time 5.75 667.35 667.35
Tina Nitsos
12/04/2018 R.N.Staff Time 9.75 622.64 622.64
Stacey Neese
12/04/2018 Health Coach Staff Time 1.50 98.88 98.88
Kristin Hullett
12/05/2018 M.A.Staff Time 9.95 286.96 286.96
Elizabeth Herald
12/05/2018 M.A.Staff Time 5.00 144.20 144.20
Amy Warner
12/05/2018 MD Staff Time 5.00 901.25 901.25
Dr.Moody
12/05/2018 N.P.Staff Time 9.50 1,102.57 1102.57
Tina Nitsos
12/05/2018 R.N.Staff Time 9.50 606.67 606.67
Stacey Neese
12/06/2018 M.A.Staff Time 5.70 164.39 164.39
Elizabeth Herald
Invoice# 764514(continued)page 2
Service Date Description Quanti Charge Recei Ad'us Balance
12/06/2018 MD Staff Time 4.00 721.00 721.00
Dr.Moody
12/06/2018 R.N.Staff Time 4.75 303.34 303.34
Stacey Neese
12/07/2018 M.A.Staff Time 5.40 155.74 155.74
Elizabeth Herald
12/07/2018 N.P.Staff Time 6.00 696.36 696.36
Tina Nitsos
12/07/2018 R.N.Staff Time 5.75 367.20 367.20
Stacey Neese
12/07/2018 Health Coach Staff Time 3.50 230.72 230.72
Kristin Hullett
12/10/2018 R.N.Staff Time 9.50 606.67 606.67
Stacey Neese
12/10/2018 MD Staff Time 5.00 901.25 901.25
Dr.Moody
12/10/2018 N.P.Staff Time 4.50 522.27 522.27
Tina Nitsos
12/10/2018 Health Coach Staff Time 7.00 461.44 461.44
Kristin Hullett
12/10/2018 M.A.Staff Time 8.97 258.69 258.69
Elizabeth Herald
12/11/2018 R.N.Staff Time 9.75 622.64 622.64
Stacey Neese
12/11/2018 MD Staff Time 5.00 901.25 901.25
Dr.Moody
12/11/2018 N.P.Staff Time 6.00 696.36 696.36
Tina Nitsos
12/11/2018 M.A.Staff Time 9.10 262.44 262.44
Elizabeth Herald
12/12/2018 R.N.Staff Time 10.00 638.60 638.60
Stacey Neese
12/12/2018 MD Staff Time 5.00 901.25 901.25
Dr.Moody
12/12/2018 N.P.Staff Time 9.50 1,102.57 1102.57
Tina Nitsos
12/12/2018 M.A.Staff Time 5.20 149.97 149.97
Marleah Money
12/12/2018 M.A.Staff Time 9.70 279.75 279.75
Elizabeth Herald
12/13/2018 M.A.Staff Time 4.60 132.66 132.66
Elizabeth Herald
12/13/2018 R.N.Staff Time 4.75 303.34 303.34
Stacey Neese
12/13/2018 MD Staff Time 4.00 721.00 721.00
Dr.Moody
12/14/2018 M.A.Staff Time 6.00 173.04 173.04
Elizabeth Herald
Invoice# 764514(continued)page 3
Service Date Description Quanti Charge Receipt Adjust Balance
12/14/2018 R.N.Staff Time 7.50 478.95 478.95
Stacey Neese
12/14/2018 N.P.Staff Time 6.00 696.36 696.36
Tina Nitsos
12/14/2018 Health Coach Staff Time 5.00 329.60 329.60
Kristin Hullett
12/17/2018 M.A.Staff Time 9.18 264.75 264.75
Elizabeth Herald
12/17/2018 R.N.Staff Time 9.75 622.64 622.64
Stacey Neese
12/17/2018 N.P.Staff Time 4.50 522.27 522.27
Tina Nitsos
12/17/2018 Health Coach Staff Time 7.00 461.44 461.44
Kristin Hullett
12/17/2018 N.P.Staff Time 5.00 580.30 580.30
Michelle Bowen
12/18/2018 M.A.Staff Time 9.18 264.75 264.75
Elizabeth Herald
12/18/2018 R.N.Staff Time 10.25 654.57 654.57
Stacey Neese
12/18/2018 N.P.Staff Time 10.00 1,160.60 1160.60
Tina Nitsos
12/19/2018 M.A.Staff Time 5.40 155.74 155.74
Marleah Money
12/19/2018 M.A.Staff Time 9.30 268.21 268.21
Elizabeth Herald
12/19/2018 R.N.Staff Time 10.00 638.60 638.60
Stacey Neese
12/19/2018 N.P.Staff Time 9.50 1,102.57 1102.57
Tina Nitsos
12/19/2018 MD Staff Time 5.00 901.25 901.25
Dr.Sampson
12/20/2018 M.A.Staff Time 4.30 124.01 124.01
Elizabeth Herald
12/20/2018 R.N.Staff Time 4.75 303.34 303.34
Stacey Neese
12/20/2018 N.P.Staff Time 4.00 464.24 464.24
Michelle Bowen
12/21/2018 M.A.Staff Time 5.60 161.50 161.50
Elizabeth Herald
12/21/2018 R.N.Staff Time 5.50 351.23 351.23
Stacey Neese
12/21/2018 N.P.Staff Time 6.00 696.36 696.36
Tina Nitsos
12/26/2018 M.A.Staff Time 4.75 136.99 136.99
Bonita Richardson
12/26/2018 M.A.Staff Time 9.80 282.63 282.63
Elizabeth Herald
Invoice# 764514(continued)page 4
Service Date Description Quanti Charge R cei Ad"Us Balance
12/26/2018 R.N.Staff Time 9.50 606.67 606.67
Stacey Neese
12/26/2018 N.P.Staff Time 9.50 1,102.57 1102.57
Tina Nitsos
12/26/2018 MD Staff Time 5.00 901.25 901.25
Dr.Sampson
12/27/2018 M.A.Staff Time 4.80 138.43 138.43
Elizabeth Herald
12/27/2018 N.P.Staff Time 4.00 464.24 464.24
Michelle Bowen
12/27/2018 R.N.Staff Time 4.75 303.34 303.34
Stacey Neese
12/28/2018 M.A.Staff Time 6.10 175.92 175.92
Elizabeth Herald
12/28/2018 R.N.Staff Time 5.75 367.20 367.20
Stacey Neese
12/28/2018 N.P.Staff Time 6.00 696.36 696.36
Tina Nitsos
12/28/2018 Health Coach Staff Time 5.00 329.60 329.60
Kristin Hullett
12/31/2018 M.A.Staff Time 10.40 299.94 299.94
Elizabeth Herald
12/31/2018 R.N.Staff Time 6.40 408.70 408.70
Katherine Kelly
12/31/2018 N.P.Staff Time 8.00 928.48 928.48
Tina Nitsos
12/31/2018 Health Coach Staff Time 7.00 461.44 461.44
Kristin Hullett
CITYCARO Invoice# 764514 Balance Due: 39562.10
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
JAN 0 3 2019
Clerk Treasurer
Indiana University Health Workplace Services,LLC
714 N.Senate Avenue
Suite 200 1
Indianapolis, IN 46202
317-963-1535
Tax ID# 20-0994452
Invoice
December 31, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite PEPM/Dec.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 764477
Service Date Description Quant! Charge Receip Ad'us Balance
12/01/2018 Monthly Wellness PEPM 599.00 1,227.95 1227.95
CITYCARO Invoice# 764477 Balance Due: 1227.95
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
JAN 0 8 2019
Clerk Treasurer
Indiana University Health Workplace Services, LLC 311)
714 N.Senate Avenue
Suite 200
Indianapolis, IN 46202
317-963-1535
Tax I D# 20-0994452
Invoice
December 31, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Misc.Onsite/Dec.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 764550
Service Date DescriptionQuant! Charae Receip AdLust Balance
- 11/01/2018 Onsite Lab Charges 1.00 4,475.72 4475.72
November 2018 Labs
11/06/2018 Miscellaneous Charge 1.00 276.40 276.40
Locksmith Fee-Re-Keyed Locks
11/19/2018 AS Medical Solutions Clinic Meds 1.00 527.68 527.68
11/27/2018 AS Medical Solutions Clinic Meds 1.00 1,281.18 1281.18
12/01/2018 Utility Expenses 1.00 725.46 725.46
12/01/2018 Building Expenses 1.00 1,086.87 1086.87
12/01/2018 Lease Expense 1.00 4,316.05 4316.05
12/01/2018 Enhanced Care-Urgent Care Visits 1.00 5,157.78 5157.78
40 visits
12/05/2018 AS Medical Solutions Clinic Meds 1.00 105.88 105.88
12/06/2018 AS Medical Solutions Mail-In Meds 1.00 6,436.34 6436.34
12/11/2018 AS Medical Solutions Clinic Meds 1.00 1,616.56 1616.56
12/14/2018 AS Medical Solutions Clinic Meds 1.00 74.52 74.52
12/17/2018 AS Medical Solutions Clinic Meds 1.00 30.96 30.96
CITYCARO Invoice# 764550 Balance Due: 26111.40
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
JAN 0 3 2019
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
December 31, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite On-Site Billing/Dec.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 764577
Service Date Description Quanti Charae Receip Ad'us Balance
12/01/2018 Onsite Facility Operations 1.00 423.00 423.00
December 2018 Facility Services
12/01/2018 Onsite Operating Supplies 1.00 260.54 260.54
December 2018 Supplies
CITYCARO Invoice# 764577 Balance Due: 683.54
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
JAN 0 3 2019
Clerk Treasurer
A _ Cut and return with payment