180967 12/30/2009 f o. CITY OF CARMEL, INDIANA VENDOR: 354957 Page 1 of 1
ONE CIVIC SQUARE SPECTRUM HEALTH SYSTEMS CHECK AMOUNT: $400.00
CARMEL, INDIANA 46032 3535 E 96TH ST SUITE 114
I NDIANAPOLIS IN 46240 CHECK NUMBER: 180967
CHECK DATE: 12!30!2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4341980 2892 242.69 WELLNESS PROGRAM
1201 4341980 19344 2892 157.31 WELLNESS PROGRAM
r
Spectrum Health Systems, LLC Invoice
provider of the Express Health Program
3535 East 96th Street Suite 114 Date invoice
Indianapolis, IN 46240 Al 9 W° 12/14/2009 2892
Bill To
City of Cannel
Barbara Lamb
One Civic Square
Carmel, IN 46032
P.O. No. Terms Project
Upon Receipt
Quantity Description Rate Amount
4 Target Gift Card Incentive 100.00 400.00
Happy Holidays!
Total $400.00
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Spectrum Health Systems, LLC
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/14/09 2892 Target Gift Card Incentives $400.00
Total $400.00
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
Clerk Treasurer
,VOUCHER NO12/28109 WARRANT NO.
ALLOWED 20
Spectrum Health Systems, LLC IN SUM OF
3535 East 96th Street Suite 114
Indianapolis, IN 46240
$400.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
iz ..l Human Resources
Board Members
D PT INVOICE NO. ACCT #/TITLE AMOUNT 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
te.c)1 2892 419 80 $242.69 materials or services itemized thereon for
19344 2892 41q $157.31 which charge is made were ordered and
(Partial) received except
20
Sig .ture
r 1
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund