189514 08/31/2010 voided CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
s CHECK AMOUNT: $2,845.50
EAP CARMEL, INDIANA 46032
8401 HARCOURT ROAD CHECK NUMBER: 189514
INDIANAPOLIS IN 46260
CHECK DATE: 8/3112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 5- 20376299 2,532.95 GENERAL INSURANCE
1205 R4347500 16049 5- 20376299 312:55 EAP SERVICE
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
08/11/10 5- 20376299 2845.50
*CITY OF CARMEL.
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please enclose top portion with payment
Rate: 1.75 Number of Employees: 542
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL. CHG AMT PAY /ADJ BALANCE
INVOICE 054589551
EMP PROVIDER
07/13/10 JULY 2010 948.50
07/13/10 AUGUST 2010 948.50
07/13/10 SEPTEMBER 2010 948.50
INVOICE BALANCE: 2845.50
D Q
AUG 3 0 2010
By
Account 0 -30 days 31 -60 days 61 -90 days >90 days Balance Due
5- 20376299 2845.50 0.00 0.00 0.00 2845.50
PAGE: 1
ST VINCENT EMPL. ASST. M F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317 338 -4900
INDIANAPOLIS IN 46260
VOUCHER NO. WARRANT NO.
ALLOWED 20
St. Vincent Employee Assistance Program l
N SUM OF
8401 Harcourt Rd
Indianapolis, IN 46260
$2,845.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
J�,oq I 5- 20376299 I 43- 475.00 I $2,845.50 i hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
�J received except
Monday, August 30, 2010
Director, Administrate n
r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Purchase Order No,
Terms
Date Due
Invoice Invoice Description Amount
Date Number n ote attac invoice(s) or bill(s))
08/11/10 5- 20376299 $2,845.50
1 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