191843 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CARMEL, INDIANA 46032 EAP CHECK AMOUNT: $3,064.05
8401 HARCOURT ROAD CHECK NUMBER: 191843
INDIANAPOLIS IN 46260
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 054908625 2,532.95 GENERAL INSURANCE
1205 R4347500 16049 054908625 312.55 EAP SERVICE
1125 4340700 54908387 218.55 MEDICAL FEES
5
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
10/12/10 5- 20376299 2845.50
`)7s a Z�53 �i5
�S
*CITY OF CARMEL.
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
P lease enclose t op portion with payment
Rate: 1.75 Number of Employees: 542
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL. CHG AMT PAY /ADJ BALANCE
INVOICE 054908625
EMP PROVIDER
10 /11 /10 OCTOBER 2010 948.50
10 /11 /10 NOVEMBER 2010 948.50
10/11/10 DECEMBER 2010 948.50
INVOICE BALANCE: 2845.50
LW
NOV 0 8 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
V NO, WARRANT NO,
ALLOWED 20
St. Vincent Employee Assistance Program
IN 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
IZ�s I 054908625 l 43- 475.00 I $2,532.95 1 hereby certify that the attached invoice(s), or
16049 I 054908625 I 43- 475.00 I $312.55 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, November 08, 2010
Director, Admimstr9rion tff2_
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 (or note attached invoice(s) or bill(s))
10/12/10 054908625 $2,532.95
10/12/10 054908625 $312.55
i hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IG 5- 11- 10 -1.6
,20
Clerk- Treasurer
St. Vincent Stress Centers
ST. VINCENT STRESS CENTER Amount Due: $218.55
ST. VINCENT EAP Amount Paid:
8401 Harcourt Road
INDIANAPOLIS, IN 46260
A/R Account 3- 1000- 1130 -00
Date Account Number
10/12/10 5- 20386066
Invoice #054908387
Carmel Clay Parks Recreation MOMWE
Attn: Lynn Russell
1411 E. 116 Street OCT `2 7 1010
Carmel, IN 46032
To ensure proper credit to your account, please enclose top portion of this invoice with your payment.
St. Vincent Stress Centers A/R Account 3- 1000 1130 -00
Rate No. of Employees
ST. VINCENT STRESS CENTER $2.35 31
ST. VINCENT EAP
8401 Harcourt Road
INDIANAPOLIS, IN 46260
Date Description Units Amount
October EAP Services 1 $72.85
2010
November EAP Services 1 $72.85
2010
December EAP Services 1 $72.85
2010
Purchase Vr IV t �;EPM CE-
Description OCT DEC t
P.O.# PorF
G.L.# q-0 7 0 O
Budget
Line escr
Purchaser Date
Approv ra Date
Total $218.55
For questions regarding this bill please call (317) 338 -4900.
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
295900 St. Vincent Stress Center Terms
8401 Harcourt Road Date Due
Indianapolis IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/12/10 54908387 Emplo ee Assistance Program Oct- Dec'10 218.55
Total 218.55
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IG 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No, Warrant No,
295900 St. Vincent Stress Center Allowed 20
8401 Harcourt Road
Indianapolis IN 46260
In Sum of
218.55
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1125 54908387 4340700 218.55
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
4 -Nov 2010
i
Signature
218.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund