HomeMy WebLinkAbout201014 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 365641 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CHECK AMOUNT: $283.94
CARMEL, INDIANA 46032 HEALTH INFORMATION MANAGEMENT
'pro 2001 W 86TH STREET CHECK NUMBER: 201014
INDIANAPOLIS IN 46260
CHECK DATE: 8/30/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 32848 78.45 SPECIAL INVESTIGATION
1110 4358200 33141 132.70 SPECIAL INVESTIGATION
1110 4358200 35358 72.79 SPECIAL INVESTIGATION
St. Vincent Hospital Invoice No
Health Information Management 32848
2001 W. 86th Street
Indianapolis, IN 46260
317 338 -2216 Tax ID:35- 0869066
Date: 08/12/2009
To: Carmel Police Department
Investigations Division
3 Civic Square
Carmel, IN 46032
Attn: Lana Howard
Duplicate Invoice 737 Days Over Due
L J
Please include your invoice number on your check.
Patient: Christopher Klooz
Request No Invoice No Medical Record No Date' Received Date Sent
K70721 32848 0000602088 07/15/2009 08/12/2009 Pages /Time Charges
Photocopy 97 51.75
If this bill has been paid, please send a copy
of the front and back of your cancelled check.
Postage 6.70
Certified 20.00
Sales Tax 0.00
Total Billed $78.45
PAST DUE
Amount Paid 0.00
Balance $78.45
To ensure proper posting of payments, please send Attn: Health Information Services Department
St. Vincent Hospital Invoice No
Health Information Management 35358
2001 W. 86th Street
Indianapolis, IN 46260
317 338 -2216 Tax ID:35- 0869066
Date: 02/19/2010
To Carmel Police Department
3 Civil Square
Carmel, IN 46032
Attn: Det Trent McIntyre
Duplicate Invoice 546 Days Over Due
Please inciude your invoice number on your check.
Patient: Kent J Emry
Request No Invoice No Medical Record No Date Received Date Sent
E79886 35358 0000360132 01/29/2010 02/19/2010 Pages /Time Charges
Photocopy 79 47.25
If this bill has been paid, please send a copy
of the front and back of your cancelled check.
Postage 5.54
Certified 20.00
Sales Tax 0.00
PS v Total Billed $72.79
Amount Paid 0.00
Balance $72.79
To ensure proper posting of payments, please send Attn: Health Information Services Department
St. Vincent Hospital Invoice No
Health Information Management 33141
2001 W. 86th Street
Indianapolis, IN 46260
317 338 -2216 Tax ID:35- 0869066
Date: 08/28/2009
To: Carmel Police Department
3 Civil Square
Carmel, IN 46032
Attn: Det T C Tilson
Duplicate Invoice 721 Days Over Due
Please include your invoice number on your check.
Patient: Richard Flores
Request No Invoice No Medical Record No Date Received Date Sent
F72344 33141 0002011387 08/05/2009 08/28/2009 Pages /Time Charges
Photocopy 290 100.00
If this bill has been paid, please send a copy
of the front and back of your cancelled check.
Postage 12.70
Certified 20.00
g p Sales Tax 0.00
PAST DUE Total Billed $132.70
Amount Paid 0.00
Balance $132.70
To ensure proper posting of payments, please send Attn: Health Information Services Department
VOUCHER NO. WARRANT NO.
ALLOWED 20
St. Vincent Hospital
Health Information Management
IN SUM OF
2001 W. 86th Street
Indianapolis, IN 46260
$283.94
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO, ACCT #/TITLE AMOUNT
Board Members
1110 33141 43- 582.00 $132.70 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1110 35358 43- 582.00 $72.79
materials or services itemized thereon for
1110 32848 43- 582.00 $78.45 which charge is made were ordered and
received except
Thursday, August 25, 2011
Chief of Police
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))
01/01/11 33141 payment for investigative services $132.70
01/01111 35358 payment for investigative services $72.79
01/01/11 32848 payment for investigative services $78.45
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
2Q
Clerk- Treasurer