172049 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
0 ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $2,787.75
CARMEL, INDIANA 46032 EAP
6401 HARCOURT ROAD CHECK NUMBER: 172049
INDIANAPOLIS IN 46260
CHECK DATE: 4/29/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 R4347500 16049 053126141 2,787.75 EAP SERVICE
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n�.
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
04/08/09 5- 20376299 2787.75
'*CITY OF CARMEL
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please enclose top portion with payment
Rate: 2.15 Number of Employees: 531
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL CHG AMT PAY /ADJ BALANCE
INVOICE 052880659
EMP PROVIDER
01/08/09 JANUARY 2009 1059.95
01/08/09 FEBRUARY 2009 1059.95
01/08/09 MARCH 2009 1059.95
03/09/09 COMPANY PAYMENT 3424.95
03/09/09 EAP EMP INCORRECT COUNT ADJ 245.10
INVOICE BALANCE: 0.00
INVOICE 053126141
EMP PROVIDER
04/03/09 APRIL 2009 929.25
04/03/09 MAY 2009 929.25
04/03/09 JUNE 2009 929.25
INVOICE BALANCE: 2787.75
Account 0 -30 days 31 -60 days 61 -90 days >90 days Balance Due
5- 20376299 2787.75 0.00 0.00 0.00 2787.75
PAGE: 1
ST VINCENT EMPL. ASST. M F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317- 338 -4900
INDIANAPOLIS IN 46260
Prescribed berate 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.
C Payee
Ace At: Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
fl53► -tl y m a +sue 2-OlD 757 �S
Total 7S 7C"
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 NO. 13 %ARRANT NO.
r i1n^
ALLOWED 20
V �(1C 1� r-1' y
IN SUM OF
2- coo
c: 9775
ON ACCOUNT OF APPROPRIATION FOR
Ackm KISS
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
V0 n %j�?�1c1 I e�� Zbill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
n 20
0
Signa4ure
ty,—J'o -e' c�3 -4--
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund