175147 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CARMEL, INDIANA 46032 EAP CHECK AMOUNT: $2,787.75
8401 HARCOURT ROAD CHECK. NUMBER: 175147
INDIANAPOLIS IN 46260
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 R4347500 16049 053394163 2,787.75 EAP SERVICE
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
07/13/09 5- 20376299 2787.75
*CITY OF CARMEL
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please enclose top portion with payment
Rate: 1.75 Number of Employees: 531
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL CHG AMT PAY /ADJ BALANCE
INVOICE 053394163
EMP PROVIDER
07/06/09 JULY 2009 929.25
07/06/09 AUGUST 2009 929.25
07/06/09 SEPTEMBER 2009 929.25
INVOICE BALANCE: 2787.75
j P
I
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 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.
f' Payee
St. Vincent EMPI Asst Program Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
IUJ July, August September 2,787.75
Total
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 N0 NO.
ALLOWED 20
,3t. Vincent Empl Asst Progra
IN SUM OF
8401 Harcourt Road
Ildidnapalis, IN 4b260
$2,787.75
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
PO# or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
16049 bill(s) is (are) true and correct and that the
partial 053394163 475 2 75materials or services itemized thereon for
which charge is made were ordered and
received except
20
r ISign u e
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund