208876 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CARMEL, INDIANA 46032 EAP CHECK AMOUNT: $2,980.05
8401 HARCOURT ROAD CHECK NUMBER: 208876
INDIANAPOLIS IN 46260
CHECK DATE: 5/1012012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 057023294 2,761.50 GENERAL INSURANCE
1125 4340700 57021257 218.55 MEDICAL FEES
ST VINCENT EMPL. ASST. PROGRAM a'�
8401 HARCOURT RD
INDIANAPOLIS IN 46260 b� Date Account Number Balance
04/17/12 5- 20376299 2761.50
*CITY OF CARMEL.
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please enclose top portion with payment
1 l Number of Employees: 526
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL. CHG AMT PAY /ADJ BALANCE
INVOICE 057023294
EMP PROVIDER
04/13/12 APRIL 2012 920.50
04/13/12 MAY 2012 920.50
04/13/12 JUNE 2012 920.50
INVOICE BALANCE: 2761.50
D
MAY 7 2012
By
Account 0 -30 days 31 -60 days 61 -90 days >90 days Balance Due
5- 20376299 2761.50 0.00 0.00 0.00 2761.50
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/17/12 057023294 $2,761.50
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. WARRANT NO.
ALLOWED 20
St. Vincent Employee Assistance Program
IN SUM OF
8401 Harcourt Rd
Indianapolis, IN 46260
$2,761.50
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 057023294 43- 475.00 $2,761.50 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
received except
M day, May 07, 2012
s
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
"o Vincent Stress Centers
ST. VINCENT STRESS CENTER Amount Due: $218.55
ST. VINCENT EAP Amount Paid: 9 X18.55
8401 Harcourt Road
INDIANAPOLIS, IN 46260
A/R Account 3- 1000 1130 -00
Date Account Number
4/17/12 5- 20386066
Invoice #057021257
Carmel Clay Parks Recreation
Attn: Lynn Russell
1411 E. 116 Street
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
April EAP Services 1 $72.85
2012
May EAP Services 1 $72.85
2012
June EAP Services 1 $72.85
2012
o MR )7 NW
Purchase W P Off vi cep A r Juv APR 2 0 2012
Description
P.O.# PorF
G.L.# f l�,'� �I'�J4C;-(0(D BY:
Budget rn
Line Desc I t irom eek
Purchaser Date
Approval Date Total $218.55
For questions regarding this bill please call (317) 338 -4900. APR 2 0 "l?
BY.............
1K Ll -20
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
4117112 57021257 Employee Assistance Program Apr, May, Jun '12 218.55
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 IC 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
I n Sum of
218.55
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 57021257 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
3 -May 2012
Signature
218.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund