216885 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $2,980.05
CARMEL, INDIANA 46032 EAP
8401 HARCOURT ROAD CHECK NUMBER: 216885
INDIANAPOLIS IN 46260
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4340700 58261141 218 . 55 MEDICAL FEES
1205 4347500 58261175 2, 761 . 50 GENERAL INSURANCE
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
01/09/13 5-20376299 2761 . 50
*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 : 526 — - --
ACCT # : 5-20376299 PATIENT: *CITY OF CARMEL. CHG AMT PAY/ADJ BALANCE
INVOICE # : 058261175
EMP PROVIDER
01/07/13 CAP MONTHLY CHARGE JANUARY 2013 920 . 50
01/07/13 CAP MONTHLY CHARGE FEBRUARY 2013 920 . 50
01/07/13 CAP MONTHLY CHARGE MARCH 2013 920 . 50
INVOICE BALANCE: 2761 . 50
D Q �
JAN 2 8 2013
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
VOUCHER NO. WARRANT NO.
St. Vincent Employee Assistance Program ALLOWED 20
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 058261175 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
Monday, January 28, 2013
` f
Director, Administra ion
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))
01/09/13 058261175 $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
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
01/09/13 5-20386066 218 . 55
*CARMEL CLAY PARKS & RECREATI
1411 E 116TH STREET JLYNN RUSSELL
CARMEL, IN 46032
Please enclose top portion with payment
Rate : 2 . 35 Number of Employees : 31 - —
ACCT $# : 5-20386066 PATIENT: *CARMEL CLAY PARKS & CHG AMT PAY/ADJ BALANCE
INVOICE # : 058261141
EMP PROVIDER
01/07/13 CAP MONTHLY CHARGE JANUARY 2013 72 . 85
01/07/13 CAP MONTHLY CHARGE FEBRUARY 2013 72 . 85
01/07/13 CAP MONTHLY CHARGE MARCH 2013 72 . 85
INVOICE BALANCE : 218 . 55
Purchase �.n�(9",ca Jan-��,la ,1AN 14 2013
De cripiion K (� V J
P.O.# P or F ,.�
G.L.# 11266'-1-D/-4.3 0700
BUdoet
Une'bescr
Purchaser Date
9-
Date 414443
Account 0-30 days 31-60 days 61-90 days >90 days Balance Due
5-20386066 218 . 55 0 . 00 0 . 00 0 . 00 218 . 55
PAGE: 1
ST VINCENT EMPL. ASST. M - F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317-338-4900
INDIANAPOLIS IN 46260
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.
St. Vincent Empl. Asst. Terms
8401 Harcourt Road Date Due
Indianapolis IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/9/13 58261141 Employee Assistance Program Jan-Mar'13 $ 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. I
St. Vincent Empl. Asst. I Allowed 20
8401 Harcourt Road
Indianapolis IN 46260 f.
In Sum of$
$ 218.55
ON ACCOUNT OF APPROPRIATION FOR
101 - General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 58261141 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
24-Jan 2013
Signature
$ 218.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund