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Home My WebLink About216885 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