222580 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $218.55
CARMEL, INDIANA 46032 EAP
o� 8401 HARCOURT ROAD CHECK NUMBER: 222580
INDIANAPOLIS IN 46260
CHECK DATE: 7/30/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4340700 59212558 218 . 55 MEDICAL FEES
IrSt. Vincent Stress Centers
ST. VINCENT STRESS CENTER Amount Due: $218.55
ST. VINCENT EAP Amount Paid:
8401 Harcourt Road
INDIANAPOLIS, IN 46260
A/R Account# 3-1000-1130-00
Date Account Number
7/9/13 5-20386066
Invoice#059212558
Carmel Clay Parks & Recreation
Attn: Lynn Russell - .-?SID
1411 E. 116th Street 7JU 5 2013
Carmel, IN 46032
13y:
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
July EAP Services 1 $72.85
2013
August EAP Services 1 $72.85
2013
September EAP Services 1 $72.85
2013
Purchase OA-P 5ERUICES
Description JOL, AWD4 SEP '1
P.O.# PorF
G.L.# 11 a5—i-oil34o-1ao
Line Descr
Purchaser e l��
Approval Date Total $218.55
For questions regarding this bill please call (317) 338-4900.
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
7/9/13 59212558 Employee Assistance Program Jul-Sep '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.
295900 St. Vincent Stress Center Allowed 20
8401 Harcourt Road
Indianapolis IN 46260
in Sum of$
$ 218.55
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
i
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 59212558 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
25-Jul 2013
�_Q M_ a)7MV( �
Signature
$ 218.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund