223032 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1
`4 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLc
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK AMOUNT: $35,371.80
CHICAGO IL 60686-0020 CHECK NUMBER: 223032
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 731243 29, 370 . 00 OTHER EXPENSES
301 5023990 731288 1, 597 . 64 OTHER EXPENSES
1201 4358800 731296 30 . 00 TESTING FEES
301 5023990 731347 4, 374 . 16 OTHER EXPENSES
Indiana University Health Workplace Services, LLC
4850 W.Century Plaza Rd.
WP-City of Carmel
Indianapolis, IN 46254-5477
317-216-2828
Tax I D# 20-0994452
Invoice
August 1, 2013
Bill to: Barbara Lamb For: City of Carmel- Onsite
City of Carmel-Onsite Onsite/July 2013
1 Civic Square
Carmel,IN 46032-
Invoice# 731296
Proc Code Service Date Description Quantit Charge Receir) AAWust Balance
07/17/2013 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
30.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
D Q
AUG 12 2013 ,
By
VOUCHER NO. WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF$
2046 Reliable Pkwy
Chicago, IL 60686-0020
$30.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
12_01 l 731296 I 43-588.00 I $30.00 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, August 12, 2013
Director, HR
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))
08/01/13 731296 $30.00
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
120
Clerk-Treasurer
Indiana University Health Workplace Services,LLC
4850 W. Century Plaza Rd. ')
WP-City of Carmel
Indianapolis, IN 46254-5477
317-216-2828
Tax I D# 20-0994452
Invoice
August 1, 2013
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Nurse Time/July 2013
1 Civic Square
Carmel,IN 46032-
Invoice# 731243
Proc Code Service Date Descriptio Quanti Charge Receipt Adjust Balance
07/01/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/01/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/01/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/02/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00
Dr.Fagan
07/02/2013 CONTRACT R.N.DAY 6.00 372.00 372.00
Gwen Kopecky
07/02/2013 CONTRACT R.N.DAY 6.00 168.00 168.00
Jennifer Lawson
07/03/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Nadelson
07/03/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/03/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Dorothy Goen
07/05/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr. Gutwein
07/05/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/08/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/08/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/08/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/09/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00
Dr.Fagan
07/09/2013 CONTRACT R.N.DAY 6.00 372.00 372.00
Gwen Kopecky
Invoice# 731243 (continued)page 2
Proc Code Service Date Description Quanti Charge Receip Adiust Balance
07/09/2013 CONTRACT R.N.DAY 6.00 168.00 168.00
Jennifer Lawson
07/10/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/10/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/10/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/11/2013 CONTRACT R.N.DAY 4.00 700.00 700.00
Dr.Fagan
07/11/2013 CONTRACT R.N.DAY 4.00 248.00 248.00
Gwen Kopecky
07/11/2013 CONTRACT R.N.DAY 4.00 112.00 112.00
Jennifer Lawson
07/12/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/12/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/12/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/15/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/15/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/15/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/16/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00
Dr.Fagan
07/16/2013 CONTRACT R.N.DAY 6.00 168.00 168.00
Jennifer Lawson
07/16/2013 CONTRACT R.N.DAY 6.00 372.00 372.00
Gwen Kopecky
07/17/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/17/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/17/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/18/2013 CONTRACT R.N.DAY 4.00 700.00 700.00
Dr.Fagan
07/18/2013 CONTRACT R.N.DAY 4.00 112.00 112.00
Jennifer Lawson
07/18/2013 CONTRACT R.N.DAY 4.00 248.00 248.00
Gwen Kopecky
07/19/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/19/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
Invoice# 731243 (continued)page 3
Proc Code Service Date Description uanti Charge Receiut AM-u-sl Balance
07/19/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/22/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/22/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/22/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/23/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00
Dr.Fagan
07/23/2013 CONTRACT R.N.DAY 6.00 168.00 168.00
Jennifer Lawson
07/23/2013 CONTRACT R.N.DAY 6.00 372.00 372.00
Gwen Kopecky
07/24/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/24/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/24/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/25/2013 CONTRACT R.N.DAY 4.00 700.00 700.00
Dr.Fagan
07/25/2013 CONTRACT R.N.DAY 4.00 112.00 112.00
Jennifer Lawson
07/25/2013 CONTRACT R.N.DAY 4.00 248.00 248.00
Gwen Kopecky
07/26/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/26/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/26/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/29/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/29/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
07/29/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
07/30/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00
Dr.Fagan
07/30/2013 CONTRACT R.N.DAY 6.00 168.00 168.00
Jennifer Lawson
07/30/2013 CONTRACT R.N.DAY 6.00 372.00 372.00
Gwen Kopecky
07/31/2013 CONTRACT R.N.DAY 5.00 875.00 875.00
Dr.Fagan
07/31/2013 CONTRACT R.N.DAY 5.00 140.00 140.00
Jennifer Lawson
Invoice# 731243 (continued)page 4
Proc Code Service Date Description Quantit Charge Receipt Ad ust Balance
07/31/2013 CONTRACT R.N.DAY 5.00 310.00 310.00
Gwen Kopecky
CITYCARO Invoice# 731243 Balance Due: 29370.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
- Cut ml etum with payment
Indiana University Health Workplace Services, LLC
4850 W. Century Plaza Rd.
WP-City of Carmel
Indianapolis, IN 46254-5477
317-216-2828 1
Tax ID# 20-0994452
Invoice
August 1, 2013
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Misc.Onsite/July 2013
1 Civic Square
Carmel,IN 46032-
Invoice# 731288
Proc Code Service Date Descriotio Quanti Charge Receip Adjust Balance
99070 06/23/2013 Young at Heart Clinic Meds 1.00 634.12 634.12
99070 06/30/2013 Young at Heart Clinic Meds 1.00 66.34 66.34
99070 07/01/2013 Onsite Lab Charges 1.00 495.48 495.48
99070 07/07/2013 Young at Heart Clinic Meds 1.00 288.16 288.16
99070 07/21/2013 Young at Heart Clinic Meds 1.00 113.54 113.54
CITYCARO Invoice# 731288 Balance Due: 1597.64
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
mss,,,,,, r,r ani rrh with�avment
Indiana University Health Workplace Services, LLC
4850 W. Century Plaza Rd.
WP-City of Carmel °)
Indianapolis, IN 46254-5477 �---
317-216-2828
Tax I D# 20-0994452
Invoice
August 1, 2013
Bill to: Barbara Lamb For: City of Carmel- Onsite
City of Carmel- Onsite Onsite Fees/July 2013
1 Civic Square
Carmel,IN 46032-
Invoice# 731347
Proc Code Service Date Descriptio Quanti Charge Receipt Adjust Balance
CARMBUIL 07/01/2013 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16
CARMLEAS 07/01/2013 City of Cannel Sports Performance 1.00 1,800.00 1800.00
Lease
CITYCARO Invoice# 731347 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
�_� Cut and return with paZment
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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
IU Health Workplace Services, LLC
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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 NOI—WARRANT NO.
ALLOWED 20
111 Health Wnrknlace Service-, LLC IN SUM OF $
—2046 Reliable Pkwy
11 60666-0020
$ 35,341 .8-0
ON ACCOUNT OF APPROPRIATION FOR
301 Medi .al Rind
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
731243 $29,370.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Acl,-��
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund