228050 1 /14/2014 CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1
f ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LL&ECK AMOUNT: $42,639.05
o CARMEL, INDIANA 46032 2046 RELIABLE PKWY
CHICAGO IL 60686-0020 CHECK NUMBER: 228050
CHECK DATE: 1/14/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 732296 4 , 374 . 16 OTHER EXPENSES
301 5023990 732545 4 , 374 . 16 OTHER EXPENSES
301 5023990 732546 30, 133 . 75 OTHER EXPENSES
1201 4358800 732565 500 . 00 TESTING FEES
1201 4358800 732583 52 . 00 TESTING FEES
301 5023990 732700 1, 957 . 02 OTHER EXPENSES
301 5023990 732720 527 . 96 OTHER EXPENSES
1205 4347500 732751 720 . 00 GENERAL INSURANCE
Indiana University Health Workplace Services, LLC
3g 1 950 North Meridian Street
Suite 200
Indianapolis, IN 46204
Phone: 317-963-1535
FEIN: 20-0994452
Invoice
December 02, 2013
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite Fees/Nov.2013
1 Civic Square
Carmel,IN 46032-
Invoice# 732296
Proc Code Date Description Qty Charge Receipt Qijust Balance
CARMBUIL 11/01/2013 City of Carmel Clinic Build Out 1.00 2574.16 2574.16
CARMLEAS 11/01/2013 City of Carmel Sports Performance 1.00 1800.00 1800.00
Lease
Balance Due: 4374.16
Invoice# 732296 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Submitted To
JAN 2014
Clergy; Treasurer
Cut and return with payment
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 200 (City of Carmel)
Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
January 02, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Cannel- Onsite Misc.Onsite/Dec. 2013
1 Civic Square
Cannel,IN 46032-
Invoice# 732700
Proc Code Date Descritp ion Qty Charae Receipt Adjust Balance
99070 11/10/2013 Young at Heart Clinic Meds 1.00 23.93 23.93
99070 11/17/2013 Young at Heart Clinic Meds 1.00 653.84 653.84
99070 12/01/2013 Onsite Lab Charges 1.00 652.42 652.42
Nov.2013 SQMF Labs
99070 12/08/2013 Young at Heart Nail-Ins 1.00 30.44 30.44
99070 12/08/2013 Young at Heart Clinic Meds 1.00 218.54 218.54
99070 12/22/2013 Young at Heats Mail-Ins 1.00 377.85 377.85
Balance Due: 1957.02
Invoice# 732700 Balance Due: 1957.02
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Submittedo "I"i
JAN A12014
Clerk r
Cut and return with payment
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 200 (City of Carmel)
Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
January 02, 2014
Bill to: Barbara Lamb For: City of Carmel- Onsite
City of Cannel-Onsite Supply Billing/Dec: 2013
1 Civic Square
Carmel,IN 46032-
Invoice# 732720
Proc Code lite Description Qty Charge eceip AdjustBalance
99070 12/01/2013 Onsite Operating Supplies 1.00 •1-2:00 12.00
Oxygen/2
99070 12/01/2013 Onsite Operating Supplies 1.00 21.13 21.13
Boise Splor 8.5x I 1,92B,FSC/1
99070 12/01/2013 Onsite Operating Supplies 1.00 27.18 27.18
2.25.0 Card File Black 500card/l "
99070 12/01/2013 Onsite Operating Supplies 1.00 51.52 51.52
Set Blood Collect 23G 3/4 12in/1
99070 12/01/2013 Onsite Operating Supplies 1.00 69.00 69.00
Mouthpiece EBT Fcir Non Trap/200
99070 12/01/2013 Onsite Operating Supplies 1.00 36.74 36.74
Plain non-Laminated Tabs/1
99070 12/01/2013 Onsite Operating Supplies 1.00 10.86 ` 10.86
Cont Sharp A Gator l ga/5
99070 12/01/2013 Onsite Operating Supplies 1.00 8.21 8.21
Pack Cold Instant 6x10 in/15
99070 12/01/2013 Onsite Operating Supplies 1.00 46.26 46.26
Test Mono One Step/1
99070 12/01/2013 Onsite Operating Supplies 1.00 11.36 11.36
Scissor Lister Bandage 5.5in/1
99070 12/01/2013 Onsite Operating Supplies 1.00 0.86 0.86
Soli Hydrgn Peroxide 3%1
99070 12/01/2013 Onsite Operating Supplies 1.00 1.69 1.69
Soln Hvdrgn Peroxide 2oz/1
99070 12/01/2013 Onsite Operating Supplies 1.00 0.56 0.56
Soln Hydrgn Peroxide 8oz/1
99070 12/01/2013 Onsite Operating Supplies 1.00 44.65 44.65
Curette Far Oval Loop Wht/1
99070 12/01/2013 Onsite Operating Supplies 1.00 47.46 47.46
Scope Curette Far/1
99070 12/01/2013 Onsite Operating Supplies 1.00 8.75 8.75
3-Hole Punch 20 Sheet Med Du/1
99070 12/01/2013 Onsite Operating Supplies 1.00 7.16 7.16
Glove Nitrile PF LF Lg Pur/1
99070 12/01/2013 Onsite Operating Supplies 1.00 21.49 21.49
Glome Nitrile PF LF Med Pur/3
99070 12/01/2013 Onsite Operating Supplies 1.00 21.49 21.49
Glove Nitrile PF LF Sm Pur/3
Invoice# 732720(continued)page 2
99070 12/01/2013 Onsite Operating Supplies 1.00 78.02 78.02
Test Strep A Quickrue Dipstick/l
99070 12/01/2013 Onsite Operating Supplies 1.00 1.57 1.57
Remover Splinter Out tin/l
Balance Due: 527.96
Invoice# 732720 Balance Due: 527.96 '
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN-30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Submitted To
JAN A 2014
Clerk Treasurer
Cw and rehtm with n—ment
Indiana University Health Workplace Services, LLC
—3o) 950 North Meridian Street
Suite 200
Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
January 02, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite Fees/Dec. 2013
1 Civic Square
Carmel,IN 46032-
Invoice# 732545
Proc Code Date Description City Charcie Receipt A&-sat Balance
CARMBUIL 12/01/2013 City of Cannel Clinic Build Out 1.00 2574.16 2574.16
CARMLEAS 12/01/2013 City of Cannel Sports Performance 1.00 1800.00 1800.00
Lease
Balance Due: 4374.16
Invoice# 732545 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Submitted To
itted To
3
JAN ,-42014
Ci r TreaSurer
Cut and return with payment —
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 200 (City of Carmel)
�1 Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
January 02, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Cannel-Onsite Nurse Time/Dec. 2013
1 Civic Square
Cannel,IN 46032-
Invoice# 732546
Proc Code Date Descriptio Qty Charge Receipt AU51 Balance
NURSEMA 12/02/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/02/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSENP 12/02/2013 N.P.Nurse Time 7.25 688.75 688.75
Erin McMurray
NURSERN 12/02/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/03/2013 M.A.Nurse Time 6.00 168.00 168.00
Jennifer Lawson
NURSEMD 12/03/2013 MD Staff Time 6.00 1050.00 1050.00
Dr.Fagan
NURSENP 12/03/2013 N.P.Nurse Time 6.00 570.00 570.00
Erin McMurray
NURSERN 12/03/2013 R.N.Nurse Time 6.00 372.00 372.00
Vicki Truitt
NURSEMA 12/04/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/04/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSENP 12/04/2013 N.P.Nurse Time 5.00 475.00 475.00
Erin McMurray
NURSERN 12/04/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/05/2013 M.A.Nurse Time 4.00 112.00 112.00
Jennifer Lawson
NURSEMD 12/05/2013 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSERN 12/05/2013 R.N.Nurse Time 4.00 248.00 248.00
Vicki Truitt
NURSEMA 12/06/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/06/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 12/06/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/09/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
Invoice# 732546(continued)page 2
NURSEMD 12/09/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 12/09/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/10/2013 M.A.Nurse Time 6.00 168.00 168.00
Jennifer Lawson
NURSEMD 12/10/2013 MD Staff Time 6.00 1050.00 1050.00
Dr.Fagan
NURSENP 12/10/2013 N.P.Nurse Time 2.00 190.00 190.00
Erin McMurray
NURSERN 12/10/2013 R.N.Nurse Time 6.00 372.00 372.00
Vicki Truitt
NURSEMA 12/11/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/11/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 12/11/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/12/2013 M.A.Nurse Time 4.00 112.00 112.00
Jennifer Lawson
NURSEMD 12/12/2013 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSENP 12/12/2013 N.P.Nurse Time 4.00 380.00 380.00
Erin MCMurraY
NURSERN 12/12/2013 R.N.Nurse Time 4.00 248.00 248.00
Vicki Truitt
NURSEMA 12/13/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/13/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 12/13/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/16/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/16/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSENP 12/16/2013 N.P.Nurse Time 5.00 475.00 475.00
Randi Antworth
NURSERN 12/16/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/17/2013 M.A.Nurse Time 6.00 168.00 168.00
Jennifer Lawson
NURSEMD 12/17/2013 MD Staff Time 6.00 1050.00 1050.00
Dr.Fagan
NURSERN 12/17/2013 R.N.Nurse Time 6.00 372.00 372.00
Vicki Truitt
NURSEMA 12/18/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/18/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 12/18/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/19/2013 M.A.Nurse Time 4.00 112.00 112.00
Jennifer Lawson
NURSEMD 12/19/2013 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSENP 12/19/2013 N.P.Nurse Time 2.00 190.00 190.00
Erin McMurray
Invoice# 732546(continued)page 3
NURSERN 12/19/2013 R.N.Nurse Time 4.00 248.00 248.00
Vicki Truitt
NURSEMA 12/20/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/20/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 12/20/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/23/2013 M.A.Nurse Time 5.00 140.00 140.00
Jennifer Lawson
NURSEMD 12/23/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 12/23/2013 R.N.Nurse Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 12/26/2013 M.A.Nurse Time 4.00 112.00 112.00
Bonita Richardson
NURSEMD 12/26/2013 MD Staff Time 4.00 700.00 "' 700.00
Dr.Fagan
NURSENP 12/26/2013 N.P.Nurse Time 2.00 190.00 190.00
Erin McMurray
NURSERN 12/26/2013 R.N.Nurse Time 4.00 248.00 248.00
Mareesa Martin
NURSEMA 12/27/2013 M.A.Nurse Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 12/27/2013 MD Staff Time 5.00 875.00 875.00
Dr,Fagan
NURSERN 12/27/2013 R.N.Nurse Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 12/30/2013 M.A.Nurse Time 5.00 140.00" 140.00
Kimberly Pride
NURSEMD 12/30/2013 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSENP 12/30/2013 N.P.Nurse Time 5.00 475.00 475.00
Randi Antworth
NURSERN 12/30/2013 R.N.Nurse Time 5.00 310.00 310.00
Vicki Truitt
NURSEMA 12/31/2013 M.A.Nurse Time 6.00 168.00 168.00
Bonita Richardson
NURSEMD 12/31/2013 MD Staff Time 6.00 1050:00 1050.00
Dr.Fagan
NURSERN 12/31/2013 R.N.Nurse Time 6.00 372.00 372.00
Mareesa Martin
Balance Due: 30133.75
Invoice# 732546 Balance Due: 30133.75
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Invoice# 732546(continued)page 4
SSubmItted To
r3 -
JAN 6'2014
Clergy `treasurer
Cut and return wilt,
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))
12/02/13 739996, Fees! Nov 2013 4,374. 16
01109114 719700 MiGG Onsitei Dee 20!3 1,957.02
01109114 732720 Supp! Billing/ Dee 2013 b2i.96
01109114 73254S
01102114 73225-465 jurse Time! Dee 2013 30,133.[b
Total $41,367.05
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
20Clerk-Treasurer
VOUCHER9� WARRANT NO.
12/0 %
ALLOWED 20
IUW0alth NAIr)rkDlace Services, LLC IN SUM OF $
2046 Reliable RkmW
�I RnRRa_nngn
�11 g2A7 fly.
ON ACCOUNT OF APPROPRIATION FOR
301 Me a!Fund
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
materials or services itemized thereon for
74.16 which charge is made were ordered and
732700 $:L 957 09 received except
7
732545 301
732546 301
31!7_3375-
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
� Indiana University Health Workplace Services, LLC
�
's 950 North Meridian Street
1 Z\ Suite 200 (City of Carmel)
Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
January 02, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Cannel-Onsite Onsite/Nov. 2013
l Civic Square
Cannel,M 46032-
Invoice# 732565
Proc Code Date Description Qty Charge Receirt Adjust Balance
11/14/2013 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
15.00
kit
Invoice# 732565 (continued)page 2
15.00
kit
15.00
kit
Invoice# 732565 (continued)page 3
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Submitted To
JAN '2014
Clerk Treaswer
Cut and return with payment
_ ------------------------------------ a- _ ,
S� Indiana University Health Workplace Services, LLC
950 North Meridian Street
1'Z 1 Suite 200 (City of Carmel)
Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
January 02, 2014
Bill to: Barbara Latnb For: City of Cannel-Onsite
City of Cannel-Onsite Onsite/Dec.2013
1 Civic Square
Cannel,IN 46032-
Invoice# 732583
Proc Code Date Descritp ion Cly Charge Receipt Adjust Balance
12/23/2013 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
22.00
Invoice# 732583 Balance Due: 52.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
FJ 42014
Clergy r-aasur r
Cut and return with payment
VOUCHER NO. WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$552.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 732565 43-588.00 $500.00 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1201 732583 43-588.00 $52.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, January 13, 2014
L✓
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))
01/02/14 732565 Onsite Nov 2013 $500.00
01/02/14 732583 Onsite Dec 2013 $52.00
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
Z1 Indiana University Health Workplace Services, LLC
950 North Meridian Street _..
Suite 200 (City of Carmel)
Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
January 02, 2014
Bill to: Barbara Lamb For: City of Cannel- Onsite
City of Cannel-Onsite EAP Services/Dec. 2013
1 Civic Square
Cannel,IN 46032-
Invoice# 732751
Proc Code Date Description C r e Receipt Ad'us Balance
EAPSERV 12/01/2013 EAP Services 1.00 720.00 720.00
Balance Due: 720.00
Invoice# 732751 Balance Due: 720.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Submitted To
JAN 6 2014
Clerk Treasurer
Cut and return with payment
VOUCHER NO. WARRANT NO.
IU Health Workplace Services, LLC ALLOWED 20
IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$720.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 732751 I 43-475.00 I $720.00 1 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, J uary 13, 2014
i
Director, Administration
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))
01/02/14 732751 EAP Services $720.00
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
20
Clerk-Treasurer